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News 2/3/17

February 2, 2017 News 5 Comments

Top News

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Children’s Medical Center of Dallas (TX) will pay $3.2 million to settle HIPAA charges related to the loss of an unencrypted BlackBerry in 2010 and theft of an unencrypted laptop in 2013.

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The organization failed to encrypt all PHI-containing devices as recommended by two consulting firms that had performed security gap and vulnerability analyses. It had also allowed its biomedical department to inventory its own IT equipment, causing the IT department to miss those devices in enforcing its security policies.

HHS OCR says Children’s practiced “non-compliance over many years with multiple standards of the HIPAA Security Rule.”

Pam Arora, SVP/CIO of Children’s Health since January 2007, was named last month by CHIME and HIMSS as their John E. Gall CIO of the Year.


Reader Comments

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From Deranged Bunny: “Re: mistakes in the HIMSS-owned publication. Here’s one from the first sentence in their lead story today.” Re-wording a press release into a “story” should have been easy for their writer since all the words were right there. For the record, “Purdue” pushes OxyContin, while “Perdue” sells chicken.


HIStalkapalooza Sponsor Profile

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InstaMed, healthcare’s most trusted payments network, delivers secure and fully integrated patient payment solutions to the largest health systems, children’s hospitals, and provider organizations across the US, processing billions of dollars in healthcare payments per month. Connect with InstaMed during HIMSS17 at booth 609 to chat about the healthcare payments experience your patients are demanding, the need for integration of patient payments into EHR/PMS, and the increasing pressure on security and compliance, including PCI scope. Plus, we are hosting an evening of conversation, food, and drinks on February 19 after the HIMSS17 opening reception. Learn more.


HIStalk Announcements and Requests

I still have seats available for our CMIO lunch at the HIMSS conference, Tuesday, February 21 at noon, conveniently located just off the exhibit hall and paid for by me. CMIOs can sign up here. Our 20 or so CMIO attendees will enjoy a great buffet lunch and casual peer-to-peer conversations – the only non-CMIO attendee will be Lorre, who is hosting. Everybody has to eat even with all the conference hustle and bustle, so a relaxing lunch with peers is a nice way to escape the neon jungle.

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We funded the DonorsChoose grant request of Mrs. W from Arizona, whose elementary school class is using the document camera we provided for reading and phonics skills along with their sections in science, math, and social studies.

This week on HIStalk Practice: Family Choice Urgent Care implements Practice Velocity software. ATA asks for comments on pediatric, mental health, stroke guidelines. MediSys adds Alpha II PQRS capabilities. PatientClick launches telepsychiatry service. DrFirst acquires VisibilityRx. Das Health develops online mental health assessment tools. Greenwood Genetic Center’s Michael Lyons, MD discusses GGC’s decision to add telemedicine capabilities.

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Welcome to new HIStalk Platinum Sponsor Siemens Healthineers. The company’s product lines include medical imaging, laboratory diagnostics, and point-of-care testing. Imaging and IT offerings include PACS, RIS, image sharing, clinical data management, software for multi-modality reading, cardiovascular care software, and enterprise imaging, workflow, visualization, and archiving. Diagnostic products include data and workflow management systems, diagnostics system remote monitoring, and laboratory inventory management. Nine out of 10 US hospitals depend on the company’s solutions, including every hospital listed on the US News & World Report Honor Roll. Siemens Healthineers and IBM Watson Health are working together to develop and deploy new population health management products and services to help providers transition to value-based care with analytics and patient engagement. It will offer IBM Watson Care Manager, a cognitive solution that supports nurses and other care managers as they monitor and counsel people with chronic conditions. See them in HIMSS Booth # 2323. Thanks to Siemens Healthineers for supporting HIStalk.

Here’s a Siemens Healthineers intro video I found on YouTube. It’s from May 2016, when the company announced its name change from Siemens Healthcare.

Listening: new from Horisont, fantastic 1970s-sound prog rock that’s actually from a fairly new band from Sweden (think Kansas meets Deep Purple in Uriah Heep’s basement). Speaking of which, RIP John Wetton, whose long career as a prog-band bassist, singer, and songwriter included stints with King Crimson, UK, Uriah Heep, and most notably Asia. Asia’s tour starts on March 15, but Wetton had already bowed out due to his chemotherapy treatments, replaced by Yes’s Billy Sherwood, who previously replaced another deceased legendary prog bassist, Chris Squire of Yes.


Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Meditech announces Q4 results: revenue down nine percent, EPS $0.62 vs. $0.52. For the year, revenue was down 2.8 percent as product revenue slipped 15 percent, having declined by 38 percent since 2014. The privately held company’s net income was $73 million in 2016, up 4 percent from last year but down 41 percent vs. 2014’s total.

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DrFirst acquires VisibilityRx, which identifies and recruits patients for clinical trials.

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Athenahealth reports Q4 results: revenue up 12 percent, adjusted EPS $0.62 vs. $0.45, beating earnings expectations but falling short on revenue.


Sales

George Washington University (DC) chooses Castlight Health’s employee health benefits management platform.


Announcements and Implementations

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Catholic Health Services (NY) rolls out Uniphy Health’s mobile collaboration app to its providers.

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Jupiter Medical Center (FL) will go live in March 2017 on IBM Watson for Oncology, the first community hospital to do so following the system’s “training” at Memorial Sloan Kettering Cancer Center. It presents individualized, evidence-based treatment options to oncologists in drawing information from 15 million pages of text from medical journals and textbooks.

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UCHealth (CO) announces technology-related developments that include virtual visits, online scheduling, a new app, and adoption of the OpenNotes standard.


Government and Politics

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A Florida urologist will pay $3.8 million to settle False Claims Act charges that he ordered medically unnecessary lab tests. Meir Daller, MD ordered 13,000 FISH bladder cancer tests of questionable medical value on Medicare patients who were steered to a lab owned by his employer, who then paid the doctor $2 million in bonuses. The assistant US attorney says the doctor would look at paper-based urinalysis results but then throw them away so he could enter whatever he wanted into the EHR, often falsely recording that blood was found in the patient’s urine to justify ordering the test. The practice’s owner, 21st Century Oncology, previously paid $20 million for its role in over-ordering the $1,000 tests for Medicare patients. The company, which operates 180 cancer treatment centers, also reported an October 2015 breach of its systems that exposed the information of 2.2 million patients.

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USA Today reports that shares of McKesson were among the healthcare-related investments made by HHS Secretary nominee Rep. Tom Price (R-GA) since 2012 that appear to be improper. Price bought MCK shares in March 2016, McKesson warned investors in early May that Medicare’s reduction in medical equipment payments could hurt its bottom line, and Price introduced legislation to cancel the cuts on May 12.


Privacy and Security

In England, an analysis of the four-day October downtime of three-hospital Northern Lincolnshire and Goole NHS Foundation Trust finds that it was caused by a misconfigured firewall that allowed ransomware to penetrate its systems.

President Trump’s long-time doctor Harold Bornstein, MD lists the president’s medical conditions and prescriptions in a New York Times interview, raising the question of whether he violated HIPAA in doing so.


Other

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HRH Princess Haya of Jordan, the junior wife of UAE’s prime minister (she’s the second of his five wives), addresses the Arab Health Exhibition and Congress in Dubai:

I have already alluded to the difficulty faced in embracing new technology in healthcare. To ensure successful adoption, we need to equip the physician, the patient, and the system with the right tools and knowledge. We also need to improve medical training to ensure future generations of doctors are proficient in the use of technology, social media, and digital platforms. This is my point. This is where the balance lies. We have seen all kinds of machines and technologies that have created the architecture, but in the end, it was for the benefit of the people, to give them a home for the future. This same balance needs to be struck between innovation and medicine.

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An interesting article lists the biometric measurements that will soon allow police to identity suspects in ways that go far beyond fingerprints. They include signature recognition, typing pattern recognition, recognizing patterns used in reading predefined passages aloud, eye movement tracking, gait analysis, and identifying people by their body odor. Facial recognition systems are already in place, with the FBI having stored the images of half of Americans in its databases. The article notes that President Trump’s executive order on immigration calls for expediting the use of biometric screening at the US border.


Sponsor Updates

  • Kyruus will present at the Harvard Healthcare Business Conference February 4 in Boston.
  • ZeOmega’s Jiva 6.1 earns ONC Health IT 2014 Edition Modular EHR certification.
  • Learn on Demand Systems releases details about its invite-only Launch event in March for customers and partners.
  • LiveProcess releases a new case study, “Communication During a Cyberattack.”
  • MedData will exhibit at the HFMA NENY Women in Leadership Conference February 9 in Clifton Park, NY.
  • Medecision releases a new video, “Aerial Powering Population Health Success.”
  • Meditech will exhibit at the AHA’s Rural Healthcare Leadership Conference February 5-8 in Phoenix.
  • Navicure will exhibit at the 2017 Healthpac Annual Users Meeting February 10-12 in Savannah.
  • Nordic will sponsor the inaugural Epic North Carolina Users Group Meeting February 8-9 in Greensboro.

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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News 2/1/17

January 31, 2017 News No Comments

Top News

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OxyContin manufacturer Purdue Pharma will give the State of Virginia a $3.1 million grant to integrate its doctor-shopper prescription drug monitoring database with provider EHRs.

The state will use the PMP Gateway of its Appriss Health NarxCare system, which uses two years of prescription data to visually represent a patient’s usage patterns and to present a calculated risk score. Beyond claims and EHR data, it can incorporate information from EMS and criminal justice systems.

NarxCare offers prescribers a Medication-Assisted Treatment locator map and patient information handouts.

The 450-employee, Louisville-based Appriss Health says its systems process 25 million database inquiries each year. It also offers law enforcement, public safety, and Medicaid fraud detection apps.


Reader Comments

From Firing Line: “Re: HIStalk. I have followed you since I worked at a big health IT vendor, where it was a fireable offense to read your blog back in the early days.” I’ve heard that about a few companies, which encourages me since I must be doing something right if they want to ban employees from reading what I write. I also enjoy hearing from readers who apologize for not evangelizing HIStalk because they consider the information they gain to be a personal competitive advantage.

From Spatial Orientation: “Re: [EHR vendor name omitted]. Has informed users that they are able to supply QRDA III reports but not QRDA I reports, meaning they are in violation of ONC’s certification requirements.” Unverified. I’ve invited the company to respond but haven’t heard back. I’ll repeat this item including their name in Thursday’s post if they don’t respond.


HIStalkapalooza Sponsor Profile

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Spok, Inc., a wholly owned subsidiary of Spok Holdings, Inc. (NASDAQ: SPOK), headquartered in Springfield, VA., is proud to be the global leader in healthcare communications. We deliver clinical information to care teams when and where it matters most to improve patient outcomes. Top hospitals rely on the Spok Care Connect platform to enhance workflows for clinicians, support administrative compliance, and provide a better experience for patients. Our customers send over 100 million messages each month through their Spok solutions. When seconds count, count on Spok. For more information, visit spok.com or follow @spoktweets on Twitter.


HIStalk Announcements and Requests

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I’m getting swamped with HIStalkapalooza emails from people who don’t appreciate the fact that I have around 50,000 readers and I have maybe 1.5 FTEs total other than me to do everything HIStalk-related, of which party planning represents about 0.01 FTE. My plea is this: come if you received an invitation, don’t come if you didn’t, and don’t email us either way because it’s the busiest time of year for us and throwing a free party isn’t our most pressing priority. To summarize the oft-stated rules: (a) don’t ask if I have extra tickets since I’m already turning people away who signed up due to a shortfall in sponsorship funds, so I certainly won’t be inviting someone who didn’t even register; (b) you’ll need to complete your registration online from the email link and bring your barcoded invitation to the event; (c) I can’t help you fix your company’s spam filter that didn’t let your invitation through; (d) you can’t bring a guest if you didn’t register them; and (e) wear whatever you want, but go big if you want to have a shot for the “best shoes” and best dressed” awards. There’s an exception to (a): get your company to sign on as a sponsor of the event and your CEO can come after all — it’s nearly always CEOs who neglect to sign up and then dispatch an underling to demand an exception, usually from vendor companies that don’t support HIStalk in any way.

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Dear HIMSS-owned publication: hi, it’s me again. Thanks for fixing the story you ran over the weekend that I called out, in which you mistook a January 2016 press release for January 2017 and splashed it out as breaking news. I won’t quibble with the fact that you just changed the story to hide your mistake without acknowledging it. On that topic, please note that there’s no such company as “Optum Healthcare IT” that you reference in your list of KLAS winners. What you meant to say was “Optimum Healthcare IT.” At least your HIMSS peer at Healthcare Finance also screwed up the same name, calling it “Optimum IT.” Don’t worry, I don’t read your site, so I won’t be catching your mistakes regularly (but hopefully your readers will!)

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We provided strategic thinking and economics games along with general supplies for Ms. D’s middle school class in Arkansas in funding her DonorsChoose grant request. She reports, “My students have played rounds of critical thinking games every week since we have received the package. This is their favorite time of the week and can’t wait to figure out what new game we are playing. After learning about Milton Bradley and Henry Ford, the students have started creating their own strategy games.”


Webinars

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements.

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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Thoma Bravo is soliciting bids to buy its supply chain management company Global Health Exchange for up to $1.3 billion, Reuters reports. Thoma Bravo bought GHX in 2014.

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A private equity news site says health information exchange platform vendor Vyne has hired a merchant bank to explore a sale of the company.

Big Massachusetts providers Beth Israel Deaconess Medical Center and Lahey Clinic announce plans to merge to better compete with the huge (and hugely expensive) Partners HealthCare, which also recently announced its own plan to acquire the Massachusetts Eye and Ear specialty hospital.


Sales

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Geisinger Health System (PA) will implement Stanson Health’s clinical decision support and analytics to add real-time, patient-specific intelligence to its EHR.

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In England, King’s College Hospital NHS Foundation Trust chooses Cerner Millennium EHR and revenue cycle for the 100-bed hospital it will build in Dubai.

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Dayton Children’s Hospital (OH) selects InstaMed’s consumer-friendly, encrypted payments solution.


People

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MedEvolve hires Jenny O’Pry (MedSynergies) as SVP of RCM and Matt Seefeld (NantHealth) as SVP of business development.


Announcements and Implementations

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Healthcare Growth Partners publishes its amply-researched and well-written HIT Market Review, which includes M&A, valuation, the year in review, and thoughts about the impact of the new administration.

A new Black Book report finds that population health management technology is a fast-growing sector even though providers are forging ahead using only stopgap tools from their EHR vendor, they’re dealing with community HIEs that offer poor population health modeling data, and they have limited data availability beyond their own EHR’s health snapshots. Hospitals report that they will need new PHM and IT talent, but shortages may limit availability. The top three best-of-breed vendors were IBM Watson Health, Evolent Health, and The Advisory Board Company, while the top three PHM and value-based care consultants were Premier, The Advisory Board Company, and Evolent Health.


Government and Politics

Vox reports that President Trump has abandoned his campaign promise to reduce drug costs by allowing Medicare to negotiate prices, changing his mind after meeting with pharma lobbyists to now favor drug company tax reductions and deregulation.


Privacy and Security

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I’ve seen several recent articles on Cambridge Analytica, the “behavioral microtargeting” analytics firm that was involved (to an arguable degree) with both the Brexit and Donald Trump wins that pollsters failed to predict. The company’s work is relevant to healthcare because: (a) it sounds a lot like how HIMSS describes its new service that will target vendor sales prospects using their personal information; and (b) it could be more positively used for public health in areas such as depression. Either way, lax US personal data laws are making us all targets of companies that train their analytical firepower to profitably sway our decisions. Cambridge Analytica, of which White House advisor Steve Bannon is apparently a board member, mines Facebook data via those mindless quizzes that bored people inexplicably take, thus giving the company access to their Facebook profiles. The company’s technology supposedly requires just 68 of a user’s “likes” to accurately predict their skin color, sexual orientation, political party affiliation, and use of drugs, alcohol, and cigarettes, while it just 10 “likes” allow researchers to “know” a Facebook user better than their work colleagues. The company combined that information with commercially sold personal information databases to develop psychological profiles on every American. It then buys Facebook ads that it micro-targets to individual personality types, which some experts say was the key to the unexpected and lesser-funded campaign victories of Donald Trump and Brexit:

On the day of the third presidential debate between Trump and Clinton, Trump’s team tested 175,000 different ad variations for his arguments, in order to find the right versions above all via Facebook. The messages differed for the most part only in microscopic details, in order to target the recipients in the optimal psychological way: different headings, colors, captions, with a photo or video. This fine-tuning reaches all the way down to the smallest groups … In the Miami district of Little Haiti, for instance, Trump’s campaign provided inhabitants with news about the failure of the Clinton Foundation following the earthquake in Haiti, in order to keep them from voting for Hillary Clinton … These “dark posts”—sponsored news-feed-style ads in Facebook timelines that can only be seen by users with specific profiles—included videos aimed at African-Americans in which Hillary Clinton refers to black men as predators, for example.

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The St. Louis Cardinals will give the Houston Astros $2 million and their two top draft picks as cybercrime compensation. The former director of baseball development for the Cardinals was sentenced to 46 months in prison and a lifetime MLB ban for accessing the scouting reports, contract information, and internal emails of the Astros using passwords he had guessed.

Officials in Missouri, the only state that doesn’t have a doctor-shopper prescription drug monitoring database, are still arguing over privacy requirements and which state agency should oversee it.


Other

Sites are slinging around news headlines saying that medical residents spend half of their time working on the computer, but they fail to note the deal-breaking limitations of the just-published study they reference: it was performed in Switzerland with unknown applicability to the US and it was an observational study (which has unavoidable bias) of only 36 internal medicine residents in a single hospital. There’s probably also the fact that residents are often expected to remain in the hospital outside of normal working hours, so it’s questionable whether EHR usage required extra time or whether they were stuck in the hospital without much else to do anway.

