News 7/22/14

Top News

Azalea Health agrees to merge with simplifyMD in an effort to become a leading provider of a fully integrated, cloud-based healthcare management and medical billing solution. The Georgia-based companies will operate as simplifyMD and Azalea Health during the transition, with the products and services of both marketed under the Azalea Health brand. Azalea founder and CEO Baha Zeidan will lead the new company.

A new study from the Associated Press-NORC Center for Public Affairs Research analyzes the public’s opinion of the quality of healthcare providers. Key findings include:

• Most patients focus on a physician’s personality traits rather than effectiveness of care or outcomes.
• An overwhelming majority of patients believes that requiring doctors to report the effectiveness of their treatments and patient satisfaction with care would improve the quality of care provided.
• Less than a quarter of patients are receiving provider quality information, and most are not very confident they could find such information they can trust on their own, including direct comparisons of physicians.
• Patients would trust word-of-mouth and personal recommendations from doctors far more than provider quality data from the government or third parties.
• About half of those surveyed believe that higher quality care generally comes at a higher cost, while 37 percent say there is no real relationship between quality and cost.
• Patients without insurance face more challenges in finding information about provider quality and cost; at the same time, they are more likely than the insured to think public reporting of such information would improve the overall quality of care doctors provide.

It’s fairly telling that the top physician characteristic most valued by patients is the ability to listen and be attentive – two characteristics many physicians feel are being lost thanks to the intrusion of EHRs into the exam room.

HIStalk Practice Announcements and Requests

It’s that time again. The HIStalk Practice Reader’s Survey is now live. I am looking forward to learning about what readers like and don’t like, and what you’d like to see more and less of on the site. The survey is short, so shouldn’t take more than five minutes. One lucky respondent will receive an Amazon gift card for taking the time to help me make HIStalk Practice even better.

Reminders: Providers and consultants are welcome to share an “Idea of the Day” with the HIStalk Practice audience.

Watching: The Grand Budapest Hotel. Director Wes Anderson isn’t for everyone, but in my book he can do no wrong, especially when it comes to casting, soundtracks, and Lego tie-ins. Coincidentally, I saw The Lego Movie around the same time, which was just as good, though in an entirely different way.

Acquisitions, Funding, Business, and Stock

Castlight Health and Teladoc partner to offer customers the ability to integrate Teladoc’s telemedicine offerings into Castlight’s technology. Employees that use Castlight’s platform to search for medical services will now be presented with telemedicine options as available.

Microsoft announces that it will cut 18,000 jobs in the next year – 14 percent of its workforce – as it moves forward with plans to consolidate its Smart Devices and Mobile Phones units. The map above shows the regions around the world that will see the most change in operations, including Finland, where hardest-hit Nokia, acquired by Microsoft earlier this year, is headquartered.

Online doctor search vendor BetterDoctor closes $10 million in Series A funding. Company founders Ari Tulla and Tapio Tolvanen are both Finnish and former high-ranking Nokia software developers. I assume some of their Finnish Nokia colleagues are part of the 1,000 jobs being downsized in that country.

Athenahealth announces Q2 results: revenue up 27 percent, adjusted EPS $0.32 vs. –$0.08, beating expectations for both. Mr. H summarized the company’s recent earnings call here, noting the current state of the company’s More Disruption Please program and the “big miss” that is Epocrates. 

Announcements and Implementations

Cornerstone Pediatrics implements Lathem’s PayClock Online time and attendance system. Practice Manager Angela Howell notes the cloud-based system’s easier accessibility has enabled her to cut payroll time in half.

EHNAC announces the Accountable Care Organization Accreditation Program for ACOs and related IT service organizations. ACOAP assesses network infrastructure and exchange connectivity in the areas of confidentiality and privacy, and technology processes and security; and focuses on technical performance, business processes and resource management. The announcement comes on the heels of EHNAC’s partnership with WEDI to establish a Practice Management System Accreditation Program.

Harbin Clinic (GA) and Cigna launch a collaborative care initiative that will benefit 5,300 Cigna customers. The program aims to improve outcomes and lower costs by using patient-specific data from Cigna to help identify patients being discharged from the hospital who might be at risk for readmission, as well as patients who may be overdue for health screenings or who may have skipped a prescription refill. Harbin Clinic is making quite a name for itself when it comes to rural healthcare facilities participating in new care models and technologies. Last year it participated in the MyJourney Compass pilot project, which provided cancer patients with Nexus 7 tablets to help them securely communicate with providers, access health information and obtain credible information online.

