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Safeguarding Smartphones in an Era of Escalating Vulnerabilities

September 28, 2016 News No Comments

HIPAA-related security concerns mount as smartphones become more ubiquitous across enterprise healthcare environments.
By @JennHIStalk

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Ransomware headlines seem to reign supreme in healthcare news, and yet industry insiders know that the greater potential for cyberattack and financial loss resides in just about every person’s pocket (or pocketbook). Catholic Health Care Services of the Archdiocese of Philadelphia’s $650,000 settlement with OCR for HIPAA violations this summer is a prime example of the vulnerability of mobile smart devices. The settlement stemmed from the theft of a smartphone containing the PHI of 412 nursing home residents. Acting as a business associate, CHCS provided IT and management services to six SNFs, and was thus responsible for protecting resident PHI under HIPAA. OCR found that, in addition to a lack of encryption and password protection, CHCS also neglected to develop a risk analysis and accompanying plan for risk management.

While the organization’s lack of cyber safeguards and subsequent fine made headlines, it’s probably a safe bet to assume that other similar entities are operating without the appropriate security safety nets.

Getting on the MDM Hamster Wheel

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Smartphone security “is a moving target,” says Alex Brown, director of strategy at healthcare communications company Voalte. “Today, there seems to be two layers of what people are looking into when it comes to smartphone security – applications on the device and the content of those applications. If your application has PHI sitting in it all the time, than you have a much higher risk than with an app that has PHI on it only when it’s connected to a server.

“Not every healthcare organization has the expertise to deploy security,” he adds, “which is why providers rely so much on vendors to make sure that they’re really keeping up to date with best practices around mobile device management.”

Brown finds that in today’s world of escalating cybersecurity concerns, constant dialogue with hospital customers about the importance of up-to-date MDM is a must. Hospitals are now faced with managing almost daily updates from Apple and Google, he explains, which, for many, has taken some getting used to.

“It’s an important piece that not a lot of sites think about,” Brown says. “It’s constantly moving. I like to refer to the smartphone space as a hamster wheel of updates. It can be a little daunting to get on it, and once you’re on it, you really have to keep up. If you don’t, that’s where you can introduce risk. The CHCS settlement was a gut check for other providers in the sense that they hopefully are now asking themselves, ‘Are we checking all the boxes constantly? Are there new boxes that we can now check?’”

Great Vendor Expectations

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Parkview Medical Center (CO) CIO and Vice President of IT Steve Shirley has seen his fair share of cybersecurity practices, having spent 30 years in banking IT and nearly eight in healthcare. “In banking, we were mandated and audited on our vendor management programs. I routinely went onsite at vendor locations to audit their data centers, review their SaaS70 reports, and determine the overall security posture of the firm. We looked at their financials and did a significant amount of work to ensure the vendor was not only financially strong and stable, but secure, and that our data was safe.”

Shirley adds that security in the financial industry is at a higher level of maturation than in healthcare for obvious reasons. “They have to protect identities and money,” he explains. “Now that health data is under attack, we need to raise security to a higher standard. At Parkview, we’re heavy users of smartphones. The challenge is that in the BYOD world, other than our MDM strategy and provisioning, we don’t have a lot of control over what devices come in the door. And so we expect the highest level of security from our vendors. We include vendor management in our RFPs and require BA agreements for any vendor dialing into our system in any way. This is in addition to the standard requirement when the vendor has access to our data for things like analytical activity.

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“When we implement new solutions,” he adds, “we collaborate with them to plan and design for security, whether at the mobile device level or system level. When we partnered with PatientSafe Solutions to roll out PatientTouch on the iPhone for services ranging from bedside medication verification to care team texting and communications, we brought in all of the vendors involved to develop a system that was not only reliable and functional, but also secure across all connections and access points. Six companies were involved: PatientSafe, their wireless vendor, our IT team and wireless vendor, Cisco, and Apple all participated in ensuring the system worked seamlessly and securely.”

Sticks Will Get the Cybersecurity Job Done

With regard to the CHCS breach, Shirley isn’t shy about sharing his opinion. “In the banking industry, I learned that we all mean to do good, but the movement of the day is so fast and furious that things tend to fall by the wayside,” he says. “And so the government stepped in with punitive measures for not meeting security or other standards. Y2K was a great example. The FDIC threatened to close banks if they didn’t have an appropriate Y2K strategy. I pray every day my hospital doesn’t get attacked and a breach occurs. As regretful and tough as the fine is, it’s a necessity because it creates an industry wakeup call for those who haven’t realized healthcare is under attack.

“It seems that while people understand that systems like servers, desktops, laptops, etc. are highly susceptible to attack if not properly protected, there’s a perception that smartphones are different,” he explains. “We, both industry and our consumers, need to get serious about understanding that a smartphone is a device that has access through the Internet and is thus vulnerable.”

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Grace Hua, director of product management, clinical communications at PatientSafe, is of a like mind in her belief that hospitals should demand that vendors provide technology support and safeguards for clinician end users. “This should be a wakeup call not only for BAs, but for the industry as a whole,” she says in reference to the CHCS news. “BAs need to fully understand the importance of the data they are potentially putting at risk, and the implications of theft or security breach, as that data now has a dollar value tied to it. Hacking is now just as profitable in healthcare as other industries.”

Increasing Staff Awareness

When it comes to safeguarding smartphones and patient PHI, Shirley and his team are taking proactive measures to keep CHCS-type incidents at bay. Higher-level efforts include membership in security organizations like the SANS Institute and making sure that new technology deployments include a project milestone for evaluating and understanding potential security risks, and then developing a plan to mitigate them.

“This seems so intuitive,” he says, “but I think it is sometimes not the highest priority in the deployment of healthcare systems. Examples of this include installation of modalities for radiology that have communications facilities onboard, or even simple things like network printers.”

Shirley is especially excited about boots-on-the-ground efforts at Parkview. “We have a network security engineer who, in addition to his technical role, is responsible for security education. He regularly visits units during their daily huddles to give security tips like how to create strong passwords or how to validate that the person on the phone is authorized to receive information. Throughout the hospital, we use our digital wallboards to deliver security messages to everyone onsite. Our employee and physician newsletters have standing articles about safety. We’re also putting together a security video that will be required viewing for all employees. The effort has been huge in the last year to increase staff awareness.”

A Rising Tide Lifts All Cybersecurity Practices

Shirley is happy to report that his colleagues at neighboring institutions are paying just as much attention to securing mobile devices. “Two years ago, I would have said healthcare organizations are not paying enough attention to cybersecurity protection,” he says. “Now, I’m seeing new and extreme efforts every single day. Recently, a competitor healthcare system went to two-factor authentication for external access, and I think that’s awesome. At Parkview, we’ve implemented MDM for all of our devices. We don’t store data on laptops or mobile devices, and we don’t deploy any mobile hardware that hasn’t been encrypted. I think the industry understands healthcare is under threat and there are many points of potential vulnerability we need to address. It’s absolutely becoming more of a focus.”

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September 28, 2016 News No Comments

News 9/28/16

September 27, 2016 News 2 Comments

Top News

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InstaMed secures a $50 million investment from Carrick Capital Partners, bringing its total funding to nearly $126 million since launching in 2004. (CCP’s only other foray into healthcare IT seems to be a 2014 majority equity investment in post-acute software vendor Procura.) The Philadelphia-based company will use this latest round to further develop its healthcare payments technology and go-to-market strategy. CCP Managing Director Jim Madden will join InstaMed’s board, while colleague Chris Wenner will become a board observer.


Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock 

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Waycross, GA-based Salus Telehealth and Chicago-based VideoMedicine merge under the Salus brand name to offer telemedicine hardware and software, including a direct-to-consumer app. Salus CEO Paula Guy will remain in that role over the newly combined company. VideoMedicine founder and CEO Charles Butler, MD seems enthusiastic about the merger, though his role moving forward remains unclear. Fun fact: He competed at the age of 18 in the 1998 Nagano Winter Olympic Games in the sport of ice dancing.

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PeriGen confirms the acquisition of Hill-Rom’s WatchChild Fetal Monitoring System. The newly combined team will be led by PeriGen CEO Matthew Sappern, while the management team will include executives from both companies. WatchChild General Manager Brian Bishop will join PeriGen as chief product officer. PeriGen also closed a corresponding investment round led by Ambina Partners, giving AP founder Greg Share a spot on PeriGen’s board.


People

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Sentry Data Systems promotes Tom Tran to CFO and COO.

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Cerner President Zane Burke joins the board of Truman Medical Centers (MO), which signed on to a 10-year EHR deal with Cerner last fall.

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Shelby Solomon (Connecture) joins Medecision as SVP, corporate development and strategy.


Announcements and Implementations

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Sunnybrook Health Sciences Centre will implement patient registration technology from Harris QuadraMed across its three facilities in Toronto.

Cigna adds virtual consults from American Well to its telemedicine offerings for 2017 employer-sponsored and individual health plans. The payer rolled out a similar service from MDLive in 2013.

Standards development organization NCPDP works with Experian Health to develop a vendor-neutral universal patient ID management tool.

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Several hospitals, including Boston Children’s Hospital and Mercy Health System (WI), and a Pennsylvania-based care program for the elderly, roll out Circulation’s medical transportation technology, which takes advantage of Uber’s API to help providers and patients schedule rides that cater to specific needs and preferences. 

Indiana-based HMO MDWise – a joint venture between Eskenazi Health and Indiana University Health – taps Valence Health to process its medical claims beginning January 1.

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San Mateo County Health System (CA) implements NextGate’s EMPI patient-matching technology across its 10 divisions and six EHRs.


Privacy and Security

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The GAO releases a “scathing” report on cybersecurity preparedness in health information technology, recommending that HHS “update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program.”

A former Alberta Hospital Edmonton employee inappropriately accesses the records of 1,300 patients over the course of 11 years, most likely out of “personal curiosity,” making it the Canadian province’s largest deliberate breach of health data.


Technology

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SnapMD adds provider-to-provider consult capabilities to its telemedicine technology.

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Varian Medical Systems develops new cancer care coordination software that aggregates EHR, IS, and portal data from the patient, PCP, radiation, medical and surgical oncology, and social services.

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Memorial Healthcare System partners with American Well to offer a telemedicine app for members of its managed care or consumer health plans.

Casenet rolls out the latest release of its TruCare care administration and management software.


Government and Politics

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President Obama gives his stamp of approval to National Health IT Week, reminding citizens of the “billions of dollars” spent to encourage the adoption of EHRs at 97 percent of the country’s hospitals, and his efforts to launch the Precision Medicine Initiative.

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Coinciding with nationwide health IT marketing push, ONC releases its Health IT Playbook, a Web-based manual that updates the Patient Engagement Playbook for Providers, offering guidance on a wide variety of health IT products and topics. The playbook includes a guide to EHR selection and contracts.


Research and Innovation

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Despite past “snake oil” commentary, an AMA survey of 1,300 physicians finds that a majority are optimistic about the potential of digital health tools to improve patient care. Enthusiasm seems to outweigh adoption: Physicians cite liability coverage, EHR workflow integration, and data privacy as must-haves for successful and consistent adoption.


Sponsor Updates

  • Forward Health Group Founder and CEO Michael Barbouche speaks at the Wisconsin BioHealth Summit September 27 in Madison.
  • Impact Advisors releases a new white paper, “Realizing Clinical Benefits from EHR Investments.”
  • Liaison Technologies and Meditech celebrate National Health IT Week.
  • Meditech releases a new white paper, “The Benefits of an Integrated Approach to Critical Care.”
  • Verscend Technologies kicks off its eighth annual conference, taking place in Palm Desert, CA through September 30.
  • Glytec receives three patent notices of allowance for its EGlycemic Management System.

Blog Posts


Contacts

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

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September 27, 2016 News 2 Comments

Curbside Consult with Dr. Jayne 9/26/16

September 26, 2016 News No Comments

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National Health IT Week is underway. According to the press release, “This annual celebration is a time for all of us to reflect on the progress we have made and recommit ourselves to advancing the promise of health information technology.” The newest National Coordinator for Health IT, Vindell Washington, MD will host a Twitter chat on Tuesday starting at 11am ET using the hashtag #AskVindell. Topics include the current and future state of health IT as well as questions and answers. There are all kinds of National Health IT Week activities taking place across the country. I’m out with clients this week so I won’t make it to any of the festivities. Still, I wanted to take a chance to reflect on my own time in the Health IT trenches.

I was fortunate to attend a medical school that rotated its students through hospitals that embraced technology. Looking back, some of it was pretty primitive, but back in the day we thought we were cutting edge as we navigated through the lab system with light pens tethered to green-screen terminals. One hospital had started its own EMR. Even in the early days, it had most of the data needed to round on patients – laboratory data, vital signs, medication lists, and more. It was a luxury to prepare for rounds at a single workstation rather than having to round up paper charts and dig through them.

Surprisingly, the more advanced hospital was a community hospital rather than the primary academic hospital. Looking back, it may have been easier to pilot informatics platforms on the community side since the roster of admitting physicians was fairly stable. Although residents and students participated in patient care, it wasn’t at the same volume as the academic hospital. The community hospital was progressive in other ways, building the first hospitalist program in the city and serving as a pioneer in laparoscopic surgery.

My medical school class was the first one to have email accounts issued to everyone with the expectation that we’d actually use it, as opposed to it being optional. Granted, it was Lotus Notes, but it was high tech at the time. We still did our histology coursework looking at carousel after carousel of 35mm slides, however. We had a transcription service where someone took notes at every class and distributed them; without laptops, we took old-fashioned paper notes then typed them up later, printed them, and photocopied them. No one seemed to put two and two together that we could have been emailing them around. Today, my school augments its gross anatomy program with virtual anatomy – 3D computer simulations based on CT scans taken of live individuals. Very different than the cadaver cross sections that we worked with.

Health IT really started to boom while I was in my residency training, with increased nursing documentation being done electronically, although paper copies were still printed and added to the chart. There was a lot of fighting over PCs because the hospital hadn’t really thought through the computerization piece or what it would look like from a workflow standpoint. The residents thought we were cool because we could dictate our History and Physical documents and Admission notes using Dragon. It not only helped avoid the lengthy, handwritten note process but made sure the documents were on the chart quickly compared to the turn-around time required for “regular” transcription. No one at the time thought of outsourcing transcription services to 24×7 resources in another country, and certainly no one thought much about natural language processing.

I purchased my first handheld device as a Chief Resident. While others seemed to be leaning towards the Palm Pilot platform, I went with the Pocket PC. Although I legitimized my purchase by using it to take attendance at Grand Rounds and to use Excel to track various program requirements, I secretly thought the coolest feature was the fact that you could put music on it. The ultimate mix tape was now in your pocket at all times (or at least as long as the battery lasted). I found that Pocket PC in a drawer a few weeks ago and it fired right up. The data files were gone but the music was all still there, providing a much-appreciated blast from the past.

When I opened my solo practice, I was supposed to be on an EHR from day one, but there were implementation issues, forcing me to spend a year on paper charts in an office that wasn’t built to house paper charts. When we finally got our system, we learned a lot about vendor bait-and-switch, starting when the trainer first arrived and tried to train us on a system that was different than what we actually had installed. It went downhill from there and ultimately resulted in a de-installation. That experience, however, set the groundwork for my career in health IT, as hospital leadership realized I had been through the wringer but learned quite a bit, and could be an asset to their future EHR plans. I slowly crossed over into the technology side of things and never looked back.

People occasionally ask whether I think it was a waste of time to go to medical school. They often assume I don’t see patients anymore. Being a physician first was critical to me winding up in the wild and crazy world I work in today, and I wouldn’t trade it even with the hideous student loans and the long, torturous work hours. I learned health IT on the side and on the fly, while building a practice and settling in as a young physician. We’ve gone a long way past many of the things I used to struggle with early in my career – trying to access charts in the middle of the night, dealing with pharmacies that weren’t comfortable with electronic prescriptions, and bringing faxes directly into the EHR. Now we’re moving into an age where pharmacogenomics is a reality and we have the world’s library at the tips of our fingers at all times.

I remember doing an interview for the hospital newsletter early in my career. The CMO called to blast me for saying that having computers in the office allowed me to look things up during the patient visit. He felt that my statement implied that I was inexperienced and that patients would avoid me. Quite the opposite: Patients appreciated having a physician who was willing to look things up and show them the actual literature so that we could make decisions together. Having technology in the room transformed how I practiced in a positive way, and I know it made a particular difference for many of my patients. Sometimes, as we reflect on how we work with technology today, we tend to demonize it without putting into perspective what our daily lives would look like without it.

Even though it sometimes drives me crazy, I’m grateful for healthcare IT and what it has done for me personally. I’m hopeful for what the future holds, even despite the mandates and regulations. I can’t wait to look back in another five or 10 years and see where we’ve gone.

How has health IT impacted you, personally or professionally? Email me.

Email Dr. Jayne.

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September 26, 2016 News No Comments

Monday Morning Update 9/26/16

September 25, 2016 News 3 Comments

Top News

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GE Healthcare launches Five.Eight, an accelerator (not to be confused with the Athens, GA rock band) for global healthcare startups aimed at improving outcomes for the estimated 5.8 billion people in the world who don’t have access to quality, affordable care. The accelerator hopes to enroll 10 companies in its first program, each of which will work with GE on developing scalable products for potential distribution or integration into GE’s portfolio. Seed funding of up to $5 million per startup may also be available.

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India-based Tricog is the first member of the new accelerator. The startup has developed technology to help ED physicians diagnose heart attack patients within minutes, decreasing time between symptoms and treatment and increasing survival rates.


HIStalk Announcements and Requests

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It’s Hillary Clinton in a landslide with heavy HIStalk reader turnout. Maybe I’ll run it again after the debates. New poll to your right or here: continuing last week’s poll, which health IT salesperson LinkedIn credential would most impress you?

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Welcome to new HIStalk Platinum Sponsor Ivenix. The Amesbury, MA-based company has transformed IV infusion delivery from the decades-old technology of competitors to the connected world to improve patient safety, eliminate workflow inefficiencies, and protect the hospital’s bottom line by reducing adverse events. The Ivenix Infusion Management System measures and adjusts IV flow rate in real time and supports mobile viewing of infusion status and alarms, integrating with the EHR to auto-program and auto-document. Adaptive technology eliminates the need for ongoing calibration, while software and security updates along with drug library updates are delivered without removing devices from the floors. Ivenix addresses the challenges of increasingly complex dosing regimens, the demand for EHR integration, and infusion technology-related patient safety issues. Thanks to Ivenix for supporting HIStalk.

I found this video that describes the benefits of the Ivenix Infusion Management System, including eliminating nurse time spent manually documenting IV pump information in the EHR.


Last Week’s Most Interesting News

  • Epic announces a number of new offerings and initiatives at its annual user group meeting, which attracted 18,000 attendees.
  • The Chan Zuckerberg Initiative donates $3 billion to “cure, prevent, or manage all diseases by the end of the century.”
  • Private GPs in England offer third-party video visits as an alternative to long appointment wait times, with NHS footing the bill.
  • The entire board of Cairns Hospital in Australia resigns following an unpopular and over budget Cerner rollout.
  • Appalachian Regional Healthcare (KY and WV) brings the computer systems of its several hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by a malware attack.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Blue Cross Blue Shield of Nebraska pulls out of the federal health insurance exchange, leaving Nebraskans with extremely limited purchasing options when open enrollment starts November 1.

TierPoint will spend $20 million to build the first phase of a 90,000 square-foot data center in Dallas.


Announcements and Implementations

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Canopy Health, an accountable care network formed out of an affiliation between California-based UCSF Health and John Muir Health, selects financial risk management and population health services from Conifer Health.

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Sydney-based Macquarie University’s MQ Health campus partners with Emory Healthcare (GA) to launch the country’s first remote intensive care unit monitoring program using technology from Philips.


