Curbside Consult with Dr. Jayne 7/1/13

It’s been a busy couple of days for me with a lot going on outside of work. Unfortunately, it was all healthcare related and not in a good way. As I was leaving the office Friday, I received a call from an elderly relative. I wasn’t surprised to hear from her since her daughter had e-mailed me earlier in the week for advice.

It started out last Monday as as a classic tale of the things that can go wrong in a medical office – phone messages not making it to the physician in a timely manner, test results being misplaced, and more. Surprisingly, this was happening in the flagship office of a hospital’s employed medical group that had been on EHR for years. There was no excuse for lost messages, missing results, or delayed callbacks, especially with a frail patient. It was bad enough that she was considering a change of physicians after nearly 20 years at the same practice.

Unfortunately the best advice I could offer based on the information available (and it being Friday after 5 p.m.) was a recommendation to go to the emergency department since the likelihood that she would get a call from the physician was low. I offered to pick her up rather than wait for her daughter to drive over. After all, when you can take a spare physician to the ED with you to make sure you stay safe, you might as well.

The facility wasn’t very busy, but the registration experience left something to be desired. She was in a wheelchair and couldn’t see the “Guest Relations Specialist” over the tall counter. I put that title in quotes because I’m not sure what she was really there to do. She wasn’t performing registration (and in fact refused the insurance cards that were offered) or doing triage. Basically she just found the name in the computer and went back to chatting with her co-worker, which she did for most of the time we were in front of her.

After some time, we met with a triage nurse, who clearly had already reviewed the patient’s records in the EHR was able to ask targeted questions in addition to the required screenings and assessments. We moved quickly to an exam room, where the actual registrar came in and took care of the insurance paperwork. She also corrected a phone number that was at least six or seven years out of date despite several recent visits to the health system.

As sometimes happens in the ED, we saw the physician before the nurse came in. I was pleased to see that the nurse had already reviewed the chart when he arrived. He specifically mentioned that he had looked at her information and would try not to ask the same things as the doctor, which was much appreciated. Although a long-time employee of the health system, he was new to the facility. We sympathized about the EHR and getting used to it. He apologized for being slow on the system and we appreciated his honesty.

I can’t say we appreciated the nurse that was mentoring him, though. She would come into the exam room from time to time and tell him he needed to do things differently in the computer. She never introduced herself or acknowledged the fact that there was a patient or a family member in the room. She barked instructions at him and then left. I could tell he was embarrassed by her behavior. I appreciated his attempts to make up for it.

We finally received the radiology results more than three hours after the tests were performed. After five hours in the ED, she was admitted, which took another 90 minutes. There was little communication about what was going on and why it was taking so long. I know it was frustrating for her as a patient and it was even more frustrating for me as a support person and especially as an ED physician who knows we can do better.

The fantastic nurse wrapped our sweet nonagenarian in heated blankets for the trip to the med/surg unit. He was rolling her out the door when his mentor stopped us to complain about his data entry skills and to make him fix the entries before he left the ED. She had absolutely no compassion for the patient and didn’t even apologize for leaving the gurney half hanging out in the hallway while she complained about the documentation.

We finally made it to the floor, only to experience another bit of silliness. Although the patient was asked at triage whether she was suicidal, whether she felt safe in her home, and the level of her pain, she was never asked her preferred name even though I know there’s a field for that in the system. She goes by her middle name rather than her first, so asking might have been courteous. The nurses immediately called her by her first name and that’s what they had on the white board in her room as her preferred name. Regardless of whether she uses her first or middle, as a healthcare professional, I would never dream of calling a non-pediatric patient (especially one in her 90s!) by anything other than Mrs. or Ms. and her last name.

By now it was nearly 2 a.m. and I helped the nurse get her settled. I’m not sure why we had to go through the instructions for the touchscreen meal ordering system or how to operate the television at that hour, but we did, along with a stack of paperwork that I’m fairly sure she would not have understood without my help. She was finally allowed to rest. Since then her hospitalization has been uneventful, but she has savvy family members that are keeping up with her treatments and medications and making sure to minimize the risk of medical misadventures.

In thinking back about all of it though, it makes me sad. I think we’ve lost the care in healthcare. We’re so busy meeting the letter of the law and checking the boxes that we can’t deliver what we hoped to when we were called to the healing professions. Those making the rules forget that patients are seeing and hearing everything we do and are recognizing that our focus is not on them.

As colleagues in healthcare IT, let’s promise to do our best to turn it around. How do you think we can make a difference? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 7/1/13

Jackson plans $830 million overhaul

Jackson Health System, a six-hospital network based in Miami, FL, is asking local taxpayers to foot the bill for an $830 million overhaul. The money would come from a proposed increase in property tax on Miami-Dade residents and would pay for building repairs, new elevators, room renovations, and $130 million in new software for the health system.

Hopkins, Walgreens partner on East Baltimore pharmacy

Walgreens is opening a new location in East Baltimore in partnership with Johns Hopkins Medicine that will be used to pilot new health products and services, including in-store clinics capable of providing urgent, non-emergency care.

Lost piece of thumb drive contained thousands of patient records

A practice in Nebraska is notifying more than 2,000 patients that their medical records may have been exposed after a physician loses an unencrypted thumb drive.

Pa. hospital sued over uninsured man’s 2011 death

In Pittsburgh, UPMC-Mercy is sued along with four doctors for failing to operate on a patient with diverticulitis over 15 months of treatment, allegedly because he did not have insurance, a fact that was noted in his medical record.

Monday Morning Update 7/1/13

From Zaphod Beeblebrox: “Re: Allscripts. The second successful activation occurred this month for Allscripts in a UK NHS hospital. This one was on time and on budget. The previous one (Salford) was three months early and on budget. Almost unheard of in the UK NHS marketplace.” The announcement from Liverpool Heart and Chest Hospital says it went live on Sunrise 15 months after their project started. UK hospitals are indeed tough customers as vendors always underestimate the localization challenges, so those Allscripts accomplishments are significant. Sunrise has always been a good product but under iffy executive leadership. The challenges for Sunrise going forward are integration, since Cerner and Epic usually tromp Sunrise easily in that regard, and wariness of the company by prospects after the previous management ran the Allscripts ship aground. A lot hinges on North Shore – LIJ, which is probably locked in no matter what because of the money and energy they’ve spent. I’d want them as one of site visits if I were a prospect, making sure to veer off the planned hospital itinerary and seek out frontline clinicians since Sunrise should excel in that regard. I’d really pay attention to the medication management aspects. And watch those KLAS scores, which if the company can turn itself around, should start to move up a couple of quarters from now.

From Indoor Privy: “Re: Intuit Health’s patient portal business. Allscripts and others are in discussions to acquire. More details may be coming Monday.” Unverified. I’ve always been amazed that Allscripts put its entire practice EMR strategy at risk by choosing a third-party patient portal in the former Medfusion, acquired by Intuit in May 2010. Intuit was apparently looking for some kind of consumer finance play that would be complementary to Quicken, but like most big companies toe-dipping in healthcare, their impact was minimal and the healthcare business is rumored to have never made a profit.

Two-thirds of poll respondents don’t routinely take all of their PTO. New poll to your right: should McKesson’s customers care that John Hammergren’s pension will be at least $159 million? Your“yes or no” answer isn’t descriptive, so click the comments link after voting and explain your thought process.

Johns Hopkins Medicine will work with Walgreens to open a new East Baltimore, MD drugstore that will develop health and wellness programs for all Walgreens locations, including offering non-emergency urgent care services delivered by nurse practitioners backed up by Hopkins primary care doctors. It’s a brilliant move since chain drugstores have a massive geographic footprint and often serve as the de facto shopping center for urban areas, allowing Walgreens to scale offerings without additional fixed costs or overhead. The company can make money even if the urgent care service doesn’t because, unlike other medical facilities, a Walgreens store has a lot of higher-margin products to sell to cash-paying customers. It’s also nice for locals because of easy access, shorter waits, and lower cost. High-margin, ambitious, and scandalously inefficient hospitals keep erecting higher and more-expensive figurative walls around themselves and are buying up all the physician practices, so the best hope for affordable, accessible care and health advice may well be chain drug stores.

