Readers Write: Twenty Things Vendors Need to Know About ONC’s New 2015 (Stage 3) Certification Program, But Were Afraid to Ask

Twenty Things Vendors Need to Know About ONC’s New 2015 (Stage 3) Certification Program, But Were Afraid to Ask
By Frank Poggio

On March 23, late on a Friday afternoon, ONC published two drafts of the proposed revisions to the 2015 Test Criteria along with new Stage 3 provider MU attestation requirements. Two separate large documents were published:

• Electronic Health Record Incentive Program, Stage 3 Draft Rule, (300+ page PDF)
• 2015 Edition Health Information Technology (Health IT) Certification Criteria, ONC Health IT Certification Program Modifications (400+ page PDF)

The first covers the proposed rules for MU Attestation for Providers under Stage 3. The second addresses proposed test criteria and requirements for vendors and revised operating rules for the Accredited Certification Bodies (ACB).

Already there has been a great deal of discussion on the first MU requirements document since it impacts all providers, while the second document is aimed at vendors and system developers and has received little attention . I commented on the MU provider piece on HIStalk earlier this week and will focus now on the impact on vendors and system developers. Some of my vendor clients have been calling and emailing me asking, “What’s changed for us?” Others are afraid to ask.

Suffice it to say there are some major additions and revisions to the test criteria and process that will give system developers heartburn, or maybe a K51.914 (ICD10=ulcer).

Before I dive into the document, let’s remember that back in 2013 ONC disconnected the MU Stages from the certification test versions. The concept that a vendor is Stage 2 or Stage 3 certified is almost meaningless since a provider could MU attest to Stage 2 using either modified 2011 test criteria or the 2104 criteria. With the eventual issuance of these new 2015 criteria, for a short period providers can Stage 2 attest using a vendor’s 2014 certified product, or if available, the vendor’s 2015 certified product.

All 2015 Test Criteria are now referred to as the 170.315 regulations. At this time, these are just draft proposals that will be formally published in the Federal Register on March 30, 2015. Then after a 90-day comment period, some revisions will be made, with the final regulations issued in the July-August timeframe.

Using the last two cycles of draft rules versus final issued regulations, I predict that some 90 percent of what is now proposed will be adopted into law. So fasten your seat belts — here we go. Some highlights (or lowlights? are:

1. Privacy and Security (170.315 d1-d7). There are some minor changes in several of these tests, such as access, time outs, integrity, device encryption and audit logs. But now under 2105 testing, they have become mandatory if a vendor wants to test out on other criteria, such as Demographics. The P&S tests were mandatory under 2011 (Stage1), then ONC made them optional for 2014, now they are back in the mandatory column. To paraphrase ONC, it’s all due to the never-ending march of data breaches. An added requirement to P&S which is stated in the MU regs, but not in any specific test criteria, is vendors now must attest to having completed a HIPAA risk analysis of their product whenever they install new releases or updates. Here’s why. In order for providers to be compliant with MU and HIPAA, they will have to get an attestation from the vendor before they install any update, the provider MU regulations state on page 64: EPs, eligible hospitals, and CAHs must conduct the security risk analysis upon installation of CEHRT or upon upgrade to a new Edition of certified EHR Technology.
2. Demographics 170.315a4. ONC wants coding for language and ethnicity to support all 900 OMB codes and all RFC 5646 ethnicity codes. But ONC acknowledges that a drop-down list of 900 data elements might cause workflow problems, so they have said a full drop-down list is not required. You just need to show in a test you support all the codes and can tailor the list for each provider client.
3. Vital Signs 170.315 a6. All values must have LOINC codes. Data elements have been expanded and pediatric vitals have separate criteria.
4. Advance Directive (170.315 a17). Now you have to electronically capture and track the AD. No more just check a box and who cares what file drawer it’s in.
5. Medical Implants (170.315 a20). Must now be tracked and reported.
6. Social, Psychological, and Behavioral data must now be captured and tracked using LOINC and SNOMED coding. (170.315 a21).
7. Clinical Decision Support tools must be linked to Knowledge Artifacts formatted in the HeD standard Release 1.2. (170.315 a22).
8. New “decision support – service” (170.315 g6) certification criterion requires technology to electronically make an information request with patient data and receive in return electronic clinical guidance in accordance with an HeD 1.2 standard.
9. New CDA standard (170.315 b1). The C-CDA standard is now the single standard permitted for certification and the representation of summary care records. An updated version, HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for ClinicalNotes (US Realm), Draft Standard for Trial Use, Release 2.076 includes the following changes: addition of new structural elements: new document sections and data entry templates: New Document Templates for: Care Plan; Referral Note; Transfer Summary. New Sections for: Goals; Health Concerns; Health Status Evaluation/Outcomes; Mental Status; Nutrition; Physical Findings of Skin, etc.
10. CDA system performance (170.315 g6). As part of the focus on interoperability, ONC is requiring performance standards for data transfers of CCA/CCR. Data transmission of CDAs will be tested for volume and response times.
11. XDM packing of View/Download/ Transmit and CCR/CCD with incorporation of industry APIs using the IHE-IT infrastructure standard.
12. Data Portability has been broken out into Send /Receive as separate components (170.315 b6).
13. Care plans (170.315 b9). ONC proposes to include the “assessment and plan of treatment,” “goals,” and “health concerns” in the “Common Clinical Data Set” for certification to the 2015 Edition. The “assessment and plan of treatment,” “goals,” and “health concerns” are intended to replace the concept of the “care plan field(s), including goals and instructions” which is part of the “Common MU Data Set” in the 2014 Edition.
14. CQM (170.315 c1). Has been expanded into separate segments: filters, create, import, and calculate.
15. Quality Management System (170.315g4-g5). Now includes an “access-ability technical component” in accordance with ADA. The QMS must be mapped to a federal guideline or industry standard. (No more home-grown QMS process/tools.)
16. Safety Enhanced Design – SED (170.315g3). Expanded and requires specific and detailed usability test documentation. ONC recommends following NISTIR 7804176 “Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records” for human factors validation testing of the final product to be certified. They recommend a minimum of 15 representative test participants for each category of anticipated clinical end users who conduct critical tasks where the user interface design could impact patient safety.
17. Authorized Testing Bodies (testing agencies) are now required to conduct surveillance (audits) on at least 5 percent of vendor installs (or max of 10) every year to verify that the certified system in fact meets each certified test criteria.
18. Attestation for Price transparency. ONC wants vendors to disclose on their web site and in marketing materials material system limitations. The vendor must also disclose any material add-on costs such as transaction fees to support interfaces/interoperability, etc. and supply any requesting entity a reasonably accurate cost estimate of total system costs. That’s ANY requesting entity, not just prospects or for bid requests.
19. ONC wants monthly reports from the testing agencies on provider complaints and counts of vendor updates and modifications. If the number of updates/modifications exceed a set number, ACB is to call vendor back in for re-testing.
20. ONC predicts the rules and test criteria will be finalized by mid-summer and vendors will work “aggressively” in 2016-17 to modify products and meet the target date of 2018 to support Stage 3 provider attestations, which will require a full year of calendar data from providers.

ONC estimates that all vendors together will have to invest approximately $300 to $400 million to effect all these changes. They calculate there are 81 unique vendors with certified products, hence an average cost of $4-5 million each, which does not include the time and cost to go through the test process.

ONC states they will continue with the “Gap” test process, meaning if you passed a test criteria under 2014 and there were no (or minimal) changes for the 2015 criteria, you get a bye. Given the preceding, my advice is if you’re a vendor that is not yet 2014 certified, you really want to get it done sooner rather than later. My experience tells me that being 2014-certified for as many criteria as you can before the 2015 criteria are cast in stone will be a better place to be.

Lastly, ONC states that the 2105 Test Criteria and Stage 3 Provider MU Attestation rules will be the last Stage for MU, but that the rules and test requirements will continue to be revised and expanded as ONC deems necessary. I guess we can next expect Stage 3.1, along with revised test criteria 2015 dot 1,dot 2 … can anyone see a light at the end of this tunnel?

Frank Poggio is president of The Kelzon Group.

News 3/25/15

Top News

A brief preliminary statement from the American Hospital Association on the Meaningful Use Stage 3 draft says the government “continues to create policies for the future without fixing the problems the program faces today,” referring to the 2015 flexibility rules. Nobody else has had much to say about the draft, probably because it’s mind-numbingly long, was released late on a Friday yet again, and is increasingly irrelevant to providers who realize the strategic advantages they lost just to collect relatively small taxpayer handouts.

Reader Comments

From Opie: “Re: RelayHealth. Is in negotiations to sell their nursing call center and care management business to a private equity firm. The division has struggled with the business model and profitability for many years. The business has lost several key management members over the past year and they have deployed Rod O’Reilly to make a determination if McKesson can grow RelayHealth or if they should sell the entire business.” Unverified.

From Clinic Director: “Re: MU audit hell update with 96 of our 139 Epic-using providers audited. CMS was responsive and the auditor, Figliozzi and Company, offered to instead perform a fast-track pilot sample. If a EP doesn’t meet MU, the sample will be expanded, but if all EPs in the sample meet MU, the remaining audits will be cancelled and all EP payments will be released. Since we had already gone through so many audits, the remaining audits were cancelled. Great news!” I was impressed with the professional and reasonable response of Peter Figliozzi and CMS following up on the practice’s request. Well done all around.

From HIStalk Fan: “Re: BJC. Their website finally confirms their Epic project.”

HIStalk Announcements and Requests

Let us review 2009’s stellar “HITECH: An Interoperetta in Three Acts” by Ross Martin, MD, MHA and The American College of Medical Informatimusicology. Ross usually makes an inspired appearance at HIStalkapalooza, so perhaps you’ll see him on stage there.

I rarely look at readership stats, but for some reason noticed that Monday’s page views were the second-highest in the seven months since I had to switch stats counters, with 11,084 page views and 8,291 unique visits. January 20 had 13,509 page views for reasons I don’t understand since I hadn’t posted anything unusual.

I don’t consume many healthcare services since I’m healthy (and having worked forever in hospitals, I’m anxious to avoid them), but a recent experience reminded me of why the billing process is so frustrating to consumers. I went to the ED in March 2014 after being urged to go there by the urgent care center doctor (who was of questionable clinical skill) checking out my dizziness that turned out to be nothing, was kept overnight and tested endlessly because I had insurance and the malpractice-wary hospital was reluctant to send me on my way without commendably trying to answer the unanswerable (via a head CT, nuclear stress test, and tons of labs and EKGs, all of which showed nothing abnormal). I received the first bill from the hospital’s contracted ED doctor service nine months later in December 2014, which claimed I needed to pay $1,500 immediately since my account was being reviewed for collection due to the non-response of my insurance company. I left phone and email messages for the ED doctor billing company and was promised a quick response that still hasn’t come. I contacted my insurance company, whose nice lady said the ED doc billing company hadn’t even requested my medical records until nine months after my visit, which violates some sort of policy or law, so they basically told them to take a hike. The insurance company said they would talk to the ED doc billing service, so we’ll see what happens. I have to wonder what’s going on with that billing company that it took nine months to send a bill, but again, inefficiency abounds in healthcare.  

