It was a glimpse back into the halcyon days of the tech boom over a decade ago: a promising IT startup hosts a party at a large venue, the CEO’s band performs and the drinks and conversation flow freely.

Except it was 2012 and Cleveland Clinic spinoff Explorys, the party’s host, is one of the leaders of the growing Big Data movement in healthcare. Such gatherings may be run-of-the-mill fare in Silicon Valley, but they’re pretty rare in Cleveland. (That’s despite Cleveland recently being cited as No. 1 in a list of cities with the biggest growth in tech jobs by Businessweek.)

Explorys rented out  Cleveland’s House of Blues for a night to host its recruiting and networking event. The company now employs about 50, but expects that number to double in 2012. Explorys is looking to hire software engineers and clinical informatics employees.

“We’re looking for people who understand technology and have a thirst and knowledge for new things, and have a passion for healthcare and medicine,” President and chief technology officer Charlie Lougheed said.

Explorys has developed what it calls a Google-like network that contains troves of clinical and financial data from hospitals, and allows health providers to analyze that data in real time. The idea is that doctors and medical researchers can mine the vast amounts of data to learn how variations in treatment can affect outcomes and uncover best practices to enhance patient care and lower costs.

Below is a brief interview with Lougheed from the event.

[Photo from flickr user Dinner Series]

The terms of the acquisition were not disclosed.

7 Medical System’s technology offerings include on-demand digital imaging, revenue cycle management and electronic medical records. Manager Consultoria em Informatica  provides practice management, EMR, radiology information systems (RIS) and picture archiving and communication systems (PACS) to hospitals and clinics in Brazil. The company with its 21 employees will operate as a wholly-owned subsidiary of 7 Medical.

“With a population of nearly 200 million people, Brazil is one of the world’s fastest growing major economies,” said Jason Studsrud, chief executive officer of 7 Medical Systems in a news release. “Manager Systems was a great match for us because of the alignment in strategy, market focus and similar product and service offerings. Besides opening up new markets, Manager Systems will enable us to expand our clinical and technical workforce in a more cost-effective and productive way.”

Still, Ms. Faulkner adds:

“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.

Balance? Hmmm.

So far, there appears to be huge skewing of information provided to health care administrators rather than doctors these days. For instance, when a doctor wants to know how many procedures their group has performed according to data they themselves entered into the Electronic Medical Record, they meet resistance. (This is not a small issue for doctors increasingly held accountable to MGMA benchmark productivity standards for their income.) Trust is a critical issue in medicine and doctors must feel they trust the data being given to them. The Electronic Medical Record systems of tomorrow should foster this kind of data transparency for doctors, not provide statistics from inaccessible data warehouses.

Doctors are eager to use their data for their patient’s benefit. And yet they see these proprietary systems that carefully-control access to information as impediments to care rather than as facilitators of decision making. To date, this end-user still has yet to see any electronic data flow from one institution’s EPIC data pool to another. Perhaps this capability will be realized some day, but for now, we still must request paper records from fellow EPIC institutions manually. While this limitation may be part of the “balance” to which Ms. Faulkner alludes, to doctors on the front line of care provision, this “balance” currently feels quite skewed away from patients and doctors.

Doctors are the largest and most influential contributors to the electronic medical record data and the cost of medicine. We see how these systems affect our patients first-hand. Unless change comes quickly to permit doctors to be involved in decisions based on the data they themselves provide the system, restricting their access to aggregated data assessment might become the greatest electronic medical error in the foreseeable future.

After all, how else will we ever be able to credibly challenge the potential for a critical programming or statistical error that could ultimately affect 127 million lives?

Healthcare big data company Explorys plans to double its number of employees to 100 in 2012.

The Cleveland-based company is looking to hire primarily software engineers and clinical informatics employees. Software engineers are among the most challenging types of workers to find because they’re in such high demand, chief technology officer Charlie Lougheed said.

To aid in recruiting efforts, the company is hosting a networking event called “Rockin’ Big Data” on the evening of Feb. 1 at the House of Blues in downtown Cleveland. “We want to get to know people and allow them to get to know us,” Lougheed said.

Explorys, which was started in 2009 under CEO Steve McHale and Lougheed, planned its hiring binge due to increasing demand for its “big data” services.

The company has developed a network that contains troves of clinical and financial data from hospitals and allows health providers to analyze that data in real time. The idea is that doctors and medical researchers can mine the vast amounts of data to learn how variations in treatment can affect outcomes and uncover best practices to enhance patient care and lower costs.

Last week, Explorys announced the 10th health system to join its network, Akron General.

Explorys is a Cleveland Clinic spinoff. Last May, it raised an $11.5 million series C round of investment that was led by Austin Ventures of Austin, Texas and Foundation Medical Partners of Connecticut.

Big data has become one of the most popular buzz phrases in business, and nowhere more so than healthcare. At a high level, it refers to bringing together any of the massive amounts of information generated in the healthcare system — doctors’ notes, radiology images, billing information, medical research — and analyzing it to improve healthcare.

“We really see big data as the new frontier across all industries, specifically healthcare,” Richard Cramer, chief healthcare strategist at data integration vendor Informatica, told eWEEK. “The next decade is going to be the data decade in healthcare.”

[Photo from flickr user TenSafeFrogs]

“CV – Irreg rate and rhythm, no murmurs, clicks or rubs.”

No doubt this was a documentation macro that was not edited or else the intern failed to examine the patient (or maybe both).

