Cerner To Acquire Siemens Health Services for $1.3 Billion

Cerner announced this afternoon that it will acquire the assets of Siemens’ health information technology business, Siemens Health Services, for $1.3 billion in cash.

According to a statement from Cerner Chairman and CEO Neal Patterson, “We believe this is an all-win situation for the clients of both organizations and all of our associates and shareholders. Through more than $4 billion of cumulative investments in R&D, Cerner has established a strong market standing and is positioned for continued growth. Siemens’ health care IT assets provide additional scale, R&D, an impressive client base, and knowledgeable and experienced associates who will help Cerner achieve our plans for the next decade. In addition, the alliance we’re creating will drive the next generation of innovations that embed information from the EMR inside advanced diagnostic and therapeutic technologies, benefitting our shared clients.”

I spoke to Patterson ahead of the announcement. He said, “Siemens could not keep up with the need to innovate across the continuum,” adding that Cerner looked carefully at how its business would fit into Cerner’s. “If it slowed us down, we weren’t going to touch it. If we didn’t think it would have a huge value proposition, we weren’t going to touch it.”

Patterson added, “The broad driver is the post-Meaningful Use era” and pointed to the $650 million combined annual research and development spend between the two companies. The companies will also jointly fund a $100 million alliance to perform development activity around diagnostic and therapeutic medicine. “IT systems are important to Siemens’ healthcare modalities,” he told me. “We will go much deeper than the workflow level.”

Patterson summarized, “This is a win-win-win across the board. Siemens clients will get a lot of value. We will partner on their core healthcare business. Lots of our clients use both systems in different capacities.”

Cerner says it will continue to support Siemens’ platforms and will support Soarian “for at least the next decade.”

John Glaser, PhD, CEO of the Siemens unit, said in a statement, “We are excited to join with one of the most competitive companies in health IT today, and a recognized leader in innovation. Siemens cares deeply about its clients and believes Cerner is the best organization to fully support their health IT needs going forward. The knowledge and strength of our combined resources opens up great possibilities for future collaboration and development, which is exciting for all of us. And our clients will benefit from our alignment with a company that has such a strong historical and future commitment to rapid innovation.”

The combined organizations will have 20,000 employees, 18,000 client facilities, and $4.5 billion of annual revenue. The transaction is expected to close in the first quarter of 2015.

HIStalk has featured rumors of the acquisition going back to early May, when Vince Ciotti was the first to tip me off to the rumors.

Morning Headlines 8/5/14

The Office of the National Coordinator for Health Information Technology’s Oversight of the Testing and Certification of Electronic Health Records

An OIG investigation finds that the ONC’s EHR testing and certification standards do not test EHR security features enough to adequately ensure that patient information is protected.

State will replace CGI, health exchange vendor

Vermont is the next to join a growing list of states that have fired CGI as their primary health insurance exchange firm. Starting in September, development responsibilities will be handed over to Optum as part of a $5.7 million deal.

Actionable Recommendations in the Bright Futures Child Health Supervision Guidelines

A new study published in Applied Clinical Informatics finds that only 20 percent of the preventative health care guidelines followed by US pediatricians are defined in a way that would allow them to be integrated into EHR clinical decision support tools.

DeSalvo says providers, hospitals on track for EHR Stage 2

With just 10 eligible hospitals attesting for Stage 2 MU thus far, national coordinator Karen DeSalvo, MD, reports “We know from past experience with meaningful-use Stage 1, for example, that people wait to attest until the eleventh hour,” adding “It seems on track with where we expect it to be, and we’re watching it closely.”

Curbside Consult with Dr. Jayne 8/4/14

I took some much-needed time off this week to try to gain perspective on where my career is going. What was once a pretty fun job has become a bit of a grind.

Ten years ago, we felt like we were doing cutting-edge work to transform patient care and help physicians deliver better outcomes. We were in the EHR business for the all the right reasons and were able to implement systems and functionality we needed when we needed them.

A good chunk of my responsibilities have been taken over by Meaningful Use. In our world, this has caused us to take workflows that were already improving patient care and then micromanage them to death. Maybe it’s the actual Meaningful Use certification requirements or maybe it’s the way our vendor has implemented them, but we may never know which is to blame. It’s probably a combination of both.

Either way, physicians and end users are unhappy with the volume of documentation they now have to do. They complain that it’s not really helping them in daily patient care.

As the CMIO, I take those concerns seriously and often personally. Although I have workflow experts and an advisory board backing me up, I’m the one who ultimately approves all clinical workflows before they’re implemented and all clinical system changes before they’re coded. If our vendor’s workflow is clunky and we don’t identify the potential problem before it goes out the door, that’s on me.

Our administration understands that sometimes we’re going to miss problematic content. They also understand that some of the MU requirements are so specific there’s just not a way to make them less annoying.

Our physicians are less understanding, however. I’m the one who has to deal with their concerns, complaints, and threats to quit. That’s not something they really train us to deal with anywhere along the CMIO training path, assuming we’ve actually been trained other than in on-the-job fashion.

I’m still relatively early in my career, but I’m wondering if I can take another 10 or 15 years of this. Considering my particular hospital situation, the bloom is definitely off the rose. I’m thinking about throwing my hat into the ring at another health system. The thing that makes me somewhat hesitant, though, is the thought that it could be just the same, if not worse, anywhere else.

How do you truly screen a potential employer or supervisor to know if they’re really visionary or just saying what they need to in order to get a position filled? I’ve had a couple of bosses that I would walk through fire for. It’s difficult to top that. At this point, however, I’d settle for someone who knew what he was doing and had the conviction to do the right thing rather than the easy thing or the politically expedient thing.

We’re in the middle of evaluating vendors for a massive system overhaul. I’m not sure our current leaders will survive, depending on which vendor is selected. That could be an opportunity for me to help move the remaining players around in a way that will rejuvenate some of our key players. Or it could be a reason for team members to jump for fear that they won’t make the cut. I’ll know more about what this is going to look like in six or eight months. Right now, we’re in a special kind of limbo.

It was good to get away, but increasingly difficult to completely unplug. There’s so much going on that it’s tempting to just peek at email, but I know better. One minute will quickly become one hour if you let yourself look.

When I got back in town last night, I had multiple voice mails from one ambulatory director with increasing anxiety in her voice because I wasn’t calling her back or returning her emails. Apparently she didn’t listen to my outbound message or pay attention to my out-of-office message that I wasn’t going to be on the grid.

I picked out two books before I left and they were an interesting contrast. I like southern fiction and the first one, The Hurricane Sisters, was available from my library’s e-book site. I checked it out for my iPad. It started with a lot of key southern elements, but I was shocked when I reached the point where Google Glass played a role as a significant plot device. Times are certainly a-changing! It was a quick read, not the best book ever, but good in the moment. I was pleased with my choice and it took my mind off things as I headed out of town.

The second one, On Call in Hell: A Doctor’s Iraq War Story was not exactly your typical beach read. It’s pretty graphic as only a book about Marines in combat can be, but I was amazed at the ability of the author and his colleagues to maintain their humanity and occasionally a sense of humor in the ultimate adverse conditions. Regardless of your feelings about war in general, reading about the experience puts everything in a different perspective.

One of the ideas that author Richard Jadick emphasizes is to be constantly improving one’s situation, whether it’s basic survival (sandbagging the forward aid station so you don’t get shot while caring for casualties) or figuring out better techniques to treat the wounded. It’s a powerful concept. It’s not about finding solutions to the chaos all around, but about figuring out your own sphere of influence and improving what you can within that space.

I’m taking that thought back to the office with me this week to see what I can do with it. I’ve already got a list in my head of what’s in my sphere of influence and what’s not, and some ideas on what we might be able to change for the better. I’m feeling pretty rejuvenated, but all that will change Monday morning when I finish tackling my inbox.

Have a transformative vacation story? Email me.

Email Dr. Jayne.

HIStalk Interviews Jan De Witte, CEO, GE Healthcare IT

Jan De Witte is president and CEO of GE Healthcare IT.

Describe your job.

I run our healthcare IT business globally. I would summarize it as four big categories. Enterprise imaging. Care delivery management — care pathways inside the hospital in the departmental areas and ambulatory care. Population health management, our joint venture with Microsoft in the Caradigm company. Then financial management, revenue cycle management, and cost analytics or margin management. 

We have different global product managers that run these categories. We commercialize and implement our systems pretty much across the world, with the US as the main market. The US makes up more than 60 percent of our business activity.

What is the status is of the Healthymagination project?

Healthymagination started several years ago. It is a focus of GE and GE Healthcare to drive outcomes in healthcare, specifically cost, productivity, and clinical quality outcomes.

As of two or three years ago, that program has matured in the sense that it has changed, shifted how we do product management on our equipment and our software. Our product managers start with outcomes in mind and then develop technologies that drive those outcomes. Before, we often — like many other companies — developed great technology without necessarily touching the outcomes that our customers needed. 

That’s how I would say Healthymagination has morphed from initiative several years back to today — a different culture and capability within our project management.

Siemens is another multi-national conglomerate and they apparently want out of the healthcare IT business. How do you see GE Healthcare IT positioning itself going forward against competitors that focus exclusively on healthcare IT?

On the Siemens-specific question, I’ve gotten questions from both customers and our employees.

There’s two elements to be asked. First, GE Healthcare, my mother company, is fully committed to driving outcomes in healthcare. If you look at the challenge for healthcare, it’s information technology that is going to be the big enabler to drive both productivity and quality. Going back to what we said on Healthymagination, we’re more than ever committed to building out our healthcare IT capabilities to fulfill that mission to make a difference in healthcare.

For the second dimension, I’m sure you’ve heard about the industrial Internet and Jeff Immelt’s commitment to building out GE’s software capabilities. What’s true in healthcare is true in many other industries. The next generation of driving improvement is going to be linked to data, analytics, and using those insights to drive better processes. From Jeff Immelt down, there’s more commitment than ever to be a significant player in software.

Those two together — my direct manager and Jeff Immelt — are fully committed to building out our healthcare IT capability. Close to half of GE’s software activity. Getting a lot of help and support from our San Ramon center of excellence to build out capabilities.

Describe how the industrial Internet fits into what you’ll be doing differently within your software areas.

Let me start with the vision of the industrial Internet. The way we put it is minds to machines can bring intelligence to machines or through machines that generate data, no matter which industry you look at. Process improvements, if you only take one percent, it’s tremendous value you can generate.

The vision of GE is, let’s complement our deep capabilities in developing excellent machines with deep software capabilities to complement those machines, take the data that comes off these machines, and make either the machines or the process around the machines more efficient. This can go from reading data from jet engines and understanding how to make them operate at higher fuel efficiencies to taking planning information from train scheduling and optimizing, planning, and routing and asset utilization in railway operations.

I’ll come to healthcare in a minute, but the commitment of GE is translated into our center of excellence in San Ramon on the West Coast, where we have about a thousand engineers today building out a cloud-based platform which we call Predix. Essentially it is all the next-generation cloud-based platform capabilities that either myself or colleagues of mine in other GE businesses will leverage to build analytics and workflow solutions on.

Very concretely, the industrial Internet initiative of GE is providing me, as a healthcare IT leader, with next-generation platform capabilities that over time will be reflected in the re-platforming of some of my current legacy applications, or brand new analytics applications that we’re building on the Predix platform right away.

How do you see the role of Centricity and how will that change with the industrial Internet?

Centricity is essentially the umbrella brand across the breadth of our portfolio. A couple of years back, we made a decision to focus the Centricity portfolio on what internally we called the next innings in healthcare. It’s clear over the past five-plus years that the whole healthcare industry has been focused on digitization — turning film into digitized information, turning paper into digitization with fax systems and with EMR systems. That’s only the first stage in any industry that goes through an industrialization phase.

We decided, from an R&D perspective, to start focusing on the next innings, which is going to be about analytics and workflows. We start to see today the next inning taking shape. 

