Curbside Consult with Dr. Jayne 3/24/14

Mr. H posted some comments from the annual reader survey last week and one of the areas that people wanted to read more about was the patient experience of IT. As he mentioned, it’s difficult to get patients involved since they probably don’t read HIStalk, but the good thing is that all of us on the team are patients ourselves. I’ve had several recent adventures in patient engagement involving IT over the last few weeks.

Fail #1: I had mentioned before my ongoing issues with a large academic center and their patient portal. It’s a solid product, but I don’t think it’s being implemented or managed particularly well. I had an issue right after I signed up to use it where my last name was spelled wrong. It had been correct on the patient information sheet at the office, but was wrong on the portal. When I inquired about it via secure email, I was told I had “aliases” in the system and it couldn’t be corrected. A few weeks ago I made an appointment for my annual eye exam, and when the appointment confirmation came, I noticed my name was now spelled wrong in two different ways. Additionally, there is incorrect allergy information now posted.

There’s no way for me to fix it from within the patient record at the moment. However, it’s unclear if the product will allow that and they don’t have that functionality live or whether the product is that way by design. I called about getting it corrected and was told again that there are multiple “alias” accounts for me and that they can’t correct it. I have a serious problem with there being multiple accounts, especially since I’m only seen in one practice at the health system. Did someone create a duplicate chart? What’s going on? And why can’t they be merged if it’s a simple duplicate issue?

I brought up the fact that now I have incorrect health information present and specifically used the phrase “patient safety risk” multiple times. I asked them what the process is to correct the erroneous records and the answer from the portal team was “talk to your doctor.” I called the physician office and confirmed that my records are accurate in the source system. How can the physician be expected to clean up an erroneous allergy that she can’t even see?

I called the portal team back and told them that the source chart is accurate and asked them again for a process to correct it. They confirmed they have none. I then asked if I could withdraw consent for participation in the portal because I don’t want the erroneous information (how much else is there that I might not be able to see?) associated with my records or populated to another physician I might see in the future. Of course they have no way of closing my account. At this point it’s more an exercise in frustration rather than engagement. I don’t have hours to spend pursuing it, so I guess I will just let it go and continue to make sure the charts my physicians are using are accurate.

The bottom line is that systems (both the actual software and the policy/procedure associated with it) need mechanisms to handle issues like duplicate patient accounts, demographic errors, and especially medical errors. I’m floored that a major institution would be so clueless. After all, they have wait time billboards for the emergency department and sponsor the local sports teams, so they must be good, right?

Fail #2: This one is wrong on multiple levels. I went to a new physician for a fairly uncomplicated skin condition last December. Although I could have treated it myself, I’m not comfortable with calling out my own scripts and figured it would be good to establish myself as a patient in case I ever really need to be seen. This was in December. Last week I got a bill from the reference lab for the same date of service as my visit but for a surgical pathology charge. I called the ordering physician’s office and explained the bill and had them look in the chart.

Sure enough, there were results on my chart, but no record that I had been notified. Had they bothered to inform me of the results attributed to me, I could have told them that there had been an error. The staffer informed me that “it was benign, so we don’t call” and I let her know that “no news is good news” went out decades ago. She went on to look through the chart and saw that the lab had faxed (who still faxes these days?) a name discrepancy report. Apparently the name on the barcoded sample and the name on the electronic order the lab received were different, but the office corrected it incorrectly. I requested a call back from the physician, which I’m still waiting for.

I don’t want to get sent to collections for a bill I shouldn’t have received, so I called the lab. While on hold for 40 minutes, I had plenty of time to think not only about the potential source of the error (human error NOS, multiple episodes, probably staff had two patient charts open at the same time) but also about why it took 90 days to get the claim adjudicated and a bill to the patient. If we had real-time adjudication at the point of care, I could have handled the entire problem at the check-out desk and the sample would have gone out correctly. When a person finally took my call, I told them that I didn’t have a skin biopsy and wasn’t going to pay for it. They were nice about it and said they’d place a call to the ordering physician and get it taken care of.

My hospital is self-insured, although we do have a benefit administrator who processes the claims. I’m sensitive to the fact that the physician compensation model (small-business “eat what you kill”) has providers directly paying for the insurance premiums of their office staff because I used to pay those premiums myself. I wasn’t about to let $300 in erroneous payments go by, so I called the benefit administrator. The representative I spoke to told me that the physician performed a biopsy on me during my visit and I must just not have been aware.

Seriously? I guess I not only slept through the biopsy, but also the informed consent process and the actual consent form itself. It took me a full five minutes to convince her that I did not have a biopsy. I also told her that the office was aware of the problem and had admitted it, that I was just letting the insurance team know so they could recoup the payment since we’re self-insured and with the rising cost of health care, etc. She then helpfully let me know that they actually paid over $600 because there was another claim for a second biopsy I wasn’t aware of. Since it was paid in full, I didn’t receive a bill.

She admitted there would be no way to know it wasn’t accurate since it was the same date of service as my actual visit. I told her that’s why I was calling, to make sure that the payment was disputed so that the money would go back into the insurance pool because otherwise they’d be unaware of the problem. That’s when it got even more ridiculous. She told me that basically it was my word against the physician’s claim, and that unless I wanted to pursue written documentation of the error, there wasn’t anything they could do. She couldn’t provide a form or documentation of the actual information she needed – she was basically saying that there is no way for a patient to easily dispute a claim.

I reminded her (since she works for the benefit administrator and probably isn’t aware) that we are self-insured and I was trying to do the right thing getting the money rightfully returned. I let her know that the lab had already reversed my portion of the charge and at this point the easiest thing for me to do as the patient was to walk away. After all, it’s not MY $600 that was paid out (although at some level it is) and I had already spent over an hour trying to pursue this and now she was asking me to pursue undefined documentation that they’d probably reject anyway. I asked if there was any mechanism for them to reach out to the physician (after all the insurance fund was the one that was wronged) and she said I’d have to provide the phone number and she’d try to call if she could. I was surprised by that (they should have the phone number since the provider is in network) and interpreted it as her attempt to just get the patient off the phone and move on. I doubt she’ll ever call.

What’s my point here? The patient experience still stinks and it’s not all due to technology. Although my first tale of woe has a distinct odor of an IT nature, people are unwilling to address it. Heck, they didn’t even try to play a “known issue with the vendor, blah blah blah” card — they just said there was no way to fix it. The second scenario is strictly human error. The office put the wrong name on the requisition and filled out the name discrepancy form incorrectly. But because all the technology components were met (CPT, ICD, DOB, MRN, insurance information) the failure wasn’t detected.

It could have been mitigated by IT, however, with the use of real-time claim adjudication and the immediate collection of the patient balance. On the other hand it could have also been mitigated by a direct pay method of funding healthcare, where I would have been presented with a bill to review at checkout and then either paid it or disputed it rather than sending it to insurance. That’s the way medicine used to work.

To put the onus on the patient to correct either of these errors is wrong. We should be bending over backward to make sure patient information is correct and that there are processes to handle incidents like these. We’re all patients, and someday that could be us on the other end of the phone. There are other elements here, too. What if that biopsy was melanoma? Then that information would be in my claims data and that would be another nightmare entirely to try to correct.

At the end of the day, patients want physicians and other health professionals to be accessible. They want them to listen. They want the office staff, hospital employees, and anyone else they have to interface with (insurance, lab, etc.) to take care of their needs without acting like they’re in a hurry or pushing back. They want to be treated fairly and have accurate records. All the technology and the bells and whistles are nice, but they’re secondary for the most part. Many of us would trade it all for a physician who had more than six minutes of time to address our needs and an office staff that was pushing for us rather than pushing paper or the electronic equivalent.

Email Dr. Jayne.

Morning Headlines 3/25/14

HHS lays out 4-part health IT strategic plan

HHS publishes a broad health IT strategic plan for 2014-2018 that focuses on expanding health IT adoption, coordinating the development of interoperability standards, and integrating clinical best practices.

Western Maryland Regional Medical Center staff adheres to ‘circle of care’ approach

In a recently released Maryland Hospital Patient Safety Program Annual Report, the state Department of Health and Mental Hygiene named EHR systems as a culprit in some adverse events. The report explains, “The inability to access pending tests or results has led to delays in treatment, inappropriate discharges and futile surgeries.”

Proposed patient-centered telemedicine policy raises licensing questions

The Federation of State Medical Boards will vote on a new telemedicine policy that requires physicians to be licensed in the state where the patient is located when telemedicine visits are conducted.The proposal is being called an unnecessary barrier to telehealth expansion and adoption by advocates.

ONC, West Health see mobile interoperability saving $30B annually

A white paper published by the Gary and Mary West Health Institute claims that if mobile medical devices had greater interoperability the nation could avoid $30 billion a year in wasteful healthcare spending.

Morning Headlines 3/24/14

Metro Detroit health systems Beaumont, Oakwood and Botsford sign letter of intent to merge

In Detroit, Beaumont, Botsford, and Oakwood health systems announce plans to merge, citing integrated medical records as a driving factor behind the decision. The new system will span eight hospitals and consolidate $3.8 billion in annual revenue.

McKesson Technologies Anesthesia Care: Recall – Patient Case Data May Not Match Patient Data

The FDA issues a Class-1 recall of McKesson’s Anesthesia Care product. The decision suggests that the FDA sees clinical applications, ones that provide CDS but do not control medical devices, as falling into the high-risk category that warrants a class 1-level recall. McKesson issued a voluntary recall of the system in 2013 after customers reported that anesthesia data had been erroneously saved to the wrong patient’s record..

‘Flawed’ patient record system led to crisis on jubilee weekend

In England, the troubled Meditech go-live at Rotherham NHS Foundation Trust is profiled by a local paper, which says that after a four-year install, the system go-live compromised key cancer treatment schedules, ER workflows, outpatient appointment bookings, and generated $17 million in cost overages.

Conn. health official accuses Mass. of hoarding federal grant for New England health insurance collaborative

Connecticut officials are seeking $10 million from Massachusetts over a $45 million federal grant that had been issued to Massachusetts in 2010 to build an HIE infrastructure that was supposed to then be shared with other New England states. The project never resulted in a platform that other states could use, prompting Connecticut to seek reimbursement for work it eventually had to do on its own.

Monday Morning Update 3/24/14

Top News

Three Detroit hospital systems – Beaumont, Oakwood, and Botsford – announce plans to merge into an eight-hospital, $3.8 billion system, citing shared electronic medical records as one of their four goals.

