CIO Unplugged 6/11/14

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

Data-Driven Performance

I have a confession to make. While I am an uber advocate of data-driven performance in healthcare and IT operations, I seldom apply these tools to my personal life. Sure, I look at data when I consider investments and major purchases, but, put it this way, you’ll never see me with a Fitbit!

I am witness to the power of data to shape clinical transformation. Are you kidding me? Serving in organizations with mature electronic health records and advanced business intelligence tools, I see the evidence in our quality reports all the time. Bam! Data-driven outcomes for sure. Evidence-based medicine—check. Ditto on the business side. In fact, my organization is among the first in the country to post our data-driven metrics online. Transparency is a great motivator.

For all my talk on leadership, innovation, connected health, and business intelligence, you might expect me to be a walking wearable. Nope. I’m wired as a visionary. Details are not my forte. I might have a grand idea for a party, but I leave the planning and execution to the detailed-minded organizers.

When it comes to athletic endeavors, I’m about getting to the finish line fast. Forget style and quality form; just get out of my path.

Over the years, the downside of this method caught up with me. Time was no longer my friend. Another confession: my performance had stayed flat for a few years. I wanted to see improvements, so I needed to change.

My friend Ben Levine is a perennial “top doc.” He runs the Institute for Exercise and Environmental Medicine and is one of the world-renowned types who’s been kind enough over the years to help train my mountain climbing teams.

Ben took me through the paces of his research lab. Part of our deal meant I had to be in a study and sport a wearable for a while.

After analyzing all the tests, he told me my body was capable of greater performance. My lifelong conditioning gave me a good base, including a resting heart rate of 40 (occasionally six BPM when asleep). But I had not reached my physiological potential.

I researched and found a triathlon coach to help me get to the next level of performance. Of course, it turned out that Amari of Dallas-based Playtri is a total data hog. She stretches me (no pun intended) beyond my comfort zone with all these wearables and resulting analytics.

In the past, I would cycle in a race and hope for the best by just doing whatever felt good. Now she had me monitoring a combo of heart rate, cadence, and wattage. Speed is secondary. If I focus on the analytics, the outcome (speed) will take care of itself. If I only look at speed, as I did in the past, I might dismount my bike only to find I have no legs left for the run —bonk!

I posted last fall about qualifying for regionals and then for the national Duathlon (run/bike/run) championships. Through grit, I lucked out and secured the last spot (age group) on Team USA. It was not pretty, but I made the team.

With the World Championship on the horizon as well as other important races, the time for data-driven performance arrived. A real life experiment—with me as the subject. Time to walk the talk.

Albeit imperfect in my utilization, Amari’s training formula is completely driven by near real-time data feeds. She makes adjustments based on daily training and race results. I dutifully wear the gear and upload. She parses the data, does meta- and microanalysis, and off we go.

What were the 120-day results?

I am writing this post on the plane home from the World Championships in Pontevedra, Spain. I followed Amari’s race plan, which was all data points: 150-165 BPM heart rate on the first 10K, 270 watts on the bike, never going lower than 165. It was not “outrun the person in front of me,” but to be patient and focus on my data. If I did that, the results would be my friend.

I finished in the top 25. I was the #4 American (an upgrade from #18 last fall) to cross the finish. Data-driven performance! I’m a believer. I can’t wait until I perfect the technology and discipline myself further under Amari’s coaching to see even stronger outcomes.

Personal life imitates professional. We must all push our organizations and ourselves to become data driven.

While being data driven leads to improved outcomes, no data tool could ever create the following. Intrinsic motivation does have a purpose.

The home stretch with .5K to go. I saw the Team USA Manager exhorting us to finish strong. Tim handed me Old Glory as I ran by and said, “Catch two more racers!” I caught my two as I turned into the stadium sprinting to the finish. Waving my country’s flag. Hearing chants of “USA USA USA.” Tears of joy.

Go Team USA!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Morning Headlines 6/11/14

IBM Joins Forces with Epic to Bid for Department of Defense Healthcare Management Systems Modernization Contract

IBM announces that it will partner with Epic in the pending DoD EHR vendor search, naming IBM CMIO Keith Salzman, MD, MPH and 22-year Army doc, as project lead.

Intermedix Corporation Acquires T-System’s Physician Billing Division

T-System sells its ED billing solution to Intermedix, stating in a press release that it would focus its efforts on ED clinical and coding workflow.

Taxpayers Face Big Medicare Tab for Unusual Doctor Billings

The Wall Street Journal analyzes CMS payment data and finds that 2,300 physician practices earned $500,000 or more by repeatedly billing for a single procedure. One doctor in California billed Medicare $2.3 million for a non-invasive cardiac procedure that he describes as “exercise while lying on your back.” Though he is not a cardiologist, his practice performed the procedure more times than all of the cardiologists at the Cleveland Clinic combined.

Alliance for Connected Care

The Alliance for Connected Care writes a letter to incoming HHS Secretary Sylvia Burwell asking that she use her authority to relax telehealth reimbursement regulations.

News 6/11/14

Top News

 

Our intrepid beltway reporter Dim-Sum has been telling us for months that IBM and Epic are pitching for the DoD’s $11 billion EMR contract, which IBM now confirms in announcing its intentions. Heading the project will be IBM CMIO Keith Salzman, MD, MPH, who was an Army doc for 22 years. Dim-Sum’s reports have been minor masterpieces of puns, semi-obscure references, and teasing hints, but I just realized that even his or her phony name is yet another one: the bid falls under DHMSM (DoD Healthcare Management Systems Modernization). I suspect we will get a June report shortly, but in the meantime, you might want to refer to his or her updates from March 5, March 28, April 9, and May 2 now that their accuracy has been confirmed (he or she reported here that it would be IBM-Epic two months ago.)  

Reader Comments

From Big Sky: “Re: Benefis Health System in Montana. Has an RFI out for EMR replacement.” Unverified. I don’t know what they’re running for inpatient, but they finished a huge NextGen ambulatory rollout a couple of years ago.

From Speechless: “Re: HIMSS chapter speakers. We are putting together a panel discussion for the fall on healthcare IT innovation. If you could choose one or two East Coast speakers, who would they be? We’re thinking of a progressive hospital CIO, someone interesting from one of the incubators, and a provider-side innovation leader.” Let’s crowdsource it with HIStalk readers – leave a comment with your suggestion or if you’d like to volunteer to present (or you can email me.) I’ve been a HIMSS chapter program chair and it’s hard to get good non-vendor speakers.

From Demon Deacon: “Re: Wake Forest Baptist Medical Center. Successfully launched Epic Inpatient for the Lexington Medical Center, which was the last Wake Forest hospital to go live.” Congratulations to WFBMC for getting the job done despite some disastrous (and preventable) early missteps that cost the health system a lot of money and credibility. My fellow barbeque fans might consider a site visit given that Lexington, NC has the highest ratio of pits-to-people in the country and one joint (Lexington Barbeque, aka “Honey Monk’s”) fed world heads of state at a 1980s summit at the request of President Reagan.

From Power Seeker: “Re: power strips. Joint Commission says that CMS ‘is no longer allowing relocatable power taps, referred to as RPTs or power strips, to be used with medical equipment in patient care areas, including operating rooms, patient rooms and areas for recovery, exams, and diagnostic procedures. The restriction does not apply to non-patient care equipment such as computers and printers or to areas such as nurse stations, offices, and waiting rooms.’ If this is true, time to invest in companies that sell UPS solutions.” It’s true. Patient care rooms are going to need a lot of red wall jacks to plug in medical devices individually. Hospitals will also need to check their liability insurance since power cords will be running all over the place and tripping people. I see the point – even UL-approved power strips aren’t intended for critical medical devices where failure could be disastrous (if there’s no battery backup, anyway) — but alleviating that risk will be ugly in already-crowded patient rooms.

From Wayne Tracy: “Re: Monday’s post. I’m very cynical about the VA’s problems and agree that because of commercial vested interests, VistA is quite likely to become a fall guy. VistA in my opinion is the most comprehensive user-developed healthcare clinical application. My fear is that the lack of advocacy is because: 1) Sonny Montgomery is no longer in Congress, 2) No vender will make money on it, 3) No consulting company can charge an arm and a leg to implement it. The proposals to do away will the VA healthcare system are at best naive. Last time I looked at our mental health system, I’m compelled to assert that it is woefully inadequate. What system can deal the population of amputees and brain trauma cases plaguing some two million recent vets? Some have suggested that some 50 percent are or will experience PTSD and related psychological problems. What civilian healthcare organization is prepared to deal with that large a patient population, or more importantly, has the proven expertise? If you think the backlog is bad now, just wait. This administration and Congress has good intentions that will potentially result in a diminished quality of care at greater expense.” Wayne is an industry long-timer and a retired Navy officer. I agree with all of his points. VistA will take a fall because the VA’s volume and people problems are drawing beltway buzzards and arrogant DoD’ers who can’t wait to see VistA replaced with something way more expensive even though it has been a poster child for doing IT the right way for patients (although the VA has struggled with automating patient scheduling). Nobody wants to talk about his second conclusion – we civilians weren’t really paying attention to what was happening in Iraq and Afghanistan because the death toll didn’t seem all that high. Our military participants were coming home alive but physically and mentally mangled and now we have to figure out how to pay for their care whether it’s delivered by the VA or otherwise. I’ve argued in the past that the VA should be dissolved and care provided by the existing healthcare system, but I’m not confident that system can handle the volume any better or that we can manufacture enough additional red ink to cover the cost.

HIStalk Announcements and Requests

Listening: Circa Survive, thoughtful indie rockers from Doylestown, PA. I’ve been listening to them nonstop once I got over my disappointment that the singer isn’t a sensitive female but instead is a high-voiced guy. Those of us with a clinical persuasion will appreciate this song title: “The Difference Between Medicine and Poison is in the Dose.” They’re touring now with Ume, who I also like a lot. Also, new albums from First Aid Kit and Passenger.  