Within the Centricity portfolio, if I  look at our Centricity enterprise imaging solutions, today those solutions are focused on enhancing diagnostic speeds and diagnostic confidence. Not just within one department, but across the enterprise, even across regions or countries. The same for our care delivery management, whether that’s Centricity anesthesia or peri-op solutions or ambulatory EMR. They are increasingly becoming systems to enable predictive care pathways. Our revenue cycle management solutions are increasingly becoming risk and profitability management tools.

With our products, all of them, our R&D is focused on providing analytics capabilities and workflow capabilities in these tools rather than digitizing. The Predix platform is a service-oriented cloud-based platform that is enabling us to build out the analytics capabilities, to build out the right user interface and user experience, and to build out the security capabilities that we are needing in that next generation of IT solutions for healthcare.

Are we in a post-EMR era and moving to analytics, connectivity, and the power of the network?

The short answer is yes. We are, definitely. I hear that from many of our customers. It started one or two years back when they said, we’ve invested a lot of money in bringing in a great EMR. We have realized today that we are not really changing our operation yet. In fact, in some cases, our physicians are less productive than we thought because they spend more time inputting data into systems.

There’s a little bit of a disappointment of the realization that the EMR is, I would call it, the necessary evil to enable the real phase of information technology, which is turning all of that data into actionable insights, and then using those insights into different workflow applications that enable caregivers to collaborate with each other across the different departments and even across geographies.

I see and I hear from my customers that there’s need for next generation. Everybody at this point is talking about population health management, which I think is the ultimate of workflow and analytics at the healthcare system level.

Along those lines, the work that GE Healthcare was doing with Intermountain was going to result in a lot of that, but they’ve moved to Cerner. What was the result of that partnership and why didn’t it continue?

The results or the intellectual property of the partnership today is to a large extent sitting into Caradigm. If I look at the models around clinical data structures, analytics, and protocol adherence type applications, all of that is in Caradigm.

The choice of Intermountain to go to Cerner, frankly I will not comment too  much on. It was essentially a choice on how they wanted to implement some of the intellectual property into their operation. The work that we’ve done over the years with Intermountain, the intellectual property, is sitting into Caradigm today, with many of the leaders that were on the project now in Caradigm.

Is GE Healthcare IT happy with Caradigm’s progress?

We’re very happy with Caradigm. Caradigm today is still, to a large extent, what we call the Caradigm Intelligence Platform. The ability to get to the data, wherever it is. Then you have the Caradigm analytics and the Caradigm population or care management suite of applications.

When we started Caradigm, we had all three components in mind. The first two go back to what we were doing with Intermountain. The population or the care management part, at that point already we were co-developing with Geisinger — care management applications for the Geisinger Health Plan. When we started Caradigm, we never gave too much visibility to it, although it was part of Caradigm on the formation of the company.

Over the past two years, much to our surprise and probably delight, the need for population health management has taken off way faster than what we assumed. We were well positioned. We have stepped up our focus on building out that suite of applications.

We’re very happy with Caradigm because it feels like we were at the right time in the right place in the industry. It’s very early days for population health management. We feel we have a very good and broad set of applications that enable population health management, from getting to the data to understanding your cohorts to setting up care management programs and linking into wellness and home health.

At the same time, when I look at population health today, there’s a lot of people who are claiming to have solutions. I consider 2014 and 2015 as the period where there’s going to be the selection made between PowerPoints and proof points. I see Caradigm as a company that will have the proof points. Everybody has the PowerPoints today. Over the next 12 months, we’ll figure out who has the real proof points of having solutions, analytics, and workflow that enable population health management and tremendous impact on the cost of healthcare.

Are your health system customers asking you to help guide them in operational improvement and population health management?

There’s a mix. I’m pleasantly surprised that many of the integrated delivery networks, which are the first ones getting on board, have brought on board people that have the right vision and the right capability.

My perception is that the need for consulting is lower than what I would have said three years ago. We bring with our technology the basic implementation consulting, but from a strategy consulting — how to set up population health management — I perceive most of the leading implementers today, having brought on board good people, smart people that know how to do that. Many of them have been experimenting. They now want to leverage technology to enable the rollouts on a broader scale.

What are the most innovative projects you’re working on that will come to fruition in the next two or three years?

We are very much focused at this point on building out our cloud capabilities, specifically in the imaging area. This is the area where we’ve leveraging to the fullest the new capabilities that GE has built in San Ramon.

At the last RSNA, we launched Centricity 360, a case exchange capability that complements our imaging capabilities. We’re further building out that case exchange capability to true collaboration capabilities that seamlessly enable institutions to collaborate together, to collaborate with affiliated and non-affiliated caregivers. First in the imaging diagnostic space, but with the technology, the platform itself is extendable to any form of collaboration. That’s one where we have the first betas.

At the next RSNA, we’ll come out with the next generation. It has the promise of bringing true cloud capabilities to healthcare and being a big enabler of allowing a very flexible way for caregivers to collaborate with each other.

Do you have any concluding thoughts?

On top of our vocabulary is outcomes. With your question on Healthymagination, what this industry needs is outcomes, not necessarily more technology. Specifically in the US, a lot of money has been spent putting technology in place. The industry has not fully gotten the outcomes for that yet in terms of productivity and quality. That’s where we’re focused.

At GE, we have the benefit of seeing different industries, also seeing how different industries have gone through different phases. I see today a lot of parallels in healthcare versus what I saw happen in airlines in the ‘90s. I’m 15 years with GE, all of it in healthcare. Before I joined GE, I was in other industries. It’s exciting to see that healthcare today is going through the same transition that other industries have gone through. Digitization and then using all that information to enable networks to operate as networks and to turn data into insights and better decisions.

I think the next 10 years in healthcare are going to be probably the most exciting ever. For those people working in the IT side of healthcare, it’s probably the best job in the world for the next decade, using technology to totally change the industry for the better.

Forums like HIStalk … the more we can enable and pump up people in IT to drive the healthcare industry, the more we’ll be part of something beautiful. This industry will not look the way it looks today 10 years from now. That’s a given.

Morning Headlines 8/4/14

Kaiser Permanente, Johns Hopkins Medicine Announce Enhanced Strategic Collaboration

Johns Hopkins and Kaiser Permanente announce a partnership that will focus on “sharing evidence-based best practices, advancing population health programs, collaborating on education and research endeavors, and exploring how the organizations can work together to create better health care models.”

Berwick believes he has a healthy chance in race for governor

Democratic candidate for Massachusetts governor Donald Berwick, MD, says in a recent interview that healthcare costs, which make up 42 percent of the state’s budget, “are just eating the state alive.” He is calling for a single-payer health care system instead.

Hospital wants back CEO charged in scheme to steal $158 million

Riverside Hospital (TX) is asking a local judge to allow one of its healthcare administrators, recently charged with $158 million in Medicare fraud, to return to work at the hospital as an unpaid consultant where he would help them address their financial issues.

Monday Morning Update 8/4/14

Top News

Johns Hopkins Medicine (MD) and Kaiser Permanente announce a collaboration in which they will share EHR best practices, develop technology to deliver personalized medicine, and create better and cheaper care models.

Reader Comments

From HIS Geek: “Re: Siemens. To understand Siemens’ lack of smooth integration, you need to go back to the SMS roots. In the 1980s and 1990s, SMS technical groups were organized internally based on hardware loyalties — DEC, IBM, PCs, networks –not customer or market needs. Silos of technology, support, and sales added more problems. Siemens failed to fix the SMS legacy. It added its own agendas on top of it all and ignored the EHR market trends.” Big vendors trying to juggle legacy products always have that problem – segregation of their expertise by product line and destructive internal infighting for executive attention. Both McKesson and Siemens bet their credibility on new showcase products that failed – Horizon and Soarian – although I respect Siemens for at least trying to build something new even though their stodgy German leadership and SMS’s mainframe mentality made it unlikely to succeed. The best full-spectrum vendors – Epic, Cerner, and Meditech – are healthcare-only and focus on a single product line that they built themselves, and even with Cerner and Meditech their weakest products are ones they acquired. Big corporations dabbling in multiple vertical industries usually populate the bottom rungs of healthcare IT user satisfaction and innovation; prospects they convince otherwise are likely doomed to repeat history.

From DenverDermPA: “Re: Greenway. We had a PrimeSUITE upgrade to 17.0 two weeks ago. The system has slowed to a crawl – it takes 2-5 minutes just to change patients. Greenway support advised that it’s a known issue documented in the 30-page release notes. The impact has been an extra 1-2 hours charting after hours every day, extra time to respond to critical lab results, and an extra day to respond to refill requests. Should I consult with legal counsel? Are other users having this issue? Can I report EHR issues to the government?” Two weeks is a long time to live with a crippled system, but Greenway is your only hope of fixing the problem. Assuming you’ve escalated to a high level and are continuing a dialog that suggests they’re working on it, I wouldn’t call a lawyer or complain to the federal government – you might feel good about lashing out, but that’s going to create a barrier between you and the only people who can improve your day-to-day existence. I’ve forwarded a high-level Greenway-provided contact who promises to look personally into your issue. If the problem is yours alone, a few hours of tech time should figure out a solution, but if it’s not (which I agree would then indicate poor QA on Greenway’s part, and I’d be interested in hearing from anyone else having the same problem), the developers need time to develop an all-client fix that doesn’t break something else. You also mentioned that you don’t have a test environment and didn’t read the release notes, which I understand as a very small practice, but that’s a lesson learned – you and your vendor bear equal responsibility for making sure new releases work in your particular environment and that you are ready to go live with the changes — including training, required configuration, and testing every critical function regardless of whether or not the vendor says they changed them (the functions programmers didn’t mean to change are usually the ones that elude QA). SVP of Product Management Mark Janiszewski provided this response to my inquiry:

Many of our Greenway PrimeSUITE customers recently upgraded to our Meaningful Use-certified release in order to attest for Meaningful Use. This release contains a number of new and changed workflows made necessary by MU 2014 requirements and also includes improvements to our lab orders module. We’re working with our customers every day to answer their questions regarding the many new capabilities of 17.0. Also, we’ve identified several areas where the workflows and tools can be enhanced to improve efficiency, and have our development team focused on getting those to our customers as quickly as possible – currently every few weeks.

HIStalk Announcements and Requests

Respondents were split 50-50 on whether EHR vendors influence government policy too much. New poll to your right: should the federal government define and mandate EHR interoperability requirements? Click the “Comments” link on the poll box after voting to elucidate further.

Welcome to new HIStalk Platinum sponsor WeiserMazars. The New York-based accounting, tax, and advisory company, founded in 1921 (!), offers providers and health plans IT consulting (planning, review, governance, network planning, system selection, contracting, project management, and facilities management), financial advisory services, revenue cycle services (assessment and transformation, revenue integrity, point-of-service collections, charge master, charge capture, and collections improvement), and full service options for managed care related services. A recent client survey found that 98 percent would recommend the company to others. Ken Fischer, who ran his own firm Smart Solutions for Health Care and worked for KPMG’s healthcare practice before that, is in charge of the healthcare group. I noticed that the company announced Friday its acquisition of pmpm Consulting Group, a California firm that offers managed care services. Thanks to WeiserMazars for supporting HIStalk.

It’s interesting that the significant percentage of Americans who are fat, don’t exercise, and ignore the instructions of their doctors can’t fixate enough about the media-hyped transfer of two Ebola patients to the US, accompanied by the embedded TV talking head doctor Sanjay Gupta.

Listening: the stunning Scotland-based heavy metal progressive (Rush meets Spock’s Beard) band Pallas, which has been around intermittently since the early 1980s.