No excuse! It’s time to end the crap being spewed forth into electronic medical records!

I say that every time such a note is discovered like this by our new medical trainess, they fail their rotation. Yep: make the penalty severe and make it stick! That way, they’ll think HARD about what they contribute to the medical record and be held accountable!

Of course there’s a few sticky problems with such a heavy-handed approach:

1. Attendings do not critically review what is actually written in the chart by interns because it is buried in pages of electronic morass and rarely found, and…
2. No one has a clue what to do to attendings who do the same thing. After all, when it comes to getting paid for your work, it’s not about what doctors write in a chart, it’s about how many things doctors write about so they can bill the government for their professional services.

The author, Dr. Westby G. Fisher, is a cardiologist at NorthShore University HealthSystem who writes regularly at Dr. Wes.

Explorys has developed a network that contains troves of clinical and financial data from health systems and allows health providers to analyze that data in real time. The idea is that doctors and medical researchers can mine the vast amounts of data to learn how variations in treatment can affect outcomes and uncover best practices to enhance patient care and lower costs.

Explorys’ multiyear deal with Akron General will enable the health system to use  the software in its hospitals, as well as its ambulatory, rehabilitation and wellness centers, according to a statement from Cleveland-based Explorys.

In addition to the 10 health systems, Explorys’ network contains records from 12 million patients and 75 hospitals, Chief Technology Officer Charlie Lougheed said. “Demand continues to grow and we expect these numbers to double in 2012, particularly as we expand our apps that enable healthcare systems to leverage their big data to improve care,” Lougheed said.

Explorys is among the leaders of the “big data” movement in healthcare, which is hoped to improve cost and quality by helping clinicians gain insights into effective treatment options through the analysis of vast amounts of patient and payer data.

Other hospitals in Explorys’ network include Cleveland Clinic, California-based St. Joseph Health System and MedStar Health in Maryland.

Officials hailed the milestone as another step toward a day when Americans’ health records will be easily accessible to physicians anywhere in the nation, Information Week reported.

Doctors in Lima, Ohio and Biloxi, Mississippi shared the data via each state’s health information exchange (HIE), secure networks that allow for moving clinical information between disparate systems.

“No more faxing, phone calls, mail delivery and couriers,” said the top official with Ohio’s HIE. “Health information exchanges across states will save time, money and lives all across the country.”

The exchange between the physicians was done using a new set of secure messaging standards called Direct Project, which enables the transport of encrypted emails containing health information between healthcare organizations, such as physicians, hospitals and labs.

The standards have been used to send health information within the same state for nearly a year, but the Ohio-Mississippi exchange marks the first time the standard has been used to share health data across state lines.

Photo from flickr user Jamison_Judd

Current medical news and unique business news for anyone who cares about healthcare.

A reward for early electronic medical record adopters. In what’s being called a gesture of goodwill, the Department of Health and Human services has bumped back the deadline for early EMR adopters to comply with the next stage of meaningful use criteria. Providers who currently meet stage 1 criteria will be able to earn bonus incentives for an extra year and will not need to upgrade their systems to comply with stage 2 meaningful use criteria until 2014, rather than 2013 as originally planned.

A health crisis in the UK. The National Health Service in Britain is being forced to trim $31 billion (20 billion pounds) from its budget, putting the squeeze on hospitals, which are now delaying non-lifesaving surgeries and raising the threshold for who qualifies for treatment. Plus, the government in January passed a bill that may bring even more cuts.

Big money’s not putting their big money on these stocks. To find out which biotech stocks institutional investors believe will underperform, Seeking Alpha ran an analysis to identify stocks with the most significant net institutional selling this quarter. The big winners — or losers, in this case — were Nabi Biopharmaceuticals, which cells vaccines for nicotine addiction; Pacific Biosciences of California, the maker of a platform for genetic analysis; and Dendreon Corp., maker of Provenge and other cancer therapeutics.

Discovering Autism. In a four-part series on autism, the Los Angeles Times explores the surge in the number of children diagnosed with the disease, which is 20 times higher than it was in the 1980s.

Samsung and Biogen make a big deal. Samsung and Biogen Idec will partner to form a $300 million joint venture to develop and market biosimilars. Samsung will contribute $255 million in an effort to diversify itself away from its consumer electronics products.

More dealflow… Johnson & Johnson’s Janssen Biotech has made a $150 million deal with Pharmacyclics to jointly develop PCI-32765, a drug compound for lymphoma.

In exchange for the credit, Cleveland-based Explorys is expected to create 165 jobs and retain 35 positions, according to the Ohio Department of Development. Explorys’ employment expansion is expected to create $13.3 million in additional payroll.

CEO Steve McHale was traveling and said he didn’t have any further information when reached by email.

The state of Ohio is no longer publicly releasing an estimated dollar value of the tax credits it issues, according to the Department of Development.

Explorys has started what it calls a Google-like service that helps clinicians analyze in real-time information culled from troves of EMRs, financial records and other data . The idea is that medical researchers can mine the vast amounts of data to learn how variations in treatment can affect outcomes, uncovering best practices to enhance patient care and lower costs.

The company’s technology was developed by a physician formerly at the Cleveland Clinic, which is an Explorys investor.

Explorys is among the leaders of the “big data” movement in healthcare, which is hoped to improve cost and quality by helping clinicians gain insights into effective treatment options through the analysis of vast amounts of patient and payer data.

