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Justin Barnes lands at Georgia Tech’s startup incubator

Here’s some more personnel news for you: Justin Barnes, who last month stepped down as chief of industry affairs and government affairs for EHR vendor Greenway Health, has been named entrepreneur-in-residence at Georgia Tech’s Advanced Technology Development Center.

The startup incubator isn’t specific to healthcare, but it sounds like Barnes will be focusing a lot of his energy on the healthcare sector. Per his bio: “He mentors and provides strategic entrepreneurial advice as well as key business connections to help grow a wide range of organizations including healthcare and IT companies, industry collaboratives, health systems and physician practices.” Barnes does have a lot of experience in healthcare. Before he spent 11 years at Greenway for 11 years, he was a founding vice president of Healinx, the precursor company to RelayHealth. Barnes also worked at HBO & Co. when that company was acquired by McKesson.

June 2, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Palomar Health innovation officer Portale stepping down June 30

Late word from the West Coast on Thursday is that Orlando Portale, chief innovation officer of Palomar Health in San Diego County, Calif., for the past seven years, is leaving at the end of June.

According to a quick e-mail from Portale, “I’m going to focus on advising health technology companies, private equity firms and healthcare organizations.” He already has dabbled in some of those areas, helping Palomar start up Glassomics, which he calls the world’s first incubator for healthcare applications and technology that run on wearable computers, including Google Glass.

Qualcomm Life provided an operating grant to Glassomics, so I wouldn’t be surprised if Portale ends up at that San Diego-based venture. Then again, Portale has a deep résumé, including senior positions at the former Sun Microsystems, health insurer WellPoint and government IT contractor Science Applications International Corp. (SAIC).  I’m sure he will have plenty of opportunities coming his way in short order.

In an e-mail to Portale — and copied to executives and board members — Palomar CEO Michael Covert said: “I want to personally thank you for everything that you have done for Palomar Health. Your efforts have put us on the map in the world of innovation and technology. We had a vision of what we could be and you helped to make it a reality. I am forever in your debt. Please let me know if I can be of support or help to you in the future. … I wish you only the best. Let us stay in touch as your career moves forward.”

 

May 29, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Video: Aneesh Chopra on ‘The Daily Show’ for a long interview

Everybody else has the news about CMS offering leniency with Stage 2 Meaningful Use, letting providers use EHRs with 2011 certification to meet Stage 2 standards because so few vendors have been certified to the 2014 standards previously required for Stage 2. I won’t rehash here.

I will, however, share the very extended interview Jon Stewart had last night with former White House CTO — and, before that, HHS CTO — Aneesh Chopra on “The Daily Show.” Stewart is a comedian with a known liberal bias, but he is not a bad interviewer when dealing with a serious subject.

Stewart has been hammering the VA over its backlog of new registrations, and stepped it up in the wake of the recent revelation that VA bureaucrats in Phoenix were gaming the system to make it look like waits weren’t as bad as they really were. He’s also criticized the federal government for failing to link medical records between the Military Health System and the VA — you know, what we in health IT call interoperability. (In Part 4, Chopra discusses lack of interoperability in the broader healthcare sense.)

I found out about Chopra’s appearance last night shortly before the show aired. Unfortunately, we were having heavy rain at the time, and my satellite TV got knocked out, so I missed it. It’s OK, because the Chopra interview was long — more than 22 minutes — and the version that was on TV is heavily edited. Here’s the full interview of the “Indian Clooney,” as Stewart called Chopra, from the show’s Web site.

Part 1  (4:41)

 

Part 2 (7:27)

 

Part 3 (5:19)

Part 4 (5:35)

 

May 21, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

APSO vs. SOAP, continued

A couple weeks ago, I had a story in Healthcare IT News about the growing use of the “APSO” notes for documenting patient encounters. APSO flips around the traditional SOAP format (subjective, objective, assessment, plan), ostensibly making it easier to view progress notes in electronic health records.

As I reported, APSO is in wide use at University of Colorado Health and at Lucile Packard Children’s Hospital in Palo Alto, Calif. Baystate Health in Springfield, Mass., found that hospitalists focused most of their attention on the “impression and plan” sections of patient records, essentially the AP part of APSO/SOAP. Physicians at Epic Systems, according to University of Colorado’s Dr. C.T. Lin, are recommending APSO as a best practice.