The Population Health Alliance announces four new member organizations: behavioral change company Coach Alba; power and related-technologies provider Cummins Inc.; Kognito, a behavior change company that specializes in immersive experiences; and health optimization firm Welltok.

Government and Politics

ONC head Karen DeSalvo, MD says in a recent interview that by 2015 the office will have an interoperability road map "that is specific enough that people will know what they’re supposed to do when." That will no doubt come as welcome news to physicians and vendors who read the agency’s recent 10-year vision for interoperability report but were left with questions around timing. I wonder if DeSalvo feels the need to speed up interoperability efforts before ONC’s funding dwindles further, and the private sector siphons off more ONC leadership.

DeSalvo also responds to House Energy and Commerce Committee members who questioned ONC’s regulatory authority earlier this summer, particularly as it pertains to the creation and oversight of the Health IT Safety Center. She notes that the Proposed Strategy and Recommendations for a Risk-Based Framework report did not propose that the Health IT Safety Center would have the authority to regulate health IT, and that a possible plan to levy user fees on companies appears to be outside of the ONC’s statutory authority. The government dialogue comes at a time when EHRs and their relationship to adverse patient safety events are being scrutinized, and rightly so. This article highlights the fact that electronic data hazards have been ranked as the number-one patient safety concern for 2014.

CMS kicks off its search for a new Healthcare.gov technology vendor, noting in its 84-page solicitation that it is looking for a business “capable of working under aggressive time constraints." Duties will include providing design, development, testing, implementation, documentation, services, analysis, maintenance, and support for the federal exchange. A quick scan of the RFP didn’t turn up mention of proposal due dates, so I can only assume time is of the essence. The next proposed open enrollment period starts November 15.

Research and Innovation

Johns Hopkins medical student Shiv Gaglani prepares to launch Quantified Care, an online marketplace for physicians and consumers. He is looking to raise $20,000 via Indiegogo to launch the website, which will include mobile health devices for sale and practical advice about how clinicians might use them. It’s an interesting and timely concept, given the volume of innovative digital health devices coming to market, and the questions physicians have around their ability to actually improve workflows and outcomes.

People

Ray Payette (Blueprint Software Systems) joins Nightingale Informatix Corp. as CTO.

Marty Beard (LiveOps) is named COO of Blackberry.

Other

The local paper highlights Cleveland Clinic Sports Health (IL), which offers a biweekly Dance Medicine Clinic to active dancers. Every staff member is a former or current performer, giving them a unique edge when it comes to communicating with their patients about dance-related symptoms and injuries. It would be interesting to see if they’ve been able to create dance-friendly templates within the clinic’s Epic EHR.

I had the pleasure recently of hearing John Marshall discuss the role passion and leadership played in his ascent from humble door-to-door Wi-Fi hotspot salesman to general manager and senior vice president of AirWatch by VMWare. I was struck not only by his PowerPoint love for Talladega Nights, but by the emphasis he put on flexibility when it came time to pivot the business into the mobile device management company that it is today. The abrupt change in direction was due in large part to Marshall’s chance tradeshow encounter with an Apple rep wielding a first-generation iPhone.

Sponsor Updates

• PerfectServe’s VP/Chief Clinical Officer Leigh Ann Myers, RN writes a blog post, “Changing the Culture for SBAR Communications.”
• Kareo opens an operations center in Las Vegas, NV.
• NextGen Healthcare provides revenue cycle management services to Putnam County Memorial Hospital (MO).
• Kareo and Falcon EHR partner to provide cloud solutions to nephrology practices.

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.

News 7/17/14

Top News

Beckman Coulter Diagnostics announces its intent to purchase the clinical microbiology business of Siemens Healthcare Diagnostics. The move lends credence to recent speculation that Siemens is set on divesting parts of its business – including healthcare IT – so that it can focus on its industrial and energy segments. The transaction is expected to close in the first quarter of 2015.

Mercom Capital Group reports that the healthcare IT sector saw its first billion-dollar quarter, with 161 deals raising $1.8 billion in venture capital during the second quarter of 2014. Ten of those deals were for over $50 million each. Over $2.5 billion has been raised so far this year, with mobile health companies leading the funding pack. Practice-centric companies took in 61 percent of all VC investments in Q2 2014, with $1.1B in 61 deals. The quarter also saw a record number of M&A transactions, with HIM companies seeing the most activity, followed by revenue cycle management, mobile health, and personal health. I wonder how these figures will play out in the near term, as the EHR market slows down and consumer-centric health devices continue to take off.

