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Monday Morning Update 7/24/17

July 23, 2017 News 1 Comment

Top News

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A Nuance investor disclosure announcement on Friday says the company has not yet fully restored all of its cloud-based systems that went offline in a June 27 malware attack.

Nuance warns that its financial results for Q3 – of which the malware incident impacted only the final week – will suffer, with expected revenue of $485-489 million instead of the previously estimated $500-$504 million. The company expects to lose $0.11 to $0.09 per share in the quarter instead of its previously estimated loss of $0.07 to $0..05. The Q3 results will be posted on August 8.

Nuance says its Q4 results will also be negatively impacted from the outage, mostly related to its HIM transcription services business.

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Nuance added that it hopes to restore services within two weeks to all customers of its EScription LH back-end transcription system for large hospitals.

Shares of Nuance Communications fell briefly in pre-market trading following Friday morning’s announcement, but closed up 2 percent. They’re up 6.5 percent in the past year but down 18 percent in the past five.

One might speculate that it’s going to be a rough Q4 for Nuance if just one week of Q3 downtime whacked $15 million off the company’s quarterly revenue — the outage on some significant systems has extended three weeks into Q4 and won’t be fully resolved for at least two more weeks.


Reader Comments

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From Firm Mattress: “Re: your HIT index. I took the liberty of scoring the top 10 of last year’s #HIT100. The low scores seem about right to me.” My scoring method tries to quantify how I assess someone’s healthcare credibility from their LinkedIn profile in looking at healthcare-specific education and accomplishments. I place zero value on social media influence. Twitter is a great way to showcase someone’s deep knowledge and thoughtful opinions (I’m thinking of people like Andy Slavitt and Eric Topol), but it’s also a medium embraced by those with few other accomplishments or possessing light credentials for rendering opinions on complex topics who just retweet stuff other people came up with. My problem with the HIT100 and similar recognition is that some people desperately seek it as validation in the absence of other achievements and brag about winning like it actually means something. To which I would ask in rudely re-introducing the real world into the discussion: how many of Modern Healthcare’s “100 most influential people in healthcare” have followed you, retweeted you, contacted you personally, or offered you a job? You earn cool points, however, for being on the list without ever having mentioned it in pandering for votes or bragging on being named. Feel free to poke holes in my scoring method or the reader’s application of it above. I’m tempted to assign points for military service, particularly in a healthcare or leadership role, since I value that pretty highly in someone’s bio.

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My final thought about self-confidence vs. knowledge and experience applies to all of us  — I’m uncomfortably aware of how well this describes me at times.

From Aphasian: “Re: HIMSS conference. We need a good marketing idea that will generate buzz in Las Vegas.” Obtain a picketing permit from the city and hire pamphlet-passing shills to carry protest signs on the public sidewalk  –your “protest” should involve your product or service.


HIStalk Announcements and Requests

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Poll respondents say the only industry awards that are significant are KLAS and the Davies, but even then, “none of the above” wins the grand prize. Reader Dewey, Cheatham & Howe looks at methodology: “Most Wired is an online form. Completing the form is labor intensive, but not difficult or vetted. If people can (and do) lie about their MU attestations, then what do you think you are getting with Most Wired? KLAS has skilled interviewers and they try to remove bias, but it is easily gamed. HIMSS EMRAM Stage 6 uses same methodology as Most Wired — little to no validation. HIMSS Stage 7 is different because it requires a site visit by experienced surveyors. HIMSS Davies requires a write-up with validation. As for the rest, I assume they are conducted with little or no pre-survey modeling of measurement criteria or post survey review of bias.”

I’ve overseen several “Most Wired” wins in the health systems I’ve worked for, but a comment from the cynical manager I assigned to complete our entry one year best summed up the form’s self-attesting ambiguity: “It’s not what we actually do, it’s how badly you want us to win.” Nobody in IT thought the Most Wired award meant anything at all since the responses allow wiggle room and our job was to support the health system instead of worrying about pointless awards, but we did feel some responsibility after the first win to keep applying. Nobody wants to be the health system that falls off the list – even voluntarily – from one year to the next. Organizations give awards and recipients proudly accept them for entirely self-serving reasons.

New poll to your right or here: which company’s stock would you buy if forced to choose one?

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Welcome to new HIStalk Platinum Sponsor Redox. The Madison, WI-based company was founded in 2014 with the belief that EHR vendors can’t solve healthcare interoperability. The company’s API allows innovators the ability to code once, connect to all. It uses cutting edge methods such as HTTPS, JSON, and OAuth to create a modern Web experience without digging into HL7, FHIR, CCD, or DICOM. The company’s integration experts know how to get data into and out of EHRs using scalable integration strategies, enabling both software vendors and providers to integrate their apps, exchange information with affiliates, and commercialize innovation. Redox has already connected hundreds of enterprise applications. It monitors and maintains interfaces 24/7; expedites pilot testing; streamlines referral management, population health, and analytics; and creates a build-once environment that fuels innovation and scalability. The company also integrates wearables and home medical devices with EHRs and data warehouses; connects payors to providers; and integrates remote patient monitoring and telehealth services with medical groups and EHRs. Thanks to Redox for supporting HIStalk.

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We funded the DonorsChoose teacher grant request of Mr. S in California, who asked for a Chromebook for his second grade class. He reports that the students are using it for online math practice, graphing, virtual field trips, and geography look-ups using Google Maps.

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I noted that Nuance’s status updates contain the same infuriating error that I see in endless emails in claiming that a stated time is “EST.” There’s no such thing until November 5, when our clocks are turned back from “EDT,” or if you can’t be bothered to understand what the rest of us get, then just write “ET” and we’ll figure it out for you. The same folks are often confused by time zones and have to confirm for scheduled calls, “What time is it where you are?” to which I’ll provide this invaluable advice: just type “time in Phoenix” or “time in London“ in a Google search box and it will tell you in engaging zero of your brain cells. Daylight Saving Time is illogical, but that doesn’t mean you can just ignore how it works.


This Week in Health IT History

One year ago:

  • University of Mississippi Medical Center agrees to pay $2.75 million to settle HIPAA charges related to the theft of an unencrypted laptop and discovery of an unsecured PHI-containing database.
  • Athenahealth announces that EVP/COO Ed Park will leave his position.
  • CTG CEO Cliff Bleustein, MD resigns.
  • Kate Granger MBChB, MBE, the NHS geriatrician who created the “Hello, my name is” campaign that urge clinicians to introduce themselves to patients before treating them, dies of cancer at 34.

Five years ago:

  • IRobot announces its first healthcare robot.
  • Shares of Quality Systems (NextGen) drop 33 percent after a poor quarterly report and the loss of long-term customer HMA.
  • The Commonwealth Fund announces former National Coordinator David Blumenthal, MD as its next president.

Ten years ago:

  • Several companies bid for struggling NPfIT contractor iSoft.
  • Mediware shuts down its OR product line to focus on “closed-loop systems.”
  • Misys exits the healthcare business by selling its lab, pharmacy, and radiology software business to Vista Equity Partners and its Misys CPR product to QuadraMed, with both acquiring companies agreeing to support the Misys Connect strategy.
  • Picis announces its intention to acquire ED revenue cycle software vendor Lynx Medical Systems.

Weekly Anonymous Reader Question

Responses to last week’s question:

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  • My boss knows me at a professional level and we do some small talk. He lives across the country, so we do not have any off-work interaction.
  • None. I try to have as little interaction as possible with her at work, let alone socially.
  • Zippo. They have no interest to ask, and I have zero interest to share. Best that way.
  • He knows of my family , no names. No social interaction besides Christmas party, and there is no family allowed in the building.
  • Not at all, and that’s the way I like it. I learned some hard lessons about being too familiar with management, and now I draw a hard line between my personal and professional relationships.
  • None.
  • I have found that my bosses have never really known much about me and my family socially, and we have had minimal interactions outside of work, and never outside of work events. For me, this led to some burnout because they were unaware of everything I was juggling. Because of that, as a boss myself, I’ve made an effort to know my team members and their family’s because it helps everyone perform better. If I know that you’re stressed because you have a particular family issue going on, it let’s me step in to help out at work to relieve some of the work stressors. When people feel like you care about them for more than just doing the work you need done, morale is higher and performance improves. And bottom line, part of being a leader is hopping into the trenches with folks and working side by side with them, which you can’t do unless you know what’s going on outside of the four walls of your office.
  • We have zero off-work interaction. Frankly, we barely have on-work interaction. He is chronically late to our scheduled 1:1 calls and sometimes doesn’t show up at all. Something “more important” always seems to be coming up. I know I’m one of the top ranked members of his team and I’m generally self-sufficient, but there’s no way he’s ever going to do any professional development work with me if he can’t even show up on calls. BTW, it’s not just me he does this with. Upper management should be appalled but no one seems to care.
  • He doesn’t. None. We spend so much time together during the week that we need to NOT see each other on the weekends. Same is true for our entire executive team. It is healthier that way. We get along just fine. Seeing more of each other would not be healthy then work would not creep but barge it’s way into the weekend.
  • Working with my boss for the past 18 months, he has never met any of my family members. As a remote worker, off-work social interaction with my peers and boss does not occur. My company does not value this interaction with its remote workers; however, it does value this interaction with on-site office staff. Perhaps my company cannot justify the cost associated with social interaction with the families of its remote workers.
  • I’m a remote employee, so “not at all” and “none”.
  • Learned the hard way during my time at McKesson, MPT, that letting work and family mix is not always the best idea. When times got tough, I would hear things like, “You better work harder and sell more or you won’t be able to provide for your children.” And then refer to them by name and even what activities that they might not be able to do because we wouldn’t be able to afford it.
  • All previous bosses took time to know me and my family within the first month of starting the position. We have a small team of six, so it is not hard to remember kids’ names and estimated ages. My current boss is in her third year and still has no idea what my kids’ names are. She avoids off-work interactions like the plague. Happy hour? No. Team building exercises during off hours? Absolutely not. On going team member conversation in the break room? No eye contact. To say the least, it is tough to work at a level of 110 percent to make someone look good who doesn’t know your kids’ names. I have always believed interpersonal skills are imperative in leadership and my current boss reinforces it that belief.
  • No off-work interaction. We share normal chit-chat in the office, names of spouses/kids, school activities, etc., but that’s it.
  • We don’t do anything socially or have any off-work interaction, nor is this encouraged or discouraged by the organization. I started my career with a consultancy who did an excellent job of pulling family into social activities throughout the year. In the 30 years since then, not really something my employers (hospitals, health plans) cared about.
  • We had lunch the day I started. Otherwise, boss refuses to engage socially. No interaction.
  • We don’t discuss family. Dogs, occasionally. There is minimal interaction outside of work and only incidental to work. Considering the question in terms of bosses I’ve had in the past, there have been some that really did care about everybody and everyone’s family. Would see them routinely out of work and even at their homes on holidays. Made work-life at the time enjoyable, sometimes a little too personal, and I can’t say the team was any more effective then ones I have participated on where this is not the case.
  • Zero interaction with family or personal life. I live on the east coast, she lives on the west. I’m a telecommuter.
  • Somewhat, but I would say 80% business.
  • Well enough to think he knows a lot, which makes him happy, but he really doesn’t and it’s going to stay that way. He uses what he knows in weird and uncomfortable ways so additional sharing is off the table. It creates some awkward situations if he’s prying for more, but handling that is a better trade off than the alternative.
  • My boss knows very little about me outside of work and that is the way I want it to be. Work life is work life and personal life is personal – separate from each other. Consequently, I spend zero time outside of work with my boss.
  • No social interaction at all, and that is fine with me ~ like the boundaries!

