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All my HIMSS coverage in one place

The last of my 10 MedCity News stories from HIMSS14 has been posted. It’s a nice mix of news, features, analysis and commentary. Here are links to all of them, in chronological order.
NantHealth launches Clinical Operating System – biggest of big data startups – with $1B (Feb. 25)

Body + biology + behavior: Intel exec explains how technology is making N=1 care possible (Feb. 26)

Tavenner: 2014 is your last chance for a hardship exemption for Meaningful Use 2 (Feb. 27)

HIMSS crowd skeptical of promise for flexibility on MU2 hardship requests (Feb. 27)

Google Glass startup expecting third healthcare client in less than 6 months (Feb. 27)

DeSalvo: True EHR interoperability – and a national HIE – is possible by 2017 (Feb. 28)

DeSalvo meets and greets – briefly – while Tavenner keeps her distance at HIMSS (March 3)

HIMSS Intelligent Hospital tracks patients, pills and clinicians in completely connected loop (March 5)

Interoperability Showcase uses car crash to show how connected data really can improve patient care (March 5)

Athenahealth’s first inpatient product isn’t quite an EHR, but a ‘Trojan horse’ into hospitals (March 10)

 

March 12, 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.

HIMSS gossip

ORLANDO, Fla.—Two days of HIMSS14 have come and gone, and I’m not bouncing off the walls just yet. But I did bounce off the pavement Monday night when I tripped exiting a shuttle bus, and have some facial scrapes to show for it. You will see the evidence whenever Health Innovation Media gets around to posting a video interview I conducted Tuesday afternoon.

Health Innovation Media’s Gregg Masters and Dr. Pat Salber have been camped out near the HIMSS press room since Sunday with their video equipment, querying various newsmakers on various health IT topics, and occasionally having guest interviewers. As I walked out of the press room on my way to the exhibit hall, I said hello to former national health IT coordinator Dr. Farzad Mostashari, who looked like he was just hanging around, but was actually waiting to be interviewed. Masters and Salber asked me if I’d be interested in interviewing Mostashari right there on the spot with no preparation, and with just 15 minutes to get down to the show floor.

If you recall, I did a live interview—yes, streamed live on the Web—last year with Athenahealth honcho Jonathan Bush, beers in hand, for the Health Innovation Broadcast Consortium that Masters and Salber were involved in. (I don’t know the status of that project, as there’s nothing new on that site since last July.) So of course I said yes, and I think it went pretty well. Well, there were a couple of hiccups, as in me thinking we needed to wrap up earlier than we actually had to. And then there’s this:

 

Followed by this:

 

Yes, the Twitterverse catches everything.

Now about that facial injury. I think I just need to avoid Orlando. In 2011, the last time HIMSS met here, I needed six stitches above my right eye after I banged my face against the edge of the bathtub in my hotel room. As I arrived for the 2008 conference here, I turned on my phone after landing and got the message that my grandfather had passed away. Just for good measure, I passed through Orlando on my way back from Europe in 2009. As the flight pulled to the gate, the skies opened up with a violent summer thunderstorm, prompting the airport to close the ramp, preventing the ground crew from unloading bags for nearly an hour. I was stuck in the no-man’s land of U.S. Customs for that whole time, where cell phones are prohibited. It was not until I cleared security, took the airport tram to a different terminal, then hustled to the gate that I knew I would make my connecting flight. So yeah, it’s become a pattern.

Anyway, speaking of Jonathan Bush, he is not at HIMSS14 because he is on sabbatical to write a book and who knows what else? Well, here’s a clue. He was spotted at the Winter Olympics in Sochi, Russia, last week with his more famous brother, Billy, host of “Access Hollywood.” (Hat tip to HIStalk for showing this video at HIStalkapalooza Monday night.)

I also heard that Bush is considering a run for political office of some kind, perhaps because it’s, you know, the family business. Anyone care to confirm this?

I do know for a fact that at least one HIMSS attendee is actually seeking office. That would be Dr. Steven Daviss, CMIO of startup M3 Information, maker of a mental health screening app called My M3. Daviss is running for Democratic Central Committee in Baltimore this year. If he wins, he plans on seeking a seat in the Maryland House of Delegates in 2018, in part because he says there is only one other physician among the state legislature.

Daviss himself is on sabbatical from his job as chairman of psychiatry at the University of Maryland’s Baltimore Washington Medical Center in Glen Burnie, Md.

February 25, 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.

