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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.
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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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Monday Morning Update 1/2/17

January 1, 2017 News 5 Comments

Top News

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Eric Topol, MD lists his “10 Tech Advances That Can Change Medicine.”

I have to be a quibbler in suggesting that changing “medicine” is far less important than changing “health” – none of these advances would move the needle on the overall health of the US population very much, although listing magic technology bullets makes for sexier reading than advocating exercise, dietary changes, and the other health determinants that drive 90 percent of health and quality of life.

We don’t really need wearable sensors or increasingly sophisticated diagnostic tools to tell us what people could do to improve their health the most, but Topol’s world view is as a cardiologist, technologist, and geneticist rather than that of a frontlines generalist. Telling people to use their own intelligence instead of being overly enamored of the artificial kind doesn’t earn many grants, procedure payments, or technology board seats.

That said, Topol isn’t the only one with the “I have a hammer, so everything looks like a nail” problem. Hospital people mistake their often clumsy episodic interventions as the most important aspect of health.

In both cases, the fact remains that the most significant health decisions are made when people are far away from their providers and the bustling business of healthcare services delivery, often when they are in fact alone. For that reason, maybe health charge should be led by public health marketing people rather than providers whose education and experience causes them to overestimate their importance to health.


Reader Comments

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From Lucid Moment: “Re: patient privacy. Patients do not realize that they give up their HIPAA rights when they use an app or system that connects to an EHR via an API. CMS requires providers to send patient information to any application that patients want to use. If a patient clicks ‘I agree’ on the usual multi-page terms of whatever app they’re using, the app vendor will gain access to their data under the FTC’s minimal privacy rules rather than HIPAA’s. Google and Microsoft will benefit because they can read patient data for choosing ads to display. That’s always been the case, but new phone access to data such as through the new Apple services opens the pipe for them.” Interesting. The above is from CMS’s November 2016 update on patient access to health information.

From Spoon Bread: “Re: misused words. This article list some good ones.” Indeed it does. Some good examples that I’ve seen:

  • adverse (harmful) vs. averse (not willing)
  • bemused (bewildered) vs. amused (entertained)
  • disinterested (unbiased) vs. uninterested (not interested)
  • flaunt (show off) vs. flout (disregard)
  • opportunistic (exploiting a situation immorally), confused with taking advantage of an opportunity
  • simplistic (oversimplifying a complex issue to the point of being misleading) vs. simple (an issue that is uncomplicated)
  • tortuous (twisting) vs. torturous (involving physical torture)

HIStalk Announcements and Requests

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Poll respondents are slightly negative on using scribes to free doctors up from doing EMR data entry work. Linda is concerned about the wide variability in scribe training and their lack of certification, while Furydelabongo says scribes are like transcriptionists who can create a standardized narrative in the absence of a usable EHR (which he or she says is at least two generations away). Frank says having the most expensive labor unit – doctors – entering data is inefficient, no different than if hospital VPs were required to enter transactions.

New poll to your right or here: Should physicians be held accountable for patient satisfaction survey results? Your thought process would interest the rest of us, so click the Comments link after voting and explain it.

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Here’s a last chance to participate:

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We funded Mr. C’s “Art of Science and Performance” video equipment grant request through DonorsChoose. He checks in from California to say that the class has recorded a school production so that everyone could watch it and will next make a San Jose Tech Challenge film as its keystone project.

I had some final site upgrade work performed over the holiday weekend. Let me know if you see anything that’s not working.


Last Week’s Most Interesting News

  • President-elect Trump meets with the CEOs of several large health systems, with privatizing some aspects of the VA being a rumored topic of discussion.
  • A study reports the benefits of adding EHRs as a topic in a hospital’s daily executive safety huddle.
  • The local paper reviews a patient death at St. Charles Medical Center (OR) in which an IV error was not caught, partly because the hospital had turned off its IV checking system after finding that it wasn’t compatible with its EHR.
  • The New York Times profiles the failure of a North Carolina physician group to move to an ACO model, with physicians who left for higher-paying hospital jobs and a big investment in technology forcing the group to sell out to a large health system.

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

Here’s the 2016 stock performance of some publicly traded health IT companies. It obviously wasn’t a great market year for them, even as the Dow rose 15 percent, the S&P 500 ended up 11 percent, and the Nasdaq increased 10 percent. Cerner shares, for instance, are trading at their March 2013 price, with their longstanding steep climb up having ended in March 2015 even before its July 2015 DoD contract win was announced.

Castlight Health – up 19 percent
Premier – down 14 percent
Aetna – down 14 percent
Cerner – down 19 percent
Quality Systems (NextGen) – down 22 percent
McKesson – down 28 percent
Allscripts – down 29 percent
Athenahealth – down 34 percent
Medical Transcription Billing – down 34 percent
Inovalon – down 39 percent

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The Philadelphia paper profiles Forerunner Holdings, which offers software that helps hospital pharmacies track prescription drugs through the supply chain to detect counterfeit medications. The company has 50 hospital customers who pay around $5,000 per year to connect with the fulfillment systems of drug wholesalers and manufacturers. The 14-employee company, which is about to launch a $10 million Series A funding round, plans to add a drug shortage warning app and a system to allow hospitals to share access to expensive, rarely used drugs such as antivenin. The company CEO and CTO both came from a Germany-based analytics software vendor and this is their first company.

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Fortune magazine profiles investors in “fake it till you make it” startups (of which Theranos is provided as an example) who refuse to believe their companies are doing anything unethical to provide the false appearance of growth. The article ponders whether startup culture has changed now that “the Valley looks as crooked and greedy as the rest of the business world.” The magazine proposes a Startup Scandal Scale that rates companies “on a scale of one to Theranos.” It summarizes,

Some founders grow into talented CEOs. Most don’t. That’s an inevitable by-product of Silicon Valley culture, where everybody fetishizes engineers, designers, and inventors while managers get little respect. “We have an epidemic of bad management,” says Phil Libin, a partner at venture firm General Catalyst. “And that makes [bad] behavior more likely, because people are young, inexperienced, and they haven’t seen the patterns before.” So inexperienced people are handed giant piles of money and told to flout traditions, break rules, and employ magical thinking. What could possibly go wrong? “We hope that entrepreneurs bend the rules but don’t break them,” McClure says. “You know the saying ‘There’s a fine line between genius and insanity’? There’s probably a fine line between entrepreneurship and criminality.”


Other

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Someone tweeted about Crohnology, a “patient-powered research network” in which people with Crohn’s disease are invited to contribute information about treatments they’ve tried so that the collective experience can be shared with all participants. It’s still in beta testing after several years, but it’s a great idea.

