Morning Headlines 10/16/13

Cerner Joins Wolters Kluwer, Hit 52-Week High

Cerner stock hits a 52-week high at $55.98 per share following an announcement that it will partner with Wolters Kluwer Health in a joint venture to develop a new physician documentation solution that will embed Wolters Kluwer’s clinical decision support tools.

Patient Engagement: How To Do It Right

InformationWeek profiles both the Cleveland Clinic and the Mayo Clinic and the work they are doing to draw patients into their patient portals.

IBM’s Watson wants to fix America’s doctor shortage

IBM’s Watson supercomputer will be implemented at Cleveland Clinic in an effort to create a digital assistant capable of scanning a patients record and pointing doctors to crucial data and likely diagnoses. The tool is still a prototype and will initially not be consulted until after a doctor has made a diagnosis. Neil Mehta, MD, the Cleveland Clinic project lead says "I’ve had a couple of patients where Watson found things that I had missed. It doesn’t work every time, but it’s getting better."

CareCloud CEO: We may go public next year

Ambulatory EHR vendor CareCloud hints at a 2014 IPO.

Novant Health honored for implementation of Epic

North Carolina-based Novant Health receives HIMSS Stage 7 designation after installing Epic across its 350 ambulatory offices this August.

News 10/16/13

Top News

Cerner shares hit a 52-week high Tuesday following announcement of a partnership with Wolters Kluwer Health to develop a physician documentation system using Provation Clinic Note content with Cerner Millennium. CERN shares are up 52 percent in the past year, with the company’s market cap now at $19 billion. 

Reader Comments

From Veteran: “Re: insurance marketplace. I take it all back. This really is a disaster. A New York Times article this weekend chronicled a whole series of issues going back months, not the least of which was HHS’s decision to project manage this themselves when they (and everyone else) knew they had neither the expertise nor the experience. Hope this doesn’t set health reform back years.” Veteran (and a few others) were critical of my comment that the opening day of the insurance marketplace was a “failure” because I was unable to access the system. According to the Times, insiders were aware of the system flaws long before the launch, but because of political concerns, continued with the original timeline. By one estimate the project is now about 70 percent of the way toward operating properly, but the time frame for completion could be anywhere from two weeks to a couple of months. Apparently I am just one of a few thousand people who have opted to wait a few weeks before making additional attempts to enroll.

From CA/DC Fellow: “Re: failed health insurance exchange site. Will US CTO Todd Park take the fall?” Healthcare.gov is a high-profile political embarrassment. In politics and government, someone has to be lynched publicly to appease the press. Todd was sent out to try unsuccessfully to talk around the situation, which I think puts him at risk. Sebelius would toss him overboard in a second to save her image. Nobody ever blames the contractors since it was someone’s job to manage them.

HIStalk Announcements and Requests

Listening: Nada Surf, a nearly perfectly listenable alternative rock band that’s been around for 20 years. I’m playing them constantly.

Acquisitions, Funding, Business, and Stock

A report predicts that HIT funding will double over last year thanks to the implementation of the ACA and HITECH. Venture capitalists invested $737 million in 51 deals during the third quarter, compared to $623 million in 168 deals a year ago.

CareCloud CEO Albert Santalo tells the Boston Business Journal that his company may launch an IPO next year.

A business publication says transcription vendor MModal, saddled with heavy debt and slow sales, may need to seek restructuring if its current turnaround efforts fail.

Sales

Australia’s NSW Heath will implement iMDsoft’s MetaVision throughout the state’s adult, pediatric, and neonatal ICU beds.

Adventist Health System selects the Explorys suite of analytic and population health management solutions.

TeamHealth (TN) chooses Shareable Ink’s Anesthesia Cloud and ShareMU solutions for selected sites nationally.

Virginia Hospital Center Physician Group selects eClinicalWorks EHR for its 100 employed physicians.

People

Henry Schein appoints Steve Klis (CareFusion) president of global practice solutions.

CareCloud names R. Scott Lentz (Aprima Medical, Picis) CFO.

AtHoc names John Tempesco (Informatics Corporation of America) as senior director of healthcare operations and marketing.

Vocera Communications hires Paul Johnson (Intuit) as EVP of sales and services.

Announcements and Implementations

Heritage Valley Health System (PA) activates Allscripts Sunrise for its Beaver and Sewickley campuses.

Medfusion rebrands its recently reacquired Inuit Health patient portal technology back to its original name and adds Vern Davenport (formerly of MModal) and Buck Goldstein (UNC Chapel Hill) to its board.

For-profit surgical hospital operator Victory Healthcare (TX) implements Omnicell’s G4 Unity medication management system.

Optum and Dignity Health introduce Optum360, a new company that will address the back office functions of healthcare systems.

Unified emergency notification systems Vendor AtHoc announces the launch of its healthcare vertical with the launch of AtHoc Home Care Alerts, which offer home care service organizations with mobile duress and emergency alerting, field reporting, and personnel tracking.

Jordan Shlain, MD and Todd Johnson of automated patient follow-up solution vendor HealthLoop will present at the UHC Conference Innovation State on Friday.

Lewistown Hospital (PA) implements Summit Downtime Reporting System for business continuity.

Lucca Consulting Group and ICD-10 Coach announce a partnership to help small hospitals and practices implement ICD-10.  

Government and Politics

The VA names Health eTime the winner of its medical appointment scheduling competition and a $1.8 million prize. The open source app allows veterans to schedule visits across VA locations and gives VA providers the ability to share appointments with the personal digital calendars of veterans.

A Pittsburgh Tribune-Review investigation finds that the VA is one of the largest violators of health privacy laws. From 2010 to May 31, 2013, VA workers or contractors committed 14,215 privacy violations at 167 facilities that victimized at least 101,018 veterans and 551 VA employees. Violations included postings of anatomy on social media sites and identities stolen to create fraudulent credit cards.

Innovation and Research

CEOs of hospitals with high levels of advanced technologic capabilities earn an average of $135,862 more than hospitals with low levels of technology, according to a study published in JAMA Internal Medicine. Hospitals with high performance on patient satisfaction also compensated their CEOs more, but no association was found between CEO pay and processes of care, patient outcomes, or community benefit. Based on the findings, researchers suggest that hospital boards place more emphasis on quality when setting compensation.

Two graduate students in Israel develop a computerized system for diagnosing Parkinson’s disease consistently. The patient performs specific movements in front of a 3-D depth camera, whose data is the analyzed by computer to determine a diagnosis with 94 percent accuracy.

Other

Encore earns top scores in a KLAS report on go-live support vendors. Santa Rosa Consulting was recognized for having the most engagements overall, followed by Encore and ESD.

The Carolina eHealth Alliance (SC) reports that the four hospital systems participating in its electronic exchange network saved more than $1 million over a 12-month period by reducing unnecessary admissions and redundant procedures.

Clinithink posts an animated video depicting the role of clinical NLP in transforming healthcare.

An article in Medical Marketing & Media says that mobile devices are yesterday’s news for marketing drugs to physicians, concluding that “EHRs will become the dominant context for physicians” in promoting drugs at the time of e-prescribing. However, it warns that overly aggressive drug promotion could lead to regulation. A drug company spokesperson predicts  consolidation of the EHR industry, saying “a relative few will own the space and will own the access” for drug companies to promote their products as part of physician workflow. Drug companies are doing away with traditional field reps for product promotion.

The local newspaper writes up Novant Health (NC), which earned HIMSS Stage 7 EMRAM last week for its $600 million Epic implementation, which Novant says it finished three years ahead of schedule and under budget.

Sponsor Updates

• Caradigm will add predictive clinical analytics capabilities from MEDai to its Care Management platform.
• Sunquest announces a new partnership with the Boys & Girls Clubs of Tucson.
• Cynthia Davis, RN, FACHE of CIC Advisory will speak Thursday at the 2013 Annual Healthcare IT Symposium in Las Vegas sponsored by the Shriners Hospital for Children. Her topic will be “Paddling Upstream: From Data Collection to Better Patient Care.”
• Epic will allow direct use of the QlikView Business Directory platform within Hyperspace and will support content sharing between joint Epic and QlikView customers.
• NTT DATA’s Optimum Suite achieves 2014 Edition Complete EHR Inpatient certification.
• The SSI Group announces that both its clearinghouse services and RCM solutions are ICD-10 ready and that it is currently testing with provider and payer communities.
• An Imprivata survey finds that the adoption of server-hosted virtual desktops in the EMEA healthcare industry could increase 74 percent within 24 months.
• Trinity Health (MI) shares how it generated $3.1 million in profits and an eight to one ROI in five years using Medseek Predict for marketing campaigns.
• VitalWare partners with DCBA to create CDiDocuMint, a clinical documentation improvement tool that uses a query and tracking methodology.
• The Washington Business Journal recognizes Clinovations as the 10th fastest-growing company in the district.
• Utah Business Magazine honors Health Catalyst Chairman David Burton, MD for his lifetime achievement as a healthcare hero.
• Weill Cornell Medical College CIO Curtis L. Cole shares how he helped Intelligent Medical Objects develop its flagship product.
• UltraLinq Healthcare Solutions partners with Mobisante to integrate UltraLinq’s image management platform with MobiUS point-of-care imaging devices, enabling providers to deliver remote diagnosis and second opinions.
• LDM Group’s pharma messaging technology is featured in an article on engaging physicians through EHR messaging.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

HIStalk Interviews Bird Blitch, CEO, Patientco

Bird Blitch is CEO of Patientco of Atlanta, GA.

Tell me about yourself and the company.

My background is in the payment space. I started a company that had a lot of focus on that. From a healthcare perspective, it was the situation where my wife delivered our first baby girl. You get home from the hospital and everything’s great until a couple of weeks later and all sorts of crazy bills start showing up. I turned to my wife and just felt like there’s got to be a better way. That was how we got started down the road at Patientco.

It also helped out that we were in Atlanta, the headquarters of healthcare IT and payments. Eighty percent of all the payments in the world are routed through Atlanta with all the big companies that do that – TSYS, Global Payments, Elavon, WorldPay, and so forth. Then of course with healthcare IT, there’s a lot of great companies in the state of Georgia. It was a really good place for us to get a lot of wind behind our sails and push off on Patientco.

The last touch patients get from a hospital is the bill. Are you getting calls from people who are realizing that the nature of sending out a bill can spoil the relationship that the clinical side has so carefully developed?

