News 4/28/15

Top News

The Institute of Medicine will rename itself the National Academy of Medicine effective July 1, 2015. The change is part of a larger internal reorganization to more effectively integrate the work of the National Academies of Sciences, Engineering, and Medicine.

Acquisitions, Funding, Business, and Stock

New York-based software development and IT consulting firm Algonquin Studios rebrands as Algonquin, and announces it will focus solely on healthcare clients moving forward. The company is undergoing significant expansion of its office space in downtown Buffalo.

Government and Politics

In an effort to ensure more accurate subsidies, CMS decides to automatically re-enroll and re-calculate the subsidies of consumers who don’t return to Healthcare.gov to update their eligibility for tax credits in 2016.

People

Medical kiosk vendor HealthSpot hires Gail Croall, MD (Anthem) as chief medical officer; Eric Eichensehr (Levitate Technologies) as CTO; and Bruce Roberts (RxEngage Partners) as COO.

Research and Innovation

A survey of small-practice physicians finds that close to a third are “not at all confident” their organizations will be adequately prepared or their employees adequately trained in time for the October 1 ICD-10 deadline. To make matters worse, 33 percent feel that there should be no transition, making me think that perhaps it’s the issue of change, rather than technology, that is keeping physicians from timely preparations.

A Northwestern University Feinberg School of Medicine study finds that patient portals may widen the digital divide between the underserved and more affluent. The study showed white patients were 2.5 times more likely to be registered as portal users than African-American patients, while those with good health literacy skills were 3.5 times more likely to be registered with the portal than those who didn’t have those skills. Study co-author Sam Smith puts the portal problem in perspective: “If we now further complicate what it means to be a patient by asking people to be engaged outside the doctor’s office – on the Web or by mobile phone – and if these same groups of patients are not as capable or ready to assume these new roles, we may further exacerbate the disparities that already exist.”

Other

David Blumenthal, MD, president of the Commonwealth Fund and former head of ONC, pontificates on the future of healthcare, daydreaming about the role the smart home (and Uber) will play in the automated care of aging parents, and the quality and deductible data that will soon be at our fingertips in a single click. He ends with a dash of reality, calling for increased interoperability, privacy, and security of cloud-based health data.

Emily Queenan, MD recounts her decision to relocate her Rochester, N.Y.-based family medicine practice, which used “the latest in 21st century technology,” to Canada after losing too much sleep over attempting to conquer America’s broken healthcare system: “I spoke with other physicians, both inside and outside my specialty, about alternatives. We invariably ended up talking about the tumultuous time that the U.S. health care system is in – and the challenges physicians face in trying to achieve the twin goals of improved medical outcomes and reduced cost. The rub, of course, is that we’re working in a fragmented, broken system where powerful, moneyed corporate interests thrive on this fragmentation, finding it easy to drive up costs and outmaneuver patients and doctors alike.”

Apple Watch officially launches. Should I ever be in the market to be even more connected and quantified than I already am, I’d probably opt for the $349 Sport model. I do wonder how well it would hold up during one of my ALTA doubles matches.

Like many consumers, I switched health insurance plans earlier this year and am still getting used to Medi-Share’s business model. I was pleased to read in their latest marketing materials that they see value in offering their customers digital health tools from CareSync and BridgeHealth Medical.

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

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5 Questions with Rushika Fernandopulle, MD CEO, Iora Health

Rushika Fernandopulle, MD is CEO and co-founder of Iora Health, a chain of primary care practices that employs 160 at facilities in six cities across the country. The four year-old company, which expects to double in size this year, interacts with thousands of patients a week – many via email, phone, text, and video. Iora Health has opted out of Meaningful Use in favor of focusing on, as Fernandopulle puts it, “the goal of building a technology platform to allow us to deliver better care for our patients, period. I’m not sure I agree with the fundamental premise that the government should decide from the top what features should be in our platform. We should decide this bottom up based on our needs. One would think the failure of Soviet style central planning would inform this.”