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The New York Times profiles the rapidly increasing world of “fake academia,” where shoddily produced but impressive-sounding journals and conferences feed the “publish or perish” needs of academics – many of them from third-world countries – who pay for the privilege of adding substandard articles and presentations to their CVs. An India-based company runs several of its conferences simultaneously from the same hotels in resort destinations; another’s 17 journals are published by one guy sitting in his apartment; and a third company warns prospective authors that its journals don’t accept papers longer than six pages. One journal accepted for publication a professor’s manuscript that contained one sentence: “Get me off your &@$! mailing list.”A company that the FTC has charged with deception offers the 4th International Conference on Biomedical and Health Informatics in Chicago and other informatics conferences, described with sometimes hilariously fractured English and illustrated with badly resized photos.

Bill Gates warns that the misuse of antibiotics has raised the odds of a pandemic spread by resistant bacteria. 

Connecticut home care agencies worry that the January 1 implementation of a Medicaid fraud prevention system will cause claims processing problems. The electronic visit verification system requires home care workers to call a centralized telephone number upon entering and leaving the client’s home. The agencies also complain that the state chose as its single vendor Sandata, requiring interfacing and loss of functionality. One agency already has a similar system in place that’s integrated into its EHR, but the change will require workers to go through the verification steps a second time just for the state’s records. An agency with 1,500 Medicaid clients says it won’t use the state’s system and will stop serving those patients if the state insists.


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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How My 20 Predictions for 2016 Turned Out

December 30, 2016 News No Comments

Here’s what I predicted on December 28, 2015 and how right or wrong I turned out to be.


Cooled-off funding markets will leave unprofitable startups struggling, IPOs will be postponed, but Health Catalyst will go public.

no

It’s hard to say whether my first two predictions were correct, but I was wrong about Health Catalyst – they weren’t as anxious or as prepared to go public as I expected. I was right in predicting a poor 2016 IPO market as successful companies in all sectors seemed to prefer increasing their private valuations instead of going public. SEC filings suggest that the trend will continue into 2017. I’m guessing many startups are indeed struggling, mostly because of their own shortcomings. Without the Health Catalyst miss I would have given myself a solid checkmark.


Healthcare costs will be a contentious point in the presidential election, provider mergers will continue, and at least one presidential candidate will timidly suggest cost controls.

yes

Seems right to me. Hillary Clinton touched lightly on cost controls and certainly the cost and premium aspects of the Affordable Care Act became a campaign issue.


Consumers will lose interest in fitness trackers.

yes

I’ll give myself a check even though “lose interest” may or may not be broadly accurate (perhaps, to quote Spinal Tap manager Ian Faith, their appeal is just becoming more selective.) The Apple Watch flopped and some fitness tracker companies sold out or shut down.


The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.

no

This is a toss-up. Epic’s Judy Faulkner is actively involved but talking more about a succession plan because people keep bugging her about it, Cerner’s Neal Patterson was sidelined temporarily by cancer but plans to come back in a few weeks, and I don’t really know about Meditech’s Howard Messing but he seems to be active. I’ll compromise by giving myself an X despite being “directionally correct.” It’s not like they’re just going to disappear while still holding the title, so only Epic and Meditech insiders would know how actively involved their executives are, unlike the publicly traded Cerner who has to be more transparent about what’s going on and Neal has made it clear he’s phasing himself out. In any case, all three companies are likely be replacing their longstanding top executive (and founder in two of those cases) within a few years, introducing the possibility of change.


ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.

yes

Meaningful Use was replaced with MACRA while ONC’s influence is debatable – 21st Century Cures gives it more scope. I could score this one either way. Certainly the “more contested” part is true as healthcare member organizations constantly issued press releases and letters complaining about everything MU-related.


Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.

yes

I should know better than to make predictions that are hard to quantify. Some companies certainly did cut back or sell out although obviously their reasons for doing so weren’t publicly announced. Like a vendor’s crafty RFP respondent, since I can’t definitively say “no” I’ll go with “yes” since that’s to my advantage.


At least three big health systems will be breached in exposing the information of 100,000 or more patients. The government and organizations like HIMSS will try to help providers share information.

yes

The 100,000-patient number seemed huge a year ago, but breaches of that size are unfortunately not uncommon these days.


The VA will announce plans to eventually replace VistA with a commercial product.

yes

The VA hasn’t specifically said, “We’re dumping VistA,” but their RFIs and conceptual descriptions – not to mention Congressional pressure — clearly suggest such a direction.


At least one customer each from Epic and Cerner will switch to the other’s product to get a better deal on maintenance fees. Epic will expand its hosting service to better compete with Cerner.

no

I’ve given myself a check on some debatable predictions, so I’ll assign myself an X here even though hospitals have certainly switched both ways between Epic and Cerner and Epic is indeed expanding its hosting services. Most of the swaps were probably related to acquisitions and Soarian customers who were pushed into RFPs that sometimes went Epic’s way, so I don’t have proof that anyone replaced a product just because its ongoing cost was too high.


The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof.

no

The terms “mobile health” and “mHealth” are getting long in the tooth and irrelevant since everything is mobile to some degree, but “telemedicine” lives on and “information blocking” is still being thrown around indiscriminately to describe unproven shady behavior by EHR vendors and providers. I was quite wrong in thinking the accusations about information blocking would fizzle due to lack of evidence proving intention. I still haven’t seen the evidence, but the accusations are still flying but with no change in the status quo for patients.


IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.

yes

I grade it as all hype so far.


The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.

no

I didn’t see much of a health IT splash from Premier and its shares are down on the year.


Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.

yes

It seems logical in hindsight that Athena would need more than a year to become a significant inpatient player if indeed it ever does, but a lot of post-acquisition hype was flying a year ago and this prediction was bolder than it seems now. ATHN share price has dropped 33 percent in 2016.


McKesson will consider packaging and divesting its many health IT offerings as non-core business.

yes

That’s exactly what is happening as the company prepares to create a new, publicly traded company with Change Healthcare and is shopping its Enterprise (Paragon) business around without any takers so far.


Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.

yes

I’ll give myself a check since Epic didn’t join CommonWell, but I’m not so sure that Epic has leapfrogged Cerner in offering APIs.


Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.

yes

I wasn’t speaking literally about Gartner’s hype cycle and I can’t say if population health management software is on it since I don’t subscribe to Gartner, but I think it’s generally true that providers are struggling to wean themselves off fee-for-service business and haven’t done a whole lot with the many software and analytics products that are being sold. You could make a convincing case that I’m wrong, however.


Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.

yes

This is true, although it wasn’t really a bold prediction since the trend was obvious even a year ago.


“Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.

no

I’ve given myself some checks for predictions that were partially correct, so I’ll balance it with an X here even though I still believe in the “little data” concept. Certainly some big data-driven studies have turned up some interesting and useful clinical information, so in that regard it probably contributed more than I expected. I could have given myself credit for foreseeing the precision medicine movement that was announced a few weeks after my prediction, but I’m undeserving — that’s really based more on genetic information instead of the “patients like this one” small-scale aggregate data analysis by an individual provider.


Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.

yes

This is another accurate but not especially bold prediction. FDA crackdowns were obviously coming and app vendors rarely bothered to prove that their products influenced patient outcomes.


CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

no

I’ll give myself an X since I’m not involved with either organization and thus can’t say how much influence vendors are able to buy. I haven’t heard of any egregious behavior by either organization.


News 12/30/16

December 29, 2016 News 2 Comments

Top News

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President-elect Trump meets with the CEOs of Mayo, Hopkins, Partners, and Cleveland Clinic, with the topic speculated to be changing the VA to allow veterans to seek care at any hospital.

There’s also the strong possibility that the group tried to convince Trump to leave intact those parts of the Affordable Care Act that boosted the profits of big health systems by insuring people to whom they would otherwise be required to treat free.

Cleveland Clinic CEO Toby Cosgrove, MD, who is a Vietnam War veteran, is rumored to be on Trump’s short list to run the VA.

Also among the pod of rich, white males was facial plastic surgeon Bruce Moskowitz, MD (who founded the non-profit Medical Device Registry for reporting problems with surgically implanted devices) and the reclusive CEO of Marvel Entertainment, who had previously donated $50 million to the cancer center of NYU Langone Medical Center that is now unsurprisingly named after him and his wife.


Reader Comments

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From Meltoots: “Re: readmissions article. It ignored the data showing that hospitals simply shifted readmissions to observation beds. Plus, the CHF death rate actually increased over the past several years as hospitals are penalized less for a death than a re-admit. It’s silly talk that the ACA reduced readmissions.” The readmissions penalty was too specific to have a predictably positive impact on patient care, being a primarily financial, incidentally clinical carrot (like other major payment methods that are driven by the patient’s midnight location). Providers have learned to play the Medicare shell game well, always finding a new way to preserve profits when the government removes one. Here’s one I was involved with at my health system. We quietly bought up some oncology practices, then made their patients come to the hospital to get their chemo infusions because it paid us better and we could milk the government’s 340B program to wildly increase drug margins. The patient, however, had to drive to our hospital (which had the usual stress-inducing lack of parking), pay a co-pay since they were now reclassified as hospital outpatients, deal with our often-indifferent registration people and financial counselors, and endure the bustle created when we funneled all those folks into hastily created infusion rooms that resembled happy ending-type massage rooms rather than places of healing. I would not have liked it as a patient — just being in a hospital would make me feel sicker and less hopeful than getting treatments in a quiet, pleasant doctor’s office. Our execs loved the idea, though, since it swelled our bottom line, which is the biggest ego stroke (other than erecting phallic, lavish buildings) that a C-level hospital executive can get.

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From The Truth: “Re: Mercy Hospital in Des Moines. Fined over a million dollars for patient safety scores and that doesn’t make HIStalk? C’mon man.” I’m constantly surprised when readers complain that I haven’t mentioned some story that is unrelated to health IT and thus amply covered elsewhere. I guess I should be honored that folks expect or encourage me to write about other topics. The hospital gets three stars from CMS, a D from Leapfrog, and poor patient satisfaction scores, so naturally they announce that all of those measures use flawed data that underreport its medical pre-eminence.

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From AnonTip: “Re: Deborah Heart and Lung RFP. I worked on it as a vendor. Some of the RFPs ran 800 pages as they demanded extensive screen shots of workflows and details, then required three days of on-site demos and then site visits. [Vendor’s name omitted] bid $40 million for the 89-bed hospital. They ended up choosing Meditech Web Ambulatory and 6.1, so they will probably dump Allscripts Touchworks at some point.” Unverified. They must have hired consultants to lead their search since it seems like overkill for a tiny hospital that has been using Meditech for decades, although maybe the threat of bolting gave them a stronger negotiating position. The hospital’s 2015 financials show patient service revenue of $163 million and expenses of $166 million, so I can understand passing on the one vendor’s $40 million bid.

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From State-Sponsored Actor: “Re: Joint Commission. They’ve flip-flopped again, now declaring that providers can’t send patient orders via secure messaging.” Joint Commission first banned sending orders via secure text messaging in 2011, then decided in May 2016 that it was OK as long as the messaging system met specific requirements. Since then, Joint Commission met with CMS and now declares, “The use of secure text orders is not permitted at this time” because its impact on patient care is unknown, specifically:

  • How much nurse work is required to transcribe those orders into the EHR.
  • The asynchronous nature of orders sent via text message requires extra steps to clarify and confirm.
  • The transcribing nurse has to deal with any clinical decision support messages and relay them to the ordering provider.

From Kilt-Lifter: “Re: DonorsChoose. Do you personally fund the projects you mention?” Not usually. I mention projects in which readers decide to donate through me to enjoy the collective good will created when I share the stories of how the projects I funded with their money (and matching funds) turned out. There’s nothing in it for me and my personal donations are separate.

From Lookie Here Now: “Re: HIStalk email updates. I’m no longer receiving them.” This happens all the time as companies ramp up their protective defenses against spam and my email system cancels the recipient as “bounced.” Just sign up again since that often works.


HIStalk Announcements and Requests

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I’ve opened my once-yearly HIStalk Reader Survey. Like last year, I’ll randomly draw respondents for a $50 Amazon gift card. I was surprised in looking over last year’s responses how many reader-suggested changes I have since put in place, although some were just too ambitious for my energy level and capabilities and the #1 response by far is always “don’t change anything.” Some good suggestions from last year and my comments:

  • Improve the site search. That’s always a challenge since Google Site Search doesn’t allow date filters, which would be really cool.
  • Find an inside-the-Beltway anonymous writer. I’m not super-interested in government and politics, but I’m open to the idea if someone is interested.
  • Write less about HIMSS (which is for vendors) and get provider input from AMIA. I don’t really have contacts in AMIA other than I was a member for a while, so I don’t have much to add there except occasionally mentioning something published in JAMIA that someone sends me.
  • Get more input from “small people” like analysts or support desk people. I would love to, but vendor executives are paid to write guest articles and otherwise contribute visibly, while those in the trenches don’t have the time or the approval of their employer to participate. I wish that weren’t the case since I suspect they are at least equally interesting.
  • Get more contributors. As in the item above, it sounds great, but even well-intentioned contributors quickly drop off as they realize the time required. One of my favorite sayings is, “I hate writing, but I love having written.”
  • Do more polls. I will consider that.
  • Send the morning headlines via an email update. I keep thinking I should do some sort of daily email update, perhaps using a separate mailing list so that it doesn’t bug those readers who aren’t interested. Given the previous suggestion, here’s a poll: Would you regularly read a daily email containing expanded HIStalk headlines? Last year, the most-loved HIStalk element was news, but clustered tightly in the next three spots were humor, rumors, and the morning headlines.
  • Cover more conferences like CHIME’s spring and fall forums, ACHE, AMDIS, RSNA, and JP Morgan. Sounds good on paper, but I don’t get invited to these meetings and I don’t really enjoy attending conferences. The only one that’s appealing is JP Morgan and I’m pretty sure my low BS threshold would be overwhelmed by all the besuited money guys running around leaving an olfactory wake of expensive cologne and self-importance.

