News 6/18/14

Top News

Nuance is reported to be discussing a sale of the company to Samsung, with shares rising nearly 10 percent Monday and a bit more on Tuesday on the rumor. One might speculate that the recent addition of two of Carl Icahn’s people on Nuance’s board may have heightened the money-losing company’s interest in finding a buyer. Samsung already uses Nuance’s voice technology in its devices (as does its arch nemesis Apple, for which Nuance provides Siri), but would probably have little interest in Nuance’s considerable healthcare businesses that includes Dragon speech recognition, transcription, clinical documentation and coding, and image sharing. Highly paid Nuance CEO Paul Ricci ($78 million compensation in three years and shares worth $60 million) swelled Nuance with a bunch of acquisitions in two main sectors (healthcare and mobile) and has declined to focus its corporate strategy despite lackluster results, while Icahn likes selling off individual parts to create shareholder value. It will be interesting to see whether cash-rich Apple will be threatened enough by the rumored Samsung interest to make overtures of its own for the $6 billion market cap Nuance or perhaps part of it if Nuance is willing to break it up.

Reader Comments

From Joe: “Re: rumored Nuance acquisition talks. Ironically Domino’s announced its Nuance-powered ‘order your pizza by voice’ app today. There’s probably a ‘Pete’s a delivery boy’ misrecognition joke in there somewhere.” Domino’s, which like Walgreens and other retailers is making technology an integral part of its product, says that typing characters is becoming obsolete and its app (which features order-taker “Dom”) will differentiate it from competitors. It’s refreshing to see how non-healthcare companies use technology to improve their business and customer experience given obvious, non-government mandated incentives (i.e., profit) to do so.

From KayCee: “Re: Epic. I asked Epic about whether their name should be capitalized.” KayCee inquired of Epic, “Only Mr. HIStalk seems to be defending the position that an all-caps reference reflects ignorance” and asked the company’s position. Epic’s response from spokesperson Shawn, who said the email was forwarded to him because, “We don’t have a marketing department,” states “EPIC” was used in an old version of the logo, but that was changed in the late 1990s and “Epic” is correct. I enjoyed Shawn’s erudite conclusion, which is more tolerant than mine: “Without judging whether it represents ignorance or an historical homage to our early years, we’re pretty forgiving and accepting of the misuse.” I will stubbornly point out that Shawn said that writing EPIC constitutes “misuse.”

From Art Vandelay: “Re: Walmart opening clinics. The mind begins to work when combining this with information from Castlight Health: there is no state exchange or ‘caid expansion, Austin, TX has very expensive office visits but isn’t representative of the state, Walmart enters with a low-cost alternative. Most large health systems aren’t worried about retailers like Walmart, CVS, and Walgreens entering the market. It is less about primary care and more about interrupting their ecosystems for chronic care management – how will the data come back, will they use similar protocols, will patient education materials and the plan of care align.” Walmart will open its second and third company-owned clinics in Texas, expecting to expand that to a dozen this year in a pilot project. They will offer primary care services for $40 and will treat insured Walmart employees for just $4, but they won’t take private insurance, only Medicare and Medicaid down the road. The clinics will be staffed by nurse practitioners and managed by workplace clinical operator QuadMed.

HIStalk Announcements and Requests 

Lorre has a lot of webinars going on and could use more CIO-type reviewers to fill out a quick evaluation form after watching a recording of the rehearsal that lasts about 30 minutes. I will send a $50 Amazon gift certificate as my thanks (or just my thanks to the folks who can’t accept them because of employer policy). Let me know if you can help out every now and then. I provide each Webinar presenter with three reviews of their practice session — two from CIOs and one from me – to make their live day webinar the best it can be in terms of educational value and in keeping my short attention span engaged. If you’d like to present a webinar, I’m all ears for that, too – I’m up for anything that is educational and interesting to readers.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Speaking of webinars, Steve Blumenthal’s abstract for his EHR contracts one was witty, so we suggested he do a video introduction. I can’t help but snicker every time I play it, especially when I see his fake smarmy, “Oh, I just noticed the camera was running five feet from my face” introduction. He’s a good actor and funny (even by non-lawyer standards), so it should be a good webinar.

Acquisitions, Funding, Business, and Stock

Cost management systems vendor Equian, which changed its name from Health Systems International a few weeks ago, completes its acquisition of AfterMath Claim Science, which offers data mining cost analysis solutions to payors. 

Consulting firm VeritechIT acquires Health Technology Solutions, a one-employee consulting firm run by Terry Grogan, acting CTO for Temple University Hospital (PA). It appears from VeritechIT’s bio page that Michael Feld — listed as founder, president, and CEO – is also acting CTO of Lancaster General Health System (PA).

Medical device maker Medtronic acquires competitor Covidien for $42.9 billion in cash and stock, giving Medtronic a convenient excuse to move its headquarters out of US tax jurisdiction to Ireland even though the company’s name will continue as Medtronic and its “operational headquarters” will remain in Minneapolis. Several companies have taken the acquisition route to evade the 35 percent US corporate tax rate that’s one of the highest in the world, the only method remaining to accomplish that since US laws now prohibit a company from simply moving its headquarters offshore to pay a lower tax rate (12.5 percent in Ireland). The deal also gives Medtronic a place to spend the $14 billion of foreign profits it has parked offshore to avoid paying US taxes.

From the Streamline Health Solutions earnings call:

• President and CEO Bob Watson apologized for the late financial report, caused by a change in CFOs, a change in audit firms, and completion of an internal controls audit required by the company’s market capitalization.
• The company is offering the commercialized version of analytics software it acquired last year from Montefiore Medical Center.
• In a refreshingly honest announcement, Watson said the company erred in taking on work to help its clients go live faster in hopes of being able to recognize more revenue from the backlog, which Watson said didn’t really help and cost the company twice as much as expected. He concluded, “An outside consultant stepping into XYZ health system doesn’t have the innate natural knowledge of how that health system’s IT infrastructure is organized and therefore cannot be that helpful. So that was our plan that didn’t work.”
• Sales of computer-assisted coding solutions were delayed after the “disastrous” results experienced by early adopters of “some of our well-known competitors.”
• The acquisition of Unibased Systems Architecture resulted in one new Q1 sale and renewals worth a total of $10 million.
• The company’s products have been renamed within the Looking Glass family nameplate and underlying analytics platform.

Healthcare benefits electronic payment systems vendor Evolution1 will be acquired by corporate payment solutions vendor WEX for $532.5 million in cash. The Fargo, ND-based Evolution1 has 300 employees.

Sales

Children’s Hospital Los Angeles (CA) and Wisconsin Statewide Health Information Network (WI) choose Orion Health’s Rhapsody Integration Engine.

The FHP Health Center (Guam) selects eClinicalWorks.

Thibodaux Regional Medical Center (LA) will implement Health Catalyst’s Late Binding Data Warehouse and Analytics platform.

People

Practice Fusion names Robert Park (Chegg) as CFO.

Dan Baker (NextGen) joins Remedy Informatics as SVP of sales.

HealthStream hires Tom Schultz (Infor) as SVP of sales and promotes Michael Sousa to SVP of business development.

Payment financing company CarePayment names Craig Hodges (Emdeon) as CEO. Outgoing CEO Craig Foude will stay on as board chair and managing partner for Aequitas Capital, founder and owner of the company.

Announcements and Implementations

Aesynt, the former Pittsburgh-based McKesson Automation plus its acquired Health Robotics, says it signed 18 IV automation contracts in Q4. Those are for the former Health Robotics i.v.STATION hospital IV room products.

The Central Texas division of Baylor Scott & White Health goes live on API Healthcare’s ShiftSelect.

Memorial Hermann (TX) launches Wolters Kluwer UpToDate Anywhere for its 12 hospitals and 5,000 affiliated physicians.

Government and Politics

The VA will issue an RFP next week for a commercial patient scheduling system to work within VistA, with its CIO saying that while VistA’s clinical system is “one of the best out there,” its non-clinical modules haven’t kept up. He also says that current events make it obvious that the new system will include extensive auditing features to review changed appointments. The VA gave up on a previous attempt to build its own scheduling system a few years ago and nothing seemed to happen with the open source Health eTime app that won the VA’s scheduling system competition last fall.

Health IT Now says HITECH has paid $24 billion to subsidize information-hogging EHRs and wants HHS to make data sharing (at no extra customer cost) a certification criterion. Health IT Now is a coalition of patient groups, providers, employers, and payers – it claims that Aetna, American Cancer Society, AHIMA, IBM, Intel, Oracle, the US Chamber of Commerce, and a few health systems are members – whose agenda involves promotion of interoperability standards, Meaningful Use changes to emphasize lower cost and improved outcomes, innovation and increased use of telemedicine, and medical licensing that spans state boundaries. I first reported on the group in mid-2007, saying, “The founding members include a couple of former Congressmen ([Nancy Johnson and John Breaux] and a cross section of influential medical, professional, and other organizations. I don’t think I’ve heard anything from them since (their “About” page claims “we will continue a formidable education agenda in 2012”), so while I agree with their platform, I don’t think it’s having much of an impact inside the Beltway. The only named employee is Executive Director Joel White, a former Congressional staffer who omits the group from his LinkedIn profile and instead list himself as President and CEO of Horizon Government Affairs, which sells political services and operates four other non-profit coalitions: Council for Affordable Health Coverage, Rare Disease Legislative Advocates, Prescriptions for a Health America, and Newborn Coalition.

DoD releases the third and near-final draft of its $11 billion DHMSM EHR solicitation, removing the veterinary medicine requirement, eliminating required use of any particular development methodology, and making the contract performance-based. Vendors will have a chance to ask questions on Industry Day next Tuesday, June 24, which would be fun to write up if you’re going.

Innovation and Research

Microsoft announces Azure Machine Learning, available in July, that will allow users who store data in its Azure cloud to use drag-and-drop predictive analytics. Potential healthcare uses include scheduling, reducing readmissions, and anticipating disease outbreaks.

Other

Research by The Commonwealth Fund finds that the US health system is not only the most expensive among 11 developed nations, it is also the worst, coming in dead last in access, efficiency, equity, and healthy lives, primarily due to the lack of universal healthcare coverage and support for the patient-physician relationship. The report also calls out the stubborn resistance to using healthcare IT. The bright spot, the report says, is that the Affordable Care Act is improving access and the system is moving toward more value-based payments. Methodology footnote: the study was done by surveying around 3,000 US residents with a self-rated health status of below average and recently treatment for a serious problem that involved at least one hospitalization, so the sample size wasn’t very large and the results reflected patient perception more than hard measures. The president of The Commonwealth Fund is former National Coordinator David Blumenthal, MD, so naturally the report pays disproportional attention to EMRs. Still, nothing in the results is all that surprising since it measures overall health of a cross-section of citizens, not just the specific healthcare outcomes of the more privileged among us.

The Wall Street Journal profiles Dignity Health’s use of Google Glass for clinical documentation, which it claims allows physicians to double the amount of time they can spend with patients. Dignity is using software from startup Augmedix to send Glass-collected information and commands to the EMR. It’s a small pilot started in January 2014 – the CMIO and two other docs – but they say manual EMR entry was reduced from 33 percent of their total time to 9 percent.

An apparent tornado damaged several homes and an elementary school within a mile of Epic’s Verona, WI campus Tuesday morning, but nobody was hurt.

Overlake Hospital Medical Center (WA) gets a S&P bond ratings upgrade to A, primarily due to completion of its Epic implementation.

In China, Internet giant Alibaba, which has more sales than eBay and Amazon combined and is planning a US IPO, unveils a 10-year plan to disrupt China’s notoriously backward hospital system with online payments, patient scheduling, e-prescribing, hospital transfer, insurance claims management, and eventually wearables and other prevention technologies. The company had released a patient self-scheduling application for 600 hospitals last year to fix the eight-hour process of getting an appointment, but the government shut it down over privacy concerns (not mentioning that the site competed with the government’s own online service). The announcement of Future Project is here, although you should probably be able to read Chinese since Google translates it as, “Today, Alipay announced a program called ‘future hospital.’ Payment was originally conducted in hospitals, registered, classified ad will be transferred to PayPal platform. The implementation of this plan is completely far away from us, section house, ‘said the doctor chase behind the ass, give praise it pro’ story can become true?” And in other breaking news, all your base are belong to us

Alexian Brothers Health System (IL) cancels plans to form an accountable care entity to manage Medicaid patients, saying it’s too hard to connect the 10 EHRs used by 80 percent of the doctors, not even counting those that might have been added to the network later. The ACE would have been required to connect 60 percent of its network to the Illinois HIE within 15 months, include 100 percent within 30 months, and file electronic summaries of care for 70 percent of the network within 15 months.