I was reviewing Steve Blumenthal’s slides from the June 24 webinar below – he’s going to be fun, I suspect, especially for a lawyer. I also sat in on the rehearsal for the radiology workflow one and it was interesting to hear about teleradiologist workflow with the high volumes of images they deal with – no wonder they sit in a quiet, dark room and look at on-screen pictures while talking into a microphone all day. Like programmers, I’m guessing they rarely see daylight.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

Acquisitions, Funding, Business, and Stock

T-System sells its ED billing business to Intermedix, saying it will focus on its clinical and coding initiatives that will continue to be offered under the RevCycle+ brand.

Indianapolis-based startup Indigo Biosystems raises $8.5 million in venture capital and replaces its CEO with the company’s founder. Its clinical laboratory software interprets visual results from instruments such as mass spectrometers, flagging outlier data for human review.

Oncology drug maker Celgene invests $25 million in NantHealth to develop personalized medicine for cancer. There’s a connection: NantHealth founder Patrick Soon-Shiong sold his own chemo drug company, Abraxis BioScience, to Celgene for $3 billion in 2010.

Sales

The federal government awards ScImage a two-year, $45 million contract for its Picom365 Enterprise system, including PACS, diagnostic viewers, VNA, and workflow tools.

United Arab Emirates-based physician helpline vendor Mobile Doctors will implement mobility solutions from Cerner.

Freestanding Cypress Creek ER (TX) chooses Wellsoft’s EDIS.

Mission Health (NC) will advance its population health management with Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

Children’s Health Alliance (OR) chooses Wellcentive’s population health management solutions.

Catholic Health (NY) selects Perceptive Software’s enterprise content management system to integrate with its Infor financial and HR systems.

People

Sunquest officially announces that Matthew Hawkins (Greenway Health) has joined the company as president.

Capsule Tech promotes Kevin Phillips to VP of marketing and product management.

Former athenahealth CFO Carl Byers (Fidelity Biosciences) joins the board of Netsmart Technologies.

Announcements and Implementations

ZeOmega announces the 5.6 release of its Jiva population health management system.

Healthcare Engagement Solutions signs an agreement with Cleveland Clinic Innovations to further develop its Uniphy mobile technology platform.

Rockcastle Regional Hospital (KY) goes live on Medhost, sending data to the Kentucky HIE through YourCareLink.

IntraCare North Hospital (TX) goes live on Medsphere’s OpenVista.

Belmont University and the Tennessee chapter of HIMSS launch a healthcare IT certification program for individuals.

The mHealth Summit announces that it will host the Global mHealth Forum for low- and middle-income countries, to be co-located at its December 7-11 conference in National Harbor, MD.

Castlight Health announces GA of Castlight Enterprise Healthcare Cloud, which provides four solutions for self-insured employers: cost-optimization analytics, benefits design, a catalog of available third-party services, and a mobile benefits app for employees. Shares were up 3 percent Tuesday, but still down 58 percent from the closing price on IPO day less than three months ago. The company’s valuation is $1.5 billion on $20 million in annual revenue and $75 million in annualized losses.

Government and Politics

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster.

CMS may be congratulating itself publicly for releasing Medicare payment data (which it did only after losing a lawsuit in trying to prevent it), but the more the statistical jockeys play around with the databases, the more obvious it becomes that CMS is asleep at the taxpayer wheel. A Wall Street Journal analysis finds that 2,300 providers were paid $500,000 or more from performing single procedures or services, some of them operating well outside their area of expertise. A non-cardiologist was paid nearly all of the $2.3 million he billed Medicare for in 2012 for performing a rare and questionable cardiac procedure (“exercise while lying on your back,” advertised on his site above) on all of his Medicare patients, with his entire training in the procedure consisting of “reading lots of articles, studies, and clinical trials.”An orthopedic surgeon billed Medicare for $3.7 million in one year even though he didn’t perform a single surgery – he charged for 108,000 massages and manual manipulations. It was billed by his former employer, Abyssinia Love Knot Physical Therapy, a PT chain run by self-proclaimed “Pastor Shirley.”

HHS tweeted this picture, which it captioned, “Welcome Secretary Sylvia Mathews Burwell!” I haven’t seen anything official that she has been sworn in.  

The Indian Health Service contributes its VistA-based RPMS scheduling system to the OSEHRA open source community.

The Alliance for Connected Care writes to Sylvia Burwell even before she takes office as HHS secretary, urging her to use her authority to open up telemedicine reimbursement for all ACO providers, not just those located in specific rural areas as is the case today. The trade association, run by former government officials Tom Daschle, Trent Lott, and John Breaux, actually sent two letters, one signed by its business members (Walgreens, WellPoint, and Teladoc, for example) and the other signed by a couple of dozen big health systems. The American Telemedicine Association sent Burwell a letter of its own listing sweeping improvements that would be enabled by paying everybody for delivering telehealth services, with that letter signed by mostly by big vendors (and HIMSS.) One might infer that while patient care could improve under such an arrangement, vendor and provider revenue would most certainly do so. Sylvia hasn’t even found the restroom yet and already the special interests are pawing at her.

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

AHRQ, presenting at the HIT Policy Committee meeting Tuesday, says that lack of EHR interoperability is a big problem, recommending that ONC define an “overarching software architecture” within 12 months and require EHR vendors to develop and publish APIs to support it. I’m pretty sure that’s not going to happen.

Other

St. Francis Hospital (GA) admits that one of its employees sent a mass email to 1,175 patients using CC: instead of BCC:, exposing the email addresses to all recipients. Apparently even that triggers the breach notification rule, at least according to the hospital’s interpretation.

BetaBoston profiles Seratis, a secure messaging app for care teams. The company is offering free personal use and hopes to get a Boston pilot. Their site is light on details, so it’s hard to determine whether its product is differentiated from similar apps from bigger players.

Victor Dzau, MD, stepping down as CEO of Duke University Health System (NC) on June 30 to become president of the Institute of Medicine, looks back on his tenure with comments about Duke’s $700 million Epic system:

I think we all recognize that to provide the best care for patients, you need an integrated information technology system … you can capture all the information of the patient made available to the providers and the patient, and make it available throughout the entire system … Through Epic, we are able to connect with other systems that have Epic, such as Novant and many others; now UNC just implemented it … It really is an entire information system that allows you to look at charge capture, laboratory testing, finances, work flow, decision-making … it’s a phenomenal system that can help us really improve patient care … about a year ago, I launched an institute called Health Innovation to try to make the whole place think about better ways to think about patients to try to bring together this whole large amount information that we have now through electronic health records and the use the analytic capabilities to look at data, big data, to determine how we can be a learning health care system, and try to use the new technology of digital technology sensors and others to manage patients better in the community in their homes and so they don’t have to use our facilities as much … we have Durham Health Innovation which is an initiative that we will work with the Department of Health and others bringing in geographic information systems, mapping the patient, the community, where do they live, what are the economic factors, what’s the closest clinic where’s the closest grocery store, the closest barber shop to work together to improve their health.

This seems like the worst app idea ever. A Singapore company creates Hospital PIX, the usual lame hospital finder app that also allows users to “post reviews about OBAMACARE.” That’s not even the “worst” part: it also encourages doctors, nurses, and patients to post their hospital photos (we have this thing called HIPAA over here). The fake photos from “Benson Hospital” feature an entirely Asian medical staff and the hospital distances shown are all from Indonesia, so perhaps the app’s localization isn’t quite complete.

In Alberta, Canada, the government-backed Telus Wolf system goes down on Monday, leaving practices without access to lab results, medical histories, and medications. According to one doctor, “There is no longer any government support. We pay $2,000 a month for this. Who is going to hold Telus accountable now? The government has abandoned us. Cost and issues switching patient data when systems are not compatible prevents us from going somewhere else.” Telus acquired Wolf Medical Systems in February 2012.

The Apple Toolbox site files a Freedom of Information Act request to find out what was discussed in several meetings between Apple and the FDA last year. The highlights:

• Apple thinks the FDA’s guidance on mobile medical apps is appropriate.
• The company believes it has a “moral obligation” to do more given the increasing number of available mobile sensors.
• FDA will regulate apps based on their intended use, not necessarily because they use a particular sensor. For example, FDA wouldn’t regulate an consumer-oriented information nutrition app that uses a glucometer, but would consider the same app a medical device if it is targeted to diabetics.
• Apple and FDA will work more closely together to ensure that Apple’s plans don’t run afoul of FDA’s requirements (it’s good to be Apple).

Weird News Andy questions whether this was really the “responsible” anesthesiologist. Washington’s health department suspends the license of a Seattle anesthesiologist for sexting during surgeries, accessing patient images for sexual gratification, and having sex at the hospital. Investigators found 250 sexually related messages he had sent while in surgery, including pictures he sent to patients of his exposed genitalia, one of which he captioned, “My partner walked in as I was pulling up my scrubs. I’m pretty sure he caught me.” 

Sponsor Updates

• Greenway customer ARcare (AR) earns recognition as Stage 7 of the HIMSS Ambulatory EMR Adoption Model.
• Impact Advisors is named to Crain’s Chicago “Fast 50 List” of high-growth companies.
• A pMD blog post addresses “Medical scribes: the solution to EHR inefficiencies, or just a temporary bandage?”
• First Coast Cardiovascular Institute (FL) reduces charge lag after going live on MedAptus charge capture.
• Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
• Gartner names AirWatch as a Leader in the 2014 Magic Quadrant for Enterprise Mobility Management.
• Verisk Health SVP Matt Siegel will moderate a panel discussion on value-based healthcare at AHIP Institute June 12 in Seattle, WA.
• Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges.
• Merge Healthcare is hosting a Coding Contest for Computer Science students June 11 at the University of Waterloo in Canada.
• ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day.
• NaviNet collaborates with Informatica to deliver a “smart” network.
• E-MDs will offer Lightbeam’s population health management solution to its clients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 6/10/14

Hospital Giant Uses Data to Vet Treatment Options

UPMC reports that it will expand its patient centered medical home program after the pilot program generated $15 million in savings over the course of a year.