Yes. I’ve really been interested in how you’ve been following that subject. That engagement or patient engagement is a big industry buzzword. We feel strongly that we’re leaving out a real vital part of that conversation, which is the financial portion of the patient engagement, which does happen when that patient leaves the hospital.

I think the real-world example is you have a great stay at a fantastic hotel. You have great food, great amenities. You check out. The bill is lots of different bills. It’s the wrong bill. You can’t understand it. It’s hard to ask questions. They haven’t even thought about how you’ll pay for it. If you left that hotel, you probably wouldn’t feel too comfortable about returning and telling people to go there. We feel like patient satisfaction is a big key in this whole part.

Do you think there’s a lot of interest from patients and providers for managing medical bills online?

I really do. When you think about it, there’s a huge problem out there right now. The fastest-growing payer is the patient. If you’re a provider, you’ve got to wake up to the fact that times are changing real fast and there needs to be a different way to manage this whole billing process. We have a cloud-based technology platform to bill patients and the key is in the consumer-friendly way. Patients have a way to uniquely pay providers in a consumer-friendly way. 

I would certainly argue that patients have a big say in this, too. I think I saw recently that is that patient is five times more likely to refer a friend to the hospital if their billing experience is a pleasant one. That relates to the total value of a patient to the hospital.

You tweeted an article recently about the Consumer Reports gripe-o-meter of healthcare complaints. One of the top problems was the patient’s dissatisfaction with the billing process. I think it’s really important. People talk about Meaningful Use, people talk about ICD-10, but there’s a big focus coming back to the revenue cycle. Our key focus is to put the spotlight on the patient. We like to talk about that in terms of patient revenue cycle.

In terms of selective marketing, it would seem that the patient revenue cycle is doubly important because if the patient is the one who has to write that check, then they are more financially desirable patients.

That’s right. Customer loyalty is really important to think about in a consumer space. That’s what we’re dealing with.

Patients are consumers. If you’re a Hilton Honors program member, they treat you differently when you check in if you’re a really good customer. I think it’s important to treat good patients in a really special way that we don’t today. We just send them a bill and hope that they pay. We do that for all patients across the entire spectrum. Why can’t patients be treated differently, especially in ways that would help them understand more and help them pay faster? That’s a real big benefit that we think we can bring to the marketplace.

The other side of that is hospitals really only have one way to deal with this problem today. A lot of times, they might outsource it to an EBO or an agency. That’s great, but sometimes they spend a lot of money to do that and they don’t get great results. It’s one of those things where patients don’t like it. I’d argue in the long term it’s not good for providers either. We just try to get people to think differently about that. 

That also goes to how you pay your vendors — pay your vendors differently. One tactic there is just to stop paying billers for percentage of what the patient pays. It’s your money to start with, so whatever the contingency you pay the agency, it’s probably too much, period.

Patients have always thought of themselves as consumers, but I’m not sure that hospitals have seen themselves as businesses that have competition and that need to cultivate them as customers. Do you think hospitals are going to be able to change their mindset to be directly accountable to the patient?

One of our goals is if you treat people right, they’ll treat you right. That’s how we run Patientco, that’s how we want healthcare to be. People treat patients right on the clinical side. You’ve got to change and think differently.

Our biggest competition is often the status quo and providers who aren’t daring enough to make a change for the better. Times are changing in healthcare. It’s important we educate people about the fiduciary responsibility they have and they can play in making this equation healthy again with patients. The tough thing is, how do you treat patients differently? We try to share to our business intelligence engine ways that patients respond differently across the IDN. If a patient’s done one thing to pay a bill differently, then we think we can share that experience.

Let’s say on a cardiology bill, we send out two e-bills with a ten per cent discount and another bill with a healthy heart recipe on it. If that makes you want to pay faster, then don’t you think that something that the hospital that owns that cardiology group would want to know?

You offer patients a secure messaging feature to interact about their bills or to clarify. Do patients use that a lot?

Yes, they do. It’s interesting because it’s hard to ask questions about your health, especially in a public place. When people are on the Internet, perhaps at work, you’d be surprised at the payments we see coming through from people around lunch hours. When they’re on lunch break working at their desk, they don’t feel comfortable about asking someone about their endocrinology bill. But through Patientco, there is that secure messaging that allows people to access questions and get answers quicker, so they feel more comfortable on what they’re being asked to pay for.

How do physicians fit in the mix?

Physicians bill patients also. If you think about the problems in healthcare, you’re going to go to a hospital. You’re going to get a hospital bill and four or five or six different physician bills. A lot of times those bills come out of different practice management system than the bills that come out of the HIS system. 

It’s important because physicians have really strong personal relationships with the patients. Patients often want to pay those physicians first before they do the hospitals. The unique thing is if you group all these bills together in one place, then a rising tide really does lifts all boats and people pay faster. The other side of that is physicians’ bills are often just as complicated and the goal here is simplicity for everyone.

Are patients are more likely to pay like a solo physician in practice instead of a faceless entity such as a large group practice or hospital to which they don’t have much allegiance?

Yes. We see that case a lot. From the hospital’s perspective, if they can be grouped together with the physicians’ bills then, there’s a 36 per cent chance that when you pay a physician bill and  the hospital bill is there for you to see through Patienco, you’ll pay that bill as well, just from a simplicity’s sake. Think about it. Why are all the different car dealers on the same side of the town? They are because it’s easier for people to make decisions around buying a car. It’s the same thing here. Where you have simplicity and everything in one place, it’s better for the patient.

What would people be surprised to learn about how patients pay bills or how they interact with people doing billing on their behalf?

We focus just as much on the providers as the patients. I’ll throw that out just to say that we look at it from both sides. 

I just talked to one of our CFOs in one of our hospitals in Iowa. He said that one out of every three members of that community pays their medical bill through automation with Patienco and he just thinks that it’s interesting when it’s all together. When you have the ability for patients to pay 24/7 in a variety of different ways and you make it easier for them to not just understand but schedule payments and whether it’s paper or electronic and you make that dynamic, then you’re going to have a lot of different types of results. We measure those results and report on all those to our providers.

What’s the status of healthcare IT and startups in Georgia?

This is a great place to start a company. There’s a lot of resources around here and of course there’s a lot of healthcare IT. You’ve got McKesson Technologies that is headquartered here. You’ve got Greenway. You’ve got athenahealth that is moving a lot of their resources down from Boston. They’ve all chosen to be here because there’s a strong employee base here of people who are knowledgeable. 

Also, it’s more affordable to live in Atlanta. It’s got a lot of the big city amenities. You see companies even like Streamline Health that moved down from Cincinnati. They all come here because you can hire great people and it’s a good city to be living in.

Any final thoughts?

We think that there’s a lot of needed change in the industry, so we want to go toe-to-toe with the incumbents. Change is good. I think if we can make patients happy and providers happy, those are the two entities that usually when one wins the other loses in today’s environment of revenue cycle. Now we have a great challenge and opportunity in front of us that we can make them winners, and what’s good for the patient is also good for the provider. 

Outside of that, it’s just all about easing healthcare’s transition towards a real patient-focused, consumer-focused transition to understanding healthcare and adding vendors that really towards having good responsibility towards the providers.

Morning Headlines 10/15/13

Mostashari shares concerns, ‘insider clues’ in first speech since leaving ONC

In a keynote speech at the CHIME Fall CIO Forum, ex-ONC leader Farzad Mostashari, MD spoke candidly about ONC policy. He reports that the Stage 2 timeline will likely stay on track as planned. He also discussed usability, saying, "“I do worry about usability. Not that it isn’t getting better…but I wonder if the market is incentivizing usability as much as it should."

National eHealth Strategy Review to be Considered This Year

In Australia, Deloitte has been contracted to run a mid-point review of Australia’s national 10-year eHealth implementation, which kicked off in 2008 and which Deloitte is also running. According to Linda Powell, first assistant secretary for eHealth policy, the review will focus on clinical adoption to ensure the systems in place are resulting in "meaningful use."

Petersburg Gets New Hospital Computer System

Petersburg, AK-based Petersburg Medical Center goes live with its $1.4 million CPSI EHR.

Advisory Panel: Three Hospital Improvement Actions

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What three actions would most improve your hospital overall and how could IT contribute to those changes?

Better understand our variances in high cost procedures. Analytics can help in finding variances and understanding why they happen and then we can work on fixing those problems. Manage high-risk patients better. IT can be used to identify (predictive modeling) and track (registry) these patients, but people will make the difference in helping them. Understand our patients better. IT could be used for better surveying of patients both in real time and retrospectively

Hospitals need to start by realizing that their days of glory are gone and that healthcare is no longer hospital centric and need to regroup. Need to start applying "lean" principles and look for ways to cut cost but not compromise care, which is indeed a balancing act. Invite and involve all the stakeholders in and have a mission statement. Admit that "all healthcare is local" and that certain rules apply in certain markets but are not valid in others where the consolidation is not so pervasive.  Realize once and for all the role of clinicians whose decisions and behavior we are trying to influence and change and  groom real leaders who are in it for the good of the community and not merely to embellish their resumes. Improve communication all the way from the CIO and C-suite to the practicing MD and nurse who are " where the rubber meets the road". It has been my experience that the larger the organization, the more broken the communication and the more bureaucratic the process. IT can do exactly that — improve communication and transitions of care.

Enhance value (improving quality and reducing cost) – IT focused on data analytics to produce actionable descriptions of current conditions and to support experiments planned to move us toward our targets. Wow our patients and families (great service experiences) – right now we’re focused on providing patient portal access. Innovation and partnerships (new models of caring) – deploying and operationalizing health info exchange.

There are three major factors that will determine the viability of hospitals over the next five years that IT has the capability to improve. First and foremost, we absolutely have to reduce the cost of care. Clearly, one of the main ways to accomplish this is through better coordination among providers as well as better clinical decision support mechanisms to reduce unnecessary tests. This is more than just duplicate checking — it is now quickly moving to personalized medicine using the more rapidly available genomic and proteomic information available for patients. Secondly, we must provide better interoperability and analytics for population health between multiple disparate providers of care. We are moving to a model of care where the primary care physician becomes the gatekeeper and we have to be able to communicate in real time the status of every patient and their disease states. This high level of coordination will only be possible with a significant IT support model. Thirdly, we have to optimize our ability to capture charges with payers who still pay in that manner. The list of those payers will continue to shrink, but we need to take advantage while we can. That also includes the ability to capture activity, especially on those newly insured patients that will be creates as a result of the Accountable Care Act.

