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News 9/30/14

September 30, 2014 News 1 Comment

Top News

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Apple’s HealthKit health data aggregation system and the apps that use it go live after being pulled previously from the initial iOS 8 rollout due to unspecified bugs. Some HealthKit-powered apps that are back in the App Store after the iOS 8.0.2 update are FitPort, MyFitnessPal, WebMD for iPhone, HealthyNow from Cerner Wellness, and Carrot Fit. Drchrono has also joined the HealthKit club with the launch of its OnPatient PHR with a HealthKit integration on iOS 8. The integration enables patients to import data from the health app into their PHR, and to then send it to their physician.


HIStalk Practice Announcements and Requests

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Today is the last day to submit your company’s information for inclusion in our annual MGMA “Must-See" Exhibitors Guide. (Don’t worry, it won’t take more than five minutes.) Current HIStalk sponsors are invited to fill out this brief form to ensure a spot in the digital guide. We’ll also include contact information for companies not exhibiting but looking to schedule one-on-one meetings.

Mr. H created a new poll at HIStalk.com that I consider very appropriate to share with the HIStalk Practice community: Is it OK for an EHR vendor to block system access to a late-paying practice or hospital? Leave a comment after voting with your thoughts.

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Don’t miss the latest DoD EHR update from Dim-Sum. I chuckled while reading his words on Intermountain joining Team Leidos. They thought-provokingly tumble after one another in the same manner as his webinar presentation a few weeks ago.

Watching: Life hacks from the Crazy Russian Hacker. Taras Kulakov seems to have found a way to do everything in life better, and presumably make a living documenting it all on YouTube. If only the healthcare industry could incorporate change just as easily. Check it out.


Webinars

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October 7 (Tuesday) 1:00 pm ET. Breakthrough Research and the Digital Consumer: Achieving Results Using Online Content. Presented by DocuSign. Presenters: BJ Rimel, MD, associate director of gynecologic oncology clinical trials in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center; Jennifer Royer, head of life sciences product marketing, DocuSugn. Learn how Dr. Rimel has achieved breakthrough results using a digital consent process for women’s research trials. The impact that Cedars-Sinai has achieved in digitizing and simplifying a previously cumbersome, paper-based process paves the way for doctors and researchers around the world to improve treatments.


Acquisitions, Funding, Business, and Stock

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Conifer Health Solutions agrees to acquire physician practice business solutions vendor SPi Healthcare for $235 million. SPi CEO John O’Donnell will join Conifer’s senior management team, reporting to President and CEO Stephen Mooney. The transaction is expected to close in Q4 2014.


Announcements and Implementations

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Quillen ETSU Physicians (TN) goes live on the Allscripts FollowMyHealth patient portal. Other area medical groups, including State of Franklin Healthcare Associates (TN) and Mountain States Health Alliance (TN) clinics will follow later this week.

Mobile health technology company Generation One and employer healthcare payment technology firm Difference Card join the Population Health Alliance.

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The Hutchinson Clinic (KS) implements a telemedicine program to offer diagnosis and consulting services to patients in rural areas and the state prison system. Clinic IT department spokesman Bob Davidson notes cost for the setup is about $700 per doctor, while cost to the agency coordinating the services can range from $10,000 to $50,000, depending on the equipment required.

Practice Fusion announces that its customers will soon be able to order, manage, and receive lab test results within its EHR through Quest Diagnostics. Physicians will also have the option to share test results with patients through the Patient Fusion portal.

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Christopher Rural Health Planning Corp. (IL) implements the eClinicalWorks EHR at its 13 locations. The federally qualified health center will also implement eCW’s patient portal, check-in kiosk, and scribe aid.

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Office Ally integrates the new OA-Rx e-prescribing module into its Practice Mate PM software and EHR 24/7 application. The news follows last month’s announcement that over 100 healthcare labs nationwide have connected to EHR 24/7. The company is partnering with Surescripts to link with 93 percent of US pharmacies.


Government and Politics

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Code for America narrows its mission to focus on supplying free and open-sourced tech development for government services to three areas – health, economic development, and safety and justice. CfA will focus on tasks that will coordinate healthcare IT development and match-make apps to community pain points. Rebecca Coelius, CfA’s new health portfolio lead, noted that, “It’s not just about the people who receive services … it’s also about the people who are public servants within our systems who often have inadequate tools to get the job done."

