News 4/9/15

Top News

Rock Health releases its quarterly report on digital health funding, highlighting an overall stall in investment growth. Lt. Dan has the full breakdown here. A similar report from Mercom Capital Group confirms the trend.

HIStalk Practice Announcements and Requests

I had a great time moderating the first #HIStalking tweet chat, featuring lively discussion topics from our HIMSS15 patient advocate scholarship winners. You can check out the Storify recap of the “The Role of Patient Engagement & Advocacy in HIT” here.

Webinars

April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.

Acquisitions, Funding, Business, and Stock

BioHealth Innovation and the Montgomery County Dept. of Economic Development in Maryland create Relevant Health, an accelerator program for early stage healthcare IT companies. The five-month mentorship and training program will accept its first cohort of eight companies in the fall.

Livongo Health raises $20 million to expand its connected glucometer-powered diabetes management service. Former Allscripts CEO Glen Tullman started and runs the company.

Lexmark will consolidate its acquired brands, including Perceptive Software, under the single name Lexmark and a new logo. Perceptive will be placed under the Lexmark Healthcare banner.

Announcements and Implementations

Montana Primary Care Association selects eClinicalWorks to help it ensure optimal HEDIS performance for its 200 providers across 16 community health centers.

MetroChicago HIE offers DirectRoute communication management from Sandlot Solutions, enabling providers with Direct addresses to customize how they receive secure patient information from their colleagues.

CareCloud and Marshfield Clinic Information Services launch a cloud-based solution for large ambulatory medical practices comprising EHR, PM, revenue cycle, and support and optimization services.

MEA|NEA partners with Virtru to provide HIPAA-compliant email services to physician and dental practices.

Government and Politics

FTC staff submit 13 pages of comments on ONC’s Interoperability Roadmap, offering guidance on shared governance mechanisms and the development of technical standards; and highlighting the importance of safeguards to ensure the confidentiality, integrity, and security of consumer data.

Data from this week’s Health IT Policy Committee meeting show that Medicare EPs had substantially higher rates of Meaningful Use achievement than Medicaid EPs.

Telemedicine

Teladoc continues to push the buttons of the Texas Medical Board, which will likely soon adopt a rule requiring doctors to see patients in person or through a webcam before treating via telemedicine. Teladoc CEO Jason Gorevic tells Politico that his company is “pulling out the stops in Texas, trying to draw physicians, employers, health plans, and patient advocacy groups together to oppose the regulations, which he said ‘will really hinder the expansion of telemedicine rather than facilitate the adoption, and hurt access to care for Texans.’” He adds that, “There are many things that don’t require a visualization. We’re relying on the physician’s experience and clinical guidelines to make sure that patient safety is first and foremost.”

A local Texas news station profiles use of the Oto CellScope (a graduate of Rock Health’s incubation program) at Scott and White Clinic (TX). The $79 scope attaches to an iPhone over the camera lens and works in the same manner as a traditional scope. The free app saves the images or video, potentially enabling patients (who don’t live in Texas) to upload and send images to their providers for remote consultation.

People

Richard Boxer, MD (UCLA) joins telemedicine company WellVia as CMO.

Research and Innovation

The Advisory Board Co. reports that 25 of the 1,000+ large medical groups subject to Medicare’s physician value-based payment modifier will receive payment adjustments this year based on their cost and quality performance. Over 300 such groups are receiving payment reductions of up to 1 percent for not complying with Medicare’s reporting requirements. ABC CMO hits the nail on the head in summing up why so many did not adhere to the requirements: “[Some] are not going to motivate until it is absolutely necessary. If you look at these small practices, a lot of them just run on a shoestring.”

Other

Kudos to Jamie Stockton, CFA of Wells Fargo Securities for sharing his take on the latest Meaningful Use data. Wells Fargo’s EP numbers suggest that Athenahealth customers lead the MUS2 pack at 71 percent, although not up to the 98 percent it boasted a couple of weeks ago, which in reality measured the percentage of EPs that attempted MUS2, not the percentage of its overall customer base.

