Readers Write: Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center

Santa Claus, Flying Reindeer, and the HIPAA-Compliant Data Center
By Grant Elliott

This holiday period will see a rerun of many classic holiday movies, with one of my particular favorites being Miracle on 34th Street. A delightful film about the importance of retaining faith, even in the absence of any evidence – in this case, whether Santa Clause is real. As C.F. Cole puts it in the 1994 remake of the movie, “We invite you to ask yourself this one simple question: do you believe in Santa Claus?” following which all across the city people start putting up signs proclaiming, “We believe.”

As I walked around the exhibition floor of the 2013 mHealth Summit last week, I felt I was being asked to take a similar leap of faith. Specifically, that every company there was HIPAA compliant simply because they said so. For most, it would be part of their sales pitch. The term “HIPAA compliant” would be sprinkled liberally throughout the description of their service. For some, it was actually emblazoned on their wall posters. “HIPAA Compliant Data Hosting” and “HIPAA Compliant Mobile Development” are two I specifically recall.

When I challenged them on what they were actually doing to be HIPAA compliant, the answer was too often limited to, “We store our data in an encrypted database,” or, “We use a HIPAA-compliant data center.” Therein lies a key challenge within the SMB health tech marketplace. Too many companies simply do not know what it means to be HIPAA compliant. That is a particular concern given that recent changes in the law mean they are now federally required to be so.

Why is simply storing data in an encrypted database an insufficient response?

The objective of HIPAA is to protect the “confidentiality, integrity, and security” of electronic Protected Health Information (ePHI). While encrypting data can certainly be a part of this, it does not cover the many other aspects also required, including determining who has access to the data; how and where the data is being shared; who can edit or delete the data; and so on.

The HIPAA security rule alone contains 42 standards and implementation specifications spread across three groups – administrative, physical, and technical. This is separate from the HIPAA Privacy and Breach Notification Rules, both of which are part of the overall HIPAA compliance requirements.

Even if you scratch a little deeper into the companies that claim to offer HIPAA-compliant hosting services, you should pay particular attention to the wording they use. While they may be willing to sign a Business Associate Agreement, they deliberately stop short of promising to provide a HIPAA-compliant solution. This is because they do not control access to the application — the solution provider does.

The next time a company tells you they are HIPAA compliant because they store their data in a HIPAA-compliant database or data center, you are certainly welcome to take a leap of faith. In the movie, after Judge Henry Harper is presented with evidence that the US Postal Service is delivering letters addressed to Santa Clause, he declares that, “…since the United States Government declares this man to be Santa Claus, this court will not dispute it.” However, I doubt that the enforcement arm of the Office for Civil Rights will be as liberal in its judgments.

Grant Elliott is founder and CEO of Ostendio of Washington, DC.

Morning Headlines 12/18/13

Former Microsoft Executive Kurt DelBene To Replace Jeff Zients

CMS taps recently retired Microsoft VP Kurt DelBene to take over Healthcare.gov. DelBene was formerly in charge of the Microsoft Office division. He will take over for Jeff Zients, who stepped in to oversee the immediate fixes needed just after the October 1 launch.

HealthTech Unifies Brands as MEDHOST, Names Herrod as President

HealthTech, the parent company of MEDHOST, HMS, and Patient Logic, consolidates all of its businesses under the MEDHOST brand name and names Craig Herrod president of the new organization. Herrod was formerly the president and CEO of MEDHOST.

Paulsen Introduces Legislation to Streamline and Enhance U.S. Healthcare Delivery

Congressman Erik Paulsen introduces a bill that would require the use of clinical decision support tools by physicians when ordering imaging studies on Medicare patients.

New Approaches for Delivering Primary Care Could Reduce Predicted Physician Shortage

A RAND study looks at alternative models for delivering primary care services that would help alleviate the growing physician shortage. Researchers focused on the patient-centered medical home (PCMH) and the nurse-managed health center (NMHC) models and found that projected PCP shortages could be substantially reduced by increasing the use of these models.

News 12/18/13

Top News

The 2014 defense authorization bill, which has been endorsed by both the House and Senate, requires the DoD and VA to develop by the end of January “a detailed plan for the oversight and execution of the interoperable electronic health records with an integrated display of data, or a single electronic health record.” If the agencies miss the deadline they risk losing their ability to spend more than 25 percent of the estimated $344 million in funding needed for the project and will be required to notify military and veterans committees before dispensing any project funds in excess of $5 million. The system deployment deadline is end of 2016.

Reader Comments

From Lion: “Re: LinkedIn. OK, I’m curious. What is the deal with your profile picture?” There’s no faster way to peg yourself as a HIStalk Newbie than by asking Mr. H why a healthcare-related website features a smoking doctor or why I have hot shoes on my LinkedIn profile. I shared with Lion that I used to have the Inga avatar on my profile, but the LinkedIn police took it down, saying only photos were acceptable. I feel like such a renegade every time I see the sexy shoe photo on LinkedIn, though I’m now thinking it’s time to feature a new pair. Stay tuned.  

From Leaving T-System: “Re: big changes at T-System last Friday. Sunny Sanyal will leave the company in January, now looking for new CEO. Mikael Ohman, COO will be working on special projects only. Jim Mullen, SVP Sales is leaving to join Allscripts. Mark Horner is now SVP & GM over RevCycle+, already updated his LinkedIn page.” Varian Medical Systems has already announced that Sunny Sanyal will be taking over as SVP and president of its Imaging Components businesses as of February 7, 2014.  We appreciate T-System’s response to our inquiries:

It is with mixed emotions that we can confirm those changes are accurate. Sunny made the decision based on a personal need to work closer to his family and spend more time with his wife and three children. Sunny was very well-liked and respected at T-System and we will truly miss him. Sunny will remain as the CEO of T-System until the end of January. On a positive note, we have some additional, exciting changes that we would like to share with HIStalk readers. John Trzeciak, a long-standing board member and principal at Francisco Partners, will help with the transition and step in as the interim CEO of T-System while we search for a replacement. John has an extensive background in leading healthcare organizations and helping companies manage leadership transitions, and is already engaged in the T-System business through his role on the board. We are excited to announce that Tom Dunn has been named as Executive VP of sales and marketing. Tom had tremendous success as the sales and marketing VP at QuadraMed, helping the company achieve double-digit growth. We anticipate that he will drive further alignment of our new revenue cycle and documentation solutions. Jim is leaving to pursue new opportunities and we’re grateful for his contributions. Additionally, Mark Horner was promoted to senior VP and GM of our revenue cycle solutions while Steve Armond, T-System CFO, was promoted with additional responsibilities that include operations for client services and performance solutions.

From Dr. L: “Re: technology tip. I appreciated your review of the Asus MeMo Pad and the tip to find it on sale at Office Depot! I checked immediately and snagged the last one at my local store. I’m in a similar situation with an aging device, and it’s helpful to follow someone you trust to wade through the plentiful options. I was considering one of the new iPad Minis, but I agree the Asus delivers a lot of value and doesn’t feel like I’m skimping. You’d have a lot of grateful followers if you included a regular Personal Technology section on your blog. I recall a comment several years ago about your strategy to use your iPod Touch on WiFi instead of an iPhone, and I adopted that idea, too. Many thanks to you and your team for all you do each week. You’re the highlight of my day!” I appreciate those nice words and I’m still loving the Asus, especially for $120 (try playing this movie on it to appreciate the HD display.) I don’t buy a whole lot of technology, but I usually get excited about it when I do, because I’m a nerd, obviously, and a bargain hunter besides. It would be fun to have readers weigh in on their latest purchases and the deals they’ve found.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Lincor. The 10-year-old Nashville-based company’s patient engagement technology portfolio includes PatientLINC (touch-screen, in-room access to clinical information for caregivers and  patient tools, communication services, and entertainment such as on-demand video and games); ClinicalLINC (secure bedside EMR access via wall-mounted terminals);  MediaLINC (in-room patient access to educational materials and entertainment); and MobileLINC (patient access to medical information, educational materials, and entertainment on their mobile devices). All of these increase patient satisfaction and improve outcomes, helping hospitals meet Medicare-funded requirements for patient satisfaction, readmissions, and Meaningful Use. The company’s systems are used by 120 hospitals and 25,000 beds all over the world, and the world headquarters have been moved from Cork, Ireland to Nashville. Just this week the company announced another funding round, this time of $3 million, to expand in the US and EMEA. Thanks to Lincor for supporting HIStalk.

My YouTube cruise turned up this new and well-done video overview of Lincor’s LINC technology.

Acquisitions, Funding, Business, and Stock

HealthTech Holdings, which includes the HMS, Patient Logic, and Medhost brands, changes its name to Medhost and names Craig Herrod president. He previously served as president and CEO of the Medhost division.

Juniper Networks will acquire WANDL, a provider of software solutions for multi-layer networks, for $60 million. 

Sales

At Home Healthcare (TX) selects Procura Homecare software as its home and community care platform.

The Louisiana Senior Care Coalition chooses eClinicalWorks Care Coordination Medical Record as its population health management solution for advancing ACO objectives.

The VA St. Louis Health Care System will implement LiveData PeriOp Manager and integrate it with its existing VistA EHR.