A TransUnion Healthcare consumer survey finds that three-fourths of respondents would look more favorably on a provider who provides upfront cost estimates, but 43 percent said it was hard to get cost information and another 21 percent said they haven’t even bothered trying.

Authors of a JAMA opinion piece say it’s too expensive for patients to get copies of their medical records since providers widely ignore a 2016 federal law that allows them to charge only direct labor and postage costs associated with creating the paper copy. Only Kentucky requires providers to give patients the first copy of their records at no cost.

Small drug company Kaleo, which makes a recently approved naloxone injector for opioid overdoses, has raised the price of its consumer-usable package of the nearly 50-year-old  drug from $690 in 2014 to $4,500 now. The company is donating the product to first responders and drug treatment programs, covering co-pays for buyers with private insurance, and selling it to the VA (which is allowed to negotiate drug prices) at a significant discount, but sticking insurance companies and taxpayers with the bulk of its profits.

In England, a report finds that human error contributed to the failure of the 1980s-era pathology system that delayed surgeries at Leeds Teaching Hospitals NHS Trust. Most of the system’s experienced support employees have left and newer analysts didn’t notice that system backups had grown so large that they were being corrupted.

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OB-GYN doctors and nurses at a hospital in Macedonia are fined when a nurse posts Facebook photos of their in-hospital New Year’s celebration that show alcohol, cigarettes, and cupcakes iced to look like vaginas. Photos of the latter item indicate that though their social media judgment is suspect, their eye for anatomical detail is admirable.


Sponsor Updates

  • Medhost Achieves Stage 3 Meaningful Use Certification (Medhost)
  • Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world? Par 1: Looking at the data.”
  • Carevive Systems will present at the Cancer Center Business Summit 2017 February 6-7 in Las Vegas.
  • ECG Management Consultants will present at the American Health Lawyers Association meeting February 1 in Orlando.
  • Elsevier will offer HFMA courses through its healthcare eLearning system.
  • Healthwise will exhibit at EClinicalWorks Day February 1 in New Orleans.
  • The CHIME Foundation appoints Divurgent’s Steve Eckert to its board.

Blog Posts

KLAS-Related Announcements


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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Monday Morning Update 1/30/17

January 29, 2017 News 8 Comments

Top News

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VoteStand vote fraud reporting app developer Gregg Phillips, who President Trump credits with convincing him that 3 million people voted illegally in the November election (all of them for Hillary Clinton), has a healthcare IT connection – he’s the chairman of AutoGov, a Medicaid eligibility decision support tool vendor. The product’s description suggest that it works similarly to his vote fraud analysis methods, merging databases together to provide a full eligibility picture of Medicaid applicants.

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AutoGov markets its big data-powered system to providers as, “You will be able to decide whether or not to admit a Medicaid patient with just a touch of a button.” It is powered by scoring algorithms that use data from 30 million cases.

Phillips, a former Texas Deputy HHS commissioner, says he augmented a 180 million-row voter registration database with other databases and geocoding data, giving him the ability to verify identity, residency, and citizenship status, although others have questioned his claim. He said in a CNN interview Friday he won’t be able to release specifics for several months given the analysis required and the demands of his day job.

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A post-election tweet by Phillips claiming that non-citizens voted was picked up by the then-President-elect, after which an apparently puzzled Phillips told a reporter, “Is a tweet really news? Isn’t everything on Twitter fake?”


Reader Comments

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From Is This Even Still a Thing? “Re: booth babes. I just got this pitch.” An Orlando modeling agency warns HIMSS17 exhibitors of the peril of hiring “below-average young women” to draw traffic, introduce products, and generate leads. I think I should run a honeypot sting operation to focus on the demand instead of the supply, setting up a fake HIMSS booth staffed by an “above-average young woman” from this agency. Each time our booth babe lures a gawking attendee into the booth, I would emerge with microphone in hand like that solemn-voiced talking head Chris Hansen in “To Catch a Predator,” inviting the now-squirming attendee to have a seat and explain to my on-camera audience (and to their colleagues and families) what they hoped to gain. 

From Research Expert: “Re: HIStalk. I read it every day and find it extremely valuable. Good thing it’s not more organized or it could put many of the advisory firms out of business. 🙂” Thanks. I’m more of a real-time fire hose since I don’t like to recycle old news just to earn reader clicks while insulting their intelligence, but I could probably get someone to repackage the already-vetted information stream into something that could be useful in a different way. However, my inherent laziness makes that unlikely.


HIStalkapalooza

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HIStalkapalooza invitations will be emailed by Monday. Every year we invite people who claim we didn’t, as our email was apparently blocked by their overly aggressive spam filters (the invitation will come from eventbrite.com). Important: you MUST click the link on the email invitation link called “Attend Event” to complete your signup, otherwise the check-in system won’t recognize you at the House of Blues and you’ll be slinking away crestfallen to the sounds of the link-clickers inside slurping down drinks, loading up plates, and performing their pre-dance stretching.

A shortfall in sponsor money means I can’t invite everyone who asked to attend, unfortunately. The pecking order is providers first, then two people from each HIStalk Platinum sponsor, then I just try to choose a good mix of job titles and companies until we hit the number I can afford (since I’m paying thousands out of my own pocket). I’ll ignore emails asking for exceptions, explanations, or anything else event related –  it’s just a party and nobody will suffer from starvation, dehydration, or dance deprivation for lack of attendance that Monday evening. Like a concert or sporting event, each person must have an individual ticket that will be scanned at the door.


HIStalkapalooza Sponsor Profile

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Cumberland Consulting Group is a leading healthcare consulting firm that helps some of the nation’s largest payer, provider, and life sciences organizations implement and optimize technologies to maximize operational efficiency. Cumberland delivers comprehensive consulting services with a focus on strategic advisory, implementation, optimization, and outsourcing. The firm excels at system selection and planning, implementation project management, system optimization, and performance improvement. In addition, Cumberland offers high-quality, certified resources to support your most complex IT projects. For more information on Cumberland’s services, visit their site.


HIStalk Announcements and Requests

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Dear HIMSS-owned publication: apparently you failed to notice that the press release you used as the sole, uncredited source for your just-published breaking news article was dated January 6, 2016. You already reworded that press release in calling it news on January 8, 2016 (although even then your sub-headline made no sense). Could you perhaps apologize to the 400 folks who have shared your “news” so far this week since you’ve made them look stupid in mistaking a year-old announcement for something new? Thank you.

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About half of poll respondents reacted negatively to the announcement that HIMSS is starting a conference and media group that will cater to vendor members targeting provider members, while 17 percent like the idea and 31 percent don’t care either way. HIS Junkie sagely comments that if HIMSS were truly member-driven, it would set up a division and conference to teach providers how to negotiate with vendors and to get better contracts, but as he notes, there’s no money in that.

New poll to your right or here: why are you going to the HIMSS conference? (a question I ask myself every year about this time).

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Ms. H asked for financial help via DonorsChoose to continue her New York high school’s “Guest Writers” series, which we provided. She says students have enjoyed getting a behind-the-scenes look of how books are written, edited, and published as described by award-winning authors who visit with the students. 

Iatric Systems donated $500 to my DonorsChoose project, which with matching funds applied (from my anonymous vendor executive and other sources) fully funded these teacher grant requests:

  • Two laptops, computer accessories and cases, a document camera, and supplies as requested by high school senior Julie for her Camden, NJ pre-calculus class
  • An Amazon Fire tablet for Ms. D’s elementary school class in Los Angeles, CA
  • A Chromebook for Mr. D’s elementary school class in Wichita, KS
  • STEAM literature for Ms. M’s fourth-grade class in Minneapolis, MN
  • An activities table for Ms. A’s first-grade class in Manning, SC
  • Hands-on manipulatives and family interactive learning technologies for Ms. A’s elementary school class in Chicago, IL

Ms. A from Chicago emailed soon after I made the donation to say, “This is beyond heart-warming! I am tearing up and smiling at the same time! The education crisis in my state is threatening more teacher layoffs, furlough days, and shortening the school year. Your donation has uplifted my spirit and brought great joy as finding innovative ways to educate my students and their families is a passion that, I learned today, I do not share alone. ”


Last Week’s Most Interesting News

  • McKesson announces that it will acquire CoverMyMeds for up to $1.4 billion.
  • A federal judge rules against the proposed merger of Aetna and Humana, citing anti-competitive concerns.
  • GetWellNetwork acquires Seamless Medical Systems.
  • Former National Coordinator Karen DeSalvo, MD, MPH joins her fellow HHS political appointees in leaving government service with the administration change.

Webinars

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

Harris Corporation will sell its government IT services business to Veritas Capital for $690 million in cash, which doesn’t sound like much for a division that’s generating $1 billion in annual revenue.

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Hospital staffing firm Jackson Healthcare will build a $100 million, 306,000-square-foot expansion to its Alpharetta, GA headquarters that will house 1,400 new employees. It will include a 39,000-square-foot amenities building modeled after the Colosseum in Rome that will house a gym, pool, restaurant, hair salon, dry cleaner, spray-tanning studio, chiropractor, masseuse, and barber. The company took in $800 million in revenue last year.


Sales

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University of Virginia Medical Center (VA) chooses clinical process measurement solutions from LogicStream Health, which it will use to drive evidence-based best practices in managing and improving its EHR’s decision support tools.

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Children’s Healthcare of Atlanta selects Voalte Platform for care team communication and alert notification.

CHI Franciscan Health chooses Clearsense analytics to aggregate and organize patient data for clinical decision-making.


Decisions

  • Memorial Hospital Of Carbondale (IL) will switch from Meditech to Epic in June 2017.
  • Trinity Rock Island (IL) will replace BD Pyxis MedStation with Omnicell in summer 2017.
  • Centura Health – Porter Adventist Hospital (CO) replaced Meditech with Epic in October 2016.
  • Elmhurst Memorial Hospital (IL) went live with Epic in October 2016.

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


People

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Will Plourde (HealthcareSource) joins LiveData as VP of engineering.


Announcements and Implementations

McKesson’s IKnowMed tops Black Book’s oncology-hematology EHR satisfaction ratings for the sixth straight year.


Privacy and Security

An employee of Campbell County Health (WY) sends the W-2 information of 1,400 employees to a hacker impersonating a hospital executive who asked for all forms for 2016.


Other

A Johns Hopkins Medicine study finds that, not surprisingly, clinic doctors who are running behind schedule unintentionally shortchange patients in trying to catch up.

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A woman sues Cone Health (NC) for trying to collect the unpaid medical bills of her deceased husband, seeking class action status under a clause in the state’s constitution that says the property of a woman can’t be attached to pay for the debts of her husband.

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ACA architect Ezekiel Emanuel, MD, PhD scoffs at the idea that technology can replace doctors and that wearables can improve health, arguing that the tech sector is missing the point that resolving a technology-identified problem still requires a face-to-face doctor-patient encounter. He says technologists should focus on solving health problems like heart disease and obesity instead of obsessing about new monitoring tools, saying that even a cure for cancer would have a minor impact on life expectancy compared to reducing smoking and high blood pressure.

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An Ohio man is charged with arson and insurance fraud after police get a search warrant to review his pacemaker data and find no evidence of heavy exertion at the time he claimed he was quickly packing and lugging heavy belongings out of the house as the fire spread.

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A Hauppauge, NY doctor is convicted of selling opioid prescriptions by instructing his assistant to set up phony EHR exam and treatment records for anyone willing to pony up $120 in cash, all while he spent most of his days out of the office playing hockey. 


Sponsor Updates

  • Arcadia Healthcare Solutions wins top honors from Frost & Sullivan for its clinical and claims analytics platform.
  • PeriGen publishes slides from its presentation on “The New Labor Guidelines: Benefit or Harm” presentation at the Steamboat Perinatal Conference.
  • Phynd will exhibit at the North Carolina Epic User Group Meeting February 8-9 in Greensboro.
  • Red Hat technologies support TransUnion’s migration to a new IT environment.
  • Wharton Research Data Services adds SK&A healthcare data.

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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News 1/27/17

January 26, 2017 News 10 Comments

Top News

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McKesson will acquire privately held prescription electronic prior authorization vendor CoverMyMeds for $1.1 billion plus another $300 million if the company hits performance targets.

McKesson will operate the Columbus, OH-based company as an independent business unit. Francisco Partners must have made a fortune from its November 2014 investment in the company.

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I interviewed co-founder Matt Scantland a couple of years ago, where he explained that drug companies pay for CoverMyMed’s services to avoid unfilled prescriptions. He also agreed then with my assessment that the company was flying under the radar in an obscure niche with $19 million in revenue. That figure jumped to $50 million the same year and $100 million the next. 

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McKesson also announces Q3 results: revenue up 4.7 percent, EPS $3.03 vs. $3.18, meeting earnings expectations but falling slightly short on revenue. Shares dropped 8.3 percent Thursday on the news.


Reader Comments

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From Build That Well: “Re: Becker’s. Changed their story on Erlanger’s loss.” Becker’s focuses on clickbait “10 things to know” listicles written mostly by new liberal arts grads for lazy readers. In this case, they tried to hype Epic as causing Erlanger’s reported loss, but the article they rewrote from the local newspaper didn’t say that at all. Above is the headline before and after. The non-alternative fact, according to Erlanger’s CFO, is that the loss was caused by overtime expense, employee insurance payouts, and drug costs, although he did mention almost as an afterthought that some overtime expense was incurred due to covering employees assigned to the Epic project. Erlanger’s CEO says in another newspaper’s article he’s happy that the hospital is hitting its year-to-date net income targets given that it amortized its $100 million Epic cost over just three years. Erlanger also notes that high-deductible insurance plans and its 33 percent self-pay rate means it can’t collect a lot of what patients owe.

From Clustered: “Re: Epic. I’m not bothered about their position on investment. How many times have there been things truly beautiful, streamlined, and elegant that were designed by committee? Investors are exactly that, collectively — a committee. They dilute decision-making in exchange for access to money and it sounds like Epic already has enough money of its own. Sure, there are things I wish Epic did differently, but I’m not sure inviting a bunch of MBAs and money folks onboard would improve things. Viva la Judy! (disclosure: I don’t work for or with Epic and never have).” Committees are like well-diversified mutual funds – they reduce the chance of both great failure and great success, at least if you’re willing to accept bland mediocrity. The best lessons I’ve learned in writing HIStalk are: (a) people can convey their strong opinion in believing that they represent the majority when in fact they could be dead wrong; and (b) instead of letting a committee tell me what to avoid doing wrong, I would rather just do what I want to do and let readers either come back or move on.

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From Silicon Valley Geek: “Re: Stanford Health Care. Since the new CEO arrived in July, the former CIO (who was promoted to chief digital officer last April) is leaving along with the associate CIO. The bloated 700-employee IT department serving a 600-bed hospital and ambulatory network has been seeing layoffs as the organizational struggles to manage operational costs, new construction, and integration of the newly acquired ValleyCare. IT lost over 50 people yesterday as the CEO announced a $100 million savings target for which non-labor cutbacks weren’t enough. Michael Sauk is now interim CIO – he used to work with the CEO at City of Hope and UW.” Unverified, except the part about Mike Sauk since it’s on his LinkedIn.


HIStalkapalooza

I’ve closed signups, so hopefully if you wanted to attend you either (a) got your name on the list in time, or (b) will be sent an invitation from one of the sponsors of the event, who get to invite a certain number of guests.

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I’m happy that our Industry Figure of the Year (one of the four nominees above) has confirmed attendance at the event, as has our “when ___ talks, people listen” recipient. I’m trying without success so far to get our “person you’d most like to see on stage” and Lifetime Achievement Award winners to stop by, but you never know.

Thanks to our newly participating HIStalkapalooza sponsors:

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HIStalkapalooza Sponsor Profile

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PatientSafe Solutions obsesses over the experience of care to help care teams communicate and work together reliably and efficiently. PatientSafe delivers measurable safety and quality improvements through a mobile platform that extends an organization’s EMR, clinical, and communication infrastructure and fits seamlessly into care team workflows. The company’s context-driven PatientTouch platform unifies communication with workflow by consolidating text, talk, alerts, EMR data, clinical workflows, and customizable care interventions, all in one mobile app, on one device. For more than a decade, PatientTouch has helped clinicians both in and outside the hospital streamline care delivery, increase quality, and lower costs.


HIStalk Announcements and Requests

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Ms. M in Houston sent photos of her students using the listening center and wipe boards we provided in funding her DonorsChoose grant request.

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Welcome to new HIStalk Platinum Sponsor Clearsense. The Jacksonville, FL-based data science company offers a cloud-based analytics solution that works with any data source and can be rolled out in a fraction of the time required for a traditional data warehouse. Its real-time, cloud-based, subscription-priced, scalable system helps healthcare organizations respond to the pressure to use data to make better and faster decisions. Examples: reducing adverse events, improving patient flow, hitting quality and patient satisfaction targets, driving research, and managing cost and payment. Thanks to Clearsense for supporting HIStalk.

I found this excellent YouTube video featuring Clearsense Chief Innovation Officer Charles Boicey MS, RN speaking at the most recent HIMSS SoCal Clinical Informatics Summit. 

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Readers have been asking for years to be able to search HIStalk articles with a company name and date range and I finally figured out how to do that in an admittedly inelegant but somewhat effective way. The date range search box allows specifying a search word (it works best with a single word) and an optional “from” and “to” date range, then shows the results in context. It’s not perfect, but it’s good if you want to see when I mentioned Cerner, let’s say, in just the second half of 2016. 

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We like to have cool people hang out at our HIMSS booth since we don’t have anything to sell and are otherwise sitting alone in our microscopic, unadorned space. Contact Lorre if you would like to entertain, amuse, or otherwise engage HIStalk readers for an hour or so – we tend to like people who are funny and don’t take themselves too seriously, which is harder to find in health than you might expect. 