Photo from flickr user DonkeyHotey

In his parting interview with the press,  he noted that 20 percent to 30 percent of health spending is “waste” that yields no benefit to patients.

Berwick listed five reasons for the enormous waste in health spending:
*Patients are overtreated
*There is not enough coordination of care
*US health care is burdened with an excessively complex administrative system
*The enormous burden of rules
*Fraud

Certainly regulatory reform is needed, but electronic health records can go far to addressing each of these issues.

Patients are over treated

When I was an emergency department resident 20 years ago, the faculty and staff of Harbor-UCLA medical center taught me best practices for safe, quality, efficiency care.   When I make decisions today, I reflect back on that intense training.  However, thousands of journal articles have been written since then, there’s new evidence suggesting more effective treatment plans, and new therapies are available.   How do I ensure the just the right amount of care is delivered – neither too much, nor too little? Decision support embedded in electronic health records.

EHRs can provide alerts and reminders — just in time advice as to what my patients need.  Educational materials and literature can be embedded in the workflow for easy reference.  Population/panel health tools can identify those patients who need followup or are deviating from care plans.

There is not enough coordination

The United States does not have a healthcare system — it has a disconnected array of clinics, pharmacies, labs, hospitals, and imaging centers.   Meaningful Use Stage 2 is likely to require significant healthcare information exchange as well as the transport,  vocabulary, and content standards needed to support it.  Although the journey to a completely connected healthcare system will take a few years, the next 24 months will include a quantum leap in care coordination as state health information exchanges connect patients, providers, and payers.

US healthcare is burdened with excessively complex administrative system

Like the tax code, healthcare regulations are dizzying in their complexity and volume.   Some are so arcane that experts cannot agree on the interpretation.    If rules can be built into EHRs such as the precise definitions for quality reporting, automated electronic coding of visits based on structured documentation/natural language processing, and payments made on objectively measured processes/outcomes instead of the quantity of care delivered, regulatory complexity can be reduced and money saved.

The enormous burden of the rules

Approximately 25% of my IS staff work on compliance related software requests — building new functional or purchasing new products to meet every increasing numbers of rules.   We all want to do the right thing, but if no one can understand the rules and the amount of overhead needed to comply is financially unsustainable, the rules are too burdensome.

Electronic health records can enforce automated care plans, provide feedback at the point of care and support administrative simplification with bidirectional electronic transactions between payers and providers.

Fraud

Although no system is foolproof, electronic health records can reduce fraud by automating the kind of data transfers that will help detect fraud and abuse.    Emerging new analytics companies are already working on techniques to discover patterns of care that do not make sense — Medicare billing for deceased patients, redundant procedures or services, and variation in billing practices among physicians that can identify outliers.

In addition to these 5 areas of waste reduction, electronic health records are an essential part of a learning healthcare system which gathers data for clinical trials, clinical research, and unique population health measurement such as pharmacovigelence, syndromic surveillance, and immunization compliance.   Don Berwick is a great supporter of the EHR’s potential to increase quality, safety, and efficiency while reducing waste.

Although healthcare reform is controversial, healthcare IT reform — the federal 5 year plan to increase the use of electronic health records and healthcare information exchange — has broad bipartisan support.

As Don Berwick returns to the private section, I’m hopeful that he’ll turn his energy back to fixing the US healthcare system and that he’ll be a tireless champion for electronic health records.

Tonight, I’m flying to the Institute for Healthcare Improvement Conference in Orlando to serve as faculty for the CEO summit.  I’ll report on Maureen Bisognano’s keynote tomorrow morning.

Patients are consumers first. The users of your product may be patients, but they evaluate new product choices the same way that any other consumer would. There’s a lot the mobile health industry can learn from the gaming and shopping industries. Communications stressed the personal relationships people have with their mobile phones. Text messages is the most scalable platform. Avoid duplicating information users can get on their own by searching the Web. Chronic diseases may provide more opportunities to guide patients with data, knowledge and action — support apps are richer. Richy Glassberg of MedHelp said the 60 percent to 70 percent of customer service requests it receives are how can the company make it easier for customers to speak with their doctors.

Reach out to physicians you know or meet to test-drive your prototype. This will help inform whether your mobile solution is practical in a physician’s practice and whether it needs to be tweaked or needs to be overhauled to fit in with the realities of how a physician works with her patients, health insurers and runs her practice.

Pediatricians are especially helpful. Serge Loncar of CareSpeak said the pediatric population and pediatricians can be an ideal avenue to try out a prototype, collect data and use that information to improve the product or as a great selling tool for your technology. Young people, particularly early teens to 21 years old, are heavy cell phone users.  “It’s easier to get a young person to accept mobile health than a senior. From a distribution standpoint, they are more likely to have cell phone with apps. They do not know life without a mobile phone.” On a more human level, a child’s emotions are more likely to generate a strong response with physicians and their parents. In a patient environment, children trust their pediatricians in a different way than adults do, Loncar says. Pediatric doctors tend to be more connected and in tune with mobile apps, are more likely to participate in a program and potentially be an early adopter.

Don’t be afraid to seek out the biggest customer. Getting pharmaceutical companies to advertise can be a delicate issue, particularly because it represents a potential minefield for this industry. Glassberg of MedHelp said when it was seeking pharmaceutical companies to advertise on the company’s community pages, each company told it to get someone to test it. “Pfizer (NYSE:PFE) was the first to test our interstitials and the test has been a very successful one leading to our being included in their 2012 up-front spending.”