Hospital Sisters Health System (IL) chooses Passport to provide RCM solutions and services to its 14 hospitals and network of affiliated facilities.

Intermountain Healthcare (UT) selects Elsevier ClinicalKey to provide electronic medical reference and knowledge-based information to its clinicians and medical libraries.

People

Medfusion names Vern Davenport (MModal) president and an equity partner.

Jack Redding (Mount Sinai Medical Center) joins Halfpenny Technologies as SVP of sales and marketing.

Oncologist Susan Desmond-Hellman, MD, MPH (UCSF) is named CEO of the Bill & Melinda Gates Foundation. One of her key policy recommendations to the National Academy of Sciences was creation of a knowledge network that would allow sharing patient data across research and clinical practice to tailor treatments to individual patients.

T-System appoints Tom Dunn (QuadraMed) EVP of sales and marketing.

Kathleen Sebelius announces the appointment of former Microsoft executive Kurt DelBene as senior advisor to lead and manage the Healthcare.gov project. DelBene was president of the Microsoft Office division, leading me to wonder if he’ll be typing many of his own memos in Word and if the memos will ever include the term “EHR.” Wouldn’t it be great if he were able to lobby his former employer to fix that annoying EHR/HER auto-correct issue?

Announcements and Implementations

HIMSS and HHS are recruiting for an “Innovator in Residence” to serve a two-year term to develop and implement a nationwide patient data matching strategy.

Susquehanna Health (PA) implements Summit Provider Exchange technology to provide bidirectional integration between its hospitals and physician practices running NextGen EMR.

Bay Area Medical Center (WI), which recently signed a letter of intent to partner with Aurora Health Care (WI), begins implementation of Epic, the platform already in place at Aurora.

The Illinois HIE and Missouri Health Connection will share clinical patient data.

Essentia Health-Virginia (MN) goes live on Epic.

Polk County Human Services (WI) adopts Forward Health Group’s PopulationManager to track and analyze the progress of patients with substance abuse disorders.

Palomar Health (CA) goes live with AirStrip ONE for remote EKG access, co-developed by the organizations based on Palomar’s MIAA (Medical Information Anytime Anywhere) platform that AirStrip acquired in mid-2012.

Oncology EMR vendor Altos Solutions and outcomes and analytics vendor COTA announce a partnership to sell value-based cancer care systems in the US.

In the UK, the Department of Health opens bidding to choose a new outsourcing provider for its Oracle HR management system, planning to replace McKesson after 13 years. The contract is valued at up to $730 million over six years.

UPMC’s Children’s Hospital (PA) will make its physicians available for second opinions to members of MDLIVE, which offers secure online access to physicians.

In England, NHS’s clinical research group uses QlikView to review clinical data quality and find unusual patterns.

Government and Politics

Medicare publishes a list of the 97 best and 85 worst hospitals for hip and knee replacements based on post-surgery complications and readmissions.

Congressmen Erik Paulsen (R-MN) and Jim Matheson (D-UT) propose legislation that would mandate the use of clinical decision support software by physicians receiving Medicare and Medicaid reimbursement when they order diagnostic imaging tests. The goal is to provide doctors with immediate feedback and recommendations for the appropriate tests to order. Sounds like a great idea that would likely create a few administrative nightmares.

Big pharma wants an independent investigation of the FDA’s computer security after a database containing clinical trial results and drug marketing plans submitted by drug companies was hacked last month. The drug companies are afraid their confidential information could end up in the hands of a competitor. FDA says the attacked system didn’t contain such information.

Other

ReferralMD Founder and CEO Jonathan Govette, like others, says that EMRs will become unbundled the same way that a myriad of Craigslist features turned into much better individual platforms started by others. Above is how he sees that happening (click the image to enlarge). Tip from @ForwardHealthGP.

HIMSS will hold an mHealth Summit Middle East in Abu Dhabi in May 2014.

StartUp Health and AARP release a report on digital health in consumers over 50. Like much of what’s packaged as mHealth, it’s mostly aimed at investors rather than consumers.

Saint Francis Hospital (NY) says its Meditech implementation forced it into bankruptcy with $50 million in debt, but adds that it was the hospital’s own poor financial implementation and not Meditech that cost it “tens of millions of dollars” of uncollectible revenue. The hospital will sell itself once it exits bankruptcy.

A group of New York City parents files suit against the city and the Department of Education, claiming that disruptive 6- and 7-year-olds are being sent by ambulance to area EDs in violation of the Americans with Disabilities Act solely because the schools can’t handle them. According to one mom, “It has caused a financial and emotional strain for me and my entire family. I feel that they sent my son to the emergency room as an excuse to not do their job. If my child acts up at home I cannot send my son to the hospital emergency room.”

A California newspaper profiles 20-employee, Sebastopol-based E-Health Records, which develops EHRs primarily for use in developing nations. It runs on Android-powered tablets over Amazon cloud services.  

A former HHS investigator shares tips for preparing and responding to a fraud and breach investigation. The investigator says one of the biggest mistakes an organization can make during an on-site visit is to make the investigator wait. I’m guessing he’s never had to be on hold forever while trying to follow up on a Medicare claim. Now that’s waiting.

Weird News Andy summarizes this story as, “Makes it easy to put on socks.” Doctors in China reattach a man’s severed hand to his ankle for a month while he regains strength for hand surgery. I’m not entirely buying it – the story sounds suspicious and the picture looks a bit Photoshoppy.

WNA also notes this non-weird story, which describes November’s US hospital admissions as the lowest in a decade, with the survey sample of 98 hospitals reporting that admissions were down more than four percent.

Sponsor Updates

• LRS releases the Mobile Connector for VPSX software, which allows users to print documents from any mobile device to any VPSX-defined output destination.
• Athenahealth will integrate Merge Healthcare’s iConnect Network into its athenaClinicals EHR to allow users to receive and view exam results and diagnostic-quality images.
• Wolters Kluwer Heath integrates its Health Language Provider Friendly Terminology with Epic EHR for mid-size to large practices and for hospitals.
• Greenway Medical adds Digital Assent, a provider of patient satisfaction survey solutions, to its online Marketplace of value-added partners.
• McKesson Episode Management releases 22 new episodes based on the PROMETHEUS Payment Evidence Informed Case Rate definitions, making it the first automated bundled payment solution to support the latest PROMETHEUS model.
• InstaMed has grown to 1,000 providers and has processed over $30 billion in healthcare payments in 2013.
• Razornsights employees celebrate the company’s Founder’s Day by building shoebox gifts in support of Operation Christmas Child.
• Minnesota’s Office of the Commission of Health certifies Sandlot Solutions a health data intermediary, authorizing the company to provide HIE services in the state.
• Maryland hires Optum/QSSI to provide project management and operational support for the Maryland Health Connection website.
• A Nashville paper spotlights Lincor Solutions and the launch of its patient engagement technology for hospitals and health systems.
• Health Catalyst board member and former Intermountain CIO Larry Grandia wins the 2013 Utah Governor’s Medal in Science and Technology.
• Fujifilm demonstrated its Synapse products and the showed the MU Stage 2 capabilities of its Synapse RIS at RSNA
• T-System authors a case study featuring its facility coding customer Memorial University Medical Center (GA), which boosted its ED revenues 20 percent through its coding initiative. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/17/13

athenahealth, Merge Healthcare Partner for Data Exchange

athenahealth and Merge Healthcare announce a strategic partnership that will connect Merge’s iConnect Network with athenahealth’s ambulatory EHR. The partnership will enable athena customers to view high-resolution images and exam results coming from Merge within their EHR.

Congress demands no more iEHR delays

Next year’s National Defense Authorization Act has language in it that requires the DoD and VA to develop an acceptable iEHR plan by the end of January 2014. The bill further stipulates that “Not later than October 1, 2014, all health care information contained in the Department of Defense AHLTA and the Department of Veterans Affairs VistA systems shall be available and actionable in real-time to health care providers in each Department through shared technology.”

HHS seeks an innovator to attack patient matching

HHS CTO Bryan Sivak says that the departments next innovator-in-residence will lead the search for better patient matching technologies to help HIEs return the correct patient chart in the absence of a national patient ID system.

Curbside Consult with Dr. Jayne 12/16/13

The vast majority of ambulatory organizations have either implemented EHRs or in the process. There are different challenges for large organizations and small practices. In talking with a couple of my peers in the physician lounge over the last few weeks, one challenge is the same: determining whether EHR projects should be clinical, operational, or IT initiatives.

When I went live on my first EHR nearly a decade ago, the project was under the IT department. It was run by analysts who knew very little about what happens at a medical practice other than what they had experienced as patients. I was in a solo practice situation at the time, but part of a larger ambulatory group who wanted to use me as a pilot for the EHR system they were planning to roll to everyone else.

The vendor was well known, however, more in the billing space than the EHR space (as was common at the time.) I was busy running my practice and seeing patients, so just went along with what the IT department recommended. At the time, I didn’t know much about project management and lacked the experience to know that things were going very badly.

The vendor sent a trainer who taught us on a different version than what we had installed, and no one caught it before I was in training. There was no training around how to modify office workflow or transform practice. It was merely a parade of templates and how to use them, hour after hour, until our minds were numb.