Last Week’s Most Interesting News

• CMS issued a rule setting October 1, 2015 as the enforcement date for ICD-10.
• McKesson turned in great quarterly numbers, but its earnings were hurt by an accounting change involving the sale of its European healthcare IT business. Revenue from the Horizon product line that’s being phased out dropped as expected.
• A GAO report found that Healthcare.gov will end up costing taxpayers nearly a billion dollars, much of that due to CMS mismanagement of the project.
• Congress moved quickly to approve giving the VA $16 billion to hire more staff, open new clinics, and pay for the outside care of veterans who can’t get prompt VA appointments.
• The Senate Appropriations Committee directed ONC to identify and decertify EHR vendors that “proactively block the sharing of information.” Meanwhile, big vendors continue to proclaim themselves as “open” and criticize their competitors – namely Epic – as “closed.”
• The companies that acquired Sunquest and Encore Health Resources say they are contributing strongly to their bottom lines and are growing.
• National Coordinator Karen DeSalvo wrote a letter to the Boston Globe expressing disappointment at its article that criticized EHR-related oversight and patient safety, adding her pitch for ONC’s proposed health IT safety center.

Acquisitions, Funding, Business, and Stock

Outpatient surgery software vendor SourceMedical acquires Encircle Healthcare, which offers a surgical eligibility and registration patient portal.

From CPSI’s earnings call Friday:

• The company implemented its new ED system in three hospitals and has two more scheduled next quarter.
• The new Medical Practice EHR is live in 10 practices.
• Ten hospitals completed Meaningful Use Stage 2 attestation and another 13 are ready. The patient engagement requirement is the big stumbling block.
• The Meaningful Use delay hasn’t impacted sales since it was really only a three-month delay – deferring to 2015 requires a full-year attestation starting October 1, 2014 instead of attesting for a 90-day period.
• Scheduling the user conference in Q2 rather than Q3 moved a $500,000 expense up one quarter.
• Chairman and CFO David Dye said that rural hospitals are struggling, but added, “I can hardly think of any time in the 25 years that I’ve been here that I wouldn’t have said the exact same thing.”
• President and CEO J. Boyd Douglas said in response to an analyst’s question about Cerner reporting small-hospital gains with CommunityWorks that CPSI isn’t seeing Cerner in any significant way after a slight uptick a year ago.
• Dye said that while CPSI might consider acquiring a population health management systems vendor, they’ve never done an acquisition and have written all products themselves.

People

Tomas Gregorio (HealthEC) is named senior executive director of healthcare systems innovation of New Jersey Innovation Institute. He was VP/CIO of Newark Beth Israel Medical Center from 2006 to 2010.

PM/EHR vendor MedEvolve names Michael Schiller (Streamline Health) CEO.

Announcements and Implementations

Carolinas HealthCare (NC) releases The Amazings, a free game app for kids 7-12 who have asthma. It helps them avoid triggers such as pollen and cigarette smoke. That’s a pretty cool project for a health system to take on.

Wisconsin-based Anthem Blue Cross and Blue Shield provides subscribers access to LiveHealth Online, which provides mobile-based, two way video telemedicine sessions with US-based doctors to residents of most states. Visits average 10 minutes and cost $49 by credit card without insurance. Doctors can generate prescriptions from the visit in many states. Users can choose a doctor by viewing their profile and their online ratings. LiveHealth Online is WellPoint’s rebranded version of American Well.

Government and Politics

Massachusetts gubernatorial candidate and former Institute for Healthcare Improvement President and CEO Don Berwick, MD says that “healthcare costs are eating the state alive” at 42 percent of the state’s entire budget, or $15 billion per year. Berwick says administrative overhead makes Massachusetts “the most expensive state for healthcare in the most expensive country in the world” and proposes a single-payer system that would create transparency and public accountability. The Democratic primary is September 9.

Other

Stanford Medicine (CA) launches the first ACGME-accredited clinical informatics fellowship, directed by Stanford Children’s Health CMIO Christopher Longhurst, MD, MS.

A federal claims court overturns the VA’s ICU systems award to Picis, finding that the VA relaxed its standards in choosing its products over those of CliniComp, which filed suit.

Richard Cope, president of specialty EHR vendor Boston Advanced Analytics (formerly Coping Systems), is fined $1,000  by the city of Quincy, MA for renting his home on Airbnb. The city’s inspector confided to reporters, “We believe there are others.”

A Tucson, AZ urology practice notifies 3,000 patients of a data breach after finding that employees don’t always remove stick-on labels from urine sample cups before throwing them away. The labels contained patient name, date of birth, chart number, physician name, and date of service.

The management team of Riverside Hospital (TX) asks a US district judge to allow its former administrator — who is charged with leading a $158 million Medicare fraud ring at the same hospital and is banned from working in healthcare — to return as an unpaid consultant to save the hospital from financial peril. The state had previously stopped sending patients to the hospital because of widespread fraud, but the former administrator contacted Congresswoman Sheila Jackson Lee, who successfully demanded that the state give the hospital another $3 million. The hospital paid “recruiters” $300 for each Medicare patient they brought off the street to one of the hospital’s six psychiatric clinics, where the senior citizens hung around all day as the hospital billed Medicare $116 million for therapy sessions.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 8/1/14

Deadline for ICD-10 allows health care industry ample time to prepare for change

CMS confirms in a press release that the ICD-10 switchover will take place on October 1, 2015.

When ‘Hacktivists’ Target Your Hospital

In a New England Journal of Medicine article, Boston Children’s Hospital SVP/CIO Daniel Nigrin, MD discusses his experiences defending the hospital’s network against cyberattacks from the hacker group Anonymous. The group was retaliating over a very public child custody dispute between a Boston Children’s physician and a child’s parents.

McKesson adjusted profit, sales rise above expectations

McKesson reports Q1 results: profit dropped slightly to $425 million, but revenue and sales were both up significantly, EPS $2.49 vs. $2.11, beating expectations.

Novant Health to roll out electronic medical records system at Triad hospitals this weekend

Novant Health will go live with Epic across four of its NC-based hospitals this weekend. The go-live is part of a $600 million system-wide transition and follows its successful install across 300 physician offices last year.

News 8/1/14

Top News

A new CMS rule officially confirms October 1, 2015 as the new ICD-10 deadline. The announcement adds a bit of unintentional humor in saying the revised date “allows health care industry ample time to prepare for change.”  

Reader Comments

From The PACS Designer: “Re: Apple iTime. TPD’s sleuthing of US Patent Office new approvals has uncovered the iWatch patent. Apple iTime is the name given to patent # US 8,787,006 B2 for the wrist-worn device. Apple’s stock price has been rising since the patent was issued, probably some employees adding stock to their portfolios before any announcement from Apple.” It’s actually a three-year-old patent that was just approved, and like any good patent, is maddeningly vague to ensure covering as much intellectual property as possible. It mentions a GPS, heart rate monitor, accelerometer, and touch screen as options that are contained in the strap.

Siemens Products
By Quiet One

In response to Chester of Malvern’s post on “What a Cerner Acquisition of Siemens Health IT Would Look Like.”

As much as I criticize Cerner, at least they have an integrated system. Siemens Health Services’ systems might as well all be from different vendors.  It seems like they deliberately made them difficult to integrate so they could sell more services. Or maybe that was the result of them laying off people in Malvern and outsourcing work to India.  

I can’t imagine why someone would want to buy this set of assets other than for the customers and the data center. I doubt that Cerner would maintain the products, which is unfortunate since having lots of choices is good for all and Invision and MedSeries4 are good systems that got neglected due to the Soarian fiasco.

• "Soarian sites are happy with their financials, which are better than Cerner’s." I would seriously question this. Hardly anyone implemented Soarian Financials and they put even less effort into this product than they did Soarian Clinicals. It would probably be true to say Invision customers are happy with their financials, although that incidentally is the oldest part of Invision, based on IBM’s SHAS, and is batch oriented with sort of a CICS-based overlay so it’s not the most ideal product in my opinion.
• “Love the Soarian business process manager — the rules engine is quite impressive." If you’re impressed with their rules engine, which is a separate product on a separate box with its own implementation fees, you’ve obviously never worked with Epic, or for that matter, Cerner.
• "Siemens RIS…" Actually, this is one of their better products and is relatively stable. It has a pretty well designed Unix/DMQ/Sybase backend. Siemens is big in radiology because of their medical equipment business. The RIS product was moved out from under Siemens Health Services, so I wonder if it would be part of the sale.
• "Siemens Lab is a legacy system that customers love. KLAS rating is high even though they do not really manage pathology very well (lab is standalone)." This astonishes me more than anything and makes me question KLAS’s methods (Siemens does actively encourage customers to submit KLAS questionnaires). To say that it does not manage pathology very well is a big understatement. It does not have any pathology functionality at all, nor does it have blood bank functionality, or even instrument interfaces. It does offer a single outgoing and incoming instrument interface to connect to a broker like Data Innovations that you get to buy separately. It’s built on top of the Siemens RIS platform, but it seems like they gave up midway. So what does it do? Not much. In fact, for the administrative/setup functions, they use forms on a Microsoft Access MDE file linked to the Sybase back end.
• "Siemens Pharmacy and MAK works with Soarian – different platform, but functional." This is a DSM/Cache-based product built on top of their discontinued Unity system and has a lot of baggage from that. It actually is standalone and is often used by Invision and Soarian sites due to integration hurdles that Siemens imposes to prevent them from going with competing products. That said, integration between Siemens Pharmacy/MAK and Soarian is surprisingly difficult. You’ll also need to purchase the rules engine separately (again a separate box and separate implementation costs) and will probably need to purchase a third-party label printing system.

HIStalk Announcements and Requests

This week on HIStalk Practice: UNC-Chapel Hill researchers develop the FutureDocs physician shortage forecasting tool. Colden & Seymour ENT and Allergy, and Children’s Healthcare Massachusetts go live on the Wellport HIE. The American Academy of Family Physicians rebrands its Center for Health IT. The Children’s Health Alliance implements the Wellcentive Advance population health management platform. The Global Partnership for Telehealth conducts successful telemedicine consultations in Honduras. 23andMe secures new funding from the NIH. Take the HIStalk Practice reader survey. Thanks for reading.

This week on HIStalk Connect: Dr. Travis covers Benedict Evans’ most recent podcast, connecting the proliferation of smartphones with the inevitable scaling of mHealth use cases. Proteus Digital Health extends its Series G funding round to make room for more investors, closing the round at $172 million. Google announces a new health-focused X Labs project that aims to capture as much data as possible on human health, down to the genome and molecular level.

Acquisitions, Funding, Business, and Stock

MedAssets reports Q2 results: revenue up 2.7 percent, adjusted EPS $0.30 vs. $0.30, meeting revenue expectations and beating consensus earnings expectations of $0.29.

McKesson reports Q1 results: revenue up 37 percent, adjusted EPS $2.49 vs. $2.11, beating expectations on both. Meanwhile, an employee McKesson fired four months after the company’s last annual meeting in which the man asked CEO John Hammergren to improve employee wages and benefits was back at this this year’s meeting, hoping to persuade shareholders that Hammergren’s $292 million change-of-control golden parachute is unreasonable. The former employee and the union he works for were unsuccessful – shareholders vote down a proposal to reduce the amount, which McKesson’s board explain as “an important tool for motivating our executives in the face of a potential change in control transaction.”

From the McKesson earnings call:

• The company’s sale of its McKesson International Technology was reclassified from discontinued operations in 2014 to continuing operations in 2015, causing a charge of $34 million ($0.11 per share) to GAAP earnings.
• McKesson won’t rebid its UK workforce solutions business when it expires late next year.
• Technology Solutions revenue dropped 8 percent because of already-expected poor Horizon Clinical revenue, the divested foreign business, and “planned elimination of a product line.”
• John Hammergren is pleased with RelayHealth’s growth.
• He talked up CommonWell, which he says will be expanded and commercialized after the pilots are completed. He didn’t say what “commercialized” means.

From Merge Healthcare’s Q2 earnings call:

• The company says it, along with other enterprise imaging system vendors, is being hurt by indecision, mergers, and a preoccupation with ICD-10 and Meaningful Use Stage 2 among providers.
• Merge says it signed seven new iConnect customers in the quarter, iConnect Cloud Archive is growing rapidly, and Merge eClinical OS increased user count by 27 percent.
• The company expects hospital mergers to trigger new VNA and universal viewer sales.
• Merge is offering per-transaction contracts with no minimums.