Reader Comments

From Tom: “Re: McKesson’s FDA Class 1 recall. The description of their product Anesthesia Care could generically be applied to almost any EMR/EHR/CIS vendor’s AIMS product and yet the FDA’s decision-making clearly does not apply to vendors equally. Also I wonder how the regulation of CDS would affect a hospital who develops their own CDS?” FDA’s highest-level recall of McKesson Anesthesia Care may be sending a message that the agency considers even software-only clinical decision support to be high risk. McKesson defines its product as an anesthesia information management system, which it also calls an “anesthesia EMR.” McKesson sought and received FDA premarket clearance apparently because the system collects data from physiologic monitors. McKesson did a voluntary recall of its product in March 2013 after a customer reported that the software pulled up the wrong patient’s information, with two other customers reporting later that it had lost medical history comments and misconnected to a physiologic monitor, affecting one patient in each instance. Some thoughts:

• McKesson Anesthesia Care is a software-only system that does not control medical devices. It collects and uses information from patient monitors. Other than that, it’s like any other high-acuity, unregulated EHR (surgery, ICU, ED, etc.)
• FDA would not have been involved if the patient monitor connection hadn’t pushed the product into its regulatory arena. FDA regulates software that makes independent patient decisions or connects to regulated devices, with the idea being that those systems are devices working on their own rather than simply providing guidance to users.
• Software vendors usually hide contractually behind the “professional judgment” test that says even if their software gives incorrect information or bad advice that harms patients, the clinical professional who uses the system makes the final decision and is solely responsible for the result.
• The danger to patients is the same as for any other clinical decision support or even EHR software. Mixing up information between patients could be disastrous any time software is presented information or recommending actions. However, high-acuity systems give users less time to make important decisions, so that probably should be a consideration in determining patient risk.
• McKesson planned to announced a Class II recall (meaning the problem wasn’t likely to cause patient harm) but FDA overrode that proposal and initiated a Class I recall indicating that patients could be harmed.
• McKesson notified users almost immediately when the first problem was reported in March 2013, but FDA’s recall didn’t go out until a year later.
• It’s not clear what users of the system should do as an alternative, or what action they may have taken since the original McKesson notification last year.
• Vendors of systems that perform equally critical functions that aren’t connected to medical devices can take whatever action they want if they are faced with the same problem since their software isn’t regulated by FDA. Other than to avoid legal exposure, they could arguably not inform customers at all.
• McKesson is a member of the HIMSS Electronic Health Record Association, a trade group that requires them to sign the EHR Developer Code of Conduct asserting, “We will notify our customers should we identify or become aware of a software issue that could materially affect patient safety, and offer solutions.” The other inpatient EHR vendor members are Allscripts, Cerner, Epic, GE, NextGen, and Siemens.
• McKesson backed legislation introduced last month (along with athenahealth, IBM, and trade groups) that would reduce “unnecessary regulatory burdens” by limiting FDA’s oversight of “low-risk health IT, including mobile wellness apps, scheduling software, and electronic health records.” 
• FDA is running late in producing a report that it says will explain its position on regulation of clinical decision support systems.

From LochnessMonster: “Re: McKesson. Reduction in force 3/20/14, roughly 300 under Pat Blake organization (uncertain number).” Unverified, but reported by multiple readers, one of them saying that the targeted areas were Horizon and Paragon.

From Bootay: “Re: vendor-convened panels. You should participate or report the results.” I don’t think so. I’ve seen many times where properly objective people turned into fawning, attention-starved glad-handers just because some company tries to buy their love by inviting them to be a speaker or advisor. It makes my skin crawl to see the obvious mutual sucking up as mutually expectant backs wait to be scratched.

HIStalk Announcements and Requests

A slight majority of respondents don’t think patients should have a greater role in the HIMSS conference. New poll to your right: who’s most responsible for the problems with health insurance exchanges?

Welcome to new HIStalk Platinum Sponsor ScImage (pronounced sye-image). The Los Altos, CA-based imaging and informatics company offers solutions that include enterprise imaging, radiology, cardiology, Echo PACS, ECG, cloud PACS,  EMR content management, vendor-neutral archive, and a Web-based DICOM exchange. Case studies include Missouri Baptist Medical Center’s cardiology PACS, Blessing Hospital’s enterprise PACS, and US Air Force’s cardiology consultation program. The privately held, employee-owned, debt-free company says it has never sunsetted a product or required a forklift upgrade. According to a physician at Cedars Sinai Heart Institute, the company’s products are the “ultimate value proposition” to its cardiology practice. Thanks to ScImage for supporting HIStalk.

Here’s ScImage PACS consolidation overview I found on YouTube.

Teach for America teacher Ms. A sent pictures of her students using the Chromebook that we as HIStalk readers provided to her first grade classroom in Maryland via DonorsChoose. They’re using it to access online reading and math programs.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

WelVU, which offers a personalized patient education application, raises $1.25 million in an initial seed round.

People

Effingham Health System (GA) promotes Mary Pizzino to CIO.

CHIME promotes Keith Fraidenburg to EVP/chief strategy officer.

Announcements and Implementations

Physicians at Jupiter Medical Center (FL) are piloting the use of email alerts and status updates when their ACO patients are seen in the ED or urgent care center. The press release is poorly written and the product has a confusing name: MicroBloggingMD. I saw their booth at HIMSS and thought it was yet another doctor writing a blog.

Government and Politics

Connecticut officials say Massachusetts owes the state $10 million of the $45 million in federal money it received to build its struggling Massachusetts Health Connector. The original grant called for Massachusetts to share its technology plans with other New England states, but those other states realized they could get their own federal money for building exchanges and went their own way, with Connecticut receiving $140 million, Rhode Island $113 million, Vermont $168 million, and Massachusetts a total of $179 million. Massachusetts says the money wasn’t intended for the other states – they were added on to the grant application at the last minute after pressure from the White House and Governor Deval Patrick to make Massachusetts a model for the rest of the country. Access Health CT’s CEO says that unlike the dysfunctional, CGI-built Massachusetts exchange, their Deloitte-created one works fine, adding, “Some states were trying to build a Maserati. We built a Ford Focus. It might not be as glamorous, but it runs. It can get you to the store.”

Technology

Google is a bit touchy over Google Glass, having previously urged its users to avoid the “Glasshole” label by not being “creepy or rude.” Now it shares “The Top 10 Google Glass Myths,” the one above being notable considering that people (some of them Glassholes, no doubt) are already using it in patient care. Google published the statement on Google Plus, which means almost nobody other than its own employees will see it.

Other

Duke University Health System (NC) will pay $1 million to settle charges that it overbilled the government by unbundling claims and billing for PA services in heart surgery. Duke says its mistake wasn’t intentional, but instead “resulted from an undetected software problem and through possible misapplication of certain technical billing requirements.” A former Duke employee had filed the whistleblower lawsuit.

In England, the local newspaper reviews the 2012 Meditech go-live at Rotherham NHS Foundation Trust that caused delays in cancer treatment, lost appointments, and cost the hospital $2 million in revenue. It mentions the project review, which found that delivery targets weren’t specific, penalties clauses were vague, and the 18-month timetable was unrealistic given that the system had never been implemented in the UK. Taxpayers got stuck with $17 million in cost overruns on top of the budgeted cost of $49 million.

A two-doctor cardiology practice in Texas will pay $3.9 million to settle Medicare fraud charges for conducting unneeded procedures. Authorities requested data from 100 nuclear tests that had been performed, but the doctors provided only 37, saying their computer had crashed and the other results were lost. The investigators found that 19 of the 37 tests had been interpreted incorrectly and 75 percent of them were performed wrong. The same foreign-born doctors were part of a group that settled for $27 million in a 2009 Medicare fraud case.

Stanford Hospital & Clinics and its former collections agency are expected to pay $4.1 million to settle charges that the information of 20,000 ED patients was posted online for nearly a year. Stanford says it encrypted the information sent to the agency, but that company forwarded it to get help creating a graph and the worksheet ended up on a student homework site.

A Motley Fool review of mobile health in China, which a Brookings Institution report says will be worth $2 billion per year by 2017,  says the three publicly traded companies that will benefit most are IBM, Microsoft, and Lenovo. It says the market won’t behave as it does here because Chinese medicine has different workflows, the language is hard, cloud-based security is a tough sell, and Apple’s mobile devices are much less popular than Android ones. It misses some facts: (a) most mHealth companies aren’t publicly traded; (b) those three companies are so large that whatever happens with mHealth in China isn’t going to move the share price; (c) it touts Microsoft as having implemented “a single, cloud-based system” that turns out to be the nearly forgotten HealthVault; (d) it predicts Lenovo’s success because it makes hybrid devices (laptop/tablet) that run Windows 8 and because it bought Motorola and found itself owning 11.8 percent of the smartphone market in China, although the article fails to mention Lenovo’s huge benefit: it’s a Chinese company.  

Sponsor Updates

• Health Data Specialists will exhibit at the Cerner Southeast Regional Users Group March 30 – April 4 at the Sheraton Sand Key in Clearwater Beach, FL.

Exhibitor Costs at the HIMSS Conference

Readers had asked for details on what it costs a company to exhibit at the HIMSS conference. I greatly appreciate the vendor executive (let’s call him “Larry,” just to keep things anonymous) who provided complete information from last month.

Booth construction: $132,000
Booth space (20×40): $26,000
Booth power and connectivity: $20,000
Breakfast briefing: $11,000
Hospitality suite: $15,000
Printing: $6,000
Giveaways: $4,000
Booth graphics: $2,500
Buying the attendee list: $1,800

Including some other smaller costs, the company’s total expense was $222,000. That doesn’t include employee salaries or travel costs.

Larry says he’s happy with the outcome. The company had 400 people visit the booth for meetings or to see a demo. About half of those had been scheduled in advance, which is an efficient way to meet with prospects, and the other 200 were walk-ups who might become prospects. He also sees value in the employee bonding experience and being able to learn from attendees.

It’s the same as for attendees, in other words: HIMSS benefits from putting interesting people in the same place at the same time. The attendees derive their value from each other.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/21/14

M*Modal Files Voluntary Chapter 11 Petitions to Facilitate Financial Restructuring

M*Modal files for chapter 11 bankruptcy two years after being acquired by private equity firm OneEquity for $1.1 billion. M*Modal markets cloud-based transcription and voice recognition solutions, and says that it will continue on with normal operations throughout the bankruptcy proceedings.

Harvard Research Reveals EarlySense Monitoring System Reduces Length of Stay in the Hospital and ICU

Harvard Researchers testing the effectiveness of the EarlySense monitoring system, a sensor that sits beneath a bed mattress and monitors heart rate, respiration rate, and movements, find that its use led to a reduction in length of stay, a reduction in ICU days, and a reduction in code blues.

REC Program Evaluation Interim Report: Round 1 Case Studies

ONC publishes findings from a review that was conducted with nine RECs, highlighting the most difficult challenges faced, and emerging best practices for helping providers achieve MU.

Key leadership in OHA, Cover Oregon to be replaced following investigation

The head of the Oregon Health Authority has resigned over the poor performance of Oregon’s health insurance exchange. The exchange, which was developed by Oracle, remains the only exchange in the US that has still not enrolled a single person in an insurance plan.

News 3/21/14

Top News

Transcription and software vendor MModal files for Chapter 11 bankruptcy protection less than two years after being acquired by One Equity Partners for $1.1 billion. The company, which lists its assets and its liabilities between $500 million and $1 billion,  says it is in “constructive discussions” with its lenders and bondholders regarding the terms of a consensual financial restructuring plan and expects to continue normal business operations throughout the restructuring process.

Reader Comments

From Experienced CIO: “Re: reader survey. I had to write to admire how many ways you politely declined to go down rabbit holes and chase information that is not within your (broad) span of knowledge. You are great at delivering what you know and show a comprehensive understanding of the business. Thus, I welcome your personal opinions and commentary. I also recommend that you discontinue HIStalkapalooza, which is a wonderful gesture when you were smaller, but has become unmanageable. Just invite everyone to get together at a cash bar and it will take care of itself in a year or two. Good job, well written, and you stick to your knitting. That is why your publication is so popular.” I appreciate the comments. I like the idea of a simpler, cheaper HIStalkapalooza, having initially envisioned a big parking lot or park with kegs of beer, grill-your-own hot dogs, and a band. Dr. Travis from HIStalk Connect wanted me to put something like that together for startups at HIMSS, but the idea didn’t come up until too late. I’m considering options for next year. Party planning isn’t my core competency.

From Arcanity: “Re: your poll about professional certifications on your business card. I think this guy takes the cake.” Looks like either a big ego or a small … well, you know. Diplomate-ically speaking, his business card must be the size of a poster board.

