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HIStalk Practice Interviews Richard Loomis, MD CMO & VP of Informatics, Practice Fusion

July 26, 2016 News No Comments

Richard Loomis, MD is CMO and vice president of informatics at Practice Fusion.

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Tell me about yourself and the organization.
I am a physician by training, trained in anesthesiology with further training in biomedical informatics. Before joining Practice Fusion, I lead informatics for the Southern California region of Kaiser Permanente. I joined Practice Fusion three years ago, ultimately becoming chief medical officer. In that role, I oversee both healthcare informatics as well as medical affairs. I also have had the pleasure of being a participant in the HIMSS EHR Association, more recently as a member of the executive committee. My vice-chair position started July 1st. I’m really looking forward to working with the association’s chair, Sasha TerMaat of Epic, the other members of the EC, as well as our work groups to advance the collective goals and objectives of the association and our member companies.

How do you and your colleagues plan on steering EHRA decision-making in the coming year, especially with regard to interoperability?
We have been very active on the interoperability front. We view interoperability and advancing interoperability as key goals over the next year and beyond. We released a fact sheet last month as part of a congressional staff briefing – that’s one example of how we are working to educate the broader community around interoperability. A couple of areas of specific focus for the coming year include interoperability standards. While they are evolving and maturing, they’ve certainly been a challenge historically. We’re enthusiastic about some of the progress that we have been making on the standards front, but there is still work to be done. The other area of focus is governance; specifically, helping provider organizations work with regulatory bodies and EHR vendors on the governance and policies around health information exchange and clinical data exchange. Those are two key areas of focus.

Generally speaking, we see the shift to various forms of value-based payment models as the most significant driver to advancing interoperability. It aligns the needs of Practice Fusion customers, and emphasizes their need to exchange data to help deliver higher quality care at lower costs.

Putting your Practice Fusion hat back on, what are your customers’ biggest interoperability challenges at the moment? Do they revolve more around technology or workplace culture?
I feel that we’ve been very successful in facilitating interoperability for our customers. We have over 600 connected partners, including labs, imaging centers, and roughly 70,000 pharmacies via Surescripts, along with billing partners and other partners in the industry. We have been very successful in enabling small practices to exchange data with other healthcare services in their community to help them deliver high-quality care for their patients.  As I mentioned earlier, we are seeing a shift in payment models that really presents the need for providers in all clinical settings to exchange clinical data, and we are responding to that as part of the 2015 certification that EHRs must achieve to participate in the third stage of Meaningful Use as well as in various programs associated with MACRA.

At the same time, it’s worth noting that, while interoperability is important to our customers, it’s just one of many regulations they’re trying to keep track of at the moment. Our customers are overwhelmed with the changes they’re seeing. It’s certainly a challenge for them to keep up with the steady stream of regulations that impact how they run their practices and how they treat their patients.

Recent Deloitte survey findings show that physicians aren’t as aware of MACRA as they probably should be – only 50 percent of those surveyed had heard of it and only 32 percent say they’ve heard of it but don’t actually know what it is. Where do you think this lack of awareness stems from?
The survey results are certainly consistent with what I’m seeing in our customer base. Providers are simply trying to keep up with all of this change, and, as such, many are not aware of the significant impact that recent legislation, specifically MACRA, will have on them. EHR vendors are often a primary line of communication for delivering information about regulatory change. We feel that in order to enable our practices to effectively use our software, we need to play a role in education and it just so happens that we are in a unique position to do so. On a side note, I think the recent announcement from CMS of additional funding to help small practices meet the changes required as part of MACRA is evidence that they recognize that it is going to be difficult and challenging for these smaller practices to make the transition.

Do you have any final thoughts?
I’d like to emphasize that we would like to partner with others in the industry, including CMS and other agencies, to help educate providers, particularly on the small practice end of the spectrum. We’re committed to helping physicians meet the challenges of MACRA as they unfold.