We struggled with the system for the first six months. It wasn’t just the software, but issues with wireless connectivity, signal interference from the tenant next door, hardware failures, and a lack of a support structure. Eventually we discovered the software had been omitting data during the note-signing process. That was what allowed us to put a nail in its coffin.

I didn’t know at the time how visible the project had been since I was just trying to muddle through while also growing a new practice and seeing patients. When we started the Request for Proposal process for a new vendor, however, it became clear that many eyes had been on the project. Based on the events of the failed pilot, hospital leadership ordered that the next ambulatory EHR initiative would not be IT driven.

The project team that was ultimately assembled had leaders from operational and process excellence disciplines. They quickly hired a physician champion who was in place before the system selection was final. One of the key drivers of the project was clinical transformation rather than just a paperless transition. This required a lot more work than a simple EHR installation. I didn’t understand at the time how important that was, but I certainly do now. By focusing on outcomes from the beginning, we were able to drive adoption in a way that we could not have otherwise.

Our IT resources reported to our project leadership through a charge-back arrangement, but it was clear that they worked for us. They were tasked with supporting the infrastructure and helping us maximize the application and its capabilities. The rest of the team focused on understanding clinical workflow and practice operations. At the same time, they learned the system so that they could pull it all together and identify the best ways to implement various features.

The arrangement served us well and allowed us to deploy the platform to several hundred physicians, but I’m not sure we could make it work in a different organization with different leadership. With that in mind, when people ask me the question about where ownership of EHR projects should sit, my answer has to be, “it depends.” It really does depend on the organization, its goals, its strengths and weaknesses, and the people involved.

Small practices see this acutely, especially those who are trying to implement EHR at this stage of the game. We’re clearly in the realm of the late adopters, and I suspect many of them wouldn’t be doing it at all if not for the Meaningful Use money or the fear of penalties.

I’ve seen a couple of my colleagues fall prey to the idea that these are IT projects and don’t need much operational or clinical involvement. I was recently asked to assist a practice that had signed up for a hosting arrangement which only covered infrastructure. They had a complete lack of understanding of what it takes to maintain a system even if they were using it in a vanilla fashion.

They didn’t understand the difference between an upgrade and a software patch, so needless to say, they hadn’t applied any since going live, yet were baffled when things in the system weren’t up to date. They didn’t attend any of the complimentary training their vendor offered. They have no idea what it takes to attest for Meaningful Use, yet plan to do so in the first quarter of 2014. I hated to break it to them that they didn’t even have all the required components installed, and that based on their continued use of paper telephone messages and dictation of office visits, they are a long way off from being true meaningful users.

I’d like to see EHR vendors perform an “informed consent” process for new EHR clients, especially the late adopters. They should spell out what it takes to be successful and warn clients of the risk if those precepts are not followed. They should explain the need to have involvement from clinical, operational, and technical leaders even if they all happen to be the same people in a small practice.

When clients fail to heed this advice, they should not demand that the vendor move heaven and earth to get them back on track. Although vendors have a vested interest in the success of their clients, practices have to bear a large part of the responsibility for success.

Over time and as our project has gone into maintenance mode, management of our EHR has transitioned to shared ownership between its clinical and operational owners and the IT department. The leadership has matured and learned from its experiences and we’ve all become stronger as a result. It hasn’t been easy, and I have colleagues at different institutions that have had completely different experiences, but I would never trade what we’ve been through together. What do you think of EHR project ownership? Email me.

Email Dr. Jayne.

Readers Write: My First Experience at the mHealth Summit

My First Experience at the mHealth Summit
By Kevin Lasser

I was inspired by Mr. H’s comments regarding his experience at the fifth annual mHealth Summit. So much so that I want to share my experiences from a little different vantage point.

I was kindly invited to not only speak on the topic of return on investment,  but also to talk to the press about my participation in mHIMSS Roadmap V2.0. Honestly, I am not sure I would have gone otherwise, but I am happy I went. Here are my thoughts.

Exhibit Hall

It was filled with very large and small companies with a few exceptions. I did not get a sense that the large companies were really doing much in the mHealth space. However, they were happy to be at the Summit because they may be able to form ventures with some of the smaller companies.

Those smaller companies seemed to be primarily looking for three things:

• Validation of product
• Money from “bankers”
• A venture with a larger company

Unabashed Product Pushes

These were also called breakout sessions and executive spotlights.

I did a breakout session on ROI. The thing I was most proud of was the number of audience members who approached afterwards who said, “I have no idea what you do. Can you tell me…..” I considered that a great compliment.

I witnessed one session where a panelist had company logos and diagrams in his slide presentation. He turned every question from the audience into a product pitch. Based on those in the audience rolling their eyes and lack of people who approached this individual afterwards, I would say I was not the only one sick of his vendor pitch.

When are people going to learn that being a self-serving shill pitching your products under the guise of education works exactly the opposite way? (i.e. nobody cares about you or your product – YOU TURN PEOPLE OFF.)

State of the Industry

As a synopsis, I believe the following as it pertains to the mHealth industry:

• There is a lot of confusion. It is hard to distinguish one app from the next.
• Exhibiting a “real” ROI to prospective clients is a must. If a vendor answers a question regarding ROI with, “Imagine if …” that is not a real ROI.
• That HIMSS designated talented people and monetary resources to mHealth is a very encouraging sign for the future.
• Technology needs to be invisible. Nobody really cares about the technology. It is what the technology can do to lower costs, keep costs contained, and improve healthcare.

Lastly, regarding Mr. H’s comment that he snickers any time she sees someone wearing Google Glass, personally, I get a little nauseous.

Kevin Lasser is CEO of JEMS Technology of Orion, MI.

Readers Write: Musical Commentary on Mr. H’s mHealth Conference Summary

Musical Commentary on Mr. H’s mHealth Conference Summary
By DJ LooptyLoop

I have to say, your synopsis of mHealth sounds a little grim indeed. Chain restaurants lacking personality? Boring. Destination developments? Depressing. Terrible weather? Bearable when inside, but energy-zapping nonetheless.

If you’ve listened to Arcade Fire’s 2010 album “The Suburbs,” you would immediately relate the above description to my favorite track on the album, Sprawl II. “Sometimes I wonder if the world’s so small that we can never get away from this sprawl,” sings frontwoman Régine Chassagne. “Living in the sprawl. Dead shopping malls rise like mountains beyond mountains, and there’s no end in sight.”

But the most disappointing of all is the abandonment of the African public health project speakers. Actually, the abandonment of all global health issues in general is pretty appalling. The mHealth slogan reads, “Where technology, business, research, and policy connect.” One would think the policy research might actually be reflected via keynote speakers who speak to global solutions at this scale. But then again, maybe they don’t exist yet.

Arcade Fire’s new jam from their 2013 Reflektor album “Here Comes the Night Time” touches on this global health issue abandonment. “And the missionaries tell us we will be left behind. We’ve been left behind a thousand times, a thousand times,” cries frontman Win Butler. “If you want to be righteous, get in line.” Well, I suppose it’s back of the line for the emerging countries at the mHealth Summit, though I did see an announcement that mHealth Alliance plans to transition its base of operations in 2014 from the UN Foundation in DC to South Africa, so let’s scratch that and bump them up to the middle of the line.

And, there’s NO MUSIC? I guess conference attendees could throw on Reflektor with just one earbud in whilst walking from speaker to speaker so as not to be completely antisocial. The album hooks listeners at the initial beat-drop with a catchy Talking Heads vibe mixed with the fearless imagination of Daft Punk. Though I’d be careful with the feedback from other conference-goers, if Win Butler’s prediction holds true. “And when they hear the beat coming from the street, they lock the door. But if there’s no music up in heaven [or in our case, the mHealth Summit], then what’s it for?”

On a separate note, I would like to think that LCD Soundsystem and Reflektor producer James Murphy would be beaming to know his music has had a far-reaching impact. He did turn down a job as a writer for Seinfeld to make music, after all. He clearly wanted to make an impact elsewhere – and that impact has reached all the way into the world of healthcare IT.

Morning Headlines 12/16/13

Cerner Corporation : Cerner Announces Stock Repurchase Program

Cerner announces a stock repurchase of $217 million, which at current stock prices would allow it to buy back 1.2 percent of the company’s outstanding shares.

Virginia Man Pleads Guilty to Mail Fraud in Scheme That Cost His Employer More Than $100,000

A former employee of The Advisory Board Company pleads guilty to fraud after cheating the company out of more than $100,000.

How Long Will Athenahealth Investors Keep the Faith?

According to Barron’s, athenahealth stock dropped last week because the company lowered its 2014 expectations and Jonathan Bush announced that he would be taking a two-month sabbatical. The company also announced that it will sell hospital clinical software to compete with Epic and Cerner.

Monday Morning Update 12/16/13

From Epic Fail: “Re: Epic. During the Q&A portion of a talk by Bernard Tyson (Kaiser CEO) at Epic today, an Epic employee stood up in front of a full Epicenter and asked Mr. Tyson if he thought that Kaiser would consider selling insurance in the future.” I will generously assume that the interrogator was one of Epic’s youthful, perfect-SAT savants who performed a quick scenario analysis and was shrewdly suggesting to Mr. Tyson that Kaiser’s business model might need to adopt to ever-changing healthcare requirements by focusing on other aspects of the corporate portfolio beyond its extensive insurance offerings. Either that or it was the typical Epic 24-year-old philosophy graduate who knows nothing about healthcare, but who has gained unwarranted conversational confidence from telling hospital people how to run their businesses using knowledge obtained from reading software manuals.