Technology

MSN Healthcare Solutions incorporates SyTrue’s NLP OS operating system and AdvancedBI’s business intelligence tools into its new NLP-based analytics offering for radiologists.

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VitreosHealth adds predictive risk models for identifying gaps in care, mental health conditions, and patient motivation to its population health management analytics engine. Models for palliative care will be rolled out towards the end of the year.


Research and Innovation

AHRQ looks for peer-reviewed, patient-centered outcomes research findings related to geriatric care shown to have improved patient outcomes for potential investment in broader dissemination and implementation. 

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I missed this a few weeks ago: The National Science Foundation awards Rice University mechanical engineer Marcia O’Malley a $1 million, three-year grant to develop a tool that will track the movement of a surgeon’s operating tool and emit a vibration if his or her technique is deemed too rough. (No details are given as to how “rough” will be determined.) O’Malley says the tool will combine virtual reality with real-time touch feedback that will hopefully make the process of learning how to perform delicate surgeries easier.


Privacy and Security

Care New England Health System pays a $400,000 HIPAA fine for neglecting to update its BA agreement with Woman & Infants Hospital (RI), for which it provides IT system technical support and information security. The lack of updated documents came to light when WIH reported the loss of unencrypted backup tapes containing the PHI-filled ultrasound studies of 14,000 patients. WIH ended up paying a $150,000 fine for its role in the breach.


Other

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Iliuliuk Family and Health Services, the only clinic serving Alaska’s extremely remote Unalaska Island (which also happens to be one of the country’s busiest commercial fishing ports), launches virtual consults via satellite technology with Anchorage-based providers at Providence Alaska Medical Center. The local news reports that the service will connect mainland ED physicians with clinic staffers to treat injuries “among the Bering Sea crabbing fleet made famous by the Discovery Channel show ‘Deadliest Catch.’”


Sponsor Updates

  • Experian Health will host its Financial Performance Summit October 5-7 in Nashville, TN.
  • Patientco releases its annual State of the Industry Report.
  • PatientMatters will exhibit at the Arkansas Hospital Association Annual Meeting & Tradeshow October 5-7 in Little Rock.
  • PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.
  • Lexmark Healthcare submits a formal pledge of commitment to interoperability.
  • Sagacious Consultants makes a charitable donation to Tri 4 Schools to help extend its Exercise to Achievement after-school program.
  • The SSI Group will exhibit at the AAHAM ANI 2016 conference October 5-7 in Las Vegas.
  • Summit Healthcare and ZeOmega will exhibit at InSight 2016 September 27-30 in San Antonio.
  • Sutherland Healthcare Solutions will exhibit at the HFMA NJ National Institute October 5 in Atlantic City.
  • Navicure receives number-one rankings in client satisfaction and client loyalty across three Black Book RCM survey categories.
  • Valence Health will exhibit at the Georgia Society for Managed Care Conference October 5-7 in Young Harris, GA.
  • ZeOmega releases a video, “SignalHealth Deploys Advanced Care Directives Repository Through Jiva HIE.
  • ZirMed ranks first for end-to-end RCM in the 2016 Black Book Report for the fifth consecutive year.

Blog Posts


Contacts

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

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September 25, 2016 News 3 Comments

News 9/23/16

September 22, 2016 News 3 Comments

Top News

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Facebook founder Mark Zuckerberg and his wife Priscilla Chan, MD will donate $3 billion to “cure, prevent, or manage all diseases by the end of the century.” Zuckerberg noted that we spend 50 times more on disease treatment than prevention and says the couple’s donation will bring scientists and engineers together to build research tools and technologies.

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The first project funded by the donation will be the $600 million Chan Zuckerberg Biohub, which will bring together scientists and engineers from Stanford, UCSF, and Berkeley. Its first two efforts involve infectious disease (developing a universal diagnostic test,  using gene editing tools to create new drugs and monoclonal antibodies, using machine learning to mine clinical trials data for vaccine development, and deploying a rapid response team during disease outbreaks) and mapping all human cells to create the Cell Atlas for research.

It’s an impressive donation, but still only one-tenth of what the NIH spends on research in a single year. It’s trendy for tech companies (IBM, Google, Microsoft, etc.) to arrogantly think they can “solve” disease. I’m a bigger fan of Michael Bloomberg’s donations that involve public health or those efforts that involve personal responsibility or uncontrolled healthcare costs rather than chasing elusive magic bullets. At least these first projects commendably blend technology with developing a baseline of intelligence than can be built upon over the years.


Reader Comments

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From Considering Further Education: “Re: your observation that salespeople typically don’t have advanced degrees. As a salesperson, how much more credible would I be with an MBA or other advanced degree? I’m young and motivated, but wondering if it would pay off.” My observation was that salespeople (and thus CEOs promoted from sales roles, as is often the case) often have no degree at all or unrelated bachelor’s degrees from universities not on anyone’s top lists, with my assumption being that they were so confident in their career path that they didn’t expect to be competing for jobs on the basis of educational credentials. I would place zero value on a salesperson having an advanced degree, but I’ll ask experienced readers to weigh in, especially as it pertains to moving from sales to executive positions.

I should mention that every time I talk about advanced degrees, I get a bunch of emails from indignant folks who don’t have them describing their personal success in a world of less-competent, less-motivated degree holders in thusly assuming they hold no value for anyone. I suspect that everyone’s ideal credentials are their own, with any more education being worthless paper-hanging and any less education failing to clear the slippery educational slope (if you don’t need a master’s, do you need a bachelor’s? What about a high school diploma?) Degrees don’t matter if you work for yourself, start Facebook, or land a CEO position, but for most people, they will elicit some reaction and affect employment opportunities at least indirectly.

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From Ascetic Acid: “Re: integration report. What do you make of this gaffe?” Looks like bad strategery.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Sutherland Healthcare Solutions. The Clifton, NJ-based company is a leading provider of consulting, BPO, ITO, and analytics services to providers, payers, government, and ACOs, with 5,000 employees working from 15 sites around the world. It offers claims administration and adjudication, coding, technology services, end-to-end RCM, analytics, patient experience consulting, and population and payment solutions. Health IT services include product development, maintenance, and support; testing as a service; implementation; integration; clinical help desk; and training. Among the company’s 100+ clients are six of the top 25 US hospitals and three of the five largest US health plans. CEO Graham Hughes, MD  is an industry long-timer, having spent time at IDX and GE Healthcare. Thanks to Sutherland Healthcare Solutions for supporting HIStalk.

This week on HIStalk Practice: Doctor on Demand CEO Hill Ferguson discusses the intersection of fintech and health IT. Health Systems Informatics launches population health management consulting services. FDA, USDA announce app development competition, telemed funding as part of Prescription Opioid and Heroin Epidemic Awareness Week. Coordinated Care Oklahoma adds DrFirst tech. Kansas City Care Clinic goes with care coordination tools from BluePrint Healthcare IT. Community Health Center selects Safety Net Connect IT as part of school-based effort in New Mexico. AAFP elects new president. Physician morale takes a nosedive.


Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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HIPAA-compliant hosting and EHR integration technology vendor Catalyze raises $6.5 million in a Series B funding round, increasing its total to $12.5 million.

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Hill-Rom will sell its WatchChild fetal monitoring system business to advanced fetal monitoring and clinical decision support vendor PeriGen to focus on its core growth areas of falls prevention, patient satisfaction improvement, and infection prevention. The 18 CWS employees assigned to WatchChild will be offered positions with PeriGen. I described the company’s history in responding to a June 2012 reader rumor report that Hill-Rom was shopping WatchChild even then as:

The WatchChild OB monitoring system is owned by Hill-Rom, mostly known for selling expensive hospital beds and a few other marginally related product lines. WatchChild was supposed to be a natural extension of the company’s NaviCare nurse call system. HRC shares haven’t exactly shone lately, dropping from $48 in July 2011 to $30 now [note: they’ve rebounded to $61 since], so Hill-Rom may simply see the frenzy of M&A activity in healthcare IT as a good opportunity to sell some or all of its IT holdings to focus on core business. All of this is speculation since they’ve made no announcement that I’ve seen. Hill-Rom used to be known as Hillenbrand Industries, whose humorously complementary business was Batesville Casket Company. I’ve always wondered if they might put some of their nurse call technology in those caskets as an upgrade for those who fear being buried alive.

TransUnion acquires RTech, which offers post-service eligibility solutions to maximize hospital reimbursement, for $62 million.


Sales

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CHI Franciscan Health (WA) chooses Glytec’s EGlycemic Management System for real-time insulin dosing in its eight hospitals, integrated with Epic.

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Adventist Health chooses Oracle Applications Cloud for ERP, human capital management, analytics, and enterprise performance management.

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Johns Hopkins Aramco Healthcare will deploy Epic and Hyland OnBase in its facilities in Saudi Arabia.


People

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Clinical trials software vendor Cure Forward hires Frank Ingari (NaviNet) as CEO.

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In England, NHS England chooses its just-appointed chief clinical officer Keith McNeil, MB to also head up its new Digital Delivery Board. McNeil resigned as CEO of Addenbrooke’s Hospital last year just before Cambridge University Hospitals NHS Foundation Trust (which includes Addenbrooke’s and The Rosie Hospital) was placed on “special measures” for a number of patient care problems; he was also CEO when the Regulator Monitor investigated the trust’s financial challenges following its $300 million Epic rollout.


Announcements and Implementations

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Bakersfield Memorial Hospital (CA) rolls out a camera-equipped security robot that patrols the ED parking lot and offers visitors a button to call a security guard.

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LiveProcess announces new mobile apps for patient care and transitions, discharge, staffing, transplant, and hospital operations.

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St. Luke’s University Health Network (PA) goes live with Caradigm Care Management to support its Bundled Payments for Care Improvement program.

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UPMC launches Curavi Health, which will offer telemedicine equipment and software to nursing homes and provide after-hours consults from University of Pittsburgh Physicians.

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Engage, the IT services division of non-profit Inland Northwest Health Services (WA), offers a NetApp-powered cloud backup and recovery solution to the 40 hospitals whose Meditech systems it hosts.


Government and Politics

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An HHS OIG audit finds that the state of Washington overpaid $9.2 million to 19 of the 20 hospitals that received Medicaid EHR incentive payments in 2011-2015.


Privacy and Security

From DataBreaches.net:

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  • Keck Medical Center of USC notifies patients that it experienced a ransomware attack on August 1, adding that it recovered its systems without paying.
  • Codman Square Health Center (MA) notifies nearly 4,000 patients that an unnamed number of its employees looked up patient information on the New England Healthcare Exchange Network without authorization, with those employees since either suspended or fired. The employees viewed information of non-Codman patients whose information was stored on NEHEN, which is an interesting twist on the usual “viewed without authorization” situation.
  • The forever-bungling Yahoo warns users that it has become the victim of what is apparently the biggest breach in history, with the information of 500 million accounts exposed in 2014 by “a state-sponsored actor” with the announcement coming right before the company closes the sale of its pathetic dregs to Verizon for next to nothing. An interesting reader comment to that item says it’s suspicious that breached companies always scapegoat unverified “state actors” instead of “some 16-year-old kid.” At least the overused “sophisticated attack” excuse is now rare. Expect the average consumer to become even more wary of signing up for health-related apps and portals.
  • The information of thousands of patients whose information was stored by a now-closed physical therapy EHR vendor is exposed in a “leaky bucket” of its incorrectly configured Amazon Web Services S3 (Simple Storage Service) account.

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In light of the AWS breach, DataBreaches.net suggests reviewing business associate agreements using the checklist above.

Hackers take ransomware up another notch with Mamba, which instead of encrypting files, encrypts the entire hard drive and offers to sell the password required to boot up the PC. At least some Luddite hospital might have its first laptop encrypted, although not in a good way.

A survey finds that half of IT professionals don’t understand that emptying a PC’s Recycle Bin doesn’t permanently erase the files it contains.


Other

Google parent Alphabet kicks off its carefully controlled DeepMind Health public outreach meeting with an apology that the event was held at Google’s opulent London offices, suggesting that more accessible community spaces might be more appropriate going forward. The company, which has been criticized for its lack of transparency for rolling out clinical products without the required government approval, says it has been clear since it acquired DeepMind for $500 million that intends to build a business model from its use of patient data it gets for free with use of its hospital software, but suggests that it would like to get paid for clinical outcomes rather than the traditional software vendor activity. A prototype of a patient portal app was shown, although development has not started.

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In Australia, the entire board of Cairns Hospital resigns following massive budget misses following its implementation of a Digital Hospital program in which it installed Cerner Millennium. Employee surveys following the go-live earlier this year – results of which the hospital has declined to release but they leaked out anyway — found that the system was not intuitive and user friendly, endangered patients with its specimen order and collection workflow, and was brought live without adequate testing and support coverage.

The local paper says McDonough District Hospital (IL) has been live on a new EHR, Cerner Safari, for three months. I’m not sure where they got that name.

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A Madison TV station runs a UGM-inspired video profile of Epic’s 90-employee culinary team led by Chef Eric Rupert (not to be confused with Chef Eric Ripert), where everything — right down to the hot dog buns and ice cream — is made from scratch. 

The Madison paper runs some highlights from Epic UGM:

  • The company is working to provide Syrian refugees with their health information on flash drives.
  • Epic will offer free licenses and maintenance to federally qualified health centers.
  • MyChart will be enhanced to allow patients to get an estimate of their care costs and to apply online for charity care.
  • Epic will integrating with state doctor-shopper databases and using predictive modeling to help manage opioid use in individual patients.
  • Video visit capability will be built into Epic.
  • The company says its Cosmos Research Network of big health systems will support better understanding and treatment of diseases.

SNAGHTML24dc388b

Naveen Rao observes the hostile user response caused by United HealthCare’s recent app update, noting that the company even recycled an apparently rare positive user comment from an old press release touting a previous upgrade in the absence of any other positive user reaction. He questions how a company of UHG’s size with a technology and innovation budget of $3 billion could release an app that apparently won’t work for many people, why users should be expected to re-enter information from elsewhere, and why UHG seems indifferent to the feedback of its customers. My conclusion is that it’s not only tough to create a consumer app that’s easy to use, is thoroughly tested under an infinite number of scenarios, and gives immediate gratification, but it’s also true that app developers aren’t used to scaling their support services to meet the understandably high expectations of patient-customers who just want a human to respond to both their technical and medical needs.

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Perhaps UHG should have read this fascinating article (thanks to Eric Topol, MD for tweeting it out) called “The Scientists Who Make Apps Addictive” that describes how the digital interface can be used to shape user decisions and how companies use complex psychology in their apps to get people to do their bidding. Expert B.J. Fogg gives Uber as an example of why companies should design for habits, where the experience is so positive that users won’t even consider alternatives. He also advocates that apps “make people feel successful,” as in Instagram’s photo options that make people feel like artists. The article notes Facebook’s use of psychology in playing to each user’s yearning for social approval via likes and invitations to connect, concluding that “whoever controls the menu controls the choices” in a digital world designed by a few 20-something men working for a handful of mega-app companies in San Francisco. The article compares apps to casinos, where slot machines are “Skinner boxes for people” and algorithms predict when a given player’s losses might encourage them to walk away, at which time the casino dispatches a “luck ambassador” to give them a free show ticket or a steak dinner to keep them losing money. The article brilliantly summarizes with insight that should interest app developers:

The casinos aim to maximize what they call “time-on-device.” The environment in which the machines sit is designed to keep people playing. Gamblers can order drinks and food from the screen. Lighting, decor, noise levels, even the way the machines smell – everything is meticulously calibrated … But it is the variation in rewards that is the key to time-on-device. The machines are programmed to create near misses: winning symbols appear just above or below the “payline” far more often than chance alone would dictate. The player’s losses are thus reframed as potential wins, motivating her to try again. Mathematicians design payout schedules to ensure that people keep playing while they steadily lose money. Las Vegas is a microcosm. “The world is turning into this giant Skinner box for the self,” Schüll told me. “The experience that is being designed for in banking or healthcare is the same as in Candy Crush. It’s about looping people into these flows of incentive and reward. Your coffee at Starbucks, your education software, your credit card, the meds you need for your diabetes. Every consumer interface is becoming like a slot machine.” These days, of course, we all carry slot machines in our pockets.


Sponsor Updates

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  • Volunteers from Impact Advisors worked with an Illinois environmental education group to recycle crayons for children’s hospitals last week.
  • Iatric Systems, Meditech, and Santa Rosa Consulting will exhibit at InSight 2016 September 27-30 in San Antonio.
  • MedData will exhibit at the HFMA Fall Revenue Cycle September 28 in Bellaire, MI.
  • Black Book names Navicure #1 in end-to-end RCM technology solutions for hospitals under 100 beds.
  • Definitive Healthcare releases a new version of its app that provides access to its provider data from Salesforce.com.
  • NTT Data will sponsor Blue Cross Blue Shield’s Information Management Symposium September 25-28 in Detroit.
  • Obix Perinatal Data System will exhibit at the Nursing Perspectives Conference September 28-30 in Buford, GA.
  • NCQA awards PCMH 2014 pre-validation status to the analytics platform of Arcadia Health Solutions.

Blog Posts


Contacts

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

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September 22, 2016 News 3 Comments

News 9/21/16

September 20, 2016 News 6 Comments

Top News

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In England, private doctors are offering third-party video visits, such as those marketed by Babylon Health, as an alternative to long appointment wait times, with NHS footing the bill. The British Medical Association warns that it’s risky for patients to receive video advice from doctors who don’t have access to their NHS medical records.

Doctors in England can get paid as video visit providers as long as the patient is outside their geographic area, which critics have called a “slippery slope towards privatization.”


Reader Comments

From  Spiffed Up: “Re: telemedicine visits. Have you ever had one?” I have not, counting myself among the 88 percent of respondents to my April 2016 poll who have not experienced a virtual visit of any kind. It would be fun to hear from doctors who have been involved in virtual visits, either as a provider or patient. I’m especially interested that despite the value we place on electronic medical records and continuity of care, we are OK with for-profit vendors of such services performing a kind of  medical speed-dating (as mentioned in the news item above from England). On the other hand, Americans tend to undervalue those ongoing relationships in reducing the art of medicine to their 30-second description of their problem, preferably with the prescription-issuing process overlapping since that’s what they really want as an outcome. Patients will score doctors highly if they offer easy parking, don’t keep patients waiting, have good bedside manner, and crank out the meds. Only in medicine do we expect vendors (doctors) to exhibit ethical behavior in not selling people profitable things that are bad for them.


HIStalk Announcements and Requests

Eight companies have taken advantage of my New Sponsor Pledge Drive specials so far in September, earning bonus months added on to their new, year-long sponsorships. Contact Lorre to join them. Usually one of the first questions companies ask Lorre is, “Can we attend HIStalkapalooza?” (answer: yes, Platinum-level sponsors get two free tickets). Another is, “Can Mr. H interview our VP of sales about a new product we’re announcing?” (answer: no, I don’t do interviews that focus on company and product pitches and I only interview CEOs).

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Speaking of HIStalkapalooza, I begrudgingly agreed to do it again despite the big personal check I’ll be writing if event sponsorships don’t cover the significant cost (the House of Blues bar tab analytics from previous years suggest that a good time was had by at least some). Contact Lorre for a sponsorship information packet. We’re even offering one and only one sponsorship for big spenders who want a bunch of invitations for clients and employees, CEO stage time, backstage access, and many other customized perks.

My latest industry observation: salespeople (and thus CEOs of companies that mostly promote salespeople) rarely have advanced degrees. it’s usually a state college or no-name bachelor’s at best.


Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Huntzinger Management Group acquires Next Wave Health Advisors.

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WebMD parts ways with CEO David Schlanger by mutual agreement, replacing him with President Steven Zatz.

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Morgan Stanley is reportedly facilitating discussions among Infor and buyout firms that are interested in investing in the business software company, whose value may exceed $9 billion.


Sales

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McLeod Health (SC) chooses Cerner Millennium and HealtheIntent to replace its Invision and Soarian systems in seven hospitals.