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JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg

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5 Questions with Mike Heckman, Vice President, Population Health Services, Cerner

July 25, 2016 News No Comments

Mike Heckman is vice president of population health services at Cerner. The company operates 40 employer health centers across the country, including three for its associates in the Kansas City area. Cerner employs over 400 clinical and support staff to care for 200,000 patients annually at these facilities, which use a variety of homegrown technologies including Cerner Ambulatory, Etreby, HealtheRegistries, HealtheEDW, HealtheLife, and Cerner Wellness. While its employer-based health centers don’t participate in Meaningful Use, they do base their standards of care and reporting on MU requirements. The company opened a clinic in Kansas City last month for International Union of Engineers members and retirees.

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What was the impetus for becoming a management organization for employer on-site clinics?
Cerner is a company that sits at the intersection of healthcare and information technology. We want to provide solutions for our clients today, while anticipating their needs for tomorrow. We foresaw the increasing wave of demand for population health management services and, years ago, began investing in platforms, models, and architecture. Our strategy to health and care is a three-pronged approach – on-site services, wellness initiatives, and health benefits and plan administration.

We started with our own health center and have been improving our model for a number of years. We wanted to leverage technology plus add a high degree of focus on the individual’s experience to improve the primary care experience. Encouraging individuals to get involved in their own health and care can have a dramatic long-term impact on the overall health of a population.

These health centers are a testament to our commitment to deliver patient-centric health care. The industry is starting to catch up with the transition to risk-based, population-based models of care provision, but employers have been managing their own risk for decades. Entities that are responsible for a large population are interested in this concept of on-site care.

How do on-site clinics help employers better manage healthcare costs for their employees?
According to the CDC, 86 percent of the nation’s healthcare costs are spent on treating people with chronic diseases that are preventable. Through Cerner services and on-site health centers, individuals learn about their health risks and get access to tools to manage those risks to prevent and control chronic conditions.

A well-designed set of programs addressing both sick care and preventive health not only focuses on maintaining a healthier workforce, it lowers direct costs such as insurance premiums and worker’s compensation claims. It also has a positive impact on indirect costs such as absenteeism and worker productivity. We base this belief on our experiences. Cerner is the sandbox to test and try new things. We’ve been using this three-pronged holistic approach to create our own health economy. Here are some results we’ve seen at Cerner:

  • In 2006, Cerner cut out the middle man and stood up our own Third Party Administrator. We also opened our first on-site health center and pharmacy.
  • In 2010, as an organization, Cerner shifted its focus to population health. We changed our mission statement, launched a company-wide weight loss challenge, and offered fitness centers to associates and their family members at no cost. From 2009 – 2013, we tracked five clinical risk factors across a consistent population of 1,900 people. Of this population, 72 percent have either reduced or maintained their overall number of risk factors over the course of five years. In addition, the number of participants with three or more risk factors decreased by 9 percent.
  • One client has saved an estimated $1.6 million after three years, leading to an estimated return of $2.01 for every $1 spent, not including the extra benefit to be calculated in the attraction and retention of employees, satisfaction at work, and long-term intangible health benefits.

What sort of healthcare technology adoption/implementation challenges are unique to on-site clinics?
When we opened our first on-site health center at Cerner, we weren’t sure if associates would participate. What we found was that the highest quality and experience outweighed any concerns associates had. Therefore, we focus on experience. If a piece of technology is running in our health centers, it is there because it helps our care teams provide a better experience, or it helps our patients directly have a superior experience.

At the Operating Engineers’ Union Health and Wellness Center, we included our own ambulatory EHR as a differentiator, but also as a tool to assist the Operating Engineers’ staff. The care team can access searchable data to stratify union members by conditions and risks. It can systematically identify high-risk and complex patients through the information gathered during screenings. This system, coupled with the clinician’s evidence–based guidelines, coordinates member care over time and throughout the care continuum. Lastly, Cerner’s HER – with embedded knowledge-based care – will prompt the providers with key clinical information at the point of care. With an automated workflow and e-prescribing, the EHR streamlines and ‘double checks’ the historic member data with known interactions and allergies from the data gathered during past member visits.