In the Quintiles Q2 earnings call, CFO Kevin Gordon says he expects the acquired Encore Health Resources to contribute services revenue of $40 million. CEO Thomas Pike adds of the acquisition with regard to its pharma customers, “With our new acquisition of Encore, we also see this real flow of interest into the electronic health records and how our customers can really understand the practice of medicine taking place out in hospitals and in clinics associated with their drugs. I think the capabilities we’re assembling just give us unique insights for those customers.” Quintiles is a big pharma services vendor headquartered in Durham, NC with 29,000 employees and a $7 billion market cap.

CPSI announces Q2 results: revenue flat, EPS $0.81 vs. $0.77.

The Advisory Board Company reports Q1 results: revenue up 15 percent, adjusted EPS $0.30 vs. $0.31.

Vocera reports Q2 results: revenue down 9 percent, adjusted EPS –$0.16 vs. $0.01.

Sales

Healthcare Data Solutions will provide its US healthcare databases and business intelligence services to aPureBase, a Denmark-based life sciences data supplier.

Michigan Health Information Network selects DataMotion to provide Direct Secure Messaging services.

Capital Women’s Care (MD) enters into a 10-year agreement with NextGen Healthcare to provide RCM services for its 45 locations.

Bon Secours Health System (MD) will deploy Premier’s PremierConnect Enterprise data warehouse and business intelligence platform.

People

Vocera names Justin Spencer (Symmetricom, Inc.) as EVP/CFO.

Avery Cloud, CIO at New Hanover Regional Medical Center (NC), will leave the organization this week to take a position with an unnamed Houston employer.  

Announcements and Implementations

Several Novant Health (NC) hospitals will go live on its $600 million Epic project this weekend. Novant says it hopes to avoid the Epic-related problems experienced by its Triad competitors Wake Forest Baptist Medical Center and Cone Health.

Navicure added 272 new accounts in Q2, a 76 percent jump over a year ago.

Geneia launches its Theon analytics platform.

Medical animation vendor Nucleus Medical Media joins the Greenway Marketplace.

Levi Ray & Shoup launches PageCenterX/Satellite to provide downtime reporting capabilities for system outages.

PMD launches its Observation Result interface to streamline cardiology test interpretations and charge capture.

Microsoft names Allscripts its “US Health Provider Partner of the Year.”

In Germany, the government will create an eHealth council to promote the exchange of digital healthcare information.

CHIME launches a new membership organization, the Association for Executives in Healthcare Information Security (AEHIS), as a professional organization for healthcare chief security officers. CSOs who are accepted by December 31, 2014 will be recognized as founding members and will receive a year of membership free.

Providence Health & Services partners with Patrick Soon-Shiong’s molecular medicine institute to buy a $10 million population-scale genomic sequencing system best known for breaking the under-$1,000 test barrier. Providence will use the genetic information to tailor cancer treatments to individual patients, processing the information on Soon-Shiong’s supercomputer array run by the NantOmics division of NantHealth.

Government and Politics

A GAO report concludes that Healthcare.gov has cost taxpayers $840 million so far and warns that continued CMS mismanagement, including sloppy contracting practices and poor oversight, will cause problems in the upcoming November open enrollment period. Accenture’s initial contract for $91 million to replace the fired CGI has already swelled to $175 million through June due to design revisions. CMS agreed with the report’s recommendations that they get their act together, which would have been nice a few hundred million dollars ago. Surely nobody other than the federal government could roll out a billion-dollar website. Maybe we taxpayers should develop our own Meaningful Use performance standards (with GAO’s help) and cut HHS’s budget for failing to meet them.

The Cover Oregon health insurance signs a $70,000 contract its former CIO Aaron Karjala, who resigned in March after the $134 million system’s failure. The state hopes he will help them build a case in their lawsuit against Oracle.

The CIA admits that its officers hacked into the computer network of the Senate Intelligence Committee, which oversees the agency.

Technology

George Takei gets a smartphone physical in Boston, although he seems more amused than impressed. 

Other

Dan Nigrin, MD, MS, SVP/CIO of Boston Children’s Hospital (MA), publishes an article in the just-released issue of The New England Journal of Medicine called “When ‘Hactivists’ Target Your Hospital.” It describes the orchestrated distributed denial of service (DDoS) attacks launched against the hospital by the hacker group Anonymous, which was upset about a child custody case. Data traffic jumped 40 times normal, although the hospital blunted nearly all of its impact by working with a DDoS defense vendor, which rerouted traffic to is filtering center and sent only legitimate web page requests through to the hospital. The group also tried direct network attacks and blasting phishing email hoping an ill-advised employee click would give it access. Dan urges hospitals to inventory their Internet-dependent systems and develop contingency plans if connectivity is lost, such as in their case where prescriptions could be created but not sent electronically to pharmacies. The hospital also temporarily shut down its email systems to figure out how to handle the phishing challenge and found quite a few undocumented internal processes that require email.

I’m trying not to swear at a writer’s incorrect summary of a predictably pro-EHR study from HIMSS Analytics (and published in two HIMSS-owned publications). It found that hospitals that are higher up the EMRAM ladder had better patient outcomes in some areas. For the zillionth time, correlation doesn’t equal causation. I have no doubt that hospitals that can run and afford Stage 6/7 EHR implementations can deliver better outcomes for specific diagnoses and procedures. However, that doesn’t mean the EHR contributed to the result just because it’s there. I bet there’s a similar correlation between patient outcomes and hospitals whose cafeteria features a sushi bar, but that doesn’t mean that adding sushi bar will improve heart attack survival rates. I would be more impressed with a vertical study that compares a single hospital’s results before and after EHR implementation. Don’t blame HIMSS Analytics since they were careful to use the word “association” – it’s writers who have never worked a day in healthcare or healthcare IT who are declaring authoritatively but inaccurately as they try to explain topics way over their heads.

A woman sues her plastic surgeon after finding before-and-after pictures of her face on his website with the label “cocaine nose.”

Weird News Andy calls this story a triple threat. A Michigan man dies when a medical problem causes him to crash his car into an abandoned house, which turned out to be full of swarming bees that kept rescuers from reaching him.

Sponsor Updates

• Six hundred Aprima users have signed up for the company’s user conference, which will be held August 8-10 in Dallas. ONC Deputy National Coordinator Jacob Reider, MD will deliver the keynote address.
• PerfectServe publishes a blog post called “TeamSTEPPS – Building a Support System for Safety.”
• CitiusTech is profiled in Forbes.
• Azam Husain discusses the importance of identity management for protecting patient health information on Caradigm’s blog.
• IHT2 shares a graph displaying the top 10 challenges faced by EHR users.
• Sagacious Consultants donates $10,000 to Wounded Warrior Project, Camp American Legion, the Legacy Fund, and the Aaron Grider Foundation in support of veterans.
• HIMSS Analytics Data reports that Imprivata OneSign is used by 51 percent of hospitals using McKesson’s Paragon or Horizon EMRs.
• Encore Health Resources CEO Dana Sellers discusses the company’s acquisition by a Fortune 500 company.

EPtalk by Dr. Jayne

I’m always on the lookout for any product or service that can make patients’ lives a little easier when they have to navigate the crazy healthcare world in which we live. I was excited to learn about CoPatient, which offers free audits of medical billing documents. The patient provides the bills and insurance information and they review and provide a no-charge report with a list of itemized costs and potential errors. From that point, patients can try to resolve the problem themselves, or CoPatient will handle the appeal for a fee.

They offer a “Negotiator” level, which is a flat 30 percent of the savings obtained. The “Guardian” level offers historical review or processing of regular medical bills through a monthly individual or family subscription. The Guardian level also includes use of their mobile bill pay app, but it’s full so you’ll have to go on a waiting list. I just finished fighting with my insurance company over an erroneous biopsy charge (I think I’d know if I had one). Based on my hourly salary and the time it took to resolve the issue, it would have been worth letting them handle it.

I had fun this morning doing a project for the urgent care where I moonlight. Although we use paper charts, many of the physicians work at other facilities where EHRs are in use. The lack of a way to electronically check medication prescriptions for patient safety and drug interactions has been a concern for several of them. I brought it up when I joined and offered to help find a system when they were ready.

We had a situation Monday night where I needed to urgently sign a Family and Medical Leave Act form that a patient brought by the office at the last minute. I’m on a belated birthday trip this week and had no access to a printer, let alone a fax machine. I signed it electronically using DocuSign (incidentally a new HIStalk Gold Sponsor) and emailed it back. Our managing partner was impressed that I knew to do that and emailed a few hours later asking me to look into eRx systems.

I knew of a couple of standalone systems but visited the Surescripts website to compare features. I was surprised by the sheer number of prescribing systems out there, whether freestanding or part of an EHR. I narrowed it down to a handful and started gathering information.

I’m planning to do a trial of the National ePrescribing Patient Safety Initiative product from Allscripts. The fact that it’s free is certainly a draw. It looked easy enough to register for the system and I’ll hopefully have time to do that in the next couple of days. I’m not scheduled to work at the urgent care until next week so we’ll have to see what I know by then.

Have you used a stand-along eRx system? Any advice? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
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Morning Headlines 7/31/14

Healthcare.gov: Contract Planning and Oversight Practices Were Ineffective Given the Challenges and Risks

A GAO report concludes that Healthcare.gov cost taxpayers a total of $840 million, including $150 million spent fixing the site after its failed launch.

Merge Reports Second Quarter Financial Results

Merge reports Q2 results: revenue is down 5.9 percent to $53.8 million for the quarter, EPS $0.05 vs. $0.01, beating analyst estimates on both.

Full-time Health IT Workers Aren’t As Happy As Consultants

A new employee satisfaction survey finds that consultants working in health IT are more satisfied with their job (43 percent vs. 19 percent) and their pay (40 percent vs. 18 percent) than traditional health IT FTE’s.

PCORI Board Approves $54.8 Million in Funding for Patient-Centered Comparative Effectiveness Research Projects

PCORI today approved $54 million in new grant awards that will support 33 new research projects. The new funding of brings its total contributions to $549 million, spanning 313 research projects.

Readers Write: From Rice Fields to Big Data

From Rice Fields to Big Data
By Ping Zhang

My journey into technology was a long road. The first 15 years of my life were spent in the Hunan province in rural southern China. My family had no running water, and more often than not, we went to bed hungry.

At five, I started working with my father in the rice paddies. I planted rice seeds while my father manually built rice rows and dug irrigation canals. Everything was done by hand. It wasn’t until I was 11 that I saw my first technological advancement — a tractor — on my way to school.

At age 15, I rode on a train for the first time on my way to college. It was only then that I realized the promise of technology and how it could save my father’s back and hands from the brutal years of manual labor.

My passion for mathematics helped me earn my bachelor’s degree at 19 in China. After the 1989 events in Tiananmen Square, I decided to try to migrate to the United States. In 1990, I landed in Fayetteville, Arkansas with only my bags and a hundred American dollars to pursue my PhD at the University of Arkansas at Fayetteville. My wife followed soon after.

Eighteen months after moving to the US, I had my first experience with the American healthcare system. Early one Friday evening in 1992, my wife suddenly felt a sharp pain in her stomach. We rushed to the emergency room. We waited and waited – and waited some more. Three hours later, she was finally seen by an OB/GYN doctor.

It turned out that she had an ectopic pregnancy. She had been pregnant, but the fertilized egg had become lodged in one of her Fallopian tubes. Two liters of blood had accumulated as she waited for treatment. She had come close to losing her life.

The next day, the doctor cleared her for discharge with a clean bill of health, leaving us with a bill of a few thousand dollars. One of her Fallopian tubes had been torn open and the other had become so clogged with lost blood that it would likely permanently block any egg. We were told the chances of her ever having a child were slim.

The experience was shocking, scary, and life altering. Thankfully, after years of infertility treatments, she was able to give birth to two beautiful boys.