Does ICD-10 have a code for repetitive stress injury caused by anxiously checking three news sites every 10 minutes, drawn by a combination of fascination and dread?

This week on HIStalk Practice: Northwest Vein & Aesthetic Center rolls out Oncomfort’s anxiety-reducing VR technology. Employee clinic company OurHealth signs on with Athenahealth. Pediatricians take aim at wearables for infants. Eye Care Leaders adds OptimizeRx to partner EHRs. Winners Circle series launches with MTBC winner and Practice Manager Baqar Naqvi. Stakeholders band together to encourage renewed value-based payment reform efforts. Compulink adds Weave’s patient scheduling tech. Sue Kressly, MD advocates for pediatric-specific functionality in EHRs. Sign up for physician practice health IT news.

Listening: the now-defunct After Forever, since Floor Jansen is in my opinion the best singer (of either gender) in the world and the band was crazy talented, as are many of those in the “Beauty and the Beast” metal genre. Now she sings for NIghtwish, where she’s equally good although with less-demanding material. Floor singing “Leaden Legacy” with AF is about as good as it gets.


Webinars

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Here’s the recording of Wednesday’s webinar, “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.”


Acquisitions, Funding, Business, and Stock

Quality Systems (NextGen) reports Q3 results: revenue up 9 percent, adjusted EPS $0.23 vs. $0.16, beating analyst expectations for both.

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Specialty EHR vendor SRSsoft renames itself to SRS Health, unleashing a fury of highfalutin’ buzzwords in which the marketing people congratulate themselves on wresting control of the company’s strategy by turning an orange circle into marketing art whose description will sail right over the heads of customers who squint thoughtfully and say, “I dunno, it just looks like an orange circle to me.” Companies somehow never learn to just make these changes without over-describing them, insisting on involving customers in their contrived logic and convoluted explanation that elicit guffaws instead of praise: 

A brand’s logo is its face to the world. Our new orb-shaped visual identity represents the continuum of how we help our clients engage their patients before, during, and after visits. It signifies the perfect balance of improved efficiency with proven outcomes. And it symbolizes the unending dedication of our team to remain in motion as we continue to pioneer the HCIT solutions of the future. The fiery color of our logo was chosen specifically to depict the passion and commitment to client satisfaction of the people who make up the SRS Health team.


Sales

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Children’s National Health System (DC) adds Millennium Revenue Cycle to its Cerner EHR.

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Local governments in Finland choose Optimum Healthcare IT to staff the 29-hospital Epic implementation of their $615 million Apotti project.


People

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Former HHS Secretary Sylvia Burwell is hired as president of American University in Washington, DC. I wondered about her advanced degree and it turns out she doesn’t have one.

Investment banker Jefferies hires Dmitry Krasnik (Houlihan Lokey) to lead its coverage of healthcare IT.


Announcements and Implementations

InterSystems and Clinical Architecture develop a “clinigraphic” graphical representation of a patient’s most pertinent information contained in medication lists, comorbidities, and test results.

The Gates Foundation donates $279 million to University of Washington’s Institute for Health Metrics and Evaluation, which publishes evidence and trends for global population health that includes the annual Global Burden of Disease report.

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Grady Health System (GA) goes live on Glytec’s eGlycemic Management System of personalized insulin dosing, blood glucose alerts, and analytics integrated with Epic as well as glucose surveillance integrated with Grady’s laboratory information system.


Government and Politics

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A small survey of PCPs published in NEJM finds that only 15 percent think the ACA should be repealed entirely, with three-quarters of them saying it just needs tweaked (some of their suggestions are above). The doctors mirror the general public in supporting existing policies such as prohibiting consideration of pre-existing conditions, allowing parents to keep their children on their insurance through age 26, offering taxpayer-funded small business tax credits and individual subsidies, and expanding Medicaid. Fewer than half support requiring people to carry insurance, however, thus again raising the all-important question of how insurance companies can create cost-effective risk pools among only self-selectors.

Massachusetts Governor Charlie Baker – a former CEO of insurer Harvard Pilgrim Health Care — defends his call for employers to pay the state $2,000 for each employee who either isn’t offered health insurance or who declines to buy it. The state’s MassHealth program is spending $1 billion per year to subsidize health insurance for low-income, full-time employees who could buy employer-offered plans but instead sign up for MassHealth to take advantage of premium subsidies, which the state says is an ACA loophole. Baker is also calling for limiting provider rate increases, with price hikes of the most expensive hospitals capped at the same level as their Medicare increases. MassHealth’s annual cost of $16 billion accounts for 40 percent of the just-released 2018 state budget.

President Trump says in a TV interview that his replacement for the “disaster” of the Affordable Care Act will offer “a better plan, much better healthcare, much better service treatment, a plan where you can have access to the doctor that you want and the plan that you want. We’re gonna have a much better healthcare plan at much less money.” He also says that he expects everyone insured through the exchange to keep insurance coverage.


Privacy and Security

President Trump’s deportation executive order instructs federal agencies to exclude illegal aliens from the Privacy Act, which prohibits the the disclosure of a person’s federal government-held information without their consent. The Act covered only citizens anyway, from what I can tell, and I’m not sure this order has any direct impact on healthcare. Perhaps the significant result is that agencies would need to know (and therefore ask) about immigration status and systems might have to be modified to record it.


Other

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A Wired article notes that improvements in graphics and artificial intelligence technology may render obsolete those doctors who look at an image and then decide what it is, warning that pathologists, radiologists, and dermatologists are at risk of being replaced by machines. It cites the just-published study in which neural networks trained on previous images performed as well as 21 board-certified dermatologists in recognizing cancerous growths.

The Wall Street Journal profiles McKesson Specialty Health’s Practice Insights analytics platform for oncology practices, which extracts EHR information for clinical insight and matches patients with clinical trials.

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A patient of a family practice owned by Carolinas HealthCare (NC) complains after noticing that her problem list included “lesbianism.” The health system said the observation was listed there to avoid offending her, but offered to move it to the notes section of her chart. The patient questions why the health system needs to record her sexual orientation at all. I’m not sure I agree since I assume she told them and thus felt they should know, but perhaps the term “problem list” casts an unintended aspersion. This could be a challenge for the OpenNotes movement – recording patient-reported or observed information in a way that patients don’t take as offensive, although this example is less of a challenge than accurately identifying someone as obese, alcoholic, or depressed.


Sponsor Updates

  • Sutherland Healthcare Solutions publishes a video describing its SmartHealthSolutions analytics platform.
  • ECG Management Consultants will exhibit at the Summit on Bundled Payment January 25-26 in Atlanta.
  • The Chartis Group publishes a white paper titled “What does the Trump Presidency Mean for Providers?”
  • EClinicalWorks and Vocera will exhibit at Arab Health 2017 in Dubai.
  • Imprivata and Obix Perinatal Data System will exhibit at the Arab Health Congress January 30-February 2 in Dubai.
  • PDR will exhibit at the Inspire 2017 Rx30 User Conference & Expo January 27-28 in Orlando, FL.
  • MedData will exhibit at the American Society for Anesthesiologists Practice Management event January 27-29 in Grapevine, TX.
  • The Intrepid Healthcare podcast features Meditech AVP of Marketing Christine Parent.
  • Nordic will host a meetup in Chicago February 3

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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McKesson Will Acquire CoverMyMeds for $1.1 Billion

January 25, 2017 News No Comments

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McKesson announced Wednesday that it will acquire Columbus, OH-based prescription electronic prior authorization platform vendor CoverMyMeds for $1.1 billion plus a potential additional $300 million based on performance.

McKesson announced the acquisition as part of its quarterly earnings report in which it beat earnings estimates but fell short on revenue.

CoverMyMeds is a RelayHealth Pharmacy partner. It will remain an independent McKesson business unit with co-founders Matt Scantland and Sam Rajan staying on.

News 1/25/17

January 24, 2017 News 15 Comments

Top News

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A federal judge sides with the Department of Justice in ruling that the proposed merger of insurers Aetna and Humana should not be allowed because it would reduce competition.

The judge also scolded Aetna for falsely claiming it exited Affordable Care Act marketplaces because of financial losses, noting that the company’s executives followed through on their threats to punish the market if their merger request was denied. Aetna says that wasn’t a threat, just a reflection of market realities. The companies are considering appealing the ruling.

The “smoking gun” document outlining Aetna’s threat to pull out of even profitable ACA markets came from Aetna Chairman and CEO Mark Bertolini, whom HIMSS invited to give the opening keynote address at HIMSS14, where he talked about integrity and the importance of the ACA marketplace that he predicted would sell insurance to 75 million people.


Reader Comments

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From Norma Rae: “Re: AHIMA. A server problem from December 30 is still not resolved, as members paid for CEU quizzes that still aren’t available. AHIMA is not answering messages and the phone wait time is nearly two hours.” AHIMA’s website says it has extended the CEU reporting deadline from December 31, 2016 to March 31, 2017 due to the unspecified technical difficulties of an unnamed outside technology vendor.

From Two Dull Dew: “Re: Capricorn Healthcare’s Epic stake. The private equity firm acquired a very small number of shares from an outside shareholder several years ago. It’s not a significant investment even though they list it on their portfolio page.” Several readers provided the same explanation, with one adding the obvious fact that if Capricorn had somehow loaded up on Epic shares, they would be crowing more demonstratively than just quietly listing Epic’s logo on their portfolio list.

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From Deck Pitcher: “Re: Theranos. Here is its first pitch deck.” The 2006 slides feature an amateurish logo and the company’s focus on drug companies as a customer base, where Theranos promised to increase drug sales by improving dose customization and monitoring that it hoped would reduce the need for FDA black box warnings. Theranos said it expected to make $50 million per clinical trial by charging $7,500 for each patient enrolled, which it said is up to 30 percent less than drug companies spend in offering testing in physician offices. The company listed as one of its “drivers for success” its management and culture, which we now know were so toxic that they should have had an FDA (or perhaps SEC) black box warning of their own. Thank goodness Theranos pivoted away from convincing drug companies to let it help monitor toxic drugs using its now-discredited lab tests.

From Peace Out: “Re: HIStalk. You have helped me do my job better. I can chit-chat with a CIO and they perk up if I mention that I read something in HIStalk – we can then carry on a well-informed conversation. I have noticed that folks can tell if one reads HIStalk. I mention your site at least three times when I’m at a client site. Your donor-matching program for kids makes my heart sing.” Thanks – you made my day as I do my empty room/empty screen thing.

From PM_From_Haities: “Re: poor customer service in physician practices. At the end of the day, the clinics rates are fixed by their customers who pay via insurance. Why should the clinic change if improving results in almost no change to their compensation? This is why socialism, communism , etc. don’t really work and capitalism with its market functions does. Capitalism has an efficient pricing function that works vis-à-vis the free market. With no real pricing function, guess what? The have no incentive to change. Make that clinic self pay only and I guarantee they would either they find a bigger waiting room or they’d have less patients.” Well said. It is folly to expect people and organizations (even those involving sick people) to behave in any way that decreases their personal benefit. People and companies do what they are paid to do, and in the healthcare system we’ve designed, they are financially encouraged to pack the waiting rooms, overbill, overtreat, and otherwise milk the maximum profit possible from the healthcare abattoir (“immoral” isn’t nearly as much of a motivator as “illegal”). Blame those who designed the game, not those who play it skillfully. As PM notes, your insurance company is the practice’s customer, not you, and you can threaten to seek alternatives to either to see how little they care. Insurers and providers are well aware of how privately lucky you feel you are to have insurance and to get an appointment. There’s plenty more customers where you came from since healthcare creates its own demand.

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From Edumacation: “Re: Betsy DeVos. She invested $1 million in Theranos, according to disclosure paperwork.” Education secretary nominee Ms. DeVos, whose family billions came from creating the Amway pyramid scheme of selling crappy beauty and nutrition products, perhaps earned an education of her own in sinking a micro-chunk of her family fortune in Theranos.


HIStalkapalooza Sponsor Profile

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Since 1975, the Healthwise mission has been to help people make better health decisions. That mission, combined with our innovative spirit, results in health education, technology, and services that make every moment in care matter. By integrating our solutions into your existing workflows, we help you engage patients with consistent, evidence-based health information for improved outcomes, increased satisfaction, and lower costs. Visit us at HIMSS in booth #1523 and check out our demo stations for Point of Care, Care Coordination, Digital & Web Experiences, and Care Transformation. Find out more or schedule a one-on-one meeting at HIMSS at healthwise.org/himss17.


HIStalk Announcements and Requests

Thanks to the several readers who asked about offer of a free pass to the Healthcare IT Marketing and PR Conference in Las Vegas April 5-7. The quick-on-the-trigger CEO who asked about it first got the pass and promises to follow up with a write-up afterward. I had just the one pass to offer for free, but others can at least save $300 by registering using promo code “histalk.” Many of my sponsors came on board due to the efforts of PR and marketing advocates and I appreciate their support.

I’ve been reclaiming my online life by muting Facebook and Twitter connections who just can’t stop spouting political bitterness or extending unsolicited political opinion despite not having any obvious qualifications commensurate with their partisan zeal. I’m also tuning out folks who repeatedly link to biased or sensationalistic news sources, which I define as pretty much all of them other than the New York Times, Washington Post, NPR, The Wall Street Journal, ABC/CBS/NBC, and the news wires. We have happily and indulgently cocooned ourselves off from civic responsibility with niche TV channels, Netflix, and Facebook and thus are collectively not really capable any longer of courteous, informed discussion. The American formula of offsetting a shortage of factual knowledge with an excess of emotional conviction doesn’t generally work (notable exceptions exist). Calling someone stupid or evil just because they have different opinions seems pretty stupid and evil.


Webinars

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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GetWellNetwork acquires Seamless Medical Systems, which offers a patient check-in and waiting room solution.

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Integration technology vendor Redox raises $9 million in a Series B funding round, increasing its total to $13 million.

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The drug industry’s trade group launches a multi-million dollar, feel-good ad campaign in trying to position itself as a responsible contributor to societal health following a series of embarrassing price-gouging news stories, most recently involving Mylan’s EpiPen. The group’s CEO makes reference to, “less hoodie, more lab coats” in trying to distance itself from non-member companies and former Turing Pharmaceuticals CEO Martin Shkreli, who in response quickly created a “Pharma Skeletons” web page to highlight the pricing misdeeds and tax-dodging “relocations” to Ireland of some of the trade group’s members.

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The Advisory Board Company returns responsibility for the maintenance and marketing of its Quality Compass infection surveillance and antimicrobial stewardship software to its original developer, Vecna Patient Solutions. Vecna offers patient access software but is probably best known for its VGo Telepresence robot. The Advisory Board Company announced the restructuring of its healthcare business three weeks ago, when it said that it will exit its still-profitable businesses of care management workflow, nursing workforce, and infection control analytics.

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The Chan Zuckerberg Initiative will acquire Meta, an artificial intelligence-powered search engine for medical journal articles. The charity, founded by Facebook CEO Mark Zuckerberg and his wife Priscilla Chan, MD, will give researchers free access.


Sales

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In Canada, 656-bed Humber River Hospital will upgrade to Meditech’s Web EHR.

Ballinger Memorial Hospital (TX) chooses CPSI’s Evident EHR.


Announcements and Implementations

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Ability Network announces its FHIR-based API program that allows partners (clearinghouses, payers, RCM companies, and EHR vendors) to connect to its platform for eligibility lookups, claim submission, and acknowledgement and remittance download.

DirectTrust says that 98 million Direct messages were exchanged in 2016, with the number of Direct-issued addresses increasing 24 percent in the year.


Government and Politics

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Former Acting CMS Administrator Andy Slavitt warns that replacement plans for the ACA often label condition exclusions as “patient choice,” highlighting this just-passed Minnesota proposal that allows insurers to sell policies that exclude coverage for cancer, emergency services, diabetes, and outpatient services. Sponsor Rep. Steve Drazkowski (R-Mazeppa) says the plan he championed is “a cure for the regulatory disease” that allows insurers to offer a la carte coverage that doesn’t include all 68 federal mandates. Critics ask the logical question – what crystal ball should consumers consult in buying plans that don’t cover yet-unknown but horrendously expensive conditions? Long-timers will recall when well-intentioned patients would present “insurance cards” pretty much like these policies — they covered basically nothing since they were ridiculous voluntary discount membership cards they bought from late-night TV infomercials in confusing them with being insured.

Here’s something to ponder – if marketplace plans go away, a lot of solo creative people who contribute to the economy (authors, musicians, entrepreneurs who are building companies) will either go back to being uninsured or will have to return to full-time jobs to earn the privilege of paying for health insurance. The ACA isn’t perfect, but making insurance available only to the employees of companies seems to discourage entrepreneurial pursuits that hold a lot more economic promise than chasing long-gone assembly line jobs. It’s a step backward if people have to remain underemployed because seeking better fortunes would preclude them from getting insurance that covers their existing medical conditions. I still recall the anguish of having to lay off a long-time hospital employee who had stuck with her not-so-great job only because she was uninsurable elsewhere because of breast cancer, and I still curse the name of the new VP who was so anxious to earn suck-up points with his executive peers that he got fooled into taking on her entire transferred team without a corresponding budget, thus getting the executioner duties turfed off on him by far more skilled but equally gutless players. He of course wasn’t available when security and I walked them off the property.

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The Congressional Budget Office says the federal budget deficit and tepid economic growth will run the national debt up another $10 trillion in the next 10 years, much of that driven by healthcare and Social Security entitlement programs. CBO still says the economy is solid and job growth is imminent. The national debt stands at around $20 trillion, most of it held by investors. These numbers don’t take into account the $1 trillion infrastructure investment and tax cuts planned by the administration.


Technology

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Health services in Norway are planning to move from Microsoft’s Windows Phone to Android because of high cost and low availability.