From Sharing is Caring: “Re: Kaiser. I just got this and it is very interesting… revolutionary, in fact. We can now share patient information between any Kaiser and all of the major hospitals in the SF Bay Area that use Epic-Sutter, Stanford, UCSF, and Alta Bates.” Shared Epic information includes just about everything from the patient, encounters, and results, omitting only flowsheets, images, smart forms, and scanned documents.

From The PACS Designer: “Re: RSNA highlights. The 2013 RSNA featured an interesting shift in how radiologists can interact with patients. Aunt Minnie listed five areas that drew the attention from attendees. TPD was pleased to see informatics among the list of the top five categories presented in the list for radiologists to consider for adoption.” According to the writeup:

In the past, big iron scanner introductions drew the lion’s share of attention at McCormick Place. One of the defining characteristics of the “new normal” for the RSNA meeting, however, may be the continued prominence of imaging informatics software in the exhibit halls and the scientific program. Indeed, market interest in these technologies seemed to provide a rare sign of hope amidst the overall malaise that still seems to be plaguing much of radiology.

That radiology maturation seemed inevitable – it happened in lab, where the intelligence moved from the instruments to the software managing the information the instruments created. Imaging costs, radiation exposure, remote viewing, patient image sharing, and radiology efficiency are all key issues that smart software (rather than the latest and greatest scanner) can improve.

Even hospital people like HIStalk readers don’t pay attention to published hospital quality data when making medical decisions for themselves. New poll to your right: is the term “mHealth” obsolete or unnecessary? I think it’s not only meaningless (as is “digital health”) but also unnecessarily divisive as companies and people wall themselves off behind that label instead of jumping into the mainstream of just “health.” That’s not a criticism of the companies waving the mHealth banner – we’re having the same identity crisis in “healthcare IT” as well as it becomes clear that our horizons should be “health” and not just “healthcare” and we try to figure out how population health management and wellness fit among our stodgy billing and order entry episode-based applications. Somewhere among all of that self-imposed digital segregation are consumers-slash-patients wondering why we have to make everything so provincial, fragmented, and complicated.

My latest grammar pet peeve examples, provided without explanation since they are hopefully obvious: (a) I went away for a couple days; (b) So I read a new book; (c) I eat breakfast everyday in the backyard. I’m also still frustrated constantly by lame articles with supercharged headlines that make them sound useful and insightful when they clearly aren’t, leaving me to feel as though I wasted my time with the journalistic equivalent of trying to make a meal of air-filled Cheetos and instead ended up still hungry and with embarrassing orange gunk on my lips (I’m often led to those worthless articles by Twitterers and Facebookers who seem to love being the first to link to awful healthcare IT articles.)

Welcome to new HIStalk Platinum Sponsor Proximare Health. The 10-year-old Savannah, GA-based company improves the referral process, with 3,000 users processing 25,000 referrals per month through its clinical rules-powered IRIS (Internet Referral Information System). The result: referrals are made to the most appropriate service, the appropriateness is validated from the Web-based system, eligibility and authorization are verified, patients are prioritized by condition, clinical documentation is managed, and results are shared among a patient’s providers. IRIS was built with the help of clinicians from nearly every specialty at Cook County in Chicago, who were trying to solve access challenges by making sure referrals were clinically appropriate, with the referral process managed by (and supported by) clinicians instead of a non-clinical utilization management department. Cook County’s results: (a) referral processing time was reduced from three months to 5.5 days; (b) 22 percent of the referrals were rejected as inappropriate; (c) referral volume increase sevenfold with fewer employees needed to manage it. Check out the short  videos covering order entry, rules engine, scheduling, document and results sharing, patient messaging, appointment preparation, interoperability, and business intelligence. Thanks to Proximare Health for supporting HIStalk.

Proximare had lots of its own YouTube videos, but I found one created by Portland IPA on how it uses the IRIS referral management system.

My first-generation iPad is getting long in the tooth to the point it can’t run newer versions of apps. I don’t use it enough to justify spending $499 on an iPad Air or even $299 for an iPad mini, so I did my research and instead bought an Asus MeMo Pad HD 7 for $119 from Office Depot on Friday. It’s amazing how much technology you get these days for so little money and in a thin, 10-ounce package: a high-definition display, super fast performance with 1 GB of DDR3 memory, front and rear cameras, dual speakers that sound really good, 10-hour battery life, highly responsive touch, 16 GB of storage, and a Micro SD card reader slot for cheap storage expansion. A seven-inch screen is plenty big when you have an HD display — even tiny text is crisp and playing a YouTube HD movie will just about take your breath away (I’ll use it to watch movies on planes, I’m sure.) Picking up my old iPad now is like hefting a yellowed, weighty encyclopedia volume from 1970. The MeMo Pad feels every bit as satisfying and well designed as my iPhone and Android is just as easy to use as iOS. Thank you, Google, for developing an economical and powerful alternative to the OS wares of Apple and Microsoft.

Cerner announces a $217 million share repurchase program. As a review, those programs involve companies using their cash to buy their own shares (which they often consider undervalued) on the open market. Or at least that they’ve announced plans to do so – companies don’t always follow through. Those purchases take shares off the market, which increases earnings per share even though overall earnings haven’t changed. They also increase executive bonuses tied to earnings per share at the expense of reduced cash that might have been spent on R&D or acquisitions. In other words, share repurchase programs don’t mean a thing despite the feel-good message that “we love our stock so much that we’re buying it ourselves.” Above is the five-year performance of CERN vs. the Nasdaq.

Jamie Stockton of Wells Fargo Securities provides the above slice-and-dice of hospital Meaningful Use attestations through 10/31/13. Meditech leads by far in total and net number of attestations, while Epic, Cerner, and McKesson have the highest percentages of clients successfully attesting. Trailing the pack in client percentages are Healthland, Siemens, and Allscripts.

Duke University Health System goes live with Strata Decision Technology’s StrataJazz for capital and long-range financial planning. 

A former IT director of The Advisory Board Company pleads guilty to defrauding his employer of $100,000 by approving the payment of invoices to a sham company he created for that purpose.

Barron’s says athenahealth’s stock drop late last week was due to concerns raised at the company’s investor meeting: (a) CEO Jonathan Bush announced that he will take a two-month leave next year; (b) the company guided next year’s earnings expectations down; (c) the company’s use of flattering but unusual financial measures that have given it a “thin-air valuation” of $5 billion; (d) athenahealth’s statement at the investor meeting that it will double its market opportunity by selling inpatient clinical software to hospitals and by doing so will “undermine the foundations” of Cerner and Epic; (e) the company has little choice for selling to hospitals because they are acquiring its practice-based customers and replacing athenahealth’s products. Athenahealth’s hospital plans apparently involve pre-certification and referrals.

Weird News Andy titles this story as “Now that’s what I call a gestation period,” although he notes that “the train never left the gestation.” Doctors find that an 82-year-old woman with stomach pain has a 40-year-old fetus inside her.

Here’s Vince’s Christmas edition of HIS-tory.

Contacts

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

More news, HIStalk Practice, HIStalk Connect.

Time Capsule: Marry in Haste, Repent at Leisure: Choose your EMR Soul Mate Carefully

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 January 2010.

Marry in Haste, Repent at Leisure: Choose your EMR Soul Mate Carefully
By Mr. HIStalk

Too much Meaningful Use has led me to Meaningless Musing. Here’s where it took me: the same handful of wrong reasons that convince people to marry unwisely also convince them to buy EMRs that will make them unhappy.

Let’s start with lust. A good-looking partner often leads to hasty and ill-advised EMR marriages. Providers swoon over the slick, sexy sales demo of an EMR that seems cool and popular. They can’t wait to get legally hitched and embark on a lifetime of what they expect to be never-ending passion and soul-mating, flinging themselves at each other several times a day.

Once the vows are said and the papers signed, the romantically foggy lens they’ve been looking through clears shockingly. In the unforgiving harsh light of day, the sultry enigma turns into an endlessly argumentative pest, or maybe a hot mess looking for company in their downward slide. Your new EMR is Bobby Brown to your Whitney Houston.

The most in vogue reason to marry an EMR is cold, hard cash. Certified EMRs come with a taxpayer-funded dowry. Golddiggers rationalize that it’s just as easy to marry someone rich as it is someone poor. You are Anna Nicole-Smith, trying to work up lustful yearnings for a billionaire who is 63 years your senior. And like Anna, EMR users may not live long enough to enjoy the fruits of their connubial labors. Once your $44,000 has been spent, you still have to enter orders and pay larcenous tech support rates for hardware maintenance.

There’s also the shotgun wedding, although that’s a hopelessly dated concept now that society’s moral linkage between parenthood and marriage has been fully disengaged. Still, HITECH-seeking hospitals and practices are sure to push doctors and EMRs together despite their inherent incompatibilities, unwilling to take no for an answer when ARRA money is on the line.