FDA details high-level meeting with Apple: “Moral obligation to do more” with health, innovative sensors

Responding to a Freedom of Information Act request, the FDA publishes details on its meetings with Apple earlier this year, which focused on health apps and the regulation of sensor-laden consumer devices.

Why the New Obamacare Website Is Going to Work This Time

Wired covers the continued behind-the-scenes effort to rebuild Healthcare.gov, and the culture clash that develops when CMS bureaucrats are partnered with Silicon Valley temp workers to tackle a job with enormous political undertones.

Curbside Consult with Dr. Jayne 6/9/14

I mentioned that I was planning to start working in an urgent care that documents patient visits on paper. I fell into an opportunity with an independent facility and worked my first shifts this week. A reader asked if I had mentioned during the job interview that I would be blogging about my work and whether I’ve been able to remain anonymous in my various work roles.

The answer to the blogging question is “no.” I enjoy my day jobs and wouldn’t want to jeopardize them. Although I share many stories about my work, there are a great many stories that don’t get told because they might result in specific people or organizations being identified. Some of the best tales will go with me to the grave.

A reader once said that as a CMIO, I’m still a doctor, but my patients are sick hospitals and physician offices. That’s true to a degree and I guard their information as I do with patient information. Often my material reflects events that are so common they could apply to many organizations across the country, so camouflaging the events and players isn’t necessary.

As far as my clinical duties, I do think I’ve been able to remain anonymous. Frankly most clinicians in the trenches are too busy keeping their heads above water to even know that there’s an entire health care IT community out there. They may not know who their own CMIO is or what he or she does, let alone that there are scores of us who know and talk to each other. The idea that there would be blogs talking about EHRs and the people who use them to torment physicians isn’t even remotely something that would cross their minds.

If I use photos from work, it’s often months after they were originally taken or in a slightly different context than where I obtained them. I have a veritable treasure trove of photos I’ll never be able to use because they would be easily identifiable or involve people that I know read HIStalk. I also use photos that have been sent to me by readers when they can help embellish something I’m writing about. Hopefully if anyone recognizes those, the story is different enough from their reality that they don’t make the connection.

Back to the world of paper records. I arrived at the office ready to go. It’s a little different vibe from working the ER. The lack of a metal detector and security guard was refreshing, although I admit after my first procedure, I missed wearing scrubs.

The physician I worked with was quick to show me the processes and systems. Staff does the intake interview, gathers the history, and performs any needed pre-testing based on a written standing order. The clipboard goes in the door with a magnet to indicate which patient should be seen next. Simple and elegant, although low tech.

The physician sees the patient, documents on a paper template (they have a dozen or so templates for their top conditions plus some more generic versions), then comes out and order whatever additional tests are indicated. If there aren’t any, we prepare the discharge instructions and prescriptions, which are done via computer. The prescription ordering system isn’t sophisticated, but it does have hard-coded selections for the most common drugs, sortable by body system and diagnosis. If you can’t find them, there’s a search dialog, and if you get in a real bind, there’s a paper script pad in the drawer.

I have to reiterate that this is obviously not a practice that is trying to achieve Meaningful Use. As an opt-out site, we’re not asking super-detailed questions about smoking history or the types of tobacco used. We’re not asking race and ethnicity. We’re not codifying problems in SNOMED. Since we’re not part of a hospital system or accredited by The Joint Commission, we’re also not spending time assessing suicide risk, nutritional status, or any number of possibly irrelevant scenarios on all our patients. This leaves us time to actually see our patients at a reasonable pace.

Even though the first part of the shift was fairly busy (5-6 patients per physician per hour), the pace didn’t seem extreme. I think mostly it felt like I was able to focus on the patient’s current needs and not feel expected to address unrelated issues just because someone made a regulation that said I needed to.

Once the provider is finished, the nursing staff then takes the discharge instructions and scripts, goes back in the exam room, counsels the patient, and addresses follow-up needs. Then the patient gets to go home. Their plan may not have all their medications printed on it nor their list of historical diagnoses, recent vitals, or a host of other things, but it does have the information they need to care for today’s problem and to follow up with their primary care physician.

Up to this point, I’ve focused on the things that made today easy. Let’s talk about what made it difficult.

The first thing that jumped out at me was the fact that there is no drug or allergy checking when we write prescriptions. Although physicians have used paper scripts for years and there are plenty of people who argue that we were better on paper, I can’t help but think that I’m going to harm someone because I don’t have technology backing me up.

I calculated most of my weight-based pediatric prescriptions two or three times because I didn’t trust myself. I had one pharmacy call-back for prescribing a drug that might have had a mild to moderate interaction with a patient’s current medication. I know it would have flagged in an electronic prescribing system, but I’m wondering if there is a chicken vs. egg phenomenon going on. Did I miss the interaction because my vigilance was weakened by my reliance on technology? Or would I have missed it anyway?

I ended up customizing 80 percent of the patient education materials to include additional precautions or information that I like to provide for my patients. Most EHR systems would allow some level of saved customization. but our discharge system doesn’t. I’ll likely create a text document of common phrases that I can use to populate them in the future and just keep it open on my desktop.

Unlike some chain or pharmacy-related urgent cares, we don’t have an easy way to send information back to the primary care physician. It’s something that definitely merits discussion with my new employer.

Looking at the workflow with a critical eye, there were other inefficiencies. Staff had to transcribe lab data to the chart that might have been interfaced with an EHR. Patient education topics had to be searched manually rather than linked from diagnoses. These inefficiencies were virtually unnoticed, though.

Having done more than one stint as a science fair judge, I can’t say this was a valid experiment of any kind. Comparing this practice (regardless of whether it uses paper or EHR) to any other place I’ve practiced in the last several years would be like comparing apples to unicorns.

One major difference is the ability to focus on the patient’s presenting problem rather than extraneous but required information. Another is the encouragement to rely on support staff for tasks like order entry and diagnosis code lookup. It’s been so long since I was just able to articulate a diagnosis without codifying it that I didn’t know what to do with myself.

Whether it was due to the workflow process, the patient acuity mix, or other factors, I noticed one thing. Even after 12 hours of non-stop work, I felt like I had spent more of my day being an actual physician than in doing other tasks. We’ll have to see if I still feel this way in six months, but right now I’m cautiously optimistic. I’m still going to lobby for e-prescribing, though.

Have a story about going back to the basics? Email me.

Email Dr. Jayne.

Readers Write: Six Ways to Capitalize on the ICD-10 Delay

Six Ways to Capitalize on the ICD-10 Delay
By Dan Stewart

Most of the healthcare industry was taken by surprise when President Obama signed legislation that delayed the deadline to implement ICD-10 by at least a year. Now that there has been time to digest the new compliance date of October 1, 2015, healthcare providers may benefit by considering a more strategic approach for their transition to ICD-10.

Prior to the extension, many healthcare providers put in patches to meet the previous and quickly approaching October 1, 2014 compliance date. Process improvements and documentation training were put into high gear to meet the deadline, and in many cases, lacked strategic planning. With the additional time, providers can revisit their approach to implementation and potentially take advantage of other initiatives that directly impact the way their organization is evolving.

Here are six strategies to take advantage of the delay to be better positioned for post-transition success.

1. Increase clinical documentation and education

Providers now have an additional year to train their workforce. Nurses, physicians, coders, and even members of the C-suite need to understand the benefits for greater specificity in clinical documentation and how it applies to their role. Customized simulation training that addresses the specific educational needs of clinician groups can simplify the learning process and speed adoption. For example, customized simulation training can allow caregivers to practice documenting care in ICD-10 through their actual EHR application, which is critically important for learning workflow and gaining new knowledge about the system.

Any time and money invested in efforts like simulation training will be financially beneficial in ICD-9 and will also provide a smoother transition to ICD-10 with reduced risk of reimbursement issues. In addition, by continuing to engage staff with training, organizations can avoid losing the focus and interest that was created by the momentum leading up to the previous deadline.

2. Evaluate and improve the revenue cycle

Providers now have time to improve charge capture and billing and claims processing. Doing so will help to identify potential lost revenue and charge issues before claims are submitted and will improve compliance in anticipation of new denials and other post-transition challenges. Improved charge capture will also create a safety net to assist in identifying any potential ICD-10 process issues.

3. Implement computer-assisted coding (CAC) systems

Many hospitals have invested in CAC systems to aid coders in digesting physician documentation and determining which of the staggering 141,000 possible codes under ICD-10 is appropriate for each diagnosis and procedure. Now is the time to support the implementation of CAC and focus on coder workflow to optimize the benefits. Remote coding programs should also be evaluated. Incorporating tools like these not only reduces post-transition risk but also assists in the recruitment and retention of coders, which are in significantly increasing demand.

4. Begin dual coding

It is a reality that hospitals will need additional coders during the transition from ICD-9 to ICD-10. The extra time resulting from the delay creates an opportunity to begin dual coding sooner, providing physicians and coders additional practice before the compliance date. Prior to the transition, CAC systems can assist in the dual coding process by providing an automated crosswalk back to ICD-9 codes for submissions to payers, clearinghouses, and other third parties. The increased accuracy and efficiency of documentation and coding optimizes the post-transition period, mitigating the risk of compliance and reimbursement issues.

5. Analyze the financial impact

Hospitals should take the time to perform an in-depth financial impact analysis to determine the highest-impact codes on reimbursement to provide focus on operational remediation and training. Such analysis will additionally assist in identifying the reserves that will potentially be needed to get through post-compliance stabilization.

