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January 10, 2017 News 12 Comments

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Politico quotes an obviously frustrated Vice-President Biden as saying healthcare industry players are the least-willing of all to share information, leading him to threaten to lock the CEOs of big EHR vendors in a room until they hear his message. “You think I’m joking. I’m deadly earnest and deadly frustrated as a lot of you are.”

Meanwhile his boss, President Obama, also said in an interview this week that EHRs are his biggest Affordable Care Act disappointment, explaining that healthcare still runs on mountains of paperwork, patients are sent bills they don’t understand, and doctors and nurses are wasting time entering data.

The president slipped in referring to “digitize” as “digitalize,” which means to dose patients with the heart drug digoxin.


Reader Comments

From Tabulator: “Re: the HIStalk Decisions section. It would be helpful to know if any of the product switches are due to an acquisition.” I don’t know that Definitive Healthcare has that information from their hospital user conversations, but I expect they’ll start providing it if so since you mentioned it.


HIStalk Announcements and Requests

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You can still sign up for HIStalkapalooza, but not for much longer. Some comments left by folks who want to come:

  • HIStalkapalooza, Still the place to be seen, The home of the stars, Time for drinking and dancing, and schmoozing with czars.
  • At some point, HIStalk will stop taking applications and IBM Watson Health will just predict who should receive an invitation. Until then, hope to see you soon.
  • Glad it’s back in Orlando. In Vegas, half the crowd left before the end, which is a disgrace to the event and the band. Pretty sure I have been last person out of every HIStalkapalooza ever.
  • What a party! The bash was probably responsible for a few HIMSS blisters — from my dancin’ shoes — but they were welcome ones (nicer than the kind developed from trudging around the exhibit hall).
  • I didn’t attend HIMSS last year and the one thing I missed most was HIStalkapalooza.
  • I only get to dance once a year! After Histalkapalooza, I turn into a pumpkin. Yours, Cinderella.

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Mrs. P says her Kentucky kindergartners are putting the tablets we provided in funding her DonorsChoose grant request to good use:

My kindergarten students use them in partner activities and individual activities working on letters, letter sounds, rhyming, reading fluency, counting, number identification, shapes, colors, following directions and basic math like addition and subtraction. With these hands on tools my students are becoming more responsible and independent, which is an incredible skill for students to master at a young age … Many have seen these but never had their own opportunities to use them or truly benefit from them … Some of my students have even come to school wanting to share things they found and learned at home using the apps and games I have told the parents about. Again, I couldn’t be more grateful and appreciative of this incredible gift and the sparks of excitement for learning you have helped create!

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Welcome to new HIStalk Platinum Sponsor Harris Healthcare. The 900-employee company’s health IT brands operate individually but are interoperable, including such names as QuadraMed EMPI indexing and cleanup, QCPR EHR, AcuityPlus staffing, Enterprise Scheduling, Enterprise Self-Service (patient access and engagement), ERP, RCM, TeamNotes clinical team documentation, and specialty solutions for the ED and perioperative suite, practice management, public health and health education, and several that are specific to the Canadian market. Analytics and business intelligence are provided at every level and the company offers professional and technical services. Thanks to Harris Healthcare for supporting HIStalk. 

A clarification on Bibb Medical Center’s (AL) August 2016 go-live on Athenahealth as reported earlier this week in the “Decisions” section. While BMC is a previous Prognosis Innovation Healthcare EHR user, they dropped that system some years ago and went back to paper, so technically Athenahealth didn’t replace Prognosis. 


Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.


Acquisitions, Funding, Business, and Stock

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Telemedicine software vendor SnapMD raises another $3.25 million in its Series A round, increasing its total to $9.15 million.

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Clinical surveillance software vendor PeraHealth raises $14 million in funding.

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Wireless heart failure monitoring platform vendor Endotronix enters into a $12 million financing agreement. The company has raised $34 million in funding through its July 2016 Series C round. 

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Accretive Health renames itself R1 RCM, ditching a memorable name (although stench-ridden due to widely publicized data theft, heavy-handed collections practices, and earnings restatement) in favor of something generic and less Google-friendly.