My college roommate’s mom had wise advice, triggered by his ill-disguised lust for all things female and fearing he would sully the family home by marrying the pregnant, drug-using dropout that he found endlessly fascinating (she even had a tattoo, unheard of back then). His mom told him to picture a person who is horribly disfigured and wheelchair-bound after being burned in a fire, requiring his constant care and attention. Would he still be happy to spend the rest of his days with that person? If not, she isn’t the one. She wasn’t, apparently.

If the sweet young thing of an EMR that’s catching your eye becomes old, cranky, or unreliable, would it still be attractive once the money is gone?

Doctors should not be shamed into EMR marriage because of societal pressure (all the other doctors are getting hitched), age (being an EMR spinster isn’t all that shameful), or lust (you can get free milk without buying the cow by messing around with computers as a hobby instead of actually using them in practice, i.e., like informatics doctors do).

Ditto getting EMR betrothed because you want a big wedding (the vendor’s celebratory dinner) or to rebound from a bad previous marriage (the EMR you de-installed because the vendor was unresponsive).

Breakups are ugly. They involve a lot of ill will, money, and wasted time and energy. Like they say, marry in haste, repent at leisure.

The right reasons to get EMR nuptialized is that you’ve finally found that special lifetime companion with whom you want to spend every waking minute, the one you admire, that special person with whom you will grow together, and that soul mate with whom you will share intimate thoughts through good times and bad. For better or for worse, for rich or for poor, till death (or vendor insolvency) do you part.

I bet my roommate’s ever-practical mom would add one last item: just on the off-chance that you’ve chosen unwisely, get an ironclad pre-nup.

Morning Headlines 12/13/13

AthenaHealth shares plunge on disappointing 2014 earnings outlook

AthenaHealth shares dropped 14 percent in after hours trading Wednesday on weak earnings forecasts ($0.98-$1.10 EPS) for 2014, that missed analysts estimates of $1.38 EPS.

Health Information Exchange Improves Identification Of Frequent Emergency Department Users

A study published in Health Affairs finds that using community-wide data from a HIE improves the ability to identify frequent emergency department users because visit history can be measured across unaffiliated hospitals. When analyzing HIE-wide data instead of site-specific data, 20.3 percent more frequent ED users were identified.

Cerner to take charge against earnings after arbitration ruling

Trinity Medical Center (ND) will receive an undisclosed settlement nearly two years after suing Cerner over accounting software purchased in 2008 that it claimed was "defective and did not deliver the promised benefits." Trinity was seeking $240 million in damages, while Cerner argued that damages should not have been higher than $4 million. The two agreed to arbitration hearings in October and a final settlement amount has now been reached. Cerner will take a $0.19 charge against its anticipated Q4 EPS of $0.35 to cover the loss.

Health Insurance Marketplace: December Enrollment Report

Healthcare.gov enrolled 258,497 in November, bringing the State and Federal total since launch to 365,000.

News 12/13/13

Top News

Athenahealth lowers FY14 guidance, projecting EPS of $0.98-$1.10 vs. analyst expectations of $1.38, sending shares down 14 percent Wednesday.

Reader Comments

From Norm: “Re: HHS Office for Civil Rights. I’m not surprised the OCR had issues with their internal security practices based on my past interactions. I’ve been through a couple of OCR audits and my staff and I spent almost as much time educating the auditors on the MU requirements and the meaning of various measurements as we did compiling the reports for the actual audit. I’m curious if that is also the experience of other HIStalk readers.” Readers are welcome to weigh in.

From Bobby Orr: “Re: Lifespan (RI). Having to borrow another $50 million during bad financial times to buy Epic may not have been the best idea.” Lifespan’s net earnings dropped from $41 million to a loss of $5 million in the most recent fiscal year excluding a one-time gain. The health system blames the “unique dynamic in play nationwide.” It paid its CEO $7.88 million in 2011.

HIStalk Announcements and Requests

In you’ve gotten behind on your ambulatory reading in the midst of the busy holiday season, here are a few highlights: MGMA requests end-to-end ICD-10 testing with physician offices. CMS will develop guidelines for the practice of copying and pasting in EHRs. Private physicians office are predicted to net profit margins of 12.7 percent for 2013. Only 17 percent of Medicaid EPs are meaningful EHR users, though 76 percent have been paid an EHR incentive. An autism module added to an EHR’s clinical decision support system improves screening. Brad Boyd of Culbert Healthcare Solutions considers the value of EHR optimization. Dr. Gregg wonders if health IT cares. If you take a moment to sign up for the HIStalk Practice email updates it will be like buying a Christmas present for your BFF (in this case me) and getting a present for yourself at the same time (come on, you know you’ve done that.) Thanks for reading.

On the Jobs Page: VP of Product Management.

Acquisitions, Funding, Business, and Stock

Streamline Health Solutions reports Q3 results: revenue flat, EPS -$0.50 vs $0.18.

Doctor on Demand, which offers $40 video chats with US-licensed doctors, closes $3 million in seed funding. Investors include athenahealth’s Jonathan Bush, Venrock, and Google Ventures.

Toronto startup Figure 1, which offers a photo-sharing app for physicians, raises $2 million in seed money.

Cerner will take a Q4 earnings charge of up to $0.19 per share (vs. expected earnings of $0.35) after an arbitrator rules in favor of Trinity Medical Center (ND). The value of the settlement wasn’t announced, but the hospital had sought $240 million, claiming that the Cerner Pro-Fit financial system it bought in 2008 was dysfunctional. CERN shares closed down 1 percent Thursday.

Sales

Estes Park Medical Center (CO) selects Summit Healthcare to integrate its Meditech HCIS and MEDHOST EDIS.

Butler County Health Care Center (NE) selects Access electronic patient signature and e-forms solutions to complement its Meditech rollout.

Springhill Medical Center (AL) chooses Allscripts Sunrise Surgical Care to manage the perioperative care process.

The 16-bed Crook County Memorial Hospital (WY) contracts with RazorInsights for its ONE-Enterprise Edition.

People

Alere appoints former US Surgeon General Regina M. Benjamin, MD to its board.

MidMichigan Health names Dan Waltz (University of Michigan Health System) as VP/CIO.

Joe Craver, president of the health and engineering sector of Leidos, resigns. The parent company of the split-up SAIC announced this week that it lost $7 million in the most recent quarter vs. a profit of $100 million year over year. Revenue in Health and Engineering dropped 20 percent, which the company attributed to completed projects, less new business, and shrinking hospital budgets. That division includes SAIC’s healthcare consulting acquisitions, Vitalize Consulting Solutions (July 2011, price not disclosed) and maxIT Healthcare (July 2012, $473 million.)

Announcements and Implementations

CommonWell Health Alliance will launch its interoperability services in early 2014 in Chicago; Elkin and Henderson, NC; and Columbia, SC.

Cerner will offer KidsHealth pediatric-specific discharge and after-care instructions within the Cerner Millennium Patient Education Content.

Practice EMR vendor drchrono releases an API that will allow developers to extend and enhance its platform.

Government and Politics

HHS Secretary Kathleen Sebelius reports that 365,000 individuals had selected plans from the state and federal marketplaces by the end of November, with November’s enrollment in the federal marketplace four times greater than that of October. Sebelius also reveals that the IT costs for the website totaled $677 million through the end of October.

HHS launched the Spanish version of the marketplace website last weekend.

Texas Medical Association urges CMS to extend the MU Stage 2 deadlines for another year.

A Kentucky doctor announces closure of his practice, erroneously blaming Obamacare (rather than ARRA) for requiring him to adopt electronic medical records. He says the change would be too expensive and would require thousands of hours of work to convert his paper records.

An OIG report on fraud prevention safeguards in hospital EHRs recommends that hospitals:

• Turn on EHR audit logging at all times (ONC responded that it will make this a certification requirement for vendors)
• Revoke permissions for users to delete or edit the audit
• Use audit logs to detect fraud, not just monitor for HIPAA violations
• Develop policies for using EHR copy-paste capabilities, issue warnings to users copying and pasting, and capture copy-paste activity in the audit log (CMS responded that it will develop guidelines on copy-paste use)

ONC will discuss findings from its patient matching initiative next week in Washington, DC.

Innovation and Research

Kaiser Permanente’s use of data analytics is helping to lower hospital mortality rates, according to CMIO John Mattison.

HIE data can identify ED frequent flyers better than a single hospital’s records, according to a Health Affairs-published study of 10 hospitals participating in the New York Clinical HIE.

Researchers at Johns Hopkins University are working with a Belgium-based technology company to developed a nanotechnology-based “lab on a chip” that would allow diagnostic testing to be performed anywhere.

Technology

In England, an NHS-funded patient safety project replaces paper charting of vital signs with automatic recording via an iPad app, which also calculates an Early Warning Score. Project developers Oxford University Hospitals was also awarded a grant to develop a system that links the EHR to the pharmacy packaging robot so that take-home meds can be prepared and delivered automatically, decreasing discharge delays.

Other

The Fire Department of NYC sends a medical bill, addressed to “unknown Asian” to The New School of New York, a 10,000 student college.  A spokesman for FDNY says their billing contractor is fixing the problem.

