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Morning Headlines 5/14/18

May 13, 2018 Headlines 1 Comment

Military Healthcare System (MHS) GENESIS Initial Operational Test and Evaluation (IOT&E) Report

A newly declassified April 30 Department of Defense evaluation of the military’s four MHS Genesis pilot sites concludes that the system “is neither operationally effective or operationally suitable” and says it is inadequate for managing and documenting care delivery.

Cumberland Consulting Group Expands Managed Services Practice with LinkEHR Acquisition

Cumberland Consulting Group acquires EHR-focused managed services firm LinkEHR, expanding its consulting and services offerings into Epic-focused help desk, application break-fix, maintenance, physician concierge support, and build / optimization.

Early investor doubles down on support for Elizabeth Holmes and Theranos: ‘She did a great job’

Venture capitalist and early Theranos investor Tim Draper says founder and CEO Elizabeth Holmes was “bullied into submission,” adding that he is “thrilled at what she has done” despite SEC charges that the company was a massive fraud from the beginning.

Monday Morning Update 5/14/18

May 13, 2018 News 19 Comments

Top News

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A newly declassified April 30 Department of Defense evaluation of the military’s four MHS Genesis pilot sites concludes that the system “is neither operationally effective or operationally suitable” and says it is inadequate for managing and documenting care delivery.

The DoD’s Director of Operational Test and Evaluation Robert Behler – a retired major general with executive experience in software engineering and consulting — found that the Cerner-powered MHS Genesis isn’t scalable enough for a full DoD rollout. Pilot sites experienced ongoing response time and downtime problems that worsened as each new site was brought online.

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Some items from the report, which was published by FCW:

  • 156 critical or severe incident reports were filed.
  • Drop-down selection lists include options from all four pilot sites, requiring users, for example, to search through every provider from all four sites to book an appointment.
  • User were only able to complete 56 percent of the 197 performance measurement tasks, leading the auditors to report that MHS Genesis “does not contain enough functionality to manage and document patient care.”
  • Users questioned the system’s interoperability with medical and peripheral devices.
  • Uses rated the system’s usability at 37 on a 100-point scale, far short of the 70 percent minimum target. They also lowered their scores as they gained experience with the system, the opposite of what would be expected.
  • Seven long downtime events occurred during the three go-lives, with users unable to log in for hours at a time or one pilot site being down for several hours due to another site’s go-live.
  • Help desk personnel were overwhelmed by the 14,000 tickets that were opened from January through November 2017.
  • Testing at the largest of the four pilot sites, Madigan Army Medical Center, was postponed because of poor results from the first three sites.
  • Prescription fill time at pharmacies increased from 15-20 minutes to 45 minutes or longer and pharmacists had to perform manual workarounds due to interface problems. The system does not support the use of NDC drug numbers or NPI provider IDs, requiring pharmacists to perform manual searches to select drugs and prescribers.
  • Providers were unable to review radiology results because radiologists couldn’t match patients to images due to interface problems.
  • The Joint Legacy Viewer did not always display critical MHS Genesis patient data.
  • The report found that, “Essential capabilities were either not working properly or were missing altogether (e.g., referral requests not processing, lab results not showing, oral surgery apps not launching). To compensate for missing functionality, users relied on lengthy and undocumented workarounds (e.g., telephoning to check whether referrals had been received). Additionally, ineffective or non-existent workflows (e.g., the inability to flag certain patient records, insurance eligibility inaccuracies, appointments tracked to the wrong clinic) caused some users to create their own workarounds. Actions that used to take one minute to complete were taking several minutes using MHS GENESIS. Users reported that, even under conditions of proper functionality, actions required up to three times as many mouse clicks than before. User comments accompanying the IRs and user interviews indicate that MHS GENESIS increased patient encounter times to the point that providers were seeing fewer patients per day, despite some providers working overtime. Users also noted operational incidents (e.g., system freezes, lockouts, login errors) that caused mission failure or delay.”

Politico reports that DoD officials said in a Friday briefing that improvements have been made since the review ended in November, allowing visit and prescription volume to increase significantly. It quotes a White House spokesperson who noted that Senior Advisor Jared Kushner wasn’t involved the DoD’s bidding process but still believes that it’s important for the the VA to use the same system.


Reader Comments

From El Mariachi: “Re: fellowships. I was surprised by your comments. My organization’s fellowship does not require extra application fees, extra dues, or mandatory CE.” I don’t know what AMIA will do with its new FAMIA fellowship beyond requiring AMIA membership, peer recommendation, and AMIA involvement, but HIMSS doesn’t charge applicants directly either upfront or ongoing, although previous HIMSS participation is required. CHIME’s fellowship is attainable only if you’re a CHIME lifer since it requires 10 years of membership plus heavy participation in its activities. AHIMA requires 10 years of HIM experience and previous membership and levies a $250 application fee. All of these fellowships are a combination of loyalty points and industry experience. None of these appear to charge renewal fees or impose mandatory education once the credential has been earned, which I think is unlike medical fellowships such as FACOG and FACC. The terminology could be confusing since scholarship-based “fellowship” and the resulting F-letters to a doctor, academic, or researcher means obtaining additional specialty study and practice, which is vastly different than just sending in a reformatted resume to a membership organization and becoming labeled as its loyal fellow in return. Even more confusingly, AMIA already offers FACMI, conferred by simple voting (17 of those fellow designations were awarded in 2017). The “pro” argument from AMIA is that members who work in a hands-on informatics role should have a way to “celebrate their accomplishments” that are “evident in the settings in which they work.”

From Darth Vader: “Re: EHR vendors. With Elliott making a play for Athenahealth, how long until Optum uses its deep pockets to acquire an EHR vendor?” I would hope that Optum is too smart to spend money buying an EHR vendor in an era of declining product demand, vendor consolidation, and questionable profit potential. It will be interesting to see if Athenahealth sells out to the aggressive (some say ruthless) Elliott Management, stays the course, or entertains new interest from other potential acquirers. Lots of companies have lost fortunes thinking they could crack the code selling EHRs. Probably the biggest financial winner but operational loser in this drama is Jonathan Bush, who owns around $70 million worth of shares (and who would benefit from the company’s change-in-control golden parachute that was enacted in October 2017) but who is in the crosshairs for not making improvements until the activitist investor stepped in and who is now prepared to put his money where his mouth is. Elliott’s challenge would be deciding whether it can leave Bush in charge (he was already stripped of his board chair role because of Elliott’s pressure) since much of the company’s success and identity was the result of his charismatic engagement with Wall Street, customers, and employees. Athenahealth without Bush would be a lot less interesting.

From Alhambra: “Re: the DoD’s analysis of MHS Genesis. It’s impossible to know whether the two competing teams would have performed better, but Cerner is failing in one of the most important areas – Military Medical Readiness. I hope the pause allows Leidos / Cerner to fix this critical component. As for me, I’m ticked that the DHMS PEO PR machine touted deployment and operational success for months and it turned out to be lies.” The people associated with projects, either on the vendor or user side, have a vested career interested in making their work appear to be successful regardless of reality, but the DoD’s scathing review of MHS Genesis is stunning in the extent of the rollout’s problems, even for a huge project like this one. I don’t know how a review could be much worse. Nor could the report’s timing, which comes out just before the VA is set to sign a White House-pressured, no-bid contract with Cerner, which also contains a massive risk that nobody is talking about – the DoD and VA implementations would be occurring simultaneously and thus would compete for resources and vendor attention, not to mention that Cerner would be the VA’s prime contractor versus its role as a subcontractor under Leidos with the DoD. There’s also the unlikely scenario in which the VA signs a $10 billion Cerner contract and then the DoD bails out (note to VA: get that in the contract). VA and DoD technology implementation projects share the common theme of disappointing outcomes despite wildly high costs, a decades-long trend that won’t end any time soon regardless of whether the software is developed internally, by consulting firms, or by commercial vendors.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Sansoro Health. The Minneapolis-based company’s API solution provides real-time data exchange between EHRs and digital health applications. Its supports chart retrieval (medical records requests, prior authorization, release of information, quality reporting, risk adjustment); advanced analytics; telehealth; surveillance; and clinical workflow that improves user satisfaction and patient outcomes with intuitive, mobile, and voice-driven interfaces. The Emissary real-time RESTful API solution allows information to be exchanged securely across any EHR platform within days rather than months of setup time while avoiding data-mapping exercises and time-consuming maintenance. It eliminates copy/paste and system toggling to provide a better user experience and improve patient outcomes. Co-founder and CEO Jeremy Pierotti is an industry long-timer, having spent time at Leidos Health,  Stanford Health, and Allina. Thanks to Sansoro Health for supporting HIStalk.

This YouTube explainer video describes Sansoro Health’s Emissary API solution.

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Poll respondents aren’t too interested in connect their Fitbit to an EHR, with comments suggesting a lack of added value and concerns about privacy.

New poll to your right or here: what is your reaction to seeing a fellowship credential such as FHIMSS, FCHIME, or the upcoming FAMIA on someone’s bio or business card?

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Responses to last week’s “What I Wish I’d Known Before” question were thoughtful in relaying both good and bad examples of physician participation in technology projects.

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This week’s question is for anyone who has worked for a solo medical practice in any capacity.


Webinars

May 16 (Wednesday) 1:00 ET. “You Think You Might Want to Be a Consultant?” Sponsor: HIStalk. Presenter: Frank Poggio, CEO/president, The Kelzon Group. Maybe you just got caught in a big re-org and don’t like where things are headed, or, after almost a year of searching for a better opportunity your buddy says, “You’ve got decades of solid experience and you’re a true professional, you should become a healthcare IT consultant.” Now you start thinking, “This could be my ticket to success. I know the healthcare industry and can show people how to do things right. The sky’s the limit!” Not so fast. Consulting offers many advantages, and many pitfalls. This webinar will discuss both the rewards and the risks of moving into a full-time consulting role, as an independent, or part of a large firm. It will present a checklist you can apply to assess whether consulting is a good fit for you, and present the ground work necessary to be a successful consultant.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Spartanburg, SC-based retail pharmacy technology vendor QS/1 lays off around 30 employees in a restructuring.