Sales

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Duncan Regional Hospital (OK) will upgrade to Meditech’s Web EHR.


People

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Intelligent Medical Objects promotes Eric Rose, MD to VP of terminology management.

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CHIME and HIMSS name Children’s Health (TX) SVP/CIO Pam Arora as their John E. Gall, Jr. CIO of the Year.

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CareSync hires Joy Powell, CPA (Healthways) as COO; Mike Hofmeister (Allscripts) as sales SVP; and Allison Guley, JD (All Children’s Hospital) as general counsel. Former COO Amy Gleason, RN has taken a new role as chief of staff.


Announcements and Implementations

Iatric Systems launches FlexButton, which allows users of several EHRs to view relevant patient information stored in other systems as part of their workflow.


Government and Politics

National Coordinator Vindell Washington, MD and FDA Commissioner Rob Califf, MD – both of whom were fairly recently appointed to their government roles and had expressed hope that they would be allowed to stay on – will leave their jobs after failing to convince the Trump administration to retain them.


Privacy and Security

From DataBreaches.net:

  • Presence Health (IL) will pay a $475,000 HIPAA settlement for taking too long to notify 836 affected patients that it lost paper-based OR schedules in October 2013.
  • Security researchers find another unsecured MongoDB healthcare database, with the sleep disorder records of patients at Womack Army Medical Center (NC) exposed to Internet searches.

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HHS OCR notifies Virginia State Senator Siobhan Dunnavant (who is a nurse and a physician) that she violated HIPAA by sending political emails to her patients during her 2015 campaign, then deleted the information from a campaign computer when she realized that she had violated the privacy of her patients. HHS OCR says she won’t be fined or penalized since she tried to mitigate the damage.

A California Department of Insurance investigation concludes that the 2015 breach of insurer Anthem, which exposed the information of 79 million people, was perpetrated by a hacker hired by an unnamed foreign government. The company will pay $260 million for security improvements and remedial action even though the report says its advance preparation was reasonable and its remediation plan were sufficient to allow its fast, effective response. The breach was caused when an Anthem employee opened a phishing email.

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Marijuana dispensaries all over the country delay appointments as “seed to sale” tracking software from MJ Freeway – whose use is mandated by several states — is apparently taken offline by hackers. The site of the vendor whose systems are used by 500 dispensaries is still down.


Technology

A Wall Street Journal article says Apple is not only failing to produce much innovation these days, it has made itself a follower to Amazon, Google, and Microsoft in the all-important rollout of artificial intelligence despite its own groundbreaking rollout of Siri five years ago. The article warns, “AI-powered voice assistants can directly replace interactions with mobile devices. It isn’t that screens will go away completely, but screens unattached to objects that can listen, talk back, and operate with autonomy will rapidly become obsolete.”

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Accenture names its health technology challenge winners:

  • QuiO (smart home injection devices and monitoring)
  • CaptureProof (a medical camera for creating a visual patient narrative)
  • UE Life Sciences (a hand-held breast lesion detection system for health agencies)

Other

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The New York Times profiles Nuna, a San Francisco-based, 110-employee startup that has combined the Medicaid databases from the disparate systems of individual states into a single cloud-based platform of de-identified data that researchers can use to explore patient behavior. The company has raised $90 million in funding. Co-founder Jini Kim — a former product manager for the failed Google Health and a participant in the fixing of Healthcare.gov – calls the company her “love letter to Medicaid” because her autistic brother’s care is paid for by the program. The article notes that nearly half of the children born in the US receive Medicaid benefits.

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Video artist ZDoggMD – aka Zubin Damania, MD, founder and CEO of members-only primary care practice Turntable Health – shuts down the so-called Healthcare 3.0 practice following the failure of the Nevada Health Co-Op in 2015 that led to loss of insurance for the practice’s patients. It had also received funding from Zappos CEO Tony Hsieh as part of his downtown Las Vegas revitalization project. Damania says Turntable Health will live on as an “ethos, brand, and movement” without a physical presence, noting that he’ll still be selling company apparel. Its EHR will be used internally by its partner Iora Health.