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This week’s question: What drives you crazy about the person at work who annoys you the most?


Last Week’s Most Interesting News

  • Athenahealth’s quarterly results beat expectations even as the company is dogged by an activitist investor and its CFO leaves the company for another healthcare IT company.
  • Google Glass is revived as X Glass Enterprise Edition, with healthcare one of the targeted industries.
  • Epic’s first full-suite implementation in Canada goes live.
  • The DoD’s second MHS Genesis pilot site goes live on Cerner.
  • Emids acquires Encore Health Resources.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call, following results that sent shares up 8 percent on Friday:

  • The company says enterprise software competitors can’t duplicate its recently launched work reduction guarantee for independent medical groups that differentiates its cloud-based services model.
  • CMS has approved the company to received adjudicated Medicare claims data as a Qualified Entity, which it says will allow it to build up a scalable hospital service that can pre-populate information without requiring redundant data entry. Jonathan Bush says, “Athena will be the only company with an EMR that actually has medical records in it before you type them in.” He also describes the claims information containing 98 million patient records as a “data asset.”
  • The replacement CFO search will focus on a “demonstrated record of operating discipline and value-creating capital allocation” who can analyze the potential return on investment of every company project as more of a COO and portfolio manager instead of just handling financial controls and accounting management.
  • The company says it is winning 80 percent of the deals it goes after, the highest in its history.
  • Bush says the company has a very high win rate in community hospitals, #1 in net hospital wins according to KLAS, mostly because they need systems quickly without using capital budget to improve cash flow. Still, he admits that the hospital business isn’t yet profitable and it represents the company’s shallowest product offering.
  • Bush says the company’s recent $63 million acquisition of Praxify gives it modern technology that can containerize future app development as the aging AthenaNet platform is re-architected in “an intense crisis level of reconstruction.”
  • Bush says electronic data interchange makes implementations tougher, especially in hospitals. “Hospitals will show up at the door with lab systems written before my children were born. Someday we’ll get the courage to say, here’s the app store. Buy any of these lab systems. We’ll pay, but we’re not connecting to that MUMPS-based museum piece.”
  • Bush says the CMS-certified Qualified Entity application required completing a 700-page application and was completed only because the Trump administration changed the data sampling requirements. He adds that CMS is not technically ready to meet the requirements: “The government is on some very tired systems. So are the contractors. We understand that the way we will receive this data is they will send us a drive in a padded envelop by certified mail. We have people on eBay now looking for machines that can receive this drive.”
  • Bush says of population health management, “Population health is population surveillance outreach, population engagement, and population love. Every health system needs to find out what population thinks of them as a prospective provider of choice and love on them in a digital continuous way rather than waiting for them to be the path to the hospital parking garage. As we get our population health clients to agree to that approach, we get a much bigger bite of their patient population and get much more traction.”

Decisions

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  • Boca Raton Regional Hospital (FL) will go live on Cerner in August 2017.
  • Monroe Community Hospital (NY) will go live on Healthmedx Vision in August 2017.
  • Gerald Champion Regional Medical Center (NM) will go live on Cerner CommunityWorks in August 2017.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Other

Part 3 of Vince’s HIS-tory of Cerner from a few years back covers how the company’s name was chosen (and by whom), stock performance, and how its lab system became #1 by the late 1980s.


Sponsor Updates

  • Over 500 Mazars employees volunteer at community organizations in six states for its third annual “Days of Service.”
  • ZappRx releases a new podcast, “It’s Hard to Prescribe Specialty Drugs.”
  • Audacious Inquiry founder and managing partner Chris Brandt is named an Aspen Institute health innovator fellow.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 7/20/17

July 21, 2017 Dr. Jayne No Comments

I thought the travel gods were going to be favorable this week, starting when the rental car clerk gave me a free upgrade on a super-sporty car since I had a one-way rental and they needed to reposition it to my destination airport. Once I made it out of the rental car facility and got a few miles down the road, I discovered that the radio didn’t work. Or at least didn’t work in the conventional way, as it randomly turned itself on and off every 10 to 30 minutes and remained stuck on a static-filled station with some fire and brimstone preacher yelling at me. Did I mention the volume controls didn’t work either? There was clearly something wrong with the electrical system and the display would randomly show the back-up camera view even when I was streaking down the highway slightly in excess of the speed limit. By the end of my trip I was just glad to be back at the airport in once piece.

I had been traveling with a customer laptop, and when I got home, I discovered that my trusty Microsoft Surface had undergone an automatic upgrade while I was away. It was stuck on the “updating, please do not unplug your computer” screen and when I restarted it the endless boot cycle started. This led to a multi-hour trip to the Microsoft Store, where everything seems to be the user’s fault regardless of what prompted it. They were able to undo the upgrade and redo it segmentally, and everything seems to be back on the up-and-up. Still, I’d rather have those hours back because now I’m woefully behind. It’s days like this that make me miss the corporate world, where a magical Desktop Support representative would have dropped off a loaner within an hour or so.

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HIMSS has opened nominations for its “Most Influential Women in Health IT” awards. This is only the second year for the program, designed to recognize “influential women at all stages of their career progressions.” Nominees should demonstrate an ongoing commitment to using IT to positively transform health and healthcare as well as providing active leadership in organizational use of IT in support of strategic initiatives. HIMSS never does anything without a hook — nominees must agree that if they are selected, they will contribute two pieces of content to HIMSS via blogs, podcast interviews, roundtables, etc. Nominations must include a biographical sketch and two letters of recommendation and will remain open through August 28.

ONC is continuing its “Interoperability in Action Day” series with a half-day webinar on “Advancing Interoperable Social Determinants of Health” on July 26. The session will focus on the current state of screening tools in care delivery and how they will play into new payment models, along with resources to increase tools around interoperability of social determinant data.

Social determinants have been used in primary care for a long time, especially in community and public health clinics. For some vendors, they’re relatively new additions to the EHR platform, feeding clinical decision support and quality measurement content as well as population health functionality. There are still challenges with communities agreeing on common vocabularies for data sharing. Other challenges include the fact that social determinants change over time and have variable impact on patient health quality. They’re often less quantifiable than physical or laboratory characteristics and combine in a multifactorial way to influence health. Discrimination, social support, and environmental factors can be hard to document in a discrete way, although other factors, such as insurance status, are easier to identify.

My EHR has some optional tools to document social determinants of health. We do gather some of them, but since surrounding health systems aren’t too interested in partnering with their competition, our data doesn’t get a lot of use.

CMS recently announced plans to delay implementation of the Appropriate Use Criteria (AUC) program by one year to 2019. The program mandates that physicians use clinical decision support when ordering certain types of diagnostic imaging, such as MRI scans. The clinical decision support information has to be included on billing claims. Physicians ordering too many tests without appropriate justification could be penalized through reimbursement cuts and radiologists performing studies identified as unnecessary would have claims rejected. Several advocacy organizations recommended delays. Based on some of the clunky EHR workflows I’ve seen created to handle this mandate, I hope vendors use the extra time wisely and for the benefit of their end users.

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The American Medical Informatics Association has expanded the publication of its Journal, to be available monthly and as an all-digital publication starting in January 2018. The publishing world has changed dramatically over the last several decades, so I’m not surprised by the change, especially from a technology-focused organization. Research is also occurring more rapidly, making the extended preparation cycle needed for a paper journal more burdensome than beneficial. I’ll miss the paper copies, which I often loaned out to students and residents interested in clinical informatics. It’s a little harder to share an electronic copy. I’ll also miss the stack of journals that motivates me to dig in and read by sitting there and mocking me. An electronic “stack” of journals doesn’t quite get the shaming done as well as paper. AMIA is also looking for a new editor for the journal, as Lucila Ohno-Machado plans to leave the position after her eight years at the helm.

