It’s late late at #hin2pt00 central. But somehow Jessica DaMassa wakes me up enough to get my views on Redbrick & Virgin Pulse, the VA finally inking the Cerner deal and Iora Health getting another $100m to build out their primary care model. Be warned, Jessica thinks I’m not full of cheer about any of it!–Matthew Holt
In this edition of Health in 2 point 00, Jessica DaMassa asks me about enterprise sales (Qventus, Medicity, Health Catalyst), DTC vs Enterprises as a market, the VA allowing nationwide telehealth,, and the TEAP & TEFCA frameworks (that last answer may have overran the 2 minutes a tad!) — Matthew Holt
Dr. David Shulkin once gave me this advice, “stop whining and complaining and lead with solutions.” To the many frustrated physicians in this country, this critique is a fair one. I took his words to heart.
Let me start by saying my husband served 20 years in the United States Army and is a proud Veteran. I think our veterans deserve better than Dr. David Shulkin. His ousting as VA Secretary by President Trump this past week is akin to “leading with solutions” from my perspective.
Dr. Shulkin appears to have engaged in considerable double-speak throughout his 13-month tenure in Trump’s Cabinet. In his New York Times op-ed, he wrote, “I will continue to speak out against those who seek to harm the V.A. by putting their personal agendas in front of the well-being of our veterans.”
When it comes to personal agendas, there are few who are as laser focused as this man. Initially endorsing campaign pledges by Trump committing to increased accountability at the VA, his European trip—for which taxpayers paid $122,334—involved more sightseeing and shopping with his wife than “official” government activities. When the Washington Post first reported this story, Shulkin assured the public “nothing inappropriate” took place.
Today Donald Trump pulled a big surprise. He changed the much criticized appointment for his new VA head from over-effusive physician Rear Adm. Ronny Jackson to well known lefty health blogger Matthew Holt. When asked why he wanted Holt to run the VA Trump said, “Look, I’m pretty smart and I’ve appointed now only the best people like John Bolton and Mike Pompeo to run our foreign policy. If I appoint someone else I like, how can I fire him quickly? That Holt guy seems to hate me, and he’s never stayed in one of my hotels, so he’s perfect for the VA–I hear that the accommodation is a bit rough, not exactly a ten.”
When THCB asked Holt why he agreed to take the job running the VA, he suggested that it had a lot to do with his English roots. “As most of my followers know I grew up in England and like the concept of everyone suffering together in a government funded and provided socialized National Health System. The VA and its fellow traveler the DOD is the only health system like that in America and it’s a brilliant place to start”. When asked about his likely future polices for the VA, Holt suggested that massive expansion was the key initiative. In a written statement, his VA spokesman noted “Given the utter lunacy of the Trump Administration and the crazy warmongers now running the show, the chances of total war versus North Korea and Iran are very high. So essentially everyone in the country will soon be called up to the military, which means that soon eventually everyone will be a Veteran. And if Trump loses in 2020, by 2021 we’ll be at war with the Russians so either way my theory pays off.”
Holt was on the Charlie Rose show last week when he told Rose about his philosophy for the future. “When everyone in the country is part of the VA, we can shut down that ineffective and expensive private health system, and instead everyone can get their care the way I think is best. And if they don’t like it Rasu Shrestha will send them their records using the Lighthouse Blue Button Carrier Pigeon system, and we’ll give them a row boat to head to Nepal or somewhere.
When TCHB reached him for comment, Cato health spokesman Michael Cannon said, “if you are going to expand this universal health care stuff, you might as well give it a real go. Lucky for me, I have bone spurs…”
Jessica DaMassa asks Matthew Holt all the questions she can about health & technology in 2 minutes. Today’s firing of VA Secretary Shulkin dominated the conversation, but there was time for a quick word on Oscar Health and what its recent huge funding round meant–Matthew Holt
CMS Gives Hospitals One Month Attestation Reprieve
CMS extends the deadline for eligible hospitals and critical access hospitals to attest for MU from November 30 to December 31, giving hospitals more time to submit MU data for the 2014 program year in order to receive payments under EHR incentive programs. CMS also pushed back the deadline for hospitals to electronically submit clinical quality measures to December 31.
VA Issues RFP for New Scheduling System
The VA issues an RFP to replace its 30 year-old appointment scheduling system with a commercially available solution to integrate with its existing VistA platform. The proposal deadline is January 9 and potential bidders will not be required to have prior experience working with the agency.
CareTech Solutions Negotiating Sale to HTC Global Services
HIT service provider CareTech Solutions files an “intent to sell” to HTC Global Services, a provider of IT services for multiple industries.Continue reading…
Thirteen years ago, in the midst of widespread publicity about anthrax-laden letters poisoning people, emergency room physicians sent a postal worker home with a diagnosis of the flu. He later died from anthrax inhalation.
Fast forward to 2014, with the Ebola outbreak in Liberia dominating healthcare coverage, a man who had just returned from the stricken nation visited an emergency room with symptoms but was not tested for Ebola. He was sent home with antibiotics.