HIStalk Practice Announcements and Requests

Mr. H is offering the HIStalk BOSS (Beacon of Selfless Service) Award to recognize, as he puts it, “those trench warriors (provider or vendor) who toil without bonuses, reserved parking spaces, or the ever-present validation of company-paid butt kissers.” He’s specifically looking to heap praise on a non-management employee who went above and beyond during a specific event to save the day. Anyone who observed the individual’s laudable effort firsthand can nominate someone – a supervisor, peer, or customer. I’m sure I can convince him to throw in a “BOSS Award Winner” beauty queen sash that the honoree can wear to HIStalkapalooza 15. Submit your candidate here.

We like to keep in touch with HIStalk Practice’s sponsors and we just sent an e-mail to all the contacts on our list. Let Lorre know if we missed you.

I’m still on my quest to try new things with HIStalk Practice, and so I’m introducing the “Idea of the Day” to give physicians and consultants an opportunity to share tips and tricks of the trade with our audience. Do you have a healthcare IT-related piece of advice or tip you’d like to share? Be sure to highlight how it has made life easier at your practice, or your client’s practice. Submit your ideas via the “Idea of the Day” link above. You can choose to remain anonymous if you’d like.

Acquisitions, Business, Funding, and Stock

IBM and Apple announce a partnership to develop business applications for iPhones and iPads. IBM will also sell Apple products and provide on-site services to business clients, while Apple gains business credibility and a tie-in to IBM’s big data capabilities that will make its devices decision-making tools. The deal also gives Apple’s iOS more enterprise credibility against the more widely used Android operating system. The companies say more than 100 business apps will be available by fall.

The US Bankruptcy Court approves MModal’s reorganization plan, allowing the company to emerge from bankruptcy in August as it had originally announced.

EHNAC and WEDI launch an accreditation program for practice-management systems, announcing GE Healthcare, Medinformatix, and NextGen as pilot participants.

ECG Management Consultants announces a new service line designed to help physician groups and ambulatory care networks improve performance and transition to a value-based environment. Services include performance assessments, improvement planning, and implementation and optimization services.

Elsevier Clinical Solutions announces its Clinical Documentation Improvement Reference App, which provides clinical term look-up and medical necessity information with an emphasis on ICD-10.

Clinicate launches its clinical file-sharing solution for providers and patients. It also contains some unrelated tools such as drug lookup. It’s free for patients and a single provider can use the system for free for up to 100MB of storage.

Healthcare Data Solutions announces availability of the HealthcareData360 EHR market intelligence database, which allows looking up EHR decision-makers within and across connected provider organizations.

Announcements and Implementations

Optimus Healthcare Partners (NJ) announces it will partner with UnitedHealthcare to care for 17,000 patients enrolled in the payer’s employer-sponsored and Medicare health plans. OHP, an ACO with over 550 physicians, already serves patients within the Aetna and Horizon Blue Cross Blue Shield of New Jersey networks. The agreement with UnitedHealthcare means nearly all of OHP’s patients are now part of the ACO.

CVS Caremark enters into clinical affiliations with ProHealth Physicians (CT), Texas Health Resources, Palmetto Health (SC), and The Baton Rouge Clinic (LA). Patients will receive access to chronic-disease monitoring, wellness, medication counseling, and clinical support programs at CVS/pharmacy stores and MinuteClinic facilities. The company will also provide prescription and visit information through integration of their EHR. CVS is in the process of switching its 800 MinuteClinics from a home-grown EHR to EpicCare. Two of the four organizations above seem to be Epic shops, so I’d love to learn how CVS plans to share data with those that aren’t.

CVS Caremark also announces, in partnership with IBM, a $1.5 million commitment to the “Technology Solutions for Smarter Health” grant program. Qualifying community health centers will use the funds for the support of technology to increase patient engagement, and improve patient care and outcomes.