An investigation finds that HHS paid WebMD $14 million to promote the Affordable Care Act.

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The Telecommunications Industry Association and a dozen other industry groups send a letter to the House Energy & Commerce Committee urging Congress to address gaps in Medicare that limit patient access to new technology. Specific requests mentioned in the missive include:

  • Authorize use of telehealth for all ACOs and bundled payments programs.
  • Authorize remote patient monitoring for congestive heart failure and chronic obstructive pulmonary disease, and diabetes in the case of federally qualified health centers FQHCs.
  • Authorize the use of telehealth payments for population health management to include all critical access hospitals and FQHCs.
  • Facilitate care for Medicare patients by allowing video visits and remote monitoring.

Research and Innovation

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Dartmouth-Hitchcock’s Center for Telehealth partners with Dartmouth Athletics and Recreation to put a telemedicine robot on the sidelines at home football games. The robot is part of a Dartmouth initiative to provide real-time, emergency clinical support via telemedicine to the school’s 34 Division 1 varsity athletic teams.

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This article highlights the impact Apple Watch will have on burgeoning technologies like Curious. The platform synthesizes genetic information, microbiomic profiles, personal traumas and life events, and biometrics collected by wearables, and then analyzes it to help users understand what’s causing, helping, or exacerbating various health conditions. The startup goes into beta testing in November. Curious co-founder Linda Avey also co-founded 23andMe.

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An AHIMA study presented at the association’s annual conference finds that top priorities for physicians making the transition to ICD-10 include EHR software readiness, increasing documentation specificity and time, and overcoming inadequate training methods and content. This year marks the first in four that I have missed the conference. I’m a bit bummed I didn’t have an excuse to travel to San Diego for keynotes from celebrity digital health practitioner Eric Topol, MD and ONC National Coordinator Karen DeSalvo, MD. I’ll happily experience the conference vicariously through reader reviews. Feel free to send me your impressions and images of the event.

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Research finds that 42 of 50 medical devices cleared by the FDA over five years lack data verifying their safety and effectiveness, despite a law that calls for sufficient detail to justify their FDA clearance. With reports of caregivers hacking into medical devices for easier use, it seems the FDA has its work cut out for it when it comes to truly verifying the aforementioned attributes, not to mention security.


Other

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The Medical Association of the State of Alabama attempts to make its case for further delay of ICD-10 with a list of “Top 10 Craziest ICD-10 Codes.”

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Local media highlights the growing frustration many small-practice physicians have with EHRs. Comments from Jacqueline Fincher, MD stand out:

“The recording of so much extraneous information as part of the clinical record is putting so much garbage in the charts that is not medically relevant and makes the important medical information like a needle in a haystack at times.”

“When I review an ER report or other report from another physician or hospital, I just want to quickly and concisely know — why was the patient there and what did you do for the patient. You’d be shocked how difficult and how long it takes to wade through pages and pages of irrelevant information just to get to the important stuff that helps me and others take care of the patient.”

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The HITRUST cybersecurity alliance issues a warning to the healthcare industry regarding the Shellshock software vulnerability: “We base the assessment that Shellshock is a more serious vulnerability than Heartbleed on the ability of potential perpetrators to use the exploit to craft malicious code that enables them to gain complete control of a compromised server. HITRUST recommends organizations review their information security controls, or if unable, then focus on those specifically related to cyber security.”


People

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Bennett Lauber (The Usability People) joins the ONC Health IT Policy Committee: Implementation, Usability, and Safety Workgroup.

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Morris Collen, MD (Kaiser Permanente) passes away at the age of 100. Cullen was a founding partner of The Permanente Medical Group, and is considered to be “a pioneer in the use of computers in medicine.”

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Mark Savage (National Partnership for Women & Families) and Beth Ginzinger (Anthem Blue Cross), RN join the Cal INDEX board of directors.


Sponsor Updates

  • Billian’s HealthDATA shares 10 recent healthcare CIO placements.
  • Greenway becomes the first ambulatory information provider to have a solution recognized as a Validated System by Healtheway’s eHealth Exchange Product Testing Program.
  • Aprima offers electronic prior authorization through Surescripts connection.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

News 9/25/14

September 24, 2014 News No Comments

Top News

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Hospital operator HCA announces that it will acquire privately held physician systems vendor PatientKeeper. Terms were not disclosed, and the acquisition is expected to close by the end of the year. Mr. H broke the news earlier this week, including inside scoop on the acquisition from PatientKeeper President and CEO Paul Brient.