Prime Healthcare chooses Santa Rosa Consulting for Epic go-live support at its 43 hospitals, with the first wave of activations scheduled for October 1.


People

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Imprivata, fresh off the close of its acquisition by Thoma Bravo, names Gus Malezis (Tripwire) as president and CEO. He replaces Omar Hussain, whose plans were not announced. 

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Verscend Technologies (the former Verisk Health) hires Joe Morrissey (McKesson) as SVP of client services.

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Video visit vendor HealthTap names Dan Edmonds-Waters (Edmonds Ventures) as VP of strategy and global sales operations.


Announcements and Implementations

McKesson announces Intelligence Hub, which connects its reimbursement solutions to third party solutions and to each other in providing API management, identity and access management, and application service orchestration.

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ACOs using population health management solutions from Lightbeam Health Solutions delivered $84 million in savings to Medicare Shared Savings Program in 2015, the company announces.

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Oneview Healthcare will hire 100 employees in 2016, half of them assigned to its headquarters in Dublin, Ireland and the rest to its offices in the US, Dubai, and Australia.

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Craneware announces data transparency functionality to its chargemaster tools that allow organizations using integrated systems such as Epic and Cerner to view data in one place.

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St. Louis-based Ascension will organize itself into two divisions, with the Healthcare Division covering its hospitals and clinics and its Solutions Division running its IT services, group purchasing, and investment activities that are in some cases marketed to other healthcare organizations. The company will also name its 141 hospitals consistently with “Ascension” first to emphasize its national footprint.

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Surescripts will offer EHR vendors free access to its National Record Locator Service until 2019.

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Coordinated Care Oklahoma will integrate DrFirst’s Backline communication and collaboration tool into its HIE.


Government and Politics

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FDA announces the 2016 Naloxone App Competition, offering a $40,000 prize for an app that overdosing opioid users can use to connect with anyone nearby who is carrying the reversal drug naloxone. That’s both a creative technical solution and a sad commentary on America’s massive dependence on prescription and non-prescription narcotics.

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A team from CMS’s Center for Clinical Standards and Quality wins the Federal Employee of the Year category in the annual Service to America (Sammies) awards.

The FDA, under pressure from well-organized and impassioned patient advocacy groups, approves a muscular dystrophy drug against the recommendation of experts who say there’s no evidence it works. Shares of Serapta Therapeutics — which offered as evidence only one poorly designed trial involving 12 patients — soared on the news, not surprisingly given that the new drug will cost $300,000 per year.


Privacy and Security

From DataBreaches.net:

  • A New Zealand medical resident is fired for obtaining information from the local health boards on two members of his family, which he then used as evidence in a court case against them.
  • Four former New York nursing home aides are charged with felonies for taking iPhone pictures of residents in undignified positions and filming themselves verbally and physically tormenting a resident, with some of the images being posted to Facebook.
  • A cybersecurity firm’s brute force scan of Internet-connected FTP servers finds at least 800,000 that can be accessed without logging in.

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The quarterly threats report from McAfee Labs notes that hackers are targeting hospitals with ransomware because their legacy systems have weak security, employees don’t have much awareness about security, workforces are fragmented, and hospitals value immediate access to information above everything else. Interestingly, it reports that many hackers consider hospital hacking as violating the unwritten hacker code of conduct, with others worry that the resulting publicity will result in a backlash against Bitcoin. A ransomware author and distributor provides Bitcoin account screenshots that apparently prove that he raked in $121 million in just six months.

A man protests that a Montana law requiring renters to get permission from their landlords before growing medical marijuana for their own use is a HIPAA violation since it forces him to reveal medical information to a third party. Like many under-informed people (some of them in healthcare), he is mistaken in thinking HIPAA broadly guarantees medical privacy rather than requiring only that covered entities practice it (providing a roof over his head doesn’t qualify his landlord as a “covered” entity).


Technology

MIT researchers develop the experimental EQ-Radio, which uses wireless,room-based heartbeat and breathing sensors to analyze an individual’s mood with 87 percent accuracy.

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McKesson CIO/CTO Kathy McElligott says that analytics and blockchain are the rising trends that most interest the company.


Other

Microsoft says it is working to “solve” cancer by using technology to individualize cancer treatments and analyze tumor images.

Apple hires Mike Evans, MD, a Toronto family practitioner best known for his five-year series of YouTube health cartoons. He declines to provide specifics about his new job, but says it involves his ability to convey a message. He describes the future of healthcare as:

I think the way we engage people will totally change. What happens now is I see you. Let’s say you have high blood pressure. I prescribe you a pill for that. I see you two or three times a year. In the future, I’ll prescribe you an app. One of our whiteboards will drop in and explain what high blood pressure is. The phone will be bluetoothed to the cap of your pills. I’ll nudge you towards a low salt diet. All of these things will all happen in your phone. I see you two or three days a year. The phone sees you every day.

A federal labor judge awards $216,000 to two laid-off CSC employees turned whistleblowers who had complained in 2012 that the company’s occupational medicine EHR could not accurately track patient health risks. CSC went live with the system despite  acknowledging the problem, after which the employees were suspended for colluding with one of CSC’s subcontractors. The judge called CSC’s arguments “an astonishing display of chutzpah” given that the company couldn’t say what information the employees were supposed to have shared,  could not identify who suspended them, and withheld the special pay it promised the employees for the extra hours required to bring the EHR live.

In South Australia, the Allscripts Sunrise EPAS system is blamed for losing computer entries and thus not allowing a hospitalized dementia patient’s death to be reported to the coroner as the law requires. The health minister says the system is being urgently upgraded to highlight deaths that occur while undergoing treatment.

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In England, Leeds Teaching Hospitals NHS Trust diverts patients after a computer problem leaves it unable to report pathology lab test results.

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Drug companies that sell opioid painkillers have unleashed an army of lobbyists and donated millions of dollars to political campaigns in trying to protect their profits by defeating proposals that would restrict the prescribing of narcotics. The companies are funding non-profits, including the American Cancer Society’s Cancer Action Network, that advocate narcotics-friendly policies. Drug companies even strong-armed the passage of a Maine law that they themselves wrote that requires insurance companies to pay for their particular painkillers.

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A rural hospital in Iowa complains that it can’t always reach its doctors by telephone and patients who call the hospital for appointments don’t always get through. The problem is caused by the patchwork system of telephone carriers required to deliver calls to rural America, with big telephone companies sometimes electing to simply drop a call rather than pay a rural carrier an amount that would leave it with no profit.

In Australia, NSW Health pledges to implement chemotherapy dosing guidelines in its systems following the under-dosing of at least 130 patients by a “fly-in, fly-out” oncologist who responded to a pharmacist’s questioning of doses with, “Tell them to mind their own business.” The doctor argues that oncology dosing guidelines are often outdated and says he used lower doses to reduce toxicity.

A Validic survey of drug companies finds that 60 percent have used digital health technologies in their clinical trials and 97 percent expect their use of such tools to increase.

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Epic UGM is underway in Verona, WI this week, with attendees and others tweeting some photos.


Sponsor Updates

  • Forward Health Group is sponsoring the Best Practices for Value-Based Care conference September 21-22 in Dallas, TX.
  • Aprima will exhibit at the American Academy of Pain Management annual meeting September 22-24 in San Antonio. The company also completes its move to new headquarters in Richardson, TX.
  • Aventura will exhibit at Health 2.0 September 25-28 in Santa Clara, CA.
  • GE Healthcare will invest €150 million to establish a biopharmaceutical manufacturing campus and advanced manufacturing training center in Ireland.
  • TeleTracking President Michael Gallup testifies before the House Ways and Means Subcommittee on Health.
  • Clinical Computer Systems will integrate its Obix Perinatal Data System with Medhost.
  • Impact Advisors is named to Modern Healthcare’s Largest Revenue Cycle Management Firms.
  • Besler Consulting releases a new podcast, “What the end of the ICD10 grace period means for your hospital.”
  • CapsuleTech and FormFast will exhibit at the InSight McKesson User Group Conference September 27-28 in San Antonio.
  • CoverMyMeds sponsors the Columbus Women in Technology Conference.
  • Cumberland Consulting Group will exhibit at HFMA’s Revenue Cycle Conference September 25-27 in Phoenix.
  • ECG Management Consultants will exhibit at the West Coast ASC Seminar September 27 in Los Angeles.
  • Built in Austin profiles E-MDs CTO Alan Ortego.
  • Extension Healthcare will exhibit at the AAMI Regional Event – Hot Topics in Clinical Care September 27-28 in Chicago.

Blog Posts


Contacts

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

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September 20, 2016 News 6 Comments

Monday Morning Update 9/19/16

September 18, 2016 News 1 Comment

Top News

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Appalachian Regional Healthcare brings the computer systems of its Kentucky and West Virginia hospitals, pharmacies, and clinics back online after nearly three weeks of downtime caused by an attack of unspecified malware. At least one hospital source says the attack involved ransomware, but the hospital declined to confirm citing an ongoing federal investigation.

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ARH says its IT department took its systems and network down to stop the spread of the virus, causing downtime it described as causing “some inconvenience for a few weeks.”


Reader Comments

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From Follow the Money: “Re: Mayers Memorial Hospital District (CA). Their EHR was down for two weeks at a cost of $100,000.” The forwarded board of directors meeting agenda did not indicate the source of the downtime, but says half of the $100,000 was spent on “equipment to mitigate future issues.” I don’t know which system was down, but an earlier board meeting agenda mentions Paragon. It’s fun to read a small hospital’s simply written meeting information, which includes such interesting thoughts as an upcoming chocolate festival fundraiser, the poor attitudes of the ED doctors, a sticky ED door that unintentionally left the department open to the public, and the development of an IT disaster backup solution that might need to be revisited.

From HTCGLOBAL: “Re: CareTech Solutions. Jim Giordano is no longer president and CEO as of this past Friday. Seven top executives have resigned in the past six months. HTC Global continues to offshore work.” Unverified, but the company’s executive page and Giordano’s LinkedIn profile are unchanged. HTC Global Services, which offers IT and BPO services, bought the company in December 2014.

From Ex-PwC Consultant: “Re: PricewaterhouseCoopers Advisory Services. Has been quietly laying off workers all summer, with rumors of 20-25 percent let go.” Unverified.


HIStalk Announcements and Requests

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Nearly half of poll respondents think the most important healthcare issue in the presidential election is healthcare costs. New poll to your right or here: who would you vote for if the presidential election were held today?

I’m excited to offer (below) the first of an ongoing series I’m calling Decisions. I’ve been talking with the folks at Definitive Healthcare about getting fresh updates about hospital software decisions and the company graciously offered to share what they learn with HIStalk readers. They didn’t even ask for anything in return, not even a plug, but it’s only fair to credit them as the source.


Last Week’s Most Interesting News

  • HHS awards $87 million in EHR improvement grants to 1,310 safety net health centers.
  • Altos announces that it will acquire Anthelio Healthcare Solutions for $275 million.
  • McKesson withdraws its participation in the independent InSight user group conference after Meditech and Cerner are invited to present alternatives to McKesson Paragon.
  • Russian backers breach the World Anti-Doping Agency’s systems and publish the medical records of Olympic athletes.
  • Apple releases iOS 10, which includes C-CDA support via HealthKit.
  • In England, NHS awards $13 million each to 12 health IT global exemplars to establish best practices.
  • Dartmouth-Hitchcock Medical Center (NH) will lay off 460 employees, blaming its financial losses on billing-related expenses and implementing of new IT systems.

Webinars

September 27 (Tuesday) 1:00 ET. “Put MACRA in your Workflow – CDS and Evolving Payment Models.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Money-losing, for-profit hospital operator Community Health Systems is rumored to be exploring the sale of its business, although the company’s massive debt may limit interest. Shares are down 76 percent since June 2015 even after a 16 percent jump Friday when word of the possible sale leaked out. The company operates 158 hospitals.


Sales

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The Healthix HIE (NY) chooses Verato’s identity management technology, which claims to deliver up to 98 percent matching accuracy by comparing known information to that contained in commercially available databases. The VA is another customer. Verato raised $12.5 million in a single funding round in January 2015 under its original name Araxid.


Decisions

  • Blue Mountain Hospital District (OR) will change time and attendance software from Healthland to ADP on October 1, 2016.
  • Valley Hospital (WA) will switch from Meditech to Cerner in 2017.
  • Lakes Regional General Hospital (NH) will move from NextGen to Cerner in December 2016.
  • Saint Clare’s Hospital – Denville (NJ) will replace Cerner with Epic in early 2018.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.


Announcements and Implementations

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In England, Cambridge University Hospital NHS Foundation Trust will outsource its IT infrastructure services for an estimated $182 million over seven years. HPE provides those services now via a 10-year agreement signed when the trust chose Epic in 2012. The trust’s growing financial deficit and significant quality problems triggered the resignation of its CEO and finance director in September 2015.


Government and Politics

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The National Institutes of Health will require drug and medical device companies to post the results of all NIH-funded clinical studies – not just the favorable ones – to ClinicalTrials.gov starting January 18, 2017.

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Oracle will pay $25 million in cash and provide products worth another $75 million to settle lawsuits over its performance in the failed Cover Oregon insurance exchange, for which Oracle was originally paid $240 million. The state had sought $6 billion in damages, but wasn’t willing to take the case to trial since legal fees alone would have run $1.5 million per month and it had already paid lawyers $20 million in the several lawsuits each party filed against the other.


Privacy and Security

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Forward Health Group’s security expert Ed Skaife is named Up and Comer Runner-Up in an international security leadership award competition.


Other

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The three big drug companies that manufacture insulin have increased average prices more than tenfold in the past 20 years in lockstep, with all three companies expressing indignation that anyone would look at list prices since insures get big discounts. The chart above shows the price of Humalog and Novolog, but you would notice that only with sharp eyesight since the prices remained identical while rapidly increasing over 20 years.

Vince and Elise offer Part 7 of their “Rating the Ratings” series, this time looking at physician practice EHRs.


Sponsor Updates

  • Experian Health will exhibit at the RBMA Fall Educational Conference September 25-27 in New Orleans.
  • PatientMatters will exhibit at the Minnesota Hospital Association Annual Meeting September 21-23 in Brainerd.
  • Qpid Health, Sagacious Consultants, Versus Technology, and Zynx Health will exhibit at Epic’s UGM September 21-23 in Verona, WI.
  • Red Hat announces plans for new facility in Boston.
  • The SSI Group will exhibit at the AMSURG Connections Café September 28 in Lake Buena Vista, FL.
  • Sunquest Information Systems will exhibit at CAP’16 – The Pathologists Meeting September 25-28 in Las Vegas.
  • Surescripts will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Audacious Inquiry is sponsoring the SHIEC Annual Conference in Scottsdale, AZ this week.
  • Meditech will attend the 2016 InSight Annual Conference September 27-30 in San Antonio, TX.
  • TeleTracking sponsors The DAISY Award for Extraordinary Nurses.
  • Tierpoint will host Techpalooza September 22 at its facility in Durham, NC.
  • Valence Health will exhibit at the ASHHRA annual conference September 24-27 in Grapevine, TX.
  • Verscend will host its annual conference September 27-30 in Palm Desert, CA.
  • Consulting Magazine includes Huron on its list of 2016 Best Firms to Work For.
  • Healthwise is included in Fortune’s “100 Best Workplaces for Women.”
  • ZeOmega launches the ZeExchange e-newsletter.
  • ZirMed will exhibit at HBMA The Healthcare Revenue Cycle Conference September 21-23 in Atlanta.

Blog Posts


Contacts

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

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September 18, 2016 News 1 Comment

News 9/16/16

September 15, 2016 News 12 Comments

Top News

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HHS will provide $87 million to 1,310 safety net health centers for purchasing or upgrading EHRs, supported by the ACA’s Community Health Center Fund that was extended under MACRA.

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HHS reports that 98 percent of health centers use EHRs. Nearly three-fourths of the patients they serve are insured.


Reader Comments

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From Lana Retentive: “Re: Charleston Area Medical Center (WV). Goes live this week in the first prominent Soarian to Millennium conversion that was supposed to have been completed in June. The go-live vendor has been asked to bring in SMEs in charging and patient accounting, but no word on whether they’re using a charge validation vendor.” Unverified.

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From Xander Steel: “Re: startups. You told the would-be CEO that HIStalk readers won’t be interested in companies until they reach either $1 million in funding or $5 million in revenue. I’m not really interested in stories about capital raised when there’s no existing demand. Any chance when you disclose investment funding that you can also mention whether the company has actual revenue? I know it’s easier said than done since the companies aren’t publicly traded.” I don’t know how to get revenue information since those small companies rarely want to disclose it (which tells you that it’s likely minimal) and their numbers would be self-reported and unaudited anyway. My newsworthiness threshold of $1 million in funding is low enough that many companies can raise that much without having any paying customers, which doesn’t necessarily mean you would be wise to become one. Significant funding suggests that investors with access to inside information bought in for good reason, but that might be based on future opportunity rather than present revenue (much less profit).

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From Doughboy: “Re: Epic. Can you believe that a publication ‘reported’ that the company’s R&D spending exceeds Silicon Valley companies without doing any type of verification?” I believe it. The obviously star-struck publication ran Judy Faulkner’s claim that Epic spends 50 percent of operating expenses on R&D without validating that number, then compared it to the SEC-filed data of Epic’s publicly traded competitors in trying and failing to make a point without letting those companies respond. The goal was obviously to earn clicks, not to provide useful information.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor InMediata. The Charlotte, NC-based company‘s InBanking payment reconciliation solution eliminates manual ERA payment and patient payment reconciliation to bank deposits; automates complex billing scenarios by splitting ANSI 835 files into separate billing systems; and converts paper payments to electronic files for posting and reconciliation. CEO and industry long-timer John Marron explained the “banking as the last mile” problem well when I interviewed him a few months ago, pointing out that while front-end RCM functions are mostly automated and clearinghouses have become commoditized, the back-end work (payments, reconciliation, and payment analytics) is mostly inefficiently manual. Thanks to InMediata for supporting HIStalk.

This week on HIStalk Practice: Medical associations weigh in on new MACRA options. The Maine Medical Association endorses DrFirst eRx solutions. AMD Global Telemedicine expands Massachusetts headquarters. Mediware adds PQRS reporting capabilities to its rehab EHR. Lynchburg, VA-area practices join Privia Medical Group. CompuLink gets into telemedicine.

This week on HIStalk Connect: Sanofi and Verily Life Sciences launch diabetes management company. Chrono Therapeutics raises a $47.6 million Series B. Frost & Sullivan recognizes Validic with an innovation leadership award. Samsung-backed smart belt startup raises more than double its Kickstarter goal.

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I’m beginning to think that a significant percentage of health IT executives sport disfiguring facial injuries or were raised in Amish families considering that their graven image is nowhere to be found on the Internet, including on their LinkedIn profiles. I frankly distrust people whose photos aren’t available online. It’s only slightly better when someone shrinks their LinkedIn photo in failing to understand that the right process is to use a full-sized image and let LinkedIn thumbnail it automatically, which doesn’t seem too far beyond the understanding of technology executives.


Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Huron Consulting Group renames itself to Huron.

Team messaging vendor Klara, which describes itself as “a professional WhatsApp for medicine,” raises $3 million, increasing its total to $5.5 million. The company pivoted from teledermatology software to messaging just a few weeks back. It did not inspire my confidence that the company’s website was down all day Thursday as I tried to learn more.

In Germany, officials reportedly raid the offices of eight drug wholesalers, including McKesson, to determine if they illegally conspired to avoid stealing each other’s customers.

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A federal judge allows Cave Consulting Group’s antitrust lawsuit against OptumInsight to continue. CCG says OptumInsight, owned by UnitedHealth Group, controls 90 percent of the claims grouper software market only because the company it acquired in 2003, Symmetry Health Data Systems, lied on its patent application. UHG agreed in April 2015 to pay CCG $12 million for infringing on its patents.