That horrible experience was over 20 years ago, but I still remember it like it was yesterday. Part of the reason is that I have spent many of those past 20 years working within the healthcare system to change it myself. I want to share three key lessons I have learned over this long journey.

The quality of healthcare is too low

The state of service in American healthcare is far below where it needs to be and where it could be, especially with its skyrocketing costs. But what if our healthcare system operated under a free competition model, much like the retail industry? No department store would ever have its customers regularly wait for hours in line to buy its products – because no one would go to that store any more (and they would book it in the other direction with haste).

Under a similar system for healthcare, providers would have to work much harder and more effectively to attract and adequately serve consumers. Open competition would lead to greater efficiency, lower cost, better quality of service, and more choices for consumers.

More innovation and disruption

Innovation and disruption must be encouraged. Over the past two decades, I learned about the underlying principles of world-class innovation from Silicon Valley. I had mentors who constantly encouraged me to break out of the box, experiment, and try something new and different. Healthcare is clearly not where it should be. We must find a better solution for something as vital to societal and individual wellbeing. Healthcare still needs a Steve Jobs and Apple-like innovation revolution to make it more clinically effective for the consumer and cost effective for all.

For example, what would healthcare look like if we could receive updates and monitor our health through a Fitbit device or health app the same way we receive ESPN notifications on an iPhone today? What if technology motivated us to pay the same amount of attention to our health as we do with our social media networks, and with the same ease? These are the simple concepts that will help us all live longer and save hundreds of lives.

Top-down is not enough; consumers need to become more invested

Consumers themselves must do more to control their own outcomes. As an immigrant to the US, I knew that I had to work much harder than my peers to succeed. Consumers today should adopt a similar drive and approach to their health. Rather than waiting for doctors to treat and prescribe “fixer” medications, we need to work more diligently to lead healthier, more proactive lifestyles – and we have the information and technology to do so at our fingertips.

What was once monopolized by professionals with years of training (and extremely costly) is now available at the nearest Best Buy or app store for just a couple of hundred dollars — or nothing at all. Look to wearable biometric devices as an example; those gadgets can accurately monitor an individual’s health, diagnose risky behaviors based on behavioral research from big data findings, and provide information on how to live a healthier, lower-risk life.

I am thrilled that my sons get to reap the benefits of a wonderfully innovative country that is slowly, but surely, transforming its healthcare system for the better. Sooner rather than later, as my boys grow into husbands and fathers, we will move past the times when emergency care is almost as painful as the medical ailment that necessitates the visit. And if we don’t, we’re doing something very wrong.

Ping Zhang, PhD is SVP of product innovation and chief technology officer of MedeAnalytics of Emeryville, CA.

Readers Write: 20th Century Man

20th Century Man
By Barry Wightman

"I work in healthcare during the day, then I go home to the 21st century."

Dave Levin, MD, founder/CEO of Tres Rios Group (@DaveLevinMD), uttered these stinging words at last week’s OnBase + Epic User Forum in Cleveland. Thanks to our friends at Nordic Consulting (@Nordicwi), who tweeted this in real time on the jungle network raising, I’m sure, a knowing smile on many a grey-haired regular Joe technology type such as myself in health IT-land. Now, I’m not here to comment Dr Levin’s presentation, but with that tasty, snarky comment, he hit on something I’ve been wanting to get off my chest for a while now.

It’s all déjà vu all over again.

And it starts with an old Kinks song.

No, really.

Good old Ray Davies, on the fine Muswell Hillbillies elpee of 1971, sang, “I’m a 20th century man but I don’t want to be here….” (cue chiming guitars and thumping drums.)

And here we are in healthcare’s 2014 and those words still ring true. And we’re faced with vast data centers that don’t interoperate well, processes and workflows that haven’t changed much since, well, let’s say the ‘90s.

Some folks complain about EHRs, saying they’ll never work – which is like attacking the telephone as a useless gadget in 1910. Yes, healthcare is conservative, slow to change, and it is a vast, terribly complex industry. But still.

See, I come out of the high-end computing and communications world of the last 40 years and we all know about the technology revolutions that came out of that time.

And it all had to do with the decentralization of power.

Power to the people.

Here’s what happened:

• Big iron, mainframe computing was overthrown, or, at least changed forever by personal computing. The data center data processing IT gatekeepers of the ‘60s/’70s, the men in the white coats (not docs) lost their complete control. Big mainframe data centers were then called “glass houses” – complex and unknowable, sealed safely away from the actual user rabble. Then user peasants with pitchforks began throwing rocks.
• Distributed processing was invented in the ‘70s/‘80s – in which mini computers and personal computers were bought by company departments, who, fed up by the long delays and general stick-in-the-mudness of corporate IT, took matters into their own hands. Lotus 1-2-3! Excel! WordPerfect! Soon, IT was surrounded. Some bit of chaos ensued. Luddites were outraged.
• Interoperability became an issue. Can I get my 1980s IBM 3081 mainframe or Cray supercomputer to talk with all these blazingly fast minicomputers and those crazy PCs and their newfangled servers? Can I get this application to communicate with that application on a batch or maybe even real-time basis? Will this data jive with that data? Oh man. There was even a huge Silicon Valley trade show called Interop. Big business. You can look it up.

And, over time, it all began to work. Standards emerged: TCP/IP, the Open Systems Interconnection (OSI) Model, designed to facilitate application-to-application communications. Forums and user groups were founded. Requests for comments solicited. Hardware and software vendors cooperated. Open systems mostly won. Proprietary systems mostly lost. Not bad.

And new business empires were built. Microsoft, Cisco, Apple, and an endless army of startups who followed in their wake disrupted markets as they went, changing the world.

Fast forward to now. Healthcare. We’ve been there before.

Thing is we’re still there. Maybe about 1990. EMR/EHR monsters have emerged: Epic, athena, Cerner, et al. The big payors – you know the list. Crazy startups in new markets are bubbling under – population health, mhealth. And there are user revolutionaries out there – visionary clinics and system departments who are moving ahead on their own, confounding CIOs and IT (with whom I have much sympathy – which reminds me of another old tune).

And just like in 1990, with the World Wide Web just around the corner, then gestating in gov, mil, and edu domains, everything changed.

And we won’t have to live in the 20th century with the Kinks. (Not that that’s a bad thing.)

And Dr. Dave Levin will be happy.

And so will we.

It’s gonna happen.

Barry Wightman is VP of marketing of Forward Health Group of Madison, WI and the author of Pepperland.

HIStalk Interviews Eddy Stephens, VP/CIO, Infirmary Health

Eddy Stephens is VP/CIO of Infirmary Health of Mobile, AL.

Tell me about yourself and the organization.

I have been with Infirmary Health System for 32 years. I have a background before that in banking and in food service for a few years. My educational background is more related to accounting and operations research, back before people called it management engineering. I have been in IT for the greater part of my career, 35 years or so. 

Infirmary Health is a regional health system located on the Gulf Coast of southwest Alabama, in Mobile. We have locations in Mobile and Baldwin County, which splits the Mobile Bay, if you’re familiar with the Gulf Coast region, over the northern part of the Gulf of Mexico.

We have a 700-bed hospital which is our flagship, Mobile Infirmary Medical Center. We have a 150-bed hospital, Thomas Hospital, in a bedroom community in Fairhope, Alabama. We have a 65-bed hospital in the northern part of Baldwin County called North Baldwin Infirmary. On the campus of Mobile Infirmary, we have a long-term acute care hospital. We also have a Rotary and rehabilitation hospital that are both located on the campus of Mobile Infirmary. We have a clinic network of about 30 physician clinics, our largest being a multi-specialty clinic that has about 70-plus doctors in it, and it actually has multiple locations scattered around Mobile and Baldwin County. We have three freestanding diagnostic and surgery centers and are in the process of expanding our network out into a couple of other communities within the greater Mobile, Alabama area.

What’s the secret to being a long-term CIO?

I became CIO here about 14 years ago. I had come here as an IT analyst from a financial standpoint. I guess the secret is just trying to keep my head down and maneuver the politics of the system. It’s a great place to work and I have just tried to ingratiate myself to the team.

I’ve tried not to have a philosophy that said we’re going to use technology for technology’s sake, but rather see technology and the IT department as a service department. We’re here to serve the needs of the business and our business is healthcare. We try not to let the technology get in the way of doing what needs to be done.

Infirmary closed one of its hospitals a while back, saying the Affordable Care Act is requiring hospitals to reevaluate how they deploy resources. Including that, what are the biggest trends you are facing?

We closed that hospital. It was an acute care hospital in the west part of town. We relocated the long-term acute care hospital on that same campus to the main campus of Infirmary.

Because of the regulatory environment that we’re in and the change of healthcare, we see a shift naturally to population health management. To keep the patient from getting sick rather than just treating the disease.

We’ve already started that move toward a focus on wellness with our own patient population. We have about 5,500 employees in our own network. We’ve spent the last two or three years focusing on wellness and prevention of disease within our own organization. We’ve begun to reach that out into the community. We have external wellness programs that we offer to businesses. We’re seeing that taking shape.

I also see the hospitals becoming affiliated more — whether it’s through merger and acquisition or whether it’s through some kind of virtual affiliation — to where there are fewer primary inpatient acute facilities over time and more freestanding emergency room-type diagnostic centers that feed main campuses of fewer hospitals, rather than every little community having its own hospital like has been the case for 100 years in this country.

Population health management and wellness management are changing the way we look at IT and the service that we have to deliver.

What technologies do you use or expect to use with those new objectives of population health management and wellness?

We signed a contract with Epic back in 2008. We looked at Epic primarily because of the ability for us to have a single record across the continuum. That has served us well to this point.

It has taken some philosophical rethinking from where a physician’s office talked about having its own record, versus the hospital having its own record, to now having more of a patient-centered record. Where the record doesn’t really belong to one of those entities, even though it never really did in the first place — that was just a concept that we had.

Interoperability is going to be a big issue. In our city alone, every major hospital or health system has a different EMR vendor. Interoperability becomes an issue. Being able to share information with other agencies, rural health, those kinds of things. All of that feeding together in addition to communicating with payers so that we can have a complete picture of the patient.

Historically we have had our view of the patient and where the patient touched our system. For us to truly be able to be effective at wellness and population health, we’re going to have a more holistic view of the patient and everywhere the patient touches the healthcare system.

Are you getting Medicare claims data or other information from payers?

We are getting some. There is still a little bit of resistance in our world, because in Alabama, Blue Cross is the largest provider. They are also the Medicare fiscal intermediary. There’s still a lot of reluctance to share a lot of that information because of competition and other things.

I was just at a meeting where Karen DeSalvo was speaking here in Mobile. One of the things we talked about regarding interoperability is that we still have this mindset about competing from a business standpoint. We all view our data as somewhat of a competitive edge. Sharing of data is still philosophically a little bit of an issue in terms of how open and honest we want to be.

I see that in most of our medical staffs, even. Physicians are reluctant sometimes to share a lot of information with other physicians because of the competitive nature for the patient. “That’s been my patient, I’ve taken care of that patient, and I don’t want that patient to go down the street to someone else.”

Those things are changing. Some of those attitudes are changing. Some of the attitudes are ingrained from years and years ago. People are becoming more open and willing to share information as we see that, both from a regulatory and from a philosophical standpoint, you can only regulate to a certain point. Philosophically, people are changing their attitudes about how important it is.

From my personal perspective, I want everybody to know everything they possibly can about me if they have any inkling that they’re going to be involved in my care. A lot of people we encounter are not like that. This physician group was on Epic and our hospital was on Epic – a patient said they might not go to that doctor any more because of sharing of the information between those two entities. It’s a little bit confusing to me why some people think the way they do, but it’s a lot about the philosophical mindset that people have about their healthcare.

Other than your internal connections to the practices you own, how are you connecting Epic to the outside world?