CHIME’s Keith Fraidenburg tweeted out this photo of Tim Stettheimer presenting at the CHIME/AMDIS CMIO Boot Camp at Ojai, CA this week. Attendees are welcome to send me a write-up about the experience.

Pittsburgh insurer Highmark stops paying higher physician chemotherapy fees devised by hospitals buying oncology practices and then billing out drugs at the much higher hospital outpatient rate. Other insurers are trying to hold down oncology costs by paying oncologists a stipend to use less-expensive (and less-profitable) chemo regimens or bundling all treatment costs into a flat payment. Brand name chemo drugs cost an average of $10,000 per month, giving physicians a financial incentive to use more expensive ones as insurance companies haven’t protested for fear of losing oncologists in their network.

Mary Milroy, MD, the new president of the South Dakota State Medical Association says EHRs add an hour of busy work to a doctor’s day, adding that, “The systems we use are cumbersome, designed by IT people and not medical people. The huge problem is they don’t communicate.” Her clinic uses NextGen, another practice she covers uses Epic, and the local hospitals use Epic and Meditech. She says none of them talk to each other.

HIMSS Analytics has issued a new report about cloud computing, but with that ever-blurring line between whether HIMSS is a member organization or a vendor, you can’t download it without providing your email address, telephone number, job title, and other contact information for the inevitable sales cold call. I’m still not clear on how HIMSS managed to change HIMSS Analytics from a for-profit subsidiary to part of the non-profit HIMSS.

Non-profit patient advocate group Stupid Cancer launches an Indiegogo campaign to raise $40,000 to develop its free Instapeer app, which will connect young cancer patients to other patients, survivors, and caregivers.

In England, Health Secretary Jeremy Hunt says new guidelines calling for hospitals to list the name of each patient’s doctor over their bed is a “huge step forward for patient safety” since it’s not always clear where the medical buck stops. A spokesperson for a patient group said writing names on a board is fine, but that won’t accomplish much if the doctor doesn’t stay in touch with the patient.

Sponsor Updates

• Regenstrief Institute joins ConvergeHEALTH by Deloitte, a real-world evidence and analytics consortium.
• SD Times names InterSystems and its Cache’ system as one of the software industry’s top 100 innovators in the Database and Database Management category..
• RelayHealth announces that RelayHealth Financial has bolstered RelayAssurance Plus 5.0, providing transparency into your claims lifecycle.
• AirWatch by VMware opens registration and lineup of analyst speakers for the AirWatch Connect Global Tour 2014 in Atlanta, London, and Sydney.
• McKesson launches Benchmark Analytics service to provide custom reports and consultation to optimize performance.
• GetWellNetwork CEO Michael O’Neil discusses the CDC Morbidity and Mortality report on the cost of cancer survivorship with a local journal.
• Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.
• Gartner names Informatica as a Leader in the 2014 Magic Quadrant for Structured Data Archiving and Application Retirement.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 6/17/14

VA Seeks Proposals for New Scheduling Technology

The VA will issue an RFP for commercial scheduling software to replace its existing VistA scheduling system which, in the fallout of the VA waitlist scandal, has been heavily criticized as being outdated and unfit for use.

Major medical records breaches pass 1,000 milestone as enforcement ramps up

The HHS “Wall of Shame”, which lists all organizations that have had major data breaches, passes the 1,000 breach mark this month. One in 10 US residents is estimated to have had their health data compromised as a result of major data breaches.

Google Wants To Collect Your Health Data With ‘Google Fit’

Google will return to the consumer health space with a new Android-based platform called Google Fit. Google Fit captures health data from activity trackers and medical devices and consolidates it into a centralized platform. The move comes despite Google’s past failures in the consumer health space. Google launched Google Health in 2008, a service with a remarkably similar business model, only to shutter it in 2011 due to an overwhelming lack of consumer interest. The unveil pf Google Fit will take place during next week’s Google I/O developer conference.

ACA triggers big drop in Minnesota’s uninsured rate

The uninsured rate has dropped 41 percent in Minnesota, to below five percent, since September’s ACA enrollment period began. Research lead Julie Sonier said, “We have never seen anything like the change that we have seen between last fall and May 1st of this year.”

Curbside Consult with Dr. Jayne 6/16/14

I’m sure those of you that follow me on Twitter were wondering what could possibly have happened last week to make it one of the strangest days of my career. In retrospect, it wasn’t just one of the craziest days of my IT career, but of my physician career as well.

My hospital is part of a larger health system. When have to have a representative on some kind of IT-related committee, I am usually tapped to attend.

We’re a decent-sized organization with plenty of employed physicians. One of my CMIO friends in a similar situation has employer-paid medical co-payments to encourage staff to see the physicians in their group. Another offers their “associates” early access to office appointments that aren’t available to other patients. Theoretically, when you’re caring for your own people, it should be like a miniature accountable care organization and might give you insight into the best way to maximize health and lower costs for a defined patient population.

I have to admit I am way behind on my email and didn’t read the agenda for our Emerging Technologies meeting prior to heading uptown for the session. I’m barely keeping my head above water and didn’t think it was a big deal because usually the topics are things I can handle on the fly. This time, however, I was seriously wrong.

The meeting happens over lunch and I was trying to grab a quick bite while scanning the agenda as people arrived. One of my IT colleagues thought he was going to have to perform the Heimlich maneuver after I started choking on my salad.

Apparently our brilliant “ET” group decided to bring in a third-party solution for “advanced access” to physicians. Unfortunately, it’s a telemedicine solution staffed not by our own physicians, but by others in the market. As the meeting started, a glossy marketing slick was passed around. I thought it might be some kind of Friday the 13th prank until I realized they were serious.

Our human resources department wants to roll this out as part of our benefits package in the fall. They wanted to vet it with our group as far as our thoughts on HIPAA and other regulatory issues. The health system would pay a fee to the vendor, which offers “doctor visits anytime, anywhere!”

I’m not opposed to the concept of virtual visits, but I’m truly surprised that we wouldn’t give our own physicians the opportunity to not only serve the employee community, but to maybe make a little extra cash as “advanced access” physician resources. Given the recent draft policy from the Federation of State Medical Boards regarding telemedicine, we would be ideal. We’re licensed in the states where most employees live (and are usually located), so that’s easy. We already have unified medical liability coverage, so that’s easy, too. We also have a vested interest in keeping our collective employees healthy as a means to strengthen the community.

I also like the idea of employees being able to receive care without disrupting work schedules, although the service promises access to physicians “at home, at work, or anywhere you need care.” We have enough issues with staff using cell phones to take care of personal business in patient care areas and don’t want to encourage them to talk about their medical issues in the workplace. There aren’t a lot of private places in most of our ambulatory practices (the physicians don’t even have private offices any more) so I’m not sure that’s a benefit.

What really got me was the assertion that the third-party physicians would become “your doctor.” Are they really advocating conducting a longstanding patient-physician relationship established via smart phone? Are they going to be accessible 24/7 to handle all the health issues that typical patients should be addressing with their personal physicians? What is their plan for continuity of care?

I was trying to see the other side of the equation. Maybe they were worried about patient privacy. Employees might not want to see network physicians because their records would become part of our central database. That’s certainly valid. Maybe they were worried about accessibility and that’s a factor, although more and more of our employed practices are extending their hours and providing walk-in accessibility. Maybe they think offering this will differentiate us as an “employer of choice,” as the HR people like to describe it.

One of the other physicians at the table who wasn’t distracted by lunch managed to access the telemedicine website and find out more about it. Apparently they’re willing to partner with healthcare organizations to involve their own physicians, but our HR department didn’t think that was important. They figured they’d just offer it to our employees with the existing provider network because that would be faster.

I wonder if they seriously considered the public relations and morale repercussions of offering our staff having virtual visits with providers from a competitor health system. I’m sure the various medical executive committees at our hospitals will have a field day with this if it moves forward. That’s likely to happen since HR didn’t seem to understand our objections or find them valid. One of the physicians actually got up and walked out. The rest of us stuck it out, if for nothing else than to gather information to help inform our next steps.

Since we’re a technology committee and we couldn’t find any significant technology objections (I have to admit their setup looks pretty slick), it’s likely to move forward. I’m interested to see what the hospital administrators will think since it will likely have an impact on their bottom line.

I’d be interested to hear from organizations who have done something like this, including whether your providers participated or whether you used an existing or external network. We’re having a discussion with the vendor in a couple of weeks, assuming roadblocks aren’t thrown up in the interim. I’m putting together my list of questions and “what if” scenarios for the meeting.

Got ideas? Or alternatively a potential job with a seaside location? Email me.

Email Dr. Jayne.

HIStalk Interviews Aaron Sorensen, Director of Informatics, Temple University School of Medicine

Aaron Sorensen is director of informatics at Temple University School of Medicine of Philadelphia, PA.

Tell me about your job.

I’m at Temple University at the School of Medicine with an affiliated health system. Our new leadership is keen on creating a robust infrastructure to support clinical research. I’m heading up the informatics aspects of that.

What is the informatics influence in the School of Medicine?

Within the health system, you have the IT shop that runs a myriad of clinical systems. There’s a feeling from the researchers that all this data exists, but it’s hard to get at. What do you do with it once you have it? What are the appropriate safeguards regarding compliance and privacy? 

The School of Medicine is trying to make it so that every time a clinical researcher wants to ask a question of the clinical data, it doesn’t become a maze that you get lost in, with different people are telling you different things. There’s this straightforward way to do it and you can go to a central team of people that will guide you through the path and help you along your way.

Describe how PCORnet came about and what it does.

My understanding is that over 10 years ago, when the NIH was originally thinking about redoing the way they fund clinical research extramurally at academic medical centers, the PCORnet idea was floated. The feeling was that it would be costly and it would be hard to achieve. They had other priorities, so instead of doing that, they funded the CTSA awards.

PCORI, the Patient-Centered Outcomes Research Institute, is not a federal organization, but it’s funded through the Affordable Care Act. It’s federal dollars, but it itself is a independent non-profit. The feeling was that it was worth pursuing the idea of creating a network of hospitals that have the ability to share de-identified patient data for the purposes of clinical research. 

Although they have grants that fund all different kind of things, just like the NIH does, I believe the crown jewel within the PCORI portfolio is PCORnet. It has 29 funded groups, some of which focus more on general health system patient populations, whereas others are more focused on particular patient groups with specific diseases.

What Temple systems are contributing data to PCORnet?

In terms of our electronic medical record, we’ve been on Epic outpatient for about three years. We’re just now kicking off the project to go with Epic inpatient. Epic, as most EMRs, receives a number of feeds from different systems. When you get to the back-end Epic reporting database, you not only have the data that originated in Epic, but from a number of different systems.

For our contribution to PCORnet, we are only using our Epic back-end database that gets feeds from cardiology systems, pulmonary medicine systems, and billing type of data. It’s a wide range of things. For the purposes of this project, we are only using what comes into our central EMR.

Can researchers query data from any or all of those 29 contributing organizations?

Yes and no. The 29 break out into two groups.

The patient-focused ones that are disease specific are called PPRNs, the Patient-Powered Research Networks. The health system ones, of which Temple plays a role, are called CDRNs, or Clinical Data Research Networks. 

I don’t know 100 percent what the PPRN plan is. I think it’s slightly less ambitious than the CDRN plan of which I’m a part. I can speak to the 11 funded groups that are part of the CDRN and that cross the country. 

There are two aspects to the PCORI contract. Our network is the University of Pittsburgh, Johns Hopkins University, Temple, and Penn State Hersey. Within our network, we have been funded to create the ability to share data for two different diseases. One is rare disease – idiopathic pulmonary fibrosis. Then a more common disease, for which we chose atrial fibrillation.

At the CDRN level, at the national PCORnet level, we have to support two cohorts. One is what they originally called an obesity cohort, but then they decided they wanted to expand beyond people who are already obese to include people who are at risk of becoming obese. They’re now calling it the weight cohort. We’re going to support a weight cohort. 

Then we have to have a randomly chosen one million plus patient pool from which PCORnet can do centralized queries. Each of the 11 groups has to make available at least one million randomly selected patients, or else their whole patient population, for these centralized queries. As well as a subset of that which will be used specifically for to measure issues around obesity. For that group, you have to have collected good data on weight, height, calculating BMIs, and things around diabetes, coronary artery disease, and certain co-morbidities associated with obesity.

Do researchers have to file paperwork for what they’re looking for? Can you tell how they are using the system?

