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.

Monday Morning Update 6/2/14

Top News

From Anonymous Tipster: “Re: ONC reorganization. Looks like the current leadership is basically staying in place. Flattening of the structure and some folks got big promotions. Rearranging deck chairs on the Titanic?” An internal email to ONC staffers from Karen DeSalvo announces that the following will serve as ONC’s leadership team along with Deputy National Coordinator Jacob Reider, MD:

• Office of Care Transformation: Kelly Cronin
• Office of the Chief Privacy Officer: Joy Pritts
• Office of the Chief Operating Officer: Lisa Lewis
• Office of the Chief Scientist: Doug Fridsma, MD, PhD
• Office of Clinical Quality and Safety: Judy Murphy, RN
• Office of Planning, Evaluation, and Analysis: Seth Pazinski
• Office of Policy: Jodi Daniel
• Office of Programs: Kim Lynch
• Office of Public Affairs and Communications: Nora Super
• Office of Standards and Technology: Steve Posnack

It’s not uncommon for a new leader of an organization to restructure the org chart, so I don’t read too much into that. I do wonder with provider pushback on the fading Meaningful Use program whether ONC will retain its influence and keep all its people busy. Government agencies never just go away on their own – they always find ways to survive and try to keep their funding. ONC is part of HHS, which is swollen with so much bureaucracy that nobody’s going to notice ONC’s little corner of it, but other than cheerleading for EMRs, RECs, HIEs, and other big ideas whose funding (and thus interest) has expired, what will ONC’s couple of hundred employees work on?

From Anonymous Tipster: “Re: VA. My prediction: The VA and DoD will eventually decide to use a commercial vendor for a combined EHR (with a multi-billion dollar price tag) and Epic will ultimately win the bid. With the forgone conclusion of the Shinseki resignation now a reality, I am wondering if there are any implications for the VistA EHR system used by the VA. While the VA OIG report points to serious problems with the scheduling system, at last year’s summit of the Open Source Electronic Health Record Alliance (OSEHRA), Stephen W. Warren, executive in charge for information and technology at the VA, bragged about the scheduling system. The whistleblower in the case is pointing out some of these technology deficiencies and it seems that VistA could wind up being a tech fall guy for some of the VA’s problem. The VA inspector general has reported that an audit by an outside accounting firm revealed continuing problems protecting mission critical systems. Many of these problems rise from the fact that VA hasn’t instituted security standards on all its servers and systems. Remember back in 2009 when the VA canceled its patient scheduling system — dubbed the Replacement Scheduling Application Development Program — after spending $167 million over eight years and failing to deliver a usable product.” I agree that the VA scandal will blacken VistA’s eye along with the VA’s ability to run big software projects since people are starting to notice the VA’s scheduling history. On the other hand, DoD is a black hole of wasted taxpayer dollars. I think it’s safe to say that giving either agency a bunch of money for software in any form is likely to result in the usual budget overruns, missed dates, internal mismanagement, and a poor ROI when considering veteran/service member outcomes. Epic might be a safer choice, but those ever-present beltway bandits will figure out a way to make it less functional and more expensive. Regard Shinseki, I doubt he had any personal knowledge of the scheduling issues despite ample OIG warnings (which could also be said of the President) but clearly political pressure meant he had to go.

From The PACS Designer: “Re: Windows 8.1 for free. Microsoft has announced that it will offer tablet producers Windows 8.1 with Bing for free to ensure that it’s the platform sold to new customers. With Windows 9 coming next year, they’ll be able to get their next OS on these recently purchased tablets with an upgrade offer.” I would much rather get Android for free than Windows 8.1.

HIStalk Announcements and Requests

Respondents were split on whether the Meaningful Use slowdown is good or bad. New poll to your right: how do you see Meditech’s competitive position compared to a year ago?

Announcements and Implementations

Jamestown Regional Medical Center (ND) goes live with Epic, spending $1.2 million to replace HMS.

Government and Politics

The State of Maryland says it will fund development of a replacement health insurance exchange using $40-50 million in leftover funds and Medicaid funding without tapping into federal money. The state will pay Deloitte to customize Connecticut’s exchange for its use. Maryland fired contractor Noridian Healthcare Solutions in February after the $170 million Maryland Health Connection failed immediately on its October 1 go-live. Some state legislators wonder why it doesn’t just use Healthcare.gov, with one saying, “What still is amazing to me is why they don’t go to the federal exchange, which is free and works. You still have to spend $40 to $50 million. It is still money they are spending on something they don’t have to.”

Oregon Governor John Kitzhaber says the state will sue Oracle, hoping to recover the $134 million it paid the company to develop the failed Cover Oregon health insurance exchange.

Other

UPMC finally admits that that all of its 62,000 employees could be at risk for identity theft rather than the 27,000 it announced in April as unknown hackers breached its payroll system and used IDs to file 800 fraudulent tax returns.

A Kansas urologist who is also the president-elect of the Kansas Medical Society says his practice’s biggest problem is electronic medical records. “Now, we’re basically key-punch operators, transcriptionists having to input the data ourselves.  Voice-recognition software and some of those things help, but it has essentially tripled the time to complete a medical record. How do you accomplish that when we are already working 12 to 14 hours a day?” He says EMRs will shake out within 10 years, but doctors are quitting over them now.

Hurley Medical Center (MI) accidentally discloses the Social Security numbers of several employees when someone accidentally attaches an employee worksheet to a mass email about insurance.

Weird News Andy notes that Illinois closed three mental health facilities in 2012, but left behind heavy equipment, a medical specimen, and boxes of paper personnel and medical records.

Sponsor Updates

• The Advisory Board Company will participate in several events at Health Datapalooza. VP Piper Su will moderate a panel on “Creating Wellness Outside the Clinic.” Jay Nagy, associate principal of corporate strategy, will participate in a panel discussion on “Integration of Patient Generated Data into HCP Clinical Workflow to Achieve Improved Outcomes.” Jonah Czerwinski , managing director of strategic planning, will serve on a panel discussion, “Creating a Sustainable Future for Healthcare.”
• Validic  will exhibit at Health Datapalooza and will announce new device integration partners.
• Michael Simon, principal data scientist at Arcadia Healthcare Solutions, provides a recap of eHealth Initiative National Forum on Data and Analytics.

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.

HIStalk Interviews Norbert Fischl, CEO, CompuGroup Medical US

Norbert Fischl is CEO of CompuGroup Medical US and SVP North America of CompuGroup Medical of Koblenz, Germany.

Tell me about yourself and the company.

Globally, CompuGroup Medical or CGM is amongst the top five to top 10 healthcare software providers. We have offices in 19 countries, customers in 43 countries, and more than 4,000 employees. 2014 revenue guidance is about $700-$712 million US and EBIDTA approximately $137-$150 million. 

We have the largest physician customer base worldwide. It’s a one-stop shop solutions and services offering. We serve small and large physician practices and huge hospital installations. One of our customers is Karolinska University Hospital in Stockholm,  which nominates the Nobel Prize candidate medicine or physiology, with over 30,000 concurrent users. Beyond that, we also offer solutions for pharmacy, lab, dentists, patients, and many more.

We entered the US market with three acquisitions in 2009-2011. We are ranked the #16 EMR provider in the US with about $50 million in revenue and 300 employees in six main offices.

We have three divisions. The ambulatory information systems, with our standalone and integrated EHR/PM systems. We have our EDI division, with our own integrated clearinghouse and reimbursement services. We also have a lab division, with a 30 percent market share in the physician office laboratory segment.

I call my vision 10-5-5-10. I want to be among the top 10 healthcare software providers in the US within the next five years, and in the top five software providers within the next 10 years. We here for the long run as an owner-led and publicly traded company as the reliable, trusted partner for our customers.

Being an entrepreneur and working in software is what I love to do. With CompuGroup Medical from 2011 until the end April 2013, I led our Northern European region with around 450 employees. Since May of last year, I’m honored to be responsible for our North American business, with the main focus on United States.

How do you see the US EHR market evolving?

There are still many doctors without EHRs. Of those, the question is, will they ever have one? We have Meaningful Use and adoption rates are still increasing, but they’re slowing down. Any market segment in any industry is characterized by incremental innovation and ultimately competing for replacement business.

What is interesting in the US is that switching rate of doctors to new software and to new software vendors is much higher than in most other countries in the world, especially on the EHR side. In Europe, for example, churn rate is more like one to two percent range. In the US, these rates are more around 15 to 20 percent. 

This means that in the EHR market and in the healthcare software market overall, there are enormous market opportunities for software vendors that understand their target groups and do their homework in terms of providing solid software solutions, a good amount of innovation, and excellence in service. CGM is delivering on those.

How will the market change if providers don’t stick around for Meaningful Use Stage 2?

Meaningful Use was supposed to improve quality by producing more fact-based measurement. Some doctors are more receptive to this than others. The money provides incentive for adopting EHRs, but that’s more appealing to some specialties than others. We see doctors who don’t give a lot of focus on the Meaningful Use topic, while others do.

Ultimately it’s the decision of the doctors themselves. I don’t think it will have a major impact on the development of the market.

How will you get a foothold in the US market?

Our US software solutions are solid and our services are of good quality and local. We will continue to invest in both product and service innovation. For example, by hiring the right talent into our service function.

Having said that, the main focus is on growing our business by continuing our path of operations excellence combined with continuous innovation. 