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Meditech reports Q1 results: revenue up 4.5 percent, EPS $0.08 vs. $0.39. Product revenue jumped 17 percent quarter over quarter. Accounting changes involving unrealized marketable securities makes comparisons to previous quarters mostly irrelevant – the company’s operating income actually increased by 19 percent quarter over quarter but net income took a major hit due to the $18 million expense entry. 

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Cumberland Consulting Group acquires EHR-focused managed services firm LinkEHR, expanding its consulting and services offerings into Epic-focused help desk, application break-fix, maintenance, physician concierge support, and build / optimization.

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Vision insurer VSP Global makes an unspecified investment in PokitDok. VSP’s innovation lab has been testing PokitDok’s blockchain solution and says blockchain technology will be implemented quickly in healthcare for claims adjudication, supply chain management, and interoperability with EHRs.

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Venture capitalist and early Theranos investor Tim Draper says founder and CEO Elizabeth Holmes was “bullied into submission,” adding that he is “thrilled at what she has done” despite SEC charges that the company was a massive fraud from the beginning. Draper previously called for the Wall Street Journal to fire reporter John Carreyrou, whose investigative reporting (“like a hyena going after her”) triggered CMS investigations and sanctions. He also blamed worried competitors and the federal government for causing the company’s problems, saying last week, “I think it was a great mission and she did a great job … We have taken down another great icon.”


Decisions

  • Johnson Memorial Hospital (IN) went live with Cerner supply chain management software in August 2017.
  • Sagecrest Hospital-Grapevine (TX) will change from a long-term acute care hospital to a short-term acute care hospital by the end of 2018 and plans to construct surgical suites.
  • Matheny Medical and Educational Center (NJ) will go live with a Yasasii healthcare information system in May 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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T-System hires Steve DeCosta (Research Now) as CFO.

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Cedars Sinai hires Anne Wellington (Techstars) as managing director of its accelerator program.


Announcements and Implementations

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Intensivists at Western Australia’s Royal Perth hospital will monitor the ICU patients of Emory Healthcare (GA) overnight, exploiting the 12-hour time difference by using Philips eICU remote monitoring.


Privacy and Security

Two California hospitals announce that the information of 900 patients was inappropriately viewed by a former employee of its medical transcription vendor Nuance.


Other

A coroner in Australia urges medical providers to stop using “antiquated technology” after a hospital faxed a patient’s lab results that suggested chemotherapy complications to the wrong number. Without the information the second hospital gave the patient another round of chemo. He died four days after. The coroner couldn’t say for sure that the lack of communication killed the patient, but said it was “difficult to understand why such an antiquated and unreliable means of communication (faxes) exist at all in the medical profession.”

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In England, an 88-year-old computer programmer creates Doctor Tick-Tack, an Android app that helps doctors communicate with patients who don’t speak the same language.

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A Hong Kong man credits his Apple Watch with saving his life after it warns him of an elevated heart rate, sending him immediately to the ED where doctors diagnosed him with coronary artery blockage that required angioplasty. I’m not sure that the diagnostic power of non-baseline, first-episode, asymptomatic tachycardia is good enough to warrant emergency medical evaluation in every case, but it worked out for him.

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GeekWire profiles Seattle-based MultiScale, a joint venture between Providence St. Joseph Health and a life sciences computing vendor whose product extracts EHR data into a secure cloud to allow building apps, creating dashboards, performing analytics, and sharing data with third parties.

Google’s new AI-powered Duplex voice system for making appointments is so realistic that it has raised ethical concerns, forcing the company to add a notice to the call recipient that they are in fact talking to a computer.

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In England, chain bookstore operator WHSmith blames a computer glitch and apologizes for pricing Colgate toothpaste at $11 in one of its 129 hospital outlets, more than triple the price it charges at its other stores. A 2015 BBC investigation caught the company marking hospital prices up heavily on items ranging from bottled water to notepads, reports of which led to government pressure that forced the company to lower prices in its hospital locations.


Sponsor Updates

  • Liaison’s Alloy Platform now exceeds GDPR compliance standards.
  • National Decision Support Co. will exhibit at the Society for Pediatric Radiology Annual Meeting May 15-19 in Nashville.
  • Netsmart will exhibit at the MHCA Spring Conference May 15 in Savannah.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the NOHIMSS Spring Conference May 18 in Warrensville Heights, OH.
  • The Technology Association of Georgia recognizes Patientco with its 2018 Advance Award.
  • Pivot Point Consulting will exhibit at the Oregon Chapter of HIMSS 2018 Annual Conference May 17 in Portland.
  • Surescripts will exhibit at Centricity Live 2018 May 16-18 in Las Vegas.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Readers Write: HLTH 2018 Recap: A Transformation in Talking about Healthcare Transportation

May 11, 2018 Readers Write 1 Comment

HLTH 2018 Recap: A Transformation in Talking about Healthcare Transportation
By Travis Good, MD

Travis Good, MD is co-founder, CEO, and chief privacy officer of Datica of Madison, WI.

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The premiere, sold-out HLTH conference ended last week in Las Vegas with a generally positive impression on its new style of healthcare conference. I, along with 3,500 attendees, laughed with Jonathan Bush, CEO of Athenahealth, as he entertained us with statements like, “All we do, all of us, is fail… And then we die!” We sat in stunned silence as Harold Paz, MD, executive vice-president and chief medical officer at Aetna shared the disturbing facts of the opioid crisis — facts like 116 people die every day in America, where we consume more opioids than any other country on Earth, and that more Americans will die this year than died through the entire AIDS epidemic or the Vietnam War.

HLTH was different than many healthcare conferences I’ve attended with its rapid-fire panel discussions, where the panelists didn’t waste time explaining high-level concepts like Blockchain, but instead jumped right in to describing the details of the emerging technology details. Numerous announcements and visionary ideas were also presented. The slick nature of the well-orchestrated HLTH event, likely made possible by the $5 million garnered in venture money, left an overwhelming impression for a first-time event.

The HLTH organizers did have one major miss: lack of strong representation of female healthcare leaders. Evidence of that agenda oversight gained audience criticism in social media and questions to panelists (including me) on why they thought few women graced the stage.

Two general themes prevailed throughout the conference. One centered on transforming the current healthcare business model to improve everything from interoperability, costs, and patient outcomes to physician burnout. The second theme that emerged throughout the conference focused on the exploration of entirely new business models that could transform the healthcare industry.

Announcements ranged from the splashy — like former CMS Acting Administrator Andy Slavitt’s launch of Town Hall Ventures, his shift from the government to investing in technologies that facilitate real change in our communities, and Change Healthcare teaming up with Adobe and Microsoft to orchestrate better patient engagement — to the mundane, like Marcus Osborne, VP of healthcare transformation at Walmart announcing, “Walmart isn’t going to stand for this” in describing the poor quality of care their associates have had to endure and Walmart’s push toward an evidence-based approach that ends physician’s entitlements.

Topics around blockchain, genomics, artificial intelligence (AI) and machine learning, cloud, augmented reality, and interoperability prevailed. During a lively panel, the so-called “unicorns of healthcare” shared their predictions of the next generation of unicorns. Anne Wojcicki, CEO and co-founder at 23andMe, predicted that the next unicorn will be in AI or chatbots. Frank Williams, CEO at Evolent Health, says precision medicine. Jonathan Bush thinks they’ll be new reimbursement models or therapeutics.

One theme woven throughout conference presentations is the idea that caring for health needs should extend beyond the walls of a treatment room and out into the community. On the first evening of the conference, David Feinberg, Geisinger president and CEO, described his vision of a new direction for healthcare for the communities Geisinger serves. The vision included not only traditional healthcare, but also feeding and housing people who need it.

Later in the conference, Lauren Steingold, head of strategy at Uber Health, described the company’s innovative new patient transportation offering that could help eliminate the $150B yearly cost to the healthcare industry resulting from 3.6 billion Americans who miss appointments due to transportation issues. Steingold described her vision of expanding that model to encompass telemedicine patients who need a ride to the pharmacy or even surgery patients who need a ride home.

My favorite quote from the conference, which pretty much sums up the current state of healthcare transformation, came from Anne Wojcicki. “What happens in healthcare is you have people who really want to do the right thing, but the ships are pointed in the wrong direction.”

All in all, the conference left attendees more informed and energized. Now HLTH organizers are taking what they learned from the first conference and planning for expansion next year.

What I Wish I’d Known Before … Working with Doctors on Technology Projects

I wish I had known that once I crossed the line to help IT that I would be an IT person and no longer viewed as a credible physician. My former peers became dismissive of my opinions, coming up with a variety of reasons — I hadn’t been in practice as long as them, I no longer saw as many patients as them, I wasn’t in a procedural specialty, etc. Looking back on their behavior, it was bullying, plain and simple.


How often one person can derail an entire initiative regardless of the validity of the reasoning.


I wish I had known the depth of ignorance on both sides of the tech / physician engagement. Be it the languages used, the ability to decipher thoughts and requirements, the ability to say, “No, not that, but maybe this.” I wish there was more empathy on both sides of the house and more diligence in learning from each side.

From the tech side, realizing that the doc/nurse in front of you has a job to do that isn’t to interact with the computer. That our tech needs to make it easier to do that job and not harder. That clinicians have trained very hard to get where they are and that it is appropriate to ask the “why” question so you can learn from their experience — and by asking why your product will be better suited to the task and use. That when the tech side makes assumptions they need to validate those assumptions against the clinicians experience. And, that the clinical roles are not all the same — learn the workflows of the roles under development.

For the doctors, realizing that customization is expensive across the development life cycle — almost as expensive as flexibility. That there is a need to be prescriptive while still being flexible. That you should call out bad design and usability, but show them how you want to use the system. Use your active listening skills to ensure that they understand what you are conveying. Realize that we don’t hate you and aren’t trying to kill your patients or ruin your practice — even if it feels like that at times

For both, that there is a need to exchange the data, information, knowledge, and wisdom that is the potential of electronic health records. Think about how your suggestions and decisions will impact analytics, research, and semantic exchange.

Lastly, maybe walking a mile or six in the other guy’s shoes wouldn’t hurt as long as you don’t get to thinking a little experience gives you great competence (e.g. the Dunning-Kruger effect).