Look at what the drugstores are doing. Drugstores are becoming much more aggressive players in the health IT/mobile health market. Walgreens (NYSE:WAG) and CVS Caremark (NYSE:CVS) allow users to refill prescriptions and view their prescription history through smartphone apps. What are they not doing? How can your mobile health technology address unfulfilled needs in a way that would fit in with their businesses?

Managing growth. One pitfall panelists observed, particularly for companies that are growing quickly is trying to do everything themselves. Recognize that you need partners to help your business. Sometimes a customer can be a collaborator as Anand Iyer of WellDoc pointed out.  he recounted how AT&T had sought out his company’s help to reduce healthcare costs and ultimately helped them with their data security.

Evaluate economic models. Will the physician or patient pay per use? How will a physician be reimbursed? If you create reimbursement codes, you can unlock significant value.

Technology is not a silver bullet. Iyer said his wife, who is a physician, says a main complaint is that many mobile health applications do not fit in with a physician’s practice. Companies need to keep in mind they will need to show how their technology can fit into a physician’s practice and provide cost savings, particularly because there will inevitably be a process of adaptation that needs to be as time efficient as possible. Any technology you develop needs to be integrable into physicians’ systems.

Anand Iyer of WellDoc on integrating mobile technology in a physician’s practice.

Anand Iyer of WellDoc talks about how WellDoc got started

Updox sells document management software to physicians and medical practices. The software is a web-based patient portal, e-mail and secure messaging system that features patient record importing and exporting, and document editing.

The mobile version of its software will have the same functionality but be optimized for the iPhone, iPad and Android operating system, said Sean Ramsey, the company’s president.

In addition, the company plans on using the state funding for two more initiatives: to integrate its software with more electronic health records (EHR) systems, and to promote its free secure messaging service to physicians, according to Ramsey.

Physicians use the messaging service to exchange information and patient data with other doctors, because e-mail isn’t secure enough for those purposes. Updox hopes to upsell physicians who like the free messaging service to the company’s full platform of services, Ramsey said.

Updox focuses on private physician offices with between one and five doctors. Prices range from $35 to $60 per month per doctor, with no upfront fee. The company is aiming to become the premier exchange platform for sharing medical information between different types of EHR systems.

Terms of the state’s 7-year loan to Updox include a 1 percent annual rate in the first year, and a 7 percent annual rate in the remaining years, according to the Ohio Department of Development. The loan also comes with a 1 percent annual servicing fee. Updox’s project funded by the loan is expected to help create 25 new jobs.

The company has eight employees, Ramsey said.

The company earlier this year received a job-creation tax credit from the state of Ohio valued at $258,000 over six years.

Blue Cross Blue Shield of North Carolina is investing $15 million and partnering with Allscripts (NASDAQ:MDRX) in a program intended to make electronic health records more widely available to physicians in the state.

That investment will help physicians leap over the biggest hurdle for EHR technology adoption: cost. Over the next five years, the money will go into a program that will allow BCBSNC to cover 85 percent of the software and setup costs for 600 physicians in eligible independent practices and 100 percent of the costs for more than 150 physicians in 39 eligible free clinics.

Allscripts will also share in the costs of the program. The financial commitment of the electronic health records technology company was not disclosed.

The initiative is called the North Carolina Program to Advance Technology for Health, or NC PATH. The program will provide training and support for physicians who implement certified EHR technology. Participating physician practices will also receive support toward being recognized as patient-centered medical homes, or PCMH, a model of comprehensive patient care that has been shown to manage costs.

BCBSNC will also work with the North Carolina Health Information Exchange to create a program that will enable providers to connect to the exchange so data can be shared.

A medical privacy breach involving Stanford Hospital in Palo Alto, Calif., led to the public posting of data for 20,000 emergency room patients, including names and diagnosis codes, on a commercial Web site for nearly a year, the hospital has confirmed.

Since discovering the breach last month, the hospital has been investigating how a detailed spreadsheet made its way from one of its vendors, a billing contractor identified as Multi-Specialty Collection Services, to a Web site called Student of Fortune, which allows students to solicit paid assistance with their schoolwork.

Gary Migdol, a spokesman for Stanford Hospital and Clinics, said the spreadsheet first appeared on the site on Sept. 9, 2010, as an attachment to a question about how to convert the data into a bar graph.

Although medical security breaches are not uncommon, the Stanford breach was notable for the length of time that the data remained publicly available without detection.

“Medical security breaches are not uncommon” is an understatement. According to the Department of Health and Human Services, 5,408,977 people have had their medical data lost or stolen, so an article that cries foul of 0.37% of this 2010 total seems fairly trivial. Worse, the reported trend is rising.

The real question that should be asked is this: What is the Department of Health and Human Services going to do about all of these data breaches? They seem to be intent on assuring us they’re doing a good job enforcing these breaches, but we have to wonder.

So far, it seems they really can’t do much to stem the tide: there are just too many people with computers claiming a “need to know” that have access to patients’ private health data.

-Wes

Addendum: Make that 7.9 million records breached since 2009. (h/t: PDara, MD via Twitter)

The author, Dr. Westby G. Fisher, is a cardiologist at NorthShore University HealthSystem who writes regularly at Dr. Wes.

