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August 23, 2016 News 14 Comments

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Apple quietly acquired startup Gliimpse earlier this year, Fast Company discovers. The company offers tools for consumers to collect and share their electronic medical record information in both readable and codified form. Self-funded Gliimpse reported just one investment, a February 2015 seed round of $1 million. The beta release of its software was launched in October 2015.

Founder Anil Sethi studied clinical engineering at Johns Hopkins, worked for Apple as a systems engineer in the late 1980s, founded Dakota Imaging (later sold to WebMD),  then founded Sequoia Software in 1992 that was sold to Citrix in 2001.

My take on all these recently uncovered Apple healthcare moves is that new iPhone health offerings will pressure EHR vendors to open up their systems to Apple integration. The company clearly plans to use that information in consumer-facing apps and iPhone-using patients are going to demand that their providers make it available. EHR vendors won’t be able to hide behind the lack of interest their hospital and practice customers have for interoperability once patients start complaining to those providers about their non-functional app.


Reader Comments

From Gabby Hayes: “Re: Oscar health insurance. Pulling out of Dallas and New Jersey.” Oscar is a goner given its total dependence on the exchange-sold policy market that even the big insurers haven’t figured out even though it’s just a small percentage of their business and yet all of Oscar’s. My prediction is this: only individual states can stabilize the ACA-powered market since they also regulate the non-exchange policy business. You can bet that a state like Arizona — which has seen so many insurers pull out of the exchange that one county (Pinal) has none left offering policies — will exert pressure on the companies who still want to sell in-state policies and whose rate increases it approves. That might be another reason that insurers are bailing – they can’t necessarily get state approval for the rates they require to avoid losing money. I’ve heard rational, anti-government people begrudgingly state that the only answer is a single-payer system, although that single payer in question hasn’t done so great running Medicare, Medicaid, and the VA. We may end up with a UK-like system where everybody gets coverage at a reasonable price, but a thriving market of more accessible providers would serve those who can afford their services.


HIStalk Announcements and Requests

I had a “how do I do this” question about the webinar signup software we use. The vendor replied with a screen capture video that they recorded specifically for me, with one of the support reps informally walking me through the individual steps. I wonder how often healthcare software vendors do this? An analyst could create the video in a couple of minutes, obviously faster than writing out step-by-step instructions, preparing a series of captioned screen shots, or trying to schedule a screen-sharing session.


Webinars

August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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In Canada, grocery store and pharmacy operator Loblaw Companies offers to buy BC-based EHR vendor QHR Technologies for $132 million in cash, although QHR is free to accept other offers until shareholders vote on the deal in October. QHR holds 20 percent of Canada’s EHR market. QHR sold its US-based clearinghouse and RCM business to MTBC in July 2015.

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Healthcare Growth Partners relocates its headquarters from Chicago to Houston.

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Premier reports Q4 results: revenue up 15 percent, adjusted EPS $0.36 vs. $0.36, beating revenue expectations but falling short on earnings.


Sales

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Union Hospital (MD) chooses Spok for enterprise communications.


People

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Patient experience vendor Docent Health, which just raised $15 million in a Series A funding round, hires Kim LaFontana (The Advisory Board Company) as chief product officer; Andrew Park (N-of-One) as CTO; Geoff McHugh (The Advisory Board Company) as VP of transformation; and Monna Nanavati (Athenahealth) as chief service delivery officer. Industry long-timer Paul Roscoe is co-founder and CEO of the company.

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Michael Zaroukian, MD, PhD, CMIO of Sparrow Health System (MI) begins his one-year term as board chair of HIMSS North America. The board has 10 members, of which five work for health systems. I didn’t realize that the vendor-heavy board of the parent organization (just plain old HIMSS global) has 13 members, of which only four work for health systems.


Announcements and Implementations

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A Huffington Post blog post by the EVP of Visiting Nurse Service of New York describes the results of a state-funded pilot project in which the role of home health aides was expanded to include medication review and updating client status on a tablet that automatically notifies a clinical manager of changes. The project reduced ED admissions by 24 percent. Patient status was documented using software from Practice Unite, the secure texting vendor that merged with physician engagement focused Uniphy Health in March 2016.

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Santa Rosa consulting offers a one-day replacement strategy workshop for McKesson Paragon users.

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In England, two London NHS trusts begin exchanging information between their Cerner-powered HIEs, allowing clinicians at each site to view patient information from the other that includes discharge summaries, diagnoses, medications, and lab results.

