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Startup CEOs and Investors: Michael Barbouche

Why I’m Happy That I Did Not Go to the JPMorgan Conference (Or, You Can Go Back to College)
By Michael Barbouche

10-9-2013 11-34-07 AM

Now in the sixth year of my entrepreneurial journey with Forward Health Group, one thing is abundantly clear—I don’t watch TV. No, really. I know nothing. “Breaking Bad?” That’s my email inbox. Many things in my world come down to the wire, but not “The Wire” [1]. About the only thing I do try and sneak into the mix is college football. [2] Fall Saturdays are my day. Social media? The only social texting in my life involves my beloved Badgers and occasional jabs at impostors. [3]

Now that the college season has ended, I will miss many things:

  • Tailgating.
  • The University of Wisconsin Marching Band, the best college band, ever, in Intergalactic [4] History.
  • SEC-on-SEC cannibalization.
  • The games that immediately follow Notre Dame’s annual 7-0 start.
  • Dish Network’s kangaroo-imbued commercial (you know, the one with Heath Shuler, the pretty boy from USC, and The Boz!)

I was reminded of Dish’s fluffy kangaroo as I read Marty Felsenthal’s very entertaining (and accurate) post last week. Having attended JPM last year, let me be the first to share the secret with my struggling peers. Yes, you can go back to college! JPM is nothing more than a return to your freshman year—cluelessness, social awkwardness, and the occasional spilled beverage.

Let’s begin.



The first thing you need to know is that the JPMorgan folks must be pretty powerful because even the Google can’t point you to the conference registration page. Try a search right now. Here’s what no one tells you—JPMorgan is like that blowout fraternity party you didn’t attend during your first week on campus. If you don’t have an invite, well, sorry, you’re not going to the actual party.

And, as a matter of record, freshmen just don’t get invited. Those are the Rules. I spent three days hoofing up and down the hills of San Francisco and never once saw your typical conference nametag. No lanyards were spotted. I would ask people, “Hey, where is the conference — you know, the actual JPMorgan event?” None of the folks I met could give me the answer.

Cunningly, JPM is setup just like your college class schedule. But for the first couple of days, you are the only person that doesn’t know how it works. Soon, however, you begin to understand the cryptic system. Meetings are scheduled on the hour, every hour. The meetings really can’t last more than 40 minutes because you need to sprint to your next meeting. Invariably, you are late to every meeting, and as you the entrepreneur stare at the clock, the fear of outright missing the next appointment overcomes your consciousness. Like the phantom fear of missing a final exam, you begin to sweat for no good reason.


Social Awkwardness

Imagine a square drawn around Union Square—four blocks by four blocks. Think of this as a human dog park. There are people running all over the place with no particular destination in mind (how else to describe the same people running the opposite direction four minutes later?) [5] The entire reason you are in San Francisco is to engage in brief, repeated sniffing sessions. After your fifth pitch session (of the day), you begin to figure out a few of the signals. [6] By Day Two, you have the routine down:

Savvy Investor (in his 43rd pitch meeting of the week): “What were your revenues last year?”

Struggling Entrepreneur: “We had a pretty good year. We did [$x]! We are really excited about this year—we think we can do [$4x], which is really great.”

Savvy Investor: “That is great. Wow. I must say, however, that our minimum investment for this fund is [$15x]. We have invested in companies as low as [$10x], but that’s atypical.”

[two minutes of awkward stumbling and rambling comments by Struggling Entrepreneur …]

Savvy Investor: “We definitely want to stay in contact with you to monitor your progress. Is it OK if we follow up with you later in the spring to see how you’re doing?”

Struggling Entrepreneur: “Sure. And thanks for the bottle of water.”


Occasional Spilled Beverage

On that Tuesday morning of JPM week, you are filled with excitement. The reason you are in San Francisco in the first place is because all of the analysts [7] at VC firms use the exact same Salesforce install with the exact same auto-email template. Beginning in late November, the auto-email template updates to include this sentence:

“Also, wanted to set a time to meet with you at JPM.” [8]

As you scan your full roster for the day, you see that the first discussion lists “2317 HYATT” as the meeting location. You are six blocks away from Union Square and you realize that there is a plurality of hotels named “HYATT” in San Francisco-proper. [9] When you get to the correct Hyatt, your native instinct is to look for the conference rooms. Oddly, when you get off the escalator, the conference rooms are named after landmarks — no numbers. A few minutes of elevated heart rate leads to a discovery—23rd floor! You get off on the 23rd floor, and, again, look for conference rooms. No such luck. You walk down the corridor of hotel rooms. Whoa, room 2317. Could it be? Seriously? You knock. The door opens. There are numerous men dressed [10] in those flat-front, skinny lapel suits that only the “I’m training for an Iron Man right now but I’m doing a half in April” triathlete crowd wears. This is your meeting location.

Think of the scene in the hotel room like the pre-party before the house party hosted by the older brother of your new college roommate’s friend’s cousin. You “know” only one person in the room—the analyst guy who emailed you to setup the meeting. There are not enough chairs. The bed has been moved into the corner to serve as a sectional sofa. The coffee table is in the corner serving as a buffet table /business card holder [11] / collection point for half-emptied water bottles. There are more butts than there are flat surfaces. Someone will be standing the entire meeting.

The hotel room door opens often as new people in skinny suits enter the room and current participants exit gracefully. That is, until one of the bed-sitters has to be excused for another meeting. This is what triggers the coffee or juice or soda spill. Thankfully, the beverage vessel is usually half-empty [12] and your analyst friend quickly jumps in with a bathroom towel to avoid a dry cleaning situation.

Though I did not attend JPM this year, I have few regrets [13]. If you are an entrepreneur and you are contemplating JPM in 2016, make your hotel reservations [14] soon. Your email invitation from that analyst is already in the queue.

Michael Barbouche [15] is founder and CEO of Madison-based Forward Health Group. At the 2014 JPM, Michael had dinner with Marty Felsenthal in the Wednesday evening 7:00 PM-8:00 PM slot.

[1] Note for Millenials–this is a reference to an HBO program that has not aired in years. You should be able to stream from your parent’s HBOGO account.

[2] True confession—I TiVo “College Gameday” to watch Lee Corso put on the headgear.

[3] Yeah, I’m talking to you, Goldy Goopher fans.

[4] Unclear if Epic has exclusive use of this term in the health IT space, so thought it was prudent to footnote. Further research needed on specific citation required.

[5] See below for explanation.

[6] If someone refers to you as “Jugdish, Sidney, or Clayton,” and that is not your name, the investors are likely to be working their iPhones before you have even finished your intros.

[7] The people who email incessantly to set up a call to pump information out of you.

[8] If you want to spend $145, you can verify with your lawyer—this simple inquiry is not the legal equivalent to a court-issued summons.

[9] During JPM, it is not uncommon to hear numerous exclamations that contain the phrase, “F*#@%ing Google Maps!”

[10] Ties are strictly prohibited. Obviously.

[11] At one of my meetings in 2014, there were business cards (face up) from two of my direct competitors.

[12] For the record, I view the vessels as half-full.

[13] I’m overdue in connecting with Ben Rooks and Michelle. Guys, we should chat soon!


[15] When I was in college, adding footnotes to your paper was complete pain in the ass. Now, it is so simple.

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January 21, 2015 Startup CEOs and Investors 1 Comment

Morning Headlines 1/21/15

January 20, 2015 Headlines No Comments

Mayo Clinic Selects Epic as Strategic Partner for Electronic Health Record and Revenue Cycle Management System

Mayo Clinic announces that it has chosen Epic to replace its incumbent Cerner and GE Centricity EHR and revenue cycle systems.

Federal Marketplace: Inadequacies in Contract Planning and Procurement

A report from the HHS Office of the Inspector General finds that CMS failed to oversee development work adequately, failed to review past performances of vendors selected for key contracts, and structured vendor contracts so that the risk of unanticipated cost increases were absorbed solely by the government, rather than shared among the selected contractors.

Geographic Clusters in Underimmunization and Vaccine Refusal

Kaiser Permanente uses its EHR data to pinpoint areas in California with low rates of childhood vaccination,  finding in one school that 50 percent of the children were unvaccinated due to “personal belief exemption.”

MMRGlobal Proceeds With $30 Million Patent Licensing Case and Files Three New Federal Appeals

MMRGlobal announces that it will appeal decisions made by the California district court to throw out its patent infringement lawsuit against Allscripts and WebMD.

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January 20, 2015 Headlines No Comments

News 1/21/15

January 20, 2015 News 6 Comments

Top News


Mayo Clinic chooses Epic, as I mentioned a few days ago from a reader’s rumor report. Cerner gets a double whammy – not only do they lose the Mayo bid, some of their systems will be displaced as they (along with GE Healthcare) are the Mayo incumbent. Actually, there’s one more Cerner insult: former Mayo CEO Denis Cortese, MD sits on Cerner’s board.

Reader Comments


From Banned in Boston: “Re: McKesson Horizon. The attached letter verifies its sunsetting on March 31, 2018. The event has passed with little fanfare since Horizon has become increasingly obsolete.” The letter, signed by McKesson EVP Pat Blake and President Jim Pesce, says the company will issue a Meaningful Use Stage 3 update and thanks Horizon users for their “partnership,” a trite, vendor-created synonym for “sending checks as a customer.”


From Jose Francisco: “Re: Scripps Health. Will be moving to Epic. Impact Advisors led the system selection – Cerner never had a real shot. Decision will become public in 30-60 days.” Unverified. Scripps chose GE Healthcare’s Centricity Enterprise in 2007 and Allscripts Enterprise for its outpatient clinics in 2009. Assuming the rumor is true, EMR critic and Scripps cardiologist and author Eric Topol, MD will become an Epic user – it will be interesting to see what he says about it among all of his smartphone infatuation. Update: I reached a non-anonymous source who says that Scripps hasn’t yet made a decision as far as he or she knows.

From Lips Pursed: “Re: HISsies voting. It’s just a popularity contest and the ballot choices are stupid.” Of course it’s a popularity contest, just like the Presidential election – what did you think it was? Readers (few of whom are stupid) make the nominations and vote for their choices as they’ve done since 2008, with the most-nominated entries appearing on the ballot. Having people who didn’t nominate anyone complain now is like moaning about the Presidential candidate chosen by your more responsible peers in that primary election voting you skipped.

HIStalk Announcements and Requests

The results of my reader survey are always interesting and useful. Thanks to those who responded.

Some nice point-counterpoint commentary was generated by CommonWell’s answers to HIStalk reader questions and a reaction article by Brian Weiss of Carebox. The comments are getting interesting as Brian suggests that (a) HIStalk readers vote as consumers on the approaches of the respective organizations, and (b) that the organizations consider developing a prototype for exchanging information securely and under the control of patients, driven only by their email address. They are also discussing patient-controlled health record banks.