A savvy physician who understands IT and the challenges we face and yet holds us accountable is the most powerful and effective program sponsor I have ever had. This physician leader, who practiced emergency medicine, pushed and led our IT organization to achievements we didn’t think were possible. He provided air cover to the program with physician colleagues across the organization. He had built trust with that community over decades of steady delivery of IT-related projects that met the needs of the physician community without incorporating the latest shiny thing. His participation was invaluable. I have seen few like him, but he was worth his weight in platinum.


I wish I’d known just how many of them would tell me “I took some programming classes in college” and would then proceed to inform me how an application should be built. Cool story, doc. I took a CPR class once, so let me tell you how to treat pulmonary hypertension.

I have also worked with some great physicians who were really open to the discovery process, and in my non-scientific sampling, the ones most tolerant of unexpected or undesired behavior were primary care physicians and the least-tolerant were orthopedic specialists. I’m not sure which way causality runs, but physicians whose entire job function is the human narrative and who trade in identifying root cause from a flood of poorly-described symptoms are way more amenable to testing things out and trying them in an unfinished state than people whose entire job is fixing an already-defined problem.


The vendor is going to have its own idea of how the software implementation plan should go and this will likely include a recommendation for staff, including doctors, to watch some videos and maybe do some reading before the vendor staff show up at the office. However, the doctors will most likely NOT do this and that changes much. Never did figure out why a doc would spend many thousands of dollars on a system and not take the vendor’s suggestion. This most often leads to a planned failure or less than successful launch and more down the road issues and the aforementioned tantrums and bad-mouthing of the vendor (couldn’t be the doctor’s fault, right?)

Maybe a possible solution would be to have the doctor sign a contract outlining the vendor recommendation to study up before go-live and an agreement to pay extra for on-site staffing when things go bad if they don’t do the pre-study.

Doctors usually want to buy a system that is totally customized to their workflow and uniqueness (think lots of $$$$$) but pay for a “one size fits all” commodity software (think much less $$).

Some docs still think they can work a full day of patients and have a successful go-live.


That there are many more physicians who are helpful and positive than those that are negative and resistant. It is just that the resistant ones make a lot more noise, commotion, and are experts at getting attention. It takes strong organizational leadership and the willingness to put some teeth into the medical bylaws to hold the resistant physicians accountable for their negative actions.


Maybe to be a little more appreciative. Looking back, some of the best projects I’d worked on. A chief pathologist who never missed a project meeting, gave a personal number for emergencies, and taught us all about lab billing. Another chief pathologist who validated an ancient AP system conversion, patiently looking side by side, old and new, checking every procedure type. In the end, 25 years of data converted, no errors. An anesthesiologist who remained obstinate through an entire Lean event, pushing the team to the edge of insanity, then led the implementation and blew down barriers in the department we did not know existed. Many other great memories of physicians who were not only generous with their time but were also key contributors.


I wish that I had known that doctors are flawless beings incapable of making a mistake and that an EMR will not work and do the same task a dozen different ways every time a doctor interacts with it.


The pervasive power of delayed adolescence fused with authority, enabled by administrative leadership complicity and medical leadership effeteness.


Every doctor I’ve worked with will not admit upfront to ignorance about system capabilities or their lack of knowledge about software in general. Why would they? Start new projects with level-setting demonstrations about what your system can do (or will soon be able to do). Physicians will react to what they see presented and offer specific insights rather than speaking in generalities.


Understand your audience. Understand what the physicians and other providers want to get out of the system. Frame your language in a way that they can understand what you’re saying. I’ve seen too many people jump into wonky language when describing projects, systems, or configurations. If they don’t understand you, they will assume the worst. And then it will be much more difficult to convince them to change anything.


Practicing medicine is an art, not only a science, so there is no cookie cutter treatment for every patient and scenario. If you understand that up front, you will not be disappointed that your plans / solutions / workflows do not work with every provider or department. You need to always seek second opinion.


That all those years of babysitting and talking kids down from tantrums would come in so handy in my future.


Weekender 5/11/18

May 11, 2018 Weekender 5 Comments

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Weekly News Recap

  • The VA says it will make a decision on how to proceed with a Cerner contract by May 28.
  • Mayo Clinic goes live on Epic.
  • Virtual visit provider HealthTap dismisses founder and CEO Ron Gutman after investigating high employee turnover and reports about abusive conduct.
  • A DoD OIG report finds that Navy and Air Force treatment facilities have not consistently implemented security protocols to protect patient information in EHRs and other system.
  • Athenahealth shareholder Elliott Management makes an all-cash offer for the remainder of the company it doesn’t already own, valuing it at up to $6.9 billion and sending ATHN shares soaring.

Best Reader Comments

FAMIA – if they model it after the ACMI fellowship, I think it could be successful. ACMI is full of academics who don’t have a clue about real world issues that Informaticists “in the trenches” deal with, and so would be nice to have some formal recognition for those of us who actually get things done (instead of just write about them, like lots of ACMI members). (Alphabet Soup)

Back in spring 2017, UIC had a meeting with vendors to kick off the procurement process. I was there with my company and Cerner people were in the room as well. Impact Advisors was introduced to all as the group that would be helping UIC. No one objected, including Cerner. Then many months later when Cerner finds out that they lost the bid to Epic, suddenly it is all about a conflict of interest with Impact Advisors. The more likely explanation is that this is just about sour grapes. Time to look for another reason for why Cerner lost. I got one – maybe UIC also figured out that the Cerner Revenue Cycle is not good. (Abe is watching)

In addition to the immediacy benefit of the 1800s anesthesia / antisepsis comparison was that anesthesia benefited the physician (no screaming patient as I cut him/ her open) and antisepsis benefited the patient. Doctors will always do what’s best for them. Every time you ask a physician to do something you need to find a way that it will benefit him/ her and the quicker, the better. (Was a Community Hospital CIO)

Athenahealth has always struggled with monetizing the data because they don’t own the data. They own the right to use de-identified aggregate data (which they use in things their flu trend reporting), but most of the valuable applications of data in healthcare require PHI that is either not de-identified or is easily re-identified, which Athena doesn’t have the right to sell. So much as they would like to monetize the data, it’s always been out of their reach. (Debtor)

It amazes me how much blame Facebook has successfully deflected onto Cambridge Analytica. (Martin Shkreli)

Athena will be out of the hospital space and focus exclusively on their core ambulatory when this merger happens. Total available market for hospital is shrinking with market pressure from new and increased entrants to the small hospital space. There is no path to profitability in that race to the bottom. Look for them to try and reinvent as an app maker. (Crazy Joe)

The #2 female finisher of the Boston Marathon this year is a nurse anesthetist, and #4 is a registered dietitian. Apparently health care makes good runners. Oh, and the #5 female finisher (nurse practitioner) worked a 10-hour shift the day after the Marathon, after driving home from Boston to NYC. (Kermit)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. R in Arizona, who asked for headphones for her classroom’s listening centers. She reports, “My students are now able to record themselves and listen and review their fluency. They have headphones that allow them to listen to audiobooks in groups and listen to their intervention program. These headphones will be helpful when going into AzMerit as there will be a listening portion and many of my students do not have access to headphones. My students loved that they can fold the headphones and use the microphone on any device we have available for the day in the classroom.”

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Also checking in was Ms. G from Texas, who asked for Dash Robots to introduce her students to coding and robotics. She says, “Thank you for allowing my students to have the opportunity to experience coding in this fun and engaging way. My kids love Dash and they are so engaged when using them in the Maker Space. At this time my kids are completing the challenges that Dash gives them. This will prepare them for the next step, which is a robot competition. The kids are practicing for the big day! They will be competing with their robots to complete some mazes and other exciting activities. All this was possible thanks to you. Thank you again for your donation and for making a difference in my students’ education.”

President Trump appoints TV huckster Dr. Oz and “Incredible Hulk” actor Lou Ferrigno to HHS’s sports, fitness, and nutrition council.

Ireland attempts to name its new national children’s hospital as “Phoenix Children’s Health,” but is forced to reconsider when Phoenix Children’s Hospital (AZ) threatens to sue over the name. An executive of Ireland’s Children’s Hospital Group tried to contact the US hospital about the proposed name, but the email went astray because he misspelled “Phoenix” as “Pheonix” in the email address.

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TV actor Ken Jeong rushes from the stage of his stand-up gig to attend to an audience member who was having convulsions. He’s qualified – he earned his MD degree from University of North Carolina at Chapel Hill School of Medicine in 1995, completed an internal medicine residency at Ochsner Medical Center (LA), and maintains a California license, although he no longer practices medicine. He developed and starred in the ABC sitcom “Dr. Ken” that ran from 2015-2017. His wife is also a doctor.

Mayo Clinic prepared for its Epic go-live this week by warning employees that parking areas will be restricted May 5-25 to squeeze in the 2,200 on-site consultants and Epic employees involved.

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Medical ethics professor Arthur Caplan, PhD criticizes the “root for your roots” advertising campaign of DNA testing company 23andMe that urges American soccer fans whose team was eliminated to instead root for World Cup soccer teams based on shared genetics from the company’s database. He says there’s already too much racism in soccer as “soccer hooligan bigots” taunt minority athletes and notes that countries aren’t neatly sorted out by genetic racial groups, also adding:

There is no correlation between genetics and who is a member of a nation’s soccer team.  People from many ethnic and racial backgrounds play for many nations. There is no Argentinian or Croatian team genotype. And why would information about your genetic ancestry lead you to root for a particular athlete or team? How about the team’s skill, not their skin color or biological makeup?

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Self-proclaimed “OB-GYN and media personality” Draion Burch, DO wins the trademark application protest brought against him by rapper, music producer, and Beats founder Dr. Dre. The patent office didn’t buy Dre’s argument that consumers would be confused by the similarly named media personalities. Dr. Drai, as he prefers to be called, is apparently not especially proud of his DO degree since he insists on just being called “Dr.” in his noted scholarly works such as “Discover 20 Strange but True Secrets About the Vagina” and the penetrating commentary in his opus titled “20 Things You May Not Know About the Penis.”

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A Missouri woman is hospitalized with facial injuries after a wild turkey crashes through the windshield of the van in which she is riding. She is OK, but the turkey is not. She was not reported to have echoed the comments of WKRP GM “Big Guy” Arthur Carlson in failing to say, “As God is my witness, I thought turkeys could fly.”