A few more hours in a day, and a week would be great! Improved collaboration around significant challenges is adversely affected by a lack of time and ability to focus on priorities. Effective use of video technologies might help, but folks are so busy it’s hard to know what can help. Creating a culture of appreciation and not just recognition. Hard to do – perhaps better use of social networking tools? Better financial performance….. if we could drive value from all of our technology investments and truly ensure that we are using 100 percent of everything we deploy and get value from all of it.

Patient safety: better clinical decision support. Patient care: better order sets and workflows. Patient engagement: in-house use of Epic Bedside.

If you are looking for the most bang for your buck in changing the hospital, it would start with the most important determinants of hospital outcome (RNs) and patient satisfaction (CNAs). It is clear to me  but hard to prove that a well-trained RN staff improves outcomes, but a good outcome, at least in the sense of following guidelines and providing consistent, checklist driven care, is now the expectation. Patient satisfaction is proportional to the number and the friendliness of the staff that deals with the personal needs of patients (toiletting, call lights). IT can help with efficient one-click charting, and clinical decision support for the RNs. We should spend a lot of our optimization time on the RN workflow. On the CNA side, a Vocera type solution that allows direct communication to a CNA as well as combining a group into a lift team will speed up response. Oh, and relax the "no personal calls" rule on your devices. These folks, typically ladies, will check on their kids. Let ’em do it quickly, openly, without apology, and back to work.

The government dropping ICD-10 and waiting for ICD-11. The costs of systems, implementations, and training, especially for physicians, is clearly not worth the benefit to a handful of researchers and will do absolutely nothing to directly improve patient care. To complain about the cost of healthcare while spending money that doesn’t directly improve care is ludicrous. The government slowing down the pace of MU and only focusing on those aspects that directly improve patient care. (Seeing a trend here?) The government stopping changes that only impact billing. Let’s put our focus and money to better use improving patient care, not worrying about how to pay less for it or spending more time on record keeping.

A  major issue with us is lack of resources across many of the departments. The Catch-22 is that IT could help by automating some of the workflows, but we do not have the money or the human capital to assist given our EHR implementation. IT is working to generate as many initiatives as possible that would allow team members to better document what we actually did to the patient through documentation and capture applicable charges. The thought here is that we could achieve better reimbursement through increased documentation of what we actually did for the patient. “You can’t manage what you can’t measure”….we are pushing out analytics and other business intelligence deliverables to leaders such that they can have information in a more timely and readable fashion. These deliverables are done real time on a proactive basis and provided at least weekly. In their office, leaders can look at throughput, length of stay, payer mix, etc. without having to call down to have one of my team members run a report and then interoffice or email the output.

Create processes for improved communication between departments – streamline tech services; increased qualified staff – mentoring programs on line; identify marketing opportunities to show case hospital success – social media support.

Reduction of regulatory burdens which consume lets and lots of resources including IT to "remediate" and impedes innovation. Support the digitization of all business processes to align with MU and transition to EMR, etc. Drive true patient engagement very openly and aggressively. IT would benefit from these changes and could work to facilitate patient engagement.

Improved integration of IT and Informatics into Strategic Planning and Business Development. Improved adherence to strategic planning (we spend too much time chasing shiny objects that don’t contribute to strategic gains). Improved measurement and learning from strategic actions taken (i.e., measuring how well we actually did).

Robust report writing capabilities with a clear roadmap of standardized reports across the organization. We have lots of data, but much is not useful. Also have people running reports from various systems that don’t match—lots of confusion! Standardized processes for onboarding employed physicians.  We have chaos that includes HR, Finance, Physician Enterprise, Property Management, Credentialing, and IT, due to a non standardized approach. Better integration between hospital operations and ambulatory operations. With the rapid growth of the ambulatory world over the last few years, these two entities have been separately managed and poorly integrated. IT can and should be a strategic partner for the planning and execution of all three of these actions, providing technology solutions and  facilitating standardization.

A shift of focus back on to patient care and not reimbursements/cost only. In our situation, we are a single-entity, regional non-profit. We have many hospital-owned clinics, of course. The past few years with all the cuts to reimbursements the organization has moved on all types of budget and process improvements. I’m all for process improvements, but the other side of budget cuts if not done well can be damaging. The organization’s competitive advantage was always patient care. The patient came to us because they didn’t want to travel to a larger city and a larger care environment. Now that we’ve eliminated whole scores of patient transport people, floor secretaries, and even furloughed some nursing staff, that advantage is gone. We run positive margins is the crazy part. I fear in time those margins will shrink and it’s not going to be because of costs. It’s going to be because we lost our best patients to other competitors. Even if your payer mix is only 10-12 percent insurance, those are the people getting the cancer/spine/heart treatments that keep a unit/hospital in the black. How can IT help that? That’s hard as that is a human element. We can support the frontline with streamlined systems but IT can’t be there caring for the patient. IT is a force multiplier on many things but not patient-focused staffing. Those patient transport staff who used to move patients out of the ER but now there is backlog getting patients to the floor from the ER.  I suppose IT could find a robotic system from and industrial plant and put that to use to automatically transport a patient to their waiting room! That will really help with patient satisfaction scores!

Curbside Consult with Dr. Jayne 10/14/13

I was hanging out this week with my nephew, who introduced me to Mega Shark vs. Giant Octopus, which if you haven’t seen it, explains what happened to Lorenzo Lamas and Deborah Gibson after they left the limelight. There are so many “attack of” movies but this one is truly larger than life. If you don’t believe it, you’re welcome to check out the trailer featured at the link above.

Having to confront things enormous and/or ridiculous reminds me of the daily grind of office practice. There are so many things to worry about from regulatory hurdles and payer nitpicking to patient satisfaction, patient engagement, and quality care. Many of them are important but some are just tiresome. It feels like there is always some shark waiting to eat you or an octopus intent on squeezing the joy out of patient care. I shouldn’t have been surprised then when I started reading a journal article and Top 20 Reasearch Studies of 2012 for Primary Care Physicians turned into “Attack of the Killer Guidelines.”

This is the second year that American Family Physician has worked to summarize the top research studies in primary care. Having been a practicing family doc in a small practice, I know how hard it is to keep up with the literature, and articles like this are very helpful. I don’t have time to read through the 100+ clinical research journals that the authors did in order to find the top 20 studies with the potential to change primary care practice. Having them summarized in a way that makes sense to the clinician in the trenches is key. As primary care docs, we don’t have time for esoteric studies or case reports featuring zebras and unicorns. We need help solving the bread and butter problems we see every day in the office, and help solving them in the most effective and efficient way possible.

Some of the points featured this year are serious game-changers when you’re looking at delivering cost-effective care that makes sense. To some degree, though, they go against the conventional wisdom and if physicians start following them, they’re going to get “dinged” on quality reports and payer metrics. Let’s look at a couple of them:

Diabetes. Does home monitoring of blood sugars lead to better management of Type 2 diabetes in patients who are not treated with insulin? The short answer is no. Hemoglobin A1C levels (which are used to monitor average blood glucose) only came down 0.25 percent after six to 12 months of home testing. The reduction was not clinically significant, but the discomfort and cost that patients bear is certainly significant. How many obese patients are going to develop diabetes in the US? Lots of them. How many are checking their blood sugars for years with little change in their overall diabetes control? Plenty. The authors conclude that home monitoring should be reserved for patients on insulin.

What? What about those commercials with Wilford Brimley hawking diabetic testing supplies “at little or no cost to you?” What about the fact that Medicare pays for it? I’ve had patients argue with me about this before, stating that if Medicare pays for it they should be entitled to it simply because they’ve paid into Medicare, clinical appropriateness be damned.

Again with Diabetes. Do older patients who have functional or cognitive impairment and tightly controlled diabetes do better than those with less tightly controlled diabetes? Surprise, those with tighter control actually had a greater risk of functional decline than those with less tight control of their blood sugars.

It sounds like heresy, but maybe we don’t need to be driving all these blood sugars down as low as we thought we should in the past. And we certainly don’t need to be overly lowering the blood sugars of the octogenarian up the street who is starting to show signs of dementia. Relaxing his blood sugar control (and his wife’s also, for that matter) could reduce their medication bill by $150/month and might prevent secondary complications due to low blood sugar. Unfortunately their primary care physician still has them on multiple medications and has them checking their blood sugars several times each day.

Back to the category of things Medicare pays for, so it must be the right thing to do. Bone Density screening. Review of evidence indicates that women with normal or mildly low bone density can wait up to 15 years before a second screening and those with moderate loss of bone density can wait five years. So why does Medicare cover this every 24 months? I’ve been on the other end of this argument, with a patient who accused me of being in favor of “death panels” simply because I told her the test wasn’t indicated after two years because her bone density was normal and she had few risk factors.

I’m tired of CMS pointing the finger at providers accusing us of fraud and abuse all the time. They come after us for upcoding, but have you ever seen a giant refund to a provider due to the vast downcoding that many perform out of fear? They routinely deny payment for services when physicians fail to understand the arcane minutia of local billing rules, yet are perfectly happy to pay for annual mammograms in 90-year-old patients when the government’s own US Preventive Services Task Force recommends screening every two years for patients stopping at age 75 because “among women 75 years or older, evidence of benefits of mammography is lacking.”

I’d love to see CMS stop paying for services that go against the government’s own evidence-based guidelines. Although some may see this as a slap in the face of patient empowerment, it would be a great help to those of us who spend a lot of time trying to convince patients that just because services are covered by their insurance plan doesn’t mean they’re a good idea. Like personalized medicine, if patients want services that aren’t evidence based, they’re welcome to pay out of pocket. In the realm of non-CMS payers, I’m still dealing with insurance companies that refuse to cover all vaccines, so maybe we could shake enough money loose to prevent some cervical cancer with wider use of the HPV vaccine.

I’m tired and cranky after a gruesome shift in the ER and don’t feel like doing the math, but I bet cutting out unnecessary mammograms, premature PSA testing, aggressive diabetes treatment in the elderly, and a handful of other things would help the Medicare trust fund go a little farther. I’d like to see dollars go into research, subsidized continuing education for health care providers, and preventive medicine rather than paying for services that may be popular but don’t lead to better outcomes.

The burning question however is this: how rapidly can guidelines and protocols adjust to these changes? Similarly, how do we convince front-line physicians that they need to behave contrary to how they have been for decades? What do you think about a truly evidence based coverage revolution? Email me.