What I dread most at the HIMSS conference: as a non-coffee drinker, I’ve always made fun of the mile-long line at Starbucks, which looks like a well-dressed morning rush at the methadone clinic. I’ve started drinking coffee in the morning, so I’ll have to decide if I want or need it badly enough to stand in that line myself. Thank goodness for in-room coffee makers.

The process of getting an HIStalkapalooza invitation hasn’t changed since 2008 – watch for the extensive notices in HIStalk, sign up, and hope you get picked before we run out of spots. Sponsor support allowed me to invite 1,400 people this year vs. 600 last year. Great, I thought – unlike last year, maybe I can get some actual work done instead of arguing with entitled people who think they should have been invited psychically since they didn’t otherwise express interest until after registration was closed. This year’s invitations went out and Lorre has already received over 100 emails from people requesting (sometimes demanding) additional invitations for guests, clients, and executives. They will all be politely turned down as will walk-ins that night – the count has been turned in, badges are being printed, and I’m on the hook personally for the $200 per attendee event cost if we run over our guarantee (like if the traditionally high no-show rate drops unexpectedly below the SWAG estimate we’ve built in). The massive HIStalk organization is maybe two FTEs total and we’re buried in our own pre-HIMSS work, so we don’t have time to individually debate the clearly explained process that 95 percent of people seemed to follow just fine. Last year I was so disgusted I was just going to give some whiner my ticket and hit a bar alone instead, which isn’t off the table for this year either.

I was thinking about the overuse of the word “disruptive,” usually by startups trying to convince investors and prospects that their lack of size and market traction is only temporary. I’d like to see the adjective reserved for companies that not only have the self-assessed potential to disrupt, but have actually done it.

Listening: YelaWolf, small-town rap from Gadsden, AL. I need to listen more to make sure I really like it, but my first impression is positive (other than his apparent need to have his hand planted firmly in his crotch for emotive rapping).

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Humana reconfigures some of its existing population health businesses under the Transcend name: Transcend, which will offer management services (the former Humana MSO) and Transcend Insights, the IT group (the former Certify Data Systems, Anvita Health, and Nnliven Systems).

Sales

Continuum Health Alliance (NJ) selects Caradigm for population health management.

MedStar Mobile Healthcare (TX) chooses the Infor Cloverleaf Integration Suite.

Maury Regional Medical Center (TN) will implement Professional Charge Capture from MedAptus.

People

   

Galen Healthcare Solutions promotes Jason Carmichael to CEO , Mike Dow to CIO, Erin Sain to COO, and Justin Campbell to VP of marketing.

Paul Holt (Quality Systems) joins NantHealth as CFO.

Englewood Hospital and Medical Center (NJ) names Dimitri Cruz (North Shore Long Island Jewish-Lenox Hill Hospital) as VP/CIO.

Barnabas Health (NJ) hires Stephen O’Mahony, MD (Norwalk Hospital) as CMIO.

Announcements and Implementations

The Physician Alliance (MI) expands its rollout of Wellcentive’s population health management solution.

Athenahealth says 98.2 percent of its AthenaOne users successfully attested to Meaningful Use Stage 2 in 2014. It also extends its MU and ICD-10 guarantee program to PQRS reporting and MSSP quality measures.

Hearst Health and the Jefferson School of Population Health of Thomas Jefferson University create a $100,000 award for outstanding achievement in managing or improving wellness.

Privacy and Security

SAP fixes bugs in its EMR Unwired mobile clinician app that would have allowed hackers to add phony information or change existing data.

Innovation and Research

I missed this item from a few weeks ago: Walgreens adds information from PatientsLikeMe to its personal health dashboard, allowing people who are taking a particular medication to see what side effects others have reported. Most side effects are subjective and questionably attributed to a drug that has no physiologic rationale (“Tylenol makes me hungry”), so this development is both brilliant and worrisome as patients may fail to consider that every drug has side effects, most side effects are rare and transient, and the prescriber has already weighed the risk vs. benefit. Yelp is great for finding a restaurant based on the sometimes iffy reviews of people you don’t know, but I’m not sure the science of medicine is improved by patients reacting to anecdotal reports.

Technology

Robert Wood Johnson Foundation gives Partners HealthCare a $468,000 grant to help people choose, buy, and use fitness trackers to create a personal fitness plan, which will be followed by a study of volunteer users that will look at outcomes. .

Other

Richmond-based lab vendor HDL will pay $50 million to settle DOJ charges that it gave doctors $20 per blood sample in kickbacks. HDL made hundreds of millions of dollars running cardiac biomarker tests, claiming that it paid doctors only because its competitors did. The company’s three co-founders pocketed $50 million in distributions in three years, while the two owners of its contracted marketing company personally took home $173 million.

Vox questions whether the dramatic rise in medical studies leads to ungrounded public enthusiasm for miracle cures, nearly all of which never pan out. Stats: only 6 percent of submitted single-study journal articles are accepted; of 49 highly cited studies, 14 were later proven wrong or had less impact than originally thought; and 85 percent of annual global research spending is wasted on studies that are poorly designed or redundant. It partially blames news outlets that don’t understand that “new” isn’t definitive when it comes to medical research – it’s the old, unexciting studies that have been validated by further research that change the human health.

Someone tweeted out this brilliant article that has healthcare startup implications, “The Battle Is For The Customer Interface.” Uber doesn’t own cars, Facebook doesn’t create content, and Airbnb doesn’t own real estate. “These companies are indescribably thin layers that sit on top of vast supply systems ( where the costs are) and interface with a huge number of people ( where the money is). There is no better business to be in … Our relationships are no longer with the service providers … In the modern age, having icons on the homepage is the most valuable real estate in the world, and trust is the most important asset. If you have that, you’ve a license to print money until someone pushes you out of the way.”  

Sponsor Updates

• RelayHealth Financial announces a new version of its RelayAccount online patient billing solution.
• Meritage ACO (CA) announces that it has lowered its readmission rate to 10.2 percent using an evidence-based hybrid care model and ZynxCarebook care transition on mobile devices.
• Impact Advisors posts “Meaningful Use Stage 3: Summary & Early Impressions.”
• ADP AdvancedMD offers “6 facets of patient safety within a small private practice.”
• Capsule Tech will exhibit at the HIMSS Middle East Conference and Exhibition March 31 – April 1 in Riyadh, Saudi Arabia.
• Clinical Architecture offers the last installment of its blog series on precision medicine, plus a thorough summary of Stage 3 Meaningful Use objectives and measures.
• Clockwise.MD Founder Mike Burke shares what he’s learned in the startup world at the #30in30 event at Atlanta Tech Village.
• CompuGroup Medical will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 3/24/15

ZeOmega Acquires HealthUnity

Population health vendor ZeOmega acquires HealthUnity, an HIE, MPI, referral management, and patient consent solutions vendor.

Statement on Meaningful Use

Reactions to MU3 are beginning to trickle out, with AHA’s senior vice president of public policy issuing a statement today saying “The release of today’s rule demonstrates that the agency continues to create policies for the future without fixing the problems the program faces today.”

Michael Bloomberg Backs Health-Data Push

Former NYC mayor Michael Bloomberg partners with the Australian government to launch a $100 million, four-year project aimed at implementing birth and death registries in countries across Africa, Southeast Asia, and Latin America in order to begin to analyze causes of premature death.

Humana to sell Concentra for $1 billion

Health insurer Humana sells Concentra, a chain of 300 clinics and urgent care centers, to Select Medical Holdings Corp for $1.05 billion.

Readers Write: Ignorance of the Major EMR Software Vendors is Not Bliss

Ignorance of the Major EMR Software Vendors is Not Bliss
By Tyler Smith

We in healthcare IT have found ourselves in a pretty sexy industry. You know that is true when Silicon Valley is practically banging down the doors to get in and KPCB’s John Doerr states that he would really like to see an open source competitor to Epic created. Damn, so Valley money admits it is losing to a slowly built behemoth in Madison – not a brand spankin’ new startup it missed an angel round on.

Needless to say, HIStalk’s Startup columns are a quite timely addition to the blog. I particularly enjoyed reading Marty Feisenthal’s explanation of the elite JPM conference. Having heard about the conference from banker friends (not HIT colleagues), his column removed much of the mystique. Being a fellow Atlanta resident and having visited the Atlanta Tech Village before, I also have greatly appreciated Michael Burke’s articles on the experiences of an HIT founder in Atlanta.

I recently co-founded a startup that aimed to bring efficiency to the Epic staffing arena by using very simple tools already in place in other industries. I do not want to call it the Uber of Epic staffing – for fear of sounding like a hack – but the basic idea was a connection platform with ratings for Epic certified consultants. While we have put the project on hold due to some shakeups on our technical team and also due to slow buy-in from provider organizations (our target clients), the pause in the action has given me time to reflect on the current state of HIT startups – particularly those looking to nibble on the enterprise EMR vendors’ scope of services.

Along with Mr. H and most readers here, when anybody from the outside comes and brings a new idea to the HIT table, I am usually skeptical. For starters, most entrants do not understand the complexity of the hospital / provider organization buyer or the provider organizations’ importance in the system. In theory, I love the idea of patient advocacy and patient-centric apps, but if providers or the systems that house them aren’t buying it, you better have something that patients see as life or death (read: an HIV curing drug, not a sleep tracking app) if you want them to fight the entrenched stakeholders for you or with you to make your startup relevant or widely used to truly create positive clinical outcomes.

Secondly and most importantly, many of these outsiders do not understand the current state of the EMR vendor landscape, and if they do, they arrogantly think they can steal market share while the enterprise systems watch from the sidelines. True, Epic and Cerner’s UX can appear very basic from an end user stand point and it often appears that the enterprise systems do not appear to be covering even close to all the functions that could be automated in a hospital or healthcare delivery organization. However, it would be naïve to think that these vendors have no big plans to tackle all of these remaining un-automated functions in the near future. When they do, unlike many of the new startups, these vendors will be able to simply make an additional sale to their already heavy client lists instead of having to undergo the arduous process of breaking down the doors to just get on the approved software vendor list at a major healthcare system.

The truth is that healthcare IT is a B2B market, not a consumer market. Organizations do not make purchasing decisions overnight, and thus while an app may actually do something better than an organization’s EMR, it better be a lot better for a healthcare provider organization to consider even meeting with the startup’s sales team.