Welcome to new HIStalk Platinum Sponsor Oneview Healthcare. The Dublin, Ireland-based company (with US offices in San Francisco and Pittsburgh) offers a Microsoft-powered customizable interactive patient care system that’s accessible by smartphone, tablet, or in-room TV. Patients get education, entertainment, communications services, messaging, scheduling, way-finding, meal ordering, nurse rounding, and remote consultation, while clinicians use it to access electronic medical records and other point-of-care applications. Two big reference clients are the newly built Chris O’Brien Lifehouse in Sydney, Australia (they have a patient experience focus and every patient interacts with the Oneview system) and UCSF Mission Bay (a three-hospital campus opening in a couple of weeks). Maimonides Medical Center (NY) SVP/CIO Walter Fahey says, “The capability that the Oneview solution can deliver is second to none and it will transform the healthcare experience, not only for our patients, but for our healthcare teams and hospital managers.” Thanks to Oneview Healthcare for supporting HIStalk.

I found this overview video of Oneview Healthcare on Vimeo.

Listening: Gary Lewis and the Playboys. Like most of America, I can’t understand how the unattractive, minimally talented son of the annoying Jerry Lewis could have become a 1960s pop star, at least until his career was waylaid when he was drafted and shipped off to Vietnam in 1967. I’ve seen him live a couple of times –he’s good natured (he’s 68 now) and he had some massive songwriting and production firepower behind his records. I have a strong need to hear “This Diamond Ring,” “Palisades Park,” “Everybody Loves a Clown,” “Save Your Heart for Me,” and “Little Miss Go Go “ every few years. Trivia: there were no actual Playboys on the records – it was all Gary and some studio musicians, heavily overdubbed and recorded using the opportunity created by his mom’s money and his dad’s name.

Acquisitions, Funding, Business, and Stock


Xconomy profiles nonprofit Wisconsin investor BrightStar, which funnels charitable donations of around $200,000 to complete funding rounds for early-stage companies that are creating state jobs. It quotes Forward Health Group CEO Michael Barbouche, who says working with BrightStar is painless and easy.


Patent troll MMRGlobal challenges recent court rulings in which its infringement lawsuits against Allscripts, WebMD, and others were rejected. Above is an illustration from one of its 13 patent applications from its 300 open lawsuits. MMRGlobal’s penny stock shares (literally: its shares are listed at $0.01 on the pink sheets) have dropped 59 percent of their value in the past year. Founder Bob Lorsch and his spokesperson/president wife were featured in a 2012 TV show called “Interior Therapy with Jeff Lewis” in which they are portrayed as emotional hoarders of a crammed houseful of stuff. I interviewed him a couple of year ago and found him charming and his product interesting, although the endless lawsuits overshadow all of that. He made one of his fortunes selling 976 telephone services in the 1980s, including a Santa Claus hotline (he sued a phone sex company for using a number similar to his) and running a children’s 976 phone service as a fundraiser for museums in which he kept $1.75 from each $2 call.


The Washington Post profiles hCentive, a software development company started by a guy who in 2009 downloaded a copy of the Obamacare bill the Senate was then debating and saw opportunity. The Affordable Care Act was signed into law nine months later and the three-person company now has 700 employees and $50 million in annual revenue after building four state exchanges and being signed by the federal government to build a small business site after it fired CGI for the failed rollout.



Wheaton Franciscan Healthcare (WI) chooses Epic in a $54 million, five-year project.  


Southeastern Health (NC) chooses eClinicalWorks Care Coordination Medical Record.

Aetna selects HealthEdge’s rules-powered health management system for payors.



Randy Carpenter (Omnicare) joins Stoltenberg Consulting as SVP of strategic services.


Xerox Government Healthcare names Scott Bennett (Siemens Healthcare) as SVP of sales.

Announcements and Implementations

PeriGen announces a doubling of its customer base in 2014, with 140,000 births to date supported by its PerCALM Tracings electronic fetal monitoring system.


St. Maarten Medical Center says it will be the first hospital in the Caribbean to use a fully electronic system when it completes its implementation of CPSI, which replaces a Siemens MedSeries4 system that was “no longer reliable and nearing a system failure.”

GE Healthcare and NextGen earn EHNAC’s first practice management system accreditation.

Government and Politics


Computer scientist Kathy Pham, a new employee of the United States Digital Service, attended Tuesday night’s State of the Union address as one of 22 guests invited by the White House. She has been a healthcare informatics researcher, a software engineer for Harris Healthcare Solutions, and a healthcare consultant with IBM. She also serves as a patient advocate for her mother, who has acute lymphoblastic leukemia.


A report by HHS’s Office of Inspector General finds that CMS’s work on was sloppy, hurried, and poorly overseen, awarding no-bid contracts worth hundreds of millions of dollars without reviewing past company performance or having firm requirements defined. As has been widely reported, CMS hired 33 companies to work on the site, but didn’t name any one of them to be in charge, although they just assumed that CGI Federal was running the project. The agreements also didn’t cap payments and allowed overbilling with minimal documentation, so some companies were paid up to three times their bid amount. CMS originally estimated the value of six key contracts at $464 million, but has paid $824 million so far.

Privacy and Security 

A security company finds that connects in the background to dozens of private websites, including Facebook, Google, and Twitter, raising concerns about cybersecurity exposure and whether user information is really private.

Innovation and Research


A new research article describes how Kaiser Permanente analyzed its EHR information to identify neighborhoods with a low rate of childhood vaccinations, allowing it to mount outreach efforts to five areas. One private school had a 50 percent rate of “personal belief exemption.”


in England, the medical director of NHS says wearables will play a vital part in future health in allowing people to be monitored at home for irregularities in heart rhythm, breathing, and edema. He adds that NHS will push a “huge rollout” of those technologies.


Bizarre: Airbnb-inspired Airpnp lets app users in need of a bio break rent bathrooms in private homes. The founders were inspired by a New Orleans decision to ban street-located Porta-Potties during Mardi Gras. It’s hard to fathom that sellers would allow a stranger into their homes (and bathrooms) for a dollar or two. It sounds like a spoof to me, but then again it’s sometimes hard to tell if a startup is serious. Perhaps the same skepticism applied early on to Uber, however, which just announced that its San Francisco revenue alone is $500 million per year – nearly four times the entire taxi market there — and is growing 200 percent per year.  

Microsoft patents user-configurable technology that can automatically dim and silence a smartphone when the phone’s GPS detects that the user has entered a theater, when it senses darkness and quiet, or when so instructed by the Wi-Fi system being used.



An epidemiologist with New York City Department of Health and Mental Hygiene tells the Health IT Policy Committee that fast outbreak identification and control requires better integration between EHRs and its disease surveillance system. She envisions EHRs sending real-time data for surveillance and then receiving back prompts for additional information, such as patient demographics.

A North Carolina OB-GYN says doctors should use computers and not vice-versa, urging his peers to look at the patient instead of the screen. “The folks who sold us these systems talked about all the wonderful things EMR can do … One might assume the EMR would excise the tumor, lower the blood glucose and stop the hallucinations. The problem is that the EMR really should not ‘do’ anything. Patients tell us their concerns. Practitioners do their best to listen and perform the appropriate evaluation, with or without technology … everything we need to know about our patients is in their face, in their voice, and in their eyes.”


Forbes India profiles India-based Narayana Health, whose first non-India hospital opened in the Cayman Islands a year ago in a partnership with Ascension Health. Founder and cardiac surgeon Devi Shetty got the idea for his medical tourism hospital from a friend who mused, “The most profitable hospital in the world is the one which is built on a ship and parked outside US waters because it gets to serve American patients and yet stays away from its jurisdiction.” The hospital has implanted an artificial heart for what Shetty says is less than half of the $1.2 million US hospital price. He’s working with two US-based health systems on new hospital software (I’d be curious to learn more about that) and is talking about starting a Caymans medical school.

image image

Weird News Andy likes the glucose-monitoring temporary tattoo on the left better than the diabetes-hating one on the right, although I’ll add that both might illustrate diabetic monitoring assuming there’s a Diastix right above the word “diabetes.”  

Sponsor Updates

  • Zynx Health VP Guillermo Ramas writes about attaining the impossible in the company’s latest blog.
  • Frank Myeroff of Direct Consulting Associates interviews Denver Health CIO Jeff Pelot.
  • Huron Consulting Group will exhibit at the AHLA 2015 Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions conference in Washington, DC from January 22-23.
  • Voalte Product Manager Anthony Mitchell blogs about the smart use of smartphones in the latest company post.
  • ExitEvent highlights Validic and its relationship with digital health startup Qardio.
  • T-System Clinical Systems Engineer Deon Melton, RN shares “Life Lessons Learned in the ER” in a new blog.
  • Caradigm Director of Product Marketing Scott McLeod pens a new blog, “All Signs Point to Population Health Management.”
  • AtHoc President and CEO Guy Miasnik writes about the role AtHoc technology played in protecting Gritman Medical Center from an active shooter.
  • The local business paper highlights the venture capital funding raised by CareSync in Q4 2014.
  • CareTech will attend the January 28 MCACHE event on “Building a Leadership Team for the Healthcare Organization of the Future.”
  • AirWatch’s Noah Wasmer offers five end-user computing technology predictions for 2015 in a new blog.
  • ADP AdvancedMD offers tips on leveraging practice data to view key performance indicators in a new blog.
  • Besler Consulting offers advice on how to increase Medicare EHR incentive payments.
  • Aventura will exhibit at the IMN Health Impact Conference of the Southeast in Tampa on January 23.
  • CitiusTech achieves the ISO 13485 quality management system standard for medical devices.
  • CoverMyMeds shares a moment with Account Coordinator Josh Campanella in the latest installment of its “Hey, You!” blog series.
  • lists amongst other companies making a name for themselves developing online booking software.
  • CommVault launches new endpoint data protection to secure, support, and back up mobile enterprises.
  • Craneware lists its goals for 2015 in a new blog post.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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January 20, 2015 News 6 Comments

Startup CEOs and Investors: Michael Burke

Accelerators and Incubators: Have They Jumped the Shark?
By Michael Burke


It seems lately that startup incubators and accelerators have become like belly buttons — everybody has one. The number of healthcare-specific platforms has increased dramatically over the past few years. A skeptic might ask if we are in an accelerator / incubator bubble. A more important question might be, “Why should I care?”

If you’re an aspiring startup founder, you may care. The well-known accelerator/incubator platforms like Techstars and Y Combinator can serve the same purpose for a startup founder as a Harvard MBA does for a young executive who wishes to climb the corporate ladder. They open doors and provide a measure of validation.

The jury’s still out on whether the newbie platforms will offer similar cachet. One of my fellow “villagers” at the Atlanta Tech Village, Kyle Porter (Founder/CEO of SalesLoft) mentioned that his experience at Techstars Boulder with Brad Feld immediately prequalified him and his company in the eyes of investors, partners and potential employees. He states:

“Accelerators taught us how to navigate the investor landscape, put together a presentation, and connect with relevant mentors.  And the networking benefits are insane.”