The company serves patients through relationships with employers and payers like Humana, and places a strong emphasis on customer service. “We start by hiring physicians and other staff who understand we are in a service industry and have the right culture,” he explains. “During training, we expose people to excellent service industries outside of healthcare (e.g.  Apple, Zappos, Ritz Carlton), and build our system to help us provide excellent service. This isn’t a program or initiative – it is at the core of who we are.”

Iora Health has been described as wanting to be “the Starbucks of healthcare.” What sort of cultural and technological challenges are you encountering in scaling primary care nationwide?
We did something a little crazy but strategic right from the start. Our first two practices opened within a few weeks of each other back in 2012. They were in Hanover, N.H. with Dartmouth College, and in Las Vegas with the Culinary Union. I don’t know of many others who would do this. We did it because we want to transform healthcare, and we knew then that in order to do that we had to think about how we would scale from the start. Today, if you go to either of these – or the 10 other practices we have around the country – you’ll see that the culture is the same.

This goes for tech, too. We didn’t build our system to support one practice. We built it to scale. Because we built it and have a team dedicated to it, when we want to change anything, we can – we don’t have to put in a request to another company and get in a queue. We prioritize our needs and implement them.

What was the impetus behind developing rather than buying an EHR off the shelf? Did you test drive any? If so, from what vendors?
Existing EHRs, not surprisingly, are built for the current business model – to increase coding and billing. We have a fundamental job to do – to improve the health of our patients and keep them out of trouble. I have worked with a number of EHRs prior to founding Iora Health and struggled to use them in our very different care and business model. For years I tried to get some of the existing vendors to adapt their products for us, and realized that – as with our care model – we simply had to start from scratch.

How long did EHR development and roll out take?
Our tech team develops and rolls out iterations of our platform every two weeks. The first instance was built in six months, which is unheard of in the EHR world! We build with MVP (Minimum Viable Product) in mind and then get feedback from the care teams and improve. The development team, by the way, includes doctors, health coaches, and other members of our care team. This isn’t a system that was built in a backroom separate from the care and delivered a year or two later!

What sort of features are unique to your EHR?
Some unique features include: the patient’s ability to view their entire chart, schedule encounters (video, phone, and in person), and send us data; robust, proactive task management; patient stratification and population management; and a wide lens where our care teams can see what is happening to our patients in the rest of the healthcare system. 

What will the next few years hold for the company? Will you look into offering telemedicine services, or other digital health offerings?
We are really excited about the future. This year we closed our Series C funding and already opened one practice with Hartford Healthcare. We will double in size and expect to double in size again next year. What’s fundamental about our vision and our success is that we built this around relationships and culture. We think it’s silly to think of telemedicine as a separate thing. From the beginning we have based our model on continuous healing relationships, and that means being able to interact with our patients using the technology they are already using in all the other parts of their lives.

Contacts

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

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News 4/27/15

Top News

PM, EHR, and medical billing vendor CareCloud gains $15 million in funding from investors, and names board member and operational advisor Ken Comée (PowerReviews) CEO. He replaces Albert Santalo, who will stay on as chairman and chief strategy officer. I wonder how long the executive shuffle has been in the works, and if the investment was contingent on Comée’s appointment. Santalo appeared in confident spirits when I met him at HIMSS, and I know for a fact he wasn’t the only one at the company to gain or lose a job title within days of the conference.

HIStalk Practice Announcements and Requests

As I mentioned last week, I’m going to post physician practice news items Monday through Thursday moving forward, devoting Fridays to a roundup of the week’s population health management news. Though likely shorter in length, these daily posts will be more specific to clinics, medical groups, and practices. Be sure to sign up for the HIStalk Practice e-blast to stay on top of everything.

I had my first opportunity to visit the main campus of Children’s Healthcare of Atlanta this past weekend. While I wasn’t there for the happiest of reasons, it was heartening to see that the space was bright, open, and airy; staff had smiles on their faces; and amenities such as a sunny playground and gardens helped patients focus on something other than their diagnosis, if just for a few brief moments. Technology blended into the background, surpassed by brightly-painted walls, aquariums at every turn, and game rooms on every floor. Given my love for books (my first job, at age 14, was at my local library), I selfishly wish the facility were closer to home so I could volunteer in the children’s library.

