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.

Monday Morning Update 8/5/13

From DCIntern: “Re: Stage 3 Meaningful Use. Expect ONC to recommend a delay during National Health IT Week.” Unverified.

From Fly on the Wall: “Re: [vendor name omitted]. Having glitches nationally and worldwide in its medication reconciliation programming, causing patient discharge medication lists to be in error. A safety letter was issued on August 1.” I’ve asked the company to confirm, but in fairness I’m leaving their name off until I hear back. A copy of the safety letter would be nice to have.

I needed updated copies of Microsoft Office and wasn’t too thrilled at the price or the limit of installing it on only one PC (it was three PCs in previous versions), so I was happy to have stumbled onto Office 365. The Premium version (Word, Excel, PowerPoint, Outlook, OneNote, Access, and Publisher, all in 2013 version) runs $99.99 year for up to five PCs or Macs and also five mobile devices. I don’t like renting software instead of owning but was about to bite the bullet when I strayed onto Office 365 University. Students, faculty, and staff of approved education institutions (like my hospital) can get a four-year, two-PC subscription that includes 20GB of SkyDrive storage for $79.99, which I did –$20 per year is just fine with me. Installation was slick, fast, and in the background. The new software versions work great, but I haven’t been able to figure out how to use the cloud features, especially with Outlook. It would be a really slick package if Microsoft offered an easy guide on how to use all the file-sharing features it touts. I admit that I didn’t spend much time trying to figure it out, but so far I’m using it just like the old CD version.

Three-fourths of poll respondents don’t see HIMSS as a major player in the debate about healthcare quality and cost. New poll to your right: do you follow the “Most Wired Hospital” type awards? The poll accepts comments once you’ve voted if you would care to elaborate.

Stock picking TV celebrity Jim Cramer, whose lips were perpetually planted on Glen Tullman’s posterior until Cramer finally advised dumping Allscripts shares way too late, is now enamored with Jonathan Bush and athenahealth. Cramer is entertaining, but watching him can be expensive if you take his stock advice. Bush says hospitals are in a decline and struggling ones are being bought up by sharp for-profit operators whose efficiency allows them to make a profit. Cramer says athenahealth “is solving a lot of the healthcare problems in this country.”

Financially struggling MaineHealth will shut down its nine-hospital tele-ICU program that loses $500K annually. One hospital says it pays $150K each year to participate, but, “While the service is fantastic for our patients, it’s not reimbursable … The consequence of this will be that some patients that may have stayed in the local community may have to travel further for care that we won’t be able to offer. MaineHealth signed a splashy deal with VISICU (now Philips) in 2005, with the health system’s president saying then, “The savings in lives and ultimately in dollars make it an important investment. It’s the kind of service that is possible only because we have forward-thinking clinical and administrative leadership.”

The previously insignificant number of physician practices that don’t accept Medicare is growing, according to a Wall Street Journal report that says 9,500 doctors opted out in 2012.

In England, a study of Internet searches for takeout food that originated from a hospital IP address finds that those searches quadrupled in one year.

An Iowa nursing home fires two employees for taking inappropriate photos of a resident and posting them on an unnamed social media site.

A former Health Management Associates hospital CFO files a whistleblower lawsuit claiming that the for-profit HMA and Tenet hospital chains paid kickbacks to two Georgia clinics in return for sending pregnant illegal aliens to their hospitals so they could bill Medicaid for emergency services. The clinics, which advertised, “We care about your health, not your immigration status,” were paid kickbacks disguised as translation service fees, according to the lawsuit. Illegals aren’t eligible for Medicaid, but emergency services, including childbirth, are covered.

Vince covers the HIS-tory of Siemens, Part 3 this week.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Time Capsule: Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached

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 April 2009.

Here’s President Obama’s Mandatory EMR Feature List: Firing GM’s CEO Makes it Clear That Federal Money Has Strings Attached
By Mr. HIStalk

Was anyone but me surprised when President Obama decided it was time for GM’s CEO to quit and that Chrysler had no choice but to merge with Fiat? Man, I guess you really give up day-to-day control when a big lender (like Uncle Sam or the mafia) puts up the cash to keep you in business. Even Nixon wasn’t so bold as to say that what’s good for the country damned better be good for GM or else.

Say, wait a minute … healthcare is getting a lot of government money. Surely the feds wouldn’t start telling us how to run our shop, right?

I wouldn’t count on it. We might be selling our souls here.