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Twitter suspends the account of pharma bad boy Martin Shkreli after he announces that he has a crush on a Teen Vogue reporter, adding a Photoshopped photo of the woman and her husband in which Shkreli replaced the husband’s head with his own. He said it was innocent fun and that the woman had harassed him previously, then urged her followers to report him to Twitter when he responded. He also invited her to attend the presidential inauguration with him, which she declined by saying that she would rather eat her own organs.

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Abington Memorial Hospital (PA) will pay $510,000 to settle a Department of Justice investigation into the theft of 35,000 doses of controlled substances by a now-jailed pharmacist who manipulated the hospital’s electronic drug tracking system. The hospital has also spent $2 million upgrading its drug inventory systems.

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Research and Markets apparently foresees a very small RTLS market.

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Cleveland.com, the Cleveland Plain Dealer affiliate that ran the firestorm article on vaccine preservatives written by the medical director of Cleveland Clinic’s wellness center, says the Clinic’s corporate communications director electronically published the piece without notifying the site so it could be reviewed, then pulled it down after negative social media reaction, surprising the site’s editor both times. The site has since rescinded the ability of Cleveland Clinic to manage its own content. A reader comment says the Clinic “runs this town and all the media and politicians do as they say” in noting how many former journalists now work for the Clinic and the fact that the site allows some contributors to post content directly. Meanwhile, PCPs are already dreading the amount of time they’ll have to spend explaining vaccines to patients all over again.

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A Johns Hopkins bioethicist describes his opioid addiction that followed several post-accident surgeries, saying physicians are inadequately trained on narcotic prescribing (they receive less pain management training than Canadian veterinary students) and helping their patients wean off the drugs. He says pain management specialists see their jobs as prescribing and not following their patients to manage withdrawal, while the fragmented healthcare system makes it unclear who “owns” a patient at any given time. 

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A Wall Street Journal opinion piece written by a former hedge fund operator singles out Epic as being primarily responsible for lack of EHR interoperability, calling the company “chief obfuscator.” He notes a friend’s personal experience in trying and failing to have their hospital records sent from Boston to Miami, Epic’s non-participation in CommonWell, his claim that Epic charges four cents per message sent (“even Apple isn’t that greedy,” he says), and his own failure to retrieve his Epic hospital records in any form other than PDF. He concludes, “Make firms like Epic look at interoperability as an incremental profit center rather than an opening for competitors. The dream of smart machines crunching health info is real. Don’t let the dream walk with paper.” Everything seems simple when you don’t understand them to any degree of detail, so my best and gentlest counterpoint would be this – have any Epic hospitals exchanged information with each other or provided electronic information to patients? If so, then it’s not Epic’s problem that his two anecdotal experiences weren’t positive.

A hospital pharmacist’s letter to the editor of P&T magazine makes mistakes in trying to explain interoperability challenges from the pharmacy department’s perspective:

  • It says the main cause of data siloes is that hospital EHRs use non-relational databases. Not true – plenty of systems use relational databases and that underlying technology is not at all a barrier to interoperability regardless. The pharmacy department wants to extract EHR information to create their own pharmacy-specific applications, which is not what most people think of as interoperability. It would be easy but not necessarily technologically sound to query a live EHR database in real time, which is why HL7 interfaces were developed for systems such as automated dispensing cabinets, pharmacy drug tracking systems, and robotic packaging technology. I understand the frustration in not having easy access to live data, but it’s not because of a sinister vendor plot.
  • The author states, “We prefer to stay with our current EMR to avoid going through the pain of a conversion.” I think his hospital (St. Joseph’s in Irvine, CA) runs Meditech, but I’m not certain, and I’m not sure the hospital’s failure to move to a different system (of similar architecture) is based on conversion avoidance.
  • The author talks about Microsoft Amalga, which was spun off and renamed under Caradigm nearly four years ago and no longer has any Microsoft ownership.