Paul Henry (ADP/AdvancedMD) joins CareCloud as VP of small group sales.

It turns out that BlackBerry’s Phoenix-like rise from the ashes has been mostly hype so far, as the company admits that sales of its new products failed to stave off a Q1 loss and will likely result in continued losses in Q2, sending the stock into the toilet Friday down 28 percent for the day. The exuberant analysts are now back to business as usual, i.e. wondering what the flesh-picking buzzards might be willing to pay for the pieces and parts in a fire sale.

A ED medical scribe company touts its success at two Arizona clinics that use its services to avoid having its doctors waste time documenting in the EHR. According to an orthopedic surgeon at on of the clinics, the scribes “may will have saved the clinic by helping with the implementation of the new EMR.”

I’m intrigued that in the promotional video above there’s a cheap, in-window air conditioner behind Kevin Parks, MD, medical director of San Antonio Community Hospital (CA), that appears to be held in place by badly cut plywood and what looks like Scotch tape (00:20).  They’re expanding the ED to 52 beds, with the opening scheduled for this year, so it’s probably a temporary solution (and looks like it.)  

Jackson Health System (FL) want taxpayers to provide $830 million for facility and equipment upgrades over the next 10 years, including $130 million for computer software and hardware. The health system hopes voters will approve a property tax increase to pay for the improvements, which it says will make it competitive.

The widow of a UPMC-Mercy Hospital (PA) diverticulitis patient sues the hospital for not performing surgery on her husband over 15 months’ of treatment before his lower intestine burst, claiming that the man’s medical record was flagged with a note that he had no insurance.

A Nebraska medical practice notifies more than 2,000 patients that their demographic information has been exposed when the doctor loses the thumb drive that he wore on a lanyard a round his neck.

Long-time HIStalk friend Dave Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, explores his artistic side by playing a variety of ensemble roles in a North Little Rock, AR community theater production of “Jesus Christ Superstar.”

Vince wraps up his Epic HIS-tory this week, ready to move on to Siemens in next week’s edition.

Sponsor Updates

• Aventura employees cooked and served dinner to children and families at Ronald McDonald House of Denver this weekend.

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: My Lifelong Clock-Puncher’s Entrepreneurial Brainstorm: How the HIStalk Home Shopping Channel Will Make Me Rich

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

I wrote this piece in February 2009.

My Lifelong Clock-Puncher’s Entrepreneurial Brainstorm: How the HIStalk Home Shopping Channel Will Make Me Rich
By Mr. HIStalk

I’m a veritable font of business ideas. That might surprise you since I’ve worked my entire career as someone else’s employee (I’m pretty sure my puzzling lack of distinction there is because they haven’t properly motivated me.) Still, one of these days, I’m going to start a company and reap a massive windfall from my pent-up entrepreneurial ability. I may be on Social Security by then, but I know it will happen and I’ll be a great yet humble CEO.

So here’s my latest and greatest idea (you are hereby non-disclosed): the HIStalk Home Shopping Channel.

I’m turning a liability into an asset. Everyone knows that conference speakers and site visit hosts nearly always have a hidden agenda — to say good things about their vendors and get something in return. Maybe they want extra-special support, or free registration to the user conference, or an eventual vendor job. Maybe they just want to convince themselves that they made a smart decision (even if they didn’t.) I’ll make that the foundation of my fledgling enterprise.

I’ll start out with a genial, eternally curious host. They’ll need to be disturbingly cheery and clueless, the on-screen empty vessel who can bond with the equally clueless audience, shrieking with unrestrained delight like the QVC crowd when Wolfgang Puck performs expert chef tasks like frying onions or whisking eggs. I’m sure some vendor marketing person can handle the role admirably, beaming with obvious delight as the celebrity physician effortlessly works the EMR system that’s on sale while dropping the occasional bon mot.

The EMR they demo won’t be the same as the one they actually use in real life, of course. Surely no one believes that Wolfgang’s restaurants use his 28-piece, $249.90 Bistro Elite Stainless Cookware Set, which would withstand about five minutes of heat from a real restaurant stove before melting into a sad, molten, Puck-endorsed puddle.

We’ll have theme shows for clinical disciplines. Blowout sales of slow-moving systems. Huge discounts on previous software versions. Maybe we’ll even cash your federal stimulus check like those sleazy "buy here, pay here" car lots.

Here’s where you come in. What moves the goods on shopping channels is ringing, hysterical endorsements of the product by telephone callers who have been carefully screened and coached to keep it positive. They’ll say anything that gets them on TV with Wolfgang since most of them sound like they watch TV all day. Plus, who wants to admit that the Bistro Elite set looks much better when Wolfgang is sautéing shallots in it instead of burning store brand tomato soup in it after getting too engrossed in Oprah to whisk?

So we’ve got a clueless host, a product-pimping celebrity, and some questionably knowledgeable and objective endorsers. All we need is some flattering camera angles, some "order now because they’re flying out of here" on-screen graphics, and offshore order-takers.

HIStalk Home Shopping would generate entirely new buyer motivations. Mobility through consumption! Picture yourself improving care with cool PowerPoint-ware! Call our Demo-Doc any time as long as you say great things – he will be your pal and you will have all kinds of fun and hijinks together!

I don’t know, maybe it isn’t such a great idea. It sounds too much like the HIMSS annual conference

OK, how about this: paid product placements in popular TV shows. Say, isn’t that a Cerner CPOE system Dr. McDreamy is using? You know you want one!

Morning Headlines 6/28/13

Update On the Adoption Of Health Information Technology and Related Efforts To Facilitate the Electronic Use and Exchange Of Health Information

ONC publishes its annual report to Congress on health IT adoption as required by the HITECH act. The report addresses EHR adoption, health information exchange adoption, and the general state of the nation as it pertains to health IT.

Created in the Corridor: Geonetric

Geonetric, a Web developer specialized in creating patient portals for hospitals and health systems, is profiled in the local Cedar Rapids, IA media for its unusual HR policies. None of its 70 employees have managers; instead, work is done collaboratively. Dress is casual, Fridays are bring your own meat for the office barbecue, and the company CEO calls its staff "probably one of the most advanced software teams in Iowa." The company’s own website is notably underwhelming considering that description, but the product must be top notch because it has plans to add 130 employees over the next year.

Sprint Launches Secure Messaging Solutions to Enable HIPAA Compliance

Sprint announces the availability of two HIPAA-compliant text messaging platforms, a functionally rich solution called TigerText and a less expensive, stripped down option that still delivers person-to-person HIPAA-compliant texting.

Cerner supports Blue Button + to engage individuals for better health

Cerner announces that it will support the Blue Button + initiative, which means that Cerner clients can now securely deliver information to any personal health record participating in Blue Button +.

News 6/28/13

Top News

ONC releases its report to Congress on healthcare IT and HIE adoption through April 30, 2013, basically a predictably uncritical annual report of its activities. I chose this graphic randomly, then immediately noticed the common mistake of saying “Advanced Directives” instead of “Advance Directives” (you specify them in advance, but they aren’t necessarily advanced.)

Reader Comments

From Chris ToeBall: “Tenet-Vanguard deal. The merger could be good news for a lot of vendors, starting with Tenet’s Conifer Health Solutions.” Tenet President and CEO Trevor Fetter says in a conference call that Conifer will provide RCM services to Vanguard’s 21 hospitals, which could provide a 28 percent boost to revenues. Less clear is the impact on athenahealth, which provides services for Vanguard’s ambulatory clinics, and McKesson, which serves Tenet’s clinics.