Operations excellence means, for example, the scaling of our direct sales force, which we’ve started to rebuild last summer. It also means that we will further improve on our service delivery and customer support. I want to be among the top 10 software providers in the next five years. I want to be best in class. We have made big progress there, but I still see big upside potential.

The US is a great market to be in. It is admittedly a highly competitive and geographically huge market. However, if you look at CompuGroup Medical’s history over the past 25 years, we penetrated all countries though acquisitions and we know how to do it successfully. We know that with the size of the US, it needs longer breadth and we have that. 

Excellence in the software business is how you take care of your customer and how close you are to your customer. The progress we made with our US business proves us right. Customers are returning from other competitors. We have won new customers in all product lines. 

It’s really doing the ground work and doing our homework. It’s not about spending millions of dollars to boost your brand recognition. Money can’t buy everything.

CompuGroup Medical stands for sustainability and long breadth. Feedback on our progress is greatly encouraging.

Do you have any final thoughts?

I would like to take the opportunity to say to our customers and to everyone else that we are back. I would like to thank everyone, our customers especially, for their loyalty and let them know that this is just the start. We are passionate about what we do, we are available 24/7, and we are here for the long run.

Morning Headlines 5/30/14

Veterans Health Administration: Interim Report

The VA OIG releases an interim report on the patient waitlist improprieties at the Phoenix VA which confirms whistleblower accusations that scheduling delays were being hidden.  Rapid Response Teams that have been conducting unannounced inspections of VA’s across the nation have confirmed "that inappropriate scheduling practices are systemic throughout VHA." The report goes on to explain that senior managers within the VA receive bonuses and salary increases based in part on their hospital’s wait list performance.

Athens Regional chief information officer resigns

Athens Regional Medical Center’s struggling Cerner implementation claims its second victim as VP/CIO Gretchen Tegethoff resigns. Athens’ CEO stepped down last week.

Quality Systems, Inc. Reports Fiscal 2014 Fourth Quarter and Year-End Results

Quality Systems, the parent company of NextGen, reports its Q4 results: revenue reached $115.2 million for the quarter, up four percent. Net earnings climbed to $5.1 million, up from a net loss of $4.1 million during the same period last year. EPS $0.12 vs. $0.24, missing earnings estimates and pushing stock prices down four percent Thursday.

Fitch Affirms MetroHealth’s (OH) Revs at ‘A-‘; Outlook Revised to Stable

Fitch Ratings affirms the "A-" rating on MetroHealth’s outstanding debt, in part based on the organizations ability to remain profitable despite a challenging payor mix. MetroHealth managers attributes their success, in part, to its implementation of Epic.

News 5/30/14

Top News

An interimVA OIG report on patient wait times at the Phoenix VA verifies the whistleblower’s claim that employees were hiding patient scheduling delays. They bypassed the electronic wait list application and instead sent screen shots of the appointment request directly to the outpatient treatment area, which was then responsible for entering them into the system but often ran weeks or months behind. The improved wait times allowed leaders to collect bonuses. OIG investigators added that inappropriate scheduling is a national problem, with schedulers gaming the electronic system in a variety of ways to show short appointment waits. They also noted that audit controls for the Phoenix VA’s VistA system were turned off. There’s no way VA Secretary Eric Shinseki keeps his job past the middle of next week given that he’s like Moses parting the Red Sea as politicians and bureaucrats of both parties put whatever distance they can between themselves and him as the lightning rod for public outrage.

Reader Comments

From The Product: “Re: Covisint. Lays off over 100, about 25 percent of the newly IPO’d company. Healthcare was rumored to have taken a huge hit, especially in analytics. The new CEO came in with the promise to streamline and cut he did.” Unverified. The new CEO said in the earnings call last week (revenue down 5 percent, EPS –$0.27 vs. –$0.10) that he is disappointed in the company’s performance and plans to cut costs and change leadership.

HIStalk Announcements and Requests

The latest in the long list of things I hate about Gmail is that its overactive spam filter can’t be customized or turned off. A reader said they sent me several emails that I finally found in Gmail’s spam folder (or label or whatever Gmail calls it) even though they bore no resemblance whatsoever to spam. I created the above filter since I would rather manually delete 50 spam messages than lose one important one.

This week on HIStalk Practice:  An MGMA physician survey finds that both physicians and patients are frustrated with the impact of ACA insurance exchanges. Atlantic City casino workers take healthcare matters into their own hands. Seema Rao, MD offers six tips on how to prepare for Meaningful Use. Healthcare actually fares worse than retail when it comes to security performance. Thanks for reading.

This week on HIStalk Connect:  Dr. Travis covers Mary Meeker’s annual Internet Trends presentation, which touches on all things technology, and now includes a section on the convergence of technology and healthcare. The CEO of 23andMe discusses the future of personal genetics testing after the FDA shuts down sales of its healthcare-focused genetic testing product. Aver Informatics closes an $8.5 million Series A round to continue development on its "episode-based" financial analytics platform. 

Listening: Swedish indie pop from Lykke Li. If you like (or Lykke) her, you’ll probably enjoy Bat for Lashes.

Acquisitions, Funding, Business, and Stock

Quality Systems (NextGen) reports Q4 results: revenue up 4 percent, EPS $0.12 vs. $0.24., missing earnings estimates. From the earnings call, the acquisition of Mirth integration engine was important as the company tries to repackage its EHR offerings into a clinical data repository that has population health management potential. Sales of inpatient core clinicals and financials aren’t doing so well, apparently. QSII shares dropped 4 percent on Thursday after the pre-market open announcement. Above is the one-year share price chart of QSII (blue) vs. the Nasdaq (red).

Sales

Kimball Health Services (NE) chooses the RazorInsights One clinical and financial system.

Miami Children’s Hospital (FL) will implement Xerox’s ICD-10 Complete.

In England, Viapath signs a seven-year, $18 million contract to implement the Cerner PathNet anatomic pathology system at Guy’s and St. Thomas’s Hospital.

Colorado Regional Health Information Organization selects Sandlot Solutions to extend its interoperability capabilities.

Allina Health (MN) chooses Omnicell for medication automation.

Intermountain Healthcare will use genomics-driven cancer care software from Synapse.

Upper Peninsula Health Plan (MI) will conduct a pilot to manage its Medicaid readmissions using infrastructure from Informatics Corporation of America .

People

Richard A. Caplin, CEO of The HCI Group, is selected as a finalist for EY Entrepreneur of the Year for Florida.

Orlando Portale has resigned as chief innovation officer of Palomar Health and will advise companies, investors, and provider organizations.

Nephrology EHR vendor Acumen Physician Solutions promotes Hugh Gaston to VP of operations and Jason Holcomb to VP of business development.

Remedy Informatics hires Scott C. Howard, MD, MSc (St. Jude Children’s Research Hospital) as chief medical officer.

Danny Sands, MD, MPH joins “digital checkup” vendor Conversa Health as chief medical officer. 

The president and CEO of Athens Regional Medical Center (GA) stepped down last week over a problematic Cerner implementation and the ensuing physician revolt. SVP/CIO Gretchen Tegethoff has become the project’s second executive casualty as the hospital announced her resignation Thursday.

Announcements and Implementations

Arcadia Healthcare Solutions announces Launchpad, which allows users to create and monitor quality improvement programs and share them internally or with peer groups.

AMIA announces availability of its updated online Clinical Informatics Board Review Course to prepare physicians for the board subspecialty exam that includes new assessment questions and simulated exam questions. A 12-month subscription includes 23 hours of CME and costs AMIA members $1,495. AMIA reminds physicians that current practitioners need only take the exam to earn certification since they are grandfathered in until 2018, but starting then, a 24-month fellowship will be required.

The 2014 Health Privacy Summit will be held June 4-5 in Washington, DC, with National Coordinator Karen DeSalvo, MD as one of its keynote presenters.

Cerner makes 600 medical calculators available free as an MPage within PowerChart in a partnership with MedCalc3000.

PatientSafe Solutions makes Lead411’s list of “Hottest Southern California Companies.”

Government and Politics

HIMSS says ONC’s Security Risk Assessment Tool is not intuitive, contains legalese that the average provider won’t understand, and references only one of several security frameworks (NIST’s.) I also noticed that ONC can’t figure out how set up a download that works for Windows 8.1 (not running the tool, just downloading it) and when I installed it under Windows 7, it gives a warning that there’s no digital certificate and shows its source as “unknown publisher” (consider the irony given that this is a security tool.) I agree that it’s full of needlessly complex wording, a reminder that just as you don’t let programmers design apps on their own, government wonks should bring in someone to put some end-user polish on their prototype. I’m still trying to figure out how to de-install it since it didn’t add itself to the start menu, the desktop, or Control Panel’s list of installed programs. I finally figured out that it just downloads to your default location (without asking or telling) and runs directly from there, which is primitive.

ONC seeks work group members for its Health IT Policy and Health IT Standards committees. Applications are due Friday, June 6.

Meanwhile in Florida, Governor Rick Scott says he’ll sue the VA for not allowing state inspectors to conduct unannounced visits to its Florida hospitals. The VA has repeatedly reminded Scott that states have no authority over the VA, but the grandstanding governor keeps sending inspection teams for the VA to turn away. Scott gained personal expertise with unannounced hospital inspections in his role as chairman and CEO of Columbia/HCA when the FBI and IRS raided several of its hospitals for Medicare fraud in 1997, which the company later admitted and paid $2 billion to make go away.

