Morning Headlines 8/12/13

Draft – FDASIA Committee Report

HIT Policy Committee’s FDASIA workgroup, tasked with determining now to address patient safety concerns with electronic health records, call for leaving healthcare IT unregulated by FDA, but encourages reporting,  post-implementation safety testing, and allowing customers to publicly rate their applications. They also call for national standards for quality process and interoperability and encouraging vendors to publicly share patient safety information.

WattsUpDoc looks at medical device power usage to spot malware

University of Michigan researchers develop WattsUpDoc, which detects malware in biomedical devices by looking for changes in the power they consume.

Merge Healthcare CEO resigns

Merge parts ways with CEO Jeff Surges after a disappointing quarterly report.

Monday Morning Update 8/12/13

From Ramblin’ Gambler: “Re: HIT Policy Committee’s FDASIA workgroup. They released their draft EHR patient safety guidelines. I don’t think they went far enough.” The draft guidelines call for leaving healthcare IT unregulated by FDA, but encourage reporting,  post-implementation safety testing, and allowing customers to publicly rate their applications. They also call for national standards for quality process and interoperability and encouraging vendors to publicly share patient safety information.

From Leopold: “Re: breach. I had to chuckle at this one. The mixup was caused by a vendor named Infocrossing.” A programing error causes the medical information of 1,300 patients of MO HealthNet to be sent to incorrect addresses. Infocrossing is owned by India-based Wipro.

From Tennessee Dreamer: “Re: Re: Halamka’s view from the bunker. One really has to wonder whom he thinks he is fooling. When a topnotch trainee, who can do his residency at BIDMC, with its cloud-hosted, thin client, mobile friendly, highly interoperable software that is used nowhere beyond a city block from campus, or go to Mass General and use a commercial product that they will very likely use in their academic careers no matter where they wind up, will they decide to contribute to or chip away at BIDMC’s ‘strategic advantage?’ To express the obvious, that the academic, informatics-based HIT development enterprise has been a failure, clearly exemplified by BIDMC being surrounded by Epic in an over-before-it-began war for keyboards and eyeballs in the Boston healthcare market, would be too much to ask of Halamka, half of whose political capital is gained by his ever optimistic view of HIT. Yes, you can build a great suite of software when the only people you have to please are your friends and colleagues in your own neighborhood, when it really gets tough is please hundreds of other institutions at the same time. If Halamka was going to have made a real impact on healthcare, he and others in  the informatics community would have stopped living off government grants and taken the plunge to commercialize their products, putting their necks on the line in the marketplace and, if they were good enough, actually winning the war, to the benefit of everyone. But why do that, when even today you can retreat to the ever fewer centers, give each other tenure and Collen awards and cite each others’ JAMIA papers for research on products that hardly anyone uses? There are many useful lessons to be learned, and productive plans to be made in the current situation. Sitting in the last Boston holdout convincing yourself that you’ve fought the competition to a tie, and might yet win, isn’t one of them.”

Nearly 80 percent of poll respondents say they don’t pay any attention to Most Wired-type magazine awards. New poll to your right: is it necessary that the next National Coordinator be a physician?

Welcome to new HIStalk Platinum Sponsor lifeIMAGE. The company provides a network for sharing medical imaging information. Physicians, hospitals, and patients can securely exchange images from any location and integrate the images with EHRs and other systems. Workflows are defined for managing CD-based exams, receiving exams electronically from any source, importing images from outside into local systems, and sharing exams with physicians and patients. The network also includes a secure social component that allows individual users to connect with each other to exchange images. The company was the first to undergo a comprehensive KLAS review, with results that include 94 percent “would buy again” responses, along with 97 percent of clients interviewed saying the company keeps its promises. Notable customers include Boston Children’s Hospital, Mass Genera, and CHOP. Thanks to lifeIMAGE for supporting HIStalk.

I found this YouTube video describing how lifeIMAGE works.  

Private equity firm LLR Partners makes an investment in Philadelphia-area consulting firm HighPoint Solutions, which says it will become the largest life sciences and healthcare IT consulting company in the world by 2017.

HIStalk Webinar

Elsevier will present “Invigorate Order Set Management: Four Essential Steps” on Tuesday, August 27 from 12:00 – 12:45 p.m. Eastern. Presenters will be Jim Nolin, MD, editor in chief for order sets at Elsevier, and Kevin W. Hatton, MD, medical director of clinical decision support at University of Kentucky HealthCare.

University of Michigan researchers develop WattsUpDoc, which detects malware in biomedical devices by looking for changes in the power they consume.

Amendola Communications employees create a fundraising page for a co-worker, hoping to raise $10,000 towards the cost of brain tumor treatments for her newly diagnosed three-year-old son.

Merge Healthcare announces that CEO Jeff Surges has resigned due to poor company sales and will be replaced by Justin Dearborn, president of the company. Shares dropped 46 percent Friday on the news, dropping its market cap to $227 million.

It’s Siemens Part 4 this week in Vince’s HIS-tory.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 8/9/13

Allscripts announces second quarter 2013 results

Allscripts announces Q2 results: revenue of $344.8 million and $0.05 EPS, compared to $370 million and $0.16 EPS for the same period in 2012. Paul Black is optimistic, based on strong bookings for the quarter driven primarily from its population health solutions.

Nuance Gains as Icahn Builds Stake in Software Maker

Investment billionaire and hostile takeover specialist Carl Icahn has increased his percent ownership of Nuance from nine percent to 16 percent, according to an SEC filing.

CDS Surveillance Significantly Impacts Patient Outcomes

A KLAS survey of 140 providers evaluates clinical surveillance systems which as a whole seem to be delivering on promises of improved outcomes, as 79 percent of customers report that utilizing the technology has a moderate to significant impact on clinical outcomes.

Inova Translational Medicine Institute and GNS Healthcare Partner To Advance Diagnosis and Prevention of Preterm Birth

The Inova Translational Medicine Institute and GNS Healthcare will partner on a commercial project aimed at developing software that will use sophisticated algorithms and datasets to create personalized prediction of preterm birth risk and more accurate gestational length estimates.

News 8/9/13

Top News

Allscripts reports Q2 results: revenue down 7 percent, adjusted EPS $0.05 vs. $0.16, missing earnings expectations of $0.10. Revenue of $345 million missed expectations of $357 million. Shares are down 6 percent in after-hours trading. It’s the third straight quarter that MDRX has fallen short of expected profit. The announcement’s headline is a clear signal of a bad quarter given that neither revenue nor earnings are mentioned, indicating that the company was forced to dive deeper into the financials to find something to brag about. Allscripts is moving its focus (or at least the attention of analysts) to population health management given the minimal mention of its ambulatory solutions. I tried to listen to the conference call, but felt cognitive dissonance as the optimism I heard didn’t match the pessimism the numbers suggest.

Reader Comments

From Fraudbuster: “Re: Farid Fata, MD. Charged with Medicare fraud. He is affiliated with Crittenton Hospital in Rochester, MI and its cancer center. It’s big news in the Detroit metro.” Federal agents arrested the doctor at his practice Tuesday, charging him with a $35 million Medicare fraud scheme that included administering chemotherapy and PET scans to cancer patients who had no chance of survival. He is accused of employing hundreds of unlicensed doctors trained outside the US to see patients first so he could visit with 50-70 patients per day and bill Medicare for his time, which totaled $25 million plus another $24 million in drug infusions, making him #1 in Michigan. He’s also accused of taking home bags of patient records to do billing from his home. The complaint says that in one case, the doctor insisted that a male patient who had fallen and struck his head on the way to the clinic be given his chemo before being taken to the ED, where he later died of the head injury. You might think CMS suspicion might have been raised earlier(and payments frozen) by doctor billing $25 million.

From Bob: “Re: McKesson Horizon. My hospital is looking to migrate to Paragon. Can anyone share insight?” If your hospital has done the conversion or is underway, please leave a comment.