HIStalk Announcements and Requests

A few of the stories you may have missed this week on HIStalk Practice: CMS offers a free online tool to help small practices transition to ICD-10. Over 60 percent of practices don’t plan to participate in an ACO. A reader suggests that Practice Fusion, CareCloud, and ZyDoc might follow Castlight’s IPO lead within the year. The potential costs associated with information loss during the ICD-10 transition could be substantial. Four major insurance carriers tell the AAFP they’ll be ready for ICD-10 by October 1. NCQA intends to raise its PCMH recognition standards in 2014. Thanks for reading.

This week on HIStalk Connect: Castlight Health shares soar 149 percent on the day of its IPO. Physician-only social networking site Doximity reaches 40 percent market penetration with US physicians. SharePractice launches a mobile app designed to let doctors use crowdsourcing to collaborate on and rank the best approaches to treating specific conditions. Dr. Travis dissects the recent failings of Google Flu Tracker and its implications on big data at large.

Welcome to new HIStalk Platinum Sponsor NYeC (New York eHealth Collaborative). NYeC is New York State’s not-for-profit public resource for healthcare IT, facilitating the EHR transition for providers and improving healthcare for all New Yorkers. Its activities include the SHIN-NY HIE; NYeC Regional Extension Center serving the upstate region and Long Island; the multi-state EHR-HIE Interoperability Workgroup; and the Patient Portal for New Yorkers that will go online this year. It runs the New York Digital Health Accelerator along with the Partnership Fund of New York City, supporting early- and late-stage digital health companies working on care coordination, patient engagement, predictive analytics, and workflow management. Chosen companies, which are required to have a New York presence, receive $100,000 in upfront funding and participate in a leadership program of healthcare leaders, entrepreneurs, and investors for the five-month term. Applications for the 2014 class are due April 11. The class of 2013 included ActualMeds, Aidin, Avado, CipherHealth, Cureatr, MedCPU, Remedy Systems, and SpectraMedix. Thanks to NYeC for supporting HIStalk.

Here’s my free “how not to look stupid” tip of the week: don’t reply to business emails on your phone. I see this constantly: the sender doesn’t notice incorrect spellcheck changes, they write barely intelligible terse text that makes little sense, and the tiny keyboard makes it too much trouble to make desirable changes to the subject or to the “Sent from my iPhone” email signature that indicates they are dashing off a reply on the fly while doing something else. You would be better composing a more thoughtful reply on a real computer later unless it’s an emergency.

Upcoming Webinars

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

Augmedix, a startup building clinical applications for Google Glass, secures $3.2 million in venture funding.

CitiusTech announces an investment partnership with General Atlantic. The company, which works with 50 healthcare organizations worldwide, reported 2013 revenue growth of 51 percent.

HIMSS acquires Harrogate, England-based conference promoter Citadel Events, renaming it HIMSS UK.

Social health management vendor Welltok acquires wellness game developer Mindbloom.

Procured Health, which offers software that manages hospital purchases of medical devices, raises $4 million in a Series A round.

Sales

The New England Healthcare Exchange Network will implement the Ability Secure Exchange Platform across its member hospitals and provider sites.

Mercy Orthopedic Hospital Springfield (MO) selects Emmi Solutions for patient engagement.

Adventist Health Hospitals (CA) will deploy Aperek Ellipse for real-time anytime spend visibility and analytics.

BJC Healthcare (MO) selects Health Language to assist with its transition to ICD-10.

People

Clinovations promotes Kevin Coloton from COO to president.

Announcements and Implementations

Methodist Healthcare (TN) deploys MedAptus Professional Charge Capture for inpatient coding and billing.

La Clinica del Pueblo (DC) goes live on Forward Health Group’s PopulationManager and The Guideline Advantage.

The Nashville paper profiles RoundingWell, the patient engagement software company launched by the founder of bulk email software provider Emma. It uses EHR-generated information to send patients questions, education, and guidance from a proprietary content library developed with Vanderbilt University School of Nursing and The Center for Case Management. A tiny study found that patient engagement rates were at 60-70 percent over 90 days, with the average patient having eight risks identified that it says wouldn’t have been addressed otherwise.

Aprima offers Etransmedia customers running Allscripts MyWay a conversion to Aprima Patient Relationship Manager, hosted by either Aprima or Etransmedia.

HealthEast Care System (MN) goes live with an early intervention program for heart failure patients that uses patient engagement technology from Pharos Innovations.

Catholic Health System (NY) deploys Juniper Networks Meta Fabric, an open standards-based architecture for data centers. 

Sanford Health (ND) completes the installation of  RTLS technology from Sonitor Technologies and Intelligent InSites at Sanford’s soon-to-be-opened Moorhead clinic.

Government and Politics

OIG testing of the 28-hospital Indian Health Services computer network reveals inadequate security and significant network vulnerabilities. OIG hackers were able to gain unauthorized access to the IHS web server and an IHS computer, as well as obtain user account and password data and records in the IHS file system.

The HHS Office of the Assistant Secretary for Preparedness and Responses and ONC launch an initiative to promote the use of HIT in emergency medical services.

ONC announces that its open source popHealth tool to process electronic clinical quality measures has been certified as a 2014 edition EHR module.

Oregon Governor John Kitzhaber fires the head of the state’s health authority and asks Cover Oregon to replace its senior management team, including the CIO and COO, following an independent investigation. Cover Oregon remains the only state whose exchange, which cost $200 million, hasn’t enrolled a single person after its planned October 1 rollout failed. The report concluded that the state’s managers had too much confidence that Oracle, which has been paid $160 million so far, could deliver what it promised.

Innovation and Research

Harvard University Medical School researchers find that use of the EarlySense monitoring system on a medical-surgical unit was associated with a significant decrease in length of stay, code blue events, and ICU stay times. EarlySense uses a sensor that is placed under a patient’s mattress to detect potential adverse events, as well as monitor heart and  respiratory rates and movement.

A study finds that facial recognition software beats humans at detecting patients who are faking pain, with accuracy of 85 percent vs. 55 percent.

Other

An ONC-commissioned review of nine RECs finds that their most difficult challenges are poor EHR product usability and the “unsavory” business practices of some vendors. Other struggles include physician resistance to EHRs and the MU program, sustainability of RECs once federal funds are depleted, and difficulties communicating often confusing details of the MU program. The authors also note three best practices that emerged for helping providers achieve MU:

• Maintain strong partnerships with the community
• Hire technical employees who that have a mix of IT skills, clinical understanding, and general business understanding
• Work with a physician champion.

The Business Journals names its “10 Markets with the Strongest Brainpower”: Washington DC, Madison, Bridgeport-Stamford, Boston, San Jose, Durham, San Francisco-Oakland, Raleigh, Minneapolis-St. Paul, and Colorado Springs.

Supply chain software vendor Global Healthcare Exchange, acquired by private equity firm Thoma Bravo a week ago, reportedly lays off 130 of its 500 employees.

Google CEO Larry Page, speaking at a TED conference in Vancouver, touts the sharing of medical records, saying, “Wouldn’t it be amazing if everyone’s medical records were available anonymously to research doctors? We’d save 100,000 lives this year. We’re not really thinking about the tremendous good which can come from people sharing information with the right people in the right ways.” He described losing his voice because of an undocumented condition and finding thousands of people with the same problem after posting a description online.

St. Luke’s Health System (ID), which lost an antitrust lawsuit filed when it attempted to buy a physician group and used its Epic system as one of the benefits, receives a $10 million legal bill from the the hospital, surgery, center, and attorney general that successfully sued it.

Cerner is among 23 Kansas City-area employers recognized for their commitment to lesbian, gay, bisexual, and transgender equality.

Doctors in England using Skype to check on a home dialysis patient notice her husband collapsing in the background and send an ambulance to help the 70-year-old man, who was later found to have bowel cancer.

Sponsor Updates

• ScImage will deliver its PICOM365 PACS with Cedaron’s CardiacCare.
• Direct Consulting Associates joins the HIMSS Innovation Center in Cleveland as a Supporting Collaborator.
• CommVault will add 250 jobs in the next three years at its 275,000 square foot headquarters under construction in Eatontown, NJ.
• Pandodaily.com spotlights Validic and its data pipeline solution for healthcare.
• GetWellNetwork sponsors the 28th annual National Disabled Veterans Winter Sports Clinic March 30-April 4 in Snowmass, CO.
• Emdeon CEO Neil de Crescenzo tells the Nashville Business Journal that his company has hired 100 people in the last six months.
• AdvanceNet Health Solutions will add the CoverMyMeds ePostRx automated prior authorization solution to its enterprise pharmacy management platform.
• Summit Healthcare partners with Indigo HIT to offer complimentary services to enable clients with streamlined and scalable CCD integration.
• Kareo adds Rignadoc to the Kareo Marketplace to help physicians with phone triage.
• ICSA Labs certifies First Databank’s MedsTracker as a 2014 Edition Ambulatory and Inpatient Modular EHR.
• The Ethisphere Institute names Premier a 2014 “World’s Most Ethical Company” for the seventh consecutive year.
• Angela Hunsberger, senior consultant for Hayes Management Consulting, discusses the need to balance security and usability in patient portals.
• Healthcare services firm Accreon partners with identity management solution provider NextGate to deliver services and technology for enterprise data awareness and exchange.
• RelayHealth Financial releases RelayClearance Plus 5.0, a pre-service financial clearance solution that includes an eligibility benefits detail viewer.
• Clinithink launches its suite of CLiX Online Solutions to translate unstructured clinical narrative for real-time use.
• TeleTracking Technologies names Hill-Rom a licensed reseller of TeleTracking’s asset and temperature tracking software, while Hill-Rom extends re-sale rights to TeleTracking for its hand hygiene compliance solution.

EPtalk by Dr. Jayne

I spent all day Tuesday at yet another continuing education class to recertify a life support certification. This is the last one until summer, so I’m glad to have a break.

I understand why they require us to stay certified, but the odds of my actually having to participate in a code situation in the hospital are pretty slim based on my clinical practice patterns. I’m more likely to have to use basic CPR at the supermarket than any of the other skills, which I guess is a good thing. This year I took the “independent study” course, which included an online pre-course as well as the in-person practice and skills testing sessions using a computerized mannequin.

In some ways, the certification seems like a racket. This week confirmed my thoughts. The health system I work for has a master license to be able to train staff on adult cardiac life support because they require most of the clinical staff to maintain certification. I have no idea how much that master license costs, but I know that the individual certification fee is $220 because I had to pay it out of pocket.

In a quirk of rule-making, since I’m not employed by the hospital in a clinical service line (my Emergency Department work is through a third-party contracting firm), there isn’t a department to cost it back to. Apparently neither the administration or IT cost centers are valid for the education department to use, which makes me nervous that someone thinks administration and technology don’t need continuing ed.

At other hospitals (such as the one where I take my pediatric course) the fee for the all-day course includes the textbooks and lunch, but ours doesn’t. I’m a girl who knows how to brown bag and I don’t mind not being allowed to keep the books because I’m never going to look at them again. Neither of those are that big of a deal, but the twist at the end of this course was unbelievable. When we turned in our evaluations at the end of the day expecting to pick up our certification cards, we were asked to pay an additional $2.25 (in cash) for the actual card. Talk about unbundling!

Hospitals are infamous for nickel and diming patients. I suppose I shouldn’t be surprised that they’re now doing it to the medical staff and the independent contractors who fill the positions they can’t staff on their own. When I registered for the course, I had to wait until my check had cleared to actually schedule it and borrow the text books. I thought that was a little weird, especially since I’ve been on staff for more than a decade and they know where to find me if the check bounced, but I understand not everyone is that reliable. Incidentally, the pediatric hospital takes online payments for their courses, so they don’t have the check cashing issue.