Here’s US CTO Todd Park’s pitch for Health Datapalooza, which kicks off this weekend in Washington, DC. I would be more interested in hearing him describe his holdings and participation in IPO flameout Castlight Health, but I’ll still be at Health Datapalooza. I also noted in reading Jonathan Bush’s new book that he lavishes extensive praise on Todd Park’s work ethic, brains, and nerdiness. I’ve interviewed hundreds of people and he’s still one of the nicest and most interesting of them.

Speaking of athenahealth, the company owned 8 percent of Castlight Health at its IPO, with athenahealth’s Jonathan Bush saying the profits led him to invest in more companies. “We bought an airplane and we made enough on that to buy a bunch of airplanes.”

A TIME article says Congress killed the patent troll law because of pressure from Senator Harry Reid (D-NV), who has received $4 million in campaign contributions from lawyers and law firms (some of them listed above in his top contributors list). Patent troll lawsuits now make up 62 percent of all infringement suits, up from 29 percent just two years ago, with estimates of $29 billion in costs to defendants in the past three years. Companies will get no relief thanks to Senator Patrick Leahy (D-VT), who pulled the bill he had introduced while uttering an impressive array of unconvincing excuses that didn’t include being scared of Harry Reid.

An HHS OIG investigation finds that Medicare paid $6.7 billion too much for office visits in 2010 based on the judgment of professional coders reviewing a small random sampling of claims, but the agency says it’s not cost-effective to for it to review the billing history of doctors who always charge for level 5, the most expensive visits.

Meanwhile, The Economist says thieves pillage the American healthcare system for $272 billion per year. It cites an example of a luxury apartment complex in South Florida that housed 500 residents who were collecting Medicaid checks. It says that ethnic mobs with weapons stockpiles have moved from cocaine trafficking to prescription drug fraud because it pays as well and the penalties are lighter. It also points out medical identify theft and the fact that CMS has yet to act on a GAO suggestion that it stop printing Social Security numbers on Medicare cards. One doctor made $12 million for writing narcotics prescriptions, with the required documentation (images or urine samples) conveniently available for purchase from entrepreneurs who set up shop at the clinic’s front door. It could get worse, the article says, as Medicare and Medicaid beneficiaries move to managed care that will provide the minimally effective government watchdogs with even less information with which to direct their unremarkable efforts.

John Halamka offers thoughts on the Notice of Proposed Rulemaking that would change Meaningful Use attestation for this year. It’s really only a 90-day breather since the 2015 year still starts on October 1, 2014, so hospitals struggling with Transition of Care summary exchanges, electronic MARs, and portals don’t get much of a break. He suggests relaxing those requirements or changing the reporting period to any 90 day-period in 2015. Transition of Care is a noble idea, but community-based doctors can’t receive those summaries because they either don’t have a Direct address or there’s no way to look them up. He suggests allowing a hardship exemption where that’s the case. He adds that even CMS/ONC are confused because they keep individually tweaking the regulations such that, “It’s getting to the point that even the authors cannot answer questions about the regulations because there are too many layers.” He suggests simplifying the program for Stage 3, eliminating certification requirements and addressing only a few big-picture policy goals — he likes the idea of building Meaningful Use into the Merit-based Inventive Payment System that offers rewards but does not impose penalties.

People tweet, blog, complain in public about #MU but only 8 comments on proposed rule? http://t.co/Zhsva81jN2 ^Plz share & comment

— Sherry Reynolds (@Cascadia) May 29, 2014

Other

Samsung announces Simband, an experimental wristwatch whose sensors can measure blood pressure, ECG, oxygen, and heart rate. Samsung will make the device available to researchers to develop their own health-related wearable apps and devices, referring to it as a “design platform” rather than a product. The company also announced SAMI, an open software platform that collects data from wearable devices. Samsung also announces the $50 million Samsung Catalyst Fund to ramp up development of “disruptive sensors and algorithms” and a partnership with UCSF to validate them. All this comes just ahead of Apple’s expected wearables announcement at its developer conference next week.

Rumors say that Microsoft may be working on wearable sensors of its own, possibly incorporating Kinect sensors in a smart watch. The potential data partner is rumored to be Caradigm, of which Microsoft owns 50 percent in its joint venture with GE.

Over 400 medical school graduates failed to match for a residency this year, victims of a system in which medical school enrollments have increased while the number of available residency positions has remained unchanged for more than 15 years. Congress pays the cost of residencies and hasn’t changed the $10 billion in annual taxpayer dollars it has made available since 1997 to fund them, creating a bottleneck where larger medical school classes won’t change the total number of new doctors. The only positive development is that competition has pushed more graduates out of high-income specialties such as dermatology and orthopedics and into primary care.

Fitch Ratings keeps the bonds of MetroHealth (OH) at A-, with one of its positive observations being that the health system’s Epic system has helped it stay profitable despite a challenging payor mix.

CIO writes about an informal, information-sharing alliance of three CIOs of non-profits who “join forces to battle cancer.” The CIOs are from the American Cancer Society, the Leukemia and Lymphoma Society, and the fundraising arm of St. Jude Children’s Research Hospital. The most interesting part is the description of the increasing ability to match large data sets (clinical or genomic) to an individual patient’s condition to optimize treatments. Its quotes from other CIOs include this one from Pat Skarulis of Memorial Sloan Kettering:  “Everyone on my staff knows someone who’s been affected. Some have fought cancer themselves. We’re not doing something for some remote benefit, something that might do some good in the future. We see on a day-to-day basis how what we do effects people’s lives. Every day that we don’t know something is a day we haven’t helped someone."

Sponsor Updates

• Ingenious Med’s Karen England discusses the ICD-10 delay.
• Concur App Center names Healthcare Data Solutions as its partner of the year for the second consecutive year.
• IHT2 offers a white paper on adding management to an LIS.
• Medical Records Associates acquires TrustHCS’s cancer registry services division.
• Awarepoint partners with Integrating the Healthcare Enterprise for interoperability demonstrations during AAMI 2014.
• DataMotion’s Bob Janacek details the difference of “push” and “pull” delivery methods for encrypted email.
• Arcadia Healthcare Solutions, CTG Health Solutions and Certify Data Systems discuss the challenges of creating and operating a successful ACO.
• PMD launches a HIPAA-compliant notification system with short, fun videos explaining the how and why.
• DrFirst, Forward Advantage, and Imprivata partner to provide e-prescribing of controlled substances for Meditech and MAGIC/OSAL platforms.
• Triangle Business Journal profiles PatientPay.
• HIStalk sponsors named on the HCI 100 for 2014 include 3M, ADP AdvancedMD, Alere Accountable Care Solutions, Allscripts, Beacon Partners, Capario, Capsule Tech, CompuGroup Medical, Craneware, CTG Health Solutions, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, Encore Health Resources, ESD, Experian Health/Passport, Greenway, Harris Corp, Health Data Specialists, HealthStream, Iatric Systems, Impact Advisors, Imprivata, Infor, InterSystems, MModal, McKesson, MedAssets, Medhost, Merge, Navicure, Netsmart, Nordic Consulting, Optum, Orion Health, Perceptive Software, Premier Inc,, Quality Systems (NextGen), Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, The Advisory Board Company, The SSI Group, Trizetto, Vocera, and Wolters Kluwer Health.

EPtalk by Dr. Jayne

I once read that part of being an effective writer is being a good reader. That’s pretty easy for me since I love to read. Sometimes I read for knowledge, sometimes I read for advice, and sometimes I just read for entertainment. Even in fiction my taste occasionally drifts to work-related content (Kate Scarpetta, anyone?) or high-tech thrillers (Dale Brown), although lately I’ve been choosing some fairly fluffy “beach read” type novels.

I’ve read a couple where the characters are in the film or TV industry. That’s about as far as it gets from my real life, so I suppose that’s good to allow my brain to recharge. Last week’s read included a plot line around a proposal for a TV show that was turned into a pilot and eventually a series. Assuming it was even halfway accurate, the process that a script goes through before it makes it to the home screen resembles either making sausage or creating CMS regulations, whichever you prefer.

There have been many notable medical TV characters. My personal favorites are the entire cast of “M*A*S*H,” “Quincy,” Beverly Crusher, and of course Dr. Quinn. I was too busy running a solo practice when “House” and “Grey’s Anatomy” initially came out, so I’m catching up on those via Netflix. My newest favorite, though, is BBC’s “Call the Midwife.”

I was in a 1950s public health mood (after finishing Season 2) when I read the HIStalk Monday Morning Update that referenced an article about physicians lacking physical diagnosis skills. I’ve had the privilege of working in extremely remote areas and I don’t disagree. I trained at a prominent medical school where technology was everywhere.

While on one rotation, I was asked what I thought about a murmur. My attending actually laughed at me when I said I thought we should get an echo for more information. Unlike the academic medical center where you could get a same-day echo, these patients had to travel several hours and generally wait a week or more to be scheduled.

During the first two years of medical school, the teaching of physical exam skills was cursory at best. We received a lecture about a given topic and were then turned loose to examine each other. It felt like preschoolers playing doctor. Unless someone has an unusual finding, there’s not much to learn from a crop of healthy 24-year-olds.

Even in third year when we examined real patients, we were generally by ourselves and without anyone more senior to make sure we understood the significance of what we were seeing, hearing, or feeling. Professional or “standardized” patients that coach students were just coming onto the scene.