This is not to say that I think that clinical apps which could be potentially developed and which will lead to improved clinical outcomes should not be attempted. What I am really saying is that before delving into development, HIT startup founders should take a much more serious look into EMR current state.

Even more importantly, startups should also consider what logical next steps vendors will be taking in their product offerings and research timelines as the massive implementation phase winds down and optimization becomes a priority for the vendors’ in house development teams. If there really is a competitive advantage which the startup has over these behemoths in the development of an EMR related application, then by all means go for it. But if not, it is probably best developing something far outside of the current or near future EMR vendor scope.

Easy for me to say as I sit on the sidelines and consult on EMR projects, I know. And you can object and say I’m siding with the status quo. Regardless, it pays to do your homework on the massive vendors. They aren’t going to crumble and they certainly aren’t going to let their clients get on products that encroach on their turf without a very solid battle.

In closing, I would ask any hopeful HIT entrepreneur: what is your startup doing that an established EMR vendor could not accomplish without a system update or by adding a new application which would seamlessly integrate with their current lineup?

Tyler Smith is a consultant with TJPS Consulting and co-founder of Hitop.co.

Startup CEOs and Investors: Niko Skievaski

Selling to a Health System Is Like Breaking Your Arm
By Niko Skievaski

"Selling to a health system is like breaking your arm." I’m speaking with J. Simpson over a Chick-fil-A in the sticky mist of the three-story fountain at MD Anderson in Houston. Many things purchased for UT System’s health campuses come across her desk at the UT System Supply Chain Alliance, MD Anderson Cancer Center included.

"When you break an arm, the cast will be on for six weeks. There are plenty of things you can do to aggravate it and extend the pain, but there’s really nothing you can do to get rid of it faster. Sometimes you never really recover."

She’s referring to the notoriously crippling 12-18 month sales cycles in healthcare enterprise sales. You crack your ulna on the way into the sales meeting. If you’re lucky, you’ll get a purchase order in 12 months. However, most of the time you’ll be looking at up to 18+ months, if you get through at all. The problem is rooted in one thing that startups know very little about: budgets.

The budget for an upcoming fiscal year is approved about a month before that prior year ends. A month before that, department managers submit their budgets up the chain. And another tick before is when they start making "first cuts," where they generate a wish list of expenses for the next year, rank, then start hacking away. This process highlights the opportunity costs. If you want that toy, you’ll have to put down the others.

What this means for us is that if we haven’t already gotten a resilient thumbs up by first cuts, we’re not going to get allocated in that budget cycle. Hence, 12-18 months. Operational budgets are negotiated by employees at every level, and contrary to entrepreneurial optimism, there is no extra play money in the budget. For the most part, we’re talking about businesses that run an extremely tight ship with increasingly small margins. So what can we do?

1. Ride the cycle. It’s pretty easy to find out the fiscal year of most of these organizations. Check out Guidestar.org. Most hospital systems operate as non-profits, hence the razor-thin budgets. Search for the hospital, click the “financials tab,” and voilà! Fiscal year-end minus three months gives you your target close date. Use this knowledge to allocate your time effectively as you work your pipeline. If you just missed a lead’s cycle, change your flight and drop in on someone else.
2. Avoid the cycle. I’ve been describing the operational budget process. Things like that sweet software licensing contract you’re selling end up here. The other way they spend money is in the capital budget. These are one-off, large purchases of equipment or buildings (and the things that go inside them). If you can package up your offering as a one-time expense, you might be able to dodge the cycle. Otherwise, if you can get the purchase under $5K, you can bypass budgets all together. Those purchases can typically get swiped, invoice-free, on the department head’s corporate card. However, those cards are a one-shot-deal, so don’t count on using this for recurring revenue.
3. The pilot close. The idea is to sell a free pilot, contingent on being written into the budget next time. This is a slight variation on the usual pilots we see pitched. Try to time your pilot so that your evaluated in time to get into the upcoming cycle. The most important part here is that your pilot has a definitive close date (the “initial term” in contract lingo), a point when you can ask them to shit or get off the pot. Identify the metrics, date of measure, and what it will cost you to give it away for free for a while. Negotiate this up front with the pilot terms. This smooths the process along and makes it much more likely to be included next go-round.
4. Stop selling to enterprise health systems. Think of another revenue model that won’t be fraught with such dire peril. For instance, Lily Truong has an amazing gadget that you shove in your ear to (gently) drill out your ear wax. It’s 100 times better than a Q-Tip and less invasive than the normal saline flushes that pediatricians frequently push on terrified toddlers (and I’m not going to mention that weird candle thing). Wouldn’t all the clinics and children’s hospitals want to get their hands on one? Maybe, but Truong’s business will likely fail before she could get through the sale. Rather, she’ll ditch the cycle and bring her gadget into patients hands directly through sales off her site and consumer retailers. It’s a shame that the best tools won’t be used for the job in the doc’s office, but at least you can pick one up at the corner drug store and the innovation wasn’t wasted. Maybe that was an easy example, but I’ve seen people spend months trying to close enterprise deals when there’s a better buyer just around the river bend.

Hopefully some of these strategies will help. I’d like to thank Jess for dropping some knowledge on us youngsters. And to pad her resume, she’s likely one of the only people in any purchasing department who has actually done sales for a startup. It’s a breath of fresh air knowing there’s at least one out there, right?

Niko Skievaski is co-founder of Redox.

Curbside Consult with Dr. Jayne 3/23/15

Just when I was excited that spring had finally sprung, our friends at CMS and ONC have dumped a load of snow on my proverbial daffodils by releasing the Meaningful Use Stage 3 proposed rule along with the 2015 Edition Health IT Certification Criteria. Although it proposes to “simply the meaningful use program,” I find it hard to believe that the 301-page rule and corresponding 431-page certification criteria can be viewed as simple. As an example, there is a four-and-a-half page glossary of acronyms near the beginning.

Having sat through the first two parts of the trilogy, I know Hollywood would have helped me out by breaking the third installment into two full-length features. Alas, we aren’t that lucky with federal regulations and we’re squeezing it into three parts, much like Shakespeare’s Henry VI. I really did try to get through it, but I think the last five or so years of reading so many regulations have shortened by attention span. I hoped if I delayed into the weekend that Mr. H would read it and provide a pithy digest, but it seems he’s thrown in the towel as well.

Glancing through, they do note that, “Stage 3 of meaningful use is expected to be the final stage” which brings a sigh of relief. However, starting in 2018, all providers would report on the same Stage 3 definition of MU regardless of prior participation. Everyone would be on the same playing field regardless of their start date, which certainly does make things simpler. It makes it nearly impossible, however, for those who have not yet started to play the game.

I liked the proposal on page 15 to remove “topped out” measures, which they believe are “no longer useful in gauging performance, in order to reduce the reporting burden on providers for measures already achieving widespread adoption.” Sorry for the easy “A” grades, folks, you’re going to have to continue to work for it. There will, however, continue to be four categories of exceptions:

• Lack of Internet access or barriers to IT infrastructure
• Time-limited exception for newly practicing EPs or new hospitals
• Unforeseen circumstances such as natural disasters
• Exceptions for EPs with limited interaction with patients or lack of control over EHR availability for those of us practicing at multiple locations

The estimated federal cost to continue the incentive programs between 2017 and 2020 is approximately $3.7 billion. They do mention that “we do not estimate total costs and benefits to the provider industry” because those would be difficult to estimate. We all know that our EHRs cost far more than the $44,000 we might be receiving through Meaningful Use. Additionally, I’m not sure what the neck and back pain that some of us experience after hours at the computer might be worth if we asked for compensation. That’s not to mention the anxiety of dealing with all the virtual I’s that have to be dotted and T’s that have to be crossed to receive the incentive payment and/or avoid a penalty.

Pages 20-23 give a nice overview of the regulatory history and if you’re interested in the definitions they start on page 24. I admit, though, that my concentration started flagging around page 30 and I decided to call it a night. The 60+ patients I saw earlier in the day (will flu season never end?) started to catch up with me as did the glass of Simi cab. I’m going to have to work my way through it over the course of the next week, but I’m still crossing my fingers that the Cliffs Notes version will come out soon.

I feel for the vendors that have to read both the proposed rule and the certification requirement documents to be ready for clients who are going to start asking how vendors plan to handle the requirements before anyone has barely had a chance to digest them. Not to mention, this is still just a proposed rule and subject to public comment and potential revision. Although we don’t expect too many changes based on the historical track record, there still might be a few. I always enjoy reading some of the public comments and I’m sure those will be good for discussion in a few weeks.

I’m still a relative youngster in the medical trenches, but reading the proposed rule did make me nostalgic for the so-called good old days that I barely got to experience in practice. I was already nostalgic after a patient encounter earlier this week, when I had the privilege of caring for one of my medical school professors. He retired the year my class graduated and happened to need care while visiting his grandchildren in my city. When I saw the name come up on my census, I couldn’t help but think of my teacher. I’m sure I was beaming when I walked into the exam room and realized it was indeed him. I’m just thankful his issue didn’t involve his specialty of head and neck so I didn’t feel like I was on the hot seat again.

I do miss the continuity of traditional family medicine, so it was nice to make that kind of connection with a patient. I can’t help but think that my class gave him more than a little heartburn and might have contributed at least a little to his retirement decision back in the day. Luckily his problem was minor, but I have to say that seeing him made not only my day but possibly also my week and my month. I went into medicine to connect with people, but I feel that connection is being lost as the healthcare system evolves. After a bright spot like that, sitting and reading government regulations just makes me sad.

I’m sure lots of other CMIOs, medical directors, and informatics pros will be digesting the regulations this weekend. I’m going to finish unwinding and get ready for a big week of budget meetings and discussion about the further evolution of my team.

I asked last week how others unwind after a long day. Several respondents cited wine or other adult beverages, but an equal number mentioned physical activity as a stress reliever. Swimming, cycling, and horseback riding also made the list. As long as the snow stays away I’ll be out in the garden, marveling at the tender shoots and the promise of things to come. For tonight, however, I’m going to close my eyes and count not sheep, but pages in the Federal Register.

Are you ready for MU3? Email me.

Email Dr. Jayne.

ZeOmega Acquires HealthUnity

Population health management system vendor ZeOmega announced this morning that it has acquired HealthUnity, which offers private and public HIE, MPI, referral management, and patient consent interoperability solutions. ZeOmega says the combined products will form a low-cost PHM infrastructure that overcomes EHR interoperability issues and allows payers and providers to drive value-based care.

I discussed the acquisition ahead of the announcement with Nandini Rangaswamy, co-founder, EVP, and chief strategy officer of ZeOmega.

