Monday Morning Update 5/5/14

Top News

Blue Cross Blue Shield of North Dakota partially blames its poor 2013 performance on newly implemented EHRs of providers that delayed their insurance claims submissions, which it says caused it to underestimate the value of those claims. I didn’t realize until reading the CEO’s discussion that Noridian Healthcare Solutions is a subsidiary of BCBS of North Dakota. Noridian built the failed Maryland health insurance exchange and was fired from its $193 million contract in February. Maryland has hinted that it may sue Noridian in hopes of getting back some of the $55 million it has already paid toward Noridian’s five-year contract. North Dakota’s insurance commissioner says the agency is watching BCBSND to make sure it doesn’t try to increase insurance premiums in the state to cover Noridian’s projected $17.8 million loss. Every time I hear that name I think of Veridan Dynamics from “Better Off Ted.”

Reader Comments

From Guillermo del Grande: “Re: CIOs. Here’s a list of “A Few Things CIOs Should Know (Or Think About).”

• If you want the FDA to regulate EMRs but have a service level agreement of two days for major fixes, you may want to learn about software development models. If you have to ask what a software development model is, how did you get to be a CIO?
• FDA requires waterfall development. This is not Niagara Falls.
• How many of the good EMRs use waterfall any more? Here’s a hint: not many. Most are agile. EMRs are more complicated than a medical device. How many different medical devices connect to your EMR? Do you even know? Do you feel like testing every scenario per medical device that connects to your EMR? Do you think your vendor does that?
• Are you afraid to let developers and your IT people watch healthcare and the software in action? You’re not agile. You’re going over the waterfall in a barrel.
• If your SLA is two days, but you require a change control meeting that only happens every two days, and then a software testing process that takes two days, and then another change control meeting, and then only migrate changes once a week, you may have a problem.
• How long does it take your vendor to fix a minor issue? You should be asking this question before you buy.
• What makes you think your IT staff can fix a problem in a SLA period when you don’t know if it’s something your IT folks can do or it’s something the vendor has to do?
• Do not try to manipulate an IT staff or a vendor into repairing your highest priority by only reporting that item. IT staff have lots of end users. Vendors have lots of customers and sometimes will fix issues only if lots of different customers are seeing them.
• If you think a problem made it to the field because the software testers at the vendor didn’t find the issue, you don’t know much about how software companies. Remember that story about the guy who had his heart burned out of his chest a few years ago because of a bug? If not, look it up on HIStalk — it was a known issue for 10 years. Ask your vendor how many known issues they have in their tracking system. Hint: they’re not all reportables.
• The Supreme Court is reluctant to take new cases and software developers are reluctant to fix bugs for many of the same reasons and use some of the same processes.
• “Not a customer workflow” is heard at many a vendor to defend not fixing a bug, often before there are any customers.

Thoughts on FSMB’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine”

The Federation of State Medical Boards is a Euless, TX-based non-profit trade association that represents all US medical boards that license physicians. It does not make regulations directly, but state boards usually adopt its recommendations.

Key points from its report include:

• Telemedicine is defined as requiring videoconferencing. Encounters conducted via telephone or email are not telemedicine.
• Physicians must be licensed in the state “where the patient is located” because physicians are licensed by individual states.
• A physician-patient relationship must exist, but it can be established using telemedicine technologies.
• The physician must document the patient’s history. Having the patient complete an online questionnaire doesn’t count.
• The physician should obtain the patient’s informed consent, including a description of the security features of the telemedicine technologies being used.
• The physician must make themselves available following the encounter.
• The physician may not promote services for which they are receiving payment or benefits.

The intention of the group is clear. It wanted to prevent providers from selling prescriptions online. Nearly all of the wording restates requirements that are already in effect for traditional physician-patient encounters, clarifying that those requirements hold true for telemedicine-based encounters. The policy attempts to prevent online-only practices by prohibiting misleading websites, undisclosed financial relationships, and running an online consultation service simply to sell drugs online.

The only significant (but unsurprising) recommendation is that physicians must hold a license in the state where the patient is physically located during the encounter. That also is no different for traditional medical practice – an ED doctor in Florida can see vacationing patients from anywhere in the world from a Florida-based hospital, but he or she can’t travel to those other states to treat the same patients at their homes unless licensed there.

The most positive development for telemedicine supporters is that the model policy allows patients to be managed entirely by telemedicine without an in-person component.

The negative aspects of the model policy are:

• FSMB isn’t a particularly transparent organization and didn’t disclose the members of the work group or who it consulted to develop its proposed policies. It also did not provide a way to incorporate industry or patient feedback.
• Doctors already diagnose and treat patients by telephone and email, but those options are not considered telemedicine in the model policy, although it doesn’t limit or prohibit them. That would suggest that nothing changes for those visits, although future questions may come up involving payment for services.
• Doctors must be licensed in the state where their patients are located, which isn’t even accurate in some cases (military physicians.)
• It doesn’t address the desirability (nor should it have, most likely) of national rather than state-by-state licensure of physicians or an expanded reciprocity program that would make it easier to practice across state lines. That’s the biggest clash between telemedicine proponents and state regulatory boards, whose revenue and power come from overseeing in-state professionals and (arguably) protecting them from competition.
• It calls for requirements that exceed those of non-telemedicine encounters, such as prohibiting randomly assigning patients to physicians (which EDs, walk-in clinics, and other services do routinely) and requiring that the medical records of patients be reviewed before treating them (which urgent care providers can’t do by definition.)

The conclusion is that telemedicine proponents wanted a policy that opened up state borders and encouraged innovative care, while FSMB’s goal was to prevent unethical doctors from running pill mills and online medical scams.

HIStalk Announcements and Requests

A commendable 37 percent of poll respondents use an activity tracker at least five days per week. New poll to your right: should doctors be licensed nationally instead of state by state? It’s an important question if you think telemedicine can improve the efficiency and geographic reach of physicians.

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

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

Vocera announces Q1 results: revenue up 10 percent, adjusted EPS –$0.14 vs. –$0.07, beating expectations for both. VCRA shares were the second-largest NYSE percentage losers on the news, shedding 14.7 percent. From the conference call:

• The company released the Vocera Collaboration Suite and an expanded Vocera Care Experience in the quarter.
• It opened a development shop in India.
• President and CEO Brent Lang called hospital spending “challenging” as hospitals wait to see where changes in patient population and healthcare reform go.
• He quoted a report that says 97 percent of hospitals don’t believe their nurses have the right tools to determine the availability of caregivers and that consumer-grade smartphones aren’t working well for hospitals.
• Lang mentioned a tentative US Army study in which use of Vocera’s system provided a 12-month payback.
• The alarm management system it gained with its mVisum acquisition in January 2014 will be launched this summer.
• Lang said the company will pursue more acquisitions.

Evariant, which offers a patient marketing platform, raises $18.3 million in a Series B funding round.

Hc1.com says it will create 175 jobs in central Indiana over the next five years, having just received $3 million in state tax credits. I can’t really tell what the company is selling since the site is a mess of buzzwords and vaguely feel-good statements behind one of the worst company names I can imagine (shades of 1999), but it seems to be a customer relationship management system for outreach labs and radiology practices.

General Dynamics will lay off at least 645 Utah-based call center employees it had hired under a CMS contract to take Healthcare.gov related inquiries about insurance.

CPSI announces Q1 results: revenue up 5 percent, EPS $0.69 vs. $0.63. From the conference call:

• The company installed financial systems in nine hospitals and clinical systems in 12.
• Add-on sales made up 26 percent of total revenue
• The company expects to gain ground with MU Stage 2 as “a number of our competitors continue to struggle with obtaining certification for their software, as well as struggling with the installation and usability of their software in the small hospital market.”
• Its new ED module will GA in Q3.
• CEO Boyd Douglas says that while Epic and Cerner talk about moving into smaller hospitals, CPSI isn’t seeing much of that, mostly just their usual small-hospital system competitors (Meditech, McKesson Paragon, and Medhost, I assume.)
• The Leerink Swann analyst managed to say “sort of” four times in one question, also using that annoying verbal crutch twice in a follow-up question.

Sales

The Defense Health Agency awards Leidos a $70.7 million, sole-source contract to support its EHR systems for the next 11 months.

Nashville-based MindCare Solutions signs the first customer for its tele-behavioral platform and provider network, Genesis HealthCare, which will offer remote psychiatric services to its 400 skilled nursing facilities.

Announcements and Implementations

New York State Immunization Information System will use Blue Button to make records available to the parents of patients.

AMIA calls for nominations for its 2014 awards for informatics leadership, nursing informatics, informatics health policy contributions, and informatics innovation. Winners won’t necessarily be the best, just the best who pay AMIA dues: a key selection attribute is “demonstrated commitment to AMIA through membership.”

The Boston Business Journal profiles Alere Accountable Care Solutions, mentioning that it will offer its care management, connectivity, and analytics systems in Europe. I interviewed CEO Sumit Nagpal in October 2013.

Government and Politics

President Obama makes fun of Healthcare.gov at the White House Correspondents Dinner on Saturday, saying that he has replaced his campaign slogan “Yes We Can” with “Control-Alt-Delete.” Near the end of his presentation, he pretended to have problems with a video and former HHS Secretary Kathleen Sebelius got a cameo as she rushed to the podium to fix it. The President’s last words of the evening, after thanking the press and uttering the obligatory “God Bless America,” were “Thank you, Kathleen Sebelius.” Other than following the party line, I question whether the fired Sebelius did anything worthy of that level of adulation.

Other

A Minneapolis cardiologist, intrigued by the use of scribes in the ED, tries them in his cardiology clinic. The four doctors he studied were spending all but two minutes of their average 13-minute patient visit working on the computer. Turning that work over to scribes shortened the visits to nine minutes, but beyond that efficiency gain, patients got seven minutes of that as face-to-face time, nearly four times as much compared to non-scribe visits. The doctors saw 60 percent more patients using scribes, boosting revenue by $206,000 in 65 clinic hours. Patient satisfaction was unchanged, which is nice for making a case for scribes but not so nice for the doctors — all that extra face time apparently didn’t impress patients.

Dr. Andy’s HIStalk Practice rant on the problem list is drawing interesting comments from his physician peers. Example: why can’t the problem list attribute cause and effect, or allow attaching meds to specific problems (or more than one problem?)

The dean of the new Dell Medical School at the University of Texas (I wonder who paid for that?) says that while Austin is behind in a competitive biotech industry market, “Areas like digital health and informatics, no one owns that right now. That is an area that’s rapidly growing and ultimately it will win and be a huge area … Companies who handle personal data see that health is a huge frontier and represents a huge economic engine, but no one has been able to innovate the platform that scales to a huge field … There are companies waiting to do that, but no one is inviting them in. We can do that.”

Mineral Community Hospital (MT) reports to its board that its NextGen implementation resulted in unplanned upgrade-related downtime and a 45-day delay in sending bills out for the 25-bed hospital.

A man Googling for CPAP machines for his sleep apnea notices that unrelated Google searches start displaying ads for those devices, leading him to complain to the Office of the Privacy Commission of Canada that targeting ads based on a health-related search constitutes a privacy violation. The office agrees after an investigation, determining that the practice not only violated its advertising guidelines, it also violated Google’s own policies that state the company won’t use health-related browser cookies to target ads. Google blames some of its advertisers and says it will improve its training and monitoring programs.

New York State Insurance Fund blames a software upgrade after the medical records of 20 worker’s compensation patients are to the wrong attorneys.

Bizarre: a mother is awakened by the sound of a man’s voice in her sleeping 10-month-old daughter’s room screaming, “Wake up, baby.” She runs into the room and sees the camera of the video baby monitor turn toward her as the hacker who is controlling the camera starts screaming obscenities at her. The woman’s Foscam IP camera had been updated to fix a security flaw, but she didn’t know about it. The conclusion is that the Internet of Things will give hackers a lot of household (and hopefully not hospital) gadgets to play around with.

Sponsor Updates

• The Health IT Quality Solutions Program of Quest Diagnostics certifies iPatientCare’s EHR as a Silver Quality Solution.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/2/14

ManTech Announces Acquisition of 7Delta, Inc.

ManTech International Corporation acquires 7Delta after the Maryland-based IT services firm won a 5-year contract with the VA through its Transformation Twenty-One Total Technology procurement program. Through the acquisition, ManTech will be in position to support the VA’s transition to newer IT systems.

Medicare Program: Hospital Prospective Payment Systems

CMS confirms, buried within a 1700-page document, that the new ICD-10 transition date will be October 1, 2015.

Sovereign Wealth Fund KIA Invests $100 Million in NantHealth, a NantWorks Company

The Kuwait Investment Authority invests $100 million in  healthcare billionaire Patrick Soon-Shiong’s newest venture NantHealth.

athenahealth Names Karl Stubelis Acting Chief Financial Officer

athenaHealth announces that CFO Tim Adams has stepped down to pursue other opportunities, and that current vice president and corporate controller Karl Stubelis will take his place.

News 5/2/14

Top News

Defense contractor ManTech International will acquire 7Delta, which provides healthcare IT contracting to the VA, DoD, and HHS. ManTech wants a piece of the VA’s Transformation Twenty-One Total Technology program, for which 7Delta has won more task orders than any other vendor.