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Weird News Andy snickers at the story he titles “Hospitals from Mars.” Candy manufacturer Mars is buying publicly VCA – which operates 800 pet hospitals and the Camp Bow Wow doggie day care chain – for $7.7 billion. WNA wonders if acquiring the company, which trades under the symbol WOOF, is a conflict of interest since chocolate is poisonous to dogs. Probably not — I was surprised to learn  that Mars already owns pet brands Banfield Pet Hospital, Eukanuba, Iams, Pedigree, Whiskas, and several others. Banfield is the pet equivalent of a chain of medical practices, employing 4,000 veterinarians (around 9 percent of the total number of US vets who treat pets). Another Mars business offers pet DNA testing. Those of us working in people healthcare can only envy the efficiency, aligned incentives, effectiveness, and patient satisfaction of our animal-treating peers. They are also better EHR users and are better at population health management in a competitive environment.


Sponsor Updates

  • Optimum Healthcare IT posts a white paper titled “Avoiding Common EHR Implementation Mistakes.”
  • PokitDok achieves EHNAC cloud-enabled and outsourced services accreditation for health information exchange.
  • Arcadia Healthcare Solutions hosts its annual users conference in Boston.
  • Besler Consulting releases a new podcast, “A Preview of Healthcare Policy in 2017.”
  • ONS Connect features Carevive Chief Clinical Officer Carrie Stricker, RN.
  • Meditech posts a case study titled “Avera Uses Pharmacogenomics, Meditech EHR to Drive Precision Medicine.”
  • Nashville Medical News include Cumberland Consulting Group CEO Brian Cahill in its list of Nashville healthcare leaders.
  • Dimensional Insight will exhibit at the Muse Executive Institute January 15-17 in Newport Coast, CA.
  • Healthgrades compiles a 2017 industry insider list for hospital marketers.

Blog Posts


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Currently there are "12 comments" on this Article:

  1. Re: A hospital pharmacist’s letter to the editor of P&T magazine… St. Joseph’s hospital is not in Irvine, CA, it’s in Orange, CA. And they have a complicated alliance with other hospitals in Orange County, CA – Hoag, which runs Allscripts, UCI which also runs Allscripts but is being forced to convert to Epic and run out of another UC data center as all the other UC hospitals run Epic, most of their physician practices use Allscripts in their ambulatory medical groups, except for some of the Hoag ones who also use eClinicalworks and other systems and they just merged or somehow are also aligned with Providence Healthcare, which seems to be 100% Epic. Plus MemorialCare bought up many of Hoag’s physician practices and Memorial Care runs Epic but the physician practices have varied systems. The sisters of St. Joseph also acquired another hospital in the last few years from Adventist Health – not sure what they run. And they have hospitals from Texas to Napa Valley. Could be a variety of systems there too. So it is possible that conversion aversion is real. They have had Meditech since the 1980’s.

  2. The pharmacist signed his letter as:

    St. Joseph Health Systems
    Irvine, California

    Which seems to be this one that gives its address as Irvine, with hospitals in California and Texas:

    http://www.stjhs.org/

    I assume he’s talking about inpatient systems since he describes functions of an inpatient pharmacy, so I assumed Meditech.

  3. In just that WSJ snippet, there is a bunch of bad info. I’ve worked with Epic as a partner for several years. Epic does negotiate and sign the BAA’s of 3rd parties. I’ve done it with them twice. They also share their API’s with technology vendors, enabling application integration. Done it. And plenty of their employees’ cell numbers are in my contacts. Who meets for beers without texting?? I’m not going to bother reading the full opinion piece….probably more garbage.

    • The author’s only apparent qualification is that he wrote a 2006 book titled “The End of Medicine, How Silicon Valley (and Naked Mice) will Reboot your Doctor.” (now available used from Amazon sellers for $0.01). A neurologist’s review of it says:

      As a neurologist well aware of medicine’s many shortcomings, I was hoping to find that a smart outsider like Kessler would provide some fresh insights and solutions. Unfortunately, he didn’t, and I was very disappointed.