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A Network World review of the 500 largest publicly traded companies finds that 25 of them disclose CIO pay. On their list is former Kaiser Permanente CIO Phil Fasano, who joined insurer AIG in the newly created position of EVP/CIO in late 2014 and was paid $8.4 million in 2015 as the #3 top earner. Walgreens Boots Alliance CIO Tim Theriault took the #1 spot with $13.6 million.


Sales

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Vigilance Health (CA) chooses population health management technology from EQHealth Solutions for chronic care management and care coordination programs in 51 California counties.

Nebraska Medicine chooses and implements Nuance Dragon Medical One for clinical documentation in Epic, with 94 percent of its surveyed doctors saying it helps them practice better medicine, 71 percent reporting that their documentation has improved, and 50 percent saying Nuance saved them at least 30 minutes per day.


People

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Julie Boughn (Cognasante) joins Audacious Inquiry as senior director.

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CTG promotes Angela Rivera and Robert Barras to vice president.


Announcements and Implementations

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The Department of Defense approves the participation of Fort Drum Medical Department Activity (NY) with the HIE of HealtheConnections, which will combine the military’s medical records of soldiers and families with those contributed by 300 connected civilian facilities to create a single overall view.

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Harvard Medical School launches Library of Evidence, which offers free, evidence-based imaging clinical decision support that can be embedded in EHRs to help clinicians choose the most appropriate imaging tests.

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Lenovo Health and LifeMed ID partner to offer an identity management solution that includes a trusted patient ID token that links to medical records. According to Lenovo Health’s website, providers can “achieve 100% accurate.”

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National Decision Support Company will offer cardiac imaging appropriate use criteria from the American College of Cardiology.


Government and Politics

Eight Republican senators that include HELP committee chair Lamar Alexander (R-TN) introduce emergency, one-year legislation that would eliminate ACA-mandated penalties for those who don’t buy health insurance and would allow consumers who are covered by exchange-issued plans to use their federal government premium subsidies to buy plans elsewhere.


Privacy and Security

From DataBreaches.net:

  • A dental practice whose patient information was exposed to the Internet explains the odd situation: (a) the practice gave live patient data to a vendor whose system it was considering; (b) the practice decided that same year not to buy that system; (c) the vendor took the server offline in 2004; and (d) somehow the server (now unsecured) was brought back online 10 years later for a two-week period in 2014 during which the practice’s patient information was exposed.
  • The Dark Overlord (or other hacker claiming to be him) threatens to publish patient information from St. Francis Health System (OK) unless it pays $15,000 by Sunday.
  • A single ransomware author claims to have made $94 million in profit during the first half of 2016.

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A legal preview of patient and provider class action lawsuits brought against Banner Health (AZ) following a breach of its food service point-of-sale systems that exposed the information of 3.7 million people raises these issues:

  • The plaintiffs don’t know whether hackers actually accessed or used the information, only that they might at some point.
  • The suit does not claim breach of contract, which doesn’t always work in breach lawsuits, and instead argues that Banner made an enforceable promise without consideration (promissory estoppel).
  • The plaintiffs argue that Banner didn’t notify them promptly.
  • The case uses recent FTC enforcement actions to claim that Banner violated the FTC act that says lax cybersecurity constitutes “unfair or deceptive acts.”

Technology

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Accenture announces a health IT innovation challenge tied to its venture fund.

BSX Athletics launches a Kickstarter campaign to fund its LVL wearable hydration monitor. It has raised $200,000 vs. a goal of $50,000 and is a smart idea that apparently actually works, although Kickstarter projects are notorious for failing and not everybody wants to wear a one-trick wristband 24/7 .


Other

An HHS OIG report finds that for-profit hospices are aggressively recruiting patients who aren’t terminally ill and who may not know that choosing palliative care means they won’t receive other treatment. Medicare paid $15 billion for hospice care in 2013 and is trying to recover $1 billion from for-profit hospices in which one in three patients leave the service without dying, double the rate of non-profit hospices. In Mississippi, 41 percent of hospice patients were discharged alive. 

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Former New York City Mayor Michael Bloomberg donates another $300 million to the Johns Hopkins Bloomberg School of Public Health, saying the US should lead the world in life expectancy instead of placing 31st. Bloomberg has donated $1.5 billion to Hopkins, of which the School of Public health received $684 million, explaining, “It’s a lot cheaper to prevent than to cure, and it’s certainly a lot more humane.”

A man who had been hospitalized for 22 years with spinal muscular atrophy dies at 54, to the consternation of employees who had grown attached to him. It would be interesting to see the final bill and to know who’s paying it.


Sponsor Updates

  • Impact Advisors and NTT Data make Consulting Magazine’s list of “Best Small Firms to Work For.”
  • InterSystems and Intelligent Medical Objects will exhibit at the Epic UGM September 21-23 in Verona, WI.
  • PDR Network CMO Sal Volpe, MD receives the 2016 Patient-Centered Medical Home Practice Award.
  • Live Process will exhibit at California Hospital Association Disaster Planning 2016 September 19-21 in Sacramento.
  • Nordic is named one of Madison Magazine’s best places to work.
  • Vyne President and CEO Lindy Benton presents at the HERe Conference in Nashville.
  • AlleyWatch spotlights MedCPU in its coverage of New York City startups that have raised the most amount of money.
  • Meditech and Nvoq will exhibit at AAFP’s Family Medicine Experience September 20-24 in Orlando.
  • Navicure will exhibit at Kansas MGMA September 21-23 in Overland Park.
  • Netsmart will exhibit at the Kansas Public Health Association conference September 20 in Wichita.
  • Nordic will host an open house September 19 in Madison, WI.
  • Obix Perinatal Data System will exhibit at the Georgia Perinatal Conference September 21-23 on St. Simon’s Island.
  • Infor Healthcare will exhibit at ASHHRA 2016 September 25 in Grapevine, TX.
  • Clockwise.MD will exhibit at the UCAOA Fall conference in Nashville September 29 – October 1.
  • Christy Kaplan and Susan Tolan of The Chartis Group presented “Transforming Care Coordination: Keys to Operationalizing Your Pop Health Strategy” at the HIMSS Population Health Forum this week.

Blog Posts


Contacts

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

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September 15, 2016 News 12 Comments

News 9/14/16

September 13, 2016 News 1 Comment

Top News

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France-based consulting firm Atos will acquire Anthelio Health Solutions for $275 million. The announcement states that Dallas-based Anthelio’s annual revenue is $200 million and that its owners are a London investment firm as well as McLaren Health Care Corporation (MI), Anthelio’s largest customer.

Anthelio CEO Asif Ahmad will stay on to lead the new company’s US healthcare practice. The former PHNS changed its name to Anthelio in early 2011.

The acquisition was accurately reported here on August 12 via a rumor report from HIT Enthusiast that Anthelio did not acknowledge when I inquired.


Reader Comments

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From Tired CIO: “Re: InSight conference. The independent McKesson user group has invited Meditech and Cerner to attend its annual meeting in case someone wants to talk to them about replacing Paragon.” A forwarded email from McKesson says InSight’s board didn’t let the company know until September 7 that it was bringing in Cerner and Meditech as co-sponsors of the user group meeting. The McKesson email adds that having competitors in attendance makes it impossible to share the company’s proprietary information with the group, so it is pulling out of the conference. McKesson adds that it is considering extending its own user forums that run concurrently in San Antonio to include everything it had planned for InSight. It’s also creating its own user group.

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From Mimsey: “Re: InSight conference. McKesson is expected to make an announcement Wednesday about the disposition of its Enterprise Information Solutions, which includes Paragon. Meanwhile, people aren’t happy that the company won’t be presenting at InSight.” At least one attendee says they may just cancel their non-refundable travel since they spend 90 percent of their InSight time attending McKesson-led sessions and workshops and it’s not worth it since McKesson isn’t coming. That person questions why Cerner and Meditech needed to be invited to the conference since they would happily travel to any prospect’s site to do demos without having to meet them at InSight. I have to agree with that attendee – even though McKesson has burned a lot of healthcare IT bridges and is about to leave its customers in a lurch of unknown dimensions, it’s unreasonable to expect McKesson to attend the meeting with its competitors who were invited specifically to pitch to its customers. Attendees got shafted once by McKesson and now by their user group. The InSight board should admit that it made a bad decision and un-invite Cerner and Meditech in trying to make up with McKesson one last time to salvage their conference. I doubt McKesson is really going to create its own UGM since it will be dumping all of the products into the new company formed with Change Healthcare anyway, so nobody will care about McKesson a year from now. Meanwhile, we’ll see what happens the morning of September 28 at the InSight session titled “EIS Roadmap.”

From Startup CEO: “Re: my startup. I would love to get a mention on HIStalk.” OK, here’s your mention, in the form of a list: (a) a one-person consulting company isn’t a startup since ‘startup’ implies impressive investment, momentum, and a team with ambitious goals; (b) you aren’t a real CEO if you’re the only employee; and (c) HIStalk readers won’t care about your company until it hits either $1 million in funding or $5 million in revenue (and maybe not even then).


HIStalk Announcements and Requests

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I was surprised to receive an oddly worded bulk email from Black Book that included screen shots from the “Rating the Ratings” series Vince and Elise did. While I’m happy to be called “the industry’s objective health information systems resource,” let the record show that I wasn’t asked for permission, I didn’t actually rate anyone (Vince and Elise did that), and while I’ve run surveys in the past whose methodology and response rate I was proud of, this one wasn’t one of those – it was informal, not validated, and self-selected.

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Medicity was the first HIStalk sponsor going back to 2004, so when they asked if I would be willing to return the favor and sponsor their Client Summit being held this week by providing pens and pads, I said sure (I just now realize  the irony of giving digital health attendees old-fashioned pens and paper). I’m always scrounging at the HIMSS conference exhibit hall to get a (rare) notepad to go with the (ubiquitous) pens, so hopefully someone found the matching set useful.

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Welcome to new HIStalk Platinum Sponsor Infor. The New York City-based company delivers industry-leading, healthcare-specific solutions used by 5,000 organizations in 30 countries (including 72 percent of US hospitals larger than 150 beds) to integrate, plan, track, and manage vital assets such as people, supplies, clinical data, relationships, and financial resources. On-premise or cloud-based solutions support human capital management, financial management, patient-centered supply chain management, enterprise performance, relationship management, business intelligence and analytics, and clinical interoperability. Thanks to Infor for supporting HIStalk.

I found this overview of Infor CloudSuite Healthcare on YouTube.

Listening: the impressively remastered  (for the second time) the Beatles “Live at the Hollywood Bowl,” a fascinating audio memento of the band’s 1964 and 1965 concerts there. I’m sure today’s listener can hear the music better than the four lads back then given the insane fan screaming that overcame their primitive audio equipment but is nicely dialed back here. They sound surprisingly talented, warm, and tired but enthusiastic, just the way they should be remembered 50 years after their final August 1966 live performance in San Francisco after conquering the world by their early 20s. Also: new from Madison, WI-based Garbage, whose heavy-with-hooks sound is hard to categorize and equally hard to listen to without desk-drumming.


Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Bedside patient engagement technology vendor Lincor Solutions will merge with its Australia-based distributor to form Lincor Limited, which will be listed on the Australian Securities Exchange. Lincor CEO Chris Cashwell will be CEO of the new company.The Hills Health Solutions business generated $23 million for publicly traded parent company Hills Ltd. in the most recent financial year.

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Surgery workflow management technology vendor ExplORer Surgical raises $1 million in a seed funding round. The company’s “surgical playbook” system was developed by University of Chicago, which is among its investors.

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Diabetes management app vendors Glooko and Diasend merge.


Sales

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Wise Health System (TX) chooses Allscripts Sunrise and CareInMotion.

Medical Center Hospital (TX) will expand its rollout of Spok Care Connect.

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Graham Health System (IL) chooses electronic patient signature and e-forms from Access.

Nebraska Medicine chooses Epic’s Healthy Planet population health management system.

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Palmetto Health (SC) will use Glytec’s eGlycemic Management System for the 40 percent of their hospitalized patients who require insulin. The system, which will integrate with Cerner, includes the Glucommander insulin dosing medical device, GlucoSurveillance to flag candidates for insulin therapy, and GlucoMetrics for monitoring key performance indicators.

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Carilion Clinic (VA) selects PeraHealth’s clinical surveillance solutions.


People

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Kit Check hires Gary Voydanoff (NextGen) as chief commercial officer.

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Oneview Healthcare names Seth Bokser, MD (UCSF) as chief medical officer and Lyle Berkowitz (Northwestern Medicine, Healthfinch) as special advisor on innovation.

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Imaging decision support vendor HealthMyne names Arvind Subramanian (Wolters Kluwer Health Clinical Solutions) as CEO and board member. He replaces Praveen Sinha, who remains on the board.

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Ingenious Med hires Joe Marabito (IkaSystems) as CEO. He replaces the retiring S. Hart Williford, who will remain board chair.


Announcements and Implementations

HIMSS offers to match the 12 just-named NHS digital health Global Exemplars with an international provider partner, which is a condition of the $13 million in funding. The announcement suggests that HIMSS wants to sell its EMRAM and CCMM benchmarking services to the newly funded trusts, which have committed to partner with organizations such as Cleveland Clinic and Mayo Clinic to  take advantage of their expertise.

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Pallav Sharda, MBBS, MMI, MBA publishes “Before Disrupting Healthcare: What Innovators Need to Know.”

Vital Images adds support for Nuance PowerScribe 360 and PenRad PenLung to its lung screening application.


Government and Politics

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ONC says 95 percent of US hospitals allow patients to view their information electronically, 87 percent allow them to download it, and 69 percent give patients the ability to view, download, and transmit the information. The information is self-reported by hospitals and therefore suspect based on the understanding of whoever filled out the AHA survey. I doubt that two-thirds of hospitals allow patients to transmit data via the Direct protocol or otherwise and I’m confident that very few patients have done so regardless. I say from experience that hospitals hold tightly onto the information they think is theirs, not the patient’s, and the HIM department or release-of-information vendors that are stuck in the 1960s guard those gates enthusiastically knowing that HHS OCR’s enforcement is indifferent.

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A group of Republican congressional committee chairmen questions CMS’s “pay and chase” practices, asking Acting Administrator Andy Slavitt to provide more information about how CMS’s Fraud Prevention System is being used.


Privacy and Security

From DataBreaches.net:

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  • Russia-based hackers breach the World Anti-Doping Agency and  publish the prescription information of US Olympic athletes. A group called Fancy Bears says it was shocked by “how Olympic medals are won” and will “start with the US team, which has disgraced its name by tainted victories.” I blurred the drug names on the file of tennis player Serena Williams above, but the hackers didn’t (the drugs were not performance-enhancing or even all that interesting, but I wouldn’t expect a hacker to know that).
  • Yuba-Sutter Medical Clinic (CA) notifies patients that it was hit by a ransomware attack on August 3. They say they regained access to their systems “relatively quickly,” but didn’t specify whether that was from restoring backups or paying off the hacker.
  • California-based occupational health provider US HealthWorks announces that a stolen laptop containing emails with patient information was encrypted, but apparently the employee had attached the password to the device.

Technology

HL7 chooses Bryn Lewis, PhD as the winner of its C-CDA viewer challenge.

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Apple released iOS 10 — which includes C-CDA support via HealthKit — on Tuesday and Duke Health (NC) announces that it will allow patients to download their MyChart portal data into Apple Health, where it can be shared with other apps.


Other

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Drug company Mylan, which enraged consumers with its never-ending EpiPen price increases, paid its five top executives $300 million over the past five years, more than competitors several times its size. The company, whose market cap is $22 billion, came in #2 behind Regeneron, which paid its top five executives more than $500 million.

A Health Affairs blog post co-authored by singer Barbra Streisand calls for researchers to include a representative number of women in their studies and to examine their data to see if findings have a gender-specific component. She says as an example that women’s heart disease is different from that of men, yet has not been as well studied or as consistently diagnosed.

BCS, The Chartered Institute for IT interviews Robert Wachter, MD about health IT, particularly that in England.

A reporter for the Tucson newspaper describes his first-hand experience watching Theranos CEO Elizabeth Holmes and the company’s lobbyists schmoozing state officials in convincing them to pass a law that allows consumers to order their own lab tests in Arizona and to allow Theranos to open wellness centers in Phoenix-area Walgreens stores. He summarizes:

This is where Arizona’s leadership fell down on the job: It failed to protect Arizona customers from a company that found the state an easy target in its zeal for deregulation. This wasn’t a company that was seeking tax breaks and incentives, which perhaps made their proposal an easier sale. What they needed was a law that gave them access to Arizona’s people.


Sponsor Updates

  • ComputerWorld profiles GE Healthcare’s move to a new transaction processing engine, and awards the company its Data+ Editors’ Choice Award.
  • HfS Research names Xerox a top business services provider in population health and care management as-a-service.
  • Aprima and Healthfinch will exhibit at AAFP’s Family Medicine Experience September 21-23 in Orlando.
  • Tech Week profiles Madison, WI-based Catalyze as part of its City Snapshot series.
  • LogicStream Health will host a wine tasting with appetizers for Epic UGM attendees on Wednesday, September 21 lakeside at Monona Terrace in Madison.
  • Besler Consulting produces a new podcast, “What to look for in the next generation of hospital finance professionals.”
  • The Tampa Bay Technology Forum includes CareSync in its list of finalists for its Technology Company of the Year Award.
  • CTG, Divurgent, and Healthwise will exhibit at the Epic UGM September 19-21 in Verona, WI.
  • Stella Technology will sponsor the SHIEC Annual Conference in Scottsdale, AZ September 18-21.
  • Healthcare Growth Partners advises Essette on its sale to HMS.
  • Cumberland Consulting Group becomes a sponsor partner of the HealthCare Executive Group and its annual forum being held this week in New York.
  • Healthgrades will present a session on launching startups internally during Denver Startup Week September 19.

Blog Posts


Contacts

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

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September 13, 2016 News 1 Comment

MACRA’s Marketing Problem

September 12, 2016 News No Comments

HIStalk digs into why provider awareness of MACRA is lacking and the likely impact it will have on their ability to stay in business.
By
@JennHIStalk

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The Medicare Access & CHIP Reauthorization Act has seen its fair share of headlines since it was introduced just before HIMSS15. MACRA’s implications for patients and providers contributed to a lot of the show-floor buzz in Chicago that year, while conversations around its potential for payment reform heated up even more in Las Vegas at HIMSS16. The release of a 962-page proposed MACRA rule in April provided fodder for industry media outlets, and last week’s release of four “pick your pace” options ahead of a final rule have no doubt eased the anxiety of many physicians fretting over the January 1, 2017 start date.

In short, it seems that MACRA has spent more than its fair share of time in the spotlight, leading many in the industry to assume that providers have been keeping up with its developments.

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The results of a Deloitte survey of physicians on MACRA awareness and preparedness (conducted before the proposed rule was released) tell a very different story. Of the 600 primary care and specialty physicians surveyed, 50 percent admitted to having never heard of the legislation, while 32 percent knew it only by name. Independent physicians were more aware of it than employed MDs, though not by terribly much at 21 versus 9 percent.

Where does this unawareness stem from? Have providers become so accustomed to regulatory delays that they no longer pay attention until implementation is just weeks away? Has CMS, for lack of a better phrase, shot itself in the foot when it comes to introducing legislation that providers automatically assume is too cumbersome to digest and apt to be postponed numerous times?

Providers who have attempted to keep the lights on through Meaningful Use, ICD-10, and now MACRA surely can’t be blamed for not keeping up with the latest reforms issued from on high. Or can they?