Government and Politics

I listened in on the recent eHealth Initiative webinar on ONC’s 10-year vision for interoperability, which focused on the five building blocks laid out in the similarly titled ONC paper released a few weeks ago. Erica Galvez, ONC’s interoperability portfolio manager, did a good job of outlining the five fundamental concepts, but I wish she’d gotten stronger pushback from commentators Mark Segal, VP of government affairs at GE Healthcare IT, and Doug Dietzman, executive director of Great Lakes Health Connect. (Both men are affiliated with eHI.) All three speakers placed great emphasis on the fact that true interoperability will occur only if industry is allowed to take the lead in terms of product innovation. Segal and Dietzman were particularly focused on the need for future certifications and standards to not become too burdensome, inadvertently hindering product development and interoperability goals. Are current standards and certifications impeding the creative/innovative use of healthcare IT at your practice, or the development of your proposed product? Share your thoughts via the comments section below. You can download slides from the presentation here.

A report from the OIG highlights flaws in the Medicaid Interstate Match program, which is intended to reduce Medicaid payments by identifying beneficiaries enrolled in the Medicaid programs of one or more states. The report found that for the three-month period under examination, not one improper Medicaid payment was recovered through the use of the program. This inability to recover improper payments was not attributed to attempts at fraud, but less scandalous issues such as eligibility errors and incomplete data. While the government does a good job of saber rattling about the amount of fraudulent healthcare payments, this report may force some perspective on the matter from CMS, which is responsible for acting on its recommendations.

NIST and OCR will co-host “Safeguarding Health Information: Building Assurance through HIPAA Security” on Sept. 23-24, 2014 at the Grand Hyatt in Washington, D.C. Onsite attendance runs $345, while Webcast attendees will pay $200.

Research and Innovation

The Stepped Care to Optimize Pain care Effectiveness (SCOPE) study finds that chronic-pain patients enrolled in a year-long telemedicine program using non-opiod medications were twice as likely to see improvement as those who received typical care for chronic pain. SCOPE automated symptom monitoring was delivered to 250 patients at the Richard L. Roudebush VA Medical Center (IN) via the Internet or interactive, voice-recorded phone calls.

Researchers query the EHRs of 23 primary care practices to identify patients likely to have undiagnosed hypertension based on their historical pattern of in-office blood pressure readings, inviting those patients to follow up with a more comprehensive series of readings. The practices alerted patients and then turned their work into a quality improvement project, continuing to remind patients and physicians of the need for follow-up until an ICD-9 code was entered indicating that hypertension had been confirmed or ruled out.

People

Jonathan Samples leaves Greenway Health to co-found Across Healthcare with former Greenway colleague Jason Colquitt, who is also head of IT Real-World & Late Phase Research at Quintiles. AH, which seems to have been in the works since 2012, focuses on custom software development; and digital health strategy, consulting, and products.

Perry Lewis (McKesson) is named VP of industry relations of CoverMyMeds.

Ralph Whitworth resigns as chairman of Hewlett-Packard’s board in order to focus on his health.

Babak Parviz leaves the Google X research team (responsible for such projects as Google Glass and smart contact lenses) for Amazon. Industry insiders speculate he’ll use his background in optic technology to help with Amazon’s recent focus on 3-D visuals and augmented reality.

Jessie Gruman, president and founder of the Center for Advancing Health, passes away after a fifth battle with cancer.

Other

This article posits that passwords will soon be things of the past as email addresses, social logins, and physical authentication take over. Apple has already introduced biometric identification to the iPhone, and Google has presented an Android phone that can unlock itself if it detects the presence of a paired Android bluetooth device belonging to the same owner, such as a smartwatch. I’m not sure that’s the best answer. While passwords are often forgotten, they can just as easily be recreated. It might be a bit more difficult to replace that lost smartwatch.

Dwayne Edwards, director of the West Virginia Regional Health Information Technology Center, writes that healthcare practices, not EHR vendors, are responsible for HIPAA compliance; Meaningful Use requirements; and protecting the confidentiality, integrity, and availability of health data in the EHR. He offers the following tips:

• Conduct a security risk analysis that compares your current security measures to what is legally and pragmatically required to safeguard patient health information.
• Develop an action plan for addressing threats and vulnerabilities.
• Manage and mitigate risks by beginning to implement a thorough P&S action plan.
• Conduct workforce education and training.
• Communicate with patients.
• Know what to do in case of a breach of unsecured patient health information.

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.

