Morning Headlines 7/8/13

Outsourced UPMC workers protest cuts

Transcriptionists at Pittsburgh’s UPMC protest the decision to outsource their jobs to Nuance. The workers were offered remote positions with Nuance, but at a significant pay cut.

ONC Patient Safety Webinar

ONC will hold a meeting on its recently announced patient safety plan this Wednesday, July 10, at 3:45pm EDT.

Low sign-up for Australian eHealth records

In Australia, the highly publicized national patient portal is criticized after the one-year anniversary of its launch passes with only two percent of the Australian population having created accounts.

Open Letter to Chuck Hagel: DoD still doesn’t know what the hell they are doing

VistA expert Tom Munnecke publishes an open letter to Chuck Hagel in which he explains why implementing VistA would be a logical choice for the DoD and why a commercial solution would be an expensive mistake. He uses England’s NPfIT failure as an example of what can go wrong when a national strategy is centered around integrating multiple systems and points to the NHS’s recent decision to evaluate the use of VistA as a single, integrated solution as validation of that approach.

Monday Morning Update 7/8/13

From Utopic: “Re: Notice of Privacy Practices. HIPAA 2013 regulations require that the NPP and breach notices be written in plain language. That didn’t happen in the original HIPAA notices and probably won’t happen in this version either. Communicating in plain language doesn’t seem to be an issue for any of your survey respondents. I have a three-page summary if anyone is interested.”

HIStalk Webinar July 17

The next HIStalk Webinar will be “Five Steps to an Enterprising Imaging Strategy” on Wednesday, July 17 from 1:00 to 1:45 p.m. Eastern, sponsored by Merge Healthcare and presented by Steve Tolle, senior VP of solutions management. The US performs 800 million studies annually and industry experts predict steady growth over the next three years. How do you plan to share this information across your organization and your referral network and to securely store it? Implementing an enterprise imaging strategy and archiving data in either the world’s largest VNA or the cloud is your ticket to true interoperability.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. According to one of the CIO reviewers who reviewed the rehearsal session, “I have to be honest, I wasn’t sure if a presentation on enterprise imaging would grab me. The presenter did a great job in covering why an enterprise imaging solution is needed in today’s world and what it could do to alleviate issues in hospitals.” Register here.

The vast majority of respondents think McKesson’s customers should care that John Hammergren will get a pension of at least $159 million, although the comments are equally passionate for both sides. New poll to your right: now that implementation of the ACA employer mandate has been pushed back, should healthcare organizations proceed plans to buy software to meet ACA-driven needs?

Welcome to new HIStalk Platinum Sponsor CoverMyMeds. The Columbus, OH-based company has put the Prior Authorization process for prescriptions into modern decision support workflow. Over 100,000 providers use its service for free with health plans, PBMs, and drug companies footing the bill because CoverMyMeds makes them more efficient. Providers access the service through their EHR or from the company’s all-payer portal and get real-time determination. It’s not just about efficiency – when Prior Authorization takes too long, 30 percent of patients to just give up and abandon their prescriptions, causing all kinds of clinical and cost issues. The average doctor spends six hours per week filling out PA forms. If your company sells a pharmacy or EHR system, you can add the “Best Feature Ever” with APIs that can manage PAs either before they are submitted or after they are rejected. Thanks to CoverMyMeds for supporting HIStalk.

I found this YouTube video on how CoverMyMeds works.

Constantine Davides has updated his popular HCIT Consolidation Chart for HIStalk readers. It lists all of the healthcare IT acquisitions by company. Take a look if you (a) wonder why your vendor’s allegedly integrated products aren’t because they were simply bought and relabeled; or (b) you are creating a healthcare IT trivia contest and need hard questions like, “What was the name of the event notification software vendor that Philips acquired?” (answer: Emergin.)

NHS England publishes “Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record” that describes its all-digital goal for 2018 and the $387 million in available grants for NHS Trusts. NHS says it will consider the use of the VA’s VistA, summarizing, “One of the significant products we have investigated is VistA and for reasons described in more detail below we are looking to adopt some of the ethos behind its creation and potentially part, or all, of the technical product, in combination with others to generate NHS VistA. NHS VistA as a concept will focus on bringing together the best of breed capability of Open Source solutions and will be driven by NHS organisations with the support of NHS England and others. The US Veterans Health Administration VistA system was created in the 1980s by clinicians and software engineers from the ground up. It has become renowned across the world as the first truly integrated, clinically owned system. It has been in operation long enough to be able to demonstrate real clinical outcome benefits.”