Cedars-Sinai chooses eight startups for the next class of its accelerator boot camp:

  • Cerebro Solutions (labor management)
  • Enso
  • FIGS (medical apparel e-commerce sales)
  • Frame Health (identifying non-adherent patients via personality analysis)
  • Healthcare TTU (cash flow and AR analytics)
  • HealthTensor (artificial intelligence)
  • Noteworth (device interoperability)
  • ReferralMD (referrals)

Other

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In England, ongoing delays in implementing Cerner Millennium at Calderdale and Huddersfield NHS Foundation Trust have increased the expected cost from $6 million to $15 million. The overrun is due to the cost of backfilling the positions of clinicians assigned to the project and a harder-than-expected data migration from legacy systems.

In Australia, someone accidentally leaves a backup generator’s switch turned off, with its eventual failure during a power outage causing a hospital blackout that required evacuating ICU patients and that also destroyed its fertility center’s 50 frozen embryos.  

NIST publishes results of a perception and experience study on EHR copy-and-paste, but I’m not going to describe it since it involved a ridiculously small sample size (five nurses and four doctors), all of them using the military’s AHLTA system that’s already being replaced with Cerner. Basically the study supports previous recommendations that (a) text that has been copied and pasted should be clearly identified, and (b) EHRs should display the “chain of custody” of the information when the user wants to see it. As most studies fail to address, it doesn’t question why the EHR requires or desires information to be stored multiple times. My guess is that someone worries that it will be missed, so I’ll fall back to my usual recommendation that EHRs should allow every user to flag individual text as being important in their care decisions rather than just dumping massive amounts of text that must be mined by each clinician for anything relevant. I like the idea of a chart being treated like a long paper document where I could use a highlighter to mark just the important sections, then date and initial them for later lookup by me or by someone else (maybe I just want to see which parts the cardiologist found useful). EHRs were designed to force users to input discrete data elements, but that’s for the convenience of non-clinicians.

I’m fascinated that one of the hottest hospital-related debates in England has always been that hospitals charge for parking. A parking app vendor files a Freedom of Information request to determine that hospital visitors were fined $17 million in a single year. Thus evolved my latest can’t-miss money-making scheme: an independent offsite parking operation that shuttles visitors back and forth directly to hospital campus locations like an airport shuttle. I would never park in an airport garage – it’s silly to pay 3-4 times the cost of an offsite shuttle that will drop me and my bags directly at the gate instead of leaving me to drag my stuff through a poorly lit garage where I have to remember where I parked. I would be equally unlikely to choose hospital garage or valet parking given a low-friction alternative.


Sponsor Updates

  • Obix by Clinical Computer Systems posts a video covering its implementation at Yoakum Community Hospital (TX).
  • Besler Consulting releases a new podcast, “The Future of MACRA in 2017.”
  • Biz Journals includes Caradigm President and CEO Neil Singh in its list of “New Seattle-area CEOs of 2016.”
  • CenterX will exhibit at the NCPDP Workgroup Meeting February 1-3 in San Antonio.

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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Morning Headlines 1/24/17

January 23, 2017 News 1 Comment

Judge Blocks Aetna’s $37 Billion Deal for Humana

A federal judge has sided with the Justice Department in blocking the proposed $37 billion merger between Aetna and Humana on antitrust grounds.

Cybersecurity Framework Draft Version 1.1

NIST releases a draft update to its Framework for Improving Critical Infrastructure Cybersecurity.

Drug industry unveils massive new campaign to counter criticism

A pharma industry lobbying group has launched a new ad campaign designed to move the industry past recent price gouging stories that have consumed media attention recently. The lobbying group’s president backhandedly calls out Martin Shkreli in describing the campaign as an effort to portray  “Less hoodie, more lab coats” . In response, Shkreli publishes a list of price gouging activities that the pharmaceutical companies funding the campaign have engaged in.

Next Generation ACO Model

CMS reports that 45 ACOs are now participating in its Next Generation model.

Monday Morning Update 1/23/17

January 22, 2017 News 10 Comments

Top News

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President Trump follows through on his promise to begin dismantling the Affordable Care Act on his first day in office by signing an executive order Friday that directs HHS and other federal agencies to “ease the burden” in doing whatever they legally can to hamstring the ACA.

Executive orders are more of a policy-signaling device rather than an unchallenged change to laws, but HHS discretion and its choice of which ACA issues to defend in court could affect key ACA elements in halting the payment of insurance subsidies (which were never approved by Congress but are being paid by HHS anyway) and tinkering with hardship waiver requirements to effectively end the “individual mandate” that at least theoretically requires people to carry health insurance.

The executive order happens before “repeal and replace” begins in earnest, before a Trump-appointed HHS secretary is installed, and in the absence of a replacement plan for the program that insures 20 million people.  


Reader Comments

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From Herd Tracker: “Re: HIMSS and overly intrusive marketing with their new Media Lab. Remember a couple of years ago when you wrote about how they were going to track the movement of conference attendees via a badge-implanted chip?” I remember clearly, although I assume HIMSS quietly backed away from that plan. HIMSS10 featured tracking of attendees via RFID badge so that exhibitors could “derive a more accurate score of a visitor’s buying potential,” logging attendee movements that included which booths they visited and for how long. I was obviously upset back then as a dues-paying member:

The conference keeps getting more similar to a cattle-butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours. You’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors. Now you’ll be tracked like livestock throughout the process … I can imagine what was going through the minds of the HIMSS dim bulbs who approved this — hey, we can charge vendors even more by selling them the personal information of attendees … and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members … Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

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From Privately Held: “Re: Epic. A private equity group called Capricorn Healthcare lists Epic as one of its holdings, which is surprising given Judy’s repeated statements about being employee-owned and not being acquired.” The PE firm lists Epic as a current holding, but doesn’t specify when or how much it invested.


HIStalk Announcements and Requests

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One-third of poll respondents say their employer has cut expenses or reduced expectations due to ACA uncertainty.

New poll to your right or here: What is your reaction to HIMSS creating a conference and a division to help vendors sell to providers?

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We funded the DonorsChoose grant request of Ms. R in New York, who asked for math manipulatives.

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I like to root for the little guy, so when HIMSS announced its marketing conference last week, I immediately thought of the HITMC conference that John Lynn and Shahid Shah have been putting on for a few years and wanted to help them out (unlike HIMSS, not only do they have no conflict of interest, they also came up with the idea first). HITMC17 is the networking and educational event for those in healthcare marketing and PR, featuring 30 presenters who will cover topics such as social media, brand advocates, online reputation, marketing automation, email marketing, branding, SEO, and content strategy. HITMC will be held at the SLS Las Vegas April 5-7, 2017 and promo code “histalk” will save you $300 on registration. I may ask Lorre or Jenn attend to help us understand how health IT marketing works (I’m a fan of marketing done the right way, but I confess that delight when it’s done hilariously badly). We’ll probably use only one of the two passes John has graciously offered us, so if you want to attend and are willing to write up what you liked and learned afterward in a short HIStalk article, email me and I might give you a free pass.

Listening: One OK Rock, a Tokyo-based foursome of 20-somethings that play hard if not terribly original alt-rock. It’s a bit intentionally boy-bandy at times, but at least it’s different than most of the chart junk.


Last Week’s Most Interesting News

  • The Wall Street Journal discovers that a Theranos lab had failed a surprise CMS inspection right before the company announced that it would exit the testing business.
  • The Coordinated Care Oklahoma HIE announces that it will shut down.
  • HIMSS announces a healthcare IT marketing conference and a new arm that will use the HIMSS database to more aggressively market the offerings of paying vendors.
  • Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has undervalued the health contributions of PCPs that he calls “incrementalists” compared to the decisively curative but less-impactful work of surgeons.
  • The Supreme Court agrees to review the use of arbitration agreements to prevent employees from filing labor-related class action lawsuits, with Epic Systems being one of the handful of companies asking for a definitive ruling.

Webinars

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Decisions

  • Long Island Jewish Valley Stream (NY) went live with Kit Check medication tracking in December 2016.

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


Government and Politics

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As I expected but haven’t seen mentioned anywhere, HHS Acting Assistant Secretary for Health and former National Coordinator Karen DeSalvo, MD, MPH has apparently left her role with the administration change based on updated HHS web pages. Principal Deputy Assistant Secretary for Health Jewell Mullen, MD, MPH, MPA is listed as having taken over the Acting Assistant Secretary role. DeSalvo, who stepped down as National Coordinator in August 2016, hasn’t mentioned her departure or plans on Twitter.


Privacy and Security

From DataBreaches.net:

  • TriHealth (OH) blames a software problem for sending the information of 1,126 patients to their previous address.
  • An appeals court rules that people whose information was stored on a stolen laptop can sue Horizon BCBS for violations of the Fair Credit Reporting Act even though they suffered no negative consequences.

Other

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Billboard profiles our amazing HIStalkapalooza band Party on the Moon and its longstanding New Year’s Eve gig playing for now-President Donald Trump. It describes their first time playing the Mar-a-Lago event, where they were noodling through harmless dinner music like “The Girl from Ipanema,” when the boss’s assistant passed along his request: “Mr. Trump would like you to stop playing this crap and play something more upbeat.” I was skeptical about hiring a cover band for HIStalkapalooza, but it’s hard to describe their stage-filling show – they play with remarkable skill and enthusiasm. the music never stops for a second, and they literally from their first note pack the dance floor with HIStalk readers who admit that they never dance otherwise.


Sponsor Updates

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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News 1/20/17

January 19, 2017 News 4 Comments

Top News

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Theranos announced in October 2016 that it would close all of its testing labs, but the Wall Street Journal finds that Theranos didn’t mention at that time that its Arizona lab had failed an unannounced CMS inspection several days earlier.

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Meanwhile, Theranos investor and friend of CEO Elizabeth Holmes Tim Draper still maintains that Holmes is a victim of a Wall Street Journal vendetta, claiming that, “the guy is getting $4 million to continue this charade,” referring to the book and movie deal signed by WSJ reporter John Carreyrou, who Draper calls a “mouthpiece” for Theranos competitors.

Draper says big lab companies, drug companies, and insurers don’t like the idea of people taking control of their health and competing with a company selling tests for less. He adds that even though Theranos admitted that some of its lab results were unreliable, “I like that they’re self-policing.”


Reader Comments

From I See Light: “Re: HIStalkapalooza. HIMSS … what a freak show of excessive marketing budgets. At least there is HIStalkapalooza to set one’s mind right!  Listening suggestion: Pet Clinic, from my adopted hometown of Pittsburgh.” I’m listening to Pet Clinic on Spotify now and am struck by how much they sound like Frank Black and the Catholics at times, especially the singer’s phrasing. I’m also reminded of how much I like the Dirty O’s fries, although it’s hard to understand why their hundreds of available beers don’t include Iron City, often pronounced “Ahrn City” in the ‘Burgh, at least by those who still care now that its blue collar heyday is long past and it has moved out of town.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Ms. L from Michigan, who asked for a portable PA system so the class could easily hear her and students who are presenting their work. I was touched by her description of the impact made by a few dozen of our donation dollars:

Just today a student told me that he loves it when I wear the microphone because then he knows I am about to "say something important" and he can shift to listening mode. Another student wanted to write and perform a rap song for you but I did not have a way to upload video so he settled on writing a poem. You’ll see it in the pictures. He hopes you enjoy it. But surely my favorite was when one student saw and heard the mic for the first time and declared, "Ms. Lab, you’re crispy." You’ve made the impossible happen: fifty-eight years old and crispy! Kudos! This technology has allowed me to speak to my students and be assured that every student has an opportunity to hear instruction. Another benefit: I no longer leave work at night with a strained voice!

This week on HIStalk Practice: MDlive ups its employer offerings. UnitedAg expands relationship with Teladoc. Essex County Mental Health Services goes with TenEleven HIT. United Medical Laboratories connects to physician EHRs. AccentHealth’s Sara Johnston advocates for digital point-of-care education during flu season. Aprima acquires Healthcare Data Solutions. Oculus Health raises funds for further CCM, CPC+ offerings. Modernizing Medicine’s Mandy Long attempts to make MIPS a little less fear-inducing.


Webinars

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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Aprima acquires Coral Gables, FL-based EHR/PM reseller Healthcare Data Solutions.

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Spok will add 60 positions at its Eden Prairie, MN office.

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Athenahealth’s accelerator invests an unspecified amount in The Right Place, which helps hospitals place patients in SNF beds. The company had previously raised $2 million in a single October 2015 seed round.


Sales

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Phelps Memorial Health Center (NE) selects Parallon Technology Solutions as implementation partner for its Meditech 6.1 upgrade and expansion.

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BJC HealthCare (MO) chooses MModal for speech recognition and clinical documentation improvement as it transitions from NextGen and Allscripts to Epic.


People

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Philips hires Roy Smythe, MD (Valence Health, HX360) as chief medical officer for health informatics.

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Allscripts hires Lisa Khorey (EY) for the newly created position of EVP/chief client delivery officer and Alan Fowles (Nuance) as president of Allscripts International.

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Next Wave Health Advisors, a Huntzinger Management Group company, hires Greg Walton (El Camino Hospital) as an advisor.


Announcements and Implementations

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Coordinated Care Oklahoma will shut down following the requirement of an unnamed payer that providers submit their data to a competing HIE. CCO announced in June 2016 that it was the first Cerner-powered HIE to connect to the DoD. We interviewed CCO Chief Administrator Brian Yeaman, MD a couple of months ago, who gave no hint that the wind-down was imminent.


Government and Politics

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A Backchannel article profiles the successes and uncertain future of the US Digital Service, created by tech-savvy President Obama, spearheaded by Todd Park, and enlisted to save Healthcare.gov but now wondering whether the Trump administration will keep the program. It’s a good article, although obvious election results bitterness makes it less effective (referring to the incoming President by last name only, slipping in smug put-downs, and ending with “God help us all” make it clear that the author doesn’t mind turning a nice feature into yet another ugly personal editorial). Here’s a snip of the less-whiny part:

Then came October 2013, when technology — once supposed to be an Obama strength — almost took down his administration. The signature legislation of his presidency, the Affordable Care Act, depended on a website that matched individuals to health insurers. It was a thermonuclear failure. When Park swooped into the situation with some of his PIF team, he realized that the only solution was to tap outside talent. Drawing on connections to the Obama campaign’s digital warriors and Silicon Valley companies, Park tapped a very small group of great coders and developers to rebuild in weeks, on the fly, what $500 million worth of contractors and government employees couldn’t do. In fact, an expensive, mishandled disaster was almost routine for government IT, where overpaid contractors with little oversight used outdated processes to work with jaded government workers. But this time the lifers had to cooperate. “The message that they got loud and clear from the White House was, This is bad enough that none of you is getting out of this alive,” Mikey Dickerson, a former Google engineer who led the team, later recalls. “Your only way out is if you get your act together and make the site work.”

CMS gives hospitals a couple of extra weeks to submit their eCQM data for the FY2018 EHR incentive program, extending the reporting deadline to March 13, 2017.

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A Health Affairs blog addresses the Congressional Budget Office’s estimates of the effects of ACA repeal, noting that House rules implemented on January 3, 2017 specifically prohibit CBO from talking about the effects of ACA changes. The article says, “Congress has thus placed itself in the position of appearing to prefer no information at all to information that might conflict with its political objectives.” Recent CBO estimates that ACA repeal would cause 32 million more citizens to lose insurance and that premiums will jump 25 percent in the first year were based on a study that was performed before the ban.

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Maryland-based Evergreen Health Cooperative – one of the last ACA-authorized, CMS-funded insurance co-ops that hasn’t gone belly up – converts itself to a for-profit, investor-owned insurance company.

Massachusetts plans to cap provider price growth rates and charge employers who don’t offer health insurance $2,000 per full-time employee. The state’s budget is getting hit hard by Medicaid enrollment that will grow to nearly 2 million in 2017 as full-time workers skip employer-provided coverage to take advantage of federal subsidies. The state’s previous universal coverage plan required employers to offer insurance and prohibited insurance-eligible employees from buying MassHealth coverage, but both requirements were eliminated with passage of the ACA.

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CMS Chief Medical Officer Patrick Conway, MD of the CMS Innovation Center will serve as acting CMS administrator with the administration change starting January 20 pending the Senate’s approval of Seema Verma. He replaces Andy Slavitt.


Privacy and Security

MAPFRE Life Insurance Company of Puerto Rico pays $2.2 million to settle HIPAA charges involving the 2011 theft of an unencrypted flash drive from its IT department that stored the information of 2,209 customers. MAPFRE also failed to follow through on correct measures assigned by OCR. The HHS announcement suggests that it scaled the settlement to the size of the multi-national company rather than the extent of disclosed information, which is an interesting way to assess penalties.

The daughter-in-law of a man who died 2014 says she was billed for new surgical procedures in the fall of 2016 by a specialty practice owned by Sentara, which recently announced that 5,400 of its patient records were exposed in a breach of one of its contractors.


Innovation and Research

An interesting New York Times article notes the startling finding by The Johns Hopkins Hospital that fewer female patients were receiving blood clot prevention treatment than male patients, leading the hospital to develop a computerized decision support system that collects information at admission and recommends treatment, taking human bias and subjectivity out of the equation.


Other

What a difference a domain makes: insurance shopping site Healthcare.com connected 2 million people with insurance brokers in 2016, all of whom confused it with the official Healthcare.gov.

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A study with a ton of flaws (old data, small sample size, lack of analysis to determine the appropriateness of ordering, failing to account for the demographic difference in non-EHR practices) suggests that doctors who use EHRs order more diagnostic imaging and laboratory tests than those who don’t.

Drug maker Mallinckrodt will pay a $100 million Federal Trade Commission fine for jacking up the price of H.P. Acthar Gel from $40 per vial to $34,000 and for blocking competition by outbidding another drug company for a similar drug. The company’s predecessor was an early dodger of US taxes in taking an Ireland tax address instead of St. Louis, reducing its taxes by more than half. Most its actions, however unsavory, were legal.  