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Reader Ed donated generously to my DonorsChoose project, allowing me to fully fund these teacher grant requests with double impact from matching funds provided by my anonymous vendor executive:

  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • A Chromebook and supplies for Mrs. I’s high school class in Orangeburg, SC
  • Math kits for Mrs. V’s elementary school class in Norfolk, VA
  • A library of 45 science and environment books for Ms. H’s third grade class in Anchorage, AK
  • Two Chromebooks for the high school health education classes of Mr. S in Bay Shore, NY
  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • Shot puts and relay batons for the track team at Mr. H’s middle school in Las Vegas, NV
  • Five sets of headphones, an electric pencil sharpener, and a programmable robot for Ms. S’s second grade class in Gladstone, MO

Ms. S replied this morning to the news that her project was funded with, “Thank you for kicking off our return from break in a great way! I can’t wait to share with the class that, because of generous people like you, we will now have some much-needed tools in our classroom. It is an amazing thing to be supported! It reminds us how valuable we are and impacts student motivation for reaching their unique potential.”

All the recent celebrity deaths made me envious of artists whose work lives on forever and finds new fans year after year, unlike the rest of us charge-leading foot soldiers who are simply replaced by the next warm body when we fall without leaving much of a non-family trace. I suppose the consolation is that it doesn’t really matter anyway once you’re dead.


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.


Government and Politics

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@Cascadia notes the existence of the Plum Book, which identifies presidentially appointed federal positions. Those marked NA are non-career appointment, CA is career appointment, and SC is a Schedule C listed appointment. Obviously it’s not quite up to date with correct names despite a December 1 publication date. Former National Coordinator Karen DeSalvo, MD, MPH, MSC is Acting Assistant Secretary for Health, which is noted as a PAS (presidential appointment with Senate confirmation) and she was never confirmed by the Senate, but I haven’t seen her officially say she’ll be leaving by January 20.


Privacy and Security

From DataBreaches.net:

  • Brandywine Pediatrics (DE) is hit by ransomware, but recovers from backups.
  • Desert Care Family & Sports Medicine (AZ) remains down from a ransomware infection that occurred in August.
  • The Dark Overlord hacker who breached several healthcare systems earlier this year penetrates a precast concrete vendor and releases information that includes contracts, a dump of a manager’s cell phone that includes photos of his children, and video of an apparently fatal workplace accident. He or she is demanding extortion payments to leave the remaining information private.
  • A hospitalized psychiatric patient breaches systems run by New Hampshire’s Department of Health and Human Services using a computer in the hospital’s library and posts some information of 15,000 people to social media.
  • A hacker breaches the paging system of Providence Health & Services, posting some of the organization’s pager messages on the hacker’s website.

SNAGHTML2269f415

This ZDNet security editor is trying to contact a New York hospital to tell them that a network-attached storage device is open to public FTP, with no luck so far. Update: Saint Joseph’s Medical Center has taken the device offline, he reports.


Technology

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A journal article describes how scientists use the workplace messaging tool Slack, which a geneticist user says is better than email that is “disastrous for group communication.” They’re using it to work on research papers, discuss conferences, monitor experiments via device integration plug-ins, create custom apps, award points for collaborative activity, create to-do lists, and train new members. Slack offers a free, endless trial, with regular packages priced at either $7 or $13 per user, per month. There’s also an open source, self-hosted alternative that offers a free team edition or an enterprise version for $20 per user, per year.


Other

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A JAMIA-published study describes the hospital-reported benefits of adding an EHR topic to daily executive safety huddles. EHR safety issues made up 7 percent of the safety concerns discussed in one year.

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A study published in JAMA finds that US healthcare and public health spending increased significantly from 1996 to 2013 — now accounting for 17 percent of the economy – with the biggest costs involving diabetes, ischemic heart disease, and low back and neck pain. The biggest spending jumps were in emergency care and prescription drugs. The only injury that made the top 20 spending list was falls. Government public health spending accounted for just 2.8 percent of the total. It’s interesting that females incurred significantly higher expense – sometimes more than double – for all age groups over 15 in 2013, with their extended longevity and thus higher numbers incurring $130 million in the 85-plus age group vs. just $51 billion for males (although per-capita spending in that group was also 29 percent higher for females at $31,000 – maybe due to loneliness?). Overall cost ramps up smoothly until ages 65, which the jumps start to get dramatic and the challenges in funding Medicare in a mostly cost-unconstrained model become obvious, although the cost-benefit ratio of applying all those expensive treatments – not only to longevity, but also quality of life – is decidedly less certain. An accompanying editorial notes that the largest public health expense category is HIV – which kills comparatively few people – but little money is spent to address lifestyle conditions, some of which involve consumer products that are backed by massive advertising campaigns.

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England’s Secretary of State for Health Jeremy Hunt touts the benefits of barcode-tracking and identifying patients, staff, and equipment that can prevent harm and provide data for studies.

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A Harvard Business Review article asks, “Are You Solving the Right Problems?” and questions whether frameworks like Six Sigma and Scrum or even root cause analysis and 5 Whys cause people to “overengineer the diagnostic process.” The answer, it observes, is often not a solution to the stated problem, and problem-defining technology or checklists can be “the subtlest of traps.” Sometimes Disney can’t speed up the ride wait, so it just entertains those waiting.

The Watertown, NY town ambulance service blames a computer upgrade for the inability of crews to open its narcotics lock boxes for several days. Ambulances from the next town over were called in when the drugs were needed. They probably could have just asked around since most towns have plenty of people stockpiling opiates.

A social worker fired by Erlanger Health System (TN) for not knowing how to call a Code Blue sues the health system. A nurse trying to revive an inpatient who had hanged himself in his bathroom asked the social worker to call a code. She says she had not been trained to do so and instead rushed to the nurses station, but found only a clinical documentation improvement employee there who didn’t call the code. She finally found five on-duty nurses in the break room, but they didn’t call the code, either. The hospital fired her for failing to call the code, for spreading rumors that the nurses were goofing off, improperly documenting the incident, and missing a meeting in which the incident was reviewed. The social worker claims racial discrimination since everyone who was involved except her is white and nobody else was fired.