Reader Comments

From Matthew Holt: “Re: HIMSS Analytics interview. Can the HIMSS PR people just stop with the BS? How many times do they have to say that they are a ‘cause-based, mission-based organization?’ This guy is selling market research to IT vendors and HIMSS non-vendor ‘members’ are all providers feeding at the federal teat. None of them are helping the starving in Africa. HIMSS has been on an acquisition tear in the conference and media business, including doing some extremely uncharitable activities towards its competitors there (not to mention the way they treat their vendor clients.) And Steve Lieber got paid $900K in 2011 and presumably over $1m by now. I’m a capitalist, I have no problem with anyone making money in healthcare while trying to change the world for the better, and I support the idea of more IT being a good thing. But seriously, who are they trying to fool with this rhetoric?” I seem to remember that HIMSS Analytics was originally set up as a for-profit subsidiary of HIMSS when it was first acquired many years, but something (presumably the IRS) forced a change. HIMSS is like hospitals: somehow it keeps minting more and more money and using it to buy for-profit companies (conference organizers and publishers, mostly) and then suddenly declaring them to be non-profit. The annual conference generates a ton of cash that can only go so many places: big salaries (check) and acquisitions (check). Or the less-obvious choice: HIMSS could scale its income to its expenses rather than vice-versa.

From Boy Wonder: “Re: Allscripts. The company sent an email to its portal users saying Medfusion caught the the company off guard with its announcement.” Medfusion announced this week that an unspecified payment dispute will force it to shut down access to its portal by Allscripts customers as of May 31, 2014 unless they sign a new contract directly with Medfusion. The Allscripts email reassures those users that they can be live on the Allscripts FollowMyHealth portal (the former Jardogs product it acquired in March 2013) by October 1 if they commit by May 31. The bottom line is that those 30,000 users have to make a commitment to one of the companies within four weeks, and if they choose Allscripts, they’ll have to try to strike their own deal with Medfusion to keep their portal running until they can make the switch. The Tullman-era Allscripts made a colossally bad decision to redistribute Medfusion’s portal instead of developing or acquiring its own, making both the company and its customers vulnerable to the actions of an external vendor. Allscripts predecessor Misys made a similarly bad decision in licensing a customer version of iMedica (now Aprima) that Allscripts resold as MyWay before retiring it and leaving those users in an equally unpalatable position through no fault of their own. In both cases, Allscripts gets a black eye for putting its customers in a jam and then trying to migrate them to another Allscripts product to fix it.

Dim-Sum provides the usual cryptic and amusing update of the Department of Defense’s commercial EHR system selection process, or as he or she describes, “Status and latest rumors in the halls of bedlam, located right K Street.” This is a huge many-billion dollar deal and the only insider reports I’ve seen are coming right here from Dim-Sum, so thanks for the update.

May 2014

1. DHMSM competitive teams are almost in place.
2. Themes are being discussed, ideas are being circulated and people are starting to wonder, “Why did I pick this team?”
3. CACI, where are you, and has anyone seen where Harris, SRA, and yes even CGI went?
4. HP is getting press and nobody knows why. I bet you wish you thought of the Newseum “experience” (outstanding job by IBM/Epic, or should it be Epic/IBM?)
5. Whatever you do, IBM, do not mix Epi-BM for your team moniker. That is a bad connotation in healthcare.
6. GDIT is sitting on the sideline with Northrop Grumman watching in awe as their fellow poobah Lockheed has found functional and willing partners in Siemens and Athena. Good luck, best of breeders! Lockheed please note: Boston is an academic mecca, you will be comfortable there. Now the firm in the Philly suburb, whatever you do, do not wear a Redskins tee shirt — Eagles fans will hurt you.
7. CSC is trying to figure out how they can make a cloud in the shape of an EHR – fun!
8. Accenture is still confident, proof positive that their strategy was focused on any large EHR vendor in the Central time zone. Personally, I like the combination – well done, Jim and Ken – airline tickets are cheaper to Kansas City anyway. Kansas City, sadly, is located 70 miles south of the airport.
9. Teams are congealing. However, smalls are scrambling and the ones invited to the table are excited. They tend to pontificate upon their vast knowledge of the current environment and then wonder if that is something to brag about.
10. IBM, can you please bring back the Blue Man Group for an epic focused percussion’ fest? That would be very cool, and yes, the pun was intentional.
11. There will be an online course for all participating COTS vendors explaining  cutting edge Kyrgyzstan interoperability standards like FTP, as well as expressing how each and every hospital across the Military Health System has one single positive attribute — they serve heroes. Outside of that, the technology is fair to awful.
12. Had some initial thoughts about themes for each team:IBM / EPIC: “Judy and Watson, sitting in a tree, K-I-S-S-I-N-G!”
    Lockheed / Athena, Siemens: “We build planes, ships, and missiles. How tough a nut can healthcare be?”
    Accenture / Cerner: “DHMSM is like an onion — lots of layers and lots of tears.” Sorry, Accenture, my kids are watching Shrek.

More in June…

HIStalk Announcements and Requests

I hear through murky sources that a huge acquisition will be announced Friday morning (by “huge” I mean “you won’t believe it.”) I’m skeptical, but also receptive to being tipped off early if you are knowledgeable of the supposed deal. The fact that I’ve heard it only once suggests that my caution is well placed.

The latest “CMIO Rant” from Andy Spooner, MD is on HIStalk Practice where he addresses “The Problem List: Foe or Enemy?” complete with screen mockups. His first rant was “The Great Prescription Pad Race.”

Highlights from HIStalk Practice this week include: Medfusion parts ways with Allscripts over payment disputes. The EHRA opposes ONC’s proposed 2015 voluntary EHR certification criteria. A National Quality Forum panel finds pay-for-performance programs unintentionally worsen disparities between rich and poor. Forty percent of physician practices are looking to replace their EHRs, while those struggling to improve collections are taking on more aggressive billing strategies. Researchers find that almost one-third of patients fail to fill first-time prescriptions. 2014 MU incentive payments indicate a potential slow-down in EP participation. Thanks for reading. This week on HIStalk Connect: NIH announces a series of grants aimed at spurring mHealth research focused on chronic disease management, remote patient monitoring, and telemedicine. Doximity, often described as LinkedIn for doctors, announces a $54 million Series C round. Israeli startup Consumer Physics launches a Kickstarter campaign to fund a handheld digital spectrometer that it claims can scan food and calculate calorie and nutritional content. Dr. Travis discusses the 10-year horizon of connected health devices and the implications that they could one day have on healthcare overall.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

The Kuwait Investment Authority takes a $100 million position in Patrick Soon-Shiong’s NantHealth. I wasn’t paying attention to the company’s logo placement on the page above and thought that the female on the left was sporting a Hiawatha-like Native American headdress.

Merge Healthcare reports Q1 results: revenue down 20 percent, adjusted EPS $0.04 vs. –$0.01. From the earnings call:

• The ICD-10 delay moves up window during which hospitals may consider upgrading their imaging systems.
• The company’s MU2 certifications give it opportunities with ambulatory radiology and orthopedic customers.
• Merge improved its Epic integration and avoided an issue involving provisional patents.
• Merge’s eClinical OS clinical trials system has 18,000 users.
• The company will introduce a retinal screening product for diabetes and glaucoma patients, with the target customer being hospitals that are bearing risk.

Streamline Health announces that its Q4 and FY2013 results will be delayed until the end of May as the company’s new auditors review its internal controls. The company says three unnamed go-lives will contribute recurring revenue beginning in Q2 and it booked a new sale for one of the products it obtained in its $6.5 million acquisition of Unibased Systems Architecture in February 2014.

Etransmedia Technology acquires Medical Billing Solutions, expanding its geographic presence placing it in the top 10 large scale RCM services business.

Athenahealth announces that CFO Tim Adams will leave the company to take the same role with electronic commerce vendor Demandware, naming VP/Controller Karl Stubelis as acting CFO.

Sales

New York City Health & Hospitals chooses UpToDate from Wolters Kluwer Health for mobile clinical decision support.

Citizens Medical Center (TX) chooses electronics forms management from Access.

People

IBM names Keith Salzman, MD (CACI International) as CMIO for IBM Federal, which hopes to sell Watson and other technologies to the federal government for healthcare use.

Health Data Specialists promotes Bill Chandler to national accounts manager.

TriZetto announces John McAuley (PatientPoint) as president of its provider solutions business.

John Thornbury, a highly awarded hospital IT leader in England, died on April 28.

Announcements and Implementations

We are live with @Cerner OneChart @StVincentsMC as of 4 AM. Patients are safe. Hospital and medical staff are amazing.

— Stuart Marcus MD (@StuartMarcusMD) May 1, 2014

St. Vincent’s Medical Center (CT) goes live with Cerner, according to a tweet from the hospital’s CEO.

Government and Politics

CMS proposes increasing Medicare payments by 1.3 percent overall for FY2015 for the 3,400 acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and that have met Meaningful Use EHR requirements. Hospitals that haven’t met Meaningful Use would lose 0.675 percent of the proposed increase.

ONC releases a 30-second promotional video about Blue Button.

The VA says it will develop the next generation of its VistA EHR with the help of contests and challenges. Former VA guru Tom Munnecke is unimpressed: “It is not clear how the government owning all submissions in a contest will attract the best in the field. It is unlikely that many people would be interested in spending time and money to enter a contest where they give away their intellectual property.”

The Health IT Policy Committee will hold a May 7 public hearing in Washington, DC to review ONC’s certification process. It seeks input on allowing anyone to submit test cases so that certification measures real-world scenarios.

HHS didn’t want the Congress-mandated ICD-10 delay in the first place so it’s hardly shocking, but a proposed 1,700-page rule changing Medicare payments seems to confirm that ICD-10 will be implemented at the earliest date allowed by law – October 1, 2015. It could be that someone just updated the pre-delay document and forgot that Congress mandated only the earliest date, not the actual date – it’s only a proposed rule. The same document also spells “HIPAA” as “HIPPA,” so even the federal government gets confused.

Other

Most physicians order unnecessary tests and procedures if their patients insist, but they also agree that ordering such tests and procedures is a big problem. They think doctors are better equipped to solve the problem (58 percent) than the government (15 percent), according to the telephone survey funded by the Robert Wood Johnson Foundation.

Athenahealth VP Kyle Armbrester explains the company’s More Disruption Please program:

Our unique spin is that, because we take a percentage of net collection, we don’t actually partner with technology companies. We partner with outcomes companies like ourselves. So to be a part of the More Disruption Please program, we give our partner the scorecard, and that scorecard shows how they’re either driving more revenue to the doctors for doing the right things, or decreasing operational inefficiencies inside the providers’ workflow, or helping to improve patient and provider outcomes.

I’m always fascinated when family members riot and destroy hospital infrastructure after an unfortunate patient outcome (which doesn’t usually happen in the US, thankfully.) In Pakistan, a mob riots at a hospital, trashes the place, vandalizes cars in the parking lot, and beats up doctors and other employees after an appendectomy goes wrong and the patient ends up on a ventilator. Five days later, doctors haven’t declared the patient dead, and I wouldn’t either given the situation.

Microsoft gives in on its “no more updates for Windows XP” policy after the Department Homeland Security warns people to stop using Internet Explorer until the company fixes a security hole present in versions 6 through 11 that “could lead to complete compromise of the affected system.” The company says it will issue a one-time-only Windows XP auto-update to fix the vulnerability.

CHIME tweet out this photo of its 1994 Board of Trustees. Who can name them all?

Weird News Andy calls this story “Well Shut My Mouth.” Pediatrics nurses in a Saudi Arabian hospital are caught taping the mouths of babies shut to stop them from crying.

Sponsor Updates

• First Databank will present new safety guidelines for pediatric dosing at the 2014 Pediatric Pharmacy Conference April 30-May 4 in Nashville, TN.
• NC HIE upgrades its Orion Health Direct Secure Messaging.
• Ingenious Med will integrate Entrada’s dictation and content fulfillment technology into its charge capture platform.
• A report names Allscripts, Health Catalyst, McKesson and Verisk as key players in the population health management market.
• HCS will lead a discussion on LTCH CARE data set changes at the NALTH meeting in Washington, DC this week.
• Gartner names Validic in its 2014 Cool Vendors for Healthcare Payers report.
• Health Catalyst announces speakers and topics for the Healthcare Analytics Summit 2014, to be held September 24-25 in Salt Lake City, UT.
• DrFirst expands its Rcopia e-prescribing with electronic prior authorization functionality from CoverMyMeds.

EPtalk by Dr. Jayne

Mr. H already scooped me on this one, but the Federation of State Medical Boards (FSMB) recently adopted “Policy Guidelines for Safe Practice of Telemedicine.” My gut reaction is that this is just another way for licensing boards to extract more money from physicians by requiring additional licensure. My second response in actually reading the document (numbered line by line such that it reminded me of a deposition) is that there seems to be a whole lot of self-importance going on here. The seven-and-a-half page document has a Preamble, for goodness sake.

Physicians have been practicing by telephone and using secure messages for years, but apparently now we need to codify new standards just because there is technology involved. News flash: all the old standards (HIPAA, standard of care, ethics, etc.) already apply.