We have almost as many non-owned clinics who have affiliated with us by installing Epic in their office through an arrangement with us as we do our own clinics. But we are also now working to share information with those physicians’ offices who may have Greenway or Allscripts or whatever in their office and did not want to go onto Epic because they already had an investment into a particular system, whether they liked it or not.

Also, under the safe harbor provisions of the Stark Law, there’s some things that I can do for a clinic who didn’t have any kind of electronic medical record versus someone who already had one that wanted to throw it out and put a new one in. We’re working that through our HISP and being able to provide CCDs, but we’re also talking about taking it to another level using EpicCare Link, which is a portal where we can provide certain level of Epic information outside to other people.

We’re also working with nursing homes to use the Kryptiq patient portal to be able to share information electronically. We’re finding that nursing homes do not have a lot of electronic health record information. For us to be able to move a patient out to that transition of care from the hospital setting to the nursing home, we’re looking at tools that we can provide to be able to electronically share that information with them. Even though they might not have a receptacle for that information, we can provide them a portal where they can securely access only the information that they need about their particular patient. We’re trying to attack it from multiple fronts, particularly as we try to meet Meaningful Use Stage 2.

Is anybody coming to you for an alert if their patient is admitted to your hospital or otherwise exchanging information for patients for whom they bear risk?

Some businesses are certainly interested in that, where they have a self-insured kind of situation. We do have some dialogue going on between different businesses and we are beginning to provide some of that service, at least from a wellness standpoint, which I think is the first foray into the population health management.

In the State of Alabama, Medicaid is trying to set up Regional Care Organizations in multiple regions throughout the state. We’re working in our region to see how that’s going to fit together. Huntsville Hospital is the main player in that whole region, almost having their own private RCO.  That kind of arrangement works well in our environment with Medicaid being spread across multiple facilities. There’s much more of a collaborative effort that seems to need to take place. We are having conversations among ourselves, the hospitals in our region, about how we’re going to be able to work within that RCO model with Medicaid.

How did you use speech recognition in your Epic implementation?

We have been a long-term user of speech recognition in some form or fashion. We Used PowerScribe for a number of years in the radiology area. We transitioned a number of years ago to back-end speech recognition in the medical records area. Subsequently we have gone to full outsourcing of transcription to Nuance. In our clinics, we had the traditional Dragon installed on a workstation with a PowerMic for many of our physicians.

As we begin to roll out CPOE and physician documentation into our hospitals at a required level, as in an “everybody’s going to have to do it now” situation, we were concerned about how we were going to get that progress note on the chart in a timely manner. We had — whether it was because of attitude, skill level, or technologically challenged — physicians who were used to either dictating some of the information and it showed up on the chart later or hand-writing in the chart. We knew that a progress note had to be an immediate action that appeared within the electronic record.

Some of them were challenged in using either NoteWriter within Epic or a template-driven kind of progress note. Many of them to this day don’t have any problem with typing or using a structured note of some type. But with a large percentage of our physician staff, we knew it was going to be a problem. They kept talking to us about how they could use transcription and how they could use dictation to be able to get their progress note on the chart.

Particularly at our two largest hospitals, we have a situation where most patients who are an inpatient at our facility have multiple clinicians following their care. There certainly would be a primary physician who is managing the care, but multiple specialists who might be involved in the patients due to the complications and co-morbidity of our patients. We knew that when Dr. A rounded, we had to have that progress note immediately available on the chart.

We were challenged with how we were going to be able to do that and also facilitate the needs of our physicians and try to make it as palatable for them as possible to transition from a paper record to a fully electronic record.

I saw Nuance’s SpeechAnywhere at UGM and purchased 10 licenses as a trial. I got my CMIO, who is a practicing rheumatologist as well, and a couple of other physician champions to try this. It worked extremely well. They began to show it to some of their peers and my 10 licenses were used almost immediately. We saw it as a way to get the progress note on the chart and to avoid the complaint that we don’t have enough devices for them to access.

Many physicians tell me they don’t do technology, but they have an iPhone on their belt and an iPad in their lab coat. They can use Epic’s Haiku application to pick their patients or for rounding or results review, so they could then pick their patient, dictate their progress note, review it, accept it, and then immediately have it show up on the chart. It was a home run for us. We have about 300 licenses active today.

It’s not for everybody. There’s a lot of people that would rather just sit down and type in their note or fill out a structured note template. But we have about 300 physicians today who are using SpeechAnywhere with the Haiku and Canto applications.

When you look ahead two or three years, what do you see as your biggest challenges?

The biggest challenge that I see for all of IT and healthcare is the onerous regulatory rules that we’re having to meet.

I’ve got a chart on the wall that shows all the things that have to be implemented by 2020. Regulations saying that not only do you have to provide a patient portal and lead that horse to water, but I have to force that horse to drink. It’s not enough for us to be able to provide that. The rules say that a certain percentage — and it’s fairly low right now, but I anticipate that going up — that I somehow have to engage the patient and make them use the technology. That to me is a little bit of a challenge — how we’re going to force people to use technology who just don’t want to use the technology. 

On the other hand, we talk about interoperability and we just say, “You just need to make it happen.” I’ve got Payer A coming to me and wanting me to do interoperability this way. Payer B wants me to do it this way. The hospital across town wants me to do it this way. 

You want me to make the healthcare system more efficient and you want me to drive cost out of healthcare, but yet you make rules that are nebulous. If you want interoperability in healthcare that works nationally like an ATM system in banking, the government is going to have to say, “Everybody is going to do it this way. This is the format and we’re all going to use it.”

It’s like HL7. HL7 is supposed to be the standard, but HL7 is not HL7 is not HL7. Everybody who uses HL7 wants to do it a little different way and add their own little nuance to it to make it somewhat proprietary.

That’s one of the big challenges that we have in moving towards this interoperability, Not only the philosophical and the attitude changes that have to take place, but making smart regulatory requirements. Let’s don’t regulate things that don’t make sense. Let’s regulate things where we really want to make things happen. By having a strict standard, we can actually accomplish interoperability.

Morning Headlines 7/30/14

Former Procter & Gamble CEO Tapped as New VA Secretary

Robert McDonald, the former Procter & Gamble CEO, is unanimously confirmed as the new VA secretary.

Many health-IT success stories to note

National coordinator for health IT Karen DeSalvo, MD, publishes a response to an earlier Boston Globe article which reported that rushed EHR implementations are introducing new, sometimes serious, patient safety risks into care delivery.

Graduate Medical Education That Meets the Nation’s Health Needs

The Institute of Medicine publishes a report analyzing what value taxpayers get from the $15 billion in annual funding that is provided to pay for medical student residencies. The report concludes that the investment is warranted, but that improvements, including more transparency and accountability, are needed.

Medical identity theft can threaten health as well as bank account

CBSNews reports that medical identity theft has become the low hanging fruit of

the criminal underworld because the security protections that banks and credit card companies have put in place to protect consumer data have not yet reached healthcare infrastructures.

News 7/30/14

Top News

House and Senate leaders approve spending $17 billion to improve services at the Department of Veterans Affairs by leasing new facilities, hiring more clinicians, and paying for care delivered outside the VA for veterans who can’t get timely appointments. Most of the “cost of war” funding goes straight to the $18 trillion national debt. In related news, former Procter & Gamble CEO Robert McDonald is unanimously confirmed as VA secretary.

Reader Comments

From Legume Enumerator: “Re: Cerner earnings call. You missed the laughter toward the end of the call when EVP Zane Burke said that EMRs that don’t interoperate are borderline immoral. This supposedly ’open’ versus supposedly ‘closed’ systems debate that is beginning to surface in Congressional testimony and now on investor calls will become the battle cry for why the kids from Wisconsin should not be allowed to win the DoD (or any other, for that matter) contract.” “Open” has become a marketing term, jumping the shark when since-deposed Allscripts CEO Glen Tullman confidently and repeatedly declared that all of the company’s potpourri of acquired systems are open and interoperable because they all run on Microsoft SQL (showing little widespread openness, not counting Glen’s mouth). It is indeed worrisome when politicians start using the word as though they understand it and aim legislation accordingly. I challenge readers thusly: what core set of published standards or capabilities must a given EHR support to be considered open? We need to put some collective thought into this.

From Gold Watch: “Re: Xerox Midas+. The managing director apologized to customers in June 2013 that the acquired product marketed as Midas+ Live failed to meet their needs. The company replaced him with the key person from the former company of the failed product, who reassigned most developers to the Juvo cloud-based product being developed using the failed product as its basis. The developers and an India-based contractor were supposed to finish the product by January 2015, but it exists only in demo form and numerous employees have left the company. Sales of the flagship product will be halted in August 2014, hoping to convince Midas+ customers to switch to Juvo, although employees have been forbidden using the word ‘sunset.’ The company’s stated mission is now to double its 2013 revenue by the end of 2016.” Unverified. A Xerox spokesperson provided this response:

We take all customer concerns seriously and address them directly to ensure our customers are delighted with our products and services. As a leader in our field, Midas+ is always working on developing new products that will enhance customer satisfaction and help improve the quality of care.

From Headcount Reduced: “Re: Siemens. You missed the 7/25/14 layoff in Malvern. It wasn’t just contractors and consultants. Rumor is that 200 employees were impacted.” Unverified.

From Stocky Lad: “Re: Health Evolution Partners. What was CalPERS thinking to put $700 million into Brailer’s first foray into private equity? It pisses me off as a California taxpayer. I assume HEP’s Summit will continue regardless since they were considering spinning it off even before this latest news. It’s a super event.” Enthusiastically endorsing the deal on behalf of CalPERS back in 2007 was its CEO, Federico Buenrostro, who was fired in 2008 and just pleaded guilty a couple of weeks ago to accepting bribes, defrauding workers and retirees, and obstructing SEC regulations. The next invitation-only HEP Summit is in April 2015. Some of its sponsors are Emdeon, McKesson, Optum, Walgreens, Healthagen, Oracle, and WellPoint. This year’s agenda featured a panel of past and present National Coordinators: Blumenthal, Brailer, DeSalvo, and Mostashari.

From ThanksForPlaying: “Re: Norbert Fischl, CEO of CompuGroup Medical US. Has been removed from his position by Germany. His tenure, similar to that of his predecessors, was just over a year.” Verified. I interviewed him a couple of months ago. My surprise is minimal.

What a Cerner Acquisition of Siemens Health IT Would Look Like
By Chester of Malvern

• Does the remote client operations (RCO) data center belong to the suitor?
• Allegra, Invision, and Soarian customers would become service level agreement fodder – positive revenue – and customers of the first two would be targeted to replace their aging software.
• Siemens US clients plus Cerner sites would push Cerner past Epic in size.
• Soarian sites are happy with their financials, which are better than Cerner’s.
• Siemens has a better and more stable international presence (see NHS Cerner replacement by CSC’s iSoft). Cerner has made some progress internationally, but regional capitation (most offer socialized care) and ease of implementation is Cerner’s burden.
• Invision sites love their accounts receivable – tough to convince happy CFOs.
• Soarian clinicals / financials could complement Cerner in the community hospital space where Cerner has historically been too expensive, specifically implementation support – complex integration.
• Siemens MobileMD is a sound HIE platform, Cerner would be better at packaging and selling it. We like Cerner’s ACO and population management approach, so CareXcell would be gone, or at least have a bake-off with Cerner’s PM solution, and Cerner’s solution would win because they have an install base.
• Siemens Intelligence could play a role as long as Soarian is not demolished.
• Love the Soarian business process manager — the rules engine is quite impressive.
• Siemens’ EDMS is better than Cerner’s and it is standalone.
• Siemens RIS — legacy, so that is not a question. Doubt if a proprietary PACS would be needed Cerner has an acceptable image management solution, but neither company is popular in radiology or cardiology.
• Siemens Lab is a legacy system that customers love. KLAS rating is high even though they do not really manage pathology very well (lab is standalone).
• Siemens Pharmacy and MAK works with Soarian – different platform, but functional. A keeper if there is a willingness to port the technology to the same Soarian foundation (pharmacy not so standalone).
• Cerner Millennium is difficult to install. Consultants who install Soarian do not have the same complaints.
• Cerner services are about as effective as Siemens services – they both lose equally to consulting firms that are or have a lot of ex-Cerner / Siemens implementation and project management personnel.
• Cerner could simply acquire Siemens for the client base and would, as most acquirers do, have a heavy hand in redundancy. However, Siemens has a surprising number of seasoned veterans if the transition is handled well and they don’t all run for the hills.
• Soarian is not worth burning, but acquisitions for market share are rarely kind. Usually they are disruptive to a point of discontent.
• Siemens need to prove a profitable community hospital IT model since Cerner hasn’t played well there. Over 3,000 hospitals have fewer than 200 beds and perhaps a Cerner Soarian campaign could help those most negatively affected by ACA.
• Both Cerner and Siemens have had challenges in the ambulatory space. Cerner touts its progress in ambulatory care, but it’s mostly IDNs with ambulatory care centers that serve as feeding conduits to the hospital. Siemens hasn’t made the commitment to acquire or build a viable product.
• The silver bullet for Epic is scalability. Even though Epic can control without collusion their pricing model, they cannot be the only choice for hospitals with fewer than 200 beds.