Hundreds of EMR, analytics, and HIE companies are trying to make a name in population health management, but they’re viewing PHM too narrowly. Competitors have some ingredients, but ZeOmega has an end-to-end strategy, anchored by what we call five pillars of PHM that includes the ability to drive an effective PHM program design and governance, aggregate data on the patient across the care continuum and all care settings, derive actionable insights from this data, enable effective real-time care coordination with those insights, and the ability to educate, engage and empower patients.

Acquiring HealthUnity lets ZeOmega close gaps in interoperability and patient resolution to become the industry’s first end-to-end PHM solution. So it’s my perspective that no other company can compete with our comprehensive offerings. That said, we will be competing with other companies who only have solutions for part of the care continuum. We’re so focused on doing what’s right for our clients, most of all eliminating information barriers to achieve real value-based care, so we probably will end up collaborating with come competitors’ solutions. We won’t shy away from that if it means enhancing value for our clients.

How do claims and psychosocial data fit into the set of information providers need to review a patient’s healthcare status?

In absence of interoperability, claims data can tell us about a patient’s health and their care-seeking and care-adherence behaviors. Psychosocial data can be used to determine factors that help influence and therefore predict patient behavior and outcomes. Analytics solutions that consider these variables can better predict the recommended course of action for the provider, which translates to more efficient use of provider resources while maximizing opportunities to impact patient health.

It’s easier to use an example. Let’s say a patient is being admitted for bypass surgery. Claims data can show if the patient has multiple co-morbidities, is taking multiple medications, or has a prior diagnosis of diabetes or a history of depression. Good analytics processes this data and identifies the patient as high-risk for readmission and hospital associated infections, perhaps even ICU psychosis, and may recommend an action plan to mitigate these risks, whether it’s by focusing on infection-risk areas or through medication reconciliation or tighter care transition.

Psychosocial factors can help determine the patient’s readiness to change. If an individual at high risk for diabetes is not motivated to change due to a situation in the family, the best thing to do may be to leave him alone until that situation changes for the better rather than spend costly resources to try to engage that patient.

Managing populations requires not just data, but making that data actionable so that busy clinicians don’t have to pore over records looking for ways to intervene proactively. How well is the industry transitioning to that model?

The industry is starting to see the value of actionable insight as they grapple with the challenge of providing timely and effective care while taking on outcomes risk with fewer resources. The industry is facing an information overload. It now also recognizes that insights from data alone are not sufficient.

Analytic capabilities can provide insights based on the data. However, if that insight isn’t actionable, then an organization may end up using valuable resources to translate that insight into the right action. For example, it’s relatively easy to tell from the claims data that an individual has diabetes but no foot exam and therefore has a gap in care. Actionable insights recommend a course of action. So knowing that the diabetic is a single mom, eligible for Medicaid, and at home with a sick child helps determine that the next best thing to do is to schedule a home health visit to cover the foot exam or provide for temporary child support so that the patient can make it to the doctor’s office. PHM platforms that deliver this effectively will make the industry’s transition to this model quicker.

How will you integrate HealthUnity’s offerings with those of ZeOmega?

HealthUnity’s portfolio of interoperability offerings – whether it’s their private and regional HIEs, patient resolution solutions, patient consent solutions, or referral management — are very complementary to ZeOmega’s solutions and will be offered as part of the Jiva PHM stack. Technologically, the integration between the HIE, master person index, and Jiva PHM platforms lets us develop a rapidly deployable infrastructure that payers and providers alike can leverage to better coordinate care and improve outcomes.

How does the acquisition fit with ONC’s interoperability roadmap?

ONC laid out 10 guiding principles and building blocks in Connecting Health and Care for the Nation. Acquiring HealthUnity helps ZeOmega meet ONC principles even better, whether that be flexibility, configurability, adaptability, reusability, simplification, modularity, privacy and security, or scalability and access.

For example, HealthUnity’s HIE supports multiple industry data exchange standards. Its Universal Patient Consent solution empowers the individual to designate which provider can see specific portions of their health record, while capabilities such as EHNAC-certified direct messaging capabilities enable providers to collaborate even though some may have less sophisticated infrastructure than others.

The HealthUnity acquisition further strengthens ZeOmega so we can continue making investments to keep our company and our clients in lockstep with the ONC’s 10-year vision.

Morning Headlines 3/23/15

HHS announces proposed rules to support the path to nationwide interoperability

ONC publishes Meaningful Use Stage 3 proposed rules and 2015 Edition EHR certification criteria, with public comments open until May 29. The rules establish a single definition of “meaningful use” that all hospitals and providers will have to meet by 2018, attempts to streamline quality reporting burdens, and introduces a number of new patient engagement objectives.

Vt. Health Connect deadline

Vermont Gov. Peter Shumlin acknowledges that despite nearly $125 million in spending, the state’s health insurance exchange may need to be shut down and replaced by Healthcare.gov.

How America’s Top Industries Have Changed, 1990-2013

The Wall Street Journal reports that in the last 25 years the healthcare industry has grown to the point that it now employs more workers than any other industry in 35 states.

El Camino says goodbye to paper medical records

A local paper covers El Camino Hospital’s (CA) $125 million Epic implementation. The hospital is finalizing its build and will move into system testing next month as works toward a targeted November 7 go-live.

Monday Morning Update 3/23/15

Top News

HHS, CMS, and ONC publish proposed rules for Meaningful Use Stage 3 and 2015 Edition EHR certification criteria. The announcement was posted as a Word document, bizarrely, and late on a Friday afternoon as is always the case. The Stage 3 rule is here and 2015 certification criteria here. Your comments are welcome, both here (any time) and at the Federal Register links (by May 29, 2015). I’ll be honest in saying that I’m so sick of the topic that I haven’t even bothered to read either document. I’m sure the many special interest groups will call out the parts they find objectionable and thus are probably the most needed. Feel free to chime in on parts you find interesting or surprising.

Reader Comments

From Yours in Nomenclature: “Re: SNOMED-CT MOOC. It’s going to happen. I might sign up since my work bumps against it.” The College of St. Scholastica offers a free massive open online course (MOOC) called “Exploration of SNOMED-CT Basics”  that starts April 20. Registration stays open until May 18 since the student just needs to finish the course by June 15. It offers 12 AHIMA CEUs. The instructor is Mike Grove, PhD of Accenture.

From Paul: “Re: Epic’s Deep Space architecture award. While I must congratulate Judy, I just left Verona with a sense of dismay at what our organization has been putting up with to build this place — north of $400 million by estimates — for a forum we’re only visiting once a year.” I think they should have concerts there. It would be fun to go to Verona for training and then walk over to see Rush or U2.

HIStalk Announcements and Requests

Two-thirds of poll respondents don’t think Congress will insert another surprise ICD-10 delay into SGR legislation, a belief that seems well founded in the draft versions presented so far. New poll to your right or here: which company do you trust least to make information exchange common and inexpensive? Of course I’m fascinated to learn why you voted as you did, so click the “comments” link afterward and explain.

I’ve emailed the 13 CMIOs who expressed interest in attending my HIMSS conference lunch on Tuesday, April 14. I still have a handful of spots left. I don’t often volunteer to pick up the lunch tab, so it’s a rare opportunity.

I’m really getting annoyed at half-wits who think it’s hilarious to use “FHIR” as “fire” in creating a lame pun for a headline or tweet.

Listening, as I was taking an extended drive and used Siri’s “what is this song” option to get the titles of the radio tracks I liked best as I constantly scanned: Christian rocker Matthew West’s “The Motions,” The Smashing Pumpkins with “Today,” a forgotten classic by the indefatigable Butthole Surfers, “Pepper,” new from Incubus, and my favorite song (nearly 40 years old) of the amazing Electric Light Orchestra.

HIStalkapalooza

HIStalkapalooza invitations have been emailed. Spam filter problems are rampant these days, so I’ve added a second level of checking: see this page, which lists who was invited in a somewhat de-identified format (first three letters of the last name, comma, and first two letters of the first name). We cannot accommodate walk-ins or guests, so the security people will admit only those who are on their full registration list. Some sponsors didn’t submit their guest lists in time, so if you’re being invited by one of the event sponsors and aren’t on the list, you should be getting an invitation directly from that sponsor.

I’ll take a second to again thank the HIStalkapalooza sponsors that are making it possible for a large number of folks to attend the event. Several of those listed are going above and beyond, with Sagacious, for example, running guest check-in and badge printing and Elsevier managing the traditional red carpet entrance. These companies are springing for dinner, drinks, and entertainment, so it seems reasonable that you click their links in return to see what’s new with them.

Platinum Sponsors
Elsevier
Santa Rosa Holdings

 
Gold Sponsors
Divurgent
Sagacious Consultants

Silver Sponsors
Aventura
CommVault
Falcon Consulting Group
Greenway Health
PatientSafe Solutions
Sunquest
Thrasys
Validic

Speaking of red carpet, here are skeletal details of the ever-popular HIStalkapalooza fashion awards, where your hot shoes will be burning down the avenue (Dearborn Street in this case). We’ll have four winners: best shoes male and female and then best overall appearance, also male and female, which will earn the HIStalk King and HIStalk Queen sashes, since like high school, we overly emphasize appearance because it’s all we have time to evaluate. Plan to enter early (maybe 6:45 to 7:15) via the red carpet, where our distinguished judges will cast their critical eyes feetward and then full body. Your regular host Jennifer Lyle of Software Testing Solutions serve as expert along with one of our patient scholarship winners Amanda Greene, who was involved with the red carpet at the Oscars this year and who works with fashion magazines. We’ll bring the four winners up to the stage to be sashed.

Last Week’s Most Interesting News

• A proposed Congressional SGR “doc fix” bill would make health IT interoperability a national priority to be achieved by the end of 2018 and proposes to penalize those who intentionally obstruct it.
• A contracting billing company’s employee falls victim to a phishing scam, exposing the information of 14,000 patients of Sacred Heart Health System (FL).
• Cerner and Athenahealth chide Epic via Twitter for its non-participation in CommonWell following its negative comments about the organization in congressional testimony.
• Premera Blue Cross discovers that hackers have had access to its 11 million patient records since May 2014.
• Meditech reports full-year 2014 results that include an 11 percent drop in revenue and profits that were reduced by 7 percent, although the company had previously restated its financials and that change may have affected the totals.
• CHIME offers a $1 million prize for an idea or technology that increases patient ID matching from the current 80 percent to 100 percent, although presumably members of Congress who could enact national patient identifier rules are not eligible.
• Implementation of New York’s mandatory e-prescribing law is delayed for a year, to March 27, 2016.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Vince Ciotti has been tracking vendor annual revenue for decades. Here’s the first installment as he introduces the episodes to follow. He confirms the feeling I’ve had that HITECH goosed company revenues for a couple of big years, but that has tailed off and left a lot of software and consulting vendors scrambling to resize themselves appropriately.  