A medical resident’s New York Times opinion piece warns that the volunteer army of people who care for their older relatives is stretched too thin due to longer life expectancy, more complex medical care, smaller family sizes, and greater geographic separation. The current ratio of seven potential family caregivers for each person over 80 will drop to three-to-one by 2050 with the resulting loss of income as they either leave their jobs or work fewer paid hours to focus on attending to their family member’s needs. The author suggests that doctors list family caregivers in the medical record, include them in decision-making, and train them to perform medical tasks.

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HIMSS finally acknowledges creation of its Media Lab that will “leverage the HIMSS database of over one million health and technology experts as our laboratory” to “lift audience engagement and revenue.” The Media Lab will use your personal information to “identify the emotional and business triggers” that will help it sell advertising-driven webinars, videos, and conferences to vendors. ”We know what information they [meaning you] consume,” HIMSS brags in describing members like a scientist talking about lab rats and highlighting that whatever “news” it produces should be taken with a grain of salt. The announcement adds, “Many healthcare IT vendors are struggling,” failing to mention that maybe the failing ones could use better products or leadership instead of more aggressive marketing. Every time I think HIMSS can’t possibly do anything more commercial or member-intruding in chasing vendor dollars, they prove me wrong (imagine the Salvation Army or Doctors Without Borders selling marketing advice and leads). As you might expect, the lengthy roster of the Media Lab people includes basically nobody with any education or background in healthcare or technology – their life’s work is to push whatever widgets they’re paid to promote. HIMSS Media runs the Privacy & Security Forum, so perhaps that’s a good venue in which to consider the privacy implications of selling member data to advertiser-stalkers. I wish I had Photoshop skills so I could superimpose Steve Lieber’s head onto that of Alec “Always Be Closing” Baldwin in the “Glengarry Glen Ross” shots above featuring “the good leads,” as HIMSS envisions those of us who pay dues and conference registrations.

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West Virginia Public Radio notes that the one bright spot in a state ravaged by drugs and unemployment is WVU Medicine, which thanks to the Affordable Care Act’s $12 million boost to its bottom line has been able to build new buildings and hire more than 2,000 people last year. The health system is the state’s largest employer and its flagship hospital runs at 98 percent capacity, with the CEO saying, “There’s almost an insatiable appetite for everything we do.” That’s good news for everyone except us federal taxpayers footing most of the bill. The health system’s 15,000 employees mean that nearly 1 percent of the state’s declining population works there.

A study finds that around-the-clock hospital chaos can cause and accelerate dementia in elderly patients that can ultimately kill them.


Sponsor Updates

  • Kyruus adds two physicians to its clinical advisory board.
  • Ivenix will demonstrate the integration of its Infusion Management System with EHRs and alarm management systems at the HIMSS17 Interoperability Showcase.
  • The Red Hot Healthcare podcast features Medicity’s Brian Ahier.
  • Optimum Healthcare IT publishes a new case study, “Security Remediation at a Large Academic Medical Center.”
  • NCQA certifies ZeOmega’s Jiva for five HEDIS 2017 measures.
  • Fortune ranks Health Catalyst one of the 30 best workplaces in the US technology industry.
  • GetWellNetwork’s All-In-One PatientLife Console achieves Electronic Product Environmental Assessment Tool certification.
  • InstaMed and PatientMatters will exhibit at the HFMA Mid-South Institute January 25-27 in Memphis, TN.
  • InterSystems will exhibit at the CIO Exchange January 22-24 in Orlando.
  • Intelligent Medical Objects will exhibit at the Allscripts 2017 South ARUG January 21-22 in Raleigh, NC.
  • TransUnion publishes a new white paper, “Money talks: Rethinking what it means to put patients first.”
  • MedData will exhibit at the American Society for Anesthesiologists Practice Management event January 27-29 in Grapevine, TX.
  • Meditech will exhibit at the 50th MHA Annual Mid-Winter Leadership Forum January 27 in Framingham, MA.
  • NTT Data team members support local children in need by volunteering at Cradles to Crayons.
  • Obix Perinatal Data System will exhibit at the SMFM Annual Pregnancy Meeting January 25-27 in Las Vegas.
  • Experian Health will present at the HFMA LA Women in Healthcare Luncheon January 24 in Baton Rouge.
  • Phynd will exhibit at the North Carolina Epic Users Group Meeting February 8-9 in Greensboro.

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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News 1/18/17

January 17, 2017 News 7 Comments

Top News

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The Congressional Budget Office says that repealing the Affordable Care Act will cause the number of uninsured Americans to jump by 18 million in the first year, swelling their numbers to 32 million in 10 years.

CBO predicts that Insurance premiums for individual policy-holders will increase by 25 percent in the first year following repeal and will double within 10 years.


Reader Comments

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From James Jones: “Re: Merge Healthcare. The big story is Nancy Koenig leaving, but the positive news is that the reorg relates to growth, not downsizing, and that the first cognitive product will be releases in Q2 2017. Here’s the internal email sent to the team on January 10.” The internal email says that the first cognitive solution release under IBM Watson Health will address aortic stenosis.

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From Pilsner: “Re: Santa Rosa Consulting. Deleted all its past tweets.” I contacted the company, who says they cleaned up their Twitter account following the departure of one of their internal marketing folks. The Twitter account will be put into use again following an upcoming rebranding.

From Willie Slicker: “Re: HIStalkapalooza. You should keep doing them – it’s great for HIStalk branding.” I don’t pay much attention to HIStalk branding, but as it stands, what I am paying attention to is the check I’ll have to write to cover the event’s cost beyond what sponsors are graciously underwriting. That has understandably dampened my enthusiasm from throwing further free parties since I have to ante up nearly double what I paid for my last new car a couple of years ago.


HIStalk Announcements and Requests

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Thanks to our two new HIStalkapalooza sponsors. Lucro offers a digital platform that helps health systems make better, faster, less-risky purchasing decisions. Physician’s Computer Company (PCC) provides EHR/PM for pediatricians that consistently out-KLASses all competitors with a 95.1 overall score.

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We helped Ms. L from Missouri in funding her DonorsChoose grant request for STEM learning materials. Her fourth graders are building the example electronic circuits and will then move on to creating their own designs.

Listening: new from Kvelertak, face-melting heavy metal from Norway that requires all of my limbs for desk drumming, complete with showy flourishes of my imaginary sticks. Face-melting isn’t for everyone, so there’s this: new from Khalid, a stunningly expressive 18-year-old singer and musical newcomer from El Paso, TX who blends R&B with old-school soul. Mark your calendars for six months from now – Khalid is going to be big.


Webinars

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

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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Document solutions vendor Auxilio acquires healthcare security solutions vendor CynergisTek for $34 million in cash and shares. CynergisTek generated $15 million in revenue and $5 million in EBITDA in 2016.

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Dear Auxilio, you forgot to change your site’s title in WordPress, so it looks really amateurish in Google searches and on the browser tab. Please correct this at your earliest convenience. Yours, Mr. H(TML), who also wonders whether “at your earliest convenience” really means something since it sounds more like something a non-native English speaker would say. At least don’t make “at my earliest convenience” part of your voicemail greeting because what that means is that you’ll call back whenever you feel like it regardless of your caller’s needs.

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Forbes profiles the just-launched Forward, a San Francisco primary care practice started by a serial entrepreneur who sold his artificial intelligence company to Google. Forward describes itself as looking more like an Apple Store than a doctor’s office. Members who pay $1,800 per year are tested on an AI-powered body scanner, are given a wearable device that the practice says it will monitor, and are sold branded nutritional supplements. We’ll have to take their word on having doctors with “world-class backgrounds” since the company is too enamored with its architecture and apps to say who’s actually delivering the care it offers (maybe it’s just a bunch of hipster docs sitting at a Genius Bar). The track record of millennial-pandering “startups” like this is pretty abysmal, both in terms of financial viability as well as making much of a difference in population health. I’ll be shocked if it’s still around two years from now.

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Formativ Health – formed last week by Northwell Health and Pamplona Capital Management – acquires EHR/PM/RCM vendor Etransmedia. It’s probably not relevant, but Northwell – the former North Shore-LIJ – uses Allscripts, which in 2014 lost a $10 million deceptive business practices case to Etransmedia, who bought a bunch of Allscripts MyWay licenses for resale only to get stuck with them when Allscripts abandoned the product. Etransmedia developed and sells the Connect2Care EHR/PM.


Sales

John Muir Health (CA) chooses Sectra’s cloud-based image archive and universal viewer.


People

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CTG hires Hamish Stewart-Smith (Encore Health Resources) as managing director of healthcare sales for North America. He is a United States Air Force Academy graduate who spent 11 years as an officer.


Announcements and Implementations

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HIMSS further blurs the barely visible line it draws between providers and vendors in launching a marketing summit in Las Vegas, with Steve Lieber saying, “We specialize in supporting organizations who market tech solutions to HIT customers.” At least he’s honest in admitting that what HIMSS does best (and most profitably) is to help HIMSS vendor members sell stuff to HIMSS provider members. Another aspect of that blatantly commercial offering is the apparently new HIMSS Media Lab (referenced but not mentioned in the announcement), whose primary objective seems to be selling ad space in HIMSS publications and relentlessly targeting the provider audience in being “obsessed with getting under their skin, on their mind, into their hearts” as they “study professionals in their natural habitat.” It’s interesting that HIMSS is launching a conference targeting marketing professionals while simultaneously trying to take away their business. Provider-siders who feel like lab rats being studied as they attempt to avoid predators now understand that they’re in the HIMSS version of “The Twilight Zone,” where the seemingly normal small town is not as it seems. We are all just paying acolytes in the HIMSS Church of the Generated Lead.

McKesson offers a cloud-based option for InterQual Criteria.


Government and Politics

FDA announces IMEDS, which will give patient safety researchers access to privacy-protected drug and medical device safety reports. 

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I found the ethics disclosure form of HHS Secretary nominee Tom Price, MD, who reports holding shares in Athenahealth and McKesson. Meanwhile, Sen. Al Franken and two colleagues ask to have Price’s confirmation hearing postponed pending an ethics investigation after reports that he traded shares of healthcare companies while sponsoring legislation that could have affected their share prices to his benefit.

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McKesson will pay $150 million to settle federal charges that it violated the Controlled Substances Act by failing to report pharmacy customers that ordered suspiciously large quantities of oxycodone and hydrocodone. The company will also stop filling controlled substances orders from its distribution centers in four states.


Privacy and Security

From DataBreaches.net:

  • Sentara Healthcare (VA) notifies 5,000 patients that their information was exposed in a breach involving an unnamed Sentara vendor.
  • Little Red Door Cancer Services of East Central Indiana is hit with ransomware, with hacker The Dark Overlord demanding a $43,000 payment that the non-profit agency declined to make since it was able to restore from a cloud-based backup.
  • In Canada, a pediatrician who had been accused by several parents of falsely claiming they had abused their children kills himself after sending a media outlet a USB drive with patient information that apparently supports his abuse claims.

Reuters covers the ways insurance companies are using technology to measure customer behavior and potentially to set premium rates accordingly. Examples: a Bluetooth-enabled toothbrush that phones home to a dental insurance company, car monitoring devices that record driving habits, and fitness trackers whose information is reported back to insurers. Those in favor say the information can change behavior positively, while critics are concerned that the information will be used to charge some customers more or to cherry-pick only lower-risk consumers.


Other

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A review of the Orphan Drug Act concludes that drug companies have hijacked the law’s noble intentions (encouraging them to develop drugs for rare conditions) by invoking orphan drug status for mass-marketed drugs to get seven more years exclusive marketing rights. The skyrocketing number of orphan drug approvals includes such bestsellers as Crestor, Ability, Herceptin, and the Humira (the world’s best-selling drug) as companies repeatedly file for protection using new rare conditions. Seven of the 10 best-selling drugs were so-called orphan drugs that earned rare disease approval after the fact. Drug companies are being coached on the process by former FDA officials who have hung out consulting shingles for fees that can approach $100,000, suggesting that the companies employ approaches such as trying out their existing drugs for treating unusual diseases in Africa. 

A Johns Hopkins study finds that privately insured patients get stuck with the high bills of out-of-network doctors hired by in-network hospitals, noting that the doctors with the highest markup (defined as the multiple they charge private patients vs. their Medicare rates) are those the patient doesn’t choose. Anesthesiologists, ED doctors, pathologists, and radiologists charge four times the rate Medicare pays them. Anesthesiologists in 10 cities made up the top 2.5 percent.

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Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has failed to appreciate the role of the primary care physician whose impact on health is less immediately decisive but no less important than the stroke of his well-aimed scalpel. He notes that his OR is equipped with a battalion of people and millions of dollars worth of equipment, while “incrementalists” are lucky to afford a nurse. Some snips:

We will increasingly be able to use smartphones and wearables to continuously monitor our heart rhythm, breathing, sleep, and activity, registering signs of illness as well as the effectiveness and the side effects of treatments. Engineers have proposed bathtub scanners that could track your internal organs for minute changes over time. We can decode our entire genome for less than the cost of an iPad and, increasingly, tune our care to the exact makeup we were born with. Our healthcare system is not designed for this future—or, indeed, for this present. We built it at a time when such capabilities were virtually nonexistent. When illness was experienced as a random catastrophe, and medical discoveries focused on rescue, insurance for unanticipated, episodic needs was what we needed. Hospitals and heroic interventions got the large investments; incrementalists were scanted …But the more capacity we develop to monitor the body and the brain for signs of future breakdown and to correct course along the way—to deliver “precision medicine,” as the lingo goes—the greater the difference health care can make in people’s lives, as well as in reducing future costs. This potential for incremental medicine to improve and save lives, however, is dramatically at odds with our system’s allocation of rewards.


Sponsor Updates

  • HBI Solutions produces a video titled “Spotlight Data Solution Overview.”
  • Agfa Healthcare publishes a new white paper, “How Enterprise Imaging Aligns with Value-Based Care.”
  • Besler Consulting releases a new podcast, “A closer look at patient reported outcomes.”
  • EClinicalWorks will exhibit at the NHMI Annual Orthopaedic Winter Meeting January 20-21 in Stowe, VT.
  • Healthgrades announces the recipients of its 2017 Distinguished Hospital Award for Clinical Excellence.

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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Monday Morning Update 1/16/17

January 15, 2017 News 5 Comments

Top News

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The US Supreme Court approves the request of Epic and other companies that asked the court to rule on the use of arbitration clauses in employment agreements to prevent employees from filing labor-related class action lawsuits.

Two federal appeals courts have ruled that the National Labor Relations Act protects the right of employees to engage in “concerted activities,” while a third court has rejected that argument in saying that the arbitration clause prohibits employees from suing their employer as a class.

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Epic wants to the court to set a standard by which such arbitration clauses will or won’t be consistently enforced.


Reader Comments

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From Pappadum: “Re: MD Anderson’s losses and layoffs. Encore ran the selection process and made $48 million, while third parties were paid hundreds of millions of dollars more. The larger story is how companies stand to benefit from an Epic selection (selling services afterward) and Epic’s inability to control the cost of their projects given their third party dependencies. You would think a system as notable and healthy as MDA would generate more discussion in the risk/reward of implementing Epic.” Unverified. I don’t have a lot to say about how consulting firms steer clients toward systems and then sell them more services, or that Epic projects are nearly always eye-poppingly expensive. However, MDA signed every agreement (apparently without a gun to its head) and is responsible for its own implementation no matter who it hired to help or at what price it elected to pay. It has a track record of underperforming EHR implementations, all the way through the homegrown ClinicStation system that Epic replaced, so perhaps the outcome was predictable. Certainly the entire industry could learn from MDA’s experience, but I don’t expect they are anxious to share. Also, to be fair, it’s early in their implementation when a lot of Epic projects look bleak before improving, not to mention that many if not most of MDA’s problems don’t have anything to do with Epic even though it’s an easy target.

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Perhaps this is a good time to refer folks to my report on Epic from almost a year ago, in which I obtained insight directly from Epic-using health systems (22 CEOs, 13 CFOs, 96 CIOs, 39 chief medical officers, and 32 chief nursing officers). All of those CFOs say they would choose Epic again, and even though project cost was Epic’s lowest score by far in my report, only 15 percent of CFOs said their projects ran over budget. The CFOs scored Epic at 7.4 on a 10-point scale on the all-important question of whether Epic’s benefits were worth its initial and ongoing costs.

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From Spiritus Frumenti: “Re: Zynx, Has essentially laid off their entire executive team.” It’s apparently a bit lonely at the top, as the company’s executive page lists only President Kevin Daly and SVP Jim Connolly. Having been expunged in the past six weeks are the other two executive team members, Bertina Yen and Victor Lee, both of them physician VPs who, according to LinkedIn, left in December 2016 (Yen does not list a current employer, while Lee is now VP of clinical informatics at Clinical Architecture). Going back a year ago finds eight executives listed, all of them now missing except for Jim Connolly. Daly was promoted to president from another Hearst company, MCG, in January 2016.

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From Cheesy Goodness: “Re: Epic’s Community Connect program, as at UIHC. It’s a stroke of genius since it takes Epic out of the picture for selling and servicing small community organizations (which Epic is not built for), it creates additional ties with the reselling large provider organization and thus increases barriers to their replacing Epic, and it hits hard at competitors such as Athenahealth and EClinicalWorks.”

From Porkpie Hat: “Re: Merge Healthcare. Lots of major reorgs going on under IBM Watson Health.” Unverified. 

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From Man About Town: “Re: WSJ article claiming Epic is hindering interoperability. This doesn’t bode well. The majority of Judy’s employees very publicly supported Democrat candidates, which served the company well when they were in power, but now could lead to repercussions.” The article was poorly done and full of inexpert opinions more suited for a crappy LinkedIn vanity piece than WSJ, but it did get exposure it didn’t deserve. I don’t think rather modest political donations will have much of an impact either way. I’m also certain Epic’s lobbying firm, Card & Associates (which had strong connections to the George W. Bush White House) is – like all other DC lobbying firms – working overtime to understand the new administration and start whispering to it the messages of its clients. I assume Epic also has a friend in House Speaker Paul Ryan (R-WI).