Too Busy to Take Notice

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“It’s not only physicians who have a lack of awareness,” explains Mitch Morris, MD, vice chair and a US global sector leader at Deloitte. “It really snuck up on the industry in general. Even now when we go in and do a briefing in the executive offices of a health system or payer, they say, ‘Wow, I didn’t realize all of that was in MACRA.’ It’s not very well understood. Unlike in the ACA, which had lots of publicity and everyone was dissecting it from Day 1, MACRA was thoroughly bipartisan and didn’t get a lot of [mainstream] publicity. The medical trade associations, the usual source of news for providers, just haven’t really been pushing this. On the surface, it sounds like a boring topic, but as you peel away the layers, you realize it’s going to be very impactful.”

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AMA Immediate Past President and emergency department medical director Steven Stack, MD says Deloitte’s findings line up with the association’s own from its physician focus groups. “I think the upcoming changes are difficult for many to absorb while they are fully engaged in the day-to-day work of their practices,” he says. “And, keep in mind that when the legislation was enacted in April 2015, physicians were told the new system would not be implemented until 2019. They had good reason to believe there was no hurry for them to get up to speed.”

“Finally, it is simply not possible for the AMA or anyone else to begin broadly disseminating detailed educational material until the final regulation is issued,” Stack says. “We have been developing resources intended to help physicians get ready, but really all they want to know is what the rules are. We just don’t have all the information yet.”

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Physicians working in the trenches of day-to-day care echo Stack’s observations. “I think most physicians would agree that the best use of their time and skill would be to simply treat patients and stop worrying about the endless administrative tasks of medical practice,” says Scott Mayer, MD, director of quality control at Today Clinic (OK). “Time to practice the art of medicine sounds so nice, but the reality is that being a physician these days requires so much time be spent outside of patient care that it has become increasingly difficult to keep up with so many changes in healthcare.”

“Patients need treatment now,” he emphasizes, “so unless a policy takes effect immediately, a lot of physicians don’t want to deal with it until it is absolutely necessary. I also suspect that many these days here the word ‘change’ and snort in disdain at the thought of something else that will further complicate their ability to practice medicine.”

University Physicians Group (NY) Medical Director and Aprima Chief Medical Officer Jeffrey Hyman, MD adds that lack of MACRA awareness on the part of employed physicians may stem more from the fact that once a physician is employed, the ‘business’ of running a practice becomes akin to background noise, outranked by patient care. “As an independent,” he adds, “you still have to worry about every issue of the practice of medicine to be successful and so attention is paid to every last detail.”

Today’s Diversions Trump Tomorrow’s Regulations

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The details diverting the attention of physicians away from MACRA preparation are numerous and probably well known to HIStalk readers. “For physicians in private practice,” says Mayer, “a considerable amount of attention, resources, and stress are focused on just getting paid for the services they provide. Decreasing reimbursement rates, more regulations, more paperwork, and the increasing costs of maintaining a profitable medical practice are sure to distract a lot of us. We are wondering what the future of medicine looks like while doing our best to provide quality care now, find joy in our work, and avoid burnout.”

Hyman puts burnout at the top of his diversion list, too. “It’s a big deal these days,” he emphasizes, “and non-physicians have difficulty with this concept. Treating patients takes a great deal of concentration on details of their histories and physical findings, ordering lab and radiology tests, and then putting all these facts together and coming up with a successful treatment plan. Also, the need to think about formularies, getting pre-authorizations, and dealing with call-backs, admissions, and labs coming in … and don’t forget the EHR and all of its messages coming in at a furious pace. It takes a great deal of attention and MACRA, when read, sounds like a future issue. It just seems distant.”

Hyman’s observations on EHR-related physician burnout, while nothing new, seem to continually be backed up by studies large and small. A prime example is an AMA-sponsored time and motion study released last week that found ambulatory practice physicians spend almost twice as much time working on the EHR or performing other desk tasks as seeing patients. Observed MDs spent only 27 percent of their available time in face-to-face interactions with patients.

The results aren’t surprising to Morris, who notes that for the third year in a row of Deloitte’s research, three out of four physicians will answer that EHRs take too much of their time and cost too much money. “As an industry, we still have a long way to go so that they feel they add value. We’re not where we should be with the vision of EHRs.”

Morris is quick to add that no matter their employed or independent status, the time and attention of physicians are increasingly spent dealing with tremendous reimbursement pressures. “There’s a lot of pressure to move from volume to value-based payment systems,” he explains, “where part of their income is placed at risk. That pressure has many physicians very, very anxious and, to some degree, angry. They’re not always sure who to be angry with, but they’re not happy about the situation that they’re in. Even though the economy has recovered and there’s more discretionary spending, there’s still a lot of screws being turned down on physician incomes.”

Passing the Buck

Morris brings up a good point with regard to the slow boil of physician’s anger at being put in a position that leaves them little time with patients and even less to deal with impending regulations like MACRA. It could be argued that numerous entities should be on the receiving end of that emotion – CMS, payers, trade groups, and vendors – even patients and physicians. Fingers will likely start pointing to these same groups once MACRA hits, no matter the chosen start date, and physicians realize they’re out of time and unprepared.

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“The industry has the obligation to educate and provide reasonable technology, tools, processes, and training to physicians to assist in the change management of MACRA,” says Kareo CMIO Tom Giannulli, MD, MS. “Those entities that contract with physicians should be very clear as to how their contracts will change. This includes CMS, which unfortunately does not communicate as well with physicians as they could, and based on their historical record, their deadlines are generally not respected. I would like to see them set up a website and online education program that requires each MACRA-participating physician to sign in and complete a half-day course on tech, tools, process, and regulation in order to continue their Medicare billing at full rate. There are a lot of other groups that have and can share a viewpoint, but those they contract with are the right source of information.”

Stack also feels that, while everyone has a role to play, CMS needs to reach out to provide simple tools and procedures to help physicians succeed. “They must strengthen their help lines and educate their staff so they can provide accurate information,” he adds. “CMS should also conduct train-the-trainer sessions and provide much more support to specialty societies to help them answer questions of particular interest to their members. Organizations like the AMA, state medical societies, and national physician groups can be very helpful by tailoring complex material more to the needs of their own members. Specialties, for example, can highlight quality reporting and CPIA activities that are most relevant to their audience, and so greatly simplify the learning process.”

“Employed physicians will likely be spared some of the specific tasks,” he adds, “and the need to be mindful of all the reporting deadlines, but there’s no doubt they will still encounter workflow and documentation issues.”

Hyman looks for MACRA guidance from Northwell’s dedicated group of staff already dealing with these issues and, as one would expect, UPG’s EHR vendor. “Aprima is also coding a great deal of information into their program to assist their doctors in getting this done successfully,” he adds.

Getting Started (but Preparing for Delay)

Hyman and his colleagues have been preparing for MACRA since it was first announced in 2015. “Our group of analysts, the Incentive Team , has begun the teaching process,” he says, “and we will interface between our physicians and the rules so it gets done in the most efficient way for our doctors. We will be ready with our team approach and help from our vendor, but understand that there most likely will be a delay as there was with ICD-10, Meaningful Use, and PQRS.”

Today Clinic staff, on the other hand, are just beginning their MACRA prep. “Our plan is to continue with our quarterly provider and staff meetings where we focus on things like MACRA,” Mayer explains, adding that he too wouldn’t be surprised if the start date was pushed back.

“Honestly, I don’t know how any practice can be prepared by January 1,” Stack says. “That is why the AMA and many others are recommending that the first reporting begin no earlier than July 1. Even compiling truly useful and accurate educational material by January is a heavy lift since we don’t expect to see a final rule until sometime in October and perhaps even as late as November 1. There is nothing in the MACRA statute that sets the start date for reporting, nor is there anything in the statute mandating that the reporting period be set at a full year, so CMS should have flexibility to begin at a later date.”

No matter the start date, Stack believes that, to get off on the right MACRA foot, physicians should first assess how they are performing under current programs since the new MIPS program will be based on those. “They also should begin exploring what qualified clinical data registries are available to them,” he adds, “since this is a new reporting vehicle that could simplify processes for them as well as yield more clinically useful feedback data.”

Morris has similar suggestions, but admits that, “You’d be hard-pressed to get everything in place by January 1 unless your organization already had a lot of this stuff in place and was just tweaking around the edges. I think the analytics capabilities and understanding your costs are difficult things. Even large health systems, which spend a lot of money on those things, struggle. Measuring my quality, having the data necessary to do that, and having the information necessary to understand my costs … I would include all of those as the biggest challenges to getting started with MACRA.”

Gauging the Likelihood of MACRA Success

MACRA’s marketing problem will eventually be a thing of the past. Delayed by choice or not, the program will be here sooner rather than later and physicians will have to make up their minds as to whether participation will be done with enthusiasm, trepidation, or opted out of altogether. MACRA will soon make clear just how painful a process it is for healthcare to move from fee-for-service programs to value-based payment systems.

“Money always talks,” says Mayer, “but to be honest, I am disappointed when the focus of policy changes or the support of policy changes is dependent on the money that will be generated, saved, or lost as a result. While it is very important to consider these things carefully, I worry that we don’t consider as thoroughly the impact such changes have on patients. Despite the intention of programs like MACRA to improve the quality of patient care, it may be hard to convince physicians to participate more for that reason than to avoid fines, decreased reimbursements, or for a promised bonus. Education, support, and follow-ups will be vital, which I think CMS is good at. What I hope to avoid is the need for more support staff to understand, implement, and maintain MACRA.”

Morris puts the move to value, which one could argue started long before MACRA was introduced, in perspective: “These are baby steps. The ACA was a step. Some of the initiatives after were steps. MACRA is another step. In many ways, this is the biggest step we’ve taken so far. I think the devil will be in the details of how well it’s executed. It’s one of those things that looks good on paper. Let’s see how it really works out.”


More on MACRA: Apples, Oranges, and Start-Date Changes

Most industry insiders familiar with MACRA seemed confident that the program’s start date will be delayed. Even CMS Acting Administrator Andy Slavitt hinted at that likelihood, and has since taken steps to ease the pain of participation with start-date options. The industry’s confidence in a delay is easy to understand, given that federal regulatory delays seem to have become the norm rather than the exception. Who can forget the beleaguered roll out of ICD-10? The anticipation of a MACRA delay lends itself to a comparative look at ICD-10.

“They’re definitely in the fruit category together,” says Mitch Morris, when asked if comparing the two is akin to looking at apples or oranges. “ICD-10 was a big change that was, for the most part, not welcome and being driven by the government. That’s definitely something they have in common. As you know, ICD-10 got delayed a couple of times before it was finally implemented, but it did really require some significant changes in office practice. If done well, it shouldn’t have had a negative impact on practice income.”

Morris adds, “With MACRA, also pushed by the government, there’s no formal sign of a delay, but as we learned from ICD-10, that can change with pressure applied to the appropriate places. MACRA has the potential to really change a physician’s income up or down, particularly those in independent practice, and particularly those who have a lot of Medicare patients. It will certainly change the dynamic, especially given the requirements and infrastructure necessary to participate.”

However, Steven Stack sees no similarities whatsoever. “I think this is entirely different,” he says. “ICD-10 in many ways was a simpler issue. It was a replacement for the already existing ICD-9 mandate. The ICD-10 issue focused on the need to be more detailed in documentation providers were already doing, in training their staff, and in lack of confidence that claims would be processed in a timely manner. Physicians were being told to keep enough money in reserves to cover their payroll and office expenses for six months due to anticipated claims payment delays. Physician practices don’t normally have that kind of cash on hand, and it was very alarming.”

“MACRA is largely about modifying an already complicated Medicare physician payment system, and then adding on new requirements for those who participate in advanced payment models,” Stack says. “There are a lot of changes happening at once all across the payment system. Quality reporting and meaningful use of EHR requirements are changing. A whole new method of measuring and comparing resource use has been proposed, new clinical practice improvement activities need to be identified and documented, and so forth. This transition will be far broader and much more complicated than the move to ICD-10.”

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September 12, 2016 News No Comments

Morning Headlines 9/12/16

September 11, 2016 News No Comments

New plans to expand the use of digital technology across the NHS

The NHS names 12 health IT “global exemplars” that will receive $13 million in health IT funding to establish best practices and a new digital health academy.

ARH continues to dodge questions on computer breach

Appalachian Regional Healthcare (WV) responds to a local paper covering its ransomware-related computer outage by sending a legal notice explaining that if the paper continued to “deliberately publish statements which defame ARH, or cast it in a false light, we will have no other recourse but to consult with our attorneys in WV, to determine appropriate legal action."

The Ethics of Behavioral Health Information Technology

A JAMA article argues that flagging emergency department frequent fliers with special icons in EHR software is unethical and clinically inappropriate because it could influence the initial interaction in a way that might lead to biased diagnostic judgment.

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September 11, 2016 News No Comments

Monday Morning Update 9/12/16

September 10, 2016 News 12 Comments

Top News

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In England, 12 NHS trusts will receive up to $13 million each from the government as “global exemplars” that will lead the way for innovation, while another 20 will be given $6.6 million each as “national exemplars” to improve their own digital technologies. The announcements follow publication of an NHS digitization recommendations report created by an advisory board led by UCSF professor Robert Wachter, MD.

Health Secretary Jeremy Hunt also announces an expansion of NHS’s 111 non-emergency line to include triage service, publication of an NHS guide of approved health apps, re-launching the NHS Choices patient services website as NHS.UK with a new capability for patients to download their own records in a Blue Button-like fashion, and publishing trust performance data for specific health services.


Reader Comments

From Recent Epic: “Re: Epic’s succession plan. It’s for the best that Carl has taken over, although whether he has any desire to stay remains to be seen. Judy’s leadership is becoming increasingly erratic as she advocates finding ways to charge for APIs and web services, has wild swings of opinion on hosting services, makes rash decisions in trying to make international deals, pushes salespeople to start cutting deals on previously principled pricing and contract provisions, and most disturbing for the direction of the company, spends an increasing amount of time on buildings and events.” Unverified.

From Datapref: “Re: HIMSS Analytics. MU attestation made it easy to find out who has installed which products, with higher quality. Their ‘Logic’ rebrand intentionally makes it hard to export mass data and the UI is a mess. They have a long lag time (3-4 months) getting financial data updated after it’s been published by CMS, while Definitive, Billian’s and even AHA are less than one month.” Unverified. HIMSS Analytics still has the massive competitive advantage of being owned by HIMSS and thus being able to dole out to its paying customers HIMSS points that earn better exhibit hall booth locations. Personally, I’m not in favor of well-funded, theoretically non-profit member organizations recruiting corporate members while also selling them services and in some cases competing with them. I would be interested in seeing the latest 990 tax forms from HIMSS to see how much HIMSS Analytics brings in, but I haven’t found its latest filing so far.

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From Pippi Longstocking: “Re: Bob Wachter’s UK digitization report. His only informatics credential is having written an awful and extraordinarily slanted book, cherry picking information to fill in a predefined narrative. The UK report seems to be mostly written by consulting firms. I find it odd that Ross Koppel speaks to informatics, Christine Sinksy to burnout, Deborah Peel to privacy, Julie Adler-Milstein to safety, and now Bob Wachter to success.” It’s interesting to me that in the “Look Inside” preview of his book on Amazon (since I haven’t bought or read the book), Wachter says that David Brailer, MD, PhD, the first National Coordinator who was appointed in early 2004, hinted that President George W. Bush’s push for EHRs came about only because he was jealous of the billions England’s Tony Blair was spending on the ultimately failed NPfIT program. Wachter also says Brailer wasn’t in favor of creating the very ONC he was later tapped to lead, worried that the federal government’s smothering bureaucracy would stifle innovation. I don’t know about Wachter’s informatics expertise, but he’s a good writer.

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From Bunchy Donovan: “Re: iPhone announcements. Removing the headphone jack has healthcare consequences since that’s how some device-attached apps use it as a connector.” The change may well put some minimally successful app vendors out of business, which might be a good thing in a herd-thinning sort of way. Meanwhile, Apple will offer an alternative to those $4 non-Apple earbuds I use at the gym — the wireless and surely easily lost AirPods, which will cost $159 and will make the wearer look as douchebaggy as those people whose Bluetooth headsets are permanently implanted in their ears. I assume the AirPods came from the Beats by Dr. Dre line that Apple (over)paid $3 billion to acquire in mid-2014. Apple has transformed itself from solving problems I didn’t know I had to solving problems that  I actually don’t have at all. Your life is pretty darned good if you can allocate $159 (plus the cost of a new and barely improved iPhone) to solve the crisis of tangled earbud wires.

From Silver Spoon: “Re: hospital administrative residencies. Would you recommend them?” They’re great if you can get chosen for them. The faith-based national system I worked for placed only well-connected graduates of their low-ranked religiously affiliated schools in those jobs even though 99 percent of our patients did not practice that religion and in most cases weren’t even aware of the connection. Not surprisingly, the chosen ones were usually fast-tracked in the “people like us” leadership model. I passed up an early-career option of working a stint in the Middle East after hearing a friend’s report of being culturally insulted and professionally disrespected as though he were a mercenary shoeshine boy there, a situation my hospital system colleagues and I found ourselves in without the long flight.


HIStalk Announcements and Requests

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Insurance companies offered the poorest customer service experience to respondents to last week’s poll, while lab companies and dentists caused the fewest problems. Hospitals ended up mid-pack, but Beebob shared recent ED visit experience that included lack of wristband checking, nearly being administered morphine despite his or her clearly recorded allergy, employees never washing their hands, and doctors and nurses leaving their EHR sessions active when leaving the room so that anyone could have clicked through patient lists and charts, all of which were reported by letter to their CEO and safety VP with no response.

New poll to your right or here: what should be the key healthcare issue in the presidential election? “Key” means you have to choose the single most important issue instead of yearning for a lazy “all of the above” option that would relieve you of your responsibility make a decision.

I’ve received several emails weekly from investment companies (both in the US and elsewhere) wanting to talk to me about publicly traded health IT companies. I get those all the time, but the volume has picked up, which isn’t a problem for me since I just delete them without responding. They must have a good business model in getting free advice and reselling it as their own insight. Just about everything I know is right here on the HIStalk page for anyone to read anyway. 


Last Week’s Most Interesting News

  • CMS offers providers four “pick your pace” options for 2017 MACRA/Quality Payment program participation in 2017.
  • Device maker St. Jude Medical sues a security firm and an investment research company for manipulating its share price and profiting from short sales via the issuance of questionably accurate security vulnerability reports.
  • In England, a health IT committee issues its digitization recommendation report.
  • Epic asks the US Supreme Court to review a lower court’s ruling that the company can’t force employees into arbitration to block class action lawsuits over employment disputes.
  • UCSF will lay off 17 percent of its IT staff and offshore their jobs to India after its IT expenses doubled from 3 percent of its operating expense total to 6 percent in the past five years.
  • A tiny, AMA-sponsored observational study finds that ambulatory practice doctors spend twice as much time working on the computer and doing desk work than seeing patients.
  • Apple toughens up App Store standards for health-related apps to increase review of those that provide inaccurate data and to limit drug dose calculation apps to approved healthcare entities.

Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.


People

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Stephen Ondra, MD (Health Care Service Corporation) joins open source data management vendor Amida Technology Solutions as chief strategy officer.


Announcements and Implementations

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USC’s family support center and gerontology school provide family caregivers with support resources (care planning, reminders, task management, and self-care content) via an app developed by Los Angeles-based Care3. The three founders have experience that includes working in Aetna’s Healthagen technology businesses.

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A new Peer60 report compares Epic and ChipSoft in the Dutch EPR market. Interesting factoids: (a) no ChipSoft hospital reported an improvement in financial outlook, while a fair number of Epic respondents did; (b) Epic scored considerably higher in enhancing patient engagement; (c) Epic scored much better in improving user workflow; (d) Epic’s “would recommend” scores are hugely higher; and (e) nearly half of the users of both systems say their projects ran over budget. The report contains a lot more interesting detail. All I know about Amsterdam-based ChipSoft is that they used to give out cool clogs from their booth at the HIMSS conference, but I stopped asking about them years ago because their booth people (who you might expect to be rosy-cheeked and happy if your only cultural reference is a Dutch Boy paint can) were always eye-rollingly surly in insisting that you put them on right there instead of packing them away for later.