Vermont’s local NPR affiliate covers the continuing saga of the state’s attempts to digitize medical records with taxpayer money. Lawmakers appear to be unimpressed with the 10-year-old Vermont Information Technology Leaders, which was established to oversee the statewide transition from paper to digital. The nonprofit received quite a bit of flak for spending $13,000 on local T.V. advertising during this year’s Super Bowl. Lawmakers contend that it’s time to reconsider the more than $3 million in taxpayer money they invest annually in the enterprise. Nearly 700 physicians are using the VITL portal to access patient data, while only about 15,000 patients have given consent for their medical records to be on the system.

The Huffington Post asserts that the AMA has distanced itself from presidential hopeful Rand Paul, MD offering its support to “anyone else interested in running for president. Anyone.” The tongue-in-cheek write-up goes on to assert that the AMA has “seen television doctors with more knowledge of actual medicine than Rand Paul. Doogie Howser, House, McDreamy, even Dr. Nick from The Simpsons. These are all doctors that the AMA would proudly back. In other words, we would literally support a fictional person for president ahead of Rand Paul.”

The Washington Post covers the life-extending work being undertaken by some of Silicon Valley’s biggest tech titans, including the founders of Google, Facebook, eBay, Napster, and Netscape. The death-defying entrepreneurs are spending billions on researching, rebuilding, regenerating, and reprogramming organs, limbs, cells, and DNA in the hopes of helping people to live longer and better. I tend to agree with Bill Gates on the narcissistic absurdity of the idea: “It seems pretty egocentric while we still have malaria and TB for rich people to fund things so they can live longer.”

Contacts

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

More news: HIStalk, HIStalk Connect.

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HIStalk Practice Interviews Farzad Mostashari, MD CEO, Aledade

Farzad Mostashari MD is founder and CEO of Aledade.

What has the last year been like for Aledade? You mentioned in an interview with Mr. H last year that it will take the “right tools, right tech, right booths on the ground, with the right team, with the right primary care providers” to really make progress in achieving the triple aim. How have those factors come together for your team and clients?
It’s been super fun for me. It’s so totally unlike the federal service, but there’s also a similarity as well. It does feel like we are embarking on something that really matters and that has the potential to impact a whole lot of people. It does feel like I’ve been training for this my whole career, pulling on the skills around analytics, technology, and change management in small practices to start an operation that’s small today, with the ability to be successful when it’s really at scale. We’re keeping our eye on the prize and feet on the ground. We always talked about that at ONC. That’s really what Aledade, if you recall, is all about, keeping your eye on the prize, on the North Star.

Process-wise, it’s been amazing to grow the team. We’re now 25 people, and we’re hiring one or two people a month. We are looking for EHR implementation specialists right now – people who are ninjas with some of the larger ambulatory EHR systems – to really do that turbo charging, that optimizing, that me and our doctors certainly feel is lacking. They have the systems but they haven’t been optimized, and so that’s something we’re engaged in actively with our practices.

We’re growing as the flurry of recent press releases has attested. We started off in four states – New York, Maryland, Delaware, and Arkansas – last year. This year, there’s been a great reception to this idea of independent primary care providers being able to take on these new alternative payment models for which, frankly, they are in a great position to succeed and thrive at with help. We’re now in Kansas. We’re in West Virginia. We’re in Louisiana. We’re in Tennessee, and there’s another state soon to be announced.

Has your business model changed over the last year?
No, it’s still the same basic model. This whole alternative payment model thing says you get paid for outcomes, and our business model is still predicated on showing outcomes. There’s a pretty small membership fee to make sure the docs are committed, but our interests are lined 100 percent with the payers, and with the providers and the patients. Participation in Meaningful Use is still a requirement to work with us, and most of our partner doctors are working on stepping up to stage two.

How many practices and patients does Aledade now serve?
We currently operate three ACOs across four states (DE, MD, AR, NY), covering nearly 30,000 Medicare beneficiaries. Additionally, we are currently undertaking physician recruitment in several other states, including Tennessee, West Virginia, Louisiana, and Kansas. 