People

 

Valence Health hires Kai Tsai (PwC Consulting) as EVP of consulting services and strategic initiatives and Mary C. Anderson, MD (Rush University Medical Center) as medical director of population health.

Karen Wavra (Allscript) joins Beacon Partners as Cerner practice director.

Announcements and Implementations

The headline “El Camino says goodbye to paper medical records” wasn’t written during its TDS implementation in the 1970s – it describes El Camino Hospital’s (CA)  $125 million move to Epic.

Surescripts names 24 health systems and technology vendors for its “2014 White Coat of Quality Award” for electronic prescribing.

Government and Politics

This is a scary graph. Healthcare is the highest-employing industry in 35 states.

An editorial in the Burlington, VT paper applauds an announcement by the governor that if Optum can’t get the state’s insurance exchange working by October, he’ll shut it down and move to the federal exchange. The state will have spent $198 million in federal taxpayer dollars by the end of 2015, with unimpressive results following screw-ups by CGI that resulted in its replacement by Optum.

Acting VA CIO Stephen Warren says that even though the DoD is shopping for a commercial EHR, the VA will stick with VistA because it was developed for patient care rather than built around billing as were commercial systems.

Technology

Good Morning America goes inside Apple’s secret fitness lab, where employee volunteers tested various sensors and technologies over the past two yeas without knowing their work was for the development of Apple Watch.

Other

A Virginia Peninsula newspaper points out that the region is one of the first in the country in which all competing health systems (Bon Secours, Riverside, Sentara, and Chesapeake Regional Medical Center) use the same EHR, Epic in their case. Like a lot of newspapers and marginally informed pundits, this article mistakes HITECH as being part of the Affordable Care Act, but this one takes it a step further in proclaiming that hospitals didn’t start testing EHRs until the 1990s and that just two major players remain (Cerner and Epic, forgetting about still-common but somewhat fading Meditech).

UnitedHealthcare runs a cute commercial that features an ICD-9 code and virtual visits.

Bob Wachter, MD, pitching his new book, writes a New York Times editorial whose content he summarizes via Twitter as “Why health IT is so bad and how to make it better.” The former was mostly anecdotes and I didn’t see much of the latter: his suggestions are: (a) train doctors to focus on the patient, not the computer; (b) create new ways to practice provider teamwork in the absence of a shared chart; (c) create federal policies that promote interoperability; (d) increase collaboration between academic researchers and software developers. Doctors may hate EHRs, but all it took was $44,000 in federal money to get them to use them. My argument would be that doctors should redesign the encounter system so they don’t need to use computers at all unless they need its help — doctors are the only professionals (accountants, lawyers, psychologists, plumbers) who key their own information into the computer instead of focusing entirely on the paying client sitting in front of them, and not only that, do most of their keystroking for the benefit of someone other than themselves. You could argue that medicine is the only profession that is practiced as a team, which might hit Bob’s second point, but I’d still say bring on the scribes and let doctors be doctors and not the medical equivalent of the grocery store checkout clerk. Everybody agrees that the information needs to be recorded, but it’s not reasonable that the highest-paid professional in the medical food chain be the one doing it.

Bob Wachter tweeted out an interesting excerpt from his book as he quoted National Coordinator David Brailer responding to the question if ONC would shrink itself as the HITECH money runs out. “Bureaucracies don’t retrench,” Brailer said. “ When a bureaucracy that starts out as the Candy Man runs out of candy, it goes dark and turns into Regulatory Man.”

Anyone who attended HIMSS09 in Chicago saw the weather change from a near-blizzard on Sunday to pretty good later in the week. Here’s what the not-so-bad weather looked like at O’Hare on April 12 of previous years (the Sunday opening day of this year’s conference):

2014: low 42, high 69, rain 0.43 inches.
2013: low 34, high 45, trace of snow.
2012: low 40, high 66, no precipitation.
2011: low 36, high 68, no precipitation.
2010: Low 48, high 63, no precipitation.

The family of a Virginia radio personality who died after routine hernia surgery is awarded around $2 million from the hospital and its PCA pump manufacturers. Nurses mis-programmed the pump and delivered five times the ordered dose of narcotic, which just about everybody agrees was because of the device’s complexity, although the manufacturer claims the nurse hadn’t been properly trained, didn’t monitor her patient, and waited eight minutes after finding the patient unresponsive before calling for help.

This photo, which a paramedic took surreptitiously as a California ED doctor grieved after his 19-year-old patient died, has received a lot of Internet attention after being posted on social media. Minutes later, the doctor had moved on to his next patient with his game face on. It’s a good reminder that a hospital is just a very clean hotel with a lot of expensive executives and non-clinical hangers-on – lives get saved, as they do on the battlefield or in an ambulance, by a well-trained fellow human who is willing and able to help.

Sponsor Updates

• Shareable Ink’s ShareQuality technology is featured in Nashville Medical News.
• Voalte CEO Trey Lauderdale shares his belief that “With Apple ResearchKit, mHealth Springs Forward.”
• Zynx Health will exhibit at the 2015 Population Health Colloquium March 23-25 in Philadelphia.
• The SSI Group and ZirMed will present at the Region 4 Mid-Atlantic HFMA Education Conference March 24 in Baltimore.
• Verisk Health will exhibit at the AMGA Annual Conference March 23-26 in Las Vegas.
• Xerox Healthcare asks, “Does Better Healthcare Require Better Patients?”
• Sunquest Information Systems will exhibit at the 2015ACMG Annual Clinical Genetics Meeting March 25-27 in Salt Lake City.
• PMD offers “Telemedicine: The Work of the Gods.”
• MedAptus, PatientKeeper, and Passport Health will exhibit at the AMGA 2015 Annual Conference March 23-26 in Las Vegas.
• The local business paper interviews Quest Diagnostics CEO Steve Rusckowski about the company’s recent successes and future plans.
• MedData will exhibit at the OHIMA Annual Meeting & Trade Show March 24-25 in Columbus, Ohio.
• MEA I NEA CEO Lindy Benton discusses the importance of improving practice communications on eHealth Radio.
• Navicure posts “Price Transparency: What does it have to do with Patient Engagement?”
• NVoq offers how to “Avoid Those ‘Few Extra Clicks’ and Improve EMR Workflow.”
• Nordic releases the second episode of its HIT Breakdown podcast entitled, “What does a great population health program look like?”
• Park Place International publishes a blog on “Winders Server 2003 End of Life and Active Directory.”
• Orion Health and Sandlot Solutions will exhibit at the 12th Annual World Health Care Congress March 22-25 in Washington, D.C.
• NTT Data will exhibit at the CIO Summit March 22-24 in Chicago.
• Perceptive Software’s In Context blog addresses “Hospital IT: Beyond the EHR.”
• BBC’s Click Tech program features the Oneview Healthcare solution used by UCSF Medical Center (CA).

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 3/20/15

A bill to amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate

A new bill in Congress calls for the permanent repeal of the SRG, but also names health IT interoperability a national priority to be achieved by the end of 2018.

Graphical Display of Diagnostic Test Results in Electronic Health Records: A Comparison of 8 Systems

AHRQ publishes a study comparing the differences in how laboratory results are displayed across eight EHR systems. The study was based on 11 criteria for the proper display of lab data. None of the vendors met all 11 criteria, and some deficiencies were misleading enough to have a significant, negative impact on patient safety.

The inside story of how Apple’s new medical research platform was born

Apple reportedly began working on ResearchKit in 2013, having been inspired by a MedX presentation by Stephen Friend, MD on the future of medical research. During  his presentation he describes his ideal platform, “Here you have genetic information, and you have what drugs they took, how they did. Put that up in the cloud, and you have a place where people can go and query it, [where] they can make discoveries.” Apple VP of medical technologies Mike O”Reilly was in the audience.

Epic System’s auditorium, contractor win national award

Epic’s new 11,000 seat, space-themed underground auditorium has been named the best new building in America in the over $200 million category.

EPtalk by Dr. Jayne 3/19/15

It was good to get away from my day job last week. I spent my days off seeing patients and intentionally not checking my hospital email account. I’m aggravated at how things are going with our upcoming EHR migration and how my team is being treated, so I thought unplugging would be therapeutic.

Initially we were told that our team would be transitioned to the new project and placed in similar job roles. Our ambulatory group continues to acquire new practices and a small team would remain to continue implementing at those sites as well as to support existing sites. We communicated this to the team and they were comfortable with the approach.

About a month ago, the plan changed. Leadership decided that they want to structure the team more consistent with what the vendor recommends. Now we’re looking for a fairly large number of project managers and plan to hire a completely new training team.

I’m reading between the lines and thinking that perhaps they don’t want people with experience because they’re worried about preconceived notions of how an implementation should look. New trainers will certainly be easier to mold to a new paradigm, but I have serious concerns about throwing away as much cumulative experience as our team has. In addition to being solid trainers, they understand our physician base and how our offices run. The offices trust them and see them as advocates.

Before I left for vacation, our leadership informed the staff of this new plan and essentially told people to get their resumes in order. If they want to move to the new project, they will need to apply for the project manager positions. Most of my team members thrive on the front lines and on working directly with users. If they had wanted to be project managers, there have been quite a few opportunities during the last couple of years. On the other hand, they don’t want to be stuck turning the lights out on a dying project and risk being let go at the end.

Because of flip-flopping by the leadership, the team is nervous and scared. At this point, I don’t know what to tell them. I’m still in limbo regarding my own position. I’ve seen at least half a dozen variations on the proposed clinical leadership structure and none of the positions have jumped out at me as being a good fit for my particular skill set. Like the team, I’ve been told to get my resume in order. Once the positions are posted, I can apply along with the rest of the CMIOs that are being consolidated.

We’ll have three days for internal candidates to apply before the positions are posted externally. It goes without saying that they’re going to hire a new system-wide CMIO who has experience with our new vendor, so at least we’re not all fighting each other for the top job. Postings are supposed to go up next week, but they’ve already been delayed several times, so I’ll be surprised if they are there before HIMSS. Once I see what is available, I’ll make my final decision on whether I’m going to stay or fly the coop.

Most people find uncertainty to be disconcerting. For me, it’s been somewhat liberating because I’ve given up on trying to figure it out. This might be the first time in my life that I haven’t had a plan. I’m starting to understand how my colleagues that fly by the seat of their pants feel every day.

After my week off, I came back to work much more relaxed and ready to see what the next curveball might be. We’ll see how long that lasts, based on the craziness that we’re thrown on a daily basis.