HIStalk Practice Announcements and Requests

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There’s still time to register for today’s 1 pm ET HIStalk webinar on Using BI Maturity Models to Tap the Power of Analytics. Join panelists from Siemens Healthcare and HIMSS Analytics as they provide an overview of BI maturity models and how they can be leveraged to optimize clinical, financial, and operational decisions.

There are just a few days left to be a part of our annual MGMA “Must-See" Exhibitors Guide. Current HIStalk sponsors are invited to fill out this brief form by September 30 to ensure a spot in the digital guide. We’ll also include contact information for companies not exhibiting but looking to schedule one-on-one meetings.


Acquisitions, Funding, Business, and Stock

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Allscripts and Citra Health Solutions (formerly Orange/MZI) announce a partnership to make their services available to each other’s customers. Citra, which unveiled its new name and branding at the Allscripts user group meeting last month, offers strategic advising, value-based management, patient engagement, care programming, quality improvement programming, client benefit administration, claims adjudication, and technical care management capabilities.

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Athenahealth is accepting applications for its More Disruption Please Accelerator program. The accelerator will provide portfolio companies with seed funding; free office space; ongoing mentorship from company experts, advisors-in-residence, and partners; and exposure to its client base. Applications will be accepted on a rolling basis, with an expected residency period of eight to 12 months for each portfolio company.


Announcements and Implementations

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Meadowcrest Family Physicians (FL) selects population health management and analytics solutions from i2i Systems. The father-son physician team (soon to be joined by a second son) serves 2,500 mostly-Medicare patients.

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Multispecialty medical practice GW Medical Faculty Associates Inc. partners with Remote Medical International to provide global telemedicine services to companies with employees working in remote areas. Industries served will likely include offshore energy, yachting, commercial maritime, shipping, and fishing.

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Online appointment scheduling company ZocDoc rolls out its services to patients in Utah. The app is already available in 40 states and 2,000 cities.

Surescripts announces the addition of four pharmacies and three EHR vendors – Amazing Charts, Aprima, and digiChart – to its Immunization Registry Reporting service.


Research and Innovation

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A four-month study on the effect of mobile technology on health behaviors finds that participants are more active and engaged in their health as a result of receiving two text messages and one email related to chronic disease management each week. Lead investigator Kristynia Robinson noted that, “We saw a significant increase in interest in the use of technology just by having the participants use the iPad to collect data pre and post. They want to use technology. They want to learn about it.”

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A survey of 62 ACOs reveals that poor interoperability between organizations remains a big barrier to improving clinical quality. Additional findings include:

  • 100 percent of respondents find access to data from external organizations challenging.
  • 95 percent find interoperability of disparate systems to be a significant challenge.
  • 90 percent feel the cost and ROI of HIT has become a key barrier to further HIT implementation.
  • 88 percent face significant obstacles in integrating data from disparate sources.
  • 83 percent report challenges integrating technology analytics into workflow.

Government and Politics

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The President’s Council on Fitness, Sports & Nutrition and Sharecare launch the UltimateMe wellness platform. Part of Operation Live Well’s year-long Healthy Base Initiative, the online tool is designed to help the military community assess, manage, and improve their health.

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An analysis of government contracts finds that Healthcare.gov has cost $2.1 billion thus far, exceeding the $834 million cost estimates originally provided by the White House. CMS spokesman Aaron Albright has disputed the figure, saying that “The GAO, HHS’s Inspector General and the department all measured the cost of marketplace-related IT contracts for Healthcare.gov, but this report measures different things, and not surprisingly, produces a different number.” I’ll be very interested to see how this financial difference compares to  estimates and ultimate totals for the DHMSM project.

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The Pharmaceutical Research and Manufacturers of America, BIO, and AdvaMed join several other dozen industry trade groups in complaining to CMS about its decision to withhold one-third of the payment information submitted by drug and device makers to the Open Payments database. CMS has not responded to their concerns, instead reminding industry watchdogs that, “… we are less than a week out [from the launch], so you can imagine that our single focus has been on meeting the mark” for September 30.”


People

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Doximity hires Emily Peters (Uncommon Bold) as VP of marketing communications and Peter Alperin, MD (Kelvin) as VP/GM of connectivity solutions. 