Privacy and Security

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This promotional email from Healthcare Informatics seems to miss the obvious fact that if you’re pitching an advertiser’s ransomware material, you should probably not use a gibberish link that the recipient won’t click on if they are even vaguely aware of phishing practices. 

From DataBreaches.net:

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  • The political team of a British member of Parliament tweets out a photo of the candidate cold-calling supporters that also included in the background a whiteboard containing the telemarketing system’s clearly visible (but since changed) log-in credentials.
  • Appalachian Regional Hospitals, whose systems are apparently still down following a ransomware attack several weeks ago, threatens to sue the local newspaper for asking questions about the situation and for publishing “statements that defame ARH or cast it in a false light.” It’s an interesting by-product of gaining public exposure for cybersecurity weaknesses or breaches that the affected organization often lashes out legally at the messenger (since the perpetrator isn’t handily available) in trying to protect their public image. 
  • The FBI charges two young men with using social engineering to hack the Internet accounts of several senior government officials that include the CIA director and Director of National Intelligence, using the information to harass them and to download sensitive information that they posted on the Internet. They gained access to the master federal law enforcement computer system, listened to the voicemails of senior officials, took control of their TVs, harassed them and their spouses by phone and email, distributed their contact lists, and fooled their spouses into providing their log-in credentials by claiming that their passwords needed to be reset.
  • Researchers warn that it would be easier for hackers to disable the country’s 911 emergency call systems by overloading their limited incoming lines with automated spurious calls from malware-infected mobile phones, estimating that 6,000 infected phones could disable an entire state’s 911 system and 200,000 could take down the entire national system.

Other

Three academic psychiatry authors write in their JAMA editorial that it’s not ethical for EHRs to flag frequent ED flyer with an airplane icon, saying it’s disrespectful and that such labeling may impede good diagnostic decision-making.

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Dartmouth-Hitchcock Medical Center (NH) will lay off up to 460 employees in the next few months following a $12 million loss in the fiscal year ending June 30. The hospital’s billing-related expenses increased by $115 million as it changed billing and revenue management systems — which caused a $40 million revenue overestimate – and outsourced its RCM activities to Conifer Health Solutions. According to the CEO, “Other great organizations are experiencing similar downturns with the implementation of new systems and rising expenses.” DHMC implemented Epic at a cost of $80 million in 2011, after which its bond ratings agency attributed its weak operating performance to reduced state funding and its Epic costs.

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Examples abound around the world where a single, dramatic photo engaged a previously indifferent public and turned a magnifying glass onto the society we’ve created. This Ohio police stop photo of two West Virginia adults zonked out in a heroin-induced stupor as the woman’s four-year-old grandson looks on just might do it in forcing us to examine our drugged-out society and the impact of only-in-America drug marketing and pricing decisions (over-marketed and thus overprescribed OxyContin whose high prices moved addicts to cheap but notoriously impure heroin freely entering the country after a failed war on drugs, with overdose victims sometimes revived as they were in this case with overpriced and thus less-available naloxone). Both adults have prior records for DUI, drug possession, resisting arrest, and other offenses. You are wrong if you think the epidemic can’t affect you or your family beyond being robbed by drug-seekers – this guy was driving on public streets seconds before this photo was taken, having just missed rear-ending a stopped school bus as he tried to take the woman to the hospital before being stopped by an off-duty officer from the East Liverpool Police Department.

Vince and Elise review the comments received about Black Book and KLAS from my reader survey in Part 6 of their “Rating the Ratings” series.

Here’s one of the most brilliant and hilarious TV ads you’ll ever see, a new Cigna public service message from the “TV Doctors of America” advocating annual physicals that many of their real-life counterparts don’t feel are medically indicated.


Sponsor Updates

  • T-System will exhibit at ENA Emergency Nursing 2016 September 14-17 in Los Angeles.
  • Crain’s features TeleTracking Technologies in its coverage of New-York Presbyterian’s new mission control center.
  • Valence Health will exhibit at Further 2016 September 14-16 in Chicago.
  • Frost & Sullivan recognizes Validic for the 2015 North America Frost & Sullivan Award for Visionary Innovation Leadership.

Blog Posts


Contacts

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

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September 10, 2016 News 12 Comments

News 9/9/16

September 8, 2016 News 5 Comments

Top News

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CMS offers providers four “pick your pace” MACRA/Quality Payment Program options for 2017:

  1. Submit test data only, which avoids a negative payment adjustment.
  2. Participate for part of the calendar year, which qualifies for a small positive payment adjustment.
  3. Participate for the full calendar year, which qualifies for a modest positive payment adjustment.
  4. Join an Advanced Alternative Payment Model, which qualifies for up to a 5 percent incentive payment.

The AMA has already issued a statement saying it “strongly applauds” the change.


Reader Comments

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From Concerned Longtime Customer: “Re: Epic’s succession plan. I don’t see how Carl won’t succeed Judy. He’s who you go to with big problems and he and Judy have similar gravitas in communicating a future direction in an artful way. I had not considered the Sumit possibility, but I see a clear drop-off since he speaks in buzzwords and cliches about how things are going to be ‘cool,’ ‘awesome,’ and I think he even pulled out an ‘insanely great’ one time. He impressed me as someone trying to play the part of Steve Jobs who doesn’t have an authentic vision of his own that reflects our needs. I have concerns about how much longer Carl will last than Judy and hope very much that Epic’s bench is deeper than I’ve seen.”

From Hissing Viper: “Re: a new nurse poll. It finds that 92 percent are dissatisfied with EHRs.” It’s always a good idea to check sources when reading health IT articles written by freelance, newly graduated authors who also craft beauty and fashion pieces.

  • It’s not a new poll. The information is from 2014 and has been amply reported previously.
  • The site you cite (no pun intended) says the survey was performed by Adventist University of Health Sciences. That is incorrect — the school simply turned existing surveys into a dumbed-down infographic as a marketing piece for its RN-to-BSN program. Using an infographic as a news source is just ridiculous.
  • The site takes 18 paragraphs to explain the infographic in failing to note the original survey source, which was Black Book.
  • Black Book still sells the old report (and thus the methodology from which it was derived) for $3,495. The number of respondents is ample, but unstated is how those respondents were selected, the respondent demographics, and the exact wording of the poll (since wording has a huge affect on how respondents answer questions).

HIStalk Announcements and Requests

[Caution: geek alert]. Several readers reported that the main HIStalk page wasn’t displaying my most recent posts due to what appeared to be some sort of caching problem, which started happening all of a sudden even though I hadn’t changed anything. I spent a ton of time trying to figure it out, working with my web host, the virtual firewall company, and an offshore guy I hired for $30. Nobody could determine what was happening, although I could see “Cache-Control:max-age=172800” headers being generated by my server from somewhere. I finally lost patience and brute forced a fix by adding “ExpiresActive Off” to the .htaccess file. I don’t like adding fixes that I don’t fully understand to address a problem that I also don’t fully understand, but at least it seems to be working.

This week on HIStalk Practice: Sahali Health Clinic implements Kannact real-time blood glucose monitoring. Cross Country Healthcare expands Boca Raton headquarters. EyeCrave Optics rolls out virtual eye exams with help from Smart Vision Labs. MMC Anesthesia Group signs on with Zotec Partners. E-MDs joins CommonWell. MarijuanaDoctors.com launches telemedicine portal.


Webinars

September 27 (Tuesday) 1:00 ET. “Stanson Clinical Decision Support: Survival Kit for Evolving Payment Models and Other Regulatory Requirements.” Sponsored by Stanson Health. Presenters: Anne Wellington, chief product officer, Stanson Health; Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai. Reimbursement models are rapidly changing, and as a result, health systems need to influence physicians to align with health system strategy. In this webinar, we will discuss how Stanson’s Clinical Decision Support can run in the background of every patient visit to help physicians execute with MACRA, CJR, et al.

View previous webinars on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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For-profit hospital operator HCA will acquire Mobile Heartbeat, whose clinical communications technologies it had previously piloted. The company will continue to operate as a wholly owned subsidiary of HCA.

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Allscripts announces eRecruit, which connects Allscripts-using providers to ePatientFinder’s clinical trial patient recruitment service. 

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In what surely must be one of the oddest acquisitions by a health IT company, health coaching chat vendor Grow Fit acquires nutritional beverage vendor Drink King (I’m not sure if the pun is intentional). Both companies are in India.

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Online doctor advice vendor HealthTap expands to Great Britain.

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Google acquires API vendor Apigee for $625 million in cash. One of the company’s customers is Walgreens, which uses Apigee’s technology for ordering photo prints and managing prescription refills and transfers. Other healthcare users are McKesson, Humana, and Kaiser Permanente.

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Medical device manufacturer St. Jude Medical sues medical security vulnerability vendor MedSec and investment research firm Muddy Waters for share price manipulation. St. Jude says Muddy Waters conspired with MedSec to short-sell St. Jude’s shares before MedSec’s critical security report was published. St. Jude also says the vulnerability report is wrong because MedSec used poor testing methodology on outdated versions of its software.


Sales

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In England, North West London Pathology Consortium signs a $19 million contract with Sunquest Europe for a hosted laboratory information system. The pathology operation is a shared service among several NHS trusts.

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LA County Department of Health Services (CA) chooses Cerner’s HealthIntent for population health management.

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Inova (VA) selects clinical decision support and analytics from Stanson Health to provide patient- and context-specific evidence-based recommendations at the point of care. 


Announcements and Implementations

Optimum Healthcare IT expands its Epic Community Connect practice and hires two executive directors to run it, Jon Straffon and Kelli Mangino from Cleveland Clinic.

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Surescripts announces Medication History for Panel Management, which supports population health management by connecting health systems, ACOs, and analytics vendors to the medication data of 14 nationwide pharmacies.

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Apple announces yet another annual round of marginally improved iPhones that will inexplicably create Apple Store lines of fanboys desperately seeking personal validation via loss of their headphone jack , the addition of waterproofing, and slightly less crappy cameras, none of which are compelling reasons to replace my iPhone 5. The company will also offer Pokemon Go for the Apple Watch, pairing a rapidly fading star with an already-faded one. The company once known for universe-denting innovation is now milking the cash cow via planned obsolescence and piling on pointless features hoping to entice overly loyal fans to ante up yet again in Apple’s form of hardware annual subscription pricing. The iPhone holds only 15 percent of the world smartphone market and these dull announcements aren’t likely to boost that number. Apple announced nothing for the ancient Mac product line. It sounds like the company is perfectly suited for its rumored entry into healthcare.

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Cerner opens a clinic and health center for the 2,200 employees of its Bangalore, India campus, which technically gives the company its first Millennium client in that country.

Imprivata adds clinical speech recognition from Nuance’s Dragon Medical One to its Cortext secure communications platform.


Government and Politics

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Blue Cross Blue Shield of Arizona steps in to offer an ACA insurance plan in Pinal County, AZ, saving the federal government the embarrassment of having one US county in which consumers have no Healthcare.gov coverage option. However, the insurer also warns that, as the only company offering plans in 13 of Arizona’s 15 counties, the government needs to stabilize the market. BCBS of Arizona has lost $185 million in the past two years selling ACA plans and isn’t thrilled about coming back to Pinal County. A study predicts that people in 31 percent of US counties will have only on ACA insurer to choose from, while another 31 percent will have only two.

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The UK’s Department of Health publishes its IT advisory committee’s report on how to spend the $5.6 billion that has been earmarked for NHS digitization that the committee says should be complete by 2023. It attempts to answer the question of whether the UK has the money (especially after recently blowing $15 billion on the overly ambitious and mostly failed NPfIT project) with, “The one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.” Their report calls for the government to:

  • Stage digitization efforts within trusts that are ready rather than trying to bring them all along at once.
  • Expect the short-term return on investment to be in the form of safety and quality improvements rather than financial.
  • Create and enforce national interoperability standards.
  • Give patients full access to their electronic information, including clinician notes.
  • Create a national chief clinical information officer (CCIO) position that will oversee the project and then appoint a clinician-informatician to serve as CCIO within each trust who will oversee at least five clinicians with advanced informatics training.

The UK’s report was written by UCSF professor, best-selling author, and medical malpractice insurance pitch man Bob Wachter, MD (asked by Secretary of State for Health Jeremy Hunt to chair the group) and his journalist wife. It not only reflects his personal feelings about US healthcare IT efforts, but also manages to promote his own book, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.” His bio doesn’t list any informatics education, training, or job responsibilities, although he’s a paid board member of some health IT vendors. The committee’s participation was in the form of nine, two-hour teleconferences and a two-day meeting.


Privacy and Security

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From DataBreaches.net:

  • The information of 43,000 patients of Baltimore-based substance abuse treatment provider Man Alive is listed for sale on the Dark Web, stolen by a Russian hacker who sent an employee a phishing email containing a macro-loaded Word document. The hacker reports that he has already sold some of the information following the facility’s refusal to pay him $9,400. Interestingly, DataBreaches.net notified the FBI that the information was listed for sale and they declined to do anything, including letting the facility know.
  • CHI Franciscan Health Highline Medical Center (WA) notifies 18,000 patients that their information was exposed in the same error by R-C Healthcare Management that affected 655,000 patients of Bon Secours Health System (VA). The difference in this case is that R-C Healthcare Management hadn’t performed any work for the hospital since 2014, so the information exposed was old cost-reporting data. R-C Healthcare Management misconfigured its network in April 2016, exposing the files it contained to the Internet.

Technology

An article in Nature reviews pharmacogenetics, the science of using a patient’s genetic profile to choose optimal drugs and doses. The article notes that only a handful of tests are being used and that the real value can be delivered only if patients are tested proactively instead of after they’ve had problems. Evidence from randomized clinical trials is not compelling, but advocates say the genetic tests are being held to an overly high standard.

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Maritime connectivity vendor Marlink announces a telemedicine solution that includes a central unit, touch screen, HD camera, ECG monitor, blood pressure monitor, pulse oximeter, and several other optional medical sensors. The system provides 24/7 consultations with on-shore doctors and includes a secure web portal for patient medical information. The announcement notes that emergency ship re-routing for a medical emergency costs around $180,000, making the company’s fully managed telemedicine service cost effective. 

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University of Washington researchers develop a smartphone app that can detect anemia by measuring blood color by shining the phone’s flash through the subject’s finger. Possibly aware that earning FDA approval is likely to be challenging, the researchers say the best use of HemaApp would be for screening before performing more expensive tests in “limited-resource environments,” i.e. not in the US.


Other

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In England, Google-owned DeepMind Health halts use of its Streams kidney injury detection app pending its approval by the UK’s version of the FDA. That means the company and NHS were using the app on hospitalized patients as an unregistered medical device.

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Epic petitions the US Supreme Court to weigh in on a lower court’s decision in May that the company cannot require employees to arbitrate employment disputes individually instead of by filing class action lawsuits.

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UCSF will lay off 17 percent of its IT staff, blaming reduced hospital payments under the Affordable Care Act and the doubling of IT expenses from 3 percent of the operating budget to 6 percent in the past five years (they went live on Epic in June 2012). The laid-off employees will be expected to train their India-based replacements from University of California system contractor HCL.

A study in Health Affairs finds that while hospital charge masters were supposed to become obsolete with the implementation of DRGs in 1985, hospitals are still using them to increase revenue and to force insurance companies to include their facilities in their networks using the threat of high list prices if they don’t. The authors suggest that legislators require more markup transparency to protect patients who have zero negotiation power with hospitals when faced with excessive charges.

A Florida TV station covers the local hospital’s use of Natus Newborn Care’s Nicview, which allows parents of babies who are in the NICU to view streaming webcam video and nurse messages.

A woman bitten by a stray dog while traveling abroad is given the same rabies drug at four locations in three countries and is shocked by the price variation: $125 (Cambodia), $18.50 (Thailand), $5,255 (a US hospital, that required an ED visit), and $427 (a US medical group). Her travel insurance covered the cost, but her husband, a former CFO, said that of the four providers, only the US hospital sent a bill that was not itemized and was impossible to understand. Healthcare economist Uwe Reinhardt offered a comment for the article:

It’s obvious that our system is unlike any other health system. Other systems were set up to care for patients. Ours was set up by the providers — the hospitals and drug companies — for their own benefit.

The New York Times notes that it’s hard for any of us – including presidential candidates — to assemble our medical records from a lifetime of providers (some probably retired or dead) who used their individual paper or electronic systems. The exception was presidential candidate Senator John McCain, who was able to release his 1,000-page medical record only because it had been assembled for a military study in which he participated, but later he was treated at Mayo Clinic and his campaign had to postpone the release of his records because they couldn’t collect all his records from several Mayo doctors. The article puts forth an interesting alternative to assessing health via old records: have each candidate examined by an independent physician panel hired by the federal government.

Voluntary reports from Kentucky hospitals indicate that 15 people overdosed on heroin over the Labor Day weekend, with 12 of them dying. This follows reports of a mid-August weekend in nearby Huntington, WV, population less than 50,000, where 26 heroin overdoses were reported in just four hours, tying up every ambulance in the county.


Sponsor Updates

  • InstaMed Senior Vice President of Product Management Jeff Lin will keynote the NTC Healthcare 2016 Symposium October 19 in Irving, TX.
  • InterSystems will exhibit at the HIMSS-NCA monthly education meeting September 15 in Arlington, VA.
  • LiveProcess will exhibit at Emergency Nursing 2016 September 14-17 in Los Angeles.
  • Ability Network is named as one of the world’s top 100 private cloud companies.
  • Access launches a newly redesigned website.
  • Aprima recaps its first-half 2016 success.
  • MedData will exhibit at the 2016 TAHFA & HFMA South Texas Fall Symposium September 11-13 in San Antonio.
  • EMDs joins the CommonWell Health Alliance.
  • BizTech Magazine features Navicure IT Director Donald Wilkins.
  • Santa Rosa Consulting assists King’s Daughters Medical center (MS) with its migration to Meditech 6.15.
  • Spok partners with Australia-based unified communication solutions integrator Progility Technologies.
  • Meditech’s Catherine Campbell is elected quality measurements vice chair of the HIMSS EHRA.
  • NTT Data Healthcare Technologies will host its annual client conference September 11-14 in Newport Beach, CA.
  • NVoq will exhibit at the AAFP Family Medicine Experience Annual Meeting September 16-24 in Orlando.
  • Obix Perinatal Data System will exhibit at the Summit of the Southeast September 14-15 in Nashville.
  • Meditech posts a case study titled “Valley Hospital Identifies and Prevents Infections with Meditech Surveillance.”
  • Experian Health will exhibit at HFMA Northern California September 15-16 in Concord.
  • PatientMatters will exhibit at the Illinois Hospital Association Leadership Summit September 15-18 in Lombard.
  • PatientPay will present at the 2016 Council for Entrepreneurial Development Tech Venture Conference September 13-14 in Raleigh, NC.
  • The SSI Group will exhibit at the NTT Data Client Conference September 11-14 in Newport Beach, CA.
  • Streamline Health will host its annual client conference September 11-13 in New York City.

Blog Posts

Learn More

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Frost & Sullivan calls Validic the de facto standard and industry leader in patient-generated health data interoperability. The company’s digital health platform connects providers, pharmaceutical companies, payers, wellness companies, and health IT vendors with data harvested from 300 in-home clinical devices, wearables, and consumer health apps. It reaches 223 million lives in 47 countries and delivers the insight needed to improve health outcomes, population health, care coordination, and patient engagement. Validic helps healthcare companies accelerate their strategic business initiatives. Learn more on the company’s website.


Contacts

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

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September 8, 2016 News 5 Comments

News 9/7/16

September 6, 2016 News 12 Comments

Top News

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A  tiny AMA-sponsored time and motion study finds that ambulatory practice doctors spend almost twice as much time working on the EHR or performing other desk tasks than seeing patients, with the observed physicians spending only 27 percent of their available time in face-to-face contact with patients.