News 7/15/14

Top News

National Coordinator Karen DeSalvo, MD reorganizes the Health IT Policy Committee, cutting six working groups and consolidating several others. The working groups now include Strategy and Innovation; Advanced Health Models and Meaningful Use; Implementation, Usability & Safety; Interoperability & HIE; Privacy and Security; and Consumer Perspective and Engagement. While some say the reshuffle and recent spate of staff members leaving for new endeavors signals the beginning of ONC’s end, I’ll play devil’s advocate and suggest these changes are the result of goals met and a job well done. HITECH Act funding has been meted out, EHR adoption seems to have finally reached a level of mass critical enough for analytics, and Meaningful Use attestations (despite physician grumblings) continue to increase, albeit slowly. I’m hoping Micky Tripathi, a  HIStalk Practice contributor and co-chair of the Interoperability and HIE group, will provide his two cents on on the committee’s progress.

Aledade, the new physician ACO venture led by former ONC head Farzad Mostashari, MD teams again with nonprofit Arkansas Foundation for Medical Care to apply for ACO status. To qualify, Aledade and AFMC are working to sign up between 30 and 50 Arkansas physicians who have at least 5,000 combined Medicare patients. Aledade Arkansas will be set up as a LLC with a 12-member board that includes nine physicians, a physical therapist, and two Aledade managers. Mostashari’s company previously worked with AFMC to help 1,600 Arkansas doctors implement EHRs.

HIStalk Practice Announcements and Requests

Don’t miss the next HIStalk webinar, “Enterprise Data – an Untapped Asset for Succeeding as Healthcare Changes,” taking place Wednesday, July 30 at 1pm ET. Presenters Jonathan Velez, MD CMIO at Hartford Healthcare Corp., and Randy Thomas, Associate Partner at Encore, a Quintiles Company,  will cover:

• Why the transition from fee-for-service to fee-for-value requires integrated data
• Why it is critical to “begin with the end in mind” in creating your analytics solutions
• How a data strategy helps healthcare providers
• Why data governance is critical in healthcare
• The role enterprise data warehouses and HIEs play in health analytics and
• Where your organization fits in the health analytics maturity model

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

Watching: The Institute, one of the most bizarre documentaries I’ve ever seen. The film, which has a faint Twin Peaks vibe, chronicles the mysterious rise and short-lived popularity of a secret underground community of life gamers in San Francisco.

Acquisitions, Funding, Business, and Stock

Patient Engagement Systems launches Care Manager Web Portal for the care of patients with chronic conditions such as diabetes and kidney disease. The new portal is targeted to healthcare organizations participating in ACOs or other value-based reimbursement programs.

Lumin Medical purchases patient-tracking solutions and sign-in kiosk developer PatientTrak, and announces it will move its headquarters from Illinois to Franklin, WI. It seems likely Lumin will also take on the PatientTrak brand, as a quick Google search turned up zero results for the acquiring company.

Greg Bottaro, PsyD launches WellCatholic, a website that aims to link Catholic patients with physicians of all medical disciplines who maintain Catholic values in their practices. It’s an interesting concept given today’s political climate. Bottaro notes that “[T]here’s definitely a huge demand for healthcare” that respects a patient’s beliefs, as well as those of their health provider.

Announcements and Implementations

MSC Cruises becomes the first cruise line to offer a multilingual pediatric telemedicine service thanks to a partnership with specialists at the Giannina Gaslini Paediatric Institute in Italy and technology from Carestream. The cruise line already offers adult teleradiology and teleconsultation services.

The Arizona Care Network becomes the first ACO to offers its members the Propeller Health (fka Asthmapolis) digital solution for chronic respiratory disease. The COPD solution is a combination of sensors, mobile apps, analytics, and personalized feedback that promotes maintenance therapy adherence. It also remotely monitors use of rescue medications to predict exacerbations and facilitate early intervention by care teams.

The local paper profiles the opening of the SwedishAmerican Medical Group Stateline Clinic (IL), which features an interesting design change related to HIT: Computer screens can now easily face the patient and doctor. While the article suggests it is a “simple solution that wouldn’t normally be looked at,” it is probably high on the list of changes many physicians would like to see with regard to tethered computer placement in the exam room. Our family pediatrician, who has been known to call EHRs “meaningfully useless,” does appreciate the analytics and population health management tools they afford, but bemoans the lack of eye contact they cause with his young patients.