Other

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Nearly 300 physician practices in Texas receive the Texas Physician Practice Quality Improvement Award for effectively using healthcare IT to educate and provide exceptional preventative services to patients.

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Farzad Mostashari, MD and Bob Kocher, MD trumpet the success of ACOs, specifically focusing on Rio Grande Valley Accountable Care Organization Health Providers. They give EHRs time in the spotlight, noting that “From the beginning, physicians in the Rio Grande Valley ACO analyzed data from their electronic health records to identify – and then focus on – high-risk patients.” It’s worth noting both Mostashari and Kocher are ex-Obama administration employees with ties to physician ACO consulting firm Aledade.

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“Is that a new iPhone in your pocket?” becomes a popular question as users of the newest versions discover their devices are more flexible than they should be. This is likely only a problem for men, who seem to keep personal belongings in pockets far longer than they (obviously) should.

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Owensboro Medical Practice alerts 3,000 patients of a data breach caused by ex-employees looking for a quick and unethical way to attract patients to a business they attempted to set up in 2011.

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That wearable giving you a guilt trip? Try installing this art project in your workspace and see how quickly you reach 10,000 steps, all while meeting deadlines.


Sponsor Updates

  • Alan Rosenstein, MD, an expert in disruptive physician behavior, posts a PerfectServe article titled “Emotional Intelligence – Understanding Patient, Staff, and Physician Needs.”

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

News 9/23/14

September 22, 2014 News No Comments

Top News

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The U.S. House Committee on Oversight and Government Reform publishes “Behind the Curtain of the Healthcare.gov Rollout,” a 26-page report that makes plain for all to see the insider bickering that took place last fall as the federal healthcare marketplace prepared to go live. (Mr. H published a few of the choicer comments emailed between CMS and HHS staffers here.) A quick scan of the report’s table of contents makes me wonder whether I’m about to read a government document or a spy thriller. The report contends that “there is also evidence that the Administration, to this day, is continuing its efforts to shield ongoing problems with the website from public view.”


HIStalk Practice Announcements and Requests

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Don’t miss your chance to be a part of our annual MGMA “Must-See" Exhibitors Guide. Current HIStalk sponsors are invited to fill out this brief form by September 30 to ensure a spot in the digital guide. We’ll also include contact information for companies not exhibiting but looking to schedule one-on-one meetings.

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Watching: Hyperdrive, a BBC comedy that ran for two seasons from 2006-07. (Netflix suggested it to me after I finished watching the dark Simon Pegg comedy Burke and Hare.) If you’re a fan of British humor (i.e. the kind only understood by those who have lived there), cheesy science fiction sit-coms, and Nick Frost, this show’s for you.


Webinars

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions, and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in the “It’s All About the Data” series, the presenters will review the pressing need for data governance and smart strategies for implementing IT using strained resources.


Announcements and Implementations

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Community Health Center of Southeast Kansas and Health Partnership Clinic (KS) select EHRs from eClinicalWorks for their 12 combined locations. The affiliated federally qualified health centers will also implement eCW’s revenue cycle management services.

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Athenahealth announces expansions in Atlanta and San Francisco. The company seems to love mixed-used developments that involve a certain degree of revitalization. It has refurbished 75,000 square feet of space in Atlanta’s new Ponce City Market, and taken over 56,000 square feet of office space in the San Francisco South of Market district. It expects to create over 1,000 jobs over the next two years at its combined locations.

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The New Jersey Innovation Institute’s Healthcare iLab develops a “turnkey” IT system for the Osler Health physician network. The system, which includes MDclick population health management and analytics technology, will roll out to an initial 50 physicians in northern New Jersey this fall.

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eVisit launches a cloud-based telemedicine platform for small and medium-sized physician practices that integrates video, text message, email, and phone calls. It also features e-prescribing capabilities and reimbursement software.

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Cloud services and IT support provider TekLinks partners with Greenway Health to offer hosted PrimeSUITE EHR software service to Greenway customers in the Southeast.


Acquisitions, Funding, Business, and Stock

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Telemedicine startup Fruit Street Health secures $500,000 in initial seed funding from a group of physicians and healthcare executives. The investment timing is opportune, as the company hopes to launch its product, which includes video, wearable technology, and other telemedicine components, later this year.

