News 12/2/14

Top News

New RAND research finds that it’s too soon to determine the benefits of HIEs due to a lack of evidence. Funded in part by the VA, the research finds that only 13 of the nation’s 100-plus HIEs have been evaluated, with six of those being in New York. It also concluded that most medical groups claim they want exchanges, but must overcome barriers to acceptance and sustainability. “The real message here is that we don’t have enough data to draw conclusions,” said lead author Robert Rudin. “It’s very possible some of these operational [exchanges] are doing a great job and producing a lot of value in terms of cost savings and benefits. Until we have more evidence of impact, every health information exchange effort in the country should be considered as an experiment. The only way to learn from experiments is to evaluate them.”

HIStalk Practice Announcements and Requests

I’m a bit biased as far as the latest HIStalk poll goes, given that I live in one of the seven cities contending for the title of the “Nation’s Capital of Health IT.” Not that I’ve tried, but you can only vote for your city of choice once.

#GivingTuesday kicks off December 2, and I’d like to use it as an excuse to highlight HIStalk Practice readers over the next several weeks who are doing good things for their patients, customers, and communities. Staff at the Greater Buffalo United Accountable Healthcare Network (NY) are a great example. They gave away 100 Thanksgiving turkeys to patients most in need for the second year in a row. Send me a short write-up of your organization’s good deed along with a pic or two, and I’ll post it here, inducing warm fuzzies and hopefully inspiring others to follow in your charitable footsteps.

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Acquisitions, Funding, Business, and Stock

Fruit Street Health amends its certificate of incorporation to become a Delaware Public Benefit Corporation, chartered to "to use business to have a social impact." The press release announcing the switch focuses more on the company’s recent media coverage than it does on explaining why the change was made. It does note that CEO Laurence Girard decided to convert the company to a DPBC to “hold the company true to its social mission and also ensure that this time around the directors act in the interest of not only investors, but also employees, society, and the patients and healthcare providers that Fruit Street serves.” It expects to launch its $300-a-month digital health and wellness platform in the next few weeks.

Royal Philips acquires a minority stake in Image Stream Medical as part of its agreement to incorporate ISM’s surgical image stream management technologies into its hybrid suite and interventional lab solutions with integrated video and live-streaming capabilities. Terms of the deal were not disclosed. The deal comes just two months after the company announced it will combine its healthcare and consumer lifestyle divisions under the HealthTech name.

The National Institutes of Health awards Leidos a $113 million contract to support IT services for its Electronic Research Administration, which manages the NIH’s multibillion-dollar research and non-research grants program.

Cybersecurity firm FireEye discloses that an unidentified hacking ring dubbed FIN4 has spent the last 18 months stealing corporate secrets in order to cheat the US stock market. The group has attacked email accounts at over 100 US firms, most of them pharmaceutical and healthcare companies, looking for insider data that could be used to profit on trades before the data was made public.

Announcements and Implementations

Advocate Community Partners (NY) selects the eClinicalWorks Care Coordination Medical Record and Electronic Health eXchange interoperability platform to help it meet Delivery System Reform Incentive Payment program objectives, which include reducing avoidable hospital use by 25 percent over the next five years. ACP, formerly known as AW Medical Office, serves 437,000 patients from primarily Asian and Latino communities.

GE Healthcare announces keynotes for its Centricity LIVE 2015 user conference, April 29-May 2, 2015, in Orlando: Atul Gawande, MD, MPH (surgeon and author), Melissa Etheridge (singer-songwriter), and LeVar Burton. I wonder if Burton, who hosted beloved children’s series Reading Rainbow for over 20 years, will talk about the benefits of crowdfunding given that he raised $6 million to revive the show as an app earlier this year. 

Gila River Health Care (AZ) selects NextGen’s ambulatory EHR, PM, and NextPEN solutions as part of its efforts to transition its behavioral health services from paper to digital, and to prepare for Meaningful Use Stage 2 and the transition to ICD-10. GRHC is part of the Gila River Indian Community, which manages healthcare administered by the federal Indian Health Services.

Government and Politics

HHS announces that over 462,000 people signed up for or renewed health insurance coverage during the first week of open enrollment at Healthcare.gov. Enrollment numbers were likely given a boost during Black Friday, thanks to outreach kiosks set up at malls in Florida, Illinois, New Jersey, Connecticut, Maryland, New York, and the state of Washington. HHS has also announced marketing partnerships with the National Community Pharmacists Association and the XO Group, which runs websites targeting brides, new mothers, and homeowners.

