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Above the Fold

HIT Newser: Millions and Millions for More Interoperbility

Feb 11, 2015

By MICHELLE RONAN NOTEBOOM

Athenahealth Pushes Further Into the Inpatient World

Beth Israel Deaconess Medical Center partners with athenahealth to enhance its homegrown in-patient EHR. Athenahealth is buying Beth Israel’s clinical applications, which it will enhance and rebrand as athenaNet. The purchase comes just a few weeks after athenahealth’s purchase of RazorInsights, an EHR platform for rural and community-based hospital.

Never underestimate Jonathan Bush’s ability to disrupt the HIT world. Athenahealth may be a little late to the in-patient EHR party, but they wouldn’t be the first company to successfully transition from an ambulatory-only vendor to an enterprise vendor: Epic, of course, got its start as a provider of ambulatory solutions.

ONC Offers $28 Million to Advance HIE

The ONC will award $28 million in grants to advance the adoption and use of interoperable HIT tools and services to support HIE.

The announcement coincided with the ONC’s annual meeting – which reportedly focused heavily on interoperability issues – and on the heels of the agency’s release of its draft HIT interoperability roadmap. Though it’s still early, “interoperability” seems to be taking an early lead as this year’s top HIT buzz word.

MGMA Asks CMS to Reduce Portal Duplication

The MGMA asks the federal government to consolidate its reporting programs and eliminate its use of multiple Web portals for physician reporting.

MGMA says its best: “it makes not practical sense to have multiple systems which create unnecessary work by requiring duplicative registration with separate usernames and passwords for physicians and practices to access reports or report information pertaining to Medicare Part B programs.”

FDA Recommends Minimal Oversight for Medical Devices

The FDA finalizes guidance on data transmissions from medical devices, saying it doesn’t intend to regulate software that receives, transmits, stores, or displays data due to the low risk to patients.

That’s good news for mHealth developers and enthusiasts, who had been concerned that too much regulation might spur continued innovation in the space.

Wheeling and Dealing

CareTech Solutions wins an eight-year agreement with Maryland’s Adventist HealthCare to provide outsourced IT services.
Boulder Community Health selects Voalte’s smartphone mobile communication technology for its acute-care hospital and regional trauma center facilities.
Lehigh Valley Health Network’s 200 outpatient offices go live this month on Epic as the first phase of the health system’s $200 million implementation. LVHN’s regional competitor St. Luke’s University Health Network will also be switching to Epic at a later date.
Gulf South Quality Network in Louisiana selects Medecision to build a data warehouse based on Medecision’s Aerial platform.

Show Me the Money

Athenahealth reports Q4 adjusted EPS of $0.58 versus the previous year’s $0.57 and beating analysts’ estimates of $0.39. Revenue was up 24%. Despite the strong performance, analysts note that revenue from Epocrates services fell 32% from the previous year, and, general and admin costs grew more than 50% as a result of increased headcount.
McKesson posts Q3 EPS of $2.89, up from last year’s $1.48 and beating estimates of $2.62. Revenues grew 36.9% to $47 billion, beating estimates of $44.6 billion. Despite strong overall results, revenues from McKesson’s Technology Solutions segment fell 7.3% as the company continued its planned elimination of its Horizon hospital software product line.
Vital Medicals, a developer of a smart glasses application for surgeons, raises $925 million from angel investors and the Stanford StartX Fund.
Telehealth solution provider Kura MD secures $1.5 million from Moneta Ventures.
PB Capital Holdings invests an undisclosed amount in EHR provider ITelagen.
Under Armour acquires Enomondo for $85 million and MyFitnessPal for $475 million, establishing the company as the “largest digital fitness community” reaching more than 120 million users.
Workflow automation software provider Aventura closes a $14 million Series C financing round co-led by Safeguard Scientifics and Merck Global Health Innovation Fund.