Physicians spent only around half of their exam room time directly interacting with the patients in front of them, with most of the rest consumed with EHR and desk work. The doctors studied also spent another 1-2 hours past their quitting time doing clerical catch-up.

It’s a very small study, both in numbers as well as the breadth of specialties, practice settings, and geographic areas that were observed. It also contains subjective interpretation of what constitutes non-patient time, in that doctors may be discussing health issues with patients or reviewing information on the screen while using the EHR since those activities are not necessarily mutually exclusive. It also doesn’t address the fact that EHR time may not necessarily be wasted depending on the situation, any more than arguing that radiologists spend too much time looking at PACS images or that anesthesiologists should pay more attention to patients and less to their monitors.

The study also does not compare the time doctors spend using paper charts or the benefits of EHRS while obviously trying to make the AMA’s point that EHRs – and not the healthcare system doctors created in voluntarily accepting checks from insurance companies and the federal government and thus being required to meet their documentation requirements – are responsible for their unhappiness and lack of productivity. I don’t like the tax system, but I don’t blame TurboTax.

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An accompanying Annals of Internal Medicine editorial touts the AMA’s STEPS Forward program and concludes, “Now is the time to go beyond complaining about EHRs and other practice hassles and to make needed changes to the healthcare system that will redirect our focus from the computer screen to our patients and help us rediscover the joy of medicine.”


Reader Comments

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From Voice of Reason: “Re: Epic’s succession plan. As a former Epic employee, the whispers I heard during my time there was that Sumit Rana was going to take over as the next CEO once Judy steps down. The recent piece on HIStalk on Epic’s board of directors corroborates this – he and Stirling are the only two members other than Judy/Carl that work at Epic. Ultimately, I think Sumit will get the nod over Stirling since Sumit has much more visibility within the company and he is a developer whereas Stirling is a TS – there’s an unwritten rule that people defer to developers within the company.” Sumit went to work for Epic in 1998 immediately after he graduated from Delhi College of Engineering and has worked his way up to SVP. Note: I don’t usually correct reader comments, but as other readers have noted and his LinkedIn profile clearly states, Stirling Martin’s background is as a developer (going back to June 1997) and he has never been a TS.

From Former Epic: “Re: Epic’s succession plan. Unless things have changed since I worked there (about three years ago), Judy is very tight-lipped about how things will work after she’s gone. She addressed it once to my knowledge, and all she said was ‘There’s a plan in place.’ As far as the qualifications of her children to run the company, Judy herself wasn’t necessarily qualified back in 1979, so I don’t see that stopping them. At this point, I think Carl Dvorak is the real brains of the operation.” The challenge might be that while the second generation of family business owners usually are much more trustworthy than the third generation, there’s still the issue of mixing founder offspring and business, especially when company ownership is turned over to a foundation. On the other hand, Judy has shown remarkable talent and focus in taking Epic where it is today, so I’m sure she is not oblivious to the challenges and will make every effort to mitigate any threat to the company’s current state. A success story to be emulated is S.C. Johnson & Son, the cleaning supply company (also based in Wisconsin) that’s in its fifth generation of family ownership and leadership with 12,000 employees and $7.5 billion in sales.

From Super Bill: “Re: Epic. Suing one of its customers. Perhaps they don’t want anyone to know how Epic forces smaller regional hospitals and independent practices to enter into agreements with larger players to help with interoperability issues. See this filing.” Epic attempts to block University of Iowa Hospitals and Clinics from complying with an open records request from an unidentified individual who seeks information about services provided by KLAS. An Epic employee sent the health system a KLAS report covering EpicConnect and included attachments that Epic doesn’t want released. Epic argues that the attachments are not public record and are proprietary. I can say from first-hand experience that Epic fights tooth and nail any attempt to obtain contract records from tax-supported organizations that are required by law to provide them to anyone who asks, apparently requiring in their sales contract that the health system send such requests to Epic’s team of lawyers that will use every available company resource to keep the information private in the ultimate form of information blocking.

From What Would HIPAA Do?: “Re: security. I work for a vendor and one of our practices is being forced our EHR after joining a local healthcare system. The new vendor gave us access to an SFTP site to transfer the practice’s data. When we logged in, we could see the data from another 4-5 practices sitting there in plain view. We reported this to the vendor and they said they aren’t worried since they only give the log-in to people they know. Should we report this or formalize our complaint to the vendor? Are we overthinking this?” I’ll invite readers to respond. Personally, I would let your customer know and let them decide how to proceed since any complaint directly from you as a competitor would look like sour grapes, not to mention that there’s no upside to your involvement. It’s always touchy to report a potential security issue that (a) does not and could not affect you; (b) is purely theoretical; and (c) risks having the insecure (pun intended) vendor file an FTC or other form of complaint claiming that you illegally accessed the information of their clients, hoping to deflect the potential damage to the messenger as has been done in several recent health IT examples.

From Will Eye Am: “Re: the magazine that always features men on the cover. Why would you question their choice of featured subject if it’s mostly men in CIO roles?” Mostly because the magazine is produced by an India-based company, and in my admittedly limited experience, it’s more culturally acceptable there than here to treat women as less than equals. Perhaps I’m jaded by my first hospital job in a rural, for-profit hospital that was a veritable Statue of Liberty for the unskilled medical huddled masses yearning to bill Medicare, where our multicultural medical staff insisted (and hospital policy mandated) that female nurses hug the hallway walls with eyes reverentially downturned as they passed. Companies can do whatever they want, but as such shouldn’t be insulted if I report the percentage of non-white men on the boards or leadership teams or, in this case, note that the magazine can’t seem to find anyone other than white men for its covers.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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3M acquires Switzerland-based semantic coding vendor Semfinder.

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McKesson discloses in an SEC filing that the Department of Justice has requested information about its previously announced divestiture of its IT business to a new entity created in a venture with Change Healthcare. DOJ is reviewing the proposed plan for any antitrust concerns.

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In Scotland, Craneware reports an 11 percent increase in first-half revenue to $67 million, with pre-tax profit of $19 million.

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CompuGroup Medical acquires Italy-based pharmacy software vendor Vega Informatica e Farmacia S.r.l.

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Vanity Fair runs a fascinating summary of the Theranos debacle and CEO Elizabeth Holmes that includes interesting observations:

  • Holmes mimicked Apple to the point of wearing Steve Job-like black turtlenecks, forbidding company teams from communicating with each other about their projects, and emphasizing the company’s “story” instead of its actual technology.
  • The Wall Street Journal reporter who broke the story was surprised that Holmes, who micromanaged every company decision, could not explain how its technology worked.
  • Company insiders urged Holmes to rebut the damaging initial WSJ report by enlisting scientists to endorse the company’s work, but that wasn’t possible because Holmes hadn’t allowed scientists to publish peer-reviewed papers about it.
  • The company’s chief scientist could not make the product work even as Holmes touted it to a widening audience, leading to his 2013 suicide.The company’s response upon being told that he had died was to demand that his widow return the company’s confidential information and later to threaten to sue her for talking to reporters.

The author summarizes the Silicon Valley mentality that created Theranos as:

The venture capitalists (who are mostly white men) don’t really know what they’re doing with any certainty—it’s impossible, after all, to truly predict the next big thing—so they bet a little bit on every company that they can with the hope that one of them hits it big. The entrepreneurs (also mostly white men) often work on a lot of meaningless stuff … [they] generally glorify their efforts by saying that their innovation could change the world, which tends to appease the venture capitalists because they can also pretend they’re not there only to make money. And this also help seduce the tech press (also largely comprised of white men), which is often ready to play a game of access in exchange for a few more page views … In the end, it isn’t in anyone’s interest to call bullshit.


People

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Culbert Healthcare Solutions hires Nancy Gagliano, MD, MBA (CVS Health) as chief medical officer.


Announcements and Implementations

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Uniphy Health announces GA of its Sentinel sepsis alerting platform.

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MedStar Health (MD) delivers patient education delivered using the technology platform of local startup Mytonomy.


Privacy and Security

In Scotland, an environmental activist sues Donald Trump’s Aberdeen golf course, charging its employees with violating the Data Protection Act by using their phones to film her peeing behind a dune on the course. The course admits that it did not register with the data protection regulator despite running at least nine security cameras that were recording guests who weren’t warned that they were being filmed, but says that’s irrelevant because those weren’t the cameras used to record the alfresco urination.


Technology

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Microsoft, which decided against offering $8 billion for team communications app Slack, is reportedly working on a similar Skype product called Teams, which will offer chat room-like channels, private direct messaging, and Facebook-like threaded conversations.


Other

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Franciscan Alliance will rename the 13 of its 14 hospitals that are named after saints to new names that reflect “Franciscan Health” plus their city name, effective next week.

Business Insider profiles the CIO of drugmaker Merck, who believes that companies must undertake digital transformation or die. The CIO says it’s a change in operation that doesn’t necessarily increase IT spending. Merck gets its CIO involved with technology VCs to get early access to startups, encourages its IT employees to find interesting startups and work with them on technology, and allows its developers to create software and sometimes helps them turn it into a startup.

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A study finds that the US has the second-highest maternal mortality ratio among 31 developed countries, with Texas recording alarmingly high numbers of women who die during and after pregnancies mostly due to state government decisions about healthcare funding and access.

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ED doctors treating an Arizona man‘s small facial cut are shocked to find that it’s the entry wound for a four-inch piece of a broken chopstick lodged deep in his brain. The man reported that he had grabbed his brother from behind in a Chinese restaurant and his brother stabbed him with the chopstick over his shoulder. He’s OK. Googling  turns up other examples of chopstick-related violence, such as a prisoner who killed himself by stabbing himself with a chopstick and a more recent example in which a man confessed to killing his elderly father during an argument by stabbing him in the throat with the wooden utensil. The National Chopstick Association has not yet invoked the “chopsticks don’t kill people” argument.


Sponsor Updates

  • PatientPay will present at the CED Tech Venture Conference next week in Raleigh, NC.
  • Aprima will exhibit at the Arizona State Physicians Association meeting September 15-17 in Scottsdale.
  • Audacious Inquiry Senior Manager King Yip is named a finalist in ONC’s Blockchain in Healthcare Challenge.
  • Bernoulli Health pledges to share its data as part of the Patient Safety Movement.
  • Besler Consulting releases a new podcast, “Live from HFMA Region 3.”
  • Boston Software Systems releases a new podcast, “Improving Clinical Workflow at Patient Discharge.”
  • CoverMyMeds will exhibit at the American Society for Pain Management Nursing Annual Conference September 7-10 in Louisville, KY.
  • Cumberland Consulting Group will exhibit at the Healthcare Executive Group Annual Forum September 12-14 in New York City.
  • Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association annual conference September 14-17 in Los Angeles.
  • EClinicalWorks will exhibit at International Vision Expo West September 15-17 in Las Vegas.

Blog Posts


Contacts

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

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September 6, 2016 News 12 Comments

Monday Morning Update 9/5/16

September 4, 2016 News 4 Comments

Top News

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Apple cracks down on questionable health app vendors in tightening its App Store Review Guidelines, saying it will increase its scrutiny of apps that provide inaccurate data, will ban marijuana-related apps and sleep apps that require placing the iPhone under a pillow, and will accept drug dose calculation apps only from approved healthcare entities.

Apple also announces that it will start removing outdated and technically obsolete apps from the App Store prior to the rollout of iOS10 this fall.


Reader Comments

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From Mayor McCheese: “Re: Healthcare Tech Outlook. That publication in India that misspelled HIPAA last year is at it again. Our company got the same email saying we’ve been shortlisted to be in the Top 10 list and can be included in their publication for $3,000.” The magazine contains CIO-written vanity pieces, fluff articles that confuse health IT and healthcare technology, and vendor pitches that sometimes misspell the paying company’s name (examples above) and mangle the English language in amusing ways. The magazine, along with CIOReview and others, is published by SiliconIndia, an India-based professional networking site. CIOs must be desperate for an ego stroke to have their work featured there. I also note that  the covers of 17 of the previous 18 magazine issues prominently feature a male subject. The one that highlights a female also includes an inset photo of a male who appears to be peering over her shoulder, the only time they’ve used a second photo on the cover.

From Chiari Malformation: “Re: Epic. Anyone know how Epic will be run post-Judy? She funds a lot of charities that seem to be run by her kids that don’t seem to have significant assets or Epic shares yet. How will these foundations control Epic’s stock to keep the company private? If her kids will be the controlling shareholders, are they qualified to lead the largest medical records company in the country? Maybe this is an academic discussion since there’s no evidence that Judy has followed through on her much-ballyhooed pledge to give away 99 percent of her wealth.”

From Zipty Dudah: “Re: ONC High-Impact Pilot grants. We didn’t hear anything by August 29 notice date. Anybody else?” ONC announced in May that it would fund 3-7 interoperability-related High-Impact Pilots and announce the winners August 29.

From The PACS Designer: “Re: ICD-10 on FHIR. With the coming addition of ICD-10 Procedure Codes to daily clinical use, the next major change to be looking for is the Fast Healthcare Interoperability Resources (FHIR) release. With ICD-10 on FHIR (pun intended) being an upgrade for HL7, we’ll have the opportunity to raise the efficiency level of healthcare practices to a much higher level.”


HIStalk Announcements and Requests

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Insurance companies are the #1 bad guy when it comes to high healthcare costs, according to responses to my poll, with providers and patients earning little of the blame.

  • Ashter calls for cost controls like most other countries have since taxpayers are paying for the majority of care.
  • Cynic says the only answer is a rational single payer system that has no chance of being implemented.
  • Furydelabongo says he’s most responsible because he expects medical miracles to protect him from his irrational behavior.
  • Frank says we’re unwilling to do as other countries have done in answering the question of “what price life?”
  • Observer says only insurance companies have seen little fluctuation in their profits because they keep adding profitable products and abandoning unprofitable ones. He has worked in the insurance business and says companies care only about signing up big employers with zero regard for the members as customers.
  • Lee says insurance companies just pay claims that are driven by an electively unhealthy population while delivering margins much lower than those of drug and device companies.

New poll to your right or here: Which organization provided the poorest customer service in your recent personal experience? Mine is a new PCP who I haven’t even seen yet. It’s a one-doc practice and it took forever to get an appointment; I showed up and filled out a mountain of paperwork only to be told by the front desk people that the doctor was out for the day and they should have let me know before I drove in. I came back a week later to see the NP (the only rescheduled appointment I could get) and they had lost the mountain of completed paperwork and I had to scale it again. Maybe worst of all I found out later that the awful front office people weren’t even relaying my questions or needs to the doctor when I called. The doc said later that her office people – all young, inexperienced, and unmotivated — are terrible and that I should call just after the 5:00 closing time and she would pick up directly, neatly dodging the question of why she hires and keeps employees who she knows are incompetent and thus puts the burden on me to avoid dealing with them.

This is the last day of my Summer Doldrums Webinar Special, for companies interested in doing a webinar. It’s also HIStalk Pledge Week for new sponsors and they get a deal, too. Contact Lorre.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.

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Last Week’s Most Interesting News

  • The Department of Defense announces an unspecified delay for its first Cerner go-lives that were scheduled for December 2016.
  • Athenahealth acquires Patient IO.
  • ONC announces 15 white paper winners of its Blockchain Challenge.
  • ProMedica and MD Anderson attribute their poor financial performance to the cost of implementing Epic.
  • Medscape’s physician EHR survey provides good news to Epic and VistA, bad to NextGen and those who think EHRs boost efficiency.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Consulting firm Health Data Specialists buys a stake in IT staffing and consulting firm Realistic Resources.

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Medical imaging cloud vendor DICOM Grid renames itself to Ambra.


Privacy and Security

In England, Derriford Hospital is hit with ransomware. The local newspaper notes that 28 NHS trusts have seen ransomware infections.

A hospital employee using a pregnancy tracking app receives a company’s congratulatory card and baby formula samples right before her due date even though she had miscarried months earlier. The app vendor had sold her data to a company that apparently did not notice that she had updated her status as “miscarried.”


Innovation and Research

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IllumiCare wins an Alabama innovation award for its EHR-hovering Smart Ribbon that displays real-time analytics information. It requires no EHR integration and costs $10 per admission for the Pro package that covers observation status, medications, labs, radiation, and cost.


Other

Executives of drugmaker Mylan – which raised the price of EpiPens 15 times over seven years in a 400 percent increase — will earn $77 million in bonuses if they hit share price targets. CEO Heather Bresch, best known before the EpiPen price scandal as the daughter of West Virginia’s then-governor (now senator) who was given an unearned MBA from West Virginia University (later rescinded, after which most of the politically appointed WVU administrators were fired), could see her compensation jump from $13 million to $28 million under the pay-for-performance program that provides ample incentives for robbing patients.

Odd: 40 middle school students are treated and five are hospitalized after eating ghost peppers at lunch on a dare from a classmate who brought them in. “It was really hot. We drank like 10 cartons of milk,” reports one capsaicinized lad, while another had trouble seeing and two vomited up their high-Scoville fruits.

Also odd in an “only in America” sort of way: a man shoots himself in the hand in the dentist’s chair when, under the influence of a nitrous oxide high while getting a filling, he thinks he hears his phone ringing in his pocket but instead whips out his loaded pistol.

Vince and Elise continue their “Rating the Ratings” series with Part 5, which describes the results of my reader survey. I’ll flag their summary with an asterisk in the interests of transparency, however, in noting (as I would hope the ratings firms would do with their surveys) that the sample size was small (74 responses); respondents were self-selected and not validated statistically as being representative; and while I assume the responses were honest, they might not necessarily be correct as evidenced by a couple of comments where the respondent’s memory about specific details might have been fuzzy.


Sponsor Updates

  • TeleTracking partners with The DAISY Foundation to establish The DAISY Award for Extraordinary Nurses in Patient Flow.
  • Valence Health will exhibit at the 2016 Accountable Care & HIT Strategies Summit September 8-9 in Chicago.
  • ZirMed will exhibit at CASA 2016 September 7-9 in Carlsbad, CA.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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September 4, 2016 News 4 Comments

News 9/2/16

September 1, 2016 News 5 Comments

Top News

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The Department of Defense will push back the first go-lives of its MHS Genesis EHR project, according to a reader-forwarded announcement from Thursday. The DHMSM project management office declined to give specific dates, saying only that initial rollouts will be moved back “a few months” and that it will issue a new schedule within 30 days.

DoD had originally announced deployment of the Cerner system to sites in the Pacific Northwest beginning in December 2016. It reiterated that the original schedule was “aggressive, but achievable” in early August 2016 despite a May 31, 2016 DoD OIG report warning that the date “may not be realistic for meeting the required initial operational capability data of December 2016.”

The military is already taking longer and spending more than it expected long before the first go-live. The project awarded Cerner a no-bid, $74 million hosting add-on contract in July, far above DoD’s original self-hosted cost estimate of $50 million over 10 years. DoD said at that time that the extra spending would not raise the project ceiling.

A consortium led by Leidos won the $4.3 billion project bid in July 2015. Leidos and its spinoff SAIC have been paid billions to develop and maintain the DoD’s current EHR, AHLTA. Some experts estimate the total taxpayer cost for AHLTA — which was just voted in a physician survey as the worst available EHR –  could be as much as $20 billion.


Reader Comments

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From Sturges: “Re: Epic. A big pro for public vs. private companies is transparency. John Touissaint at ThedaCare publishes all the time, but never mentions that he’s on Epic’s board. The boards of both Epic and Meditech will be a big deal in the coming years, particularly in terms of succession planning and how Epic will operate as a foundation once Judy turns it over as a charitable donation.” I edited Epic’s board and director list in the corporate document above to remove addresses since some of them are of private homes (including the shockingly modest residence of Judy Faulkner). John Toussaint is a former CEO of Epic customer ThedaCare (WI) and is CEO of the ThedaCare Center for Healthcare Value. The board members who aren’t Epic employees as far as I can tell from their names alone (which is all that’s on the state filing) are:

  • Roger Hauck. I assume it’s the one who’s on UW Medical Foundation’s board.
  • Leonard Mattioli. There’s an owner of a closed chain of Wisconsin appliance stores with that name.
  • Nicholas Seay, VP/CTO of Cellular Dynamics.
  • Paul Kundert, president and CEO of the UW Credit Union.