CMS seeks comment on its proposed final ACO rule, which makes adjustments to the Medicare Shared Savings Program that include:

• Providing more flexibility for ACOs seeking to renew their participation.
• Encouraging ACOs to take on greater performance-based risk and reward.
• Emphasis on primary care.
• Alternative methodologies for benchmarks.
• Streamlining data sharing and reducing administrative burden.

Those of you itching to comment are out of luck at the moment. Links to the full proposal and comments page both seem to be down as of Monday night.

People

Community Health Services of Lamoille Valley (VT) honors Diana Smith with its annual Spirit Award for her work as the EHR systems specialist for the organization’s eClinicalWorks software program.

Research and Innovation

A MIT Technology Review article titled “Google Glass is Dead; Long Live Smart Glasses” says interest in Glass has rapidly evaporated as Google has lost key personnel and failed to advance the product from geek beta experiment to consumer mainstream. The article says the technology is fine, but the form factor needs to evolve so that the technology is hidden within the glasses instead of being perched like a prism on top of them, perhaps even being incorporated into a contact lens. Despite MIT’s dire prediction, Glass is looking to develop a more consumer-friendly, second-generation headset featuring an Intel processor. Rumor has it Intel will promote the new model to hospitals and manufacturing companies.

Researchers from the Pitt Graduate School of Public Health identify six categories of barriers to sharing medical data worldwide: technical, motivational, economic, political, legal, and ethical. Dean Donald Burke explains that, “These barriers and categories describe a landscape of challenges that must be addressed comprehensively, not piecemeal. We must work together as a global community to develop solutions and reap the benefits of data-sharing, which include saving lives through more efficient and effective public health programs.”

Other

Practice Fusion co-Founder and VP Matthew Douglass takes to TechCrunch to argue for “an open and unbiased Internet” to “ensure a future of American digital healthcare progress and startup innovation.” He points out that:

“This new concept of tiered pricing based on the type of content being delivered would disrupt the internet as we know it and would harm doctors, patients, and smaller startup Internet companies working diligently to upgrade our nation’s digital healthcare infrastructure. To ensure America’s healthcare technology infrastructure can continue to grow and flourish for the rich and poor alike, it is imperative that ISPs are not allowed to create tiers of speeds in this manner.”

Several commentators point out that his argument is weak on facts, but I give the guy high marks for responding to each naysayer.

Brant S. Miller, MD shares his frustration with the walk-in clinic experience after waiting 65 minutes for a flu shot at a clinic affiliated with the University of Texas Health Science Center at San Antonio:

1. The CVS MinuteClinic business model appears to be in trouble.
2. It has severe IT problems.
3. It doesn’t take a NP to give flu shots.
4. It doesn’t take an electronic medical record to give flu shots.
5. There appears to be little, if any, supervision of the MinuteClinic NPs by the UT system.
6. If this were a heart attack patient coming in with symptoms masquerading as "the flu," the NP would be so busy fooling around with the computer that she wouldn’t recognize the potentially fatal acute condition until it was too late.
7. It’s important to focus on the patient first, and not on the computer or the business model.
8. I wonder if and when the business gurus managing this clinic will figure out that it is taking way longer than 8 minutes to administer flu shots.

Wired paints a pretty complete picture of the Kiva robots Amazon uses at its fulfillment center in Tracy, CA to handle the frenetic online shopping associated with the long Thanksgiving weekend. The center houses 21 million items, with the capacity for 5 million more, and ships out 700,000 items on a peak day.

No mention is made of the percentage of ugly Christmas sweaters stored and shipped via Amazon. I haven’t felt the need to don one (ever), but that might change come National Ugly Christmas Sweater Day, which falls this year on December 12.

Contacts

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

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From the Consultant’s Corner 12/2/14

Portals: The Next Step in Patient Engagement

Although healthcare practices are racing to adopt patient portals to meet MU Stage 2 requirements, these tools offer much more than just a way to receive incentive dollars. When employed strategically, they can facilitate personalized patient engagement, improve satisfaction and maintain loyalty, elevating an organization’s clinical and financial performance as well as its service delivery.

How Portals can Capture Patient Attention
Portals facilitate engagement, and ultimately the patient experience, by providing significant benefits to both patients and providers. For example, a portal operates on the patient’s timeframe with 24/7 availability anywhere the patient wants to use it. Moreover, it provides a confidential communication platform for personalized two-way dialogue between patients and providers, allowing patients to get their questions answered in a private and secure manner without having to make an appointment and spend time visiting the doctor’s office. This often encourages patients to address health issues more readily.

Portals also increase efficiency by offering real-time, online appointment booking that saves patients and staff time. Patients can even pre-register for appointments online, streamlining their arrival to the office and getting them in front of the physician faster.