The feeling that my medical education was somehow lacking (despite the steep tuition payments) became even clearer during a fourth-year rotation. I was at a community hospital that had a large number of residents who had trained at international medical schools. I quickly realized that most of them had not only studied in another country, they had been practicing physicians for years. They were repeating their training to try to get positions in the US.

My favorite resident was a neonatologist from the former Soviet Union. She could hear a tiny murmur from across the room and knew what it was before anyone else. Despite her busy schedule, she actually took the time to teach us, unlike many of the faculty who made it seem like teaching students was interfering with their research. Unfortunately, she couldn’t get a residency in her field and was therefore learning adult medicine after being in practice for nearly a decade.

There are a lot of pressures moving us away from physical diagnosis and towards tests. Patients often feel that high-tech evaluations are more accurate or just better than time honored skills. Others want data to convince them they’re OK rather than a person, who might be wrong. Defensive medicine, skyrocketing malpractice awards, and a fear of any kind of bad outcome (even if not preventable) cause unnecessary testing and added expense. Add that to the expectation that physicians complete an entire visit (including history, physical, documentation, and billing) in less than 10 minutes and corners are going to be cut.

In one of our offices, the exam rooms have speakers and a radio station constantly plays throughout the office to disguise the fact that there is no soundproofing in the walls. Without the radio, you can hear everything happening in the next room. Unfortunately, each room’s volume control is on the wrong side of the exam table, leading to decreased willingness for physicians to walk around, turn it down, use the stethoscope, and then turn it back up, especially during an increasingly compressed office visit.

The Washington Post article also mentions the fact that insurance pays for tests but doesn’t compensate us for spending extra time with the patient performing a more thorough history and physical. We are paid based on the amount of physical exam that is medically necessary based on the diagnosis – not what we do. I don’t get credit for performing diagnostic maneuvers if I end up determining that there is nothing wrong with you, because only a low level visit is justified.

Distraction is also an issue. I had a student shadowing me a few months ago. After seeing a particular patient for a rash, I asked what she thought about his tremor. She was so busy flipping through his chart that she missed a classic physical finding. I couldn’t blame the EHR for this one – the patient was a brand new patient and had brought his paper military file with him. The student was fixated on that, probably because it was a novelty.

Back to my initial thoughts about relaxing with a good book or learning about how TV shows are produced. A few years ago, there was a group of PBS series that took modern families and placed them in historical environments – “Frontier House,” “Colonial House,” and “The 1900 House” are the ones I remember watching. This was the educational aspect of the early reality shows.

If anyone knows anyone in the entertainment industry, I want to propose some sequels. Let’s do them all again, but with modern physicians in the cast. Let’s give them the tools of the trade appropriate to the time period and see how well they do with common period ailments.

Better yet, mix it up with graduates from top-tier research schools, primary care-oriented state schools, and schools in countries that lack abundant technology. In keeping with the spirit of today’s reality shows, let’s keep score. Any patient they misdiagnose or can’t help with the technology at hand gets added to their “kill chart” and lowers their rankings. And when they successfully figure out what to do with some of the odd-looking medical equipment from their time periods, they can earn points.

I think it would be entertaining, but I don’t think the outcomes would be surprising. I’ll bring my little black bag, my amputation knife, and my trephining drill. Who’s with me?

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 5/29/14

I.R.S. Bars Employers From Dumping Workers Into Health Exchanges

The IRS issues a ruling clarifying that employers are still required to provide health insurance for employees and cannot just give them a tax-free stipend and send them to the health insurance exchanges.

Trust your doctor, not Wikipedia, say scientists

A group of researchers compared clinical information about certain diseases published on Wikipedia with information published in peer-reviewed journals and found that Wikipedia articles on medical conditions have erroneous information 90 percent of the time.

Federal pain research database launched

The NIH, AHRQ, CDC,and FDA have co-developed a database called the Interagency Pain Research Portfolio designed to centralize pain management research findings.

Big Data Offers Promise of Big Changes in Health Care, but Hurdles Remain

A report from the Network for Excellence in Health Innovation concludes that while big data projects may one day help transform healthcare, there are a host of real world challenges that are preventing meaningful cost reductions or improvements in care quality.

HIStalk Interviews Dana Moore, SVP/CIO, Centura Health

Dana Moore is SVP/CIO of Centura Health of Englewood, CO. 

Centura is replacing Meditech with Epic. What led to that decision?

In Colorado, the market has changed dramatically since we made the decision to put in Meditech. We have seen Epic become the predominant system, where before there was a hodgepodge. Meditech probably had the most, but it was a hodgepodge of vendors.

As we’ve looked and seen Epic come into Sisters of Charity, University, Poudre Valley, Memorial, etc., it gave us pause before we made a decision to go to 6.1. Should we continue to invest with Meditech, who’s been a great partner with us, or should we look at alternatives? We decided that before we commit that much money, let’s look at alternatives.

We made a decision that Epic offered great benefits for the community and Colorado. We have providers that go between the various health systems. Having familiarity with the go-between hospitals was a plus. Same with nursing. Then for the residents of Colorado, the Epic sharing is huge. We felt that gave the residents an extra safety component as well. Those were drivers that went into our decision.

What strengths and weaknesses do you see of Epic versus Meditech?

One of the challenges we had with Meditech was in the ambulatory space, the old LSS product. As you probably know, Meditech is completely rewriting that ambulatory product. What we have seen so far looks very good. But it’s new and we need a solution now in that ambulatory space. That is something we see as a plus with Epic.

The other thing we saw with Epic was some functionality that Meditech either does not have yet or is on their roadmap. Anesthesia is one that comes to the top of my mind. Epic has that in place. Those are some benefits we see.

We also see the benefits of being able to share Epic content with health systems. Not just locally, but nationally, and some pretty well-known health systems around clinical content. It’s not sitting in a room trying to reinvent the wheel.

Did Meditech encourage you to interact and share content with fellow customers?

No, they did not. It wasn’t that they discouraged us, it just wasn’t something that they did. We didn’t go into it with that as a primary focus, but coming out of it, that had a lot of appeal.

The final thing for us is that we have eight affiliate hospitals. We have a lot of hospitals approaching this that are not affiliates yet, saying, “Can you manage my IT?” While we were going down that road with Meditech, the Community Connect program that Epic has that’s already a formal program was just another little piece of icing on the cake to help us make that decision of where we want to go as an organization — providing IT services, EMR, etc. This would jump-start those efforts for us.

Was cost or achieving return on investment a concern?

We’re a values-based organization. One of our values, of course, is stewardship. We like to say that in any decision of this magnitude, you’re going to have tension in the values.

Certainly yes, there was tension around, “We are going to increase our costs. We’re going to make a significant investment in putting in Epic.” But we felt it was in the long-term best interest of the ministry for a variety of reasons that I’ve described. We felt this was the direction we needed to go. The board agreed and approved it and here we go. Now the fun starts.

Did you consider Cerner?

We did look at Cerner. As you may or may not know, Centura is a joint operating agreement between Catholic Health Initiatives and Adventist Health out of Florida. We seriously looked at Cerner with the idea that we could piggyback on the work that Adventist Health has done and that could jumpstart our implementation. 

In the end, our providers were really more comfortable with Epic. It was overwhelming support for Epic. Not so much that there was anything wrong with Cerner — it was just the situations I described that pushed Epic to the forefront.

How have you done with Meaningful Use and how will Epic change your plans?

We’ve attested for Stage 1 for all of our hospitals except a brand new hospital that’s in the measurement period right now. We are in our first measurement period for Stage 2 and we’re running into a couple of challenges.

One is that when we started, there were two physicians in the entire state of Colorado that had a Direct address, so we’ve been scrambling to help get providers signed up. Then Meditech’s patient portal got deployed in February. We’ve been scrambling to get people pushed to the portal on the acute side. 

We feel like we’ve made a lot of good traction there. Our next timeframe that we can measure will be July through September 30. We have to make it then. I’m cautiously optimistic we will hit that. It’s been a big push with our CEOs of our hospitals.

Where do you think the Meaningful Use program will end up, or where do you hope it will?

That’s a great question. I hope we will achieve the goals of connectedness, meaning transitions of care between providers, between levels of care, become much better. I hope it doesn’t become so hard that more people decide “I’m done” and opt out. 

I know the government is struggling to find that fine line of, “I just don’t want to hand out free money and everyone gets a participation trophy. I have a goal I want to achieve, but if I make it too hard, no one will participate.” That’s my fear, that we’re going to see more people just decide this is too challenging and opt out. Then all the foundation work we’ve done may be didn’t achieve what we hoped.

Do you think that would be a bad outcome? The idea was to get EMRs installed, which happened in Stage 1, and not giving out more money wouldn’t change that. It would let vendors and providers go back to their own agendas.

I don’t necessarily think it would be a bad thing, meaning we wouldn’t have just wasted all this money. What I worry about is, in healthcare, we tend to be slow to take initiative at times. It’s like we built the house, but we didn’t quite finish it. Would we go ahead and finish it? Would we go ahead and really work hard to make it better for transitions of care? Would we do all that on our own if there’s neither carrot nor stick? That’s what I worry about.

The adage is that the carpenter never finishes his own house. Would we do that? I’m all for not just continuing just to hand out money, but let’s at least stay at the table and have conversations and make it meaningful to get this finished.