My suggestion to the education department was to just raise the course cost to $222.50 (or even $225) so that they’d have the full payment up front and not ask for cash at the end of the course. I was told that the clinical departments only allowed $220 for the course and the reason they charge for the card was because the “regular employees” don’t actually need the card, they just need a statement from the education department that they had passed the course. Only “external” attendees need the card, hence the extra charge.

I guess external is a nicer way to say that I’m an irregular employee, or to possibly admit that our hospital is so cheap they won’t pay $2.25 for the 20 or so “external” attendees who take the course each year. Or that they’re ignoring the cost savings of recycling textbooks that they’re charging individuals for.

I’m afraid that as healthcare reform evolves, this is only going to get worse. Our hospital has hired a fleet of financial staffers to micromanage every facet of patient care (without admitting they’re telling physicians how to practice medicine) at the same time they’re cutting positions for nurses and patient care technicians. They were already in the business office, where I did battle over the fact that I can only order one printer cartridge at a time (despite the fact that they’re cheaper in a two-pack) due to new purchasing rules. They were already on the hospital floors, where we have to bar code scan every gauze pad and bandage we touch. Now they’re even in CPR class.

We are the embodiment of penny-wise and pound-foolish. I’m curious about the trends our readers are seeing in the hospital or clinic. Has everyone gone as mad as my employer seems to have gone? Are we headed towards the level of care seen in other parts of the world, where patients are expected to provide their own bandages and meals? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 3/20/14

Penetration Test Of the Indian Health Service’s Computer Network

The OIG conducts staged cyber attacks on the Indian Health Services computer network and finds significant and addressable vulnerabilities. During the exercise, OIG hackers were able to access internal IHS networks and databases, uncover user account and password details, and remotely take over IHS computer terminals.

IBM Watson goes after brain cancer

A group of New York hospitals along with researchers from the New York Genome Center will team up with the IBM Watson group to start work on a new Watson application that will evaluate a patient’s genome and EMR data, and then reference medical literature and a library of medical charts to help create a personalized treatment plan based on outcomes probability. To start, researchers will focus on glioblastoma, an aggressive and malignant brain cancer.

Healthcare Organizations Haven’t Maximized Full Potential of Meaningful Use, According to HIMSS14 Stoltenberg Consulting Survey

A non-scientific study conducted by Stoltenberg Consulting during HIMSS finds that a lack of resources is the number one barrier to advancing meaningful use adoption, followed by restricted timeframes, a lack of buy in, and competing IT projects.

CIO Unplugged 3/19/14

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

Trains

I spent my early years in Europe, where travel by train was the most efficient form of transportation. I loved the excursions where we bypassed the Autobahn, moving swiftly across the landscape of Germany and surrounding countries.

Returning often as an adult, I became increasingly aware of the differences in how trains were run by country. Even my kids quickly learned that German and Swiss trains were always on time, while the French trains were often delayed or just plain cancelled. We crossed our fingers whenever we had to jump a train for France.

I asked some Swiss operators why the French trains had such a dismal reputation. They blamed it on the culture — their processes were not as sharp as those of other countries.

December 2010, I had a rude awakening that my internal operations, or “trains,” were more French than they were German. I detailed some of the lessons learned in this post. I realized that our culture, unattended, had drifted. We had no logical processes that were detailed except in the minds of one or two key individuals. Not good.

Around 2 a.m that fateful day, one of my team convinced me it was time for a major change and that we needed uber focus on process. Convince me … Nothing! I was desperate!

Since then, I’ve learned that the majority of IT organizations across all industries don’t have formal process plans. Based on historical success or experience, they operate without intention. Some do extremely well with this non-method; others don’t.

We operated well without a plan for years. But given the complexity in this increasingly digital healthcare world, the risk became too great to operate whimsically. We chose the ITIL framework. I’m not endorsing ITIL, but it is the framework we selected for IT service management.

As a result, we’ve seen significant improvements in our operations. Like most frameworks, ITIL isn’t just about operations, but it is the area we chose to focus on initially.

We started with a gap assessment. Yep, we had holes in our processes, and we knew it. Our train tracks were not always true.

We started to close those gaps, reassess, find more holes, and filled them. We were tenacious. It became one of our top priorities.

Three years later, we won a major industry award for the impact of our ITIL journey. Again, it is just an external validation of what was taking place internally. A complete transformation of our operations. This train is going places, reliably!

This is the video that was shown prior to my employer winning this prestigious award conferred by Pink Elephant.

If you find yourself with operations that are more akin to the French trains than German ones, here are some steps you can take to transform your operations:

• Lead this personally so everyone knows how important this initiative is.
• Hire someone, redirect a current position if you must, to have someone focus 100 percent on your framework.
• Have an external review of all IT service management processes.
• Pick highest risk areas and focus relentlessly.
• Require IT service management certification as a condition of employment (I was in the first class).
• Require advanced certification of all your leadership.
• Everyone takes our classes, including administrative support.
• As momentum grows, add staff as needed to enable transformation, even if it means repurposing existing staff.
• Make your maturity level goals part of your key performance indicators to ensure everyone has skin in the game.
• Invest in an appropriate number of staff to become experts.
• Annual external assessments to review progress to KPI.
• Never lose the focus or determination, talk about it often.

Not everyone will be on board. You will experience pushback from your own team. That is part of leadership. Have the vision and execute. Listen to your team and adjust accordingly, but never lose sight on the need to drive this until IT service management is just a part of the culture and folklore.

Our results on our operational areas of focus:

Area Baseline, Year 1, Year 2

• Service Desk – 2.5, 3.28, 4.04
• Incident Management – 2.0, 3.07, 3.79
• Problem Management – 1.5, 3.13, 3.63
• Change Management – 1.25, 3.10, 3.34
• Configuration Management – 1.0, 3.10, 3.07
• Knowledge Management – 1.0, 3.18, 3.69

We met our KPI by meeting a 3 or greater CMMI level of maturity. We now push towards 4 or greater and have expanded our areas of focus.

An example of how this translates into transformation is our rate of unplanned changes (Emergency and Urgent) has been reduced by over 40 percent. We now have a vibrant service catalog. Ninety-four percent of all team is ITILv3 Foundation certified and 95 percent IT leaders have at least one advanced certification. We now have nine ITILv3 Experts.

But the best part is how our focus on running our trains efficiently and effectively has impacted business and clinical performance. I am unable to share our metrics at this point, but the reason we won the Pink Elephant had everything to do with ensuring the reliability of our systems to enable superior business and clinical outcomes. Simply put, we save lives.

Perhaps your trains run well and IT service management is not an issue for your organization. Bravo. I know this was not the case for us. Today our customers can trust that our trains won’t be delayed or cancelled. All aboard….

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

Reader Survey Results 2014

Right after the HIMSS conference every year, I survey HIStalk readers. The responses, which are always smart and insightful, help me plan the next year. That’s important since I rarely see readers in person – they don’t seem to stray often into the spare bedroom in which I write HIStalk alone, which is probably a good thing since I don’t have any extra chairs.

Some demographics of the 600 survey respondents:

• 38 percent of respondents have worked in the industry for more than 20 years, while another 31 percent have more than 11-20 years of experience.
• 45 percent of respondents work for vendors, 20 percent for consulting firms, and 27 percent for hospitals or practices.
• 6 percent of respondents are CEOs, 5 percent are CIOs, and 2 percent are CMIOs.
• The most-appreciated features of HIStalk are news, rumors, humor, and the morning headlines.
• 86 percent of respondents say they have a higher appreciation of companies I’ve mentioned on HIStalk.
• 37 percent of readers say they’ve recommended HIStalk to others in the past month, while people whose world revolves around social media might be surprised that only 11 percent of respondents saw even one of our tweets.
• My favorite stat: 92 percent of respondents say reading HIStalk helped them performed their job better in the past year. That’s the metric I watch most closely.

I’ve learned not to overreact to individual comments on the survey. Like everyone else, I think I’m representative of all readers and therefore can see obvious things that should be changed, but that’s not really the case. I don’t run HIStalk by committee because the result — as happens when software vendors let user groups dictate their entire R&D — would be a product that nobody hates but that nobody loves either.

Not everybody likes the same parts of HIStalk. Some people love interviews, some hate them. For every person who complains about music reviews, several say they love them and want more. Readers Write articles are often vendor fluff pieces even though I’m rejecting more of those, but some people don’t even like the really good ones because they just want to read news presented as tersely as possible. The bottom line on content is that I have to write and report what I think is relevant and interesting. I write something I would want to read. For those who don’t agree, other sites do it differently.

I’m also careful not to let my reach exceed my grasp. I get a lot of suggestions to cover more international news, to dig deeper into the payer market, or to cover more healthcare news in general and not just the healthcare IT side. I don’t have the time or interest to cover entire new subject areas well,  so I’ll stick with what I know. I’ll always try to make HIStalk better, but I don’t really want it to get bigger because then it wouldn’t be fun for me. It’s been 11 years since I started it and I would have quit long ago if I wasn’t having a good time.

I ask a couple of open-ended questions on the survey and will address some of the responses. I should add, though, that the most common comment was “don’t change anything.”

Get deeper into the implementation cycle. Do stories about how people get solid benefit realization.

I’m happy to do this. Providers are busy and don’t often have time to participate, but I almost always ask questions around benefit realization when I’m interviewing CIOs. Maybe that’s the opportunity – if you work for a health system in a non-CIO role but can speak authoritatively on implementation lessons learned, optimization, and benefits, I will interview you, anonymously or otherwise (since I know many hospitals don’t allow interviews without approval).

That answer applies to several suggestions. Readers want more information from providers just like I do, but it’s hard to bring those people into the conversation.

Create a moderated forum for further discussion.

I did that awhile back and participation was pathetic. Everybody loves the idea, including me, but a lesson I’ve learned is that while many people enjoy consuming content, few want to create it. It’s hard to solicit engaging comments and thoughtful guest articles except from people who are pitching something.

Express more opinion in your observations.

I agree. Sometimes I get so busy, especially for the Tuesday and Thursday night posts when I’m getting tired, that I focus on summarizing complex news items without adding as much personal commentary. That’s one takeaway from the survey – I will do more of that, although the folks who say “less commentary and just the facts” won’t be thrilled.

Add the patient experience of IT to the mix. It is a missing voice in HIStalk. Otherwise, it is off the charts incredible.

That would be great, but I don’t know to get them involved since they likely don’t read HIStalk. I just thought of something that I might be able to do along those lines, so let me think it through and I’ll report back.

I would add some basic educational materials targeted at folks who are new to healthcare IT.

I keep thinking about how to do this, but it’s a big job for me to take on alone.

The webinars still feel a bit too vendor sales focused.

We’ve tried to make the ones we’ve produced more educational, but the bar was set low and we haven’t been able to raise it as quickly or as far as I’d hoped yet. We’ve had vendors come to our rehearsals without the presenter even having seen the slide deck. We have drawn the line in some ways – I review the slides and rehearsal ahead of time and if I think it’s irrelevant except as a sales pitch to prospects, I make them say so in the abstract’s target audience. The one thing I’ll say is that the webinar you see will always be better than it would have been without our guidance. Whether it could have been better still is the issue we’re addressing.

Let’s hear more from front-line nurses, like a Dr. Jayne column.

I agree. I would need someone insightful with the time and ability to write well and regularly. I’ve solicited that kind of talent before and have struck out. I would be happy to hear from a nurse in an actual caregiving role who is IT savvy, opinionated, and an engaging writer.

Add tags for discussion, links to specific story items, or improve the search function.

I haven’t found an easy technical way to do any of these things. The “one post, many items” format is perfect for reading, but doesn’t lend itself to breaking out discrete data elements for searching or filtering. I would contract out doing some manual indexing if I could figure out what the result would even look like. Someone suggesting reaching out to an informatics professor to have their students devise a solution, which would be fun.