Reading: 7 by Jen Hatmaker. Described as “an experimental mutiny against excess,” the book chronicle’s Hatmaker’s seven-month journey to reevaluate the effects of clothes, spending, waste, food, possessions, media, and stress on her life.

Announcements and Implementations

Ntegrus Solutions subsidiary PatientlySpeaking integrates its appointment-reminder system with the Aprima Medical Software platform. The company completed a similar integration with Practice Fusion earlier this month.

T-System launches T Sheets Digital for Urgent Care. The new care documentation tool offers 45 complaint-based templates. 

CareWell Urgent Care chooses Athenahealth’s EHR and practice management system for its 49 providers.

Government and Politics

The VA field tests two programs to give veterans electronic access to additional records including full health summaries, MRIs, and X-rays. Military.com reports the images will be available for download via the Blue Button tool on the My HealtheVet website. The agency is also working on a way for vets to personally transmit the images to non-VA providers.

Minnesota’s health commissioner says he’s concerned about pushback on the state’s 2008 requirement that all providers use EHRs by the end of this year. He debunks four privacy myths that are apparently the crux of the unstated opposition’s campaign.

HHS Secretary Sylvia Burwell, testifying on the department’s $84 billion 2016 budget request, is challenged by Sen. Lamar Alexander (R-TN) who stated that half of doctors don’t like their EHRs to the point that they’ll accept Medicare penalties rather than deal with workflow disruption, adding that the AMA found that 70 percent of doctors say their EHRs weren’t worth the cost and that EHRs are the leading cause of physician dissatisfaction. Burwell responded that HHS will work with Congress on a list of administrative action items related to EHRs.

The VA forms an 11-member medical advisory group to advise it on healthcare delivery issues.

Telemedicine

Brian Caulfield wins the second annual Google Wearables in Healthcare Pilot Challenge with development of a virtual therapist to help patients recovering from orthopedic surgery. The 4G-PT wearable provides real-time feedback on rehab exercises and activities, plus makes some of the exercises more game-like. Caulfield, who is director of the Insight Centre for Data Analytics at University College Dublin, was one of 89 participants and 11 finalists.

Tennessee Medical Association President John W. Hale Jr., MD outlines his support for telemedicine in a guest column in the local paper. Hale calls on the community at large to be open to “new technologies that can improve access to quality health care in Tennessee and, if used and regulated appropriately, contribute to better patient health and help reduce overall health care costs.” The state legislature is contemplating requiring a full Tennessee license to practice telemedicine instead of the less restrictive telemedicine license requirements already in place.

TeleHealth365 partners with the TeleMental Health Institute to offer behavioral health providers free HIPAA-compliant video conferencing. The press release is somewhat vague in fleshing out the benefits to TMI. I can only assume they’ll get some sort of marketing kickback for every physician that signs up for a TeleHealth365 video-consult membership.

Research and Innovation

Smithsonian profiles the Wake Forest Institute for Regenerative Medicine’s work on 3-D printing of organs, along with the ethical implications widespread adoption of such an innovation would imply. The number of 3-D printers shipped to medical facilities is expected to double in the next five years.

A poll conducted by physician social network Sermo finds that 81 percent of its 2,020 respondents believe talk-show host Dr. Oz should resign from his faculty position at Columbia University or lose his medical license. The survey stems from headlines made last week when a group of 10 physicians wrote a letter to Lee Goldman, MD dean of the Faculties of Health Sciences and Medicine at Columbia University, calling the medical school’s affiliation with Oz "unacceptable." He is currently listed as vice chair, department of surgery, on Columbia’s website, and is affiliated with the New York-Presbyterian health system.

A KLAS report finds that Athenahealth, Epic, and Medfusion are the most effective vendors at helping their customers drive patient portal adoption. Surveyed customers of all three report that at least 20 percent of patients have accessed the portal.