VistA expert Tom Munnecke’s “Open Letter to Chuck Hagel: DoD Still Doesn’t Know What the Hell They Are Doing” says “DoD is trying to get out of a hole by digging it deeper.” A snip:

Rather than lifting up the VA eligibility problem to a shiny new common information system, you are on the verge of dragging health IT into the same bureaucratic vortex that has already done so much damage in the past. AHLTA was declared “intolerable” in a Congressional hearing four years ago. Yet, not only is it still around (and absorbing $600m/yr operations and maintenance costs), but it is also serving as a template for the next generation of the IEHR – a top down, mega-centralized administrative system far removed from the clinical needs of health care professionals and patients. DoD continues to focus on the organization chart, not the patient, closely coupling their software designs to their bureaucratic stovepipes.  Indeed, it is rare for me to even find the word “patient” in any DoD health IT documents.

Christopher Assad, MD develops a prototype CPR app for Google Glass that walks laypeople through the process of performing CPR effectively following the beat of “Staying Alive,” which coincidentally sets a pace of 100 compressions per minute.  

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

Outsourced UPMC transcriptionists hold a rally outside the health system’s headquarters in the US Steel building in Pittsburgh to protest the transfer of their jobs to Nuance. Their union wants them to receive severance pay, health insurance through Nuance, uncontested unemployment claims, and an apology from UPMC CEO Jeffrey Romoff. All were offered jobs by Nuance, but at $8 per hour instead of their previous $12-15.

ONC will hold a Webinar on its just-released patient safety plan on Wednesday, July 10 from 3:45 to 5:30 p.m. Eastern.

Vince covers the death the death last week of computer mouse designed Douglas Engelbart.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 7/5/13

May 2013: EHR Incentive Program

May marks the slowest growth in eligible professional attestation since June 2011, netting just 892 new EPs and moving total attestation rates from 55.3 percent to 55.4 percent.

Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record

In England, the NHS issues a report which confirms that it is evaluating the implementation of VistA to meet its health IT goals in an open source environment.

Lawmakers release comments on call for ‘reboot’ of Meaningful Use program

Six Republican senators have released the public comments they solicited in April regarding a request to HHS to publish a written plan for how it is implementing the HITECH Act.

Indiana FSSA notifying clients of potential information breach

A computer glitch that caused medical records to be erroneously printed and mailed to the wrong patients is being blamed for a massive personal data breach in Indiana that has impacted as many as 187,000 patients.

News 7/5/13

Top News

A Dow Jones article says Intuit not only found its healthcare portal business to be a poor fit in its financial product lineup, the company had to write down $46 million in May after Allscripts bought Jardogs, which offered a patient engagement platform that will likely eliminate the dependence by Allscripts on the Intuit Health patient portal. The customer comments I heard at ACE 2010 (the Allscripts user group meeting) weren’t complimentary about Intuit’s portal, which it had just bought with its acquisition of Medfusion. It will be interesting to see if Allscripts will make a play for Intuit Health since it has already acquired Jardogs as an alternative.

Those with memory deficits might want to study yet another example of how outsider companies throw down big money to buy their way into the healthcare market because it looks easy, then slink off licking their wounds shortly afterward as they dump customers off to any bidder willing to take over the smoking wreckage of what used to be a decent company and product. That might be a fun exercise: leave a comment about which big company screwed up the most in its unsuccessful foray into healthcare. I always vote for Misys, which I’ve always suspected was created solely to amuse the industry with an exaggerated parody of incompetence.

Reader Comments

From RustBeltFan: “Re: HIPAA Omnibus Rule Advisory Panel responses. Scary answers! Maybe you’d be doing all of us a favor by developing a HIPAA Omnibus Rule 101 series for HIStalk!” Most of the CIO/CMIO respondents said their organizations were generally oblivious to the new rule, which kicks in September 23, 2013. If you are an expert on the topic, consider presenting an HIStalk Webinar to enlighten readers. This would be purely educational, with no commercial bias or sponsorship, and I’ll provide the platform and promotion to let you reach an appreciative audience (and it’s not bad for resume expansion and industry exposure besides.) Contact me if you’d like to present on this or any other educational topic.