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Teladoc raises $50 million, bringing its total investments to around $100 million. The company, which announced a partnership with healthcare price transparency business Castlight Health earlier this year, offers around-the-clock telemedicine access to physicians via phone or video consultation.

Cerner gets Federal Trade Commission approval to acquire Siemens Health Services with early termination of the waiting period, keeping the acquisition on track for Q1 2015.


Government and Politics

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CMS Administrator Marilynn Tavenner announces that the agency will carry out 28 Healthcare.gov security recommendations from the Government Accountability Office before the next open enrollment period begins on November 15. The announcement, made during her recent questioning by the House Committee on Oversight and Government Reform, came with an added promise that, “Our intent is to complete a full end-to-end [security test] later this month or October.”

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This article highlights the heightened financial frustration many physicians feel as a result of the CMS revelation that it won’t be ready to review Meaningful Use attestations by the October 1 deadline. It has not offered any further commentary on the “glitch” that is preventing physicians attesting for the first time, though rumor has it everything will be cleared up by October 15.

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The Australian Defence Force goes over its EHR implementation budget by $77 million – doubling its original budget to $133 million. Project Manager Rear Admiral Robyn Walker noted that “[The problem] was not around the software. It was more about how we implemented the change and implemented the system as a full program.” The project is being rolled out by familiar players that include CSC and PriceWaterhouseCoopers. I wonder if future DHMSM project managers will learn a thing or two from Australia’s roll out to just 82,000 staff and reservists.


Research and Innovation

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A new study digs into the digital communication preferences of physicians in the U.S., U.K., Germany, and France. Startups take note: Thirty-nine percent of U.S. physicians surveyed think a scheduling app would be helpful for patients to record symptoms over a certain period of time prior to consultation.

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Researchers conclude that EHRs can prevent physicians from accidentally harming patients. Their study found that implementing an EHR capable of alerting providers to possible medication order mistakes and guiding their decision making lead to a 30-percent decline in medication-related safety events and a 25-percent decline in complications as a result of treatment.


People

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Doug Fridsma, MD steps down as ONC Chief Scientist to become president and CEO of the American Medical Informatics Association.

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Captain Alicia Morton (ONC) is appointed director of the ONC Health IT Certification Program.


Other

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Cerner and athenahealth say they, like Epic, are working on integrating their systems with Apple’s HealthKit. Athenahealth will test its "proof of concept" application with non-profit Hudson Headwaters Health Network (NY), while Cerner will work with “focused, smaller organizations.” Both will focus initial HealthKit development on apps for patients with chronic diseases.

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CompuGroup blocks Full Circle Health (ME) from accessing the digital records of 4,000 patients due to $20,000 worth of unpaid bills, which FCH acknowledges but says is related to an unresolved billing dispute over  unexpected maintenance fees and charges for hardware never delivered. FCH implemented HealthPort’s EHR in 2010, paying $30 in monthly maintenance fees. That fee skyrocketed to $2,000 when CompuGroup acquired HealthPort’s EHR business 18 months later. Seems to me there’s a direct correlation between unpaid EHR bills and patient safety.

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The local paper profiles Family Practice Associates and its journey to become part of the Southeastern Rural Physicians Alliance – Accountable Care Organization, a group of 10 independent practices in Nebraska. “We’re either visionaries or fools,” says Bob Rauner, MD, who started the ACO with other physicians within the Nebraska Academy of Family Physicians. “We’ll find out which in a year and a half.”


Sponsor Updates

  • ADP AdvancedMD’s EHR earns ONC-ACB certification as a Complete EHR.
  • EClinicalWorks names several ACO clients that are generating savings after deploying its CCMR.
  • ESD’s Phil Sierra discusses the value of healthcare IT in a recent blog.
  • McKesson Specialty Health announces that its My Care Plus patient portal now reaches over 100,000 oncology patients.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.

JennHIStalk

CMIO Rant with … Dr. Andy

September 19, 2014 News 3 Comments

Now Why Didn’t I Think of That?
By Andy Spooner, MD

I am sure the AMA meant well in its statements demanding some changes to how the business of designing and implementing EHRs should go. I like the spirit in which the statements were offered. I see that these statements resonate with physicians. The problem is that I am not sure what action to take in response to them.

I have worked with several EHR companies, and all of them do all of these things that the AMA recommends— even companies that are small or struggling – at least the things that are within their control.