Acquisitions, Funding, Business, and Stock

GetWellNetwork acquires patient rounding and satisfaction system vendor Marbella Technologies.

Personal vital signs analytics software vendor Naperville, IL-based VGBio changes its name to PhysIQ and raises $4.6 million in Series A funding. The VA Center for Innovation is piloting the software in its VitaLink program, which warns caregivers of developing health issues by analyzing information from sensors worn by patients at home.

Oncology data vendor Flatiron Health moves its headquarters to a newly leased 15,000 square foot office space at 96 Spring Street in New York City.

The CEO of Roper Industries, speaking about its Sunquest division in Monday’s earnings call: “Sunquest had an all-time record quarter. There is Meaningful Use implementation and our ability to approve Sunquest’s ability to execute really paying huge dividends now, lot of upgrades in the hospitals. And we continue to invest very aggressively internally in Sunquest to capture more of the anatomic pathology and genomic testing opportunities that we see ahead. That’s lot of internal investment in there, but we’re also very active in the acquisition pipeline area around those areas … we’re going to expect double-digit growth for some time out of Sunquest that areas that we’re taking them into are very exciting areas. There is a lot of opportunity in the short run … It generates lot of cash.”

Sales

Nebraska Methodist Health System (NE) selects Strata Decision’s StrataJazz for decision support, cost accounting, operating budgeting, management reporting, and productivity improvement.

Advocate Health Care (IL) will deploy vendor management technology from Connance.

Comanche County Memorial Hospital (OK) selects Merge Healthcare iConnect Enterprise Archive and iConnect Access.

Eskenazi Health (IN) selects Streamline Health’s Looking Glass business analytics solutions.

Cape Regional Medical Center (NJ) will implement Summit Provider Exchange to connect its multiple EHRs to the NJSHINE HIE.

War Memorial Hospital (MI) will deploy the JEMS Telehealth System.

People

Quantros names Annie Callanan (Systech International) as president and CEO, replacing interim J.P. Fingado.

Steven Davidson, MD, MBA (Maimonides Medical Center) joins PatientSafe Solutions as CMIO.

Impact Advisors hires Tonya Edwards, MD (Bon Secours Medical Group) as physician advisor.

Dave Cannell (Deloitte Consulting) joins Cumberland Consulting Group as managing director of the company’s life sciences practice.

Announcements and Implementations

Cerner names Rainbow Services, Inc. (KS) as the test site for its Community Behavioral Health mental health EHR.

SSI introduces its A/Rchitect suite, which includes analytics, denial management, and contract management. 

Maryland’s CRISP HIE issues an RFP for a pilot to add image exchange to its query service.

Government and Politics

National Coordinator Karen DeSalvo writes a letter to the editor of the Boston Globe, saying that the paper’s story about EHR safety problems failed to mention positive EHR outcomes. She also pitches ONC’s proposed health IT safety center – the one Congress keeps saying ONC isn’t empowered to create.

A VA investigation finds that one of its pulmonologists copied and pasted old clinical information into its electronic patient records more than 1,200 times, possibly committing insurance fraud as a result if third-party payers were billed for his services. The unnamed doctor blames his “technical incompetence” and “stupidity.”

Innovation and Research

Baltimore startup Quantified Care, run by mostly Johns Hopkins graduate students and selling evidence-based mobile apps and hardware, starts a $15,000 Indiegogo fundraising (and PR-generating) campaign that offers an old-school but high-tech doctor’s black bag for a $300 contribution.

Other

A new Institute of Medicine report says that while taxpayers are spending $15 billion per year to pay for medical residencies and fellowships — much more funding than any other profession receives and giving hospitals cheap and obedient medical labor — the government imposes little accountability and the system is not producing the kinds of doctors needed. The report also concludes that the program overemphasizes hospital training, reflecting its 1960s-era origins in falling short on healthcare IT, preventative care, and chronic disease management. The report recommends making changes to Medicare regulations over the next 10 years to create a more accountable and performance-based system, then deciding at that time whether taxpayers should be funding graduate medical education at all.

Schools of osteopathic medicine, which grant the DO rather than the MD degree but are otherwise nearly identical except for their emphasis on community medicine and preventive care, are producing a third of all new medical school graduates. Last year, 144,000 applicants competed for 6,400 DO school spots. Sixty percent of new DOs enter primary care vs. 30 percent of MDs.

A CBS News report says that medical identify theft is “the low-hanging fruit” for criminals and is increasing dramatically because the healthcare system doesn’t protect their information and those whose identities are stolen don’t find out unless their bills go to collections. The article points out that the impact isn’t just financial – a patient could be given the wrong meds or blood products or have their insurance terminated. The article leads off with the story of a woman who almost lost custody of her children because a drug user gave birth using her identity.

It’s a Pyxis for pot: Medbox obtains patents for its biometric-powered marijuana dispensing technology. The company offers related services that include armored car cash transportation.

Weird News Andy notes “keeping cancer in the dark” as an animal study suggests that breast cancer becomes resistant to treatment with tamoxifen if the test subject is exposed to light at night, which suppresses melatonin production.

Sponsor Updates

• Frost & Sullivan awards Validic its best practices award for value and customer focus in healthcare interoperability solutions,
• Healthcare Data Solutions (HDS) releases a new white paper, “How EHRs Can Become More Than Just Vendors.”
• DocuSign posts an article called “Don’t Risk Your Health (Data) with Paper.”
• Beacon Partners posts a new blog entry titled “Four Questions the Proposed Meaningful Use Rule Doesn’t Answer.”
• ZirMed announces partnerships with JASE Health, HAS-Software, AmeriCare, medQ, and Scorpion Healthcare.
• University Hospitals (OH) expands its Premier relationship to include Premier Connect Enterprise as well as extending the supply chain services agreement for three years.
• Health Catalyst adds keynote speakers and sessions and expands the attendee limit for its Healthcare Analytics Summit 2014 September 24-25 in Salt Lake City.
• InstaMed announces that 70,000 healthcare providers have been paid through Member Payments since its launch one year ago.
• Predixion Software CEO Simon Arkell is named a finalist in the “Outstanding CEO” category of the Orange County Technology Alliance.
• Jen Reese shares how telemedicine technology is creating the need for doctors to have licenses in multiple states on pMD’s blog.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 7/29/14

Lawmakers reach $17B deal on VA bill

House and Senate lawmakers announce a $17 billion plan aimed at addressing appointment wait times.  The bill would provide $10 billion for veterans to seek medical treatment from non-VA providers, with another $5 billion going toward hiring additional medical to help the VA keep up with appointment demands.

Almost half of Kaiser Permanente members book appointments, request refills and send messages online

A new Kaiser Permanente report claims the health system’s portal and mobile app saw 131 million visitors during 2013. Kaiser ties their web presence to impressive gains in medication adherence rates and chronic disease management.

Early Q2 financials show reform benefiting hospitals’ bottom lines

The ACA is generating increased patient volumes, and thus having a positive impact on quarterly earnings for publicly traded hospitals, according to Modern Healthcare.

Geisinger CEO will step down

Geisinger Health System CEO Glenn Steele, MD, will retire next year after 12 years leading the organization.

Curbside Consult with Dr. Jayne 7/28/14

I had a chance to catch up with an old friend this weekend. He’s an OB/GYN, and as an employed physician, he’s had EHR in both the hospital and ambulatory settings for years.

Their efforts have resulted in massive amounts of data that can be mined to improve patient care. Surgeons can easily access their own outcomes data and compare morbidity and mortality data when incorporating new techniques (such as robotic surgery) into their practices.

There’s a dark side to that big data, however, and it’s starting to rear its head.

Although most laypeople are aware that babies are going to arrive when they’re going to arrive, administrators at his hospital may have missed that part of health class. They’re creating reports looking at delivery times and labor lengths under the guise of optimizing patient care. The seedy undercurrent of their research, however, is a desire to reduce staffing costs. Although they haven’t overtly said it, he suspects they’re on the verge of asking physicians to start acting in the hospital’s best interest rather than the patient’s.

I delivered babies at the beginning of my career. When you’re caring for a mother in labor, it can be hours of waiting punctuated by moments of terror. Although delivering a child is a natural human process, in the US, we’ve medicalized it for a variety of reasons. As a result, over the past quarter century, we’ve seen an increase in the percentage of babies delivered surgically (it sounds a little scarier when you say it that way, rather than “by C-section”) and there have been concerted efforts to try to reduce this trend.

It’s not just a problem in the United States. The World Health Organization has set a goal of 15 percent C-sections as realistic number for the procedure. In the US, it’s at about 28 percent, in Britain it’s 25 percent, and in Brazil, nearly 80 percent of women delivering in private hospitals have C-sections. Some blame cultural factors for the rise in the procedure. The ability to deliver “on schedule” is certainly a plus for some women as well as for their physicians. Others blame our medical payment system, because reimbursement is higher for a surgical delivery.

It’s not just C-sections, though. We’ve seen a rise in labor inductions, where drugs are used to start labor, often before the due date. Although there are definitely medical reasons when this might be indicated, it had become so prevalent (one in every five women) that ACOG, the OB/GYN professional organization, issued revised guidelines to try to ensure appropriate use of medical interventions.

Why would someone want to electively deliver a baby (through induction or C-section) anyway? Some blame the risk of litigation in the case of a poor outcome. Others blame physicians who want to deliver babies at their convenience. In my practice, I had a fair number of women request induction because they live far from their families and wanted to schedule the delivery to ensure relatives could travel to assist with the baby or help with young children at home.

In countries that spend a lot of money on post-partum home visits or in-home assistants, this may be less of an issue, because women may feel more supported at home after a delivery. Data is shared between community-based caregivers and coordinating physicians so that care can be delivered outside of the hospital. That kind of care has a cost, though, and isn’t an option for many US women, hence the request for inductions.

When thinking about cost controls, however, the idea of asking physicians to intervene in the labor and delivery process to try to better match facility staffing capacity is just too much to accept. Using data in this way sets us on a very slippery slope. What’s a little extra Pitocin? We can convince ourselves that it would be better for the baby to be delivered sooner than later, and if it happens so we can deliver before shift change, so much the better. Looks like the extra drugs may be creating some fetal distress, better prep the OR.

I haven’t delivered a baby in years, but I can’t imagine the stress of having my labor and delivery management decisions questioned by someone who has motives other than reducing maternal and neonatal morbidity and mortality.

Pregnant women are some of the most empowered patients I see in practice. They have more time to research various options and choose the best for themselves and their families, unlike patients facing cancer, injuries, and other unexpected issues. They share the knowledge of how to fight back against the medical establishment (as proven by anyone who has had a patient arrive with a 20-page Birth Plan) and are increasingly demanding of alternatives to the hospital birth experience. Many women in my area are using Doulas and Labor Coaches to have a dedicated patient advocate with them if they do deliver in hospitals. Some can cite the labor and delivery data and the risks of interventions better than a med student prepping for boards.