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CommonWell Health Alliance adds patient-facing services that will allow people to enroll themselves in CommonWell, link their own records among providers, and review information about them stored on CommonWell’s network. CommonWell members MediPortal and Integrated Data Services will add the patient capabilities to their portals by the end of the year, while Aprima, Athenahealth, Cerner, Evident, Modernizing Medicine, and RelayHealth have committed to doing so without committing to a timeline.

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Lexmark Healthcare announces new products: a zero-footprint Health Content Management Viewer for documents, medical imaging, and XDS content; a redesigned video capture device for PACSGear; and video and image enablement workflow for Epic.  

A LifeImage survey of 100 CHIME members finds that imaging responsibility has moved from the radiology department to IT; most hospitals still can’t move imaging data between applications; and one-third of CIOs worry that their organizations could be losing revenue due to lack of interoperability that could detect orders for duplicate and clinically unnecessary exams.

Nebraska Medicine takes over operation of the student health center of University of Nebraska-Lincoln and brings Epic live there.


Privacy and Security

From DataBreaches.net:

  • In Pakistan, a hospital employee steals data from its CT machine and also corrupts the machine’s software, which the hospital says it will have to repurchase for at least its original $330,000 purchase price. 
  • Orlando Health (FL) says it caught at least one of its employees reviewing the electronic medical records of survivors of the Pulse nightclub shootings in June.
  • A HIMSS survey finds that one-third of hospitals and half of non-acute providers don’t encrypt data in transit.
  • An HHS OIG report finds that the security of CMS’s wireless network has four vulnerabilities.
  • In Canada, two people behind a hospital records breach in which the information of new mothers was sold to companies selling educational savings plans get off with fines and community service. Two others had already pleaded guilty and received house arrest, probation, and community service, one of them a former OB nurse who also faces professional misconduct charges.

Technology

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Gartner releases its Hype Cycle for emerging technologies. Virtual and augmented reality are moving to the Slope of Enlightenment, but Gartner predicts that machine learning, software-defined anything, and natural language question answering have the shortest times to mainstream adoption at 2-5 years.


Other

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In Canada, a medical marijuana consultation doctor whose poor (and possibly falsified) paper recordkeeping led to his three-month suspension is ordered by the College of Physicians and Surgeons of Ontario to implement an EHR as a condition of his continued licensure.

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In Australia, Monash Health’s ED goes back to paper for two days when its Emis Health ED software goes offline, although the hospital disputes the downtime in saying that it was a planned six-hour upgrade. 

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A JAMA literature review of the high cost of drugs in the US blames “the granting of government-protected monopolies to drug manufacturers” and restrictions on drug price negotiation.

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A JAMA research letter finds that, not surprisingly, it’s harder for medical students to get into residencies for the higher-paying medical specialties. Primary care specialties have the lowest average annual salaries at around $250,000 and only around half of those residency spots are filled with US medical school graduates. On the other end of the spectrum as a huge outlier is neurosurgery, with average compensation of $750,000 and a near-100 percent fill rate of US residents. Opportunistic graduates might want to choose pathology since it’s the highest income in the least-competitive group.

Meanwhile, those high-earning diagnostic radiologists respond to the American College of Radiology’s call to action (and its suggested use of its advocacy app) in expressing outrage at the VA’s plan to allow advanced practice RNs to order and interpret MR and CT studies without physician oversight. I’m shocked that advocacy-enamored HIMSS hasn’t developed an app of its own to give members an easy way to support profitable health IT legislation.

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Here’s an interesting title for a think tank’s editorial that complains about “the federal government’s takeover of EHR.”

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A vandal (or politically paid artist, I would guess given the level of sophistication) defaces Los Angles hospital signs in preparation for Hillary Clinton’s visit, apparently spreading the unproven rumors that she is not in good health. It’s surprising to me that nobody has breached and published her records as often happens with celebrities, although perhaps people have looked and found no smoking gun to be worth their trouble. No matter how the election turns out, we’ll be left with the sobering reality that a lot of Americans of all political persuasions are angry, too partisan to carry on a civil debate, quick to resort to online harassment and bullying, and not especially bright or well informed, problems that will persist no matter who’s sitting in the Oval Office for the next four or more years. I expect hospitals to be busy the week of November 8 election dealing with the human results of unfortunate post-election events.

NYC Health + Hospitals, facing a $1.8 billion annual shortfall, tries to cut costs and diversify into new businesses without running afoul of unions and city leaders who won’t support cutbacks in staffing, which represents 70 percent of its overall costs. It’s a good example of a seldom-mentioned healthcare cost problem – bloated, inefficient health systems are often the largest employer in their communities and as such earn the unwarranted support of politicians who are more concerned about local employment and hometown prestige than national healthcare costs.

Health management company Equity Healthcare refocuses its employee wellness services from cold-calling workers to encourage healthy lifestyles to instead use claims data to focus on those with chronic conditions who are most likely to respond.