CCHIT, KLAS might signal new era in EHRs

Two stories that have hit in the last 48 hours illustrate how the status quo in EHRs is being upset.

First off, as John Lynn broke late Tuesday night—first as a rumor and then as a confirmed fact—on his EMR and HIPAA blog, CCHIT, formerly known as the Certification Commission for Health Information Technology, is getting out of the health IT certification business, thus making sense out of the name change. The organization will continue to offer preparatory courses for ONC-sanctioned testing and certification, but no more actual certification.

CCHIT recommended that vendors turn to another authorized testing and certification body, Verizon-owned ICSA Labs, though there are others that still do offer certification, including Drummond Group, SLI Global Solutions, InfoGard Laboratories, and, for e-prescribing technology, Surescripts. Interestingly, CCHIT also announced that it will partner with HIMSS to offer a series of health IT events for vendors and providers. This is interesting because HIMSS was one of the three founding organizations of CCHIT in 2004, and CCHIT was under fire five years ago for maintaining too close of a relationship with HIMSS (also see this link).

When Meaningful Use came along with the passage of the American Recovery and Reinvestment Act in 2009, CCHIT lost its exclusivity in certifying health IT products, as EHR certification essentially became commoditized. Other certifying bodies also have undercut CCHIT on price, so this move really does not surprise me.

The other big story, if you pay attention to things such as vendor rankings, is that Athenahealth just unseated Epic Systems as KLAS Research’s “Best in KLAS Overall Software Vendor” of 2013. Epic had held the top spot for eight years in a row. “The old guard of HIT leaders is finally being displaced by more nimble, innovative models designed for health care’s future—not for its past. The latest KLAS rankings show that closed-system, traditional software offerings are not robust or flexible enough to meet providers’ demands anymore,” Athenahealth CEO Jonathan Bush said in a statement.

I’m not sure I’d go that far, as Epic is still eating everyone else’s lunch in the enterprise market. But, to me, this shows that smaller physician practices that don’t have IT departments are adopting EHRs and want a cloud-based product that is easy to maintain. That certainly heralds a major shift in health IT.

January 30, 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: Live from HIMSS with Athenahealth CEO Jonathan Bush

NEW ORLEANS—I made my debut for the new Health Innovation Broadcast Consortium last night with a live webcast interview with Athenahealth CEO Jonathan Bush. As usual, I didn’t need to prepare much for the interview because Bush almost interviews himself, so I just decided to wing it. Also as usual, we kept it light, as each of us had a beer in our hand, since we were at the House of Blues in the French Quarter, where Athenahealth had its annual HIMSS party. (This year featured a jazz funeral marking the “death of software.”) But we did discuss some topics actually relevant to health IT, including meaningful use and Athenahealth’s recent acquisition of Epocrates. Enjoy.

Watch live streaming video from hibc at livestream.com
March 4, 2013 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: Jonathan Bush at HIMSS12

As has become custom, I carved out some time at HIMSS to interview Jonathan Bush, the always outspoken and insightful CEO of athenahealth. This time, instead of meeting in some sterile conference room, we got together just before the start of athenahealth’s annual HIMSS party, which happened to be at Ghostbar at the top of the Palms hotel in Las Vegas.

The setting, on the balcony of the 55th floor, tied into the company’s embrace of the cloud. The staff of both the bar and of athenahealth did a great job finding a single spotlight on the balcony, overlooking the bright lights of the Strip. Yeah, there’s a shadow on Bush’s face and you can hear the wind at times, but I think it adds to rather than disrupts the vibe.

As usual, we joke around a lot, but we also get into some serious discussions about ICD-10, meaningful use, health IT innovation and even my involvement with Health eVillages, a subject that came up because athenahealth has a health IT charity effort of its own in India. (Speaking of HealtheVillages, co-founder Donato Trumato is presenting a case study at HIMSS Thursday morning. It’s at 9:45 a.m. PST in Marco Polo 803 on the first floor of the Venetian. I’ll probably be waiting for the media availability of Dr. Farzad Mostashari at that time. Something about meaningful use Stage 2.)

Enjoy the video. I know I did.

Jonathan Bush at HIMSS12 from Neil Versel on Vimeo.

 

February 23, 2012 I Written By

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

A vendor’s view on selling of data

As long as there have been EMRs, there have been vendors selling aggregated, de-identified data. And there have been people worried about privacy.

That issue came up last week AHIMA Legal EHR Summit right here in Chicago, during a session exploring issues related to data ownership and stewardship in the era of cloud computing. (I’ll have a more complete rundown of the session Monday in InformationWeek Healthcare.)