Heal releases a house call app for the Apple Watch that allows users to request a doctor visit with a single touch. Doctors equipped with mobile diagnostic apps such as the AliveCor ECG and CellScope otoscope arrive at the desired location within an hour and spend as much time as needed for a fixed fee of $99.

Other

Indonesian physician Gamal Albinsaid develops Garbage Clinical Insurance, a micro-insurance program that helps uninsured patients afford care and clean up their neighborhoods at the same time. The two year-old startup works with clinics to receive trash from patients and then recycle it, with funds going to pay for care for the previously uninsured. To put things in perspective, 11 pounds of recycled cardboard are worth close to $1US, which is enough to provide one patient with two free monthly visits to one of the five participating GCI clinics.

The local paper pens a hilarious write up of one man’s high-noon showdown with his Dell XPS 410. Lucas Hinch faces a misdemeanor charge after shooting eight bullets into his computer in an alley behind his homeopathic herb store. Hinch alleges that the machine had apparently given him the “blue screen of death” one times too many. Seems to me like there’s a business model in this escapade somewhere, especially for physicians looking for an outlet for their EHR-induced frustrations.

Sponsor Updates

• E-MDs will exhibit at the MGMA regional meeting April 29 in Galveston, TX.
• Nordic offers a recap of #HIMSS15 through its Twitter feed.
• Versus Technology publishes “Reflections on the Oklahoma City Bombing, from a Nurse Who Was There.”

Contacts

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

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News 4/23/15

Top News

BlackBerry launches the BlackBerry Center for High Assurance Computing Excellence to develop tools and techniques that deliver a higher level of security protection than currently available. CHACE will collaborate with the healthcare community, including the Diabetes Technology Society, to address security and privacy concerns for next-generation wireless medical devices and applications.

Reader Comments

From Survey King: “A large immunization-based GPO, Physicians’ Alliance, is doing an interesting EHR survey, different from any I’ve seen so far. They are trying to get real data about the effect on productivity and time (the skeleton in the closet of EHRs) from practicing clinicians.  The way the survey is constructed, they’ll be able to break it down by specialty and EHR. Their results will largely come from primary care docs, which makes it additionally interesting.  I have spoken with PhysAll and they plan to publish the results.” The survey is just 10 questions, and you have the added bonus of potentially winning a $50 Amazon gift card for giving them five minutes of your time.

HIStalk Practice Announcements and Requests

I enjoyed tuning in to the Health Catalyst webinar on “Microsoft: the Waking Giant in Healthcare Analytics & Big Data” featuring SVP Dale Sanders. Check out my tweet recap above.

Announcements and Implementations

Kareo announces a new version of its outsourced billing solution.

SuperCoder launches BoneCoder10 ICD-10 coding and compliance workflow software.

Pulmonary Critical Care and Sleep Medicine Consultants (TX) implements the MD Coder 10 Charge Capture solution from Medical Design Technologies.

Government and Politics

GAO Director of Information Security Issues Gregory Wilshusen tells House Oversight Committee members that the office will release a report on security incidents at Healthcare.gov later this year, alluding to the fact that hackers may have breached the site’s defenses more than once.

People

Ahmed Haque, ONC’s director of the office of programs and engagement, will join former National Coordinator Farzad Mostashari’s Aledade. (Funny, he didn’t give any hints he was leaving during the ONC press conference at HIMSS last week.)

LocumTenens.com names Elizabeth Drum, MD and Kris Johnson, MD MedicalMissions.org Physicians of the Year for international and domestic service, respectively.

Chicago-based healthcare technology incubator Matter adds 10 new board members from organizations including the AMA, University of Chicago, JP Morgan Chase, and Takeda Pharmaceuticals.

Telemedicine

Florida-based credit union GTE Financial offers its members and employees telemedicine services via MDLive. Individuals will pay $15 a month for unlimited calls, while families of up to six will pay $20. That’s a nice discount from the typical MDLive consumer rate of $49 per visit. MDLive made news last week when it announced a partnership with Microsoft, making it the first telemedicine business to offer remote consultations via Skype.