If you are an investor, you definitely care. A friend of mine, Greg Gottesman, is uniquely qualified to comment. Greg is an informal advisor to Clockwise.MD (my startup), and he has a vested interest in the topic. In addition to founding and serving as Managing Director of Madrona Venture Group, he also leads Madrona’s recent leap into the incubator world: Madrona Venture Labs. Here’s what he has to say:

“To the extent that accelerators and incubators enable more ideas to be tested quickly, I think they are a good thing. But most of these early concepts won’t and shouldn’t get funded with significant dollars. The best teams and ideas — the ones with customer traction and viable business models — will stand out relatively quickly. I wouldn’t look at the percentage of successes these accelerators and incubators create over time, but rather whether they can produce a small number of meaningful winners.”

Accelerators and incubators can clearly help investors sort the wheat from the chaff early in the life of a startup. David Cummings is a serial entrepreneur, partner in Atlanta Ventures (which has its own accelerator), and creator of the Atlanta Tech Village( a “community of innovation powered by a 103,000-square-foot building”). The Tech Village is a big laboratory of over 100 startups ranging from companies consisting of a single person to upwards of 50. In addition to the ping pong tables, gaming consoles, and free Cokes, there’s also a ton of exciting stuff happening — lots of big successes and big failures, all of which are observable to the community there. It’s not strictly an accelerator, an incubator, or even a co-working space. It sort of combines the best of all those platforms. David states the advantages simply:

“[These platforms] help bring structure to a messy process and increase the likelihood of success.”

That’s fine for an aspiring founder or an investor, but how does that help the purchasers of the innovation these platforms are supposed to generate? What’s in it for health IT customers?

My company has had a number of big customers choose us over larger competitors. These customers know that a startup (i.e., a company whose size makes them more flexible and responsive) can give them a greater measure of control over the process of solving a problem with technology. They assume (correctly) that they’ll have more influence over the final deliverable than they might if they worked with a bigger company. A startup from an accelerator, incubator, or “community of innovation” can – as David Cummings pointed out – increase the likelihood of success and mitigate the risks for the customer.

Donna Hyland is the CEO of Children’s Healthcare of Atlanta (CHOA). CHOA is one of the largest and most recognized health systems in the US dedicated to the care of children. She and her staff have been regular visitors to the Atlanta Tech Village and work with several companies from the village, including Clockwise.MD. Here’s what she has to say:

“Atlanta is very fortunate to have a burgeoning community of technology innovators and entrepreneurs. Children’s Healthcare of Atlanta is continuously looking for ways to better care for and serve our patients and families. We are working with companies from Atlanta Tech Village on great tools to improve care and the patient experience. We are grateful to have so much technology talent in our community.”

Back to the original questions. Are there too many incubators and  accelerators? Do they add value?

I don’t know if there are too many of these platforms, but I suspect that many if not most add value. If we revisit the business school analogy, we see that not everyone can get into Harvard, but most will probably still get a great education at a lesser B-school. I assume the same is true for these innovation platforms. I further assume that accelerators and incubators themselves are subject to the same Darwinian forces that send the majority of startups out of business, and that we’ll see a changing of the guard, if not a thinning of the herd, over the next several years.

Michael Burke is an Atlanta-based healthcare technology entrepreneur. He previously founded Dialog Medical and formed Lightshed Health (which offers Clockwise.MD) in September 2012.

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January 20, 2015 Startup CEOs and Investors No Comments

Morning Headlines 1/20/15

January 19, 2015 Headlines 1 Comment

The Role of Health Information Technology in Care Coordination in the United States

A study evaluating the role that health IT systems play in coordinating care finds that a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT

ACOs make progress in using big data to improve care

Modern Healthcare takes a look at the slow progress being made as ACOs work to roll out effective data analytics systems.

2015 Top 10 Hospital C-Suite Watch List

ECRI names 3D printing, Google Glass, telehealth, and alert fatigue to its 2015 hospital c-suite watch list.

Cleveland Clinic joins 5 Ohio health systems to form statewide healthcare collaborative

The Cleveland Clinic, along with five other Ohio health systems, have formed the Midwest Health Collaborative, which will share information in an effort to improve quality and reduce costs within the state.

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January 19, 2015 Headlines 1 Comment

Curbside Consult with Dr. Jayne 1/19/15

January 19, 2015 Dr. Jayne 7 Comments


Several readers have sent words of encouragement after reading about my last few weeks in the CMIO trenches. I definitely appreciate all of my virtual colleagues, even those who just write to say they understand and to wish me calmer seas. It sounds like many of us are going through the same trials and tribulations even though some of ours may be a little messier than others.

Our hospital is part of a larger health system that has announced its intent to replace all the clinical systems with a single vendor platform. I’m taking a couple of days off this week to really put my thoughts around whether I want to stick around to watch it happen.

I understand the need to consolidate systems. Our IT department is larger than nearly any other except for nursing. The budget for maintaining this “ultimate best-of-breed nightmare” is exorbitant. Many of our systems feel like they’re held together with duct tape, baling wire, and bubble gum. Some of them are just plain old. And several hospitals are on a platform that is being sunset by the vendor, so their systems simply have to go.

Being part of the larger project to turn this new single-platform vision into a reality is potentially exciting. But it also looks a little bit like a bottomless pit of long hours with not enough staff to work at a pace that would allow us to deliver a quality system without burnout. It’s also difficult to know that the health system has plans for how they plan to handle legacy clinical data that will not make our ambulatory physicians very happy.

Those of us that are “in the know” about the strategy have to keep quiet until it’s formally announced. I’m not used to being told what I can and can’t say to the physicians I serve.

It’s also bittersweet to watch systems be torn out when you’ve spent the better part of your professional career building them. We’ve held our users’ hands while they learned them and while they coped with upgrades. We’ve been at the other end of plenty of angry phone calls, but we’ve also heard the appreciation when we started to provide data to help proactively manage complex patients and to identify gaps in care. Of course our new system will also do this, but it was special to see how physicians reacted the first time they realized it was possible. Now those features have become old hat.

In addition to consolidating systems, our leadership also plans some pretty radical consolidation among hospital leadership and medical executives. We’ve always functioned as a federation, but this is taking us much more towards a centralized clinical and financial model and it’s not entirely welcome. A couple of chief medical officers have already moved on and I suspect a couple of hospital-level CMIOs and CNOs are planning to move as well.

On the non-clinical side, however, mid-level administrators seem to be proliferating. The number of buzzwords in an average hour of meetings has skyrocketed. We have four different consulting companies involved and they’re stepping all over each other with contradictory advice.

I’m not sure I want to leave the provider aspect of the CMIO game. There are definitely opportunities out there, but I really don’t want to relocate unless something pops up in Hawaii, in which case all bets are off – the idea of living in a place where the difference between winter and summer is 10 degrees does have a certain appeal. I just started clinical work with a new group that has a lot of promise and an extremely low chaos factor, which is a welcome change. I also spent the fall doing a ton of work on my garden and can’t imagine walking away.

There are some interesting vendor opportunities that don’t require relocation, but I’m not sure about crossing that bridge. My friends in the vendor space seem less stressed than those of us on the provider side (except during Meaningful User certification testing, in which case I recommend either steering clear or providing copious amounts of wine and moral support). It will be interesting to see if any new opportunities arise as we get closer and closer to Meaningful Use Stage 3.

Consulting is also an option, but I’m not sure I can handle being on the road as much as most of the larger firms expect. I’ve also heard the horror stories about being on the billable hours hamster wheel. I’ve dabbled in consulting over the last several years and would consider going out on my own as long as I have some ongoing clinical work as a financial safety net. I’m not enamored of what clinical practice has become in the last decade, however, so going full-time is not an option.

Today was my day to relax and think about nothing work related, but tomorrow is my day to sit down, run the numbers, and see if I can come up with a business plan that might fly. Wednesday I’m getting together with a couple of colleagues in the same boat, where we can trade ideas and see if anyone else has come up with a better plan. Thursday I’ll be back in the office, and it will be interesting to see how that plays since I’ve pledged not to touch my email or answer my phone while I’m out. Appropriate backup resources are in place, but I know my boss isn’t used to being unable to reach me. He’ll just have to get over it.

Here’s to crunching the numbers and hopefully to some new ideas about my next career move.

If you could do anything you wanted, what would it be? Email me.

Email Dr. Jayne.

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January 19, 2015 Dr. Jayne 7 Comments

Startup CEOs and Investors: Brian Weiss

Common CommonWell Thoughts (or, Who is Working on A National Social Being Identifier?)
By Brian Weiss


Did you read the CommonWell piece on HIStalk?

Mr H. did us all a great service in providing a platform for directing HIStalk reader questions to the CommonWell alliance from Cerner and company. Yes, I know that only 60 percent of the panel responding to the questions actually works at Cerner, but my articles are too long already without listing the full membership of CommonWell. I hope you’ll forgive me if Brightree isn’t the first vendor that jumps to mind when I think about CommonWell.

Given the fact that CommonWell is not consistently spelled “Commonwell,” we need to be especially appreciative that Mr. H gave them publishing space. I’m only allowed to write this article because I named my company “Carebox” even though I’m still waiting for the first person not related to me to spell it that way rather than “CareBox.”

Now, if you’re reading this article (clearly you are) and you still didn’t read that one (and you’re not related to me), you need to do a better job prioritizing what parts of HIStalk you read. We’ll all wait for you here while you go read that piece.


The Alliance

CommonWell is an “alliance.” I’m pretty sure that was selected over “empire” in the tight balloting in the CommonWell name-calling subcommittee because of the whole “Star Wars” context. For those who slept through the relevant decades, the “Alliance” is what you call the good guys, and if you’re reading this article and never saw “Star Wars” (even if you’re related to me), you really need to work on overall life balance.

By the way, I’m not 100 percent sure they have a formal name-calling subcommittee at CommonWell and, yes, I’m aware that the term “name-calling” has other connotations that have little do with HIT (OK, maybe a little).

From the questions that appeared in that article and the comments building up afterwards, it appears that there’s a bit of debate among some readers of HIStalk as to whether this alliance really gets to wear the orange jumpsuits and fly the Y-wing fighters. I’m not interested in getting into that debate. However, given my recent self-appointment as the voice (representing nobody) of innovative (self-labeled) startup companies that are seeking to leverage consumer healthcare data in various applications and services, duty calls! Give me just a minute here to adjust my cape. OK, ready …


Is a Patient in HIT a Subordinate Clause of Their Provider?

The quote I want to focus on from the CommonWell article is this one:

A single connection to the CommonWell network will enable providers and the patients they serve to access to [sic] their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach.

I was busy doing my math homework when we were in English grammar class so I don’t know if “and the patients they serve” is actually a subordinate clause or not. I’ve got a sinking feeling, though, that the high-sounding “serving the patient” expression doesn’t change the fact that whoever wrote that sentence views patient access to their own data as “subordinate” to the healthcare IT vendors and their healthcare provider customers. And nobody can mistakenly think that the “you” in “each provider you need to reach” from the quote above, refers to the patient/consumer.


The Missing Patient Service

I went to the CommonWell services page and I couldn’t find the service whereby a patient can request a copy of their healthcare records from everyone on the CommonWell network.

Interestingly, the word “patient” appears seven times on that page. There is talk of how to “link patients across organizations” and “patient identification” and even “patient-authorized.” But as far as I understood, that all seemed to be in the context of how providers exchange information with each other behind the patient’s back.