On the business side, portals facilitate patient payment through electronic statement delivery and remittance capabilities. Not only does this make payment more convenient, it increases the likelihood patients will pay, helping the practice improve cash flow while decreasing the risk of bad debt.

Strategies for Optimizing Portals
When used to their potential, portals can provide a competitive advantage over market peers, especially those without a robust tool. The technology communicates that a practice is forward-thinking and patient-focused while enabling convenient and responsive care. As healthcare reform gives patients more flexibility in where they seek services, it is becoming even more important to fully leverage portals to foster patient engagement and satisfaction. This increase in patient satisfaction can ultimately help improve a practice’s financial performance.

In my opinion, practices can get the most out of their portal by implementing the following tactics:

• Create a multi-disciplinary group to develop an overarching portal strategy. When viewed as an IT project, portal implementation tends to focus on meeting MU requirements rather than enhancing the patient experience. To avoid this scenario, practices should bring together clinical, practice management, and IT leaders to define portal goals and objectives, keeping the patient top-of-mind. During this time, the group should clearly outline roles, so that everyone knows the part they play in optimizing portal use before, during, and after implementation.
• Use clinical staff to promote portals and get patients registered. The portal’s credibility goes up when physicians or nurses talk with patients about the tool’s capabilities and benefits, and encourage enrollment. Clinicians should take advantage of one-on-one time with patients to explain how current care could be more efficient if the patient used the portal, providing specific examples the patient can understand. For instance, the provider could point out that patients are able to refill prescriptions via the portal, reducing the time the physician and patient need to spend during the onsite visit discussing refills. To further prompt enrollment while the patient is in the office, practices should provide convenient registration opportunities—perhaps through a designated kiosk, desktop, laptop or tablet.
• Engage patients when sign-up occurs. To fully reap the benefits of a portal, practices should look beyond enrollment. If patients sign up and nothing happens, they probably won’t use the portal in advance of the next visit. On the other hand, if the practice immediately contacts the patient with a personalized acknowledgement, the patient may be more likely to use the technology long-term. I’ve seen practices send a message to patients a few hours after enrollment with a communication from the physician explaining lab results and providing prescription renewals. This draws the patient in and clearly demonstrates the portal’s value. In my opinion, organizations that commit to regularly using the portal to communicate information of value can dramatically expand patient adoption and care involvement.

The Future Looks Bright
As providers and patients increasingly accept portals, new applications will broaden their impact on care delivery and the patient experience. For example, portal-enabled e-visits are an emerging way to streamline care for certain patient types and non-urgent issues, while meeting consumer demand for convenience. Instead of making an appointment and driving to and from the practice — sometimes requiring more time than the appointment itself — the patient communicates directly with a nurse practitioner or other clinician via the portal. The e-visit carries a flat fee that is payable when the patient books the appointment online. Even though the cost is not currently covered by all payers, this has not deterred patients in those practices now offering e-visits.

Given the current trajectory, portals stand to play an expanding role in healthcare delivery. In my view, organizations that are prepared with a patient-focused portal strategy can ensure they get the most out of the technology, helping to improve the overall patient experience and strengthening the practice’s future viability.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Contacts

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

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Thanksgiving Edition News 11/27/14

Top News

The New York-based HIXNY RHIO unveils its patient portal, which it anticipates will improve access to patient information between providers through the SHIN-NY (come to find out it’s pronounced “shiney”) statewide HIE.

HIStalk Practice Announcements and Requests

Don’t let the holidays pass you by without acknowledging how much you appreciate that colleague who  goes above and beyond. Managers, peers, and customers can nominate a non-management employee (vendor or provider) for the HIStalk “Beacon of Selfless Service” award. We’ll happily announce winners over the next several weeks, hopefully inspiring others to go that extra mile. The HIStalk team will also be running recaps of holiday-related company good deeds or celebrations this holiday season, so please send along your recaps with a photo or two.

Watching: Thanksgiving at my house doesn’t officially start until the Macy’s Thanksgiving Day parade commences. It’s a great excuse to lounge on the couch in leisurely attire just a little bit longer before heading into the kitchen to finish prepping the turkey and trimmings. This article provides helpful links to the route map and where to watch live-stream video (great for people like me who cut the cable cord long ago.)

Long holiday weekends are golden opportunities for binge watching. On deck for me is Netflix original Peaky Blinders, a gangster family epic set in 1919 Birmingham, England. It won’t take you long to figure out where the title comes from.