Yes. Within our network, we have IRB protocols that have been set up to allow for the researchers to ask certain questions. That’s specified ahead of time and is pretty locked down.

For PCORnet, they have the ability to ask anything. The data is always de-identified. You’re not typically ever sharing patient-level information. You’re aggregating it so that they can get an understanding within a given population how it breaks out — what the demographics are, what the prevalence or incidence of a given disease is, etc. 

For those questions, they are not pre-established. It’s not like at the beginning of the project that we know, “We will ask these 100 questions over the next year and a half.” Each funded site will have the ability to not respond to a given query, assuming that they have good justification not to do so.

The advantage to the researcher is that they might need to reach outside of Temple to identify a patient cohort large enough for their project, right?

Exactly. For our rare disease, idiopathic pulmonary fibrosis, at the time we submitted the grant, we estimated that we only had about 70 living patients with that disease. If you went to Pitt, which was the highest, they maybe had about 350 or so. 

With only 70 patients, maybe you don’t even have the number to show any statistical significance in certain differences between drugs or other interventions you’re trying to assess. Whereas if you were to combine all the centers together and you get above 500 patients, then all of a sudden potentially you have the ability to make a finding that will stick with the general population.

Is there a plan to add organizations or conditions or to use the data more widely?

Yes. We were initially funded for 18 months. That 18 months is supposed to be used largely to build an infrastructure to support future research. There will be some research done during the 18 months, but the idea is to make sure you can set up this robust network for the future. 

PCORI has said that they will be having a Phase 2 in which no longer will they be paying to help you set up this infrastructure, but instead they will want specific questions answered. You have the ability to then apply for Round 2 funding, in which you will potentially participate in clinical trials where, using the network, you identify certain patient profiles and you go out and enroll them in certain studies, or for large-scale retrospective studies, where you harness the power of the longitudinal data you have for your one million plus cohort of randomly selected patients times 11.

So at least 11 million patients that you can then query to say, over the last 10 years, patients with this profile who were given this type of therapy, how did they fare over the last 10 years compared to this other therapy? There will be a Phase 2 where we can extend the funding to actually try to answer certain questions.

In terms of being awarded the contract, everyone was being asked, to what level is your institutional leadership committing to making this sustainable over the long run? Should the money dry up tomorrow, do you have strategies and do you have commitments from your top leaders to make sure that this stays in place and that you extend it to anyone outside of the network so that any non-funded investigators have the ability to ask any center and consortium … my consortium is called PATH , the initials of all the participating institutes. Geographically, we’re the mid-Atlantic CDRN. So anyone in our geographic area who is not at a funded institution has the ability to request access to our data and to collaborate with any of our investigators on any particular study.

Is there anything else you’d like to talk about?

The one really neat thing that’s come out of this that’s linked to PCORnet is the use of i2b2. It stands for Informatics for Integrating Biology in the Bedside. It’s an open source software package created at Boston Children’s. It is used extensively throughout the Harvard-Partners HealthCare network. It allows you in an open, non-proprietary way to take data out of any clinical system, merge it with other data you might have – such as genetic data from other systems — and to make it queryable, both at your institution or potentially teaming up with other institutions. The adoption rate has been growing by leaps and bounds.

Temple was not an i2b2 user before this initiative. While we are implementing it for the purposes of PCORnet, as are many of the other CDRNs, we also are using it as a springboard to create an internal tool that our investigators can use for any patients of any disease asking potentially any questions using the EMR data. 

A lot of times when an institution implements a new clinical data warehouse, they take their time and go step by step. It evolves over a period of years, potentially. Whereas because of this PCORI initiative, we had to go from zero to 60 quickly. Phase 1 lasts 18 months, and at the end of 18 months, you have to show that you’ve successfully created this infrastructure which can be used for robust clinical research. 

The i2b2 prevalence within academic medical centers over the US has been growing. As I dug into it, I realized that people use it in different ways. If you are trying to share data with another institution via i2b2, one approach is to try to convert all your data to the same standard. If you have internal lab codes and the other institution has their own internal lab codes, you could try to convert all your codes to a standard like LOINC. Or, you could allow them to stay as they are and then you have some lookup table that converts on the fly from your local ones to a standard.

As I was experiencing this and going through the baptism by fire of getting our institution using i2b2, not only for PCORI but for ourselves, it became clear that there should be a boot camp that helps you think about all these things. It needs to give you what I call the mental scaffolding, so that from the beginning of a project, you can consider all of the types of decisions you’ll have to make and the potential downstream ripple effects.

I contacted Harvard, the folks that created i2b2 and the accompanying SHRINE software that allows you to connect other institutions. I gave them some ideas about how it would have been great if I had been able to take this intensive boot camp before our project started. We went back and forth and we’re going to offer a pilot i2b2-SHRINE boot camp at Harvard in early 2015. 

Harvard is trying to assess what type of a demand would there be for such a boot camp after the pilot. We’ll try to fill maybe 25 spots with the pilot, but then whether there is enough hunger and demand to offer it regularly. If any of your readers have any thoughts about that, I’d love feedback in order to gauge whether it’s a minor niche thing or if it has wide applicability.

Morning Headlines 6/16/14

Cumberland Consulting Group Acquires Cipe Consulting Group

Nashville,TN-based Cumberland Consulting Group acquires Cipe Consulting Group, a Seattle-based firm that specialized in EHR and Revenue Cycle projects.

Is Meaningful Use Becoming the Next ICD10?

Eric Boehme, associate director of informatics at Vanderbilt University Medical Center, questions the future of the EHR Incentive Program after MU Stage 2 is delayed, ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius all resign, and ONC’s stimulus funding begins to dry up.

Lack of input, training created problems with Athens Regional electronic records system

A local paper reports that two Cerner VP’s and the hospital’s own CMO are blaming the IT department at Athens Regional Health System for its failed $31 million implementation, saying that IT-led installs are atypical and that the clinicians that would ultimately be the primary end users should have made many of the decisions that were being made by IT leadership.

Beware Bad Data About Hospitals

Johns Hopkins’ patient safety expert Peter Pronovost, MD, PhD publishes an editorial on the unregulated and often confusing state of hospital quality data.

Monday Morning Update 6/16/14

Top News

Cumberland Consulting Group will announce Monday that it has acquired Cipe Consulting Group, a 50-consultant, Seattle-based EHR and RCM consulting company. Franklin, TN-based Cumberland has 230 consultants.

HIStalk Announcements and Requests

 

Responses to my poll about meeting attendance in the next year indicate that it’s the HIMSS conference (33 percent) and vendor user groups (26 percent) well out front, followed by CHIME (9 percent) and then a scattershot of other meetings with low percentage numbers. New poll to your right: how well does Epic support interoperability compared to other EHR vendors? After you vote, click the “Comments” link at the bottom of the poll to explain why you think so.

Things you can do to help me with HIStalk: (a) read HIStalk Practice and HIStalk Connect; (b) support my sponsors by checking out their ads, reviewing the listings in the Resource Center, and using the RFI Blaster for any consulting needs; (c) review the archived educational material on HIStalkU; (d) send me anything readers would find useful – people I should interview, conferences I should attend, and of course news, rumors, and fun stuff; and (e) tell people you know about HIStalk since I don’t advertise and nobody will hear about it otherwise. Thanks for reading HIStalk even though I started writing it in 2003 just for myself and it was mostly that way for years.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 25 (Wednesday) 2:00 p.m. ET. Cloud Is Not (Always) The Answer. Sponsored by Logicworks. Presenter: Jason Deck, VP of strategic development, Logicworks. No healthcare organization needs a cloud – they need compliant, highly available solutions that help them deploy and grow key applications. This webinar will explain why public clouds, private clouds, and bare metal infrastructure are all good options, just for different circumstances. We’ll review the best practices we’ve learned from building infrastructure for clinical applications, HIEs, HIXs, and analytics platforms. We will also review the benefit of DevOps in improving reliability and security.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

July 2 (Wednesday) noon ET. The CIO’s Role in Consumer Health. Sponsored by HIStalk. Presenter: David Chou, CIO, University Of Mississippi Medical Center. We are moving towards an era where the consumer is searching for value. Healthcare is finally catching up with other industries and this is forcing health care providers and health plans to rethink their "business model" as consumers test new decision-making skills and demand higher quality and better value. Technology can provide value in this space as we move towards a digital healthcare.

Acquisitions, Funding, Business, and Stock

Streamline Health Solutions reports Q4 results after a delay involving an auditor change and an internal controls audit: revenue down 3 percent, EPS –$0.14 vs. –$0.63.

Announcements and Implementations

IT gets the blame (at least from non-IT people looking for a scapegoat) for the failed $31 million Cerner implementation at Athens Regional Health System (GA). The hospital’s chief medical officer says users weren’t well trained and the CIO was holding back information, while Cerner claims IT was running the project without getting users involved. The CEO and CIO were forced out after physicians protested.  My suspicion is that the medical staff docs were already mad at administration over something unrelated, refused to participate, then capitalized on go-live challenges to get the CEO fired. The CIO was probably collateral damage since an IT system was the claimed problem.

Government and Politics

Senators Ron Wyden (D-OR) and Chuck Grassley (R-IA) ask unnamed stakeholders for ideas on how the use of government healthcare databases can be expanded. Chuck asks a lot of questions and writes a lot of letters, but that’s usually the last you hear about it.

Vanderbilt University Medical Center’s Eric Boehme, associate director of informatics, worries that the already-complicated Meaningful Use timetable could take an unexpected turn between the recent Notice of Proposed Rule Making and the actual rule, as in what happened with ICD-10. He also takes an interesting long view: “This is all too late and too little. MU is in trouble. Two powerful committees in Congress asked for a pause for MU to evaluate the success of the program and to emphasize the lack of true interoperability. ONC has lost a significant portion of its funding as the stimulus money dries up. Recently, some members of Congress questioned how much ONC should regulate HIT. ONC National Coordinator, Farzad Mostashari, CMS Administrator, Marilyn Tavenner, and the HSS Secretary, Kathleen Sebelius have all resigned.”

Other

A Wall Street Journal editorial by patient safety expert Peter Pronovost, MD, PhD of Johns Hopkins Medicine urges consumers to “Beware Bad Data About Hospitals” in the current “Wild West” environment in which “there are greater protections about what claims we can make about toothpaste than a hospital or measurement organization can make about quality of care.” He recommends creating the equivalent of a Securities and Exchange Commission to oversee development and use of quality indicators. Until then, he suggests that consumers use only composite scores such as those from The Leapfrog Group and Consumer Reports. He concludes with a simple plea: “There really is very little useful information on pricing. There should be.”

An unnamed IT system goes down at Fletcher Allen Health Care (VT) Friday morning, forcing the hospital to go to paper.

The Detroit newspaper profiles Sorie Kanue, a former Michigan State football standout and team captain (playing safety) who worked in IT after college and then went to nursing school. He has been named nurse of the year twice at Detroit Medical Center’s Heart Hospital and is working on his MSN.

Fortune profiles Elizabeth Holmes, who as a Stanford sophomore in 2003 founded blood diagnostics company Theranos, which now has 500 employees and a valuation of $9 billion. When questioned by her professor about why she wanted to start a company, she answered, “Because systems like this could completely revolutionize how effective healthcare is delivered and this is what I want to do. I don’t want to make an incremental change in some technology in my life. I want to create a whole new technology, and one that is aimed at helping humanity at all levels regardless of geography or ethnicity or age or gender.” The company’s product can run dozens of tests from a single, tiny sample of blood drawn via pain-free finger stick, and the company’s app supports its pledge that “we believe you have the right to your own health information” and “answers at the speed of digital.” Test cost is as little as a tenth of what hospitals charge. Walgreens will put the company’s labs in many of its drugstores, but Theranos is also working with UCSF, Dignity Health, and Intermountain. Holmes says patients don’t have 40-60 percent of lab test orders drawn because of the pain or inconvenience involved.

”The Daily Show” invites a group of Google Glass fans to defend their worship of the technology, include one woman who claims that she was a victim of a hate crime because she wore Glass into a bar and filmed fellow patrons without their permission, eliciting their angry taunts as she cursed at them and announced while recording, “I want to get this white trash on tape for as long as I can.” The same woman’s neighbors had previously filed a restraining order against her for recording their private conversations. She and her fellow Glassholes probably should have stayed home: after hearing that Glass early adopters are called Explorers, the host responds, “Magellan was an explorer. Chuck Yeager was an explorer. You guys have a %&@! camera on your face.”

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.

Morning Headlines 6/13/14

ONC’s Chief Privacy Officer Tenders Resignation

Joy Pitts, the ONC’s first Chief Privacy Officer, resigns after four years of service.