HIStalk Announcements and Requests

Happy Independence Day. I’m not a fan of calling it the “Fourth of July” since that’s devoid of creativity and as dull as calling Christmas the “Twenty-Fifth of December” or New Year’s Day the “First of January.” About the only good thing about calling it the Fourth of July is that politicians weren’t tempted to make it a Monday holiday and thus destroy its historical significance simply to give Federal workers (and eventually the rest of us) a long weekend. At any rate, my flag is flying outside and I hope yours is, too. I worked a regular day today at the hospital and now I’m writing HIStalk, so I’ll celebrate by watching a few minutes of “A Capital Fourth,” which I’ve actually seen in person on the National Mall once. It was fun but dangerously hot, and while I’m glad I did it once, I have no plans to do it again other than on TV.

Other than HIStalkapalooza, what HIStalk activities, if any, would you like to see at the HIMSS conference in February? Let me know. I’m planning it now before I get swamped again starting in October.

On the Jobs Board: Senior Healthcare Policy Analyst, Epic Project Director, Android Developer – Healthcare + Google Glass, Staff Software Engineer .NET.

People

   

Scott MacLean, deputy CIO and director of operations at Partners HealthCare, starts his one-year term as chair of the HIMSS board. Carol Steltenkamp, MD (CMIO, University of Kentucky Healthcare), is named vice chair; Paul Kleeberg, MD (CMIO, Stratis Health) becomes chair elect; and Pete Shelkin (Shelkin Consulting) is named vice-chair elect.

New HIMSS board members starting their three-year terms this month are Beverly Bell, RN (VP, Health Care Dataworks); Beth Halley, RN (principal advisor, MITRE Corporation); Rick Schooler (VP/CIO, Orlando Health); and Michael Zaroukian, MD, PhD (VP/CMIO, Sparrow Health System).

Government and Politics

The Wall Street Journal apologizes for not having been critical enough of the Affordable Care Act, which it calls “a fiasco for the ages” and a “rolling train wreck.” It speculates that the Treasury Department pushed for delayed implementation (possibly illegally since Congress didn’t approve a delay) of the employer mandate because its own software isn’t ready to handle the changes. Apparently only the WSJ missed the obvious point that employers could bypass new healthcare expenses by either (a) cutting their headcount to drop below the 50-employee minimum; or (b) turning full-time positions into part-time positions. Their conclusion: the whole ACA could go right down the toilet because it was sloppily written, is impossible to execute, and will hurt employment. 

Speaking of the ACA, here are some interesting thoughts from a well-connected reader who knows what he’s talking about: with the announced delay in the ACA employer mandate and the uncertainty about the individual mandate, will hospitals ever really see the influx of newly insured patients they have expected? And if they have any doubt about that (which they should), will they curtail big software investments now?

Other

US Army Sgt. Kyle Patterson and his wife Ashley thank The Aroostook Medical Center (ME) for using an iPad and Skype to create a video connection that allowed him to participate in the March 29 birth of his daughter from his post in Afghanistan. According to Ashley, “Kyle was just over the moon. He told me before the birth that he was not going to cry, but he did. He sure did.” The family presented TAMC with a flag that Sgt. Patterson flew in their honor at Bagram Airfield. The hospital flew that flag on July 4 to honor all members and veterans of the military.

A New York Times article entitled “American Way of Birth, Costliest in the World” says we spend $50 billion per year on four million births, a lot more than other developed countries that provide comparable access to services and technology. It describes a pregnant woman whose insurance doesn’t cover maternity costs trying to figure out how much money she would need, only to be told by the local hospital that it would be between $4,000 and $45,000. Her response: “How could you not know this? You’re a hospital … I feel like I’m in a used-car lot.” 

Maine Medical Center says it has fixed its problems with Epic, with Epic itself issuing a rare statement in saying MMC’s problems weren’t related to software defects. The hospital admits that the computer issues caused budget problems, but says those aren’t related to the buyout offers it will send out to 400 employees this week.   

The bonds of North Mississippi Health Services (MS) are downgraded because of financial losses largely due to $11 million in one-time expenses in implementing Allscripts at its Tupelo campus. Fitch Ratings says the implementation required more staffing and budget than expected and also increased length of stay.