From DCInternRoomate: “Re: ONC-funded HIEs. They are failing, so expect a huge Blue Button push next week.” I’m assuming you are saying that HIEs have had minimal impact, so patients will be reenlisted as the hand-carrying human interfaces between non-interoperable systems. I wouldn’t necessarily disagree. Technology bears some of the blame for mandatory sneakernet, but mostly it’s the screwy US health system that created the problems involved with expecting competitors to freely share information, not to mention to disenfranchise the patient to the point where they are merely the widget that must be processed in order to trigger sending out a bill. Medicare in the 1960s made healthcare a business and not a charitable endeavor or a public health project as it simultaneous drove (short term) and drained (long term) the US economy, so it’s hard to work corporate empathy and compassion in there. Hospitals have generally good intentions but poor execution.

From Velvet Hammer: “Re: HCA. This e-mail should give you an idea about HCA’s EMR plans.” The e-mail describes plans for HCA and Reston Hospital Center to roll out Meditech Advanced Clinicals, which would suggest that perhaps HCA won’t abandon Meditech for Epic or Cerner after all.

From MyFirstTime: “Re: [vendor’s name omitted]. I called them to learn more, but they say they are getting so many calls that they have started a wait list for new customers. Is healthcare IT so popular that it is now mainstream?” I can’t imagine that a lab ordering and results solution is creating such demand no matter how good it is, but readers have reported that it’s the real deal. I’m not mentioning the name again because this comment smells a bit like a company planted item, having originated in the same location as the company’s headquarters.  

From Gordian Knot: “Re: Halamka’s recent self-indulgent blog post about benefits of keeping his organization homegrown. First, I really, really wonder what the cost analysis is when sites need to meet current regs. Second, I do find it humorous how other bloggers and semi-news sources immediately linked his comments with Maine Med having issues with an install of Epic. It all sounded like voices that have been waiting to jump on anything negative about Epic. How many people in leadership got ejected because of an install gone bad with Allscripts or Cerner or Siemens any other system? Look at Lahey and UCSF as extremes of installs gone bad. Since Epic is just about the only one installing anything,  a few missteps gonna happen.” I used to advocate homegrown software, but those days were gone once the federal government started setting the development agenda. It’s ironic that hospitals that outsource activities such as food service, ED coverage, and even clinical departments assume that they are better enterprise software developers than companies whose own core mission is exactly that. Sometimes organizations really do have expertise and processes that preclude using commercial software effectively, but usually they just overestimate their wonderfulness. Those big hospital systems that like developing their own systems (not BIDMC specifically – I ‘m generalizing now) often have the money to run huge IT departments because they’ve created a lofty-brand pricing monopoly rather than because they have the highest efficiency or best outcomes, and with reimbursement changes, they will just keep buying up practices and hospitals and spreading mediocrity.

HIStalk Announcements and Requests

From HIStalk Practice this week: 80 percent of clinicians use smartphones and almost half of physicians use a combination of smartphones, tablets, and laptops / desktops for professional work. Patients using EMRs through online portals express significantly higher satisfaction with their physicians and believe they are receiving better care. The AMA says CMS still has more work to do on the Medicare Physician Compare website. A reader reports on Aprima’s national user conference. A Colorado orthopedic clinic fires an employee who emailed PHI to her personal email in order to do some work from home. August is “Admit You’re Happy Month” which seems like the perfect reason to admit you’d love to make me happy by signing up for HIStalk Practice email updates. Thanks for reading.

Some recent HIStalk Connect posts worth your time:

Epocrates Mobile Trends 2013
HIStalk Connect Interviews Joe Reinardy, Founder and CEO, CenterX
Battle of the App Stores: athena vs. Greenway

Listening: Built to Spill, Idaho-based catchy guitar indie rockers that hit their popularity peak in the late 1990s that I’ve somehow missed until now. They’re on tour and I’m likely to check them out.

Welcome to new HIStalk Platinum Sponsor Valence Health, which offers providers turnkey solutions for delivering value-based care. The Chicago-based company has been doing that for 20 years and serves 35,000 physicians, 115 hospitals, and 15 million patients. Customers include Cleveland Clinic, Scott & White, OhioHealth, and half of the country’s freestanding children’s hospitals. Hospital solutions include clinical integration, population health, care management, analytics, managed services, physician network development, and financial analysis of value-based arrangements. Its Vision platform combines data from practice-based PM/EMRs, standardizes it with other data (hospital bills, labs, PBMs, LTC, payer), runs it through a proprietary EMPI, and then generates reports and analytics that measure quality, cost, and utilization and provides risk scores, identification of high-risk patients, and information to establish programs for specific populations and conditions. Its vMine technology obtains daily data from all certified PM/EMR systems and takes only 30 minutes to install remotely. Thanks to Valence Health for supporting HIStalk.

Elsevier will present “Invigorate Order Set Management: Four Essential Steps” on Tuesday, August 27 from 12:00 – 12:45 p.m. Eastern. Presenters will be Jim Nolin, MD, editor in chief for order sets at Elsevier, and Kevin W. Hatton, MD, medical director of clinical decision support at University of Kentucky HealthCare.

Acquisitions, Funding, Business, and Stock

LifeNexus, which offers a personalized health information smart card, raises $3.7 million from unnamed investors. Smart cards have been a solution looking for a healthcare problem for at least 20 years and almost always fail miserably, even when packaged as a hospital loyalty card.

Could computing vendor ClearDATA secures $7 million in second-round funding from Excel Venture Management and Norwest Venture Partners.

SEC filings indicate that activist investor Carl Icahn has increased his stake in Nuance from the 9.3 percent of the company’s shares he reported in April to 16 percent now.

Sales

Geisinger Health System selects VisiQuate to develop predictive revenue cycle analytics to increase efficiencies and lower collection costs.

Boulder Community Hospital Physician Clinics select Wellcentive’s Advance platform to facilitate care coordination in support of its PCMH implementation and as part of its comprehensive primary care initiative.

Twenty-four bed Cozby-Germany Hospital (TX) will implement RazorInsights ONE-Enterprise Edition.

People

Chris Belmont (Ochsner Health System) will be named as VP/CIO of The University of Texas MD Anderson Cancer Center (TX). I interviewed him in February.

Announcements and Implementations

St. Louis Children’s Hospital (MO) goes live on iMDsoft’s MetaVision for perioperative.

The Medical Center of Central Georgia (GA) implements Cerner CPOE with assistance from HCI Group.

The Baylor Quality Alliance ACO (TX) will expand its private HIE into a community HIE using technology from Sandlot Solutions.

Quantros will announce Friday that more than 1,500 Target stores and 50 Target clinics will implement its Safety Rx medication incident reporting system.

Texas Health Harris Methodist Hospital Hurst-Euless-Bedford, which surely must possess the longest and least-pronounceable hospital name in America, goes live on PCCI’s Pieces EMR-driven clinical surveillance and risk scoring system. PCCI is Parkland Center for Clinical Innovation, launched by Dallas-based Parkland Health & Hospital System in October 2012. Meanwhile, Parkland Memorial Hospital was finally deemed safe by CMS on Wednesday, which threatened in 2011 to cut off the hospital’s Medicare and Medicaid funding because of patient safety issues. The federal government said then that Parkland’s problems posed “an immediate and serious threat to patient health and safety,” forcing the hospital to spend $75 million on changes in the past two years.

Lubbock, TX hospitals launch the Llano Estacado Access Partners HIE, with the $80K startup costs underwritten by University Medical Center and Covenant Health System. 

Government and Politics

HHS releases a strategy for accelerating HIE in support of delivery and payment reform. Specific strategies and policies include:

• Developing regulations and guidance on existing programs to enable the secure portability of health information
• Advancing HIE among long-term, post-acute, behavioral health, and laboratory providers
• Developing standards, including an interoperability and certification road map and HIT standards for quality measurement and improvement
• Implementing incentive and reward-based policies to encourage providers to incrementally incremental adopt electronic HIE.

Innovation and Research

The Inova Translational Medicine Institute at Inova Fairfax Hospital (VA) and GNS Healthcare will develop and commercialize computer models for predicting risk of preterm live birth using next generation sequencing and EMR data.