Stop being so pro-Epic.

I report about Epic the same as any other vendor. They are successful and a driving force in the industry, but they also aren’t perfect and I report that too (questionable non-competes, hospital bond ratings that suffer because of Epic rollouts, and weaknesses in specific product lines). Epic will get mentioned more than some vendors because they are big and many readers, especially the big-hospital ones, are involved with their products and have more to say about them. Everybody either loves or hates Epic  (often breaking down into Epic users vs. Epic competitors), but I think I’m as much in the middle as anyone. Of course everyone thinks they are unbiased and I’m no different.

Do more interviews with non-sponsoring companies.

I will interview almost anyone who sounds interesting and who volunteers or who agrees when I reach out, although for companies I only interview at the CEO level. I don’t guarantee sponsors that I will interview their executives, but their PR people often make the CEO available and I’ll usually accept under my rules (no blatant promotion, no advance screening of the questions, no approval editing of the transcript, I’ll talk about what I want to talk about and that probably won’t be the usual PR fluff.) I love interviewing providers, but they rarely volunteer. Typically the only interviews I decline are non-CEOs and CEOs of companies that aren’t doing anything interesting or important enough for most readers to care.

Avoid the whining sour tone that creeps into HIStalk.

This is another area where opinions vary. Some people claim I’m an industry cheerleader oblivious to the facts, while others see me as a negative naysayer. I can only say that I’m being myself when I write and you either like it or you don’t. I’m not changing.

Have you considered charging people to write "Readers Write" articles? They have become self-promotional advertisements for consultants or software vendors.

I agree that they had become tedious until a couple of months ago. My policy was to accept anything that wasn’t promotional. Lately, I’ve started rejecting articles that don’t present useful information appropriate to a knowledgeable audience and I’ve alerted the PR people who were ghost-writing them that I can’t use those articles. I will also say that anyone who interviews or submits guest articles is promoting something, even themselves, or they wouldn’t bother, so it will never be perfect unless I stop accepting guest content altogether.

HIStalk seems to be getting rather smug and self-congratulatory, especially in the case of HIMSS coverage and the HISsie awards and the HIStalk party. It seems you are beginning to think that what HIStalk does IS the news rather than you report the news.

We do cover ourselves at HIMSS since everything we’re doing there involves readers, but not to the exclusion of anything else. It’s tongue in cheek – it’s not news, just acknowledgment that HIMSS brings a lot of readers and us together. I barely mentioned the HISsies awards and only enough about HIStalkapalooza to allow people to sign up and to read the recaps afterward. It isn’t news, but then again neither is most of what happens that week.

I would like to see more B2B opportunities for sponsors and other companies to connect with each other for partnerships, staffing, or even acquisitions.

I’ve always liked the idea, although I’m not sure I have any particular expertise to make it happen. I’m open to ideas.

I believe there’s an opportunity with HIStalk for readers to share with the entrepreneur community what are the real world problems that still exist and still remain unsolved. 

Readers would have to step up and contribute and that doesn’t usually happen. I could ask for volunteers to serve as an ongoing provider panel, contacting them every six months or so.

Morning headlines don’t seem very useful. The information is usually covered in more detail during the following news post.

That’s the point. Some people just want a quick glance at the most important news. It stands to reason that stories important enough to be included in the headlines would also be covered in the regular HIStalk post, with the assumption that someone short on time might not get to the latter right away.

The email updates don’t offer anything helpful. They just say something new was posted to the website.

That’s all they are intended to do. I’m not writing a newsletter, I’m just letting people who signed up for the updates know there’s a new post. The majority of readers come to the site by clicking the email link. I am willing to put Lt. Dan’s morning headline posts into their own full email if people want that, and a few respondents do.

Include more regular content from healthcare M&A investors.

I would be happy to do that, but those folks are busy enough that nobody has volunteered. People like the idea of writing regularly for HIStalk, but then realize that it’s a fair amount of work on a fixed schedule. I’ve tried several people as regular writers and they dropped out not long after they started.

More information about cutting edge technologies.

I’m willing. It’s hard to tell which startups are BS or doomed to a mercifully quick death (and quite a few are both), but I will interview CEOs (or even better, their customers, if they have any) since that’s the best way to find out what they’re doing.

Filter comments more to get the non-productive ones out.

That’s a slippery slope. I generally approve all comments except those that are potentially libelous or are of a suspicious nature (like someone making unsubstantiated claims about a publicly traded company.) I would love having more thoughtful and balanced comments, but I can’t make people submit them. I have started deleting the incessantly anti-EMR whining ones from the many fake names of the reader known as Not Tired of Suzy, RN because they all say the same thing.

A bit less content. It’s a lot to read 

It is quite a bit of reading, maybe 10 minutes per day, but it’s everything important going on the industry. I reject 95 percent of the “news” that’s out there because it’s irrelevant and what’s left is what I think is important. Certainly you could skip some sections that you know in advance won’t interest you as being hard news (probably the reader comments, sponsor updates, upcoming webinars, etc.) but I’m writing for people with a lot of backgrounds, some of whom find information on sales, business news, and people changes to be the most useful parts of HIStalk. In other words, everyone would like to see content tailored to their specific interests, but those interests vary.

Create a cleaner front page design.

I have to be honest that I’m more of a content guy. Everybody likes the idea of a different page design, but when I looked at it awhile back with reader input, nobody had any great ideas given the nature of the content. However, I will take this chance to remind that you can click the “View/Print Text Only” link at the bottom of the post to get a simpler layout that some find easier to read. It also makes it easier to copy/paste if you want to send a snippet to someone. Try it right now.

Interviews with users and not just C level.

I’m willing to interview anyone who is interesting, but I can’t make them volunteer. I don’t have any good way to get in touch with floor nurses or hospitalists from hospitals all over the country.

How about a column from someone at ONC or a member of the HIT Policy Committee? Also, The Investor’s Chair has tapered off and it would be good to see more of him.

I’m certainly willing on the former. On the latter, I love running Ben’s stuff but I guess he’s been busy, same as Dr. Rick Weinhaus’s “EHR Design Talk.” Volunteer contributors  have jobs and lives that come first. Writing isn’t their primary activity.

I would love a section for analytics.

I probably need to dig a little deeper into that, but there’s an awful lot of frothiness out there (or maybe that’s a reason do to it instead of a reason not to.) I will figure out how to get more education on the topic since I’m a casual follower for now. 

Create an HIStalk podcast or audio format of HIStalk for the morning commute.

I could do that, but I don’t know if enough people would care to make it worthwhile. I’m biased because I’d much rather read words than listen to audio or watch video where I can’t skim, but it might be fun for commuters.

Bigger venue for HIStalkapalooza.

HIStalkapalooza has turned into a headache as it keeps getting bigger and expectations are raised, but I’ll try to make it better where I have enough influence with the company that’s paying. I dread it every year because I get into emotional arguments about how many people I can invite, where it will be held, and how we’ll handle things like guest requests or special diets. Then I get into a Vietnam of requests from righteously indignant people who didn’t sign up or who I couldn’t invite because of capacity. I said after this year’s event that I was done with it, but I’ll probably change my mind over the summer.

Don’t dilute your brand with things outside your core of news and comments.

I’m keeping close to the core, I think. The only new offering involves webinars and I let Lorre manage those so I don’t get distracted. I received probably 30 or more ideas of things I should get more involved with, but I will likely pass on most or all of them and stick to my knitting. I have enough challenges already.

I would make the "Anonymous CIO" interviews a regular feature.

I would love to. I asked for volunteers and got the one you saw. That’s it.

Bring back the old logo. Don’t give in to the PC police!

I didn’t drop the smoking doc logo because of political correctness. It’s still at the bottom of every post, in fact. The problem was that it wasn’t designed as a logo. It was cool, but the size, shape, and detail didn’t work as a logo. I still get occasional hysterical emails from people who don’t get the intentional irony of a 1950s, reflector-wearing, pipe-smoking doctor, who think that they are the first to have noticed that a healthcare IT site features smoking.

Most of your content is regurgitated news from other sources.

News almost always comes from other sources no matter what you’re reading, although I will take exception in that some of the reader comments, rumors, and interviews provide news that nobody else has. None of the big-budget publications have people out there on the street doing investigative journalism or first-person reporting – we’re all somewhat reliant on announcements, journal articles, vendor propaganda, and lame survey results (and in the case of many sites, using what they find on HIStalk and pretending they didn’t get it there.) The HIStalk difference, I hope, is that I won’t run space-filling stories that don’t interest me, I summarize the stories and put them into perspective, and I’ll add my own commentary when I think I can add value. I’ve been on the provider side for a lot of years, so I would hope I can do a better job than a reporter fresh off a fashion magazine. 

Separate out the content areas into separate sections in their own posts.

I don’t want to do that. People want one quick glance to see everything, not to go clicking on several separate posts just to see what’s new. I know other sites do it that way, but I think they are wrong.

Take a break and get some R&R more often so you don’t flame out prematurely.

I’ve been writing HIStalk for almost 11 years and I still look forward to it every day. Sometimes the administrative parts take more energy than I’d like, but that’s why I got smart and brought Lorre and some other folks on board to help out so I can do the parts I care most about.  

A couple of readers have asked about my succession plan. There isn’t one. If I flame out prematurely or otherwise, HIStalk flames out with me. That leaves Inga or Lt. Dan to post my obituary, which I hope in honor of my tiny legacy will be crisply concise and snarky.

Morning Headlines 3/19/14

From vital signs to clinical outcomes for patients with sepsis: a machine learning basis for a clinical decision support system

Researchers at the University of California Davis Health System have demonstrated that EHR data can be used to predict sepsis, and are working on an algorithm that can be incorporated into EHRs to generate alerts and drive interventions.

Colorado health exchange workers are paid more than similar positions in three other states

20 percent of the 36 employees working at the Colorado health insurance exchange make more than $100,000 per year, drawing criticism from local papers. Patty Fontneau, the executive director over the HIE, defended the salaries, saying "I had to hire individuals with skill sets to implement a significant project in a short period of time."  Colorado has one of the best performing exchanges in the country, but it did have significant technical issues at launch, and its enrollment numbers are below the state’s expectations.

New York Presbyterian Hospital Announces Winners and Results from NYC’s First Hospital ‘Hackathon’

New York Presbyterian Hospital awards the three winners of its hospital hackathon $50,000, $25,000, and $10,000 respectively. The two-day hackathon it held drew 17 teams and focused on developing tools to improve patient engagement and the patient experience.

Google’s Flu Tracker Suffers From Sniffles

David Lazer, a Northeastern University computer science professor, publishes a paper criticizing Google Flu Trends for presenting highly inaccurate data, saying that last year Google predicted twice as many flu cases as the CDC later said there were.

News 3/19/14

Top News

The comment period opens for a CMS proposal that would allow it to recoup improper PQRS and e-prescribing incentive payments in a four-year project that would look for errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications.

Reader Comments

From Cupola Dogs: “Re: Epic Emeritus Program. Interesting.” Forwarded documents describe a program in which Epic will offer vetted, independent “Epic Emeriti” (Epic-experienced retirees who are least 55 years old) who will help customers as Epic subcontractors. It’s an interesting concept, especially considering that the average Epic employee is probably under 30. Obviously most of the Emeriti will come from hospitals, where experience is considered an asset rather than a liability. Maybe Epic is finally acknowledging that while industry newcomers can follow a carefully documented project plan, sometimes it’s nice for nervous customers to have someone who has walked in their shoes standing beside them.