In England, the head of the defunct NPfIT is called out, along with two other executives, for spending more than $100,000 for a consultant to help them look good in a single meeting with the Public Accounts Committee. A Member of Parliament describes their performance at the hearing as “woeful,” and suggests, “Perhaps they should ask for their money back.”

Weird News Andy succinctly titles this photo, “The ‘M’ stands for … “

EPtalk by Dr. Jayne

A Minnesota study demonstrates improved blood pressure readings using telemonitoring technology. Patients also kept their blood pressures controlled six months after the intervention ended. Pharmacists provided consultation and education over the phone once readings were received.

We know that exercise helps many of us deal with stress. Princeton researchers show that exercise creates new brain cells while also creating calm in other parts of the brain. The study involved mice running on wheels, which is a lot like being employed in the health information technology realm, especially during the summer. So many people assume summer is a “slow” time but I’ve found it to be stressful with many co-workers on vacation and the same amount of work to be done. Don’t forget to get your exercise and be glad you don’t have to be immersed in ice-cold water to be stressed (like the mice were.)

Thank you to everyone who sent comments (both posted and e-mailed) regarding my “tale of the ED” Curbside Consult. I’m happy to report that my sweet grandmother was discharged home to continue living independently. Her medications were adjusted, she’ll have some home therapy, and we’re off tomorrow to see if she’s a candidate for an injection of the pinched nerve that seems to be the root of the problem. I’m pleased to report that the care she received on the med/surg unit was both high touch and high tech, which renews my hope that we don’t have to sacrifice one for the other.

Thank you also to HIStalk contributor Ed Marx, who was the first to wish me a Happy Birthday this morning even though he is in the midst of climbing Mount Elbrus. His team is scheduled to summit on the 10th, so please join me in wishing them a safe journey. For our US readers, enjoy the Independence Day holiday. If you’re working in the trenches, double thanks to you.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Advisory Panel: HIPAA Omnibus Rule

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

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

This question this time: Are your organization’s executives paying a lot of attention to the HIPAA Omnibus Rule or is it just business as usual?

It has been difficult to get executive attention on HIPAA security topics in general. We are going to use the HIPAA Omnibus rule to kick start a new education and training program across the entire organization. We will start with executives first.

Pretty much business as usual.

No, or if they do, we are not aware of it, which is just the same. Business as usual — the yearly training from a hired overpaid consultant so we can check the box for compliance.

[vendor member response] We are paying a lot of attention. As part of a recent acquisition, we are now part of a larger organization that is working to extend coverage of HIPAA, HITECH, and the BAA more broadly.

Business as usual.

It’s primarily business as usual, however, there are some provisions of the rule that may require us to revisit many of our third-party contracts. That has the potential to be a major endeavor, so it is something we are evaluating now.

Business as usual.

IT executives are because we are also on the hook for data security. The ability to not share data on specific encounters defined by payer type (insurance vs. self pay) concerns me a lot. I am not sure the HIS/ EMR/ EHR vendors are ready. I can’t say any of our other executives have even read a brief on the Omnibus rule.

[vendor member response] We are very concerned about the increased risk/liability for breaches. This is a big concern when using contractors. Our clients are not knowledgeable about the changes and truly not focused on it at all. On the ambulatory side of things, practices, even larger ones, are so swamped with EMR/EHR, and revenue loss from managed care that they consider HIPAA a done deal.

No. They are not at all, even after several attempts to raise awareness.

The organization is ignoring the rule, but the expectation is that IT and HIM stay on top of it. I don’t have a problem with that and so IT/HIM are finishing up our changes in order to comply.

We hired a CISO out of the military with a background in technology security. She makes sure the execs are paying attention. We have a team that consists of privacy officer, corporate compliance, audit, and CISO. They meet regularly to address all aspects of HIPAA and HITECH requirements including education.

It is business as usual with no real interest from the senior team or the board.

Our Privacy & Security Officer are, and they’re slowly getting the attention of leadership. We addressed a lot of the changes in the proposed rule, so we don’t have as much to address as we would otherwise.

Business as usual.

[vendor member response] Within our customer base I am seeing customers starting to pay attention to making sure all BAAs are updated and signed. However, I have had a couple of folks tell me there is no ‘hurry, since we have until early fall to totally comply.” I personally am not hearing of any urgency to meet the rule within any conversations I am having at the executive level. I am hoping that urgency is there just not being expressed to me!