6. Expand the implementation plan

The ICD-10 extension presents an opportunity to strategically link its transition with other initiatives like Meaningful Use, Patient-Centered Medical Home (PCMH), and Accountable Care. Combining plans to adopt all of these programs can help ensure they each work together as efficiently as possible.

Miami Children’s Hospital, for example, is working to deploy a revenue cycle management system in addition to working toward ICD-10 compliance. Now that there is less immediate pressure to have physicians trained as soon as possible on ICD-10, their training can occur after the new system modules are implemented to better reflect the healthcare provider’s specific system and workflow. Implementing both of these programs in tandem saves time and money and strengthens the success of each.

While it would be easy for healthcare providers to decide to pause their efforts to become ICD-10 compliant as a result of the recent delay, it would benefit them much more to view the extra time as an opportunity to take a more strategic approach. Continuing the process will position the provider for a more successful, efficient transition to ICD-10. 

Dan Stewart is vice president and partner of strategic consulting and advisory services with Xerox.

Morning Headlines 6/9/14

Cleveland Clinic Chief Out of Running for V.A.

Dr Delos Cosgrove, CEO of Cleveland Clinic, has withdrawn his name from consideration as the next secretary of the VA.

Moody’s downgrades Lifespan Rhode Island Obligated Group (RI) to Baa2; outlook negative

Moody’s has downgraded Lifespan’s (RI) bond rating based on a "multi-year trend of declining operating performance," but notes that the rating could go up once it finishes its Epic implementation.

Global IT company launches Manchester base

Allscripts is opening a new office in Manchester, England where it will house 100 employees working to help build its UK presence.

Tech expert Stack chosen as next AMA president-elect

Modern Healthcare notes that Dr. Robert Wah, the incoming president of the AMA, is a health IT expert, as is his 2015 replacement Dr. Steven Stack.

Monday Morning Update 6/9/14

Top News

The Senate confirms Sylvia Burwell as secretary of HHS in a remarkably non-contentious process. Reports suggest that she will be sworn in and take office Monday.

Reader Comments

From Hallway: “Re: mapping applications. I saw your mention of Esri just after participating in a Google+ Hangout on Google Maps. One of the presenters was the CEO of Jibestream, which gives a hospital example.” Geographic tools will get a lot play because of consumerism and population health as health systems seek to understand their patients and target market better, move their health-related work into community social services, and  plan their locations and resource deployment. Tying databases to physical locations will become even more important with hospitals taking on risk-sharing arrangements and expanding to cover wider geographic areas. My advice to population health technology vendors and data geeks – get some exposure to geographic information systems now. The screen shot above is from another GIS mapping software vendor, Caliper’s Maptitude, which can be purchased online for $695 (I’m not recommending it since I don’t know anything about it – I just Googled and there it was.)

From The PACS Designer: “Re: Apple introduces new programming language Swift. It’s a variation of C intended to make it easier to create software solutions. Healthcare could use Swift to provide better access to siloed data and to sync consumer apps from iTunes.” It’s likely to be better and more programmer-friendly than its predecessor (Objective-C) but only if you don’t mind ignoring the majority of the world’s smartphone users who don’t use Apple devices. The non-fanboy market will decide if it really needs yet another programming language, especially a proprietary one. I would expect that for apps that don’t require a lot of hardware-intensive resources (anything but games, probably) HTML5 would work just fine and it runs on everything.

From Korn: “Re: Apple’s Health and Epic. Will it be as important as the hype suggests?” I doubt it. Apple probably hasn’t dug deep enough into healthcare to realize all of the potential issues as they (as one closed system) try to make something with universal consumer access to data from Epic (another closed system) and not run afoul of HIPAA issues. It’s great that a company the size of Apple is at least thinking about healthcare, but I think they are a lot more interested in consumer health monitoring since that might sell more Apple hardware in a way that I doubt hospital information would do. Surely Apple remembers Google and Microsoft stumbling in trying to turn personal health records into a business that consumers didn’t want. Think about it from your perspective: would anything from Epic be amazing just because you could do something new with it on an iPhone? I think the relationship is more in the other direction – Epic can take in information from Health, but that doesn’t really seem to benefit Apple very much. 

Meanwhile, the Australian free practice management systems vendor HealthKit was less than delighted to hear about the surprise use of its name by Apple, with one of its executives saying, “I’d like to think that [Apple] forgot to spend five seconds and type www.healthkit.com into their browser. But other people have said that possibly they did, and thought that we were just a startup and they could really just squash us.” In Apple’s defense, its product is called simply Health and only the development framework is called HealthKit. I’m sure Apple’s IP team did due diligence and saw no potential for confusion. I don’t think any names exist that someone hasn’t already locked down, which is why companies just make up words.

From Job Seeker: “Re: senior executive jobs in healthcare IT. Any idea what percentage are filled via retained search firm?” I don’t know, although I assume it’s different for provider CIO positions vs. vendor executive hires. Reader insight is welcome as long as it doesn’t contain a plug for a search firm.

From Arthur’s Sword: “Re: ONC’s new leadership. I wonder how many of the newly named folks have walked the walk and worked for a vendor or practice using an EMR? They are making important decisions for everyday physicians.” I found these backgrounds, but I will first say that I might question your premise of whether the folks in these positions really need current EHR exposure to do their jobs. Being an effective leader is more about listening than applying personal experience that might be dated or unrepresentative. It’s also not reasonable given the demands of these jobs to expect ONC’s people to deliver patient care or work with technology directly – they already work a lot of hours (for relatively low pay) and they solicit field input via committees, work groups, and the public comment process . My guess is that the “voice of the user” is represented behind closed doors when necessary by Reider and Murphy, who have the credibility to represent both the ambulatory and hospital providers, respectively. I would also question whether ONC will retain the influence you mention now that its money trough has mostly been lapped dry and providers rightfully start thinking about whether the dangling taxpayer cash is worth the hoop-jumping.

Kelly Cronin, healthcare reform coordinator.  Healthcare consulting, mostly government-related.

Jodi Daniel, policy. Lawyer and government.

Karen DeSalvo, national coordinator. Physician. Education, government. Her bio isn’t clear on when she last practiced medicine.

Doug Fridsma, chief science officer. Physician with clinical experience.

Lisa Lewis, deputy national coordinator for operations. Running federal grants programs.

Kim Lynch, programs. Government and REC.

Judy Murphy, deputy national coordinator for programs and policy. Nurse with extensive and recent hospital EHR leadership experience.

Seth Pazinski, planning, evaluation, and analysis. Government.

Joy Pritts, chief privacy officer. Lawyer and professor.

Jacob Reider, deputy national coordinator. Physician. Vendor and provider EHR experience.

Nora Super, public affairs. Government relations.

Steve Posnack, standards and technology. Government.

Speaking of ONC and HITECH, here’s what I said about it back in April 2009 (HITECH was approved in February 2009):

Healthcare is getting a lot of government money. Surely the feds wouldn’t start telling us how to run our shop, right? I wouldn’t count on it. We might be selling our souls here … Everybody’s clinking their glasses and high-fiving over the gravy train headed healthcare IT’s way. Fear the person from the government who’s here to help: there may be a hidden price. It’s clear that CCHIT (or something like it) will enjoy unprecedented power to set mandatory product requirements. “Effective use” will do the same for providers, spelling out exactly how they must use their technology. As Uncle Sam becomes an even more dominant buyer of healthcare services, the ratchet may be turned on reducing costs and following somebody’s medical cookbook … is the real agenda to use government clout to finally whip private industry around a little, making businesses behave in some unspecified way that runs contrary to the free market?

HIStalk Announcements and Requests

Poll respondents were mixed on whether Meditech’s competitive position is changing. New poll to your right: which events will you attend in the next year?

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information

Lorre reports that she visited athenahealth’s Watertown headquarters in Boston last week, enjoying a social event, a campus tour, and a briefing from Jonathan Bush, who then autographed a copy of his new book for her. 

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

Acquisitions, Funding, Business, and Stock

Allscripts opens its European headquarters in Manchester, England, expecting to hire up to 100 people in the next three years.

People

Mary Carroll Ford (MBC XPERT LLC) joins WeiserMazars as a principal in the company’s healthcare group.

3M Health Information Systems promotes JaeLynn Williams to president.

Andis Robeznieks at Modern Healthcare points out that the incoming president of the American Medical Association as of June 2014 is a healthcare IT guy (Robert Wah of CSC, who has been an associate CIO and ONC’s deputy national coordinator) and so is the next president who will take office in June 2015, Steven Stack (long-standing chair of AMA’s health IT group).

Announcements and Implementations

E-MDs is named as Austin’s top biomedical R&D employer by the local business newspaper, with 200 local employees.

The local paper covers the use of InteHealth’s patient portal at Raritan Bay Medical Center (NJ).

Government and Politics

More signs that the VA’s VistA baby will be thrown out with the agency’s dirty bath water:  the President says publicly that the VA needs a new information system. Evidence is ample that that the real problem was that VistA’s scheduling system was accurate and transparent, and due to the VA’s resource and management challenges, that created a reason for users to avoid using it. In other words, the system gets thrown out because it was doing exactly what it was supposed to do. The political heat will require taking decisive action quickly, which probably means the VA will be pushed in the same direction DoD is heading, which nearly ensures that Epic (under a fat cat contractor) will get the deal.

The good news for insurance companies is that HHS now allows them to run their connections to Healthcare.gov on Amazon Web Services, the cloud-based hosting solution used in all industries. The bad news is that most of those companies had already purchased their own servers since HHS rejected their request to use cloud-based hosting just six months ago.