Government and Politics

The local paper details the state of Connecticut’s proposed Guide Path program that would assist practices in becoming patient-centered medical homes. While physicians already participating in the Medicaid model have seen a 2-percent cut in per-person costs and a 32-percent increase in the number of participants, many struggle with adopting the model due to the high costs of EHR implementation. "We take pride in the high-quality care that our patients receive, but that doesn’t help pay for raises,” says David Howlett, MD, who operates a PCMH at East Granby Family Practice.

HHS seems to be on a bit of a spending spree lately. After announcing the availability last week of $100 million to support 150 new health centers, the department invests $100 million in technical support for Medicaid programs. The new Medicaid Innovation Accelerator Program aims to develop resources to support state-based healthcare reform efforts that will improve service delivery and bring down costs.

The state of Vermont may be filling out its Medicaid IAP application right now, as it looks for a technology firm to overhaul its Medicaid management information system to the tune of $70 million. The RFP in circulation is part of a larger $400 million IT overhaul that will include the state’s health insurance exchange.

Research and Innovation

A comparative study of EHR use in seven independent primary care practices finds workarounds for a number of problems including user interface issues, barriers to electronic health information exchange with outside organizations, and struggles to incorporate new technologies into existing office space. Researchers spent one month in each practice to observe EHR use, interview clinicians and staff, and conduct patient pathways.

Arizona State University’s Center for Sustainable Health launches Project Honeybee to bring ASU’s network of partners and resources together to respond to healthcare issues. The project will first focus on harnessing the growth in wearable biosensors for clinical applications through a data-validation approach. “Within 10 years, every patient will be monitored by devices,” said Leland “Lee” Hartwell, the center’s chief scientist, at a forum introducing the project. “While there are lots of new discoveries, the translation into the clinic for utility is nearly zero. We need to create a process to make this technology reliable and useful, with new capabilities, to find out the best application that will have the greatest impact on medicine, and give patients control of their own health.”

Google and the Alcon eyewear division of Novartis announce they will create a smart contact lens that can measure a diabetic’s blood sugar level directly from tear fluid on the surface of the eye. The lens, which will contain a low-power microchip and nearly invisible electronic circuit, will send that data to the wearer via mobile device. Novartis also hopes to develop lens technology that will enable long-sighted people to autofocus on what they are looking at, preventing the need for glasses.

People

GE Healthcare promotes Eric Stahre to the head of its molecular imaging and computed tomography unit. Stahre takes over from Steve Gray, who has been named president and CEO of the detection and guidance solutions unit.

Mark Scruggs returns to Zotec Partners as a partner of corporate strategy.

Other

Microsoft accurately predicts the winner of the World Cup. Its prediction engine – put into play as a marketing stunt for the company’s Bing search engine – also accurately predicted every stage of the event’s knockout rounds. Some (i.e. people with too much time on their hands) have compared the prediction to the success of Paul the octopus in predicting Germany’s 2010 World Cup games.

Speaking of search results, Elle magazine profiles top Google white hat hacker Parisa Tabriz, who leads a team of engineers to discover weaknesses in Google Chrome. I love that Tabriz opted for the official title of Security Princess, rather than Information Security Engineer, which she tells the magazine is “just completely dry and boring and horrible.”

I couldn’t resist snapping a pic of this fashionable tape dispenser during a leisurely stroll through my favorite big box store. While I don’t have quite the shoe fetish that my fabulous predecessor did, I do appreciate a pair of fashionable yet practical pumps.

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.

DOCtalk by Dr. Gregg 7/14/14

Just Another Pug

By sheer force of will, he pulled himself up from his corner stool. He gripped the ropes for an extra second to make sure his buckling knees would hold. What round was this? He wasn’t sure. The twelfth? Thirteenth? It felt like the four hundredth. He was a game pug, always ready for the fight, but this one seemed like it might be one fight too many. He remembered Ferdie “The Fight Doctor” Pacheco’s famous line: “They only made one mistake; they signed this fight.”

The bell rang. He drew a deep breath, brought his gloves to his face, and again entered the fray.

His eyes were so swollen he could no longer clearly see his opponent’s face. It could have been anybody peppering him with those barrages of body blows and hammering head shots. As he neared center ring – and his nemesis – he thought back to his glory days, when he easily vanquished every foe. He had stood so long and faced so many; his record was impressive with many wins and only a draw or two.

As the right jab snapped his head back – and snapped his mind back to the present – he realized his heydays were probably past. The following left hook confirmed this as his brain repeatedly bounced back and forth within his skull.