If the hospital is serious about this, I hope the physicians and nursing staff stand their ground. Better yet, I hope the patient community gets wind of it and reacts strongly.

As for my friend, he’s trying to work from the inside to convince hospital leaders that this is the wrong way to use big data. I hope he’s successful, but I also know he’s fearful for his job as an employed physician.

Have any other examples of misuse of Big Data? Email me.

Email Dr. Jayne.

HIStalk Interviews Linda Reed, CIO, Atlantic Health

Linda Reed is VP of integrative and behavioral medicine and CIO of Atlantic Health System of Morristown, NJ.
 

Tell me about yourself and your job.

I’m the vice president of integrative and behavioral medicine and chief information officer. I’ve been at Atlantic Health 10 years. For the first six, I was vice president and CIO.

About five and a half years ago, I got integrative medicine, which is massage, yoga, supplements, functional medicine, and acupuncture. Then about three years ago, I got behavioral health. One of my doctor friends here says, “Who did you annoy that you were able to get such a wide variety of things?” It’s funny because I tell the CFO here that I’m like the empress of everything that is expensive that makes no money. It’s interesting. My day is right brain, left brain.

I’m a nurse by background. I’ve been a CIO for almost 20 years. I just love what I do every day. I’m an activity junkie and this job really suits that.

How much of your IT effort is focused on plumbing type work like Meaningful Use and ICD-10?

I’d say it’s probably 60 or 65 percent.

We try really hard to do some other interesting things. We’ve put a lot of effort into mobile health. We’ve got a mobile health strategic plan. We just published a mobile health app. Taking a look at some interesting new and different kind of things to do with mobile health. We’re trying to spend a lot of time there doing a little more with telemedicine. There’s all this new, cool stuff you want to do, but you’re really anchored back in the ICD-10, Meaningful Use world.

We’re doing a lot of acquisition. We’ve added two hospitals in the last three and a half years and we’ve got one more coming at the end of December. They’re all different. One hospital was on a really old platform, not the one that we’re on, so we kind of ripped and replaced. The second one that we got had put some money into the platform that they’re on, so we decided to leave that one alone because they had attested. The third one that we’re getting is a little bit of both. They’ve got two different systems on the front and back end, so we’re still looking to see exactly how that one’s going to transition in. We just went live on Tuesday with a brand new ambulatory system for our physicians. It never stops.

Which ambulatory system did you go live on?

Epic ambulatory.

Are you still primarily a McKesson shop?

Yes, we’re still McKesson.

They’ve sent some mixed signals about their healthcare IT direction. How do you see that playing out?

Their direction is Paragon. The hospital I said that had a pretty good platform that we left in place is Meditech. 

We belong to a consortium called AllSpire. That is us, Lehigh Valley, Lancaster General, Hackensack Medical Center. Of the seven members, four are already on full Epic.

We know the direction McKesson is going with Horizon. We’re going to have to make a decision in the next couple of years as to where we’re going to go. We know we’re not going to stay on Horizon.

My job is to try and give the organization options. When you take a look at what’s going on in healthcare and you start looking at the trajectory of hospital buy-ins, can you really justify a huge expense?

Nobody goes ambulatory Epic unless they’re going inpatient as well. Isn’t that predetermined?

I don’t know. I’m not really sure. Before we did this, I talked to a number of consulting companies. How much cross do you have between the people that come into your ambulatory and are in the hospital? How much back and forth do you really need? Could that be done by a summary of care, CCD, and CCDA? I’m not sure — that might be.

We’ve got a direction we could take, where we have like-for-like licenses because of all the investment we’ve made over lots of years. We’ve got an option for an integrated platform that already exists in one of environments — it might be something we want to do. We’ve got a third option that we’ve already got the ambulatory component in, and then if we wanted to work with our partners in our coalition, we could do that. What I’ve tried to do is try to give Atlantic Health multiple options to choose from.

What do you think the driver will be as to which way they go?

I think it will be looking at where we are from a volume perspective, where we want to be on the risk side, how much we want to manage what we have.

We’ve got two accountable care organizations. If we do a good job in that realm, aren’t we going to be driving patients out of our own hospitals? If we do that, we want a really, really robust ambulatory system along with population health management, analytics, and care management tools. How big does the hospital system really now have to be?

Have you looked at any of those technologies for ACOs, population health management, and analytics?

No. We stepped in gingerly. We took our time. We tried to use what we had in place.

We started off with RelayHealth. We’ve been a big user of RelayHealth for many years. RelayHealth provides the platform for our regional health information exchange. We’ve got 30 hospitals on that here. We started off with that, and then we moved into some business intelligence. We have MedVentive for population and risk management. McKesson does a lot of work in the payer space for disease management, so we’re working with them right now on putting in their care coordination tool.

We spent a little time understanding what it is we needed to do, then tried to put a few technologies in to be able to do that. We’ve got the business intelligence. We’ve got to work on the care coordination tool — that’s next. We’ve got Relay to do some of the health information exchange.

We use Imprivata Cortext, a secure texting tool. We’ve built specific directories for the ACO physicians so that they can now use that as a secure referral tool for each other.

I’ve been a customer of Imprivata in multiple organizations. They’re an easy company to do business with. I’ve used their OneSign. Our doctors love the tap-and-go because they all have their little card and their one workstation. They don’t even log off, they just tap. It closes the screen and they tap it again wherever they go — it brings up their session wherever they are. They just love that. We started using their secure texting about a year ago.

They’re using Imprivata Cortext it as their communications clearinghouse so they don’t have to play phone tag? They just send the text message and walk away?

That’s right. Our ACO put together a per-member, per-month incentive for physicians up front so the physicians don’t have to wait until savings at the end of the year. There’s a number of different sections there. There’s one for the use of technology. If they use RelayHealth, if they use Imprivata Cortext, if they automate their offices, they get a certain amount of money. For some process measures, they get it. For some outcomes, they get it. There’s a couple of other things. Their whole per-member per-month incentive is based on certain activities that they do.

I assume you need to analyze your data across the Epic on outpatient and McKesson and Meditech on inpatient. What are using for a data warehouse?

We use Horizon Performance Manager. The pop stuff all comes out of MedVentive. MedVentive has data from the EMRs, from the HIE, and whatever they might need from the hospital.

Are you looking at any technologies that can help support the clinician-patient relationship and patient engagement?

Our app is a patient-facing app. We’re constantly working on we help physicians and patients communicate.

A number of years ago, we put in RelayHealth, which had secure messaging with physicians. I had one doctor say to me, “ I will never, ever, ever, ever trade an email with a patient.” Then about a year ago, she came back and she said, “That’s not so bad.” She was telling another doctor, too, “I talk to my patients on email all the time.” It’s really interesting to see the dynamics. I think we’re probably going to be looking at doing something very similar on the mobile front.

Tell me about the mobile app.

It’s called Be Well. We have one for each one of our hospitals, because our physicians are more specific to our geographic area. It’s got a physician directory, ED wait times, and a whole bunch of different health trackers, including a way to download your Fitbit information.

Did you develop that yourself or have it developed?

We worked with a company called Axial Exchange. Everybody today will tell you that it doesn’t make any sense to go out and do that kind of work yourself when there’s just so many other companies that you can work with. 

There’s a health encyclopedia in there, but it’s the same kind of health encyclopedia we use on our website. For us, now we’re migrating from the web to mobile. That’s where we’re going there.

As a nurse, do you think nurses are underserved as far as technology that helps them do their clinical role rather than just documenting so that somebody else can send a bill or have the doctor read their notes?

That’s an interesting question. We put in Vocera a lot of years ago now. One of nurses’ biggest issues was the phone tag that they were playing with doctors. They don’t all carry around organizationally-provided smartphones. From an access to information, it could be more helpful if they did.

Do you discourage them from using their own?

We don’t. We do discourage them from SMS texting on their own. It is one of the reasons why we went out and got Cortext. Just telling people not to use SMS text and not giving them something to use makes no sense. It’s like spitting in the wind. 

The interesting thing about nurses is that we’ve got those computers on wheels. They’re on those things all the time. To take them off takes them out of their work flow. The Cortext component has a PC-based user interface, not just mobile. You can be on the COWs or you can be on the mobile.

Right now for nursing, I think it’s moving in that direction. I just don’t think that it’s quite as mobile-enabled as some of the physician tools right now.

What are the organization’s biggest strategic issues that need IT help?

Care coordination is huge. We’re kind of schizophrenic because we still are fee-for-service and we still are doing procedures and patient care in the hospitals, but we also have these ACOs. While we still need to be able to get people in and have great turnaround time, decrease the length of stay, get more turns in as much as we can, on the other side, we’re still working on how do we keep people out of the hospital and in the ACO and keep and have that gap and address all the gaps in care and the transitions of care? 

It’s like two different initiatives that we’re working on. We still have to keep the whole patient engagement and satisfaction thing going on the other side.

One of the things we did a few years ago –it’s on paper and we’re just getting ready to take a look at how to automate it — is we had created a patient itinerary report. One of the big things that patients always complain about is that they don’t know what’s going to happen to them during the day. We created a report that pulled it from different parts of our technology — what’s the patient’s name, why are you here, when did you get here, who are the care providers on your case, what medications are you on, what labs did you have ordered for you, what were the results of the labs that you had yesterday, are you going for any other tests? Then there’s a little spot for “questions to ask my doctor.” That really was pretty popular and the patients seemed to like that. We’re probably going to automate that. 

One of our next ventures in the mobile space is probably a bedside app that would give you that whole access to “my care team, my itinerary, my meds.” We also have that on our TVs right now, but we’ll look at putting it on an iPad.

Most hospitals would use an interactive patient system approach and put it on the TV, but you’re going to give patients iPads. Has anyone done that?

No. There’s a couple of places that are looking into doing it. There’s also a company out there called PadInMotion. They do some of that and they also give patients access to like Netflix and things like that on the iPad. 

The more of this education stuff that you’re going to put in front of patients, a TV on a foot wall is really a tough user interface to give patients unless the thing is like 120 inches. I don’t know how big the screen has to be. Giving them an iPad is probably a good way to do that, but again, we also have to take a look at the patient population. When my dad was in the hospital, he could barely work the remote control on the TV, much less an iPad. It’s just trying to meet the needs of the patients that are there. You have to have multiple user interfaces to help patients through all the technology we throw at them.

Physicians are moving, or moving back, into leadership roles in health systems. What advice would you offer nurses who want to move into leadership roles outside of nursing?

Don’t say no to anything. I have a job today that practically didn’t exist when I first started in my nursing career. Take on any opportunity. 

The one thing that sometimes you see with nurses is that they like to have things that are very concrete. It’s interesting because we work on the fly every day. We are the leaders of multitasking. But sometimes I think having a job that doesn’t have a very concrete job description or isn’t very clear on the time or the hours or the responsibilities — I think they shy away. They don’t realize how freeing a job that’s maybe not quite baked can be, because you can bake it yourself.

Nursing is also very isolating because you’re in those nursing units all the time. Sometimes you don’t get a lot of opportunity to meet and speak to board members, meet and speak to senior leadership. You’re just tucked away enough that you’re not exposed. That’s the other thing–say yes to any committee. Get out of the nursing unit and get some exposure.

Do you have any final thoughts?

For anybody who’s in a hospital and just thinks of healthcare as a hospital, where we are going should be frightening to you. We’re not going to be a hospital, especially if we start taking a look at the people who are going to disrupt us the most — retail medicine. 

We have to start thinking about ourselves as the providers of retail medicine. We have to think about fast access, customer service, the customer’s always right — those things that you’ve traditionally heard about retail environments. We have to stop thinking about healthcare as a civil servant-type environment where you call and you get an appointment four weeks later. It’s going to change everything we do. We’re going to have to get faster, better, and more consumer friendly very quickly.