Cleveland Clinic President and CEO Toby Cosgrove withdraws as a candidate for VA secretary. It probably wasn’t that hard of a decision given a massive pay cut (from a couple of million per year from the Clinic plus his highly profitable cozy vendor ties), never-ending political headaches, and moving from a highly regarded organization to one whose luster has been tarnished somewhat unfairly. Who would you choose? I might go with Paul Levy, who underwent his own form of tarnish, although I don’t know if he has any military experience and that would be nearly mandatory. @Farzad_MD has a good suggestion: HCA Chief Medical Officer Jonathan Perlin, MD, PhD, who was previously the VA’s Under Secretary for Health and then CEO of the Veterans Health Administration. A mid-sized health system CEO can make $1 million or more, so it’s tough to find someone who is highly credentialed, willing to take on massive federal bureaucracy, and move to Washington DC on a salary of maybe $200K.

Innovation and Research

Todd Park just announced OpenFDA at Health Datapalooza, but Social Health Insights already has created a query tool built over FDA’s adverse event reports database.

Other

A hospital in Israel implants a “connected” pacemaker that transmits cardiac condition information over the cellular network as low-bandwidth text messages.

New Google+ Hangout interview videos from John Lynn include John Squire (Amazing Charts), Mac McMillan (CynergisTek), Vishal Gandhi (ClinicSpectrum), Alan Portela (AirStrip), and Daniel Cane and Michael Sherling (Modernizing Medicine).

A patient sues University of Cincinnati Medical Center (OH) when her syphilis diagnosis and her medical bill is posted to a member-only Facebook group called “Team No Hoes.” The woman refused to tell her former boyfriend why she was being treated at the hospital, so he asked another girlfriend who worked in the hospital’s billing department, who looked it up in the EMR. The patient’s name and diagnosis was then posted to a Facebook page devoted to identifying supposedly promiscuous women. The hospital is named in the lawsuit along with the billing employee it fired over the incident.

Moody’s downgrades the bonds of Lifespan (RI) to near-speculative (junk) status, listing as its challenges shrinking margins, high area unemployment leading to bad debt, an underfunded pension plan, heavy employee unionization, and high IT costs. Moody’s says it will upgrade its ratings when Lifespan completes its Epic implementation and shows improved metrics. The system announced its choice of Epic in March 2013, saying the project would cost $90 million.

Here’s a brilliantly fun video from medical school students at University of Chicago. A bit of sleuthing finds that the talented medical student star is Beanie Meadow, who has appeared in several similar videos. 

Weird News Andy calls this “unencrypted notepad.” The information of 400 Connecticut health insurance exchange enrollees is exposed when someone finds a backpack containing their manual paperwork on a Hartford street. Access Health CT thinks the backpack was lost by an employee of its contractor Maximus, which provides call center services. Officials suggest that the contractor’s employee may have been stealing information.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

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Morning Headlines 6/6/14

Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure

ONC publishes a 10-year plan for delivering on nationwide health IT interoperability. The plans objectives are divided into three year, six year, and 10 year milestones and culminates with the realization of “a learning health system.”

Senate confirms Sylvia Mathews Burwell as new secretary of HHS

Sylvia Mathews is officially confirmed as the next secretary of HHS, replacing the departing Kathleen Sebelius.

Telehealth scheme set to be rolled out to 300,000 households

The NHS will distribute 300,000 iPads and iPhones to seniors with chronic diseases to support a new telehealth initiative that’s earlier pilot project resulted in a 70 percent reduction in hospital admissions.

eCQM Library: Annual Updates

CMS publishes its annual update to the electronic clinical quality measures for eligible provider. Reporting on the measures is required for providers participating in Meaningful Use and the Physician Quality Reporting System, though providers are free to report on any eCQM version.

News 6/6/14

Top News

It’s been a busy week for ONC. After news of a reorganization, cheerleading for open data at Health Datapalooza, and receiving a letter from GOP leaders questioning its authority, the office publishes a 10-year vision statement on the future of interoperability. At 13 pages, it is “an invitation to health IT stakeholders … to join ONC in figuring out how we can collectively achieve interoperability across the health IT ecosystem.” Highlights include:

• Nine guiding principles that stress customization, educating and empowering the public, simplicity and modularity, and leveraging the market.
• Proposed development of an interoperability roadmap .
• Three-, six- and 10-year goals that widen the healthcare ecosystem with each successive year to incorporate stakeholders from outside of the traditional healthcare IT industry, as well as placing more responsibility on the individual patient to provide digital data to caregivers.
• Five building blocks upon which ONC will implement the aforementioned goals, focusing on core technical standards and functions, certification, privacy and security, HIE governance, and a supportive environment comprising all manner of stakeholders.

Several parts of the paper provide food for thought. How will the Meaningful Use deadlines line up with these goals? How will an organization like Epic react to ONC’s desire to “promote competition among network service providers in a way that avoids providers or individuals being ‘locked in’ to one mechanism to exchange health information?” The term “levers” is used throughout, prompting the question of whether ONC will continue to use carrots or sticks to promote interoperability.

It does mention that “ONC will help define the role of health IT in new payment models that will remove the current disincentives to information exchange,” so perhaps carrots will be the method of choice. All in all, the paper makes plain that ONC will be around for some time to come, both as a certification body and driver of regulatory health IT change.

Reader Comments

From Valleyproud: “Re: Valley Health in Winchester, VA. Implements Epic in all six hospitals and all of its physician offices and clinics. The Epic project went live in 11 months, big bang style. This is a huge achievement and one of the first projects of its kind, incorporating a partnership with INOVA Healthcare to share a patient database and single instance of Epic with no ownership ties between the two systems.”

From Still Holding On: “Re: Allscripts. Surprised not to see anything about the Allscripts layoffs last week. Hit the Burlington office fairly hard. Rumors in my area are saying 50+ folks got their walking papers.” Unverified. This is the first I’ve heard.

From Kit Kaboodle: “Re: dictation. Does anyone have a recommendation for a basic, phone-based dictation system? A group of a dozen docs that have accents that do not work well with Nuance’s Dragon is looking. It’s almost like they want a simple, old type Dictaphone machine except it records via the telephone handset, then just ability to listen to it. No other bells and whistles — they made a point of that.”

HIStalk Announcements and Requests

This week on HIStalk Practice: Eric Shinseki resigns from the VA amidst calls for out-of-network care for veterans. ONC shuffles its leadership team, while GOP leaders take it to task. VITL Medical Director Kate McIntosh, MD discusses the role of patient feedback in HIE development. A new report highlights the ICD-10 coding and reimbursement challenges faced by pediatric practices. CMS refuses to look more thoroughly at the claims of Medicare upcoders despite spending $6.7 billion too much on reimbursements. Arkansas taps North Carolina for guidance in setting up patient-centered medical homes. Physician leadership is found to be key to ACO success. Thanks for reading.

This week on HIStalk Connect:  Following Apple’s big entrance into health apps, Dr. Travis generates some heated debate with his post questioning Apple’s place as guardian of our health data. Kickstarter opens its crowdsourcing platform to just about everyone except health IT startups. At Health Datapalooza, StartUp Health introduces the newest class of startups accepted to its incubator program.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  Building a Data Warehouse and Analytics Strategy from the Ground Up. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This easy-to-understand discussion covers the key analytic principles of an adaptive data architecture including data aggregation, normalization, security, and governance. The presenters will discuss implementation tactics (team creation, roles, and reporting), creating a data-driven culture, and organizing permanent cross-functional teams that can create and measure long-term improvements.

Acquisitions, Funding, Business, and Stock

Cerner leverages Red Hat Enterprise Linux to enhance the stability and performance of its CernerWorks application hosting services. Nearly 14,000 healthcare facilities host Cerner Millenium solutions remotely via the CernerWorks service.

GE Healthcare unveils its Clinical Engineering Technology Management service to assist IT and clinical engineering with design, deployment, maintenance and management of mission-critical networks, wireless networks, distributed antenna systems, and devices that connect and provide critical patient data to healthcare providers and hospital IT systems. The company also announces that it is partnering with Real Time Medical to combine its Omnyx Integrated Digital Pathology solution with RTM’s DiaShare workflow management platform.

People

The HIMSS Privacy and Security Committee names Jeff Bell (CareTech Solutions) chairperson.

CompuGroup Medical USA promotes Christopher Lohl to the position of vice president for research and development for its webPRACTICE and webEHR products and hires Michael Marini (Thomson Reuters) as RVP of sales for the ambulatory information systems division.

Announcements and Implementations

A California grand jury report finds hospital leadership at fault in Ventura County Health Care Agency’s troubled Cerner rollout, claiming the organization failed to hire a project manager and create an implementation project plan. The jury’s findings are interesting given the recent C-suite fallout at Athens Regional Medical Center (GA) after its own troubled Cerner implementation. What seems to come through loud and clear in both cases is that technology implementations are only as successful as the leadership teams behind them.

Kettering Health Network (OH) connects to the HealthBridge HIE summary record exchange service. The new service will enable KHN to share more complete patient information including tests, procedures, medications, and diagnoses. Earlier this year, KHN became the first health system in the state to meet Stage 2 Meaningful Use requirements for reporting of laboratory results when it sent results for eight facilities to the Ohio Department of Health via the HealthBridge network.

Government and Politics

CMS releases its annual electronic clinical quality measures for eligible professionals, as well as corresponding specifications for electronic reporting. ECQM specifications are used for such programs as the Physician Quality Reporting System, to reduce the burden on providers to report quality measures, and to align with EHR incentive programs. While CMS encourages implementation and use of the updated eCQMs and specifications, it will accept all versions for the EHR incentive programs.

While the fact that VA hospitals use MS-DOS is nothing new, revelation that it takes more than a dozen steps and multiple users to schedule an appointment takes on heightened relevance in light of the ongoing VA wait times scandal. In other VA bad news, a local paper sheds light on delays and rising costs associated with 41 construction projects for new VA outpatient facilities. Like its wait times, these construction delays are no surprise: the Government Accountability Office revealed earlier this year that only two of the 41 projects were on time, with average delays running to 3.3 years and costs increasing from $153.4 million to $172.2 million.