In Case You Missed It


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Morning Headlines 5/11/18

May 10, 2018 Headlines 1 Comment

Hearing to Review the FY2019 Budget Request for the U.S. Dept. of Veterans Affairs

VA CFO Jon Rychalski tells the Senate Appropriations Committee in a Wednesday budget hearing that the agency will decide if it wants to move forward with a Cerner contract by May 28.

EHealth Exchange to Become Carequality Implementer

The Sequoia Project will divide its corporate structure into two subsidiaries – Carequality and EHealth Exchange – this summer.

Contract Nurses, Mayo Clinic Divided on Success of Epic Training

A local TV station receives several complaints from temporary nurses who were hired by contractor HCI to help with Mayo Clinic’s Epic implementation.

Amazon is building a ‘health & wellness’ team within Alexa as it aims to upend health care

Amazon develops a team to make Alexa more relevant in the healthcare space, as well as to ensure future applications are HIPAA-compliant.

News 5/11/18

May 10, 2018 News 3 Comments

Top News

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VA CFO Jon Rychalski tells the Senate Appropriations Committee in a Wednesday budget hearing that the agency will decide if it wants to move forward with a Cerner contract by May 28.

Asked about the project’s delays, Rychalski said, “[Acting VA Secretary Robert Wilkie] has said that he’s going to make a decision by Memorial Day. He explained that when he came in, he sort of came in cold. He knew what was going on within DoD, but not enough about the VA and needed to do due diligence to make sure he was comfortable with making a decision of this magnitude … Before that, they were looking at the contract, the interoperability, which was probably worthwhile because they came up with about 50 recommendations to improve it.”

The most interesting aspect of this quote is that it suggests the possibility that the VA may be reconsidering signing with Cerner at all rather than just hammering out specific contract terms and conditions, although at this point the money has been allocated, the no-bid decision has been announced, Wilkie doesn’t seem to have a problem with Cerner, and various members of Congress and the White House have made it clear they expect the VA to get the project underway, making it likely that the deal will be done.


Reader Comments

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From Apricot Sky: “Re: [EVP/CIO name omitted]. Heard he has left the organization. That’s huge!” Unverified, so I’ve expunged the person’s name until if/when I get a response to my inquiry from the health system. His LinkedIn remains unchanged. UPDATE: Memorial Hermann Health System confirms that EVP, Chief Strategy Officer, and CIO David Bradshaw has left the organization after 20+ years.

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From Clapton is a Bishop at Best: “Re: GDPR. I seem to have slept through the discussion. Do readers feel US health IT will require changes before the end of the month, or is everybody assuming we’ll be OK as long as we are HIPAA-compliant and not operating in the EU?” The EU’s General Data Protection Regulation enhances the privacy of all EU citizens and regulates the exportation of their personal data outside the EU. It guarantees “the right to be forgotten,” mandates prompt breach reporting, requires opt-in consent for data sharing, and carries big fines for violation. US companies, including health systems, fall under GDPR requirements only if they collect information from anyone who is physically in the EU at that moment (or at least that’s how I read it) and that’s the big out – GDPR doesn’t apply when a EU resident receives care in the US since they aren’t physically in an EU country at that moment. Potential health system problem areas for the May 25 implementation date mostly involve web pages that collect information from anyone via a contact form, survey, or newsletter signup, in which case you’re on the hook if one of your respondents is in an EU country. I look at GDPR as a potential competitive advantage for a US-based health system since patients are always worried about privacy, although I doubt GDPR awareness is high among the US population and therefore they might not care either way. I don’t know what impact GDPR has on EHR vendors that sell to EU customers. I’ll open the floor to readers.

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From Southern CIO: “Re: CHIME. It bothers me when I receive a message from CHIME that includes a vendor name, as in this example. I looked to CHIME as being focused on members and not corruptible by the industry. I will chalk it up to a sign of the times.” HIMSS long ago eliminated the line of decorum between vendors and providers and in fact turned itself into one big, profitable vendor itself in its “ladies drink free” model of using low-paying provider members to attract high-paying vendors anxious to sell them something. It’s brilliant as a business strategy as long as providers don’t rebel at being exhibited like Amsterdam red-light district hookers to salivating vendor-johns, which based on casual HIMSS conference observation, is questionable behavior that is nonetheless entirely consensual all around. 


HIStalk Announcements and Requests

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Welcome back to returning HIStalk Gold Sponsor Burwood Group. The 250-employee, Chicago-based healthcare IT consulting and integration firm helps organizations develop strategy, deploy technology, and create an operational model, also working with them to improve patient safety, quality, and satisfaction outcomes by applying expertise in technology selection, clinical communication strategy, facility transformation, and end-user adoption planning. The company’s clients have realized improved staff engagement and waste reduction through workflow automation, meaningful clinical alerts, and streamlined communication and collaboration. Thanks to Burwood Group for supporting HIStalk.

Listening: new suave harmonies from The Temptations, which despite frequent member changes in the group’s 50+ year history, still have one original member left in the 76-year-old Otis Williams (I’ll defer to their amazing musical legacy by declining to snarkily dismiss the group as “The Temptation”). The album features covers of present-day hits from Bruno Mars, The Weeknd, and others, while the album’s bonus track of “Stay With Me” covered gospel style is stunning. I shall acknowledge and support this premise – after some number of decades, a band with few or even no original members left can still rightfully perform under the original name as long as it respects its legacy in accepting the torch as handed off by the founders, no different than a symphony whose membership revolves while its sound remains the same. Anyway, today’s Temptations may well still dutifully cover the band’s nostalgia-inducing hits while strutting 1960s-style hokey dance moves, but they are far from a novelty act – their new music is nothing short of contemporary and grand.


Webinars

May 16 (Wednesday) 1:00 ET. “You Think You Might Want to Be a Consultant?” Sponsor: HIStalk. Presenter: Frank Poggio, CEO/president, The Kelzon Group. Maybe you just got caught in a big re-org and don’t like where things are headed, or, after almost a year of searching for a better opportunity your buddy says, “You’ve got decades of solid experience and you’re a true professional, you should become a healthcare IT consultant.” Now you start thinking, “This could be my ticket to success. I know the healthcare industry and can show people how to do things right. The sky’s the limit!” Not so fast. Consulting offers many advantages, and many pitfalls. This webinar will discuss both the rewards and the risks of moving into a full-time consulting role, as an independent, or part of a large firm. It will present a checklist you can apply to assess whether consulting is a good fit for you, and present the ground work necessary to be a successful consultant.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Analytics vendor Innovaccer secures $25 million in a funding round that brings its total raised to $41 million.

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The Sequoia Project will divide its corporate structure into two subsidiaries – Carequality and EHealth Exchange – this summer. The EHealthExchange health information network, which will adopt the Carequality framework, is used by 59 HIEs and 15 EHR vendors.

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Healthcare Growth Partners examines the trend of publicly traded health IT companies going private, as in the case of what Elliott Management is proposing in its bid for Athenahealth. HGP says market dynamics have changed such that private companies may be valued higher than their publicly traded counterparts, adding that acquirers may believe that paying a premium for full control may more than offset the built-in discount for share illiquidity. My unsolicited enhancement to HGP’s analysis is this – in a poor, thin IPO market, it may make sense for investors to take over a struggling company private by buying all shares at a premium, improve its operations and financials, and then take it public again down the road when conditions have improved and investors are ready to chase the next sure thing.

NantHealth reports Q1 results: revenue up 18 percent, EPS –$0.21 vs. -$0.34. NH shares have lost 10 percent in the past year vs. the Nasdaq’s 21 percent gain, valuing the company at $334 million.


People

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Wes Wright (Sutter Health) joins Imprivata as CTO.


Announcements and Implementations

AMIA announces a fellowship (FAMIA) program that targets applied informatics practitioners. It sounds much like the lightly-regarded, non-academic FHIMSS or those fellowships sold by medical membership groups (FACOG, FACC), whose primary focus seems to be creating an ongoing revenue stream for the parent organization by charging would-be fellows to evaluate their credentials and provide them with mandatory ongoing education and membership (although to its credit, HIMSS does not require FHIMSS holders to renew their fellowship, so there’s no ongoing expense). It appears that you’re in as long as you work in a relevant job, have been a member for years, and can get other members to vouch for you – no effort is required beyond completing the application. I would question whether the accomplishment really means anything that isn’t already clear on someone’s resume, but people love having alphabet soup after their names and a wall full of self-love certificates.

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AdvancedMD develops Rhythm, cloud-based software that puts EHR, PM, RCM, and patient engagement tools on a single platform.

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Wellsoft works with GoRev to develop integrated EHR, PM, and RCM software for urgent care practices.

Medication administration software vendor EBroselow offers a free version of its dosing software for medical emergencies.


Sales

  • The Indiana Family and Social Services Administration will implement Cerner Millenium and RCM software at its six inpatient psychiatric facilities.
  • Mayo Regional Hospital (ME) chooses Cerner Millennium and revenue cycle solutions using the CommunityWorks hosted deployment model.
  • Northern Valley Indian Health will deploy EHR software from EClinicalWorks at seven locations in California.

Government and Politics

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At AHA’s annual meeting, HHS Secretary Alex Azar laments the lack of interoperability he encountered during his recent inpatient stays for diverticulitis:

Today’s compartmented system is a burden on both patients and providers. Imagine if I could have shared my medication list just once. Imagine if, instead of running through my story with each new contact, I could have told it just once. Think about the opportunities for mistakes and inaccuracies that would eliminate—and think about the time that would free up for seeing more patients, offering them the care and attention they need. Now, think about that not just in the context of one guy with an angry colon, but across 330 million Americans: It is amazing what freer exchange of information would mean for our whole system. That is the promise of interoperability.

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At the VA budget hearing, VHA Executive in Charge Carolyn Clancy, MD says telehealth will be the VA’s “killer app,” not only for providing services, but also for recruitment. By 2020, all VA clinicians will be required by their job descriptions to be available to provide telehealth services.

The CEO of drug maker Novartis goes into damage control mode after STAT reveals that the company paid $1.2 million to President Trump’s personal lawyer Michael Cohen in trying to get a leg up on a new, unknown White House administration. The company said  paying a self-proclaimed Trump fixer to gain access was a mistake, but blames its former CEO, who left in February 2018. It also notes that Cohen was unable to deliver the work he promised, but couldn’t be fired because of the contract the drug company signed (he’s a lawyer, after all).