Some of the items on the list are not really within the control of the software at all. For example, the AMA recommends that "EHR systems … should … allow physicians to delegate tasks as appropriate.” Isn’t this more a matter of policy than software design? If it is acceptable from a regulatory standpoint to delegate some data-management task, I don’t really know how an EHR could prevent one from delegating it. The AMA could really help by lobbying against regulations that require overly detailed physician documentation, like the CMS E & M coding guidelines, which really set a floor of complexity below which we cannot sink.

The statements are also somewhat self-contradictory. For example, we are supposed to expect our EHRs to "reduce cognitive workload,” and at the same time "track referrals, consultations, orders, and labs so physicians easily can follow the patient’s progression throughout their care.” The latter entails a massive “cognitive workload.” To do all this tracking on paper would be intractable; therefore we did not do it, and had a lower “cognitive workload” as a result. The EHR at least gives us a way to track all this stuff, but one still must take a look at the data and react to the fact that Patient X never made it to see the cardiologist you referred them to. On paper, you might never have known this until they came back in for a future appointment (if you could even find the note where you mentioned the referral). In the EHR, you can track this stuff prospectively or post-hoc … either way, there’s “cognitive workload.” Is this workload the fault of the system that makes it possible for you to do what was impossible before?

The fundamental “problem” with EHRs is that they allow us to do more. For example, we can comply with documentation regulations at a level far exceeding what was ever possible on paper. We can examine information that was simply not available before. We can track things. We can review the lifetime clinical record. We can peer into the practice of multiple specialists. We can obtain records from providers located hundreds of miles away in seconds — even if they do not use the same brand of EHR we use. We can see which prescriptions got picked up, and which did not.

On paper, we got accustomed to lack of access to information. Now that we have more, we want to give our patients the very best service possible by reviewing all of it. We should review all of it. We need to realize that access to information is not a design flaw … it’s what we’ve wanted since the earliest visions of EHRs. It comes at a cost, but most people would agree that it is our job to synthesize what we know and can know about a patient.

The other big contradiction in the statements seemed to assume that user input is not being sought by those who design EHRs. If anything, EHR designers seek too much user input, trying to make the systems do all things for all people and making these systems, following the exact advice of the AMA, “customized for each practice environment.” Customization can be really good, but it does not tend to make software simpler. I have heard people ask why the EHR can’t work more like an iPod. Part of the reason it cannot is that the iPod user interface was not designed by trying to accommodate every conceivable use of the device. Steve Jobs openly eschewed focus groups for a reason. I am not suggesting the same approach for the EHR industry. But customization begets complexity. And we work in a complex profession.

I went for a checkup the other day. My internist and I went through my chart, reviewing meds, ED visits, consultant reports, family history, and so on. In the old days we might have just shot the breeze for a few minutes, and I might have brought up a few tidbits of stuff I remembered about my medical past. And that’s all he’d have to work with. He has more to work with now. I feel like he knows me, and can give me good advice. The visit probably took longer than it might have in a less information-rich time. Is that bad?

My recommendations to the AMA would be:

  1. Lobby to simplify E & M coding guidelines. Make reimbursement guidelines more about time than the number of bullets you can document.
  2. Set a professional standard that text should not be copied forward, since reading the same paragraphs over and over (placed there for bogus "billing purposes”) is unnecessary.
  3. Promote reimbursement incentives for those who use choose to use time-saving, existing tools to summarize the patient’s state, like the problem list.
  4. If it is thought that there is a minimal number of clicks or certain kinds of displays that are acceptable to do something, write a specification and lobby to make it part of an incentive program. Personally, I am skeptical that such a specification is possible to create, but there is probably much to be learned in proving me wrong.
  5. Work to align AMA policy with the literature on EHRs. If there are gaps in that literature (there are), encourage the filling of those gaps in AMA journals so that statements like “the quality of the clinical narrative in paper charts is more succinct and reflective of the pertinent clinical information” or “these products have performed poorly in real-world practice settings” have some objective basis.
  6. Get to know people at EHR companies and align statements with what they are actually doing. Commission an article for JAMA that explains how this industry really works. Include interviews with the physicians who do the design — there are lots of them.