Business as usual.

Some attention — trying understand implications…

Except for Compliance, Legal, and IT, it hasn’t had a lot of attention. Many vendors, especially small to mid-sized cloud hosting vendors, have not fully realized the implications.

Appropriate attention has been paid by those over that area.

Our executives have reviewed the rule to see where we need to comply and what actions to take.

Yes.  his has been an agenda item for our executive-level compliance, privacy steering committee. As a result we’ve modified our business associate agreement, are in process of rewriting notice of patient’s right to privacy, same with data breach evaluation criteria.

Just business as usual.  Haven’t heard it come up even once.

Business as usual.

Business as usual. We are overwhelmed right now with MU and NCQA. So many regulations, such limited staff to execute.

If anyone is paying attention to this, it is hard to tell.

More of business as usual. The interpretations and evasions are so vast and pandemic that it more of a series of workarounds than a policy.

All with active BAAs are being touched. Mail-merged form letter, follow-up phone call, lawyer letter if still no response.

Morning Headlines 7/3/13

Health IT Patient Safety Action and Surveillance Plan

ONC releases its much-anticipated patient safety and surveillance plan that tackles a number of issues, such as how patient safety problems will be reported and tracked. EHR certification bodies will be required to confirm functionality and usability not only through testing, but through field observation. The Joint Commission has also been contracted to help identify and address safety issues.

Intuit Announces Next Phase of Structural Moves; Organizational Foundation Now in Place

Intuit will sell its Intuit Health Group, reporting that it had initially evaluated healthcare as a growth opportunity, but that it had come to realize that its health group would be better off with an organization that has a stronger focus on the healthcare industry.

Judge orders Affinity to bargain with union

A judge in Ohio has sided with a nurses’ union at Affinity Medical Center after they filed a unfair labor charge over a rushed Cerner implementation. Nurses claimed that the go-live date was too aggressive and a lack of training compromised patient safety. The judge ruled that Affinity leadership violated labor laws a number of times, first by refusing to negotiate with the nurses’ union, but other less-than-honorable examples cited by the judge included managers reducing the number of nurses in the ICU as retaliation and managers scrutinizing the charts of nurses who were outspoken union supporters in an effort to initiate disciplinary actions.

Washington Hospital "goes live" with $86 million electronic medical records system

In Freemont, CA, 339-bed Washington Hospital goes live on Epic across all inpatient and outpatient departments.

News 7/3/13

Top News

• ONC wants EHRs to be equipped with a “report a problem” type button that would collect information about the issue and send it to Patient Safety Organizations using AHRQ’s Common Formats.
• Certification bodies will be required to “conduct surveillance” to ascertain that the capabilities of a given certified EHR are the same in the field as they were observed in certification testing.
• Certification body surveillance will also monitor EHR vendor responsiveness to user complaints.
• ONC will monitor FDA’s MAUDE medical device problem reporting database to find reported events that are related to health IT.
• Meaningful Use and certification standards will be expanded to cover more patient safety-related objectives.
• ONC will create tools that will allow provider EHR users to assess patient safety in their organizations.
• ONC awards the Joint Commission a sole source contract to assist the ONC in detecting and proactively addressing health IT-related safety issues across a variety of care settings. The Joint Commission will develop an IT incident classification system, provide de-identified reports on related sentinel events, conduct at least five event investigations each in hospitals and practices, develop provider tools to help providers understand IT-related sentinel events, and publish a research paper that analyzes IT-related sentinel events.

From Evangelist: “Re: Epic. Killing it in large practices.”More than half of all EMR-using practices that have 40 or more doctors use Epic, according to SK&A. Allscripts and eClinicalWorks each serve a substantial percentage of the smaller offices and the top 20 vendors support almost three-quarters of all practices using an EMR. Where people get in trouble is trying to infer from this limited information who’s buying what, which is more a question of practice ownership rather than practice size as hospitals keep buying out doctors and sticking Epic and Cerner in there.From Pointy Head: “Re: McKesson. Killing the MED3OOO Unity project and sunsetting InteGreat in favor of Practice Partner. There have been layoffs.” Unverified. McKesson acquired MED3OOO in October 2012 and claimed major go-forward love for InteGreat, so that’s quite a change in stated direction if so.

