News 10/2/14

Top News

UnitedHealth Group’s Optum division acquires MedSynergies, which offers physician practice billing and quality services. I had the opportunity to check in with MedSynergies CEO J.R. Thomas to get his take on the acquisition: “With this relationship, MedSynergies has the ability to take our existing MSIGHT solutions platform and expand it to focus on some of our goals to create solutions in the clinical and hospital space. Optum’s commitment to the global healthcare industry and improving operations at all levels of the health system is perfect alignment for MedSynergies and our mission to improve the way healthcare is delivered in the communities we serve.” Thomas has been with the company since it was founded in 1996 by a group of Texas ophthalmologists. I am fascinated by the fact that he holds a bachelor’s degree in zoology from the University of Arkansas.

CMS’s Open Payments website goes live, publishing transactional data on $3.5 billion worth of payments made by pharmaceutical and medical device companies to doctors and hospitals over the last five months of 2013. The launch comes with its detractors, such as the doctors groups and manufacturers that spent heavily to keep payment details from public view. The Physician Payments Sunshine Act is mentioned in almost 2,000 lobbying reports since Republican Senator Chuck Grassley of Iowa introduced the legislation in 2007. I attempted to play around with some of the data sets, but eventually backed out of the rabbit hole for fear of crashing my trusty Dell. I’m hoping Dr. Jayne or our good friend Data Nerd will chime in on their experiences with the new site.

HIStalk Practice Announcements and Requests

It seems MGMA has unleashed its media lists for the upcoming annual conference, since my inbox has been filling up over the last several days with interview requests and general exhibitor announcements. I’m looking forward to walking the show floor, and would especially like to do so in the company of a physician (anonymous or otherwise). Please drop me a note if you fit that category and could spare 30 minutes or so to escort me around the exhibit hall. I’d love to hear first-hand the likes, dislikes, and excitement that might arise as we peruse vendor offerings.

Acquisitions, Funding, Business, and Stock

Private equity firm Imperial Capital Group of Toronto completes a round of investment in disclosure management and HIE technology company MRO Corp.

Philips secures FDA clearance to market eCareCoordinator and eCareCompanion telehealth applications – the first clinical applications of its new digital health Hospital to Home platform. The company announced  the digital health platform collaboration with Salesforce earlier this year.

Rock Health announces that digital health funding has passed the $3 billion mark, while a separate announcement from StartUp Health pegs industry funding at $5 billion. StartUp stats show the 10 largest deals year-to-date include Privia Health, Preventice, Proteus Digital Health, NantHealth, and Flatiron Health. The 10 most active subsectors for that same period include big data/analytics, navigating the care system, practice management, sensors/diagnostics, and patient engagement.

Announcements and Implementations

YMCA selects CampDoc.com’s EHR for its specialty camps across the U.S. YMCA members will have access to the EHR at an introductory, discounted rate for the first season of service.

The Iowa Health Information Network connects to the Nebraska Health Information Initiative, enabling providers participating in the state HIEs to share health data across state lines via Direct Secure Messaging. The news just barely precedes notice that two North Carolina-based HIEs, Carolinas HealthCare System CareConnect and Mission Health Connect, will share their 3.5 million patient records.

WRS Health introduces cloud-based EHR, practice management, and patient communication services for pediatric practices.

Government and Politics

CMS announces it will not transfer Healthcare.gov to a new hosting service for the upcoming open-enrollment period. The website will remain on Verizon servers, rather than move to Hewlett-Packard servers, due to a lack of time for adequate testing with HP.  The agency plans to transfer 75 percent of new users to a portion of the site hosted by Amazon Web Services.

The VA announces it plans to field a new, commercial patient scheduling system by 2017, not 2020 as originally stated in contract documents released last month. VA CIO Stephen Warren reiterated in a blog post that, “We’re glad our draft release gave us a chance to catch this portrayal of our deployment plan so that we can correct it before the plan is released. VA’s goal remains to select a vendor who can meet our aggressive deployment timeline of 2 years after contract award, in six month increments or less.”

CMS reports that it received 44,000 hardship exception applications from providers prior to the July 1 deadline. It plans on notifying providers individually if they have been granted a hardship exemption, but did not say how many exemptions would be granted.

CMS also reports that the Physician Quality Reporting System enrollment window for the Group Practice Enrollment Option will remain open until October 3 due to a software glitch that prevented some provider groups from enrolling by the September 30 deadline.

Research and Innovation

A new study finds that nearly 75 percent of consumers do not use a fitness tracker or smartphone app to track their health, weight, and exercise. Forty-eight percent of those respondents said they would adopt one if provided by their physician. The findings tell me two things: First, the market is huge for wearables right now, and new, shiny gadgets like Apple Watch stand a good chance of making a big dent. Its price point won’t be as high as $349 forever, and will likely spawn more competitively priced products, not to mention a robust replacement market as second and third generations are unveiled. Second, vendors will be key to easing physicians down a path of easy, patient-reported data acceptance. Reimbursement will be another story.

A study finds that pregnant women shown an interactive computer program educating them about prenatal testing were more likely to skip noninvasive screening blood tests and ultrasounds. They were also more likely to skip invasive testing such as amniocentesis.

People

Travis Hiscutt (CRI) joins PerfectServe as sales director of the southeast.

Keith Chew joins Integrated Medical Partners as managing director, strategic positioning and consulting services.

Other

Apple releases an update for recent versions of its OS X operating system to patch the Shellshock bug. If you’re interested in a concise explanation of Shellshock’s impact on healthcare organizations, do yourself a favor and read “Will You be Shocked by Shellshock?” the latest HIStalk Readers Write contribution from John Gomez.

InVision CEO Clark Valberg highlights the tipping point Healthcare.gov’s dismal roll out ushered in for user experience, and issues a call to arms to product designers everywhere: “The HealthCare.gov debacle was, effectively, the consumer nation’s declaration of independence from instruction manuals, call-center help lines, and design frustration. To hell with them. This is where we step in as designers – whether we are designing networks, products, or landing pages. The people are demanding better. We have the chance, now more than ever, to start making deep and disruptive change in places where no one knew change could take place.”

Oracle’s new co-CEO Safra Catz makes no bones about the company’s plans to start acquiring applications companies in an effort to compete in an increasingly cloud-driven world. “We’re No. 1 in database, we’re No. 1 in middleware, but we’re No. 2 in applications,” Catz explained. “At Oracle, silver medal is first loser.” Catz was recently named to Fortune’s 2014 list of the Most Powerful Women in Business.

Amazing Charts apologizes for long customer support wait times, blaming a Meaningful Use services rush. Users unhappy after the company’s 2012 acquisition by Pri-Med are venting their frustration on the company’s discussion boards, with one summarizing, “AC has created these logjams by being unable to prioritize what is important, continuing to partner with NewCrop, releasing buggy new versions, and offering unlimited support for a flat price which may create abuse.” Users are also upset that the company is charging them to watch Meaningful Use webinars.

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 9/30/14

Top News

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

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.

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

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

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

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.

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.

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.

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

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.

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

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.

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.

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.

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

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.”

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.”

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

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

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.”

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.

News 9/25/14

Top News

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

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

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.

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

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.

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.

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

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.”

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

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.

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.

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

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

Other

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.

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.

“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.

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.

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.

News 9/23/14

Top News

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

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.

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

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.

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.

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.

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.

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

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.

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

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.”

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.

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

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.

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

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

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

Other

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.

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.

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.

CMIO Rant with … Dr. Andy

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.

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.