Other

Seventy-nine percent of providers using clinical decision support surveillance software report that utilizing the technology has a moderate to significant impact on clinical outcomes, according to a KLAS report. Nearly all Epic, Hospira, and Wolters Kluwer users reported a moderate to significant impact on clinical outcomes, including reductions in length of stay, antibiotic usage, medication costs, and adverse reactions as well as better IV-to-PO conversions.

Highly rated with preliminary data in the KLAS report is PeraHealth, formerly Rothman Healthcare Corporation. I interviewed co-founder Michael Rothman in 2010 about what was then known as the Rothman Index, a real-time patient assessment and clinical decision support tool that readers found promising.

Genesis Health (IA) alerts several hundred patients that the transcription company used by Cogent Healthcare, its contract hospitalist provider, had exposed their information. It turns out it wasn’t just Genesis: Cogent now says India-based M2ComSys exposed information on 32,000 patients due to an incorrectly secured Web server. Cogent has since fired M2ComSys, which might have triggered confidence concerns initially given that all the photos on its home page still bear the stock photography watermark indicating that they apparently just stole the pictures instead of licensing them.

GlaxoSmithKline announces that packages of its vaccines will include two-dimension bar codes, which are smaller and can contain more information that linear bar codes. GSK will include lot number and expiration date so that hospitals and practices can log the information automatically in their EMRs.

Weird News Andy says he isn’t Captain Renault, but he is shocked – shocked – to read that CMS is months behind in testing data security for the health insurance exchanges that are supposed to be operational on October 1. CMS, having missed two June test dates, says it will instead test security on September 30, the day before the PPACA-mandated insurance exchanges are scheduled to be open for business.

Sponsor Updates

• Encore Health Resources announces that its Activation Support Services has supported 28 go-lives in 22 hospitals involving more than 10,000 physicians in the past 18 months. Chief Medical Officer Judi Binderman, MD will present EHR go-live challenges in an August 15 HIStalk Webinar, “Full Speed Ahead: Creating Go-Live Success.”
• Sharp HealthCare (CA) reports that its use of Caradigm’s Identity and Access Management suite has allowed it to grant system access requests in an average of one day compared to 21 days previously.
  NextGen Healthcare reseller ITelagen introduces UroWorx, a series of urology-focused templates for use with NextGen Ambulatory EHR.
• Imprivata announces that its OneSign solution is the most widely deployed SSO product at hospitals using Siemens Soarian Clinicals.
• CTG Health Solutions posts a white paper outlining the potential impact of big data on healthcare organizations.
• TrustHCS joins Greenway Medical’s online marketplace to offer PrimeSUITE customers access to its coding and ICD-10-readiness solutions.
• StrataRx releases details of its annual conference September 25-27 in Boston.
• iHT2 interviews Rick MacCornack, chief systems integration office for Northwest Physicians Networks (WA), who will be a featured speaker at iHT2’s August 21-22 HIT Summit in Seattle.
• Emdeon simplifies the new ACA operating rules and guidelines in its August newsletter.

EPtalk by Dr. Jayne

I can’t count the number of emails and text messages I received this week asking what I thought about Dr. Farzad Mostashari’s impending departure from ONC. Of all the names that are being thrown around as possible successors, none of them happen to share his impeccable taste in neckwear. I’m going to continue to appreciate each day that he remains on the job, although I suspect I will likely have to go into mourning when he leaves. I have a feeling we haven’t seen the end of his influence on health IT regardless of where he lands.

CMS issues a clarification on how multiple eligible professionals contributing to a patient portal may count a patient who views information. I’m glad they clarified that the patient does not have to specifically view information contributed by a particular provider for him/her to receive credit. Trying to track that level of data would truly be a chore.

Registration for ONC’s Third Annual Consumer Health IT Summit will begin on August 12. The event is September 16 and will include an announcement about a new eHealth campaign. How’s that for a teaser? The email from ONC was quite mysterious, and although it included a sentence missing the object of a preposition, it didn’t include a link to register or a specific website.

It may be old news, but I didn’t want to fail to mention the planned partnership to link LOINC and SNOMED. It should help with interoperability and hopefully will make things a little less difficult for those of us who have to hook everything up behind the scenes for hospitals and health systems.

Earlier this week one of my good friends mentioned he was frustrated with my health system’s lack of a patient portal. He can access the competitor’s portal but not ours and wanted to let me know. I was surprised since I helped install it almost four years ago. Turns out his physician is merely on staff at one of our hospitals rather than being employed by us, therefore uses a different EHR that may or may not have a portal live. We had a nice chat about the different kinds of community physicians and that their choice of EHR is largely determined by their employment status. It reminded me how obtuse the architecture of our healthcare delivery system is and how ridiculous it must seem to people working in more reasonably structured industries.

Pressure ulcers are a major problem in debilitated patients and ONC announced the winners of their mobile app challenge aimed at assisting nurses in documenting assessments and interventions for ulcer risk and prevention. The winning solution was WoundMAP PUMP from MobileHealthWare. It includes automatic graphing of wound size and time-lapse review of photos. The app is currently in beta testing.

I always like to hear about low-tech solutions and this story got my goat. Eco-Goats provides “environmentally friendly vegetation control,” which will be used at Washington’s Congressional Cemetery. Maybe I can get them to assist with my kudzu problem.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Advisory Panel: Physician Order Cost Tools

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

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

This question this time: What IT tools do you use to help physicians make cost-effective decisions as they are creating patient orders?

Although our system allows us to create rules that would give the provider options for less expensive selections, we do not use that feature. The pharmacy already has an aggressive substitution policy and the thought of more alerts makes us concerned. I’d love to hear how others are approaching this.

Not as much as we should. We try to build our order sets in a way that makes it easy to make cost-effective decisions. In particular, we try to make it easy to use best practices and make it difficult to order unnecessary tests and therapies. But we haven’t taken the path (yet) of displaying costs next to drug orders, for example.

We have not been very effective in bringing utilization management to the physician ordering workflow. We’ve tried with mixed success to incorporate best practices embedded in Zynx order sets into the standard content, but our physicians have many workarounds to avoid using condition-specific order sets. 

We embedded a link and query tool in Cerner PowerChart to our charge master that allows physicians to review costs of medications, tests, procedures, DME, etc., with their patients in the exam room. In our organization, the charge master reflects our actual charges and reimbursements from the national insurance company. In the course of re-competing our Cerner contract, I asked the EMR vendors to build a prototype equivalent of the Amazon shopping cart in the EMR. That is, as a physician completes the order, the total cost of the order accumulates in the upper right corner of the EMR.  RazorInsights developed a prototype demo that was very slick. None of the other vendors could do it in the timeframe of the re-compete. Of course, because of the laughable situation of the charge master in the US market, it’s not a very easy thing to pull off in a real setting. But at least we could have the functionality in the EMR, waiting for the industry to catch up.

None at the present.

Rank diagnostics and medication choices in increasing order of cost.

Right now, only thing I can say is they can use UpToDate to help make the right choice. We are looking into the option of displaying price and/or cost-effectiveness indicators in the ordering panels. And as we start improving our analytics capabilities so we can better understand variance, I assume we will start using more protocols/pathways to help ensure the right test is ordered for a specific condition.

Having the cost of the ordered test may help…duplicate tests alerts on CPOE, trend value of labs viewable in the clinical summary tile.

[From a vendor member] As a revenue cycle management company, we use various reports to show physicians where they are adequately being paid for the services they render and where there are gaps in the way they bill claims.  We do this retrospectively and not real time as coding is a matter of physician choice.

Our primary interventions to help physicians make cost-effective, appropriate decisions for patient care are actually 1) our actual hospital formularies themselves 2) antibiotic stewardship clinical decision support embedded in electronic orders for antibiotics at some facilities 3) evidence based order sets standardized by diagnosis at the facility level that are designed with high quality, high safety, high reliability and cost effectiveness in mind. Not overly fancy interventions, but they have been successful and really these are truly the basics that everyone should be doing in every hospital in the world (even laggard facilities out there that are still stuck on paper based provider ordering can be making an impact in all three of these areas).