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My thoughts go out this week to Senator John McCain and his family, after his recent diagnosis with glioblastoma. It’s a nasty kind of tumor that often persists despite surgery, chemotherapy, and radiation. Regardless of your politics, McCain’s reputation as a maverick has kept government activities interesting over the last several decades. He’s fortunate to be able to get care from a top-notch team and I wish him a speedy recovery. It just doesn’t seem fair that a guy who has made it through all life has thrown at him should have to deal with this. I hope the folks looking to cut funding for medical research and prevention think twice when they think of their colleague.

Email Dr. Jayne.

Morning Headlines 7/21/17

July 20, 2017 Headlines No Comments

Athenahealth, Inc. Reports Second Quarter Fiscal Year 2017 Results

Athenahealth reports Q2 results: revenue climbed 15 percent compared to the same quarter last year, reaching $301 million. Adjusted EPS $0.51 vs. $0.34, beating expectations for both.

Fit for 2020 – Report from the NHS Digital Capability Review

England’s NHS Digital publishes a report outlining its plan to meet its lofty 2020 goals.

Team Trump Used Obamacare Money to Run PR Effort Against It

An investigative report finds that HHS is using taxpayer funding that was supposed to be spent on marketing campaigns to boost ACA enrollment on a series of “viral videos” about individuals that claim to have been harmed by ACA.

News 7/21/17

July 20, 2017 News 3 Comments

Top News

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Athenahealth reports Q2 results: revenue up 15 percent, adjusted EPS $0.51 vs. $0.34, beating expectations for both.

ATHN shares rose 7 percent in after-hours trading following the announcement. They’re up 15 percent in the past one year and 54 percent in the past five, but both significantly trail the performance of the Nasdaq index.

The company’s market value is $5.7 billion. Co-founder, CEO, and board chair Jonathan Bush holds shares worth about $45 million.

Activist investor Elliot Management disclosed in May 2017 that it had acquired 9.2 percent of the company’s outstanding shares and will try to force the company to consider “strategic opportunities.”


Reader Comments

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From e(x)HMP: “Re: David Waltman’s golden parachute at Cerner. Not the first time he has found a way to fail upwards. He represents everything that is wrong with the VA/VistA fiasco. By all means, let’s give this guy a third shot.” The reader linked to a 2013 story about the VA’s $162.5 million contract award to ASM Research to improve the user experience with VistA, triple the price offered by two competitive bidders. One month later, the VA’s David Waltman – who had worked on the contract as chief UX architect of the iEHR project – announced that he would be leaving to take a chief strategy officer job with Accenture-owned ASM. ASM’s subcontractor in the project was Agilex, which had hired former VA CIO Roger Baker. Waltman lasted only nine months at ASM before going back to the VA as chief information strategy officer. Baker worked two years for Agilex, which was then also acquired by Accenture.

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From Soft Machine: “Re: Teladoc and Analyte Health. Definitely headed toward covalent bonding. What do you make of them?” Analyte Health offers telehealth providers lab ordering, specimen collection, and testing services. The CEO is industry long-timer Kevin Weinstein, who was chief growth officer at Valence Health through its acquisition by Evolent Health. Teladoc and Analyte health announced a partnership in January 2017. Being a hospital guy, I’m not crazy about Teladoc’s model since I can’t fathom why hospitals don’t launch their own branded telehealth service with their own doctors and keep patients within their system (no different than retail clinics), but TDOC shares have doubled in price in the past year to a $2 billion market cap, giving the company money to use for acquisitions. Analyte Health would be a significant differentiator since many telehealth encounters involve an awkward lab test handoff and having integrated lab services opens the door to offering services for conditions beyond the usual rashes and ear infections. Hospitals that compete with or are indifferent to Teladoc might like working with Analyte Health since it doesn’t run its own labs – it contracts with hospitals and commercial lab providers and thus could steer business to the hospital lab.

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From Aging Programmer: “Re: your HIT index. Loved it! I scored myself and got an 82. The main potential issue I see is the definition of management – maybe it should be managing at least five employees, in which case my score drops to 67. Ironically, my consulting time had almost as much impact as my CMIO experience, but I know there’s a lot of dead wood consultants out there.” I reviewed AP’s LinkedIn and I think his very high score of 82 seems about right given his medical education and extensive provider experience that emphasized informatics. I thought about trying to define the scope of management, but the only person who would know that is the individual since LinkedIn only lists titles, so I think you get points for title regardless of actual responsibility. In comparison, quite a few of the “most influential” folks would score in the low single digits with no healthcare-related education or significant health/health IT work experience. I’m certain many of them would protest that their speaking engagements, unpaid advisory board participation, and blog posts should boost their scores, but I don’t see how those necessarily qualify someone to render analysis and opinion. Nobody pays much attention to what armchair quarterbacks and barstool coaches think about football.

From Scribe Feedback: “Re: scribes. I’ve had two experiences with scribes in the past two weeks. The PCP scribe was new and could not navigate Epic well. The PCP was also coaching someone, so I was outnumbered four to one by the PCP, scribe, MD-to-be, and the nurse. The PCP spent 80 percent of his time focusing on the scribe and the person he was coaching while communicating with the nurse. The second interaction with the specialist was very good – he kept his eyes on me and after explaining the role of the scribe, it was like she wasn’t even in the room. The specialist also uses Epic. I’m not sure if the PCP’s documentation requirements caused the difference, but there has got to be a way to make the scribe less intrusive.”

From Can Spam: “Re: Athenahealth turnover. The amount of churn is remarkable. Since 2015, they’ve lost their chief technology and product officer, COO, two CFOs, and the VP who was instrumental in building AthenaNet. Likely more to come given the involvement of activist investor Elliott Management.” Investors have reacted positively to Elliott’s involvement (as they often do), although customers should probably be less enthused since it’s not necessarily in their best interest to have the company sold or broken up into more lucrative pieces.


HIStalk Announcements and Requests

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We’ll be missing Dr. Jayne’s regularly scheduled post tonight as she struggles (yet again) with the Microsoft Surface she unwisely purchased that seems to have given her constant problems since. This time a software update killed it.

This week on HIStalk Practice: Waud Capital Partners acquires ChiroTouch. Nebraska HHS, HIE work with DrFirst to advance PDMP. Cow Creek Health & Wellness Center rips and replaces with help from Greenway. Solo family physicians advocate for low-cost, easy-to-use patient-generated data tools. New CDC director takesTwitter for a spin. Carolina Center for Occupational Health goes with Bizmatics HIT. Tom Lee, MD hands over One Medical reigns. North Carolina health officials find themselves in hot water due to a trail of data entry oversights.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Netsmart acquires home care and hospice software vendor DeVero.

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The State of New York provides $2 million in tax breaks to electronic referrals vendor EHealth Technologies, which will expand its 215-employee Henrietta operations in adding 160 full-time positions in the Finger Lakes area. 

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EHR security tools vendor Protenus raises $3 million in an extension of its Series A funding round that has raised $7 million.

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Private equity firm Waud Capital Partners acquires chiropractic software vendor ChiroTouch from private equity firm K1 Capital, installing its own CEO as part of the “partnership.”

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In the United Arab Emirates, Emirates Hospital — owned by UAE-based investment group KBBO – buys a 60 percent position in Dubai-headquartered MD 24-7, which offers online and face-to-face wellness and concierge services.


Sales

Medical Associates of Clinton, IA chooses EClinicalWorks 10e cloud-based EHR for its 49 providers.


People

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PokitDok hires Joe Murad (Willis Towers Watson) as CEO and board member. He replaces co-founder Lisa Maki, who remains on the company’s board.

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AHIMA announces in a member email that CEO Lynne Thomas Gordon’s last day was July 15, although it did not provide a reason for her departure. A search for her replacement is underway.

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Home care software vendor HHAeXchange promotes Greg Strobel to president and CEO. Founder and former CEO Raphael Nadel will become chief innovation and strategy officer.

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Missy Krasner (Box) reportedly joins Amazon in unannounced healthcare role.


Announcements and Implementations

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Arizona Pulmonary Specialists (AZ) and Harbor-UCLA Medical Center (CA) go live on ZappRx’s specialty medication drug prescribing platform, with the director of Harbor-UCLA’s pulmonary hypertension center saying its first prescription was approved within 48 hours vs. the common paper-based process that sometimes took more than three weeks.

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Three of North Carolina’s largest health systems – Novant Health, Carolinas HealthCare System, and Duke Health – will connect to the state-operated HIE NC HealthConnex, which also announced that the Coastal Connect regional HIE will join.

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Seventy-bed Jones Memorial Hospital (NY) and two other hospitals affiliated with UR Medicine receive a $5.7 million state healthcare transformation grant to replace Meditech and LSS with UR’s Epic system.

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In Ireland, a former hospital CEO develops CliniShift, a staffing app that allows a hospital to match its vacant shifts with available staff. It also tracks the status of credentials and allows managers to monitor how the app is being used. The company expects to begin a pilot project at an unnamed large hospital on the US East Coast in September and has opened an office in Boston. 

Meditech announces that it will offer CommonWell interoperability services in early 2018.

Change Healthcare joins the Hashed Health blockchain technology consortium.


Government and Politics

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England’s NHS Digital responds to a review of its practices that notes ambiguous expectations, a lack of centralization of innovative ideas, worse than expected feedback fro its data services customers, and reliance on outdated technologies. NHS Digital says it will:

  • Implement an effective enterprise architecture function
  • Create a service operations capability and future roadmap
  • Standardize delivery methodologies
  • Create a build vs. buy strategy
  • Develop a unified security model and security operations center
  • Implement new business intelligence and customer relationship management tools
  • Work more closely with stakeholders
  • Create a thought leadership program
  • Create an investment approval subcommittee of the NHS Digital Board
  • Set up a workforce planning center to extend recruitment and review the eight office locations

An investigative article finds that HHS is using taxpayer money that was intended to promote Affordable Care Act insurance signups to instead fund a PR campaign against it, creating videos of people who claim to have been harmed by the ACA. The White House chose the video subjects and flew them to Washington DC, with some of those participants later saying that the HHS people pushed them into being more negative about the ACA than they really feel. Former CMS Acting Administrator Andy Slavitt commented, “Congress appropriates funds for you to carry out laws they passed, not to spend those funds on activities that counteract those laws.”