As reported here this past weekend on HIStalk from an Indoor Privy rumor, Intuit announces plans to divest its health group, including the patient portal business it acquired from Medfusion in 2010 for $91 million. Intuit says it thought the health group could make money, but it needs to be owned by someone who understands healthcare better. It would not be surprising to see one of Intuit’s resellers — such as Allscripts, GE, or Greenway — make a play for the business.A union investment group urges McKesson’s shareholders to vote out Chairman and CEO John Hammergren and two other directors because of Hammergren’s compensation, also demanding that the company split the chairman and CEO roles he holds.

Flagler Hospital (FL) went live this past weekend on Allscripts SCM, ED, lab, radiology, HIM, registration, scheduling, billing, pharmacy, medication administration, and CPOE. According to HIStalk friend CIO Bill Rieger, “So far so good. Mandatory compliance for physician training has led to some great conversations. The Breakaway Group training simulator program has worked and benefited us Day 1 more than we thought it would. MAKE Solutions workflow testing team work really saved us a lot of Day 1 pain as well. Kudos to the Allscripts team for excellent support and response.” CMIO Michael Sanders, MD dressed for the occasion in a brand new Kevlar vest and garish go-live socks, while the command center crew kept on top of the trouble tickets.

Innovation and Research

The Hoosier Healthcare Innovation Challenge will present three developer challenges in Indianapolis on July 12: reduce infant mortality by delivering educational information, eliminate duplicate messages caused by multiple Continuity of Care Documents, and perform medication reconciliation across inpatient and outpatient encounters. Teams can receive cash and an in-kind services worth up to $25,000.

• Vocera demonstrates how its badges work with the Stanley Hugs infant  protection solution.
• Infor integrates NextGate EMPI and identity management solutions with its Cloverleaf integration and information exchange suite.
• ZirMed announces that its first claims acceptance rate is averaging 98 percent or higher.
• Sunquest launches a new website.
• SIS posts a blog entry called “Careers in Nursing Informatics: Applying Your Knowledge.”
• The ONC Beacon-EHR Vendor Affinity Group names SuccessEHR National Director of Government Affairs Adele Allison the group’s co-chair, along with Chuck Tryon of MyHealth Access Network.
• Truven Health Analytics releases the Truven Health Unify ACO solution to help Medicare shared savings program participants manage their ACOs.
• Forrester Research names CommVault a leader in The Forrester Wave: Enterprise Backup Software, Q2 2013.
• Jonathan Handler, MD, MModal’s CMIO, shares his thoughts on population health data and why doctors struggle with it.
• T-System creates a video on its RevCycle+ RCM solution.
• St. Cloud Orthopedics (MN) discuss how the practice earned $342,000 in Medicare incentives payments following its implementation of SRS EHR.
• A Windows 8.1 version of AirStrip ONE Cardiology will be released as part of the company’s strategic partnership in Microsoft’s AppsForSurface program.

Contacts

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

More news: HIStalk Practice, HIStalk Connect

Morning Headlines 7/2/13

Halamka: IT Must Plan For Disparate EHRs

InformationWeek picks up a blog post by John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, in which he suggests that the "rip and replace" approach to integrating large health systems will not be possible much longer as ICD-10 and Meaningful Use Stage 2 continue to consume capital and IT resources. He advocates a form of affiliation planning in which critical workflows are targeted and automated rather than integrating all care areas.

El Camino Hospital Cuts Readmissions 25% With Health IT

The 433-bed El Camino Hospital in Mountain View, CA reduces readmissions by 25 percent by identifying patients who are likely to be readmitted and taking aggressive action to correct the problems. One solution that shows promise is a tele-transfer planning program that requires clinicians working at long-term facilities to begin participating remotely in discharge planning meetings early in their patient’s stay at the hospital.

Digital health funding is up, but growth slows, says Rock Health

San Francisco-based health IT incubator Rock Health releases a report detailing venture capital investment activity in the health IT startup sector. The report concludes that investments are up 12 percent from last year, with nearly $900 million invested in startups thus far in 2013, but that the pace of growth has slowed as compared to last year.

Facebook grapples with rules for patients seeking organ donors

Facebook is working on implementing a communication platform that will help match patients seeking organ donors with those that may be in a position to respond. This is the second major announcement from Facebook on the subject. The company recently implemented a program that allows users to declare themselves organ donors on their Facebook profiles, an action that automatically launches an official donor registration website where users can register, then posts a message about being an organ donor on the users profile. That initiative has been credited with significantly increasing organ donor registration rates since its deployment.