In both the body of the article and the comments section, there was quite a bit of back-and-forth about payment models and how the revenue pie should be shared among CommonWell members (vendors), the doctors who contribute the data, and McKesson (the company that got picked to provide the service).

There were also some interesting analogies made to financial transactions. Indeed, I believe there is a whole world of “behind the consumers’ backs transactions” that take place across financial institutions and in other EDI contexts. But at the end of the day, as a consumer, I can get a (free) copy of all of my transactions from all of my financial providers. And I can use a service like to act on my behalf and make it easier and more valuable for me to do that.

I’m not saying that’s the ideal model, is consumer-centric enough, or (conversely) is directly/fully appropriate for healthcare. But it’s interesting to think about how it works relative to how things are intended to work – and not only in CommonWell – when it comes to healthcare networks.

Curiously, I don’t recall that there was a need for Congressional involvement in order to establish a National Banking Identity for everyone. If I want to establish a mechanism to transfer money from my checking account to my mutual fund account, I set that up and provide the authorizations. As far as I know, the mutual fund company and the bank aren’t part of an “alliance” that provides “identification and linking services” to make sure they correctly match my bank account with my mutual fund account so that they can move information about me between them once they get me to sign a consent form I don’t fully understand while I’m at the bank teller.


What’s Your National Photographer ID?

Given how tough it is to do patient matching (I have a little MPI experience and it really is pretty tough), I’m amazed that Instagram has manage to get as far as they have without a National Photographer ID. How come LinkedIn doesn’t need my National Employee ID and Facebook doesn’t need my National Social Being ID (or my National Annoying Communicator ID for WhatsApp?)

It seems that by some miracle, armed with nothing more than an e-mail address, I can securely and reliably authorize any sharing network I want about my most sensitive information. Oh, wait, there is one catch — I have to be a little involved in process.

If my mom and my wife want to share information about me without me being involved (scary thought) then I suppose they would indeed need some kind of ID and matching process to ensure they aren’t sharing information about someone else when they use their “record locator service” to access each other’s database of information about me. But if I have my information stored with each of them in my e-mail-keyed (and easily validated) account that I maintain with each of them (hey, it’s an analogy, relax) and I authorize the sharing, it doesn’t need an act of Congress to get the information flowing.


This is Not Just a CommonWell Issue

Now if it sounds like I was being disingenuous above about not taking sides on CommonWell while adjusting their Darth Vader helmets, that’s a mistake. As far as I can see, CommonWell is mostly providing a more practical and commercially effective model for what the US government said it wanted to do all along in terms of national health networks – with the usual vendor politics and dynamics in play, as is to be expected.

Whether it’s FHIR as per my previous article, CommonWell in this one, Epic openness debates, or evaluation of data interoperability strategic roadmaps, I think one of the litmus-test questions has to be something like this:

How does your (standard, service, alliance, network, system, strategy, roadmap) empower a consumer to exercise their HIPAA-mandated right to get an electronic copy of their healthcare data and share it with (family, caregivers, providers, research groups, pharmacist, clinic, employer, people who will pay them for it, whoever) whenever they want?

CommonWell may have a better answer to this question than most, but it isn’t shining through yet clearly enough for me in their article on HIStalk or on their web site.

Is that a question from the noble, bright, and good part of the Force? Not necessarily. It’s as self-serving as anything in the CommonWell materials or anything else. I have a smaller company than Cerner to try and make successful, so if anything (deliberately using that word a third time in this paragraph – and breaking the flow of the paragraph – again – so I can generate some loyalty from the commenter who critiqued my problematic writing style in my last article), I can afford to be even less altruistic.

In the interest of transparency, I’m working on a draft resolution for my upcoming board meeting to have our name-calling committee allow me to swap out “CEO/Founder” for “Emperor.” I’ll let you know how it goes.

Brian Weiss is founder of Carebox.

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January 19, 2015 Startup CEOs and Investors 4 Comments

HIStalk Interviews Ted Reynolds, SVP, CTG Health Solutions

January 19, 2015 Interviews 3 Comments

Ted Reynolds is senior vice-president of CTG and is responsible for CTG Health Solutions


Tell me about yourself and the company. 

I’ve been in healthcare since the 1970s. My first go-round was in June 1979. I started off working for a hospital, the last of which was Stanford, and worked for a couple of vendors. Then I went to the dark side and went to consulting.

CTG is a long-established firm, having been around 48 years. I lead the healthcare division, which includes payers and providers. We’re one of what KLAS used to call Tier 1 firms. We provide a full breadth of services — advisory, planning, implementations, technical services, and application management. People know us a lot for legacy support since we do as much of that as anybody in the country.


CIOs are getting pulled in a lot of directions. What are they focusing on most?

Oh, boy, they’re getting pulled in all directions. A lot of them have been chasing Meaningful Use dollars trying to get EMRs implemented. But in the future, it’s going to be very confusing as people start to transition from volume- to value-based payments, whether you call it an ACO or population health or whatever. Those are going to be very complex. It’s going to change the paradigm to where you’re going to be reimbursed for not doing work. It’s going to be very interesting to see how they evolve. I think it’s going to be difficult for them.


What projects are requiring people to call you for help?

Because we work on the payer side, we help a lot of organizations as they move into the ACO world. We’ve been helping a lot of them set up patient-centered medical homes. We’ve been doing planning for that — getting tied into the physicians, helping them do evaluations of systems they should look at. We’ve worked for some of the payers in looking at what they need to do to help them manage the populations.

This is kind of like HMOs II. In the early 1990s, it didn’t work very well. A lot of them, candidly, really didn’t have the data. Most of them were trying to manage their populations using claims data. That’s like trying to drive a car looking in your rear-view mirror because the data is two months old. Now with EMRs, I think they will have more success.

But there were still some early successes back then. Kaiser and some of the large group models actually succeeded and survived, but a lot of them did fail because they couldn’t manage the risk. I’m hoping that we can see something that will drive the cost down. That’s going to be a lot of the challenges we’re seeing with the groups. 

A lot of the hospitals and large physician groups are looking are mergers and acquisitions. Who do you play with, how big do you need to be to absorb a risk. Because if you start going in some sort of capitated risk arrangement, you’ve got to have a pretty large financial base to survive.


Interoperability isn’t just a technology problem because hospitals don’t have much incentive to share risk with competitors. What are they telling you about their desire to exchange information with other health systems?

You hit the nail right on the head. A lot of them are competitors and they do not want to share their information. I don’t want to make it easier for you to steal my patients from me.

But I think you’re starting to see more and more of that break down as we go forward. If they go with some sort of at risk where they share any risk for a population, they’re going to have to share their information. I think that’s going to break down the barriers. That’s what we’re seeing. It is a technology issue, but also there’s a lot of issues I think socially we’ve got to understand and get over.

For example, in the United States, nobody wants you to know anything about them until they’re unconscious on the ER table. Then they want you to know all the information. Maybe it’s too late then. Whereas you’re seeing in Europe things like national patient identifiers. We’re not willing to step up and do that yet from a political perspective. It’s quite interesting.

I spent a third of last year over in Europe. They have big advantages. Most of them have a single-payer system, socialized medicine. I’m not sure that’s the way we need to go over here. I’m not sure that would be the solution.

But what they’ve done is that everybody has a national health identifier. They have issues with some certain percentage of the population like we do with immigrants, but they’ve addressed that. If you look in some of the northern parts like Denmark, some of them have a national patient identifier. They have national patient portals so they can look at the information. They have a national registry that has all the drugs, all the hospital visits, all the physician visits. They can inquire into those. The technology is not very conducive to use because it’s not one integrated system, but at least they do have access to it.

Some of them legislated that all the primary care had to implement an EMR about six years ago now. Because of that, they have a lot of information. Most of the care both here and there is provided in an ambulatory setting. That’s where you’re missing a lot of the information. Same thing here in the states. Hospital EMR implementation is further along than the physician offices, but it’s getting there very quickly.


Are providers here supporting the idea of empowering patients or are they resisting it?

They are moving to where more and more of them are encouraging it. But if you look at healthcare, it compares to the banking industry. In some ways, we’re back years and years ago when the banking industry started rolling out ATMs.The local banks could not afford to roll out an ATM network, so you started with the regionals buying out the local banks and then the nationals started buying out the regionals. This is very analogous. You wouldn’t go to a bank today where you didn’t have electronic banking or an ATM.

In the future, I think you’re going to see the same thing with what patients are going to expect. You’re going to expect to see your lab results within a day or two by the time you get home. You can schedule your appointments online. You can pay your bills. You can do your medication refills. Why wouldn’t you?

I’ve seen our employees and my previous employees switch which providers and hospitals they’re going to based on who had the patient portals. You’ll see that that’s going to put a lot of pressure. Regardless of what happens with the political situation, patients as consumers are going to expect that, especially the newer population. You have it with banking, which is a lot less complex. Why wouldn’t you have it with your healthcare? We’re starting to see that pressure. Some of the providers aren’t pushing as fast, but in some of the large metropolitan areas, this is already happening, where they have large EMRs already installed.


After the Sony Pictures breach, are you getting a lot of security-related inquiries from hospitals trying to figure out how to make themselves more secure?

Yes, we are. Not as much as I would expect, though.


How do you think cybersecurity fits into all the other things that are on the CIO’s plate today?

It’s a huge risk. The question is, is how much effort and cost do you put into it to prevent it? You see some organizations where it’s getting to become a larger part of their budget to actually try to put all the prevention in. 

A lot of it is just the basics. A lot of it is changing human behavior. Some of the breaches that you see is where people download the information on laptop and it gets stolen. You’ve seen it time and time again and that seems to be a lot. It’s just a matter of continuing education. I think it’s not only a technology issue, but it’s also an educational issue throughout the entire organization.


Health systems aren’t only helping each other with consulting, but also hosting systems such as in the Epic Community Connect model. Is that a threat to your business?

We just finished one of the largest region connects that Epic has done last year. They used us to help them install it because it was an hour and a half. They brought up six hospitals very quickly. I think it was 10 months and ten days from the date they signed the contract.

But it was an hour and a half away from their facilities. It’s hard to ask somebody who’s got a family to drive an hour and a half each way. They didn’t sign up for a travel job. They didn’t sign up for consulting. They want to be home with small kids, participating in their family’s activities at night and things like that.

We helped them what that deployment. Very successful. I think you’ll see more and more of that. However, some of them are starting to get teams who will travel and they’re starting to change expectations of some of their employees, too.


You worked for Epic during some of its biggest ramp-up years. What did you learn there?

That was a lot of fun. What I learned and what I always appreciated is that Epic always seemed to have the client’s interests first and foremost. I got to appreciate the integration that they’ve done between the hospital and the physicians. They’ve done quite well as they deploy that model across the country. 

I had tried to lead a development effort for that back in the 1980s for a company that McKesson now owns. They saw the integration dream. You’re seeing a rise of a lot of the integrated vendors. Cerner’s doing well, Epic’s doing well, and then probably Meditech. A lot of the other ones are struggling as they’re trying to integrate the packages. You’re seeing that in the market today.