Some of the policy’s contents are very much common sense:

• The need for a “credible physician-patient relationship.” I suppose they’re trying to prevent physicians from turning into so-called pill mills, but then again they haven’t done a great job of preventing those in traditional face-to-face medicine. A quick look at the number of dishonest physicians selling work excuses and gratuitous prescriptions for controlled substances proves that.
• Adherence to privacy, security, consent, and safety principles. Again, already in force simply because we’re physicians.
• Proper supervision of non-physician clinicians.

On a subsequent read, however, several other provisions caught my eye.

• “Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.” Isn’t this exactly what happens when a patient presents to the emergency department, an urgent care, or many public health clinics? They are seen by the next available physician. They don’t get to pick and choose. Same thing with the assignment of patients to managed Medicaid panels, at least in my state. Again, not a lot of choice there and often a random assignment. Why should telemedicine be treated any differently?
• “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.” Again, this feels like a money-grab. I practice in a border town. The idea that I should have to get a different state license to practice telemedicine on a patient when I can see them in person with the license I already have if they’re willing to hop in the car, bus, or train is preposterous. What is magical about telemedicine that I should have to prove my competence to another state board?
• “The practice of medicine occurs where the patient is located.” I tend to think the practice of medicine occurs where my brain and ears are located – where I can hear, understand, and process the patient’s story. In medical school, we learned that 80 percent of the diagnosis comes from the history. The exam just confirms it and provides additional information when it is unclear. I guess the FSMB is now going to turn that old adage on its head. What if my patient sends me a camera phone picture of her rash (via a secure patient portal message using Certified EHR Technology) while on her beach vacation? Do I need a Florida license now because that’s where the patient is? The policy seems to say so, per Page 4, Lines 3-5 and 13-14. Maybe those line numbers were handy after all.
• “The maintenance of preferred relationships with any pharmacy is prohibited.” Excuse me? I have had preferred pharmacies my entire career. I prefer Mom and Pop shops rather than chains, especially when they know their stuff and don’t try to sell my patients aisles of junk food, questionable candy, and outdated cosmetics. I really prefer a pharmacy that doesn’t tell the patient, “The physician never sent your script” when they’re too busy to check the secondary screen on their prescribing software. I agree with the follow-up sentence that physicians shouldn’t send scripts to a specific pharmacy in exchange for benefits if we’re talking about SIGNIFICANT benefits (oh yeah, there’s a typo on Page 7, Line 23) but really, no preferred pharmacy? Does the fact that the Mom and Pop down the street brings a physician homemade cookies during the holidays make her unduly coerced? After all, that’s a benefit. What if the physician also takes them cookies because she’s grateful they are so meticulous with her patients’ scripts? Does that negate the benefit?

In this day and age with the mobility of our society, mobility of physicians, and the technology at hand, it seems more and more preposterous that individual states should continue to license physicians individually and/or without a greater degree of reciprocity. There are all kinds of problems with physicians being disciplined in one state and just going for a license in another state. Why not have a national licensure process? I suppose a counter argument would be that Medicare has a single provider identifier but still can’t correctly identify fraud, but that’s another story.

I really like their closing paragraph. Here’s a winner: “…physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral)…” Why should this be unique to telemedicine? Isn’t this something we grapple with on a daily basis, patients who come in wanting a script or referral they don’t need? What about those that want a test “because Medicare pays for it” whether they need it or not? Often our remuneration is ultimately based on whether we comply, either through patient satisfaction scores or the simple fact that they will vote with their feet. On the flip side, what about aesthetic medical services? Aren’t those ultimately driven by patient-desired outcomes? Especially ones like this recent find for aesthetic foot surgery.

On its face, this policy regulates us too much in regards to telemedicine, but perhaps I’ll go a little Jonathan Swift and suggest that maybe we’re not regulated enough in regards to everything else. It’s like saying we’re going to regulate wine in a box but not in a bottle. At this point, the policy is “advisory” so states can take it, leave it, or modify it.

What do you think about the FSMB’s plans for telemedicine and telemedicine technologies? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/1/14

Merge Reports First Quarter Financial Results

Merge reports Q1 results: revenue dropped to $50.9 million from $63.6 million during the same period last year, but lowered costs drove a net income increase of 47 percent. EPS of $0.00 vs -$0.07, stock prices ended trading five percent down on the day.

Boston Medical Center fires vendor after data breach

Boston Medical Center fires its transcription service vendor after it was discovered that 15,000 patient records were posted on the vendor’s website without password protection.

VA Eyes Cash Prizes To Generate Ideas For New Health Record

According to a notice posted on a federal contracting website, the VA will launch a series of design challenges to help generate innovative solutions for its next-generation VistA platform.

March 2014: EHR Incentive Program

CMS has now paid out $22.9 billion since the start of the EHR Incentive Program.

Health IT from the CIO’s Chair 4/30/14

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers. Objects in the mirror may be closer than they appear. MSRP excludes tax. Starting at price refers to the base model; a more expensive model may be shown.

The Budget Paradox

Hospital IT budgets come in two forms: capital budgets (one-time project expenses) and operating budgets (staff and ongoing expenses.)

I probably don’t need to write much by way of background to make the case of why hospitals are under pressure to reduce expenses. It would be fair to add that the pressures are more intense these days. The larger problem involves how we deliver care, but that does not mean that hospital systems aren’t equally focused on cutting expenses.

To be more precise, most budget reduction efforts are macro projects to either hit a specific target or to “bend the curve” such that operating expenses don’t rise or rise at a slower pace. This can be particularly vexing for IT for a number of reasons.

The first big one relates to how organizations view information technology. Often, to the chagrin of IT leaders, IT is seen (or willed) to be a magic bullet. As such, solutions are ordered in increasing numbers, creating scenarios of increasing IT demand. Often these systems are justified around the capital budgets alone, with the operational budget implication not fully understood until a year or two later.

If IT shops were standalone businesses, this increased demand would be a good thing (more customers! ) But IT shops aren’t standalone business, so they often have loose ROIs to carry. The resulting consequence is more weight added to the operating budget.

This in itself does not really create a paradox, but it does add to the pressure of trying to meet a budget target. The budget paradox is tied to a changing philosophy and approach around IT pricing.

Before I tie the pieces together, let me talk about Meaningful Use. Forget for a moment stages and government regulations. At its core, MU was a great idea to reward or incent organizations not for just installing IT, but for using IT. Some ideals and subjective concepts were added to aim beyond “use” and to strive for something higher (Meaningful Use), but that aside, of the things MU did was legitimize the pricing strategy that IT software could (and maybe should) be measured by use, not by installation.

Prior to this thinking, most hospitals bought large IT purchases around capital budgets and booked the expense based upon install. Reflecting the early days of IT, we took credit for simply getting a system in.

I support and like the idea that we should get credit for success upon use. While it’s hard to measure and define what might be “meaningful use” versus “use,” I think as long as we are generally focused on having IT measured beyond the install, we are aiming in the right direction.

Back to the budget paradox. Traditional thinking around operating budgets is that as you continue to operate, you should be able to control or reduce costs. Experience, efficiency, and maturity of operations should all lead to cost reductions. This manifests itself in common year after year quests to either keep operating budgets flat or reduce them. 

But as IT pricing models have shifted to use-based or volume-based, and with the magic venture capital words of “recurring revenue,” the idea of year-over-year reductions and rising costs from growing use begin to conflict.

Take the following example. A hospital deploys an EMR. Over the course of the year, it builds upon its success and increases its user base. Let’s imagine more orders entered, more concurrent users, and maybe even new modules and functions turned on. Juxtapose this against an expectation to achieve operating maturity and flat or reduced budgets. You are aligned for a paradox as you pay new fees for new use.

Of course, like every good CIO, I keep great records for my “guilty but with an explanation” budget list. I use sophisticated spreadsheets to demonstrate that on a “same-store basis,” my budget is trending down. But none of this matters if the organization’s macro demands are for budget control.

How do we solve our paradox? How can we continue to grow and contain costs? 

No doubt the answers are different for everyone and deeply tied to specific situations, but I think we need to work on a few themes.

1. We need to get as good at turning off older systems as we are at turning new ones on. Incremental gains don’t much help here. A discipline of measuring off or on must be applied.
2. We need to look at ways to leverage infrastructure at scale beyond our own individual sizes.
3. We need to find ways to use more of what we have to gain richer functionality from the systems (and costs) that we already own.
4. We need to be close to our labor costs and understand how best to balance all the levers.

The challenges ahead are complicated and will require us to think about things in new ways. The hospital IT budget is only going to be faced with new demands. It’s time to get innovative.

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

HIStalk Interviews Blain Newton, SVP/COO, HIMSS Analytics

Blain Newton is SVP/COO of HIMSS Analytics of Chicago, IL.

Tell me about yourself and HIMSS Analytics.

I started in IT, with a focus on healthcare IT, probably 15 years ago as an accountant in finance. I moved into operations and strategy at some large EMR vendors, both here and in the UK. I was CEO of CapSite, acquired by HIMSS. I joined the HIMSS Analytics business unit from there.

HIMSS Analytics is the sister company to HIMSS North America, which is what most people think of when they think of HIMSS. We’re a market research firm with a number of market intelligence solutions, databases, and a suite of customized consulting services. We’re the data and the information behind the HIMSS EMR Adoption Model that you’ll see a number of hospitals and vendors post on your site about on occasion as they reach Stage 7.

Describe how HIMSS Anayltics operates as part of HIMSS.

We’re part of HIMSS Worldwide. We’re a strategic business unit of HIMSS Worldwide, as is HIMSS North America, HIMSS International, and HIMSS Media Group. We’re not-for-profit. We are part of the cause-based, mission-based organization that HIMSS is.

We operate independently. We help vendors make more strategic, informed decisions about going to market and how they’re competing in the landscape. We help providers make more informed IT investment and deployment decisions. 

We are separate entirely from the HIMSS North America that you’d be familiar with the trade show or with membership or with advocacy operations. We’re run as a cause-based not-for-profit, but separately run from the broader HIMSS.

CapSite had interesting offerings like market research and the contracts database. What elements of CapSite have been rolled into HIMSS Analytics?

The really good thing is there was really very little overlap in the HIMSS Analytics offerings and the CapSite offerings. They’ve been integrated in a very complementary fashion.

We still offer the CapSite database of contracts and proposals. There’s over 6,000 of them covering 150 categories. Actual Ts and Cs, actual pricing information, to help vendors understand how their competitors are going to market, to help providers understand where they can mitigate risk and potentially negotiate better deals. That still exists and is being integrated more fully with the HIMSS Analytics database, which was an existing asset.

The market research and reports that you’re talking about also still exist, although we’re now leveraging the information that we get in the HIMSS Analytics database to add even more flavor and information to these reports. 

In the next 12 months or so, you’re going to see a different spin on those. It’s still the same level of information coming from the market research, the same kind of color to the palette, let’s say. Who’s doing what in the market and why and why decisions are being made, along with a historical view of what has happened in the market over the last few years and where the market stands today as far as market share, mind share, etc. Those offerings still exist and are being built out to leverage the strength of the HIMSS Analytics tools in a more robust way.

How do you collect the information for the database?

For the HIMSS Analytics database, we do a census survey of every hospital in the country, as well as Canada and several other countries across Europe and Asia. It’s not census-based in Europe and Asia, but in the US we reach out to well over 5,400 hospitals that have another 40-plus thousand affiliated ambulatory practices and a number of ACOs. We talk to their CIOs or others to gather information about what IT they’re using, how they’re using it, etc. What their replacement plans are for those technologies.

On the CapSite database, we also work with the provider organizations directly and gather this information under the Freedom of Information Act. As part of a cause-based organization, we bring that information in and we redact it so there’s nothing proprietary going out. We’re not in the business of sharing vendors’ family secrets and we’re not in the business of exposing any healthcare organization. Our role with the CapSite database is providing a level of transparency in the IT procurement cycle. But again, it’s all gathered under the Freedom of Information Act.

What products do you sell and who buys them?

We sell the HIMSS Analytics Database to vendors. They use the tool to understand where they fit in the competitive landscape. Helping them understand market share, where there’s market opportunity, where they can better present their offerings to the market.

From the providers’ standpoint, they also utilize the HIMSS Analytics database — it’s free of charge to them — to help them benchmark themselves against their peers, help them understand where they fit on the maturity models that we have out — the EMR Adoption Model, the Ambulatory Adoption Model, the DELTA Powered Analytics Assessment — we have a number of maturity models.

On the CapSite side, vendors also purchase the CapSite database to understand how they’re presenting themselves and proposing themselves against their competition. Providers use it, as you can imagine, to understand when they’re sitting at a data negotiating table, how are they mitigating their risk, how are they making sure they’re getting a good deal for their organization.

To complement those market intelligence solutions, which is what we call those databases, we offer a variety of customized research capabilities, whether it be helping providers do gap analysis and roadmap assessments for where should they spend that next dollar of IT budget or for vendors helping make strategic decisions about product direction and where they should take their portfolio as well as how they can maximize the products that they have in market today through understanding their client base better through voice of client engagements, win/loss engagements. Win/loss engagement is tailored to and tied to the market intelligence tools that we have to do more than just win/loss — it’s focused on organizational improvements to help capitalize on the market better. 

Then of course we offer the research reports that you talked about. We have a tool called the Essentials Report that we put out as well as the CapSite syndicated reports. As I said, we’re going to be merging those two together into a new and improved Essentials for the next 12 to 18 months.