Readers Write: Uncovering the Unexplored Role and Benefits of Clinical Data Abstraction

Uncovering the Unexplored Role and Benefits of Clinical Data Abstraction
By George Abatjoglou

With the industry’s move to electronic health records (EHRs), healthcare information management (HIM) professionals as well as RNs must play a guiding role through implementation and beyond, seeking processes and solutions to manage the conversion of enormous amounts of historical health information into meaningful, structured data. One helpful and often underexplored strategy for getting organizations up and running smoothly on an EHR involves pre-go live clinical data abstraction.

Historically, clinical data abstraction has been used to retrieve meaningful information that exists in unstructured formats – paper or otherwise – to fill in the “holes” in the electronic chart. Typically, this occurs so an organization can perform better financial or quality reporting. However, with the current push to implement EHRs within the ambulatory setting under Meaningful Use, healthcare organizations often underutilize or completely overlook using clinical data abstraction as a strategy for jump starting the EHR rollout process. In short, by populating EHRs with these details from paper charts and unstructured legacy EHRs before organization-wide rollout, physician practices to health systems and ACOs can reap EHR benefits more quickly, while ensuring more optimal data quality and integrity.

Whether patient records are electronic or paper-based, most contain “legacy” health information that requires someone to pluck relevant data from unstructured content and incorporate it in a structured, representative history in the EHR. While you may think it sounds like copying and pasting, the medical and scientific nature of the information makes this more complicated than it seems. In other words, clinical abstraction, when done well, is best left to the experts, including trained and credentialed HIM professionals and RNs who are consistently focused on clinical data integrity in their day-to-day roles.

With practice makes perfect, and experts in this arena are skilled magicians at identifying and pulling nuggets of information that will provide practitioners with the most valuable details moving forward, especially from a continuity of care perspective. Moreover, these individuals understand data in a broader way than a coder might, and as a result, take into consideration different clinical components that shape the picture of a person’s whole health as they mine critical details for the new EHR.

Leveraging clinical data abstraction as a strategic step in EHR population can take two forms.

• Existing resources. Healthcare organizations can facilitate the effort themselves by using staff clinicians and/or hiring additional nurses, medical assistants or students to abstract clinical data.
• Outsourcing. Other healthcare organizations work with partners who embed clinical experts within the organization to facilitate the process.

Although it’s feasible for smaller healthcare organizations—community hospitals, critical access hospitals, and small practices, for example—to abstract and manage data internally, clinical data abstraction becomes increasingly complicated for larger physician groups and health systems that provide care to hundreds if not thousands of patients in a given day. When these large systems try to enlist internal staff to conduct data abstraction and enter historical data into EHRs, they are likely to run into roadblocks.

For example, relying on internal resources for data abstraction will further decrease the productivity of clinicians and HIM professionals already diminished by an EHR implementation and preparing for the ICD-10 deadline. Clinicians typically decrease the number of patients seen during the EHR implementation period in order to adjust to the new workflows demanded by the technology. A physician who normally sees 20 patients per day may need to decrease patient appointments to 12 per day and gradually work back to a normal activity level after several months. If paired with abstraction responsibilities as well, the productivity decline is often viewed as too steep.

Although it may seem counterintuitive, using internal resources also can lead to the generation of even more non-standard, unstructured data. With patient care being the top priority for clinicians, abstracting clinical data and entering historical information may not always be executed in the same way as a full-time abstractor whose sole focus is on that one task, guided by standardization across every record. While some data is better than none, the benefits of unstructured data within an EHR are not much different than working with paper-based records, which defeats the value of EHR implementation.