Our clinicians believe in technology as an enabler, but also know that without the human connection between care teams and patients, we can never provide the ideal experience. That is why we believe so strongly that the need for a great care team and technology are needed within our health centers.

How are Cerner clinics using digital health tools to engage with patients, or to enable physicians to securely communicate with each other?
The on-site health centers use Cerner’s leading healthcare technology to manage everything from patient records to appointment scheduling. Services usually include routine screenings, physical exams, lab services, medication dispensing, and the diagnosis and treatment of acute and chronic illnesses. Patients are able to interact with their providers, review their medical records, and schedule appointments using our secure, online portal. The health centers offer an array of wellness services designed to assist members in managing and preventing illness.

Cerner Wellness is a Web-based solution that provides employers the ability to automate and manage an effective wellness program that helps individuals understand and engage in their health in a meaningful way so that they are healthier, happier, and more productive. Cerner Wellness gives members access to:

  • NCQA – certified PHA.
  • Over 30 standard workshops.
  • Team challenges.
  • Nutrition and exercise tools.
  • Health coach communication tools.
  • HealthyNow mobile application and third -party device integration.
  • Incentive and rewards tracking.

Cerner is also using our HealtheIntent suite of solutions to support our care teams in truly managing population health. These tools are critical in identifying and addressing gaps in care, robustly analyzing data to determine where an employer might best invest resources, and pulling together a longitudinal record of activity to best prepare the care team to serve the patient.

What tips/best practices do you have for employers looking to implement on-site clinics? How much of a differentiator should healthcare technology be?
We believe that the key to an on-site health center is providing the best possible experience for the patient, both while they are physically in the facility and between visits. For this reason, technology is a key differentiator.

It can be stressful for an employee to participate in their employer’s on-site health center. They need to know that their data and information is secure, used only as appropriate and used to help them receive the best possible care.

We over-weight on the amount of time a patient or member spends with their provider. If they come in for a 25-minute visit, they will spend 20 of those minutes with their provider. In this way, they provide a much deeper and richer relationship with the care team, and are more likely to get, and stay, engaged. The transparency that technology provides (we show the EHR directly to the patient) is critical in driving trust. The interaction that a patient has between visits can be boosted by high-quality technology, along with a care team that is structured around putting the patient first.

So focus on experience, ensure that the health center is not siloed from the rest of healthcare, and create an environment where a combination of great clinicians supported by great technology can support the population. This is real population health. Employee populations have their own sets of cultural norms that need to be understood and positively influenced. An on-site health center can be a beacon of health for any employer campus … and act as an anchor for transitioning from sick care to healthcare.


Contacts

JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg

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Population Health Management Weekly Wrap Up 7/24/16

July 24, 2016 News No Comments

CMS selects 516 participants to join the Million Hearts Cardiovascular Disease Risk Reduction Model, a five-year population health management program designed to prevent heart attacks and strokes among 3.3 million Medicare patients. Providers will use a data-driven predictive modeling approach to create personalized risk scores and develop custom care plans with patients to reduce the risk of heart attack or stroke.

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Senior care services provider US CareNet establishes NavCare, a new care management division focusing on chronic care and transitional care management, population health management, and care coordination services for PCPs. The new business line serves 50,000 Medicare patients in Alabama, Florida, Georgia, Illinois, Louisiana, South Carolina, and Texas, with plans to expand its services nationwide.

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Hearst Health and the Jefferson College of Population Health at Thomas Jefferson University accept nominations for the second annual Hearst Health Prize, which recognizes individuals or organizations that have demonstrated improved outcomes through population health management programs. Community Care of North Carolina won the inaugural prize last year for its statewide transitional care program for Medicaid patients. Nominations are due August 26.

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Royal Philips acquires Atlanta-based population health management software vendor Wellcentive. While terms were not disclosed, Mr. H provided some interesting context when the news broke earlier this week.