This particular government, faced with a dismal economy and an ambition to make major changes in American society, doesn’t seem to be shy about crossing that previously sacred line between government and private industry. It’s surprising that a Democratic government would be as hard-nosed as private equity firms in putting their people in key positions of responsibility, demanding equity in return for financial support, and mandating changes in product development and sales despite the market’s sometimes differing interest (car makers made a ton of profit on gas-guzzling SUVs that consumers apparently wanted, at least until gas got temporarily expensive and financing became unavailable).

Everybody’s clinking their glasses and high-fiving over the gravy train headed healthcare IT’s way. Fear the person from the government who’s here to help: there may be a hidden price.

It’s clear that CCHIT (or something like it) will enjoy unprecedented power to set mandatory product requirements. “Effective use” will do the same for providers, spelling out exactly how they must use their technology. As Uncle Sam becomes an even more dominant buyer of healthcare services, the ratchet may be turned on reducing costs and following somebody’s medical cookbook. Viewer discretion is not advised.

It was flattering when Obama and company got interested in our little world of healthcare IT. Now it’s scary.

There’s not much question that government is now driving the HIT industry. The question is: to what? Will it be just like today, only bigger? Or is the real agenda to use government clout to finally whip private industry around a little, making businesses behave in some unspecified way that runs contrary to the free market?

I’m as shell-shocked about the economy as everybody else, so I get tired of reading headlines of mind-boggling historical significance that still sound like just more bad news. Somehow, Obama’s giving GM and Chrysler marching orders got my attention, even after watching the financial industry basically disappear overnight. The CEO of every company right now, right or wrong, is the former junior senator from Illinois who has never held a real job (I don’t count being a professor or lawyer) or run a business.

All I will say is this: be careful out there. It’s becoming clearer that government gifts, like private equity investments, come with strings attached. I’m really confused at this point whether I should feel proud or disgusted.

Morning Headlines 8/2/13

Cerner to redevelop Bannister Mall site as office park with as many as 15,000 workers

Cerner has purchased a 236-acre former mall outside Kansas City that it will use to house its growing workforce.

EDCO Awarded Patent for Medical Record Scanning Technology and Process

Frontenac, MO-based EDCO Health Information Solutions has been granted a patent for a scanning solution capable of identifying a document type by analyzing its content, rather than requiring a bar code.

Hospitals Face Challenges Using Electronic Health Records to Generate Clinical Quality Measures

The American Hospital Association reports that hospitals are struggling to adopt automated clinical quality reporting following a study that tracks the implementation of electronic clinical quality measures across four hospitals.

Quality Systems Seen Luring Bids Amid Pressure: Real M&A

According to Bloomberg, NextGen parent company Quality Systems, Inc. could attract buyout bids from Siemens and McKesson.

News 8/2/13

Top News

Cerner announces plans to acquire a 237-acre abandoned mall near its Innovation campus in Kansas City. A new campus on the property will eventually house up to 15,000 new Cerner employees as the company grows over the years.

Reader Comments

From Jobu: “Re: access control. Have there been recent discussions about deploying fingerprint or iris scanner recognition systems vs. multiple passwords?” I’m sure there’s a case study out there somewhere from Caragidm or Imprivata or another user access systems vendor. Feel free to point the way if you’ve seen something.

From Bluebonnet: “Re: Oregon Health & Science University patient information stored on Google Drive or Gmail. Does this not point to an organization not meeting the needs of its users to promote patient care? Given that this organization has been pretty progressive, is it not troublesome?” That question rarely gets asked: what system deficiencies created the need to store information on consumer-grade services in the first place? OHSU plastic surgery residents were keeping a spreadsheet of their service’s patients on Google Docs, which contained minimal patient information. A similar practice was discovered in the urology and kidney transplant areas. Questions: (a) was the only problem that the hospital didn’t have a business associate agreement with Google? (b) does the hospital’s system not provide a snapshot of which patients each service is covering? (c) if not, then does the hospital not provide network storage for saving copies of files, or was the problem related to mobile devices? Give the residents credit for trying to do the right thing in making sure handoffs were done and using technology to do it. It’s a tough sell to argue that ubiquitous cloud storage is fine for almost everything except PHI.

From HIS Junkie: “Re: Siemens. Looks like the CFO will take over. Is the SMS ride about to end? Less R&D for Malvern? John Glaser in trouble? We all know they been losing their client base to Epic and others for the last three years. Will they come to the same conclusion as GE – healthcare IT can’t be a winner?” Siemens issues a surprise profit warning and uncharacteristically quickly fires its CEO, replacing him with the CFO (you just can’t beat the excitement of an engineering company run by a bean counter.) The new guy says the company tried to grown too fast and needs to get back to execution (not referring to that of his predecessor). The deposed CEO, who steered the company around its global bribery scandals, will get $20 million in severance and a $20 million pension for his six years in the job.