Is it typical for a member organization to conduct market research of members who are prospects and sell that information to members who are vendors?

We view it a little bit differently than that. We look at it as the way that we’re helping with the cause of better healthcare IT. We’re trying to bring transparency to the entire procurement cycle. 

To the extent that we can help a provider understand what they should be looking for in terms of next steps in technology, how they should deploy it — that’s a positive. To the extent that we can help a vendor position their product in a way that will more effectively meet the needs of the provider — that’s a benefit. 

We don’t look at it in terms of, we’re going to help you sell your product. We look at it and say, the more transparency that we can bring into this cycle, the less cost will be present in it, the more openness and transparency will be in it, and the better off everybody is for doing it. We’re really just trying to bring information to the market and let the parties on either side of the table make decisions based on that information.

Do you contact every hospital in the country? What kind of logistics are required to do that?

We do. Much of it’s self-reported. We have tools in place to allow the provider organization to self-report much of the data. So much of what we do is validation and gap fill. In exchange for getting peer benchmarking reports, in exchange for understanding whether organizations fit on the EMR Adoption Model and other maturity models, many of the participating organizations — which is virtually all — self-report much of the data.

What trends are you seeing that most people wouldn’t have expected?

I don’t know if there’s anything terribly surprising based on what’s out there and what folks read on your blog. But as you can imagine, folks are now moving beyond Meaningful Use Stage 1 and understanding what’s going next. A lot of it is optimization of what’s already been bought. There’s still much to do in doing that.

But the biggest trend we’re seeing is this push towards patient engagement and care outside of the walls of an organization. How do you care for that patient and what is the value proposition to do so? There’s a lot of interest right now in understanding that and moving towards that. As we’ve gathered all this data as part of setting up our EMRs, now what do we do with it and what is the value proposition behind it? 

I don’t think it’s anything terribly surprising. Different organizations are at different stages of it. Some of that depends on whether or not they have patient lives at risk under a healthcare plan, for example. They may be more inclined to understand care beyond the walls than somebody that doesn’t have those patient lives at risk as part of a healthcare plan. But again, it’s just really understanding now we have all this data, what do we do with it? 

We launched at the last annual conference in Orlando a couple of additional maturity models to help organizations make sense of that, the Continuity of Care Model and the Total Revenue Management Model.

Part of the transparency that’s most needed is the products someone bought that didn’t work out as they expected or the lessons they learned the hard way in implementing new ideas or strategies. Do you report any of that?

We don’t report it, per se, as part of data. We do look at adoption of technology. We can look through and say, this particular solution has not been adopted to the level that others have. That’s hard to say whether or not it was product implementation or organizational. We don’t get into that level of detail. 

As you know, you’ve been in this game a long time, a perfectly good solution could not be as successful as folks wanted it to be for any variety of reasons. It’s rarely just because of the solutions, so we don’t report them that directly. We do help vendors who are trying to improve their retention rate, improve their win rates. We do go in through qualitative and quantitative research, help them understand why their solutions are being adopted successfully or not, and help them make those organizational improvements to do so.

We think that’s in the best interest of the industry as a whole. If we can get all the vendors better understanding how they can be successful, then that’s a good thing for everybody.

Are vendor user groups the best place for that to happen? People seem to just want to know what their fellow customers did, what problems they had, and how they solved them.

I think vendor user groups can be very successful. In a previous life, I was very active as a moderator in a vendor user group and I saw tremendous value come out of it, as long as there was that willingness to be open and honest about strengths and weaknesses on both the provider and the vendor side. I think that’s just one avenue to start to get this information out there.

We try to do it through a variety of mechanisms — through focus groups, webinars, and vendor user groups. We work closely with the HIMSS regional chapters to try to share this information with members and vendors. I think it’s a powerful forum, the vendor user groups, but it’s one of many.

What changes do you expect with HIMSS Analytics and in the industry in the next three to five years?

As I think about where HIMSS Analytics is going to be, we’re experiencing strong growth right now. We can expect to continue that. We expect a lot of our growth to happen on the customized consulting side. 

Everyone had a blueprint for what they needed to do previously. They needed to go out and buy an EMR. Now their question is, what’s next? We see a lot of folks coming to us and asking, where’s this market going and how do we succeed in it and make our clients happy?

We see providers saying, all right, we have all this data, what technology should we go after next to achieve the most benefit from that data and this information that we have? We see huge growth coming from our consulting organization as we help both sides make better, more informed strategic decisions.

From the industry side, we launched the Total Revenue Management Model. We launched the Continuity of Care Model. That is an indication of where we see the industry going. As we start to shift towards a more accountable care world, what technologies are going to be needed to care for that patient beyond the walls of your facility, beyond the walls of your organization, in the patient’s home, in a non-affiliated practice? What are the value propositions and the revenue implications, the bottom line implications, of doing that? 

We structured these two models — along with the DELTA-Powered Analytics Assessment, which is a way to understand an organization’s capabilities in terms of using data as information — to help guide the industry in those next three to five years because it’s a bit of an unknown. We’ve seen some very successful organizations achieving significantly improved outcomes and cost realizations from using analytics and capturing information outside of the organization, but those are rare. Those are not the norm right now. That’s the trend we see happening.

Some of your readers have had thoughts about it. Dr. Wellbeing brought up a point that the technology’s great, but it’s ahead of the payment paradigm right now. That’s certainly true in some instances, but we see that trend beginning to shift and organizations beginning to understand the value of leveraging as much information as they can to improve patient care and achieve cost-benefit realizations.

Any final thoughts?

I’ve been in this game for 15 years or so. We’re at a really exciting time. I think both of us remember the time when very few people had EMRs and no one quite knew what to do with them. We’ve moved into this place where virtually all have and a significant portion are using them in a very capable way. 

Now that we have them in place, we can truly use the information that’s coming out of them to improve care, reduce cost, and start to achieve the vision that everyone had when we laid out the notion of healthcare IT.

We have a long way to go, but it’s a pretty exciting time. I’m thrilled to be part of an organization that can help bring some clarity to a market that may be a little bit cloudy at the moment.

Morning Headlines 4/30/14

M*Modal Files Chapter 11 Plan Backed By Creditors

MModal files its disclosure statement and reorganization plan, detailing the company’s strategy to exit Chapter 11 bankruptcy by August 15.

UPMC Selling Analytics to Curb Health Care Costs

UPMC will begin licensing its homegrown clinical analytics system to other healthcare organizations. The platform identifies the lowest cost treatment plans that consistently lead to the highest quality outcomes and then benchmarks individual physician performance against this data. In the ED, the system is used to predict which patients were more likely to be readmitted, helping UPMC staff reduce readmission rates by 37 percent.

Medfusion’s Relationship with Allscripts Comes to an End

Medfusion will no longer offer its patient portal through Allscripts "due to unresolved payment disputes," according to a statement released Monday.

Nuance CEO Paul Ricci tops in pay among Massachusetts executives

The Boston Globe calls Nuance CEO Paul Ricci the most overpaid executive in Massachusetts. Ricci earned $87 million over the past three years, during which time his company’s stock fell 16 percent.

News 4/30/14

Top News

MModal files its plan to exit Chapter 11 bankruptcy by August 15. The company provided a statement: “MModal is pleased to have reached this important milestone in our financial restructuring process. The proposed Plan of Reorganization reflects the previously announced agreement the company reached with the controlling majority of its lenders and bondholders that will dramatically reduce the company’s debt, strengthen its balance sheet, and provide it with significant financial flexibility.”

HIStalk Announcements and Requests

Bonny from Aventura provides an Charles Schulz-powered illustration of the ICD-10 situation that will resonate with many people.

I noticed these signs in a doctor’s office today. It seems that all forms of customer-insulting emphasis are represented: capitalization, bolding, underlining, and massive deployment of exclamation points (always five except for the laptop message, which ends with an unprecedented six exclamation points for those undeterred by inferior numbers.)

Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

Physician networking site Doximity closes a $54 million Series C fundraising round, planning to expand into Canada and to add other healthcare professionals, such as nurses.

Truven Health Analytics acquires Fortel Analytics’ predictive healthcare fraud technology, which will be integrated into Truven’s payment integrity solutions.

General Atlantic commits $125 million to Alignment Healthcare, which offers a care coordination solution.

Alere reports Q1 results: revenue down three percent, adjusted EPS $0.55 vs. $0.53, missing revenue expectations. The company also reported that its Health Information Solutions segment experienced a decline in net product and services revenue from $134.2 million a year ago to $123.7 million.

Press Ganey acquires Dynamic Clinical Systems, a patient-reported outcomes services and solutions provider.

Infor completes its acquisition of substantially all the assets of GRASP Systems International, a provider of automated patient acuity, workload management, patient assignment, and consulting services.

Consumer engagement provider Accolade acquires konciergeMD, which offers a platform for care plan adherence.

For-profit hospital operator HCA discloses in its earnings call that it took in $30 million in EHR incentive money in Q1 vs. $39 million in 2013, incurring EHR-related expenses of $43 million and $26 million, respectively, meaning it spent exactly the same as it made in the two years. Seems like quite a coincidence.

Roper Industries says in its earnings call that its Sunquest operation experienced “double-digit revenue growth” due to improvements in its implementation process and expects to have a “quite an exceptional year in 2014.”

A German business magazine predicts that Siemens will announce on May 7  the elimination of 5,000 to 10,000 jobs and the merging of its four main divisions (industry, energy, healthcare, and infrastructure/cities) to create a flatter hierarchy.

Sales

Craneware wins a seven-year, $3.8 million contract with an unnamed US hospital group for its Chargemaster Corporate Toolkit.

Southern Illinois Healthcare, MBB Radiology (FL), Radiology Imaging Associates (CO), Southwest Diagnostic Imaging Center (TX), St. Paul Radiology (MN), and Washington Radiology Associates (VA) and 13 other organizations select Merge Healthcare’s iConnect Network interoperability platform for clinical data exchange.

CHE Trinity Health will implement Verisk Health’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives.

The board of trustees of Cumberland River Hospital (TN) approves $156,644 in upgrade costs to allow the hospital to update its CPSI software to meet Stage 2 MU requirements.

The University of Arizona Medical Center will use services from Besler Consulting to identify Medicare Transfer DRG underpayments.

Kettering Health Network (OH) selects Wolters Kluwer Health’s ProVation Order Sets.

University of New Mexico Medical Group chooses StrataJazz from Strata Decision Technology for budgeting and planning.

People

Castlight Health appoints Ed Park (athenahealth), brother of co-founder and US CTO Todd Park, to its board.

Symphony Technology Group promotes Al Vega to president/CEO of Symphony Performance Health.

Jonathan Perlin, MD, CMO will step down as chair of ONC’s HIT Standards Committee. He will be replaced by Jacob Reider, MD of ONC.

MEA|NEA appoints Scott Hefner (Jopari Solutions) VP of sales.

Announcements and Implementations

Practice Fusion launches a population health management offering in collaboration with drug manufacturer Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with the rates of other Practice Fusion providers.

Regional Medical Center Orangeburg (SC) goes live on Cerner’s patient portal.

Central Illinois Health Information Exchange, Lincoln Land Health Information Exchange, Illinois Health Exchange Partners, and MetroChicago Health Information Exchange connect their health information exchanges, which collectively serve 63 hospitals.

Government and Politics

CMS releases an interactive search tool to streamline access to Medicare provider payment data.

The GAO appoints three members to the Health Information Technology Policy Committee: Christop U. Lehmann, MD, American Academy of Pediatrics (representing vulnerable populations); Neal Patterson, Cerner (representing vendors); and Kim Schofield, Lupus Foundation of America’s Georgia chapter (representing consumers and patients.) Paul Tang, MD of Palo Alto Medical Foundation was reappointed as physician representative.

Innovation and Research

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Brigham and Women’s Hospital chooses four companies in its “shark tank” competition for pilot projects: Twine Health (collaborative chronic disease management), MySafeCare (patient and family reporting of safety concerns), Healo (remote monitoring of wound healing), and Tenacity Health (peer health coaching.) 

Other

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to care for only those patients located in their licensure coverage areas, establish a credible patient-physician relationship; and adhere to safety and privacy principles.

A Boston Globe columnist names Nuance Communications CEO Paul Ricci as the most overpaid executive in Massachusetts based on his compensation of $87 million over the past three years, during which time the company’s share price dropped 16 percent.

Medfusion ends its relationship with Allscripts “due to unresolved payment disputes” and gives the 30,000 Allscripts users of its patient portal until May 31, 2014 to sign a contract directly with Medfusion. The termination is hardly a surprise given Allscripts acquisition of the competing Jardogs product last year.

Boston Medical Center (MA) terminates its transcription contract with MDF Transcription Services after discovering that the records of 15,000 of its patients are visible on the company’s Internet server.

St. Joseph’s Hospital Health Center (NY) discloses in a prospectus offering to sell $68 million worth of junk-quality bonds to pay for a new power plant and EHR system that it will probably be sued over claims that a disruptive surgeon slapped and verbally abused anesthetized patients going back to early 2012.

Rural hospitals are considering EHR implementation assistance as one reason to affiliate with a larger organization, hoping to earn financial incentives or avoid penalties.