We have all experienced clinical software that seems like it could be more elegant or functional. The fact that EHR software creators (both the commercial providers and the home-grown shops) continue to publish upgrades is testament to that. All of those upgrades reflect a desire to achieve the goals the AMA articulates, while continuing somehow to maintain stable software and respond to a torrent of user feedback to allow the software to work better within the team-based workflows we all use. Organized medicine could really help things along by setting professional standards, promoting advancement of knowledge, and, most importantly, by lobbying for regulations that reduce complexity of the practice of medicine.

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Andy Spooner, MD, MS, FAAP is CMIO at Cincinnati Children’s Hospital Medical Center. A general pediatrician, he practices hospital medicine when he’s not enjoying the work involved in keeping the integrated HER system useful for the pediatric specialists, primary care providers, and other child health professionals in Cincy.


News 9/18/14

September 17, 2014 News 1 Comment

Top News

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Congresswoman Renee Ellmers (R-NC) introduces the Flexibility of Health IT Reporting Act of 2014, which if approved would allow providers to report HIT upgrades in 2015 through a 90-day reporting period as opposed to a full year. In addition, providers would have the option to choose any three-month quarter for the EHR reporting period in 2015 to qualify for Meaningful Use. Introduction of the act coincides with a letter to HHS Secretary Sylvia Burwell from 16 industry groups calling for similar adjustment.


HIStalk Practice Announcements and Requests

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Thanks to all of the HIStalk sponsors that have requested to be a part of our annual MGMA “Must-See" Exhibitors Guide. Don’t worry, there’s still time to participate. Fill out this brief form by September 30 to ensure a spot in the digital guide. We’ll also include contact information for companies not exhibiting but looking to schedule one-on-one meetings.


Webinars

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Today (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

September 25 (Thursday) 1:00 ET. Using BI Maturity Models to Tap the Power of Analytics. Presented by Siemens Healthcare. Presenters: James Gaston, senior director of maturity models, HIMSS Analytics; Christopher Bocchino, principal consultant, Siemens Healthcare. Business intelligence capabilities are becoming critical for healthcare organizations as ACOs and population health management initiatives evolve in the new healthcare marketplace. The presenters will explain how BI maturity models can help optimize clinical, financial, and operational decisions and how organizations can measure and mature their analytics capabilities.

September 26 (Friday) 1:00 ET. Data Governance – Why You Can’t Put It Off. Presented by Encore, A Quintiles Company. Presenters: Steve Morgan, MD, SVP for IT and data analytics and CMIO, Carilion Clinic; Randy Thomas, associate partner, Encore, A Quintiles Company. In this second webinar in a series, “It’s All About the Data,” the presenters will review the pressing need for data governance and smart strategies for implementing it using strained resources.


Acquisitions, Funding, Business, and Stock

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Doc Halo and American Messaging Services enter into a revenue-sharing agreement and partnership that will deliver a combined suite of mobile health, secure communication, and critical messaging technologies to healthcare providers. American Messaging will also acquire a 25-percent equity interest in Doc Halo.

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The CEO Council on Health and Innovation, which includes leaders from Verizon, Walgreens, Coca-Cola, Aetna, and Bank of America, challenges business leaders to formally quantify and share ideas and data on company wellness practices and outcomes. Their advocacy ties into the release of a similarly themed report and initiative at the Bipartisan Policy Center.


Government and Politics

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This article predicts that former U.S. CTO Todd Park will be subpoenaed by Washington, D.C. lawmakers in order to force him to testify about Healthcare.gov’s security flaws before a subcommittee of the House Science, Space, and Technology Committee. Park has refused to testify before the Science Committee on multiple occasions without a subpoena. I’m sure the use of one will make him that much more willing to “come clean” about the security failings of the federal insurance marketplace.

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U.S. Digital Service Administrator Mikey Dickerson shares Healthcare.gov war stories with the O’Reilly Velocity New York Conference audience: “Amazingly, there was no sense of urgency, because this was just like any other government project. Government IT contracts fail all the time. There was almost no place where we could point to a decision and say we’d made the right one. We didn’t expect to fix this. We just gave it our best shot, because somebody had to. Most of this was labor-intensive, but not very hard.”


Announcements and Implementations

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Madison Radiology Medical Group implements Meaningful Use-certified eRAD RIS with Speech Recognition. The group, which has been an eRAD PACS customer since 2001, plans to start attestation for Meaningful Use right away.

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IDC Health Insights launches Healthcare IT Services Strategies, an advisory service that provides data and analysis to suppliers and purchasers of IT services to help them save time, reduce cost, and mitigate risk.