From TooMuchCoffee: “Re: Mass Health Exchange. Cuts ties with CGI Federal. There has been a lot of finger-pointing over the poor-performing sites, but the one common factor in the lousy sites is the lousy contractor CGI Federal, period. WA state was done by Deloitte and is doing fine.” My cynical suspicion is that the combination of governmental and contractor incompetence creates a lot of dysfunctional software that neither party wants publicized. The insurance exchange sites just happened to be public-facing and political, ensuring that their problems make the papers.

From Parker: “Re: McKesson. Still struggling to find a major health system on their Horizon product to convert to Paragon in order to prove to the naysayers that Paragon can manage complex systems. Atlantic Health was going to, but now is not going to move until they see more progress before making a final decision.” Unverified. It’s tough to get customers to switch to a different product offered by their incumbent vendor without their at least going out to the market first, so that may be causing indecision. It’s also tough to convince them to stick with a vendor who’s retiring the product they bought, which will require a painful new implementation no matter whose product they choose. That’s not a reflection on Paragon, just the reality of why most customers aren’t going to be thrilled, especially the larger ones that can afford to buy another system instead of accepting a free one.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor VisionWare. The Newton, MA company provides a healthcare-focused data management platform that provides world class operational and analytical integrity. Its Master Data Management solutions address data management, integration, and data visualization. VisionWare’s Patient 360 brings in information from a variety of enterprise systems (including retired ones) to provide providers, payers, and HIEs a 360-degree view of a person (patient, member, or customer) and meet the needs for Meaningful Use Stage 2, ACO reporting, and fee-for-value reporting. Provider 360 manages provider engagement, credentialing, referral management optimization, and relationship management. Specific solution components include an EMPI, provider registry, data verification, data visualization, and data governance. Long-time friend of HIStalk Paul Roscoe joined the company as CEO in January after running The Advisory Board Company’s Crimson analytics unit and Microsoft’s Health Solutions Group. Thanks to VisionWare for supporting HIStalk.

Listening: reader-recommended Lake Street Dive, skilled jazz/soul featuring amazing vocals and a female upright bass player who rocks it. They even sound great in a driveway.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

April 2 (Wednesday) 1:00 ET. A Landmark 12-Point Review of Population Health Management Companies. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Learn the 12 criteria that a health system should use to evaluate population health vendors and to plot its internal strategy, then see the results of grading seven top PHM vendors against these criteria. No single vendor can meet all PHM needs. The most important of the 12 criteria over the next three years will be precise patient registries, patient-provider attribution, and precise numerators in patient registries.

Acquisitions, Funding, Business, and Stock

AbilTo, a provider of behavioral health telehealth services, closes a $6 million Series B round.

Castlight Health signs a deal to turn Leapfrog Group’s 2013 hospital survey information into report to help consumers understand hospital performance.

Varian Medical Systems will acquire the oncology team imaging collaboration software product of Atlanta-based Velocity Medical Solutions.

Bloomberg Businessweek profiles CrowdMed, where patients whose unusual conditions have stumped their local doctor post their the symptoms and offer a reward for a correct diagnosis. The site says 180 people have gone through the process, with 80 percent of them reporting that they received a useful diagnosis.

Sales

The Veterans Health Administration Midwest Health Care Network will deploy Lexmark’s Perceptive Software Acuo VNA to consolidate medical image storage.

Meridian Health Systems ACO (CA) selects Halfpenny Technologies to provide analytics modules and an interface engine for exchanging lab information.

Capital Regional Medical Center (MO) selects Summit Healthcare’s Exchange technology to enable CCD integration and Direct messaging.

Saint Peter’s Healthcare System (NJ) selects athenahealth’s athenaOne EHR, PM, and communication system.

Health Choice (TN) selects Valence Health to build a clinically integrated network for population health management and clinical integration.

UNC Health Care (NC) chooses FrontRange HEAT for its newly consolidated service desk, replacing ServiceNow.

New Hanover Regional Medical Center (NC) chooses Strata Decision Technology’s StrataJazz for cost accounting, budgeting, planning, forecasting, management reporting, and productivity improvement.

Valley Hospital (NJ) will upgrade to Meditech 6.1, including the company’s new CCU/ICU application.

People

R. Andrew Eckert (CRC Health Group/Eclipsys) joins TriZetto Corporation as CEO.

CynergisTek hires Erin Fulton (T-System) as VP of operations.

NexTech names Eric Nilsson (Surgical Information Systems) CTO.

Home health and hospice EMR provider HealthWyse appoints Graham Barnes (HealthyCircles) CEO.

Lois Rickard (Press Ganey Associates) joins Streamline Health Solutions as SVP/chief people officer.

Deloitte names Sarah Thomas (NCQA) director of research for the Deloitte Center for Health Solutions.

Box appoints Aneesh Chopra (Hunch Analytics) and Glen Tullman (7WireVentures) as advisors for its healthcare and life sciences practice.

SSM Health Care (MO) SVP/CIO Tom Langston will retire on July 3 after 33 years with the health system.

GetWellNetwork appoints Bart Witteveen (Matrix Medical Network) CFO.

Announcements and Implementations

Three teams share $85,000 in prize money for winning NewYork-Presbyterian Hospital’s InnovateNYP, a two-day hackathon to develop patient engagement ideas for its patient portal. The winning concepts were: (a) a platform that allows inpatients to connect with each other for games, communication, and education; (b) an app that allows patients to connect with other patients, mentors, friends, and families; and (c) a tool that streamlines appointment check-in and rewards patients for healthy activities.

The Boone County Health Center (NE) and clinics go live on Cerner.

Grady Memorial Hospital (GA) implements RTLS from Intelligent InSites to track mobile assets and tissue and blood samples.

InstaMed launches InstaMed Go, which allows providers to collect patient payments via smartphones from any location with the payments posted automatically to their practice management systems and receipts emailed to patients.

Government and Politics

A salary review of Colorado’s health insurance exchange finds that its 36 employees are paid generously with mostly federal tax dollars, with 20 percent of them making more than $100,000 per year and all of them receiving a  10 percent contribution to their retirement plan. The executive director makes $191,000 per year and was given a $18,500 bonus within nine months of being hired. According to a healthcare policy expert for the Independence Institute think tank, “This is a bunch of people really responsible for nothing other than getting government grants.”

Innovation and Research

Inpatient EHR information can be used to predict sepsis, according to a study published in JAMIA. Researchers are working on a sepsis risk algorithm that an EHR can automatically calculate.

Technology

Google beats Apple to the smartwatch punch by announcing Android Wear, available later this year. The watches, which will be tethered to Android-powered phones, will offer voice control, a Siri-like personal assistant, Google Maps, and fitness-tracking sensors. Android Wear may eventually power other wearables, such as a smart jacket.

Other

UNC Health Care System-owned Rex Healthcare (NC) will pay $28 million this year for its portion of UNC’s Epic implementation, which is scheduled for a summer go-live.

CDC’s flu tracking data is better than Google Flu Trends even taking its lag time into account, with Google Flu Trends overestimating flu prevalence by more than 50 percent in the past two flu seasons.

AHIMA, CHIME, and other ICD-10 stakeholders urge Congressional leaders to continue to move forward with the October 1, 2014 ICD-10 implementation deadline and ask for support for the Medicare Audit Improvement Act, which addresses challenges with the RAC program.

A doctor in England is caught by fraud investigators for falsifying electronic medical records to earn NHS quality care bonuses. He enlisted the help of an IT person to enter fraudulent data, but after getting caught, blamed the technician and then computer coding errors for the falsified records. Some of the patients he claimed to have treated were imprisoned, abroad, or dead at the time. 

Weird News Andy titles this, “Lungfish?” Student engineers program at Rice University (TX) enrolled in a program that addresses the problems of hospitals in developing countries create an affordable bubble CPAP device (it helps newborn breathe by pushing air into their lungs) made from two aquarium pumps and a Target shoe box. The device has been deployed in hospitals in Malawi and is being rolled out to other countries. One of the students visited a hospital in Malawi and was told by a nurse there that their device had saved her own baby’s life.

Sponsor Updates

• Nuance will host a free “Art of Medicine” panel discussion on Thursday, March 27 from 9:00 to 11:00 a.m. at the W Hotel in Boston, MA that features Beth Israel’s John Halamka, MD; the AMA’s Steven Stack, MD; and Mass General’s Keith Dryer, DO, PhD discussing demands that take doctors away from patients. Email to register.
• SyTrue is chosen to participate in the first Wharton DC Innovation Summit on April 29-30, which will bring together investors, innovators, entrepreneurs and academic leaders. CEO Kyle will present a session on “Innovation Tools.”
• Gartner positions NTT in the Challengers Quadrant of the 2014 Magic Quadrant for Global MSSPs.
• Canon USA introduces Nuance eCopy ShareScan v5.2, which features an email and folder-watching service to simplify electronic workflows.
• The Drummond Group certifies Kareo EHR for MU 2014 Stage 2.
• Truven Health Analytics reports that its Treatment Cost Calculator tool for estimating out-of-pocket medical costs now reaches 20 million consumers through its client base of employers and health plans.
• Culbert Healthcare Solutions VP Brad Boyd and Oschsner Health System medical director of accountable care Philip M. Oravetz,MD will discuss strategies for extending EHR technology to affiliated practices at next month’s AMGA conference in Dallas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect 

Morning Headlines 3/18/14

CMS Wants Money Back from PQRS, eRx Programs

According to a Federal Register notice, CMS will launch a four-year program that will survey PQRS and eRx program participants to verify data quality. The project will include efforts to "evaluate incentive payment information for accuracy and identify improper payments, with the goal of recovering these payments.”

Group advocates for single-payer system over HIX

Several states, including Pennsylvania, discuss following in Vermont’s footsteps by creating a state-level single-payer system as an alternative to supporting expensive and problematic health insurance exchanges.

Massachusetts to Cut Ties With CGI Group Over Troubled Online Health Exchange

Massachusetts fires healthcare.gov contractor CGI Federal over the state’s own failing health insurance exchange rollout. CGI Federal is also under investigation for fraud in Vermont stemming from another failed health insurance exchange rollout there.

Curbside Consult with Dr. Jayne 3/17/14

There was a great response to last week’s Curbside Consult and my mention of the therapeutic powers of baking. Despite everything going on at the office, it ended up being a fairly low-key week, so the only things coming out of my kitchen were a pan of brownies and a batch of banana bread.

(I admit I played a little bit of the Mad Scientist game with the banana bread. Although it was good, it wasn’t significantly better than the original recipe, so maybe I’ll stop trying to mess with perfection.)

We made a fair amount of progress in our due diligence efforts around bringing the patient records from the practice we acquired onto our system. Although some people might find it boring, I actually enjoy rolling up my sleeves and digging in. It’s predictable work in some regards.

Our DBAs started looking at their system’s data structure to identify how many custom fields they are using compared to a vanilla version of the software. Some of our EHR analysts started looking at the actual user screens to identify custom fields from that perspective as well as to begin diagramming the workflow they’ve built in the EHR.

We’ll send people on site and work with their training team to determine whether the EHR workflow matches how they operate in the practices or if this is an opportunity to retire any custom elements that aren’t actually working in the field. I’ve seen plenty of instances where physicians have customized their systems to the point where efficiencies are lost. This tends to happen more when users don’t have adequate training or don’t agree with the design intent of the software.

Where there are customizations in the workflow, we’ll also do some statistical analysis to look at how many times custom fields are actually used. Just because they were built doesn’t mean anyone uses them regularly.

Our medical group has grown substantially over the last few years. Given the number of physicians who currently use an EHR, we’ve had to do a fair number of conversions. Some of them are simple, especially when the source EHR is fairly primitive or doesn’t have a robust data structure. In those situations, we might convert the patient notes to PDF files and bring them in as if they were scanned documents. It doesn’t give us a lot of discrete data, but in some regards it may be safer than trying to map imprecise data.