E-mail Dr. Jayne.

Morning Headlines 10/14/13

Cirdan Ultra Acquires US GE Healthcare Subsidiary

GE’s Centricity Lab product is acquired by Lisburn, UK-based Cirdan Ultra. Cirdan will take over all assets and responsibility for service and support for current GE lab customers.

Which Chicago corporate boards deliver for shareholders?

The board of Merge Healthcare is named least-competent Chicago-area board of directors by Crain’s Chicago Business.

Boston Children’s Hospital Innovation Chief Talks Hurdles

Boston Children’s Hospital CIO Naomi Fried is profiled in an InformationWeek interview. She discusses a number of in-house integration projects she oversaw to help her clinicians optimize their EHR, bed management system, and other clinical applications.

eClinicalWorks Kicks off Sold Out 2013 National Users Conference

eClinicalWorks is holding its national conference this weekend in San Antonio, running through Monday.

Monday Morning Update 10/14/13

From Alarm Fatigue: “Re: patient death. Alarms on hospital doors are ignored.” San Francisco General Hospital (CA) offers no explanation of how a 57-year-old patient reported missing from her hospital bed was found dead 17 days later in an alarm-equipped hospital stairwell. The hospital’s chief medical officer suggests that alert fatigue from “a cacaphony of chirps and beeps” may have contributed to the problem.

From Patient Advocate: “Re: retina surgeon follow-up appointment. My two drugs had a dosage change, given to me verbally. I started second guessing myself as I was sent upstairs to see my specialist, who reviewed the surgeon’s notes send by fax with different dosage instructions. The meds seemed to be pre-printed on the form, so I asked the tech to check with the surgeon. The specialist then added another drug, giving me a sample with no dosage label and verbal instructions. Most of this specialist’s patients are 50 an over, going home with verbal instructions only. How about a simple printout of dosage instructions? As I was leaving the exam room, the person charting on the laptop asked me about my other eye drugs so she could enter data.  Guess she was seeing the trees and I was walking through the forest … with less than perfect vision.” Technology should get neither the blame nor the credit for how providers interact with their patients. They are responsible for choosing and using whatever tools they need to get the job done. I can’t think of any other professionals who blame the computer for their inability to perform at a reasonable level, although I also can’t think of any professionals whose minute-by-minute behavior is managed by government, insurance companies, and unseen owners using the computer as a blunt instrument of control.

From The PACS Designer: “Re: 5th Gen iPad. Now that we have the news that October 22 is the launch for the 5th Gen slimmer iPad-mini, here’s an advanced look courtesy of the Sonny Dickson website. The smaller form factor is destined to be a hot item, and eagerly sought by those who are constantly attached to their device.”

The reader-requested poll about ICD-10 and liability and workers comp insurers yielded a scattershot of inconclusive responses. New poll to your right: what’s the cause of Healthcare.gov insurance marketplace technical problems?

Here’s John Lynn’s latest  Hangout, recorded live at CHIME 13.  

In Northern Ireland, medical imaging technology firm Cirdan Ultra acquires the assets of GE Healthcare’s Centricity Laboratory Division and will take over support for the former Triple-G product, which was at one time the highest-rated LIS (before GE acquired it, obviously).

ESD wins the Best Video Award at the CHIME CIO Fall Forum with a CIO-customized Diamond Dave-style version of “Just a Gigolo.”

Weird News Andy concludes that “this just doesn’t cut it.” A man in China suffering from arterial embolism saws off his own leg after being turned down by a doctor because he didn’t have enough money to pay for the procedure. He jammed a block of wood in his mouth and cut the leg off with a saw, also losing three teeth from biting down hard in pain. The man appealed for help to have the other leg amputated, resulting in a doctor offering his services for free.

The non-profit New Cities Foundation publishes a video describing its urban e-health project in Rio de Janeiro, in which GE Healthcare provided “e-health backpacks” to allow home visits for health maintenance in an urban environment.

For the geeks among us looking for a new technical toy, check out WearScript for Google Glass, which allows programmers to control and develop for Google Glass using Javascript. The developers hope to create an open ecosystem around Glass and to encourage accessibility.

Berlin will host the first HIMSS European mHealth Summit in May 2014.

The sold-out eClinicalWorks user conference started this weekend at JW Marriott Hill Country in San Antonio, TX.

On tap this week: Cleveland Clinic’s 2013 Medical Innovation Summit a the just-opened Global Center for Health Innovation in Cleveland. I’m surprised any healthcare work gets done at all in October given the number of people that seem to do nothing all month except attend conferences.

Crain’s Chicago Business names the board of Merge Healthcare as having the least-competent Chicago-area board of directors given their pay, noting that the company lost $28.8 million last year while the six-member board took home $8.2 million in compensation.

Vince launches his HIS-tory of McKesson, having tapped into the personal memories of several industry pioneers including Walt Huff himself (the “H” in HBO & Company). Vince also got some reader help in identifying some of the HIT faces of yesteryear. Vince spends a lot of time gathering information that you won’t find anywhere else, and I for one enjoy the heck out of every episode.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: The Best Time to Build a Data Warehouse Was 20 Years Ago: Why Someone Should Create a Standard Clinical Data Warehouse for Providers to Populate

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in October 2009.

The Best Time to Build a Data Warehouse Was 20 Years Ago: Why Someone Should Create a Standard Clinical Data Warehouse for Providers to Populate
By Mr. HIStalk

No matter what you do, it’s never enough. We healthcare IT geniuses have advanced the industry all the way into the early 1990s with our proprietary software applications, portals, and wireless infrastructure. Job well done, right?

Now all of a sudden, nobody’s happy with just capturing data electronically. They actually want to use that information for other stuff, moving the finish line right as we’re about to win the race.

All those state-of-the-art MUMPS and COBOL applications aren’t good enough for government work any longer. Automating for efficiency is yesterday’s news. It’s the information we’re capturing that’s important – for getting paid, for improving outcomes, or maybe even for keeping doctors and hospitals out of the red by selling data to those rich drug and device companies who need to conduct medical research or outcomes studies.

My hospital, for example, has a homegrown data warehouse. It’s useful (as it ought to be for what it costs to develop and maintain). It’s still only as good as the systems that feed it, though, and the analysts who work on those feeder systems always have a ton of "yes, but" cautions about the data they can provide, the kind of caveats that egghead data consumers hate to hear.

A common question: what bed was the patient in when a given item was ordered? Our answer: our systems don’t capture that. What’s their weight history? Same answer. Who ordered the treatment? Maybe we know, maybe not (it depends how far you want to go back in our CPOE journey). What time was the surgical incision made? Don’t know. What was the condition for which a drug was ordered? Only your doctor knows for sure.

The bottom line is that the information we have is pretty good, but we’re always running up against useful pieces of data that we don’t have. We can answer questions, but some only with an asterisk.

It is highly satisfying (not to mention enlightening) to be able to assemble complex electronic data elements into a reformatted database that will support some research project. It’s depressing, though, that our vendor systems simply don’t capture everything we need (and that the vendors, at least in our case, have zero interest in providing those capabilities).

My hospital’s IT resources and vendor are certainly average or better. If we have gaps and compromises in our data, I’m sure those are nearly universal (and even worse if you’re talking about physician practice EMRs).

Write this down: if your organization doesn’t already have a rich warehouse of query-capable data, it needs one. It’s a tough, expensive, and technically tedious effort to figure out all the what-ifs with your current transaction processing systems (What happens if you change a drug name? Can you handle merged patient records? How can erroneous information be fixed or deleted?)

It’s worth the effort for two reasons. First, it will help you get paid. Second, you’re sitting on a treasure trove of data that could be anonymized and licensed to big companies that have a lot more money than the average provider, some of which might even use it to conduct patient-benefiting research. Everybody wins.

Academic medical centers have blazed the trail. It’s time for community hospitals and physician practices (and their systems vendors) to follow.

It would be easier if someone would simply design an off-the-shelf data warehouse known to work well for clinical and population-based inquiries, and then simply give the input specs to the provider and their vendors. That’s great for interoperability. Maybe more importantly, it’s a clear target for providers to shoot for.

I know it’s annoying that everybody’s suddenly pontificating on the importance and economic value of encounter data. Trouble is, they’re right.

HIStalk Interviews Sumit Nagpal, CEO, Alere Accountable Care Solutions

Sumit Nagpal is president and CEO of Alere Accountable Care Solutions.

Tell me about yourself and the company.

I started a company called Wellogic in 1993. I’ve been at this for now over 20 years. I took Wellogic through three generations of product development with always a common vision, which was unifying clinical information for doctors at the point of care. Making that easily available to them.

In December of 2011, as we started hitting our stride and started seeing actual growth in the marketplace, some real growth opportunities, we realized that obviously we needed to bring in capital for that growth. We sought ought various types of capitalization strategies. The one that made the most sense for us was what we arrived at with Alere. I met with Alere’s founder-CEO Ron Zwanziger some time in October of 2011 and hit it off immediately. We had a common vision for how to make a real impact on clinical practice and improvement of both outcomes on the one hand and reduction management of cost on the other.

We had a very common vision. He came at it from the diagnostics perspective. I came at it from what happens in workflows, in physician offices, and how to tie everything together into a unified story. The rest is history. We became a part of Alere in December of 2011 and have been on an incredible journey ever since. That’s where we are today.

What’s the vision for a company that was primarily medical devices and diagnostics to cover HIE platforms, analytics,  wellness, biometric device connectivity, and EHRs?

It’s pretty simple when you step back and see what Alere started out to do. We started out as a diagnostic company, both point of care and diagnostics in patient’s homes. Our goal was to help patients with chronic conditions stay as healthy as they could wherever they were, primarily as they received physician instructions and worked to comply with them in their homes. What we deployed as diagnostic device into patients’ homes, our hope was that we would be able to improve outcomes simply by giving patients the information that they needed to stay compliant. 

There were challenges there. While were seeing improvements and outcomes, we weren’t seeing the dramatic changes that we had hoped for, primarily because patients weren’t getting the help they needed to make sense of the numbers. And of course there were compliance issues as well. We expanded our company’s offerings to include care management, where nurses would build relationships with patients and help them remain compliant, help them understand what their numbers were, help them with their dosing changes, and so on, so that outcomes were improved. On the one hand, costs and unnecessary hospitalizations and other types of adverse events were reduced.