Privacy and Security

Japan will take “strict action” against drug maker Bayer, which acknowledges that three of its employees inappropriately accessed survey-generated patient data to plan a promotion for the company’s Xarelto blood thinner.

Fortified Health Security releases its mid-year cybersecurity report.


Other

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Sherpaa founder Jay Parkinson, MD, MPH blasts the venture capitalists who funded his company, then tried to liquidate it given the inherent disconnect between the VC desire to quickly scale and sell out vs. the “glacially-moving industry” of healthcare. Sherpaa’s handful of employed doctors offer online-only routine primary care encounters, charging individual customers $270 per year for unlimited app visits 24×7, which includes managing prescriptions, lab tests, referrals, and second opinions. Parkinson said the investor made himself CEO and then fired all the staff, including the doctors who could not legally stop seeing patients without giving them advance notice. He also accuses the investor of sending the company’s primary competitor, One Medical, its client and payments list in unsuccessfully trying to sell the company. The investor/CEO and board finally resigned a year ago and left the company’s remains for Parkinson to revive, but Parkinson says One Medical’s sales team then used Sherpaa’s proprietary information to badmouth it and to undercut Sherpaa’s employer rates. It’s an interesting idea and certainly cost-effective given the expense and overhead of arranging a PCP visit, but I would have to wonder how the VC was pitched in the first place. The company requires no upfront fee or ongoing commitment, so anyone who wants to give it a shot only has to pay the the first month’s $25 and then request a visit. I’m not sure how their doctors handle prescribing across state lines or how they manage referrals that are within the customer’s insurance network. 

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An insightful editorial says it’s counterproductive to call someone who is experiencing g a horrible disease – specifically Sen. John McCain – a “fighter” since the “warrior rhetoric” doesn’t improve their outcomes and can cause them to feel that they’re letting people down if they struggle or if they wisely choose palliative care instead of suffering through more rounds of painful treatments that offer little chance of success.

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A Cancun, Mexico hospitals refuses to allow a premature baby to be transported back home to the US until the parents pay $30,000. That solved Mexico problem preceded the inevitable US one – the grandparents paid $18,000 for air transport to a Florida hospital that refused to accept the baby because of the mother’s Indiana Medicaid insurance, so now they’ll have to pay another $30,000 to get him to Indiana.


Sponsor Updates

  • Liaison Technologies awards its first data-inspired Future Scholarship to high school graduate Antonio Ferris of Mesa, AZ.
  • Tech.MN includes LogicStream Health in “The Ultimate Guide To HealthTech in Minnesota.”
  • Santa Rosa Consulting is named a “best place to work”by Modern Healthcare for the sixth consecutive year .
  • Optimum Healthcare IT is named one of the 50 fastest-growing companies in Northeast Florida for the second straight year.
  • LogicWorks partners with CloudHealth Technologies to optimize cloud management and performance.
  • Meditech will exhibit at the AHA 2017 Leadership Summit July 27-29 in San Diego.
  • Obix Perinatal Data System, developed by Clinical Computer Systems, will exhibit at the AWHONN Florida Section Conference July 27-28 in Ponte Vedra, FL.
  • Experian Health receives the 2017 MongoDB Innovation Award in the healthcare category.
  • PatientSafe Solutions joins the Integrating the HealthCare Enterprise as a member organization.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 7/20/17

July 19, 2017 Headlines 1 Comment

The US Digital Service Report to Congress: July 2017

In its report to Congress, the US Digital Service provides details on the work it is doing with CMS to develop APIs that “will reduce the cost and burden of participating in CMS programs by enabling the market to build software that interacts directly with Medicare systems and data.”

Trump administration to continue paying cost sharing reductions

The White House announces that it will continue paying cost sharing subsidies to help consumers afford coverage on exchanges through the month of July, but that the subsidies’ status is “undetermined beyond that.”

Trump Demands That Senators Find a Way to Replace Obamacare

One day after Senate Majority Leader Mitch McConnell acknowledged that the newest ACA repeal and replace bill did not have the votes to pass, GOP senators are now pursuing a repeal-only version of the bill that the CBO estimates will increase the number of people without health insurance by 17 million in 2018.

Electronic Health Records Are Stressing Doctors Out

KQED covers the frustrations clinicians are having with EHRs, including increased administrative burden and ongoing interoperability shortcomings.

Morning Headlines 7/19/17

July 18, 2017 Headlines No Comments

Glass: We’ve All Been Busy

Google revives its Google Glass business with a focus on enterprise sales, rather than consumer applications.

Cleveland Clinic names CIO

Ed Marx, former CIO of University Hospitals(TX) and EVP at the Advisory Board Company, is named the new CIO of Cleveland Clinic.

Gov. Eric Greitens orders prescription drug monitoring program for Missouri

The governor of Missouri signs an executive order mandating that a PDMP be implemented in the state, though the state representatives are questioning the validity of the order because the governor does not have the authority to allocate funding to pay for the project.

Mackenzie Health Launches First in Canada Epic End-to-End Electronic Medical Record

In Canada, Mackenzie Health goes live on Epic across its inpatient and outpatient locations, marking the first system-wide Canadian install for Epic.

City Hall In Your Borough: First Year of Electronic Medical Record System at Two Queens Hospitals Shows Improved Patient Experience

NYC Health+Hospitals calls its Epic implementation a success in a one-year retrospective review of the project.

News 7/19/17

July 18, 2017 News 5 Comments

Top News

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Google revives its long-dormant Glass hands-free display – which never graduated from consumer beta status — with an enterprise edition that can run apps, display training materials, and connect workers with colleagues via a live video stream.

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Technically Glass Enterprise Edition is part of X, the “moonshot company” research subsidiary of Google’s parent company Alphabet. The still-mothballed Glass Explorer Edition is under Google’s hardware group.

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Google is featuring Glass’s use as an EHR remote scribe charting and documentation solution as sold by Augmedix.

SwyMed will deploy its telemedicine solution on Glass Enterprise Edition as part of its DOT Telemedicine Backpack, which connects mobile care providers to doctors in real time. 


Reader Comments

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From Bill: “Re: Nuance. Seriously mis-timed marketing or a company that just doesn’t care after two weeks without service to some health systems.” Some Nuance systems remain offline 21 days after its malware attack, so perhaps the new client pitch could have been timed better. Still, the company has to continue on under the assumption that its systems will eventually be fully restored.

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From Unbreak Healthcare: “Re: Athenahealth. A university practice customer wanted to directly send outbound orders to the hospital lab’s LIS and EHR after finding that poorly configured fax orders were sending one order per page, meaning thousands of pages per day. However, Athena only allows transmission of outbound orders by its AthenaCoordinator Receive Lab Orders. The company wants to charge the hospital (which has no desire to be an Athena ‘customer’) subscription model pricing instead of as a one-time fee, incurring a significant cost for each patient requisition with some discounts for volume. This has not been warmly received by the hospital. Thanks, Jonathan, give me more of this disruption, please!” Unverified, but the document above that I found on Athenahealth’s website says labs can receive orders only if they sign a contract and pay $1.00 per order. 

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From Expanding Paunch: “Re: HIT100. I’d like to see the winners scored on real-life experience and accomplishments instead of chronic Twitterhea.” I spent way too much time thinking about this idea, coming up with a scoring methodology that reflects what I look for in assessing someone’s accomplishments in deciding whether they are therefore qualified to render healthcare-related opinions. Here’s my first pass – score yourself and your peers and tell me which criteria you would change. I’ll grade the HIT100 once they are named, using the self-reported information (often inflated) from their LinkedIn profiles since everything should be right there. The scores I tested tracked pretty closely to my assessments of some of our industry’s more prolific pundits, ranging from 0.5 points to over 70. I was kind in deleting an additional metric that deducted points for using self-styled, questionably accurate labels such as thought leader, visionary, thinker, innovator, and entrepreneur.


HIStalk Announcements and Requests

The latest in my long string of pet peeves is using the initialism CMO, which in our industry means chief medical officer, not chief marketing officer. I’m also annoyed at sites that use trademark and copyright symbols when referring to products and companies – that’s not good form outside of company-produced material since those symbols apply to commerce, not journalism. I’m also frustrated at awkwardly worded sentences caused by incorrectly using “there” as a subject and then stubbornly trying to wrangle the rest of the sentence into submission, but that’s hardly new.

Listening: new from Charlotte & Thieves, a Norway-based band whose moody, slow song “Apparently” is quite fine.

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Thanks to new HIStalk and HIStalk Practice Founding Sponsor Medicomp Systems. I have just two Founding Sponsorships available on each site (both of which have been held by the same companies for 10+ years, Medicity being one) and Nuance’s new marketing person hadn’t heard of HIStalk and decided to end their sponsorship, after which at least a dozen companies expressed interest in grabbing their Founding spot. Medicomp got first dibs as the oldest sponsor, with CEO Dave Lareau (he did a great interview with me a couple of years back) graciously stepping up as he has in years past, including sponsoring great HIStalkapaloozas in New Orleans and Orlando. Physicians and nurses love Medicomp’s intuitive Quippe documentation and clinical viewer tools that work with any EHR and allow them to see more patients with better usability and more focus on the patient instead of the screen while giving them the full clinical picture. Quippe Clinical Lens offers a problem-oriented view of all relevant clinical data for any disease state, eliminating the clinical static to improve effectiveness and efficiency. Medicomp has been singularly focused since 1978, when it was founded by legendary MEDCIN terminology inventor and company president Peter Goltra (I met him years ago at a HIMSS conference and he’s an impressive and humble guy). Thanks to Dave and Medicomp for supporting HIStalk and HIStalk Practice, not just now, but for many years running.