Healthcare authentication software provider Imprivata sets terms for $75 million IPO

Imprivata reports that it will raise $75 million in its upcoming IPO by offering 5 million shares at a price of $14 to $16 per share.

KeyBanc Downgrades Computer Programs and Systems (CPSI) to Underweight

Analysts downgrade CPSI stock due to increased small market competition. Healthland is seen as a stronger market presence, and Epic is encroaching on the territory through its Community Connect program.

NHS waiting list passes 3m for first time in six years

In England, the NHS appointment wait list has passed 3 million patients for the first time in six years, though it managed to meet its goal of providing 90 percent of patients with appointments within 18 weeks.

News 6/13/14

Top News

ONC announces that Chief Privacy Officer Joy Pritts, JD has resigned after four years on the job.

Reader Comments

From Anonymous Tipster: “Re: Wayne Tracy on VistA. I agree it would be a tragic shame to see VistA replaced. Unless Epic were to make some dramatic changes in its approach to interoperability, this could be a disaster for the VA. Anyone who has ever suffered through a migration to Epic could tell you how difficult this can be from a workflow perspective (not to mention cost overruns). You think there’s backlog now? Remember the iEHR project that died? It’s an election year and the money is rolling in big time from lobbyists  — maybe Epic will even begin to divert some of its campaign dollars to Republicans).” The DoD’s IT efforts have been financial disasters, with AHTLA and its predecessors rumored to have cost $10 billion. The VA has done very well with VistA, but its more recent efforts involving government contractors (BearingPoint’s CoreFLS at Bay Pines) were spectacular failures, so there’s no guarantee that VistA wasn’t a one-trick pony. It’s also true that DoD and VA don’t agree on anything despite their common responsibility in caring for active service members who eventually (hopefully) become veterans. Kaiser had to pull the plug on its IBM-developed system that cost hundreds of millions of dollars and replace it with $4 billion or so worth of Epic, so that’s an interesting IBM-Epic partnership (I can’t imagine Epic letting IBM tell its 25-year-olds how to implement.) Add replacing VistA to DoD’s $11 billion project and you’re probably talking about $30 billion worth of overruns, delays, and potential patient harm as the VA and DoD are forced to smoke their first-ever HIT peace pipe – that number has substance since the DoD walked away from iEHR because it was going to cost $28 billion and nothing involving the federal government ever comes in on budget, especially if the military is involved. Britain’s failed NPfIT has been called one of the most expensive government IT projects in history at around $17 billion, so we’ll beat that for sure. One final thought: Epic’s Judy Faulkner and InterSystems’ Terry Ragon are already healthcare billionaires as sole owners of their hugely successful private companies — an IBM-Epic DoD deal would certainly raise the numeric placeholder in front of their billions.

From Expandable Beltway: “Re: DoD bid. Cerner is teamed up with Accenture.” Unverified. I am getting anxious to hear what Dim-Sum has to say. Lorre would love to get him or her to present a webinar on the DHMSM topic, for which I would even arrange one of those voice-changing gadgets.

From Cool Runnings: “Re: Benefis EHR RFI. They use Meditech inpatient and replaced LSS with NextGen a few years ago. NextGen is taking a hit in Montana – a small hospital sued them, Bozeman Deaconess is rumored to be switching from Meditech/NextGen to Epic, and Community Medical Center in Missoula is merging with Billings Clinic, which very likely means a move from NextGen to Cerner Ambulatory.  I’ve heard that Benefis is talking to athena, but may be leaning toward looking for an integrated solution instead of just an ambulatory switch.” Unverified, but I should have checked Meditech’s online customer list, which would have told me that Benefis runs its soon-to-be-gone systems.  

HIStalk Announcements and Requests

It’s time to say goodbye to Inga, who has moved on to greener pastures after seven years of contributing to HIStalk and HIStalk Practice. She finished working on the sites in April and has finally tied up her last loose ends. Rumors that she is launching a healthcare shoe division of Christian Louboutin may or may not be unfounded, but we will wish her well in any case. Jennifer Dennard took over writing HIStalk Practice several weeks ago, while Lorre is happily handling the non-writing HIStalk chores.

This week on HIStalk Practice: ONC’s 10-year vision statement on interoperability prompts CommonWell to up its game. Several trade associations line up with telemedicine-related requests for new HHS head Sylvia Burwell. ARcare receives the HIMSS Analytics Stage 7 Ambulatory Award. Epocrates ranks number one again. HIT Policy Committee meeting numbers show $24 billion in MU incentive payments so far. Jim Morrow, MD gives healthcare IT its due as an independent physician. Wesley Medical Center docs face employment ultimatums. Northern Virginia launches the HeaLiXVA HIE. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the concept of patient ownership of health data, its benefit to public health in general, and the role that Apple and Samsung will play in advancing the concept. ZocDoc expands its business model to include corporate wellness services. Autism Speaks signs a deal with Google to create a database that will store 10,000 fully sequenced genomes in the cloud, where researchers across the globe can access the data.

Upcoming Webinars

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

Acquisitions, Funding, Business, and Stock

Imprivata sets terms for its $75 million IPO that values the access management company at around $400 million.

KeyBanc downgrades shares of CPSI, saying that Healthland is strong in the small-hospital market and that Epic’s Community Connect program is making it a competitor there as well.

Elsevier acquires Amirsys, which offers clinical decision support and learning tools for radiology, pathology, and anatomy that will be integrated with the Elsevier Clinical Solutions suite.

Mediware acquires Harmony Information Systems, whose systems help state and local agencies track long-term care policies.

Sales

The State of Vermont signs a six-month $5.69 million contract with OptumInsight for evaluation, remediation, and operations support for its health insurance exchange.

In England, Oxford Health NHS Foundation Trust awards a five-year, multi-million pound contract to Advanced Health & Care to develop an EHR that up to 3,500 clinicians will use on iPads. Oxford Health provides services for mental health, home care, children and family, and substance abuse.

Irving, TX-based USMD chooses the population health management platform of Lightbeam Health Solutions for its ACO and other risk-based programs. I interviewed Lightbeam CEO Pat Cline three weeks ago.

People

IMDsoft names Lars-Oluf G. Nielsen (Epic) CEO.

Announcements and Implementations

Estes Park Medical Center (CO) goes live on Medhost EDIS.

UPMC (PA) will deploy 2,000 Microsoft Surface Pro 3 devices to deploy its Convergence app, which UPMC says it first tried to roll out on the iPad without success. Convergence, developed by UPMC and Caradigm, gives clinicians a single view of UPMC’s Cerner and homegrown applications and suggests and monitors compliance with clinical pathways.

Nevada, MO, Cerner’s testbed for healthy communities, gets a new playground courtesy of the company and the Nevada Parks and Recreation Department.

Government and Politics

CMS reassures taxpayers that the workers who were sleeping on the job at the call center of Serco (which has a $1.25 billion Healthcare.gov contract) are busier now that the site is actually working.

Jon Stewart makes fun of the June 9 testimony of Assistant Deputy VA Under Secretary Philip Matkovsky, in which Matkovsky says in in the deadest of deadpans, “Our scheduling system scheduled its first appointment in April of 1985. It has not changed in any appreciable manner since that date.”

It isn’t just the VA that has an appointment problems. England’s NHS backlog hits three million patients who are waiting for appointments, not even counting six trusts that couldn’t report data because of computer problems. Still, NHS squeaked by in meeting the requirement that it treat 90 percent of patients within 18 weeks. As with the VA, increasing demand could cause NHS to start missing its goals routinely.

OpenFDA was possible only because the agency used a startup’s technology to turn its document backlog into discrete data. Captricity uses a combination of optical character recognition and crowdsourcing the unreadable parts by giving human reviewers “shredded” sections so they don’t see entire Social Security numbers or full names, preserving confidentiality. Pricing runs around 15 cents per page.

Innovation and Research 

Device maker Medtronic says every person will eventually want sensors implanted in their bodies that will generate data for self assessment, remote monitoring, and disease management. The company is testing a pill-sized cardiac pacemaker and has already released the Linq insertable cardiac monitor that’s the size of a AAA battery and uses cell technology for remote cardiac monitoring.

Other

Via Christi (KS) asks for patience as it tries to recover from slowdowns caused by its Cerner Millennium go-live, with one patient reporting a 12.5-hour wait to get from the ED to a bed.

A McKesson-sponsored report predicts that value-based payments will double within five years, to two-thirds of the total.

AMA approves guidelines recommending that limitations on physician payments for providing telemedicine services be removed as long as a valid patient-physician relationship has been previously established, the physician is licensed in the patient’s state and follows that state’s laws, and standards are followed the same as for in-person encounters.

CHIME and AMDIS announce an alliance in which CHIME will provide health IT support to AMDIS and AMDIS will provide physician informatics advice to CHIME. The organizations recently jointly offered the CHIME/AMDIS CMIO Boot Camp, modeled after CHIME’s longstanding CIO Boot Camp.

Georgia Regents University will host the week-long NLM Georgia Biomedical Informatics Course September 14-20 at the Brasstown Valley resort in Young Harris, GA. Applications are due July 7. The nationally known faculty will teach change agents (biomedical educators, medical administrators, faculty, and others who don’t have knowledge of the field but who can spread the word) how to apply informatics solutions such as clinical informatics, big data, and telemedicine to their delivery, research, and education challenges. Enrollment is limited and competitive since the National Library of Medicine will pay for the registration, travel, housing, and meals of those accepted.

For $2,500, you can buy a report containing a SWAG at the size of the EHR market over the next four years in which the authors clearly don’t have a clue about data precision and presentation. Either that or they are very good at estimating the market to within 0.004 percent. I don’t see them trumpeting proof of previous accuracy.

A hospital in France blames a drug delivery robot’s computer bug for sending $15 million worth of drugs to the incinerator in the past five years.

An English hospital apologizes for the death of an 11-month-old baby whose acute appendicitis was not diagnosed because the samples for ordered tests were not delivered to the lab. A Trust spokesperson said that the pathology computer system has been upgraded to flag specimens ordered but not received.

Castlight Health co-founder Giovanni Colella, MD (formerly of RelayHealth), says big data rather than government intervention is needed to fix healthcare. He recommends: (a) companies should analyze the claims data from their health plan to see what they’re paying for; (b) gag clauses prohibiting the release of price contracts between insurance companies and providers should be abolished; (c) the government should allow the private sector to use Medicare claims data and physician quality data; and (d) price, utilization, and quality data should be made publicly available in the absence of a compelling reason not to.

More from Castlight Health: the company releases interactive maps showing national in-network pricing for lipid panel, PCP visit, head CT, lower back MRI (above, which ranged from $676 in Fresno, CA to $2,635 in Sacramento, CA, just 171 miles away by car.)

Sponsor Updates

• Healthland will offer its hospital customers Meaningful Use Manager of Iatric Systems to help with their Meaningful Use attestation.
• Grinnel Regional Medical Center (IA) reports a seven percent increase in cash collections, 79 percent of payments made via self-service, and 124 saved hours per month in a two-year review after its go-live with Patientco’s payment automation solution.
• Impact Advisors and the Scottsdale Institute publish a report from the CIO Summit on IT Cost Management and Value Realization.
• Sixteen medical innovations were showcased at Premier, Inc.’s Innovation Celebration in San Antonio, TX this week.
• Quest Diagnostics certifies MedicsDocAssistant EHR v. 7.0 from Advanced Data Systems as a Silver Quality Solution under its Health IT Quality Solutions Program.
• Janssen Diagnostics collaborates with Halfpenny Technologies to provide specialized reporting for HIV/AIDS healthcare.
• GetWellNetwork recognizes several providers for using its solutions to improve care at GetConnected 2014 in Chicago, IL.
• Hills Health Solutions signs a distribution agreement to make Lincor’s interactive patient engagement technology available in Australia and New Zealand.
• Craneware and Centura Health (CO/KS) will co-present best practices of charge capture during HFMA ANI 2014 in Las Vegas June 24.
• InstaMed shares how its Premium Payments solution has changed the consumer payment process.
• Medfusion publishes a white paper on creating patient value through portals.
• Gartner names Covisint a Leader in Identity and Access Management as a Service.
• PeriGen CNO Rebecca Cypher will discuss fetal heart rate interpretation at AWHONN 2014 in Orlando June 14.

EPtalk by Dr. Jayne

This has been a rough week in the healthcare IT trenches. Our medical group has been in acquisition mode again, resulting in the addition of several new specialties. Unfortunately, this time around our EHR vendor doesn’t have content for any of them.