Yet, the inventor of the SOAP note, Dr. Larry Weed, still believes his format is superior. You saw his comments in the Healthcare IT News story. But every time I have the privilege of speaking to the nonogenarian Renaissance man, he always has more to say than I can fit into the average article. I often can’t keep up in my note taking, but, fortunately, in this case, Weed and his son/occasional co-author Lincoln, took the time to put their thoughts in writing for me.

I left most of their comments out of the story due to space limitations. I don’t have that problem here, so I present their entire statement to me:

The following represents our collective thoughts, including references to relevant portions of Medicine in Denial [their 2012 book].

The supposed advantage of the APSO alternative — that it begins with the physician’s assessment rather than data — is actually a failing. This sequence tends to make the note provider-centered rather than patient-centered, and judgment-based rather than evidence-based.  In contrast, beginning the progress note with data disciplines the provider’s assessment. The provider must think in terms of specific data, specific problems on the problem list to which the data relate, and the interrelationship of each problem to the other problems on the list. Moreover, it’s important to begin the progress note with subjective (symptomatic) data from the patient rather than so-called “objective” data,  As Medicine in Denial states (p. 168):
“… progress notes should begin with subjective data, because progress should be assessed from the patient’s point of view.  Practitioners should be alert to discrepancies between subjective and objective data (for example, where the patient does not feel better when lab results show improvement). These discrepancies may signal an error in data or misstatement of the patient’s problem.”
In short, provider thinking can be disciplined with problem-oriented SOAP notes as a standard of care. Yet, regulators and academics who are in a position to act on this issue have shied away from the whole notion of standards of care for organizing data in medical records. See our comments on ONC’s Stage 2 regs and our comments on the PCAST Report.
The need for standards of care in medical records goes far beyond the SOAP vs. APSO issue in progress notes. In fact, that issue is secondary. Two more fundamental issues for medical records are the following:
  1.  Determining initial inputs to the record. Initial inputs are determined by selection of data needed for the patient’s problem situation, and once the data are collected, analysis of the results.  Both selection and analysis are fatally compromised when determined by the physician’s clinical judgment. External standards and tools, based on a combinatorial standard of care, must govern the selection and analysis. Once that happens, then judgments of patient and practitioners (not just physicians) may supplement the combinatorial minimum standard.  See Medicine in Denial, pp. 53-61, 69-79, 136-37, 145-52.
  2.  Organizing the medical record around the problem list. Once initial data are collected and a complete problem list is defined, then care plans, orders, and progress notes should be problem-oriented, that is, labeled by the problem(s) to which they relate on the problem list. This disciplined practice is essential to justifying provider actions in terms of defined patient needs. Yet this practice is not followed or enforced with consistency. Indeed, some EHR systems do not even enable electronic links between the problem list and care plans, orders and progress notes. See Medicine in Denial, pp. 134-35, 144, 159-60, 166-67.
Like so much else in medicine, medical record practices are a Tower of Babel. Medicine need standards of care for managing clinical information (knowledge and data) no less than the domain of commerce needs accounting standards for managing financial information. This failing is a primary root cause of the health care system’s failures of quality and economy.

For that matter, Lin had more to say than what you saw in the story. He discussed the supposed importance of the subjective and objective elements. “That’s true in cases where there is diagnostic uncertainty,” Lin said. But he added that those components are still there for reference, jut not up front.

Lin called SOAP “a phenomenal innovation,” but suggested that EHR complexity sometimes makes it difficult to find the assessment and plan. For example, he said that a non-Epic EHR in the emergency department at UC Health has as many as 17 different screens for progress notes. “At least with APSO, you would collect the assessment or plan in the first half,” Lin said.

Because SOAP is so entrenched, Lin ran into much resistance when he proposed switching to APSO at 40 affiliated practices. He, of course, heard the tired, “But we’ve always done it this way” defense.

“I learned myself about culture change very acutely,” Lin said. “I was literally shouted out of the room by our physician leadership.” He had neglected to prepare the heads of various departments and clinics for the change in advance of the meeting where he announced the plan.

He subsequently had to have individual conversations with all 40 practice directors. And then Lin dropped a great quote from none other than Niccolo Machiavelli (speaking of Renaissance men): “Those who benefited from the old order will resist change very fiercely.”

Yes, that’s absolutely perfect for an industry as resistant to change as healthcare. But is APSO superior to SOAP? I’d love to hear your thoughts.

May 20, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Some truths about health IT and innovation

This morning at the annual SAS Health Analytics Executive Conference in Cary, N.C., former national health IT coordinator Dr. Farzad Mostashari dubbed Dr. Eric Topol “the high priest of personalized medicine.”