In the mean time, there’s always room for pastry therapy. In honor of St. Patrick’s day I made some outstanding cupcakes that a friend had suggested I make. I just may have found my new favorite buttercream frosting recipe. Slainte!

Email Dr. Jayne.

News 3/20/15

Top News

The House’s proposed doc fix SGR bill includes a requirement stating that “Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018” and orders HHS to take action if interoperability metrics aren’t reached that could include Meaningful Use penalties and EHR decertification. The bill would also require providers to declare that they that they haven’t restricted interoperability as part of their attestation (that sounds tricky to interpret). It also calls for studying the creation of an EHR feature comparison website. Other language in the proposed legislation addresses data usage and telemedicine, so it’s pretty heavy in IT-related language. Now the political sausage-making begins, hopefully without someone’s ICD-10 Hail Mary sneaked in as time expires.

Reader Comments

From Data Driver: “Re: Demand-Driven Open Data (DDOD). I’m cautiously optimistic about this new mechanism to open and track government data requests. I say ‘cautiously’ because I’ve seen competent people in HHS’s ‘Entrepreneur in Residence’ program have their projects stymied by unspecified limitations.” HHS’s DDOD program, launched in November 2014, lets startups, providers, and researchers tell HHS (via online use case requests on Github) what data or APIs from CMS, NIH, CDC, and FDA they would like to have. Requests are prioritized by potential cost savings and input from data users, and if approved, the requestor works with HHS to manage its development as a project. Some interesting use cases: retrieve Medicare pricing by CPT, create a consolidated registry of marketed medical devices, export FDA’s drug warning letters to data format, and create a de-identified claims dataset for tracking utilization and quality.

From Brutus: “Re: Standard Register. I haven’t seen any news on its implosion. The CFO resigned in January, they got booted from the NYSE, and now they’ve filed Chapter 11. They bought iMedConsent from Dialog Medical awhile back and seemed to be making a slow transition from their paper forms business.” They’ve announced restructuring plans to sell the company to a turnaround-focused hedge fund for only $275 million. Standard Register’s electronic healthcare offerings include electronic forms, document capture, electronic consent, electronic storefronts, medication history, discharge follow-up, and workflow. The company bought Dialog Medical for $5 million in 2011.

From Sturges: “On the noise around Epic and the Senate interoperability hearing, everyone is missing one piece: who asked the question on CommonWell to Epic’s Peter DeVault?  The answer: Tammy Baldwin, US senator from Wisconsin. Judy is one of her largest political donors. So, Epic (and/or Brad Card, their lobbyist) planted the question with Baldwin’s staff. Baldwin is happy to help a large donor. Epic’s DeVault provides his rehearsed, untruthful reply. It is typical Washington." Senator Baldwin is not only Judy’s heaviest-supported politician (Judy’s campaign contributions are listed are above), Senator Baldwin was one of five members of a Congressional delegation that in 2011 wrote a letter to the Department of Defense urging it to consider buying Epic, which seemed cheeky at the time, but now Epic is one of three finalists for the DoD’s $11 billion EHR project and the free VistA is off the table.

From MrSoul: “Re: Spartanburg Regional Medical Center (SC). They’re going Epic, replacing GE Centricity in the clinics and McKesson Horizon inpatient. That means Bon Secours St. Francis, GHS, and Spartanburg Regional will all be Epic soon. No Epic jobs on their site yet.” Glassdoor is now showing some Epic jobs at Spartanburg Regional.

HIStalk Announcements and Requests

This week on HIStalk Connect: Health Catalyst raises a $70 million Series D round to expand its data analytics platform. Google secures a patent for a wrist-worn system that will search for and then attack cancer cells in the bloodstream. 23andMe announces that it will begin using its genome database for drug discovery research. HealthTap introduces RateRx, a platform for doctors to rate the effectiveness of medications.

This week on HIStalk Practice: Austin Regional Clinic gets into virtual visits via CirrusMD. Mettrum Health launches physician portal for medical marijuana services. AHIP attempts to one-up the AMA in Chicago. VSee helps telemedicine go galactic. Jerry Broderick outlines how practices can give themselves a leg up when it comes to capturing physician commitment. HHS and PwC look back at ACA hits and misses. Zobreus Medical takes its EHR to Kickstarter. Physician optimism around mobile apps may be naive.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Clinical trials software vendors CentrosHealth and Clinical Ink merge.

The Houston business paper profiles seven-employee Medical Informatics Corp., which offers the FirstByte alarm management program and says its real-time clinical decision support application should pass FDA approval and enter the market in this year.

IBM invests an unspecified amount in Modern Medicine, which is working on Watson-powered ambulatory clinical decision support.

Sales

Washington’s Department of Social and Health Services chooses a hosted version of Cerner’s Millennium and revenue cycle for three psychiatric hospitals.

Announcements and Implementations

Premier announces PremierConnect Supply Chain to manage a health system’s entire purchasing process including, real-time supply analytics, online sourcing, catalog management, and materials management. Test sites included Adventist Health and Fairview.

Cerner and Intermountain announce implementation of iCentra — the EHR/PM system they’ve been working together to develop — at two hospitals and 24 clinics, with the rest of Intermountain going live through 2016. The announcement says the collaboration makes iCentra “more unique” (which is grammatically horrifying) than competing EHRs.

Government and Politics

California tax authorities and Blue Shield of California are criticized for failing to disclose that the insurance giant’s non-profit status was revoked seven months ago before people starting signed up for insurance on Healthcare.gov. The state’s insurance commissioner applauds, saying Blue Shield charges excessive rates and doesn’t operate any differently than for-profit insurance companies. The organization paid its CEO $4.6 million in 2011 (and has declined to say what it has paid him since) and spent $2.5 million for a San Francisco 49ers luxury box last year. Blue Shield’s just-resigned public policy director is running a public campaign to convert the insurer to  a for-profit company that could be worth up to $10 billion and use the money for safety net care. The questions raised could be logically extended to health systems that don’t pay taxes despite billions in income, millions in surpluses, and the highest executive salaries in the non-profit world.

Privacy and Security

Sacred Heart Health System (FL) notifies 14,000 patients that their information was exposed when the email account of a contracted billing vendor’s employee is hacked. Please, well-intended writers and self-appointed experts – stop yammering about encrypting data at rest (which wouldn’t have prevented any of the recent big breaches) and focus on phishing attacks. They aren’t as easily detected as earlier primitive attempts that featured laughably poor English and poorly disguised links that would fool only the least computer-literate employees. Phishers have become convincing in luring even intelligent people into clicking official-looking links or opening malware attachments that claim to be faxes, legal documents, or password reset links. That doesn’t even account for phone phishing where smooth-talking people convince employees to divulge passwords. Encryption is worth zero if someone steals the password of an employee who has data access.

Innovation and Research

An AHRQ-funded review of how eight inpatient EHRs display lab values finds inconsistency and graphical limitations, with the authors suggesting that ONC beef up certification criteria. Some EHRs failed to include the patient’s birthdate, a description of the value being displayed, or a data legend.

Clinicians and technologists in Vermont join to create MEDSINC, a mobile app for poor countries that allows users with no medical training to input information about a sick child and then receive suggested treatment options based on local conditions. The app was envisioned by UVM pediatrician Barry Finette, MD, PhD and built by Physicians Computer Company co-founder John Canning with input from 10 university pediatricians who reviewed WHO protocols and evidence-based research. Testing at UVM suggests that pediatricians and the app agree 94 percent of the time vs. the 80 percent agreement typically found when two board-certified pediatricians review a case. Field deployment in Bangladesh begins later this year. The developers say it might eventually land in the US provided they can get through the FDA’s process. They’ve formed a company called ThinkMD.  

A report says Apple decided to move ahead with ResearchKit in September 2013 after one of its executives heard a Stanford MedX talk by Stephen Friend, MD, PhD, a  former drug company oncology SVP who co-founded Seattle-based non-profit Sage Bionetworks that provides tools for large-scale, transparent biomedical research. It says Friend decided to work with Apple rather than Google or Facebook because as a hardware manufacturer, Apple won’t sell data.

Technology

Don DeCoteau is developing BellaVista, an EHR-agnostic, native client (iOS, Android, and JAVA-supported desktop) that displays clinical results with a framework to integrate QR codes, real-time medical device streams, videoconferencing, and voice-based ordering and documentation. He’s got it running with the VA’s VistA to illustrate that the client can work with any EHR that offers an API for accessing clinical information. Don is looking for early adopters.

A New York Times Magazine article pokes fun at people who worship “optimization” because it’s easier to appease their “inner bean counter” than to develop talent or ambition also takes on the Apple Watch in comparing it to the Stalin Gulag’s computer-driven optimization of “maximum work given minimum food”:

After time keeping, the watch’s chief feature is “fitness tracking”: It clocks and stores physiological data with the aim of getting you to observe and change your habits of sloth and gluttony. Evidently I wasn’t the only one whose thoughts turned to 20th-century despotism: The entrepreneur Anil Dash quipped on Twitter, albeit stretching the truth, “Not since IBM sold mainframes to the Nazis has a high-tech company embraced medical data at this scale. And yet what attracts me to the Apple Watch are my own totalitarian tendencies. I would keep very, very close tabs on the data my body produces. How much I eat. How much I sleep. How much I exercise and accomplish. I’m feeling hopeful about this: If I watch the numbers closely and use my new tech wisely, I could really get to minimum food intake and maximum work output. Right there in my Apple Watch: a mini Gulag, optimized just for me.

Other

It’s fun to have a sideline seat for the public vendor interoperability squabbling generated by the Congressional testimony of Epic’s Director of Interoperability Peter DeVault, who disclosed upon direct Senatorial inquiry this week that Epic charges customers $2.35 per patient per year to send data to non-Epic systems. Athenahealth’s Jonathan Bush says he’ll pay Epic’s $1.4 million fee to join CommonWell, while Cerner calculates the many millions Epic receives from its data sharing tollbooth. Meanwhile, as reader Where’s Waldo suggests, we can take one important issue off the table right now if McKesson’s John Hammergren will simply state in writing that his RelayHealth business (CommonWell’s technology provider) will never sell data, which is different than having CommonWell itself say it won’t sell data. Hammergren has seemed awfully excited when describing CommonWell to investors.

A KLAS report on small-practice (1-10 doctors) EHRs puts Cerner at the top for broad market vendors in a fairly stunning turnaround, with PCC topping the specialty category (pediatrics in its case). Bottom-ranked and trending hard in the wrong direction are NextGen, Allscripts, and McKesson. McKesson leads the pack in clients planning to replace its product at 43 percent, while PCC has the highest planned retention at 98 percent. Small-practice customers in general say their EHR vendors spend too much time chasing Meaningful Use and ICD-10 rather than delivering customer-suggested enhancements. Users of Greenway Intergy, NextGen, and McKesson called their vendors out as having “black-hole syndrome” where support loses or ignores their tickets or fails to follow up. Customers of Allscripts, eClinicalWorks, and Bizmatics complained that the support reps often don’t speak English very well and one NextGen customer reporting that he’s tired of getting calls from overseas at 3 a.m. The biggest complaint by far of customers planning to replace their EHRs is poor usability (although those same EHRs had the same poor usability when those same customers bought them, so those customers are more to blame than anyone). 