HIStalk Announcements and Requests

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HIStalkapalooza signups are winding down, both for this year and forever since it’s the last one. We’re at around 900 requests, so it’s about time to call it.

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About a fourth of poll respondents either left for a better job or were promoted in the past year. Desperado expresses appreciation to the less-competent salespeople who allowed him to get promoted last week, while Paragon(e) and J3 lost their jobs to offshoring and acquisition, respectively. Frank’s advice for those who want a real promotion is to do your own thing, where you can focus on what’s important to you and be paid commensurate with your abilities, as hanging out your own shingle is “the last promotion you’ll ever need.”

New poll to your right or here: Has your employer cut expenses or reduced future expectations because of ACA uncertainty? I would be happy to get your poll vote and elated to read your comment explaining it.

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Welcome to new HIStalk Platinum Sponsor Parallon Technology Solutions. The Nashville-based company’s 400 professionals have implemented EHRs in 300 facilities and offer staffing and remote support services for all major acute care and ambulatory EHRs (Meditech, McKesson, Epic, Allscripts, etc.) and related applications. Its services include EHR implementation, help desk, application support, managed services, hosting, technical staffing, and strategic IT consulting services. It can help optimize Meditech investments, being certified to deliver READY Levels 1-3 and Pathway implementations for 6.x. Its Tier 1 Help Desk service alleviates challenges with hold times and first-call resolution rates, freeing up internal resources to work on priority projects and providing legacy system support. Technical services include data extraction and archive, reporting,  wireless network installation and support, voice communications, and integration. The company also outsources hard-to-find talent such as application developers, product analysts, DBAs, and network engineers. President and CEO Curtis Watkins is an industry long-timer with executive IT experience at HCA, St. David’s HealthCare, and Community Health Systems. Thanks to Parallon Technology Solutions for supporting HIStalk.

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We funded the DonorsChoose grant request of Ms. L on the west side of Chicago, who asked for math center materials for her kindergarten class. She is using the games during 25-minute math station rotation, putting out two or three of the games for students to learn from even as they’re having fun. She says they always rush to the Unlock It! game pictured above.


Last Week’s Most Interesting News

  • Two California HIE announce plans to merge.
  • President-elect Trump nominates David Shulkin, MD for the post of Secretary of Veterans Affairs.
  • Congress quickly begins dismantling the Affordable Care Act.
  • IBM Watson Health and the FDA announce plans to study the use of blockchain technology to exchange information between study participants and researchers.
  • President Obama and Vice-President Biden express frustration with lack of healthcare data exchange, with the President saying EHRs are his biggest disappointment of the Affordable Care Act.
  • A Wall Street Journal opinion piece calls Epic the “chief obfuscator” in being primarily responsible for the lack of EHR interoperability.

Webinars

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

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Sales

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Southern New Hampshire Medical Center (NH) chooses the Voalte Platform for smartphone-based secure communication and alert notification.


Decisions

  • Sycamore Medical Center (OH) with switch from BD to Omnicell automated dispensing cabinets in 2017.
  • Optim Medical Center (GA) will switch From Metro MedDispense to BD Pyxis MedStation automated dispensing cabinets in March 2017.
  • Baton Rouge General Medical Center – Bluebonnet (LA) will go live with Omnicell automated dispensing cabinets in 2017.

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


Government and Politics

In Scotland, 18 clinician organizations respond to the government’s call for input on its digital health strategy, urging the government to increase information-sharing capabilities among clinicians.

The New York Times speculates on the effect of proposed legislation that would dismantle the Affordable Care Act:

  • Eliminating insurance subsidies will cause 22.5 million people to drop their coverage, driving up prices for everyone as fewer healthy people sign up.
  • Eliminating the federal Medicaid expansion will leave 12.9 million people without coverage.
  • Consumer protections such as those involving pre-existing conditions, lifetime limits, and insuring adult children can’t be changed using the budget reconciliation process, so those will remain in place.
  • Eliminating the requirement that people carry insurance and that employers offer it will reduce the incentive of healthy people who can’t get employer-provided insurance to insure themselves.
  • Taxes on high incomes, prescription drugs, medical devices, and health insurance could be rolled back to pre-ACA numbers.
  • Value-based care models and other Medicare payment experiments will likely continue.

Privacy and Security

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In England, Barts Health NHS Trust shuts down some of its systems (but not Cerner Millennium) after an unspecified cyberattack that it says wasn’t ransomware.


Other

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Cleveland Clinic tries to distance itself from the somewhat anti-vaccine comments made by its wellness center medical director, although it draws Twitter wrath for: (a) promoting other “bogus treatments;” (b) not pulling the original article down; (c) downplaying “a series of bad decisions flying in the face of evidence” in calling it “confusion;” and (d) running a wellness center in the first place. There must be tension given that CC is a medical and research powerhouse on the one hand, while on the other the wellness center’s online store offers trendy detox kits, meditation DVDs, and bags of quinoa. Surely patients must be confused as the clinic outsources to them the responsibility to reconcile the separate-but-equal parts of the organization that may or may not offer evidence-based care.

A study in Israel finds that rude patients get their doctors worked up to the point they deviate from practice standards. Teams of NICU doctors and nurses who were scolded by an actress playing an angry mother fell short for the rest of the day in all 11 performance measures reviewed in the study. The researchers then tried two possible solutions. Having the clinicians write about their experience afterward made the situation worse, but assigning them a behavioral modification game raised their rudeness thresholds to the point that their performance was identical to that of the control group, in effect providing them with rudeness resistance. The bad news for patients is that even if you don’t get  nasty yourself, you are equally disadvantaged when following another patient who did (and we all know there’s plenty of them out there).


Sponsor Updates

  • Santa Rosa Consulting migrates Memorial Health System (OH) to Meditech 6.15 Ambulatory.
  • ZeOmega publishes a new case study explaining how its clinical and technology assessment team helped MDwise improve operational efficiencies and increase ROI.
  • The Red Hot Healthcare podcast features Conduent (formerly Xerox Healthcare) VP of Health Strategy Rohan Kulkarni.

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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News 1/13/17

January 12, 2017 News 6 Comments

Top News

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The California Integrated Data Exchange (Cal INDEX) will merge with the Inland Empire HIE.

Cal INDEX, which has had statewide ambitions since its 2014 founding by Blue Shield and Anthem, has struggled with lack of participation by providers in a competitive environment who may not be willing to give an insurer-operated HIE their data. Its only health system members are Dignity Health and the just-signed St. Joseph Hoag Health.

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Former White House and ONC HIE advisor Claudia Williams has been hired as CEO, Cal INDEX’s fourth since 2014.


Reader Comments

From Ray Wrangler: “Re: Merge Healthcare. GM Nancy Koenig is taking a year-long personal leave of absence and will be replaced in interim by Andy Warzecha. A permanent GM is being considered.” Unverified. I’ve asked the company to confirm but haven’t heard back.

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From Snowman: “Re: Epic. Various critical access hospitals in Iowa (such as Virginia Gay in Vinton and Myrtue Medical in Harland) are converting to Epic as part of the University of Iowa Hospital and Clinics Epic Community Connect program. This is being run through an entity called University of Iowa Health Ventures.” Thanks. I had mentioned Myrtue’s conversion recently in my Decisions section from Definitive Healthcare.


HIStalk Announcements and Requests

Signups are still open for the 10th and final HIStalkapalooza, so you won’t want to miss Party on the Moon’s figurative closing rendition of “The Last Waltz.” Meanwhile, I need some help with red carpet duties in a key role, so contact Lorre if you’re a quick-witted, outgoing female willing to spend some time participating in the event instead of spectating. I still need event sponsors, too, for companies interested getting enough tickets to create their own sub-party as well as earning significant industry exposure. Signups so far include 90 CEOs and presidents, 14 CIOs, financial industry bigwigs, and more SVP/VPs than you can shake a stick at (like a post-blackout baby boom nine months later, deals will be announced months from now whose consummation began with a House of Blues twinkle in someone’s eye).

We’ll have another CMIO lunch at the HIMSS conference on Tuesday, February 21, starting at noon at Bistro HIMSS (just off the exhibit hall floor). I’ll buy lunch for up to the 20 attendees we’re allowed and you’ll get to eat something nice while sitting comfortably with CMIO peers. Sign up if you’re interested. Everybody seemed to enjoy it last time.

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We funded the DonorsChoose grant request of Mrs. I in South Carolina, who asked for a Chromebook for class science research. She says students are using it for virtual labs and study drills and adds, “I have inquiring, smart, and engaging students and I am planning a new project on encouraging students to focus more on STEAM , which I believe is the way to go in order to produce engaging and inquiring minds that will be able to compete in a global community.”

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Welcome to new HIStalk Platinum Sponsor Logicworks. The cloud automation and managed services provider offers secure, compliant cloud solutions in helping organizations architect, maintain, and automate custom Amazon Web Services infrastructure with 24x7x365 support, a team of highly qualified engineers, and 100 percent uptime SLAs. They’ll also help extend the data center to the cloud with their hybrid cloud offering, which includes cloud orchestration, 22 years experience in migrating and managing legacy systems to AWS, security management, and maintaining sensitive information in a private cloud to meet HIPAA, PCI, and SOX mandates while taking advantage of AWS’s scalability. Logicworks offers automation software that helps enterprises get to the cloud faster, fueling their next big ideas by allowing developers to spin up servers in seconds. Cybersecurity is implemented and monitored around the clock by best-in-class security experts. The company has completed 400 cloud projects in its 20 years in business, with deep expertise and an average engineer tenure of six years. Clients include 30 state HIEs, the largest health insurance exchange in the country, leading SaaS clinical software providers, global healthcare systems integrators, and healthcare analytics vendors. It just announced a mind-boggling $135 million funding round led by Pamplona Capital. Thanks to Logicworks for supporting HIStalk.

Here’s a Logicworks overview I found on YouTube. They also did an HIStalk webinar called “Cloud Is Not (Always) The Answer” a couple of years ago.

This week on HIStalk Practice: UnitedHealth buys Surgical Care Affiliates in $2.3 billion deal. Teladoc adds lab testing services from Analyte Health. Aledade raises $20 million. HealthTap debuts Dr. A.I. Emmi Solutions CEO Devin Gross shares patient engagement tips for practices facing resource limitations. Northwell Health launches new practice management business. MedEvolve debuts practice analytics. Humana VP of Provider Engagement Caraline Coats explains the ways in which the payer’s quality rewards program is helping physicians transition to value-based care.


Webinars

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

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

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 


Acquisitions, Funding, Business, and Stock

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The charitable foundation of the late Helen Diller, who with her husband made billions by investing in San Francisco real estate, donates $500 million to UCSF, the largest gift to a university in history. She had previously funded a cancer research building that bears her name.

Arizona’s attorney general opens bids for law firms to sue Theranos for consumer fraud. Just in case CEO Elizabeth Holmes is reading, she’s leading a couple of HISsies categories, should she be available to receive her honors in person in Orlando (note: wear old clothes).


People

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ID Experts hires Brent VanLoo (HealthSparq) as CTO.


Announcements and Implementations

IBM Watson Health and the FDA will study healthcare data exchange using blockchain technology, initially focusing on oncology data. The two-year project will look at sharing owner-mediated data – from EHRs, clinical trials, genomics, and devices – with researchers.

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Telemedicine provider HealthTap launches Dr. A.I., an artificial intelligence-powered symptom evaluator that “converses” with users, matches their subjective information against their health profile, and then uses the company’s data repository to offer care recommendations and “patients like me” suggestions.

Press Ganey and Kronos will study a subset of their shared clients to measure the impact of workforce characteristics on nursing quality indicators.


Government and Politics

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President-elect Trump nominates VA undersecretary of health David Shulkin, MD for Secretary of Veterans Affairs, who if confirmed would be the first non-veteran to serve in that role. He is also the first Obama administration holdover nominated by the Trump team. Shulkin is best known in HIT-land as having testified to Congress in June 2016 that the VA and DoD will be fully integrated by 2018 in describing the VA’s proposed digital health platform that may or may not include VistA.  

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Another ONC staffer will leave as part of the administration transition – Lucia Savage, JD, chief privacy officer. Deputy National Coordinator Jon White will serve as interim national coordinator with the departure of Vindell Washington, MD.

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The Senate votes along party lines to repeal the Affordable Care Act, using the same budget reconciliation process that was used to approve it seven years ago (with similarly partisan support). The House will vote quickly on the resolution, which if approved will give congressional committees the green light to craft legislation to dismantle major parts of the program. The Senate’s vote did not preserve protections for pre-existing conditions or the ability for parents to keep their children on their insurance plans through age 26. President-elect Trump said in his Wednesday press conference that he will roll out his replacement plan as soon as his HHS Secretary nominee Tom Price is confirmed. 

Here’s something to keep in mind as Congress guts the ACA: a new study finds that 60 percent of Americans don’t have enough savings to cover an unexpected $500 expense. I’m not sure subsidized health insurance helps much anyway considering that deductibles often top $7,000 before insurance pays a penny for non-routine care.

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ONC announces the Phase 2 winners of its Consumer Health Data Aggregator and Provider User Experience challenges that required using FHIR APIs. Winners in the Aggregator category: PatientLink Enterprises (gathering and managing patient data), Green Circle Health (family health dashboard), and 1upHealth (patient data organizer).

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Winners in ONC’s Provider category: Herald Health (alert workflow with push notifications), a team from University of Utah, Intermountain, and Duke Health (baby jaundice clinical decision support), and PHRASE Health (clinical decision support).

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John Halamka offers advice to the new administration about health IT:

  1. Create a national health identifier, a national directory of provider electronic addresses, and a baseline privacy policy and data sharing consent  that covers all 50 states.
  2. Don’t dictate provider workflows – let them decide how to use technology to keep people healthy and hold them to some element of quality and cost reporting.
  3. Align incentives while avoiding regulatory ONC zeal and use the only three clinician influence factors that work: pay them more, improve their professional life, or spare them public embarrassment.
  4. Share cybersecurity threat and mitigation information across the industry.
  5. Let EHR users drive product direction instead of forcing it via certification.

Privacy and Security

From DataBreaches.net:

  • Security experts alert a plastic surgeon and spa owner in Canada that his PHI-containing servers (including photos of unclothed women) are open to web searches. The problem was – as is often the case – an open Rsync device.
  • A two-state cosmetic surgery center is hit with ransomware, but apparently restores its systems without paying.

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Security firm Tresorit releases ZeroKit, which will offer developers using Apple’s open source framework CareKit with user authentication and end-to-end data encryption.

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A newly published book, “Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records,” says the “hidden trade” in medical information has become a multi-billion dollar business (mostly helping drug companies push their products) without improving outcomes.


Other

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Nearly half of Arizona’s doctors haven’t signed up for the state’s doctor-shopper prescription database, use of which will become mandatory in October. Doctors previously shied away in saying that the system is clunky. One PCP who’s been using it for years say she always checks a patient even though it takes 2-3 minutes.

In Washington, a car crashing into a utility pole on New Year’s Eve takes down the county’s 911 system and the local hospital’s connections to Epic for more than a day. Jefferson Healthcare says it will look for a backup plan in hopes of avoiding future interruptions to the services of its broadband provider, whose cables were damaged in the accident. At least it wasn’t the usual backhoe cut that zapped the hospital’s lifeline to the world.

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In Italy, a hospital suspends two of its ED doctors and its director after social media photos show doctors treating patients who were lying on the floor. The hospital had run out of stretchers after loaning several to an ambulance service. Hospitals were swamped after extreme weather and a meningitis scare happened during a holiday weekend when many doctors were on vacation. The director said that treating patients on the floor was better than not helping them at all.

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Weird News Andy is singing along to “Parentage by the Cell Phone Light.” Doctors at a hospital in China use their cell phone lights to illuminate their delivery of a baby of a woman who had gone into labor in the hospital’s parking lot. WNA wryly concludes, “Of course there are photos.”


Sponsor Updates

  • Rock Health awards Medicity’s Brian Ahier with the Digital Health Evangelist of 2017 award. Snowed in and unable to accept the award in person, Ahier posts his acceptance speech from his blanketed driveway.
  • Iatric Systems will exhibit at the MUSE Executive Institute January 15-17 in Newport Coast, CA.
  • AlleyWatch includes MedCPU in its list of the nine largest health tech startup fundings in New York City in 2016.
  • Meditech releases a new case study, “It’s in Their DNA – Avera Health Drives Precision Medicine at the Point of Care.”
  • Nordic Consulting releases a new podcast, “What the best health IT consultants do at the end of their contracts.”
  • PokitDok CEO Lisa Maki weighs in on the possible repeal and replace of the ACA on Bloomberg News.

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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News 1/11/17

January 10, 2017 News 12 Comments

Top News

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

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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

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

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

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


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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

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

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


Sales

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


People

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

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

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


Announcements and Implementations

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


Government and Politics

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


Privacy and Security

From DataBreaches.net:

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

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

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

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


Technology

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

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Accenture names its health technology challenge winners:

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

Other

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

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

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

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

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Research and Markets apparently foresees a very small RTLS market.

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

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

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

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

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

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


Sponsor Updates

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

Blog Posts


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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Morning Headlines 1/9/17

January 8, 2017 News No Comments

Repealing the ACA without a Replacement — The Risks to American Health Care

In a NEJM opinion piece, President Obama makes a case against Republican efforts to repeal ACA without coming to an agreement on what its replacement will be.

Cleveland Clinic doc apologizes for anti-vax column, hospital promises discipline

The medical director, and COO of Cleveland Clinic Wellness Institute comes under fire after publishing an op-ed piece on Cleveland.com questioning the safety of vaccine preservatives and recommending that parents consider alternative vaccine schedules for their children. The op-ed has since been taken down and Cleveland Clinic has promised disciplinary action.