What we found in that expansion was that our nurses and care managers were operating with two key handicaps. They typically operated without the help of the rest of the care team in understanding the physician’s care plan for the patient. They weren’t tightly integrated into the continuity of care for the patient. Telehealth or home monitoring, depending on what market you’re in, were separated, isolated types of services that didn’t really interweave themselves into routine clinical care.

Secondly, our care managers were operating with just about the information that the patients were able to report, either through the results that they shared from tests or what came across on the home monitoring channels. Some of that was augmented by payer data, but that was also always after the fact. We realized that we really need to close those gaps. That’s where the information technology portion of our vision came together.

Six years ago, Alere began its journey to start filling in those gaps, firstly by enhancing what we could get from our traditional sources of information from the payers, and then tying in the clinical feed, the information that came in from routine day-to-day clinical practice, from office-based and hospital-based settings, and then extending that into long-term care on the one hand, and then some of our markets now also extending that into social care. When you think of it that way, these are really not isolated thoughts. It’s really one very coherent vision that puts the patient at the center regardless of where they’re receiving care, we pull that information together. We activate that information through evidence-based guidelines. We deliver gaps and care reports to doctors, PCPs and such. so that they are better able to manage the healthcare and financial outcomes for those patients. We’re able to also then follow those patients into their homes as they get identified with chronic conditions and are able to help intervene early so that they avoid hospitalizations on the one hand and also continue to receive guidance from their providers and remain a part of a medical home with their providers in the long term.

The vision is very cohesive from that perspective. Diagnostics and information technology are really both essential for making it all work.

Do you think there’s any potential that we’ll ever have a single care plan for a patient that crosses all disciplines?

All disciplines? Well, there might be a holy grail for that. But our eyes are more on the immediate and mid-term horizon where for specific chronic conditions, a care plan that extends across the community, across the continuity of care from the home into the PCP’s office, into their specialist’s office, where all physicians are collaborating on a common set of goals for the patient. We’re going to see that emerge with our work in New Jersey at Virtua, for example. You’re going to see a common care plan that extends across that entire continuum, emerge out of the work we’re doing there. Very much out of the work we’re doing in the UK with the NHS Leeds. We are working on exactly that type of capability.

Is there convincing evidence that home medical monitoring devices will improve outcomes or cost on a large scale?

We’ve had these outcomes numbers for a long time. We can demonstrate across all the major chronic conditions–diabetes, asthma, COPD, heart failure–we can demonstrate improvements in both outcomes and reductions in cost. We have real and critical data that proves that. Ten, 12, 18 percent reductions in costs across those diseases and measurable improvements in patient outcomes are already on the record. When you look at our anticoagulation program, for example, you’ll see that, compared with all other types of anticoagulation management techniques, our home monitoring, when a patient gets discharged post heart failure on warfarin therapy and we measure the patient’s coagulation time within limits factors at home, around their blood coagulation. Our efficacy of our intervention with the home monitoring exceeds that of every other measure that we have compared that against, by a meaningful margin. 

Home monitoring really does work. The question is, does everyone who needs home monitoring get prescribed it, at discharge or the right moment? How does that home monitoring fit in with routine clinical care? Both of those things have to happen for home monitoring to work on a grand scale. The work we’re doing in large connected communities like Southern New Jersey and the entire city of Leeds in the UK, that work is actually aimed at showing how we can scale this on a large scale. But our studies already performed on very substantial numbers of patients already proved that home monitoring standalone can have that impact.

What advice would you have for a health system that’s trying to figure out what it needs in terms of HIE platforms, analytics, and business intelligence and who to consider buying them from?

There is a lot of hype out there. There is a huge amount of me-too behavior being exhibited by customers. I was asked during a presentation to a pretty large HIE customer when we were making the sale to them, one of the leaders from the buying party essentially asked, "Well, Sumit, we know you, we trust you, but all the other vendors come in and tell us that they’ve got the same stuff. Why should we believe you when you say that they may or may not have it versus what they’re saying?"

That’s a real important problem. It’s a problem that has plagued software forever. The largest companies in the software industry created the notion of vaporware. They set the stage, they created the model where organizations sold a vision first, and when they had the contracts, they went and built the fulfillment of the vision. It’s very hard to distill reality from vapor, even after involving customers, because every customer has a vested interest in having their vendor succeed. Even customers help vendors in presenting themselves in the best light.Those are just the realities of software, unfortunately. 

What’s a buyer to do? The challenge there is ultimately answered by who’s actually going deep into proving the benefits and to proving the outcomes? Who is actually investing tangibly in the full picture rather than lipstick on the pig on the one hand, or, you know, the same-old, same-old, just repackage, just new marketing. Lipstick on the pig on the one hand, or incremental, small-scale investment hoping that they’ll hit the jackpot and then they’ll take off. Those are the things that customers really have to watch out for. Alere is dead serious about R&D. We spend, over $150 million a year on R&D. That is the basis for our differentiation, the fact that we’re serious about making all the stuff work, pre-integrated out of the box, is a key differentiator for us. You’re absolutely right; the market does have to be concerned about this problem.

We don’t really seem to have any alignment here public health and the encounter-based care our system was built around. Are we as a country prepared to move from an encounter-based care model to population health management?

As an economy, we’re certainly set up to be more local. We’re much more autonomous than most other economies in the world. The kinds of public health or population-based measurements that you’re describing that, say, in many European countries, in Southeast Asia, in Africa, might be taken on as national level initiatives. In the US, their implementation ultimately becomes a federated, local matter.

That’s very much all about who we are as a culture and as an economy. We compete, we like to have autonomy, and we like to make decisions about what matters in our own communities. Having said that, there’s lots to be gained, and we’re seeing this already, by individual health systems that actually pay attention to population health as a competitive differentiator for them. I think we will see a real uptake on population health measurement as a commonplace technique for health improvement in this economy. There are obviously incentives that CMS provides for achieving various goals and measures, and so that’s the national level agenda. But there’s lots and lots of local differentiation.

That’s not a bad thing because it creates a kind of innovation and the kind of differentiation and the competition that actually allows us to try many experiments to see what works, rather than everyone barrel down a path that might not pan out. And really provide choice for the various participants who then, given their varying degrees of ability or interest, choose to engage with very local decision making. It’s just our way, and I guess that’s what we will do.

Everybody likes to ask you questions about what it was like to work with Steve Jobs. Do you see any companies or people in healthcare IT that are in any way like Steve Jobs or Apple?

The kind of innovation, the kind of energy, the kind of "we’re going to change the world" spirit that I saw at NeXT, because that’s where I was when I worked with Steve. That kind of spirit is sorely lacking in healthcare. We are rather jaundiced or disillusioned as an entire sector in so many ways, and that’s unfortunate. There is huge amounts of innovation happening in pockets, in small companies that are working on the edges, but by and large, the bulk of the industry is innovating at a pace that is glacial compared with what it should be for the kinds of challenges that we’re all working to solve. We’re hoping to show that we are a different kind of company from those perspectives.

Should expectations be limited given that even Apple probably would have struggled if it had to work in an environment that was so heavily government controlled? Do you think that we’ll ever have real innovation in healthcare IT?

I think you’ve really put a finger on one of the things that gets in the way. We talk about this very often, that Apple succeeded in so many ways because they figured out what the consumer buying their stuff really cared about. They made that thing really enchanting for the buyer.

In healthcare, the buyer happens to be very different almost all the time from the actual user or the consumer. That creates a very big problem for spenders, for companies like us, who are actually working to create things that will gain adoption, that people will be enchanted by, that users will actually love to use, and make a part of their daily routine, blend into their woodwork just the way the iPhone and the iPad and so many other technologies out of companies like Apple have blended into our lives. We all, especially at Alere, we’re focused on bringing that kind of innovation to the market. But we also recognize that the buyer doesn’t necessarily turn out to be the same person who is the user. And in some cases, that does pose a challenge.

Government regulation and the fact that there’s so much of healthcare being paid for under, for example, CMS-based reimbursement. In so many ways that it’s actually created much of the momentum that we’re seeing for the kinds of technologies that are now starting to be talked about and even starting to be adopted. Interestingly enough, the changes that have happened over the past few years have actually boosted, created innovation. They’ve started a pocket. They’ve created benchmarks for healthcare providers to meet, which in turn have created benchmarks for vendors like us to meet. All of that, I think, is goodness.

Will we ever see the kind of innovation that is seen in other industries? As care becomes more and more consumer driven, I see a vehicle for driving more and more transparency, more and more openness with data sharing, more and more ability to make use of the data to engage and benefit the consumer. That will happen, it’s only a matter of time. And the question is, how long will it take. So, you know, I’m bullish on this industry for that reason. Because I think the forces that have been unleashed over the past six years really have started moving us down that path.

Any concluding thoughts?

This is a really exciting time to be in this industry. We are burdened with a legacy. We are burdened with infrastructure and limitations that are in so many ways of our own making. But at the same time, we’re also seeing the same kind of cracks in the fabric, or the infrastructure, that have caused industries ranging from travel to stock brokerages and financial organizations to break down those barriers, reduce the friction, and become consumer focused and consumer driven. We’re seeing those same patterns emerge in healthcare as well. We expect to be right at the forefront of enabling those kinds of changes to happen, and it’s just a very exciting time for that reason.

Morning Headlines 10/11/13

Physician job satisfaction driven by quality of patient care

A RAND study that interviewed 220 physicians across the US finds that a primary driver of their job satisfaction is being able to provide high-quality healthcare, and while some physicians acknowledge advantages of EHRs, the general consensus is that the systems in use today are cumbersome and are an important contributor to their dissatisfaction.

Kansas City Council approves $4.3 billion Cerner campus plan

The Kansas City Council voted 10-1 Thursday to approve a $1.63 billion tax incentive package to support development of Cerner’s new 4.5 million-square-foot campus. The new campus will house an estimated 15,000 new employees by the time it is complete in 2024.

KHC electronic records go live Sunday

25-bed Knoxville Hospital (IA) goes live with its new $2.8 million Cerner system on Sunday night, October 13. 

Union protests shutdown at VA Medical Center

Union employees at the Iowa City VA Medical Center are protesting in support of their IT staff who, because of the government shutdown, will begin working without pay this week. A spokesman for the union said that since there are no paper records in VA hospitals, the hospitals are entirely reliant on computer systems and the absence of funds to pay for the VA’s IT staff will cause problems for many VA hospitals across the country.