A random telephone survey (which raises validity flags every time even if you ignore the leading questions that are asked or days and times calls were made) finds that 75 percent of respondents think their providers should be able to share their information, while 87 percent don’t think either providers or patients (i.e., themselves) should have to pay for it. Most respondents also said they love puppies and their country (wait, I made that part up). The real way to tell if data sharing is important is to ask people (a) if they’ve switched providers who don’t or can’t share information, and (b) would they pay extra for it.

Epic’s underground Deep Space Auditorium is judged the best new building in America in the over $200 million cost category, with the Madison-based contractor that built it also winning a top award.

A female pediatrician in England accuses a gym chain of “blatant sexism” upon finding that she couldn’t enter the women’s dressing room because the gym’s security system assumes that anyone with a “Dr.” title is male.

An Internet domain company challenges a policy under which the new .doctor domain will be issued only to medical doctors who provide evidence of their credentials, saying it’s not fair to PhDs and companies with “doctor” in their name, such as Rug Doctor.

Sponsor Updates

• PatientSafe Solutions President and CEO Joe Condurso publishes “Liberate and activate EHR data with mobile tools for clinicians and patients.”
• InterSystems releases a white paper entitled, “Data Scalability with InterSystems Caché and Intel Processors.”
• Intellect Resources posts a new blog on “Identifying Your Career Motivators.”
• Hayes Management Consulting Offers “3 Ways to Minimize Anxiety During an EHR Implementation.”
• HDS posts “The Push for Pull Marketing in Healthcare.”
• InstaMed offers “Why Healthcare Needs Apple Pay.”
• E-MDs will exhibit at American Academy of Orthopaedic Surgeons 2015 March 24 in Las Vegas.
• Galen Healthcare Solutions introduces Web Access for VitalCenter in its latest blog.
• Ingenious Med blogs about “The Future of Innovation.”
• Healthwise will exhibit at the World Health Care Congress March 22-25 in Orlando.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 3/19/15

DirectTrust Interoperability Report Suggests Best Practices, Improvements

DirectTrust reports that thus far 35,000 healthcare organizations are connected to the Direct Network, accounting for 23 million Direct exchanges last year.

Healthcare reform: Five trends to watch as the Affordable Care Act turns five

PwC reports on the impact the Affordable Care Act has had on the healthcare industry five years after its passage.

Health Insurance Coverage and The Affordable Care Act

In its own five-year analysis, HHS reports that 16.4 million uninsured adults have gained insurance coverage since the implementation of the ACA.

Morning Headlines 3/18/15

Premera Blue Cross Says Cyberattack Could Affect 11 Million Members

Premera Blue Cross discovers that 11 million of its patient records have been compromised by hackers, with bank account information and clinical data among the exposed information.

High Value Health IT: Policy Reforms for Better Care and Lower Costs

A Brookings Institute report recommends that the Meaningful Use program focus on supporting payment reform, and improving outcomes and interoperability.

Medical Information Technology, Inc. Form 10-K

Meditech reports 2014 annual results: revenue down 11 percent to $517 million. Sales revenue dropped 26 percent, but impact on total revenue was partially offset by a $10 million increase in service revenue.

Health Catalyst Raises $70 Million to Fuel Product Development

Data analytics vendor Health Catalyst raises a $70 million Series D investment round on a $500 million valuation, instantly becoming the next rumored health IT IPO.

News 3/18/15

Top News

Seattle-area Premera Blue Cross discovers that hackers have had access to the demographic, clinical, and claims information of 11 million people going back to May 2014. The FBI is investigating. The organization describes the attack using the mandatory adjective “sophisticated” that hints at a higher level of corporate competence than the incident suggests.  

Reader Comments

From EMRAMfan: “Re: Radboud University Medical Center. It is the first in the Netherlands and the third in Europe to achieve HIMSS Stage 7.” They use Epic, I believe.

From Questionable Content: “Re: LinkedIn discussion email (aka ‘spam’). Of the 13 article headlines, ONE has a title that isn’t a question. I’m not sure when media coverage of the healthcare industry ceased to be researched articles that took a position and became this regurgitated series of questions with no value added whatsoever, but it’s painful. This is why I read HIStalk.” Titling an article with a question is lazy, especially when the article fails to answer the question it asks (which is almost always). It’s a combination of lazy readers as well as lazy writers – someone must be reading this drivel, which is probably due to social media-shortened attention spans. If an article doesn’t tell me something I truly needed to know, it wasted my time and I’ll hold a grudge. I also avoid opinion pieces written by people whose lack of relevant credentials suggests that they should be reading rather than writing.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Surescripts. The company backs up its tagline of “How Healthcare Gets Connected” by connecting 900,000 providers (including 95 percent of pharmacies and 400 hospitals) and 270 million patients. Its network processes 7 billion transactions and a billion electronic prescriptions each year, integrating with 700 EHRs. It’s also one of just 105 US companies with ISO 27001 security, the highest level possible. Surescripts offers automated clinical messaging, CompletEPA EHR-integrated electronic prior authorization, electronic prescribing (including controlled substances), immunization registry reporting, aggregated medication histories from pharmacy and claims data, and a patient portal with secure messaging. Thanks to Surescripts for supporting HIStalk.

I found this Surescripts overview video on YouTube.

Our HIMSS conference patient scholarship winners have finally lined up their Chicago housing. FormFast has graciously volunteered to donate a hotel room (and a very nice one at that) so that our winner from France won’t have to couch surf as she was planning. Medicity also provided a room as I mentioned earlier. The five ladies are getting a lot of attention from vendors wanting their time and asked my advice, which was this: keep companies at arm’s length during the conference since it’s easy to be swayed and I don’t want them to lose their activist fire. Their job is to be somewhere between inquisitive and politely disruptive in representing the interests of patients. They came up with the #HIStalking hashtag if you want to follow their activities on Twitter.

We’re wrapping up our HIMSS guide, but only a fraction of sponsors have submitted their information (booth number, giveaways, events, etc.) Once it’s done, it’s done, so this is your last chance (until HIMSS16, anyway) to contact Jenn to get listed if your company sponsors HIStalk.

Webinars

March 31 (Tuesday) 1:00 ET. “Best Practices for Increasing Patient Collections.” Sponsored by MedData. Presenter: Jason Bird, director of client operations, MedData. Healthcare is perhaps the last major industry where the consumer does not generally have access to what they owe and how they can pay for their services. Collecting from patients is estimated to cost up to four times more than collecting from payers and patient pay responsibility is projected to climb to 50 percent of the healthcare dollar by the end of the decade. Learn how creating a consumer-focused culture, one that emphasizes patient satisfaction over collections, can streamline your revenue cycle process and directly impact your bottom line. 

Acquisitions, Funding, Business, and Stock

Health Catalyst raises $70 million in an oversubscribed Series D round, increasing its funding total to $170 million and valuing the company at over $500 million. An IPO seems inevitable.

Diabetes management app vendor Glooko raises $16.5 million in a Series B round.

A federal judge allows a proposed class action lawsuit to proceed against Epocrates for failing to disclose change in its drug company advertising contracts. The lawsuit claims that Epocrates, which was acquired by Athenahealth for $300 million in 2013, tried to boost its doctor alerting business after its IPO by implementing a “use it or lose it” policy that forced drug companies to buy new sponsored alerts in the hopes of propping up sagging revenue.

Meditech files its 2014 annual report, with full-year revenue down 11 percent and profit down 7 percent. Service revenue increased, but product revenue took a 26 percent dive. Revenue and net income slid back to 2010 levels. Neil Pappalardo owns 42.7 percent of the company, which values his stake at around $700 million.  

Sales

The US Navy selects Carestream’s PACS for its 1,000-bed USNS Mercy hospital ship.

Memorial Sloan Kettering Cancer Center (NY) selects Versus RTLS to improve patient flow at its urgent care center, extending its implementation beyond the initial two outpatient clinics.

People

  

Recondo Technology hires Alicia Hanson (MedAssets) as SVP of business development, Jamie Oakes (Adreima) as RVP of sales, and Kevin Kenny (Allscripts) as VP of strategic sales/east.

In-home medical assessment vendor CenseoHealth moves Executive Chairman Kevin McNamara to CEO and names David Brailer (Health Evolution Partners, an investor in the company) as board chair.

Geisinger Health System’s XG Health performance improvement company names Marcy Stoots, DNP, RN (EHR Transformation Associates) as general manager of EHR apps.

Indiana HIE promotes John Kansky to president and CEO, a role he has held in an interim capacity since June 2014.

Announcements and Implementations

Labor and delivery software vendor PeriGen joins the CommonWell Health Alliance.

CHIME pre-launches a National Patient ID Challenge, offering a $1 million prize for a solution that increases patient ID matching from 80 to 100 percent. It will be interesting to see how CHIME puts together a million dollars (from vendors, I’d have to guess) and who owns the winning solution.

Government and Politics

A WEDI survey finds that a third of respondents haven’t heard of Blue Button, but the survey methodology is shaky: (a) it drew only 274 responses and the method of recruiting respondents wasn’t specified, which I assume means it was an online, self-selecting survey; and (b) nearly half of the respondents were technology vendors or from “other” categories beyond government and providers, which makes you wonder why they responded at all or why their responses were used (most likely answer: because throwing those responses out would have left a ridiculously small sample). I don’t understand the point of asking non-providers how their PHRs work or whether they’re using Direct. I see other sites writing decisive articles with headlines such as “Blue Button Awareness, Personal Health Record Usage Grows” and  “Blue Button protocol for easy EHR transfers fails to gain traction,” but rest assured neither conflicting conclusion can be drawn from this skimpy and poorly collect data. Let’s hope the federal government doesn’t actually use this report for anything (or pay WEDI for producing it).

HHS’s Office of Inspector General publishes its annual “Compendium of Unimplemented Recommendations,” listing the top 25 cost and quality items OIG has recommended that HHS has ignored. The two IT-related items are to improve the Transformed Medicaid Statistical Information System and to get ONC and CMS to collaborate on addressing EHR fraud vulnerabilities.

New York’s RHIOs ask for $45 million in the state’s 2015-2016 budget.