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An investment group affiliated with Goldman Sachs invests $400 million to fund the expansion of Privia Health, a physician-led ACO and population health technology company. Investors have set up holding company Brighton Health Group to align with Privia and help prioritize its expansion into eastern U.S. markets.

Wide River partners with 4Medapproved to offer its customers 4Medapproved’s online education and certification resources. 4Medapproved’s customers will, in turn, be introduced to Wide River’s healthcare IT consulting services.

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The Kentucky Health Information Exchange unveils the myhealthnow patient portal, developed in collaboration with NoMoreClipboard. The portal rollout is in pilot phase with an unspecified number of healthcare facilities across the state. It is expected to be available to the public for use later this year.

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Surescripts adds four pharmacy benefit management companies and six EHRs to its electronic prior authorization service.

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GlobalMed introduces the ClearSteth Digital Stethoscope, which is capable of sending sounds within the body to an off-site healthcare provider. The digital stethoscope can then save the audio file in a patient’s EHR.


Research and Innovation

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A new study finds, not surprisingly, that consumers who use social networks – especially those with chronic diseases – are more likely than those who don’t to search for health information online. It also found that there is still a significant gap between the online health information gathering habits of older men with low incomes and minorities, and those of women and people with higher incomes. None of this is particularly revealing in and of itself. Study results should, however, temper the enthusiasm of those who think Apple’s entry into healthcare will be the game changer that patients truly need. There are too many consumers who are not sporting the latest smartphone or overly interested in quantifying themselves to provide Apple with the critical mass it needs to shake up healthcare outcomes.

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New research estimates that the global  mobile health market will account for over $13 billion in 2015, and could represent up to $290 billion in annual healthcare cost savings worldwide by the end of next year. It also predicts that wearable devices will account for over 150 million unit global shipments by the end of 2020. That kind of prediction may not represent critical mass, but it does prove that Apple can make a significant impact if it plays its cards right.


Other

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Steven Waldren, MD, director of the American Academy of Family Physician’s Alliance for eHealth Innovation, breaks down the Meaningful Use final rule and the definition of certified EHR technology. He notes that “The AAFP has articulated to CMS and ONC that not changing the 2015 reporting requirements means this is still a large stretch for many physicians.”

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Epic has been in the news this week thanks to its gigantic user group meeting in Verona. While the company mainly grabs hospital-centric headlines, I can’t help but comment on the contrast between the amount of money in the room above, and recent headlines that the state of Wisconsin needs $760 million more to pay for healthcare for the needy over the next two years. Epic may be partly to blame: Part of the added cost to taxpayers for the state’s needed Medicaid programs also comes from automatic decreases in federal aid that are being triggered because of Wisconsin’s improving economy.

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Family physician Eugene Heslin, MD reacts to recent reports that physicians lose 48 minutes each day due to EHR use:

“Efficiency need not be measured solely in terms of minutes required to use the electronic record. It should also be evaluated in terms of the quality of care and savings derived from reducing the number of costly, redundant lab tests and X-rays and reducing the number of patients who need to be admitted or re-admitted to a hospital. This level of efficiency requires electronic health records, and importantly, requires the ability to interconnect these electronic systems.”

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Ruth Ann Crystal, MD tweets a picture of either the latest physician fashion accessory, or a bold statement on the current state of reimbursement.


Sponsor Updates

  • Flagler Hospital (FL) chooses Allscripts dbMotion to connect community EHRs.
  • Billian’s HealthDATA makes its searchable Vitals hospital news and RFP feed available at no charge. 
  • Allscripts offers a short list of dos and don’ts of clinical IT deployment based on a new Alberta Health Services case study.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

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Reader Comments

  • The Alchemist: RE: Crazy Russian Hacker. Очень, очень хороший ... Полностью потрясающий!! A great purpose for paper - entertainm...
  • Tom Banaski: It seems to me MU will succeed in only complicating the delivery of Healthcare or extending the physician's day (and str...
  • Jeannie Marcus: I read the AMA recommendations with interest. I think the underlying issue is that there are not enough physician clinic...
  • Chip Hart: Bravo. Too many folks seem to forget that EHRs exist for payment support, not clinical improvement. Until the docs are...
  • Craig Joseph, MD: As usual, kudos to Andy Spooner for writing what many of us in clinical informatics were thinking. I actually thought mu...