None, yet. We’ve looked at a tool from Nuance for imaging orders–I can’t recall the name. We’re planning a rebuilding of order sets (and I’ll sleep when I’m dead) with fewer options and more guardrails to make it harder for practitioners to deviate from best evidence based practice when available.

Mainly the lab flow from the EHRs and the imaging studies from the  EHRs to avoid duplication of tests already performed.

There are efforts to incorporate the cost of various medications and treatments in the drop down menus. These also include the efficacy of the various treatments. In study after study, we find that the order of the options in the menus is significantly influential in determining the selection. At least if options were listed by least expensive to most expensive (and include efficacy) they would be useful guides to choices

We have been live with CPOE for several years and took the traditional approach of using various third party content providers to provide some insight into the clinicians thinking as they were attempting to build their own content. This helped us move along but didn’t assist in aligning cost to outcomes during their ordering process. We looked at opportunities prior to live hypothesizing on how CPOE would reduce re-tests but didn’t have much support to evaluate post live to assess any benefits realization. For us I think it is a matter of how much time do we have to spend looking back vs. focusing on the road ahead. Perhaps a good example of the unintended consequences of the things that you don’t do given other various obligations (MU2, I10, Bundle Payments, etc.).

There is little support to physicians to ensure / suggest more cost-effective treatments via the EHR / CPOE process. We do provide order sets that have some element of cost consciousness in them, but that it somewhat limited in scope.

Standard order sets. Descriptive information on order screens showing relative cost "$", "$$", or "$$$".

Morning Headlines 8/8/13

Federal policymakers to develop EHR testing program for behavioral health, long-term care facilities

ONC will announce a voluntary program for the testing and certification of EHRs used by long-term care, post-acute care, and behavioral health providers.

Principles and Strategy for Accelerating Health Information Exchange

ONC releases the results of its March 2013 RFI on interoperability and health information exchanges, and publishes its broad, long-range strategy on accelerating HIE adoption.

4 potential candidates to replace Mostashari

Government Health IT speculates on ONC internal and external candidates that may take the helm after Farzad Mostashari, MD, moves on. The list includes current Principal Deputy National Coordinator and former Baylor Health CIO David Muntz and Beth Israel Deaconess Medical Center CIO John Halamka, MD.

The Pros and Cons of Electronic Health Records

This month’s issue of The Hospitalist explores the EHR cut-and-paste dilemma through a fictional clinical scenario told from a physician’s perspective.

The Skeptical Convert 8/7/13

The Curmudgeonly Diatribe

One reaction to the penetration of digital technology into medical practice is a type of editorial I hereby term the “curmudgeonly diatribe.” As the name suggests, it’s written by a senior practitioner who is displeased with something — or maybe everything — about the electronic medical record. The prototype is a JAMA piece  "Cut and Paste" but less clever examples have been appearing intermittently over the years. (My own experimental fiction trying to illustrate rather than just complain received mixed reviews).   

The latest such effort  was noted by Mr. HIStalk a few weeks ago, and it goes over ground much covered before (you can read part of it here). It’s well written enough, and not wrong on many specific factual statements, although I think it takes some cheap shots about distracting minutiae in EMRs that should in my view be minute enough to ignore.

But the main thrust of the article stems from a deep appreciation for a literary style of medical recordkeeping that the author remembers from back in his youth. He ends by making a plea for preservation of the kind of nuance an experienced clinician can bring to a case, as well as some sort of separation of what he sees as “the clinical record” from all of the data that clutter up the screen. 

OK, well whether the author may choose to claim curmudgeon status or not, I do, and I share his appreciation of nuance in medicine, especially in the context of evaluation of difficult diagnostic problems. And it’s true–the process of organizing a structured written report does help to organize and direct your thinking toward better conclusions. 

But it’s been obvious for decades that medical information had to be computerized in some way, and it’s obvious that much of the data in the medical record is granular enough to be collated and organized into database format. We had to have some sort of on-screen product. So here’s this big piece of complex software. And you don’t like things about it. You can imagine something better. OK, design it. 

Oh, but that’s not what you’re good at. The fact is that in medicine we’re mentally focused on discovering existing structures, not on creating new ones. Which is why big change in medicine tends to come from outside the clinical confines of the profession, either from basic scientific discoveries or new technological tools.  

And when we do change our internal structures, it tends to be by a gradual — well, gotta call it evolution — rather than wholesale redesign. The whole idea of laying out a new intellectual environment for ourselves has been problematic, not just because we aren’t trained in it, but at a basic intellectual level. We have to accept what our own methodology has done to us.

So outsiders had to design for us. And there’s a lot we don’t like about what we’ve got  But obviously there’s going to be improvement and redesign going on for the indefinite future, and input from specialty users will be critical.  

So sure, complain, but look ahead. And in the mean time, if you like to write and have language skills, there’s a lot you can do right now to improve things. Text is still critically needed –people will pick out coherent narrative and pay attention to it. Write good text, but get it in the system where people will read it. If that means reorganizing your traditional H&P format, APSO style, do it. 

But pay attention to the advantages the computer brings. You may not like the way it organizes things, but it sure does do it consistently. And what it organizes best is lists. You may not want to use them, but others will, and the experts have to police their accuracy. There are things you know that other people don’t. If you know that generic cardiac arrhythmia problem on the list  is WPW, change it.

But stop kidding yourself about the good old days. Back then any hospital had some talented people whose reports were incisive and informative. And a lot of others who just went through the motions. It’s just the same now. But at least now I can read what they are or aren’t saying. 

You can still be a curmudgeon. But be a useful one. Wow, good name for a column …

Robert D. Lafsky, MD is a gastroenterologist and internist in Lansdowne, VA.

CIO Unplugged 8/7/13

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

I See Your Faces – Death at Work

One responsibility of a leader, and perhaps our greatest privilege, is to comfort the souls of those we lead through times of sorrow. Dealing with grief can be torturous. I’d rather hide. Take refuge behind a good movie. Just pretend all is well and move on.

That’s cowardice, and we all know it.

Intellectually, I understand death to be the more merciful ending. Spiritually, I recognize it as a new beginning. But the physical experience punches through my stomach, fingers up into my chest, and crushes my heart.

Nobody trained me to handle death, and my education never referenced it in the workplace. Even as a combat medic and engineer officer, we had no checklist telling us how to walk our troops through the valley. Hell, I can’t even write this post without stopping to dry my tears.

I lost another person today. Number five. No, not number five; his name was Fred. I will remember him as I have remembered all the others. I see their precious faces. They live in my Contacts, and each year, their date of death anniversary pops into my reality.

I see you, Dale S., Zarema, Dale D., Stacy. I will see you, too, Fred.

Valuable faces.

August 1, Dale W. You were my first. Who knew as you drove your bike into work that fateful morning that your life would be taken. You were way too young, and your best years were yet to come.

May 10, Zarema. I disliked you at first, but you grew on me. You cared about me, and I learned to care. Your pursuit of perfection challenged me to chase new heights. In 2005, you no longer felt pain. Your gain; our loss.

November 15, Stacy. You died a few weeks after I arrived. Only 27 years old. You infected people at work with enthusiasm. I remember your smile.

June 5, Dale D. We attended chapel together. Who would have known your drive home that evening would be your last? I recall the last thing you said about IT. “We save lives.” True words, my friend.

July 16, 2013, Fred. The testimonials at your funeral and memorial service said it all. You were humility coupled with old-school work ethic. Excellence and friendship defined your contribution. Your code lives in your kids and in your programs.

Leaders. Odds are you’ll have to deal with death in the workplace. Here are practical steps for when that time comes. Pain teaches much when we let it.

Care for surviving family

• Offer all support possible for an extended period
• Remain visible for an extended period
• Connect with Human Resources

Care for your staff

• Talk with staff openly
• Consider grievance counselors
• Leverage your employee assistance program
• Model and encourage the expression of condolences

Care for yourself

• Don’t hold back; talk about it
• Stay tight with your Human Resources
• Engage pastoral care staff
• Cry as needed

If possible, hold your own workplace memorial service. Often, staff is unable to attend the official memorial service due to timing and location. Engage your pastoral care staff and create your own. Allow people to share their feelings online and in person. This promotes healing.