University of Mississippi Medical Center (MS) CIO David Chou recounts what it’s like when a hospital loses Internet connectivity and access to cloud-based applications. The article mentions that low adoption rates prevented using Twitter and Facebook for communication during the outage, which I assume means by smartphone cellular since nobody could get to those sites otherwise (although they could use self-hosted Yammer instead if Microsoft still offers that.)

A San Francisco Examiner opinion piece by an orthopedic surgeon complains about his hospital’s use of the “all-pervasive Epic” system, which he says has caused doctors to focus on the computer instead of the patient and has sterilized the medical record to the point of uselessness. He seems to blame the system for the behavior of its users, saying it only improves care “from the point of view who want to watch data from across the room” while he prefers to “talk to the patient” and be a “hands-on doctor,” neither of which as far as I know is prohibited among Epic users.

UPMC (PA) will partner with one of three unnamed companies to sell analytics software it developed to benchmark costs per individual physician. UPMC says it spent $5-12 million to develop the system, which it claims has reduced its readmissions by 37 percent.

A state audit reveals that a former IT consultant with the University of Iowa Hospitals and Clinics illegally sold $57,000 worth of hospital computers to staffers and friends between 2005 and 2013. A woman tipped off the IT department after trying to get technical support from Dell for a laptop the consultant gave her, only to be told that it was registered to the hospital.

Weird News Andy (“Weird News You Can Use”) finds this ironic: hundreds of attendees of the national Food Safety Summit in Baltimore get food poisoning. WNA is also transported by this story, in which doctors trigger vivid memories of a patient’s childhood as they stimulate areas of his brain with electrodes in trying to determine the cause of his epilepsy.

Sponsor Updates

• McKesson launches Managed Mobile Services to simplify mobile device management.
• iHS2 releases a research report entitled “Healthcare Security: 10 Steps to Maintaining Data Privacy in a Changing Mobile World.”
• Craneware and its customer Southeastern Ohio Regional Medical Center will discuss the future of patient access at the National Association of Healthcare Access Management 40th Annual Education Conference May 16 in Hollywood, FL.
• Independent auditor LBMC confirms that PerfectServe has achieved Service Organization Controls (SOC) 2 Type II of its security and privacy controls.
• Allscripts recognizes its customer Carson Tahoe Health (NV) for attesting for MU Stage 2 using Allscripts Sunrise.
• Medhost adds high-availability disaster recovery and remote monitoring and management to its managed IT service offerings.
• Shake IT Baby is the theme for Impact Advisors’ annual Impact Palooza April 30-May 2 in Scottsdale, AZ.
• William J. Leander, SVP for Santa Rosa Consulting, will discuss value-based healthcare at next month’s MUSE 2014 International Conference in Dallas.
• Allscripts profiles Unity Health System (NY) in a blog post and discusses how dbMotion’s HIE technology helped Unity achieve better outcomes.
• Liaison Healthcare partners with AOD Software to connect its long-term provider customers with lab and imaging vendors on the Liaison EMR-Link hub.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/29/14

Merck Teams With Electronic Health Record Provider Practice Fusion To Improve Patient Health

Merck partners with Practice Fusion to bring EHR-based immunization reminder tools into physician practices. The partnership will provide physicians with the added ability to track immunization rates at the population level, and automatically send immunization reminders to patients.

What Do Physicians Read (and Ignore) in Electronic Progress Notes?

Researchers at the University of Massachusetts Amherst studying the eye movements of physicians as they read electronic notes find that the clinical narrative within the impression and plan section of the note was nearly always carefully read, but that the remainder of the note was only quickly scanned.

Reading Pain in a Human Face

Researchers with the Institute for Neural Computation have created software tool that can outperform humans at differentiating real pain from faked pain by analyzing facial expressions. In the study, participants were asked to watch a video showing subjects expressing either real pain or  faked pain. The participants were only able to correctly identify real pain 55 percent of the time, but the computer program could accurately identify real pain 85 percent of the time.

Curbside Consult with Dr. Jayne 4/28/14

Death of a Practice

I wanted to be a physician from a very young age. Most people find that interesting because no one in my family is a physician or even in the healthcare field.

Going into junior high school, my best friend (who eventually became a nurse) and I became candy stripers, starting our healthcare careers. My first memory of a physician who didn’t make me cry was the kindly general practitioner my parents took me to after our pediatrician retired. He was the kind of doctor who kept his patient records on index cards (they were 4×6 inches) and wore a reflector on his head – old school.

Flash forward to second year of residency, when most primary care trainees start looking for a job. I had a potential offer from the medical group affiliated with the hospital where I was training. I had seen too much from the inside, though, to really want to work for them, so I decided to investigate whether that hospital where I first started was hiring any physicians.

In a stroke of luck, they were looking for someone interested in solo practice. I was offered a start-up in the small town where I grew up.

Their deal looked pretty good. Although technically employed during the first couple of years, the group allowed their sites to run like private practices and the physicians were on a largely eat-what-you-kill model. They were allowed autonomy over their practice except for certain office processes, which were paid for through a management fee taken off the top. Compared to hiring separate billing, compliance, OSHA, legal, HR, and other services, the management fee was extremely competitive.

I had rotated in one of their practices as a student and had seen first-hand how things ran. Two trainees ahead of me had taken jobs with them and everything was on the up-and-up. The non-compete was such that physicians could actually buy their practices and go private, staying in the same location, once they got off the ground. Coupled with the fact that they were willing to install an EHR at no cost to me and the fact that as a solo doc I wouldn’t have to deal with anyone else’s baggage, it was a done deal.

I had a lot of input on the office itself since construction had just started in a local strip mall. It was built for electronic health records from the beginning and was large enough to eventually house three physicians. The sponsoring hospital had done its homework and knew there was primary care demand in the community. We had people trying to make appointments more than a month before we were set to open.

I completed residency at the end of June, sat for the Board exam two weeks later, and opened the practice the following Monday. I saw nine patients that first day and never looked back.

I was proud to be part of the community. I had my own branding, Most people didn’t realize we were affiliated with the hospital. That was a big draw for some and gave us a certain pride of ownership I don’t think we would have had if we were visibly under the hospital umbrella.

Patients loved us being in the strip mall near a high-traffic intersection, glad they could park 20 feet from the door rather than having to use a parking garage or large lot at one of the hospital-based practices. I threw candy from a float in the Founders’ Day parade. It many ways, it was a dream come true.

My little office grew by leaps and bounds (“local girl comes home” is a powerful marketing statement.) Before long, I was ready to add another physician and eventually a nurse practitioner. The hospital sponsored several other start-up primary care practices, hiring a couple of my residency colleagues to help them build a troop of primary care docs to stay ahead of the community’s needs.

As for my site, since we were piloting the EHR system that the hospital’s parent health system planned to implement for all owned practices, I became pretty visible as an EHR champion. Eventually I was hired as part-time medical director for ambulatory EHR. One half-day a week at the IT office became two, then four, to the point where several years later I was only in the practice one day a week.

Eventually, patients’ lack of access to me became the topic of every office visit. Realizing it wasn’t good for the practice or my morale, one of our IT directors figured out a way for the hospital and IT to buy me out. It was a bittersweet decision to leave my little start-up, which wasn’t so little any more. We never turned an enormous profit, but we did break even and I had the opportunity to recruit my own replacement. It seemed like things were in good hands, so off I went to the land of IT.

The practice thrived until the recession started, the auto industry failed, and other heavy industry went to states with cheaper costs of labor. I had moved on career-wise, but still had enough connections to hear the updates on “my” practice. The staff was a little less busy, the bad debt write-offs grew, and the finances moved into the red.

The hospital president believed in primary care, though, and continued to subsidize the practice, knowing there was a need in the community (I’m not naïve — he also knew how many million dollars in ancillaries the average primary care doc drives to his or her preferred hospital.) And so the office stayed open.

Fast forward, and the hospital (now a major part of the regional safety-net rather than a community resource that drew patients through innovation and excellence) posted several major losses, sending its president to greener pastures elsewhere. Then one of the providers left for a higher salary, followed by another who took a maternity leave and never came back.

The hospital had a hard time finding a physician who wanted to care for patients with difficult socioeconomic challenges, especially when affluent practices with richer payer mixes beckoned. They weren’t willing to guarantee a salary that would have convinced someone to stay. I had last heard the practice was running with a single nurse practitioner who was supervised by a physician 20 miles away.

I found out today that the office is closing. Once I stood on the sidewalk with the mayor of our small town, cutting the “Grand Opening” ribbon with his giant gold-painted scissors. Now that sidewalk will lead people to yet another vacant quasi-retail space.

The provider who remains is being “consolidated” into a shared office on the hospital grounds, where physicians seem to land when they can’t get along with their partners or their practice loses too much money. Any trace of the office we worked so hard to build will soon be gone.

The economic reality is that no one wants to own small primary care practices any more. The work is hard, the hours are long, and the pay is less than other specialties. Hospitals stepped in hoping to lure primary care docs to their communities and solidify their slices of the revenue pie. Once they stop making money, though (which is often the reality of primary care in our current model,) it’s the beginning of the end.

Perhaps new payment models could have saved my little practice, but we will never know. Rather than having a family physician down the street or around the corner, patients will drive half an hour and navigate the maze of the hospital campus. They’ll probably be subject to a facility fee now, as I’m sure the remaining provider will be set up as a hospital outpatient department to try to eke out as much revenue as possible.

Even though I haven’t practiced there in years, I feel bad about it. I’m sorry that primary care doesn’t get the respect or compensation it deserves. I’m sorry that the hospital is no longer willing or able to subsidize valuable community services.

But most of all, I’m sorry for the patients. I’m grateful, though, for the time we had together, for the times I was able to help, and most of all, for the memories.

Email Dr. Jayne.

HIStalk Interviews Cynthia Petrone-Hudock, Chief Strategy Officer, The HCI Group

Cynthia Petrone-Hudock is chief strategy officer of The HCI Group of Jacksonville, FL.

Tell me about yourself and the company.

I have a background in financial institutions, about 17 years. I’ve spent about the last eight years in healthcare.

As our mission states at The HCI Group, I focus on collaborating somewhat from a management consultant perspective. I work with clients to identify what their needs are and then develop creative solutions that reduce the cost of healthcare and at the same time improve their ability to increase the quality of healthcare.

We were established to meet the system implementation needs of healthcare organizations, but we promote cost-effective solutions. In the electronic health record arena, that seems to be very important these days.

People always compare healthcare to the early days of banking before ATMs and online services. How do you compare the two?

It’s quite fascinating because I do see a lot of analogies. We are at the stage now in healthcare where we’re selecting systems and implementing them, but then truly sustaining them in a cost-effective way and getting to interoperability.

You think about interoperability in the banking world. They’ve mastered it. I think we’ll push a little further in healthcare when it comes to data analytics and making sure that we’re using the data that we capture in a proactive and focused way. We saw some of that in banking, too, but I think it will mean more in the protocols of care in the healthcare arena.

Treating patients as a customers means hospital systems should include some aspects of a customer relationship management system. Is there a demand for those capabilities?

Yes. A lot of our focus is on business intelligence. We launched a sustaining support service line at HCI. Our goal is to support users of the electronic health record, but when you really think about it, it’s business intelligence of how they’re using that system to meet the needs of their clinicians who are taking care of their patients is what it’s all about. 

Maybe the future, when we’re talking about patient engagement, it’s really the analytics around that and the touch points of how the patients are interacting with the healthcare system which will be key. Forward thinking, where are we three to five years from now? It’s full-service care and you can interoperate on the health record. You’re certainly putting that full-service care capability in the hands of a clinician.

Back to the bank analogy, hospitals are putting in systems that run what happens inside the bank or at the ATM, but not how banks market to customers and prospective customers in between and keep them engaged. Could the same transition happen in healthcare?

Yes.  I think healthcare is starting to realize that they can get their arms around that capability. We’re seeing it now. We’re seeing it with marketing departments and healthcare systems who are now focused on engaging the consumer. Even with the new consumer technology, whether it’s handing out free Fitbits and having folks proactively start to monitor their health and having reasons for them to be reaching out to the doctor in a proactive way.

It’s exciting. I think we will see that. It gets back to the ability for the patient to be in control of their care. I’m hoping that’s what the enabling technology brings to bear.

For large hospitals, the market has pretty much boiled down to Epic versus Cerner. From the selections you’ve been involved with, why do hospitals choose one versus the other?

They start with their thoughts around the business case and their total cost of ownership, including their incumbent situation. But they do focus on functionality and where they want to get down the road. 

Quite often the cultural difference between the two organizations plays in some of the demonstrations and the ability to understand how their patient will be engaging with their organization going forward and whether that’s an integrated touch point or not. Most of my background is in Epic, but The HCI Group is vendor neutral.

How do you characterize the cultural factor differences between the vendors and which one prospects respond to?

I haven’t been around the block enough to weigh in on that from a client’s perspective. I’m guessing different clients would tell you they have different reasons why they are more comfortable in one camp versus the other.

Both systems, of course, are very exciting for us to be working with, and just knowing that we have organizations worldwide that are getting on EHRs for the first time, which is also exciting. We do a lot of work in that space, so I get to see organizations who are literally on paper, and just knowing that they’re going to get on electronic medical records is changing the protocols of care at the moment they go live. 