That reminded me of an e-mail I received a couple weeks ago, suggesting that someone should start a blog called, “What’s Eric Saying?” As this correspondent explained it, all you need to do is read Topol’s Twitter stream to know where health IT and the practice of medicine are headed. I checked it out. It’s true.

Some examples:

 

 

 

And that’s just since Monday.

Meanwhile, Mostashari added some truisms himself this morning. “Med speed is slow. Tech speed is fast,” he said, apparently paraphrasing current TEDMED owner Jay Walker. Then, speaking as a physician, Mostashari said, “Most of what determines our outcomes isn’t what happens in our office.” Which is kind of what Topol has been trying to get across for several years.

If only the financial incentives would encourage care outside the office, we might be getting somewhere. It’s starting to happen, but, as it says above, med speed is slow.

May 14, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Still no consensus on digital/mobile/connected health

A while back — three months, to be exact — I asked readers if they had a preferred term to describe “the application of new, personalized technologies to healthcare.” I gave you the choice of digital health, connected health, wireless health, mobile health and telehealth, and surmised that the results would not be conclusive. On that part, I was right:

digital health poll resultsHowever, I was surprised that connected health, a relatively underutilized term, did so well and that telehealth got but one vote. Wireless health certainly has kind of become passé, but I was surprised nobody picked it at all.

In any case, these results, however unscientific they may be, are representative of the fact that it is so hard to reach consensus on anything in health IT. They also are symbolic of the silos that still exist in newer technologies.

May 6, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

IBM acquiring Epic or Cerner? I dunno

The “unconfirmed rumor of a huge acquisition” that HIStalk (a.k.a. the National Inquirer of health IT) tweeted about on Wednesday apparently is that IBM was going to acquire Epic Systems. Mr. HIStalk on Thursday expressed some reservations.

 

 

So am I. The announcement was supposed to happen Friday morning, which is right now (10 am EDT as I write this). IBM is in the Eastern time zone and Epic is in the Central time zone; for that matter, Cerner also is on Central time, and when you think “huge” in health IT, really only Epic and Cerner come to mind. If there were to be an announcement not involving anyone on the west coast, it probably would have happened already.

In any case, I’m told that IBM has been rather quiet with analysts of late. I actually haven’t been able to find the ages of Epic honchos Judy Faulkner and Carl Dvorak, but they’ve been at this for some 35 years. Cerner CEO Neal Patterson is 65 and has an ownership interest in the Sporting KC soccer team. He’s also been in the health IT business for 35 years.You’d think any or all of the three have to be thinking of retirement, or, in Patterson’s case, moving on to the hobby of running a pro sports franchise. Except that Faulkner seems to love what she does.

Cerner’s stock price has dipped a bit in the last couple of months, but it has risen by 259 percent in the past five years, according to Yahoo! Finance. It still seems as if the health IT business has plenty of room to grow, especially among the biggest players, who promise to be the biggest beneficiaries of consolidation on the lower end of the market.

Until I hear something more substantive, I am not buying the IBM-Epic rumor. IBM-Cerner seems a tad more likely, but I still need to hear more.

May 2, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Docs, stop whining, start e-prescribing

The whining is getting old.

Per Surescripts, in 2012, the latest year for which statistics are available, about 69 percent of physicians nationwide used e-prescribing technology in one way or another, and 44 percent of all prescriptions written nationwide were routed electronically. (That report came out in early May 2013, so expect some new numbers soon.) Both are up substantially from the previous year, probably due in no small part to the Meaningful Use EHR incentive program, which does require a minimal level of e-prescribing.

But what about the holdouts? A recent article in the journal Perspectives in Health Information Management found that cost remains the No. 1 reason why physicians still haven’t ditched the paper prescription pad in favor of electronic prescribing.

“While e-prescribing offers many benefits, not all providers have been excited about implementing e-prescribing systems. A major barrier, reported by more than 80 percent of primary care physicians, has been lack of financial support. New technology requires training and information technology support for installation and upkeep. A practice must take these costs into account when deciding whether to implement an e-prescribing system and also when choosing a stand-alone system or one that is integrated into an EHR system. According to the Health Resources and Services Administration, in a 2007 study the total cost of implementing an e-prescribing system was found to be $42,332, with annual costs after implementation of about $14,725 per year, for a practice of 10 full-time equivalent psychiatrists,” the authors reported.