Luckily we’ve been through this enough to have a process in place. Our implementation team sends out a staffer or two to observe the practice’s current state workflow and documentation style. This is essentially a reconnaissance mission. We try to blend in and to avoid having the practice ask us a lot of questions while we gather data.

The team then comes back and makes a presentation to the implementation manager, the application team manager, and me to talk about what their current process looks like and how much we’ll be able to handle with the EHR as-is, without any additional development. Depending on the specialty, it’s hit and miss.

For example, when we added vascular surgery, we were able to handle 95 percent of their needs because we have both general surgery and cardiovascular content. On the other hand, when we’ve added certain pediatric subspecialties, we’ve had to get creative with what we choose to offer them. Vendors haven’t quite figured out that children are not just little adults and it’s not as easy as just having them use adult content with the same specialty name.

For example, pediatric cardiology deals with care for children who have had a variety of surgical procedures that are largely unspoken of in the adult cardiology world. On the flip side, there isn’t very much coronary artery disease or many triple vessel bypass surgeries among the pre-adolescent set.

Often we’re working with physicians who are used to dictating their notes and having them transcribed. We’ve had good success at putting them in our EHR “core” templates for documenting histories, assessments, and plans, but we augment the “story” part of the visit with voice recognition. It’s a hybrid approach, but it prevents us from doing costly development that will only be used by a handful of physicians. It also provides for physician satisfaction in that they’re used to being able to include a detailed narrative in their visit documentation.

We encountered a rare bird this week, however: a subspecialist who seriously believes she’s going to be happy with point-and-click documentation. She wants us to build a whole herd of custom screens for her. She dictates on the hospital system at present and has no previous experience with discrete data.

In our experience with other physicians of the same subspecialty, it’s generally not worth building custom screens. They tend to change their minds before the content is even built. If they don’t change their minds, once they see it, they decide it’s too “clicky,” and 90 percent of the time they end up dictating anyway.

We had our follow-up meeting with her today. We ran through the options and asked her to try some typical click-by-click workflows in the general medicine templates just to get a feel for what it would be like. She wasn’t terribly proficient, so we had her try voice recognition within the system. She did fairly well with that. It was clear to the team that she’ll likely do better with that kind of hybrid approach. The subspecialist was unconvinced, however.

We moved to our next tactic,  which is to ask the physician to use our recommended workflow for a couple of months and then decide if we still need custom content. It was obvious that she was not buying what we were selling. She told us we were just being difficult and didn’t want to do what she asked. She then accused us of trying to skimp on her content for budgetary reasons.

We explained the history with other physicians in her specialty, even trying to show her the content we had previously built that her peers had abandoned. She didn’t want to see that either, but made it completely clear that she expected us to build custom content for her alone. I knew we weren’t going to win this discussion, so we agreed to go back to the office, brainstorm other solutions, then meet up in a few weeks.

In debriefing with the team in the car, we’re not sure what to do for her. We have more than a decade of experience doing this. We know what works and what doesn’t work. However, we have a physician with no EHR experience (and no track record as an end user – she won’t even use the hospital system) who is demanding a certain course of action. My team asked what we should do.

My thoughts went into doctor mode. It feels like the scenario where a patient is demanding an antibiotic where none is indicated, or insisting on a procedure that could potentially be more risky than it is worth. The patient in this case is arguing with the IT-equivalent of our professional medical opinion as to the course of care. In the medical world, we wouldn’t be bullied into doing something that is not of benefit. Not to mention that building clicky screens for a provider who has never been exposed to that documentation style is a recipe for unhappiness.

Our plan is to bring some of her soon-to-be colleagues in the same subspecialty with us to our next meeting and hope that their shared experiences will steer her in the right direction. We’d like her to make the choice herself without us having to flat out reject her request, but I’m not sure how we’ll handle it if she doesn’t start to get on board with our advice. Being new to the group, we know her level of trust of our team is low and her experience with EHR is minimal, so that seems like a logical approach.

I never like disappointing people. It’s always difficult to have those conversations with patients when you deny their requests. It’s doubly challenging when you’re dealing with a peer who might be more senior than yourself, and particularly difficult when they’re in a seemingly more prestigious subspecialty than your own.

In other parts of the physician universe, we’re also dealing with some significant Meaningful Use issues where physicians are requiring retraining and a lot of hand-holding. This was just one more thing to add to the mounting heap of stress.

I polled a couple of my CMIO peers on how they handle these situations. They didn’t have too many better answers. For all our readers on the implementation and content side, what’s your take? Is there a silver bullet solution? Email me.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 6/12/14

Q&A: Karen DeSalvo on Meaningful Use, ONC Reorg

National Coordinator for health IT Karen DeSalvo, MD, sits down with Scott Mace of HealthLeaders Media to discuss EHR usability, ONC’s restructure, and the future of Meaningful Use.

Group Of Electronic Health Record Vendors To Become Officially Interoperable

CommonWell, the EHR vendor interoperability alliance, will begin rolling out data sharing functionality to its customer base this summer.

AMDIS and CHIME Form Strategic Alliance to Further Adoption and Transformation of Health IT

CHIME and The Association of Medical Directors of Information Systems announce a strategic partnership in which AMDIS will serve as a physician informatics advisor for CHIME, while CHIME will serve as a health IT advisor for AMDIS.

HIStalk Interviews Matt Zubiller, VP of Strategy and Business Development, McKesson

Matt Zubiller is vice president of strategy and business development for McKesson.

Give me some background about what you do at McKesson.

I’ve been with McKesson for about 10 years. I’ve held a variety of roles, both on the strategy side and the general management side. Most recently I was the general manager for decision support, InterQual, and the Clear Coverage business. Now I am responsible for the strategy for the McKesson Health Solutions business, which connects payers and providers.

What is the Better Health tour?

McKesson put on the Better Health tour with a variety of its customers and stakeholders. McKesson touches a lot of different people and customers. We brought pharmacists, payers, providers, diagnostics manufacturers, and technology companies together to talk about healthcare and what type of change is needed to move it forward.

We’ve done that across several regions–Portland, Boston, and also in Minnesota now. We are looking to bring together each of these different types of constituents to help them move healthcare forward and help be the change we want to see.

What kind of innovation are they talking about on the tour?

It starts with looking at the change. We as McKesson operate on an international basis, but healthcare happens very locally. Depending on the region you’re in, there are different problems that are being addressed.

They were macro issues, like the changing of reimbursement from volume to value. But also issues about how you help to move technology along, along with physician adoption. How do you help payers or a health systems collaborate more effectively with each other to help drive the inefficiency out of healthcare?

Can you describe what you’re seeing that’s interesting or what attendees are talking about?

They talked about a few models — particularly in Boston — that were interesting to us. There are technology innovators that we invited. We call them Edisons. They are the folks who are  pushing both technology and different healthcare business models forward.

One example was a company called Iora Health. They contract with payers, providers, and primary care to provide primary care services on a fixed fee per-patient basis. That business model innovation is super interesting. When you use technology to support it, it becomes a lot more efficient and effective so you can track the performance of those patients.

Another example is some work that the Tufts health system has been doing. Tufts is a big health system, the oldest in the country, I believe. They had been looking across their region within the Boston area. They had contracted with and also connected to community hospitals so they could serve a much broader region of patients. You don’t have to have patients come in all the way into the Tufts health center to be able to be served. The community physicians themselves and the community systems can help support their patients.

There are several different ways we’re using technology to help break boundaries, but also to be able to shift business models.

Jonathan Bush had an interesting thought in his book that part of the limitations of healthcare are geographic as well as driven by state-by-state licensure. In addition to telemedicine, he says hospitals should physically transport patients from long distances into their hospitals that perform high volumes of specific procedures, the focused factory model. What’s the potential of telling a patient in Boston that the best treatment for them at the best price might be in Ohio or Minnesota?

I think that is another factor as well. The walls are both regulatory and just the way we think about healthcare today. 

Clayton Christensen was presenting at our innovation conference as part of the tour. He was talking about different types of innovation, both incremental and disruptive innovation. One of the things he has espoused is the fact that you need to provide the best care in the lowest-cost setting. I think that equally applies to your point, around the fact that care can be provided in one region or another depending on how efficient and how effective that really is.

Part of the problem in healthcare — and this is something that also came up –  is how do you effectively measure that? When you move from a volume-based model to a value-based model, where everybody’s talking about being paid based on value, how can you truly get to agreement around what value is? That’s a particularly difficult concept that the government’s trying to push forward with the ACA program, to begin to define different types of metrics.

But in the end, part of the wall you need to break down is not just understanding what good quality clinical care is, but what the financial decisions are that come along with it so you can begin to represent value.

I’ve worked in hospitals almost all of my career and we never told patients that another facility might be better at doing certain things. You worked in an area of McKesson that managed that data, so you could see it. Is it hard to convince patients that their local, shiny hospital that’s a source of community pride isn’t always the best place for them to seek care?

It’s an incredibly difficult sell, but I think it’s also generational. If you look at the generations who are a bit older, their fundamental healthcare relationship is based on that trust between them and their physician. If you look at some of the new generations, they’re beginning to not only question that, but they’re looking for the tools, as consumers in healthcare, to find the best healthcare at the best cost. 

I think it’s incredibly difficult to bend that, but generationally we will probably end up getting there, even if it’s going to be 20 years from now. I prefer to believe we can use technology to accelerate that.

The big thing two or three years ago was medical tourism, with foreign hospitals marketing their Joint Commission accreditation, English-speaking employees, and luxurious accommodations. What happened to that?

I think medical tourism still has its place. I think that is still progressing forward. Telemedicine will help progress that forward.

What seems to be a big catalyst that’s going to be needed is this push towards value. It’s super hard to compare and contrast where can I truly get the best care at the best cost. It feels like medical tourism is still a bit of a novelty. 

But when you begin breaking down these walls, if you can very clearly communicate to the patient, the consumer making that decision, what quality procedure they can receive with turnaround times and outcomes associated with it as well as cost, I think you’ll begin to see consumers demanding more of that information from the rest of the healthcare system.

Health IT startups usually claim they are innovative, but they are also often naive about the entrenched players and the difficulty in targeting an audience to make a sale or even get a pilot. What advice do you have for those companies?

Before I was in McKesson, I was both an entrepreneur and worked with a lot of entrepreneurs. One of the blessings you have as an entrepreneur is that you have wide-angle views, but also you don’t believe the obstacles in front of you are as big as they really are. I guess that’s the definition of an entrepreneur.

Healthcare moves slowly, more slowly than anybody else, because of all the constituents, stakeholders, and agendas that are involved. 

Most folks who know of McKesson don’t immediately think that we are this incredible source of innovation. But it’s interesting in that I see a lot of pockets across McKesson in the various different constituents we have that we are innovating. But I think that we can do it faster. I think we can do it smarter. 

That one of the reasons we put the tour together, to connect to those Edisons out there, those entrepreneurs who are thinking about new business models, who are thinking about overcoming the challenges that they see in front of them, and help us maybe get past, or in some cases, out of our own way. The partnership between the notion of the Davids and the Goliaths.

I guess you could argue that  McKesson can very much seem like a Goliath in many ways. But if we can partner with those Davids out there who are going to eventually disrupt the businesses that we work in in a way that helps support the innovation, I think we can get what consumers need in the long run, which is more clarity around value, as well as being able to progress and change and adapt our business models before they get adapted for us.

What’s a good way for McKesson to work with those little companies?

We’re still figuring that out ourselves. We’ve tried the acquisition route before in the past. We’ve also tried the investment route before in the past, and we’re going to continue to evolve that over the course of the next 18-24 months as well with a couple of things that are coming out that we’re happy to talk with you about.

But one thing I’d throw out there is that we know that both on the outside and the inside that McKesson’s really good at scaling up, being able to take existing business models that have shown good promise and be able to provide both the technological support and the infrastructure and the scale to be able to blow it out to all the different stakeholders that are involved. And be able to do that while managing all the various conflicts.

For an entrepreneur, that’s really hard work. Not only that, it’s some of the most difficult work for them to try to pass through, because most of the time, entrepreneurs are starting new things and trying to grow companies, while the scale that McKesson brings is super important. 

I think that there’s a nice pairing there, where people who are looking to start new businesses and be innovative can look at things in different ways, show how that works, and then McKesson can bring its scale and its process excellence, customer relationships, and network to help it grow quickly.

If you took the start-ups that have a paying customer or two, you would eliminate probably 90 percent of them. Assuming they’ve cracked the code and gotten that far into healthcare, what are the biggest potholes in the road that could cause them to fail?

One is time. Most of the time as an entrepreneur, you’re naturally also very aggressive around time. But in healthcare, the clock moves so much more slowly. 