News 10/11/13

Top News

The DoD issues a solicitation to EHR vendors to demonstrate their products the week of October 21 for market research and planning purposes. The DoD says it is interested in “off the shelf” enterprise EHRs, including VistA solutions, to replace its legacy systems and notes that participation in the demonstration “is not mandatory, required, or a prerequisite for any future procurement activities.”

Reader Comments

From Curious: Re: PatientKeeper. Does anyone know if PatientKeeper is MU certified? Couldn’t find them by name on the CHPL website, but that’s not the world’s most reliable or usable site.” The folks at PatientKeeper shared this response:

PatientKeeper is certified for 2011 Edition as a Modular EHR, including CPOE and Medication Reconciliation, and we will be seeking 2014 Edition certification by the end of this year.

From HIS Junkie: “Re: HIPAA. Does HIPAA apply to the ACA Health Insurance sites? If there is a breach, will OCR slap HHS with a $1.5 million fine for each breach. No doubt we’ll soon find out. In a recent report, testers identified five major breach weaknesses in the Health Insurance web sites. They were: fake sites, all access requests for other sites, click jacking threats, cookie threats, and scam psychology threats. Firms like HPs web security group and Trend Micro did the testing. Clearly the slapped together sites would fail a HIPAA compliance audit. With people registering having to put in all their family member’s SSNs, the report concludes, ‘Expect Mischief.’”

From Wannabe Recovering Consultant: “Re: anonymous CIO interview. Incredibly fascinating. I would love it if you could do more of them. His or her insights into the thinking of a CFO made me think that an anonymous CFO interview would be equally insightful as relates to IT expenditures and activities.” That would be fun, too, if anyone wants to volunteer.

From MoreCowBells: “Re: California Medicaid. Any truth to the rumor that they won’t be ready to accept ICD-10 by next October. Are other states in the same situation?”

HIStalk Announcements and Requests

I spent most of the week in San Diego at the annual MGMA conference and posted several updates on HIStalk Practice. Take a read to get my impressions on some of the sessions, what was cool and not so cool in the exhibit hall, the scoop on after-hours parties, and what folks were talking about. If you prefer a more visual experience, you’ll find lots of pictures, including one or two of hot shoes. I also encourage you to check out Dr. Gregg’s latest post, which offers a few comebacks to the EHR nay-sayers. Thanks for reading.

Welcome to new HIStalk Platinum Sponsor Medi-Span, part of Wolters Kluwer Health. Medi-Span offers customized drug databases and medication decision support modules that enhance patient safety, support interoperability, and decrease alert fatigue. Medi-Span makes EHRs and other clinical systems smarter, supporting functions that include prescribing, dispensing, and claims processing for 1,600 hospitals, 49,000 retail pharmacies, and all 10 of the top pharmacy benefits managers. In addition to drug information, decision support, and pricing tools, MediSpan’s new offerings include Controlled Substances File that covers both federal and state requirements; Alert Control customization capability, Patient Safety Programs File that identifies drugs that have Black Box Warnings, Medication Guides, tallman names, or REMS; and ICD-10 Mapping Files. Thanks to Medi-Span and Wolters Kluwer Health for supporting HIStalk.

Webinars

Health Catalyst will offer “Surviving Value-Based Purchasing: A Road Map to Success Under the New Reimbursement Model” on Tuesday, October 15 from 1:00 – 2:00 p.m. Eastern. Presenters will be Bobbi Brown, VP of financial engagement for Health Catalyst, and Jane Felmlee, healthcare consultant.

Acquisitions, Funding, Business, and Stock

Francisco Partners makes a strategic investment in EMR/PM vendor NexTech.

Three top executives of Bottomline Technologies take a pay cut from the previous fiscal year following the company’s 2012 net loss of $14.4 million. The combined compensation packages fell from $5 million to $4 million.

API Healthcare announces Q3 accomplishments that include a 23 percent increase in bookings and 35 new healthcare customers.

Sales

Augusta Health (VA) will implement community HIE technology from Sandlot Solutions.

Sentara Healthcare selects HealthMEDX to automate its clinical and financial operations for its skilling nursing, transitional care, and assisted living facilities.

San Luis Valley Health (CO) adds the iDoc document management software from CareTech Solutions.

Northern Colorado Anesthesia Professionals, LLC (CO) chooses Shareable Ink’s Anesthesia Cloud for data capture, billing, and scheduling and will use the company’s ShareMU program to help its providers earn EHR incentive payments.  

UNC Health Care (NC) extends its relationship with Practical Data Solutions, Inc. to deploy data models for Epic Resolute and Cadence, adding to its previous work with UNC on GE Centricity and Allscripts Enterprise.

People

Alere ACS hires Helen Figge (HIMSS) as VP of clinical integration.

St. Joseph’s Healthcare System (NJ) names Jane Tsui-Wu (Stony Brook University Hospital) as VP/CIO.

Streamline Health Solutions names Jack W. Kennedy, Jr. (PRGX Global, Inc.) as SVP/chief legal counsel.

Ian Gordon (Topaz Shared Services) joins McKesson Health Solutions as SVP/GM for decision management.

Liaison Technologies announces three new board members: William E. Kitgaard (Covance Global IT), David Parker (WebLogics), and Joseph B. Volpe III (Merck Global Health Innovation Group).

Announcements and Implementations

Knoxville Hospital and Clinics (IA) goes live on its $2.8 million Cerner implementation.

Bon Secours Health System (MD) integrates Wolters Kluwer Health’s UpToDate clinical decision resource within Epic.

Athenahealth will monitor and share population health information on flu outbreaks and other communicable diseases from its national database to fill the current gap in CDC reporting. Because of the government shutdown, the CDC has furloughed 8,754 employees (70 percent). Makes you wonder how much money the government could save if the private sector took over a few more tasks.

iMDsoft makes the MetaVision AIMS, MV-OR available via cloud-based hosting, with licenses offered on a subscription basis.

MEDHOST introduces AXON, a native iPad app that enables clinicians to interact with the MEDHOST EDIS.

Infor launches Health 3.0, the company’s vision for the future of HIT, which includes a suite of products that address the shift to value-based reimbursements.

Government and Politics

The VA Office of Information and Technology furloughs 2,754 employees, halting all software development on the VA’s benefits management system.

Union members of the Iowa City, IA VA medical center protest the effect of the government shutdown on the hospital’s IT workers. “Right now, the Information Technology section of our hospital that does all of our computer systems doesn’t have a budget, and those employees are currently working without pay. [Hospital employees] pretty much are at a loss for everything — charting, documentation, everything is at a loss.”

Innovation and Research

NIH awards Sutter Health, IBM Research, and Geisinger Health System a $2 million research grant to develop analytics methods to detect heart failure using EHR data.

Virtual assistant developer Next IT announces GA of Alme for Healthcare, which will respond to customer service questions and increase patient engagement.

Other

Epocrates introduces Provider Directory to help members easily identify other clinicians for consultations and patient referrals.

A RAND study finds that the primary driver of job satisfaction for physicians is being able to provide high-quality healthcare. EHR use impacts doctor job satisfaction because of worries that EHR use interferes with face-to-face patient interaction increases clerical work by doctors. Physicians also have concerns that medical record accuracy may be negatively impact when templates are used.

American Well expands its $49 a visit telehealth consult services to 44 states and DC.

The Orlando business newspaper lists the salaries of executives of Adventist Health System. CIO Brent Snyder made the list with $1.14 million in salary in 2011.

Kansas City’s City Council Planning, Zoning & Economic Development Committee unanimously approves a plan to give Cerner $1.63 billion in tax incentives for its $4.3 billion expansion project. The full council is expected to extend approval Thursday for the 11-building, 4 million square foot development that would be built in 14 phases over the next 10 years.

A quality incentive program for salaried physicians at Massachusetts General Hospital improved EHR adoption and hand hygiene compliance, reduced ED use, and increased efficiency in radiology and cancer centers, according to a study published in Health Affairs. Physicians could earn incentives of up to two percent of their annual income, leading researchers to conclude that even small incentives can impact behaviors that improve the quality of care.

Sponsor Updates

• eClinicalWorks hosts its national users conference October 11-14 in San Antonio.
• Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Quality Tools report.
• Visage Imaging is exhibiting at this week’s ACR Annual Informatics Summit in Washington, DC, with GM Brad Levin participating in an October 11 vendor panel on mobile imaging solutions.
• Aprima Medical offers customers an option to use TSPi’s MicroCloud Platform as a Service solution to host their Aprima EHR.
• Billian’s HealthDATA and the Alliance for Home Health Quality & Innovation co-host an October 22 Twitter chat on mobile health and in-home technologies.
• CCHIT extends ONC 2014 Edition Modular EHR Certification to PatientTouch System 3.2.2 and PatientTouch System 3.3 from PatientSafe Solutions.
• Cerner will add Wolters Kluwer Health’s Provation Clinic Note content and decision support into Cerner Millennium.
• TriZetto releases details of its 2013 Executive Vision Summit November 12-14 in Scottsdale.
• The American Hospital Association extends its exclusive endorsement of data center hosting services from CareTech Solutions.
• Michael Mutterer, VP of senior services at Riverside Medical Center (IL), shares his thoughts about “I couldn’t live without … HealthMEDX clinical EMR.”
• pMD explains how its mobile charge capture solution can improve the PQRS reporting process.
• Technology from Awarepoint and Versus are featured in a 24X7 article on the growing use of RTLS in healthcare.
• EClinicalWorks adds Elsevier’s ExitCare technology for evidence-based patient education and discharge instructions into its EHR.
• Quality Systems’ subsidiary Mirth releases Mirth Connect 3.0, an open source healthcare integration engine for HL7 message integration.
• 3M Health Information Systems introduces the 3M Outpatient CDI Program, which offers consulting services for outpatient facilities and physician practices needing to improve the documentation and coding process.

EPtalk by Dr. Jayne

I’m completely disheartened by the behavior of our elected officials during this government shutdown and the months leading up to it. Regardless of your side of the aisle, it seems everyone is behaving badly at this point.

One of the things that surprised me is the shutting down of government websites. I was looking for information on a potential vacation site and discovered the National Park Service websites are down. I understand not paying people to create new content or update pages, but am not following the logic on how taking down the websites is saving a significant amount of money.

If they’re using commercial hosting at all, I doubt their vendors decided to quit charging them due to lack of appropriations. If they’re self-hosted, did they just turn out the lights at the data center and leave a few random servers up to share the message of gloom and doom? Are they hoping to cut their cooling bill as a way to balance the budget? I understand it’s all a political maneuver to make it as uncomfortable for everyone as possible, but it seems a little over the top. I decided to do some informal surfing to determine which websites were “essential” or not.