Patient power through records

The Boston Globe profiles the work of Harvard Medical School professor Warner Slack, MD, who in the mid-60s pioneered the idea of storing medical records on computers and sharing them with patients.

Monday Morning Update 1/9/17

January 8, 2017 News 2 Comments

Top News

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President Obama says in a NEJM opinion piece in which he denounces Republican intentions to repeal the Affordable Care Act before offering a solution of their own,

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the healthcare system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the healthcare system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in healthcare costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving healthcare that may no longer be affordable or accessible. Furthermore, there is no guarantee of getting a second vote to avoid such a cliff, especially on something as difficult as comprehensive healthcare reform.


Reader Comments

From Caraway: “Re: selling software to hospitals. What are the most important factors or strategies?” I’m not a salesperson, but my experience on the other end of the transaction leads me to these conclusions:

  1. Figure out my likely problems without wasting my time probing me to discover them. It’s not my job to tell you what to sell me. Instead, ask what’s in my strategic plan since that’s where the money will be going.
  2. Bring success stories from hospitals like mine.
  3. Tell me tactfully about the weaknesses of competitive products, but don’t slam those companies. Salespeople switch jobs often and it’s embarrassing all around when you show up with a shiny new business card of a company you were trashing six months before.
  4. Figure out who has influence in the hospital. It’s a lot easier to align with an IT director or informatics person who knows the hot buttons and can devote research time, thus earning a recommendation and faster track to the CIO’s office.
  5. Be respectfully persistent without being a pest. The squeaky wheel earns some grease, but only the point that the noise becomes so annoying that it gets replaced.
  6. I might glance at your white papers and other marketing material, but the only thing that will convince me is conversations, preferably with customers.
  7. Don’t expect me to get excited about an offer to be a pilot site for a product under development. Even free systems involve a lot of headaches and the potential for both the vendor and the IT person to take a black eye
  8. Don’t bring a solution that doesn’t address one of my biggest problems or that won’t pay for itself. You are competing with a lot of important projects. Your star fades considerably if a capital investment is required since that’s a long-term, highly competitive budgeting process.
  9. Don’t try to sell around me. Give me the courtesy as an IT person to let me know who you’re talking to so I don’t get blindsided. You can create demand that will end up in my lap, but I still have some degree of technology veto power if you try to box me out.
  10. Don’t be in a hurry. We don’t usually slam-bam in health systems no matter how much your quarterly numbers need a boost.

HIStalk Announcements and Requests

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HIStalkapalooza sign-ups are open. Some fun comments added by those requesting tickets:

  • HIStalkapalooza 2016 was my favorite evening event HIMSS last year! Skills I can contribute to the event: willing to sample all the food at the buffet to make sure it is tasty; also will get out on the dance floor with some really mediocre moves to make everyone else feel more confident about their dancing.
  • A frigid sales rep from ‘Sconsin, Longed for a ticket to yon sun. He daily read HIStalk, Its insight he unlocked. That his legacy nev’r be undone.
  • I like to dance; I manage HIT interoperability partnerships with 35 partners. HIStalkapolooza is a righteous ton of fun.
  • I read HIStalk every day and it’s an important part of why I’m effective at my job. Basically, I’m a big fan. Another haiku about HIMSS since you liked it last year: Gray suits and gray hair, Your booth’s fireplace is too much, No one wears color.

To answer questions asked in the requests: (a) Party on the Moon will indeed be on stage again; (b) shoe-related activity will abound; and (c) based on response so far, it appears that, as in the last couple of years, I’ll be able to invite everyone who requests a ticket (but if I don’t, providers come first).

Note: the overly large photo above serves as an eye-catcher – every year, people (usually executives or their assistants bristling with self-importance) waste my time in claiming they religiously study every single HIStalk word I write, yet somehow missed the many, many times I mentioned that signups are open and thus didn’t request the ticket they absolutely must have. I’ll just send them a screenshot of the announcements like this. The party is for readers and I feel no obligation to someone who clearly isn’t one. Your life (and certainly mine) won’t be irreparably damaged if you have to find something else to do Monday evening because you weren’t paying attention.

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Three-fourths of poll respondents say doctors should be held accountable for patient satisfaction results. A couple of folks question why it’s just physicians and not the front office and billing people who are on the hook, while others think it’s OK to measure and report patient satisfaction but not OK to tie the results to compensation. Others note that patients are subject to the usual maddening human variability (see: Yelp reviews) and will ding the doc because their hospital meals were under-salted or they were told to lose weight. Meltoots gives examples of risking satisfaction survey retribution by doing the right thing – making patients get out of bed and refusing their demand for narcotics, no different for scoring a teacher highly because they never give homework.

New poll to your right or here: When did you last earn a significant promotion or leave for a better job? Some explanation would be nice – click the Comments link after voting.

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Welcome to new HIStalk Gold Sponsor Sphere3, a Gartner Cool Vendor that offers the Aperum patient experience management platform. It integrates patient perception with nurse call system activity to provide insight into patient satisfaction, caregiver workload management, and patient safety. Nursing administration gains visibility into patient needs, workload, and the voice of the customer. Aperum’s Hot List identifies patients whose behaviors increase their fall risk, while the nursing department enjoys reduced call lights and response times. Clients have reported an 18 percent increase in patient experience domain scores, a 24 percent reduction in call light activity, and a 10 percent increase in HCAHPS response to call light. Check out  their white paper “Reinventing Nurse Call to Enable the Real-Time Health System.” The Kansas City, KS-based company will exhibit in the Startup Area at HIMSS17, where you can meet CEO Kourtney Govro. Thanks to Sphere3 for supporting HIStalk.

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Mrs. M reports that students in her New York media classroom are using the headphones we provided in funding her DonorsChoose grant request for online learning and test-taking.

I was annoyed but unsurprised this week when I needed to send my doctor an insurance form and they said it had to be faxed – they don’t have the ability to accept a scanned document attached to an email. The person’s tone suggested that they are the innovators and I’m the Luddite for not having a fax machine at my eIbow. I pictured them tending their time capsule technology dressed in No Fear shirts, singing along with Right Said Fred, and stroking their Beanie Babies.

Listening: new from The Dogs, an apparently nearly unknown Norway-based punk rock band whose raw, angry sound is reminiscent of the Pixies but with more sonically rich musical hooks, a fantastically growly organ, novella-like lyrics, and a killer stage presence. This is the antidote to lip-synching, fading divas and tedious, Auto-Tuned hip-hopper collaborations. If you don’t see puddles of sweat in front of the singer, you didn’t get your money’s worth. The Dogs earns my highest recommendation and would be amazing headlining my future low-rent version of HIStalkapalooza in a vacant lot with kegs and barbeque. I’m binge listening their whole catalog on Spotify and it’s exhilarating. Judging from their albums and concert video, this has to be one of the best bands in the world.


Last Week’s Most Interesting News

  • The Advisory Board Company announces layoffs and office closures following a post-election slowing of customer activity.
  • CTG says it will counter the slide in post-Meaningful Use EHR work by focusing on optimization and application services.
  • A Black Book consumer survey finds a rapidly growing “digital divide” in which patients don’t trust providers to protect their data, don’t know how to use technology such as patient portals, and withhold information from their doctors due to privacy concerns.
  • Security researchers report a spate of cases in which improperly secured MongoDB analytics databases are being hijacked by hackers who are holding the information for ransom.
  • Senate Republications introduce an aggressive timeline for dismantling the Affordable Care Act without proposing an alternative.

Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Tax, advisory, and business consulting firm WeiserMazars renames itself Mazars USA.

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Coding and compliance services vendor Aviacode acquires facility coding outsourced services vendor Revant Solutions.

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Genetic information company Invitae acquires AltaVoice, which hosts Patient Insights Networks that connect researchers with patients, for $15 million.

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Detroit Lions defensive back Glover Quinn invests in PeerWell, whose app supports physical therapy rehab patients with exercise programs and the ability to perform their own range-of-motion measurements at home. The company has raised $2.1 million in a single November 2016 investment.


Sales

Prime Healthcare chooses Phynd to gather, manage, and share data on its 75,000 providers across 43 hospitals.


Decisions

  • Myrtue Medical Center (IA) will switch from Medhost to Epic in October 2017.
  • Heart Hospital Of Lafayette (LA) will move from Cerner to Epic in September 2017.
  • Bibb Medical Center (AL) migrated from Prognosis to Athenahealth in August 2016 and will go live on its ambulatory EHR in 2017.
  • Nash General (NC) will replace Cerner with Epic in 2018

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


People

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Huron Consulting Group promotes John Kelly to EVP/CFO and names EVP/COO Mark Hussey as interim healthcare practice leader. Hussey replaces Gordon Mountford, who has left the company. HURN shares are down 17 percent in the past year, valuing the company at $958 million. 

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Healthgrades hires Eric Jensen (Avia) as EVP of health systems products and strategy.


Announcements and Implementations

ZH Healthcare (never heard of them) launches a “new unified brand” of blue EHR , unleashing a torrent of buzzwords: “enhance the power of world-leading malleable and customizable EHR … The brand stands for stability, strength and trust that clients place in our solution. The color blue speaks to infinite capabilities.” Kudos to whatever marketing firm profitably convinced the company that they ‘re adding value in cooking up this gibberish, although slipping in “malleable” was pretty cool assuming it doesn’t refer to frustrated users beating their PCs with a hammer.


Other

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Eric Topol, MD is unhappy with the way reporters hype a tiny decline in cancer deaths over nearly 60 years in hyping a 25 percent decrease since 1991.

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A rant by the medical director/COO of the Cleveland Clinic Wellness Institute highlights the awkward situation that can result when a traditional, respected medical institution launches a trendy alternative / integrative medicine operation whose beliefs are not only different, but sometimes scientifically sketchy. Daniel Neides, MD says he is “tired of all the nonsense” as government and businesses force us “to live in a toxic soup.” He should have stopped in that weird but safe ground, but then launched into a Jenny McCarthy-like tirade against the preservatives in vaccines, confidently opining that ADHD is a thing not because it has been defined as a disorder and parents encourage overdiagnosis, but because “something(s) are over-burdening our ability to detoxify.” He doesn’t suggest refusing vaccinations, at least, only recommending that parents talk to their doctor about timing of the injections for their children. A predictable firestorm ensued, with Cleveland Clinic issuing a terse statement that Neides won’t be doing interviews and that his opinion piece doesn’t reflect its position.

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The Boston Globe profiles Warner Slack, MD, a medical school professor who developed a patient computer questionnaire in Wisconsin in the mid-1960s. One of his students was Epic CEO Judy Faulkner. The article debates whether interoperability will ever be prevalent, quoting Slack as saying he’s disappointed that EHRs aren’t providing more benefits to patients.


Sponsor Updates

  • Validic CEO Drew Schiller presents at CES 2017.
  • ZeOmega releases a white paper, “The Value of an Advanced Predictive Analytics Approach in Population Health Management.”

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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News 1/6/17

January 5, 2017 News 3 Comments

Top News

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The Advisory Board Company will restructure its healthcare business, laying off 220 employees and closing four offices. It will exit its businesses of care management workflow, nursing workforce and infection control analytics, and two niche consulting practices.

The company blames its November-December sales slowdown on the election, as health system customers paused to contemplate potential changes under the Trump administration.

ABCO shares didn’t react much on the news, but are down 26 percent in the past year, valuing the company at  $1.4 billion.

Specific products – such as Crimson platform or ABCO’s Clinovations consulting group – were not specifically mentioned. The company says the businesses they’re shedding generated $18 million in 2016 revenue vs. $14.5 million of expense, so they should interest potential acquirers if that’s the company’s plan.


Reader Comments

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From Puffer: “Re: your Mr. H avatar. Get rid of the pipe.” Every year since I started writing HIStalk in 2003, a few folks who feel blessed with extra-special insight note (often with smugness) that a site about healthcare shouldn’t feature a smoking doctor (like I somehow didn’t notice the irony until a newbie clued me in). I specifically had the avatar designed with a pipe – right down to describing how I wanted the wafts of smoke to appear – as my version of a pirate’s Jolly Roger warning that this is not the usual health IT pablum written by corporate cheap-seaters. You would be surprised to see how many dignified executives have someone take their picture embracing my happily smoking doc standee at the HIMSS conference. 

From Stud IT Director: “Re: promotion. I’m 42 years old and have been IT director for nine years, seven under the CIO who was brought in not long after I was promoted. How do I know if I should stay or seek greener pastures?” My thoughts:

  • You already failed to be promoted when your boss was hired, so you may be permanently branded as mid-level management material better suited for a corner in the IT cube farm instead of Mahogany Row. Some places just don’t like promoting internal candidates for C-level jobs.
  • Are you the favored child among your peers? If not, forget it and move on.
  • Have you been given any indication that you’re next in line, or for that matter, that the CIO isn’t going to hang around for another 10 years as your window closes? Not many first-time CIOs are in their 50s.
  • Are you sure you’re qualified to be a CIO? If it hasn’t happened by 42, maybe it’s not in the cards or you’re being wasted in the wrong place. It’s common for IT directors to think they can do everything their CIO boss can do, but they miss the point that the most-valued skills aren’t the obvious ones. It’s not technology, but the ability to earn the trust and respect of peers, being able to take the big-picture view beyond bits and bytes, and leading a team). It’s more than checking boxes for education, experience, and results. Maybe your boss is an incompetent doofus,but if he or she is still holding the position, someone important must not think so and maybe you are missing something.
  • Are you willing to bet a lot on your abilities? If so, connect with a recruiter and groom yourself to be hired as a CIO, probably in a struggling hospital or godforsaken part of the country that’s less attractive to better-pedigreed candidates.

HIStalk Announcements and Requests

HIStalkapalooza sign-ups are open. About 400 people have put their names in the “I want to come” hopper so far, many of whom provided a fun bonus in entering witty comments on their forms.

I’ve received around 150 responses to my annual reader survey, the results of which drive most of my agenda for the year. Weigh in here, which will also enter you in the running for a $50 Amazon gift card. I’ll deal with the creative tension cause by the usual polarizing results, such as the “I love rumors” vs. “I hate rumors” responses. I like that a couple of readers say that reading HIStalk is their guilty pleasure, although the “guilty” part means I won’t gain many readers via word of mouth.

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Mrs. S from Virginia says her second grade class is using the Osmo math and language apps we provided in funding her DonorsChoose grant request to learn in small groups and to compete as teams, with some students who were behind in math using the tool to catch up.

This week on HIStalk Practice: Private practice MDs in Massachusetts react to new HIE integration law. Duane Reade clinic closures point to market saturation. Kareo’s Lea Chatham explains the ways in which physician independence trumps hospital employment. EarlySense adds American Well consults to its consumer-facing remote-monitoring platform. Trade groups sound off on potential ACA repeal/reform. Carena’s Ralph Derrickson makes telemedicine predictions for 2017. Athenahealth shakes off its layoff doldrums. MDGuidelines’ Joe Guerriero sees steady sailing for the future of value-based care. CompuGroup Medical adds genomic decision-support tools to its EHRs. Drchrono’s Michael Nusimow outlines the ways in which MACRA will impact physician compliance in 2017.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

McKesson and Change Healthcare announce that the new health IT company they’re creating will be called Change Healthcare, so decided after “a thorough strategic and creative review process.” 

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Health benefits platform vendor Castlight Health will acquire competitor Jiff. Castlight President/COO John Doyle will become CEO of the new company, Jiff CEO Derek Newell will become president, and Castlight CEO Giovanni Colella will leave the executive suite but remain in the boardroom as executive chair. Jiff is a much smaller company with just $7 million in annual revenue vs. Castlight’s $102 million. Castlight shares dropped sharply on the announcement. They doubled on the company’s IPO day in March 2014,  but have dropped 89 percent since, valuing the company at $443 million.

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Health data aggregation and analytics technology vendor Arcadia Healthcare Solutions receives a $30 million growth capital investment from Merck Global Health Innovation Fund, GE Ventures, and existing investors. I asked CEO Sean Carroll when I interviewed him in late 2015 where he wanted the company to be in five years:

We’re very dedicated to the notion that clinical data in particular — for the next five years and perhaps beyond — aggregated from electronic health record, is fundamental to an effective data strategy. A data strategy is fundamental to being successful in value-based care. We’re focused on that.  We certainly understand the necessity to deliver on the full outcome, but our focus will remain on solving this important and fundamental challenge that organizations have, which is, "I’ve made huge investments in my electronic health record strategy. I need the information out of all of them. I need it timely. I need to be able to then process it right it away in much broader ways, including looking at the full population that I serve. That’s the only way that I will be effective in executing in any sort of risk model."

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A letter to shareholders from CTG says that the company’s mandate-fueled EHR work has slacked off, so it will move its focus to high-margin work in optimization, performance improvement, application management, and service desk and will focus its staffing offering on higher-margin work.

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Athenahealth will double its Atlanta-based workforce to nearly 1,000 by next year in the Ponce City Market. Athenahealth was the first office tenant of the former Sears, Robuck and Co. regional headquarters that then served as City Hall East for 20 years. I’m fascinated by the list of tenants in the Central Food Hall.


Sales

Vancouver Island Health Authority selects Vocera’s smartphone solution for secure text messaging, voice communications, and alerts.

The Department of Defense chooses Vocera for wireless hospital communication in a $14 million contract, the company’s largest ever.

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Medical Center Health System (TX) engages QuadraMed’s Professional MPI Clean-up Services in preparation for its Cerner go-live in the spring.

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Piedmont Healthcare (GA) chooses patient-provider matching solutions from Kyruus.

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Melissa Memorial Hospital (CO) chooses Athenahealth, presumably for ambulatory although the local paper’s recap doesn’t actually say. The chatty story says Cerner was the losing bidder and that annual costs for Athena will be $221,000.