What do the best health system CIOs do that the others don’t?

The ones that are the most successful see IT as an enabler and can help the organization drive value from the system. You try to drive it to where it has a true return on investment. It may be clinical quality, it may be patient safety. But also, you have some quality indicators and you involve the operational organization in trying to drive benefits from the system.

I’ve always been a believer that you don’t put in technology just for technology’s sake. You put it in to try to help improve your business operations. Clinically, financially, attract patients to your facility, one of those. The ones that have engaged the operational organization do the best and they take it out of the framework of being a pure technologist.


Do you have any final thoughts?

HIStalk is one publication I read religiously. It’s timely, it’s accurate, and I really enjoy it. It’s to the point. I love Dr. Jayne — she’s got a very pragmatic approach to things.

I think healthcare is going to change a lot. We’re finally getting automation to the degree to where we really can make a difference. With the advent of genomics, we’re going to see a pretty dramatic change in the next five years over personalized medicine to where you can really, truly provide the best, cost-effective care. A lot of the things we treat today don’t provide the highest quality for the least cost. I think we’ll get there, hopefully very quickly, because now we got the information that we didn’t have before.

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January 19, 2015 Interviews 3 Comments

Morning Headlines 1/19/15

January 18, 2015 Headlines No Comments

Official Who Led Medicare Through Insurance Shakeup Is Resigning

CMS administrator Marilyn Tavenner resigns, telling staffers in an email that February will be her last month. Tavenner joined CMS in February 2010, just before President Obama signed the Affordable Care Act, and went on to oversee the troubled rollout of in October 2013.

Electronic Medical Record Provides Dartmouth-Hitchcock Pathologists Powerful Tool to Push Best Practices in Transfusions

A new EHR alert implemented at Dartmouth-Hitchcock Medical Center (NH) has significantly reduced the improper use of two-unit blood transfusions for non-bleeding patients.

ER visits still rising despite ACA

At ERs with traditionally high patient volumes, annual visits have only gone up since the rollout of the Affordable Care Act, with one physician speculating that “More people have insurance, but the cultural norm has been to wait until they’re sick to seek care. As they get educated, ER use will go down over a period of years.”

New Department of Biomedical Informatics

Harvard opens a new Department of Biomedical Informatics that will work to leverage new biomedical data streams to develop new methods for research and clinical care. The new department’s advisory board includes digital health pioneer, and Rock Health founder, Halle Tecco.

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January 18, 2015 Headlines No Comments

Monday Morning Update 1/19/15

January 18, 2015 News 5 Comments

Top News


CMS Administrator Marilyn Tavenner, most known for her key role in the botched rollout of and for miscounting its enrollees to the White House’s embarrassment, resigns. Former Optum executive Andy Slavitt will take the role as interim. Trivia: Tavenner worked her way up from staff nurse at an HCA hospital to president of a 20-hospital HCA division. 

Reader Comments

From VeeDub: “Re: McKesson. Our system uses Horizon Clinicals at several of our hospitals and is just beginning the conversion to a new EMR. McKesson has told us that the last day of support for Horizon Clinicals will be March 31, 2018. I don’t know if this also applies to the rest of the Horizon product line.” Unverified, but McKesson has sent strong signals that sunset is on the Horizon.


From Dollar Short: “Re: CIO salaries. You used to run these. Bring it back!” Since I’m a pleaser, I put together a few for you. I used to calculate the CIO’s salary vs. the non-profit organization’s revenue, but big health systems started gaming that number by setting up management corporations to hide executive salaries and reporting revenue in not very digestible ways. I chose a few big-name CIOs. Who’s up for names and pictures of the million-dollar club? (probably not members of the million-dollar club)

TX: $689,993
MA: $702,153
FL: $616,330
VA: $965,552
FL: $415,676
MA: $812,817
NY: $922,942
NY: $1,206,457
VA: $470,783
TX: $817,753
NC: $674,896
CA: $1,527,838
MA: $415,172
WI: $330,573
AZ: $1,084,140
FL: $1,091,266

From Hold the Mayo: “Re: Mayo Clinic. Will announce its EMR selection (Cerner or Epic) on Tuesday.” Unverified. One of the companies will get a lot of mileage out of that decision, and not long before the Department of Defense is making its choice besides.

HIStalk Announcements and Requests

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



My most recent poll  responses can be sliced and diced in a few ways. Forty-six percent of respondents overall will attend HIMSS15, while 22 percent who went to HIMSS14 aren’t coming this year (but those are outnumbered by readers who didn’t go last year but will this year). Based on that I would ordinarily project a slightly higher attendance for HIMSS15, but I’m not so sure the industry isn’t contracting a bit overall and attendance may not get that boost. New poll to your right or here: has technology significantly empowered patients? I would enjoy hearing your comments – click the link after voting and share your thoughts.

Listening: The Subways, a hard-rocking British three-piece band that puts on a hyper-energy live show (the bravest crowd surf ever is at 45:00 in the video). They’ll be touring to support their new album starting in a couple of weeks, but only in Europe. I’m rehearsing now for my US-based desk-drumming and air-guitaring support.

Last Week’s Most Interesting News

  • Google joins the Department of Defense EHR bid team of PwC, General Dynamics, Medsphere, and DSS.
  • A whistleblower lawsuit brought by two former NantHealth executives claims the company is “engaged in a multitude of fraudulent activities.”
  • Athenahealth acquires small hospital EHR vendor RazorInsights.
  • ONC’s numbers show that 77 percent of Meaningful Use Stage 2 eligible hospitals have attested along with 60 percent of eligible practices.

Acquisitions, Funding, Business, and Stock


I’m fascinated by the continued share price decline of former high-flyer Castlight Health, which closed on its first day of trading last March at nearly $40, took a sharp slide immediately afterward, and now sits at less than $9, down nearly 80 percent. The company will announce full-year and Q4 results on February 18, which will be interesting.


In the UK, Sheffield Teaching Hospitals NHS Foundation Trust selects HP Enterprise Services UK to implement Orion Health’s clinical portal with Imprivata’s single sign-on.



The SSI Group names Jay Colfer (Surgical Information Systems) as EVP of sales.


Atul Butte, MD, PhD (Stanford University School of Medicine) will join UCSF to run its new Institute for Computational Health Sciences.

Announcements and Implementations


Practice Fusion adds an online check-in module that collects patient information via practice-customizable online forms, then sends it to its EHR.

Wolters Kluwer Health enhances its Sentri7 surveillance system to support creation of antimicrobial stewardship programs.

Government and Politics


FDA releases draft guidance for “General Wellness: Policy for Low Risk Devices.” FDA says it isn’t interested in treating low-risk wellness products as medical devices. Apps and devices are fine as long as they (a) address general wellness such as weight management, mental acuity, physical fitness, or sleep management without claiming to treat a specific disease or condition, or (b) use accepted medical knowledge to promote lifestyle management to reduce the risk of specific diseases or conditions.  

Privacy and Security


Sensato announces its Hacking Healthcare 2015 cybersecurity conference, March 24-26, 2015 at Ocean Place Spa & Resort in Long Branch, NJ for health systems, payers, technology vendors, and physician practices. It will cover top healthcare security threats (including those involving biomedical devices), dealing with business associates, and developing strategies for addressing current threats. 

A New Jersey goes into effect that requires insurance companies to encrypt patient information on both desktops and laptops.

Innovation and Research


Massively overexposed Mark Cuban, mostly known for being irreverently obnoxious before and after he made a ton of money, will emcee the Impact Pediatric Pitch Competition for pediatric digital technologies on March 16 at SXSW Interactive in Austin, TX. The event will be hosted by Boston Children’s, Cincinnati Children’s, Children’s Hospital of Philadelphia, and Texas Children’s.



Fascinating: an astronaut needed a wrench, so NASA emailed up a CAD drawing and he 3D printed the tool on the International Space Station.

Samsung offers software developers and researchers a free prototype and development kit of its Simband wrist-based sensor. A tutorial steps through the writing of a heart rate variability algorithm in C, while the company also offers de-identified vital signs test data it will be collecting from research participants. 


Berkeley, CA-based startup Eko Devices announces the $200 Core 1, which clips onto a standard stethoscope to record its sounds to any smartphone or tablet via Bluetooth, allowing doctors to share the sound file in consulting with a remote specialist.


Stride Health launches a type medical insurance app that targets 1099 workers, claiming its app is easier to use and suggests insurance options that are more tailored to the user. The app is free since the company gets a commission on the insurance users buy. Mayo Clinic is an investor.



The Seattle paper covers what it calls the “OpenTable for medical appointments” patient scheduling apps, mentioning ZocDoc for medical appointment scheduling and InQuicker for ED scheduling. It quotes a New York dermatologist who says he couldn’t compete without ZocDoc, which sends him 15 patients per week, which seems unnecessary given the stats I’ve seen on long waits to get a new patient derm appointment, but he knows better than me. An ED patient who used InQuicker reports, “There must have been 50 people there, and they took me in 10 minutes,” which surely delighted those other folks who actually showed up and waited as the happy InQuicker user skipped the line for her “emergency.”

Speaking of EDs, Modern Healthcare reports that annual visits keep rising sharply despite the Affordable Care Act, with one ED doc saying, “We’re seeing a failure of access to care” as primary care practices close or stop accepting Medicare. Others say the newly insured just haven’t gotten used to the idea that they can be seen in places other than the ED.

Dartmouth-Hitchcock (NH) uses an EHR best practice alert to improve its blood transfusion practices, reducing the number of questionable two-unit transfusion orders from 47 percent to 15 percent.


Harvard Medical School announces the formation of the Department of Biomedical Informatics, to be led by Isaac Kohane, MD, PhD of Boston Children’s Hospital who co-founded the predecessor organization, HMS Center for Biomedical Informatics. The department will have five core faculty members.


Weird News Andy nominates this as his quote of the year: “Being a corpse was the most bizarre experience, but I’m so glad I managed to get out alive.” An Alabama teen with the rare mental illness Cotard’s Syndrome, in which those afflicted believe that they are literally dead, recovers three years later after psychiatric help and watching Disney movies (insert commercial skepticism or promotional opportunities here, especially since she says she and her boyfriend now want to work for Disney World). Those with the condition believe they are dead and/or immortal, that their body parts are missing or decomposed, or that they can relax only in cemeteries.

