From EpicConsulting: “Re: Epic going into the consulting business. What’s being said internally at Epic is that the program will be limited to employees with 4+ years of experience, it will provide some location independence, and the intention is to undercut in price most of the Epic consulting industry. It’s an attempt to give Epic employees less incentive to quit, sit out their one-year non-compete, and then come back doing the same job making twice the pay for half the hours. Epic has talked about doing this for years, formerly calling it Ongoing Services, but hasn’t actually gone this far until now. Consulting firm reaction has been, ‘Why would you want the same person who dug you into a hole to be the one to dig you out?’ but can they compete when Epic sells services at $75 per hour and they’re billing $150? Would a CIO pay double for a non-Epic voice? Will hospitals gain negotiating power with another option in the market? Fun question, too: will KLAS rate Epic’s consulting and will companies like Nordic, Sagacious, etc. score higher than Epic itself?” All unverified, but interesting.
From Please Please Me: “Re: HIStalkapalooza. I’ve never requested an invitation, so I’ve never been refused. But it sounds like fun and you guys are great to do that – don’t let the poor souls who don’t get in discourage you.” Inga reminded me that despite reader Gary’s insistence that he didn’t get an invitation for three years straight, we sent one to every single person who registered in 2013 and 2011, and I’m pretty sure we invited everyone in 2012 as well. Gary either didn’t register in time those years or his company’s spam filter trashed our emailed invitation, which happens a lot (and creates extra work for us because people always email us wanting individual assistance.) Demand this year was unprecedented – it will be the largest HIStalkapalooza yet, but around 900 more people asked for invitations than we have available. And to address the most commonly asked question, sorry, but we have no way to accommodate guests even though I’m sympathetic to those who want to attend with a spouse or friend – we’ve already had to turn away hundreds of loyal HIStalk readers.
Two-thirds of poll respondents haven’t been promoted in the last two years. New poll to your right: generally speaking, are the vendors and products named in the “Best in KLAS” report really the best ones? You won’t win favor for your position by simply clicking yes or no, but you might if you click the Comments link after voting to explain your rationale.
I mentioned that I decided to run an occasional ad at the top of the HIStalk page only so I can donate most of the proceeds to the DonorsChoose, which supports teachers whose classrooms need help buying books and supplies or paying for educational projects. I’m indifferent at best toward most charities (including hospitals) because they are inefficient, ineffective, and overly generous with executive compensation, but years ago my research led me to DonorsChoose and it has become (along with the Salvation Army) my charity of choice. I’ll be funding the first projects this week and updating the HIStalk giving page so we as readers and sponsors can feel good about the results – you’ll be able to see project details, status, photos, and the teacher’s letter of thanks and description of the outcome. I’m really excited about this. You are making it possible by reading HIStalk, for which I am grateful.
Listening: Blondfire, a Michigan-based dreamy indie pop brother-and-sister band that has new album coming out Tuesday.
Welcome to new HIStalk Gold Sponsor MEA | NEA of Norcross, GA. The company’s cloud-based solutions allow health plans and providers (both medical and dental) to electronically request and deliver images and documents that would previously have been printed and mailed. FastAttach improves revenue cycle management by allowing providers to submit documents to support their electronic medical claims via a Windows-based application that’s compatible with all practice management and revenue cycle systems. FastAttach also allows providers to quickly and securely respond to RAC and other audits through the company’s participation in Medicare’s Electronic Submission of Medical Documentation program (esMD) using the CONNECT gateway to send scanned images, print capture, screen capture, uploads, files, and mobile capture. Thanks to MEA |NEA for supporting HIStalk.
HIMSS Conference Social Events
Send us your event details if it’s a good one (i.e., free food and drinks at minimum) and you promise that all HIStalk readers are welcome to attend, even if they work for your most hated competitor as a given reader might well do.
Nordic is sponsoring an open house at King’s Bowl Orlando, International Drive, Tuesday from 6-8 p.m. Email to sign up.
Upcoming Webinars
February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.
February 13 (Thursday), 12 noon ET. Advancement in Clinician Efficiency Through Aware Computing. Sponsored by Aventura. In an age of information overload, a computing system that is aware of the user’s needs becomes increasingly critical. Instant-on roaming for virtual and mobile applications powered by awareness provides practical ways to unleash value from current HIT investments, advancing efforts to demonstrate meaningful use of EHRs and improve clinical efficiencies. The presenters will review implementation of Aventura’s solution at Orange Coast Memorial Medical Center.
February 18 (Tuesday), 1:00 p.m. ET. Epic 2012 Training and Support: Building Your Team. Sponsored by MBA HealthGroup. The webinar will present a case study of creative staffing solutions for an Epic 2012 upgrade at an academic medical center, describing the institution’s challenge, its out-of-the-box solution, and the results it obtained working with a consulting firm.