A reader asked whether outside healthcare IT experts could help veterans and what the 90-day agenda would look like. Proud veteran, healthcare IT guy, and HIStalk/HIStalk Connect contributor Lt. Dan provided this response:

I’d scrap iEHR and spend what’s left of the money creating a patient portal that would make the soldier the acting custodian of their own electronic medical record. After every clinic visit, ED visit, or hospitalization, the entire chart from that visit is pushed to the patient portal. It has lab results, physician notes, PT/ OT, all of it, an exact carbon copy of everything entered in the chart for every visit. The portal IS the medical record, and it houses all details of any injuries or illnesses treated.

The portal follows them through their military career and grows as they need services. If they’re transferring from Ft. Bragg, NC to Ft. Stewart, GA they process out of medical at Bragg where the Bragg doctor signs off on the chart and the portal is updated to show that the soldier is transferring to a new duty station, and that Ft. Stewart is now the primary care location.

When the soldier is ready to be discharged, they have their entire military record on the portal from all bases, including medical and dental. When they get back to the civilian world and meet their new civilian PCP, they can at worst print out the medical record for them, and at best leverage some type of HL7 interface to push a medical summary (CCD) to the provider with extractable allergies, prescriptions, problems, and medical history.

If the vet needs to submit a disability claim with the VA, they grant access to their portal so VA reps can review the records immediately, rather than waiting up to 90 days for DoD to find, print, and mail them a copy.

Vets already have a portal. It’s called My HealtheVet. It looks exactly like your typical portal. A dumbed-down, patient-centric version of a medical record. It’s fine, it’s just missing much of the information clinicians will want to see if they’re taking you on as a new patient after military service, or information that a VA rep would want to see if they’re processing a disability claim.

To help vets within 90 days, I’d get the entire medical record from the first day the soldier enters the military, feeding into that patient portal so that soldiers would have custodianship of their own medical record. Then I’d enhance that portal so that vets can easily authorize access to any or all of the content within it and could transmit a CCD from it.

I’d get a team of sergeants, corporals, and privates to execute the plan. It would be done in 89 days and there would be enough money left over in the budget to spend the last day drinking beer and barbecuing.

HIStalk Announcements and Requests

What you may have missed this week on HIStalk Practice: the number of physicians opting out of Medicare has tripled since 2009, according to CMS. CareCloud adds more than 150 new medical groups in the second quarter, with more than half also selecting CareCloud’s integrated EHR/PM. Dr. Gregg shares a story of a blogosphere encounter with another physician who took his office fully live on EMR in one day. Dr. Gregg offers additional insight on the doctor’s EMR platform in a subsequent post. Click over to HIStalk Practice and catch up on the latest ambulatory HIT news, sign up for e-mail updates, and check out the offerings of our sponsors. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Ascension Health Ventures invests in Quantros, a portfolio company of Francisco Partners.

The Advisory Board Company reports Q1 results: revenue up 18 percent, adjusted EPS $0.31 vs. $0.31. The company also announces its purchase of referral technology vendor Medical Referral Source for $11.5 million.

MedAssets reports Q2 results: revenue up 4.7 percent, adjusted EPS $0.30 vs. $0.28.

McKesson re-elects all its board members at the company’s annual meeting despite dissent from activist shareholders who wanted the company to cut CEO John Hammergren’s pay and split his chairman and CEO roles.

A Bloomberg article says, without any facts to back it up, that Quality Systems has become a Siemens and McKesson takeover target because its share price has dropped and proxy fights have pushed the company to reevaluate its strategy.

Sales

Hallmark Health System (MA) selects athenahealth’s athenaClarity to proactively manage its patient population and engage in new reimbursement contracts.

The Hospital for Sick Children in Toronto selects MetaVision’s MVperfusion solution.

People

HIT Application Solutions names Betty Jo Bomentre, MD (Vitalize Consulting Solutions) CMIO.

Healthwise SVP Karen Baker joins the board of Center for Plain Language, a nonprofit that advocates for clear communication in government and business documents.

Health Care DataWorks names Kathleen Kimmel (MedeAnalytics) chief clinical officer.

Announcements and Implementations

Cerner opens an on-site health center for 2,800 employees and covered dependents of the California-based ViaSat, a communication products company. Providers will use Cerner’s EHR and patients will have access to the Cerner Patient Portal.

Brightree changes the name of its CareAnyware EMR software to Brightree Home Health and Hospice.