Here’s a overview video I found on YouTube describing how Medicomp’s Quippe Clinical Lens helps prevent MACRA-caused lost productivity and physician dissatisfaction.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Ability Network acquires patient payments management system vendor Secure Bill Pay.

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Bright.md, which offers a patient interview tool for telehealth visits, raises $8 million in a Series B funding round, increasing its total to $11.5 million.

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Singapore-based ST Engineering will acquire TUG robot vendor Aethon for $36 million. Aethon — which had raised $56 million but reported an asset value of negative $1 million as part of the acquisition — sold its pharmacy logistics line last week.

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The private equity owner of EMDs is looking for a buyer, according to a Wall Street Journal article that estimates the EHR vendor’s 2017 EBITDA as $13 million.


Sales

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Colorado’s HHS chooses H4 Technology’s Compass data management and analytics platform for its behavioral health program. Founder and CEO Chris Henkenius also founded Stella Technology.


People

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Cleveland Clinic (OH) hires Ed Marx (Advisory Board) as CIO. He replaces Martin Harris, MD, MBA, who left late last year to become AVP/chief business officer of the Dell Medical School at the University of Texas at Austin.

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Karl Stubelis (Athenahealth) joins Arcadia Healthcare Solutions as CFO.

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Joe Alberta (Verscend) joins OmniClaim as SVP of sales.


Announcements and Implementations

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In Canada, Mackenzie Health goes live on Epic’s first full-suite implementation in a Canada-based hospital.

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CMS qualifies National Decision Support Company’s CareSelect as a decision support platform for Appropriate Use Criteria under PAMA and MACRA.

The patent office issues a patent to Sphere3 for its Aperum LeadIt, which correlates data from nurse call lights, smart beds, and RTLS to patient care perception.


Government and Politics

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Sen. Chuck Grassley (R-IA) writes a lot of indignant letters making demands that go nowhere, so here’s his latest – he and Sen. Orrin Hatch (R-UT) want CMS to go after the $729 million in Meaningful Use incentives that HHS OIG estimated was overpaid in its June 2017 report. The senators also want to know how much of the $291,000 was recovered from the 14 sample EPs who were found to have been paid too much and are asking for a random review of EP self-attestation documentation.

Image result for Naval Hospital Oak Harbor

The DoD’s MHS Genesis project continues as its second site, Naval Hospital Oak Harbor (WA), goes live on Cerner. Meanwhile, Cerner hires former VA IT executive David Waltman for its federal team. He led the VA’s VistA Evolution program before a short stint as chief strategy officer of federal IT contractor AbleVets.

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Missouri Governor Eric Greitens signs an executive order directing the state’s Department of Health and Senior Services to create a prescription drug monitoring program database. Missouri is the only state that doesn’t have a PDMP database, but experts say the state’s new one won’t be fully functional since pharmacies will be required to submit prescription information, but doctors and pharmacists won’t be able to us it during prescribing and dispensing — it’s only intended to be used by pharmacy benefits managers to monitor drug cost and overprescribing. The governor signed the order at the headquarters of pharmacy benefits manager Express Scripts. Lawmakers question whether the governor’s order is legal since his office can’t allocate spending, so the legislature will be required to provide any funding to create it.  

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A Politico article observes that the Affordable Care Act gave hospitals – especially big ones – more paying customers who would previously have been charity cases, with the top seven hospitals enjoying a combined $4.5 billion annual revenue boost while their charity care dropped by 35 percent. The article notes that hospitals still enjoy tax-exempt status and adds, “Many US cities boast hospitals that are among the best in the world, but the communities around those hospitals might as well be the Third World” as the non-profits provide their executives with million-dollar salaries and country club memberships.

United Hospital Center (WV) will go live on parent company WVU Medicine’s Epic system on August 1.


Technology

Microsoft, always late to any technology party, will set up an artificial intelligence research lab.


Other

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The interim CEO of NYC Health + Hospitals declares its implementation of Epic a success in two Queens hospitals, citing improved patient experience, growing patient interest in MyChart, a reduction in time from ambulatory visit arrival to completion from 104 minutes to 80 minutes, and improved management of unscheduled visits. He also says improved capture of patient information has increased the case mix index in adding $7 million in revenue in one hospital. The organization will begin rolling out Epic’s revenue cycle system in Q4 2018 and expects to complete the full Epic implementation by the end of 2020.

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Eric Topol tweeted out an interesting study about whether people can detect Photoshopped news photos, which the article concludes they cannot. The article’s genesis was a 2015 photojournalism awards program in which 22 entries – including the winner – were disqualified for manipulating their entries. Everybody already knows this, but just because you see a photo or video doesn’t mean you’ve seen truth.

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A remarkable LA Times story finds that USC’s former medical school dean hung out with criminals and prostitutes and was a a crystal meth and ecstasy user, all unwisely captured in photos and video. He quit his $1.1 million job after word leaked out that his 21-year-old female companion’s hotel room overdose on a date rape drug required him to call 911. USC also placed him on leave as an eye surgeon once the story ran.

In India, a hospital contract nurse who hadn’t been paid for two months beats up a doctor on rounds “with her footwear first.” Also in India, the local government orders several nursing schools to suspend classes for five days and send their students to hospitals as replacements for their striking nurses.


Sponsor Updates

  • The Boston Business Journal recognizes Definitive Healthcare as the fourth-best place to work in Massachusetts.
  • Besler Consulting releases a new podcast, “A new study shows readmission penalties don’t correlate to heart attack outcomes.”
  • The Tampa Bay Business Journal recognizes AssessURHealth’s Kyle Mynatt as a Hero at Work.
  • CareSync publishes a new white paper, “Chronic Care Management: Improve Patient Health, Increase Practice Revenue.”
  • Cumberland Consulting Group is included in Gartner’s “Market Guide for Revenue Management in Pharma and Biotech.”
  • Direct Consulting Associates will exhibit at mHealth & Telehealth World July 24-25 in Boston.
  • Elsevier and HIMSS Asia Pacific launch the CMO of the Year Award.
  • Healthgrades will integrate Medicom Health’s health risk assessment tool with its CRM solution.
  • EClinicalWorks will exhibit at the 2017 Michigan Primary Care Annual Conference July 24 in Acme, MI.
  • FormFast announces that over 100 “Most Wired” healthcare organizations use its technology.
  • InterSystems will exhibit at the Defense Health Information Technology Conference July 25-27 in Orlando.
  • Medical Billing Service Review includes AdvancedMD in its list of top five medical billing service companies.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 7/18/17

July 17, 2017 Headlines 4 Comments

Emids Acquires Encore, Broadens Services to Healthcare Providers

Health IT service provider Emids acquires Encore Health Resources for an undisclosed sum.

Senate Letter to CMS Administrator Seema Verma

Senators Orrin Hatch (R-UT) and Charles Grassley (R-IA) send a letter to CMS asking what steps have been taken to recover the EHR Incentive Program overpayments uncovered in a recent OIG investigation.

Taking the Next Step: Deploying a Single Integrated Record across Inpatient and Outpatient Settings at Naval Hospital Oak Harbor

Cerner and the DoD bring Naval Hospital Oak Harbor live on MHS Genesis, its first inpatient setting go-live.

Cerner hires former VA IT strategist for EHR team

Cerner hires former VA chief information strategy officer David Waltman to work on its federal team. During his time at the VA, Waltman worked on the VistA modernization project and DoD/VA interoperability efforts.

Curbside Consult with Dr. Jayne 7/17/17

July 17, 2017 News No Comments

There’s a well-known quote attributed to Henry Ford: “Quality means doing it right when no one is looking.” Sometimes that’s a hard sell for organizations that haven’t done the cultural transformation work to make it a reality. Practice administrators sometimes make excuses for this with the old adage, “When the cat’s, away the mice will play” or try to convince me that their team just tends to slack off.

Usually this conversation segues right into the concept that what gets measured gets managed, and that there are ways to motivate people that don’t always involve having a manager looking over their shoulders. Quality is often driven by the goals we set for people – whether they are goals related to compliance with a specific processes or to a desired outcome.

I’m a big fan of setting both individual and organizational goals. I’ve worked with too many organizations that either set one or the other, or try to blend goals but give too much weight to one. When individuals are overly incentivized without the right systems in place, we sometimes see a breakdown in teamwork.

I’ve seen members of consulting teams who jeopardize their clients’ success by scheduling them far into the future when other team members have current capacity — to make sure they hit their billable metrics. Others may create their own collateral and tools and not share with peers because they feel it offers them a competitive edge. They don’t believe that the rising tide floats all boats, but rather seem to be focused on making sure their boat doesn’t take on any water and stays farther ahead than the competition.

When organizations swing too far to the group incentive side, I tend to see formerly hard-charging individuals begin to withdraw. They may feel that the group is pulling them down or that they aren’t empowered to lead the group to higher levels of achievement. If the group incentives aren’t aligned with what individuals can actually impact, we sometimes see outright apathy.

I saw this recently with a group of workers who previously had individual productivity goals that were directly tied to tangible bonuses and were then shifted to a bonus framework that was tied exclusively to the overall financial performance of the hospital. They had done a great job controlling their own costs and utilization metrics under the previous system, but were disheartened at knowing that poorly performing departments would likely cost them their bonuses in the coming year. Since there weren’t any cross-functional initiatives to take the successes from one team and implement them elsewhere and there weren’t any ways for the teams to work together, they saw it as a lose-lose situation and their own performance suffered.