Near the start of the panel, Daniel Orenstein, senior VP and general counsel of Athenahealth tried to put any lingering questions to rest right away. “I think data monetization is kind of a red herring,” Nussbaum said of people who criticize vendors for selling sensitive patient information. According to Nussbaum, de-identified data no longer includes any protected health information as defined by HIPAA, and only has value in the aggregate.

What he didn’t mention—and what nobody on the panel or in the audience brought up— is the possibility that data that supposedly were de-identified could be re-identified to a reasonable degree of precision. I’ve heard this for years, but I don’t know if anyone’s actually re-identified patient data outside of academia. Is this a real threat, or is Nussbaum right about it being a red herring?

UPDATE, August 22, 4:25 pm CDT: Here’s the InformationWeek story I referenced.

 

August 21, 2011 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: athenahealth’s Jonathan Bush at HIMSS11

As has become custom at HIMSS, I sat down with Jonathan Bush, chairman, CEO and president of athenahealth, at the 2011 conference in Orlando, Fla., last week. But due to some technical difficulties in getting the room we thought we had reserved and in getting my audio recorder to work (OK, OK, I didn’t have fresh batteries on me), I busted out the HD video camera. (Wouldn’t you know, the battery was losing steam there, too, so I had to plug the camera in. I have since determined that the USB port wasn’t working, so I exchanged it this past weekend. But I seriously digress.)

In this interview, we talk athena’s business, meaningful use, 5010/ICD-10, ACOs, cloud computing and health reform. We poke a little fun at the “boat show” that the vendor expo has become and make plans for the “Cloud Cavalry” to ride into Las Vegas at HIMSS12.

YouTube recently raised the maximum video length to 15 minutes, but we went on for about 20, so I had to break the interview into two parts.

Part One

Part Two

Don’t forget to check out my fledgling YouTube channel, http://www.youtube.com/neilversel.

February 28, 2011 I Written By

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

Podcast: Jonathan Bush at HIMSS09

CHICAGO—It’s becoming a tradition, sitting down with athenahealth Chairman, CEO and President Jonathan Bush for a podcast during the annual HIMSS conference. If you missed the original in 2007 or the sequel in 2008, you missed a whole lot of fun. If you happened to catch either or both of those, you know you’re in for some more entertainment, and perhaps even some enlightenment. We get awfully intellectual this time.

By the way, this one is rated PG-13 for language, but the kiddies wouldn’t understand the topic anyway. Enjoy.

Podcast details: Interview with athenahealth’s Jonathan Bush at HIMSS09. MP3, stereo, 64 kbps, 16.6 MB, running time 36:11.

1:45 Thoughts on “meaningful use”
2:25 Maybe accelerate PQRI?
3:30 Why EHR implementation has failed so far
4:40 David Ricardo and physician transcription
4:35 Let primary care physicians be the disruptive force
5:30 Lessons from “House”
6:15 Rethinking medicine
6:50 Micromanagement by the government and thoughts on scope of practice
7:50 Practice models that work
9:05 Data that help manage populations
10:05 Lobbying in Washington and qualifying for stimulus money
11:15 Medicare audits
11:30 HIMSS membership and “defensive” business management
13:00 Software-enabled service vs. software vs. ASP vs. software as a service
14:30 Examples of software-enabled services
16:45 Why standalone software is dying
17:15 Uninstalls of other products
18:15 How the stimulus has affected the company
21:20 “Aggressive stance” of Medicare
21:40 Many things happening at once
22:40 Unintended consequences of government actions
24:50 Entitlement spending and end-of-life care
28:30 Potential similar problems with stimulus and a return of the <a href="
http://clinicalit.blogspot.com/2007/03/podcast-jonathan-bush.html”>”plutonium sneakers.”
29:20 Decision-makers who have never run a practice
30:00 Hopes for David Blumenthal as national coordinator
30:30 Thoughts on comparative effectiveness studies
31:20 Concerns of HIT industry: “Don’t make what I’ve been doing for years illegal.”
31:50 Different needs for different doctors
32:35 New standards on data mining and patient privacy
34:20 The example of General Motors

April 12, 2009 I Written By

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

More on Allscripts—and the fight over data

Earlier today, I posted news about Allscripts-Misys Healthcare Solutions intending to sell its Medication Services division to an unnamed purchaser for an unspecified amount. I’ve since gotten clarification via e-mail from company spokesman Todd Stein:

“The release is earlier than we would normally have liked because we’re required to reveal all material non-public information about the company prior to undertaking a share repurchase program like the one we also announced yesterday. That’s to ensure that shareholders know everything about the company that they need to know in order to make an informed buy-or-sell decision.”