Other

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Mayo Clinic attempts to cheer the 400 transcriptionists it is laying off with gifts for Medical Transcriptionists Week, which starts May 13. The transcriptionists, who have until May 19 to accept severance packages, aren’t convinced that the provider’s new Epic system in Rochester isn’t responsible for their downsizing.

Meanwhile, a local TV station says it has received several complaints from temporary nurses who were hired by contractor HCI to help with the implementation. One unnamed nurse was quoted as saying, “Since we’ve been in orientation with HCI, we have been verbally abused, we have been intimidated, we have been threatened that we would lose our job, not on a daily basis, but almost a nearly hourly basis.” HCI Group says it will look into the issues raised during the training sessions.

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The Michael J. Fox Foundation and Alphabet’s Verily division will outfit 800 participants with the Verily Study Watch as part of a two-year project that will capture fitness, environmental, and physiological data, which will then be made available to independent Parkinson’s researchers.

A small survey of hospital RCM decision-makers finds that 69 percent use more than one RCM vendor, resulting in problems with denials that impact their bottom line.

A senior living center nurse is charged with the death of the father of former National Security Adviser H.R. McMaster. The contract LPN is accused of failing to perform neurological checks after finding his patient following an unwitnessed fall, then falsifying the medical record to indicate that he had done the exam.

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A Black Book survey of 7,400 hospital nurses finds that only 4 percent are so frustrated with their EHR that they want to go back to paper recordkeeping, down from 26 percent in 2015. Nearly all respondents say their IT department responds quickly to their suggestions for EHR documentation changes, although 82 percent complain that they don’t have easy access to computers or mobile devices in patient care areas and their productivity suffers accordingly. Nearly all respondents say that  that EHR competency is a highly-sought employment skill, while 80 percent of  job-seeking RNs indicate that the EHR a hospital uses is an important part of their decision to take a new job.


Sponsor Updates

  • The American Cancer Society adds the Healthgrades physician search finder tool to its website.
  • CareCloud adds speech-recognition technology from NVoq to its EHR documentation tools.
  • Loren Mann (Advisory Board) joins The Chartis Group as performance practice director.
  • Cumberland Consulting Group will sponsor CBI’s Medicaid and Government Pricing Congress May 21-23 in Orlando.
  • LogicStream Health releases a new podcast, “Partnering with physicians to make a solid business case and deliver ROI with Dr. Richard Priore.”
  • Elsevier partners with PerkinElmer and its ChemDraw software to enable faster, more intuitive chemistry research.
  • EClinicalWorks will exhibit at the Kentucky Primary Care Association 2018 Spring Conference May 14-15 in Lexington.
  • Hayes Management Consulting will exhibit at Centricity Live 2018 May 16-18 in Las Vegas.
  • HBI Solutions will exhibit at Pop Health East May 14-15 in Boston.
  • The HCI Group partners with the Mayo Clinic (MN) on a successful go live in Rochester.
  • Healthwise and Iatric Systems will exhibit at ANIA through May 12 in Orlando.
  • Huntzinger Management Group congratulates customer Adena Health System on its 2018 Gallup Great Workplace Award.
  • Image Stream Medical will present at Product Camp Boston May 12.
  • InterSystems will exhibit at the Healthcare Providers Transformation event May 15-16 in Dove Mountain, AZ.
  • Kyruus will present at RevDev18 May 16 in Boston.
  • Audacious Inquiry Director of Master Data Management Services Jeremy Wong joins The Sequoia Project’s new Patient Unified Lookup System for Emergencies Advisory Council.
  • Aprima concludes an award-winning fiscal year as it looks ahead to its 20th anniversary.
  • Change Healthcare announces it will work with Microsoft and Adobe to improve patient relationship management and engagement initiatives.
  • Spok forms physician and nurse advisory councils for its Care Connect platform.
  • Access HealthNet partners with Datica to ensure compliance requirements are met for its healthcare bundling platform.
  • Datica will provide security and compliance layers for cloud-based bundled payment solutions vendor Access HealthNet. 

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 5/10/18

May 10, 2018 Dr. Jayne 3 Comments

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Primary care physicians continue to look for ways to get off the hamster wheel that our profession has become. The Direct Primary Care (DPC) movement is the answer for growing numbers of physicians who engage with patients on a cash or retainer basis, cutting the insurers and health systems out of the equation. The 2018 DPC Summit will be held in Indianapolis in July, welcoming both existing DPC practices and those looking to explore their options.

I have several good friends with DPC practices. The movement is something that health IT companies should start thinking about if they’re not already. These practices often embrace electronic health records and technology that better enables connections with their patients along with comprehensive and high-quality care, but they don’t want the distractions of convoluted workflows to support billing requirements or other regulatory content.

My practice’s EHR has a setting that allowed us to completely turn off all of the Meaningful Use content, which was a great physician satisfier when we made the change. There are niche vendors such as Atlas.MD whose product is designed for DPC practices, but physicians often look for ways to transition their practices without a system switch. If your products can’t handle monthly recurring credit card billing, telemedicine, and plug-and-play interoperability, you’re going to miss out on these practices.

I’m often asked if I would ever go back to the primary care trenches. Informatics is definitely my first love, but I do miss the ongoing patient relationships I had previously. Given the stresses to the system and the level of burnout that many physicians are experiencing, I think the only way I would do it would be to either be part of a direct-type practice or part of a relatively closed system such as a civilian contractor to the military. Of course, there is a magical salary number that would take me back into the trenches tomorrow, but I have better odds of winning the PowerBall than I have of seeing a typical primary care physician hit that number.

I was somewhat puzzled by the headline on this CMS press release: “CMS Announces Agency’s First Rural Health Strategy.” Correct me if I’m wrong, but hasn’t CMS had a rural health strategy for a long time through the Rural Health Clinic (RHC) program? I’m a big fan of the idea that words mean something, so it’s kind of disheartening to think that people who have been working in the Rural Health arena for years might be hearing that their hard work wasn’t part of any strategy. CHS formed its Rural Health Council in 2016 and the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) was created in 1987. I guess they didn’t have any strategy either. But maybe we’re just now calling it a strategy?

I’m unimpressed by the level of rhetoric coming out of CMS lately, which seems more political than patient focused. I’ve searched through some press releases I kept from previous years and I don’t see “this Administration” or “the X Administration” mentioned nearly as often as I see “the Trump Administration” mentioned. Of course, this is strictly anecdotal and has no statistical power – maybe one of my AMIA colleagues will consider doing an analysis of the content of HHS, CMS, and ONC press releases to see if the language really is that different.

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Speaking of AMIA, the organization is introducing a new program to recognize applied informatics professionals. Fellows of AMIA will demonstrate education, commitment to the practice of informatics, contributions to the field of applied informatics, and a sustained commitment to AMIA. The organization plans to begin recognizing Fellows at the AMIA 2018 Annual Symposium and will begin accepting applications by July. I’m not sure I’ll qualify since my practice of informatics is far from typical, but I’ll check it out nevertheless.

CMS recently updated its Hospital Compare website with new Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data on patient experience. The new data was collected between July 2016 and June 2017. The patient experience ratings are separate from the overall CMS quality star ratings and cover 11 publicly reported measures. One available map I found listed hospitals in the wrong place, so I hope patients using the map look carefully at the legend to ensure they’re getting the right information. My 4-star hospital was replaced on the map by a 2-star hospital, so I had to do a double take.

The 11 patient experience measures are: cleanliness; nurse communication; doctor communication; staff responsiveness; pain management; communication about medicines; discharge information; care transition; overall hospital rating; quietness, and willingness to recommend the hospital.

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I’ve spent quite a bit of time on aircraft over the last decade and continue to be amazed by the level of self-centeredness of some of the passengers. Despite recent in-flight incidents, people continue to ignore safety briefings and defy flight attendant instructions. Usually I sit in the exit row, but was near the front due to a tight connection, and watched four people try to use the lavatory while the seatbelt sign was on and the plane was on its initial climb. The flight attendant sent each of them back to their seats, but no one seemed to pay attention to the person in front of them being turned away or the multiple overhead announcements.

On another flight where the row in front of me didn’t recline, I had an irate woman (who had already been told by the flight attendant that the seat didn’t recline due to being in front of an exit row) lift herself up in the seat and try to force the seat to recline with her whole body weight, almost breaking my laptop screen. We had people jumping up and out of their seats while we were still taxiing, requiring the flight attendants to unstrap themselves and force people to sit down.

It’s not just the lack of following published rules, but the general lack of civility. I watched a woman berate a flight attendant for not putting enough cream in her coffee, even after the flight attendant carefully verified how many units of cream and sugar the passenger wanted. The coffee was almost white and I had to resist the urge to remind the passenger that this was a Southwest Airlines flight, not a Starbucks.

Right now, I’m watching a woman give a full-on back rub to a man with no shoes, using a massage tool that she pulled out of her carry-on. I also saw someone rubbing liquor on the lips of his sleeping companion, trying to wake her up. I had to look around and make sure I wasn’t on some episode of a prank TV show. If you’re a ground-based employee and interact with road warriors, give them a little slack if they seem grumpy. They may have just gone through three hours of wondering what crazy thing would happen next.

Email Dr. Jayne.

Morning Headlines 5/10/18

May 9, 2018 Headlines No Comments

Tencent’s WeDoctor raises $500 million, values firm at $5.5 billion pre-IPO

In China, diagnosis and appointment booking app company WeDoctor raises $500 million in a round led by AIA Company Ltd. Its $5.5 billion pre-IPO valuation puts it ahead of competitor Ping An, whose recent IPO peaked at $1.1 billion before shares started to tumble.

A few days after Epic Systems roll-out, everything going as planned

Mayo Clinic’s Epic roll out in Rochester, which kicked off Saturday, is going according to plan, perhaps “a little better than expected,” according to implementation co-chair Steve Peters, MD.

Innovaccer Raises $25 Million Series B to Build Healthcare’s Leading Data Platform and Drive $1 Billion in Healthcare Savings

Analytics vendor Innovaccer secures $25 million in a funding round that brings its total raised to $41 million.

Morning Headlines 5/9/18

May 8, 2018 Headlines No Comments

Former Medicare chief Andy Slavitt formally launches Town Hall Ventures to invest in healthcare

Former CMS Administrator Andy Slavitt launches Town Hall Ventures to invest in health IT companies focused on serving Medicaid and Medicare populations.