I feel a close affinity to VITL as one of our New England collaborators (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut) but more importantly because of my longstanding relationship with VITL’s CEO, Dr. David Cochran, MD who was senior vice president for strategic development at Harvard Pilgrim Health Care and an influential driving force in the rollout of electronic health records in Massachusetts.

On a personal level, Vermont is one of my favorite places with remarkable countryside, a strong willed people, and a can do attitude.    Hurricane Irene has deeply affected the state but everyone is pitching in to accelerate the recovery.

My keynote will reflect on the journey from EHR implementation to true quality improvement using decision support, advanced analytics, and novel care management tools.

For the first time in my career, I am seeing a cultural transformation such that the majority of clinicians believe an EHR is a necessary part of their practice.  Emerging accountable care organizations are stressing the need for health information exchange and financial/clinical analytics as a foundation for the healthcare reform work ahead.

Meaningful Use Stage 1 sets the stage for quality measurement by moving clinician offices from paper to structured data entry.  Stage 2 will require more data exchanges and increasing use of controlled vocabularies that will make quality measurement easier.   Stage 3 will include new levels of decision support and data mining to prospectively and retrospectively help clinicians manage population health.

BIDMC’s strategy to prepare for future stages of meaningful use and healthcare reform includes

*Embracing health information exchange by serving as a pilot site for government, academic, industry, payer, and patient engagement experiments
*Capturing the value of unstructured data by testing novel Natural Language Processing software
*Empowering users with new analytics using new business intelligence platforms
*Embracing novel sources of information including data from home care devices and patients themselves
*Exploring the implications of gathering and using genomic data for clinical care and clinical trials

I’ll share examples of each of these with my colleagues in Vermont and in upcoming blog posts.

One of the most exciting developments is that we now are sending HL7 CDA document summaries from every patient visit to a community-wide registry which generates our meaningful use quality measures, submits our PQRI measures and supports ad hoc clinical queries.   By requiring every EHR vendor to send a CDA document over the New England Healthcare Exchange Network (NEHEN) to the Massachusetts eHealth Collaborative Quality Data Center, we have created the technical foundation for our emerging ACO that is in production now.   I’ll post a more complete technical overview next week.

I look forward to exchanging lessons learned with Vermont.

Arnel Rillo, who leads Clinical Healthcare Corporation in St. Louis Park, is developing a tool to better support physicians treating asthma and expects the product to launch in the first quarter of 2012. It will be the first product of the health IT company’s eVeritas Software Solutions platform that ultimately will create clinical decision support software for diabetes, chronic obstructive pulmonary disease, heart failure and hypertension.

Rillo believes that what will distinguish his company’s products from those in the marketplace is the proactive approach the software takes to alter physician behavior while treating those chronic diseases. He said that most clinical decision support software programs are based on old claims data. Those systems also basically lift the clinical guidelines that have been developed on that particular condition and presents that information to physicians without distilling or simplifying the information in any way.

Health systems and insurance companies use the information gathered from these treatment support software programs to go back after patients have been treated to see how that particular disease was managed by the physicians. That approach is not effective, Rillo said.

“Instead of waiting until they have treated a patient and using the information on the back end to get them to change behavior and do a better job of adhering to those treatment guidelines, we try to provide that information up front at the point of care,” he said. “We use proprietary algorithms based on assessment questions that the guidelines recommend and help physicians walk through that decision tree.”

The software also has reporting capabilities that should be valuable to large health systems looking to see how each clinic site manages particular disease states.

“Why is the clinic in Apple Valley doing a better job in managing diabetes than the one in Maple Grove?” is a question that the software will be able to answer, Rillo explained.

The application also requires physicians to explain why they did not follow a treatment guideline if they take an alternative path to provide care for a patient.

“It’s still up to the physician to practice the art of medicine,” Rillo said. “We do not force them down a certain path.”

Rillo believes that the current emphasis on electronic health records (EHRs) and President Obama’s intent to create Accountable Care Organizations is providing fertile ground for companies like Clinical Healthcare that want to help healthcare providers bend the cost curve of healthcare and provide better care.

Rillo said he has been in discussions with individual physician groups, small and large, to gauge their interests in using eVeritas, but declined to name them. The company has also raised some money and intends to raise more to help commercialize the asthma treatment support software in the first quarter of 2012.

The use of EHRs, clinical decision support (CDS) and electronic guideline-based reminders and alerts, are on the rise in the U.S., and a big reason for that is the $19 billion that the federal government made available to speed up their adoptions through the American Recovery and Reinvestment Act.

However, some don’t believe there is a significant correlation between increased use of EHRs and CDS, and better healthcare outcomes.

A study in the Archives of Internal Medicine published in May found that there was “no consistent association between EHRs and CDS and better quality.”

Mayo  researchers will integrate advances in genetic studies of heart and blood vessel diseases into electronic medical records (EMRs) as part of the four-year grant.

In a genome-wide association study, researchers analyze hundreds of thousands of genetic variants in people who have or don’t have certain health conditions in order to identify genes that cause or contribute to diseases.

“We will develop genetic risk scores for heart attack and adverse drug reactions, as well as tools to communicate genomic risk to both patients and care providers,” said Dr.  Iftikhar Kullo,  Mayo cardiologist and co-principal investigator, in a news release. “The goal is to accelerate the translation of recent advances in genetics and pharmacogenetics to the clinical practice, leveraging the electronic medical record.”