The ability to not only get customers on board, but to demonstrate results to show that you can actually improve costs or improve outcomes, is critical. Once you do that, you can scale. You have to address time. You have to be able to demonstrate outcomes and cost savings.

Once you’re able to do that, one of the biggest challenges that the entrepreneur has is figuring out how to break into the markets. Being able to get in front of payers, for example. Payers are obviously very busy and they’ve got a lot of things on their plate already. They tend to be somewhat siloed organizations. If you’re trying to get into a payer organization, you have to figure out how to leverage relationships to go do that.

That’s one thing McKesson can do, and it’s something I’ve seen myself. On the provider side, we obviously have relationships with thousands of health systems and tens of thousands of providers. That same issue — how do you break into the mindset of the physician when not only you but every other entrepreneur out there is trying to figure out how to get a hold of their attention to have them use your product or to be able to buy your solution?

It takes almost as much effort for an insurance companies other deep-pockets investors to do a little deal as a big one, so it may not be attractive to take a minority position or to invest in a small company. Is there a middle ground where they should look to someone other than a McKesson to help them get to the next level without giving away all of their equity?

I’ve seen a lot of experimentation out there. You see joint ventures that are happening because they’re a little bit less intensive in terms of taking equity away from the entrepreneur. There’s a shared upside on both sides, which is nice. There are a couple of organizations that are out there that are using that very well to their advantage. 

There are venture funds that are being started by different organizations to support investments in those start-ups, which I think is also a good avenue depending on the level of engagement that the executives at that company have with those funds. That’s the real value the entrepreneur gets out.

If you serve a unique or specific niche or segment need, you can start with a simple partnership to demonstrate value and have the organization help you demonstrate that value. That can go a long way to the next step, be it a joint venture, a venture investment, or a potential acquisition down the road.

What do you see as the most likely area in which there could be true disruption versus incremental innovation, focusing on the technology side?

I look at technology as a great enabler of a disruption, but I don’t look at it as the source of the disruption.

As we move and shift our reimbursement system, it’s going to be a tremendous impact on our organizations. ACA, for whatever it’s worth, did many things. One of the things it did was expand access. It hasn’t done a lot around controlling costs.

I think you’ll see the next big change is going to be how to get our costs under control. Health systems have tremendous operating margin pressure. Health plans themselves are limited in terms of where they can reduce medical costs. 

In the end, I think the shift in reimbursement model from a volume-based, fee-based model to a value-based model is where you’re going to see significant disruption. You’re going to see providers beginning to think about pushing volume out to lower cost settings. You’re going to see payers incentivizing providers and doing it in a way that’s clear. 

They’re going to need technology to do all of this, from population management — which is one of the thing McKesson is focused on — through risk management, through telemedicine, through connectivity. CommonWell is a good example — to be able to share data across different systems. Work we’re doing around decision support to both know clinically and financially what’s most appropriate at the point of care. Those are technological innovations that are going to stem from that business model disruption.

Do you have any final thoughts?

The tour is an exciting thing for us, but it’s just one part of the many things that McKesson is looking to do to drive and partner with innovators. Recognizing that we are a big organization that’s been around for a really long time, by working with those companies who have great ideas and those people who want to change healthcare for the better, the tour is just one good example of us trying to make that happen.

CIO Unplugged 6/11/14

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

Data-Driven Performance

I have a confession to make. While I am an uber advocate of data-driven performance in healthcare and IT operations, I seldom apply these tools to my personal life. Sure, I look at data when I consider investments and major purchases, but, put it this way, you’ll never see me with a Fitbit!

I am witness to the power of data to shape clinical transformation. Are you kidding me? Serving in organizations with mature electronic health records and advanced business intelligence tools, I see the evidence in our quality reports all the time. Bam! Data-driven outcomes for sure. Evidence-based medicine—check. Ditto on the business side. In fact, my organization is among the first in the country to post our data-driven metrics online. Transparency is a great motivator.

For all my talk on leadership, innovation, connected health, and business intelligence, you might expect me to be a walking wearable. Nope. I’m wired as a visionary. Details are not my forte. I might have a grand idea for a party, but I leave the planning and execution to the detailed-minded organizers.

When it comes to athletic endeavors, I’m about getting to the finish line fast. Forget style and quality form; just get out of my path.

Over the years, the downside of this method caught up with me. Time was no longer my friend. Another confession: my performance had stayed flat for a few years. I wanted to see improvements, so I needed to change.

My friend Ben Levine is a perennial “top doc.” He runs the Institute for Exercise and Environmental Medicine and is one of the world-renowned types who’s been kind enough over the years to help train my mountain climbing teams.

Ben took me through the paces of his research lab. Part of our deal meant I had to be in a study and sport a wearable for a while.

After analyzing all the tests, he told me my body was capable of greater performance. My lifelong conditioning gave me a good base, including a resting heart rate of 40 (occasionally six BPM when asleep). But I had not reached my physiological potential.

I researched and found a triathlon coach to help me get to the next level of performance. Of course, it turned out that Amari of Dallas-based Playtri is a total data hog. She stretches me (no pun intended) beyond my comfort zone with all these wearables and resulting analytics.

In the past, I would cycle in a race and hope for the best by just doing whatever felt good. Now she had me monitoring a combo of heart rate, cadence, and wattage. Speed is secondary. If I focus on the analytics, the outcome (speed) will take care of itself. If I only look at speed, as I did in the past, I might dismount my bike only to find I have no legs left for the run —bonk!

I posted last fall about qualifying for regionals and then for the national Duathlon (run/bike/run) championships. Through grit, I lucked out and secured the last spot (age group) on Team USA. It was not pretty, but I made the team.

With the World Championship on the horizon as well as other important races, the time for data-driven performance arrived. A real life experiment—with me as the subject. Time to walk the talk.

Albeit imperfect in my utilization, Amari’s training formula is completely driven by near real-time data feeds. She makes adjustments based on daily training and race results. I dutifully wear the gear and upload. She parses the data, does meta- and microanalysis, and off we go.

What were the 120-day results?

I am writing this post on the plane home from the World Championships in Pontevedra, Spain. I followed Amari’s race plan, which was all data points: 150-165 BPM heart rate on the first 10K, 270 watts on the bike, never going lower than 165. It was not “outrun the person in front of me,” but to be patient and focus on my data. If I did that, the results would be my friend.

I finished in the top 25. I was the #4 American (an upgrade from #18 last fall) to cross the finish. Data-driven performance! I’m a believer. I can’t wait until I perfect the technology and discipline myself further under Amari’s coaching to see even stronger outcomes.

Personal life imitates professional. We must all push our organizations and ourselves to become data driven.

While being data driven leads to improved outcomes, no data tool could ever create the following. Intrinsic motivation does have a purpose.

The home stretch with .5K to go. I saw the Team USA Manager exhorting us to finish strong. Tim handed me Old Glory as I ran by and said, “Catch two more racers!” I caught my two as I turned into the stadium sprinting to the finish. Waving my country’s flag. Hearing chants of “USA USA USA.” Tears of joy.

Go Team USA!

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

Morning Headlines 6/11/14

IBM Joins Forces with Epic to Bid for Department of Defense Healthcare Management Systems Modernization Contract

IBM announces that it will partner with Epic in the pending DoD EHR vendor search, naming IBM CMIO Keith Salzman, MD, MPH and 22-year Army doc, as project lead.

Intermedix Corporation Acquires T-System’s Physician Billing Division

T-System sells its ED billing solution to Intermedix, stating in a press release that it would focus its efforts on ED clinical and coding workflow.

Taxpayers Face Big Medicare Tab for Unusual Doctor Billings

The Wall Street Journal analyzes CMS payment data and finds that 2,300 physician practices earned $500,000 or more by repeatedly billing for a single procedure. One doctor in California billed Medicare $2.3 million for a non-invasive cardiac procedure that he describes as “exercise while lying on your back.” Though he is not a cardiologist, his practice performed the procedure more times than all of the cardiologists at the Cleveland Clinic combined.

Alliance for Connected Care

The Alliance for Connected Care writes a letter to incoming HHS Secretary Sylvia Burwell asking that she use her authority to relax telehealth reimbursement regulations.

News 6/11/14

Top News

 

Our intrepid beltway reporter Dim-Sum has been telling us for months that IBM and Epic are pitching for the DoD’s $11 billion EMR contract, which IBM now confirms in announcing its intentions. Heading the project will be IBM CMIO Keith Salzman, MD, MPH, who was an Army doc for 22 years. Dim-Sum’s reports have been minor masterpieces of puns, semi-obscure references, and teasing hints, but I just realized that even his or her phony name is yet another one: the bid falls under DHMSM (DoD Healthcare Management Systems Modernization). I suspect we will get a June report shortly, but in the meantime, you might want to refer to his or her updates from March 5, March 28, April 9, and May 2 now that their accuracy has been confirmed (he or she reported here that it would be IBM-Epic two months ago.)  

Reader Comments

From Big Sky: “Re: Benefis Health System in Montana. Has an RFI out for EMR replacement.” Unverified. I don’t know what they’re running for inpatient, but they finished a huge NextGen ambulatory rollout a couple of years ago.

From Speechless: “Re: HIMSS chapter speakers. We are putting together a panel discussion for the fall on healthcare IT innovation. If you could choose one or two East Coast speakers, who would they be? We’re thinking of a progressive hospital CIO, someone interesting from one of the incubators, and a provider-side innovation leader.” Let’s crowdsource it with HIStalk readers – leave a comment with your suggestion or if you’d like to volunteer to present (or you can email me.) I’ve been a HIMSS chapter program chair and it’s hard to get good non-vendor speakers.

From Demon Deacon: “Re: Wake Forest Baptist Medical Center. Successfully launched Epic Inpatient for the Lexington Medical Center, which was the last Wake Forest hospital to go live.” Congratulations to WFBMC for getting the job done despite some disastrous (and preventable) early missteps that cost the health system a lot of money and credibility. My fellow barbeque fans might consider a site visit given that Lexington, NC has the highest ratio of pits-to-people in the country and one joint (Lexington Barbeque, aka “Honey Monk’s”) fed world heads of state at a 1980s summit at the request of President Reagan.

From Power Seeker: “Re: power strips. Joint Commission says that CMS ‘is no longer allowing relocatable power taps, referred to as RPTs or power strips, to be used with medical equipment in patient care areas, including operating rooms, patient rooms and areas for recovery, exams, and diagnostic procedures. The restriction does not apply to non-patient care equipment such as computers and printers or to areas such as nurse stations, offices, and waiting rooms.’ If this is true, time to invest in companies that sell UPS solutions.” It’s true. Patient care rooms are going to need a lot of red wall jacks to plug in medical devices individually. Hospitals will also need to check their liability insurance since power cords will be running all over the place and tripping people. I see the point – even UL-approved power strips aren’t intended for critical medical devices where failure could be disastrous (if there’s no battery backup, anyway) — but alleviating that risk will be ugly in already-crowded patient rooms.

From Wayne Tracy: “Re: Monday’s post. I’m very cynical about the VA’s problems and agree that because of commercial vested interests, VistA is quite likely to become a fall guy. VistA in my opinion is the most comprehensive user-developed healthcare clinical application. My fear is that the lack of advocacy is because: 1) Sonny Montgomery is no longer in Congress, 2) No vender will make money on it, 3) No consulting company can charge an arm and a leg to implement it. The proposals to do away will the VA healthcare system are at best naive. Last time I looked at our mental health system, I’m compelled to assert that it is woefully inadequate. What system can deal the population of amputees and brain trauma cases plaguing some two million recent vets? Some have suggested that some 50 percent are or will experience PTSD and related psychological problems. What civilian healthcare organization is prepared to deal with that large a patient population, or more importantly, has the proven expertise? If you think the backlog is bad now, just wait. This administration and Congress has good intentions that will potentially result in a diminished quality of care at greater expense.” Wayne is an industry long-timer and a retired Navy officer. I agree with all of his points. VistA will take a fall because the VA’s volume and people problems are drawing beltway buzzards and arrogant DoD’ers who can’t wait to see VistA replaced with something way more expensive even though it has been a poster child for doing IT the right way for patients (although the VA has struggled with automating patient scheduling). Nobody wants to talk about his second conclusion – we civilians weren’t really paying attention to what was happening in Iraq and Afghanistan because the death toll didn’t seem all that high. Our military participants were coming home alive but physically and mentally mangled and now we have to figure out how to pay for their care whether it’s delivered by the VA or otherwise. I’ve argued in the past that the VA should be dissolved and care provided by the existing healthcare system, but I’m not confident that system can handle the volume any better or that we can manufacture enough additional red ink to cover the cost.