Telemedicine has its day in court, with stakeholders touting its benefits and calling for expanded use during a Senate subcommittee hearing. Subcommittee Chair Sen. Roger Wicker (R-Miss.) also announced plans to reintroduce a bill that would extend Medicare coverage for telemedicine services provided in underserved areas.

Research and Innovation

Color Genomics announces a $249 saliva test kit that detects 19 genetic markers for breast and ovarian cancer. Lt. Dan provides a breakdown here.

A study of over 28,000 online physician reviews comparing patient satisfaction scores among 23 specialties finds that patient satisfaction decreases as a physician’s level of education and training increases. Researchers noted that “patients complain online four times as often about a medical practice’s customer service – such as receptionists’ cordiality and doctors’ bedside manners – as they do about a doctor’s ability to heal.”

A study finds that Epic EHR implementation at Cleveland Clinic’s Cole Eye Institute, a large multispecialty ophthalmic practice, made little difference to productivity or revenue compared with the pre-EHR era. Not surprisingly, the Meaningful Use incentive payments did not offset costs of implementation.

Another JAMA study finds that digital clinical decision support for pediatric healthcare providers can help reduce body mass index in children. Families and clinicians experienced better results the more thy adhered to coaching from the CDS tools, including decision support on obesity management and interventions for self-guided behavior change.

New research finds that 70 percent of the U.S. population now lives in areas served by ACOs, with between 15 and 17 percent receiving care via the business model. While the research notes ACO growth has slowed, it points out that the new Next Generation ACO model will likely help kick start new interest – no doubt good news for companies like Aledade.

Other

The local paper covers the work physicians in Idaho are doing to move to value-based care, highlighting the State Healthcare Innovation Plan, which launches this spring. SHIP goals include improving care coordination through EHRs and health data connections; and a statewide data analytics system to track, analyze, and report key health metrics back to physicians.

Cory Franklin, MD sums up the pros and cons of EHRs in light of a recent JAMA study that found 29 million medical records were hacked, stolen, or compromised between 2009 and 2013: “Welcome to the brave new world of health care. Computerized medical records have given your health care providers better access to your medical information than ever before, even while your medical history will never again be as secure as that of your grandparents. Most people in health care consider this progress. But as George Orwell once observed, progress is invariably disappointing.” Fun fact: Franklin was Harrison Ford’s technical adviser and one of the role models for the character Ford played in The Fugitive.

Amazon and Barbie win big in Germany’s annual “Big Brother Awards” for privacy abuses. Non-profit Digitalcourage honored two local Amazon subsidiaries for violating Germany’s privacy laws, while Hello Barbie got a nod for its ability to record users’ conversations so that parents can review them later. 

Sponsor Updates

• ADP AdvancedMD offers “Recent enhancements to the EHR charge slip.”
• Culbert Healthcare Solutions offers “A Consultant’s Perspective: Teach ‘Em How to Fish.”

Contacts

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

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Readers Write: Leveraging Video for Positive Outcomes via Telehealth

Leveraging Video for Positive Outcomes via Telehealth
Replicating the Primary Care Provider Experience for Acute Unscheduled Care
By Alan Roga, MD

You’ve struggled through a long Friday at work, feeling run down but knowing you needed to push through. Once at home, you feel even worse: You’re burning up, your head is pounding and you feel like you just ran a marathon … without the benefit of training. There’s no way you’re up to driving six miles to the urgent care clinic or waiting for an undetermined length of time in your local hospital’s ER. Tomorrow is Saturday, so even if your primary care doctor could see you Monday, you’re miserable now. Luckily, you have a telehealth provider standing by for exactly this reason. This provider gives the option of a phone call or video appointment. Which would you choose?

Video conferencing has quickly become a preferred means of communication for both business and leisure. According to a global survey of corporate leaders, 76 percent of respondents currently use video solutions in the workplace, with 56 percent participating in at least one video call per week. Despite widespread acceptance in the business realm, video conference utilization varies greatly among telehealth providers. Some embrace video utilization, leveraging it in both Web and mobile applications, while others conduct most patient appointments via phone.