Announcements and Implementations

Drchrono uses Apple’s Touch ID fingerprint reader to authenticate physicians logging into its EHR. Apple opened up the biometric reader to third-party developers when it released iOS 8. Three taps of the finger – one to get into the iPad, one to open the app, and another to open the EHR – gets them in without having to enter a passcode (though that option is still available).

Acquisitions, Funding, Business, and Stock

Optimized Care Network aims to install 100 CareSpace telemedicine kiosks in hospitals and physician practices as part of an investment deal with Mobility Exchange, which will bundle the kiosks with wireless data plans from Verizon. Founded less than a year ago, OCN landed a $1 million investment earlier this month from Modern Medical CEO Joseph Favazzo.

Forbes lays out the past, present, and likely dim future of digital health IPOs, calling out companies like Castlight Health, Vocera, Imprivata, Everyday Health, epocrates, and Accretive Health as those that have underperformed since their respective IPOs. Of those reviewed, only Veeva Systems and Medidata Solutions are trading above their IPO price, leading to the conclusion that, “Despite sizable market opportunities within the healthcare sector thanks to government legislation, the public seems confused about what digital health is.”

Government and Politics

Thanksgiving also marks Family Health History Day, as ONC so kindly reminded me in the holiday edition of its weekly e-blast. While I agree that knowing my family’s health history is important, it’s not necessarily going to be my first topic of conversation over turkey at the dinner table. A quick peek at the My Family Health Portrait online tool makes me think it’s in dire need of a redesign.

People

The National Association of Professional Women recognizes Karen Mingain (HealthNET Systems Consulting) as 2014 Professional Woman of the Year.

Research and Innovation

An AHRQ study finds (not surprisingly) that EHRs should be developed for pediatricians with functionalities “related to a child’s evolving maturity.” Researchers determined that EHRs should include vaccination, development, physiology medication dosing, pediatric diseases management, pediatric norms and the relationship between pediatric patients and their caregivers. They added that, “Key Informants indicated that if these functionalities are implemented well, the EHR will also better support the care of all patients.” I think the keyword here is “well.” Pediatricians likely already have the ability to document most of these details, but finding the time to do it “well” when faced with an already overbooked day of appointments probably makes it very challenging.

An overwhelming majority of physicians on PracticeFusion’s EHR say that their patients have not asked about incorporating health data from wearable fitness trackers or health apps into their health records. Combine this with privacy and security concerns, plus a physician’s lack of desire to receive this type of data, and it’s not likely we’ll see much marketplace traction with Apple’s HealthKit.

Other

The Commonwealth Fund issues a brief outlining the significance of the release of Medicare physician payment data, limitations of the dataset, current uses of the information, and proposals for making the data more meaningful for public use.

There’s apparently still time to register for the HITLab Innovators Summit, happening December 1 in New York City. The promo code will knock your general admission registration fee down to $550, plus a $30.95 processing fee.

This article points out the UK’s need for EHRs in light of the recently uncovered fact that one fifth of data security breaches in the healthcare sector are the result of paper records being lost or stolen. To combat the problem, the Department of Health has appointed Dame Fiona Caldicott to the new position of national data guardian for health and care. Health secretary Jeremy Hunt has committed to ensuring a paperless NHS and fully integrated digital patient records across NHS and social care services by April 2018.

Ryan Jeffrey Shaw, assistant professor in the Duke University School of Nursing, voices his frustration with the over-hyped wearables craze:

“[T]he biggest challenge for most patients isn’t gathering data, but changing human behavior. You can have the hottest medical gizmo on the planet, but it’s not going to help you much if you keep eating junk food and avoiding the gym. So, yes, by all means push aside those turkey leftovers and go check out these new wearable health devices on Black Friday. Just don’t expect them to magically make you healthier. That’s something you — and our country’s health care system — still need to work on if these tempting holiday gifts are going to live up to their promise.”

If you’re an optimist and believe that a wearable will make all the difference in your journey to health and wellness, check out CNET’s guide to 14 Black Friday deals.

Boston.com correspondent MD Mama, aka Claire McCarthy, MD shares a list of things she’s thankful for, including:

• “that baseball season is completely over (since Boston Children’s is right near Fenway Park–traffic gets nuts)”
• “that nobody in the family complains if I work late”
• “my job and my wonderful colleagues–and my wonderful patients who let me into their lives and let me serve them.”

Sponsor Updates

• Intelligent Medical Objects, Allscripts, and eClinicalWorks earn glowing remarks from the HIStalk Advisory Panel.