The Mayo Clinic grant is part of the second phase of the Electronic Medical Records and Genomics Network (eMERGE) initiative whose goal is to develop, disseminate and apply approaches to genetic research based on large numbers of medical records gathered from multiple locations.  The initiative seeks to know whether “EMR systems can serve as resources for such complex genomic analysis of disease susceptibility and therapeutic outcomes across diverse patient populations.”

Mayo is one of seven institutions part of the eMERGE network to have received a grant. A total of $25 million was awarded.

The topic is electronic health records and the data shows that consumers are clearly worried about the safety and security of those records.

In February 2011, a CDW Healthcare survey of 1,000 U.S. consumers showed a “broad cross-section of the American public who were uneasy about the potential security problems associated with the move from paper to electronic records.”

CDW reports that patients are concerned their health records will wind up with cyber thieves, who in turn will use the data to steal consumer identities. Consumers are also wary of their employers getting their hands on personal health records; they fear that companies will make hiring and firing decisions based on those health records.

In the report, titled “Elevated Heart Rates: EHR and IT Security,” CDW analysts say that while consumers do trust their doctors to protect their health data, 49 percent believe that electronic health records “will have a negative impact on the privacy of their health data.”

More telling for healthcare startup owners whose companies handle health records, consumers clearly hold healthcare organizations accountable and responsible for the security of those records.

• 86% of survey respondents said that healthcare companies are responsible for protecting financial data
• 93% say such companies are accountable for personal identification security
• 94% say that healthcare organizations are responsible for a patient’s family data

Clearly, safeguarding patient data is a burgeoning responsibility for healthcare entrepreneurs. “The new era of EHR brings with it a whole new set of requirements for healthcare organizations – particularly in the area of IT security,” says Bob Rossi, vice president of CDW Healthcare. “Digital files are not inherently less secure than paper files, but they do require a completely different set of technologies, processes and internal policies for protection.”

This week’s security breach that exposed 2,000 hospital patients’ information doesn’t do much to strengthen consumers’ faith in the security of their records.

It’s no wonder, then, that another survey, this one released today by Xerox Corp., says that “more needs to be done” to reassure consumers that their medical data is safe and secure. The Rochester, N.Y.-based company surveyed 2,720 U.S. adults, and found that 80 percent of consumers are worried about their personal health data being stolen.

 ”The survey results indicate an urgent need for better patient-provider communication,” said Paul Solverson, partner, strategic advisory services, ACS, A Xerox Company. “Providers need to start conveying the benefits of electronic records, particularly the security advantages over today’s paper-based system.”

The Xerox report cites the example of Botsford Hospital in Farmington Hills, Mich., which will roll out a new Electronic Medical Records (EMR) system at the end of this year. According to the hospital, the system will allow EHRs to “follow” a patient as he or she moves through different departments of the hospital, enhancing the quality of care.

Botsford is taking great pains to communicate with patients how the new system will work, and what the hospital is doing to secure their health data.  “We consider communication and training an important part of implementation,” notes Dr. Paul E. LaCasse, president and CEO, Botsford Hospital. “It’s essential to allay concerns and demonstrate what a powerful tool EHRs can be in providing quality healthcare.”

That’s the type of approach that other healthcare service providers must take to ease the fears of consumers over their personal data. If not, consumer advocacy groups may well show up on their doorsteps.

And it won’t be a social call.

We used this presentation, which covers three major themes:

*Meaningful Use Stage 2 gap analysis work
*The Standards Summer Camp Activities
*The Standards and Interoperability Framework activities

Doug started by reiterating the guiding principles of the HIT Standards Committee which essentially translate into

“We will select no standard before its time”

Doug reflected on the way we select standards, assigning each requirement to one of four “buckets”

a. Functional criteria only – no standards are needed
b. Sufficient standards and implementation guides are available
c. Existing standards are available but not implementation guides
d. No standards or implementation guides are available

He discussed early work to place proposed Meaningful Use Stage 2 policy goals into these 4 buckets.

Since many of the Stage 2 goals will not have supporting standards and implementation guides in time for the regulations, it’s like that some of stage 2 will be described using functional criteria and not standards.   What does that mean?   Here’s an example

Electronic medication administration records (EMAR) are unlikely to require a specific bar code format.  Instead, it will be sufficient to require that a certified application be capable of 5 functions

*Generate alert for wrong patient
*Generate alert for wrong medication
*Record the dose and route
*Record the provider administering the medication
*Record the time/date the medication was administered

Implementation details will be left to the creativity of the marketplace.

I described the Standards Summer Camp schedule and offered updates on

• Metadata
• Patient Matching
• ePrescribing
• Surveillance Implementation Guide
• NwHIN

Doug completed the presentation by describing the Standards and Interoperability Framework Projects

*CDA consolidation
*Transitions of Care
*Lab Results reporting
*Provider directories
*Distributed query (Using a web brewer to query multiple databases such as is done with Shrine/I2B2 )

We took questions from the committee including how best to develop drug/drug interaction standards, how the policy committee can best work with the standards committee by providing requirements early and often, and how we can all plan for the future of stage 3.

A great meeting!

Current medical news and unique business news for anyone who cares about the healthcare industry.

What the end of Google Health says about the health tech industry. Google announced Friday it will discontinue Google Health, its digital health records service, in January 2012. Launched in 2008, the service didn’t catch on like the company had hoped. Although Google Health Founder Adam Bosworth said the service failed because “it’s not social,” Dave Chase, the founder of Microsoft Health, wrote an insightful blog post about why Google Health was ultimately doomed to fail, and what its failure means to the health tech industry.