ZeOmega integrates Forecast Health’s patient risk analytics into its Jiva population health management product, adding the capability to perform predictive modeling based on social determinants of health.

MCM Solutions for Better Health promotes Mike O’Connor to CEO, Amy Gasbarro to president, Tom O’Connor to COO, and Connie Wolf to senior vice president of sales & marketing. Matt Rose (Interlink) has joined the company as vice president of sales and business development.


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JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg

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News 7/21/16

July 21, 2016 News No Comments

Top News

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Theranos attempts to move past its CMS sanctions with the addition of two new hires. Dave Wurtz (Thermo Fisher Scientific) joins the company as vice president, regulatory and quality, to oversee laboratory and device development standards. Daniel Guggenheim (McKesson) joins as chief compliance officer. His will likely be the most high-profile role, given the monumental turnaround task of ensuring the startup follows federal and state health regulations. (I can’t help but question the men’s motivation behind joining such an unstable enterprise, not to mention how the company can afford to pay employees at this point.) The company has also formed a new compliance and quality committee to oversee Theranos executives and directors. Board member Fabrizio Bonanni believes the turnaround “will take forever – it is a never-ending process. We will build a bunch of things first, then we will improve on them, then we’ll be inspected and we’ll get additional suggestions. You will only be as good as the last inspection was. You’ll never rest.”


Webinars

None scheduled in the next few weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Announcements and Implementations

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Healthcare CRM vendor Updox debuts care coordination software for pharmacists that helps them exchange secure messages with physicians, receive transitions of care, and offer patients the ability to schedule services like vaccines and screenings.

Vasco Data Security International launches identity proofing, credential issuance, fulfillment, and authentication services for providers and health IT vendors.


Acquisitions, Funding, Business, and Stock

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Athenahealth EVP and COO Ed Park will step down at the end of this year, transitioning to a seat on the Board of Directors. SVP and Chief Product Officer Kyle Armbrester, who also leads the company’s inpatient efforts, will take over Park’s role. Park has been with the company since 1998. The news came during release of the company’s latest earnings, which included a 20-percent revenue growth over the last six months, and a $2.7 million net loss as of the six months ending June 30. The company added 5,000 new physician and 80 new hospital customers.


People

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Amy Mechley, MD (Christ Hospital Health Network) joins Pershing Yoakley & Associates as a principal within its Strategy & Integration business.


Telemedicine

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Premier Diversified Holdings will acquire up to $500,000 of units (or 2 millions shares) of telemedicine company MyCare MedTech, which provides virtual consults via its GoEvisit app. Premier President and CEO Sanjeev Parsad will take a seat on the MyCare board. The deal marks Premier’s first foray into telemedicine. Its current holdings include medical diagnostic clinics in Canada and China, a reinsurance business based in Bermuda, and a Canadian craft beer brewery.

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Talkspace implements Agora.io’s video-for-telemedicine cloud service as part of its Unlimited Messaging Therapy and LiveTalk Online Therapy programs. The Agora technology will offer Talkspace users higher-resolution, real-time voice and video calls during therapy sessions.


Government and Politics

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CMS hunts for a new CTO. Applications for the position, currently occupied by George Linares, who has been with the agency since 2003, are due by August 21. The selected candidate will “provide executive direction, leadership, and support to the entire organization with regard to the Health Insurance Marketplace,” as well as ensure efficient and effective use of all IT resources related to marketplace programs.


Research and Innovation

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The Patient-Centered Outcomes Research Institute awards Group Health Research Institute $2.8 million to compare methods of measuring blood pressure in confirming new diagnoses of hypertension. Methods will include home BP monitoring, clinic BP monitoring, and taking measurements via retail kiosk. They’ll be compared to 24-hour ambulatory BP monitoring for accuracy, comfort, and convenience. It would be interesting to also determine which method most seamlessly transfers BP readings to physician EHRs.