Sponsor Updates

  • Liaison Technologies CEO Bob Renner dives into five micro trends that will define big data over the coming year.
  • Versus client Dan Chambers, MBA, COE, of Key-Whitman Eye Center writes in the January issue of Ophthalmic Professional magazine about RTLS and how the technology improves patient flow.
  • Healthwise SVP Molly Mettler reflects on the opening of Healthwise 40 years ago in a new blog.
  • The local Fox News affiliate mentions Healthgrades in a story on keeping New Year’s resolutions.
  • Healthfinch makes “Another Case for Strategy, Not Just Tactics” in its latest blog.
  • Harris Corp. will exhibit at the iHT2 conference in San Diego January 20-21.
  • Impact Advisors publishes a white paper, “Optimization: The Next Frontier.”
  • Healthcare Data Solutions lists five things to love about pharmacists in celebration of National Pharmacists Day.
  • Extension Healthcare blogs about channeling change and your inner Florence Nightingale in 2015.
  • Health Care Software Inc. will exhibit at the LeadingAge California meeting in San Diego on January 23.
  • DocuSign shares tips on enhancing employee productivity in its latest blog post.
  • Hayes Management Consulting shares “Everything You’ve Wanted to Know About Keeping Employees Happy During System Implementations But Were Afraid to Ask” in a new blog.
  • SCI Solutions offers a new blog on “Eliminating the Blind Side in Care Coordination.”
  • Sagacious Consultants offers insight into improving sepsis detection using Epic in its latest blog.
  • PMD’s Siavosh Bahrami offers a new blog on “Mediums of Thought and How I Approach Problems.”
  • Phynd CEO Thomas White offers insight into the company’s ROI model in a new blog post.
  • PeriGen doubles its PeriCALM customer based in 2014, bringing total estimated number of births supported to 140,032.
  • The local paper profiles Perceptive Software’s office in a roundup of Johnson County’s coolest offices. (nice pic, too)
  • Nordic releases the third episode in its series on Epic’s Cupid application, covering differentiators and implementation stumbling blocks.
  • NVoq shares the top three providers should know about its SayIt speech-recognition technology.
  • Netsmart releases two new white papers: ”The Recovery Movement” and ”In Transition: How Electronic Data Sharing Enables Improved Health Outcomes and Reduced Costs.”
  • MEA I NEA publishes a new blog entitled, “Connected practices may be hindered by lack of a website; yes, a website.”


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.


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January 18, 2015 News 5 Comments

Reader Survey Results 2015

January 18, 2015 News 5 Comments

Thanks to everyone who completed my reader survey. Congratulations to the three winners of $50 Amazon gift cards I’ve sent (I had fun writing an Excel randomization routine to make sure I wasn’t biased in any way in choosing the winners).

I run the survey once per year. It helps me plan going forward. I always like to share some of the interesting feedback I get from it.

I’ll chime in on a few of the comments and suggestions. I should mention that the most common recommendation was, “Don’t change anything.” I appreciate that.

I have a diverse readership, and while it might seem obvious that I should make a given change, that’s from one person’s viewpoint. People have different motivations for reading HIStalk – some want just the top news boiled down, some are scouring for competitive intelligence, and many want to be entertained along with their news. I don’t want to get in the trap of writing by committee no matter how well intentioned the advice, where I please nobody in trying to please everybody. My audience is self-selecting – you either like what I write or you don’t, and I have to make you want to come back every day. It’s harder than it looks sometimes given all the distraction that’s out there.

Some major points from the survey:

  • Readers mostly work for hardware or software vendors (47 percent); hospitals, health systems, and practices (27 percent), and 68 percent have at least 11 years of experience in healthcare IT and healthcare.
  • The most common job function is IT or vendor staff or management, nine percent are clinicians, and about six percent of readers are CEOs and the same percentage are CIOs.
  • The most-appreciated elements of HIStalk are (in order) news, morning headlines, rumors, humor, and Dr. Jayne. The least-liked element is Readers Write.
  • Eight-five percent of respondents say they have a higher interest in companies when they read about them in HIStalk.
  • The most important survey result is this one: 91 percent of readers said reading HIStalk helped them perform their job better last year.
  • More than a third of readers recommended HIStalk to a peer in the past month.

Here are some of the recommendations.

Separate out Dr. Jayne’s Thursday night contribution into its own post for easier reference.

Good idea. That’s easily done. Long-time readers may remember that when Dr. Jayne started five years ago, I ran her post at the end of Tuesday night’s news. Then I had the brilliant idea (that’s not exactly true – a reader suggested it in the reader survey five years ago) of moving her post to Monday nights on its own. Dr. Jayne is a busy lady, so I’ll have to coordinate with her schedule.

Don’t write so much about startup funding.

More people said I should write more about it. I haven’t changed my threshold for what seems interesting or newsworthy about funding — there’s just more of it to cover these days as investors chum the waters. Clinical readers sometimes yawn at the business news and vice versa, but at least the business section is easily skipped (the idea of breaking out posts with subheadings also came from a long-ago reader survey, in fact).

Stop putting so much emphasis on the HIMSS conference and the events you have there.

I agree, although many readers follow that closely. I’ll try to find more substance at the conference to write about, but it seems to be in short supply.

Don’t be so snarky.

The “be more snarky” camp has you outnumbered in their responses, I’m afraid.

Stop promoting Epic so much.

I’ve analyzed my mentions of Epic and they are balanced. Most of the time I’m reporting something newsworthy or that would interest my Epic-using provider readers (of where there are many), and in those cases where I editorialized, it was a pretty even split between positive and negative. Writing about Epic is a challenge because any time I mention them, people who (a) compete with them; (b) aren’t Epic users; or (c) tried to get a job there and failed scream “favoritism.” I write about Cerner’s new campus and nobody says a word, but I mention Epic’s new campus and smoke starts coming out of the ears of some readers who react to the word “Epic” as a bull does to a matador’s red cape. If you think something I say is biased toward Epic, say so in the comments and see if others agree. I do pay attention.

Stop calling Epic’s Judy Faulkner “Judy.” It’s demeaning because you don’t do that with males.

Sure I do. I write about Neal, Farzad, Vince, Ed, and JB (for Jonathan Bush) using only their first names for the same reason – just about everybody knows who I’m talking about because their names are uncommon, unlike Paul, Robert, or John. When I hear people talking about Judy Faulkner, 90 percent of the time they just say “Judy.” I’ve never heard anyone respond with, “Judy who?”

Expand the contributor group – not everybody seeks the spotlight.

The problem is that many people shun the spotlight. I’d greatly appreciate more contributors with different viewpoints, but the single best lesson I’ve learned in 12 years of writing HIStalk is that everybody likes to read, but almost nobody likes to write. I’m always encouraging different people to write Reader’s Write articles, submit their own series of articles, or be interviewed — what you see on the page is what I get (usually vendor people interested in the exposure, which is why people don’t like Reader’s Write). Non-vendors and lesser-knowns, get in touch if you are willing and able to contribute because I’m up for it.

Start a column with new perspective from a pharmacist, lab director, nurse, and others on the front lines.

See above. I’ve asked before, especially for a nurse who writes well and has interesting points to make, but nobody has volunteered and I can’t force them to do it.

Get the contributions of government contractors since they know what’s going on.

Dim-Sum’s contributions about the Department of Defense EHR have been outstanding. I would be thrilled to run more government-oriented pieces, even anonymously, if someone is willing.

Get the contributions of patients and consumers.

I’ve tried getting people for that too with no luck, but at least I’ll have something from HIMSS since I’m providing several scholarships to patients who will attend and write about their experience on HIStalk (more details to follow).

Offer a column, interview, or other collaboration with HIMSS.

We each tend to do our own thing, but I’m willing if they are, assuming it’s interesting to my readers and not just promoting HIMSS.

Offer a column to incubators like Rock Health.

I’ve started with startup CEOs and investors and an incubator or accelerator column would be fun, limited again by the willingness of someone to actually do it. And the complaints of those HIStalk readers who say they’re tired of hearing about startups.

Put on more non-commercial webinars like the Dim-Sum and Vince ones.

The rate-limiting factor is presenter willingness, not mine. All the presenter needs is a bit of time and expertise – we lead them through the process from abstract to delivery and of course I bear the expense gladly. Dim-Sum’s webinar on the DoD EHR has had 1,531 views on YouTube and Vince’s Siemens-Cerner presentation has been viewed 1,807 times, so demand exists for webinars that are more educational than commercial, which I had in mind from the start. I have the forum and platform if you have something educational to offer readers.

Perform more analysis of informatics literature.

I love doing that myself when I have the time and have the full-text of an interesting article. I’ve asked before for an academic type to be a “literature scout” to find good journal articles and summarize them, but I haven’t had any takers. I’m feeling like a looping recording in saying repeatedly that I don’t get volunteers, but I’m just explaining why it’s not quite like the engaged community anxious to contribute that you might envision.

Stop using blue font for the reader quotes.

I’ll have to think about how to best indicate that I’m quoting a reader.

Improve the search function.

That comes up in every year’s survey, but I don’t have a solution. It’s already a Google search that works well, but what some folks want is to be able to click on a word like “Cerner” or “genomics” and have a perfectly sorted list of articles by date pop up. It just doesn’t work that way with the format I use, which is intended for an easy summary read rather than to support discrete searches. HIStalk, technologically, is just a bunch of web pages with one per post, not a massively indexed database (it’s kind of like a free-text chart entry vs. individual EHR data fields). I’m open to technology suggestions if anyone has some. Lots of  health IT vendors offer tools that convert free-text documentation to structured and searchable, so maybe this is their test case.

Spell Meditech as MEDITECH.

No. There’s just no reason to make it all capital letters. I go by the AP Stylebook, as does the Boston Globe, which spells it Meditech. Companies can go marketing crazy with cute capitalizations and symbols within their names, but that doesn’t mean publications have to buy into it. Hospitals are getting into the act, such as NewYork-Presbyterian (no space) and Partners HealthCare. Apparently spelling a word correctly following civilized rules doesn’t sizzle enough to stand out.

Stop being so picky about grammar.

No. I hate it when people make up their own rules because following society’s rules is inconvenient. Many people worked hard to teach me English, so I feel no shame in using it correctly. Americans are bizarre in passing along to their children their bemused indifference to competence in English and math, so we’ll see where that gets us in a competitive world market.

Some of the interviews feel scripted – mark those that are done live.

I do every interview live by telephone. Also, the subject hasn’t heard the questions until I ask them and doesn’t get to approve the final transcription. Two exceptions: (a) the “HIT Moment With …” where five-question interviews are done by email, and (b) a couple of times over many years, my interview subject did not speak easily understood English and I knew both the subject and I would have to work a lot harder to complete the interview, so I begrudgingly allowed email answers. I’ve done many hundreds of interviews and all but a handful were me talking on the phone asking off-the-cuff questions (I do edit out the many times the subject says, having become accustomed to low-quality reporter interviews, “What a great question …”). It would probably be fun to listen to the actual recording that gets transcribed – I interviewed Premier CEO Susan DeVore while having fajitas and a Tecate in a Mexican restaurant since I was super busy that day. I started off by telling her that she was hearing my private mariachi band serenading me in the background, which she found amusing.

Respond when someone leaves a stupid comment on a post.

I don’t want to talk over a reader who leaves a comment, even one I don’t agree with or that is factually incorrect. I let other readers correct them as they see fit. If they don’t, then I assume the comment is at least somewhat justified even if it stings a bit (my skin’s not as thick as it might seem).

I would like to have a quick way to see quickly the comments left on a post and then jump to them.

I will look into commenting options. I had a good cloud-based tool that seemed perfect, but it didn’t work for reasons I never could figure out in multiple attempts.

Send the email blast in the middle of the night instead of at around 8 p.m. EST. It creates pressure to read and I’d rather have it pop up in the morning with the other news I read.