How are you handling distributing payments to the individual providers Aledade works with?
As you know, in the Medicare Shared Savings Program, ACOs receive 50 percent of the savings they achieve against Medicare predictions of cost of care. Of that amount, 60 percent is distributed to our individual practices, with 40 percent reinvested in further improvements to the ACO.

Your time at Brookings helped you to better understand what makes an ACO work and what doesn’t. Have those findings generally held up now that you’re seeing ACOs from a boots-on-the-ground perspective?Absolutely – and interesting that you use the phrase "boots on the ground."  While at Brookings, we identified four key competencies for running a successful physician-led ACO:

1. Identifying and managing high-risk patients.
2. Developing high-value referral networks.
3. Using event notifications for hospital admissions, transfers, discharges, and other similar events.
4. Engaging patients.

A little less than a year into running Aledade, we believe those conclusions even more strongly. We’ve learned a lot from our practices – as well as our regional partners – and it is truly these capabilities, coupled with our data and analytic expertise, as well as the work of our regional partners, that have helped our ACOs succeed thus far.

The foundation of all of our ACO success though, has really been the identification and engagement of top physician leaders everywhere we’re running ACOs.  We’ve been fortunate to partner with docs who are leaders in their communities, are well-versed in EHRs, and, most importantly, share our vision and values for what ACOs can accomplish.

How have Next Generation ACOs impacted your business? Are your practices interested in it?
I really appreciated the Next Generation ACO proposal. Maybe not this year, but next year I think some of our ACOs will be ready to take on that challenge, especially if there are some tweaks made to that model. That’s what, to me, is the most significant part of this type of ACO. It’s further evidence that CMS is committed to figuring this out. This is not a one-shot experiment. There are a whole series of efforts to tweak and modify and work on and adapt and evolve the fundamental ACO model until they find one that really will serve patients, providers, and payers. That to me is the bottom line, not a take it or leave it kind of situation. CMS really wants to work with the providers to make a model that works.

You’ve mentioned that EHR optimization takes up a good bit of Aledade’s time. What type of optimization challenges are you running into the most?
We really want to have the EHRs at the top of their license, and so we need to help the providers be absolutely certain that their systems are not only capable of meeting MU certification requirements in the lab but also in the field. It’s been a little unsettling to see how many certified EHRs providers upgraded to that can’t perform in the real clinical setting. Take portability requirements, for example. They got tested to them in the lab and they could certainly do it in the lab, but they’re not really able to perform that certification function in the field.

This has been something that I was super happy to see ONC take on squarely in the notice of proposed rulemaking. This was also, frankly, what the congress touched on when saying ONC should decertify systems that are, for example, blocking information. It all comes down to not necessarily more requirements to certification, but making sure that the requirements that are there meet the intent and satisfy the customers, and to have a mechanism for customer complaints if they’re not getting what they thought they were buying. It would be beneficial for the certification bodies to do a small sample of practices and actually get in the field and say, "We’ve tested it in the lab, but we’re going to go and test five or 10 practices in the field and make sure the systems are capable of doing what they’re supposed to be doing."

Have you had to assist any in selecting a new EHR?
There are, unfortunately, a number of our practices, and I don’t think they’re unique in this, who are unhappy with their systems, particularly if they’re a little bit older technology. The optimization, the interfacing … it’s just getting so painful for them, so they ask me, "Look, you’re the formal national coordinator for health IT, tell me what should I switch to?" One of the things I’m actually going to be doing at HIMSS, and this is going to be quite interesting for me, is walking around in the mind-frame of a customer, someone who’s looking to buy an EHR that really meets the criteria for practice happiness. A system that is able to achieve MU requirements in a thoughtful and workflow-optimized way, and has the willingness and interest in working with third-party population health applications. Those are the three criteria that I’m going to be looking for so that we can make educated recommendations to our practices who do want to switch systems.

Were there any rumblings from physicians about the 10-year interoperability roadmap? How does that play into your plans for them and how might that be shifting what they had originally intended to try and achieve with their EHRs?
For a lot of the small practice primary care docs, the interoperability that really matters to them is functional interoperability. It’s having their lab results be in their system electronically. It’s having a discharge summary or a referral be sent electronically. It’s being able to electronically report their immunizations to the state immunization registry. Their expectations are not very fancy.