It’s more a fit and feel between the two organizations and whether that organization feels confident that they’ll have interoperability opportunities down the road. I think even the paper-oriented firms abroad are very focused on someday it should all interoperate.

Have hospitals done a good job in understanding and budgeting the post-live requirements for personnel and maintenance costs? 

I think there’s a lot of realization going on after they get past the capital period and they’re in their expense mode. They’re realizing that they need to focus on the lowest common denominator. 

For instance, our sustaining support line is a good example where when we go into an organization, we help look at the total process of supporting that application. At every point along the cycle, if there’s a way to do that service at a higher quality and a lower cost, of course we assist in improving the process. It’s the ability of having capacity that can ebb and flow, whether you’re looking at an upgrade or you’re looking at bringing in the new module that you didn’t go live with out of the gate. 

I do believe the CIOs are finding themselves in the situation where they’re explaining to the CFO why their piece of the total cost of ownership pie has gotten bigger. In some cases, it’s going to stay that way because you can no longer give care without the enabling technology. This is where The HCI Group is going to be able to go in and collaborate. Every organization’s slightly different. Some will say, I need a little support with the Epic application, for instance. Others will say, it’s the whole support model — I just can’t keep the staff on board at the right caliber to be servicing my clinicians. The unique approach by organizations in terms of what is best for their future is where we focus. A lot are going down the path of shared services, which I’m sure you’ve heard about.

Do you think hospitals looked at the cost of these systems as requiring a return on investment or did they just assume they are a cost of doing business?

If you had asked me eight years ago, I would have said they’re a cost of doing business. Now I believe organizations are more focused, even on the international front, with making sure they at least can realize the benefits that go along with spending the money. The return quite often is focused on the quality of care, which is nice to hear.

But there’s a new eye on this total cost of ownership that I didn’t see when I entered eight years ago. It’s exciting for me because some of our international clients are public healthcare systems, and whether you’re spending the public’s money or you’re spending an individual’s or a payer’s money, you still want to be doing it an efficient, effective way. I’m happy to see that.

How are the needs of those international customers different from domestic ones?

We are focused on being recognized as a global leader in delivering innovative IT solutions. What we’re finding is there’s a lot of opportunity on the global front to learn lessons that we’ve experienced here in the States.

I think you do have to take into consideration where they are in the journey. Some are where you may think healthcare in the US would have been 20 years ago. It looks to someone from the States like a pretty simple, low-hanging fruit opportunity, but what it brings is a tremendous transition. I think it’s greater change management for them than we have experienced here as we’ve come along. 

In most cases, whether we’re in the UK, the Middle East, or Australia, when I turn the system on, we’ll be changing protocols of care in our country, which is very exciting, to making sure that we’re being fiscally responsible. It’s been wonderful to work in that international marketplace and bring to them lessons learned so they don’t have to maybe climb over the same hurdles that we have done here in the States.

Have you worked on projects where hospitals wanted to involve patients more in their care?

A few organizations, we’ve worked with around patient engagement. The ones that are most exciting, they’re not being really led by the IT department — they’re being led by the business development arm of the organizations. 

Of course, in the Epic world, there’s Connect, but then there’s also these opportunities to engage the community in care, some of the new devices that are out for the consumers. What’s exciting about is it there’s a focus to think through new strategies to engage patients. It’s more than just the patient portal. It’s the medical devices that you may be able to use in your home and bringing more home health, which as the baby boomers age, we definitely need to be focused on as an industry. It’s been exciting to be working with the business development arms of the healthcare systems.

Give me some unusual, bold predictions for the next 3-5 years.

It’s really analytics and how we’re going to end up using all of this massive data. I think there will be a blip in inefficiencies since we have the challenge of big data, how we govern, what’s being asked of the IT department to pull out information around that data and use it in a positive way to change care, evidence-based care and research. That’s the exciting part.

We’re all  heads down pushing through the new technology today, but the exciting part will be five years from now. There are organizations, of course, that are ahead of the curve and doing it already. But to bring the rest of the country and the world to where we have as close to real-time information to be making great decisions.

Any final thoughts?

In terms of looking at where The HCI Group operates, we’ve just recently brought in a new CMIO, Dr. Bria. He has a fabulous background as one of the founders of the concept of the CMIO. He’s going to be working on some clinical service lines for us which start to leverage the ability of what the electronic health record has brought to the industry. So I guess in closing, wait and see what we’re able to do with it. We’re all excited at The HCI Group to have him on board and to refocus ourselves on the CMIO’s needs and not just the CIOs that we support so well today.

Morning Headlines 4/28/14

Cover Oregon: $248 million state exchange to be jettisoned in favor of federal system

Oregon’s health insurance exchange program will be dissolved and replaced by the now functional Healthcare.gov site. Oregon spent $248 million trying to bring its exchange live, but failed to enroll a single person.

It’s Insanely Easy to Hack Hospital Equipment

Fargo, ND-based health system Essentia Health asks its head if IT security to thoroughly evaluate its network for security vulnerabilities. Two years later, the team reports that they were able to hack into the hospital’s EHR system and its imaging system. In addition, they were able to hack into and change the settings on drug infusion pumps, wireless defibrillators, and refrigerators that store blood products. 

2015 Edition EHR Standards and Certification Criteria Proposed Rule

The HIMSS EHR association publishes its comments to ONC’s proposed 2015 EHR certification criteria. EHRA’s primary concern is that there is not enough time left after final rules are published for vendors to properly code and test enhancements. The association is requesting an 18-month window be built into the timeline for coding and testing to take place before customers are expected to be live with the new features.

Hacker group Anonymous targets Children’s Hospital

Hacker group Anonymous is suspected of recent hacking attempts on Boston Children’s Hospital’s networks. Anonymous threatened to initiate attacks after a doctor from the hospital brought medical child-abuse charges against the parents of a patient, leading to the child being removed from the parent’s custody.

Monday Morning Update 4/28/14

Top News

Cover Oregon waves the white flag and shuts down its $248 million health insurance exchange website without having enrolled a single citizen. The state will convert the site for Medicaid enrollment for an additional $35 million (federal taxpayers will pay 90 percent of that) and everything else will be turfed off to Healthcare.gov. The only winner is Oracle, which was paid $134 million even though the state says the company failed to deliver what it promised. The folks who run Cover Oregon, who seem to think their credibility emerged unscathed, say it would have cost $78 million to fix the disaster it oversaw but only $5 million to piggyback onto Healthcare.gov, which it could have done on Day 1. The money Cover Oregon wasted, like that of other states that decided they could build their own sites slightly less incompetently than the federal government, is pretty much gone since the site was to have paid for itself via a tax on insurance company sales.

Reader Comments

From The PACS Designer: “Re: Google Ara. Google’s approach to the next smartphone will be a modular one called Ara from Google’s ATAP (advances technology and projects) group. By allowing the Android phone to be constructed to a controlled style, it will let developers limit what a user can do with the smartphone. This should be of interest to those who want to reduce BYOD usages in institutional settings.” It’s an interesting approach, like taking tablets back to the IBM-compatible PC days when you could buy components from anybody and just plug them in. I suppose the upside is that your phone will have a long life cycle since it’s really just a core board that accepts components. On the downside, Google excels at building ugly, frustratingly non-standard products (Gmail) and Apple and Samsung phones are selling just fine even if they are rendered obsolete after only two or three years. Not to mention that Google has no retail stores from which to sell and support consumer hardware. I’m no expert, but this project has “bust” written all over it, which seems to be a regular occurrence among the Googlers these days.

From Ex-Epic: “Re: Epic. Has been sending a team of people to Denmark (Copenhagen) for a few months now on regular sales/early stage implementation meetings. Haven’t seen it mentioned here with the other international sales mentioned lately.” I mentioned in November 2013 that Epic would be providing systems for all of eastern Denmark.

HIStalk Announcements and Requests

Most poll respondents don’t think any differently about HHS after it released Medicare physician payment information. New poll to your right: do you use an activity tracker such as FuelBand or Fitbit at least five days per week? My sense is that the wearables fad is over – the devices don’t measure a whole lot given their cost and walking still isn’t fun or practical for many people – they don’t need discouraging electronic reminders that they failed to meet their goal.

Listening: new from Stream of Passion, because I can go only so long without needing some Dutch progressive-opera metal (fronted by a female singer from Mexico for some reason.)

I support DonorsChoose projects that help classrooms in need, and in return, I get nice thank-you emails and photos from the teachers who appreciate the support. I realize I haven’t mentioned the most satisfying part – receiving letters from the students themselves. This particular project was for remanufactured toner cartridges and file drawers for a total cost of $187 as donated by HIStalk on behalf of readers. One of the students said, “I’m grateful that you donated to us because some teachers don’t have any printing supplies and my teacher was one of those people, but now he’s not, so I’m thanking you.” This is from a highest-poverty school in Mississippi, where the teacher (Mr. Delperdang, a Teach for America teacher )was spending his own money printing classroom materials from home.  

Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

Acquisitions, Funding, Business, and Stock

From the Cerner earnings call:

• The company’s backlog increased to $9.24 billion. For non-investment types, “backlog” refers to products or services that have been sold, but whose revenue hasn’t been recognized due to accounting principles. In non-manufacturing businesses like healthcare IT, backlog is a good thing because it represents sales that haven’t shown up as income yet but will down the road. Backlog isn’t positive for manufacturers because it means your factory isn’t cranking out widgets fast enough, meaning you’ll need to make big capital investments to increase capacity or else your customers will find another vendor.
• Sales revenue increased 4 percent, but the big jump was in services at 25 percent. Cerner is very good at generating that kind of recurring revenue without having to go through the grueling process of finding new customers, especially ones who are also considering Epic.
• The company sold zero new ITWorks or RevWorks deals, and in fact “have not added a full RevWorks client in recent quarters.” Cerner just can’t seem to get anything right when it comes to financial software and services.
• 25 percent of the quarter’s bookings were to non-Millennium customers. That’s a big deal – obviously the company is taking business away from someone else’s customers.
• The company says the ICD-10 delay will give a slight boost to its revenue cycle business because some prospects were on a software hold while focusing on ICD-10. They didn’t mention that if that’s true, business will take the same slight downturn next year when ICD-10 looms again.
• Revenue from sales outside the US dropped 16 percent, mostly because of reduced low-margin hardware numbers.
• Cerner’s highly publicized deal with Intermountain Healthcare was summarized as pushing trigger events in front of clinicians, with the challenge being to turn the processes Intermountain has developed into “self-contained diagnostic, treatment, outcome, and reimbursement containers” that “replaces the claim in the fee-for-service world” and that can be used in non-Cerner systems. Sounds great if it works, which has never been the case in any example I can recall where a big-name hospital’s rules were benevolently sprinkled down like holy water on bowing masses of less-blessed hospitals.
• The company mentioned HIMSS exhibits that showed “elegant graphs that purport to provide great insight into the data,” but that unless you can put that information in front of the physician in real time, “you’re just reporting the news vs. making the news.” That sounds inherently true, but the reality isn’t quite that dramatic – a hospital could use an analytics system to find potential areas of improvement (right down to the individual physician) and then use its order entry/clinical decision support system to build in guidance make it easier for physicians to do the right thing. Hospitals have plenty of capability built into the systems they already own without chasing yet another Intermountain project that seems to work for nobody except Intermountain. Every hospital I’ve worked in had plenty of information that could have improved outcomes and cost – what they lacked wasn’t technology, but rather the willpower to make the significant percentage of cowboy doctors follow the agreed-on rules. They needed competence and leadership, not more information to ignore.
• Concluding the Intermountain hype was a statement saying that the most exciting part of the partnership is to sell Cerner consulting services.
• The company still claims it can steal some Epic clients who have reached EMRAM Level 7 “because they don’t feel like the solution they have will suit their future needs.” I would think the best chance of that happening would be to undercut Epic’s maintenance costs, but Cerner didn’t mention that.

Tee Green, CEO of Greenway Health, provided HIStalk with this statement regarding the departure of President Matt Hawkins (above),who came over from his previous role as CEO of Vitera when Vista Equity Partners bought Greenway and combined the two companies in November 2013:

Matt Hawkins was instrumental in driving the growth and operational efficiencies at Vitera Healthcare, helping position that organization to combine with Greenway Medical Technologies and SuccessEHS to form the company Greenway Health is today. As Matt prepares to assume a new leadership role outside of Greenway, we’re very excited for him and wish Matt and his family nothing but the best. As Greenway moves forward, our priorities remain the same: to continue supporting and enhancing our solutions and to help our customers remain efficient and financially strong as they deliver care that improves the health of their patients and whole patient populations.

Sales

Texas Health Resources will deploy the AirStrip One clinical mobility solution throughout its system.

People

Joshua Seidman, PhD (Evolent, ONC) joins Avalere Health as VP of the newly created Center for Payment and Delivery Innovation (according to the press release) or Center for Delivery System System and Payment Innovation (according to his LinkedIn profile.)

KentuckyOne Health (KY) names Doug Jones (Providence Health & Services) as regional CIO.

Government and Politics

The AMDIS listserv brings up an interesting CMS attestation calculation quirk: any measure that requires “more than” a specific percentage actually requires the next-higher whole number percentage. You fail if you hit 50.4 percent on a measure that requires “more than 50 percent” since CMS rounds down to 50 percent and you didn’t exceed that. It’s bizarre that they round numbers at all.