Readers in Pacific times zones jump on HIStalk as soon as the email goes out, so I would hate to hold it until the next morning, plus some people want to see the news as soon as they can. I remember clearly when Todd Cozzens ask for a show of hands from the stage of HIStalkapalooza in Chicago how many people drop everything when the HIStalk email arrives – a frightening number of them went up.

Develop a mobile app.

I’ve been looking into that, although the existing mobile format works OK. Real-time notifications might be useful, though.

Ed Marx never did write anything about the Ebola debacle. The omission makes me think that maybe HIStalk is not as impartial as it says it is.

Let’s be realistic: would your employer give you permission to speak off the cuff to a media outlet about an issue of great human, corporate, and legal sensitivity? Or if your spouse died of Ebola, would you want to see the hospital CIO prattling on about that tiny piece of the case that he knows something about? Ed contributes articles, but he’s not free to talk casually about his employer or the patients they see, no different than when nearly got fired by my hospital when I started writing HIStalk and a loser vendor complained to my boss that I was saying bad things about them (leading to my immediate interest in anonymity).

Keep up the music recommendations.

I’m heartened by several such comments since usually someone complains about anything even slightly off topic, always in the form of, “I don’t read HIStalk for …” as though I’m an HIT-posting robot banned from going off script. Sometimes I fantasize about starting a new, unrelated site about some topic I know next to nothing about just to see if I could make it interesting while learning about the topic.

Write shorter posts or write news daily to shorten the individual posts.

Both are tough for me. I only include items I think are interesting and I cover a lot of ground succinctly, so I’d have to cut something I think is worth reading. I used to write news daily, but readers observed that HIStalk wasn’t particularly special any more when it hit their inbox every workday. Lt. Dan posts morning headlines each weekday if you just want a quick skim to see the major news items without the usual commentary and snark.

It sounds like you think you need to change something. Whatever you do, keep the news, juicy gossip, and sly, somewhat jaundiced humor.

I’ve been writing HIStalk for 12 years, so sometimes I get the urge to try something different. Occasionally I see all of the movers and shakers out there doing cool stuff (starting companies, developing products, running think tanks, etc.) and feel a pang of regret that I’m a sideline reporter rather than a full-contact participant in those high-profile or society-benefitting activities. That usually passes quickly, though, and every day when I face that blank screen yet again with excitement and hopefully some creativity, I realize I how lucky I am to be able to something I enjoy in whatever way I want. I’ve learned to be happy with my place in the world.

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January 18, 2015 News 5 Comments

CommonWell Answers HIStalk Reader Questions

January 16, 2015 News 15 Comments

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David McCallie, Jr., MD, SVP of medical informatics for Cerner and co-founder of CommonWell Health Alliance, invited HIStalk readers to submit their questions about CommonWell. He obtained answers from the most appropriate CommonWell resource. These replies were provided by David along with Dan Schipfer (VP/GM of government for Cerner and CommonWell operating committee chair); Nick Knowlton (VP of business development for Brightree and CommonWell membership chair); Bob Robke (VP for Cerner and CommonWell treasurer); and Jitin Asnaani (director for Athenahealth and CommonWell operating committee co-chair).

How do organizations like CommonWell promote interoperable transfer of health information to non-members? If our goal is a national infrastructure for transfer of PHI, don’t these aggregations of health partners create barriers to a national solution?

From a strategic point of view, CommonWell’s founders created the network because they did not believe that any of the existing approaches met the need for national-scale federated query based on robust identity management and record locator services. CommonWell’s founders believe that regional and vendor-proprietary networks won’t meet the demand for universal query connectivity. In contrast, CommonWell membership is open to all HIT suppliers and their customers, nationwide. However, if other networks emerge that cover substantial portions of consumers, CommonWell is open to creation of bridging services that could interconnect with other networks.

More tactically today, we feel that CommonWell has already promoted interoperable transfer of health information by publicly calling out the important issue of the lack of a common patient identifier in US health care. Second, to advance the state of the art, CommonWell members have designed and published specifications that address the problem of the missing patient identifier. These specifications are available for any and all (i.e. members and non-members) to evaluate, improve, implement, and use under common open source licensing. 


Does CommonWell have any plans for taking the initiative outside of the US?

We’re taking it one step at a time. Currently, CommonWell’s focus is to deliver real-world interoperability services across the US.


Why did some folks refer to CommonWell (in its early days) as the "HIE killer" and is that still a valid point? Accordingly, do entities like Aetna (who has invested in Medicity) and Optum (with their Axolotl acquisition) consider CommonWell to be a threat?

It is difficult to speculate on behalf of “some folks,” but CommonWell is not attempting to “kill” any type of exchange. CommonWell is designed to offer a national-scale service because we believe that a patient’s provider should have access to that patient’s information regardless of where the information lives. Through this approach to “universal plumbing,” members can expect an increase in the access to health information for their providers and a decrease in the cost and time for providers and their patients to gain access to their health information.

By addressing shortcomings in existing exchange models (such as imprecise standards that inhibit vendor to vendor connectivity), CommonWell is drastically reducing time and associated expense to achieving health information exchange. Furthermore, in a world driving towards the triple aim, interoperability initiatives such as CommonWell are aligned with goals common to payers, patients, provider networks, and national healthcare delivery objectives.


How does CommonWell relate to the Argonaut project?

There is no formal relationship. The Argonaut Project is an industry-funded initiative to accelerate the development of technical standards (FHIR and OAuth) in conjunction with HL7. On the other hand, CommonWell is a trade association that is deploying a national network. The results of the Argonaut Project should complement CommonWell’s existing use of standards, which are partially based on FHIR, as well as on standard IHE profiles like XCA (for document-based exchange). The standards work stimulated by the Argonaut Project will be important to HIT in general. CommonWell hopes to leverage these new standards to provide enhanced services as they become formalized.


What fees will be collected for using CommonWell’s system, who pays those fees, and where does the money go?

CommonWell is a non-profit trade association that relies on two different fee sources to operate.

One is membership dues, as are common to most not-for-profit trade associations. The dues schedule is based upon an organization’s annual US HIT revenue and provides for the organizational expenses of running the Alliance. A more detailed breakdown of the membership fees is available on our website.

The second fee, a Service Fee, covers the cost of the core services provided by CommonWell to its members to facilitate data exchange and includes the identity management and record locator services. By doing this at the vendor level, CommonWell is able to achieve unprecedented economy of scale gains for streamlining connectivity. Members who provide access to CommonWell to their customers are free to charge (or not charge) for those services as they see fit. As a non-profit trade association, CommonWell has chosen not to mark up these costs to membership.

CommonWell cannot set the fees charged by member companies to their customers. However, our expectation is that those fees will be modest compared to the value of the services delivered and will be assessed in the “commodity service” philosophy espoused in our founding principles. As noted in CommonWell Board Chairman Jeremy Delinsky’s recent blog, athenahealth’s service fee equals about one-tenth of one-percent of their annual revenue.

What’s costly for everyone is the need to build numerous point-to-point interfaces and reinvent the wheel of patient identity management for every exchange scenario. Connecting once to a nationwide network, as the health care industry has done in other instances, has proven to be a better model for widespread data exchange.


Will EHR vendors pay a competitor (McKesson and CommonWell’s IT provider RelayHealth) to exchange information with other systems?

CommonWell Health Alliance delivers the services to the HIT members. RelayHealth is CommonWell’s initial contracted network service provider. As with any service offering that requires hardware and software, the services fees paid by the member to the Alliance help to offset the Alliance’s network service provider investment and compensate them for the costs of providing that service.


I heard it costs $2 million to become a member of CommonWell. What is the ROI for those members?

As noted above, if a vendor chooses to offer CommonWell Services to its clients, the vendor is charged a Service Fee in addition to the Membership dues. The Alliance currently charges an annual Service Fee to cover the cost of the core services. The Service Fee is based upon the Member’s annual HIT revenue. This annual fee allows the Member to onboard an unlimited number of clients onto the CommonWell Network.

CommonWell plans to publically post the Service Fee schedule on our website later this year, but for the vast majority of members, the costs will be far below that amount.


If I’m an Epic shop, what can CommonWell do that I can’t already do through Epic? What are the cost comparisons?

CommonWell provides a national-scale identity management service, nationwide record locator service, and universal connectivity to any vendor that offers the service. A single connection to the CommonWell network will enable providers and the patients they serve to access to their health information at all those various systems and organizations and won’t require peer-to-peer contracting for each provider you need to reach. The identity management and record locator services reduce matching errors and make it seamless for the provider since the patient does not have to remember the places where they have records. We don’t know of any single vendor network that can enable access to a patient’s health data regardless of where they have been seen.


Why would providers want a few publicly traded vendors running a fee-based backbone instead of pushing the government to create freely usable standards available to all vendors?

CommonWell’s founders believed that identity management and record locator services were necessary for effective national-scale query connectivity. Those services have to be organized and paid for by someone and the existing government-related approaches were not committed to delivering those services. Additionally, the founders believed that the vendor community was in the best position to “build in” support for efficient, seamless connectivity. The standards on which CommonWell is based are indeed freely available, but the national scale services that make those standards useful require an organization and appropriate organizational governance.


How are health plans and payers represented in the CommonWell alliance? Medicare’s risk adjustment have always demanded better access to and merging of administrative and clinical data. Now that the ACA demands risk adjustment for commercial population the need for this marriage is even greater. The ability for health plans to better assign risk to their members and the ability for providers to help close care gaps and meet their CMS-mandated obligations for data exchange can be greatly facilitated by providing improved attribution mechanisms for identifying members, providers, and specific encounters. And there should be a common means for plans to provide care gap info.

Right now, CommonWell is made up of 17 health IT vendor organizations, but we encourage membership to any organizations, including payors, that share the association’s values and vision for interoperability. In the early days of the Alliance, we had to remain focused on designing, building, and deploying our core services. These existing services offered by the Alliance are well aligned with offering improved delivery of healthcare for the nation, and that inherently provides benefits for all stakeholders – including patients, providers, and payors.

While this is a great start, we recognize that there are other opportunities to provide value for how healthcare is delivered and CommonWell certainly has an opportunity to build upon the established model to provide additional value. The Alliance welcomes participation from and conversations with payors and other healthcare stakeholders outside of the core EHR community. We have engaged early conversations with several payors that share our vision and understand how crucial interoperability and data liquidity are to improving care.

To complement this, the Alliance has established a process for reviewing member-proposed potential service line extensions and welcomes payors to help determine if the identity management and record locator services offered could add additional value to the patient populations represented by the members in the Alliance, through examples such as care gap closure, without compromising any of our core principles.


What factors convinced Cerner to join the CommonWell and what is Cerner’s play after the three years of free services?

The early days of CommonWell have been focused on getting the network deployed as widely as possible to ensure that meaningful health information is delivered. We understand that the value of the network depends upon how widespread the usage is. Cerner wants to remove as many barriers as possible to help speed deployment. Removing financial barriers to early adoption was a straightforward decision for us. After the initial three years, we expect that the costs associated with the services will be in line with other EDI like transactions and will be considered minimal in comparison to the value a client receives.