HIStalk Announcements and Requests

 HIStalk Practice highlights from the last week include: Humana takes the top spot in athenahealth’s 2013 PayerView Report, while Medicaid continues to underperform. Financial management issues are the most challenging difficulties currently facing group practice executives. Consumer Reports publishes an excellent overview of the PCMH model. The AMA votes to lobby CMS for a two-year grace period to avoid complying with the ICD-10 transition – which seems like wasted energy to me, given the ONC’s promise to hold firm on the current October 2014 deadline. CMS concludes that the adoption of EHRs in community practices doesn’t necessarily impact costs. Dr. Gregg amuses with a fairy tale in the kingdom of happy healthcare. Maybe HIStalk Practice isn’t exactly summer beach reading, but there is still lots of good stuff to check out. Thanks for reading.

On the Jobs Board: Data Analyst Meaningful Use, Healthcare Software Project Manager, Resolute PB Team Lead.

Acquisitions, Funding, Business, and Stock

Craneware warns that its revenues and earnings will be below market forecasts, saying it will likely not close one of its large sales opportunities despite increased levels of sales activity.

PokitDok, a startup that offers a platform for healthcare providers to advertise directly to consumers, raises $4 million in funding.

Sales

Erlanger Health System expands its relationship with MModal to include MModal Fluency Flex for creating reports and documenting patient records.

Slidell Memorial Hospital (LA) will implement Medhost’s EDIS and ED PASS for self-service patient check-in.

Piedmont Orthopaedic Associates (SC) selects SRS EHR.

South Georgia Medical Center will implement RelayHealth’s HIE platform.

ProMedica’s Lenawee Physician Hospital Organization (MI) selects Wellcentive’s population health management and data analytics solutions.

North Shore-LIJ Health System chooses InterSystems HealthShare for connectivity of all its systems in a $25 million deal. Competitor Allscripts dbMotion, now owned by NS-LIJ’s incumbent EHR vendor, wasn’t mentioned.

The Miami VA chooses GetWellNetwork for in-room entertainment, Internet access, and patient education under a $2.4 million contract.

People

CareTech Solutions appoints Brian Connolly (Oakwood Healthcare) chairman of the board, replacing Peter Karmanos.

Chris Bauleke (RelayHealth) joins Healthland as CEO. Former CEO Angie Franks (above) continues as president.

PatientPoint hires John McAuley (Allscripts) as COO and Eldon Richards (UnitedHealth Group) as VP of engineering and technology services.

Nordic Consulting promotes Vivek Swaminathan to chief consulting officer.

Jacobus Consulting names Noel Allender (Beacon Partners) managing director of its Epic practice.

RemitDATA names Michael Kallish (MPV – above) SVP of business development and Jim Harter (e-Rewards) CTO.

Imprivata President and CEO Omar Hussain is named as an Ernst & Young Entrepreneur of the Year in New England.

Huron Consulting hires Tracey Mayberry (CSC) and Kevin Smith (MedeAnalytics) as managing directors in its Huron Healthcare practice.

Announcements and Implementations

Cerner achieves HDI Support Center Certification.

Quest Diagnostics makes its Care360 Solution Suite available through AT&T Healthcare Community Online.

The local TV station profiles Cedar Rapids, IA-based healthcare website developer Geonetric, pointing out that none of its 70 employees have managers, food is available and free, and flex time and sabbaticals are standard. According to the HR director, “We want you to enjoy life and experience life, and do great work for us. And it’s awesome.” It says the company will hire another 130 people and move into a new building. Its website declares it to be the “coolest healthcare Web company. In the history of ever.” According to its site, employees get free ice cream when a new client is signed,  dress is casual, Grillin’ Friday is BYOM (bring your own meat), and there’s a knitting circle.

AMIA’s review course for the clinical informatics subspecialty certification that starts in October is scheduled for July 15 availability. Live courses started in April.

Caristix introduces Caristix 2.0, the latest version of its HL7 interface lifecycle management platform.

Allscripts announces that Sunrise Acute Care 6.1 and Sunrise Ambulatory Care 6.1 have been certified as Complete EHRs under ONC 2014 Edition criteria.

Penn State Hershey Children’s Hospital uses Amcom Messenger for calling Code Blue.

Cerner announces its support for Blue Button +.

Sprint announces the availability of the TigerText HIPAA-compliant secure messaging solution and a less-expensive offering powered by TeleMessage branded as Sprint Enterprise Messenger – Secure.

Government and Politics

Industry officials testifying before the Senate Committee on Finance offer opinions on how to improve healthcare quality. Concerns raised include:

• CMS should consider reducing the 1,000+ quality measures currently used for reporting and payment programs and develop measures that are more outcome- and patient-oriented.
• Many traditional EHRs, especially those used by small physician practices, are not well designed, which limits a provider’s ability to produce meaningful data for quality reporting.
• Provider payments need to be better aligned with outcomes and quality reporting.
• The government should go beyond the EHR incentive program and work towards the development of a framework for care coordination and long-term care outcome measurements.

CMS redesigns its Physician Compare Website to include details on physician or practice specialties, EHR use, board certification, and hospital affiliation.

Practice Fusion launches a medical imaging API that will allow its practice users to connect to imaging centers, allowing physicians to receive results electronically for Meaningful Use and giving imaging centers potential new business. Use is free for the practice, but not for the imaging center.

Technology

Arizona-based surgeon Gil Ortega, MD performs the world’s first orthopedic trauma surgery while wearing Google Glass, which he says will be useful for teaching students who will have a clear view of the sterile field, recording the surgery, and requesting information via the device.

A study finds that the survival rate for non-hospital heart attack patients doubled when paramedics performing CPR were coached using Real CPR Help software that is standard on  ZOLL Medical’s defibrillators.

Other

A study published in JAMA finds that treating the costliest Medicare patients in doctors’ offices instead of ERs may not save as much money as previously hoped, only about 10 percent.

Porter Research looks at ICD-10 readiness among physician practices and finds that most are concerned with disruptions in cash flows when the new code set goes into effect. Of practices that have not yet started preparing for the transition, more than a third believe they have adequate time to prepare. The rest either don’t know where to begin or lack time, staff, or training resources.

Healthcare attorney David Harlow, who writes HealthBlawg, launches a crowdfunding project called Hacking HIPAA. It will a create a new Common Notice of Privacy Practices that will give patients an explanation of potentially beneficial electronic transfer of their data (e-mail, cloud, video, text messaging) and obtain their consent for its use before the new Omnibus HIPAA Rule “will make cloud hosting of healthcare projects untenable very soon.” He’s hoping to raise $10,000. That’s Fred Trotter in the video.

Who proofed this announcement? It’s apparently how they role.

Kaiser Health News test drives the health insurance exchange enrollment software that will be rolled out in Minnesota, Maryland, and DC for the scheduled October 1 launch.

Weird News Andy hopes the patient remembers his native language. A 69-year-old man being treated for stroke at Robert Wood Johnson University Hospital is sent unconscious on a charter flight back to his native Poland when he’s found to be uninsured and living in the US illegally.