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Weird News Andy calls this video story “She Stoops to Conquer.” He explains, “A lady gives birth on camera while her husband parks the car. Pretty amazing video with nothing that squeamish. The good stuff starts at 1:18. She just squats and there’s the baby.”


Sponsor Updates

  • Printing virtualization vendor UniPrint.net joins Imprivata’s development partner program.
  • GE Healthcare employees volunteer at Milwaukee area schools to help spruce up classrooms before students return for the new school year.
  • Besler Consulting will exhibit at the HFMA Region 8 MidAmerica Summer Institute August 24-26 in Minneapolis.
  • Boston Software Systems releases a new podcast, “CVSHealth: Best Practices for Growth with Automation.”
  • In Canada, Markham Stouffville Hospital will upgrade to Meditech 6.1.
  • CoverMyMeds will exhibit at the Ohio Ambulatory Care Summit August 26 in Columbus.
  • CTG profiles new President and CEO Arthur “Bud” Crumlish.
  • Elsevier Clinical Solutions CMIO Jonathan Teich, MD offers his predictions for addressing the social and health demands of a growing global population.
  • EClinicalWorks will exhibit at Medical Fair Asia August 31-September 2 in Singapore.
  • HCTec makes the 2016 Inc. 5000 list of fastest-growing private companies in America.
  • Healthfinch CEO Jonathan Baran will speak at the NCHICA Conference August 31 in Asheville, NC.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there are "14 comments" on this Article:

  1. The NYC Health & Hospitals link directs to a Seeking Alpha article of PINC’s Q4 earnings call transcript. I don’t see anything in there about H&H. Is that the article you intended to link to? If so, what page of the transcript is the H&H mention on?

    [From Mr H] Sorry, I did an EHR-like mass copy and paste! I fixed the NYCHH link, which is:

    http://www.bloomberg.com/politics/articles/2016-08-22/new-york-city-hospitals-seen-unwilling-to-take-stronger-medicine

  2. The HIMSS report on lack of encryption is completely unsurprising. The lack of any real data security in healthcare IT is the culmination of a problem a decade (or two!) in the making. Providers insisted on highly customized EMRs, which require huge on-site technology teams to install and maintain. That sort of in-sourcing opens the door to all sorts of issues. If my local bank branch told me that their core banking software was hosted on site, managed entirely by their in-house IT department, and heavily customized based on the feedback of a few “super user” bankers, I would laugh… and then take my money elsewhere.

  3. Docent Health hires are interesting, but even more interesting is how long Paul Roscoe will last considering all the moves he has made since Sentillion sold out to Microsoft. How did he become a co-founder at this company right after he left his most recent position? Wonder if he co-founded this while on the “clock” at Visionware and whether they own any of the intellectual property?

  4. I can personally attest to the ridiculous drug pricing in the US.

    While on sabbatical in Austria, the medications I needed to purchase from the pharmacy were at least an order of magnitude cheaper than in US. How/why we put up with this in the US remains a complete mystery to me.

  5. Re Apple’s Gliimpse acquisition:
    There will be a paradigm shift in coming years which transfers more ownership of Personal Health Information to the patient. Currently the stewards of a given record hold tightly to that information, in part because of HIPAA and trust issues, but in part because owning that information binds the patient to the steward (whether the steward is a health system or practitioner). With MU mandating outbound encounter information to a destination of the patient’s choice, all that is left is for the patient to have a (personal) destination in mind. Historically that has been the next caregiver, b/c there is no business model for the creation of a personal PHI destination.
    I think the winning model will be that such a destination is not yet another stewarded model such as a Health Vault, but instead will be an app with a storage destination of the patient’s choice…
    We have let HIPAA anxiety confuse us that PHI is so sacrosanct only a third party steward can actually hold it. That’s nonsense.

  6. NYC Health and Hospitals.

    Sure, blame the hospitals for rising cost of care and ignore the real culprit … big gubberment!

  7. Re: Jim Thompson Says: Re Apple’s Gliimpse acquisition: Re I think the winning model will be that such a destination is not yet another stewarded model such as a Health Vault, but instead will be an app with a storage destination of the patient’s choice…

    10 years ago and for the following 5-6 years (including the introduction years of ARRA/HITECH), a group of prestigious, voluntary, healthcare IT professionals, known as the PDF Healthcare Committee and organized under the sponsorship of the ASTM International standards development organization (SDO), developed not “an app”, but something just as practical and applicable. The Committee developed the PDF Healthcare “Best Practices Guide” (BPG), supplemented by an “Implementation Guide” (IG) with interoperability use cases, describing the generally unknown attributes (e.g., extensible to contain any well-formed XML) of the Portable Document Format (PDF: an ISO-ratified, open, international, and published standard, originally created by Adobe Systems, Inc., but now developed and maintained by ISO) to facilitate the capture, exchange, preservation and protection of personal health information (PHI).