I’ve seen systems that don’t use any kind of formatting on data fields (such as restricting blood pressure entries to numbers only) that lead to garbage in the record. In those situations, I typically sit down with the physician and explain the choices: we can either bring the data as images (akin to scanning a paper chart as far as patient safety is concerned) or we can spend a lot of time and money trying to map it. In the latter scenario, they will need to sign off on any corrections.

Most physicians who hear about the time commitment for mapping data run shrieking out of my office and I never hear from them again until I see their signature on the checklist approving the test extract that’s been pulled into the imaging system. Those who aren’t scared off by the time commitment are usually scared off by the budget, which our medical group usually isn’t very keen on funding.

I’m surprised (at least at some level) but the number of physicians who realize they have dirty data but don’t do anything about it. They see the typo’d letters in the BP fields and authenticate their notes anyway rather than talking with their staff about data accuracy. Very few have thought to talk to their vendors about why the system even allows typing of letters into a BP field.

I guess I shouldn’t be that surprised, because I’ve seen even wackier things in the paper world, such as subspecialists who had their staff stamp consult letters with nonsense like, “Dictated but not read; signed by secretary to expedite.” Someone who is OK with that probably doesn’t care about potentially erroneous data in their notes.

So far, the potential conversion doesn’t look that bad from a technical perspective. Although there is a fair amount of customization, it’s not being used extensively. In fact, overall use of the EHR is pretty light. From a change management perspective, though, that’s pretty ominous, especially since our group requires significant commitment to documentation via discrete data. We’ll have our work cut out for us in helping them truly adopt EHR as well as in helping them adapt to our culture.

I almost wish the technical aspects of the conversion were more daunting because I could use that to buy more time with the powers that be. Our analysts still have a bit of digging to do and the workflow teams will find plenty of issues when they go on site, but I’m not sure we’ll have as much time to formulate an effective plan as I’d like. We’ll have to see how things unfold.

Regardless of what we find, I know we won’t have anywhere near as much budget as we need to do our best. We’re pretty good at delivering the impossible, though, so I’m hopeful. And when all hope is gone, there will always be pastry.

Email Dr. Jayne.

HIStalk Interviews Bill Anderson, CEO, Medhost

Bill Anderson is chairman and CEO of Medhost of Franklin, TN.

Tell me about yourself and the company. 

I’ve been in business a long time, more than 40 years now. This is my first foray into the healthcare IT business. My background has generally been in the financial area and financial technology. I was about 20 years in consulting, went to be CFO of a large public company, and ended up doing the Internet with a company called Bankrate.com. As I got into technology, I got more and more interested in different types of technology and ended up in healthcare.

We’re a diversified technology company, an HCIT company with enterprise software and some innovative new products. We’re just finishing up our audit, but we think we’ll be around $180 million this year. We’re really proud of the fact that we’ve grown in excess of 20 percent a year over the last five years. We have about 1,000 customers, about 60 percent of in general acute care, but with significant market share in some specialty areas like LTACs, inpatient behavioral, and inpatient rehab.

Even experienced industry people were confused about HealthTech’s multiple product brands until the names were changed to Medhost in December. What took so long to consolidate?

We realize the importance of consistent branding. We had a couple of choices, and so we had to sort through the situations where we could actually get good title to names as well as having the URLs and all the other type of connectivity that you’d like to have. We settled upon the fact that Medhost was the best choice for us. We’ve been very happy with the reception from that so far.

I don’t think I ever noticed HealthTech’s booth at previous HIMSS conferences, but with the Medhost name this year, it was a nice presence and the booth had a lot of activity every time I went by. Did you notice a change?

We did, and thank you for the compliment on the booth. I think that many HCIT buyers did not realize what a comprehensive line we had. When we pulled our different product lines together in the Medhost booth and did some promotion around the new branding, we got some much higher response rates or levels of interest than we had in the past. We were very pleased with the HIMSS conference.

I would assume most people know the company from the EDIS product line that provided the company’s new name. But you have a variety of products, many of them from acquisitions. How do you portray the company’s identity now and how hard is it to support a fairly diverse and extensive product line?

We do have a diverse and extensive product line. It’s come about principally through acquisition, but also some significant organic growth.

We acquired a company called HealthCare Management Systems, which was an enterprise software business, because two of the most important departments in a hospital are the perioperative and the ED. We acquired a company called Acuitec, which essentially was selling the Vanderbilt surgery and anesthesia system. And Medhost, with EDIS.  Today we think we’ve got leading products in these very important areas. Those came in by acquisition, as three pieces.

There are also two product lines that you may have noticed that we’ve built internally. One being our YourCareCommunity platform with our first app that runs on that platform, which is our patient portal. Also, our profitability solutions.We call those solutions because they’re a combination of our patient flow product, our business intelligence product, and a consulting group. We have the full range of the products necessary to deliver a higher profitability to our customers.

Is there sales synergy across these products or do they each have to be sold on their own?

Oh, absolutely. You know, we view ourselves as a distribution company. One of the things that has characterized Medhost is that about 60 percent of our customers are associated with a multi-facility organization. Over the years, we’ve demonstrated an ability to distribute products into our customer base, who are growing rapidly themselves. We have tried to tailor our products — acquisitions and the parts we’ve developed — to meet the needs of that customer base. That’s been a successful strategy for us.

Who are your biggest competitors and what advantages do your products offer?

We view our sales as being a middle market provider in the HCIT business. I would say our principle competitors in the general acute care space would be McKesson’s Paragon and probably Meditech. We obviously see Cerner, who comes down into the middle market with a hosted solution, as well as CPSI, who comes up market with their product line. But as far as direct competitors, we would probably identify those two as the most directly comparable.

What are you seeing as the key drivers of the decisions made by that market?

In our customer base, we think we’ve got customers for which ROI really makes a difference. We have a heavy concentration in the for-profit healthcare business. What we view is that for our customers, a combination of market-appropriate features plus ease of use results in a low total cost of ownership. As a result of that, that’s what differentiates us in the marketplace.

It’s always interesting that for-profit hospitals buy and deploy differently than the not-for-profits. Why do you think that is?

Our customers are not only good at delivering healthcare, but they are very good at running businesses. As a result, I think they’re looking for the effectively the right product for the facility they have. In many cases, we’re in customers that have segmented their bases, and we tend to be in the hospitals and other facilities where our features match up  with what that facility’s doing. And again, we offer what we believe is a low total cost of ownership.

Where does the company’s future lie?

We’re pretty happy with our menu of products for the inpatient world right now. We think we’ve covered bases with that. We would like to do additional acquisitions, because we think our customers have needs, and we’d like for them to be able help serve those needs.

We would be looking at areas like post-acute care. Many of our customers are going to be more and more involved in dealing with patients outside the four walls of a hospital. Also in services, because again those are becoming more and more important to both our corporate customers and our standalone customers. Things like revenue cycle outsourcing, some other types of services like that, we think are going to be very important to these customers as margins are squeezed and they need to be able to control their costs.

Probably the biggest area that we are interested in either building products or acquiring products or partnering with customers is in this YouCareCommunity platform. Essentially what we’ve done is combined an HIE with an enterprise master patient index to allow people to pull records from both ambulatory and inpatient EHRs into the cloud. Using that platform, we’ve launched some initial applications, being our patient portal, and we’re working on a disease management product and some other products. But we’re also looking for partners and acquisitions that add additional applications to that platform.

Is this product the answer to the HIMSS buzz around population health management or analytics, or do you have other strategies or do you even want to be in those markets?

Yes, we absolutely want to be in that market. This would be the platform that we use to address the needs of our customers in that marketplace. 

Population health has a number of different facets. The really important thing, though, would be to help manage the patient, or even better to help the patient manage themselves, to prevent things like readmission, disease management, things of that nature. We think that with our cloud-based platform and our strategy to engage the patient on a regular basis, even when they are not currently in the hospital or have recently been in the hospital, will allow our customers to help affect their downstream cost on those customers.

What are your customers telling you about their state of readiness or state of interest in Meaningful Use and ICD-10?

Everyone is very focused right now on the Meaningful Use program. I think that’s been a challenge, particularly to our smaller, standalone customers. They’re interested in trying to attest as quickly as possible and move on to other things, one of those things being ICD-10.

We view this as being a very difficult transition for many of our customers, and one that we hope we’ll be able to assist them with. We believe we have the right tools in place for them to do that, but it will be a significant change in training and how a facility has to deal with some of their billing and coding issues.

Evidence suggests that smaller hospitals may be walking away from Meaningful Use money after the first couple of years. Do you see that happening?

That’s going to be difficult to do. There will be some in the very small end of the hospitals. We have less than a 100 critical access hospitals in our more than 1,000 customers, and with many of those really small facilities, the economics are not going to work for them.

The cost of attesting and maintaining the Meaningful Use progression is going to be more than the potential penalties or the rewards. That is going to be an issue globally for healthcare, because it is in the best interest of the healthcare delivery system in general for those customers — our customers — of that size to participate, as well as other facilities of that size. That will be an issue that ultimately the government will have to address — how to pool those customers into the system. Because it is going to be difficult.

You are emphasizing a touchscreen user experience in the keystroke-heavy world of healthcare. Do you think that is the market changing to now accept and even demand a touchscreen experience?

Absolutely. While we think of our users as healthcare professionals, they’re also consumers. Every day they use mobile platforms. They use consumer software. Healthcare professionals, like other consumers, are going to be more demanding about the quality of their software.

As a result, we’re making and are continuing to make significant investments in things like workflows, usability of the product, and making it mobile agnostic. Our belief is that tablets will be very important in the medical area. We do have some phone apps and some others that are in process, but inherently the phone apps or smartphone apps are going to be more difficult to use.

Tablets, however, will give the clinician much better access to data and the ability to kind of process data without being tied to a particular workstation or having to sign in and sign out. The convenience and the ability to increase productivity will make that important for all software providers.

Many of the early claims vendors made about mobile access involved Citrix running a desktop session on an iPad. How is the industry is progressing in creating a true mobile experience?

The industry in general has had a lot of demands upon it and has been distracted from some of the work flow and ease-of-use type of objectives that I think are shared by most vendors. Everyone will have to cycle back to that.

Almost four years ago now, we started a renovation of our enterprise systems to put an HTML 5 interface layer on top of it. The reason for doing that is that the combination of wanting to have a more inexpensive hosting solution as well as being mobile agnostic. You can do that an HTML 5 interface as long as you’re paying attention to form factors and how you design a page. Then the same page I can view on a computer, I can view on my tablet and get a very satisfactory experience. Those types of solutions are going to be very important in the future.

What are you priorities for the company in the next three to five years?

Our priorities are to continue to grow our base and our enterprise business, but also at the same time, to take these new product lines that we have in our profitability solutions and YourCareCommunity and to try to meet more the needs of our customers in those areas.

We think in particular, our ability to provide a patient portal in both the ambulatory and inpatient area that is certified and can pull together the care community is going to be a really important thing. We are out trying to talk to as many of our customers as we can about the advantages of being able to build this community in terms of improving patient care, giving the patient better ability to manage their own care, as well as keeping revenues within the network.

Do you have any final thoughts?

There’s a lot of changing coming and has been coming in both the healthcare provider industry and in the healthcare IT industry. With change, there’s always opportunity. Our goal is to try to take advantage of that opportunity and return as much benefit to our employees and shareholders as we can.

Morning Headlines 3/18/14

Castlight Health Soars in Stock Market Debut

Castlight Health’s stock price climbed 149 percent during its Friday IPO. The company was seeking a $1.4 billion valuation, but closed its first day of trading at $3 billion. Some are calling the IPO evidence of a tech bubble because Castlight ended 2013 with only $13 million in revenue and a net loss for the year of $62 million, yet was still valued as a billion dollar company.