An analysis of around 100 health insurance plans offer to New Yorkers via Healthcare.gov finds that nearly none of them offer out-of-network coverage. The report blames the unintended consequences of a 1992 state law that required insurance companies to cover anyone who wanted insurance regardless of their health but didn’t require individuals to buy insurance, sticking insurance companies with the cost of treating a high proportion of chronically ill patients.

The Senate’s Committee on Health, Education, Labor, and Pensions convened a hearing Tuesday titled “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care.” AHIMA President Angela Kennedy gave a personal account of how lack of interoperability makes it harder to care for her children. Epic Director of Interoperability Peter DeVault, pictured above, testified that the company charges $2.35 per patient per year to send data to non-Epic systems. He said Epic declined to join CommonWell because it would have cost millions of dollars and the company was asked to sign a non-disclosure agreement, which Epic took as meaning that CommonWell had something to hide (like planning to sell data, he gave as an example) and the “lack of transparency didn’t sit right with us.” Instead, Epic connects to Healtheway’s Carequality connectivity network and urges CommonWell to join it. Cerner issued a statement in response to DeVault’s comments: “Today’s rhetoric is a slap in the face to many parties working to advance interoperability. It was discouraging to hear more potshots and false statements when it’s clear there is real work to be done. We’re committed to CommonWell as a practical, market-led way to achieve meaningful interoperability.”

The House is finalizing a permanent SGR Medicare payment fix at a cost of $200 billion over 10 years, with taxpayers paying $140 billion and high-income seniors paying $60 billion in new Medicare costs.

CMS releases its physician referral data sets.

A Brookings Institution report says the Meaningful Use program should be refocused on value and outcomes rather than specific technology requirements and that ONC should take a more active role in creating interoperability standards. 

Privacy and Security

Microsoft will offer enterprise-grade biometric security (fingerprint, eye, or face) in Windows 10. What it won’t offer in Windows 10: Internet Explorer, which will finally be killed off in favor of a newly written and so far unnamed browser shown in the prototype above.

Innovation and Research

In China, a health district and technology company jointly open the country’s first cloud hospital that connects 100 healthcare organizations and 226 “cloud doctors” who see patients in virtual diagnosis rooms and send prescriptions electronically to pharmacies.

Technology

Banks that were anxious to jump on the Apple Pay electronic payment system are now complaining about fraud rates that are 60 times higher than with traditional credit cards, mostly because Apple made it so simple to sign up for credit that thieves can easily use stolen credit card numbers without being caught. Apple Pay was ironically designed to reduce fraud by making it impossible to steal credit card numbers, but banks receive minimal customer information from Apple that would help them detect fraud and have been too scared of Apple to speak up.

Botswana is delivering broadband and telemedicine services to remote areas via unassigned TV band frequencies.

Other

A study of questionable validity and applicability finds that hospitals with fewer readmissions have more user-voted stars on Facebook, with the authors concluding that social media ratings correlate with traditional hospital quality measures. The many sites that confuse correlation with causation should therefore urge all hospitals to enlist volunteers to rate them highly on Facebook to improve their readmission rates.

University of Pittsburgh, UPMC, and Carnegie Mellon University form the Pittsburgh Health Data Alliance to perform research and to commercialize products.

Venture capitalist and Uber investor Bill Gurley says he’s passed on over 100 healthcare technology business plans because healthcare is driven by regulation and subsidies rather than market forces. “It’s asinine,” he says, adding that the government used HITECH money to interfere with the market’s low demand for EHRs.

A study finds that medical residents are underpaid (average salary: $47,000 per year) because they are willing to work for less for a prestigious hospital that has limited openings. Here’s a fun fact I didn’t know that’s timely given that Friday is national medical residency match day: the two men who developed algorithm that matches graduating medical students with residency programs based on their mutual interest won a Nobel Prize in economics for their program, which is also used to match kidney donors and to assign students to public schools. Doctors are also aware that the program underwent a complex modification in the 1990s to try to match married medical students to residency sites that would accept them together.

Coca Cola admits that it paid dietitians and bloggers to write posts recommending Coke as a healthy snack.

Bizarre: a New Jersey doctor charged with selling oxycodone prescriptions for up to $3,000 attempts to hire someone to burn down his office (and the incriminating records in it) in return for an oxycodone prescription.

Weird News Andy critiques a study finding that loneliness shortens life as much as obesity or smoking, with WNA analytically pondering, “What about lonely, drunk, fat smokers?” However, he then retracts his call for further research after reading a scientific study that concludes that we have too many scientific studies.

Sponsor Updates

• The Indiana Hospital Association endorses Besler Consulting’s Transfer DRG Recovery Service for its members.
• HealthMEDX CEO Pam Pure will present at this week’s NextGen Health Care Symposium on “Advancing Transitional Care”  in Indianapolis, IN. I couldn’t help but notice as I scrolled down the list of speakers that only three of the 26 are female, so bravo to Pam for being one of them.
• Caradigm Provisioning earns certification for use with FairWarning’s Ready for Identity Management program.
• A Forward Health Group video describes its work with Northwestern Medical Center.
• PerfectServe posts “Real-time healthcare: Preventing the need for immediacy from eroding quality.” 
• Zynx Health joins the NPSF Patient Safety Coalition.
• ZeOmega posts “The Five Pillars of Population Health Management: Data Aggregation and Integration.”
• The Chartis Group publishes “Local, Regional, and Beyond: Clarifying the Role of Academic Medical Centers.“
• Divurgent and Sensato will host “Hacking Healthcare 2015” March 24-26 in Long Branch, NJ.
• Culbert Healthcare Solutions will exhibit at AMGA 2015 Annual Conference March 24-26 in Las Vegas.
• CommVault posts a blog about “Learning from Emailgate” and the challenges of information management.
• CareSync CEO Travis Bond is interviewed in the Health Data Consortium’s latest blog.
• Anthelio Healthcare Solutions CEO Asif Ahmad will be featured on Fox Business Network March 22 at 11:30 a.m. ET.
• Bottomline Technologies will exhibit at Microsoft Convergence 2015 through March 19 in Atlanta.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 3/17/15

American Telemedicine Association receives 200 applications for accreditation program

The American Telemedicine Association has received 200 applications for its Accreditation for Online Patient Consultations certification, which certifies that an organization is delivering telehealth services to the ATA’s standard.

Workgroup for Electronic Data Interchange Blue Button Initiative Survey Results

A WEDI survey finds that awareness of the Blue Button PHR interoperability initiative among industry stakeholders has decreased overall since 2013, while provider awareness remained flat, and significant increases were measured among government respondents.

Standard for improving emergency information interoperability: the HL7 data elements for emergency department systems

HL7 has completed its review of the updates that the Data Elements for Emergency Departments System (DEERS) with get with HL7 v3. DEERS is a standards-based specification for ED-related HL7 data exchange.

Readers Write: For Cybersecurity, Prevention First, But Don’t Forget About the Treatment

For Cybersecurity, Prevention First, But Don’t Forget About the Treatment
By Terry Edwards

Cyber-attacks are nothing new. We’ve all seen the attacks on major retailers, entertainment giants, and financial institutions. Healthcare is gaining attention as the next industry under attack since cyber-criminals are finding unprecedented value in patient health records.

A patient record can sell for $50 to $150 per record on the black market, more than a credit card number or a Social Security number. This gives buyers the  ability to impersonate patients using all the personal information included in a health record to commit identity fraud or even obtain prescription drugs. In 2014, a record number of healthcare providers were hacked and a number of high-profile healthcare breaches have already made headlines in 2015.

The healthcare industry is taking these attacks seriously and working hard to protect itself against potential threats. However, it’s becoming more difficult for healthcare providers to ensure the continued integrity of patient data. Not only are hackers growing more advanced and nimble, but the number of vulnerabilities in the system is only increasing as the industry moves to population health management.

Care delivery is not quite as contained as it used to be. Patients can be treated in a variety of settings as their care teams grow in size. In addition, more types of devices are collecting and sharing patient data, offering more entry points for cyber-criminals to infiltrate. Healthcare organizations are also dealing with tight IT budgets, which in some cases only cover what’s necessary for regulatory requirements.

While it’s critical for healthcare organizations ramping up IT defenses to protect the data of their patients, to avoid a breach, organizations need to get back to the basics by focusing on the following:

1. Develop an internal security committee to conduct a formal risk assessment and identify any areas at risk for a data breach. The committee needs to have the backing of the highest levels of the organization to demonstrate the commitment to protecting patient data.
2. Following the risk assessment, the committee should develop an organization-specific risk management strategy to include processes, procedures, tools, and technologies.
3. Educate the staff on the new processes and procedures. Implementing new procedures can be the biggest challenge for organizations. It’s not enough to deliver one training session and assume employees are following protocols. Instead, organizations must provide employees with frequent reminders to flag suspicious emails, keep their passwords protected, and encrypt any communication with protected health information.
4. Reassess risk ongoing to make sure employees are following the appropriate processes and procedures and to identify any new vulnerabilities within the system. Cyber-criminals are constantly using new methods to find weaknesses in the system, so healthcare organizations must stay on their toes to keep technology up to date.

Even with the strongest security protocols in place, sometimes a cyber-criminal can find a way through. The experience of other industries shows that while customers are generally understanding when a breach occurs, they need assurance that the organization recognizes the breach and is taking steps to avoid another one. One of the biggest threats of a data breach for healthcare organizations is the potential hit to patient trust, the cornerstone of the patient-physician relationship. Healthcare organizations need to maintain that trust to deliver effective care.

To protect patient trust and the reputation of the organization following a breach, providers must put a treatment plan in place:

1. Communicate early and often. Immediately following a breach, a healthcare organization must alert patients with details on what data may have been jeopardized, what actions they need to take (such as changing a password), and how the organization is working to protect the security of patient information. By giving patients as much information as possible, the healthcare organization can convey it is treating the issue seriously and is taking all necessary precautions to ensure another breach does not occur.
2. Offer services to monitor and alert patients. By offering tools to monitor their credit and identity theft, healthcare organizations can show they’re concerned about minimizing any risk to patients. In addition to credit reporting, healthcare organizations should reach out to patients whose data was compromised to ensure patients are regularly reviewing their explanation of benefits for any fraudulent activity. Organizations can consider email guides, webinars, and in-person meetings to help patients understand how to review their accounts regularly and what to look for.
3. Educate staff on how to handle patient inquiries. Some patients will have questions about the breach and may ask employees like receptionists or nurses who are not used to fielding those types of inquiries. Give employees guidance on how they should respond to upset or concerned patients so that they can get the correct information through appropriate channels.

It does not look like cyber-criminals will stop their attacks on healthcare organizations anytime soon, but with the right protocols and procedures in place, healthcare organizations can put their best defense forward and be prepared to respond in case of a breach.

Terry Edwards is CEO of PerfectServe.