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In Germany, an unimaginative (and, much to my surprise, sober) 22-year-old imitates a viral YouTube video in trying to scare a sleeping friend by thrusting a running chainsaw near his head. The 18-year-old victim might want to find smarter friends – the chainsaw prankster missed that part of the video in which the saw’s chain was removed, leaving his unintended victim with a nearly amputated hand.

Odd: the HR director of home health software vendor Axxess Technology Solutions sues a company called Dicks By Mail (whose founder claims to have made millions from the insult-oriented business), seeking to learn the identity of the anonymous individual who sent her a box of penis-shaped candies. She thinks it may be the same unknown person who keyed her car and posted phony Craigslist ads about her. Ordinarily I would suggest that surely she must already know anyone who hates her that much, but then I remembered that she’s in HR.


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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Morning Headlines 12/29/16

December 28, 2016 News No Comments

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre–Post Analysis

A study published in the Annals of Internal Medicine measuring readmission rates before and after ACA’s Medicare Hospital Readmissions Reduction Program went into effect, finds a reduction of 60 to 90 readmissions per 10,000 discharges.

Abbott gets FTC approval for $25 billion St. Jude deal

Abbott Laboratories wins FTC approval to acquire medical device manufacturer St. Jude for $25 billion, under the condition that the two companies divest their cardiac device business units.

Value-based insurance coming to millions of people in Tricare

The recently-signed Defense Spending Bill includes a mandate to test value-based reimbursement initiatives stemming from the DoD’s Tricare insurance program.

Trump Picks Thomas Bossert as Top Counterterrorism Adviser

President-elect Donald Trump names cybersecurity expert Tom Bossert as his homeland security advisor.

News 12/28/16

December 27, 2016 News 11 Comments

Top News

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An Oregon district attorney says he was “on the verge of filing criminal charges” against St. Charles Medical Center-Bend (OR) for halting the use of Baxter’s DoseEdge barcode-driven IV checking system, thereby contributing to the death of an inpatient who received a mislabeled and ultimately fatal IV. The DA backed down when the hospital agreed to make safety changes.

The hospital said both McKesson and Baxter promised that Baxter’s DoseEdge system was compatible with its newly purchased McKesson Paragon EHR, but the hospital had to revert to manual medication checks when it found those claims to be untrue.

Hospital employees claim the hospital turned the DoseEdge system off in a cost-saving move and complain that the Paragon equivalent was too slow to be used.

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The fatality occurred because of the usual “Swiss cheese effect” of having several safety steps break down sequentially:

  • An expert pharmacy technician who had worked at the hospital for 37 years prepared the patient’s IV with the surgery muscle blocker rocuronium instead of the ordered seizure drug fosphenytoin.
  • A pharmacist at the hospital didn’t notice the pharmacy technician’s mistake and approved the IV to be sent to the patient’s room.
  • A nurse hung the bag even though it was clearly labeled with a “neuromuscular blocker” warning  sticker that she says she didn’t understand.
  • The patient was left unmonitored despite her physician’s order for continuous cardiac and pulse oximetry monitoring, which the nurse admitted she ignored.
  • The nurse had to leave the patient’s bedside when a fire drill was called right after the IV was started.

The patient was found unresponsive 42 minutes later and was taken off life support two days after the incident.

The hospital has improved its processes, but it still won’t have a replacement IV checking system until it goes live on Epic in April 2018.


Reader Comments

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From Ex Epic: “Re: fun with numbers. Epic is replaying the hits related to R&D investment on their site, although they’ve at least left the Google and Apple nonsense out this time. Oddly, the site’s chart doesn’t match the corporate overviews shared across the campus. Epic’s 2014 and 2015 charts showed Allscripts spending more than Cerner, but their 2016 trend line (which includes those years) has Cerner outspending Allscripts. Which is it?” The trend line shows Cerner and Allscripts spending around 22 and 18 percent, respectively, in 2015, while the bar chart shows 19 and 25 percent. I wouldn’t put much faith in the numbers anyway since Epic compares itself with three publicly traded competitors that follow GAAP recognized accounting standards, while privately held Epic is under no such limitation. Companies can also elect to capitalize as R&D such items as allocated indirect costs (such as a portion of expensive office buildings), maintenance costs, support expense, and other gray areas that may provide little customer benefit. The bottom line (no pun intended) is how products perform and are viewed by customers regardless of how the vendor’s accountants book R&D expense, no different than with any other product. McDonald’s supposedly spends a gazillion dollars trying to invent new menu items that never catch on, but that R&D usually earns the company scorn rather than admiration and their food tastes the same regardless.

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From Publius: “Re: Toby Cosgrove as a potential VA secretary. Since Cleveland Clinic is an Epic shop, does this increase the likelihood that the VA procures Epic as its commercial EMR solution, or is Cerner a foregone conclusion given the DoD project?” That’s a tough one. The VA and DoD have disdainfully declined to work together in advancing interoperability until mandated by Congress (and sometimes not even then), so while Cerner might make more sense, I would expect the VA to choose Epic just to be contrary. I think it’s a done deal that they will replace VistA with one or the other. Epic must still be stinging after losing to Cerner for the DoD’s MHS Genesis, so I assume they are using whatever DC influence they have (see: Paul Ryan) to bag the VA deal.

From Meltoots: “Re: integrating state prescription monitoring program (i.e., doctor-shopper) databases with EHRs. We asked our EHR vendor and the state of Ohio for this integration 14 months ago. Here is the click-type data entry nightmare we do today. Does anyone understand this?” Meltoots lists the required steps to perform the patient lookup in the PMP database, which might provide its own deterrent to opiate prescribing:

  1. Find the PMP’s webpage.
  2. Log in using the user name and password that constantly changes.
  3. Click OK that you understand this is private info.
  4. Click Search.
  5. Click and type in first name and last name (spelled perfectly), date of birth, ZIP code, etc., going back and forth locating the information in different EHR areas and then typing it into the PMP’s web form.
  6. Click and hope to find the patient.
  7. If the patient is listed, download the generated PDF file.
  8. Read the PDF and then print it to prove that you read it.
  9. Scan the PDF and attach it to the EHR chart to prove that you did it.

HIStalk Announcements and Requests

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It’s a dead heat between Epic and Cerner in the admittedly subjective “who gained the most ground in 2016” category.

New poll to your right or here: is the increasing use of medical scribes good or bad? Polls need to be simple by design, so if you feel boxed in by my default answers, feel free to click the Comments link after voting to explain your position.