These are always challenging issues to deal with in healthcare, where our ultimate customer is a patient with a health need. It sometimes feels crass to talk about processes and metrics when you’re working with a certain quantity of human suffering in the equation. Of course, there are extremes: organizations that seem to treat the patient like a widget that can be moved from point A to point B and always with the same characteristics. Such organizations are often accused of being heartless or profit-driven, regardless of their not-for-profit status. The other end of the spectrum often fails to understand the business ramifications of their processes and decision-making or refuses to factor in efficiencies due to the perceived uniqueness of each patient’s or worker’s situation.

As with many things, the answer is typically somewhere in the middle and this also applies to how we incentivize our teams. In addition to balancing individual goals, we also need to look at blending both short-term and long-term goals. When the finish line (or the prize) is too far in the future, it’s hard to stay motivated.

This is the particular challenge we are seeing in trying to motivate physicians and their teams to fully engage with quality initiatives. I think many of our friends in government assume that physicians are motivated by money, hence the way regulatory programs have been structured. Although a good number of physicians took advantage of the incentives or finally jumped in to avoid the penalties, others were more motivated by the idea of autonomy and continue to opt out. One could argue that the incentives (or penalties) weren’t large enough to meaningfully hit people in the pocketbook, but that only applies to some.

Autonomy can sometimes be a negative force when we’re looking at clinical transformation, as providers feel that “their way” is better than that of their peers and don’t want to come together to participate in common care paths or clinical protocols. I’ve seen this to the point of irrationality, where one physician was willing to leave the practice because her personal colorectal cancer screening protocol (which incidentally didn’t mesh with current available data) was not built into the EHR’s clinical decision support framework. Providers like this are the same ones who argue with me when I recommend posting signs for diabetic patients to remove their shoes (shown to increase the percentage of diabetic foot exams) because they have any number of reasons they disagree with it.

In order to be successful under new value-based care systems, we have to let go of some of that autonomy and figure out how to align our individual goals with those of both small (practice) and large (ACO) organizations. We also have to design systems to address short term “wins” such as a more efficient workday that will help get people to the right psychological space to play the longer game with quarterly holdbacks and annual payer incentives.

Finding the right way to motivate people is always a challenge. Physicians tend to be at least a little competitive, having been through the process of medical school admissions, residency matching, and finally entering their fields. Some will be motivated by seeing their performance against their immediate peers, such as partners or hospital data, more than they will be motivated by national benchmarks. Those individuals love real-time reporting or as close to real-time as their technology will allow. They may be more willing to participate in operational tweaks to streamline outcomes and have a vested interest in being part of the solution. Others who are less competitive or unsure of their own abilities tend to shy away from those frameworks, needing more individual coaching or peer-to-peer involvement to be successful.

This spectrum varies across specialties as well. Some have been used to publicizing complication rates for some time, where others find this brand new. One has to be careful with competition though, especially when you’re dealing with top-caliber people and processes. I am working with one organization where all of their providers are routinely in the top decile for various care metrics, if not in the top 3-5 percent. Pitting them against each other isn’t going to be productive from an efficiency (or psychological) perspective.

There’s no magic recipe or secret sauce on how to incentivize people. The best advice I can offer an organization is for them to spend time and energy consciously thinking through these concepts and working with their managers and employees to find a solution that will motivate them to excellence. Assuming it’s one size fits all is a mistake but one that I see all too frequently, as is assuming that people are just intrinsically motivated to do the right thing.

How does your organization motivate people? Email me.

Email Dr. Jayne.

Emids Acquires Encore Health Resources

July 17, 2017 News No Comments

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Global health IT services provider Emids has acquired Encore, A Quintiles Company, the company announced this morning. Terms were not disclosed.

Pharma development services vendor Quintiles acquired 300-employee Encore Health Resources in 2014 for an unspecified price. Quintiles merged with competitor IMS Health to form QuintilesIMS in a $9 billion deal in May 2016.

Encore will be operated as an Emids business unit under Tom Niehaus, president and CEO of Encore. Encore co-founder Dana Sellers will join the Emids board. Encore has 200 consultants.

Sellers and Ivo Nelson launched Encore Health Resources in early 2009 with headquarters in Houston, focusing on EHR-related services. The company gradually transitioned into analytics.

Nashville-based Emids also has offices in London and Bangalore.

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Emids Founder and CEO Saurabh Sinha said in a statement, “As healthcare becomes more integrated and the focus on consumerism grows, payers and providers are working more closely together. The ability to provide healthcare technology expertise and solutions that serve both payers and providers, as well as healthcare technology partners, will be critical to help our customers succeed in the future.”

Morning Headlines 7/17/17

July 16, 2017 Headlines No Comments

athenahealth Announces Chief Financial Officer Transition

Athenahealth CFO Karl Stubelis resigns after just a year on the job, while current board member Jack Kane takes on the role of interim CFO. Discussing potential replacements, CEO Jon Bush says, “We intend to focus our CFO search on leaders who bring a record of operating discipline and value-creating capital allocation. I look forward to working closely with the athenahealth Board, especially Jack Kane and Tom Szkutak, former CFO of Amazon, to identify the best individual for the role.”

eClinicalWorks Settlement Reaction Survey

A small survey of providers’ opinions finds that 27 percent report a decrease in confidence in their own EHR vendor following the eClinicalWorks settlement announcement.

KVH in the process of making large-scale electronic medical record switch

A local paper covers Kittitas Valley Healthcare’s (WA) consolidation of various clinical IT systems on a single Cerner implementation.

Monday Morning Update 7/17/17

July 16, 2017 News 3 Comments

Top News

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Athenahealth CFO Karl Stubelis resigns “to pursue other opportunities” after just over a year on the job. Board member Jack Kane has been appointed to serve as interim.

Stubelis’s predecessor Kristi Matus resigned in May 2016 “to pursue other challenges” that her LinkedIn profile suggests she hasn’t found yet.

ATHN shares closed up 2 percent Friday on the news, but the year-long price chart is basically flat.


Reader Comments

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From IT Guy: “Re: expensive implementations like at Mayo Clinic. Same thing is going on at NYCHHC. With the total cost of some of these implementations, these hospital systems could literally BUY an HIT vendor.” We had that discussion many years ago at my hospital, where I somewhat jokingly suggested that we buy the company instead of its product since the investment wasn’t much different and we could at least control our own destiny. We also signed up with a desperate vendor that we privately worried we would drive out of business via the overly generous contract they signed in trying to meet that quarter’s revenue target. Don’t forget, however, that the software vendor’s licensing fees are a tiny chunk of the contract’s value, with most of the cost being labor (both internal and external), third-party licenses, and hardware. A $1 billion Epic implementation does not mean the health system writes Epic a $1 billion check. It’s also true that the client would have borne some of those expenses anyway – it’s not like they went from paper to Epic, they were already paying contract fees and labor for the legacy systems being replaced and the savings will offset some part of the new system’s cost. Finally, a lot of the figures you see are just a rumored number with no confirming detail.


HIStalk Announcements and Requests

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More than half of poll respondents spend one hour or less each week on Facebook, with many of those not using it at all. Thirty-eight percent are on the site for one to 10 hours, while around five percent of respondents spend more than 10 hours weekly on Facebook. I can’t personally imagine that the seven people who park for 20 or more hours each week won’t eventually regret spending a big chunk of their lives staring at an imaginary world instead of taking 10 steps outside to see the real one where actual people and experiences live, but that’s just me. Quite a few people live under the illusion that they aren’t under Facebook’s spell, a premise easily disproven by observers who can plainly see how often and how long they are entranced by it on their PCs and phones.

New poll to your right or here: of the endless number of awards available in healthcare — most of them created solely to advance the agenda of the awarder – which ones do you think are meaningful? (you can choose more than one). Click the Comments link on the poll after voting to explain.

I was reading yet another celebratory announcement about a donor who funded the purchase of some hospital’s new diagnostic imaging machine as a benefit to the community. I’m puzzled why it’s a community benefit since the hospital isn’t going to perform those procedures for free (begging the question, why not?) The hospital will undoubtedly profit from cranking out more billable procedures on the machine, paid for by the insurance companies of those same community residents and thus raising the costs for all. As I’ve said before, I’ve spent most of my career working for hospitals and never, ever would I donate money to one or mistake them for a charity rather than a business of questionable motivation and management.

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I’ve just about run out of DonorsChoose money even though I have matching funds left, but the project we funded for Ms. A in South Carolina  was a big hit as her students “clapped and cheered” when their new “teacher’s table” arrived, giving them a space to work on small group projects.


This Week in Health IT History

One year ago:

  • Hacker The Dark Overlord lists the digital assets of breached healthcare IT vendor PilotFish Technology on the Dark Web.
  • The VA hires KLAS for $160,000 to advise in on an EHR selection.
  • Philips acquires Wellcentive.

Five years ago:

  • Dissident Quality Systems shareholder and board member Ahmed Hussein launches his fourth attempt to take control of the company by nominating his own board.
  • The CDC reports that 55 percent of US doctors use some type of EHR, with an 85 percent satisfaction rate.
  • SAIC announces that it will acquire MaxIT Healthcare for $473 million.
  • Microsoft reports the first quarterly loss in its 26-year history as a publicly traded company, triggered by a $6.3 billion write-down of its purchase of ad platform AQuantive.

Ten years ago:

  • Cerner announces the retirement of 48-year-old COO Paul Black.
  • A Modern Healthcare editorial says “national interoperability can wait” and instead advocates the use of patient-carried smart cards that contain information downloaded from each provider’s EHR.
  • McKesson announces plans to acquire Awarix.