HIMSS names MedPeds (MD) a 2013 Ambulatory HIMSS Davies Award of Excellence winner for its use of EHR to improve the healthcare delivery process and patient safety while achieving a demonstrated ROI.

Horizon Blue Cross Blue Shield of New Jersey notifies 840,000 customers that their personal and clinical information has been exposed after two unencrypted laptops are stolen from its offices. 

Healthcare app platform vendor Happtique, which sells services to app vendors intended to improve provider confidence, suspends its certification program when an outside developer finds that apps in the first group Happtique certified two weeks ago store usernames, passwords, and data as easily exposed plain text.

A tweet by UCSF physician Bob Wachter, MD says that each ICU patient triggered an average of 1,156 alarms per day, leaving nurses with 2.5 million alarms to deal with in one month.

Weird News Andy suggests redefining “never.” In England, NHS reveals that 150 patients were harmed in six months by “never” events that included performing heart surgery on the wrong patient, removing a woman’s fallopian tube instead of her appendix, and 69 cases in which surgery implements were left inside patients.

Sponsor Updates

• Market research firm Radicati Group names AirWatch a “Top Player” in the Enterprise Mobility Management Market Quadrant.
• Cornerstone Advisors Group chooses three client-related hospital projects to support from its Cornerstone CAres charitable program funded by the company and its employees.
• The Orange County Register names Kareo a top workplace in the mid-sized company category.
• Clinithink wins the 2013 MediWales Innovation Judges Award for the development of innovative technology and outstanding contribution to the life science sector.
• Business NH Magazine names Bottomline Technologies to its Best Companies to Work For Hall of Fame for 2013.
• The HROToday Forum names Aspen Advisors and its big data platform Pando the Top Technology Innovator for 2013.
• Forward Health Group CMIO John Studebaker,  MD discusses the transition to value-based care in an MGMA on-demand webinar.
• Halfpenny Technologies discusses how access to actionable and complete lab and clinical results data enables health insurance organizations improve care management.
• DrFirst presents a case study profiling Edward Sobel, DO and David Krasner, DO and and their transition to e-prescribing.
• Craneware sponsors a December 17 HFMA webinar featuring Lake Regional Health System’s (MO) development of an audit management process. 
• The Boston Globe names Imprivata one of the city’s best places to work for 2013.
• Porter Hills Retirement Community Services and Home Care shares how it found flexibility and time savings through the use of the HealthMEDX Vision solution. 
• Liaison Healthcare predicts six 2014 trends that will make an impact on the healthcare and life sciences industries.
• Laura Kreofsky and Jason Fortin of Impact Advisors provide commentary on the recently announced extension of Stage 2 and Stage 3 MU deadlines.
• Lincor Solutions launches a portfolio of products for delivering patient engagement to hospitals and health systems.
• Truven Health Analytics releases MarketScan Oncology EMR Database for oncology-focused research studies.

EPtalk by Dr. Jayne

I enjoyed reading Rebecca Sutphen’s piece on bringing up family health history during the holidays. Not only is it important for individuals to understand their family history for genetic purposes, but it’s good for the younger generations to be aware of conditions their older relatives may be treating. Knowing that Uncle Sal is diabetic may be helpful if he starts acting funny on Christmas Eve and he hasn’t been hitting the eggnog.

It can also be important to understand relatives’ end-of-life plans. I encourage everyone to discuss their wishes with family, especially if they don’t have an Advance Directive in place. The holidays may be the only time families get together and talk about these important issues. Good information on talking points can be found at FamilyDoctor.org.

I’ve received a lot of correspondence regarding Monday’s Curbside Consult discussing the CMS changes to Stage 2 and Stage 3. I got quite a few questions about the three years of Stage 2 for those practices that started Meaningful Use in 2011 or 2012. At this time, participating providers and hospitals will have to complete all three years and there won’t be any skipping allowed. All of the CMS materials will need to be updated, but I’m sure they will be clarifying this.

As CMS tries to use information from Stage 1 and Stage 2 to inform Stage 3, a reader shared John Halamka’s recent blog (written before the announcement) about rethinking certification. Make no mistake, the recent timeline shift does not do anything to delay the need for hospitals and providers to have their certified 2014 software live so that they can attest in 2014. I agree with his assessment that the certification criteria are “overly burdensome…. And disconnected from the attestation criteria.” Some of the certification criteria have also forced vendors to modify functionality in ways that fracture provider workflows and make it more difficult to provide care.

Since I use several different big-name products, I know that there are some nuances in the ways that vendors implement these requirements, but some of them are particularly difficult to implement with good usability in a way that actually supports clinical care. I visited one of my providers the other day and listened to what can only be described as a tirade against all the bells and whistles that don’t do anything to help him provider better care to his patients. I agreed, but also pointed out that it’s bigger than Meaningful Use and EHRs, though – there are many things that have happened in medicine during the last few decades that do little to improve patient care.

E&M coding rules, draconian audit methodologies, Medicare RAC hit squads, pre-payment audits, and the rise of defensive medicine have done little to improve care. In my experience as a patient, I think that patient portals are the best thing since sliced bread. I enjoy being able to use secure communications to take care of issues without having to take phone calls at work or schedule time off.

However, in looking through communications with my physicians over the last two years, not a single question has been medical. I don’t think it’s because I’m a physician and am making my own medical judgments. My clinical history looks very similar to most women in my age group and it’s not that complicated. Looking at the topics of communication across a couple of practices reveals: requesting a mammogram order with a wet signature for no good reason other than the imaging center wants one because it’s afraid of an audit; dealing with wacky insurance rules that require me to reschedule a visit because it’s one day earlier than the insurance plan allows; requesting to have a prescription rewritten with specific directions because my pharmacy benefit manager disagrees with one that meets all of the Surescripts guidelines for correct and accurate prescribing; and dealing with a co-pay issue because the office didn’t understand that I don’t pay one for preventive visits. There are more, but the theme is the same.

My fear (which I think is well founded) is that things are only going to get more complex. To make things more interesting, like many Americans, I have brand new health insurance starting after the first of the year. Now I get to figure out all the nuances that took me years to figure out with my previous carrier. At least we can all sympathize. It’s looking like 2014 is shaping up to be a very interesting year indeed.

A shout-out to my friend Dr. Doug Farrago of the Authentic Medicine Gazette for sharing this quote of the week which sums up my recent challenges as a CMIO:

I never did give anybody hell. I just told the truth and they thought it was hell.

Contacts

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

More news, HIStalk Practice, HIStalk Connect.

Morning Headlines 12/12/13

Kathleen Sebelius calls for HealthCare.gov contracting, management investigation

HHS Secretary Kathleen Sebelius has asked the HHS Inspector General’s office to investigate the failed rollout of Healthcare.gov.

Open-source community helps with emergency VistA patch

A Georgia Tech graduate student working on his master’s degree thesis uncovers a security vulnerability in VistA that could impact patient’s medical treatments and compromise patient data. He brought the problem to the VA, but received no response. Next, he brought his findings to OSEHRA, a nonprofit open-source EHR developers forum. OSEHRA coordinated efforts fix the issue and, in partnership with VA, ensured that the patch was installed across all VA facilities.

CommonWell Announces Launch Geographies and Participants

CommonWell announces the first geographic areas that will be included in its vendor-backed HIE effort: Chicago, Illinois; Elkin and Henderson, North Carolina; and Columbia, South Carolina.

Data Helps Drive Lower Mortality Rate at Kaiser

John Mattison, MD, CMIO of Kaiser Permanente says that a large part of Kaiser’s lower than average mortality rates are "directly related to how we use data and integrate data.” He predicts that by 2020 ten times more medical research will be generated by by big data analytics than by conventional models of clinical research.

From the mHealth Summit 12/10/13

I’ve been at the conference for two days and it still doesn’t have a clear identity in my mind. Others told me the same thing – it’s unfocused and hard to describe, much like “mHealth” itself.

The term “eHealth” was coined a few years ago and was quickly hijacked by companies and people who didn’t have much credibility in the non-eHealth world. Everybody else piled on to avoid being seen as passe’, turning eHealth into a frothy marketing term that meant whatever you wanted it to mean. It didn’t take long to shake out the 80 percent of that movement that was unsound and absorb the rest into the mainstream of healthcare IT. The term was retired because it was no longer necessary.

The concept of mHealth as a separate area of focus needs to be retired. It no longer means anything. It was born when so few healthcare people were using smartphones that it seemed like a geeky special interest that required intentional cultivation.

Since then, the mission has been accomplished. Mobile is a given. Nobody spends their lives perched in front of a desktop PC or even a “mobile” computer on wheels. You’re mobile if you use a connected smartphone, laptop, or tablet. That’s pretty much everybody, which means the mobile device itself as a common thread of interest is no longer compelling.

The mHealth Summit features topics that have little in common. Some themes might be:

• Consumer-facing apps
• Global and population health outreach
• Clinician access to systems and information
• Connected health devices and real-time body monitoring systems
• Non-mainstream and often naive ideas about transforming healthcare and health
• Startups and investors (by far the overriding theme)

The HIMSS conference has a lot of subject areas as well, but it’s so big and the content so deep that any attendee can create their own track and feel fulfilled. Most of them are hospital people, but those from other work settings (practices, research, technology, etc.) can find plenty to keep them busy and justify their employer’s cost to send them.