J. D. McCarty Center (OK) chooses CPSI’s Evident EHR.


People

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AHIMA installs Ann Chenoweth, MBA (3M Health Information Systems) as president and chair of its 2017 board.

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Dave Miller, MHSA (HCCIO Consulting) joins Access Community Health Network (IL) as CIO.

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Kelley House (Jackson & Coker) joins Culbert Healthcare Solutions regional sales VP.


Announcements and Implementations

Ingenious Med releases a value-priced edition of its system for organizations whose primary need involves charge capture.

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CompuGroup Medical US will integrate real-time genomic decision support tools from ActX into its EHR.


Privacy and Security

From DataBreaches.net:

  • A single hacker has hijacked 3,500 unsecured MongoDB databases and is demanding around $200 to release them, one of them apparently belonging to Emory Healthcare.
  • Box.com changes its publicly shared folders after a security researcher finds that information contained in them is visible in Internet searches.
  • Creative ransomware authors add new features: (a) one variety decrypts the files of an infected user who passes the ransomware on to friends; (b) the Jigsaw malware deletes files every hour until the ransom is paid; and (c) Koovola restores encrypted files if the victim agrees to stop downloading unsafe files and reads two suggested ransomware articles.
  • New Hampshire’s health commissioner apologizes not only for breach that exposed the information of 15,000 people, but for upsetting relatives of deceased individuals who received breach notification letters addressed to them. I’m not sure there’s a good answer to this unless it’s possible to reliably cross-reference to Social Security death records. Or, do family members have a right to know anyway?

Technology

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An interesting article in The Economist ponders whether artificial intelligence can “crack biology” and thus help treat or cure disease. A snip:

Pharmaceutical companies are finding it increasingly difficult to make headway in their search for novel products. The conventional approach is to screen large numbers of molecules for signs of pertinent biological effect, and then winnow away the dross in a series of more and more expensive tests and trials, in the hope of coming up with a golden nugget at the end. This way of doing things is, however, declining in productivity and rising in cost … The trouble is that too much new information is being produced to be turned quickly into understanding … This is where AI comes in. Not only can it “ingest” everything from papers to molecular structures to genomic sequences to images, it can also learn, make connections and form hypotheses. It can, in weeks, elucidate salient links and offer new ideas that would take lifetimes of human endeavor to come up with. It can also weigh up the evidence for its hypotheses in an even-handed manner. In this it is unlike human beings, who become unreasonably attached to their own theories and pursue them doggedly.

The health-related products honored with the CES conference’s Innovation Award are:

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Aipoly Vision — tells blind people what their phone camera is pointed at.

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EyeQue – home vision testing from which eyeglasses can be ordered.

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K’Track G – real-time blood glucose monitoring using a skin sensor-powered, wrist-worn device.

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ReSound ENZ02 – a hearing aid whose attributes can be changed from an iPhone.


Other

This article seems to be shocked and appalled that a drug company’s “senior management pressured employees to convince customers to order its key medicine in order to meet financial targets.” Isn’t that what senior management and salespeople are supposed to do? The fact that it’s healthcare is, from a business standpoint, irrelevant. It is surprising to me that people expect profit-driven businesses (drug companies, physician practices, medical device vendors, insurers, supposedly non-profit hospitals, etc.) to voluntarily behave differently only because their particular widget involves sick people. People do what they’re paid to do and our healthcare system richly rewards profit-maximizing behavior.

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Here are some interesting thoughts by Pamela Wible, MD.

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I’m thinking of the healthcare possibilities of the wearable passenger medallion that Carnival Cruise Line is rolling out. The quarter-sized, credit card-linked sensor – carried in a pocket or worn like jewelry – provides touch-free credit for buying high-margin onboard products, opens cabin doors on approach, is tied into the new high-tech casino system. identifies passengers to iPad-carrying waiters and other staff who can then then address them by name, and allows users to tailor their on-board experience to their interests. Carnival will install 7,000 sensors per ship that allow apparently allow it to track passenger movements. It would be pretty cool if a sensor loaded with healthcare and preference information were used to reduce the depersonalization that occurs in healthcare settings. 

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The Houston paper notes that Ron DePinho, MD, president of “financially ailing” MD Anderson Cancer Center, has been awarded a $208,000 bonus for the year, boosting his total 2016 compensation to $2 million even as the medical center lost $110 million in the last quarter alone. Commendably, he’s donating his bonus back to the institution. One element of his performance review was implementation of Epic, which MDACC says has hurt its short-term bottom line. This is our health system conundrum – executives take a PR beating if their hospital (a) loses a lot of money, or (b) makes a lot of money, with whatever else the institution accomplishes playing secondary importance (maybe because they pay CEOs so much). Meanwhile. MDACC announces that it will lay off up to 900 employees immediately in trying to stop its bleeding.


Sponsor Updates

  • Philips Wellcentive ranks highest in flexibility of meeting customer needs in KLAS’s population health management report.
  • PatientKeeper releases a new video, “Why Billers & Coders Love PatientKeeper Charge Capture.”
  • KLAS rates Health Catalyst the highest among early “preliminary data” population health companies in its new population health management report.

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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News 1/4/17

January 3, 2017 News 1 Comment

Top News

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An excellent Black Book survey of 12,000 consumers finds that:

  • 57 percent are skeptical of patient portals, mobile apps, and EHRs because they don’t think providers can protect their information from hackers.
  • Nearly all respondents express concern that information about their prescriptions, mental health, and chronic conditions is being shared with retailers, employers, and the government.
  • A startling 89 percent of respondents withheld information from their providers during their 2016 encounters.
  • The percentage of people who distrust health IT has jumped from 10 percent in 2014 to 70 percent today.
  • 92 percent of patients who are discharged from hospitals under 200 beds don’t understand how to use the patient portals, engagement tools, and monitoring systems that hospitals provide, with 94 percent of nurses in those hospitals saying they don’t have time to add technology literacy to their discharge planning.
  • 94 percent of doctors aren’t interested in reviewing data from patient wearables or fitness and nutrition apps.
  • 82 percent of doctors report that some patients bring so much information from their web searches that they don’t have time to review it during the short time allotted for office visits.
  • Nearly all respondents who use health improvement apps and devices say their PCP ignores their technology, with 24 percent of those respondents saying they may choose a more tech-savvy doctor as a result.
  • 94 percent of providers think the government should pay for patient technology literacy training.

I’m not sure it’s quite the “digital divide” that Black Book calls it, though, since both consumers and providers struggle with technology, aren’t well trained to use it, and worry about breaches (both internal and external). “Divide” suggests some consumers benefit more than others and I’m not sure that’s the case. There’s not a lot of difference between not having the means to use apps vs. not having the interest or confidence to use them.

The most interesting thing about these results is that surveyed consumers nearly always, (a) claim they are in favor of something that sounds innovative, but (b) say their technology fears override everything else (even as they are spewing masses of personal data via Facebook and are willing to provide whatever information companies require to access free games or prizes). In this case, they have nothing positive at all to say about consumer health IT. You would expect similarly low usage of those products, which taxpayers have richly funded.


Reader Comments

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From Cornichon: “Re: NextGen. Filed an SEC 8-K form giving shares to leadership, many of them vesting only based on the passage of time and not performance. The vesting is accelerated if the company is sold, which has been a topic of speculation for months. The executives also got new change of control benefits for those let go in conjunction with any sale.” CEO Rusty Frantz gets shares worth $850,000 for sticking around for four years plus another potential $472,000 for company performance, plus accelerated vesting if the company sells out. He also gets 150 percent of base salary and bonus, 18 months of health insurance, a pro-rated current year bonus, and outplacement services if he leaves after a sale. The other execs get a similar deal with 100 percent of base salary and bonus. QSII shares have taken a long slide down since mid-2011, now trading at 2005 prices and valuing the company at $840 million. Founder Shelly Razin, who lost his board chair seat in late 2015, holds more than 10 million shares, worth a cool $138 million although that’s a horrifying $358 million less than the same number of shares were worth a handful of years ago.

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From Retired HIT guy: “Re: Summa Health (OH). It replaced its five-hospital ED staffing on January 1 with a company owned by the husband of Summa’s chief medical officer, with just 36 hours’ notice. Staff wondered how staffing would work given the weeks-long credentialing process and the lack of familiarity with the computer systems used.” The new company apparently realized the challenges facing it since it offered the existing ED  docs a $100,000 incentive bonus and an extra $75 per hour join their company, with no takers. The hospital denies employee reports of long ED wait times and patients leaving without being treated.

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From Marketing Slick: “Re: CommonWell. Cerner claims it was a founder of Carequality even though it fought it as a CommonWell competitor. All Cerner did was buy Carequality participant Siemens Health Services.”

From Connective Tissue: “Re: Carequality and CommonWell connecting their systems. I agree it’s the golden spike. Some backstory: Epic and McKesson were in a lawsuit over MyChart, as MCK wanted Epic to use RelayHealth. There was also an Epic concern that CommonWell might create a patient portal that would compete with those of providers. Cerner realized that with the VA deal on the table, they needed to get on board because the government supports Carequality. The question was over who charges who – for example, disability and life insurance companies pay the customer because it saves them paperwork. CommonWell wants to charge fees, but Epic wanted Carequality to be free for patient record exchange involving for care coordination. The agreement was for CommonWell to create a record locator service that they can charge for, while Epic agreed to support it for their interested customers (Surescripts offers the only national locator service – the rest are regional ones offered by HIEs). This agreement is like that of cell carriers in that Carequality and CommonWell can charge only their own customers, not those of the other service, and thus Cerner and Epic can’t charge each other. Since multiple participants are involved, rather than calling it a golden spike between two participants, perhaps the agreement could be better described as the linchpin in the nationwide ATM for healthcare.” A few folks who were involved have told me about the April 1, 2016 meeting that was brokered by Micky Tripathi, CEO of the Massachusetts EHealth Collaborative. There’s also that unverified rumor that Cerner is interested in acquiring RelayHealth, but I don’t have a solid source on that even as MCK sheds its other health IT assets and announces no plans for the best one (Relay).

From Unbalanced Sheet: “Re: R&D accounting. I would be surprised if Epic doesn’t use GAAP accounting like most large companies, but it’s never an apples-to-apples comparison. The question is how much R&D is capitalized and thus ends up on the balance sheet vs. expenses that are flushed through P&L. Aggressive companies like Cerner have capitalized 35 percent or more over the years, which allowed it to report higher earnings than more conservative companies. Management has a great deal of discretion over things like that that go toward quality of earnings.” I read somewhere that software companies must now treat R&D as an expense as it is incurred unless they can prove that the investment has a quantifiable future benefit. For software development, I was thinking that the only opportunity to capitalize R&D is the time between technical feasibility and GA, meaning you have to expense a product’s cost once it is released. However, the definition of “product” and “GA” may be squishy.


HIStalk Announcements and Requests

Your chance to weigh in:

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I applied matching money to Vicki’s donation to my DonorsChoose project to fully fund these teacher grant requests:

  • A math fluency activities bundle for Mrs. M’s elementary school class in Fairfield, OH
  • A document camera and interactive whiteboard system for Mrs. W’s middle school class in Middletown, OH
  • Composition books and math games for Mrs. D’s elementary school class in N. Little Rock, AR.

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Mrs. M reports that her Virginia students are surrounded by technology that they don’t always get to use because of economic circumstances, adding that the kids have jumped in to create a plan of how they will use the two tablets we provided in funding her DonorsChoose grant request.


HIStalkapalooza

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HIStalkapalooza sign-ups are open. The usual rules apply:

  • Everybody who wants to come has to sign up on this form (even me) – nobody gets invited automatically.
  • Each person who wants to come has to sign up separately even if they’re a guest of someone else (because we use an automated check-in system with individually barcoded tickets),
  • Signing up doesn’t guarantee that you’ll get an invitation since that depends on how many people I can invite, which is based on how many sponsors I get. Invitations will be emailed in three weeks or so.
  • We pay per click of the House of Blues turnstile and thus close the doors early in the evening since someone swinging by for a late-evening beer still costs many dozens of dollars. If you can’t attend the whole event, please don’t take up a slot.

Thanks to our HIStalkapalooza sponsors who are graciously making the industry’s most talked-about event possible. I’ll have a write-up on each company leading up to the event, which is less than seven weeks away.

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I need another couple of sponsors to hit the break-even point on HIStalkapalooza. Companies that want invitations to give out, recognition, and even to have their CEO welcome guests on the red carpet should contact Lorre. She will get creative in finding something fun — for example, HOB offered the idea of outfitting every server with a tie with a sponsor’s logo. I joked that it should be like Nascar where they wear fire suits plastered with logos, to which our HOB contact responded with a dry, two-syllable ha-ha before moving on to something important like the food options.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Xerox completes its spinoff of its 93,000-employee business process services company Conduent, whose shares trade on the NYSE as CNDT.

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Kaufman Hall acquires contract modeling, budgeting, and decision support software vendor KREG Information Systems.

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Israel-based “smart shirt” company HealthWatch Technologies raises $20 million from a China-based drug company for its 15-lead, hospital-quality sensor garment.


People

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Vocera hires Ben Kanter, MD (Extension Healthcare) as CMIO.


Announcements and Implementations

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EHNAC releases 2017 standards for its 18 accreditation programs for electronic healthcare data exchange.

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University of Vermont Medical Center files a $112 million state certificate of need to extend its Epic implementation.

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United Healthcare will expand its wearables program to allow employees of some companies for which it provides health insurance to allow their employees to use their own wearables, connected via Qualcomm Life’s 2net connectivity platform. Employees can earn up to $4 day in credits for meeting walking goals involving frequency, intensity, and tenacity.


Government and Politics

Senate Republicans introduce an aggressive timeline for dismantling the Affordable Care Act on their promised first day of the new Congressional session. They are using a budget reconciliation resolution that can be passed with a simple majority vote in the Senate (the GOP has 52 seats) vs. the the usual 60-vote legislation approval level. The resolution was introduced by Senator Mike Enzi (R-WY), who says the ACA caused “skyrocketing premiums and soaring deductibles” while driving insurers out of the market.


Privacy and Security

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A New York Times op-ed piece on healthcare cybersecurity co-authored by Eric Topol, MD calls for health systems to stop storing and owning patient health data, instead making patients responsible for storing their own information in the cloud or a digital wallet – possibly using blockchain technology – and deciding for themselves who to share it with. He adds,

We cannot leave it to the health record software companies — the Cerners, Epics and Allscripts of the world — to bring about the needed changes. Their business is to sell proprietary information software to health systems to create large centralized databases for such things as insurance reimbursements and patient care. Their success has relied on an old, paternalistic model in medicine in which the data is generated and owned by doctors and hospitals … Patients have shown an overwhelming willingness to share their information for altruistic reasons (which far exceeds the track record of doctors and health systems when it comes to sharing data).

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US Special Operations Command in Florida is investigating a claim by security researcher Chris Vickery that he was able to breach the database of a company that provides healthcare workers for one of the group’s programs. Vickery has found several hundred unsecured MongoDB installations, at least some of which have been breached by a hacker with their data held for ransom. A security expert recommends blocking access to port 27017 or limit server access using binding local IPs, then restart the database with the –auth option after assigning user access. The no-SQL MongoDB is used to run big data analytics.


Other

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Eric Topol, MD pans the apparently successful “Pure Genius” TV series in which a young technology billionaire creates a hospital that uses cutting edge technology to treat patients that other hospitals can’t help. He not only notes medical mistakes (calling a stroke a heart attack), but questions the show’s premise:

Patients are cured, their lives are saved, or they have dramatic responses to unproven, otherwise unavailable treatments. And in each case Bell, without any medical training or background, makes the critical clinical decisions: “Best idea wins,” he says at the series’ beginning, and they’re usually his. He meets directly with patients and their families, makes extraordinary promises, dresses in scrubs, and uses technology that has never been applied to human beings. When the amnestic police officer does not respond to what the show calls neurostimulation, Bell blurts out, “I’ve always wanted to reprogram someone’s brain” and administers some form of optogenetic intervention that partially restores his memory. The notion that a medically untrained tech billionaire walking around in casual clothes and flip-flops can make life-and-death decisions for people using far-fetched, unchartered therapies is preposterous.

A life insurance company in Japan replaces 34 of its claims adjusters with IBM Watson Explorer, which will analyze hospital records to determine insurance payouts. The company expects the investment to pay for itself in less than two years in replacing employee salaries with much-lower maintenance fees. The article succumbs to the sensationalistic “rise of the robots,” but it is inevitable that companies will replace expensive human labor with technology (both manufacturing and information), which is great for shareholders, at least until the customer base evaporates due to unemployment.  

A Texas couple sues Apple after a driver distracted by using FaceTime on the highway caused an accident that killed their 5-year-old daughter. The couple says Apple should have warned users not to FaceTime while driving and should electronically prevent them from doing so (it would be interesting to see how Apple could distinguish a driver from a passenger).

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Weird News Andy titles this story “Pean pain paean” (hint: “pean” is a type of surgical forceps). Surgeons in Vietnam remove surgical forceps left in a man’s stomach for 18 years, ironically in the same hospital that apparently left them there in the first place. The hospital only keeps medical records for 15 years, but says it will try to locate the surgical team even if they have retired to let them know they messed up.


Sponsor Updates

  • CTG employees support the Family Justice Center with donations of food, toiletries, and gift cards.
  • AdvancedMD compiles its most popular e-guides and videos from 2016.
  • Aprima employees donate over nine tons of food to Dallas-area families in need through Metrocrest Services.
  • Besler Consulting releases a new podcast, “A brief history of healthcare reform in America.”
  • CoverMyMeds will sponsor and present at CodeMash January 10-13 in Sandusky, OH.

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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Reader Comments

  • Histalker: Interesting that Banner is encountering the same problems with Cerner that the prior owner encountered with Epic. Could ...
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  • John@chilmark: The reason I didn't reply to your Histalkpalooza survey was simply because you did not offer networking with the great g...
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