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Fantastically generous donations from Epic Reader, Bucky Badger, Dr. J, Friend at Impact, and Bill – combined with matching money from my anonymous vendor executive and other sources – allowed me to fully fund these DonorsChoose teacher grant requests:

  • 3D pens and printing supplies for Mrs. S’s elementary school class in Oakley, CA
  • Makey Makey circuit kits for Mrs. C’s elementary school class in Walhalla, SC
  • Two Chromebooks for Ms. V’s middle school class in Phoenix, AZ
  • Two Chromebooks for Mr. B’s middle school class in Phoenix, AZ
  • A Chromebook for Mr. S’s second grade class in Buena Park, CA
  • 18 sets of headphones for Mrs. F’s kindergarten class in Hampton, VA
  • Math centers for Ms. R’s kindergarten autism class in Newport News, VA
  • Five Chromebooks for Mr. V’s high school biology class in Lake, MS
  • Four science activity tubs for Mrs. B’s elementary school class in Fayetteville, NC
  • A document camera, projector, laser printer, and other projection supplies for Mrs. A’s middle school class in Oakland, CA
  • 3D printer pens for Mr. C’s robotics competition team in San Jose, CA
  • Five Chromebooks and 15 sets of headphones for Ms. K’s fourth grade class in Detroit, MI
  • Programmable robots for Mrs. O’s elementary school library maker space  in Katy, TX
  • A bamboo building block set for Mrs. B’s kindergarten class in Sumas, WA
  • 30 sets of headphones for Mrs. D’s elementary school class in Sumter, SC
  • $200 toward getting 10 Chromebooks for Mr. P’s 10th-grade class in Plant City, FL

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Ms. L responded quickly even though Detroit schools were closed Tuesday: “I am beyond excited and grateful for your generous contribution! I can’t begin to explain how much these computers, headphones, and Flocabulary subscription will impact my students. We have been struggling with a lack of technological resources that has made it difficult to use the computer programs that are available to us in a meaningful and effective way. Your donation is helping bring up-to-date, WORKING, technology to our classroom. My students and I can’t say enough thank yous!”

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Mrs. E from South Carolina says her students are learning from the programmable robots we provided in funding her DonorsChoose grant request. A snip of her email: “Many of the students come from low-income families that would never have had an opportunity to work with these tools if we didn’t have them at school. One of my students wrote in his thank you letter, ‘I have never in my whole life seen or touched a robot. They do really cool stuff.’ You have made a real difference in the lives of these students, not only by your donation in allowing the purchase of these materials, but also that someone cares enough about them to donate.”

Listening: new from 19-year-old Irish singer Catherine McGrath, who seems to be minimally known even though that should probably change. It’s sort of like pop-oriented US country music sung by Dolores O’Riordan of the Cranberries. Also: new from Columbus, OH-based science fiction-themed hard rockers Starset. One more: the amazing Christian hard rockers Skillet. Check out UK-born drummer-singer Jen Ledger, who plays with hair-flying, thrashing joy that reminds me of a female Keith Moon. Skillet’s tour starts January 28 and includes health IT towns like Madison, Philadelphia, and Indianapolis; they have over 1,000 Ticketmaster reviews with a five-star average and I’m pretty sure they would be entirely worth the $30 or so ticket price.


Last Week’s Most Interesting News

  • The Department of Justice gives anti-trust clearance to the creation of a new health IT company by McKesson and Change Healthcare.
  • CMS indicates that 171,000 Medicare-eligible providers will receive an EHR Incentive Program downward adjustment in 2017.
  • HIMSS announces the retirement of President and CEO Steve Lieber, effective at the end of 2017.
  • A JAMA-published observational study involving Medicare ICU patients finds that those overseen by female intensivists experience better outcomes than those with male doctors.
  • HHS tweaks the Health Insurance Marketplace rules for 2018, with the most significant changes involving risk pools.

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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A business site profiles the South Korea-based hospital-vendor partnership behind Bestcare 2.0, a hospital information system deployed in South Korea and Saudi Arabia that the group hopes to expand into the US market.


Decisions

  • Marina Del Rey Hospital (CA) will switch from Cerner Soarian to Epic.
  • Virginia Gay Hospital (IA) moved from CPSI to Epic In November 2016.
  • St. Mary’s Hospital (CT) will replace McKesson Paragon with Epic in July 2017.

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


Government and Politics

A New York Times opinion piece urges President-elect Trump to follow through on his previously expressed support for universal health insurance, warning him that Republicans in Congress (including his nominee for HHS secretary, Congressman Tom Price, MD) are giving him bad advice in pretending to support such a program while actually pushing “repeal and delay” without any plan of their own to replace the Affordable Care Act and thus driving insurers faced with poor risk pools out of the market. It recommends,

The crucial first step is to avoid repealing the insurance expansion without simultaneously replacing it. The new Congress comes to Washington next week, and its members should know where you stand from the beginning. It won’t work to promise millions of people health insurance on spec. If you avoid this trap, you can then push both parties toward a different version of universal health coverage.

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FDA issues final guidance on post-market medical device cybersecurity.


Other

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Lisa “Venture Valkyrie” Suennen posts her annual holiday song lyrics parody “Thriving Here in Venture Fundingland,” sung to the tune of “Walking in a Winter Wonderland.” She just took a job as managing director of GE Ventures.

A Black Book poll of C-suite provider executives predicts these trends for the first half of 2017:

  1. Hospital IT budgets will remain flat while physician practices will cut their technology spending an average of 13 percent from 2016.
  2. Electronic data warehouses will top the list of short-term priorities.
  3. Hospital interest in enterprise resource planning systems will be restored in a value-based care environment.
  4. Most hospitals haven’t budgeted for projects that would increase interoperability.
  5. Large hospital groups fear that cyberattacks will move upstream from the mostly small facilities that were impacted in 2016, expressing concerns about insufficient threat detection systems and the possibility of security alert fatigue.
  6. Hospitals are confident about their cloud application strategies even though most of them haven’t bought cloud-based disaster recovery solutions or don’t understand what they have purchased.
  7. Small-hospital CFOs will revise their RCM strategies and increase their focus on coding and clinical documentation improvement, with many of them considering outsourcing.
  8. Salaries for hard-to-find skills such as healthcare analytics, big data, security, mobile, and cloud technologies will jump as competition heats up and H-1B visa programs could be scaled back.
  9. Providers are interested in precision medicine, but nobody’s really buying systems to address it due to expected implementation difficulty.