NorthCrest Medical Center (TN) implements Allscripts Sunrise Clinical Manager.

PinnacleHealth (PA) goes live on Soarian Financials.

University of Arkansas for Medical Sciences had the first of three Epic go-lives Thursday, bringing up ambulatory scheduling and registration, kiosks, referring physician portal, retail pharmacy, MyChart, and professional billing in all of its clinics. A third of the clinics also went live on EMR.

The Discovery Channel aired an episode of “Today in America” highlighting PeriGen’s PeriCALM and PeriBirth on Thursday. It’s pretty good, although host and former NFL quarterback Terry Bradshaw struggles painfully to pronounce the big words as he adopts the “Serious Terry” persona instead of his usual goofy on-screen presence.

The US Patient & Trademark Office awards EDCO Group a patent for its Solarity medical record scanning and indexing process that identifies a scanned document type by its recognizable content rather than by a printed bar code.

PatientOrderSets.com announces the integration of its order set tools with Cerner Millennium.

Government and Politics

VA Undersecretary of Health Robert Petzel, MD says that while one million veterans currently use some type of VA telehealth offering, he hopes to boost the number to more than four million.

Above is Farzad Mostashari, MD responding to questions at the Senate Finance Committee hearing on healthcare IT this week, courtesy of Brian Ahier.

ONC releases its user guide to EHR contract terms.

Innovation and Research

Researchers find that providers who use EHR clinical decision support predictive tools at the point of care are less likely to order antibiotics for respiratory tract infections.

Technology

The American Hospital Association says even EHR-experienced hospitals are struggling to implement electronic clinical quality measures, recommending: (a) slow the transition by reducing and then improving the measures; (b) make EHRs and eCQM tools more flexible; (c) improve EHR and eCQM standards to meet Meaningful Use expectations; (d) test eCQMs to make sure they are reliable and valid before rolling them out nationally; and (e) provide more tools and guidance for the transition.

Other

A Capterra infographic lists the 20 most popular ambulatory EHRs based on number of customers, number of users, and social media presence. The accuracy of the information is suspect given that Epic is listed as having one to 50 employees rather than its actual 6,500. Potential buyers should note that “most popular” is not the same thing as “most likely to succeed” in a given practice, where the vendor’s prolific Tweeting and Facebook likes may provide little consolation.

Consumer advocates in Florida oppose a proposal that would boost allowed charges for providing copies of medical records to $1.00 per page rather than $1.00 per page for the first 25 pages and then $0.25 per page afterward. Lobbyists for release of information provider HealthPort technologies filed the request, surely seeing dollar signs at the prospect of nearly quadrupling revenue given the size of the average chart.

Dialysis patients of Boston Medical Center (MA) were exposed to hepatitis B earlier this year because nurses weren’t allowed to use the hospital’s EMR, the state health department has concluded. Contracted dialysis nurses from DaVita weren’t given access to the EMR that would have flagged an infected dialysis patient, leading them to improperly sterilize equipment and expose 13 patients to the disease. The state said the hospital should give EMR access to non-employed nurses who are delivering patient care.

Healthcare employers cut 6,843  jobs in July, the highest monthly total since November 2009. Hospital finances have been hurt by sequestration, Medicare payment cuts, and lower utilization as patients move to high-deductible insurance policies.

The CEO of WakeMed Health & Hospitals (NC) warns employees of possible cost-cutting and layoffs as the health system’s accumulated losses hit $15 million before the September fiscal year end. The hospital is spending $100 million implementing Epic and expects a $23 million reduction in payments next year.

The bond ratings agency for Johns Hopkins Health System gives it kudos for its system integration, including installing Epic system-wide.

In England, the BBC finds that Royal Berkshire Hospital has paid $25 million to 200 consultants over five years to help it bring up Cerner Millennium. The article says the total cost is $42 million so far, it’s still not working right, the annual cost is $10 million, and IT is now one of the biggest departments in the hospital.