Sponsor Updates

• Visage Imaging releases a case study about the use of the Visage 7 Enterprise Imaging Platform by teleradiology provider Rays.
• UltraLinq Healthcare will incorporate cardiology decision support tools from DiACardio into its cloud-based image management and reporting system.
• Karen Marhefka, MHA, RHIA of Encore Health Resources will present a primer on value-driven healthcare at the Texas AHIMA convention today (Friday, June 27) at 1:30 p.m. Central time.
• Quantros announces the patent pending status of its Smart Classification technology for classifying incident reports in real-time.
• The Center for Economic Growth recognizes etransmedia Technology with a technology innovation award.
• Cornerstone Advisors announces its #1 KLAS mid-term ranking in the Planning and Assessment category and its projected 100 percent growth this year.
• Nuance Communications names 11 hospitals as 2013 winners of the Million Dollar Club, having saved at least $1 million by using Dragon for medical transcription and clinical documentation.
• Xerox VP Ed Gala asks JetBlue co-founder Ann Rhoades and hospital IT executives what airlines and hospitals have in common.
• Greenway Medical will integrate the inpatient EHR of Health Management Systems its PrimeSUITE solution.
• Nuesoft Technologies celebrates its 20th anniversary.
• Kareo integrates its PM application with Demandforce, an Intuit company, to help practices build their online reputations and proactively engage with patients for preventive or recurring care.
• Sandlot Solutions CEO Joe Casper discusses improving care with HIE and data analytics.
• Verisk Health recaps its recent Webinar featuring Granite Healthcare Network’s (NH) use of data analytics to provide cost-effective care.
• Versus offers a replay of the AHA-hosted Webinar on improving safety measures with RTLS featuring Western Maryland Health Systems. Versus also offers a case study that details how the organization reduced elopements and improved response times with RTLS technology.
• AT&T partners with Project HOPE to improve women and children’s healthcare in Asia and Africa.
• Northern Ireland’s health minister writes about the transformation of the country’s healthcare system using technology from Orion Health.

EPtalk by Dr. Jayne

The National Uniform Claim Committee announces that CMS has finally approved the new 1500 claim form. It allows identification of whether ICD-9 or ICD-10 is being used and expands the number of diagnosis codes which can be reported. The deadline for transition to the new form seems to be fluid. Providers should contact their clearinghouses to determine when they will begin accepting the form and should work with their vendors to ensure practice management systems can generate the new form.

HIMSS calls for proposals for pre-conference symposia. New this year, they’re looking for abstracts for full-day preconference programs. The deadline is July 22 and those selected will be notified in August.

Medical Economics identifies “10 regulatory irritants fueling physician dissatisfaction” according to a Physicians Foundation study. The list includes:

1. Meaningless work
2. Box checking
3. Data is replacing information
4. Quality
5. Site of Service
6. Fraud
7. Sustainable growth rate (SGR)
8. PCORI and IPAB
9. Costs
10. The government is coming between me and my patients

Bloomberg discusses the top US states where physicians have gone digital. I was surprised to see Washington, DC at the bottom along with Louisiana, New Jersey, and Connecticut. Wisconsin is at the top, followed by Minnesota, North Dakota, and Massachusetts.

Note to marketing folks: always test your mail merge skills before sending out blast e-mails (and especially snail mail). This week I’ve been on the receiving end of two charity letters asking me to send my pledge (which wasn’t a pledge but an outright donation) and now an e-mail addressed to “Dennis.” First impressions are everything, folks.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/27/13

VA envisions an app-based future for health IT

Kathleen Frisbee, director of web and mobile solutions at the VA, hinted that an iEHR compromise is in the works that will result in the collaborative development of integrated mobile apps for clinicians rather than a full integrated EHR. It’s an interesting concept, but one that’s sure to leave a lot of the problems that initially inspired the iEHR program unsolved. One benefit of approaching integration through a series of small projects, like apps, is that the likelihood of failure is lower, and the capital investment at risk is similarly lower. Also, developers should be able to zero in on effective integration points because smaller projects will allow them to be more responsive to early adopter feedback.

New CEO Signals Growth at Healthland

Healthland, a Minneapolis-based EHR vendor focused on the rural and critical access market, announces the appointment of Chris Bauleke as CEO effective July 8. He will replace Angie Franks, who will now serve as Healthland’s president and lead the company’s strategy and market development efforts.

Cloud could save health industry $11B, study says

In a survey of 109 CHIME members, respondents estimate that they could reduce IT costs by nine percent, or $11 billion, over the next three years by switching to a cloud-based service model.

Readers Write: Health Data Analytics Provides Greater Value Over Big Data

Health Data Analytics Provides Greater Value Over Big Data
By Joe Crandall

Like you, I’m tired. I am tired of the latest buzzword in healthcare circles: “Big Data.”

The problem I see as a healthcare professional is that most experts are not offering solid, realistic ideas about how to leverage data at the decision-maker level. Most articles and experts are talking about using data to fundamentally change healthcare (genomics, population health, etc.) How many times have you heard that a new something was going to change healthcare forever? These experts are doing a disservice to the large majority of hospitals and health systems out there. I suggest you forget the term “Big Data” and begin to think about Health Data Analytics (HDA).

The truth is that most hospitals have been using health data analytics to some degree for a long time. Because of external and internal drivers, healthcare organizations are now being pushed to do more with less. That means leveraging their data and tools more efficiently. This isn’t about predictive analytics . It is about giving the clinical decision maker the information they need when they need it so they can make better decisions to drive better outcomes.

Six things to think about in regards to HDA:

1. Ignore the hype. Don’t fall for the sales pitches and doom and gloom if you haven’t bought a business intelligence (BI) tool yet. About 90 percent of the hospitals out there are in the same boat as you. The hospitals giving the “Big Data” talks have been on that path for decades and have spent millions of dollars. Not surprisingly, they are only starting to leverage the data for research. You don’t need “Big Data” — you need analytics.
2. Be realistic. Let me say that again: be realistic. You are not going to go from a data-averse culture to a data-driven culture overnight. You aren’t going to be able to convince everyone this is the right project to invest in. Buying the best in KLAS BI vendor is not going to magically transform your organization. If you do decide to buy a BI tool, be realistic when setting expectations with a BI vendor. The implementation won’t be as easy as they say and the people won’t flock to the platform as quickly as they say. In fact, it is like every other platform IT has installed. Focus on the people rather than the technology for lasting success.
3. Conduct an in-depth assessment. Before you start a HDA program, take an honest assessment of your current state of health data readiness. A readiness assessment saves money in the long run by clearly identifying any gaps in skills, tools, or process. Answer some basic questions first. Does our organization have a culture of sharing data? Do we have a good data governance program in place? Do we have data integrity issues? Do our people know how to use the information we can provide? Knowing where you are starting and your end goal is an important part of any project. A great assessment will help you plan to reach your goals with clearly laid out courses of action.
4. Start small. HDA projects need to start small with scalable and sustainable processes that will allow the program to expand intelligently. While in the military, we used the “crawl, walk, run” methodology and it applies to implementing a HDA program at your facility. Do not start running with “Let’s change the discharge process” as your first HDA project. A better and more focused choice could be to crawl with “On the labor and delivery floor, how do we discharge patients before 11 am?” Start small with big results. Then grow.
5. Grow intelligently. Once that first project is a success, look into expanding under the guidance of a strong executive sponsor and a competent governance structure. Keep in mind that you don’t need to duplicate the first project throughout your facility – you need the ability to replicate it. Duplication implies a direct copy, while replication allows variances for each situation that might be encountered while implementing the new way of doing business. Once people start to see the benefit of a data-driven culture, requests for projects will pour in and the organization will need a plan to intelligently address all requests and aggressively pursue the best ones.
6. Focus on your people. Most importantly is the focus on the people. Each person within your organization has a decision-making maturity that may or may not be able to leverage the HDA program effectively. This is why certain programs are successful under the leadership of one person but flounder once that leader moves on. It is why someone can look at raw data and see patterns in the business and make decisions that drive action. It is why a project can be successfully run by staff while being led by an inept leader. It is the maturity of each individual that will determine the success of the HDA program, not the tools or platform.

The requirement of leveraging data to gain a competitive edge is upon us. Healthcare organizations are being asked to improve outcomes as the main driver for improving the bottom line. A data-driven culture will transform an organization from volume based to value based, but it will take time and the right people. Focus on one project initially, guided by a strong executive sponsor utilizing a process that is scalable and sustainable.

If you do this, before you know it, your organization will be utilizing health data analytics to make more intelligent decisions that will ultimately improve outcomes. You will have created a data-driven culture.

Joe Crandall is director of client engagement solutions for Greencastle Associates Consulting.