The CEO of a health startup backed by Eric Schmidt and top VCs has been fired amid allegations he intimidated employees

HealthTap’s Board of Directors ousts CEO Ron Gutman after looking into high turnover rates and concerning reports about his abusive conduct.

Protection of Patient Health Information at Navy and Air Force Military Treatment Facilities

The DoD’s Office of the Inspector General finds glaring disregard for data security across 17 information systems at a handful of Air Force and Navy healthcare facilities.

Walmart and Sam’s Club to restrict opioid fill limit up to seven days nationwide; require e-prescriptions for opioids by 2020

In order to cut down on fraud and abuse, Walmart will require that all opioid prescriptions be filed electronically with its pharmacies by 2020.

News 5/9/18

May 8, 2018 News No Comments

Top News

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Athenahealth shares spike on yesterday’s news of an unsolicited takeover bid from Elliott Management, which has made several buy-out offers since taking on a 9-percent stake in the company last year. The hedge fund this time around made an all-cash offer of $160 per share for Athenahealth, putting the total value of the transaction between $6.5 and $6.9 billion. Elliott representatives believe they can close the deal in as little as three weeks, after which they plan to take the company private.

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Athenahealth’s Board of Directors responded with a letter to shareholders announcing that they will review the offer.


HIStalk Announcements and Requests

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Responses to this week’s question so far run the gamut, from realizing that tantrum-solving skills would come in handy, to going into projects with a more appreciative attitude for “physicians who were not only generous with their time, but also key contributors.” There’s still time to share your experience.


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 16 (Wednesday) 1:00 ET. “You Think You Might Want to Be a Consultant?” Sponsor: HIStalk. Presenter: Frank Poggio, CEO/president, The Kelzon Group. Maybe you just got caught in a big re-org and don’t like where things are headed, or, after almost a year of searching for a better opportunity your buddy says, “You’ve got decades of solid experience and you’re a true professional, you should become a healthcare IT consultant.” Now you start thinking, "This could be my ticket to success. I know the healthcare industry and can show people how to do things right. The sky’s the limit!" Not so fast. Consulting offers many advantages, and many pitfalls. This webinar will discuss both the rewards and the risks of moving into a full-time consulting role, as an independent, or part of a large firm. It will present a checklist you can apply to assess whether consulting is a good fit for you, and present the ground work necessary to be a successful consultant.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Mobile messaging vendor MPulse Mobile raises $11 million in a Series B round led by SJF Ventures. The company also announced development of AI-based chat bot messaging capabilities.

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Microsoft patents related to sensors for stress and blood pressure monitoring emerge, suggesting the company may be getting back into wearables. It discontinued its Band fitness tracker in 2016 as smart watches began to overtake trackers in popularity and capabilities.

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Wall Street Journal Theranos investigator John Carreyrou uncovers a list of high-profile investors who helped the company secure hundreds of millions of dollars in funding. Founder Elizabeth Holmes, who settled with the SEC in March over fraud allegations, has told the last remaining shareholders that the company will be liquidated by August.

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Former CMS Administrator Andy Slavitt launches Town Hall Ventures to invest in health IT companies focused on serving Medicaid and Medicare populations.


Sales

  • Cody Regional Health (WY) selects Plexus Technology Group’s Anesthesia Touch EHR.
  • University of Missouri Health Care will extend its Cerner Millenium system to affiliate Capital Region Medical Center.

People

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Kristin Gillen, RN (HonorHealth) joins Bluetree Network as CNIO.

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HealthTap’s Board of Directors ousts CEO Ron Gutman after looking into high turnover rates and concerning reports about his abusive conduct. Career CEO Bill Gossman has been tapped to take over the position.


Announcements and Implementations

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Patientco announces availability of its Smart Patient Financial Engagement Platform.

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Developers and healthcare organizations can now leverage FHIR for data exchange on the Redox network.

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Meditech announces GA of its Expanse Web-based EHR in the UK and Ireland.

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The VA San Diego Healthcare System rolls out LiveData’s PeriOp Manager in its eight ORs.

Health Fidelity investor UPMC (PA) implements the company’s HF360 Provider workflow software to identify and close gaps in risk across patient populations.


Privacy and Security

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After visiting three Navy facilities and two Air Force facilities, the DoD’s Office of the Inspector General finds glaring disregard for data security across 17 information systems. The laundry list of problems included a lack of multifactor authentication, adequate passwords, system review and assessment procedures, and physical security standards to protect PHI. Excuses included a “lack of resources and guidance, system incompatibility, and vendor limitations.” Resulting HIPAA violations could cost up to $1.5 million annually for each violation.


Other

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In an effort to help cancer patients avoid the ER, Fred Hutchinson Cancer Research Center (WA) and Microsoft will develop and pilot AI-powered technology to identify and help those patients likely to suffer from severe chemotherapy side effects. The company has also committed $25 million over the next five years to develop AI that will help people with disabilities.

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In order to cut down on fraud and abuse, Walmart will require that all opioid prescriptions be filed electronically with its pharmacies by 2020.

A Black Book survey of 709 inpatient facility executives finds the majority are open to outsourcing clinical areas of expertise, particularly teleradiology and medical imaging, as they focus already stretched internal resources on the move to value-based care.


Sponsor Updates

  • Surescripts publishes its annual National Progress Report.
  • Aprima opens registration for its user conference August 17-19 in Dallas.
  • Audacious Inquiry achieves EHNAC accreditations recognizing excellence in information security.
  • Bluetree Network will exhibit at the HIMSS Executive Institute Leadership Live Conference May 14-15 in Dallas.
  • The Editorial Board from Biomedical Instrumentation & Technology awards Bernoulli Health a Best Research Paper Award for its “Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit” paper.
  • Influence Health partners with Sg2 to add strategic planning capabilities to its hospital marketing services.
  • Collective Medical partners with the Florida Hospital Association, giving members access to its real-time, risk-adjusted event notification and care collaboration platform.
  • CompuGroup Medical will exhibit at the AUCH Annual Primary Care Conference May 17-18 in West Valley City, UT.
  • Conduent will exhibit at the National Medicare Advantage Summit May 16-18 in Washington, DC.
  • CoverMyMeds will exhibit at AAACN May 9-12 in Orlando.
  • CTG publishes a new case study, “Inova Health System Relies on CTG for Epic Clinical Service Desk Solution.”
  • Culbert hosts its 12th annual employee celebration at Baltimore’s Inner Harbor.
  • Divurgent publishes a new white paper, “A Culture of Security: Turning Your Greatest Threat into an Asset.”
  • The local news highlights Docent Health’s patient experience work at Dignity Health’s Memorial Hospital (CA).
  • The Microsoft Build 2018 Developer Conference showcases Datica’s compliant cloud technology.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 5/8/18

May 7, 2018 Headlines 5 Comments

Paul Singer’s Elliott makes all-cash offer for Athenahealth of $160 a share

Elliott Management makes an all-cash offer of $160 per share for Athenahealth, putting the transaction’s total value at more than $6 billion.

MTBC Signs Acquisition Agreement that could Increase Revenues by at least 50%

MTBC will acquire the practice management, revenue cycle, and group purchasing organization assets of Houston-based Orion Healthcorp and its 13 affiliates.

How to Lose $700 Million, Theranos-Style

Wall Street Journal Theranos investigator John Carreyrou uncovers a list of high-profile investors who helped Theranos secure over $700 million in funding.

Curbside Consult with Dr. Jayne 5/7/18

May 7, 2018 Dr. Jayne 1 Comment

Atul Gawande, MD is one of my favorite authors, and I’m currently working my way through his book “Being Mortal,” which discusses how we handle aging and infirmity in the United States. It is particularly relevant for me, since my family is dealing with some issues involving elderly relatives, and I know I discuss some of the book’s topics every time a child brings an elderly parent into the urgent care after a fall or some other type of accident. I was glad to see him featured on Freakonomics Radio addressing the “freaking mess” that is our so-called healthcare system.

When many of us think of the mess of the system, we think about the cost disparities, access disparities, and the regulatory burdens. Gawande cites challenges with the time it takes for good ideas to take hold in medicine, largely because of delays between the obvious or immediate impact of change and the delayed effects that may be difficult to see. He uses the examples of anesthesia and antisepsis in the 1800s as examples. Anesthesia was rapidly adopted, where antisepsis through hand washing and disinfection of medical equipment took significantly more time. Gawande attributes this difference to the obvious benefit of anesthesia as opposed to the somewhat invisible impact of disinfection. There were also cultural changes associated with antisepsis in the surgical realm that took time to resolve. He goes further to discuss the release of the drug Viagra, which had immediate impact on patients and was widely prescribed in short order. However, surgery checklists have been “harder to sell” because they represent an investment of time to prevent “problems which are often not immediately visible to people.”

Gawande talks about a conversation with a Cheesecake Factory manager about how to approach the healthcare industry as far as quality control, cost control, and innovation. The approach involves breaking down processes and standardizing them, along with figuring out what the best-performing organizations are doing and translating that into a “recipe” that can be used by many organizations. He talks about the problems he has to solve as a surgeon, including arranging care for uninsured patients, having to skirt around information that patients don’t want shared with their families, and working with patients who have high-deductible or narrow network health insurance plans that add layers of difficulty for patients. He does note that in his Boston practice, he rarely sees uninsured patients due to the universal coverage provisions in Massachusetts that preceded the Affordable Care Act. Despite being covered, however, patients with high deductibles might be skipping medications that control chronic conditions. He writes, “It’s been dramatic to me to see people who now have deductibles in the thousands of dollars routinely making decisions – you can see people are not filling their high blood pressure medication, and they’re not taking their statins for cholesterol control, and things like that that have long-term consequences, but on a day-to-day basis don’t feel any different.”

I enjoyed reading his comments on the intersection of politics and healthcare. He notes the disconnects between academic knowledge on issues and the questions that politicians are trying to answer: “Often people are trying to come to experts for technical answers to questions that don’t have a technical answer.”

Regarding the Affordable Care Act, “people fundamentally disagree on what the goal of the healthcare coverage is. Is it to free up a trillion dollars for tax reform? Is it to secure universal coverage for all? Is it to cut costs? You can’t take a trillion dollars out of the healthcare system and make healthcare better at the same time and increase coverage in a short time frame.”