WHAM! The Meaningful Use left staggered him. Endless check boxes and extra steps required to document what he’d always done so that somebody somewhere could tell him that he’d done it whirled through his brain.

POW! The insurance company uppercut caught him right under the chin. Declining reimbursements, endless denials, appeal after appeal, and red tape for red tape’s sake left him woozy.

His counterpunches were useless and no matter what he did, he couldn’t seem to cover up enough.

UGH! The thunderous EHR blow to his midsection almost made him upchuck. He was no slouch, but figuring out which EHR would work for him at a cost that wouldn’t cripple his already slim operating margins was a gut-wrenching challenge. Even worse was the task of finding one with a workflow that actually flowed; most “flowed” about as well as punch drunk’s vocabulary; well-intended, but stuttering, rambling, and often without apparent purpose.

BLAM! The vaccine reimbursement roundhouse sent him into the ropes. He had always tried to keep his guard up – and those of his patients – by offering immunizations to every paying customer. He was staggered when he discovered that one of his karmic good gestures had backfired: He took military insurance to help veteran’s families the way he felt they should be helped, only to find that he was bleeding money every time he gave a vaccine to one of them. The military insurance, it seems, didn’t feel obligated to pay him for the full cost of the vaccines. In fact, they didn’t even come close. The financial blood gushed out.

THUD! The ACA kidney punch was a powerhouse. When one of the largest state university medical centers decided they wouldn’t accept any insurance obtained through the Healthcare.gov site, he lost a major nearby referral base for his many of his families. The ACA had helped many of the poor and underpaid of his community – and he was grateful to see them helped – but why the politics of big institutions had to then slam other good folks was beyond his pugilistic fathoming.

He tried to work his way inside, to tie up his opponent with a clinch to stop this incessant pounding. His heavyweight counterpart pushed him aside as if he were a mere featherweight.

CRACK! CRACK! Despite his best bob and weave, he was struck by a right cross from the declining appointments that the changes in insurance coverage had wrought. Despite more folks getting covered, many now had such high deductibles that they put off doctor visits more and more. They previously might have been regulars, doing all the recommended follow-ups and such, but their pocketbooks now demanded putting off doctor appointments in favor of paying rent or buying food.

CRASH! The liver shot of ever higher overheads and staffing costs sent him reeling.

BOOM! The rabbit punch to his clouded skull of constant hardware and software upgrades, repairs, or replacements caught him off guard. (He briefly flashed upon days gone by when documentation upgrades involved new pens or nicer paper and when hardware repairs involved Scotch Tape.)

He staggered forward as the ref penalized his opponent for the illegal hit to the back of his head. The penalty was shrugged off by a smirk as his adversary closed in with a glint in his eye, that look of coming in for the kill.

BAM! The corkscrew punch of fellow independent providers leaving the fight and joining the Big Gym of ACOs and mass group practices sent sharp spikes down his spine and stars up before his eyes.

Just as it looked like there was no more room to hide within the seemingly shrinking confines of his four-sided ring, the bell sounded!

He had survived one more round.

Bleeding and bruised, he shuffled to his corner. He wondered just how many more rounds he could go. He was a gamer, pound-for-pound one of the strongest ever. He had a good set of whiskers and was known as a brawler. But, he was definitely shopworn. Was he also a faded fighter, past his prime? Could he bring enough to the canvas to go even one more round? Were the opponents of today too much for him?

As the cutman applied the enswell to his eye and his corner man jabbered on about some tactic he couldn’t quite hear because of his now bilateral cauliflower ears, he considered his options. Maybe he could try to play possum. Maybe try Ali’s rope-a-dope. He even though he might have to resort to a Tyson-eque ear chomping. Hmmm…

He gnashed his teeth as he glowered at his rival. He wasn’t yet ready to throw in the towel.

From the embattled trenches…

“No mas.” – Roberto Duran

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 7/10/14

Top News

HHS Secretary Sylvia Burwell announces the availability of $100 million from the Affordable Care Act to support 150 new health center sites across the country in 2015. The funds will likely add to the 550-plus health centers that have sprung up in the last three years thanks to ACA funding. Today, over 1,200 health centers provide care to over 21 million patients across 9,200 delivery sites. Community-based organizations that deliver primary care have until August 20 to complete the first part of the application process.