Create a memorial wall for your office. The one in our lobby displays pictures of all who’ve left us. We recently added a forever-lit candle. Our memorial is accessible and visible any time we enter and exit the office.

See their faces.

Leaders bear the burden of visibility. Your presence is needed more than your presents. Make every attempt under the sun to attend funerals and all other memorial traditions. As a representative of your organization, take the lead and reach out to the family. Don’t hide behind your own insecurities, but instead, think of the family’s needs. Dependent on the circumstances, you might need to speak to those gathered and make family and friends aware of the workplace contributions by the deceased.

If you died, would you not want assurance that all the hours you put into your job meant something, especially at your funeral? Make it so for your deceased employee. Your words may very well spread like a comforting salve to the survivors.

Leaders do not forget the faces.

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 8/7/13

Farzad Mostashari, M.D., ONC Chief, Stepping Down

Farzad Mostashari, MD will step down this fall after serving two years as the National Coordinator for Health Information Technology.

Reduction in federal funding will result in job cuts at many Vermont hospitals

Fletcher Allen Health Care (VT) will add 280 jobs over the next 10 years despite an expected $200 million operational loss. The job growth is attributed to its recently implemented Epic system.

Nuance cuts forecast on delayed deals, move to subscription

Nuance lowers its year-end forecast from $1.33 to $1.45 EPS to a revised $1.27 to $1.35 EPS, due largely to contract delays from mobile customers and a migration to a subscription-based revenue model. The news led to a six percent drop in stock price during after hours trading.

News 8/7/13

Top News

It’s true “@Cascadia: New era coming as @Farzad_ONC announces he is leaving @ONC_HealthIT”

— Farzad Mostashari (@Farzad_ONC) August 6, 2013

Farzad Mostashari, MD, MSc announces via Twitter that he has resigned his position as National Coordinator for Health Information Technology, a post he has held for two years and will vacate in the fall. The internal announcements are here.  Who would you choose to replace him, either the individual or the ideal background? Leave a comment with your thoughts – you never know who might be listening.

Reader Comments

From BowTie No More: “Re: ONC. Big announcement coming out tomorrow …” I received this anonymous rumor report Monday. I asked the official ONC press contact as well as an insider if Farzad was resigning and received no response from either, which I told Inga seemed suspicious. The tiebreaker was that Inga’s contact didn’t know anything about it, so I decided to wait and see. I should have direct messaged Farzad, although he probably would not have confirmed.

From Piker: “Re: Farzad. Where’s he going?” He claims he doesn’t know. I would do what he’s doing: announce my availability well before my last day at ONC and see what offers roll in during the interim. He’s not making a mint working for Uncle Sam and therefore probably can’t undertake a lengthy job hunt after his federal checks stop, but he certainly can cash in big time afterward if that’s his ambition. A reader sent a rumor that he described as “weak” that perhaps Farzad is going to Siemens, playing off an earlier rumor that the company was about to hire an unnamed notable. Other than Farzad’s relationship with Siemens Medical Solutions CEO John Glaser, I don’t know why he would go there, so I would put those odds as low.

From Lazlo Hollyfeld: “Re: Farzad. Vendor – no way.  He’ll join a policy / consulting shop (maybe a K Street firm or not), get a few director positions on various boards (10-20k/year for each director position that is almost free), and reevaluate what he wants to do. It’s time for him to go make some easy cash, stop getting grilled on the Hill, and kick back.” That’s more along the lines of what I would expect him to do. His conscience would be clear that he didn’t sell out completely since he would still involved with healthcare IT at a high level, he wouldn’t have to deal with ugly vendor issues like profitability and product lines, and his value would be highest in offering his cache to the highest bidders. 

From InfoDoc: “Re: HIMSS board. I am considering running for a position. Will it be worth my time? Will HIMSS be gaining or losing power in the next four years?” The general consensus is that HIMSS has become increasing vendor-focused in recent years, as opposed to provider-focused. With that shift, I am sure there are plenty of providers and provider organizations who believe HIMSS is not the unbiased advocate it may have been 10 or 15 years ago. On the other hand, you don’t have to look further than the increasingly crowded exhibition floor at the annual conference to recognize the importance that vendors place on HIMSS. As to whether a board position is worth your time, I’d say it in part depends on whether you are hoping to be a voice of providers or of vendors. Readers?

From Boy Lee: “Re: recruiter. This recruiter needs 20 analysts per Cerner module. Is a large nation-state converting to Cerner?” That’s a lot of analysts, suggesting a fast rollout by a big organization. I thought first of HCA, which at one time was looking at Cerner and Epic as an alternative to Meditech 6.0. If you know who it is, tell me. I started to call the recruiter, but dreaded getting locked into a lengthy conversation that probably wouldn’t have resulted in my getting the employer’s name anyway.

From Larry: “Re: Practice Fusion HL7 ORU laboratory specs. The tech writer forgot to take the spec doc out of Word’s Track Changes mode before saving it as a PDF. Perhaps you can drop a hint to accept all changes, turn off the balloon display option, and convert it to a clean PDF with working hyperlinks? Just trying to help on the long slog to interoperability.” Hopefully this will provide the hint.

HIStalk Announcements and Requests

Forget MU and all of Farzad’s accomplishments at the ONC. The real bummer is that Dr. Jayne and I will have to seek a new HIT crush. This is my favorite picture of Dr. Jayne, by the way, who photo-bombed an intense conversation between Farzad and Jonathan Bush at this year’s HIStalkapalooza.

Lt. Dan not only writes  the daily HIStalk news headlines and articles on HIStalk Connect, he’s also a veteran and healthcare IT guy. I ran his comments about how he would approach the never-ending (and always expensive) VA-DoD EHR issues. He got a response from an Army Medicine physician who’s working on project similar to what Lt. Dan proposed. We may have updates, depending on what can be said publicly at this point since it’s more of a concept than a finished project.

Welcome to new HIStalk Gold Sponsor Talksoft, which offers HIPAA-compliant patient reminder systems (phone, email, mobile, and SMS) for appointments, recall reminders, broadcast messages such as last-minute practice closings, payment reminders, notification of new lab results, and outreach calls to help meet Meaningful Use requirements. Practices can estimate their ROI with the on-screen calculator. Orthopedic Associates of Rochester felt pretty good about its 9.4 percent no-show rate vs. the national average of 16 percent, but using Talksoft dropped it to 5.6 percent. Setup took a week (some customers are up and running within a day), one hour of office time, and no phone line or computer hardware, plus Talksoft charges only for usage with no subscription commitment required. I enjoyed playing around with the sample messages and looking at the audit report, and thought it was cool that the practice’s brand is protected because caller ID shows the practice’s number, all aspects are customizable, and the practice records its own messages so the patient hears a familiar voice. Thanks to Talksoft for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

The SSI Group acquires the Dallas-based Claimsnet.com, a provider of claims processing solutions and payer connections.

Hospital billing provider HealthTech Solutions acquires RCM provider Gaffey.

Vocera reports Q2 results: revenue up 12.9 percent, adjusted EPS $0.01 vs. $0.09, beating earnings expectations of –$0.03. Shares are up 18 percent in after-hours trading.

Nuance announces Q3 results: revenue up 9.5 percent, adjusted EPS $0.34 vs. $0.45. CEO Paul Ricci warned that a shift to a subscription-based revenue model will hurt revenue and margins of its mobile offerings in the short term. The company’s healthcare unit was the star, with sales up 29 percent.

Sales

Providence Health & Services contracts with Quantros to provide safety performance improvement advising services across 16 of its facilities.

BCBS of Tennessee will implement Care Team Connect’s population health management platform.

The VA awards CACI International a $14 million contract in to build a data exchange platform that consolidates EHR data and benefits information across the VA, DoD, and other agencies as part of its VLER program.