REST and FHIR
I’m hearing buzz about REST and FHIR Web-based programming coming from various vendors and from ONC. It sounds important for future healthcare IT development and interoperability, so I decided to look up the concepts since I don’t know anything about them. This is my cartoonish, stick-figure understanding that certainly could use more informed (but simple) explanation from knowledgeable readers about what it means in healthcare and who’s using it.
REST (representational state transfer) is the architecture that runs the Internet, where your browser sits there waiting for you to enter data or click a button and then something cool happens. Applications developed using RESTful programming respect the fact that the Internet works perfectly fine without individual programmers screwing around with tricky or proprietary techniques. Your browser knows how to process your Amazon order even though you don’t know or care how Amazon’s servers are set up, the Firefox people didn’t customize their browser to work with Amazon.com, and Amazon didn’t develop its site so that it only works with Firefox. REST-built systems can interact with each other with minimal overhead. It’s pretty much the opposite of how most healthcare applications were built, in other words, since it presumes that all boats are equally floated when applications work and communicate in a common way using existing infrastructure and methods, making life easier for programmers and users alike.
FHIR (fast healthcare interoperability resources, pronounced “fire”) is an HL7 framework that further defines REST for specific building blocks for developing healthcare applications. Applications developed using FHIR are theoretically easier to develop and support, are inherently interoperable, and follow Web standards.
I’m not as interested in the technical underpinnings as the possible benefits. REST and FHIR concepts are new to healthcare IT and probably aren’t ready for prime time. I can understand why vendors would be cautious about chasing trendy standards that not only threaten their proprietary existence but also could go out of fashion faster than the Harlem Shake, but it’s still an interesting design that could make life better for everyone (including patients and providers) if everybody used it.
This is the cue for an reader who is unbiased, technical enough to understand what all this means strategically, and blessed with the ability to describe it simply (but not simplistically) to enlighten the rest of us who just want stuff to work.
iHealth 2014 Report
The only conference I attend regularly is HIMSS for a variety of reasons — cost, time required, and often because I don’t even know when or where a given conference is being held with enough lead time to plan. I always invite readers to provide a summary of their experiences.
Here’s ADG’s writeup of AMIA’s iHealth conference:
iHealth 2014 was a good excuse to get away from the cold and snow of wherever you were and come to Orlando for some warm rain. Farzad Mostashari in particular was seen immediately after the PBS-style fireside chat of the four previous national coordinators without a bowtie and in the company of a couple of cute kids. Getting the four on the same stage was a logistics coup and they were immensely personable. The two with the initials “DB” — David Brailer and David Blumenthal — cheerfully referred to each other as DB1 and DB2. Their themes included the coming penalties for non-compliance with MU, and DB1’s very sharp insights, which included the observation that he expects FDA regulation of EMRs within “single digit” years. Their advice to the current ONC coordinator Karen DiSalvo seemed to be a version of “buckle up.” DB1 in particular was praised by the others for his sharp organizational and entrepreneurial skills in getting the office started on the right foot.
We came to Orlando to get practical advice (and to get out of the cold, see above) and there is some comfort that all are struggling — large and less-large, academic and less-academic — with rapid change. Most noticeable was a sharp divide between the academics and the operational types, with the academics suggesting that if you do the right things, the “regulators will catch up,” which is an actual quote. The operational types knew that regulators will deny payment for any failure to cross the T and dot the i and that their organization would be out of business for lack of money by the time the regulators “caught up” to the “right thing.” There was a terrific dinner hosted by AMIA for recent diplomates of the board of Clinical Informatics, and we discovered we all have frighteningly similar backgrounds and tastes. Blackford Middleton, chair of the board of directors of AMIA, gave an excellent short toast. There were no grand insights, but lots of one-on-one incremental gains from each other, and HIStalk was mentioned at least a couple of times from the stage(s).
Jim Hansen of Lumeris / Accountable Delivery System Institute knows I like what we call “Judy-isms,” little nuggets of cynical wisdom from Epic’s Judy Faulkner. He culled these from last week’s HIT Policy Committee meeting:
“Be careful about prescriptive standards. If there was a usability committee for the iPhone, there wouldn’t be one.”
“We see a huge international move to EHRs without incentive money. We can’t test it here, but would it have happened anyway?”
“With regard to Meaningful Use and providers saying, “I paid for an EHR, therefore you as the government owe me,” I think of girls on dates and I don’t think that’s a good idea.”
Brian Ahier provides the full text of the SGR Repeal and Medicare Provider Payment Modernization Act that proposes to move the Meaningful Use program into the Merit-Based Incentive Payment System.
From athenahealth’s Friday earnings call:
Jonathan Bush talked up athenaCoordinator for Enterprise, “our first truly hospital-facing service” that will tie together the company’s services for pre-certification, pre-registration, scheduling, and population health management. It will cost hospitals 1 percent of revenue.