Research and Innovation

A new report finds that CVS has the “dominating lead” when it comes to number of retail clinics, with more than double that of closest rival Walgreens. The report also finds that the CVS “MinuteClinic has earned a certain status among the healthcare establishment, forcing that establishment to recognize the retail clinic movement as a legitimate part of the healthcare ecosystem.”

Google Glass continues to make inroads as a support tool in surgical settings. This article highlights the pros and cons several surgeons have experienced as a result of consistent Glass use during operations. Pierre Theodore, MD cites poor internal battery life and difficulty giving voice commands in noisy environments as drawbacks, though they haven’t precluded him from using Glass for more than 30 patients. He  is the first surgeon to receive clearance from a local institutional review board to use Glass as an “auxiliary surgical tool” in the OR.

The HHS Idea Lab, ONC, and Total Communicator Solutions Inc. partner for a research project in workplace wellness as part of the SmartAmerica Challenge. Project Boundary is a mobile app that delivers personalized messages to help employees make healthier choices during the work day. Using Apple’s iBeacon technology, the app will send messages that offer health suggestions to workers near such places as stairways, elevators, vending machines, and water fountains. Employees will be incentivized with points to follow the automated suggestions. The idea to promote healthy choices at work is a good one, but the recent mania around consumer privacy and security will necessitate strong incentives to back up any “points” users may try to accrue.

NHS Scotland announces that it will roll out telemedicine equipment, incorporating iPhones and iPads to 300,000 households over the next two years as part of an initiative aimed at elderly patients with chronic conditions. The scope of the project and the results achieved thus far seem unprecedented no matter what side of the pond you’re on. NHS hopes to replicate the 70 percent reduction in hospital admissions seen during trial testing.

Other

Cerner’s plans for expansion at its Three Trails Campus take a back seat to the challenges of enforcing its dress code during the summer. Julie Wilson, the company’s chief people officer, tells the local paper that, “It’s a challenge for all of us. And it’s becoming more challenging as the workplace has become more casual.” Wilson has her work cut out for her. Cerner, one of the fastest-hiring companies in Kansas City, plans to add 6,000 employees over the next 10 years.

Vanguard Communications releases the Happy Patient Index, a ranking of 100 U.S. cities according to patient ratings of physicians, group medical practices, clinics, and hospitals found on Google+ and Yelp. The top three happiest cities are San Francisco/Oakland, Honolulu, and Madison, while the unhappiest are Laredo, Toledo, and Bakersfield. It would be interesting to compare the utilization of healthcare IT in the happiest cities with that of the unhappiest to see if any correlation exists.

The local paper covers the planned Cerner go-live at Chase County Community Hospital and Clinic (NE).

Sponsor Updates

• Voicebrook releases VoiceOver SRE for pathologists, powered by Nuance’s Dragon Medical 360 technology.
• BMH Physician Group launches MyHealthPortal powered by Medfusion.
• Hudson Valley Bone & Joint Surgeons (NY) will implement the SRS EHR for its nine providers.
• Victoria Romejko of Seamless Medical Systems discusses the ICD-10 drama and engaging patient in health on the company blog.
• SpeechCheck will participate in the AHRA’s 42nd Annual Meeting and Expo August 10-13 in Washington, DC.
• Validic adds Omron, Misfit Wearables, and Polar to its collaborators.
• Zephyr-Tec signs a reseller agreement with nVoq to offer speech recognition to its current and future EMR clients for dictation and navigation.
• Optum executives will participate in a workshop with HealthEdge at AHIP’s Institute 2014 June 11-12.
• Good Samaritan Hospital (IN) launches myGoodSamHealth its online patient portal, powered by RelayHealth.
• Clinical Architecture enhances Symedical, including 400+ terminologies and HL7 value sets to assist clients in meeting MU.
• PatientPay CEO Tom Furr shares the vision and goals behind the company in an online blog.
• Ingenious Med supports The Georgia Institute of Technology with a summer internship program.
• GetWellNetwork introduces its patient and family engagement technology incubator GetWell Labs.
• Halfpenny Technologies executives will participate in the AHIP Institute 2014 in Seattle, WA June 11-12.
• Elliot Health System (NH) will implement Besler Consulting’s Transfer DRG Revenue Recovery Service to identify and manage underpayments.
• NextGen’s Sharon Tompkins discusses HQM and P4P reporting and why it matters.
• Aperek CFO Phil Sandy is named 2014 CFO of the Year by Triangle Business Journal.
• Allscripts is hosting a population health management analyst summit at the CCM in Pittsburgh, PA with presentation replays on their website.
• Vigilance Health (CA) partners with Sandlot Solutions to provide HIE services including Sandlot Connect, Sandlot Dimensions, Sandlot Metrix, and Sandlot Care Assist.

EPtalk by Dr. Jayne

I was intrigued by this Smithsonian article that cites the pocket watch as the “world’s first wearable tech game changer.” It was interesting to learn how a simple thing like a watch impacted society. It goes on to discuss wristwatches and solutions like Pebble and Google Glass. I wonder what they’ll think about our technology in 100 years?

I’m still waiting to get my hands on technology from Ringly, which promises jewelry that will deliver phone notifications. I’m looking forward to a time where people can get their devices off the table and back in their pockets and purses where they belong. Despite rules about devices in meetings, I’ve seen a spike in people trying to multitask, which results in them completely missing the conversation in front of them.

Continuing the wearables theme this week, Intel releases information on its “smart shirt” that tracks heart rate without a separate chest strap. Data will go via Bluetooth or WiFi to a phone or computer. It looks quite a bit like a cycling jersey, so I don’t know if the fashion conscious will bite. Maybe we can get Ed Marx to field test it on one of his future adventures.

In other consumer news, the Journal of the American Osteopathic Association publishes a piece reviewing Wikipedia contents for the 10 most costly medical conditions, including heart disease, cancer, hypertension, and diabetes. Although the authors discourage professionals from using Wikipedia as a medical reference, I’ve found it useful as a means to see what my patients are reading and to find quick links to citations for traditional publications.

CMS releases its annual update of Clinical Quality Measures for 2014. I always enjoy their press releases: “To help eligible professionals navigate the updated eCQMs, several resources are available… particularly the Measure Logic Guidance Document, which contains the technical release notes, additional guidance, and additional resources for implementers.” Do they actually expect eligible professionals to read this stuff? The Measure Logic Guidance Document is 259 pages long and I can’t imagine any frontline provider reading it.

The call for proposals for HIMSS15 is open through June 16. That’s nearly 10 months before the actual conference, decreasing your chances of seeing presentations that are fresh and timely.

HHS announces the winners of the Code-a-Palooza challenge. The winning entry, Smart Health Hero, is “designed to help patients and their families use Medicare claims data to make health care choices.” I had mentioned before that I’m not sure how claims data can help patients make decisions (especially given the concerns regarding the integrity of the data itself) and am looking forward to seeing it. If you have the scoop (or information on any of the other winning entries) email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/5/14

GOP questions health software regulator’s authority

Fred Upton (MI), Marsha Blackburn (TN), Joe Pitts (PA) and Greg Walden (OR) send a letter to Karen DeSalvo, MD, questioning the ONC’s authority to levy certification fees on EHR vendors, as its 2014 budgetary documents suggest it will.

Grand Jury: Ventura County, Calif., Mishandled Electronic Health Records Transition

A California Grand Jury report finds hospital leadership at fault in Ventura County Health Care Agency’s troubled Cerner rollout, claiming the organization failed to hire a project manager or create an implementation project plan.

Proteus Digital Health raises $120M, names HP veteran as CFO

Proteus Digital Health, a startup building ingestible sensors that track medication adherence, raises a $120 million investment and names former HP CFO Steve Fieler as its CFO.

Economic Outlook, Spring 2014: Healthcare trends from the C-suite

A new Premier survey finds that only 59 percent of health executives are satisfied with their organization’s EHR system.

Morning Headlines 6/4/14

Cleveland Clinic CEO being considered for VA post

The White House has approached Toby Cosgrove, MD as a possible candidate to run the VA. Cosgrove is the CEO of Cleveland Clinic and a Vietnam War veteran.

Tucson area’s largest health network racks up nearly $30 million in losses

The University of Arizona Health Network has run $32 million over budget on its Epic implementation, which it attributes to a two-month go-live delay, and funding for additional training and support.

Sebelius: Open federal data here to stay

At Health Datapalooza, Kathleen Sebelius reports that HHS has released more than 1,000 datasets as part of its effort to open access to health data to the public.

Net Health buys ReDoc, expands into rehab market

Net Health acquires ReDoc, a Nashville-based EHR vendor focused on the physical, occupational, and speech therapy markets.

News 6/4/14

Top News

Apple announces (but does not demonstrate) HealthKit at its developers’ conference, which will combine and present information from healthcare apps and wearables. It will be part of iOS 8. Apple said in the announcement that it’s been working with Mayo Clinic, which will connect to the Health app within HealthKit, and also Epic, which has integrated HealthKit information into MyChart.   

Reader Comments

From Carol R: “Re: Dana Moore interview on Epic at Centura. One point I thought would have made the article more real and interesting was if Dana had discussed the journey from Epic to Meditech and then back to Epic. Centura decommissioned Epic in 2006 when it was replaced by Meditech. That was a directive from the board and Dana for cost containment overall and possibly other reasons as he stated in his review. Kelsey-Seybold Clinic in Houston also moved off and then back to Epic. I think there is a lot to learn from other organizations on a big decision over time such as the purchase of Epic. Why not share this knowledge in case there are other organizations struggling to figure this out?” I’m happy to run any information anyone would like to provide. It’s an interesting topic. 