There are two things that have come up that I think the interoperability roadmap intersects with very directly. One of them is that it is incredibly helpful in running an ACO to have technician discharge transfer notifications. If there is one HIE function from a public or private HIE that I would prioritize for population health, it’s just that simple HL7 ADT-fed notification of admissions, discharge,  and then transfers, which is considered pretty bare-bones for an HIE. That’s where there’s so much value today. I think more HIEs should first focus on delivering what people actually need today for population health.

The second interoperability challenge that is really top of mind for these practices is, in many cases, that they have spent years inputting data into the systems that they have paid for, and now, to get their own data out of those systems, they’re having to pay the vendor $5,000 to $10,000 for an interface. We’re covering that cost, but it’s outrageous. What we really want is basically the CCDA that they, for certification purposes, are supposed to be producing anyway. Those are two things that I would highlight as being key, functionally, for ACO participants.

Given that you see so many EHRs and different types of vendors, have you seen them paying more attention to population health management?
It’s the big buzz word, right? That and patient engagement, and soon to come, precision medicine. Everyone talks about it and I feel like saying, “Look, we gave you a roadmap for what population health requirements are. It’s called Meaningful Use. If you had really embraced the intent behind Meaningful Use, you would have not only not frustrated your customers with a compliant approach, but you also would have had a leg up in this new value-based world. It is exactly those things. It’s decision support. It’s tied to quality measurement. It’s quality measurement at the time of care. It’s registry functions. It’s having and sharing data needed for identifying high-risk patients and managing their conditions. It’s safety around medications. It’s engaging patients to be partners in their own care. It’s giving them care plans. It’s all there. Now they are, in many cases, touting their population health bona-fides as if they had discovered it for the first time.

In working with different practices in different states, have you seen any using their EHRs or other types of health are IT creatively, in a way that you thought might work for a different provider in a different part of the country?
Yeah, absolutely. Holly Dahlman, MD is at one of our practices, Greenspring Internal Medicine near Baltimore, and she is a nationally recognized Million Hearts champion. She’s doing amazing work with hypertension control. Her use of the EHR is fairly sophisticated. She uses registry functions to identify unrecognized, under-diagnosed, or under-treated patients so that she can then work to engage with them on their heart health. She’ll then initiate home monitoring and reporting of blood pressures from home monitors into her system. It’s great to see one of our practices being one of the stars in that initiative. We’re rolling that out to our other practices.

How many RECs do you interact with? How have you seen their role evolving (or drying up) as EHR adoption plateaus? 
Right now, we have partnerships with eight RECs – in New York, Delaware, West Virginia, Tennessee, Kansas, Louisiana, Florida, and Arkansas.  As EHR adoption has plateaued over the last year or so, the role of the RECs has evolved, and possibly become more important.  Even as EHR market penetration has increased, we’re seeing doctors and their office staff still struggling with operability of some of these systems – not just functionality with other systems, but functionality on their own systems, accessing their own patient data. Some of this has to do with business practices of some EHR vendors, but regardless, the RECs have been there, on the ground with these practices, working to help them get the highest level of functionality out of their system. They are an invaluable piece of on-the-ground support for independent physician practices, and that’s why we’ve chosen to partner with so many of them.

Do you have any final thoughts?
Health IT and delivery reform are twins. You can’t get the full value of each one independently without the other. You can’t do these new payment models without pretty sophisticated use of information technology, but this is a point that is often lost. A lot of these population health-oriented, prevention-oriented, care coordination-oriented technologies don’t make sense in a fee-for-service world, but they make perfect sense in a world where people are paid for outcomes. For the HIStalk listeners, their work in making health IT that works has never been more needed and more significant, and this is going to go not only to the professional and healthcare desires to take the best care possible of patients. It’s actually going to determine the financial and business viability of their organizations; so kudos, keep up the hard work. I’m cheering on both populations.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
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#HIStalking Tweet Chat Recap

News 4/7/15

Top News

The AMA submits comments on the ONC’s Interoperability Roadmap, offering the following recommendations:

• Prioritize “cornerstone” interoperability issues and high-value use cases.
• Forego using a punitive approach on providers to achieve interoperability.
• Address cost and EHR usability barriers to interoperability.
• Continue to allow private sector governance efforts to flourish.
• Acknowledge the impact Meaningful Use is having on interoperability.