Yes, but the paper also says this: “E-prescribing improves the efficiency of the prescribing process. Though the actual entering of a new prescription takes about 20 seconds longer per patient than writing a prescription, this time is offset by the time saved because of the fact that less clarification is needed for electronic prescriptions. Prescribers spent more time on the computer, on average an extra 6 minutes per prescriber per day or an increase of 20 seconds per patient when seeing 20 patients per day. If implemented correctly, e-prescribing should cause little disruption in the workflow of ambulatory care settings.”

In other words, those resisting the switch are being penny-wise and pound-foolish.

Besides, e-prescribing systems don’t have to cost that much. In fact, they don’t have to cost anything. Allscripts offers a free, standalone e-prescribing system online, while PracticeFusion, DrChrono and Kareo have e-prescribing modules in their free EHRs. A startup named ScriptPad has an e-prescribing app for Apple iOS that’s free to prescribers; transaction fees get billed to pharmacies. I can’t vouch for the efficacy of any of this software, but cost doesn’t have to be an issue.

I think the real problem here is intransigence. Some doctors simply don’t want to get with the times, and the only losers are patients.

April 24, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Athenahealth-EHRA news significant only that it shakes up the status quo

By now, you’ve likely heard the news that Athenahealth has decided to quit the HIMSS EHR Association. As Athenahealth’s Dan Haley put it in a blog post: “At the end of the day, athenahealth left the EHRA because we never really belonged there in the first place. The EHRA was founded in 2004 by a group of EHR software vendors. Today, a decade into the age of cloud technology, the EHRA is still dominated and governed by a group of EHR software vendors.”

Athenahealth long has billed itself as a services company, not a software vendor, going so far as to hold a jazz funeral for the “death of software” at HIMSS13 in New Orleans. Athenahealth didn’t join the EHRA until 2011 anyway. It sounded like a bad fit.

I contacted Athenahealth, and was told that the company remains “fully committed” to the CommonWell Health Alliance, a coalition of health IT companies — also including Allscripts, Cerner, CPSI, Greenway Health, McKesson and Sunquest Information Systems — that came together for the stated purpose of “developing, deploying and promoting interoperability for the common good.” (There’s also the unstated purpose of fighting the dominance of Epic Systems.)

Athenahealth is staying on the interoperability path, but as is befitting the corporate culture, is going rogue when it comes to EHRs. It’s not the first time. It won’t be the last time, because it’s not like most of the other vendors/service providers, if for no other reason than CEO Jonathan Bush doesn’t fit the buttoned-down model of an executive. For that matter, neither did his co-founder, Todd Park, whom I often called an “anti-bureaucrat” during his time with the federal government. Park’s brother, Ed, is COO of Athenahealth, and also has unconventional tendencies.

I can relate to this mentality in a way. I quit the Association of Health Care Journalists years ago because it didn’t feel like a good fit for me. That group tried to include health IT in its programming, but it really was an organization for consumer and scientific reporters, not those of us in the business and trade press. Eight years later, I still don’t think the national media are doing such a great job covering health policy or explaining the nuances of this complicated industry. And, as I’ve said many times before about healthcare, the status quo is unacceptable.

 

April 23, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Despite scandal, TMIT is still operating

You’ve no doubt hear about the kickback scandal involving CareFusion and Charles R. Denham, MD, founder of the Texas Medical Institute of Technology (TMIT). I wrote a piece about it in the context of Meaningful Use for Healthcare IT News this month, since Denham co-chaired the steering committee of the National Quality Forum’s Safe Practices for Better Healthcare program during the time CareFusion allegedly paid Denham $11.6 million to promote its products.

CMS, of course, has, to date, based Meaningful Use quality measures on NQF recommendations.

Denham has become a pariah of sorts in patient-safety circles since the U.S. Department of Justice announced a $40.1 million settlement with CareFusion in January. Yet, believe it or not, TMIT is still in business. The organization’s Web site is functional; in fact, the “about” page prominently features a video with Denham. And the TMIT Twitter account is activem, promoting a webinar as recently as yesterday.

 


Perry Bechtle, D.O., is a neuroanesthesiologist at Mayo Clinic in Jacksonville, Fla., and a former U.S. Navy flight surgeon. I want to believe that his credentials are impeccable, but it’s hard to take TMIT seriously these days in the absence of a major house-cleaning. Interestingly, the last academic article Denham wrote before the scandal broke was in the December 2013 issue of the Journal of Patient Safety. It’s entitled, “Safe Use of Electronic Health Records and Health Information Technology Systems: Trust But Verify,” and co-authors include heavyweights such as David Classen, M.D., and David Bates, M.D.

How are we supposed to trust an organization that itself was wrapped up in such a serious breach of trust?

April 18, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.