From Lyle: “Re: Epic. See the first comment after this article. I was subject to this during my time at Epic.” An anonymous comment to a post on the “Life After Epic” blog claims that Judy Faulkner “exhorted managers to be capricious. Her idea was that you keep people at peak productivity by making sure they never know, exactly, where the goal post is. Independently-minded malcontents won’t stand for it and will leave; but people eager to please — people who need to please — will just keep trying. So you can essentially keep pulling 125 percent out of them indefinitely by being an ass and constantly moving the marker of what they need to do or how they need to do it.” As an example, the commenter claims that Judy told team leaders to randomly deny employee vacation requests just to keep them guessing. The commenter also opines that “the software is basically an undocumented rat’s nest of bailing wire and duct tape that it works because Judy has an unlimited supply of college kids graduating in a crap economy to throw at it.”

HIStalk Announcements and Requests

Congratulations to HIStalk friend Barry Wightman of Forward Health Group, whose novel Pepperland (which I enjoyed immensely) just won a regional fiction award. Barry is just about the coolest guy I know.

I’m a bit stretched on time since I’m at Health Datapalooza, so I’ll keep it short this time and catch up by the weekend.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  Building a Data Warehouse and Analytics Strategy from the Ground Up. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This easy-to-understand discussion covers the key analytic principles of an adaptive data architecture including data aggregation, normalization, security, and governance. The presenters will discuss implementation tactics (team creation, roles, and reporting), creating a data-driven culture, and organizing permanent cross-functional teams that can create and measure long-term improvements.

Acquisitions, Funding, Business, and Stock

Outpatient specialty documentation system vendor Net Health acquires The Rehab Documentation Company.

McKesson sells its European technology product line, which includes its System C hospital offerings acquired in 2011, to private equity firm Symphony Technology Group.

Sales

Orthopaedic Associates of Southern Delaware (DE) chooses SRS PM/EHR.

People

Healthgrades names Jeff Surges (Merge Healthcare) to the newly created role of president.

Announcements and Implementations

Boston Software announces GA of Boston WorkStation Version 10, its workflow automation technology.

Kareo releases a social media and reputation management guide for practices that have limited resources to develop an online presence.

NextGen Healthcare claims it has achieved “vendor agnostic interoperability” because one of its client practices has exchanged C-CDA Summary of Care messages with Tucson Medical Center’s Epic system using the Surescripts network.

Government and Politics

The federal Bureau of Prisons issues an RFI for an EHR to replace the system it has used since 2006.

The Wall Street Journal reports that the White House is considering Cleveland Clinic CEO Toby Cosgrove, MD as the next VA secretary.

Edith Dees, CIO of Holy Spirit Hospital (PA), says the hospital is trying hard to meet Meaningful Use Stage 2 requirements but is struggling with issues outside of its control, including one vendor’s requirement that its system run on an OS version the hospital doesn’t support, an HIE vendor whose product doesn’t meet Direct Project security standards, EHR vendors that require buying additional products such as patient portals and add-ons, and delayed and buggy vendor MU releases.  

Other

NPR covers Health Datapalooza, which it calls “an awkward adolescence” in which “2,000 people [are] shrieking with excitement over federal healthcare databases,” cautioning that all of those cool apps that people are developing trying to make a buck are largely unproven works in progress.

University of Arizona Health Network (AZ) has lost $28.5 million so far this fiscal year ending June 30, which it says is due to $32 million in unplanned training and support costs for its $115 million Epic implementation.

A ProPublica series on national prescribing irregularities wins the Health Data Liberators Award at Health Datapalooza.

The 12th International Congress on Nursing Informatics will be held June 21-25, 2014 in Taipei, Taiwan.

Weird News Andy titles this article “Daft Graft Graft,” adding that “he had skin in the game.” A Pennsylvania man is arrested for stealing skin grafts worth $350,000 from Mercy Philadelphia Hospital over two years.

Contacts

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

More news: HIStalk Practice, HIStalk Connect. 

Get HIStalk updates.
Contact us online.

From Health Datapalooza 6/2/14

This is the first time I’ve attended Health Datapalooza. I thought from the name, location, and people involved that it would be entirely about government-released datasets and how companies are using them. Those topics were certainly covered, but many of the presentations and exhibitors had nothing at all to do with publicly available data or the government. Instead, Health Datapalooza is a seemingly random conglomeration of startups, consumer health, wellness, new payment models, chain drug stores, and just about anything else that bears (deservedly or not) the “innovative” label.

In that way, Health Datapalooza is identical to the mHealth Summit, held in December on the other side of the Potomac in National Harbor, MD. Health Datapalooza is mostly not about data and the mHealth Summit is mostly not about mobile. In fact, my first thought was that they should just combine the two conferences because they seem equally unfocused, like the HIMSS conference minus the hospital and ambulatory systems vendors, with skinny jean hipsters and Glass-wearing nerds intermingling uncomfortably with the stiff suits from insurance companies, federal agencies, and investment firms, all trying to figure out what they have in common other than patients and consumers.

I assume that most of the 2,000 Health Datapalooza attendees aren’t paying their own travel or registration costs. I tried to figure out the kinds of employers that would get their money’s worth sending their people, but I wasn’t coming up with much. I’ve seen many of the same faces you see at seemingly every conference held, the folks whose entire jobs seem to be tweeting and socializing from one conference to the next at their employer’s expense, but I don’t have a good feel for the demographic otherwise.

The event was held at the Washington Marriott Wardman Park in northwest DC. I didn’t stay there since I’m cheap: the special rate was still $224 per night and of course being a conference hotel everything costs extra – Internet access, breakfast, and the $46 per night parking charge. It looks great on the outside, but I wasn’t impressed with its 3.5 Tripadvisor stars, so instead I booked an $80, 4.5 star hotel in Alexandria (not far from Old Town) with free Internet, parking, breakfast, and shuttle to and from the Metro station. It took maybe 40 minutes to ride up the Yellow Line and switch to the Red Line to the Woodley Park Metro station, which is just a few hundred feet from the Marriott.

Monday’s keynote lineup was impressive: Elliot Fisher, MD, MPH (Dartmouth), Karen Ignagni (America’s Health Insurance Plans), Todd Park (US CTO), Jeremy Hunt (UK Secretary of State for Health), Jonathan Bush (athenahealth, unless you believe the conference agenda that says he’s the CEO of “aetnahealth), and Atul Gawande, MD, MPH (Brigham and Woman’s). Fisher had some strong opinions backed by data about the not-so-great state of US healthcare. Ignagni had some mildly interesting observations about insurers. Park was, as always, bursting with energy and enthusiasm about the “data liberators” and announced openFDA, which will give researchers API access to the FDA’s databases. Hunt was as charismatic and visionary as you would expect a politician to be and spoke eloquently about hospital errors and transparency. Bush was his usual shot-from-a-cannon rollercoaster of irreverent observations and insight. Gawande talked about the healthcare system and the use of data for quality improvement and also to target specific patients for interventions to improve their health and reduce their resource consumption.

It was a nice bonus that the conference provided lunch in the exhibit hall, with the only challenge being to find a table on which to eat it. The exhibit hall was manageable, with a few dozen exhibitors representing a wide variety of company types. I intentionally didn’t register as press since I wanted the same experience as everybody else.

I was admiring a book on geographic information systems at the Esri exhibit and they gave me a copy, which even included the mapping software DVD. It’s a really cool tutorial on the tools to apply geographic and mapping functions to databases. It would be a fun skill to learn for people who love tinkering with Access or data analysis tools.

This company’s booth was staffed by three reps, none of whom were coming up for air from poking at their phones while facing each other to form a protective circle against potential intruders.

Healthspek offers a free PHR, of which I’m skeptical, but it was a great-looking app, does some interesting merging of CCD data, has a provider view, and offers an emergency card that gives providers online access to the patient’s information in an emergency.

Validic had a nicely done graphical handout that described exactly what it offers, a digital health platform that connects medical devices, health apps, and wearables to the systems of hospitals, population management companies, pharma, and payers.

Some of the other booths I visited were:

• Privacy Analytics, which provides data anonymization services.
• AnalytixDS. The company’s Mapping Manager is a pre-ETL data mapping tool that caught my eye.
• Arcadia Healthcare Solutions, who gave me an overview of EHR services and data analytics solutions.
• Verisk Health. The company got a great off-the-cuff plug from Atul Gawande’s keynote in which he mentioned using their analytics tools to identify patients who were otherwise falling through the cracks and not receiving treatments and interventions they needed. His example was a blind diabetic patient who was racking up massive cost because of poor glucose control, which required only one visit to fix: he didn’t realize that he had to turn the insulin vial upside down to draw up his dose, so he was injecting himself with air instead.
• Healthy Communities Institute. It offers a population health improvement portal for communities. The rep didn’t seem too interested in telling me more, but it looked pretty cool.

Many of the booth reps seemed disengaged, even worse than at the HIMSS conference. Maybe it’s because companies don’t send their A-teams to Health Datapalooza, or that attendees are so diverse that there’s no clear sales opportunity, or maybe they just would rather play around with their phones than anything else. I walked up to several booths and was ignored completely, while others gave me a quick “let me know if you have any questions” before turning away (usually my intended question was “what do you do?” since it was often hard to decipher the buzzwords.) I saw one guy take a delivered pizza to the booth and eat it while the hall was open, while others abandoned their booths entirely or discouraged interaction by gabbing with each other.

I attended a session that was a panel discussion among investment guys (I say “guys” because they were all male and most were from insurance companies.) I didn’t realize how actively insurance companies are investing in healthcare IT now that their previously lucrative insurance profits are drying up. Some interesting points:

• Consolidation of hospitals and big practices could reduce the number of potential customers to a few hundred nationally.
• The market has too much noise. There’s no way Castlight Health will be worth as much in 10 years as it is today. Lots of companies are getting investments that haven’t really earned them and most of them will fail.
• Some of the big investors will put money into startups, especially those involved in consumer engagement, while others focus on later-stage companies that are already making money.
• Investors are wary of companies whose product adds another platform and instead look for products that fit easily into the ecosystem. “We don’t need any new shiny objects.”
• Investors won’t touch a healthcare software company whose business model assumes that consumers will pay for something.
• Up to 90 percent of the investments the panelists are making involve services rather than products businesses, but they have to be convinced that the business can scale and be productized.
• Investors don’t require a majority take as they often did previously, but they want enough equity to be worth their trouble and to give them some control over the company’s direction.
• Strategic investors aren’t as interested in steamrolling the founder as they once were – they will take a minority position and let the company grow.
• Investors have a strong interest in making investments in healthcare IT. Companies shouldn’t be shy about asking for what they really want.