What questions or concerns did you have about interoperability when you selected Epic?

Certainly it was a concern. Their comment back is, “We do more sharing than any other system.” Of course you look at it and it’s a lot of Epic-to-Epic sharing.

I would say, because of our experience with Meditech — which was traditionally been somewhat similar to what Epic’s been accused of as far as challenging to get information out to share– that we said it’s going to be a challenge and we’re going to have to address it. But we also feel like that they have to respond with the CCD. They’ve got to hit all the requirements of Meaningful Use. 

I would argue that there probably isn’t really any EMR that is plug-and-play to share clinical information in a meaningful way yet. We’ll address the challenges as we come up against them.

The other party Epic was a bit late to was analytics, but they are moving with that. What are you doing or what are you looking for in terms of analytics and population health management?

We started down that road with Explorys for doing some population health. We have Explorys and Verisk tied in with them, tied in with some other products. 

We are probably a little late to the party ourselves as far as robust data warehouse. That’s the direction we’re going. But we recognize, great that we can get this Epic data or in today’s world this Meditech data and we can analyze it, but that’s only a subset of all the data we need to analyze to get a whole picture of the patient or of the system of care, anything. We need to tie that together. Not just Centura’s data, but we have the Centura Health Neighborhood, our clinical integrated network with a couple thousand of affiliated physicians all using various EMRs that we need to tie into our systems as well.

We’ve got a lot of work to do on data analytics, as does healthcare in general. I know we’re not in alone in talking with my counterparts about how we solve this problem.

Hospitals use Epic as a competitive weapon to a certain extent, offering it to owned and affiliated practices who can’t afford and support it on their own. That also gives the health system access to their data. Do you think your physicians will be concerned about Epic differently than LSS?

No. It’s amazing. We’ve already been approached by several physicians asking if they can get on Epic with us. There’s a lot of excitement in our community around the fact that we’re bringing in Epic.

In terms of innovation, are you doing anything that would be considered risky or offbeat or using smaller companies that few people would have heard of?

A lot of our time has been spent recently on making the Epic decision. But the work we’ve been doing with population health with this integrated network I described, so that’s where Verisk and Explorys come in.

We did some innovative stuff this year with our health plan firm associates. Innovative for our area, not necessarily nationwide or outside of healthcare. But we did the tobacco testing, the biometric screening. If you didn’t meet certain criteria, your premium went up. If you met it, you got a discount on the premium. You had opportunities to do wellness activities that could help you earn points for lower premiums as well. 

To measure all that, we used CafeWell and brought all that data from the biometric screening, everything, into CafeWell. It was Year One. We certainly learned things that we will do different in Year Two. But that’s been a pretty interesting change for our associates. We’ve talked about wellness now for years, but now it impacts me and my house and my dollars if I don’t do what I need to do health wise.

You oversee non-IT services such as supply chain and recruiting, a different span than the average health system CIO has. How does that make you see IT differently from someone who just runs the IT organization?

To give you some background on that, I’m the non-traditional CIO. I never worked in IT until I came to Centura. I’ve done project management and some software packages, but I was never a traditional IT person. My background is primarily revenue cycle and finance in healthcare.

Centura was going to outsource the IT department. I was asked to do the financial model with the outsourcing company, representing Centura to get this deal done. Then it became evident that the model didn’t make sense, it wasn’t going to work here. We did a reorg of the IT department. Then I was asked if I would consider staying. I fell in love with the organization, so here I am as the CIO.

We finished the Meditech implementation. We had a new CEO come in, Gary Campbell, who’s still our CEO. He was doing his talent evaluation and reorg, looked at my background, and was intrigued by it. He wanted to create a structure that separated what he calls “corporate” from “service center.” Corporate would be things like finance or his office, where I’m dictating down to the organization a policy or setting strategy. He defined service center as these are services that the hospitals, the physicians, the organization, are "purchasing" — and I put purchasing in air quotes because they’re paying through their management fee — purchasing these services from the service center. That would include IT, supply chain, revenue cycle, and departments like that. 

He said, “As I’m creating that, I need someone to oversee this service center.” That’s how that came about. He said, “You know, your background lends well to overseeing these areas.” Here I am six years later still overseeing them. It’s been a very educational opportunity for me. 

Where it helps me is that because of my background, I came in and I somewhat understood the organization from a non-IT perspective. But now when you also have operational oversight for these departments, it gives you more views into the organization from different perspectives than you would get just being the CIO. You get clinical from lab and you’re seeing clinical and cost savings from supply chain. It’s very helpful. I think it also helps the leaders of those areas because they get different perspectives from me as well because of the diversity of what I’m overseeing.

Do you think other organizations will do the same thing in putting someone with no IT background in charge because it’s really not that important any more that they have programmer or infrastructure experience?

I think so. It’s not going to be something that happens overnight. There’s still a lot of people that say, when it comes down to making that hiring decision, I need that person that understands the IT infrastructure because I don’t. Because you think about who’s doing the hiring — it’s usually a CEO, COO, CFO — and they traditionally don’t have any IT background. They’re concerned, “If I put that non-traditional person in place, is that going to come back to bite me? Because I need someone that really understands it.” 

I think more progressive organizations will move there. They’re going to see that if I get the right leader, they can get a good CTO, they can get the right people in place. I need them to understand the strategy in how IT can enable us to move that strategy forward, versus well, we got a new generator, that’s exciting. But I think it will be a long, long road.

My other concern with that is, how do you keep your talent inside of IT excited and not leave to go outside of healthcare where maybe there’s an opportunity for them to move to VP or CIO or something else? Because if they see that inside of healthcare it’s going to be going to more operational people than IT people, I need to go somewhere else to advance. You have to tie it back to the mission and why we’re here and keep them focused and excited on that as well as creating opportunities for advancement for them.

What do you see as your biggest challenges and opportunities in the next few years?

Certainly cost is always going to be a challenge. We’ve made a decision to put in Epic and that will drive up our costs, but how do we find other areas where we can generate efficiency, hold cost down or minimize the increases as we in this industry get a wake-up call on our cost structure? That is one.

How do we support the organization in identifying opportunities outside of IT’s budget for cost reduction? How do we get the analytics in their hands fast enough so they can identify opportunities and move on them? Those are both opportunities and challenges.

I think the other opportunity we have is as an organization is this implementation of Epic. We did a lot of standardization when we put in Meditech. We were probably more a federation of hospitals than a health system. Putting everyone on a common platform, the same universe of Meditech, forced a lot of standardization. Then we’ve continued down that road with the ambulatory implementation, the home care, putting out CPOE. We’ve moved more and more people to trying to do things together.

I think we have a wonderful opportunity with the new implementation to take that to the next level. Our users are much more sophisticated than they were six years ago because they’ve been using an AMR for six years. They know the challenges they’ve had and the things that have worked really well for them. We know we have to reduce clinical variation even further to drive out cost. This gives us an opportunity to have those discussions with our providers. It’s also the opportunity to further drive standardization and revenue cycle, etc., where we can do even better as an organization. 

This is an opportunity. We have to be very careful not to just re-implement an EMR and check the box that we got it done and then figure we’ll optimize and do everything later. We need to seize the opportunity while we’re implementing to refine what we’ve already done and make it even better.

Do you have any final thoughts?

Thank you for what you do. I got turned on to your site back when we announced Meditech. Someone said, “Do you read HIStalk? You guys are on there.“ I don’t think I’ve ever missed an article since. Thank you for all the hard work because I can only imagine how much time this consumes of you and your team. You do great things, so thank you.

Morning Headlines 5/28/14

MGMA ACA Exchange Implementation Survey Report May 2014

In a survey of MGMA members, 90 percent report that they have already started seeing patients carrying insurance acquired through an ACA insurance exchange. 56 percent reported no change in their practice’s patient population size as of yet, but nearly half expect to see at least a slight increase in patient volumes by the end of the year.

Bidding opens for £240m health data sharing cash

In England, the NHS unveils a new $400 million grant pool to support local health data sharing projects. To qualify, hospitals must submit a business case that includes documentation on how the proposed project will generate at least a fifty percent return on investment.

Cerner will buy up to $317 million of its shares

Cerner’s board approves a $100 million increase to its share buyback plan, pushing the upper threshold of the approved buyback plan to $317 million.

Readers Write: Al’s Story

Happy Memorial Day. Today’s article is dedicated with a special, heartfelt thank you to all of our veterans serving our country abroad and to those here at home. Many thanks to all of the family members of the soldiers currently serving in harm’s way and to those who have lost loved ones. You all truly demonstrate great courage on a daily basis.

Mr. HIStalk, thank you for being so supportive of the troops. I’ve been present at many events across the country where you have personally recognized and paid tribute to anyone who has served in the military.

I recently sat down with Captain Donna Rowe who shared the story of her husband, Colonel Al Rowe.

Al’s Story
By Lisa Reichard, RN, BSN

Colonel Alvin G. “Al” Rowe

Al Rowe was born in Dubuque, IA in 1933. He became an Eagle Scout by the age of 12. He was a proud Iowa Hawkeye and graduated from the University of Iowa in 1956 with a bachelor’s degree in civil engineering. It was then that he entered the US Army as a Second Lieutenant through the university’s ROTC program. Al also received his masters in science degree from Iowa State University. Like many soldiers, Al could have made six figures working in the public sector as a civil engineer, but instead he chose to serve his country and did so faithfully for 30 years.