VA Is Competing For The Pentagon’s Electronic Health Record Contract

The VA will enter its newly revamped VistA EHR platform into the competition to be the DoD’s next EHR.

Form 8-K for ACCRETIVE HEALTH, INC.

Accretive Health has been delisted from the NYSE after failing to file restated financial reports from 2012.

Hospital database hacked, patient info vulnerable

Valley View Hospital (CO) discovers that a computer virus within its network has been taking screenshots of sensitive patient information, including social security numbers and credit card numbers, and saving them in a hidden folder on one of its servers. The virus went undetected for three months and captured information on 5,400 patients.

Monday Morning Update 3/17/14

Top News

Castlight Health’s share price climbs dramatically after its Friday IPO, surging 149 percent from $16.00 to $38.90. The company was valued at $1.39 billion at the IPO price, placing it in the $3 billion plus range after Friday’s market close. The company had $13 million of total revenue last year and lost $62 million, reportedly placing its loftily priced IPO price (107 times revenue) as the highest multiple since the dot-com era. Still, the company’s underwriters left a lot of Castlight’s money on the table at pricing the shares so far below their first-day closing price. Nobody’s saying how much shares owned by the already-loaded founders are worth (Todd Park, CTO and co-founder of athenahealth; Bryan Roberts, PhD, chairman and co-founder of venture capital firm Venrock; and Giovanni Colella, MD, founder of RelayHealth.) They might want to sell their shares soon: studies show that shares of companies valued at this level of frothiness have historically had a three-year return of –92 percent.

Reader Comments

From Krikey: “Re: ongoing column writers. There are some very perceptive and witty folks out there, just a challenge to find and encourage them to contribute. I have ideas, but hesitate to name names.” I enjoy the writings of Ed Marx, Darren Dworkin, Dr. Gregg, and others on the provider side who have an interesting perspective and an entertaining way of presenting it. I’m happy to entertain the possibility of adding to that roster, but with the added comment that lots of folks think it sounds great until they realize it’s an ongoing commitment.

From Orange Belt: “Re: hospital salaries. Why are you so down in paying high-performing executives what the market demands?” Because non-profit hospitals shouldn’t be a market – they are a charity for taking care of sick people and should pay comparably to other charitable organizations even though they are inexplicably forced to run like a big business instead. I’m pretty sure that while the talent pool might be different if a health system paid its CEO only $500K instead of several million dollars, that amount would still be sufficient to hire a committed and skilled candidate. Making excuses such as (a) “We have to pay too much because everybody else does”; (b) “We have to compete against the giant corporations our executives would be lured away to run given their vast experience in dealing with nurses and insurance companies in a non-consumer driven market”; and (c) “Our executives are worth every penny because we’ve made a fortune since they took charge” are just excuses to avoid admitting that running a hospital has become a lucrative profession rather than a selfless calling and has attracted leaders who would wander off in an instant if they were paid responsibly.

HIStalk Announcements and Requests

Quite a few readers reported their annual job compensation, breaking out into the categories above. New poll to your right: should patients have a greater role in the HIMSS conference?

Thanks to everyone who completed my reader survey. I’ve emailed $50 Amazon gift cards to three randomly selected winners (I use a random number generator to choose from the available Excel rows of responses). I will be reviewing the results carefully over the next several weeks and will report back, but the item above is the one I watch most carefully, in which 92 percent of respondents said that reading HIStalk helped them perform their job better in the past year.

Another DonorsChoose classroom update: Mrs. Pew’s Louisiana second graders are already enjoying the books you and I bought them four weeks ago using proceeds from the top HIStalk banner ads during the HIMSS conference. She reports, along with sending the photo above, “Your donation has helped make it possible for all students to be actively engaged in my classroom in one way or another. They are able to interact with one another, discuss the books they listen to, and learn new words. Thank you for your generous donation and for bringing such joy to my classroom.”

Listening: Dead Confederate, country-tinged hard rockers from Athens, GA.

Upcoming Webinars

March 19 (Wednesday), 1:00 p.m. ET. The Top Trends That Matter in 2014. Sponsored by Health Catalyst. Presenters: Bobbi Brown, VP and Paul Horstmeier, SVP, Health Catalyst. Fresh back from HIMSS14, learn about 26 trends that all healthcare executives ought to be tracking. Understand the impact of these trends, be able to summarize them to an executive audience, and learn how they will increase the need for healthcare data analytics.

Acquisitions, Funding, Business, and Stock

Mobile open source healthcare network vendor Cytta and telehealth technology provider ViTel Net announce plans to merge some or all of their companies. Sounds like they suffer from either commitment issues or premature declaration.

Announcements and Implementations

As expected, formerly high-flying Accretive Health is notified by the New York Stock Exchange that its shares have been delisted because the company has not filed its revised 2012 annual report. Above is the five-year share price chart of AH vs. the DJIA. The company’s market capitalization is still at $790 million, but shares are down 75 percent from their July 2011 high. The company tangled to its eventual disadvantage with Minnesota’s attorney general in early 2012 over is aggressive collection practices for hospital patients, including strong-arming patients with no outstanding balances who were still in their ED treatment rooms. I explained my mixed feelings about the company’s practices at that time:

The question raised by the Accretive mess that nobody wants to ask or answer is this: how much collection effort is too much? If the model forces a hospital to operate as a business, is it fair that some customers get away without paying, quite a few of them perfectly capable but just unwilling to do so because it’s not exactly a pleasurable purchase? Or that they don’t pay because hospital list prices are absurd, with insurance companies getting huge discounts on the $4 aspirin that cash-paying patients are expected to pay at list price? Accretive probably went too far, but it’s a slippery slope. They are the symptom, not the problem. Imagine if a restaurant couldn’t turn away hungry but broke patients, has to serve them steak and lobster if that’s what they want, and has to welcome them back for meal after meal even though they’re capable but unwilling to pay. Is that fair to the other diners who will have to make up the difference?

Duke LifePoint Healthcare, a joint venture between Duke University (NC) and for-profit LifePoint Hospitals, will acquire Conemaugh Health System (PA) for $500 million, adding to its total of 60 hospitals and 29,000 employees. LifePoint, whose annual revenue is $3.68 billion, paid its CEO $9 million in 2012, with its other six officers making between $1.8 million and $3.4 million each. 

Government and Politics

The VA Secretary Eric Shinseki says the VA will enter its VistA Evolution in the Department of Defense’s EHR procurement project, claiming that the upgraded system will be equal to the commercially sold EHR systems that the DoD seeks. The VA announced its interest in receiving bids for developing VistA Evolution in late January, allowing eight business days to receive responses. It requested $269 million for 2015 to develop it.  I can’t decide if Shiseki is just yanking the DoD’s chain, calling DoD out publicly knowing they would rather use stone tablets and chisels than admit that the VA’s systems are better, or if he really thinks the DoD is open-minded and taxpayer-respectful enough to use what makes sense instead of what it can control with an iron hand and an army (pun intended) of government contractors. Hopefully he won’t trigger a DoD-led military healthcare junta.

At the same House Veterans Affairs Committee meeting, the American Legion scolded both agencies in written testimony, saying the agencies “squandered more than a billion dollars of taxpayer money and wasted years in an ultimately empty pursuit of a joint electronic medical record system that would have streamlined and simplified logistics between the two agencies …The warfighter turned veteran is the same patient and deserves a system that honors that person with continuous care and seamless transition between agencies.  It is unforgivable that DoD and VA have spent the past several years infighting rather than actively developing a comprehensive solution that is in the best interest of the American service member.”

The Defense Health Agency expects to spend $1.5 billion in 2017-2019 to buy a new EHR, according to new budget documents. I’m guessing that line item didn’t come from the VA’s RFI response.

Innovation and Research

Patrick Soon-Shiong says on Larry King that like fellow billionaires Warren Buffet and Bill Gates, he has signed the Giving Pledge and will thus donate more than half of his wealth to charitable causes.  He also announces his latest invention: a $300 hearing aid that can be tuned by smartphone, making hearing correction affordable for the 700 million people who need it. He used the same technology to develop the $100 Notes personalizable headset and will donate a hearing aid for each two headsets sold, hoping to give away one million hearing aids in the next five years.

Other

Washington’s state medical commission files unprofessional conduct charges against the former physician head of Harborview Medical Center’s burn unit, finding that he testified about the value of using flame retardants in furniture without disclosing that he was being paid by the companies that produce the chemicals. Government scientists had concluded that the products are toxic and don’t work, leading the chemical companies to create a phony three-member consumer watchdog group to create public fear about fire danger and to pay experts for favorable testimony. The group was quietly shut down in 2012. The doctor is also accused of making up compelling patient stories and violating patient privacy laws by using a minor patient’s photo without permission. 

Valley View Hospital (CO) notifies 5,400 patients that technicians found an encrypted, hidden server folder that contained their credit card, Social Security, and demographic information, adding that the information may have been used for identity theft. An unnamed virus collected and stored screen shots of online web pages that may have been sent outside the facility. The hospital says it has since improved its antivirus and firewall systems.

The Sacramento paper profiles Davis, CA-based Cedaron Medical, which offers software for cardiac care, rehab documentation, speech pathology, occupational therapy, and worker’s compensation evaluation. I’m fascinated that founders Malcolm and Karen Bond also started Bondolio, an award-winning olive oil business.

An editorial in BMJ says that doctors would provide better care if they knew that patients were recording their encounters, even suggesting that doctors record sessions themselves and offer patients a copy. It addressed a debate in England in which the UK General Medical Council eventually changed its position that such records would not be admissible in professional practice reviews. The article concludes that there’s no way to stop patients from recording their physician interaction, so the medical profession might as well figure out how to use that information to improve care.

Former Epic project manager Brian Stowe is sentenced to 38 years in prison for sexually assaulting six of his female Epic co-workers and a 17-year-old girl and filming the attacks. The victims were unaware of his activities until video from his computer surfaced years later, leading to the unproven possibility that he drugged them, that speculation bolstered by the fact that one his computer’s video folders was labeled “drug assaults.” One set of photos was apparently made during an Epic business trip. Stowe apologized, said he was “out of control,” and added, “The only part about getting caught that truly upsets me is that it’s caused the lives of all these people I love and care about to implode.” Stowe, who had pleaded guilty, faced a sentence of more than 400 years for 62 felonies, but that count was reduced to 27 felonies in a plea deal.

A former contract ED doctor working at Spectrum Health (MI) sues the hospital group, claiming it banned her from working there for making a Facebook comment. She thought she recognized a patient depicted in an ED nurse’s Facebook photo of a woman’s backside, so she added a comment, “OMG. Is that TB?” The doctor claims the hospital was unhappy that she was planning to consult with other EDs using materials she had developed, so they falsely claimed her comment was a HIPAA violation. She adds that a nurse was reprimanded rather than fired for leaving a comment, “I like big butts and I cannot lie.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/14/14

Validic Secures $1.25 Million in New Funding, Adds Key Executives

Durham, NC-based Validic closes a $1.25 million convertible note to support expansion for its mHealth integration engine.

MMRGlobal and Cerner Announce Patent Agreement

Cerner signs a confidential agreement with MMRGlobal over MMR’s Personal Health Record patents.

Unique Database Collaboration Will Enable Improved Care for Heart and Lung Surgery Patients

The Society of Thorasic Surgeons will link its database with CMS to provide researchers a means of tracking long-term outcomes.

Wearable Computing at BIDMC

John Halamka, MD, CIO at BIDMC, writes about his hospital’s trial use of Google Glass in the ED.