Weekly Anonymous Reader Question

Responses to last week’s question:

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  • Evernote has become my go-to app for everything from minutes, notes, and online article indexing to creativity with its drawing capabilities. All data elements are available on all devices, which alleviates access issues, especially for those of us with a hectic travel schedule.
  • I use the Hemingway Editor to trim emails and write-ups. Brevity is a virtue.
  • OneNote. I use it to organize meeting notes and key documents that are needed for reference. I take handwritten notes during conference calls and then take photos of the notes to post in OneNote for recall later.
  • CamScanner on my smart phone to create PDFs. Allows me to work on expenses during my travel — no scanner required.
  • FollowUpThen.com, a free service that automatically reminds you about emails you send to other people after whatever time you specify elapses. For example, if I email my co-worker asking for some information or action, I can add 2days@followupthen.com in the BCC field, and I’ll get a reminder in two days about it. If I put the email address in the CC field instead, we’ll both get reminders. It’s like a nearly-automatic task list for email follow-up.
  • Any time (iPhone or http://e.ggtimer.com/) where I can put 60-90 minutes on the clock, turn my phone over, minimize Outlook, and dig into something without interruptions. That and Evernote.
  • Evernote. Love being able to synch notes between my ipad, PC, and phone. Use it for everything from meeting notes to grocery lists.
  • OneNote. It’s an amazing tool for keeping me organized and I’m sure I don’t even use a fraction of its capabilities.
  • Google Inbox.
  • Outlook. As much as I have a love-hate relationship with it, it has a fair amount of flexibility to do the things your need if you spend the time to set it up fully.
  • Excel. I can dump and sort data there. If I’m trying to reason something out, I can structure my thoughts in a list or table and easily add rows/columns.
  • Tiny Scanner. Mobile scanning app, free, and it has saved my neck so many times.
  • Datawatch’s Monarch software. I was a programmer/analyst before I retired but when I worked there wasn’t a day that went by where I didn’t use Monarch for data/problem analysis. You could create ad hoc extracts or put code in scripts using Monarch to extract data from downloaded reports and delimited or fixed length files. Coupled with some other free or inexpensive software that ran in DOS (and its successor environments) like febootimail, WinSCP, etc., I could put together a script that grabbed a standard report from an HIT system, separated the wheat from the chaff, put it into a human- or machine-readable format and email/FTP the output, typically in less than a couple of hours. I’ve been out of the HIT biz for a few years now and I still use a personal copy of it from time to time.
  • SelfControl www.selfControlapp.com. Free open-source application for Mac OS. It lets you block your own access to distracting websites, your mail servers, or anything else on the Internet. Just set a period of time to for blocking, add sites to your block list, and start. Until the timer expires, you will be unable to access those sites–even if you restart your computer or delete the application. ColdTurkey https://getcoldturkey.com, Flexible and difficult to circumvent. Dashboard accommodates a weekly schedule, including a lock to prevent the impulse to make changes during the lock time. It accepts brea ktime between work periods. It will allow for setting up blocking everything except for a few sites, or the entire Internet, and offline games. Wonderful for assuring sleep time with Frozen Turkey, a feature which assures you’ll be locked out of your device for a specified period of time. It is also activated 10:30 p.m. to 6 a.m. on kids’ devices during the week.

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This week’s question: How well does your boss know you and your family socially? What off-work interaction do you have?


Last Week’s Most Interesting News

  • Mayo Clinic goes live on Epic at the first sites of its $1 billion implementation.
  • Cerner Chairman, CEO, and co-founder Neal Patterson dies of cancer at 67.
  • Jawbone’s financial pressures lead to its planned shutdown, with its founder moving on to data acquisition and analysis vendor Jawbone Health Hub.
  • Some Nuance cloud-based systems remain unavailable to users nearly three weeks after its June 27 cyberattack.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Collectly — which offers EHR-integrated personalized debt collection programs with a focus on physician practices — raises $1.9 million in seed funding. The company charges a flat rate of 10 percent of collected debts that are less than six months overdue.


Sales

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Baylor Scott & White Health (TX) chooses Kyruus for provider search and scheduling across its 48 hospitals and for its API-powered ability to match consumer-reported conditions and symptoms to potential providers on its website.


Decisions

  • Mary Starke Harper Geriatric Psychiatry Center (AL) went live on CoCentrix in 2017.
  • Cozad Community Hospital (NE) will replace NextGen Healthcare’s revenue cycle management software.
  • Several Select Specialty Hospital locations will implement Epic.
  • Treasure Valley Hospital (ID) will replace Healthland with Cerner in July 2017.
  • Saint Thomas Highlands Hospital (TX) will implement Cerner in October 2017, replacing Medhost.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Howard Landa, MD (Alameda Health System) joins Sutter Health as VP of clinical informatics/EHR.

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Stony Brook Medicine hires Kathy Ross, MBA (Ascension Health Services) as CIO.


Announcements and Implementations

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A tiny Reaction survey of 113 ambulatory providers finds that a significant percentage of them trust EHR vendors less in general following news that EClinicalWorks paid $155 million to settle Department of Justice charges, with two-thirds of them also indicating that they probably won’t consider buying EClinicalWorks in the future.


Other

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The local paper covers the replacement by Kittitas Valley Healthcare (WA) of its NextGen, Empower Systems, McKesson Paragon, and McKesson Horizon Home Care with Cerner.

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Interesting: a failing, formerly county-run Alabama hospital prevails in a four-year-old legal battle over the 12 citizens of China it recruited to invest $500,000 each in return for a fast-tracked citizenship via a federal government program. US Citizenship and Immigration Services rejected the application in saying that the hospital didn’t meet the federal government’s definition of a “troubled business” that would allow wealthy foreigners to buy their US citizenship via investments.

Here is Part 2 of Vince’s HIS-tory of Cerner from a few years back. It’s fascinating to read about Cerner predecessor PGI’s fortuitous entry into health IT when lab systems were catching on and the big players were HBO, Spear, BSL, MedLab, SMS, and McAuto, all long gone since those heady days of 1980. I saw some familiar but also-dead companies on his 1988 list – TDS, Antrim, Citation, and Terrano, for example. I’m peeking ahead at Vince’s next episode and I’m fascinated about how the name Cerner was chosen and by whom.

Weird News Andy pitches a new TV series he’s calling “Ambulance Wars,” even providing a tagline of “Both companies are losing patients.” Houston-area Republic EMS sues rival City Ambulance and its president Mohammad Massoud, claiming that City Ambulance vandalized its ambulances a dozen times in retaliation for losing business and employees to Republic. Republic says City Ambulance hired people to shoot out its ambulance windows, cut the brake lines of one of its ambulances, and covertly installed GPS trackers on its ambulances to harvest client addresses for follow-up advertising.


Sponsor Updates

  • Optimum Healthcare IT posts a study of its work on Allegheny Health Network’s Epic Community Connect.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 7/14/17

July 13, 2017 Headlines 3 Comments

Opioids in Medicare Part D: Concerns about Extreme Use and Questionable Prescribing

An HHS OIG report finds that one in three Medicare Part D beneficiaries received a prescription opioid in 2016, while 90,000 beneficiaries were given extreme amounts of opioids, and 400 prescribers had questionable prescribing patterns.

HGP Releases its Mid-Year Health IT Market Review

Healthcare Growth Partners releases its midyear health IT market review.

Elizzbeth Holmes Just Put Theranos’s Palo Alto Headquarters Up For Rent

Theranos puts its 116,000 square foot Palo Alto headquarters office up for rent.

Mayo launches new $1.5 billion records system

Mayo Clinic brings its first facilities live on its $1.5 billion Epic installation.

News 7/14/17

July 13, 2017 News No Comments

Top News

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An HHS OIG report finds that one out of three of Medicare Part D’s 44 million prescription drug coverage beneficiaries filled at least one opioid prescription in 2016 at a taxpayer expense of over $4 billion.

Alabama and Mississippi led prescribing rates, as nearly half of their Part D patients received opioids.

HHS finds that 90,000 people are at risk of misuse or overdose due to high doses or apparent doctor-shopping. One patient filled 11 opioid prescriptions in a single month from eight prescribers and six pharmacies across five states.

The report says prescribers must use state PDMP doctor-shopping databases, recommends that HHS crack down on doctors who overprescribe opioids for possible patient resale or recreational use, and urges improved public health surveillance and advancement of pain management practices. 


Reader Comments

From Mel Practice: “Re: lab results. We had a patient harmed because the lab didn’t receive their orders from the EHR due to interface problems. For HIStalk readers, do your nurses track pending results and follow up with the lab or does the EHR auto-alert the provider if no results are reported? What happens when the lab receives a specimen without an order?”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Five-employee, Seattle-based BloomAPI raises $2.4 million in venture funding to continue development of its EHR information exchange and record release and technology. Founder Michael Wasser also co-founded insurance signup site HealthSherpa as an alternative to Healthcare.gov.

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Venture capital firm Canal Partners sells its stake in rehab and therapy EHR vendor WebPT to Battery Ventures for 16 times its original investment.

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A Craneware trading update says the company expects to report double-digit revenue and earnings growth in its September report, also noting the first sale of its cloud-based Trisus Claims Informatics solution.

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Social services coordination platform vendor Healthify raises $6.5 million in a Series A funding round led by BCBS Venture Partners, increasing its total to $9.5 million.

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The fading-fast Theranos lists its Palo Alto, CA headquarters building for partial or complete sublease.

Minneapolis-based medical liability insurance vendor Constellation sells its health IT consulting and analytics business (MMIC Health IT) to Med Tech Solutions.


Sales

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New York-Presbyterian (NY) chooses Epic to replace several systems, most notably those of Allscripts. MDRX shares have declined in price by around 7 percent following analyst reports stating that NYP is the fifth-largest Allscripts Sunrise EHR customer, representing 6 percent of its installed base and contributing up to $30 million of the annual revenue of Allscripts.