Rideout Health (CA) chooses the Pavisse incident management solution from RGP Healthcare.

American Medical Software selects Health Language applications from Wolters Kluwer Health to enhance clinical documentation and regulatory compliance in its ambulatory EHR solutions.

The Indian Health Service awards SAIC a $17 million task order to help replace the agency’s electronic dental record system.

HealthSouth signs a five-year deal worth up to $20 million to implement a nurse communications system from Australia-based Austco Marketing and Services.

People

David Furnas, CIO of Gila Regional Medical Center (NM), resigns in the wake of the hospital’s financial crisis that has resulted in the departure of most of the senior leadership team.

TeraRecon names Jeff Sorenson (Hyland Software) SVP of global sales, marketing, and business development.

UltraLinq Healthcare Solutions hires Bao Ho (Canon Healthcare Solutions) as VP of sales.

Announcements and Implementations

The Indiana HIE and Predixion Software will jointly develop predictive health analytics solutions to be offered by IHIE to ACOs and hospitals across Indiana.

Taylor Regional Hospital (GA) integrates its CPSI EHR with PeriGen’s PeriCALM perinatal system.

The Mount Sinai Medical Center launches RateMyHospital, a real-time patient feedback survey tool for patients seen in its cancer treatment center.

Modern Healthcare announces what it calls “Healthcare’s Hottest,” its list of the 40 fastest-growing companies (companies nominate themselves and their own financial information is used to choose the winners). I don’t recognize all the names, but sponsors that were included are Allscripts, Beacon Partners, CTG Health Solutions, Cumberland Consulting Group, ESD, Impact Advisors, Imprivata, Intellect Resources, and The Advisory Board Company.

Government and Politics

ONC’s Consumer Health IT Summit will be held in Washington, DC on September 16, 2013. Admission is free and the morning’s general session will be streamed live. Registration opens next week.

Other

According to a Health Affairs-published study co-authored by the ONC’s Farzad Mostashari, MD, almost six in 10 hospitals actively exchanged electronic health data in 2012., an increase of 41 percent since 2008.

An organization-wide e-mail sent by Kaiser Foundation Hospitals and Health Plan CEO Bernard J. Tyson says the organization needs to focus on affordability and intends to hold per-member, per-month costs flat, reducing the current 3 percent trend to zero, because of “competitors who are enjoying unprecedented success in managing costs.” He wants to see membership growth, care transformation, and standardization of care and service at all locations. HealthConnect wasn’t mentioned, which never would have happened under George Halvorson.

The CEO of Fletcher Allen Health Care (VT) says that despite an expected $200 million in losses over the next 10 years due to Medicare cuts, the health system will add 280 jobs. Many of them will apparently result from its implementation of Epic. According to the CEO, “You do create new jobs. If you’re going to interface new technology, you need people who are savvy about health care and that are savvy at getting into relatively complex software and systems.”

An investigative report finds that six of UCLA’s 17 academic deans claim that their medical conditions require them to fly first class despite a University of California ban prohibiting it. One of them is triathlon competitor and self-professed “cardio junkie.”

Weird News Andy is moved by this story. A man who has been hospitalized and ventilated for 45 years after a bout of polio-caused infantile paralysis teaches himself computer animation and is creating a TV series about his life.  

Trustwave warns that a luxury toilet’s Android app could allow hackers to “cause the unit to unexpectedly open/close the lid, activate bidet or air-dry functions, causing discomfort or distress to user.”

Report from the AHDI Conference
By Jay Vance, CMT, CHP

The Association for Healthcare Documentation Integrity (AHDI) has wrapped up its Annual Conference & Expo held this year at the Buena Vista Palace Resort in Orlando. This is the annual meeting of the professional association for Healthcare Documentation Specialists (formerly referred to as medical transcriptionists).

Unabashed rebranding is underway to portray HDS as true HIM professionals who are important contributors to accurate clinical documentation, quality patient care, and by extension, to improved reimbursement. As part of this rebranding, future annual meetings, beginning next year in Las Vegas, will be known as Healthcare Documentation Integrity Conferences. Additionally, AHDI is working closely with AHIMA, the American Health Information Management Association, to bring greater understanding of the important role of HDS to a wider audience.

Admittedly late out of the starting gate, our association is nevertheless pushing back hard against the perception of HDS as glorified typists who cost money and are easily replaced by technology such as speech recognition technology and, of course, electronic medical records systems. The reality is that SRT still requires thorough review by human editors, while many EMRs are so user-unfriendly that an entire medical scribing industry is springing up to relieve caregivers from the burden of having to use those expensive EMRs which were supposed to reduce costs by eliminating the need for transcription.

Furthermore, it seems more than coincidental to many HDS that costly clinical documentation improvement programs have grown in inverse proportion to our devaluation and outright elimination. Declining physician productivity and satisfaction? Those have also gotten worse as dictation has been eliminated and transcription budgets have been slashed.

Of course we understand that correlation doesn’t necessarily equate to causation, and certainly there are other forces in play. But just because we’re paranoid doesn’t mean they aren’t out to get us. All facetiousness aside, there are a number of research initiatives underway within our industry to quantify in real terms to what degree, if any, removing skilled HDS from the clinical documentation process has adversely affected the quality of documentation, and concomitantly, negatively impacted patient care and provider revenues.

Sponsor Updates

• Stern Cardiovascular Foundation (TN) reports that its use of Emdat for dictation and transcription services has resulted in significant process improvements, reduced costs, and improved provider productivity.
• Orion Health introduces a converged cloud service based on HP’s CloudSystem Matrix, which will support cloud services tailored to individual customers.
• Siemens Healthcare will offer mobile alert, notification, and secure messaging services from EXTENSION to users of Siemens Soarian and legacy Siemens EHR products.
• CCHIT designates eClinicalWorks V10 compliant with the ONC 2014 Edition criteria and certifies it as a complete EHR.
• CIC Advisory releases a report on the challenges and opportunities facing the country’s top healthcare organizations.
• Aprima PRM 2014 EHR/PM v. 14.0 earns Meaningful Use Stage 2 certification as a Complete EHR.
• The FDA grants 510(k) market clearance for Alere MobileLink, a self-testing at home device that connects to Alere’s Connected Health platform.
• Allscripts, McKesson, Medicity, and Sandlot Solutions sponsor a webinar discussing how leading healthcare organizations are using data and analytics.
• Outside Magazine names iSirona to its list of best places to work.
• The Association of Affiliated Plans names CTG Health Solutions a preferred vendor.
• Clinical Architecture CEO Charlie Harp reviews data normalization in a blog post.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Internal Announcements of Farzad Mostashari’s Resignation

HHS provided this information.

From: Sebelius, Kathleen (HHS/OS)
Sent: Tuesday, August 06, 2013 10:51 AM
Subject: Important Staff Announcement

Hello Colleagues,

I am writing to share the news that Dr. Farzad Mostashari has advised me he will be stepping down as National Coordinator for Health Information Technology this fall.

Farzad has been a leader in the Office of the National Coordinator for Health Information Technology (ONC) for the last four years.  Farzad joined the office in 2009 as Principal Deputy National Coordinator and took over as the National Coordinator in 2011.  During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among health care providers.  Farzad has seen through the successful design and implementation of ONC’s HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records—all while ensuring the ultimate focus remains on patients and their families.  This critical work has not only brought about important improvements in the business of health care, but also has helped providers better coordinate care, which can improve patients’ health while saving money at the same time.

During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the Department.  His expertise, enthusiasm and commitment to innovation and health IT will surely be  missed.  In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.

Kathleen Sebelius

From: Mostashari, Farzad (HHS/ONC)
Sent: Tuesday, August 06, 2013 10:23 AM
To: OS – ONC Feds
Subject: Announcement

My Dear ONC’ers,

On a pre-dawn morning in June 2009, I paced helplessly outside my Mom’s hospital room as alarms beeped and the monitor showed the most recent run of life-threatening heart arrhythmia. I had screwed up my courage to ask to see the paper chart, but I couldn’t even read the cardiology consult’s name. After her discharge it was also very difficult to get her records; she didn’t get needed follow-up and required emergency surgery. The complications, which weren’t supposed to happen, indecently increased the hospital’s revenue.