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The New York Times profiles the failed attempt of North Carolina physician group Cornerstone Health Care to transition to an ACO care model. The practice lost a third of its doctors (especially its high-revenue specialists) to higher-paying hospitals such as UNC Health Care; it had to borrow $20 million for capital projects such as new IT systems; and some of its doctors sued it in claiming that their compensation was reduced arbitrarily to cover debts incurred due to mismanagement. The practice ended up selling out to Wake Forest Baptist  Health, which experts say is likely to raise costs as the focus changes from keeping patients healthy to feeding the hospital’s revenue-generating departments.

A CDC survey finds that physicians rarely collaborate with laboratory professionals in the 15 percent of encounters in which they aren’t sure how to order diagnostic tests and the 8 percent in which they received results they don’t understand. The primary barriers are that doctors don’t know who to contact or don’t have the time to do so. Physician respondents suggested adding lab ordering criteria to CPOE systems, publishing mobile clinical decision support apps, and adding lab professionals to multidisciplinary rounding teams.

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Medical University of South Carolina will open an Apple-sanctioned retail computer store in its library that will offer discounted Apple and Dell products to students and faculty. It’s also considering using the store to provide health-focused technology, such as healthcare apps, to patients.


Sponsor Updates

  • Horses for Sources and its research division cover a patient experience redesign project at Lawrence General Hospital led by  Sutherland Global Services.

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 12/26/16

December 25, 2016 News 3 Comments

Cornerstone: The Rise and Fall of a Health Care Experiment

The New York Times profiles provider group and accountable care organization Cornerstone Health Care (NC), telling the story of its transition to ACO status and its eventual sale to Wake Forest Baptist Medical Center.

Year in Review: Cerner presses forward despite year of uncertainty

Cerner closes out 2016, a year that brought with it CEO Neal Patterson’s cancer diagnosis, delays on its DoD implementation, and ongoing construction at its new Kansas City campus.

Medical scribes free doctors to spend more time with patients

A local paper reports on the introduction of medical scribes in the CHI Memorial (TN) emergency department, linking the rise of scribes to ARRA and the resulting increase in EHR use by providers.

Morning Headlines 12/23/16

December 23, 2016 News No Comments

Google Deepmind and Imperial in streams deal

Google’s UK artificial intelligence company, Deepmind, will implement its only non-AI app, Streams at Imperial College Healthcare NHS Trust. Streams monitors clinical information and alerts doctors of deteriorating patients.

Analysis of Nearly 51,000 Geisinger Patient Exomes, EHRs Reveal Actionable Variants, Drug Targets

A study analyzing the DNA and EHR data of 51,000 patients finds that 3.5 percent of the study participants had clinically actionable variants.

Eight More Health Systems Join Growing Support for Surescripts National Record Locator Service

Eight new health systems have joined the Surescripts National Record Locator Service, which runs patient record searches within the Carequality HIE.

UMass Memorial posts $68M surplus for 2016

UMass Memorial Health Care reports a $68 million surplus in 2016, up from $47 million last year, despite $125 million in new debt that it is using to implement Epic.

News 12/23/16

December 22, 2016 News 6 Comments

Top News

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The Department of Justice gives anti-trust clearance to the previously announced creation of a new health IT company by McKesson and Change Healthcare, clearing the way for the deal to go through as planned in the first half of 2017.

McKesson will own 70 percent of the new company, to which it will contribute most of McKesson Technology Solutions.


Reader Comments

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From CCOW, MUCOW: “Re: Meaningful Use penalties. A CMS document says it will apply a downward payment adjustment to 171,000 EPs in 2017 for failing to demonstrate MU.” I’ve long lost interest in Meaningful Use and its offspring. We as taxpayers have paid $35 billion to bribe doctors to use old, poor-selling EHRs they wouldn’t use voluntarily, which is maybe a first in any industry. I suppose that as a stimulus package, it delivered the expected economic benefit (although it was late to the party by the time the details were worked out), but I’m not seeing much difference in cost or quality so far. Maybe it’s a laying-the-tracks sort of thing that will pay for itself downstream. Meanwhile, I read somewhere that ONC now has 400 employees, reproducing itself like typically virulent federal agencies, departments, and offices.

From Piezo DeVoltaic: “Re: equipment. Other than the Wi-Fi adapter you mentioned, what else do you use to write HIStalk?” I have a Toshiba laptop that I got from Office Depot for less than $300 several years ago and a 27-inch Acer monitor that I think cost around $130. That’s it other than keyboards, which I go through frequently due to the volume of writing I put out – I buy the basic Microsoft wired keyboards three at a time since they’re only around $12. Starting on a new keyboard is like a new beginning because I’m always snacking while working due to lack of time, so the crumb load is significant (shaking my keyboard upside down looks like a snowstorm). On the non-work front, I have an iPad Mini and my beloved Chromebook. I also need to replace my iPhone 5 at some point, I suppose, although I can’t get excited about the iPhone 7 Plus that seems like its logical successor.

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From LFI Masuka: “Re: article comparing medicine to ‘Moneyball.’ The movie was really about using statistics to better value assets in an environment of limited money to spend on those assets. The vision was not getting the best possible Oakland A’s – it was getting the best Oakland A’s for a reasonable price. The equivalent for medicine would not be best practices – it would be to set up budgeted compensation guidelines to more realistically address those activities that promote long-term health. Getting more bang for our collective bucks. Without the financial aspect, Medicineball is what we used to call ‘science.’” I like that. I would also say that it’s a subtle but important mistake to assume that hospitals are best equipped to do anything more than patch people up and send big bills after they treat ‘em and street ‘em. Somehow everybody just accepts that hospitals are the logical overseers of population health management. I disagree. Most of us see our PCPs a lot more often than we have a hospital encounter, not to mention that hospitals are notoriously bureaucratic and inefficient. Maybe it’s because the doors of medical practices are locked at least 75 percent of the time, sticking hospitals with less-convenient coverage hours but making them the most reliable and accessible provider. I’ve spent most of my career working in hospitals and I would never (a) donate money to them, (b) trust them; or (c) become their inpatient without having someone sitting at the foot of my bed at all times to catch their inevitable mistakes. They’re like universities – too much emphasis on money, overly large employee egos, and an inflated sense of entitlement and global self-importance.


HIStalk Announcements and Requests

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Donations from three HIStalk readers, paired with matching money from my anonymous vendor executive, allowed me to fund these DonorsChoose projects:

  • An Osmo Wonder Kit for Ms. F’s sixth grade class in Costa Mesa, CA
  • Science, STEM, and weather books Ms. H’s second grade class in Fayetteville, NC
  • Scientific calculators for Ms. H’s seventh grade class in Indianapolis, IN

Ms. H responded quickly to the news that her project was funded. “I am so grateful that you are helping us out. We do not get a lot of science materials in second grade. This is exactly what I needed for my students when we come back from the winter break. I can’t tell you how much this means to me to give my students the best so they can learn. My kids love science and now you are giving us materials for them to really dig in and learn. You are the best.”