New Blood

Kaiser Permanente names Richard (Dick) Daniels EVP/CIO. Daniels has served as interim CIO since September 2014; previously he was SVP of enterprise shared services for Kaiser.
Former Epic executive Dave Cassel joins Healtheway, a nonprofit collaborative focused on advancing interoperable HIE, to lead the company’s Carequality initiative.
RemitData appoints Laura Hescock (Public Consulting Group) director of strategy and operations and Stacie Bon (Rodgers Townsend) senior director of marketing, and, promotes Jason Whiteaker from director of sales to VP of partner strategy.
Specialty surgical hospital network Coordinated Health names Greg Flanagan, former COO for Advanced Health, CIO.

Etcetera

A spokesperson for New York City Health and Hospitals Corporation attributes its use of EHR for protecting the health system from record loss after a fire destroyed a warehouse that housed duplicate copies of archived patient records.

A Detailed Analysis of the Republican Alternative to Obamacare

Feb 11, 2015• 57

By ROBERT LASZEWSKI

House Energy and Commerce Chairman Fred Upton along with Senate Finance Chairman Orin Hatch and Senator Richard Burr have outlined what is, at least for now, the Republican alternative to Obamacare.

Republicans will now argue they have a better health insurance reform plan and that Obamacare should be repealed and replaced by it––particularly if the Supreme Court plunges the new health law into chaos by throwing the subsidies out in 37 states.

They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause.
Continue reading…

A Shout Out to Our Sponsors

Feb 11, 2015

By THCBist

THCB thanks our corporate supporters

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Our next generation software solutions are transformational and will streamline your IT environment, provide a fast track to achieving your interoperability goals, and create operational leverage within your organization.

Learn more: visit CorepointHealth.com

Send a message of support to THCB’s community: Become a corporate underwriter.

Open Enrollment, Take 2: What Matters For The ACA Marketplace?

Feb 11, 2015

By LAURIE T. MARTIN

By the end of 2014, more than 6.5 million people were enrolled in health insurance plans through the Affordable Care Act (ACA) Marketplace, also called the “exchanges.” In some cases, this was relatively easy. But for many, the ACA’s first open-enrollment period was a confusing and frustrating time, compounded by a lack of clear, easy-to-understand information about plan options, coverage, and cost.

How Technology Will Disrupt Your Doctor’s Monopoly

Feb 10, 2015• 13

By ALAN PITT, MD

Although you may not realize it, your doctor is a monopoly. Yes, you can see someone else, but not without difficulty. And if you wanted a second opinion, how far would you go? In part, through insurance coverage, in part based on a desire for convenience, healthcare is generally a local monopoly. However, that may be about to change.

I’m a radiologist, an expert in medical imaging. When I started my career in 1997, I’d show up for work and it was just me and my films. The exams presented to me were a mix of imaging- CT, MRI, ultrasound, plain X-Rays- all captured, presented and stored on film. By 2000, the film was gone. Just about everything I did was done on a computer.

I was an early proponent for this technology (also know as PACS for Picture Archiving and Communications Systems). It allowed my group to work faster and smarter. However through a series of steps (consolidation, specialization and finally commoditization/globalization) technology broke up the local monopoly many radiology groups enjoyed. Similar to Instagram, PACS allowed medical images to be seen instantly by anyone anywhere. And now, based on improvements in technology, I’m expecting similar changes for the rest of healthcare.

Consolidation

Tele-radiology first emerged in hospitals when computers began to be used to optimize the daily workload. At the beginning of my career, several doctors divided work for the day into piles. Each person did his or her allotment with no real help from peers. With the transition to digital, work became a common pile that was shared among physicians in the same hospital. Faster doctors filled downtime gaps reading more cases, resulting in improved overall efficiency.

False Positives and Real Dollars: Why $88 won’t effectively screen for lung cancer

Feb 9, 2015• 11

By MATT HAWKINS, MD

Let me be clear. I think lung cancer screening is a good thing. The National Lung Cancer Screening Trial (NLST) had air-tight design and was impeccably performed. Those who have paid attention know that the NLST demonstrated a 20% relative reduction in mortality from low-dose CT screening (as opposed to chest x-ray). Plus, the all-cause rate of death in the low-dose CT group was 6.7% lower than the radiography cohort.