Readers Write: The Case for One Source of Truth

The Case for One Source of Truth
By Deborah Kohn

The notion of managing and being accountable for the health status of defined populations requires much more sophisticated clinical data collection methods and skills than most healthcare organizations have today. However, for decades, numerous coded systems have been used to successfully capture clinical data for reporting purposes, such as quality initiatives and outcome measurements, as well as for reimbursement and other myriad purposes.

Such coded systems, which health information professionals categorize as either clinical classification systems[1] or clinical terminology systems[2], can continue to be used to assist in determining prospective, pre-emptive care management on covered populations. However, no single classification system meets all use cases. ICD-9 CM does not contain medications. ICD-10 CM does not address functional status. In addition, no single terminology system meets all use cases. LOINC is used to encode laboratory data. SNOMED CT is used to encode clinical care data. RxNorm is used to encode medications.

Consequently, using the existing or newer coded systems to meet any of the fast-growing clinical data collection and analysis initiatives presents a significant challenge: too many systems from which to choose, hindering any efforts to change the collection of the data into actionable information for interoperability and health information exchange. To resolve this challenge, one “one source of truth" or one central authority platform (CAP) for all clinical data capture systems, existing and new, allows all coded systems to be used to capture and exchange information.

© Deborah Kohn 2013

With one CAP, healthcare organizations need not be concerned about when to use which data collection system for which purpose. Organizations are able to capture required clinical, financial, and administrative data once and use it many times, such as for adjudication and information governance purposes. In addition, organizations are able to compare the data for data integrity purposes. More importantly, organizations are assured that electronic healthcare data input by different users is semantically interoperable, i.e. the data are understood and used while the original meaning of the data is maintained.

For example, for typical diabetic patients, Reference Lab #1 might denote glycohemoglobin within the chemistry panel, Physician Office Lab #2 might denote glycohemoglobin as an independent test: HgbA1c, and Hospital Lab #3 might use the embedded LOINC code: 4548-4. The central authority platform recognizes each of the three laboratory information system inputs representing the same value — glucose level. Subsequently, the healthcare organization’s electronic health record (EHR) or business intelligence system makes use of the common meaning, and for example, generates a trend analysis of the patient’s glucose readings over time.

Developing a CAP requires considerable effort. The platform must be able to store all coded values, metadata, and all the content / terms. It must be able to normalize and catalog all the content / terms. It must be able track all changes in content identifiers, watches for differences in terms, cross-maps the content, route the content while preserving the data and context, and regenerate the data and content as it was stored. Finally, it must be able to manage all the content updates / releases. Today both the public and private domains have been moderately successful in developing the platform.

The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) collaborated with the National Library of Medicine (NLM) to provide the Value Set Authority Center (VSAC). VSAC is to become the public domain, central authority platform for the official versions of the value sets that support Meaningful Use’s 2014 Clinical Quality Measures (CQMs). However, currently VSAC does not go far enough to cover all use cases.

In the private domain, several health information technology vendors provide most of the required capabilities of the CAP. Interestingly, these vendors collaborated with clinical professionals to create different categories of coded systems to describe their products than those categories created decades ago by health information professionals. For example, the vendors refer to any coded system used for capturing and exchanging data as a “terminology” system, even though some of these systems are categorized by health information professionals as classification systems. In addition, the vendors categorize all “terminologies” as either standard[3] or local terminologies[4]. Some of these vendors go even farther in categorizing all “terminologies” as either retrospective or point-of-care terminologies[5]. Consequently, today not only are there too many coded systems for data capture and exchange from which to choose, but too many categories of coded systems to make sense of it all.

Assuming that both public and private domain CAP options will prevail, healthcare organizations can expect widespread use of the platforms, allowing EHRs and other electronic records, such as financial records, to incorporate multiple coded systems for specified needs. In addition, workforce demands for the clinical informatics skills needed to manage all the coded data will continue to remain strong.

[1] Clinical classification systems, such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS derive from epidemiology and health information management. These systems group similar diseases and procedures based on predetermined categories for body systems, etiology or life phases. As such, they organize related entities for easy retrieval. They are considered “output” rather than “input” systems and were never intended or designed for the primary documentation (or input) of clinical care.

[2] Clinical terminology systems (a.k.a., nomenclature or vocabulary systems), such as SNOMED CT and RxNorm derive from health informatics. These systems are expressed in “natural” language, and, typically, codify the clinical information captured in an electronic health record (EHR) during the course of patient care (because the number of items and level of detail cannot be effectively managed without automation). As such, they are considered “input” systems.

[3] Standard terminologies consist of “administrative” terminologies, such as ICD and CPT, and “reference” terminologies, such as SNOMED, LOINC, RxNorm, and UMLS.

[4] Local terminologies are those that healthcare providers, such as laboratories or physicians, use on a daily basis in their records, on the telephone, etc., to describe specific diagnoses and procedures.

[5] Retrospective terminologies consist of all standard terminologies (administrative and reference) and local terminologies, while point-of-care terminologies are those that are healthcare provider-friendly and used for specific documents.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with Dak Systems Consulting.

Morning Headlines 6/26/13

For McKesson’s CEO, A Pension of $159 Million

The record-breaking pension owed to John Hammergren, chief executive of McKesson, is discussed in a Wall Street Journal article. Had he left on March 31 this year, Hammergren would have walked away with $159 million, the largest pension in corporate American history.

Hawaii Health Systems revises upward its estimate of electronic conversion of medical records

Hawaii Health Systems Corp revises the estimate for its EHR conversion. The health system originally budgeted $58 million to implement Siemens across 14 hospitals, but is now saying that the cost will likely fall north of $100 million.

1,900 new jobs, $9.5m tax break for Athenahealth

Athenahealth has pledged to hire an additional 1,900 employees to its Watertown campus by 2022 in exchange for $9.5 million in state tax credits under a tentative deal worked out with Massachusetts economic development officials.

Quality and Safety Implications of Emergency Department Information Systems

Contributors from the American College of Emergency Physicians published an article in the Annals of Emergency Medicine that discusses the patient safety related benefits and dangers associated with the use of emergency department information systems. The article concludes with seven recommendations for patient safety.

News 6/26/13

Top News

McKesson Chairman and CEO John Hammergren is due a $159 million lump sum pension payout when he retires, the company discloses in its annual proxy filing. Experts believe it’s the largest pension in corporate history, also noting that the amount doubled in the past six years. I mentioned the hoops the company’s board went through to boost his pay without being obvious to shareholders back in January 2009, when he would have received only $85 million. Above is the six-year share price (blue) vs. the standard market indices. You can decide whether he’s worth it and if healthcare can afford it.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Seamless Medical Systems, which offers the SNAP Practice cloud-based patient engagement platform. It includes an iPad-based patient registration app and health education and literacy tools. SNAP Express includes primary care forms, digital signature capture, and forms tools, while the enterprise version also includes a bidirectional interface to the PM/EMR along with marketing tools. The iPad-based system engages patients in the waiting room as they complete forms electronically, read health and wellness information, and take notes about their visit and e-mail them afterward. Download it to your iPad for a free trial. Thanks to Seamless Medical Systems for supporting HIStalk.

I found this SNAP Practice overview on YouTube.

Acquisitions, Funding, Business, and Stock

Next Wave Health makes a minority investment in HealthPost, which offers a provider search and booking platform.

Tenet Healthcare will acquire Vanguard Health System for $4.3 billion, which includes the assumption of Vanguard’s $2.5 billion in debt. The transaction will make the combined company the second-largest for-profit US hospital chain with $15 billion in revenue, 79 hospitals, and 157 outpatient centers. Obviously they aren’t worried that healthcare costs are going down any time soon.

Sales

Baptist Memorial Health Care will integrate Micromedex clinical referential and patient education resources into Epic.

Kerckhoff Klinik in Germany choses iMDsoft’s MetaVision for its 267-bed facility.