    Without creating or proposing another standard, the PDF Healthcare BPG allowed healthcare providers and consumers to create a secure, electronic container that stored and transported relevant health information, including but not limited to personal documents, handwritten clinical notes, laboratory test result reports, electronic forms, scanned images, photographs, digital X-rays, and ECGs.

    For example, if a consumer, provider, or provider organization wanted to / needed to send a patient’s (structured) medication list and (unstructured) radiology exam result report to multiple physician offices – some with office EHRs, some without – the consumer, provider or provider organization was able to embed those documents in the PDF container and securely send them. If the reports were sent to a provider office that did not have an office EHR, the receiving provider could view the documents and / or print them to paper. (In addition, the receiving provider could print the documents to paper from his/her smart phone without the need of a computer!) However, if the reports were sent to a provider who had an office EHR, the EHR was able to consume the XML data in that PDF container and populate the EHR.

    Sadly, this bold development, even popularly-demonstrated at HIMSS 2009 (Chicago), crumbled due to the pressures of competing, behemoth SDOs as well as the “mom ‘n pop-based” (read: lack of $ and expertise) Committee’s marketing challenges.

  8. What the Bloomberg article fails to mention is the H+H rollout of Epic and the associated costs. Cadillac EMR for the indigent.

  9. Re: PDF/XML AFAIK, the problem with this approach was that at the time of the attempt to send discrete XML data as part of PDF documents, the only existing implementation of an engine/library to properly do this was the one from Adobe. Anyone else who had an implementation to create such files had a license from Adobe. Just like the single source medication prices are being jacked up through the roof these days, the same thing would have likely happened with Adobe’s license fees if that approach had been codified as a government regulation.

  10. HHC has a lot of issues besides the politics, but choosing Epic is probably not one of them. Their Quadramed system was terrible, and for a system as large as hhc, with integrated inpt and outpt data, what would the alternative be? Their problem is more likely trying to roll it out on a shoestring.
    HHC’s own report on its future had a lot of wishful financial thinking , like getting more $ from the state.
    Maybe Ed Marx can give some insider info?

  11. RE: Eddie T. Head Says: Re: PDF/XML: Re: the problem with this approach was that at the time of the attempt to send discrete XML data as part of PDF documents, the only existing implementation of an engine/library to properly do this was the one from Adobe. Anyone else who had an implementation to create such files had a license from Adobe. Just like the single source medication prices are being jacked up through the roof these days, the same thing would have likely happened with Adobe’s license fees if that approach had been codified as a government regulation.

    1. No one was suggesting the approach be codified as a government regulation, even though the ASTM International SDO sponsored the effort.

    2. Even though the first and only existing implementation of an engine/library to properly do this was from Adobe, the Committee was full-bent on working on additional implementations without Adobe, especially since PDF became an ISO-ratified, open, international, and published standard developed and maintained by ISO.

    3. Years later, the industry remains without a (relatively) simple and popular interoperability solution. I’d be happy to try again if it weren’t for the pressures of competing, behemoth SDOs as well as HIT vendors that have far more marketing money and political clout than this little committee.

  12. Re: PDF/XML – PDF may be “an ISO-ratified, open, international, and published standard developed and maintained by ISO”, but no one actually has implemented full support for it. Similarly, the specification for the C# computer language is an open, international standard developed and maintained by ECMA, however, only Microsoft has fully implemented the standard. Anyone wanting to develop enterprise software in C# must use Microsoft products (Mono, an alternative C# implementation, lacks features like WCF, for example).

    The format for exchanging healthcare information in an interoperable way is only one part of an overall interoperability solution, and PDF/XML fails on multiple requirements for being the format of such a solution.







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Reader Comments

  • Ben: Agreed. As a veteran and long-time member of our industry, I agree with Dr. Rick. My VA providers have always said ...
  • Echo chamber: Why wouldn't Cerner, or Epic, or any other commercial vendor be able to innovate as fast or faster? I'm guessing Vista ...
  • Fake News: Dr. Weinhaus' conclusion is as flawed as his proffered evidence. The Texas Health issue with Ebola was tracked back to ...
  • Brian Too: There is so much that is right about this post. So why then do I find myself disagreeing with the message? Highlight...
  • Expat Consultant Guy: I don’t know if this is getting traction back home, but Epic’s having a mess of a time with its program in Denmark. ...

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