Leveraging video to treat patients via telehealth not only promotes a better patient experience, but also helps promote the best possible outcome. This fact is validated by the Federation of State Medical Boards, which developed the Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine. Per FSMB, fostering a physician-patient relationship is paramount, and video is a critical tool to help achieve this relationship. Video appointments foster the connection formed through face-to-face interactions. The ideal doctor-patient relationship, whether it encompasses a single care episode or 100, is centered on a feeling of trust, communication, and above all, connection.

In addition, video enables the physician to observe the patient’s actions, mannerisms, and expressions. This skill is a core attribute of a seasoned physician and critically important because it draws upon a physician’s knowledge, experience, and instincts. The same way a detective can read a suspect or a teacher can intuit the best way to instruct a child, doctors have perceptions seasoned by their knowledge and experience.

Lastly, video appointments provide a more conducive environment for certain telehealth best practices. By leveraging technology, these best practices facilitate doctor-patient communication, comprehensive data gathering, and an accurate diagnosis:

1) Replication of the physician office visit
From spending a moment in the virtual waiting room to receiving discharge instructions and prescriptions, doctor’s appointments have a cadence familiar to patients that should be replicated in telehealth. This cadence facilitates the proper pace for physicians to view the patient, collect data, and ask and answer questions. It allows sufficient time for clinical documentation. Toward the end of the appointment, the doctor can confirm pharmacy information and give instructions about next steps and a work release form for the patient. Conducting the appointment in a face-to-face video environment also helps replicate the tried-and-true office visit. Together, the face-to-face video environment along with a structure that follows a typical appointment can help ensure the physician and patient both obtain all the necessary information to promote the best outcome.

2) An identical experience regardless of technology or location
Telehealth enables anywhere, anytime access – an advantage for the business traveler in an airport lounge or vacationing parents with a sick toddler in their hotel room. Ideally, the patient should have the same experience whether it’s via phone or laptop. As mentioned previously, this appointment should replicate a traditional office visit as closely as possible. The mobile app, therefore, will ideally offer the same experience – from video visit to discharge paperwork – a doctor and patient would have via computer.

3) A strong doctor-patient connection along with comprehensive documentation
Today’s patients are accustomed to talking while clinicians type data into an EHR. While technology such as EHRs serves an important role, it can hinder the doctor-patient connection. In a telehealth appointment, technology must help foster an intimate connection between the doctor and patient. Tools to facilitate faster, easier documentation can enable the physician to gather extensive data, from the patient’s chronic conditions to the number and ages of the individual’s children – all while maintaining eye contact, picking up non-verbal cues, and maintaining the conversational flow. In short, technology should make patients feel like they are in the room with the physician having an intimate discussion – but not at the expense of comprehensive documentation. Ultimately, this type of telehealth encounter not only results in improved patient satisfaction, but also reduced referral rates when physicians are able to more accurately treat patients through improved technology and documentation capabilities.

In addition to these three items, telehealth providers should keep other best practices in mind. For example, physicians should not only ensure the best possible outcomes for patients, but also identify any non-acute follow-up items such as referrals or chronic condition management. Additionally, it’s important to establish a team-based approach to care by composing a dedicated team of physicians who know each other. They can then provide more cohesive, consistent care and further reduce any sense of anonymity or feeling of transience a patient may experience.

According to the Association of American Medical Colleges, the physician population will only increase by 7 percent in the next 10 years, which will likely create more strain on emergency departments and primary care providers. As telehealth emerges as a viable, cost-effective solution for unscheduled acute care, providers must integrate video and make it a priority for all patient care episodes. Through video, telehealth providers can achieve the best practices necessary to ensure positive outcomes, excellent patient experiences, and strong physician-patient connections.

Alan Roga, MD is a board certified emergency medicine physician, founder and chief executive officer of StatDoctors in Scottsdale, AZ.

Contacts

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

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