The North Dakota HIN selects Orion Health HIE for its statewide exchange.

Washington Regional Medical Center (AR) selects patient portal and HIE solutions from InteliChart.

ProMedica (OH) will add dbMotion’s interoperability platform.

Bon Secours Health System (MD) will implement HIE technology from Aetna’s Healthagen subsidiary.

Athens Bone and Joint Orthopedic Clinic (GA) selects simplifyMD.

Novant Health chooses CSI Healthcare IT to fill training positions for its October Epic go-live.

People

Care Team Connect names Richard Popiel, MD (Cambia) to its board.

Shaun Shakib (Caradigm) joins Clinical Architecture as chief informatics architect.

Brett Davis (Oracle) is named general manager of Deloitte Health Informatics, a newly launched informatics business.  

The Premier healthcare alliance names Leigh Anderson (Global Healthcare Exchange) COO of informatics and technology services.

Announcements and Implementations

The Yale Center for Clinical Investigation deploys an interface between Yale’s Epic EMR and the OnCore Clinical Research solution.

Fulton County Hospital (MO) goes live on Healthland’s financials and clinicals.

Deloitte and Intermountain Healthcare launch OutcomesMiner, an analytics tool that leverages EMR data for comparative research.

RFID Journal profiles Texas Health Harris Methodist Hospital Alliance and its use of RTLS, including software from Intelligent InSites. They interviewed Winjie Tang Miao, the hospital’s president.  I did too, in December 2012.

SCI Solutions releases v36 of its Schedule Maximizer patient and resource scheduling system.

Government and Politics

The VA reports that it has processed 97 percent of its two-year-old veterans’ disability benefits claims and is now working on one-year-old claims.

Other

Hawaii Health System revises its estimate for converting its 14 public hospitals to Siemens, which now stands at $100 million compare to $58 million five years ago and $75 million at the end of last year. The health system say consultants underestimated the time required to maintain the system and the infrastructure in its facilities is in bad shape.

The Massachusetts eHealth Institute will award grants of up to $75,000 each to 32 collaborative projects to help 80 healthcare organizations connect to the Massachusetts statewide HIE.

Massachusetts economic development officials tentatively agree to extend $9.5 million in state tax credits to athenahealth in exchange for athena’s pledge to add 1,900 workers by 2022. Athenahealth also announces it will bring 500 new jobs to Atlanta and invest $10.8 million in a new office complex.

Weird News Andy isn’t sure what the business model of Figure 1 (the narrator of the video above pronounces it “figger one”) since it offers free photo sharing for clinicians, but WNA hopes they have plenty of photo screeners. The company says it has figured (figgered?) out a way to limit use to licensed physicians. A terse comment about the video says it all: “Looks like a quick way to get fired. Or sued.”

WNA also likes this story, which he titles “Busted!” A Chinese woman lying on her stomach playing a smartphone game for several hours experiences chest pain, which the hospital diagnoses as a ruptured breast implant.

Sponsor Updates

• First Databank launches a five-part blog series on prescription drug abuse.
• Merge announces the eClinical OS Marketplace, which allows users to electronically request and receive services from within clinical study workflows.
• CCHIT certifies that Health Care Software’s INTERACTANT v6.9 software is compliant with the ONC 2011 Edition criteria as an EHR module.
• Levi, Ray & Shoup earns HP’s Silver Partner in Excellence Award.
• Allscripts outlines its population health management strategy during a gathering of industry and financial analysts at the Center for Connected Medicine.
• Novant Health chooses CSI Healthcare IT to fill training positions for its October go-live with Epic.
• Beacon Partners publishes an article that highlights four healthcare system executives and their perspectives on integrating strategic initiatives.
• Elsevier launches EduCode Doc Briefs, an ICD-10 education series for physicians and other practitioners.
• Kareo reports that one-third of the 4,000 providers signed up for its EHR have moved from another EHR system.
• Clinovations staff volunteered at the Spring Kick event with DC United, which brought soccer to 400 underprivileged youth from 12 DC neighborhoods.
• CareTech Solutions will offer its help desk clients Courion’s PasswordCourier password management and AccountCourier user provisioning solutions.
• Verisk Health will give away three $30 Starbucks gift cards to random participants of its online survey on the shared-risk care delivery model.
• EClinicalWorks has signed up 1,000 providers for its RCM during the first six months of 2013 and is projected to reach $100 million in revenues by 2015.
• SQL Server Pro highlights the new version of Predixion Software’s collaborative predictive analytics platform.
• Conway Medical Center (SC) shares how its implementation of Rev-Cycle+ from T-System helped the organization increase collections 41 percent over five and a half years.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 6/25/13

The Impact of Electronic Health Records on Ambulatory Costs Among Medicaid Beneficiaries

A study published in the Medicare and Medicaid Research Review followed the implementation of ambulatory EHRs in three communities, concluding that the adoption of EHRs in community practices does not consistently impact Medicaid costs either positively or negatively.

Vanguard deal would bolster Tenet in key markets

Dallas-based Tenet Healthcare Corp. will acquire Vanguard Health Systems in an all-cash $1.8 billion deal. The acquisition also requires that Tenet assume $2.5 billion of Vanguard’s debt, bringing the true price to $4.3 billion. The new health network will include 79 hospitals across 30 markets. The deal also brings ACO expertise to Tenet as the organization prepares to move toward a value-base purchasing reimbursement model.

Disruptions: Medicine That Monitors You

The New York Times covers the rise of ingestible "smart pills" after a recent FDA decision to ease their regulatory requirements. The pills contain sensors that monitor a variety of conditions, powered by electrical current within the human body. They can send an alert to the patient and their physician should they detect an abnormality.

Today at DIA: Deloitte, Intermountain Launch OutcomesMiner Solution

Just four months after embarking on a collaborative big data partnership, Deloitte and Intermountain unveil the first tangible result of their efforts. This week at Drug Information Association’s 2013 Annual Meeting, the organizations unveiled OutcomesMiner, an analytics tool that help researchers evaluate treatment options and predict likely outcomes specific to unique sub-populations.

Curbside Consult with Dr. Jayne 6/24/13

There are some days where I just have to shake my head. Today is one of them. I received some news from one of the hospitals where I moonlight. It was the kind of news that defies all logic, and especially in the era of healthcare cost cutting, makes you wonder what in the world people are thinking. In trying to process through it, I’ve decided that there must be some kind of extraterrestrial accounting system (not to mention logic) that only applies to hospital administration.

It reminded me a little of the starship Bistromath in Life, the Universe, and Everything by Douglas Adams. For those of you who aren’t sci-fi aficionados, the Bistromathic Drive is a propulsion system that “works by exploiting the irrational mathematics that apply to number on a waiter’s bill pad and groups of people in restaurants.” Read the full description — it’s good for a laugh. I always think of it when I’m with a group trying to figure out who owes what part of a check.

I’m not against hospital administrators. This is not an “us vs. them” rant. I understand they have to make the same types of difficult choices that all of us do in trying to deliver high-quality, cost-effective care to the right people at the right time. Some of my best friends are administrators. They seem to be between the proverbial rock and the hard place a good percentage of the time, especially those at non-profit and safety net facilities. How they juggle the competing requests for resources and determine how one priority takes precedence over another is often beyond me.

What did they do this week however that was so logically convoluted I had to take my jaw off the floor? The administration of a semi-urban safety net hospital decided to close the “quick care” part of the emergency department. I’ve written about my work here before, joking that we could provide more cost-effective care by stationing a well-trained Boy Scout with a first aid kit at the front door.

People come to this hospital for everything under the sun. I’ve worked on the express care unit for half a decade because the “real” emergency physicians don’t want to go there. Those of us that are board certified in other specialties enjoy the work because it looks a lot like a primary care practice although without a stable patient population.