      First, the style was annoying. Name-dropping and pointless dialogues were apparently meant to pass for breezy, energetic journalism. But the biggest problem was that Kessler didn’t do his homework. For example, he unaccountably decided that CT scans of hearts were superior in all ways to echocardiograms, which he regarded as second-rate rip-offs. He completely missed the point that echocardiograms show the heart’s walls and valves in motion (the heart is a pump, it moves — get it?), portraying its physiology and function in a way that no static anatomy test such as a CT could show.

      The author failed Medical Reporting 101 — evidently so confident in his own wisdom that he didn’t have to get his facts straight. I imagine he’s a better investor than medical reporter, but, due to his lack of due diligence in getting his medical facts straight, this reader won’t bother to investigate his other books.

      I’m not sure why WSJ found him the best qualified person to speak to interoperability or to Epic. If I were Epic, I would demand a retraction unless he can prove what he claims since you can’t hide behind misstated facts by claiming it was an opinion piece (saying that Epic refuses to sign NDAs is not opinion). Even the wording is slanted — Epic “refused” to join CommonWell rather than “declined” to do so.

  4. They have two office locations one in Orange and one in Irvine. Depending on what functional area you need determines which one you go to. I work for Quest Diagnostics/ChartMaxx and I have been to both locations many times.

  5. I think you put the bar too low. Ask not if Epic is exchanging data with other Epic instances/hospitals, but if Epic is exchanging data across a heterogeneous EHR community.

    • The guy who wrote the article specifically called out Epic as an obfuscator in claiming his two Epic hospitals couldn’t exchange information and that he couldn’t get an electronic copy of his Epic information. Regardless of how Epic does or doesn’t connect to other EHRs, his claims are incorrect (and thus the entire article suspect, if it wasn’t already) if any Epic customer can exchange information with another Epic site or provide an electronic download. His hospitals are getting off easy since he’s not blaming them.

  6. Why is it that so many of the DonorsChoose donate tablets to kindergarten classes? Do our 5 and 6 year old kids really need more time sitting in front of a screen? What are we paying teachers for if we can just hand the kid an iPad and let them educate themselves? (that’s a rhetorical question)

    • Classes use them for special activities and reading lessons for the most part, usually working with learning software and allowing teachers to assign work that can be undertaken while he or she is helping individual students or as enrichment for those ahead of or behind the class. That’s during assigned time slots — they don’t just surf the Web. I only fund projects in which the teacher has a clear plan of how the devices will be used to supplement normal class work (which is nearly all of the time). Some of these kids never get to interact with technology outside the classroom, so that’s a motivator as well.

  7. “Meanwhile his boss, President Obama, also said in an interview this week that EHRs are his biggest Affordable Care Act disappointment, explaining that healthcare still runs on mountains of paperwork, patients are sent bills they don’t understand, and doctors and nurses are wasting time entering data.” For those keeping track, Google, Microsoft, and now POTUS and the federal government have failed to move the needle in HIT. If your are a startup or company casually interested in reforming healthcare, think about that for a moment. Oh and just wait until the true cost of the ACA kicks in – cyberattacks and ransomware. After all that taxpayer money has been wasted on EMR silos… But alas a new industry sprouted up overnight and it is only a matter of time before hospitals are telling their Congressman we need cybersecurity subsidies. Paper was cheaper and more secure.







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Reader Comments

  • Dysf(n): I would say the speaker meant "epic" (vs "epoch"), using the concept from Agile development. I don't have hard data, but...
  • Agile Ninja: I agree the tenant/tenet one is maddening, but I'm not sure epics is wrong. Agile project management works in "user sto...
  • Mr. HIStalk: I hate typos and I'm happy to have fixed this one. Thanks....
  • Mr. HIStalk: Thanks! I'm too trusting of my editing software "remembering" the URL of the page I visited last. Fixed....
  • Sam: Minor correction (aptly timed given comments about tenant/tenet) - Epic's population health platform is Healthy Planet, ...

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