But the details reveal concerns – those with financial and geographic-specific implications that have, until now, mostly escaped public debate. The fanfare that accompanied the glorious NLST quest has supplied perverse financial incentives for entrepreneurial types – and has put patients in places such as the Ohio River Valley at potentially increased risk from exploitation of our interminable fear of cancer. It has also given providers in these regions the unenviable and perhaps impossible task of balancing costs, patient expectations, and disease prevalence.

The Histo-belt

I took this picture while driving along a rural southern Indiana highway during a recent trip to visit family. Southern Indiana (and neighboring northern Kentucky) are known for blue-collar shipping industries, steamboats, and high school basketball. They also rest squarely in what is colloquially known as the “Histo-belt.” Histoplasma capsulatum is a fungus endemic to the Ohio and Mississippi River Valleys. It is everywhere. You get it by breathing. Prior studies suggest that >80% of those living in these regions have contracted the fungus. The majority of people with histo don’t get sick. But – they get lung nodules. Lots of them. The nodules are benign but often indistinguishable on imaging from “early” lung cancer. Continue reading…

Halamka Speaks: athenahealth & the Future of AMCs as Tech Innovators

Feb 9, 2015• 4

By MATTHEW HOLT

It’s always interesting to talk with John Halamka, and last week–after athenahealth bought the IP but apparently not the actual code of the Beth Israel Deaconess Medical Center (BIDMC) web-based EHR he’s been shepherding for the past 18 years–I got him on the record for a few minutes. We started on the new deal but given that had already been covered pretty well elsewhere we didn’t really stay there. More fun that way–Matthew Holt

Matthew Holt: The guys across town (Partners) ripped out all the stuff they’ve been building and integrating for the last 30 years and they decided to pay Judy Faulkner over a billion dollars. And you took all the stuff that you’ve been building for the past 15 to 20 years and sold it to Jonathan Bush for money. Does that make you a better businessman than they are?

(Update Note 2/11/15: While I’ve heard from public & private sources that the cost of the Partners project will be between $700m and $1.4 billion, Carl Dvorak at Epic asked me to point out less than 10% of the cost goes to Epic for their fees/license. The rest I assume is external and internal salaries for implementation costs, and of course it’s possible that many of those costs would exist even if Partners kept its previous IT systems).

John Halamka: Well, that is hard to say, but I can tell you that smart people in Boston created all these very early systems back in the 1980s. On one hand, the John Glaser group created a client server front end. I joined Beth Israel Deaconess in 1996 and we created an entirely web-based front end. We have common roots but a different path.

It wasn’t so much that I did this because of a business deal. As I wrote in my blog, there is no benefit to me or to my staff. There are no royalty streams or anything like that. But sure, Beth Israel Deaconess receives a cash payment from Athena. But important to me is that the idea of a cloud-hosted service which is what we’ve been running at Beth Israel Deaconess since the late ’90s hopefully will now spread to more organizations across the country. And what better honor for a Harvard faculty member than to see the work of the team go to more people across the country?

MH: There’s been a lot of debate about the concept of developing for the new world of healthcare using client server technology that has been changed to “sort of” fit the integrated delivery systems over the last 10 years, primarily by Epic but also Cerner and others. In particular how open those systems are and how able they are to migrate to new technology. You’ve obviously seen both sides, you’re obviously been building a different version than that. And a lot of this is obviously about plugging in other tools, other technologies to do things that were never really envisaged back in 1998. You’ve come down pretty strongly on the web-based side of this, but what’s your sense for how likely it is that what has happened over the last five or ten years in most other systems including the one across the street we just mentioned is going to change to something more that looks more like what you had at Beth Israel Deaconess?Continue reading…

Anthem Was Right Not to Encrypt

Feb 9, 2015• 53

By FRED TROTTER

The Internet is abuzz criticizing Anthem for not encrypting its patient records. Anthem has been hacked, for those not paying attention.