A new report from the National Academy of Sciences and the Institute of Medicine finds that the Department of Homeland Security is struggling to implement an enterprise-wide electronic health management system capable of collecting and analyzing the health data of its 200,000 employees. The 380-page document notes that, “Although DHS is moving toward an enterprise approach to HIT, the committee did not find evidence that the department is fully aware of the informatics capability required to maximize the potential of an integrated health information management system.” The department is apparently in the process of acquiring  such a system, but funding has not yet been approved. No doubt its HIT needs have been put on hold while the DoD and VA get their respective problems sorted out.

Announcements and Implementations

Cigna announces it has achieved its 2014 goal of creating 100 Cigna Collaborative Care arrangements with large physician groups that reach 1 million customers. While the announcement doesn’t specifically note technology’s role in the success of the programs, I can only assume it played an important one given several of Cigna’s noted keys to success: sharing claims data; predictive modeling; communication and collaboration; and clinical integration.

NuPhysicia Inc. (TX) launches a telemedicine-based tobacco cessation program for Caterpillar sales and service company Mustang CAT, already a customer of NuPhysicia’s telemedicine on-site clinic service. Clinic medical staff will deliver live, face-to-face counseling via videophone to employees enrolled in the program.

Acquisitions, Funding, Business, and Stock

Allscripts acquires Oasis Medical Solutions Ltd., a privately held, London-based provider of patient administration systems and health informatics solutions. Allscripts will combine the Oasis PAS technology with its Sunrise clinical platform to offer a single-source electronic patient record solution throughout the U.K.

Following a disappointing second quarter, Royal Philips announces it will implement a new management structure within its healthcare sector, with all healthcare business groups reporting directly to Philips CEO Frans van Houten. Philips Healthcare CEO Deborah DiSanzo has decided to leave the company.

IOD Inc. and athenahealth partner to offer IOD’s ICD-10 readiness program to athenahealth customers via its More Disruption Please program. The ICD-10 program includes terminology training for coding and billing staff, online education for physicians, documentation training for clinicians, and an interactive platform to share ongoing best practices.

Government and Politics

The ONC Health IT Policy Committee meeting presents data that show that, as of July 1, over 2,800 eligible professionals have attested for Meaningful Use for the 2014 reporting year, with 443 new participants, and 972 eligible professionals attesting for Stage 2. Eight EHR vendors are used by those who have attested for Stage 2, with 61 percent using athenahealth and 20 percent Epic. This reporting period marks the first time CMS has conducted them based on calendar quarters rather than 90-day timeframes.

Students have just one day left to apply for an unpaid ONC internship in Washington, D.C. The chosen one will assist with such projects as high quality research memos, the preparation of background memos for the National Coordinator in advance of meetings, assisting with the legislative affairs portfolio and the execution of large meetings, and performing some administrative duties, among other tasks.

Research and Innovation

A new study examines characteristics associated with enrollment in and utilization of portals by patients with diabetes. Barriers to enrollment included a lack of patient capacity, desire, and awareness of portal functions. Barriers to utilization included patient capacity, lack of provider and patient buy-in, and negative usage experience.  It seems to me that diabetic patient utilization faces many of the same challenges that non-diabetic patient utilization does, all of which likely stem from provider buy-in and patient education.

Survey results find that EHR adoption and implementation issues rank as the number-one IT problem of physicians for the second year in a row. A lack of interoperability between EHRs, and implementation and utilization costs follow closely behind, though costs are not of as much concern as they were last year.

People

HealthTrust appoints Kent Petty (Wellmont Health System) as CIO.

Other

Researchers at GE develop a prototype device that will one day determine the calories in a plate of food, and deliver that data to consumers via smartphone. The device, which uses microwaves to measure fat content, water content, and weight, right now only works on blended foods. The company is already thinking ahead to incorporating the technology into microwave ovens and other kitchen appliances. Those of us that have abandoned tedious calorie-counting apps after just a week or two may also find this sort of “baked in” technology better able to deter us from unhealthy choices. I’d like to think this is the sort of innovation Jack Donaghy would be proud of.

Sponsor Updates

• Hennepin County Medical Center (MN) details how it was able to save almost $11 million after working with Leidos Health on a revenue cycle optimization plan.
• Hayes Management Consulting explains the details of decision support extracts. 
• DrFirst announces in a new briefing that there are now over 28,000 pharmacies nationwide that accept electronic prescriptions for controlled substances.
• NextGen forms an agreement with HMC/CAH Consolidated Inc. by which NextGen solutions will be deployed at five of HMC’s critical access hospitals.

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

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