He discusses the challenge of taking academic knowledge and applying it to actual care delivery, noting “We’re drowning in the complexity of the knowledge that’s been discovered over the last century.” I remember talking to a senior physician during medical school, who had been in practice probably close to 50 years. He told us that when he graduated from medical school, there were two antibiotics – penicillin and streptomycin. I think of him every year when I purchase my updated “Pocket Pharmacopoeia” reference and it continues to grow in size even despite shrinking print. Physicians are trying to not only make sense of new treatments, but to figure out how to deliver them in a cost-effective way that is also clinically effective. Yet, Gawande goes on to mention that one of the basic problems we’re dealing with is high blood pressure. Many of the medications are inexpensive, but the follow through and execution of treatment have significant opportunities for improvement.

The interview asks Gawande’s thoughts on the need to address healthcare fragmentation and the misalignment of incentives. He responds that a technical improvement like a better computer system isn’t going to fix fragmentation, and sees the tying of healthcare coverage to employment as one of the major problems in healthcare today. He cites data that when one looks at job growth over the last decade, more than 90 percent of new jobs don’t have healthcare benefits tied to them – contract work, freelancers, temporary workers, etc. He states that having “a regular source of care over time, over years” leads to better outcomes at five years. Those of us in the primary care trenches knew this to be anecdotally true, because as we got to know our patients, we were able to better strategize with them around their health and their willingness to change to healthier behaviors and better compliance with recommendations. When I was in the family medicine trenches, however, the average patient stayed with me only two or three years due to insurance changes, which hampered the development of those relationships. Fast-forward a decade and patients want even more convenience, preferring to visit a retail clinic, urgent care center, or telemedicine provider rather than wait weeks for an appointment with a primary care physician. Gawande also notes that high deductible plans often lead patients to “sacrifice” primary care, changing the playing field for preventive medicine and long-term cost savings.

Regarding healthcare informatics, Gawande calls our current state “the MS-DOS phase of computerization and healthcare.” He mentions that systems are great for billing but challenging for recording clinical data such as allergies: “We’re at the stage where it’s ripe for the Apple of healthcare to come knock the C-prompt out.” He goes further to say we need to move from being “cowboys delivering the care” to “pit crews” with teams of physicians, nurses, social workers, and health coaches caring for patients by “dividing and conquering and communicating,” but states we only take that approach a small part of the time.

Gawande also talks about being a writer, which resonated with me. He notes that physician writers have “this daily exposure to the human experience” that other writers don’t have, including exposure to money, technical challenges, family dynamics, and more. He states, “I feel like I would have totally burned out on my medical-practice work if I were only in the trenches and not able to lift my head up and see what’s really going on.” I understand where he’s coming from – some days as I watch organizations swirl around and people struggle with new mandates and requirements, it’s only when I sit down to organize my thoughts to write HIStalk that things start to become clear about how I need to advise physicians or care teams.

He also comments on juggling his clinical work with his public health work and his writing, saying “every day is a problem to solve” on how he sorts out his various priorities including to “make sure I get enough sleep most of the time.” I totally get that – often I’m writing at midnight or into the wee hours of the morning, or stealing scraps of time in between conference calls and meetings.

Gawande doesn’t claim to have all the answers, but he does provide ample food for thought that should be consumed by healthcare policymakers and financiers. How can we better tackle the “freaking mess” that is healthcare today? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/7/18

May 6, 2018 Headlines No Comments

Mayo Clinic launches massive medical records overhaul

Mayo Clinic goes live on Epic at its Rochester, MN campus as part of a $1.5 billion system-wide software overhaul that will bring all of its facilities onto a single platform.

Buffett targets CEO for Berkshire-Amazon-JPMorgan healthcare venture soon

Berkshire Hathaway CEO Warren Buffett reiterates his commitment to the healthcare improvement project his company is launching with JPMorgan and Amazon, emphasizing that a CEO will be in place within the next two months.

Trump May Pick 40-Year VA Insider To Run Veterans Health Administration

DisabledVeterans.org suggests that President Trump will meet with National Association of Veterans Affairs Physicians and Dentists President Samuel Spagnolo, MD to discuss his potential nomination for VA Secretary.

Monday Morning Update 5/7/18

May 6, 2018 News 2 Comments

Top News

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Mayo Clinic goes live on Epic at its Rochester, MN campus as part of a $1.5 billion system-wide software overhaul that will bring all of its facilities onto a single platform. Preparation for the big-bang event on May 5 was so extensive that the local power company created a new substation to power it.

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Mayo has already implemented Epic at its facilities in Wisconsin and southern Minnesota, and expects to begin deployment at its hospitals in Florida and Arizona after the Rochester implementation is complete.


HIStalk Announcements and Requests

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Recent privacy breaches have swayed the majority of reader interest in consumer genetic testing services, though the comments left don’t give me a good indication if they’ve been more swayed into not using these types of services. Wary Consumer points out that, “When you add to the privacy breaches the fact that Chinese companies have invested in the DNA companies and are now offshoring our genetic data, it should give all of us pause. Additionally, you’re paying for a service, so unlike free sites where you basically pay with your data, you’re basically paying twice, since you know they’re going to reuse or resell your data. It’s crazy that people don’t stop to consider this when clicking through end user agreements that they don’t read.” Steve’s interest has stayed the same – zilch. “Wasn’t interested before, still am not. People are so concerned with the risk that their credit card information might end up on line (when you can easily cancel a credit card). Some of these same people are more than willing to send in their DNA to be stored for years to come. How many hackers do we think are actively working to find their way into those databases?”

New poll to your right or here: Does connectivity to your EHR make you more or less likely to buy a Fitbit?

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Here are reader responses to “What I Wish I’d Known Before … Firing Someone for Cause.” A lack of support, plus a tendency to tiptoe around tossing bad apples seem to be common themes.

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I’m hoping Epic employees and others toiling in the Minnesota trenches of the Mayo Clinic will anonymously weigh in on this week’s question.


Webinars

May 9 (Wednesday) 2:00 ET. “How to Make VBC Work for You: The Business Case to Transform Into the Health System of the Future.” Sponsor: Philips Wellcentive. Presenters: Mason Beard, co-founder and chief product officer, Philips Wellcentive; Scott Cullen, MD, principal, ECG Management Consulting; Seema Mathur, director of strategy, Sage Growth Partners. How well is your organization funding its transformation to VBC? This free webinar explains how to achieve ROI as your organization transforms to meet the future. You’ll learn how VBC is impacting healthcare system management, three strategies for funding your transformation, and what the healthcare system of the future will look like.

May 16 (Wednesday) 1:00 ET. “You Think You Might Want to Be a Consultant?” Sponsor: HIStalk. Presenter: Frank Poggio, CEO/president, The Kelzon Group. Maybe you just got caught in a big re-org and don’t like where things are headed, or, after almost a year of searching for a better opportunity your buddy says, “You’ve got decades of solid experience and you’re a true professional, you should become a healthcare IT consultant.” Now you start thinking, "This could be my ticket to success. I know the healthcare industry and can show people how to do things right. The sky’s the limit!" Not so fast. Consulting offers many advantages, and many pitfalls. This webinar will discuss both the rewards and the risks of moving into a full-time consulting role, as an independent, or part of a large firm. It will present a checklist you can apply to assess whether consulting is a good fit for you, and present the ground work necessary to be a successful consultant.

May 24 (Thursday) 1:00 ET. “Converting Consumers into Patients: Strategies for Creating Engaging Digital Experiences People Demand.” Sponsor: Healthwise. Presenters: Antonia Chappell, director of consumer solutions, Healthwise; Josh Schlaich, senior product manager, Healthwise. Nearly three-quarters of US adults use a digital channel to manage their health and the internet to track down health information. It’s clear that consumers have come to expect online interactions as an integral part of their overall patient experience. In fact, the Internet may be the first way people come in contact with your organization. They have more choice than ever on where to get healthcare services, and their decisions are increasingly influenced by how well organizations connect with them in the digital space. This webinar will show you how to create engaging digital and web experiences that convert casual consumers into patients and keep them satisfied throughout their entire patient journey.

June 5 (Tuesday) 1:00 ET. “Increase Referrals and Patient Satisfaction with a Smarter ‘Find a Doctor’ Web Search.” Sponsors: Phynd Technologies, Healthwise. Presenters: Joseph H. Schneider, MD, MBA, FAAP, retired SVP/CHIO, Indiana University Health; Keith Belton, VP of marketing, Phynd. A recent survey found that 84 percent of patients check a hospital’s website before booking an appointment. However, ‘Find a Doctor’ search functions often frustrate them because their matching functionality is primitive and the provider’s information is incomplete or outdated. Referring physicians need similarly robust tools to find the right specialist and to send the patient to the right location. Attendees of this webinar will learn how taxonomy-driven Provider Information Management improves patient and referrer satisfaction by intelligently incorporating the provider’s location, insurance coverage, specialty and subspecialty, and services offered that can be searched via patient-friendly terms.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Berkshire Hathaway CEO Warren Buffett reiterates his commitment to the healthcare improvement project his company is launching with JPMorgan and Amazon. At Berkshire’s annual shareholders meeting, he reiterated that all three companies want their 1 million-plus employees to receive better care at lower costs, but didn’t get into specifics. He did mention that a CEO for the new venture will likely be placed within the next two months.


People

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TeleTracking promotes Christopher Johnson to president.

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David Nace, MD (Lantern) joins Innovaccer as CMO.


Announcements and Implementations

In the UK, the Somerset Partnership NHS Foundation Trust joins TriNetX’s research network.


Sales

  • Renown Health selects Phynd to synthesize, transform, and share provider information across its health network in Nevada.
  • In Australia, the Victorian government allocates $124 million to implement Epic at three hospitals.
  • Calvary Hospital (NY) will host their Meditech system on CloudWave’s OpSus Healthcare cloud.
  • Massac Memorial Hospital (IL) selects Parallon Technology Solutions to implement and host its Meditech Expanse software.

Decisions

  • Holzer Medical Center (OH) will switch from Allscripts to Athenahealth in late May or early June.
  • Kingman Regional Medical Center (AZ) will go live with Meditech supply chain management software in September.
  • Crisp Regional Hospital (GA) will switch from Meditech to Cerner in 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Government and Politics

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New York City-based urgent care chain CityMD will pay $6.6 million to settle a civil fraud lawsuit filed by a whistleblower and the Manhattan US Attorney General’s Office. CityMD, which has 88 facilities, admitted to billing Medicare for procedures that weren’t as lengthy or complex as it claimed.