The National Park Service sites are down. Everything redirects to the Department of the Interior home page, which is up. Also live is the Deepwater Horizon oil spill page for those urgent updates from the 2010 spill. Not sure why that’s essential. The web pages of the USDA Forest Service are live with a disclaimer that they will remain available for public safety announcements and updates for wildfires, floods, and other natural disasters, which seems reasonable.

The Centers for Medical & Medicaid Services sites are up, with a disclaimer that information may not be up to date. That approach at least makes more sense than what the National Park Service has done. Is depriving fifth graders the ability to read about Old Faithful really the best way to serve the next generation of leaders? I think not.

One page that I found live with absolutely no disclaimer or mention of the shutdown is the HealthIT.gov page on How to Implement EHRs. Even the HHS HealthITBuzz blog is up without a disclaimer, although the last update was September 26. I wish the majority of physicians I worked with shared the same urgency for EHR adoption as the website does. Also, I was happy to see most of the Veteran’s Affairs websites still up (although there may not be people processing anything on the other side of the wires, which is shameful).

Those of us that work in healthcare IT are constantly preparing and refining our business continuity plans. We make sure we know how to deal with a business disruption and how to actually resume our processes when the systems come up. I wonder how many federal IT departments have the same level of thought or planning? I doubt they perform regular “government shutdown” drills and they probably don’t even have a downtime box because there would be no one there to use its contents. We can only assume that when the systems come back on line things will be messy.

Hopefully the parties involved will figure out a way to come together and start serving the American people again but, I think that’s probably asking a lot at this point. In the meantime the rest of us will continue doing our jobs, caring for patients, keeping the systems running, and paying our bills. And at least one of us will be dreaming of the Dry Tortugas. Got a seaplane? Want to sneak into a National Park? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 10/10/13

ACO veterans share lessons from the trenches at MGMA

Stephen Nuckolls, CEO of Costal Carolina Health Care, led a discussion on lessons learned from his organizations ACO experience during this weeks MGMA conference. Inga attended the conference and offers her own insights over on HIStalk Practice.

Early detection of heart failure gets the big data treatment in NIH study with Geisinger Health, IBM

Geisinger Health System, IBM, and Sutter Health have been awarded a $2 million NIH grant to study how data analytics might help primary care doctors detect heart failure earlier than is currently possible.

Advice to the Next National Coordinator

Boston,MA-based Beth Israel Deaconess CIO John Halamka, MD offers his advice to the next National Coordinator for Healthcare IT. He remembers Blumenthal’s era as the "regulatory era," and Mostashari’s as the "implementation era." He says the next coordinator will need to "consolidate our gains" during a period that will likely include a significantly smaller budget.

Shinseki wants a budget for the VA

As more and more bills are passed during the government shutdown funding special programs, VA secretary Eric Shinseki has requested funding to continue paying disability benefits beyond their November 1 expiration. 

Readers Write: Maintaining Customer Loyalty Despite Our Mistakes

Maintaining Customer Loyalty Despite Our Mistakes
By Ryan Secan, MD, MPH

Who can spot the difference between these two uses of the words “I’m sorry”:

• “I’m sorry you have a black eye” vs. “I’m sorry I punched you in the face”
• “I’m sorry you lost money in a Ponzi scheme” vs. “I’m sorry I stole all of your money”
• “I’m sorry you need another operation” vs. “I’m sorry I left an instrument in your abdomen”

In the first cases, “I’m sorry” is an expression of sympathy, in the second, it is an apology. The word that follows “sorry” makes all the difference. “I’m sorry you…” is an expression of sympathy, “I’m sorry I…” is an apology (also note the passive voice in the first examples vs. active voice in the second – this is classic for the “mistakes were made” rhetorical device).

It’s easy to see the difference in the above examples. The tough part is that when we’re deep in a situation (and maybe we’re feeling shame, or embarrassment, or want to avoid responsibility) it is easy to offer sympathy to someone who really deserves an apology. The victim dealing with the bad outcome, while likely appreciative of your sympathy, really wants and deserves an apology. Regardless of how much sympathy you offer, on some level, they are not going to be satisfied without a true apology.

In all aspects of life, there are occasional bad outcomes. As a physician, I unfortunately see these far too frequently. These can be in our business or personal relationships as well. Bad outcomes often take place despite our very best efforts to prevent them. The universe isn’t always fair.

However, sometimes we make mistakes that lead to the bad outcomes. Since we all want to provide great customer service (or have high quality relationships in our personal lives), these bad outcomes need to be addressed. In medicine, culture is finally shifting away from the expression of sympathy to the apology (when appropriate). At the University of Michigan, a comprehensive medical disclosure policy (including an offer of compensation) has been put into place leading to a significant decrease in new claims, lawsuits, and costs. Part of the reason this policy has been successful is that it includes a discussion of the plan for preventing the same mistake for happening again.

Also, don’t use the word “but” in your apology and expect it to mean something. Think of one of the examples above, and how it would sound with a “but” in it:

• “I’m sorry I punched you in the face, but …”

What can you possibly say after the “but”, that isn’t an attempt to weasel out of responsibility and negate the apology? While you should explain what happened (and what you’re going to do to prevent it from happening again), don’t try to qualify your apology with it. Remember, even if they haven’t heard the saying before, intuitively, people know that “everything that comes before the ‘but’ is BS.”

The next time you make a mistake with a customer or in your personal life (and we know it’s going to happen soon enough), consider offering a sincere apology – (active voice, “I’m sorry I”, no “but”, best possible redress, and plan for prevention in the future). You might be surprised at how well this improves your customer’s loyalty.

Ryan Secan, MD, MPH is chief medical officer of MedAptus.

Readers Write: The True Benefit of Big Data in Healthcare: A Perspective from the Industry

The True Benefit of Big Data in Healthcare: A Perspective from the Industry
By Rich Temple

In response to a September 9, 2013 “Readers Write” article that suggests “big data” is the next boondoggle, I would like to illustrate the promise of big data, also referred to as business intelligence and analytics (BI) in healthcare. In that post, the author alludes to the challenges faced by industries embarking on big data journeys dating back to the 1960s.

While the struggles he noted were valid through those experiences, so much is different now in terms of the absolute necessity of big data in healthcare, as well as the exponentially-improved technology that can crunch numbers in nanoseconds. We need to recognize that the game has changed and now is the time for BI to make a significant impact to improve healthcare.

In general, broad concepts such as BI do have the potential to run aground in industries where they are treated as “nice to have.” The healthcare industry in 2013 is at a key inflection point where it absolutely cannot move forward without key BI and analytics as an engine for these healthcare reform initiatives, as well as many others:

• Accountable Care Organizations (ACOs)
• Population Health
• Health Information Exchanges (HIEs)
• Health Insurance Exchanges (HIXs)
• Value-based purchasing reimbursement initiatives
• Reporting regulatory requirements around quality and cost coming from the government

BI and analytics become the fuel that powers the healthcare industry’s ability to fulfill its obligations to all its stakeholders under healthcare reform. If we are going to improve the quality of care necessary for the above mentioned healthcare programs, BI will need to be used to provide information with the highest level of integrity possible for accurate decision-making across the healthcare industry. When a concept reaches a critical mass as an essential business driver for growth and sustainability for healthcare providers, it should not be seen as a boondoggle.

While healthcare still has quite a way to go on its journey toward true interoperability across systems, recent initiatives, such as Meaningful Use, ACOs, HIEs, among others, point to just how much has been achieved in mitigating the data integrity challenges that the author notes. These challenges are not only being addressed, but are in the process of being solved by current initiatives to connect systems and organization through:

• HIEs
• HIXs
• Interoperability between hospitals and their affiliated physician networks
• ACOs

Recent mandates involving coalescing around particular standards (e.g., LOINC) also help facilitate interoperability. As these challenges continue to be worked through, it becomes that much easier to extract truly actionable information from the mounds of data that are housed in our disparate healthcare information systems.

Another key differentiator that makes BI not only possible, but achievable in ways that it could never have been until recently, is the advanced technology that is now available to process staggering amounts of data in time units measured in seconds or minutes, as opposed to weeks, months, or years. With new BI technologies such as Hadoop, it is no longer ridiculous to assume that an organization can mine many terabytes of data in just seconds.

In the past, organizations had no way to access all that data in nearly real-time, rendering a lot of their efforts to come to naught. Today, we do have that capability. When today’s consumer cell phones contain more sophisticated computing technology than the Apollo rockets that landed on the moon, it has to be taken as a given that certain challenges that industries grappled with in the past no longer apply to today’s world of BI.

Given the tumult in healthcare and the new abilities to use data in ways previously thought impossible, I see BI not as a boondoggle, but as an essential component of any healthcare organization’s survivability. The author is spot-on when he expresses concerns about the challenges of harmonizing data across disparate provider and functional systems; all systems, whether they are EHR, payer, decision-support, financial, case management, or one of many others, need to communicate much richer information than ever before. But the changing face of healthcare is pushing these “conversations” along in ways we could not have imagined even a few years ago.

Without BI and analytics, the new paradigm of healthcare will fail if we don’t move forward full speed ahead. Stakeholders will need to bring the commitment and expertise to bear. By working through the challenges together and moving forward, we can finally unlock the potential of the systems we have invested in to provide real improvements in the quality of care and bend the cost curve to make the benefits of healthcare transformation available to all. BI will play a central role in this effort to take healthcare to the next level.

Rich Temple, MBA is national practice director for Beacon Partners.

HIStalk Interviews Michael Barbouche, Founder and CEO, Forward Health Group

Michael Barbouche is founder and CEO of Forward Health Group of Madison, WI.

Tell me about yourself and the company.

I am a math guy by training. I studied algebra. Then I had the good fortune of stumbling into health services research as formal training. I’m married to a general internist. We have three great kids, and following my lovely wife around through training, I had a very Forrest Gump-like journey that took me through all sorts of different places with healthcare data.

The company was established formally in 2009. We are a population health measurement group based in Madison. We help get the good, fresh data to flow.

A lot of companies offer population health management and analytics tools, some of them brand new. How do you differentiate yourself from competitors?

We didn’t set out to start a population health company. We ended up solving a riddle going back to 2004. Our team came together and we took on one of these longstanding challenges that plagues the healthcare world. Namely, how to measure apples to apples performance looking at outcomes. System to system, platform to platform.