A survey of 1,000 employees working for large companies finds that a majority believe that workplace health and wellness programs have had a positive impact on their physical health. An even higher percentage – 91 percent – regardless of income or age, noted they would participate more if they were rewarded. Just under 50 percent had participated in a program to help them improve their physical health. I wish the study had dived into what type of rewards employees would respond to most – money, time off, cheaper health benefits …


Other

Denmark for the gold: Danish authorities reveal a nationwide 2015 data breach that occurred when two CDs containing unencrypted health data on 5,282,616 citizens were mistakenly mailed to a firm contracted by China’s embassy in Denmark. Datatilsynet, Denmark’s data protection authority, has verified that personal and health data was exposed in the breach, including national identification numbers.


Contacts

JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg

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News 7/20/16

July 20, 2016 News No Comments

Top News

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The Theranos saga, which Mr. H has admirably been keeping up with at HIStalk.com, veers into physician practice territory with the filing of a lawsuit filed by a patient in Arizona. The lawsuit (the company’s ninth) alleges that the company’s now-invalidated tests contributed to the patient’s heart attack. The patient, who is referred to as “R.C.,” had an annual heart panel done at a Walgreens Theranos facility at the behest of his physician. Though results came back normal, no doubt setting R.C.’s mind at ease, he later suffered an attack. The suit argues that valid testing might have led R.C. to seek additional care, preventing the heart attack. R.C. is also suing Walgreens, which finally cut ties with Theranos last month.


Webinars

None scheduled in the next few weeks. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


People

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Wayne Dix (UnitedHealth Group) joins SSA & Company as vice president, healthcare.

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Zillion promotes Andy Brooks to CFO.


Government and Politics

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The local news gauges consumer reaction to the HHS report addressing privacy and security gaps in apps, wearables, social media platforms, and other entities not covered by HIPAA. When asked if they are bothered by such gaps, or the fact that many vendors sell their health data to third parties, reactions ranged from mild outrage to a total lack of concern:

  • "I guess I feel cheated by just the fact that these companies are selling my personal information and stuff that I’m doing in a gym or walking around my neighborhood and they’re making extra profit off of it.”
  • "My social security number is not really attached to it and you know if they want to know how many hours of sleep I sleep, great! Let them have it. I don’t really see any problem with giving that information.”
  • "I haven’t read the policy. To be honest with you, like, 99 percent probably haven’t either.”

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That last comment reminds me of one of my favorite documentaries, Terms and Conditions May Apply, which “exposes what corporations and governments learn about people through Internet and cell phone usage, and what can be done about it … if anything.” It seems to me that, until consumers call for it, there won’t be much emphasis given to developing more robust standards around the use of consumer-generated health data.


Research and Innovation

An AMGA survey shows that physician compensation in 2015 remained relatively flat, with a 3.1-percent average increase for all specialties.  Emergency medicine (9.6 percent), cardiac/thoracic surgery (8.1 percent), and cardiology (6.9 percent) experienced the biggest jumps. Primary care docs saw saw an increase of 3.6 percent, which is relatively good news given that their compensation experienced a 0.3-percent decrease in 2014.

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A Cybersecurity Ventures survey finds that companies do a lackluster job of managing user passwords for employees with the most access. Twenty-five percent, in fact, have the same level of security for privileged users as they do for standard users. Also alarming is the fact that 30 percent of companies surveyed still have not changed their default passwords on privileged accounts, and 30 percent allow passwords and accounts to be shared. The more these types of studies come out, the more I’m convinced that cybersecurity issues stem from human nature than a lack of technology and protocols.

Interviews with 25 PCPs working within the Johns Hopkins health system (MD) reveal that (surprise, surprise) a majority like some of their patients more than others, though favorite patients may not be the most compliant or similar to the physician. Favorites tend to be those whom the physician has known over a period of time, and/or those the physician has seen more frequently. “Doctors are human too, and as humans we like some people more than others – in both our personal and professional lives,” says researcher Albert Wu, MD. “We want our doctors to be humanistic, and patients benefit from positive regard. It is good to recognize it, to avoid playing favorites, which is different than having favorites.”


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