Indeed, Allscripts announced yesterday a $150 million buyback program and related $150 million increase in its credit commitments.

The company also was named in a Bloomberg story today as one of three firms leading the fight over whether to include greater privacy protections than HIPAA currently affords in the $20 billion health IT section of the economic stimulus legislation. Privacy advocates, including Dr. Deborah Peel’s Patient Privacy Rights Foundation and the American Civil Liberties Union, favor the House version. Business groups, including IT vendors, pharmacy benefit managers and the pharmaceutical industry, prefer the Senate version that allows data mining and direct-to-consumer marketing to continue.

For the record, the other companies named as possible major beneficiaries of the legislation are athenahealth and Quality Systems, the publicly traded parent company of NextGen Healthcare Information Systems.

How do I know this story is a Big Deal? Peel and her cohorts have been very active in keeping the media up to date on developments on Capitol Hill the last couple of weeks, knowing that this could be the last chance for another decade or more to change existing healthcare privacy laws and practices.

February 11, 2009 I Written By

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

Privacy, please

A weekend trip to Maine for a family wedding turned into a business trip (and a tax deduction) when I was reminded that the 16th National HIPAA Summit and related Privacy Symposium were taking place at Harvard University this week. Since I was flying in and out of Boston, I hesitantly forked over the $150 extortion—er, change—fee to American Airlines and sprung for a hotel room, mostly so I could attend a heated debate—er, “roundtable discussion” (even though the table was not round)—about whether patient privacy rules were effective.

I’m pretty sure it was worth the money. Boston usually is. While in the area, I also got a tour of athenahealth’s Watertown headquarters. I learned that “chief athenista” and new daddy Todd Park is on paternity leave for the next several months, is relocating to the west coast and will come back as a board member only while he dedicates much of his time to some new ventures.

But I digress once again.

The roundtable featured a couple of heavy hitters in the privacy world, namely Dr. Deborah Peel and Dr. Bill Braithwaite, as well as Partners HealthCare System Chief Privacy Officer Karen Grant, Linda Sanches, representing the HHS Office of Civil Rights, and, via telephone, Jodi Daniel, from the Office of the National Coordinator. Given the expense I just incurred, I wrote a story Tuesday about the Peel-Braithwaite debate for someone who actually will pay me, Digital HealthCare & Productivity.

In the interest of getting the news out and getting picked up by this week’s Health Wonk Review, I’m going to give you for free some notes from other Tuesday sessions.

On Friday, HHS released some proposed dates for transitioning to the next generation of HIPAA transactional code sets—otherwise known as ANSI X12 version 5050—as well as to ICD-10 standards for E&M coding. The proposal also includes the the National Council for Prescription Drug Programs standard version D.0 for electronic pharmacy transactions.

The full language is at http://www.cms.hhs.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp#TopOfPage and will appear in this Friday’s Federal Register to trigger a 60-day comment period, closing Oct. 21.

“This is not a do-over of HIPAA,” said Workgroup for Electronic Data Interchange Chairman James Whicker, who also phoned in to the HIPAA Summit. Whicker, director of EDI and e-commerce at Intermountain Healthcare in Salt Lake City, said that changes are necessary because the current version 4010A1 is more than six years old already and has significant shortcomings.

Among the changes he highlighted:

  • The 835 transaction for remittance advice adds an embedded link to payer URLs for some payment adjustment and denial codes.
  • 834 will allow ICD-10 to report pre-existing conditions and address some privacy concerns
  • 270 and 271 eligibility transactions bring what Whicker called “a significant number of changes and improvements” from the provider perspective. For example, he said, the new code sets clarify instructions for sending inquiries based on whether the patient is the health plan’s primary enrollee or a dependent. If the eligibility date, plan name or benefit effective date for a particular encounter is different from that of the overall coverage, the health plan must report it as part of the transaction. Version 5010 also requires alternate search options for 270 and 271 transactions so a provider can search by member ID, last name only or date of birth to help eliminate false negatives and phone calls, Whicker said.
  • 276 and 277 transactions for healthcare claims status have minor changes addressing privacy concerns over sensitive patient information that is unnecessary for business purposes.
  • Implementation guides will no longer be free when 5010 takes effect.