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From MT Hammer: “Re: Nuance Transcription Services. Laying off all its California-based employees as of September 30. The layoffs will apparently include both transcriptionists and supervisory staff. Affected employees were informed via conference call on Wednesday, August 31.” Unverified, but discussion abounds on the MTStars message board, where posters suspect that their jobs are being offshored to India. That shouldn’t be surprising given the company’s announcement in January 2016 that it would hire 3,000 transcriptionists in five cities in India, hoping to achieve a 50 percent transcription growth rate there given the inherent time zone and cost advantages. It may not have helped that California is rapidly increasing its minimum wage to $15 per hour by 2022, which is more than at least some transcriptionists are paid as hourly employees.

From Mr. Porky: “Re: Kaiser Southern California. Its Cerner Millennium lab system was down most of Monday and Tuesday due to a server issue.” Unverified.

From Unfortunately Informed: “Re: [vendor name removed]. Their chief growth officer is about to be booted after a short stint following a mass exodus of the sales team and pending lawsuits of harassment.” Unverified. I’ve omitted the company name for obvious reasons, but we’ll see if an announcement is forthcoming.

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From Victor Victuals: “Re: the upcoming OCR/NIST HIPAA security conference. Attendees can add lunch and refreshments to their registration fee for $306. The latest GSA for Meals and Incidentals is $69. Wonder what kind of lunch and refreshments they’re providing at that price?” It’s a really bad deal when you look at the registration page to see what’s included – just two continental breakfasts, two buffet lunches, and one afternoon break. The overpriced hotel restaurant (was that redundant?) has a bakery basket or fruit plate for around $10 and lunch items (even steak) for around $20, which would total maybe $60. Perhaps this is a social engineering experiment where NIST wants to see whether attendees will fall for an obvious, phishing-like ruse. I’m trying not to preach about their use of “EST” instead of the correct “EDT.”

From Kitty Has KLAS: “Re: KLAS. Vince is incorrect in saying that KLAS requires vendors to pay. They don’t – they only have to provide a customer list. However, if they want to review the report ahead of time or publicize their rating, they have to pay. KLAS also offers billable consulting services, where they tell vendors where to improve based on the feedback from their customers.”

From Skitch: “Re: KLAS. They’re the Consumer Reports of healthcare IT. Enough said.” No, they aren’t, and they don’t claim to be. Consumer Reports is a publication whose paying customers are readers, not vendors, and trying to assess the quality of a dishwasher is a lot different than rating hospital software based on a few customer reports. Both organizations rate products, but Consumer Reports:

  • Is published by an independent, non-profit consumer advocacy group.
  • Does not accept advertising or any form of payment from vendors.
  • Does not allow vendor involvement in testing products or obtaining customer feedback.
  • Performs product testing in its own labs.
  • Does not sell consulting services, customized reports, or anything else to vendors and investors in keeping arm’s length from them to maintain objectivity and transparency.
  • Does not allow vendors to publicize the rankings they receive.

From Good4U: “Re: patient advocates. Is inviting them to industry meetings the best way to improve the healthcare system?” I don’t think so since there’s no scale or consumer push involved. I would rather invest the time and money to mobilize consumers to understand their rights, instruct them on how to protect themselves or their loved ones as patients, and give them resources to contact when they need help with medical decisions they don’t fully understand. It would be a nice tribute to Jess Jacobs to develop an educational program to help others navigate the indifferent, inefficient, and sometimes life-threatening healthcare quagmire she found herself immersed in since every one of us will face it eventually despite what we know as insiders. We may happily work in hospitals, but deep down we all know that one of the most dangerous places in the world is a hospital bed.

From Spastic Colon: “Re: [publication name omitted]. Check out their top stories.” I get tired of being asked to analyze what other sites run as news since I don’t really care and I don’t read them anyway, so I’ll answer just one last time. The site has 11 “latest news” stories on their home page. None of them contain any actual reporting – they are simply re-worded material they found on other sites (not always credited) in padding out uninteresting items to 10 or more paragraphs. I had already declined to cover nine of their 11 items that I felt weren’t worth the time of HIStalk readers. Of the 11 news items:

  • Six are re-worded press releases, two of which have zero to do with health IT.
  • Two summarize journal articles, while another re-words a TV station’s story.
  • One is a sponsor advertisement.
  • One is a slideshow of old news.

HIStalk Announcements and Requests

Grammar gripe: beginning a sentence with the word “there.” It’s easy to instead word the sentence with the usual subject followed by a verb. Instead of “There are many articles covering population health management,” write, “Many articles cover population health management.” Try to determine the subject and verb of each of those sentences and you’ll see the problem with the former. I also continue to be annoyed by listing a physician as “Dr. John Smith, MD” or simply as “Dr. John Smith.” In my experience, the former is usually written by a third-party person of cluelessness or an arrogant doctor determine to shove his or her title down one’s throat twice, while the latter is often employed by those who are at least slightly and illogically embarrassed that they hold non-MD medically-related practicing doctorates such as DNP, DO, DC, MBBS, DPM, DPT, DAUD, or PharmD.

We run a back-to-school type new sponsor special every Labor Day as the industry picks back up, giving new companies extra months for free. Contact Lorre. We’ve had quite a few sign up lately, wisely avoiding the pre-HIMSS rush period that sometimes stymies procrastinators.

This week on HIStalk Practice: NorthStar Anesthesia deploys Plexus Technology Group’s anesthesia EHR. Pennsylvania goes live with ABC MAP PDMP. AMA adds population health data to its workforce mapping tool. Senator Gary Peters includes a telemedicine stop on his statewide motorcycle tour. HHS announces $53 million in funding to help states combat opioid abuse. Falcon Physician adds charting capabilities to its EHR for nephrologists.

This week on HIStalk Connect: DoseMe, Health2Sync raise new funding rounds. NIMA develops gluten-testing tech. Access announces new partnerships. Elementary school student prints prosthetic hand for teacher. My Health Guide App produces new case-study video.


Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Theranos withdraws its request for fast-track approval of its Zika-virus blood test after the FDA finds that the company’s trials in the Dominican Republic were not overseen by an institutional review board. CEO Elizabeth Holmes used her August 1 stage time at the AACC conference to pitch the test and a new lab analysis machine, neither of which have passed FDA muster to reach the market.


Sales

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Sharp HealthCare (CA) will implement Cerner PowerChart Ambulatory for one of its two medical groups, integrated with its inpatient Millennium system.


People

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University of Rochester Medical Center (NY) hires Tom Barnett (NorthShore University HealthSystem) as CIO.


Announcements and Implementations

Philips and Qualcomm will use each other’s technologies to offer personalized connected care solutions involving home medical devices.

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In England, King’s College Hospital goes live with Allscripts Sunrise.


Government and Politics

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A McKinsey analysis of proposed ACA-sold insurance plans for 2017 finds that three-fourths of them will be of the higher-profit HMO type with a narrow network (often just a single hospital system and its affiliated doctors), while only one-fourth will be PPO type plans with broader coverage.


Privacy and Security

From DataBreaches.net:

  • Information from ambient light sensors used to adjust smartphone and laptop screen brightness is now available to any website that uses a new API, meaning a website or hacker could use the information to identify a specific user or determine information about their home. I didn’t realize that some retailers adjust their prices based on the user’s device, charging iPhone users more than those shopping with an inexpensive Chromebook.
  • In the UK, healthcare represents by far the greatest number of Q1 data breaches, although most of the incidents involved paper rather than electronic information.
  • Also in the UK, Wythenshawe Hospital launches an internal investigation into the journal report of “bagpiper lung” cited by Weird News Andy. The deceased patient’s daughter wasn’t told why he died – she learned it only because the journal article contained enough details to make it obvious to her who the case study involved.
  • New York State Psychiatric Institute notifies 22,000 patients that its systems were breached this past spring.
  • A potential class action lawsuit against Flowers Hospital (AL) involves a now-imprisoned phlebotomist who used information contained in unsecured daily file folders to file fraudulent tax returns.

A DataBreaches.net analysis of the FTC’s case against LabMD notes the “pretzel logic” of going after theoretically exposed data that was viewed only by a vendor trying to sell security services to LabMD. It calls out the lack of FTC definition of acceptable security standards and the FTC’s subjective interpretation of risks that might reasonably cause consumer harm, which should interest every healthcare provider since FTC is getting more active in healthcare security. It concludes,

If one government agency – HHS – that is the premier agency for protecting patient privacy and data security didn’t even consider this incident a reportable breach under HIPAA back in 2008, then doesn’t it strike anyone else as a bit absurd that the FTC would turn around years later and claim that this incident was not only “likely” to cause substantial harm, but did cause substantial harm – even though they didn’t interview even one person whose data was in the errant file? For the FTC to declare by fiat that consumers experienced substantial harm in this case is just over the top.


Innovation and Research

NIH profiles AiCure, a medication adherence app whose further development was funded by NIH’s National Center for Advancing Translational Sciences. The company’s app uses facial recognition and motion-sensing smartphone sensors to visually verify that a particular med was taken as prescribed, specifically targeting clinical study participants (and obviously hoping to tap into the always-popular and cash-flush drug companies as customers). The New York company has raised $12 million.


Other

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A Slate article declares that workplace wellness programs are “a waste of time and money, they don’t improve health outcomes, and they’re a front for shifting costs onto employees.” The article adds that such programs promote questionably useful tests, encourage unnecessary doctor visits, and collect health information using sloppy security policies. It cites the 2009 claim of grocery store operator Safeway that its wellness program (optional, but employees had to pay higher insurance premiums if they opted out) helped hold its healthcare costs flat, when in fact only 14 percent of its employees were even eligible to participate and the way Safeway kept costs down was to raise insurance deductibles. The company’s questionable wellness program results led to the so-called Safeway Amendment to the ACA that allows employers to shift more premium costs to employees who fail wellness tests.

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A smartly written editorial by a surgeon criticizes a Texas district attorney who continues to publicly declare that vaccines cause autism and who appeared in a trailer for the movie “Vaxxed.” He summarizes by comparing the respective burden of proof required by the court system and the FDA:

The video in which he appeared is so much like anti-vaccine videos I’ve deconstructed over the years and suffers from the same confusing of correlation with causation. LaHood himself views the movie like a trial against vaccines and seems quite impressed by the “evidence” it presents. Unfortunately, as tempting as it is for a lawyer and DA to see everything in legal terms, science doesn’t work that way. He goes on and on about how children seemingly regressing after vaccines is “strong circumstantial evidence.” Yes, perhaps, but in science, circumstantial evidence … is what we in the medical biz call anecdotal … the weakest form of evidence.

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A reporter from the Boston business paper tweets out while visiting Steward-owned New England Sinai Hospital that computers on wheels were jamming up family waiting areas because employees had limited wall sockets available for charging them. Hospital executives responded by saying the carts had been moved, which is good since it means that someone at the hospital follows Twitter, although that doesn’t seem to address the problem of needing to charge them somewhere.

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Columbus-based Big Lots donates $50 million to Nationwide Children’s Hospital (OH) and will get naming rights to the clinical department and a planned pediatric psychiatric hospital. Even though I’ve bought stuff at Big Lots (while overlooking piles of junky merchandise and the occasionally troubling behaviors of my fellow bargain-seeking shoppers), I don’t know that I’d want to be admitted to a hospital named after a company selling closed-out distress merchandise out of previously abandoned stores in dying strip centers. The NYSE-traded retailer is worth $2.2 billion on $5 billion in revenue, while recent tax forms show that the hospital made $244 million on $1.4 billion in revenue. 


Sponsor Updates

  • Influence Health will exhibit at SHSMD Connections September 11-14 in Chicago.
  • Ingenious Med and Obix Perinatal Data System will exhibit at the Georgia HIMSS annual conference September 7 in Atlanta.
  • Illinois Senator Dick Durbin visits the Intelligent Medical Objects office.
  • Live Process will exhibit at the Nevada Hospital Association Focus on the Future conference September 7-9 in South Lake Tahoe, NV.
  • MedData will exhibit at the Texas Society of Anesthesiologists Annual Meeting September 8-11 in San Antonio.
  • Meditech representatives discuss interoperability at the 2016 KLAS Cornerstone Summit.
  • PatientMatters will exhibit at the Kansas Hospital Association Fall Conference September 8 in Overland Park.
  • PaymentsSource profiles PatientPay’s healthcare “paper fix.”
  • Forbes names Red Hat as one of the world’s most innovative companies.
  • The SSI Group will exhibit at the CASA 2016 annual conference and exhibit September 7-9 in Carlsbad, CA
  • IT Business Edge covers SyTrue’s partnership with IDS.

Blog Posts


Contacts

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

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September 1, 2016 News 5 Comments

Keeping Up with Amazon Alexa’s Healthcare Potential

August 31, 2016 News 2 Comments

HIStalk looks at the ways in which patients, providers, and vendors are using Amazon’s virtual assistant technology to improve healthcare inside and outside of the hospital.
By
@JennHIStalk

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When it first launched in mid-2014, the Amazon Echo looked like nothing more than what many thought it initially was – a voice-enabled wireless speaker that could offer up information via the company’s proprietary Alexa voice assistant technology. Whether it was traffic conditions, weather forecasts, or trivia questions, the Echo at first seemed capable of helpful but extremely basic tasks.

As consumers began to dig into its features and Amazon opened up the Echo’s platform to developers, new capabilities began to emerge, many of which caught the eye of those with a keen interest in the role consumer-facing technologies can play in healthcare.

Straight from the Patient’s Mouth

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As with many technologies today, (wearables being a prime example), consumers soon began using Alexa as a personal healthcare assistant. Julie McGovern, CEO of practice management consulting firm Practice Wise, was quick to recognize the value its features could offer in helping her care for her ailing mother. “Alexa has made life easier for my mother on a daily basis,” she says. “Besides medication reminders, which we set as timed alerts, she uses Alexa to add items to her shopping list, get news and weather updates, listen to music and audio books, and amuse herself by having Alexa tell her jokes.”

McGovern has her eyes – and those of her mother’s providers – peeled for new Echo aging-in-place features. She’s especially excited about a new interactive medication management feature that will notify designated family members and caregivers if her mother doesn’t acknowledge to Alexa that she has taken her meds after a certain number of attempts.

From Contest to Market

McGovern and her mother may soon be able to take advantage of just such a feature from DaVincian Healthcare, the Overall Champion of the PYMNTS.com & Amazon Alexa Challenge held earlier this summer. The Austin, TX-based startup created DaVincianRx for the competition, an “interactive prescription, communication, and coordination companion” designed to improve medication adherence while keeping family caregivers in the loop.

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The prototype, which took six weeks to create, was developed with the end goal of helping patients become more active in their own care and staying on track with medication plans. “When we combine prescription abandonment and non-adherence costs,” explains DaVincian Healthcare Chief Medical Officer Meredith Porter, MD, “they are staggering. Estimates range around $300 billion every year. Yet even more concerning than the wasted medical costs are the clinical costs – worsening medical conditions, unnecessary appointments and hospitalizations, and poor health outcomes, including death. Out team focused on leveraging Amazon’s Alexa to find a real solution to address this problem, keeping in mind the importance of closed-loop communication between the patient, provider, and family.”

Porter adds that Alexa-enabled tool, which the company plans to roll out through the Amazon ecosystem, is perfectly suited for aging-in-place patients like McGovern’s mother. She also believes that it will do well, “especially with those who feel overwhelmed or isolated when it comes to their health management. Our skills help people stay on track with knowing why and when they should be taking medications; reminding them about new prescriptions or needed refills; and tracking adherence to offer the critical closed-loop connectivity to family members and health teams.”

Bringing Alexa to the Bedside

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Providers are certainly aware of Alexa’s potential, perhaps none more so than Boston Children’s Hospital, which developed an Alexa-based app earlier this year that offers parents advice when their child runs a fever. BCH Chief Innovation Officer John Brownstein, PhD attributes the hospital’s interest in Alexa to its well-documented interest in emerging consumer technologies and how they might be applied to healthcare. “As voice-assisted technologies have emerged,” he says, “we began to think about whether or not this could be a new channel through which consumers can receive health information. Echo became a great example for us to choose because it had been such a commercial success, and we had this ability to work within the Amazon environment to build out Alexa-related skills.”

Brownstein has been pleased with reception of the KidsMD app, which has thousands of users. “It’s really a two-way form of communication in that we’re providing useful information to patients and also collecting really interesting data about symptoms that could potentially be used for better understanding things as they’re happening in various parts of the country. That background data can be useful for public health.”

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The KidsMD app is just the beginning as far as Brownstein is concerned. His team is busy evaluating a number of other use cases, many of which evolved out of a mini Alexa hackathon held at the hospital in May. “Could you use voice to pull up an image from the EHR while you’re in surgery so you don’t have to scrub out, for example? Can you use it as you’re interacting with a patient to take an image?” Brownstein poses. “We’re really excited about Alexa’s potential in situations where you want to either have the ability to keep working without having to change course,” Brownstein says, “or where you might want better interaction with your patient by not having to turn your back to them and start typing on a computer. Not to mention the opportunities for patients in their rooms. If they need to access information and they’re not mobile, this might also be an opportunity for them to access information or communication. We’re experimenting with all of these scenarios in parallel.”

Brownstein adds that patients invited to BCH’s Alexa brainstorming event were most interested in potential home uses, and his team in turn became interested in the resultant opportunities in collecting feedback and offering post-discharge care guidelines and educational materials. “To be able to get to that level of detail quickly through voice is really interesting,” he says.

Prioritizing Further Developments

BCH hasn’t yet pulled the trigger on formally launching these ideas because of privacy and security concerns. “We’re working with Amazon to figure out HIPAA compliance and better understand what the risks are,” says Brownstein. “We’ve built a consumer version of Alexa with the KidsMD app, so we’re not concerned from that perspective because it’s just providing general information. When you start talking about electronic medical data or interfacing with the hospital system, that’s when you really need to figure out how the enterprise version of Alexa will have to emerge. We’re still working on that.”

Prioritizing internal opportunities also plays a part in BCH’s further development of Alexa-related enterprise capabilities. “Like anything,” Brownstein explains, “it has to be thought of in the context of other efforts and where that should be prioritized. Then, of course, there’s the integration issue. There’s still a challenge to integrate with our existing Cerner EHR. We’ve done a prototype of it, but the integration into the core IT fabric of the hospital will take a lot of work.”

Gauging Real-World Patient Potential

Whether it’s enterprise environments or home-based opportunities, Amazon’s Alexa technology is well poised to impact healthcare delivery and outcomes, not to mention patient satisfaction scores. “I think that any time you make information more easily available to patients, any time you make the experience more enjoyable, more seamless, I think you’ll have a real impact on the overall patient journey,” Brownstein enthuses.

Porter is equally enthusiastic about the innovation Alexa could bring to healthcare. “We recognize that the potential for this technology in healthcare is nearly limitless,” she says, “from health education and chronic disease management to reducing healthcare costs and transforming lives in health.”

The ultimate litmus test for Alexa’s role in transforming healthcare will be conducted in the lives of patients like McGovern’s mother. An enjoyable, seamless, and even humor-inducing experience that results in improved medication management and care coordination will surely help escalate Amazon’s virtual assistant technology to a vital part of the care team.

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August 31, 2016 News 2 Comments

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Reader Comments

  • rxpete: Seems like the President of one of your big vendors (Cerner) being a board member might be a bit of a conflict of intere...
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