The HIMSS EHR Association offers its comments to ONC’s proposed 2015 EHR certification criteria:

• Early notice of proposed changes helps vendors prepare, but doesn’t address the real problem — certification rules are changed too often.
• Vendors would have less than a year to build 2015 requirements into their products, so they want the edition labeled as 2016 rather than 2015.
• Vendors can’t spend all of their time chasing certification requirements – they also have to consider customer requests and other government-mandated changes.
• ONC underestimates the cost for vendors to keep up with its requirements – EHR says the real cost numbers are 10 times those ONC puts out and the 2015 criteria will be more than 15 times more expensive than ONC claims.
• EHRA doesn’t think certification should be required for anything other than providers collecting HITECH money – certification should not be broadly expanded.
• EHRA says it’s not reasonable to put the electronic clinical quality measures in 2017 edition certified software – there’s not enough time left.   

Innovation and Research

Brigham & Women’s Hospital (MA) will hold Pilot Shark Tank on Monday, where entrepreneurs are invited to pitch their ideas to hospital doctors and nurses who can approve a pilot project. Finalists are CareMon (3D optical patient monitoring), Constant Therapy (iPad-based stroke rehab therapy), Healo (remote monitoring of wound healing), Home Team Therapy (PT programs for home), MySafeCare (patient and family reporting of safety concerns), Revvo (bio-adaptive exercise bike), Tenacity Health (peer health coaching), Twine Health (collaborative chronic disease management), VerbalCare (patient-caregiver communication), and Vital Score (Apgar-like scoring of unhealthy behaviors that contribute to chronic illness).

Technology

In the least-surprising news of the week, Google+ goes comatose as its leader quits, its teams are reassigned, and the groups working on its Hangouts and photo features are moved under the Android operating system. Only Google could have designed product even clunkier and more confusing than Facebook except without the first-mover advantage and network effect that keep Facebook popular (at least for now.) Nobody wanted to use it as a Facebook alternative, so maybe at least some of its expensively developed parts can be salvaged for something useful. People wants EHRs to be as simple to use as Facebook, so maybe Google could drag up the moldy source code for Google Health and kludge something together that would turn two flops into one success.

Most electronic hospital  equipment can be taken over by hackers,according to a study by healthcare provider Essentia Health: IV pumps can be changed over the network, Bluetooth-powered defibrillators can be triggered at will, and unsecured medical images can be viewed by anyone, for example. The Essentia team also found that they could reboot some devices to force them back to factory defaults and that many pieces of equipment are connected directly to the Internet instead of being inside the firewall, allowing any hacker to simply plug into an available hospital jack and start finding devices to hack. A key finding is that EHRs accept data from unauthenticated devices, so bogus information could cascade into more harmful treatment decisions.

More speculation on why Nike stopped manufacturing its FuelBand activity tracking hardware: the software portion (NikeFuel) may end up on Apple’s iWatch or other wearable platforms.

Other

Security experts say the hacker network that calls itself Anonymous may be responsible for a series of cyberattacks launched against the website of Boston Children’s Hospital (MA), which left patients and clinicians unable to use the hospital’s portal (the site is down as I write this Saturday afternoon). The group had demanded that the hospital fire the head of its child abuse prevention unit after a high-profile custody battle in which the hospital filed medical abuse charges against the parents of a 15-year-old female patient who was later placed in the state’s custody. Anonymous found itself embarrassed two weeks ago when it launched attacks against Israel-based sites, but Israeli hackers launched a counterattack by tracking the IP addresses of the Anonymous members and hacked their computers, including hijacking their webcams to snap and publish photos of the not so Anonymous members.

Athenahealth announced last week that it was dropping its membership in the HIMSS EHR Association, which it says “ostensibly” represents EHR vendors in federal policy debates. The company says it “never really belonged there in the first place” because EHRA is dominated by non-cloud EHR vendors and athenahealth isn’t really an EHR vendor but rather a services company (a debatable point.) Athenahealth (a) doesn’t like that EHRA pushes for more vendor-friendly federal policies (longer timelines, lower bars) and (b) wants CMS to name vendors whose customers seek hardship exemptions while EHRA “presses just as hard to protect its members from the consequences of their failures by opposing any such disclosure.” EHRA decided not to wage press release warfare with athenahealth, but says its membership diversity creates value and credibility and while it’s sorry to see athenahealth leave, some of the company’s statements are incorrect (specifically the one claiming that EHRA opposes hardship exemption transparency, about which I could indeed find no stated EHRA position.) Athenahealth also says it takes too much time to explain to people why it regularly disagrees with its own trade association. My opinion: athenahealth voluntarily joined EHRA hoping to gain something from it (DC influence, publicity) and is quitting for the same reason (publicity and hoping to differentiate itself competitively from its former fellow members, especially after ATHN announced unimpressive quarterly result last week). Customers don’t care one way or another, and with the company’s size, it can do its own Washington glad-handing. Every member of CommonWell Health Alliance (except Sunquest) is also a member of EHRA, so maybe athena should storm off from that group as well.  At some point, a large, publicly traded company crosses the line from “disruptor” to “disruptee” and athenahealth may be getting close.

ECRI Institute’s listing of healthcare IT data integrity as the #1 problem facing healthcare organizations includes specific examples: data entry errors, missing or delayed delivery, accepting incorrect default values, copying and pasting, using both paper and electronic systems, and incorrectly attributing device data to the wrong patient. It recommends assessing clinician use, improving testing, offering better training, and giving users an easy way to report system problems they see.

Athenahealth’s Jonathan Bush and business writer Stephen Baker team up to write Where Does It Hurt?: An Entrepreneur’s Guide to Fixing Health Care, available May 15. Sounds interesting except that JB’s incessant verbosity makes it tough to convince free milk drinkers to plunk down cash to buy the cow.

Strange: a New York doctor is sued for stiffing the Scores strip club for $135,000 worth of lap dances in four visits over 10 days. He claims he was drugged by club employees and disputes that he was even present despite security camera video suggesting otherwise. A Scores spokesperson said of the cardiologist, “If I had five dancers dancing for me, I’d be in the ICU. He’s a heart doctor – I guess he’s got a good heart.”

Sponsor Updates

• Liaison Healthcare enhances its EMR-Link EHR interoperability solution with Meaningful Use Stage 2 capability.

Switching from a Cloud-Based EHR Vendor

I mentioned a while back about hearing from a physician practice that was finding it next to impossible to extract EHR information from their cloud-based EHR to move to a different system. I offered to write about the experience from the points of view of both the vendor and the practice. Here is a summary of the communication, which should provide lessons learned for both customers and vendors.

From Matthew “Toby” Cox, MD, MPH, Families First Pediatrics, South Jordan, UT

• We started with ADP AdvancedMD in April 2011, but found it didn’t meet our needs and we are switching to the peds-specific PCC EHR.
• ADP Advanced MD claimed on their website that they won’t hold data hostage – they will provide an encrypted hard drive with all data plus mapping and documentation within one week for $1,250.
• We paid $1,250 on January 30, 2014 and received a thumb drive several weeks later. The new vendor, PCC, says the new information is a comma-separated value file that makes no sense.
• After several weeks of getting no response, ADP AdvancedMD (whose national headquarters is less than a mile from our practice) sent a technician, who said the file the practice was given was incomplete. Another file was supposed to be sent, but wasn’t.
• Three months later, we still have no usable data and the ADP AdvancedMD representative suggested pulling up every patient chart and printing a PDF.

Response from Jim Elliott, VP of marketing, ADP AdvancedMD

• The delay was due to a process issue that has been resolved.
• The ADP AdvancedMD rep hand-delivered the 4.5GB data file that can’t be split into smaller files readable by Access or Excel because records are sorted by date of service and that would break up a patient’s chart.
• The practice had set up templates and each field they used can only be defined by the practice since the system doesn’t “know” how they are being used.
• The new vendor, PCC, understood the layout and required no further changes.

From Dr. Cox

• Nobody from ADP AdvancedMD told us in training that when we added items to templates that we were adding “codes” that would complicate the data extraction process.
• Our last EHR conversion from another vendor at least gave us individual patient PDFs that could be accessed by a menu button – not ideal, but usable.
• The practice management data extract from ADP AdvancedMD was perfect. Only the EHR information is a problem.
• I asked ADP AdvancedMD during their sales pitch about our access to our data if we decided to leave since it seemed unusual that they were offering a month-to-month contract. Their salespeople said we would have access to the data and be provided a hard copy of it. I was not savvy enough at that time to probe deeper into this as I took their word for it (dammit Jim, I’m a doctor, not a computer data specialist!)

From a programmer at Physician’s Computer Company (PCC)

• We never indicated to ADP AdvancedMD that we found their extract usable. The limited guidance we received was weeks later and only after repeated requests.
• We do vendor conversions every week and have done every major vendor. This is the only one that we have not been able to convert.
• Anyone on ADP AdvancedMD who thinks they can switch vendors is deluded.
• Here is a consecutive snippet … it’s the same date of service for the same patient, but it’s a random mix of stuff.

From Dr. Cox to ADP AdvancedMD

• If you were handed that data file, how would you import the information into Advanced MD step by step?
• Has anyone every successfully imported that information into another system?
• Is a bulk export to an industry-standard layout (CCD/CCR/CCDA) possible?
• Can a mass export to PDF be done as a last-ditch effort to get patient information into their new system?

From Jim Elliott to Dr. Cox

• There were communications gaps between the two vendors. ADP AdvancedMD spoke to PCC’s technicians and understood that the new vendor had everything needed to convert.
• ADP AdvancedMD is still a few months away from delivering the capability to bulk export to CCD or CCR, but it can be retrieved from individual patient records.

The practice’s information is still not available in their new system three months after their initial request and payment and Dr. Cox is worried about the clinical impact to patients of missing three years’ of their data.

My suggestion: regardless of whether your EHR vendor is a traditional or cloud-based one, ask them now (not later) for the names of former customers who successfully migrated off their platform with all data intact (which will prove that it’s at least possible). Or, far less desirably, ask for a sample extract with documentation.

I’ll also ask the technical folks who work for EHR vendors to weigh in on the data snippet above. Would your company be able to migrate intact, complete patient records using a file with that layout? It looks to me as though the individual items are identified using free text and non-standard codes that would be meaningless outside the source system.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/25/14

Cerner Reports First Quarter 2014 Results

Cerner reports Q1 results: Revenue is up 15 percent, to $784 million, driven by all-time high bookings of $910 million. Adjusted EPS $0.37 vs. $0.33, meeting analyst’s forecasts.

A fatal wait: Veterans languish and die on a VA hospital’s secret list

The Phoenix Veterans Affairs Health Care system, unable to keep up with the VA’s mandated 15 to 30 day appointment turn-around time, starts maintaining a secret "off the books" wait list where some veterans end up waiting for more than a year. As a result, an estimated 40 veterans died while waiting for care they otherwise would have received. The House Veterans Affairs Committee has ordered all records from Phoenix to be preserved while an investigation is launched.

Congress unhappy with DoD, VA health records progress

House lawmakers will withhold 75 percent of the VA/DoD’s 2015 budget request for their joint EHR project until they demonstrate that progress is being made.

Medical Records and Health Information Technicians

The Bureau of Labor Statistics is predicting a 22 percent increase in jobs for medical records and health IT workers over the next 10 years.

News 4/25/14

Top News

Cerner delivers strong Q1 numbers: revenues up 15 percent, adjusted EPS of $0.37 versus $0.33 a year ago, both in line with analyst estimates. The company also reported its $910.2 million in bookings was an all-time number for a first quarter.

Reader Comments

From Haberdash: "Re: Matt Hawkins. Greenway sent an email to customers saying that President Matt Hawkins is on the way out.” The note, which was sent Tuesday, indicates that Hawkins is leaving the company to pursue “an exciting new leadership position outside of the company.” The departure of Hawkins, who was CEO of Vitera Healthcare prior to the Greenway/Vitera merger, could be unsettling for any Intergy customers already concerned about Greenway’s long term product strategy. I emailed the company Wednesday for a comment but have not yet received a reply.

HIStalk Announcements and Requests

Mr. H is out and about today so I am flying solo. I am not sure what he’s up to but since I’d like to be sitting on a beach with an umbrella drink, I’m just going to pretend he’s doing something fun like that.

Some highlights from HIStalk Practice this week include: EHR vendors could learn from Surescripts’ “alliance of foes” model. The AMA reminds providers to order their ICD-9 codebooks for 2015 now that ICD-10 has been temporarily shelved. CVS MInuteClinic surpasses 20 million patient visits since opening its first in-pharmacy site in 2010. Rushed physicians create frustration and tension for both patients and providers. Orthopedists were the most highly compensated physicians last year. Wikipedia trumps Google Flu Trends and the CDC in tracking flu outbreaks. Dr. Gregg promotes “multiview” as a necessary EMR feature. Thanks for reading.

This week on HIStalk Connect: Nike shuts down its Fuelband activity tracker line, cancels plans to introduce a new tracker this fall, and eliminates 55 of the 70 staff members in the activity tracker business unit. Twitter announces the winners of its #BigData grant program, half of which were healthcare-focused research projects. In an otherwise neglected market, eCaring raises a $3.5 million Series A for a simplified health journal designed to help seniors age in place by trending for changes in physical or behavioral health and alerting appropriate caregivers.

Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

Acquisitions, Funding, Business, and Stock

VMware reports Q1 results: revenues up 14.2 percent and adjusted EPS of $0.80 vs. $0.74, beating estimates.

Kaufman Hall, a provider of financial consulting services and software for healthcare, acquires Axiom EPM, a provider of financial performance management software for healthcare and other industries.

Huron Consulting Group enters into an agreement to acquire the assets of Vonlay.

Quest Diagnostics posts Q1 numbers: revenues down 2.3 percent and adjusted EPS of $0.84 vs. $0.89 a year ago, missing estimates. Quest blames an unusually harsh winter that deterred people from going to its centers for tests.

NexJ Systems acquires Liberate Ideas, developer of a point-of-care patient education solution.

Owlet, developers of a smart baby bootie monitor that measures a child’s heart rate, raises $1.85 million from multiple firms, including ff Venture Capital and Eniac Ventures.

Heart Corporation expands its Hearst Health group and Zynx Health division with the acquisition of CareInSync, the developer of a mobile platform for provider-patient communications.

CTG attributes its 22 percent drop in Q1 profits on lower revenue from its healthcare technology services business. CEO James R. Boldt says the lower revenues are the result of hospitals delaying EMR and other IT implementation projects as they manage Medicare cuts from a year ago.

HealthStream reports Q1 results: revenues up 29 percent and flat earnings of $0.07 per share, beating revenue estimates but missing on earnings.

Sales

Crozer-Keystone Health System (PA), Tahoe Forest Health System (CA), Capital Health (NJ) and Hocking Valley Community Hospital (OH) will implement the InteHealth Patient Portal.

Michigan Health & Hospital Association Keystone Center will use RegistryMetrix from ArborMetrix at 60 hospitals to capture OB data and measure clinical performance.

Johns Hopkins Health System selects Carestream Health’s Vue PACS system.

Southern Illinois University HealthCare selects Allscripts TouchWorks EHR for its physician clinics.

SCL Health System will implement Stanson Health’s clinical decision support system.

People

Population health management and patient engagement provider Rise Health names Connie Moser (McKesson) president and COO. Moser replaces Mark Crockett, MD, who will remain as CEO, and Fred Croft, who will shift to CFO.

QPID Health forms an advisory that includes David W. Bates, MD (Brigham and Women’s Hospital); John D. Halamka, MD (Harvard Medical School); Julia Adler-Milstein (University of Michigan); and Robert M. Wachter, MD (University of California, San Francisco).

Extension Healthcare hires Jill Vavala (CareFusion) as CNO.

Covisint names Michael Keddington (McDermott & Bull Executive Search) SVP of worldwide sales.

The NCQA appoints Michael S. Barr, MD (American College of Physicians) EVP in charge of leading the organization’s research, performance measurement, and analytics efforts.

David J. Bensema, MD moves from CMIO to CIO for Baptist Health (KY).

Essia Health names Rachel Leiber (Providence Health & Services)  to lead the company’s EMR implementation services division.

Accretive Health CEO Stephen Schuckenbrock will step down from the troubled company when his contract expires October 2.  Last month the company was delisted from the NYSE after failing to file restated financial reports from 2012.

Announcements and Implementations

The Greater Houston Healthconnect network and the Austin-area Integrated Care Collaboration establish health information sharing through the Texas Health Services Authority’s HIETexas.

American Health Network implements eClinicalWorks Care Coordination Medical Record for population health management to manage its three ACOs in Ohio and Indiana.

Via Christi Health (KS), which is owned by Ascension Health, will go live on its $85 million Cerner system June 1 across all of its Wichita hospitals and clinics.

Behavioral Health Information Network of Arizona leverages NextGen’s Mirth Connect platform to become the first statewide behavioral health information exchange in the country.

Lady of the Sea General Hospital (LA) goes live with T-System’s EDIS EV.

The W. W. Caruth Jr. Foundation awards Parkland Center for Clinical Innovation (TX) a $12 million grant to establish the Dallas Information Exchange Portal to connect Parkland Memorial Hospital with local social service agencies.

Government and Politics

HHS says two entities have collectively paid almost $2 million to resolve potential HIPAA violations following the theft of unencrypted laptop computers.

The House Appropriations Committee approves a 2015 budget plan to that would hold back 75 percent of the VA’s requested funds to upgrade its EHR until Congress is convinced the DoD and VA are making progress in their efforts to share EMRs.

CNN reports on the Phoenix VA Health Care System and how delays in scheduling appointments has led to 40 deaths. The report also reveals details of a scheme by VA managers to hide the scheduling delays in order to improve official scheduling metrics. A retired VA doctor claims that the health system maintained a “sham” waiting list that was shared with Washington officials that showed timely appointments, as well as a real but hidden list with wait times of more than a year. To create the secret list, staff entered appointment details into the computer, printed the screen, but did not save what was entered. Patients remained on the secret list until the scheduled appointment was within 14 days, then details were transferred  to the sham list and the hard copy was shredded. The US House Veterans Affairs Committee is now investigating.

The FBI warns that healthcare systems and medical devices face an increased risk of cyberattacks because private health data has a higher financial payout on the black market than credit card numbers.

Other

The chairman of the board of supervisors for Riverside County Regional Medical Center (CA) takes Huron Consulting to task and questions its lack of progress fixing the hospital’s financial woes. Huron, which is six months into a $26 million dollar engagement, was hired to implement cost-saving initiatives to address the hospital’s $83.2 million cash shortfall, but so far the deficit has only been cut $1.2 million. The hospital’s CFO defended Huron’s work, noting that the company’s efforts have already contributed to $9 million in savings, but declining patient traffic during the same period has resulted in a $12 million decline in revenue.

The Department of Labor predicts a 22 percent increase in the number of jobs for medical records and health information technicians between 2012 and 2022.

Health IT, care coordination, and drug shortages lead an ECRI-complied list of top 10 patient safety concerns for healthcare organizations.

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications.

A Rhode Island court issues a consent decree saying that the state’s EHR database CurentCare must be more transparent and offer patients more privacy protection. The ruling stems from a 2010 lawsuit filed by the ACLU that charged the state’s department of health didn’t spell out clearly or publicly enough how patients could remove or change their own records from the database.

A quaky lawsuit out of Oregon: a woman sues her mother’s neighbor after the neighbor’s pet duck attacked her. The duck ambushed the woman without provocation, causing her to fall, break her wrist, and sprain an elbow and shoulder. The victim, a retired nurse, is seeking $275,000 for pain, suffering, and other damages.

Sponsor Updates

• Elsevier will market Stanson Health’s CDS alerts and analytics solutions.
• IDC Health Insights names Wellcentive a leader in its MarketScape report on US population health management vendors.
• Merge Healthcare releases iConnect Retinal Screening for identifying and diagnosing patients with diabetic retinal disease.
• Quest Diagnostics recognizes Liaison Healthcare’s EMR-Link solution with its Quality Solutions Certification for meeting or exceeding HIT quality standards for secure clinical lab ordering and results reporting.
• BESLER Consulting will market the MedAptus charge capture management suite to its clients and MedAptus will promote BESLER’s revenue recovery and compliance services.
• McKesson Business Performance Services adds outpatient and inpatient facility coding services to its coding and compliance portfolio of services.
• CommVault enhances its PartnerAdvantage program for channel partners to accelerate revenue growth and simplify collaboration.
• Quest Diagnostics acquires the remainder of Steward Health Care System’s (MA) outreach laboratory services operations and will provide testing services to providers previously serviced by Steward.
• iHT2 posts highlights from its Atlanta Health IT Summit.
• Imprivata hosts its HealthCon 2014 conference May 4-6 in Boston.
• Aspen Advisors shares a white paper on building a technology roadmap to support an organization’s value-based model.
• Orion Health and two of its customers will discuss how state public health agencies can expand the use of integration engines to prepare for quality reporting during the Public Health Informatics Conference April 29-30 in Atlanta.
• Health Catalyst opens registration for the 2014 Healthcare Analytics Summit September 24-25 in Salt Lake City.
• Aspen Advisor principal Jim B-Reay offers tips for keeping the mind fresh in  CHIME’s CIO Connection.

EPtalk – by Dr. Jayne

I caught up with one of my medical school buddies this week as she was passing through town on the way to the class reunion that I’m skipping. She’s a primary care doc turned informaticist as well, so the opportunity to talk shop with someone who has walked a mile in the same virtual shoes as me was exciting. We got to chatting about the Flip the Clinic initiative which aims to “re-imagine the medical encounter between patients and care providers.”

The website has a variety of information on “flips” in categories like communication, design, education, empowerment, etc. The idea is that by making the clinical interaction better, patients will be healthier and providers happier. Although I like the idea it’s a little hard to get on board without some objective evidence that these interventions will make a difference. Some of them are straightforward: reducing noise in the healthcare environment, or removing physical barriers between patients and the office staff. Others are more abstract such as reforming the broken payment system. I think it’s great to have a discussion but I’m not seeing how some of these concepts will translate into practice, especially for those of us who are in employed models.

My former classmate and I have both struggled with being employed physicians and our inability to get buy-in from administrators when we want to try innovative maneuvers. Administrators frequently want proof that we’ll have positive return on investment but fail to realize not all returns are monetary. It’s difficult to try to find energy to fight the status quo when all the forces surrounding us (MU, CMS, HIPAA, and the rest of the alphabet soup) seem designed to stifle any attempt to think outside the box.

It’s going to take more than concerned individuals to truly Flip the Clinic. Organizations will need to address culture issues and there will need to be institutional buy-in before change can begin. The commitment needed to actually have that level of change take place, let alone “stick” and become hard-wired is something that very few of us can muster right now.

From Demo Dave: “Re: replacement systems. I sold EHR systems to physician groups for 15 years, all before MU started to skew the market. At least 30-35 percent of the systems I sold were to practices looking for additional functionality that was already in their existing system. These practices simply never learned to utilize the capabilities of their existing systems. When an administrator told me their existing EHR was lacking functionality or reporting, I simply smiled and confirmed what they wanted in a new system. I then focused demonstrations and implementations to meet their needs.” Many EHRs have gotten to the point where they have more features than users can understand let alone incorporate on a daily basis. Anyone who thinks they can learn a system with a few days of training and never think about it again is woefully shortsighted. Having workflow validation and optimization visits at 30, 60, and 90 days post go-live can help – any bad habits can be corrected and new features can be regularly introduced to those users who are ready for them. Customers should also consider actually reading the user manual and other documentation before they throw the proverbial baby out with the bath water.

Most of our readers know I enjoy a good cocktail and also love to travel, so I was intrigued by a story on NPR that talked about powdered liquor. I should have read it right away rather than bookmarking it for later – when I returned it had been updated stating it’s not actually legal in the US. Apparently I’ll have to go to Japan, Germany, or the Netherlands to check out the options.

Speaking of the need for a stiff drink, there’s still a fair amount of chatter about the release of the Medicare payment data. The newest Coda-a-Palooza challenge  calls for developers to leverage that data to “help consumers improve their health care decision-making.” I’m a professional, I understand what the Medicare data does and does not reflect, yet I still struggle to think of ways that the data can be useful in consumer decision-making. The site says the data “shed significant light on how physicians actually work.” Excuse me? How does data on Medicare payments explain how I care for patients? Maybe I’ll understand better in June when the winners are announced. In the mean time, any explanations that you can send my feeble post-call brain?

Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/24/14

Fed privacy enforcers sock health org with $1.7M penalty

The HHS Office for Civil Rights hits Concentra Health Services(TX) with a $1.7 million fine over a data breach that stems from an unencrypted stolen laptop. Within the announcement, OCR states, "Our message to these organizations is simple: Encryption is your best defense against these incidents."

Top 10 Patient Safety Concerns for Healthcare Organizations

ECRI publishes a list of the top 10 patient safety concerns healthcare organizations have reported, according to its database of 300,000 patient safety event reports. Topping the list is "Data integrity failures with health information technology systems."

UMass Memorial to Integrate End-Of-Life Care Directives Into EHR

UMass Memorial Health Care will partner with Luminat, an end-of-life technology solutions provider, to help doctors document each patient’s end-of-life wishes and then incorporating the document into the health system’s EHR.

Morning Headlines 4/23/14

The Personal Connected Health Alliance Launches with Goal to Improve Health and Wellness through Connected Technologies

The Continua Health Alliance, mHealth Summit, and HIMSS launch a new non-profit called the Personal Connected Health Alliance that will represent the consumer voice in the growing connected health industry.

Care Everywhere, a Point-to-Point HIE Tool

An Applied Clinical Informatics study says that using Epic’s Care Everywhere module in four Allina Health ER’s resulted in fewer duplicate diagnostic tests and procedures, and more drug seeking behaviors being identified.

athenahealth Announces 2013 Meaningful Use Attestation Rate and Early Stage 2 Performance Data

athenaHealth announces that 95.4 percent of the company’s participating providers successfully attested for Meaningful Use Stage 1 in 2013.

Medicare chief Jonathan Blum leaving Obama administration

CMS Principal Deputy Administrator Jonathan Blum will resign effective May 16, according to an internal email sent by CMS Administrator Marilyn Tavenner.