HIStalk Practice Announcements and Requests

Join me and our patient advocate HIMSS conference scholarship winners for an #HIStalking tweet chat Tuesday, April 7 at 11 a.m. ET. @LAlupusLady, @woodymatters, @leffet_papillon, @CarlyRM and @bostonheartmom will talk about patient engagement, advocacy, and healthcare IT. You can brush up on their backgrounds here and check out discussion topics here. They’ll be wearing their Walking Gallery shirts at the conference as they follow a busy schedule of interviews, meetings, and exhibit-hall cruising.

I can’t believe there is less than a week to go until HIStalkapalooza. My ensemble is ready, and I can’t wait to see what others will sport on our red carpet. While I don’t expect anyone to don Cinderella-type shoes, I do hope guys and gals will make an effort to put their best feet forward, especially in light of the fact that we’ll honor two lucky winners with a unique award to proudly display at your HIMSS booths or tout around the exhibit hall the next day. (And speaking of the exhibit hall, find out what HIStalk sponsors are doing on the HIMSS show floor by checking out our guide.)

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

Reading: The Portlandia Cook Book. (And yes, they put a bird on it!) This $5 find is yet another reason why I love the books-for-sale shelf at my local library. This tome, which does have actual recipes, is similar in genre to one of my all-time favorites, America (The Book).

Webinars

April 8 (Wednesday) noon ET. “Leveraging Evidence and Mobile Collaboration to Improve Patient Care Transitions.” Sponsored by Zynx Health. Presenter: Grant Campbell, MSN, RN, senior director of nursing strategy and informatics, Zynx Health. With mounting regulatory requirements focused on readmission prevention and the growing complexity of care delivery, ACOs, hospitals, and community-based organizations are under pressure to effectively and efficiently manage patient transitions. This webinar will explore the ways in which people, process, and technology influence patient care and how organizations can optimize these areas to enhance communication, increase operational efficiency, and improve care coordination across the continuum.

April 22 (Wednesday) 1:00 ET. “Microsoft: The Waking Giant in Healthcare Analytics and Big Data.” Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP of strategy, Health Catalyst. Microsoft has been quietly reengineering its culture and products to offer the best value and most visionary platform for cloud services, big data, and analytics in healthcare. This webinar will cover the Healthcare Analytics Adoption Model, the ongoing transition from relational databases, the role of new Microsoft products such as Azure and Analytic Platform System, the PowerX product line, and geospatial and machine learning visualization tools. Attendees will learn how to incorporate cloud-based analytics services into their healthcare analytics strategies.

Announcements and Implementations

The New Mexico HIE goes live with technology provided by Orion Health.

Non-profit health information provider Healthwise offers a course on shared decision-making.

Telemedicine

Telemedicine startup PointNurse partners with the crowdfunding platform Swarm Fund to create the first Global Telemedicine and Telehealth Distributive Collaborative Organization, enabling providers to join the community as members, receive fees, and have a proportional stake in the software.

Government and Politics

Patient advocates and state legislators breathe a sigh of relief when New York Governor Andrew Cuomo decides not to cut the budget of nydoctorprofile.com, the state Dept. of Health’s physician profile website. “As we move towards more transparency and public access to health care information,” explains Assembly Health Committee chairman Richard Gottfried, “this budget language will speed up both reporting by physicians and website updates by the Department of Health.”

Mental health professionals, dentists, and chiropractors push back on a Minnesota law that requires all healthcare providers to implement EHRs. St. Paul psychologist Peter Zelles intends to comply with the law, despite reservations about patient privacy. “Some patients are treated differently because they are being treated for mental health problems,” he explains, adding that some female patients worry about being stigmatized by physicians once they see they’ve had an abortion.

CMS announces that nearly 36,000 consumers have signed up for health insurance via Healthcare.gov during the extended enrollment period, which ends on April 30. That figure is well below the administration’s estimate of 220,000.