Sponsor Updates

• Joseph Eberle of CTG Health Solutions presents a case study on using data analytics to improve outcomes for chronic kidney disease patients at this week’s National Forum on Data & Analytics.
• Impact Advisors’ Senior Advisor Janice Wurz co-authors an article with Henry Ford Health CTO John Hendricks on planning and designing strategic technologies for clinical BI.
• Allscripts adds integration with Spaulding webECG, allowing the app to be launched from within Allscripts Enterprise EHR to support physician orders and provide access to ECG reports.
• 3M Health Information Systems introduces Patient-focused Episodes software, which considers the costs and outcomes of longitudinal care.
• Quest Diagnostics works with Greater Houston Healthconnect to make lab results available to providers.
• Ingenious Med offers a white paper, “Transition from ICD-9 to ICD-10: Managing the Process.”
• Andre L’Heureux and and Kevin Entricken of Wolters Kluwer participate in a roundtable on the genome approach to investing.
• INHS recognizes 18 of its customers that were named Most Wired.
• API Healthcare reports that it expanded its market reach to include behavioral health and rehabilitation centers in the second quarter.
• Truven Health Analytics will add animated videos from Health Nuts Media to its Micromedex Patient Connect Suite.
• Holon’s Scott McCall discusses the importance of good communication skills for HIE implementation team.
• INHS client St. Elizabeth Hospital (WA) earns HIMSS Analytics’ Stage 7 recognition for EHR adoption.
• Health Catalyst SVP Dale Sanders lists five indispensable information systems needed for ACO success.
• RazorInsights will showcase its ONE Enterprise HIS solution during the Illinois Rural Health Association Educational Conference Aug. 22-23.
• Five Medicity clients are serving as HIO ambassadors to a Chinese delegation gathering best practices for organizing, administering, and sustaining an HIO.

EPtalk by Dr. Jayne

The American Academy of Family Physicians has a new Web page covering the Medicaid-Medicare parity payments specified in the Affordable Care Act. Included is a checklist with the steps providers must follow to obtain the payments.

Clinical Decision Support update time: The US Preventive Services Taskforce publishes a draft recommendation for annual screening of high risk smokers by CT scan. Although it’s still a draft and insurers are not paying yet, it’s a good excuse to review the steps needed to configure new screening guidelines in your EHR.

I was intrigued by a blurb about Cisco’s “Video-enabled virtual patient observation” offering. Essentially it’s remote monitoring of patients who would normally require a “sitter” to ensure they don’t fall out of bed, remove IVs and other tubes, or otherwise cause self-harm. I wanted to find out more about it, but couldn’t without filling out a 17-field questionnaire including budget and timeline information. Based on my recent experiences from the patient perspective, I’d lobby that no technology can replace the presence of a family member at the bedside. For those who can’t have someone there 24×7 or for hospitals that have a shortage, it might be an interesting option.

Researchers at Temple University in Philadelphia are conducting a two-year study looking at virtual speech therapy. Patients will be pushed to spontaneously generate speech rather than practicing scripted conversations.

There have been several additions to the HealthIT.gov site recently, including a document on key terms used in EHR contracts. Based on some of the questions I receive from our affiliated providers, it should be required reading for anyone thinking about purchasing an EHR or going live on a hospital’s platform as part of an alignment strategy or Accountable Care Organization. It’s not a bad read on legal terms in general, especially for providers in the habit of signing documents without reading them.

Bianca Biller alerted me to the proposed cuts to the 2014 Medicare physician fee schedule. Highlights include the (now usual) 24.4 percent cut due to the SGR formula, implementation of value-based modifiers, changes to the Physician Quality Reporting System, and limitations on nearly 200 services where the physician fee schedule non-facility payment is more than the total payment for the same service in a facility setting.

It’s been a rough couple of weeks in the trenches, so I’m going to recharge my magic wand with a long weekend somewhere sunny. If I were a fairy godmother, this is what I would feel like about now. Here’s to sunscreen and fruity drinks.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 8/1/13

CareCloud Surpasses Record Revenue Growth, Secures Funding for Expansion

CareCloud reports that it has achieved sustained growth for 14 consecutive quarters and beaten its all-time quarterly revenue record with its latest Q2 results. The company also announced that it has closed a $20 million Series B financing round.

EHR Contracts: Key Contract Terms for Users to Understand

ONC publishes a guide that explains EHR contract terms for healthcare providers shopping for a new EHR.

Go-live gone wrong

Recent high-profile implementation failures are profiled in an article that points a finger at Meaningful Use for forcing a culture of big bang implementations.

Mount Sinai Lands $3.7M for Genomic Medicine Project in Kidney Disease

Researchers at the Icahn School of Medicine at Mount Sinai receive a $3.7 million grant from the National Human Genome Research Institute to find out if incorporating genome data and genome-related alerts into EHRs can improve treatment of kidney disease in patients who are of African ancestry.

Hospital Board — Two Profitable Months

Twenty-five-bed Fulton County Hospital (AR) closes its fiscal year on two profitable months, projecting a 2013-2014 net loss of $53,000 compared to the previous year’s loss of $380,000. Fulton’s accounts receivable days jumped to 66 after a Healthland EHR implementation, which caused short-term financial hardships.