Quick care has been doing its part to keep the overall ED wait times low. We handle all patients door-to-door in close to 60 minutes or less, which is amazing when you consider the population, their lack of follow-up, and the volume. The hospital is one of the busiest facilities in the region, which is why I was completely floored when I received notice today that the quick care unit was closing. Since this isn’t my full-time hospital, I had no idea it was coming. Worse yet, neither did the staff with whom I just worked last week.

The hospital has decided to take the unit and roll it into the rest of the ED. As another part of the cost-saving measure, they’ve decided to terminate the services of all the part-time physicians. Quick care patients will be handed by nurse practitioners and physician assistants embedded in the “regular” emergency department.

Why doesn’t this make sense? Several things jump out at me.

The physical quick care unit will be repurposed and the patients will be physically seen in the existing ED. This is a net loss of nine beds. The existing ED physicians will be expected to supervise the midlevel providers in addition to their normal shift duties. Nursing staff ratios will be kept the same and the quick care nurses were laid off as well. I almost cried when I realized that. These men and women are the rock stars of the ED, handling nine patients at a time and keeping the flow moving while doing the same level of documentation as the rest of the ED, often having to clean rooms themselves because of the lack of other support staff and sometimes taking care of really sick overflow patients still at a 9:1 ratio. They are hard workers who know just how to juggle patients to keep the visits under 60 minutes. Most of them have been in quick care for more than a decade.

It was this realization that led me to believe they must be using some kind of Bistromathic accounting. In this healthcare climate, who lays off nurses? Especially nurses who can juggle patients and flip rooms as fast as this crew? Who thinks they can just take an additional 50 to 60 patients per shift and funnel them into the ED workflow without drastically sabotaging the ED wait time statistics? And with nine fewer beds? I also wonder who thought the ED physicians would be game to supervise additional midlevels without compensation, which is part of the package.

I think there may have been a bit of sorcery involved as well because none of the line staff seemed to know this was coming. I’m sure the department chair and the nursing directors were in cahoots with the administrators and accountants, but the rest of the team sure wasn’t. Keeping a secret like that is pretty impressive. They managed to keep it quiet a good long time too, only showing their hand the week before the closing. I guess I won’t be bringing my famous chili dip to the July 4 shift party after all.

For those of us that don’t have regular shifts, it was like a death in the family – realizing that you may never again see people you’ve (literally) shared blood, sweat, and tears with. For the handful of staff that are losing their full-time jobs, it’s stunning. Maybe it will go better than I expect, although I can’t wait to see the next quarter’s numbers for wait time, patient satisfaction, and provider productivity.

I’m mourning for my colleagues and missing them already. I suppose it’s a good thing since I’ll have unexpected free time. But if you happen to need a skilled adrenaline junkie to pick up some shifts, give me a call.

E-mail Dr. Jayne.

Readers Write: My Notes On Last Week’s Senate Finance Committee Hearing

My Notes On Last Week’s Senate Finance Committee Hearing
By Data Nerd

In a rare twist of fate, I had some down time last week in between deadlines and got to choose between a variety of Congressional hearings to ridicule observe. While I’d really have loved to see Gen. Alexander prove that the NSA has foiled a legitimate terrorist threat, I decided to go with the Senate Finance Committee’s hearing on the dually-pressing grievances of high prices and low transparency in the health care industry as enumerated in Steve Brill’s Time piece, “Bitter Pill: Why Medical Bills are Killing Us.” The hearing lasted about as long as it took me to read the original article and unfortunately I couldn’t “observe” all of it, but here are the questions and responses I found most relevant on the topic.

Sen. Baucus kicked off the questioning by stating that disclosure alone may not be sufficient to bring down healthcare prices and asked each of the panelists to supply a solution to the problem. Mr. Brill pointed out that injecting competition into the insurance market alone doesn’t guarantee price reduction. He brought up the large amounts of campaign contributions made by the healthcare industry to each of the members on the committee, the least of whom accepted half a million dollars in the past five years. Suzanne Delbanco, executive director of Catalyst for Payment Reform, states that consumers tend to assume that higher price means higher quality, while Paul Ginsburg, president of Center for Studying Health System Change, suggests changing benefit design so that consumers care which provider they see.

Sen. Hatch questions what type of data is being released and how reliable and useful it is to consumers. Dr. Ginsburg hones in on insurers and employers as the best source for consumer health care pricing data, stating that data has to be customized and reflect details of particular health plan, and these organizations are in best position to provide that.

Sen. Hatch shifts focus to hospital chargemasters: “If they are only marginally relevant, what steps should we take to move away from these systems and replace them?” Dr. Delbanco responds by agreeing that CMS pricing data released was great education for all concerning price disparities, but that providers and consumers need to understand costs of delivering care and the costs of delivering high-quality care.

Sen. Thune next takes the floor and cites some state measures to publish price lists. He asks Dr. Delbanco if published price lists for elective procedures are effective in putting market pressure on hospitals. Dr. Delbanco states that very little research has been done on whether consumers use this data, but is a beginning. She stresses the need of customization to make usable, vis a vis connecting price data to health care plan specifications.

Sen. Thune astutely acknowledges the role of recent regulations in pushing the industry towards more consolidation and asks what role this plays in pricing and whether antitrust laws need to be reevaluated in light of this shift. Dr. Ginsburg says that the best approach is to take steps to make the market more competitive despite its consolidated state. He mentions a need to revisit FTC Safe Harbor policy to require demonstrations of benefits for patients, and asserts that government can take a legislative approach to outlaw non-competitive contracting practices between health plans and providers.

Sen. Burr asserts that “seniors don’t like choice” and that “faced with healthcare decisions, their [adult] children are increasingly being turned to rather than healthcare providers”. He also offered that it “would be a cheap shot” to say that donations that health care organizations have made to him as informing the healthcare legislation he has written. Mr. Brill pointed out that he didn’t accuse him of such.

Sen. Rockefeller brought up the “public option” and the fact that everyone loved it but no one voted for it, so it was replaced with a “medical loss ratio” that resulted in private insurers being forced to issue rebates to consumers. He brings it all home by praising Congress on the establishment of IPAB to take the power of the purse away from lobbyists and Congress and give it to physicians that can make “wiser” decisions to save Medicare dollars. To this, Dr. Ginsburg responds that IPAB is “constrained,” with only the authority to squeeze money from reimbursement. Reimbursement, he says, is on autopilot and Congress can still lower reimbursement amounts at will. Instead, he expects more savings to come from Innovate Reimbursement models.

Sen. Baucus highlights the price variations and states that “he saw a chart somewhere” that showed that Medicare reimbursement amounts do not vary as much as private insurance reimbursement. He asks why this is so and if CMS has access to private insurance reimbursement data. Dr. Ginsburg agrees with Sen. Baucus’s assessment and asserts that new reimbursement models should address price variances. He mentions regulating private prices like Maryland has done since the late 70s. Brill asserts that a five-column list should be made public: what Medicare pays, what the Chargemaster charges, and what the three largest insurers pay for the same service. Dr. Delbanco asserts the need for quality input. She states that it matters little what you pay for a service unless the quality is satisfactory.

Sen. Menendez quickly launched into an attack, stating that Mr. Brill’s article did little to acknowledge how healthcare reform is addressing price disparities. Brill interjects and refers the senator to a specific paragraph of the article, to which the senator tells him to wait until he is done stating his question. He then attempts to corner Mr. Brill into agreeing that Obamacare addresses price volatility by eradicating low-quality health insurance plans and expanding coverage for citizens. Mr. Brill maintains that, while beneficial in other areas, the ACA does not directly address price variation in the market. Menendez asks him if he believes prices should be controlled by the government. Mr. Brill states that he believes “patented, life-saving drugs” should be controlled, but not procedures, and that “some interference is needed to preserve a free market.”

Sen. Baucus asks why hospitals are so fancy and compares healthcare to education and insurance to student loans. Dr. Delbanco points out that patients do not have data on which to base their provider choice, so they generally go on perception of facilities. Dr. Ginsburg states that consumers are removed from cost.