Contacts

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

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5 Questions with James Stevermer, MD Medical Director, Callaway Physicians

James Stevermer, MD is medical director of Callaway Physicians, a part of the University of Missouri Health System. The practice, which recently met NCQA patient-centered medical home level 3 criteria, employs 16 full-time and 16 part-time staff members who see an average of 80 patients a day.

How have you and your colleagues seen technology change the way healthcare is practiced at CP, especially given that it recently celebrated its 40^th anniversary?
There have been remarkable changes, whether we are looking at therapeutic interventions or the day-to-day practice. EHR has been a substantial work-flow change.

What EHR does CP use, and where are you with Meaningful Use?
As part of MUHealthcare, we use Cerner Powerchart. We’ve met Stage I and will work towards Stage 2 next year.

Given that CP is in a rural setting, has it looked into adopting telemedicine services?
We have had telemedicine, but it’s been little used. Partially because it wasn’t used much when first put in, due to technologic barriers at the time. Although rural, the distance isn’t that far to referral systems, so I think patients prefer to travel. We use it regularly for educational purposes.

Has the practice encountered any healthcare IT implementation challenges recently?
Our biggest challenge was a couple of years ago when we went to CPOE. Fewer challenges in the last couple of years. Things also improved when we moved bandwidth beyond a bare minimum for the size of the practice.

What implementation best practices can you share with other providers?
Have several champions, not just physicians. Have extra help during transitions. Be prepared for unanticipated workflow changes.

Contacts

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

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DOCtalk with Dr. Gregg 11/25/14

MU: It Do and It Don’t

Dr. Robert Wachter recently wrote a wonderful piece that later posted on Healthcare IT News entitled Meaningful use: Born 2009 — died 2014? His subtitle was “I believe that meaningful use is now doing more harm than good,” a sentiment perhaps echoing through the barren halls of MU leadership as top echelon folks seem to be good at writing-on-the-wall reading.

It does seem that MU has gotten waylaid in processes and procedures, becoming less and less meaningful, and more useless than useful.

Did MU make a difference? You bet it did. If it doesn’t change its current course, will it continue to be of value? Doubtful, very doubtful.

Reflecting on its effects and impacts, here’s a few observations on the impact of MU, when “it do” help and when “it don’t.”

It Do:

• Every time you see the notes from a consulting doc whose scribble used to be illegible, and whose notes are now clean and crisp in their Times New Roman or Arial font.
• Whenever a lab result comes whistling into your EMR, directly from the lab, with values that are trended over time, and easy to view.
• When pop up reminders help you catch a vaccine that might have been missed or remember a lab redraw that you didn’t want to forget.
• When you want to hurry through your last few patients because it’s been a very long “one of those days” and your brilliant little EMR catches you in your tired rush before you prescribe an antibiotic to which a patient is allergic.
• Each time a patient messages you through the portal and you realize how easy the portal makes it to communicate better with your patients, with less interruption to your daily flow (and with no phone tag!)
• As your bank account receives a boost when the MU check clears after successfully meeting and attesting to your MU compliance.
• When you want to know something about your practice, or your patients, and a relatively simple search reveals insights your paper chart system could never have supplied.

IT DON’T:

• When you visit your otherwise very high-tech specialist who still uses paper charts and who swears that, after considering the negative impact on their currently comfortable workflow and running the ROI numbers, he thinks the penalties for MU avoidance are less bothersome than the expense of going digital.
• As you want to contribute to electronic syndromic surveillance and are stymied by the inability of your state public health agencies for accepting such digital submissions.
• Each time the fax machine rings and you receive another 87 pages of records transfer that you’d just love to have in digitally manageable form.
• Indeed with every fax you receive as you realize that so little interoperability has been implemented that you still receive the vast majority of your patient-related communications from other providers the same way you did 20 years ago.
• When you open your mail (snail-type) to read a consultant’s report that comes from a hospital-based specialist, part of a hospital system that you know for a fact uses Extormity, and yet here you are slicing open an envelope.
• Whenever you decide to switch EHRs and realize that data migration standards and capabilities are less 2014-ish than they are 1995-ish.
• When you receive a letter from CMS notifying you of an upcoming audit and you go online to read about some pretty nasty – and lengthy – provider MU audit experience nightmares.

Dr. Wachter has a line near the end of his post that reads: “Rather than continuing to push highly prescriptive standards that get in the way of innovation and consume most of the bandwidth of health IT vendors and delivery organizations, MU Stage 3 should focus on promoting interoperability, and little else.”

Seems like a good prescription, doctor.

From the trenches…

“It do and it don’t.” – Barry Hunter, manager and trainer of dethroned boxing champ (steroid-related) Lamont Peterson

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

Contacts

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

More news: HIStalk, HIStalk Connect.

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