It’s that time of year again. The 2011 BIO International Convention is now under way in Washington D.C. With more than 15,000 expected attendees from 65 countries, the convention will bring together some of the world’s most influential industry, academic and government leaders.

Diabetes — the next global health issue? The number of adults with diabetes worldwide jumped to a startling 347 million in 2010, compared to 153 million in 1980, according to a new study in the British journal Lancet. Public health officials have said the rise in diabetes is more worrisome than the rise in high blood pressure rates and high cholesterol levels because it’s harder to prevent and treat.  The findings predict a significant increase in medical costs for diabetes over the next decade.

Genentech will put up a fight for breast cancer drug. In a hearing this week, Genentech will appeal to the FDA to keep the drug Avastin available for breast cancer treatment. In December, the FDA proposed to revoke approval of the drug because new research showed it didn’t help patients.

More news on Genentech. The San Francisco-based cancer treatment company has made a deal with Forma Therapeutics to support the finances of a new drug program that starves tumors by blocking molecules involved in cancer cell metabolism in exchange for exclusive rights to the program.

A few thoughts

• Google Health has the best user interface, feature set, and ease of use of all the stand alone personal health records
• Google Health is truly innovative and broke new ground when it created interfaces to hospitals, labs, and pharmacies in 2008.    I was there at the beginning and can definitively state that it was Google’s reputation and vision that broke down the political barriers keeping data from patients.
• Google will be using the Direct standards to enable patients to transmit their Google Health data to Microsoft Healthvault and other PHRs

Thank you to Google and the Google Health team.  You really moved the industry.

———–
Dear Google Health Partner,

As we just announced in the Official Google Blog, we will be discontinuing the Google Health service and platform over the next several months. For more context around this announcement, please check out our blog post.

Going forward, we recommend that you notify your team and discontinue any current development around your Google Health integration. Also, you’ll need to remove the integration functionality as well as Google Health related text and logos from your website as of January 1, 2012. Please consider this as our notice to terminate our agreement with you on the Google Health API Terms and Conditions, found at https://services.google.com/fb/forms/googhealthdevelopers.

We truly appreciate your partnership and support of the Google Health service.

Best regards,

The Google Health Team

I keep getting lots of inquires from physicians and EHR vendors about meeting EP Meaningful Use measure #15: Protect Electronic Health Information.

The measure is met by conducting a security risk analysis and implementing new security updates and corrective actions when a deficiency is identified. Some think there is a requirement to have a third party come in an perform the analysis. False. Some think they need to spend money on interactive software to meet this measure. False.

Let’s settle this once and for all and then move on to more important issues, like improving health care.

Meeting this requirement can be logical, simple, and actually bring value to a medical practice. The analysis should be embraced as a way to possibly identify threats to the protection of electronic health information. Who could argue with that? Regarding this MU measure, below is the relevant info. This is not my opinion. It is based on the regulations. EPs can do more, but it is not required for Stage 1.

Here is the specific MU Measure: “Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process”.

Here is the link to referenced 164.308 –  HIPAA Security rule. Here is a link to an important document – Security Standards: Implementation for the Small Provider. This document addresses specific requirements and details ways to address them.

If I was an EHR vendor, I would create a template for all my customers with check lists, sample questions, and guidance. Medical practices have to actually perform the analysis and potential corrective action, but this does not have to be complicated, expensive, or time consuming. Sometimes less is more.

Orange, California-based St. Joseph Health System becomes the sixth hospital or health system to add its patient records to Explorys’s network.

Cleveland-based Explorys acts as a repository and cleanser of data that comes from many different heatlh providers and puts all the data into a central research database. The idea is that healthcare organizations can mine that electronic medical records data to look for trends that could lead to improvements in patient safety and clinical effectiveness.

The more data Explorys adds, the more valuable its network will become so the company needs to continue expanding aggressively. The company recently raised an $11.5 million series C round of  investment to do just that.

In addition to adding data from St. Joseph’s dozen or so hospitals — most of which are in California — the new client helps expand Explorys’s geographic reach to the West Coast. Other members of the network are Cleveland Clinic, University Hospitals and MetroHealth System in Cleveland, Summa Health System in Akron and MedStar Health in Maryland.

Explorys was formed in 2009 on technology developed by Cleveland Clinic, which holds equity in the company.

Much of the documentation and attestation of “meaningful use” is based on “patient encounters”. Well, what exactly is a patient encounter? This is obvious for an internist or general practitioner. Not so obvious for others.

This has been one of the most perplexing questions for specialists. If a patient is referred to an Ambulatory Surgical Center and a gastroenterologist performs a colonoscopy, is that a patient encounter? What about when a radiologist reviews and provides an impression of an image? How about when a cardiologist is called in to review an EKG but never sees the actual patient? If these events are classified as patient encounters that could be very problematic for specialists because in these scenarios it might be difficult to meet numerous MU measures simply because they might not have access to the type of data required for these patients to document meaningful use. Such EP measures as Vitals, Problem List, Medication Allergy List, etc. might  be impossible to meet for these patients because the specialist would not have access to that type of information. If these patients must be included in the denominator of meaningful use calculations, that would spell failure for many attempts by specialists to obtain the CMS incentives.