I joined ONC a week later.  This office had a daunting task ahead of it. Working backwards from the outcomes we hoped to enable, we had to define “Meaningful Use” of electronic health records, establish a new certification program, endorse national standards, design and set up a slew of new grant programs to assist in health IT adoption, exchange, workforce, research, and privacy.  There were 32 staff members. 

You will remember the successive sprints – to recruit and establish the Regional Extension Centers and collaborate with newly appointed Health IT coordinators in every state.  The “Office of No Christmas” moniker that we earned for yuletide rulemaking. Trudging 4 miles through the blizzard–to a hotel that still had power– for Beacon application reviews.

And then came an intense focus on implementation and integrity of our grant programs. Accelerating consensus around healthcare standards through an innovative new open source community paradigm in the Direct Project and its successor Standards and Interoperability Framework. Coordinating policy with our federal partners.  Adding a new focus on consumer eHealth, and giving consumers access to their own data through the Blue Button. Creating a Health IT safety program.

We gradually assembled within ONC a microcosm of the diverse and passionate Health IT community itself.  Implementers, doctors and nurses, software developers and project managers, privacy experts, proud standards geeks, patient advocates, public health workers, researchers and data analysts. And we added strength, integrity and resilience by recruiting a core of civil servants who are dedicated to lifelong public service.

You each brought to ONC your own personal commitments and your community’s perspectives, and we unified those divisions through our shared goals: A better health system– that truly knows and cares for all of its patients- through application of information and learning. You nurtured a culture of commitment to American innovation, and an essential optimism that healthcare’s best days are ahead of us.

Regional extension centers have assisted 140,000 providers- over 40% of all primary care providers in the country and over 80% of critical access hospitals- the largest medical technical assistance project in history. Nationwide, adoption of health records has tripled in doctor’s offices and increased five-fold or more in hospitals. Over half of prescriptions are now electronic.  New functionalities essential for population health management are increasingly available and used. National standards and protocols for information exchange and interoperability are being implemented throughout the industry. Over the next 12 months we will see a great democratization of health information as individuals become empowered to download their own health information, and venture capital investment in new tools to help us manage our own health and healthcare are skyrocketing. Meanwhile, hospital readmissions are dropping, healthcare cost inflation is at historic lows, and the movement towards payment that rewards quality and value is gaining speed. 

My mom has recovered now. Her hospital is working to implement new systems to provide accountable care. Her prescriptions and health records are electronic and can be shared across the state. Like 37 million other elderly Americans, we can access her medical history with her Medicare Blue Button records on her mobile phone.

There are formidable challenges still ahead for our community, and for ONC. But none more difficult than what we have already accomplished.  In these difficult and challenging times, your work gives us hope that we can still do big things as a country. That government and the private sector working together can do what neither can do alone. We have been pioneers in a new landscape, but that landscape is one changed for ever, and for better.
It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on.

Best wishes to you all,

Farzad

Mostashari Announces Departure from ONC

It’s true “@Cascadia: New era coming as @Farzad_ONC announces he is leaving @ONC_HealthIT”

— Farzad Mostashari (@Farzad_ONC) August 6, 2013

Farzad Mostashari, MD confirmed via Twitter this morning that he will step down from ONC as National Coordinator. He did not announce his plans and his replacement has not been announced.

HIStalk reader “Bow Tie No More” provided that rumor yesterday, but ONC would not confirm.

Full text of the internal announcements is here.

Morning Headlines 8/6/13

Can plagiarism detection tools catch EHR upcoding?

A Government Health IT article explores the idea of combating copy-and-paste documentation in healthcare by adopting anti-plagiarism software popular in many academic settings.

CACI wins VLER contract

The Department of Veterans Affairs has awarded CACI International a $14 million contract to build a data exchange platform that will consolidate EHR data and benefits information across the VA, the Defense Department, and other agencies in support of the Virtual Lifetime Electronic Record program.

EMR Impact: How Patients Are Connecting To The Future Of Healthcare

A study of 1,000 insured US health consumers finds that 52 percent are interested in using a patient portal, but are not currently doing so. Patients indicating that they are using a portal reported higher than average patient satisfaction scores and stronger network loyalty.

St. Elizabeth Hospital Recognized as Leader in Electronic Medical Records

Thirty-eight bed Saint Elizabeth Hospital in Enumclaw, WA achieves HIMSS Stage 7 recognition.

Readers Write: A Meaningful View of Meaningful Use

A Meaningful View of Meaningful Use
By Helen Figge, PharmD, MBA, CPHIMS, FHIMSS

Meaningful Use has meaning to us all. While we struggle to decide timelines for milestones and determining measured success, we all experience Meaningful Use in our daily lives.

First and foremost, we are all consumers of healthcare living in a society that wants immediate gratification. As consumers, we are being granted instant healthcare gratification through the lens of Meaningful Use. We receive visit summaries, electronic copies of our medical records, and a detailed report of our current medications. Our providers have access to information such as our laboratory reports, X-ray reports, and notes from our specialists. We are encouraged to engage in our own care by having access to our data through patient portals.

We can ask our clinicians new questions based on previous test results, which is great for the patient, but perhaps less than ideal for the clinician (e.g. a TSH ranges from 0.3 to 5.0 – so what is normal for me or for you? Does a low value mean something versus a higher one?) We assume all are equally computer savvy, which in turn creates a potential digital divide. Some more tech-savvy patients “get it” with little prodding, while others finding this new Meaningful Use approach cumbersome, yielding potentially more work for the clinician. 

Maybe to counteract this one potential angst of patient computer illiteracy, should we offer patients a computer literacy course in order to take advantage of the opportunities presented to them by Meaningful Use?

There seems to be a learning curve for us as healthcare consumers. Not only learning the technologies given to us for data access, but also comprehension of the new rules of healthcare engagement. Given that we want it and want it now, Meaningful Use is the lightning bolt needed to energize the healthcare delivery system. Most noteworthy of all, Meaningful Use to a healthcare consumer is invisible, and translates to a meaningful interaction with our healthcare provider with the highest quality of care delivered to us that is coordinated, seamless, accessible, real-time, and complete.

Next comes the clinician, whose perspective is somewhat more sterile. Patient record transparency and best practices yielding to a more informed patient with data in real-time, workflow supportive and organized is the nirvana. But, in reality, the technologies do not always support clinician workflow, hence the angst felt today with the execution of Meaningful Use to some clinicians. Additionally, clinicians have an extra burden to exercise patience with their patients who might overuse or underuse these new approaches for data access.

But if patience is exercised, Meaningful Use will work to transform healthcare the way we all want it to be. It just might take a little more time for some to realize the benefits, lending fuel to the current discussions of some “catching up” with others in the various stages of Meaningful Use. And to compound our “want it and want it now” mentality, don’t forget the Direct Project that if exercised correctly could improve communication across many layers of clinician thought. The problem with that project, however, is the select few who enjoy its rewards as many haven’t caught up to the pack yet for this vehicle offered in healthcare today to work for optimal effect.

Now enter the poor vendor who finds Meaningful Use an opportunity, but also a challenge. The challenge comes not only from the institution that purchased the technology, but the various stakeholders that institution represents. Vendors who can’t keep pace with these demands will now become easily identified, and these vendors in turn will now more than ever experience negative selection because stakeholders will opt for software that supports healthcare delivery.

Vendors also need to contend with clinicians who have the extra burden of now hearing from patients that the technologies are not user-friendly, adding fuel to patient dissatisfaction. This is a double whammy of frustration. Complaints fielded by clinicians are in turn angsts for the CIOs, who then turn their aggressions on the vendor for immediate response and relief.

Rome wasn’t built in a day and neither were software platforms, yet our need for instant gratification overrides the ability to work through issues that otherwise without emotion would be handled quite effectively. Darwinian Theory of evolution plays well here: only the best adapted will survive (the vendor, I mean). The meaning of Meaningful Use to a vendor is twofold: to deliver high quality technology meeting acceptable government criteria and also technology that all stakeholders find acceptable, functional, and timely.