Not so at the mHealth Summit. Few people make “mHealth” their living, so most of what is being presented is irrelevant to any given individual. If you are interested in physician mobile access to enterprise systems, you aren’t likely to care about SMS health messaging in Africa or some cool gaming app for nutrition. The fact that they both run on smartphones is irrelevant.

Most of the people I saw at the conference seemed to be wandering around in a daze trying to figure out what they should be doing. I felt the same way. I spent time in the exhibit hall trying to find something that interested me and came up short for the most part. I couldn’t find many compelling educational sessions, especially after ruling out those that didn’t involve a vendor.

Health 2.0 offered a co-located afternoon track. Someone remarked to me that the mHealth Summit probably needed Health 2.0 more than the other way around. Both place heavy emphasis on startups, mostly those selling to consumers, sometimes for passionate health-related reasons but often because their people and products are too rough around the edges to sell into the conservative hospital and physician practice market.

Both conferences seem to highlight companies that are just as interested in selling themselves as their products. The mHealth Summit feels like a speed-dating event for questionable companies and wary investors, with all of us other attendees there trying to educate and entertain ourselves around the commerce-driven mating rituals. Maybe that’s what the mHealth Summit should morph into – a conference purely for startups and investors. They dominate the proceedings anyway and that would at least allow prospective attendees to plan accordingly.

I wonder how many of this year’s attendees are first-timers and where the returning attendees work. My speculation is that people from broad healthcare IT go once and don’t find a reason to come back, while the company and investment people dutifully return hoping to raise or invest money, find partners, and recruit staff.

It’s interesting to me that the mHealth Summit is run by HIMSS Media, which probably explains the both heavy presence and promotion of its own advertiser-driven products and the appearance of vendors in nearly every aspect of the conference, including opening keynotes by company executives who were mostly pitching their companies. Even the wildly commercialized HIMSS conference doesn’t usually give company CEOs timeslots in the first morning’s session where attendees don’t have alternatives (both conferences, however, shut down the educational track for blocks of hours to herd attendees into the cash machine of the exhibit hall.) The pre-HIMSS mHealth Summit featured keynoters from the National Institutes of Health or heads of foreign governments rather than VPs from Qualcomm and AT&T.

A few random observations:

• The biggest racket on the planet is Freeman, the company that provides exhibitors with carpet, chairs, and technology. Need a single cheaply made chair for your booth? That’s hundreds of dollars, probably 10 times or more to use the chair for three days than buying it outright. If you want to plug in your laptop, that will be $100 per day for the power strip and connection, please. Our tiny booth had only a chair and table and it will end up costing me over $1,000, Lorre says. I knew it was expensive, but somehow seeing it on an invoice brings it home.
• Maybe I’ll get over the urge to snicker every time I see someone walking around in public wearing Google Glass, but I don’t think it will be any time soon.
• The conference badges were slick, including embedded RFID chips instead of barcodes for booth scanning, but the font was unreadably small unless you planted your face directly into someone’s chest.
• Imprivata was giving away those gloves with the little metal things on them that allow you to use your mobile device in the cold. Several people asked me where I got mine.
• Like every other conference, most of the people in the booths were screwing around with their phones at any given moment. I saw several booths in which people walked up, waited, and finally grabbed a couple of pieces of collateral and walked away, all while the booth rep intentionally ignored them by staring into their phones.
• I heard quite a few complaints about the food service set up inside the hall. Apparently the pre-made sandwich, chips, and a drink cost $15. I feel pickpocketed every time I attend a conference and have no alternative to overpriced concessions that still require waiting in line. Lunch alternatives were nearly non-existent – the open-air restaurant outside the exhibit hall had a sign up that said “Now Serving Breakfast and Lunch” and I was hungry enough to be willing to pay $16 for the salad and soup bar, but promptly at 11:00 they stuck out a sign that said they were closed until the next day, leaving only the sports bar.
• I was surprised to gaze down the Innovation Zone exhibit area and see almost all men in dark suits, making it look like a Secret Service convention. I didn’t picture the environment there as being heavy on suits, so I don’t know if these were the startup people, investors, or attendees who just don’t feel complete without a tie.
• The best discovery is that right across from the Gaylord is a CVS drugstore well stocked with snacks and drinks that, unlike everything else in National Harbor, don’t carry a “you don’t have a choice” surcharge. They even had pre-made sandwiches and salads that looked better than the ones in the Gaylord at half the price or less.

Lorre wants to thank our exhibit hall booth neighbors from Endeavour, who helped her hang our banner and took messages from booth visitors while she was away from the exhibit hall running the DocuSign webinar. On the other side of our booth, the Kore rep let her plug in her laptop to charge since she knows I would have vetoed $100 a day for a power strip. Across the aisle, Geoff from AT&T was really friendly and tracked down our expensive Freeman-provided chair that someone in another booth took because they hadn’t rented their own. We don’t know anything about exhibiting, so Lorre appreciated the support from folks who weren’t new to it.

I took a look at MediVu, which offers a tablet-based EMR view that gives doctors the big picture of all their patients. It was pretty cool, although I bet interfacing to the EMR would be ugly.

I saw a brief demo of MediSafe, a family-oriented medication adherence solution that lets you visually follow your own medication schedule or monitor the adherence of a loved one. They sell the software and partner with another company to provide the pill bottle sensors.

AT&T demoed some cool solutions in their ForHealth lineup. EverThere is a hands-free personal monitoring device that monitors a person’s activity with fall detection and connects to a call center. The real-time graph was pretty slick – it was easy to detect changes in movement pattern or a fall to a horizontal position.

I also looked at Toggle from AT&T, which allows enterprises to create a virtual desktop-type setup on a person’s individual mobile device to allow them to securely run enterprise apps in BYOD situation.  They’re offering a 30-day free trial, according to Lorre’s friend Geoff who gave me the demo.

The VGo mobile telepresence robot was interesting.

mHealth Summit Observations from Anonymous CIO

Monday

I saw the HIStalk booth and stopped by and introduced myself to Lorre. I thought she represented the site very well.

This is my first time at this conference. I came with a set of expectations that does not seem to align with what I’ve seen. In my view, a mobile health strategy for a provider should address all four quadrants found below (sorry for the rudimentary examples in each category).

Much of what’s been presented at the educational sessions and on the exhibit floor focuses on the Patient Health quadrant. A tiny bit addresses the physician component. (I thought that the Wired Magazine Health Conference in NYC a month or so ago did a better job, in a shorter, less expensive forum, providing a greater breadth of info – and much, much better food included in the price.)

I am surprised to see how few — relative to vendors or developers – hospitals and health systems seem to be represented here. When at HIMSS, I can barely move five feet without encountering someone I’ve worked with during the decades of my career. Here, I’ve found barely one. So it begs the question, what are providers doing about developing a mHealth strategy?

Some of the sessions I attended were completely mislabeled. As an example, a session called “Adopting mHealth Strategies to Remain Competitive” was nothing more than four independent vendors promoting their wares. (I notice that this conference does not ask for participant feedback on each session – probably a good thing).

The Executive Breakfast that I paid additional money to attend, entitled “The World is My Waiting Room” I thought would be chock full of discussion about patient outreach in a variety of ways, seemed like nothing more than friendly banter amongst the presenters. The “breakfast” was nothing more than croissants, yogurt, fruit and coffee – none of it remarkable. I left disappointed and hungry. I paid to attend tomorrow’s breakfast as well. I’ll eat before I go.

Weather apparently kept more than a few presenters away, so maybe this isn’t the right time of year for this forum.

All your comments about the venue and location itself I agree with.

So maybe I expected too much? Maybe this part if the industry is too new to provide what I’m looking for? I don’t know. What I do know is that in my new role in the health system into which we’ll be merging, I’m tasked with developing and implementing a Phase One mHealth strategy, and thus far, this conference isn’t giving me much to work with.

Tuesday

For whatever reason, the sessions I attended seemed more interesting than yesterday’s. In most cases providers, were interspersed with technology providers. A lot more real-life stories of how to deploy technology for the betterment of a certain patient population were told.

At the Executive Breakfast, Nasrin Dayani from AT&T for Health and David Levin from Cleveland Clinic brought real passion to the discussion about mHealth’s role in patient engagement. Still stumped as to why I had to pay to attend this session – which was full. This panel seemed just like all the others in content and message.

At today’s keynote, both Astrid Krag (Denmark) and Muhammad  Yunus (Bangladesh) did a great job speaking about how technology improves a population. Is it wrong to say I admire what I perceive as somewhat homogenously populated countries who seem to be able agree on an agenda to actually get things done? Eric Dishman’s personal story was effective too.

One of the two most significant sessions for me was “Aligning mHealth to Your Strategic IT Plan.” That’s just what I showed up to this conference to hear and I took away really useful info.  

At “Streamlining Chronic Care: Keeping the Patient and the Bottom Line Healthy,” I’m not sure they effectively covered all of that, but all presenters were really good and spoke to actual experience in the mHealth space.

My other favorite session was “Lessons Learned from the mHealth Grand Tour.”  It showed what breaking down the walls of politics and connectivity can do to achieve something great for a specific population group, in this case, diabetics,  in mHealth.