Anthem was right, and the Internet is wrong. Or at least, Anthem should be “presumed innocent” on the issue. More importantly, by creating buzz around this issue, reporters are missing the real story: that multinational hacking forces are targeting large healthcare institutions.

Most lay people, clinicians and apparently, reporters, simply do not understand when encryption is helpful. They presume that encrypted records are always more secure than unencrypted records, which is simplistic and untrue.

Encryption is a mechanism that ensures that data is useless without a key, much in the same way that your car is made useless without a car key. Given this analogy, what has apparently happened to Anthem is the security equivalent to a car-jacking.

When someone uses a gun to threaten a person into handing over both the car and the car keys needed to make that care useless, no one says “well that car manufacturer needs to invest in more secure keys”.

In general, systems that rely on keys to protect assets are useless once the bad guy gets ahold of the keys. Apparently, whoever hacked Anthem was able to crack the system open enough to gain “programmer access”. Without knowing precisely what that means, it is fair to assume that even in a given system implementing “encryption-at-rest”, the programmers have the keys. Typically it is the programmer that hands out the keys.

Most of the time, hackers seek to “go around” encryption. Suggesting that we use more encryption or suggesting that we should use it differently is only useful when “going around it” is not simple. In this case, that is what happened.

NATE: Making Choices Easier

Feb 9, 2015• 3

By AARON SEIB

You have the choice to get your health information anywhere and any way you want –according to the Office of Civil Rights with some limitations. Today, more and more uses of health information are being presented to consumers as innovators recognize our demand for health related applications. Unfortunately, there is a dilemma. Over the past ten years a lot of things have changed – more and more providers are using technology to improve how they deliver care and, once that care is delivered, how they share information with other caregivers that see the patient. Sadly, other things are still pretty much as they were in the 19th Century, including how patients get access to information about themselves held by their provider.

The release of the National Association for Trusted Exchange’s (NATE) Blue Button for Consumers (NBB4C) Trust Bundle is aimed at simplifying interoperability between the healthcare delivery system and the consumer, enabling you to decide how to use your health information.

NATE is an association focused on enabling trusted exchange among organizations and individuals with differing regulatory environments and exchange preferences. With beginnings back in 2012, NATE emerged from a pilot project supported by the Office of the National Coordinator for Health Information Technology (ONC). NATE was incorporated as a not-for-profit organization on May 1, 2012 in the District of Columbia. NATE has been operating Trust Bundles in production since November 2012 and recently took over administration of the Blue Button Consumer Trust Bundles. Working with a broad set of stakeholders through multiple task forces, crowdsourcing and a call for public comment, NATE announced the first release of NATE’s Blue Button for Consumers (NBB4C) Trust Bundle February 4th at the ONC’s Annual meeting.Continue reading…

Will Getting More Granular Help Doctors Make Better Decisions?

Feb 7, 2015• 11

By MARC-DAVID MUNK

I’ve been thinking a lot about “big data” and how it is going to affect the practice of medicine. It’s not really my area of expertise– but here are a few thoughts on the tricky intersection of data mining and medicine.

First, some background: these days it’s rare to find companies that don’t use data-mining and predictive models to make business decisions. For example, financial firms regularly use analytic models to figure out if an applicant for credit will default; health insurance firms can predict downstream medical utilization based on historic healthcare visits; and the IRS can spot tax fraud by looking for fraudulent patterns in tax returns. The predictive analytic vendors are seeing an explosion of growth: Forbes recently noted that big data hardware/software and services will grow at a compound annual growth rate of 30% through 2018.

Big data isn’t rocket surgery. The key to each of these models is pattern recognition: correlating a particular variable with another and linking variables to a future result. More and better data typically leads to better predictions.

It seems that the unstated, and implicit belief in the world of big data is that when you add more variables and get deeper into the weeds, interpretation improves and the prediction become more accurate.Continue reading…