At long last CMS has issued some very good and flexible guidance on the issue of what constitutes a patient encounter. CMS states: ”

All cases where the EP and the patient have an actual physical encounter with the patient in which they render any service to the patient should be included in the denominator as seen by the EP. Also a patient seen through telemedicine would still count as a patient “seen by the EP.” However, in cases where the EP and the patient do not have an actual physical or telemedicine encounter, but the EP renders a minimal consultative service for the patient (like reading an EKG), the EP may choose whether to include the patient in the denominator as “seen by the EP” provided the choice is consistent for the entire EHR reporting period and for all relevant meaningful use measures. For example, a cardiologist may choose to exclude patients for whom they provide a one-time reading of an EKG sent to them from another provider, but include more involved consultative services as long as the policy is consistent for the entire EHR reporting period and for all meaningful use measures that include patients “seen by the EP.” EPs who never have a physical or telemedicine interaction with patients must adopt a policy that classifies as least some of the services they render for patients as “seen by the EP” and this policy must be consistent for the entire EHR reporting period and across meaningful use measures that involve patients “seen by the EP” — otherwise, these EPs would not be able to satisfy meaningful use, as they would have denominators of zero for some measures.”

Steve McHale

Credit Steve McHale for having a knack for putting himself in the right place at the right time.

Six years ago, McHale and partner Charlie Lougheed sold the previous company they founded, Everstream, for $15 million to Concurrent Computer. Everstream provided analytics and reporting around the then-emerging field of on-demand video.

Now, with their new company, Explorys, the two partners have jumped into health data management, a field that’s expected to explode in the coming years, thanks largely to $17 billion in federal incentives aimed at persuading doctors and hospitals to adopt electronic medical records (EMRs).

With all that cash going toward EMRs, there’s a strong need for a means of making sense of that data and uncovering any trends it holds that could improve patient care. Explorys believes it can fill that need, and some deep-pocketed investors apparently agree.

Last month, Explorys raised an $11.5 million series C round of investment, led by Austin Ventures of Austin, Texas and Foundation Medical Partners of Connecticut. The round also included follow-on funding from Austin-based Sante Ventures and Cleveland Clinic.

The company has 25 employees, but anticipates such high demand for its software that it projects that number to hit 100 around the end of next year. Founded in 2009, Explorys has five hospital clients and has amassed EMR data on about 10 million patients. Explorys will need to quickly hike those numbers if the company is to hit its goals.

McHale recently chatted with MedCity News on the possibility of an Explorys IPO, why this is a “watershed” year for health data, and why the medical industry has been slow to follow other industries in adopting IT.

Q: In announcing Explorys’s latest funding, you called 2011 a “watershed” year for healthcare data. What exactly did you mean by that?
A: There are a number of forces that have really come together to provide this watershed environment. There are the economic forces like the fact that healthcare has become such a big part of our GDP, so the federal government has gotten involved to improve the delivery and efficiency of healthcare. All of that improvement is predicated on data. So, the government gave doctors money to put in systems to build that data. All the money that doctors and hospitals will get is all related to building systems that will ultimately help us understand how healthcare is being delivered and how it can be improved.

So, we’re coming in to bring value to that data. The systems today are really just about creating and logging the data in records. That’s good when you’re dealing with the patient face-to-face, but how do you leverage that data on a population level to improve medicine, both clinically and financially? You need to aggregate it and analyze it.

Q: What do you see as Explorys’s most likely exit scenario?
A: We’re not thinking about that. We’re in a position where we don’t need to. We see potential in a public offering at some point. I think that’s coming back into favor and it’s a real possibility for us. I wouldn’t say that’s an exit. I’d says it’s the next stage of the business. I think we’re a next-generation company like Google and Facebook with a really important mission.

Q: Why do you think it’s taken U.S. hospitals so long to use all the patient data they collect to enhance patient care?
A: A bit of it is the culture of who drives the healthcare system. Doctors are brilliant and that’s why they’re in healthcare, but they’ve been working with manual processes and that’s what they know. So, embracing technology wasn’t the first thing that would come to their minds like it would in other industries like banking, telecommunications or retail, for example. Healthcare was built on the expertise of the physician, not the technology. It’s a culture change, but even now there are still doctors out there who don’t want to change and don’t care about the government money. They’re more comfortable with the processes they use today. There’s no question healthcare is behind in the IT space compared to other industries. So, we’ve implemented disruptive platforms to manage this large-scale data and turn it into useful information and knowledge.

Q: In trying to sell Explorys’ services to hospitals, what’s the most common objection you hear from executives?
A: I think sharing your data is a leap. There’s a lot of ‘Hey, this is our data. It’s special and it’s unique.’ You always have to be careful about patient privacy, so that’s a concern. We have to quell those concerns by showing that’s at the top of our minds as well. It’s really an education process.

Q: Things are looking good for Explorys in the wake of your series C investment, but what’s the biggest challenge facing the company right now?
A: I think the biggest challenge for us is we’re like a puppy in front of a giant bowl of food; we don’t want to eat ourselves to death. We’ve been very good as a leadership team of not knee-jerking, but still focusing on opportunities that have the right balance where we can contribute real value and still get compensated for delivering that value. There’s tremendous opportunity and need in the health space around leveraging data. Data ultimately is the foundation of healthcare reform. It’s been the lack of data and information that’s stifled our healthcare system. You can’t understand what works and what doesn’t without data. Data is the underpinning of the whole process of transforming and improving healthcare in the U.S.