If you are attending Health Datapalooza, leave a comment. What did you hope to accomplish there and how’s it going? Have you seen anything interesting?

Lorre’s Impressions

I was excited about attending Health Datapalooza 2014. HIStalk wasn’t exhibiting, so rather than spending the majority of time in a booth, I was free to participate. I mapped my day out in advance and set out bright and early to make the most of it.

Mr. H and I both attended the keynote events. Bryan Sivak did a great job moderating. He was interesting and energetic and injected relevant comments and some fun to keep people alert.

Todd Park announced the release of OpenFDA and discussed the need for more open data. He finished with a moving tribute to George Thomas, the chief data architect for the HHS Office of the CIO who died recently.

The Right Honourable Jeremy Hunt was passionate while talking about his priorities for improving health and care in the UK. He shared the data to illustrate their success with improving mortality rates to among the best in Europe. He emphasized the need to share electronic health information across borders and collaborate to solve common issues. What I found most interesting is his case for greater accountability and error reporting. Bryan mentioned that someone referred to Hunt as “dreamy” during the conference rehearsal and I would agree.

Atul Gawande, MD, MPH spoke about the importance of insurance coverage for everyone and emphasized it with personal experience. He was passionate in discussing the need to improve safety and performance in surgery, childbirth, and care of the terminally ill.

Jonathan Bush was a whirling dervish when he took the stage to talk about the importance of liberating data and discussing the attributes of organizations that suffer from “Upper Right Quadrant Syndrome” or URQS. He ended with a narration of a YouTube video that demonstrates what can happen when one person takes the lead and perseveres. He may have mentioned his new book, “Where Does It Hurt?” which is number 6 on the New York Times Bestseller List.

Between the keynote speakers, selected vendors gave short presentations on their companies and products. The best one by far was Purple Binder. President Joe Flesh did a fantastic job describing how the application enables people to quickly find available community resources for which they are eligible. The mission of the company impressed me and the application appears to be just as impressive.

I saw several attendees wearing their jackets as part of Regina Holliday’s “The Walking Gallery.” That’s always encouraging to see and the wearers are always eager to tell their patient advocacy stories.

After the keynotes, I went to the exhibit hall. I was eager to check out the booths, especially those of our nine sponsors who were there.

I visited all of the booths in the exhibit hall and introduced myself to the folks at the booths of our nine sponsors that are exhibiting. Only three seemed interested in talking to me about their products and services, so I can describe only what I heard from those.

It is always a pleasure to see our friends from CareSync. Amy and Travis were excited when they told me Amy would be giving a demonstration on the main stage on Tuesday. The person working in their booth was fun and attentive each of the times I stopped by during the day.

The folks manning the Validic booth were highly energized and eager to talk about their platform. As soon as I expressed interest, before they even knew I was with HIStalk, they were connecting me with the marketing manager to explain their product. I was impressed with the visual they use to explain how they take data from multiple sources and convert it to one language the end user can easily manipulate and use. It’s no wonder Gartner recently named them a Cool Vendor.

I especially enjoyed visiting the QlikView booth. The person in their booth was knowledgeable and interesting. He not only showed me how to use the application, he gave me instructions for downloading a free version of it.

The conference has well-managed logistics and the size is comfortable even though its focus is fuzzy. Health Datapalooza’s emphasis on patients is admirable and it’s always nice to reconnect with industry colleagues.

Curbside Consult with Dr. Jayne 6/2/14

I haven’t been on a job interview in years, so I didn’t really know what to think when I found myself getting ready for one a few weeks ago. Since giving up traditional practice, I’ve worked in a variety of part-time and locum tenens primary care situations. I’ve also done part-time work in several emergency departments. I’ve worked directly for hospitals and also for staffing companies hired to populate the ED. It really doesn’t matter where my paycheck comes from – patients are patients and we care for them the best we can.

Due to a couple of regional shakeups with ED staffing companies and posturing by competing health systems, I recently found myself without a place to hang my clinical hat. My own hospital has decided that unless you are board certified in emergency medicine, you can no longer cover the ED (unless you’re a midlevel provider — then you’re OK to work as many shifts as you can cover.)

I find it ironic that they’d rather have a nurse practitioner straight out of training then a seasoned physician who happens to be certified in a non-emergency specialty. It’s less ironic, though, when you understand the real reason, which is as it always is, the bottom line.

Anyway, to take any kind of leave of absence is a pain. Unless you have an active practice address, you’re expected to surrender your state controlled substance license. They won’t let you just transfer it to your home or to an administrative office. I know this well because I got caught in the trap before and it took months to untangle. We received a 90-day notice that our contracts would be ending, so the race was on to find new positions.

Unfortunately, there were about a dozen other physicians in the hunt. Most were looking for full-time positions, though, so I had a bit of an edge being willing to work the odd shift here and there rather than needing a primary income.

I also have the edge of being sassy and single, which means I don’t mind working holidays or providing late-night coverage. In fact, I like the late nights. Usually the nursing staff has a better sense of humor and there are definitely great stories that come out of the ED after 11 p.m. As long as it doesn’t interfere with my CMIO duties, I’m up for it.

In a turn of serendipitous events, I was cold-called by a recruiter who was given my name by a friend of a friend. He vetted my profile using LinkedIn and thought I might be a reasonable candidate. A local urgent care was preparing to open a second location and needed additional coverage while they recruit full-time staff. Just my speed: low acuity, reasonable patient volume, not a terrible commute, and fair pay. And so it was that I found myself on my way to a job interview.

I explained my situation to the owner – that I have a full-time job but enjoy seeing patients on the side and am looking for a way to continue doing both. He asked me a lot of questions about being a CMIO. We talked about his PACS and the patient education system.

I became a little suspicious when the questions about standalone e-prescribing systems started, so I finally just asked what system they’re using. He kind of laughed and told me not to worry, the learning curve is about 30 seconds. I wish I could have seen my face when he handed me the clipboard.

I haven’t used paper in what seems like forever. Even during downtime I didn’t do formal paper documentation, but rather took a few notes to document in EHR later. I suppose it’s probably like riding a bike, although I think the combination of computerized PACS and discharge system with paper charting might feel a little strange. Part of me decided I wanted to work there just to see what going back in time would be like. At least they use templated paper forms, so it’s not like I’ll be writing SOAP notes from scratch.

I start in a couple of days, picking up a few hours after work one night to get used to the system while they’re fully staffed with other physicians. I’m most worried about getting to know the staff, figuring out the informal processes that aren’t documented anywhere, and trying not to make rookie mistakes.

I admit I’m a little nervous, though, not to have the backup of prescription error checking and clinical decision support, not to mention the convenience of e-prescribing. I had to dig through my storage area to find the leather prescription pad holder I received as a medical school graduation gift. Maybe to go full circle with the old-school vibe I’ll have to get myself a fountain pen.

Here’s to new adventures and hopefully a slow first shift. I’ll let you know how it goes. The monogrammed white coats have already been delivered, so there’s no turning back. I hope everyone stays well, but if you happen to find yourself at an urgent care with a sassy physician carrying a hot pink clipboard, you might want to do a double take.

Email Dr. Jayne.

Morning Headlines 6/3/14

Health. An entirely new way to use your health and fitness information.

Apple unveils its long awaited health app, duly named "Health." The app centralizes health data from third-party fitness apps, activity trackers, and medical devices. Epic was named during the unveil as a partner that would help integrate the the app’s data with existing health IT infrastructures.

Successful Results from CMS ICD-10 Acknowledgement Testing Week

CMS reports that during its March ICD-10 testing week, 127,000 claims were submitted from 2,600 providers and that 89 percent were accepted, down from Medicare’s 95-98 percent average for ICD-9 claims, but still deemed a successful test week by CMS.

FDA launches openFDA to provide easy access to valuable FDA public data

The FDA is opening its database of adverse drug events and medication error reports as part of a new data sharing program called OpenFDA. The FDA hopes that researchers and software developers will use the data to create new consumer tools.

Morning Headlines 6/2/14

Pivoting for the Future

National Coordinator for Health IT Karen DeSalvo, MD, publishes an internal memo Friday announcing an internal reorganization of the ONC. She explains, "This functional realignment will improve the overall effectiveness and efficiency of ONC by combining similar functions, elevating critical priority functions, and providing a flatter and more accountable reporting structure. In addition, this realignment will support our focus on developing and implementing an interoperability roadmap, supporting care transformation, and establishing a framework to support appropriate use of health data to further meaningful consumer engagement, system-level quality and safety of care, improvements in the public’s health, and advancements in science."

UPMC: ID theft scam affects all 62,000 workers

After months of denying the extent of its employee records data breach, UCPM finally admits that all 62,000 of its employees were likely exposed. Employees are being offered free credit monitoring services to compensate. The breach has resulted in 800 fraudulent tax returns being filed thus far.

State won’t tap federal grants for new exchange

Maryland will build a new health insurance exchange to replace the one that the state was forced to abandon. Health Secretary Joshua M. Sharfstein reports that there is enough money left over from the federal funding provided to develop the original site to pay for the $50 million replacement.

JRMC gets new records system

25-bed Jamestown Regional Medical Center (ND) goes live on its new Epic system which, through a partnership with Sanford Health, will replace HMS at a cost of $1.2 million.