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Ms. C sent photos from her California middle school showing the daily news show equipment we provided in funding her DonorsChoose grant request (microphones, a $50 camera-equipped drone, iPhone tripods and clips, and accessories).

A TV show is on in the background as I’m writing, in which a limelight-seeking singer is butchering a Christmas carol with overwrought vocal gymnastics in an ill-advised attempt to “make it her own” instead of just singing the damned thing without gimmicking it up. The only worse thing I’ve heard is when a “Nashville recording artist” wearing a laughably misplaced cowboy hat hacks up the National Anthem before a Nascar race, providing 10 bad, rambling notes for every one that was originally written. Even the “artists” who follow the Star-Spangled Banner reasonably well still feel compelled to wing it toward the end, probably in relief for remembering all the words. Apparently they are mistaken in thinking they know better than the composer.

This week on HIStalk Practice: Fallas Family Vision selects RevolutionEHR. Greenwood Genetic Center launches telegenetics program in South Carolina. Michigan will implement Appriss Health’s prescription monitoring program tech. Orthopedic + Fracture Specialists goes with Odoro patient self-scheduling software. MedStar NRH’s John Brickley outlines the challenges PTs face when selecting health IT. Our Children Our Future selects TenEleven Group’s behavioral health EHR. Walgreens looks to Matter for innovation inspiration as it works out Theranos kinks. Palo Alto Networks’ Matt Mellen offers ways to spot spoofing in healthcare emails.

I’m leaning toward taking the weekend off from writing HIStalk, so if indeed I do, have a Merry Christmas or whatever holiday (if any) you celebrate. I don’t gain much wisdom from Facebook, but I liked a quote I saw there: “It’s not what’s under the Christmas tree — it’s who’s around it.”


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.


Sales

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In England, Allscripts PAS customer Dudley Group NHS Foundation Trust adds Sunrise and dbMotion.

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Deborah Heart and Lung Center (NJ) will upgrade to Meditech Web Ambulatory and 6.1.

In England, Imperial College Healthcare NHS Trust will implement Google-owned DeepMind clinical deterioration detection system.


Announcements and Implementations

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Eight large health systems go live with the Surescripts National Record Locator Service. The company offers EHR vendors free access to the system, which operates under Carequality’s framework, until 2019.


Privacy and Security

From DataBreaches.net:

  • A security firm’s analysis finds that the black market price of a patient’s complete medical record has dropped over several years from $50 to less than $10, which has caused cybercriminals to refocus their efforts on spreading the more profitable ransomware.
  • Fairbanks Hospital (IN) notifies an unspecified number of patients that their information was visible to unauthorized employees for several years, adding that it’s not even sure who viewed the information.
  • Henry County Health Department (OH) alerts 500 of its home health and hospice patients that their information was contained on a nurse’s stolen laptop, adding that it will start encrypting laptops.
  • Community Health Plan of Washington notifies 400,000 current and former members that a security vulnerability in the network of contractor NTT Data exposed their information. 

Innovation and Research

A Geisinger study in which patient genomes were matched to their EHR information finds actionable variants for familial hypercholesterolemia in 3.5 percent of those studied.


Other

The $125 million that UMass Memorial Health Care (MA) borrowed for its Epic implementation reduced its fiscal year operating profit, but it still made $47 million vs. $58 million last year.

Saint Vincent Hospital (PA) is forced by the Equal Employment Opportunity Commission to rehire six former employees it fired in 2013 for refusing to take a flu shot and then providing questionable clergy-signed documentation of their claimed religious beliefs. EEOC says the hospital’s requirement constitutes religious discrimination. The hospital must now accept any excuse an employee offers for declining to be immunized.

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Denver Health (CO) fires $360,000-per-year pediatric anesthesiologist Michelle Herren, MD for posting Facebook comments about First Lady MIchelle Obama that said, “Doesn’t seem to be speaking too eloquently here, thank god we can’t hear her! Harvard??? That’s a place for ‘entitled’ folks said all the liberals! Monkey face and poor ebonic English!!! There! I feel better and am still not racist!!! Just calling it like it is!" She apologized, saying she didn’t realize “monkey face” might be taken as racist, that her comments were taken out of context,  and that she thinks it’s a double standard that everyone can make fun of Melania Trump but the First Lady is off limits. Unlike Ms. Obama’s degrees from Princeton and Harvard, the exclamation point-shrieking Dr. Herren earned her medical degree from Nebraska’s Creighton University, ranked among the bottom 15 US medical schools.

Weird News Andy offers his Merry Christmas story. New Mexico Department of Health epidemiologists investigate their own agency’s catered holiday lunch after 70 of its employees get sick afterward. I don’t usually worry about catered food, but I’m nervous  about eating at potlucks or picnics, where you can’t verify the food safety standards employed by well-intentioned people who don’t understand that food needs to be refrigerated as soon as it’s cooked and until it’s heated and eaten. Compounding the problem is that hospitals and office buildings don’t always have a real kitchen with big enough refrigerators to hold everybody’s dishes for several hours or a range to heat them up, so there’s always a big line waiting for the cheap, countertop microwave. Think twice before you take leftovers home. Sometimes I think that every American should take a food safety course since it’s surprising how many people leave food out after cooking or after eating, somehow thinking that simply covering it keeps bacteria out.  


Sponsor Updates

Holiday Activities

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PeriGen and its new acquisition WatchChild hold their first combined team meeting in Cary, NC, with employees also building 10 bicycles for the local Big Brothers, Big Sisters organization, They were surprised afterward to be joined by the children whose bikes they had just built.

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Xerox Healthcare donates gifts to the Northern Rivers Holiday Giving Campaign.

  • Consulting Magazine awards Impact Advisors VP Jenny McCaskey a Lifetime Achievement Award.
  • Everest Group places NTT Data Services in the Leader quartile for three of the 2016 Peak Matrix Assessments, including the new EHR category.
  • PatientKeeper releases a new video featuring customer reviews of their charge-capture solution.
  • The SSI Group raises money to place over 400 wreaths on the graves of veterans.

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

  • HIT Girl: Amazingly, he's the CEO of a patient-payment company. You'd think he'd have bothered to pop the hood on the whole billi...
  • Johnny B: ACP paper - I don't know that providers will ever be able to come to a consensus on how they want to document. Some want...
  • FLPoggio: What this piece totally ignores is that you and the provider (roofer) dealt directly with each other. Now what if you ha...
  • AC: That's not an apt comparison. Imagine instead if while the roofer was doing his thing, another random roofer dropped by ...
  • HIT Girl: I've worked in EHR design & support for the last 14 years or so, and when I was hospitalized in I think 2007 I got m...

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