People

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Merrie Wallace, RN, MSN (Premier) joins PerfectServe as chief revenue officer.

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SPH Analytics hires Suzanne Cogan, MBA (Orion Health) as chief commercial officer.

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AuntMinnie.com International Editor Eric Barnes died July 5.


Announcements and Implementations

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USC’s Keck Medicine (CA) goes live on QGenda for publishing ambulatory clinical and call schedules.

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Datica publishes its Digital Health Success Framework, which helps digital health developers “take products from napkin scribble to market without any snags.”

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Health Fidelity launches a patient data acquisition and aggregation platform for providers and health plans, with its first customer Mount Sinai Health Partners (NY) using it to automate retrieval of Epic patient records for review in bypassing the use of extract-transform-load tools.

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Healthcare Growth Partners publishes its mid-year health IT market review, which notes that while digital health investments have increased dramatically, mergers and activities haven’t quite kept up. The economic analysis is, as always, near-poetic in its brilliance:

Last year, HGP discussed the concept of Exploiters and Solvers in the healthcare industry. The US healthcare economy is indisputably inefficient. Inefficient markets create opportunities for exploitation or solution. Exploiters seek to exploit inefficiencies to maximize returns for a select few. Solvers seek to eliminate inefficiencies to maximize returns for many. In the context of healthcare, one can quickly see the potential for moral hazard. Martin Shkreli, for example, is an egregious exploiter.

However, exploiting versus solving in healthcare cannot be taken at face value because economic interests often do not align with patient interests. Martin Shkreli is chastised for his actions, but many stakeholders in the healthcare industry pursue some degree of self-interest at the expense of patients that ultimately utilize their product. Two non-profit health systems in the same region may compete at the expense of the patients they serve. Shkreli just crossed the subjective line of moral hazard.

The basic economic pricing model underscores the disconnect. Pricing is generally the equilibrium (or optimization point) between profit and quantity based on the consumer’s perceived value of the product. In practical terms, this means that a product is priced as high as a customer can bear before choosing a substitute product. The latter definition of pricing certainly sounds like a moral hazard in the context of healthcare, and it would be if the patient were the customer. However, the patient is not the customer because he or she is not part of the economic equation to establish price equilibrium

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Piedmont Atlanta Hospital (GA) rolls out Atlanta-based Gozio Health’s mobile way-finding app.

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Mayo Clinic’s first sites go live on its $1 billion Epic system.


Government and Politics

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HHS’s Medicaid Strike Force charges 412 defendants — including 115 licensed professionals – with fraudulently billing $1.3 billion in medically unnecessary services, many of those incidents involving patient recruiters who were paid kickbacks to provide patient information. Of those charged, the DOJ says 120 were prescribing and/or distributing opioids. 

Paralyzed Veterans of America urges the VA to focus on moving ahead with its Cerner contract negotiation and implementation, explaining that the organization believes that, “Cerner Corp. holds the key to saving the lives of disabled veterans in the future, and doesn’t want it waylaid by political posturing about the bigger healthcare debate.”


Privacy and Security

In England, the government pledges $27 million to help hospitals update their IT systems to protect them against ransomware. NHS Digital will also issue cybersecurity threat alerts, staff an incident hotline, and conduct onsite security assessments.


Other

Here’s Vince’s HIS-tory of Cerner, Part 1 from a few years back to pay tribute to Neal Patterson. I’m thinking about re-running the remaining five parts of the series since I enjoyed them the first time around.


Sponsor Updates

  • Optimum Healthcare IT is named a top-rated implementation services firm in a new KLAS report.
  • EClinicalWorks describes how its Healow Kids mobile app connects parents with their child’s pediatrician.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 7/13/17

July 13, 2017 Dr. Jayne 3 Comments

I’m going on Hour 8 being stuck in an airport and I’m getting a little punchy. My flight has been delayed a couple of times and I’m now looking at getting to my destination airport at 2:45 a.m. I’ll then have another hour drive to my client, assuming I find an alert taxi driver at that hour since a rental car will be out of the question.

My road warrior readers know what this is like, but for those of you who haven’t spent a good chunk of your lives at the whim of the airlines and the weather, please have pity on the rest of us when we arrive tired and perhaps a little bedraggled. Hopefully the old residency adage that “a shower is worth two hours of sleep” will hold enough to get me through the day.

The airport I’m in has a number of seating areas with electrical outlets, but unfortunately none of them work. Airport decision makers that are OK with that sort of thing should be forced to spend a couple of days stranded at their workplace, left in limbo without charging their phones or using electronic devices yet still being responsible for their daily work.

As long as my battery lasts, it’s a good opportunity to catch up on some vendor updates and try to make a dent in my email backlog. I’ve unfortunately already finished the novel I brought for emergencies, so I may have to break down and go back through security to hit the bookstore, which is bafflingly not in the actual gate area where all the captive people are.

CMS released an article about the “modernized National Plan and Provider Enumeration System (NPPES)” which is used for providers to obtain and maintain their National Provider Identifier (NPI) number. The document is heavy on detail, but from what I gather, they’re making the process around non-individual providers more secure and efficient. Not surprisingly, people responsible for maintaining the IDs of hospitals, nursing homes, and physician groups were sharing credentials, which helped lead to the changes. New fields have been added to PPES to document provider-specific information such as languages spoken, race, ethnicity, accessibility, hours, and the provider’s direct email address.

I’m fine with most of that information being collected since I have to provide it every year on various credentialing applications. Hopefully it will be shared somehow so I don’t have to fill it out over and over. I’m not about to provide my direct email address, however, without understanding how it’s going to be used and who will have access.

CMS also published the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide Version 1.0 for Eligible Clinicians and Eligible Professionals Programs. For anyone suffering from insomnia, I highly recommend it as an alternative to the Federal Register or Ambien. For those of you who aren’t familiar with the document or who have never heard QRDA, it’s the recipe for electronic exchange of clinical quality measure data. Vendors must keep expert resources on staff who not only know the material, but who can expertly digest updates to the specifications and deploy them to developers, engineers, and more. It’s incredibly dense information and I admire the people who master it and make the world safe for those of us who need to report quality measures.

I’ve received some feedback on my recent piece on training and adult learning. Most of it has been of the “right on” variety, but one shameless vendor used it as an opportunity to try to guess what hospital system I use and market their simulation software. There wasn’t even a decent introductory greeting, just a link to HIStalk and straight into the sell. Any vendor who thinks that kind of approach works is sad. 

One reader noted, “I have deployed and trained everything from a full EHR to portals to secure messaging to population health. The percentage of clients who let me apply even basic adult learning principles was sadly very, very low. Yet, as we know, the downstream impact of poor and/or incorrect or irrelevant training lasts for years.” I have good data on the costs of retraining as well as the loss of productivity after poor training and I drag it out frequently to convince reluctant practice leaders to do the right thing.

Early bird registration is now open for the AMIA 2017 Annual Symposium in Washington DC in early November. This year’s theme is “Precision Informatics for Health: The Right Informatics for the Right Person at the Right Time.” I like the fact that they used “person” rather than “patient” because we need to continue to understand the impact of technology on the users, not just on patient outcomes. There are days where I feel like I’m a human participant in an unregulated study that some deranged Institutional Review Board approved without regard to the safety of its subjects.

AMIA has also opened submissions for the Workshop on Interactive Systems in Healthcare (WISH) program, which aims to bring research communities together around the challenges of designing, implementing, and evaluating interactive health technologies. The theme for WISH is “Citizen Science: Leveraging interactive systems to connect to our data, our families, and our communities.” Submissions are open through August 7.

There are entirely too many conferences going on during October and November, so it’s going to be a challenge to decide where to spend my travel dollars. In addition to industry meetings, several friends are headed to a patient safety conference in New Orleans and it’s awfully tempting to select that over the technology offerings, especially when gumbo and beignets are on the line. I also have to start thinking seriously about my primary care board certification, which is coming due faster than I hoped, so that will factor into the conference shopping process as well.

One trip I did decide on is my semi-annual pilgrimage to put my toes in the sand and think about little more than whether I am reapplying sunscreen often enough. I’ve got my coverage arranged and am looking forward to being disconnected from my clients, at least for a couple of days.

Email Dr. Jayne.

Morning Headlines 7/13/17

July 12, 2017 Headlines No Comments

Improving the Health Records Request Process for Patients

ONC leverages human-centered design principles in its new report on making medical data easier for patients to access.

Enlisting Virtual Reality to Ease Real Pain

The Wall Street Journal profiles the work researchers are doing using VR to treat pain.

Humana And Oscar Partner To Sell Health Plans To Small Businesses

Health insurance startup Oscar Health partners with Humana to begin offering policies to small businesses.

House passes bipartisan FDA user fee bill

The House of Representatives passes legislation reauthorizing the FDA’s ability to collect user fees from drug and device makers, a process that funds much of the FDA’s operations. The Senate still needs to approve its own version, and the two need to be reconciled, before the current authorization expires in September.

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Reader Comments

  • Matthew Holt: For a publication, audience and author that apparently doesn't care about awards, a shit load of attention has been paid...
  • Brian Too: One more thing. If you can ever convert a clinical skeptic into a supporter, often those people become your best and st...
  • Brian Too: To use colorful 'political' language, I'm beginning to think that the Republicans couldn't lose their virginity in a who...
  • Time Will Tell: Given the political hot potato the VA unfortunately is you have to think at some point Cerner's name fair or not will be...
  • Big Hat, No Cattle?: Another Re: your HIT index: I’m a clinician who has worked in HIT for 17 years. Your rating scale made me wonder abo...

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