If you go back to 2004, we didn’t have HIEs. We didn’t really have widespread EHR adoption. We didn’t talk about that stuff. But the perspective of employers and purchasers and payers was the same. They needed to get to some kind of new way of measurement.

Our team developed that for a group called the Wisconsin Collaborative for Healthcare Quality. That led to a whole series of very interesting conversations. A bunch of people that came and knocked on the door in ’06 and ’07 and ’08 saying, we need to extend this, why don’t we take this into practices? We weren’t reluctant to set up a company. We solved the riddle first on how to get to the data. Then we figured out, we’d better make this into a service and into a solution that can be widely adapted and broadly spread to help get clean data in the hands of all sorts of stakeholders, not just practices, but researchers, payers, and everybody in between.

Where do you get the data and how do you get it into a form that makes it that usable?

The data’s a mess. I mean, it’s a horrible, bloody mess. It’s bad out there and it’s all over the place. The data sources are varied. They’re ever moving, they’re ever shifting. Really what we are is a company that builds good denominators. Not very sexy, not probably a great conversation starter, but that’s we do. We figured out in ’04 and what we’ve really been working on ever since is to get the data to align and to kind of flow in a good direction, we need to begin by building sound denominators.

That means we have to work on tricky things like attributions. We have to work on all sorts of messy stuff with the data that doesn’t come forward very clean and very clear. It also means that we have to look at every potential data source. It’s not just an EHR connection or a lab interface or what have you. Most health systems have multiple versions of all of those and some practice management systems and some legacy things to boot. We build a custom strategy to find the most sustainable way to get data every place we go.

Do you think people underestimate the challenge not just collecting data in one place, but trying to make sense of data that is inconsistent and possibly not even reliable?

Oh, heck yeah. There have been so many people my entire career, 25 years now, that have talked about building this giant vacuum cleaner in the sky that sucks up all the data and it’s just going to magically appear. But, you know, we all know now very well that healthcare has this very painful metadata problem. It doesn’t know how to build data about itself. I think all of our careers will be over before anybody actually knows what a clinical FTE actually is in a practice. It’s really hard to things like attribution. There’s no right answer.

But if you try to suck up all this data into a giant vat and then make sense of it and distill it down, when you put it in front of somebody like my wife, you’re not going to get anywhere. That’s one of the litmus tests that we set out to kind of solve, that you have to be able to have all stakeholders look at the data and go, "Yeah, all right, yeah, we’ve got to improve." And there’s a real important credibility lift there that says the data is quite custom, it’s quite local, it’s quite turbulent. We need to really understand that and go for that.

Tell me what The Guideline Advantage is and what you’re doing with them.

That’s a spectacular program, and we’re really honored to be part of it. This is a tri-agency led by American Heart Association, American Cancer Society, American Diabetes Association. We didn’t set out to become their partner. They had a data problem. They followed a traditional registry model for getting data, and then they stumbled into us. We were delivering data for one of our clients, total population, total denominator. All of a sudden, that magical, “how do we get the data out of EHR?” 

The program is really focused on primary prevention and looking at the role of the inventory side, saying that chronic disease is something that we can tackle head on. With our platform, PopulationManager, we are now looking at practices across the country to get them in synch with the guidelines developed by these three great organizations, and then talking to one another and collaborating so they can begin to move things forward together. The goal is very simple — to raise all boats. We’ve put spirit behind the Wisconsin Collaborative Initiative that we’re a part of, and it remains the same here with The Guideline Advantage program.

Who is your typical prospect or customer?

We work with health systems. We work with physician groups and hospitals. We work with payers. We work with researchers. Everybody really needs to become a consumer of this data. This is what we’re all after.

There are two pots of data out there. There’s administrative data, and we’ve been working on that for forever. And now there’s all this clinical results stuff. Everyone’s figuring out, oh yeah, that clinical results stuff, that’s where outcomes comes from. So to the degree that a stakeholder has an interest in seeing outcomes move in the right direction, this is the foundation of value-based fill-in-the-blank or anything else you want to put as a label, you’re going to need that clinical result data. 

When you look market by market across the country, some will be payer-led. It has to be that way. Others will be health system or provider led. The Guideline Advantage is a third-party group that has a very strong research and reporting mission. We work with any kind of group that needs to get into the business of having good, clean, fresh data.

Describe what hospitals might do differently having implemented PopulationManager.

First, let’s just talk about the burden on IT. The limited resource in every one of your reader’s systems are their shaggy-haired, headphone-wearing data analysts. You just can’t hire enough of them. We learned back in ’04 and ’05 that that resource couldn’t be tapped in an unlimited manner. Instead, they had to find a way to get at data that was already there, that was essentially rotting in place, and figure out a way to maximize it. We put together a good harvesting strategy and system that within six months, IT becomes our very best friend because we remove the tremendous burden on their part of ad hoc reports and trying to keep pace.

But more than that, we’ve flooded the system with a tremendous amount of actionable data that’s in the hands of their docs, clinic managers, schedulers, nurses, and a whole lot of other folks in between. We want the install to be very fast and very much a light lift to the entire organization. We have to get it done in about 8 to 12 weeks, because the data in their world is ever shifting, it’s on sand, it’s always moving. What they have to measure is ever shifting. If we stood around and said, well, it’ll take six months or a year, every assumption we had made would already be busted. We have to go quick, and we have to hand them essentially their data back in a way that is very intuitive and very easy to understand.

A lot of times in healthcare specifically you can make a set of data look decent enough, but future data may not follow the rules. Do you find that you have to do ongoing maintenance to keep the data clean?

More than that. We have this construct that we call a data refresh.The customer selects the cycle, let’s just say quarterly. On a quarterly basis, we act like we’ve never been there, and every assumption, every  mapping, and every kind of transformation we’ve done has been busted. Because most of the time, it has been. 

We have to essentially take the data through that process once a quarter and make sure that all of the links are live. We can’t publish data out on our visualization platform and have 28 percent of the blood pressures all of a sudden just go missing. It happens. It’s not because they didn’t deliver the care, it’s because the data got moved or there’s a new interface or what have you. That burden falls to us, as the measurement partner, to make sure we find those hiccups before they occur.

If I’m a patient of a health system that’s implemented PopulationManager, what do I see different in my care?

We set out to deliver tools that are like a mirror, a mirror of performance across the system or across the health plan. Our clients are pushing the boundaries of taking the data that we deliver and really saying, we need to make this patient facing. We don’t have a patient portal, but we’re now positioning the data — which isn’t our data, by the way, it’s our client’s data — in a position where they can begin to leverage it. 

I’ll give you a quick example. We have this very simple scatter plot that’s so intuitive it just drops off the page. But if you plot that out and you select the colors and you select the shapes, when you look at all of the crazy dots on the screen, there are patients that stand out immediately. We’ve had some of our medical directors at our site say, I need to show this to my patients who are outliers so they know when I’m saying, “Look, buddy, it’s you” they can really see on the screen they’re the ones that are standing out. There’s a huge frontier of patient reported data and all this other stuff that needs to come into the mix. We look at that quite simply as just another very rich data source that’ll have to be brought into the mix.

Do data projects take into account that what looks like a good set of data today could be not-so-good set of data a month from now?

Their data is ever moving, ever shifting. They’re doing upgrades and they’re adding on new locations and there’s new devices. But then what they’re measuring is always shifting as well. You have these two continual states of flux that are absolute, and I don’t know how we’re ever going to change those. We had to build the bridge in between that said, we know that your stuff’s ever moving and we know what people want from you is ever shifting. Let’s split that balance in between.

It’s very difficult for the health system, for the hospital, to deploy their resources, to go to all the meetings and figure out, these are our clinical priorities, these are our financial priorities, and we need to map those into the world of our data. There’s just too movement there. We’re a denominator company. We say, all right, what are our focus areas now, and, oh, you’re going to change now? Well, OK, great. At the next refresh, let’s blow away all of your existing measures and put in new ones. There’s nothing rigid or fixed in our approach, because the systems don’t have that ability. We have to meet them where they are, which is in a very, very constant state of flux right now.

Where do you see the company moving in the next several years?

What inspires all of us, our team and everything else, is it’s working. Our sites inspire the heck out of us. They’re moving the needle in the right direction. There are tremendous opportunities in all areas of care. Some of the work I think we’re the most proud of is behavioral health and HIV, which you don’t find much stickier or thornier data than that. But to see the innovations that are coming from the practices. Not because we have done anything magical. We’ve just given them access to their data and we give it to them in a way that’s very intuitive, it’s very clean, and it’s accurate. Where they’re going with it, I think that’s the real potential. 

For the company itself, we’re on a great run. We’ve got great partnerships and we’ve got good momentum going. What we need to do is continue to get rich data as well, and put that in the hands of more and more practices. There is a secondary opportunity out there that we’ll certainly have to address, which is mainly what to do with all that rich data, because there are wonderful, important answers for research, for the financing of healthcare, in the collected data. When you get it clean, when you get it accurate, and it’s apples to apples, you can answer some pretty powerful questions.

Any concluding thoughts?

I just want to say, as many do, that I very much appreciate what you do. Your site is wonderful. I’d also really like to give a shout-out to my great team. Without them, I wouldn’t be here. The work and the dedication that they’ve done through these years as a little bootstrap company means the world to me. They are a great group, and I’m very honored to be their CEO.

Morning Headlines 10/9/13

Software, Design Defects Cripple Health-Care Website

The federal government has acknowledged for the first time since the October 1 launch of the federal insurance marketplace healthcare.gov that coding and architecture issues are causing the site’s poor performance. Until Sunday, the administration was maintaining that the site was technically sound, but could not keep up with traffic demands.

Nuance Adds Two Icahn Associates to Board

After months of pressure from activist investor Carl Icahn, Nuance names two Icahn delegates to its board: Brett Icahn, Carl Icahn’s son, and David Schechter, a longtime business partner.

PatientKeeper CPOE Rated the Easiest-to-Use CPOE Solution by KLAS Research

KLAS gives PatientKeeper’s CPOE system an ease-of-use score of 8.3 (out of 9), placing it almost a full point above Epic’s second-place score of 7.4.

WellStar launches massive project to merge data, improve access

WellStar Health System, a five-hospital system based in Marietta, GA, is covered by the local news as it begins a $125 million Epic implementation that will integrate its hospitals, urgent care centers, practices, home health agencies, nursing homes, and hospice.