Finally the last group who should or could benefit from Meaningful Use if implemented, accepted, and seamlessly delivered involves insurers (third-party payers) that have been battling the cost containment of healthcare for quite some time. If insurers were really wanting to make a difference in healthcare costs, they would reward more for preventive care and support universally such processes as the Patient Centered Medical Home and also invest in the health of our bodies real time, not years later when we are ravaged by illnesses due to poor lifestyle, poor gene pool, or a combination of the two. In the end, if Meaningful Use is supported by these groups, the insurers will benefit from lower healthcare consumption, more efficiency, and better outcomes.

Meaningful Use has meaning to us all and worthy of support. It just needs to be appreciated and agile enough to survive the need for our society’s immediate need for gratification and be resilient enough to let some play catch up.

Helen Figge, PharmD, MBA, CPHIMS, FHIMSS  is advisor, clinical operations and strategies, for VRAI Transformation.

Readers Write: Building an Accountable Care Organization? Consider Starting in Your Own Back Yard

Building an Accountable Care Organization? Consider Starting in Your Own Back Yard
By Claudia Blackburn

Explaining my healthcare IT profession to my parents and children has never been straightforward. Yet sometimes they are the ones who can boil it down to the essence of what we do, perhaps even better than we can.  Before I became a consultant, my mom once told a family friend that I, "paid people to be healthy so that the hospital I worked for didn’t have to pay as much for health insurance." The friend responded,"Where can I sign up?" They both clearly understood the value of population health management (PHM) programs.

With the CMS news released this month about those Pioneer Accountable Care Organizations (ACOs) that have demonstrated success and shared in the savings — and of those Pioneer ACOs that are not continuing the program — there’s healthy debate about the model and the key success factors.

For those organizations considering starting an ACO, consider test-driving the concept in your own back yard with your health plan member population.

The Opportunity: An Integrated Wellness Model

Several self-insured employers – both healthcare organizations and companies from other industries – have proven that an ROI is achievable through population health and wellness programs. A few shared their program experiences showing impressive return for their wellness dollars:

• In 2011, Mercy Clinics, Inc. reported a four-to-one return on investment of wellness dollars spent. Mercy uses coaches within its practices to assist with coordination of care.
• Franciscan Missionaries of Our Lady Health System decreased health plan expenses 13 percent, with a 21 percent decrease in medical claims alone in 2011. A four-to-one return over five years projected a savings of $37.3 million.
• John Hancock’s Healthy Returns program increased savings per participant from $111 in 2009 to $261 in 2010, and preventative care increased 1 percent to 4 percent per year with an overall 2.5 to one ROI.

Just as any other employer, hospitals face increasing healthcare costs for their employee and member population. However, hospitals can use their healthcare expertise to develop practice protocols that change habits and ultimately improve the health of their self-insured member population and decrease employee benefit costs.

Strategic Elements of a Successful Population Health Management Program

Screening, prevention, and care management are all involved in population health improvement, but by far, changing the habits of individuals is the most challenging. Smart phone applications and portals, in addition to payers and providers pushing information, have not engaged members.

To engage members for best outcomes with accountability and oversight, the health management program must be a combination of people, new processes, new technology, and much better use of the collective data. There are several essential elements of an integrated PHM model:

• Claims data. Claims data define healthcare services received across the continuum of care and risk in order to target program benefits and measure improvements in utilization and cost.
• Health risk assessment (HRA). A HRA captures basic information to determine the consumer population health status and risk stratification, especially important for those with no claims.
• Electronic medical record (EMR) / biometric screening. It’s important not to allow the member to self-report on weight, cholesterol, blood pressure, and glucose. Instead, a coach or nurse should measure other biometrics charted in the EMR. Patient data from a personal health record (PHR) can be useful and selectively imported into the EMR.
• Aligned incentives. Incentives are important to move members towards participation and keep them active and accountable. Incentives such as reduced premiums, door prizes, or gift cards are helpful to encourage enrollment. Once enrolled, outcomes-based incentives can be used to keep the member working towards health goals.
• Coaching. Successful PHM programs have coaches armed with full information from claims, HRA, and EMR to motivate members to change behaviors.
• Consumer portal. The portal allows for better engagement between provider and consumer and monitoring of healthy habits, such as exercise.
• Data warehouse /analytics. Armed with holistic information about the consumer, high-risk root causes can be identified, targeted with strategic program initiatives, and measured for success or rework as part of a feedback loop to assure data-driven increased quality and decreased cost.

From the above list, clearly the “glue”for connecting the PHM program elements is a solid technology foundation. It provides a concise picture of population and individual holistic health. When combined with coaching, health systems are able to not only monitor but also influence change. Additionally, the closed-loop feedback mechanism enables measurement of the success of strategies at an enterprise level and a member level to allow for continuous improvement.

Just as my mom and her friend understood, the value of population health and wellness programs can be substantial. Keeping members accountable through incentives increases healthy behaviors and reduces the self-insured health insurance cost of the employer.

Hospitals can take a leadership position in the move toward the IHI’s Triple Aim both as an employer and a healthcare provider via PHM programs for its own self-insured member population. The individual wins, the employer wins, the hospital wins, and the community wins.

Claudia Blackburn is a consultant with Aspen Advisors of Pittsburgh, PA.

Curbside Consult with Dr. Jayne 8/5/13

Even though I’m back in town, I’m still in vacation mode, taking a few extra days to clean up some of the things I never seem to have time to tackle. I’m procrastinating on a couple of household projects, so I thought I’d catch up on email. I don’t get anywhere near the email that Mr. HIStalk gets, but I have trouble keeping up nevertheless, so tonight we’ll dip into the reader mailbag.

Dear Jayne,

I was driving to work the other day listening to the local public radio station. As usual, the “commercials” were just brief blurbs read by the station’s on-air personalities. What caught my ear was the fact that athenahealth was advertising. Do you think they get much business from that kind of exposure?

Wait Wait… Don’t Tell Me!

Dear NPR Fan,

That’s a great question. It certainly can’t get the company any less exposure than some of the EHR ads that I see in medical practice journals. You know what I’d really like to see, though? Jonathan Bush being interviewed by Car Talk hosts Tom and Ray Magliozzi. The amount of scattered random thoughts would be truly amazing.

Jayne

Dear Jayne,

I liked your recent piece on downtime. Here’s something that has helped our clients be prepared.

Lexmark Luthor

Dear Lex,

Thanks for sharing your video on the downtime-ready printers. It looks like it can work with minimal training and being able to access the downtime reports using proximity badges makes it easier for those of us who don’t want to remember one more password. I smiled when I saw the “Tray 2 Empty” indicator on the printer’s touch screen – it seems like every printer I encounter lately ends up needing paper.

Jayne

Dear Jayne,

I work in a busy ER and we have a lot of locum tenens physicians that cycle through. There is this hysterically funny blonde that recently started working with us. When I saw the zebra print clogs, it occurred to me that you might be working in my ER. Am I right?

Memphis Belle

Dear Belle,

Although I’m definitely a fan of Corky’s, I am not currently walking in Memphis. I’ll let you know if I come your way, though!

Jayne

E-mail Dr. Jayne.

Morning Headlines 8/5/13

Maine hospitals disband remote ICU program, citing costs

MaineHealth announces that it will stop offering its tele-ICU service in October after several participating hospitals drop out. The program connected nine rural hospitals across the state with a 24-hour-a-day ICU command center at Maine Medical Center in Portland.

Whistleblower suit: Hospitals defrauded Medicaid

A whistleblower lawsuit filed by the former CFO of Health Management Associates charges HMA and Tenet Healthcare with paying kickbacks to clinics that referred pregnant illegal immigrants to their hospitals where emergency care claims were then submitted for their deliveries. The report says that the scheme has been operating for more than a decade.

More doctors avoiding Medicare patients

According to CMS, the number of doctors opting out of Medicare has tripled since 2009, with 9,500 physicians opting out in 2012.