In 1965, he was sent with the 82nd Airborne to quell a communist uprising in the Dominican Republic. He was in his Jeep with his comrades and battalion. Sniper fire from rooftops hit him in the head. His comrades saved his life. There would be no one left behind.

“Al [shown third from the right] loved his comrades and put them first. He was a soldier’s solder who cared about his men,” said Donna.

My Sweetheart

According to Donna, “Al was treated for his injury at Fort Bragg, NC. This is how I came to meet him at Womack Army Hospital. He was my patient. I was a nurse supervisor at the time and we met briefly while he was recovering from surgery. Our first encounter was when I had to ask Al to quiet down. He was singing too loudly in the ward. Four days later when he was off duty, he asked to see me and if he could take me to dinner and I said OK. Although Al asked me for my number, I got busy and I walked off without giving it to him.”

“He called for three weeks to get my number, but since army policy is to never give out phone numbers, the ward would not release it. Finally, he called one of my friends who got my permission to give Al my phone number. We finally had our dinner date and when Al came to get me, my Louisiana-native roommate at the time, Carol Burnett, said with a very southern accent when Al picked me up in a white T-Bird convertible, ‘Donna, he has come to pick you up in a white stallion and carry you away.’ We were married 18 months later in 1967.”

Newlyweds Sent to War

Al and Donna were sent to Vietnam during the peak of the war in 1968 and 1969. Donna served as a head nurse of the Third Field Hospital in Saigon, one of the largest shock-trauma-triage emergency rooms in Vietnam. Al served as an adviser and equipment supplier to soldiers in the field during combat.

“Al and I were married 47 years and 10 months. He was my best friend,” said Rowe.

Donna and Al in Vietnam, Christmas 1968: “We sent this photo home to our families.”

Remembering an American Soldier and War Hero

Donna explained Al was shot down five times in Vietnam, but survived. “The communities where Al served loved and respected him a great deal both here and abroad. The South Vietnamese awarded him the Vietnam Cross of Gallantry.”

Col. Rowe received other military medals and decorations, including the Legion of Merit, the Bronze Star, Meritorious Service Medal, Joint Service Medal, Army Commendation Medal, Purple Heart, and the National Defense Service Medal, and many more. He was also a Master Parachutist.

After Vietnam, he went on to serve in the Pentagon, followed by the Army War College in Pennsylvania, before setting up forces command at Fort McPherson.

“Al [2nd from left] loved his comrades and put them first. He was a soldier’s solder who cared about his men.”

Al’s promotion to colonel at Fort McPherson in Atlanta in 1974 with Donna and son Richard at far left

“Al was a wonderful family man, and he was very active in the community,” said Donna. “We have two wonderful sons. He was a father figure to many.” She continued, “The military life can be very tough on families. They make lots of sacrifices.”

Upon his retirement from the Army, Al moved to Marietta, GA where he worked for Lockheed as a research engineer. Col. Rowe retired from the Army in 1983 as a colonel and was president of the Georgia Vietnam Veterans Alliance for four terms.

Another Battle

Col Rowe contracted Lou Gehrig’s disease, a neurodegenerative condition that affects nerve cells in the brain and the spinal cord, and struggled with the debilitating disease for three to five years. Donna believes it was service-connected (US Dept of Veteran Affairs – Agent Orange). “The journey with Lou Gehrig’s was difficult. It was another war that Al and I fought together.” She added, “The Department of Veterans Affairs in DC was wonderful during the illness. I really can’t say enough about how well we were treated.”

“Al served his country for 30 years, 10 months, and 22 days before he passed away on January 21, 2014. I miss him dearly. He was loved by many more friends and comrades-in-arms, and he will be dearly missed by everyone who knew him.”

Col Rowe’s legacy lives on through many programs, including the Society of American Military Engineers (SAME), which provides scholarships.

Fast Forward to Telemedicine Possibilities

With the recent resignation of Robert Petzel, undersecretary for health for US Veterans Affairs, there is a lot of discussion around improving timely access to care. General Eric Shinseki, US Secretary of Veterans Affairs, recently said most veterans are satisfied with the quality of care they get, but more must be done to "improve timely access to that care." Telemedicine could help to improve compliance and provide specialized care while decreasing long appointment waits both in the fields and at home for veterans.

Donna was willing to share her thoughts on telemedicine. “I really think it would be great to have telemedicine for diabetes patient maintenance and for treatment of Post-Traumatic Stress Syndrome (PTSS). It would cut down on a lot of hassle around travel time, parking, and other logistics and could help to increase compliance with maintenance programs,” she emphasized. Donna said that telemedicine will be great for soldiers in the field and that email centers exist for communication.

Final Thoughts — Help a Veteran

Hire Heroes USA provides career placement assistance to all of our returning service men and women. Here are some vet-friendly employers, including several healthcare companies.

Thank a Veteran

Donna sharing stories with me from her personal memoirs.

Donna was candid and generous to share her photos for this article. This interview was a good reminder for me that, like Donna and Al, every soldier has their own unique story just waiting to be told. If you get a chance this Memorial Day or any day, talk to a veteran and thank them for their service to our country.

When I started the interview with Donna Rowe about her husband Al, I thought it would make her day. Instead, I left the interview knowing that she had made mine.

Lisa Reichard, RN, BSN is director of community relations at Billian’s HealthDATA. HIStalk also featured an interview with Donna Rowe on The Kathleen Story for Nurses Week in May 2012.

News 5/28/14

Top News

An MGMA survey of large (median of 10 FTE physicians), mostly independent physician practices finds that 62 percent are struggling to identify patients whose insurance came from an Affordable Care Act exchange and to verify their eligibility or obtain plan details. Most practices also say that patients who got their insurance via an ACA exchange are more likely to have high deductibles and don’t understand that fact. Half of the practices say they can’t provide services to ACA exchange patients because their practice is out of network.

Reader Comments

From Trinity: “Re: Meditech READY Certification Status. How many firms will be named to this list? What’s the upside for Meditech clients and the consulting firms?” Certainly READY Is one of the more contrived acronyms ever: rapid adoption, evidence based, advanced workflows, dedicated team, and your success. Apparently it’s an Epic-like certification that allows consulting firms to implement Meditech 6.x. The company says its purpose is to drive a big bang go-live and its implementation team members “will become workflow experts armed with a more global view of how the solutions work together and will be trained to collaborate with one another when the software is delivered to the customer.” The key components are (a) more application consultant time at the client site instead of having the customer travel to Meditech; (b) project leadership and physician training by Navin, Haffty & Associates; (c) delivery of standard system content; and (d) a course for hospital clinical leaders to address process improvement.

From Jockamo: “Re: Meaningful Use Stage 2. The attached document is from the administrator of a multi-specialty group.” The unnamed practice administrator urges everyone to tell CMS that MU Stage 2 is unreasonable via the comment period for the proposed changes. The main concerns: (a) 50 percent of patients must provide email addresses to meet the requirement that they have portal access; (b) orders must be initiated electronically directly by the clinician instead of dictated, written, or verbally issued to a clerical support person; (c) data entry timeliness is unworkable given that patients are to be given an electronic summary of care within one day; (d) summaries of care must be sent or received with each transfer out or in.

HIStalk Announcements and Requests

Listening: Portland-based Heatmiser, which in its five years of existence that ended in 1996 begat Elliot Smith (who died in 2003 at 34.)

Acquisitions, Funding, Business, and Stock

Risk scoring vendor Apixio raises $13.5 million in a Series C investment round.

PatientPay receives a $2.5 million investment from San Francisco-based Mosaik Partners.

Wisconsin-based payment analytics vendor Aver Informatics raises $8.5 million.

Cerner’s board approves a $100 million share buy-back, raising the total from the original $213 million repurchase program approved in December 2013.

Atlanta-based insurance software vendor Ebix acquires “ask a doctor” service vendor Healthcare Magic for $6 million and will roll it into its A.D.A.M. Health division.  

People

Helayne O’Keiff (IBM) joins Beacon Partners as senior regional director for the South.

Sean Nolan (Microsoft) will leave the company and his role with HealthVault.

August Calhoun, PhD (Dell) joins Truven Health Analytics as SVP/GM of the company’s Provider Solutions business.

Announcements and Implementations

AirStrip will incorporate PeriGen’s enhanced context and decision support tools for obstetrics into AirStrip One.

Government and Politics

From The Onion.

A Vermont Information Technology Leaders RFP indicates that the company will spend $175,000 on awareness advertising campaigns for the public and for providers as it prepares to launch the Vermont HIE, which is about to exit beta testing. VHIE drew controversy a few weeks ago when it announced that any provider will be able to look at any patient’s information, which the CEO says was done to reduce the number of forms patients would need to sign.

Innovation and Research

An engineer develops a $300 smart spoon that stabilizes up to 70 percent of a person’s hand tremor, allowing people with those conditions to eat without help. More attachments are coming.

Other

The Columbus, OH newspaper profiles Columbus-based CoverMyMeds and the prior authorization process.

AtlantiCare (NJ) will merge with Geisinger Health System (PA), with both organizations citing value-based care as their motivation. 

The VA hospital in Denver reports that two laptops containing respiratory testing information on 239 patients have been stolen from its pulmonary lab.

in England, NHS says the operating cost of its new e-Referral service will be 80 percent less than that of the $600 million Choose and Book system it replaces.