Two days later, he was diagnosed with Ebola. In the intervening days, he potentially exposed family members and many more to the deadly virus. At the hospital where the misdiagnosis occurred, officials acknowledged the doctors had the information about the patient’s recent travel in Liberia but didn’t act on it..
How can this continue to happen? In 2010, the Institute of Medicine (IOM) examined the threat of bioterrorism and infectious disease outbreaks and said the most “crucial step in disease detection is the first one – recognizing that an ill patient has a potentially unusual disease…” But it recognized the potential for misdiagnoses of diseases physicians rarely see – such as Ebola and anthrax poisoning – especially in busy emergency departments where information can get lost or overlooked.
The IOM recommended the use of clinical decision support tools to ensure doctors quickly and accurately detect and diagnose unusual diseases. Four years later, some hospitals have these tools and use them. But most do not, even though they’re readily available, affordable and proven effective.
Earlier this month, the U.S. Senate passed a Department of Veterans Affairs health reform bill in response to scandals in patient care at VA centers. The $16.3-billion bill,signed by President Barack Obama, includes measures that will attempt to overhaul information technology and introduce telemedicine procedures at VA clinics and hospitals.
But who’s going to implement these reforms? Infield Health President Doug Naegele talked with G2Xchange Health Cofounders David Blackburn and Eric Klos to understand how the bill might create new opportunities for health entrepreneurs.
Can you talk for a minute about how some of the bill’s provisions make room for entrepreneurs?
This bill has a number of specific information technology mandates for the VA that are ripe for innovation. Many of the mandates are a direct response to excessive wait times, the need for information sharing when our veterans access care outside the VA, and the gaming that was done by VA staff to hide wait time issues at VA facilities. Three examples of opportunity areas for entrepreneurs include:
1) Digital Waiting List – You may have seen billboards on the highway that show the Emergency Room wait time at a local hospital. This is an example of the type of transparency that would permit veterans to monitor the average wait times by facility and type of care.
2) The VA has 90 days to establish a system to monitor and issue Veterans a “Veterans Choice Card,” which will facilitate the receipt of care from non-VA health providers.
3) Data for patient safety, quality of care and outcomes must be extrapolated from the existing VA electronic health records (VistA) and published as a comprehensive database within 180 days. This data must be “fed”’ into the HHS Hospital Compare website. Again, transparency is a key driver for the VA.
In the name of patient privacy, the U.S. Department of Veterans Affairs allegedly threatened or retaliated against employees who were trying to blow the whistle on agency wrongdoing.When the federal Health Insurance Portability and Accountability Act passed in 1996, its laudable provisions included preventing patients’ medical information from being shared without their consent and other important privacy assurances.But as the litany of recent examples show, HIPAA, as the law is commonly known, is open to misinterpretation – and sometimes provides cover for health institutions that are protecting their own interests, not patients’.
“Sometimes it’s really hard to tell whether people are just genuinely confused or misinformed, or whether they’re intentionally obfuscating,” said Deven McGraw, partner in the healthcare practice of Manatt, Phelps & Phillips and former director of the Health Privacy Project at the Center for Democracy & Technology.For example, McGraw said, a frequent health privacy complaint to the U.S. Department of Health and Human Services Office of Civil Rights is that health providers have denied patients access to their medical records, citing HIPAA. In fact, this is one of the law’s signature guarantees.”Often they’re told [by hospitals that] HIPAA doesn’t allow you to have your records, when the exact opposite is true,” McGraw said.
I’ve seen firsthand how HIPAA can be incorrectly invoked.
In 2005, when I was a reporter at the Los Angeles Times, I was asked to help cover a train derailment in Glendale, California, by trying to talk to injured patients at local hospitals. Some hospitals refused to help arrange any interviews, citing federal patient privacy laws. Other hospitals were far more accommodating, offering to contact patients and ask if they were willing to talk to a reporter. Some did. It seemed to me that the hospitals that cited HIPAA simply didn’t want to ask patients for permission.
The case studies include a chapter comparing America’s two most broadly deployed EHRs: The VA’s VistA and Epic. The tale RAND tells is not one of different EHR technologies, as both VistA and Epic both employ the MUMPS programming language and file-based database. Rather, it is about how different origins, business models and practices have dramatically influenced the respective systems. As the report itself says, the contrast offers “useful insights into the development, diffusion, and potential future of EHRs.”
VistA, “the archetype of an enterprise-wide EHR solution,” supports the Veterans Health Administration, “the largest integrated delivery system in the United States.” Initial VistA development was a collaborative, distributed, grass-roots effort where individual VA medical centers built out new clinical functionality on a common platform.
In the mid 90’s, VistA became the instrument of change at the VA.
The pace and scope of EHR adoption increased dramatically under the leadership of Dr. Kenneth W. Kizer, who served as the VA’s Undersecretary for Health from 1994 through 1999. Dr. Kizer considered installation of a major system upgrade to be a core element in his effort to transform the organization …Continue reading…