I personally don’t know what to make of the 5010 news, but I know that there is significant opposition to the proposed Oct. 1, 2011, compliance date for ICD-10. As Whicker spoke, I was reading a press release from the Medical Group Management Association denouncing the idea, and would wager a large sum that the American Medical Association thinks three years and two months is not long enough.

And now back to the privacy debate.

In a separate session, Sanches vigorously defended OCR’s record on HIPAA privacy enforcement, despite the fact the office has not assessed a single civil monetary penalty in the five years the rules have been in effect. “Our enforcement has resulted in changes,” Sanches said, a sentiment also expressed by Michael Phillips, a health insurance specialist in the CMS Office of E-Health Standards and Services regarding enforcement of HIPAA security regulations.

Sanches said most privacy complaints have either been dismissed or resolved with corrective action, while some, as with Providence Health and Services last month, have been settled with with “resolution agreements,” usually resulting in a fine. Sanches described the resolution agreements as “forward-looking,” since they require corrective action even though there is no admission of liability. “We will be monitoring their compliance,” Sanches said of Providence, which agreed to pay $100,000 as part of the deal.

Suffice it to say, OCR still has plenty of critics. Deven McGraw, director of the Health Privacy Project at the Washington-based Center for Democracy & Technology, said that enforcement clearly is lacking. “When you haven’t imposed a single civil monetary penalty, you are not sending a message that you are going to hit people in the pocketbook,” McGraw said during a joint session with Peel.

Those who don’t know Peel well might think she would wholeheartedly agree with this sentiment, but she says the August 2002 HIPAA privacy amendments that created the “treatment, payment and healthcare operations” exemption effectively neutered the rule. “We believe there is nothing for OCR to enforce because there isn’t a privacy law anymore,” she said, arguing that lack of privacy is keeping people from seeking treatment for some conditions, including Iraq war veterans who might suffer from depression or post-traumatic stress disorder.

As for HIPAA security enforcement, Phillips said OCR gets many more privacy complaints per year than CMS does for the security rule, largely because so many violations involve paper PHI and the security rule only applies to electronic information. He said that CMS has received 350 security rule complaints, to date, but, surprisingly, given all the attention paid to laptop theft, only 10 percent have involved lost or stolen devices.

Of those 350 complaints, 248 have been resolved and 102 investigation remain open.
Phillips also discussed the CMS contract with PricewaterhouseCoopers to conduct 10 compliance reviews this year, saying that the audit firm has done six reviews, including the well-publicized critique of Piedmont Healthcare in Atlanta. Phillips said CMS will share information about one of the 10 cases when all the reports are done.

Another conference session focused on the Piedmont case, and I think I will do a story for one of my publication clients in the next week or two. Stay tuned.

And finally, since anything involving David Brailer tends to generate a lot of traffic to this site, I shall call your attention to the following from former U.S. Sen. Dave Durenberger (R-Minn.), who founded and chairs the National Institute of Health Policy and sits on the Medicare Payment Advisory Commission:

DAVID BRAILER a few short years ago was the No. 1 name in American healthcare according to the annual Modern Healthcare survey of important people in the field. His job then was to be President Bush’s “Health Information Czar” to get the medical system moving toward automation and electronic information interchange.

Today he runs Health Evolution Partners out of San Francisco. He says HEP was founded to accelerate the best in the inevitable change taking place in the healthcare market. It will focus on redefining quality, efficiency and accountability of healthcare services to consumers and payers. He has developed a “Purchaser Value Initiative” as well, and raised nearly a billion dollars from CALPERS and from an additional four or five state public employees retirement funds (including Minnesota).

Susan and I enjoyed lunch with David recently at the Buckeye Roadhouse just off CA Highway 101 near Sausalito. David’s no. 1 interest these days is in his family, especially his seven-year old son and year old daughter. I listened to much of a fascinating discussion over elementary education in San Francisco and the merits of various institutions before we got to passion no. 2. How health system entrepreneurs will use the cost-quality-access quandary we face in this country, to innovate our way to better health, medical care and health management services.

Listening to Brailer, you get the impression that there may have been a lot not to like in the Bush administration’s approach to “consumer driven healthcare.” On the other hand, it focused us on a critical reality. Everyone in America is a potential consumer of better health, more appropriate medical services and, someday, good judges of value in the healthcare system. Entrepreneur innovators are doing it right now, and Brailer’s EHP team will help make sure they succeed.

August 19, 2008 I Written By

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