Also in England, the government opens bids for its Integrated Digital Care Technology Fund, which will provide up to $400 million in matching funds over the next three years to projects that create open source data sharing tools.

Sponsor Updates

• Technology leasing provider Winthrop Resources achieves its second “Peer Reviewed by HFMA” designation.
• The e-MDs 2014 user conference is scheduled for June 5-7 at the AT&T Executive Education and Conference Center in Austin, TX.
• TriZetto (Gateway EDI) offers four things to prepare for ICD-10 after attending WEDI’s ICD-10 Summit.
• Glytec receives FDA approval to add pediatric insulin dosing to its Glucommander.
• Greenway Health is recognized by Black Book Rankings as a Top EHR Vendor for ambulatory settings.
• Culbert Healthcare Solutions offers proactive steps in transition to value-based physician compensation.
• Liaison Technologies adds template-based mapping to its Contivo Data Integration Suite.
• Capsule’s Karen Lund discusses the importance of nurses understanding the ‘big picture.”
• Beacon Partners discusses the good and bad aspects of the recently proposed CMS rule that would defer MU Stage 2 until 2015.
• Phoebe Putney Health System is live on the Summit Healthcare Summit Care Exchange platform communicating with RelayHealth.
• CoverMyMeds’ CEO Matt Scantland shares the processes behind the company’s success with a local publication.
• McKesson will be the headline sponsor for the 5th Annual Health IT Leadership Summit November 20 in Atlanta.
• Newark Community Health Centers (NJ) will implement Forward Health Group’s PopulationManager for its seven clinics.

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.

HIStalk Interviews Dave Dyell, SVP, NantHealth

Dave Dyell is SVP of product development of NantHealth of Culver City, CA.

NantHealth exhibited at the HIMSS conference, but nobody I talked to could figure out exactly what the company is selling even after talking to the people in the booth. What is being sold today? 

The solutions fall primarily into two sections today. One of those is connectivity, the older iSirona set of products, but taking them beyond the traditional “in the house” variety that iSirona has focused on. Focusing primarily more on telehealth.

There were other assets that were available as part of NantHealth that we’ve brought to that connectivity suite. Medication adherence — it’s a solution called the GlowCap and the GlowPack that we can place into a home that allows to track whether or not a patient is actually taking their medication when they’re supposed to. That is live today in multiple organizations.

We currently also have a product we call the HBox, which is just going GA right now, which is allowed to go into the home and be able to communicate to virtually any medical device that a patient may have in the home. This could be an off-the-shelf glucometer, your scale, blood pressure cuff, things of that nature that would bring that data back and send it to the cloud.

The second part of the solution set is what we call interoperability. This is the ability to go in and partner with an ACO organization to provide the technology platform. That is our Clinical Operating System that we launched at HIMSS, which allows us to then connect to all of those systems that a particular physician’s practice may be running. The ACO is going to be needing to be able to interact with the data about that patient, obviously connecting to the hospital systems.

Any typical hospital can have 80 to 100 different systems. We can pull data from all of those silos, as well as then the insurance companies, and bring in all the historical claims data and other information from maybe even pharma. Any of the claims data that would be related to any of the healthcare around that patient.

I wasn’t clear when the announcement was made about the Clinical Operating System. I understand that there’s like 80 acquisitions involved and suddenly declaring those to be a Clinical Operating System seems like a bit of a stretch from an interoperability standpoint.

The Clinical Operating System actually came from a single organization previously known as Net.Orange. It was built from the ground up to be a Clinical Operating System. That was the original vision that that team had for that particular product.

You’re looking at seven-plus years of development that’s gone into that particular platform, building each and every one of those individual connectors over time. All of them tied to an implementation. That’s the key –going into an organization and actually performing that integration rather than just building an off-the-shelf connector to it.

I must have missed that point with the announcement. Tell me again, what exactly is the Clinical Operating System and what is its heritage?

It was designed from the ground up to be based on bringing supply chain principles to healthcare. Dr. Rangadass and his team came from the old i2 space in supply chain management. Obviously i2 had a breadth into healthcare as well. One of the things that frustrated them was the waste that happens in healthcare. 

When they started looking at building the next generation of platforms, they wanted to build something that could literally sit on top of all these different systems, gather the data, and then bring it to the front. In the case of applications, that would look at things that we call Value Monitor, which would help you see how you’re comparing to your peers.

A lot of the typical trending applications that we’ve all seen in healthcare and worked around for a while — their real goal was to see, can we build a data model and a set of services that essentially, if you wanted to build any healthcare application on, we would have those basic services. That’s what they set out to do. That’s why we call it an operating system, because they’ve literally built a service that can do just about anything you would possibly want to do in healthcare if you were trying to build a clinical application.

There are customers live on this now?

There are. US Oncology is one of those customers that’s been using the platform for 5+ years. They’ve got all of their physicians on it.

But they’re not really a hospital and you’re targeting this to hospitals. Are there hospitals live?

St. John’s Health System in Los Angeles.

That’s the only one?

It is, yes.

When you’re describing this to a hospital that might be a prospect, what is it that you tell them they could do and what capabilities they need to run this on top of their existing systems?

The biggest traction we’re getting right now in the conversations with hospitals is of course around population health management. Everybody’s trying to figure out what is population health management. There’s a lot of buzz, a lot of noise. But one thing is for certain – everyone  is trying to identify that platform that they’re going to use to pull all of this data together.

They all understand they need the data. They know there’s data locked in their EMR. They know there’s data locked in their other independent systems. They know there’s data locked in the multiple physician EMRs that are out there. How do they bring all data together into a single platform, that if they’re going to form some type of accountable fee structure, that they can use that data to care for that population? That’s normally where the conversation starts. 

Once everybody understands the full depth and breadth of the Clinical Operating System, they immediately see the value. They immediately see where this is different than anything they’ve seen before. Where we can bring together that data unlike anything else that’s ever been done before. Then you add to it the rest of the things that belong in the NantHealth family. You start talking about genomic data, you start talking about proteomic data, and you bring that science in and add that to that clinical component. It’s not like any platform you’ll ever find out there.

Are all these acquired companies still operating independently under their own names or is the plan to roll them all up into a super-product?

Unknown to the market is that this didn’t start like a light switch on January 1. Dr. Soon-Shiong has been an investor in iSirona for over five years. He’s been an investor in many of these companies for years. This has always been something we talked about. It’s always been something that we started to plan for and operationalize around, even from a perspective of technology choices we’ve made in our applications. 

We’ve had most of our things interoperable over the years to be prepared for this. I personally spent most of 2013 and parts of 2012 taking other assets that he had invested in that were no longer surviving as a market go-forward company and bringing those in and integrating them into iSirona in the background, being ready to launch on January 1. The launch of NanthHealth was January 1.

As of January 1, we are a single operating company. We are going to market with a single sales force, single message, single company. There won’t be an iSirona any more. There won’t be in Net.Orange. There won’t be any of these individual companies any more. They will only be NantHealth. The market is going to sit back and wait to see whether we can pull off or not but it has already actually been in place for a large number of years.

What’s the effort required and what are the steps that are required to turn a bunch of piecemeal investments into something integrated?

We’re a little over 350 employees right now as a company. We have 280+ hospitals that are using some aspect of our technology. Most of that is the iSirona stuff, but still, there are others that are using different pieces of the rest of the portfolio.

We’ve got over 50 percent of the different US Oncology practices that are currently using our decision support engine. That came in from a company called Eviti that’s a part of the portfolio. There are a very large number of practices and companies and revenue that are coming in the door today. 

As far as putting it all together and making it that single cohesive story, again, we believe we did that in preparation for the launch at HIMSS. We are out in the market with that single message.

You had 180 or so employees at iSirona. I didn’t appreciate what a big chunk it is of NantHealth.

We are, yes.

Dr. Soon-Shiong has a far-reaching vision on personalized medicine and genomics. What are the steps required to take NantHealth to meet that vision?

We already have the genomic, the proteomic technology. What needs to be done now is taking that data and being able to map it in a meaningful way into the rest of the care process.

If you’re a case manager who’s looking at a care plan and walking your way through that on a member of your population that you’re trying to manage, and all of a sudden a physician orders a gene mapping and you get those results back, what do you do with that data? How do you map that wisdom that’s going to come back from the science into the overall decision support workflows that are going to be around traditional population health management to make it different? 

We like to say it this way within NantHealth. What’s that one piece of data, that if we could get in front of a caregiver, would make for a significantly better outcome? That’s really what drives us all — trying to find that one piece of data, that one other piece of data that I could put in front of a physician, put in front of a caregiver, put in front of a scientist for that matter, that would give that patient a much better outcome.

BlackBerry seems to be on its last legs. Why did it suddenly get interested in healthcare and what will it co-develop with NantHealth?

That’s an interesting perspective, because one of the largest portions of the market that BlackBerry owned was healthcare. I don’t think I’ve walked into a hospital in 15 years that hadn’t had some form of BlackBerry technology there. The BlackBerry enterprise server is installed in hundreds of hospitals, if not thousands across the country, because of its secure messaging and because of HIPAA concerns and those things. People have been using BlackBerry for years.

They use BlackBerry devices, but this is actually developing healthcare-specific technologies and not just saying they’re going to park BlackBerry in a hospital.

It is, but that’s to me why it’s a natural foray for them. They’ve already go this large infrastructure. They’ve got a large customer base that’s already in healthcare that’s using one of their devices. 