“The on-ramp that is turning out to be Epocrates” will be enhanced to include secure text messaging, a provider director, and clinical decision support tools and the rollout of Epocrates Prime that will allow non-physician secure messaging participants and referral capability.
New company locations include Austin, Atlanta, and San Francisco.
Sales to small hospitals, the only underperforming area, will be better supported by teams that include operational analysts rather than just a single salesperson.
Bush, responding to an analyst’s question about how cost-shifting to patients will affect the company, said, “As long as they don’t become uninsured self-payers and they keep their financial selves tangled up in impossible-to-understand bureaucratic health plans, which is now the law of the land, it doesn’t hurt us.”
Bush says the company may need to create a patient-facing division because patient portal use is low industry-wide.
In describing the company’s patient engagement efforts, “The goal is to just do everything possible for the doctor over the cloud, to the patient, at home where they get better answers to clinical questions. Like tell me about your diet and your life and all the things you need to know for the doctor, all your smoking, your seatbelts, your sex life. All those things are much easier to talk about at home or in private than sitting in the freaking waiting room, or worse, on that butcher paper with your knickers off. So we’re going to use the social good created by all of our increasingly sophisticated patient outreach to be way better than we are.”
Enterprise Coordinator will include the patient facesheet from athenaClinicals and clicking on the patient’s name, even by a practice that doesn’t use athenahealth, will launch a session of the hospital’s EHR.
Bush described the company’s future strategy as, “The goal here is to get into the front door and the back door of the hospital and work our way through the wards and departments with cloud-based services that allow them to virtualize, get business from more places, and focus more of their resources on actual clinical care. Other places we need to go is we need to go to patients. So every patient in America needs to have something in their wallet and something on their wrist, some sort of 2D barcode or in their iPhone that says, ‘This is me. Zap this thing and pull me up on athenaNet if I’m unconscious.’ So that’s some sort of patient outreach. I don’t know if it’s a partnership with the big dogs out in California, the Facebook or whatever — maybe I have to meet the Zuck, who knows. And then the other one is to get into the finance side. So health plans have been largely kind of strapped down and held still by regulation. They can’t be responsive to their customers. They need new ways of underwriting healthcare and a partner that could bring a claimless healthcare network where nobody sends a claim or receives a claim. All of this is instantaneous intelligence built into the wire. That should be us.”
In summarizing 2013, Bush said, “That wraps up a fantastic year. And over the last few days, we have given out beautiful crystal things, checks, and stock options. And if that wasn’t enough, we gave a few people hangovers so that they knew that what they had done in 2013 and then we took all their needles and returned them to 0. And we noticed last night that you all got excited about how the year went and the stock went up. And we want you to know that we have turned our needles with you to 0. We have a very long way to go and it is only to us about how we journey. There will be a healthcare Internet and we will be the ones who have created it. ”
Speaking of athenahealth, ATHN shares jumped 25 percent on Friday, the second-largest percentage gain on the Nasdaq, after Thursday’s earnings announcement, valuing the company at $6.5 billion. A $10,000 investment five years ago would be worth $52,000 today.
CMS extends the deadline for EPs to attest for MU 2013 by a month to March 31, 2014.
The White House Office of Science and Technology Policy announces that several drug chains have pledged to support or expand their use of the Blue Button initiative to allow patients to access their prescription information: Walgreens, Kroger, CVS Caremark, Rite Aid, and Safeway. Walgreens, always the technology leader in retail pharmacy and arguably in healthcare, says it will adopt BlueButton+ guidelines to allow customers to share their data and use third-party health applications.
The Federal Trade Commission approves a settlement with IP-based video camera vendor TRENDnet over a software vulnerability that allowed anyone to view a camera’s live feed over the Internet without a password. One marketed use of the secure video systems is monitoring hospitalized patients.
In England, a privacy group criticizes West Suffolk Hospital after it reports 20 documented breaches since 2010, including seven in 2013. All of breaches last year involved paper records that were filed or mailed incorrectly.
Weird News Andy includes an actor’s name pun in titling this story, “He’s a Lauriette.” A German doctor diagnoses a patient’s cobalt poisoning caused by a broken artificial hip after recognizing its symptoms from an episode of the TV series “House.” The doctor says he’s not thrilled at being called “the German Dr. House” since he finds rude behavior unacceptable, but concedes, “It’s important to be nice, but you don’t get patients healthy just by being nice.”
Sponsor Updates
Clinical Architecture announces Symedical for the iPad, which provides mobile access to map administration.
John Gomez of JGo Labs is working with investment bankers interested in investing in healthcare IT companies with $5 million to $30 million EBIDTA, a proven business model, and good revenue growth. He’ll be available to meet with interested companies at HIMSS.
Contacts
Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.
More news: HIStalk Practice, HIStalk Connect.