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This article suggests that President Trump will meet with National Association of Veterans Affairs Physicians and Dentists President Samuel Spagnolo, MD to discuss his potential nomination for VA Secretary. Spagnolo is also a senior attending physician at the VA Medical Center in Washington, DC and a professor of medicine at George Washington University. He has served in numerous positions within the VA throughout his career.


Other

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The majority of respondents in a Reaction Data survey of 145 believe that Anthem’s decision to stop covering ER visits it deems unnecessary will have a negative impact on their organizations and patients, especially when it comes to out-of-pocket patient expenses and restricted clinical care.


Sponsor Updates

  • Medicity publishes a new perspective paper, “Interoperability 2.0: How to Consume, Organize and Share Health Data to Achieve Greater Value.”
  • The New York State Psychiatric Association endorses DrFirst medication management tools for use by the psychiatric community in New York State.
  • Mobile Heartbeat will present at the 2018 ANIA Conference May 12 in Orlando.
  • Liaison Technologies is accepting applications for its fall semester 2018 Data-Inspired Future Scholarship.
  • Meditech, PatientSafe Solutions, and PerfectServe will exhibit at the 2018 ANIA Annual Conference May 10-12 in Orlando.
  • The National Council for Behavioral Health awards Netsmart the 2018 Mental Health First Aid Business Leadership Award.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Allscripts Client Experience May 8-9 in Saskatchewan.
  • OmniSys, Experian Health, and Surescripts will exhibit at the NCPDP Annual Technology & Business Conference May 7-9 in Scottsdale, AZ.
  • Qventus and TriNetX exhibits at the HLTH 2018 conference through May 9 in Las Vegas.
  • T-System partners with Precision Practice Management to develop the Complete Care clinical and business solution for urgent care providers.
  • T-System exhibits at the 2018 UCAOA Urgent Care Convention & Expo through May 9 in Las Vegas.
  • Heather Russell joins TransUnion as chief legal officer.
  • Wellsoft will exhibit at the Annual Rural Health Conference May 8-11 in New Orleans.
  • WiserTogether partners with digital health marketplace ZendyHealth.
  • The local news profiles ZappRx.
  • Consulting Magazine includes Impact Advisors VP Keith MacDonald in its list of top 25 advisors of 2018.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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What I Wish I’d Known Before … Firing Someone for Cause

How much stress I would feel leading up to the actual moment. I find myself spending a lot of time worrying about the impact on the person, their family, their potential future mental state, etc., particularly if I have had a good personal relationship with them and the cause is poor professional performance rather than something more obviously "fireable" like sexism, racism, theft, etc. And, in these cases, how much less stress I found myself under after making the decision, going through the documentation and attempted rehabilitation process, and then finally moving on. Having poor performers around drags down the entire team and moving them on lifts a weight from everyone else.


That I could be personally liable for the outcome if pursued legally and found in favor of the plaintiff.
That HR would not be as supportive of my needs to meet quality and project standards as in assuring they were legally protected.
Employees who should have seen it coming actually don’t, despite best efforts to prepare them.
That it is hard, even when it is fully justified
That staff who remain behind will need to be told something, or the rumor mill will take over – prepare a statement.
That staff who remain behind will glorify the employee, even if they were previously negatively impacted by the terminated employee.


I wish I had known how much the firing manager would be put "on trial" for the performance of the "firee.” Sometimes, someone is just in the wrong job, but it seems that the employee’s manager has to own all of the employee’s failings as lack of providing direction, lack of leadership, lack of mentoring, etc.


The extensive process of documenting everything to ensure there’s no lawsuit can be a pain. I’ve only had to fire one person for cause in healthcare IT and worrying about confidentiality with the reason wasn’t an issue. There was no speculation as to why “Beavis” was fired, only a general reaction of “what took so long,” even though confidentiality was maintained. I’ve worked for companies where managers would rather transfer the coworker and wash their hands of them, rather than have to go through the firing process, which really penalizes the good employees who have to work with the bad.


That you may not get to replace the employee because of attrition. The company uses empty positions for potential attrition cost savings.


Timing is never ideal when firing someone, but timing can be better than others; we terminated an employee of middle management two weeks post bringing in a consultant team. Gave the appearance that the consultant team was changing the org chart.


How hard it would be. Internally, our employees are so well protected, it’s hard to get them out based on performance – even over a lack of showing up. They are given every benefit of the doubt, and we end up down a person for months and months, yet we’re still accountable for our metrics.


Would I have done so for anybody or was this person an anomaly. Remove all personal bias and read your rationale, asking if this were X, would I do the same? If not, expect repercussions.


Regardless of the amount of documentation or agreement from those within your department, there will always be those that feel the employee was treated unfairly. You know the reasons for the firing, but that’s not something you can easily explain to others due to confidentiality issues. If you’re going to fire someone, you have to be confident in your decision and not let pushback from others impact your team’s performance.


Don’t count on your manager supporting your decision! You’re probably on your own here.


I wish I’d known how to convince my company to let me do it. They never let us fire anyone – always has to be something sneaky, like a layoff, which sometimes has collateral damage. There are bad apples out there that need to be tossed, but our HR team is dreadfully afraid of letting us do when needs to be done.


Many not-for-profits seem to treat most people with performance-based challenges as if they have guaranteed lifetime employment and it seems like everyone plays by union-like rules. That is – many write-ups. It seems like you need to have HR in the loop well in advance of the first inkling of an issue and it takes multiple performance improvement plans, sometimes with arbitration-like discussions, to move someone on.
In other cases, where the previous "model employee" is cited by someone as having caused a non-performance issue, it seems to be guilty until proven innocent. I really fear for the surfacing of potential accusations from many years back. I have yet to hear about a "statute of limitations" at my employer. These are truly crazy times.

Weekender 5/4/18

May 4, 2018 Weekender 2 Comments

weekender


Weekly News Recap

  • In the UK, Health Secretary Jeremy Hunt brings in Eric Topol, MD to lead a review of how to best train NHS staff on using new technologies including AI, digital health, robotics, and genomics.
  • Reports surface that a West Palm Beach physician with ties to President Trump’s inner circle may be behind the VA/Cerner contract delay.
  • Fitbit will use Google’s Cloud Healthcare API to share user data with providers via their EHRs.
  • Beth Israel Deaconess taps CIO John Halamka, MD to lead its new Health Technology Exploration Center, which will explore the role of emerging technologies like blockchain and IoT in healthcare delivery.
  • Cerner shares drop after the company reports lower than forecasted Q1 revenue of $1.29 billion.

Best Reader Comments

Moskowitz: ‘I know because I have to use it!’ The gall of a physician user pointing out that Cerner powerpoints don’t align with Cerner reality. (Vaporware?)

Have to ask: Is Bruce Moskowitz,the next nominee to head the VA? I mean, he is a doctor after all and that qualifies him for pretty much anything. Also: Would blockchain have prevented Trump from writing his own medical assessment (“healthiest individual ever elected to the presidency.”)? (Recovering CIO)

They absolutely seem lost since Neil died. It looks like no one wants to make decisions or set a direction. I was hoping the new CEO would step in and set a new direction, but that doesn’t seem to be, at the moment. The Siemens acquisition was interesting. They were basically buying market share and being the low cost ($1B being low, all things considering) they have basically made their money back. However, what they have done with Financials is baffling to me. One would have thought they would have taken the good parts of Soarian Financials and what little good parts there are with Millennium and create a new product. Yet, they have kept both lines and are still selling both financial systems. I mean, 3 years seems to be plenty of time to architect a new Revenue Cycle platform considering their resources …. The UIC issue you have to take as an outlier. Yes, Cerner pursued legal action but the fact remains, they are actually right in this context, whether we like it or not. Was the procurement process followed, NO. It is very clear, especially when Impact Advisors put in writing that they would ONLY bid on Epic work, should Epic win the bid. That is a clear conflict of interest, any way you slice it, and thus, violated the procurement process the state of Illinois has. Not to mention, Epic Implementation costs were NOT in the final bid, which again, was a requirement of the RFP. You may hate Cerner, and fine whatever, to each his own, but the FACTS are that there were violations of State Procurement and thus the selection process has to happen all over again. Epic probably still wins and the outcome is the same, but that isn’t the point. If anything, this is almost more on Impact than it is UIC. I mean, really, when you are doing a vendor selection, you NEVER state that you would ONLY support one vendor over the other. You have to stay neutral through the whole process. (Associate CIO)


Watercooler Talk Tidbits

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We funded the teacher grant request of Ms. H in Texas, who asked for STEM game night activities for her special education class. She reports, "I cannot thank you enough for your donation to our classroom. My students and I have formed an obsession with STEM projects. My students love to learn about jobs they could have in the future based on information provided in the STEM activity. I have students that, at a young age, are picking what they would love to be when they grow up based off of these activities. My students are able to explore, plan, build, and report at a higher level due to these interactive STEM activities."

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“Big data” (and “Big Brother” for that matter) takes on new meaning in China, where manufacturing companies have taken to outfitting workers with brainwave-monitoring helmets in an effort to keep tabs on their levels of concentration, anxiety, depression, and rage. One brain science academic in China ominously explains that, “When the system issues a warning, the manager asks the worker to take a day off or move to a less critical post. Some jobs require high concentration. There is no room for a mistake.” The technology is also being rolled out in hospitals to help staffers keep an eye on potentially violent patients.

NBC investigators get back unexpected results during the course of a report on at-home DNA testing kits. Results from Orig3n DNA’s $29 kit were included in a seven-page report that listed attributes like strong muscle force and cardiac output, but failed to note the DNA in question was in fact from a dog.

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Boston Marathon officials decide to award prize money to non-elite runners who finished with faster times than their professional counterparts. Fifth-place finisher Jessica Chichester, a nurse practitioner from Brooklyn, will take home $15,000. She has jokingly claimed that “[f]requent hand washing and Lysol-ing everything” have been key to her running success.

Bill Gates turns down a semi-serious job offer from President Trump after he asks about the White House’s vacant science advisor position during a meeting in the Oval Office on global health security.


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