HIStalk Announcements and Requests

Listening: Circa Survive, thoughtful indie rockers from Doylestown, PA. I’ve been listening to them nonstop once I got over my disappointment that the singer isn’t a sensitive female but instead is a high-voiced guy. Those of us with a clinical persuasion will appreciate this song title: “The Difference Between Medicine and Poison is in the Dose.” They’re touring now with Ume, who I also like a lot. Also, new albums from First Aid Kit and Passenger.  

I was reviewing Steve Blumenthal’s slides from the June 24 webinar below – he’s going to be fun, I suspect, especially for a lawyer. I also sat in on the rehearsal for the radiology workflow one and it was interesting to hear about teleradiologist workflow with the high volumes of images they deal with – no wonder they sit in a quiet, dark room and look at on-screen pictures while talking into a microphone all day. Like programmers, I’m guessing they rarely see daylight.

Upcoming Webinars

June 11 (Wednesday) 1:00 p.m. ET.  A Health Catalyst Overview: An Introduction to Healthcare Datawarehousing and Analytics. Sponsored by Health Catalyst. Presenters: Eric Just, VP of technology; Mike Doyle, VP of sales; Health Catalyst. This short, non-salesy Health Catalyst overview is for people who want to know more about the company and what we do, with plenty of time for questions afterward. Eric and Mike will provide an easy-to-understand discussion regarding the key analytic principles of adaptive data architecture. They will explain the importance of creating a data-driven culture with the right key performance indicators and organizing permanent cross-functional teams who can measure, make and sustain long-term improvements.

June 24 (Tuesday) noon ET. Innovations in Radiology Workflow Through Cloud-Based Speech Recognition. Sponsored by nVoq. Presenters: David Cohen, MD, medical director, Teleradiology Specialists; Chad Hiner, RN, MS, director of healthcare industry solutions, nVoq. Radiologists – teleradiologists in particular – must navigate multiple complex RIS and PACS applications while maintaining high throughput. Dr. Cohen will describe how his practice is using voice-enabled workflow to improve provider efficiency, productivity, and satisfaction and how the technology will impact evolving telehealth specialties such as telecardiology.

June 24 (Tuesday) 2:00 p.m. ET. Share the Road: Driving EHR Contracts to Good Compromises. Sponsored by HIStalk. Presenter: Steve Blumenthal, business and corporate law attorney, Bone McAllester Norton PLLC of Nashville, TN. We think of EHR contracts like buying a car. The metaphor has is shortcomings, but at least make sure your contract isn’t equivalent to buying four wheels, an engine, and a frame that don’t work together. Steve will describe key EHR contract provisions in plain English from the viewpoint of both the vendor and customer.

June 26 (Thursday) 1:00 p.m. ET. The Role of Identity Management in Protecting Patient Health Information. Sponsored by Caradigm. Presenter: Mac McMillan, FHIMSS, CISM, co-founder and CEO of CynergisTek. Identity and access management challenges will increase as environments become more complex, users create and manage larger amounts of sensitive information, and providers become more mobile. Learn how an identity and access management program can support regulatory compliance, aid in conducting audits and investigations, and help meet user workflow requirements.

Acquisitions, Funding, Business, and Stock

T-System sells its ED billing business to Intermedix, saying it will focus on its clinical and coding initiatives that will continue to be offered under the RevCycle+ brand.

Indianapolis-based startup Indigo Biosystems raises $8.5 million in venture capital and replaces its CEO with the company’s founder. Its clinical laboratory software interprets visual results from instruments such as mass spectrometers, flagging outlier data for human review.

Oncology drug maker Celgene invests $25 million in NantHealth to develop personalized medicine for cancer. There’s a connection: NantHealth founder Patrick Soon-Shiong sold his own chemo drug company, Abraxis BioScience, to Celgene for $3 billion in 2010.

Sales

The federal government awards ScImage a two-year, $45 million contract for its Picom365 Enterprise system, including PACS, diagnostic viewers, VNA, and workflow tools.

United Arab Emirates-based physician helpline vendor Mobile Doctors will implement mobility solutions from Cerner.

Freestanding Cypress Creek ER (TX) chooses Wellsoft’s EDIS.

Mission Health (NC) will advance its population health management with Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

Children’s Health Alliance (OR) chooses Wellcentive’s population health management solutions.

Catholic Health (NY) selects Perceptive Software’s enterprise content management system to integrate with its Infor financial and HR systems.

People

Sunquest officially announces that Matthew Hawkins (Greenway Health) has joined the company as president.

Capsule Tech promotes Kevin Phillips to VP of marketing and product management.

Former athenahealth CFO Carl Byers (Fidelity Biosciences) joins the board of Netsmart Technologies.

Announcements and Implementations

ZeOmega announces the 5.6 release of its Jiva population health management system.

Healthcare Engagement Solutions signs an agreement with Cleveland Clinic Innovations to further develop its Uniphy mobile technology platform.

Rockcastle Regional Hospital (KY) goes live on Medhost, sending data to the Kentucky HIE through YourCareLink.

IntraCare North Hospital (TX) goes live on Medsphere’s OpenVista.

Belmont University and the Tennessee chapter of HIMSS launch a healthcare IT certification program for individuals.

The mHealth Summit announces that it will host the Global mHealth Forum for low- and middle-income countries, to be co-located at its December 7-11 conference in National Harbor, MD.

Castlight Health announces GA of Castlight Enterprise Healthcare Cloud, which provides four solutions for self-insured employers: cost-optimization analytics, benefits design, a catalog of available third-party services, and a mobile benefits app for employees. Shares were up 3 percent Tuesday, but still down 58 percent from the closing price on IPO day less than three months ago. The company’s valuation is $1.5 billion on $20 million in annual revenue and $75 million in annualized losses.

Government and Politics

A  VA self-audit of 731 facilities finds that 13 percent of schedulers were told to enter desired appointment dates different from what the patient requested, eight percent of facilities kept external scheduling lists invisible to the VA’s EWL/VistA systems, and unrealistic targets encouraged facilities to game the system. New patients waited up to three months to see a doctor. The VA announced immediate changes: eliminating the 14-day appointment target as unreasonable, implementing real-time patient surveys, conducting an external audit, freezing new hires and eliminating bonuses at VA headquarters and regional offices, and creating an HR team to get clinicians hired faster.

CMS may be congratulating itself publicly for releasing Medicare payment data (which it did only after losing a lawsuit in trying to prevent it), but the more the statistical jockeys play around with the databases, the more obvious it becomes that CMS is asleep at the taxpayer wheel. A Wall Street Journal analysis finds that 2,300 providers were paid $500,000 or more from performing single procedures or services, some of them operating well outside their area of expertise. A non-cardiologist was paid nearly all of the $2.3 million he billed Medicare for in 2012 for performing a rare and questionable cardiac procedure (“exercise while lying on your back,” advertised on his site above) on all of his Medicare patients, with his entire training in the procedure consisting of “reading lots of articles, studies, and clinical trials.”An orthopedic surgeon billed Medicare for $3.7 million in one year even though he didn’t perform a single surgery – he charged for 108,000 massages and manual manipulations. It was billed by his former employer, Abyssinia Love Knot Physical Therapy, a PT chain run by self-proclaimed “Pastor Shirley.”

HHS tweeted this picture, which it captioned, “Welcome Secretary Sylvia Mathews Burwell!” I haven’t seen anything official that she has been sworn in.  

The Indian Health Service contributes its VistA-based RPMS scheduling system to the OSEHRA open source community.

The Alliance for Connected Care writes to Sylvia Burwell even before she takes office as HHS secretary, urging her to use her authority to open up telemedicine reimbursement for all ACO providers, not just those located in specific rural areas as is the case today. The trade association, run by former government officials Tom Daschle, Trent Lott, and John Breaux, actually sent two letters, one signed by its business members (Walgreens, WellPoint, and Teladoc, for example) and the other signed by a couple of dozen big health systems. The American Telemedicine Association sent Burwell a letter of its own listing sweeping improvements that would be enabled by paying everybody for delivering telehealth services, with that letter signed by mostly by big vendors (and HIMSS.) One might infer that while patient care could improve under such an arrangement, vendor and provider revenue would most certainly do so. Sylvia hasn’t even found the restroom yet and already the special interests are pawing at her.

Statistics presented at Tuesday’s HIT Policy Committee meeting indicate that of EPs who first attested for Meaningful Use in 2011, 84 percent attested in 2012 and 75 percent in all three years of 2011, 2012, and 2013. Nearly half of those who attested the first year and then skipped 2012 returned in 2013. EHR incentive payments totaled $24 billion through the end of May.

AHRQ, presenting at the HIT Policy Committee meeting Tuesday, says that lack of EHR interoperability is a big problem, recommending that ONC define an “overarching software architecture” within 12 months and require EHR vendors to develop and publish APIs to support it. I’m pretty sure that’s not going to happen.

Other

St. Francis Hospital (GA) admits that one of its employees sent a mass email to 1,175 patients using CC: instead of BCC:, exposing the email addresses to all recipients. Apparently even that triggers the breach notification rule, at least according to the hospital’s interpretation.

BetaBoston profiles Seratis, a secure messaging app for care teams. The company is offering free personal use and hopes to get a Boston pilot. Their site is light on details, so it’s hard to determine whether its product is differentiated from similar apps from bigger players.

Victor Dzau, MD, stepping down as CEO of Duke University Health System (NC) on June 30 to become president of the Institute of Medicine, looks back on his tenure with comments about Duke’s $700 million Epic system:

I think we all recognize that to provide the best care for patients, you need an integrated information technology system … you can capture all the information of the patient made available to the providers and the patient, and make it available throughout the entire system … Through Epic, we are able to connect with other systems that have Epic, such as Novant and many others; now UNC just implemented it … It really is an entire information system that allows you to look at charge capture, laboratory testing, finances, work flow, decision-making … it’s a phenomenal system that can help us really improve patient care … about a year ago, I launched an institute called Health Innovation to try to make the whole place think about better ways to think about patients to try to bring together this whole large amount information that we have now through electronic health records and the use the analytic capabilities to look at data, big data, to determine how we can be a learning health care system, and try to use the new technology of digital technology sensors and others to manage patients better in the community in their homes and so they don’t have to use our facilities as much … we have Durham Health Innovation which is an initiative that we will work with the Department of Health and others bringing in geographic information systems, mapping the patient, the community, where do they live, what are the economic factors, what’s the closest clinic where’s the closest grocery store, the closest barber shop to work together to improve their health.

This seems like the worst app idea ever. A Singapore company creates Hospital PIX, the usual lame hospital finder app that also allows users to “post reviews about OBAMACARE.” That’s not even the “worst” part: it also encourages doctors, nurses, and patients to post their hospital photos (we have this thing called HIPAA over here). The fake photos from “Benson Hospital” feature an entirely Asian medical staff and the hospital distances shown are all from Indonesia, so perhaps the app’s localization isn’t quite complete.

In Alberta, Canada, the government-backed Telus Wolf system goes down on Monday, leaving practices without access to lab results, medical histories, and medications. According to one doctor, “There is no longer any government support. We pay $2,000 a month for this. Who is going to hold Telus accountable now? The government has abandoned us. Cost and issues switching patient data when systems are not compatible prevents us from going somewhere else.” Telus acquired Wolf Medical Systems in February 2012.

The Apple Toolbox site files a Freedom of Information Act request to find out what was discussed in several meetings between Apple and the FDA last year. The highlights:

• Apple thinks the FDA’s guidance on mobile medical apps is appropriate.
• The company believes it has a “moral obligation” to do more given the increasing number of available mobile sensors.
• FDA will regulate apps based on their intended use, not necessarily because they use a particular sensor. For example, FDA wouldn’t regulate an consumer-oriented information nutrition app that uses a glucometer, but would consider the same app a medical device if it is targeted to diabetics.
• Apple and FDA will work more closely together to ensure that Apple’s plans don’t run afoul of FDA’s requirements (it’s good to be Apple).

Weird News Andy questions whether this was really the “responsible” anesthesiologist. Washington’s health department suspends the license of a Seattle anesthesiologist for sexting during surgeries, accessing patient images for sexual gratification, and having sex at the hospital. Investigators found 250 sexually related messages he had sent while in surgery, including pictures he sent to patients of his exposed genitalia, one of which he captioned, “My partner walked in as I was pulling up my scrubs. I’m pretty sure he caught me.” 