Sen. Schumer points out that higher costs at teaching hospitals are justified because they typically treat more rare, last-resort patients.

Sen. Baucus proposes an entrepreneurial approach to itemizing costs at a hospital on any given procedure and making that data available to consumers. Ultimately, he asked “What data, if any, should be proprietary?”

Overall, the Senators prepared meaningful questions to ask the panelists and were provided well-thought-out responses that intimate the complex nature of this issue. Consumers do not want raw massive files of data to pore over – they want someone to provide it in a way that is personalized, comprehendible, trustworthy, and ultimately actionable. Doing this will require a complex system of cost to quality analysis coupled with personal health and insurance policy parameters.

In my opinion, any true consumer solution will offer an element of predictive capability on which to base insurance and provider choices. To the entity (or entities) that can provide this in the least-intimidating way go the spoils. Who knows whether it will be insurance companies themselves, a joint venture between them and employers, or an entrepreneurial one-size-fits-all solution? 

I’m giddy to see the day when I can not only predict my tax burden six months in advance and strategize how to minimize it for free online, but also chart out a course for my family’s healthcare and make informed decisions about how much coverage we need and where we should go to get care.

Morning Headlines 6/24/13

Experts tout Blue Button as enabling information exchange between medical provider and patient

The Pittsburgh Post Gazette covers the federal government’s Blue Button initiative, calling for its expansion into the private sector and citing it as a key concept to moving forward in an EHR-enabled healthcare system.

Creative Skills For Life – Creative England Competition Fund

In England, the NHS and Creative Skills for Life announce a $154,000 contest that challenges developers to create apps that will help young people with life-threatening or debilitating medical conditions explore their creative potential.

Optometry EHR Breached in Florida, 9,000 Notified

An optometrist’s office in Gulf Breeze, FL is notifying 9,000 patients that their personal health information has been compromised after hackers break into the practice’s EHR and copy the medical records data.

Monday Morning Update 6/24/13

From Over Overlake: “Re: Overlake Hospital & Medical Center, Bellevue WA. Recently went live on Epic and is conducting a RIF by reposting its jobs and requiring current employees, including those supporting and installing Epic, to reapply for their jobs. Estimates are they will eliminate 10-15 percent of the IT workforce. The CIO is on a month-long leave while the RIF takes place.” Unverified.

From Robot Ghost: “Re: Duke University Hospital. Live on Epic as of Saturday morning.” Verified, according to the forwarded e-mail.

Respondents aren’t impressed with the EHR Developer Code of Conduct, with the vast majority saying it won’t have any effect on anything. New poll to your right, inspired by Ed’s “Bank Life, Not Vacation Days” post: do you take all the paid time off provided by your employer in a given year? I admit that I don’t, meaning my PTO days roll to the long-term bank and I’ll never get them back.

I have HIStalk Webinars scheduled through the end of the year and need more CIO reviewers to spend about 45 minutes reviewing a recorded Webinar rehearsal and providing feedback to the presenter. I’ll send you a $50 Amazon gift certificate and my thanks. Let me know if you are interested.

With Friday’s official start of summer, the industry takes a collective break and legitimate news tapers off until September. HIStalk articles will sometimes be shorter (like this one), but you aren’t missing anything. I just refuse to waste your time padding out the posts with junk news cleverly written to sound important.

Welcome to new HIStalk Platinum sponsor Clinical Architecture. The Carmel, IN-based company provides solutions that overcome healthcare’s terminology-related barriers. Those challenges include translating the terms within Continuity of Care Documents for Meaningful Use using structured and coded information (lab to LOINC, meds to RxNorm); mapping local terminologies specific to users or departments; handling translation ICD-10; and meeting PQRS/NQF quality reporting by identifying patients using normalized information and a standard coded vocabulary. The company’s approach with its high-performance, self-monitoring Symedical Server is to normalize (with its Cognition Engine), standardize (Coordination Engine), correlate (RelationSense Engine), and interpret (Sift Engine). Behind the scenes, Symedical Server handles high performance run-time APIs, a messaging and communications framework (including an iPad app), content distribution, a domain designer for custom content domains, and tools for searching and collective reasoning. Customers include providers and HIEs (semantic interoperability, quality reporting, and aggregating clinical and administrative data), HIT vendors (meeting Meaningful Use requirements and managing terminology content), and payors (analytics and improving efficiency). Everything in healthcare revolves around terminology and Clinical Architecture’s solutions enable the efficient and semantically accurate exchange of actionable healthcare data. The company is running a Share Your Healthcare Terminology Dream or Nightmare contest just for HIStalk readers, with winners receiving a Windows Surface Pro. Thanks to Clinical Architecture for supporting HIStalk.

Here’s a new YouTube video from Clinical Architecture that describes healthcare terminology challenges.
 
 

Miami Valley Hospital (OH) CIO Mikki Clancy is promoted to COO.

Former AirStrip VP Connie McGee launches Evolve Women, a career development website for women.

The “Race for Heroes” 5K race in Alpharetta, GA raises $100,000 for job training for veterans and their spouses. MedAssets and Hire Heroes USA were the sponsors.

Catholic Health Initiatives chooses QuadraMed, now owned by Canada-based Constellation Software, to provide data consolidation services. 

Creative Skills for Life, along with NHS England, is running a contest that offers $154,000 in prizes to developers of 10 prototype apps that support young people in the UK who have life-threatening and limiting medical conditions.

I’m really enjoying Vince’s HIS-tory of Epic, including his Part 3 installment.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Through a Different Lens

Through a Different Lens
By Kathy Krypel

In the end, it was hepatitis. Not some organized alphabetized version, but a quick, no-holds-barred attack from inside that would give me 10 days in the hospital and a look at healthcare from a very different perspective.

I am a clinician. I am also a healthcare IT expert. And now, I am a patient.

My induction into patient life was abrupt and unexpected. I, who had not been hospitalized in 30 years, was afflicted with sepsis in very short order. The trip to the emergency department, the 103 degree fever, and the 10 days spent in the hospital are all a bit of a blur.

Looking at it weeks later, from the slow recovery side of things, I offer these observations.

The Clinicians

I don’t know if they still teach something called ‘bedside manner’, but my experience with clinicians varied significantly. On the high end of the scale were the infectious disease doctor and hospitalist who coordinated care, modeled teamwork, and went out of their way to explain tests and procedures to me and my family. On the low end was the consulting physician, who referred to me as the ‘bile duct in 52’ in a hallway conversation that I happened to overhear.

The nursing, lab, radiology, and transport staff will forever have my gratitude for the way they fiercely protected my modesty (even when I was too sick to care), kept me informed about test results, and treated me and my family with utmost kindness.

The Electronic Medical Record

Ironically, I actually helped build the EMR and train users at the hospital where I was admitted. It was astonishing and very impressive to see it in action. I was able to see how quickly blood test results came back, watch the multiple ultrasounds and CT scans, and even observe my own liver biopsy.

It was fascinating, but reminded me that the EMR is only a tool that offers safeguards and suggestions. The physicians on my case were dogged in their pursuit of this infection, but even with the best of electronic records, they could not grow a blood culture faster or obtain instantaneous results on lab draws. These just take time. As good as an EMR is, it can help with the diagnostic process, but cannot magically make it faster.

The Patient

At the end of the day, it’s the human things that I will remember most – the infectious disease doctor who held my hand in the ED, the hospitalist who sat on the end of my bed for 30 minutes and explained what was happening and said that she would “tell us when to worry,” and the number of nurses who looked me in the eye and said, ‘I am so sorry this is happening.”

Despite advances in healthcare information technology, there’s still an inherent need for the personal connection – the relationship. That is the vehicle for healing. As the industry tackles the patient engagement challenge, the relationship – the patient experience – truly is at the center.

Kathy Krypel, LICSW, PMP is a master advisor for Aspen Advisors.