An EHR implementation can only be as successful as the quality of its data. As the saying goes, “garbage in, garbage out.” Regardless of an organization’s decision to use internal or external resources, clinical data abstraction overseen by seasoned HIM professionals and supplemented by knowledgeable RNs offers several benefits—some of which are more heavily weighted in the interest of utilizing outside consultants:

• Improved data integrity. As healthcare organizations go live with EHRs, data need to be organized in a structured and sustainable format to provide consistent core medical content for clinicians across all patient records.
• Increased patient safety. When data consistently and accurately reflect patient conditions in a streamlined, structured format, EHRs become easier to navigate from a decision-making and care management perspective, contributing to increased patient safety and care quality.
• Enhanced productivity and satisfaction. By relying on outside experts rather than tapping internal resources to abstract and enter historical data, clinicians’ time is maximized and remains focused on providing patient care, while internal HIM professionals are able to focus on other mission-critical tasks like ICD-10 training.
• Better patient experience. Tasking clinicians to enter data does not add value to the delivery of care, nor does it contribute to the clinician–patient interaction. Unfortunately, with the learning-curve that often accompanies EHR implementation, a patient appointment can become rather data-driven and impersonal if clinicians spend more time looking at the computer screen than their patients. Using data abstraction experts allows physicians to maintain a positive “human” interaction with the patient, a critical component to meeting patient expectations.
• Higher return on investment. No matter who facilitates it, there is an absolute cost associated with abstracting clinical data. Outsourcing the process does carry an initial expense, which may then be recouped by physicians’ sustaining their activity loads. On the other hand, revenue lost through decreased provider productivity when clinicians are tasked with performing data abstraction may not be regained. Cultivated by the improved patient experience, outsourcing the clinical data abstraction effort may also lead to additional gains such as practice expansion and patient retention.

The number of provider choices for patients is multiplying and steering healthcare into a more consumer-driven model. The healthcare organizations that thrive into the future will be the ones that safeguard data integrity and use it to streamline the physician/patient interaction. Tapping into the data management expertise of HIM professionals in particular and using clinical data abstraction to improve data quality, patient safety, and clinician productivity is one key to providing a positive experience for patients and clinicians alike – both throughout and beyond an EHR implementation.

George Abatjoglou is CEO of IOD.

Readers Write: My Tradeshow High Horse

My Tradeshow High Horse
By Annie Oakley

Perhaps you’ve read HIStalk posts in the past – particularly after HIMSS – lambasting the poor showmanship of exhibitors at tradeshows. Eyes down, phones on, beckoning smiles nonexistent.

You may also have read subsequent reader comments from said exhibitors attempting to explain away their need to ignore attendees for the sake of an incoming service call. I get it. Everyone has multiple jobs to do while at a conference. I’d be surprised to find a healthcare professional – provider or vendor – who doesn’t wear multiple hats these days and gets taken advantage of by 24/7 connectivity.

But, like many others out there in HIStalk land, I say turn your phones off when you’re in the booth. If you need to take or make a call, exit the exhibit hall.

I’ve been on both sides of the booth at tradeshows over the years, and so I feel qualified to get up on my high horse for just a few more paragraphs about my recent trip to the HFMA ANI show. It was an experience that left me optimistic about the tradeshow experience overall, but left me with a bitter taste in my mouth on more than one occasion.

The HFMA staff and volunteers were incredibly helpful, always had smiles on their faces and good attitudes to back them up. The majority of exhibitors that I had a chance to approach were pleasant to speak with. Some were downright engaging, leaving me with lasting positive impressions of their employees and brands. Most were extremely patient in explaining revenue cycle concepts and challenges – not easy completely absorb on first go round.

The “booth babe” phenomenon continues to die a slow death, unfortunately. I found out during an educational session that HFMA membership is 60 percent women. Do exhibitors really think they’ll attract female attendees with models dressed up in racing gear? I saw one male attendee look happy enough as he posed for pictures with them, and I shook my head in shame. Is that really how you want to get your leads? Is that really the impression you want to leave people – mostly female people – with?

Drew Brees was on the show floor for a time signing autographs, an attraction which drew a few dozen folks into a line that crisscrossed the exhibit floor. Now that’s a way to create buzz without alienating anyone.

One more comment, then I’ll get off my high horse. Exhibitors, please don’t be stingy with your giveaways. You and I both know that come the last day of the show, you’ll be moaning and groaning about having to ship them back. I approached one booth BECAUSE of their unique giveaway, but was immediately turned off when the rep, thinking I’d already been by, gave me the cold shoulder. I pleasantly explained to him that we had indeed conversed the day before, but I had not acquired any of his trinkets. He apologized – sort of – and actually said he hates having to talk to people twice! Buddy, if you don’t like talking to people twice, maybe you shouldn’t be in sales.

This particular conference was a great experience for me overall. The positives far outweighed the negatives. But, it’s true what they say: one bad apple can spoil the tradeshow bunch.

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.