Sponsor Updates

• Greenway customer ARcare (AR) earns recognition as Stage 7 of the HIMSS Ambulatory EMR Adoption Model.
• Impact Advisors is named to Crain’s Chicago “Fast 50 List” of high-growth companies.
• A pMD blog post addresses “Medical scribes: the solution to EHR inefficiencies, or just a temporary bandage?”
• First Coast Cardiovascular Institute (FL) reduces charge lag after going live on MedAptus charge capture.
• Kareo and ChartLogic partner to deliver cloud solutions for surgical, orthopedic, and otolaryngology specialties.
• Gartner names AirWatch as a Leader in the 2014 Magic Quadrant for Enterprise Mobility Management.
• Verisk Health SVP Matt Siegel will moderate a panel discussion on value-based healthcare at AHIP Institute June 12 in Seattle, WA.
• Truven Health Analytics launches its cost-sharing reduction analysis and reconciliation solution for health insurance exchanges.
• Merge Healthcare is hosting a Coding Contest for Computer Science students June 11 at the University of Waterloo in Canada.
• ADP AdvancedMD supports the Greater Springfield Habitat for Humanity during a corporate team-building day.
• NaviNet collaborates with Informatica to deliver a “smart” network.
• E-MDs will offer Lightbeam’s population health management solution to its clients.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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Morning Headlines 6/10/14

Hospital Giant Uses Data to Vet Treatment Options

UPMC reports that it will expand its patient centered medical home program after the pilot program generated $15 million in savings over the course of a year.

FDA details high-level meeting with Apple: “Moral obligation to do more” with health, innovative sensors

Responding to a Freedom of Information Act request, the FDA publishes details on its meetings with Apple earlier this year, which focused on health apps and the regulation of sensor-laden consumer devices.

Why the New Obamacare Website Is Going to Work This Time

Wired covers the continued behind-the-scenes effort to rebuild Healthcare.gov, and the culture clash that develops when CMS bureaucrats are partnered with Silicon Valley temp workers to tackle a job with enormous political undertones.

Curbside Consult with Dr. Jayne 6/9/14

I mentioned that I was planning to start working in an urgent care that documents patient visits on paper. I fell into an opportunity with an independent facility and worked my first shifts this week. A reader asked if I had mentioned during the job interview that I would be blogging about my work and whether I’ve been able to remain anonymous in my various work roles.

The answer to the blogging question is “no.” I enjoy my day jobs and wouldn’t want to jeopardize them. Although I share many stories about my work, there are a great many stories that don’t get told because they might result in specific people or organizations being identified. Some of the best tales will go with me to the grave.

A reader once said that as a CMIO, I’m still a doctor, but my patients are sick hospitals and physician offices. That’s true to a degree and I guard their information as I do with patient information. Often my material reflects events that are so common they could apply to many organizations across the country, so camouflaging the events and players isn’t necessary.

As far as my clinical duties, I do think I’ve been able to remain anonymous. Frankly most clinicians in the trenches are too busy keeping their heads above water to even know that there’s an entire health care IT community out there. They may not know who their own CMIO is or what he or she does, let alone that there are scores of us who know and talk to each other. The idea that there would be blogs talking about EHRs and the people who use them to torment physicians isn’t even remotely something that would cross their minds.

If I use photos from work, it’s often months after they were originally taken or in a slightly different context than where I obtained them. I have a veritable treasure trove of photos I’ll never be able to use because they would be easily identifiable or involve people that I know read HIStalk. I also use photos that have been sent to me by readers when they can help embellish something I’m writing about. Hopefully if anyone recognizes those, the story is different enough from their reality that they don’t make the connection.

Back to the world of paper records. I arrived at the office ready to go. It’s a little different vibe from working the ER. The lack of a metal detector and security guard was refreshing, although I admit after my first procedure, I missed wearing scrubs.

The physician I worked with was quick to show me the processes and systems. Staff does the intake interview, gathers the history, and performs any needed pre-testing based on a written standing order. The clipboard goes in the door with a magnet to indicate which patient should be seen next. Simple and elegant, although low tech.

The physician sees the patient, documents on a paper template (they have a dozen or so templates for their top conditions plus some more generic versions), then comes out and order whatever additional tests are indicated. If there aren’t any, we prepare the discharge instructions and prescriptions, which are done via computer. The prescription ordering system isn’t sophisticated, but it does have hard-coded selections for the most common drugs, sortable by body system and diagnosis. If you can’t find them, there’s a search dialog, and if you get in a real bind, there’s a paper script pad in the drawer.

I have to reiterate that this is obviously not a practice that is trying to achieve Meaningful Use. As an opt-out site, we’re not asking super-detailed questions about smoking history or the types of tobacco used. We’re not asking race and ethnicity. We’re not codifying problems in SNOMED. Since we’re not part of a hospital system or accredited by The Joint Commission, we’re also not spending time assessing suicide risk, nutritional status, or any number of possibly irrelevant scenarios on all our patients. This leaves us time to actually see our patients at a reasonable pace.

Even though the first part of the shift was fairly busy (5-6 patients per physician per hour), the pace didn’t seem extreme. I think mostly it felt like I was able to focus on the patient’s current needs and not feel expected to address unrelated issues just because someone made a regulation that said I needed to.

Once the provider is finished, the nursing staff then takes the discharge instructions and scripts, goes back in the exam room, counsels the patient, and addresses follow-up needs. Then the patient gets to go home. Their plan may not have all their medications printed on it nor their list of historical diagnoses, recent vitals, or a host of other things, but it does have the information they need to care for today’s problem and to follow up with their primary care physician.

Up to this point, I’ve focused on the things that made today easy. Let’s talk about what made it difficult.

The first thing that jumped out at me was the fact that there is no drug or allergy checking when we write prescriptions. Although physicians have used paper scripts for years and there are plenty of people who argue that we were better on paper, I can’t help but think that I’m going to harm someone because I don’t have technology backing me up.

I calculated most of my weight-based pediatric prescriptions two or three times because I didn’t trust myself. I had one pharmacy call-back for prescribing a drug that might have had a mild to moderate interaction with a patient’s current medication. I know it would have flagged in an electronic prescribing system, but I’m wondering if there is a chicken vs. egg phenomenon going on. Did I miss the interaction because my vigilance was weakened by my reliance on technology? Or would I have missed it anyway?

I ended up customizing 80 percent of the patient education materials to include additional precautions or information that I like to provide for my patients. Most EHR systems would allow some level of saved customization. but our discharge system doesn’t. I’ll likely create a text document of common phrases that I can use to populate them in the future and just keep it open on my desktop.

Unlike some chain or pharmacy-related urgent cares, we don’t have an easy way to send information back to the primary care physician. It’s something that definitely merits discussion with my new employer.

Looking at the workflow with a critical eye, there were other inefficiencies. Staff had to transcribe lab data to the chart that might have been interfaced with an EHR. Patient education topics had to be searched manually rather than linked from diagnoses. These inefficiencies were virtually unnoticed, though.

Having done more than one stint as a science fair judge, I can’t say this was a valid experiment of any kind. Comparing this practice (regardless of whether it uses paper or EHR) to any other place I’ve practiced in the last several years would be like comparing apples to unicorns.

One major difference is the ability to focus on the patient’s presenting problem rather than extraneous but required information. Another is the encouragement to rely on support staff for tasks like order entry and diagnosis code lookup. It’s been so long since I was just able to articulate a diagnosis without codifying it that I didn’t know what to do with myself.

Whether it was due to the workflow process, the patient acuity mix, or other factors, I noticed one thing. Even after 12 hours of non-stop work, I felt like I had spent more of my day being an actual physician than in doing other tasks. We’ll have to see if I still feel this way in six months, but right now I’m cautiously optimistic. I’m still going to lobby for e-prescribing, though.

Have a story about going back to the basics? Email me.

Email Dr. Jayne.

Readers Write: Six Ways to Capitalize on the ICD-10 Delay

Six Ways to Capitalize on the ICD-10 Delay
By Dan Stewart

Most of the healthcare industry was taken by surprise when President Obama signed legislation that delayed the deadline to implement ICD-10 by at least a year. Now that there has been time to digest the new compliance date of October 1, 2015, healthcare providers may benefit by considering a more strategic approach for their transition to ICD-10.

Prior to the extension, many healthcare providers put in patches to meet the previous and quickly approaching October 1, 2014 compliance date. Process improvements and documentation training were put into high gear to meet the deadline, and in many cases, lacked strategic planning. With the additional time, providers can revisit their approach to implementation and potentially take advantage of other initiatives that directly impact the way their organization is evolving.

Here are six strategies to take advantage of the delay to be better positioned for post-transition success.

1. Increase clinical documentation and education

Providers now have an additional year to train their workforce. Nurses, physicians, coders, and even members of the C-suite need to understand the benefits for greater specificity in clinical documentation and how it applies to their role. Customized simulation training that addresses the specific educational needs of clinician groups can simplify the learning process and speed adoption. For example, customized simulation training can allow caregivers to practice documenting care in ICD-10 through their actual EHR application, which is critically important for learning workflow and gaining new knowledge about the system.

Any time and money invested in efforts like simulation training will be financially beneficial in ICD-9 and will also provide a smoother transition to ICD-10 with reduced risk of reimbursement issues. In addition, by continuing to engage staff with training, organizations can avoid losing the focus and interest that was created by the momentum leading up to the previous deadline.

2. Evaluate and improve the revenue cycle

Providers now have time to improve charge capture and billing and claims processing. Doing so will help to identify potential lost revenue and charge issues before claims are submitted and will improve compliance in anticipation of new denials and other post-transition challenges. Improved charge capture will also create a safety net to assist in identifying any potential ICD-10 process issues.

3. Implement computer-assisted coding (CAC) systems

Many hospitals have invested in CAC systems to aid coders in digesting physician documentation and determining which of the staggering 141,000 possible codes under ICD-10 is appropriate for each diagnosis and procedure. Now is the time to support the implementation of CAC and focus on coder workflow to optimize the benefits. Remote coding programs should also be evaluated. Incorporating tools like these not only reduces post-transition risk but also assists in the recruitment and retention of coders, which are in significantly increasing demand.

4. Begin dual coding

It is a reality that hospitals will need additional coders during the transition from ICD-9 to ICD-10. The extra time resulting from the delay creates an opportunity to begin dual coding sooner, providing physicians and coders additional practice before the compliance date. Prior to the transition, CAC systems can assist in the dual coding process by providing an automated crosswalk back to ICD-9 codes for submissions to payers, clearinghouses, and other third parties. The increased accuracy and efficiency of documentation and coding optimizes the post-transition period, mitigating the risk of compliance and reimbursement issues.

5. Analyze the financial impact

Hospitals should take the time to perform an in-depth financial impact analysis to determine the highest-impact codes on reimbursement to provide focus on operational remediation and training. Such analysis will additionally assist in identifying the reserves that will potentially be needed to get through post-compliance stabilization.

6. Expand the implementation plan

The ICD-10 extension presents an opportunity to strategically link its transition with other initiatives like Meaningful Use, Patient-Centered Medical Home (PCMH), and Accountable Care. Combining plans to adopt all of these programs can help ensure they each work together as efficiently as possible.

Miami Children’s Hospital, for example, is working to deploy a revenue cycle management system in addition to working toward ICD-10 compliance. Now that there is less immediate pressure to have physicians trained as soon as possible on ICD-10, their training can occur after the new system modules are implemented to better reflect the healthcare provider’s specific system and workflow. Implementing both of these programs in tandem saves time and money and strengthens the success of each.

While it would be easy for healthcare providers to decide to pause their efforts to become ICD-10 compliant as a result of the recent delay, it would benefit them much more to view the extra time as an opportunity to take a more strategic approach. Continuing the process will position the provider for a more successful, efficient transition to ICD-10. 

Dan Stewart is vice president and partner of strategic consulting and advisory services with Xerox.

Morning Headlines 6/9/14

Cleveland Clinic Chief Out of Running for V.A.

Dr Delos Cosgrove, CEO of Cleveland Clinic, has withdrawn his name from consideration as the next secretary of the VA.

Moody’s downgrades Lifespan Rhode Island Obligated Group (RI) to Baa2; outlook negative

Moody’s has downgraded Lifespan’s (RI) bond rating based on a "multi-year trend of declining operating performance," but notes that the rating could go up once it finishes its Epic implementation.

Global IT company launches Manchester base

Allscripts is opening a new office in Manchester, England where it will house 100 employees working to help build its UK presence.

Tech expert Stack chosen as next AMA president-elect

Modern Healthcare notes that Dr. Robert Wah, the incoming president of the AMA, is a health IT expert, as is his 2015 replacement Dr. Steven Stack.