Research and Innovation

A UCSF study finds that patients prefer getting biopsy results over the phone rather than via secure email. As someone who has received biopsy results, I can tell you a phone call is the most appreciated option, as it gives patient and physician an opportunity to discuss next steps in real time. I found it interesting that just over half of physicians in the study would pick up the phone to deliver bad news, while 31 percent would take the time to make a call for good news.

An eClinicalWorks physician survey finds that top portal patient engagement benefits are the ability to review and share medical records, schedule appointments, and receive automatic appointment alerts and reminders. Over half believe having access to patient information from wearable devices or fitness trackers would be somewhat useful to help treat them, though the survey’s findings did not delve into just how they’d incorporate that data into patient medical records or office workflows.

The Health Information Trust Alliance announces that it will sponsor a broad, empirical study of health IT security threats aimed at analyzing “the methods, severity and pervasiveness of cyber threats targeting a variety of healthcare organizations.”

A WEDI survey on ICD-10 compliance reveals that over half of respondents are still uncertain as to if and when the transition to ICD-10 will take place. Not surprisingly, only 25 percent of providers have completed end-to-end testing, a decrease from the 35 percent that had begun testing in August 2014.

Other

Kroger’s The Little Clinic earns The Joint Commission Gold Seal of Approval for the third time. The Tennessee-based chain of retail clinics implemented its first EMR in 2006, and most recently went live on VisualDX’s Web-based diagnostic tool for physicians.

I’m kicking myself for missing this: CERN reports on April 1 the “first unequivocal evidence for The Force” using its Large Hadron Collider. Ben Kenobi of the University of Mos Eisley, Tatooine, explained that “The Force is what gives a particle physicist his powers.”

I did a double take when I came across this headline: “Seattle’s Medical Records Offers Electroconvulsive Therapy on Record Store Day.” It’s amazing how susceptible my mind has become to healthcare references.

Sponsor Updates

• Versus Technology offers a blog on how wireless technology works to track the spread of infection.
• NVoq describes “The Link Between the Simple Checklist and Improved Patient Safety.”
• ESD posts 25 days of its history as it commemorates its 25th anniversary. Check out Day 7, where you’ll see its video of HIStalkapalooza 2012 in Las Vegas, which it did a great job of sponsoring.
• Healthwise shares “The Secret Behind Serving Up the Right Information Every Time.”

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.
Become a sponsor.

The Role of Patient Engagement and Advocacy in HIT – #HIStalking Tweet Chat Tuesday, April 7 at 11 am ET

Join @JennHIStalk and HIStalk’s HIMSS15 patient advocate scholarship winners – @LAlupusLady, @leffet_papillon, @CarlyRM, @woodymatters and @bostonheartmom -  for a discussion on patient engagement, advocacy, and healthcare IT. You can check out their backgrounds here, preview discussion questions below, and brush up on how to participate in a tweet chat towards the end of this post.

#HIStalking Discussion Questions

Q1 from @bostonheartmom: How can we use HIT to democratize our data, giving patients and MDs equal access? EHR #UX have role to play? #HIStalking

Q2 from @LAlupusLady: How can HIT include patients in the development and design process? #HIStalking

Q3 from @CarlyRM: How might we use HIT to reinforce human connection and the expertise of patients across the world? #HIStalking

Q4 from @woodymatters: How can technology assist in post-market safety of drugs from a consumer perspective? #HIStalking

Q5 from @leffet_papillon: How can online patient communities improve the quality of patients’ lives, and their care? #HIStalking

Join us on Tuesday, April 7 at 11 am ET for the #HIStalking tweet chat, and then look for @bostonheartmom @leffet_papillon @CarlyRM and @LAlupusLady in #HIStalking shirts at #HIMSS15.

Tweet Chat Instructions

It’s easy to join the Twitter conversation by logging into TweetChat, which automatically keeps you in the conversation by tagging all tweets with the #HIStalking hash tag. If you are unable to access the TweetChat room, simply search in Twitter for #HIStalking and follow the conversation. To contribute, be sure and tag your tweets with #HIStalking so they can be seen by other chat participants.

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.
Become a sponsor.