What they saw obviously with NantHealth is on our connectivity side again. Connectivity everywhere, regardless of where you are. We think the smartphone is another logical place to provide some of that connectivity. Not everybody’s going to want an Hbox in their home. A lot of us that are more tech-savvy are going to want our smartphone to be that. 

Having the Nantoid with BlackBerry is going to be a really interesting play for us to be able to provide a device that’s optimized for that connectivity, optimized for image display, those types of things.

The NantHealth offering isn’t exclusive to BlackBerry, right?

No, of course not.

So their contribution is just to optimize it for BlackBerry?

Correct.

What are the milestones the market will see in the next few years from NantHealth?

I think what you’re going to see over the next few years is some significant growth within the telehealth side of the business as we continue to expand the connectivity-everywhere approach. You’re also going to see on the interoperability side us expand much more heavily into population health. We have some releases and stuff that will be coming out soon and new customers on that end where the Clinical Operating System is being used as the basis for multiple population health deals. These are again primarily focused around ACOs at this particular point.

Wearing your iSirona hat, what did you think of the FDA’s report and the topic of medical device integration with EHRs?

What’s interesting is if you look at the majority of the market, at least for the more mature companies, everybody’s already there anyway. Cerner produces medical devices. Siemens produces medical devices. GE produces medical devices. Maybe an Epic on the outside, but they’re got laboratory systems, many of which are already regulated. 

I’m not sure why any of them would be concerned about this from an overall ruling perspective. Most of them already have some type of quality management system and build their software under that ruling anyway. I was a little bit shocked that the FDA didn’t take it a little bit further than they did considering that reality.

I think there’s this misperception in the market that somehow software vendors don’t follow quality processes. But for the most part, they do, especially if you’re going to be an international company. For the rest of the world, if you’re not building your clinical software especially under a quality management system of some sort, whether you’re fully ISO certified or not, just having a quality management system is so important in trying to market to the rest of the world. If you’re going to be an international company at all, you have to be able to show that you do actually use quality within your development practices.

What about the status of alerting and alarming? What’s being worked on to try to make that smarter?

We obviously follow that space pretty closely because of the fact that we connect to so many medical devices now. A lot of those vendors in that space look to us for the data. We got our own alerting and alarming package cleared last year that we call Magellan. We started to bring that to market around HIMSS as well. We’ve launched that and we should be seeing some press releases on that coming out soon. It’s a space that we believe in, obviously, and one that we’re going to continue to invest in.

Do you see a point where there won’t be a third-party product in between the medical devices and the EMRs to help negotiate the conversation so that it makes sense to the clinicians?

I really don’t. You’re right – HL7 and other types of integration standards that have tried to standardize the industry, what we found is is that until customers demand that interoperability, there always ends up being somebody in the middle. 

I’ve been in healthcare long enough to remember when HL7 was in its infancy and when products like Cloverleaf and at that time DataGate and the old Healthlink product were all just coming to market. Every one of them, everybody thought would last a few years and then HL7 would have that broad market adoption and nobody would need integration tools any more. EAI was going to be a short-term thing. Those engines are still going strong today. 

In the mean time, companies like Orion, companies like InterSystems have come out and completely stolen market share away as those products have died in some cases, especially in the case of the eGate thing after they sold it off to Sun and Oracle. You really see that everybody believes these integration technologies will only be around for a little while, but they end up staying because even once the standard’s adopted, the standard doesn’t necessarily always fit every situation. So no, I don’t see middleware, if you would, going away any time soon to help broker that conversation.

Morning Headlines 5/27/14

Veterans Allowed More Care at Non-VA Facilities Amid Criticism of Agency

Following weeks of turmoil over the length of time veterans are waiting to get VA appointments, the VA unveils a new program that will allow some veterans to skip the waiting line altogether and seek routine care at non-VA facilities.

Insurers Once on the Fence Plan to Join Health Exchanges in ’15

The successful 2014 enrollment period for Healthcare.gov, which drew eight million subscribers, has sparked the interest of insurers. Several major payers that had stayed away from the marketplace thus far, including Cigna and UnitedHealth Group, have indicated that they will sell plans over the exchanges next year, while others like Harvard Pilgrim, are announcing that they will expand their current presence on the marketplaces to include new plans and coverage in new states.

Curbside Consult with Dr. Jayne 5/26/14

Several readers emailed about last week’s EPtalk, where I shared my frustration with CMS and the constantly-changing game of Meaningful Use.

Dear Dr. Jayne,

I’m sorry for how you feel about CMS and long for days of old when $5 got you a doctor visit at home. I’m 76 and have been on Medicare for over a decade. From a patient viewpoint, it beats big payers hands down. One little card with a red, white, and blue stripe gets you everything from any healthcare system, any physician, no referrals, no one ever asks a question, and, if you have a gap insurer, you almost never pay a nickel. As I recall, CMS gave every doctor $44,000 to buy an EMR and every hospital a lot more. I’m sure over $50 billion was given to providers and now CMS wants something in return. Sounds reasonable to me and almost rare that the government can’t be accused of a giveaway.

I think a lot of MU requirements are off target as to need and value. Most EMRs are off the mark in architecture, workflow, and value. So, we have the equivalent of a 1.0 standoff, but at least it is a start. Hopefully by 2.0 both the MU and EMR will have both evolved to a better place. This will take at least a decade and the practice of medicine and the technological advancements during this period will make the current systems look like stone age work.

Don’t give up on Medicare and CMS; make it better. The alternatives are much less attractive.

Sincerely,
Spirit of ‘76

Dear Seventy-Sixer,

Speaking as an Eligible Provider, I can confidently state that CMS hasn’t “given” us anything. It’s true that up to $44,000 each was available to eligible providers over a multi-year period. For most providers in my community, however, it cost far more than $44,000 to dot the “I” and cross the “T” of each Meaningful Use requirement. Even in the first iteration of Stage 1, providers had to meet 22 objectives (several of which have multiple subcomponents). For many physicians, this meant overhauling practice operations. Unfortunately, I’ve seen a lot of box-checking at the expense of clinical quality. When providers go to file their attestation, it’s all or none in nature, which creates a great deal of stress on caregivers and staff.

I’m glad you have had such a positive experience with Medicare. Patients in my community aren’t as fortunate, as many physicians have stopped accepting Medicare assignment or are limiting the number of Medicare patients they see. CMS has many coverage and medical necessity rules and my patients are spending a lot more out of pocket than some of them think is fair. We’re still in a recession and quite a few patients have been forced to drop their supplement plans or have chosen barebones coverage that they don’t like. Those who have gone on Medicare Advantage plans hate the narrow networks and further limitations, but like the cost.

Speaking of cost, going back to what it costs to implement an EHR. Looking at HealthIT.gov for numbers, they list the five-year total cost of ownership (estimated average) as $48,000 for an in-office system and $58,000 in a software as a service model. That doesn’t include practice losses during implementation or ongoing loss of efficiency, the need to add additional staff to manage all the metrics, or hiring contractors and attending classes just to make sure one understands all the maze of rules.

I agree with you that necessary change will take a decade. Unfortunately, CMS only gave providers half that time to accomplish ever-changing (and sometimes obscure) goals involving elements beyond their control before the penalties kick in. I hope there are some primary care providers left when the dust settles. I’m seeing my peers retire in droves and there aren’t enough new hires to fill the gaps, increasing patient wait times.

Sincerely,
Jayne

Dear Jayne,

What do I think? Well, I’m glad you asked. I have just spent about four hours reading, digesting, and summarizing in a document I can share internally what this could mean. Then again, it might not mean any of what I have summarized. Theoretically depends on public comments.

This has been such a frustrating process for everyone. I work with providers and healthcare organizations. There was so much confusion with the 2014 CEHRT requirement already. This will undoubtedly make it so much worse. For some EPs, it could be a life preserver – several vendors aren’t CEHRT yet. Maybe the 62-year-old provider I met with last week (whose EHR vendor wants him to sign a 10-year contract for their patient portal) will be able to delay and shop some more. Perhaps another client I work with won’t be forced to purchase a CQM module and sign a three-year contract by June 1 or be faced with missing MU Stage 2 this year because the vendor won’t have them upgraded in time.

Waiting the 60 days for public comment, however, will be like trying to fly stand-by the Wednesday before Thanksgiving. If you get the flight, all will be well and you’ll spend the day smiling and toasting your good fortunes. If you don’t, you had better be scrambling to figure out how to thaw a turkey overnight. MU and a turkey – it’s a good analogy!

Sincerely,
Apple Pie Fan

Dear Pie Fan,

Thanks for writing. Your thoughts reflect those of many people I’ve spoken with this week. The potential delay doesn’t mean anything if it doesn’t go through. If you wait for the final rule and you didn’t guess right about its content, you’re going to be caught short. In the mean time, everyone has to push forward as if there will be no delay.

I really like your turkey analogy. In contrast to CMS, however, Butterball has a turkey hotline you can call for actual answers.

Sincerely,
Jayne

I’m not sure how many readers we will have given the Memorial Day observance. I hope you were able to spend time with loved ones and took the opportunity to remember those in the armed forces that made the ultimate sacrifice. If you’re wondering about today’s picture, it’s courtesy of Smithsonian.com and was taken at the site of the Battle of the Somme. There are several other haunting images that show the scars that remain even after 100 years.

Email Dr. Jayne.