Sometimes at these events, I’ll buy my lunch and look for random folks join at a table to start a conversation. I actually picked a great table and the conversation was flowing. It got even better when Kyle Samani sat down with is Google Glass.

Morning Headlines 12/11/13

Timeline Changes for Meaningful Use

Brian Ahier publishes a revised Meaningful Use Attestation table that helps clarify the impact ONC’s stage 2 extension will have.

Separating EMR Fact from Fiction: Are Technology Platforms Predictors of Clinical Success?

A recent KLAS report finds that healthcare providers do not believe that the underlying technology an EHR is built on is a true predictor of its capability or clinical success.

Gov’t Health IT Report Expected in Early 2014

The FDA, ONC, and FCC will issue a joint report early next year outlining the federal government’s strategy for promoting innovation in health information technology.

OIG: OCR Needs to Improve Compliance

A report from the Office of the Inspector General says that HHS’s Office for Civil Rights, which is responsible for enforcing HIPAA, has failed to comply with a number of federal cyber security requirements.

News 12/11/13

Top News

Practice Fusion closes a $15 million Series D round led by Qualcomm Ventures, bringing the company’s total funding raised to date to $149 million.

Reader Comments

From Lorre: “Re: mHealth. So many people were coming up to me asking if I was Inga that I finally had to make this sign. I am going to get a well-made one for HIMSS. At one point today I showed someone my shoes and he said, ‘Yeah, you’re not her.’” Lorre was holding court at our little HIStalk booth at this week’s mHealth conference. I’m going to recommend that she not only get a better sign for HIMSS but step up her shoe attire, just to confound suspicious readers.

From Helen: “Re: mHealth Summit. I met Lorre – she rocks!” Lorre enjoyed meeting those (few) readers who attended the conference this week. I’m not sure it was relevant enough for a return next year, but we’ll see.

From ASMD: “Re: floppy disks. New York Times or Dilbert?” An article points out that government is not the most sophisticated technology user, noting that The Federal Register often receives submissions from federal departments via 3.5” floppy disks.

Acquisitions, Funding, Business, and Stock

HealthLoop, which offers an automated patient follow-up solution, raises $10 million in Series A funding led by Canvas Venture Fund. The company’s CEO is Todd Johnson, the former CEO and president of Salar.

IMS Health, a big data firm that aggregates and sells large databases of de-identified healthcare data, acquires Pygargus, a Swedish health analytics firm. Bloomberg, by the way, reports that IMS Health is considering an IPO in 2014 and  may seek a company valuation of at least $8 billion.

Sales

The Indiana HIE selects AT&T’s healthcare Community Online information exchange platform for clinical messaging and medical record sharing.

Crystal Run Healthcare (NY) selects the Health Catalyst data warehousing and analytics platform.

UF Health Shands (FL) contracts with Besler Consulting for its Transfer DRG recovery services.

People

HMS Holdings names Joel Portice (Verisk Health) divisional president of government solutions and corporate strategy and Douglas M. Williams (Aveta) divisional president of commercial solutions.

Teleheatlh solution provider AMC Health appoints Lisa J. Roberts (Viterion Corporation) SVP of its government market division.

Juan Diaz (Association Capital Resources) joins The HCI Group as SVP/general counsel.

Bobbie Byrne, MD is named SVP/CIO of Edward-Elmhurst Healthcare, created by the merger of her former CIO employer Edward Hospital and Elmhurst Memorial Healthcare. She will also have responsibility for the facilities and construction departments at Edward as well as the two locations of the Edward Cancer Centers.  

Next Wave CONNECT names Doug Cusick (HP/IBM), Robert Cothron (Singing River Health System), Becky Heflin (IBM), John McDowell (Oslo’s), and Sherry Reynolds (HHS) to its community management team.

Announcements and Implementations

St. Mary’s Health Care System (GA) makes the Epic MyHealth portal available for hospital patients.

Billings Clinic (MT) implements Omnicell automated dispensing cabinets integrated with Cerner Millennium EHR via the CareAware iBus.

Mercy Medical Center (MD) deploys BridgeHead Software’s Healthcare Data Management for the protection of its Epic system data.

PA eHealth, eVantage Health, and Caradigm will complete the pilot for their HIE project in early 2014.

The Mount Sinai Health System (NY) will use $5 million in funding from the NYC Economic Development Corporation to establish the Mount Sinai Institute of Technology. The Institute will initially focus on digital health technologies, biologically integrated technologies, and prescription technologies.

Government and Politics

The FDA, ONC, and FACC will release a report early next year outlining strategies and recommendations on an HIT framework that promotes innovation, protects patient safety, and avoids regulatory duplication.

Do as I say, not as I do: the OIG finds that the HHS Office of Civil Rights failed to comply with certain federal cybersecurity requirements for the IT systems used to store HIPAA-compliance investigation data. The OCR says all deficiencies have now been corrected.

Other

Almost 76 percent of the largest not-for-profit senior living organizations are implementing EHR technology and 83 percent are implementing point-of-care systems.

KLAS finds that despite vendor claims of the importance of technology differentiation, providers find that technology platforms do not accurately predict EMR capabilities or clinical success.

Also from KLAS: StatRad, Rays, and TRS earn top scores for overall customer satisfaction in a report on teleradiology in the ED.

Thanks to Brian Ahier for forwarding an updated graphic that clarifies the newly proposed timeline changes for MU. Brian notes, “I think the important point here is that although there will very likely be more changes to come, healthcare organizations and providers should not count on any delay or changes but prepare for plans to proceed under this current current regulatory framework.”

Further thoughts on the MU Stage 2 extension: the Stage 2 timeline is unchanged, as Brian’s graphic depicts. Just because Stage 3 has been pushed back a year doesn’t mean that ONC is ignoring concerns about Stage 2 as CHIME and other groups seem to assume by their ballistic reaction to the Stage 3 announcement. ONC’s decision-making process has been thoughtful, participative going back to when Farzad was named National Coordinator. ONC announced the Stage 3 decision Friday and mentioned this week that it will offer a public comment period for the regulatory strategy being worked on with HHS and FDA when that report comes out in in early 2014. Those events show show that nothing has changed just because Farzad has moved on – ONC is listening and won’t blindside anyone with salvos of dictatorial imperatives. The pundits are also missing another important point – decoupling product certification from MU gives vendors more predictable certification updates and the change to give input. Vendors can deliver what the market wants (usability and patient safety features, for example) instead of chasing certification checkboxes.

A Massachusetts man spends about $10 and 20 minutes to make a prosthetic hand for his 12-year-old son on a 3D printer using plans he found on the Internet. The estimated cost for a traditional prosthetic hand is $20-$30,000.

Sponsor Updates

• API Healthcare reports that more than 250 hospitals and other healthcare providers have chosen its ShiftSelect to automate staffing and scheduling processes.
• HMS will integrate Medi-Span Controlled Substances Drug File from Wolters Kluwer Health into its Prescriber Eligibility solution.
• Visiongain includes AT&T and Airstrip on its list of Top 20 Mobile Health Companies for 2014.
• Anthelio Healthcare Solutions and Encore Health Resources align to promote economies of scale and expand available services.
• Certify will participate in next month’s IHE NA Connectathon 2014 in Chicago.
• Caristix posts a white paper on managing predictable outcomes and margins with  HL7 integrations.
• Iatric Systems hosts a December 12 webinar on integrating EHRs with Welch Allyn vitals.
• Billian’s HealthData shares its list of the five most popular health market reports for 2013.
• Twenty-nine percent of patients participating in the 2013 Connance Consumer Impact Study rate their most recent hospital billing experience with top satisfactions scores, though 19 percent express full dissatisfaction.
• PeriGen hosts a December 11 webinar featuring the company’s chief clinical officer Thomas Garite, MD and a discussion on problems with Category II fetal heart rate problems.
• KLAS gives 3M Health Information Systems the highest overall performance score among vendors for the 360 Encompass System, 3M’s inpatient CAC technology.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 12/10/13

Practice Fusion Grabs Another $15M for Electronic Health

Free cloud-based ambulatory EHR vendor Practice Fusion raises another $15 million on its series D round, bringing the round total to $85 million and its lifetime fundraising to nearly $150 million.

Royal Berks suspends Cerner contracts

In England, Royal Berkshire NHS Foundation Trust has suspended two contracts it has with Cerner worth $10 million. The contracts were awarded in 2012 for 10 years of customer support for the Trust’s Cerner Millennium EHR. The contracts were cancelled due to due to higher than anticipated operating costs associated with the project. To bring costs back in line, the Trust cancelled the support contracts and plans to train internal staff to fill the support roles instead.

IMS Health Announces Acquisition of Pygargus

IMS Health, a big-data firm that aggregates and sells large databases of de-identified healthcare data, acquires Pygargus, a Swedish health analytics firm.

You’re Getting Too Much Healthcare

The Atlantic discusses overconsumption of healthcare services in America. According to a recent Institute of Medicine report, 30 percent of total healthcare expenditures in the US are for unneeded care. 42 percent of doctors surveyed in a 2011 Archives of Internal Medicine study reported thinking that their patients were getting more care than necessary.