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January 16, 2015 News 15 Comments

Morning Headlines 1/16/15

January 15, 2015 Headlines No Comments

Google joins PwC’s Vista-based bid for military health records

Google will join PwC, General Dynamics, Medsphere, and DSS in their bid to install VistA as the DoD’s next EHR.

Whistleblower Lawsuit Calls Billionaire Patrick Soon-Shiong’s Healthcare Startup ‘Fraudulent’ And Dangerous

Two ex-employees of physician billionaire Patrick Soon Shiong’s startup NantHealth file a whistleblower suit alleging that the company is “engaged in a multitude of fraudulent activities.”

The new 10-year standard: Find a more accurate EHR total cost ownership

Becker’s Hospital Review calls for a change to the way total cost of ownership is calculated during EHR procurements, saying that five or seven year timelines are not long enough when in reality a successfully installed EHR won’t be replaced for ten years or longer.

Philips and MIT investigators collaborate to give researchers unprecedented access to critical care patient data

Philips is collaborating with MIT to provide researchers access to the de-identified medical records of 100,000 ICU patients that received care in one of Philips’s eICU centers.

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January 15, 2015 Headlines No Comments

News 1/16/15

January 15, 2015 News 5 Comments

Top News


PwC adds Google to its Department of Defense EHR bidding consortium that is pitching the VA’s VistA. Google joins, PwC, General Dynamics IT, DSS, and Medsphere. Google’s contribution would be collaboration and search tools, which seems to be more sizzle than steak as PwC tries to make VistA sound sexier to the DoD, whose contempt for that system is legendary. The group has also put up a web page to make its case.

Reader Comments


From Weird News Andy: “Re: Iowa health insurance startup, the second-largest co-op in the country and heavily funded by the federal government, fails. The key is in this quote: ‘CoOportunity Health’s pool of people was larger than expected, was sicker than expected, so their risk became much greater than the funds that were available.’ That’s an economics lesson. Sicker people spend more and choose the one that saves them the most money, so you end up with a pool of sicker, more expensive members. If the founders of the organization did not see this going in and did not charge enough for their service, the fault is theirs. But then if they charged more, fewer people would select them and …” That’s a big problem with medical insurance. The fingers of insurance company actuaries fly over their Excel worksheets in their attempt to assemble a customer base that includes lower-risk, healthier patients to offset the expensive ones so they can bid competitively. However, individual patients sign up expecting to use more services than they’re paying for, to the point of not even buying insurance until they’ve accumulated enough problems to make it worth their while. It’s like a buffet restaurant eyeballing prospective diners at the door in trying to choose a profitable mix of picky eaters and starving chowhounds for a predetermined price, but their downfall is that few picky eaters will pay for an all-you-can-eat buffet knowing they’re subsidizing those who inhale everything in sight.

From RVA: “Re: concierge medicine. My PCP is moving to concierge practice, saying he doesn’t want to use Epic and that he can’t provide good care because his face is always in the computer ((FYI, he cashed his MU check). The concierge company touts their USB chart that allows you to take your important clinical information anywhere — apparently MyChart was not good enough (the guy sitting next to me joked that when they run out of USB drives, they’ll switch to 8-track tapes). He has approximately 1,200 patients (mostly Medicare) and a poorly-managed practice. They showed a scary video about how doctors are ‘forced’ to give up their practices and referenced the use of ‘mid-level providers’ in a negative way. A lot of people ate it up and started pulling out their checkbooks – oh, he has limited capacity, so it’s first-come, first-served at $2,500 per year. I’m worried that we’re creating a class system where those who can’t afford the fee get less than premium care.” It’s tough to ignore economics by suggesting that those who pay less should receive equally generous, excellent, and responsive healthcare services, even though we as decent people wish that were possible. All of us working in healthcare expect to be paid, so unless we turn it back over to the nuns and counties that ran hospitals as true non-profits using cheap and volunteer labor, those days are likely gone. The ED is the last foothold of healthcare democracy, where everybody is treated the same based on need, but then again, it’s a cost cesspool for that reason and hardly a poster child for open access to all. Healthcare economics is like a balloon – squeeze it in one place to cut costs and another part bulges out as providers who are understandably unwilling to reduce their personal standard of living figure out new ways to charge for their services. We’re at three tiers now: (a) those who use ED and public clinics or who don’t buy insurance because they don’t see the immediate value; (b) the large middle class who have insurance but are getting hit hard by out-of-pocket costs and sometimes facing bankruptcy because of huge and often questionable bills, with that group subsidizing the first one by paying excessive charges and taxes; and (c) those whose assets are adequate to self-insure and whose time is valuable enough to make it worth finding the best and most customer-friendly providers who don’t take insurance. It’s unrealistic to expect the care and outcomes to be identical across all three groups. It’s also reasonable to expect people in the middle group to move down rather than up, and it’s the loss of that group that threatens to implode the system. It’s just like the tax system: some percentage of people pay nothing, the wealthy pay a low overall percentage because of their small numbers and large accounting tricks, and those in the middle foot most of the bill.

HIStalk Announcements and Requests

Last year right before the HIMSS conference I supported Donors Choose by offering companies a large, short-term banner that appears beside the HIStalk title on every page, using the proceeds to fund a bunch of projects for classrooms in need. It felt good and it was fun, so I’m doing it again this year. Contact Lorre if you’d like to book the most prominent ad on the page and help needy students in the process. Like last year, I’ll write up the projects we funded and share the student comments and photos that result.


I followed through on a reader’s suggestion of an HIStalk Book Club sort of thing where I review an HIT-related book and invite readers to share their thoughts. I reviewed Eric Topol’s “The Patient Will See You Now” and next up is “America’s Bitter Pill.” Read along, add your thoughts, and suggest what book I should read next. I have a copy of John Halamka’s “GeekDoctor: Life as a Healthcare CIO” that HIMSS sent me in return for completing a survey, so maybe that should be next.


I’m sure we’ll see this at the HIMSS conference: every hip meeting now includes a “graphics facilitator” who documents everything on a flipboard, compelling attendees to proudly tweet out photos of the drawing afterward. I don’t want to attend a conference where a cartoonist understands the presenter better than I do.

Here’s one last appeal for you to complete my once-per-year HIStalk reader survey, which takes just a couple of minutes but helps me immensely.


This is a fond farewell to Agilum Healthcare Intelligence, whose marketing person told us, “I’ve never even heard of HIStalk” in declining to renew their sponsorship after many years. They’ve been supporters for a long time and I appreciate it. I also appreciate the service of the marketing guy, who though he has zero health IT experience, is a former Army infantry captain who led a field artillery battery in Iraq, according to his LinkedIn profile.

This week on HIStalk Practice: Telehealth reimbursements are set to go live in New York. Tulane University Medical Group implements eCW’s CCMR. Etherapi takes advantage of the Kaiser strike in California. HHS breaks down its own silos, and enjoys flying first class. Dr. Gregg looks into the future of healthcare IT, circa 2037. Third-party patient portals go head to head with vendor-specific options. Thanks for reading.

This week on HIStalk Connect: 23andMe finds a new source of revenue as it closes a $60 million deal with Genetech in which it will use its dataset to support Parkinson’s disease research. Athenahealth acquires cloud-based inpatient EHR vendor RazorInsights, and confirms that it will move into the hospital space. Augmedix raises $16 million to scale a promising Google Glass-based telecharting business. 

Acquisitions, Funding, Business, and Stock


Todd Cozzens of Sequoia Capital is featured on Fox Business’s “Opening Bell” live from the JPMorgan Healthcare Conference. He mentions his firm’s investment in Health Catalyst (analytics) and MedExpress (retail clinics). A Forbes profile of Sequoia Capital mentions its 40-plus year history, including its 1980 investment in Apple’s IPO (the founder thought the 22-year-old Steve Jobs “looked like Ho Chi Minh”) and its recent gains from Airbnb, Dropbox, and WhatsApp. The firm’s partners make a fortune, apparently, as the article mentions a 2003 fund that returned gains of 41 percent per year for 11 years, with the firm’s partners pocketing $1.1 billion as “Sequoia is turning its own partners into billionaires while keeping outside investors purring.”


I mentioned that Athenahealth has acquired small-hospital EHR vendor RazorInsights for a rumored $40 million to give it an inpatient foothold. I really like what RazorInsights is doing in giving small hospitals an inexpensive, cloud-based system that covers both clinicals and financials, but I don’t see the benefit to Athenahealth in buying a four-year-old company with only a couple of dozen small customers. RazorInsights has much larger competitors (Meditech, CPSI, Medhost, NTT DATA, McKesson Paragon, etc.) with established infrastructure and most hospitals have already spent their money on a Meaningful Use dance partner, some of them even choosing to run Epic or Cerner as provided by another hospital (or to be acquired by those hospitals). Athenahealth has choked on its previous acquisition Epocrates, which is highly regarded but is stumbling even more than before under Athenahealth’s ownership. I think Athenahealth wants desperately to crack the inpatient market (after insulting that market for years), realizes it doesn’t have the expertise to build a new hospital system from scratch, and decided to spend money instead of time to get a name-plated product quickly to market and then ramp it up. The challenges are many:

  • RazorInsights is small for a reason and not being owned by Athenahealth may not be it.
  • Both product and company scalability are unknown.
  • Few big companies have low-enough overhead to profitably roll out products to cash-strapped 25-bed hospitals.
  • Expected synergies may (as they often do) prove to be elusive.
  • Companies have been historically lured into unwise acquisitions because the product aroused them technically and filled a perceived immediate need at high expense (Allscripts buying Eclipsys).

I think Jonathan Bush will talk this up as though Athenahealth is the next Epic (or Salesforce or whatever high-flying comparison comes to mind), but the acquisition is just another distraction as the company tries desperately to keep its Wall Street plates spinning in the air despite concerning profits and a year-long share price stall.


Aetna announces that it will raise its minimum wage to $16 per hour in April and will offer an enhanced insurance plan for employees who participate in wellness programs starting in 2016.



Two former NantHealth executives file a whisteblower lawsuit against billionaire doctor Patrick Soon-Shiong’s company, claiming that NantHealth is “engaged in a multitude of fraudulent activities,” violates HIPAA requirements, has failed mock FDA audits, and offers products that harm patients. Stephanie Davidson (former SVP of professional services) and William Lynch (former senior director of marketing) also claim that several customers were prepared to stop using the company’s Clinical Operating System, citing an internal report that characterized that product as “10 years behind in technology capability” that “runs on LUCK.” The pair claims that NantHealth’s marketing material is misleading and that Soon-Shiong’s charitable foundation defrauded Medicare by donating millions to a hospital that would then use CMS matching funds to buy NantHealth’s products. NantHealth’s responds that the employees, who are in a romantic relationship and had worked for the company for only a few months, demanded that NantHealth pay them $2 million to prevent them from launching a pre-IPO smear campaign after NantHealth fired Davidson. Perhaps it’s not a coincidence that the lawsuit was filed just as Soon-Shiong gave the company’s investor pitch at the JPMorgan Healthcare Conference.


Craneware says second-half sales for 2014 increased 10 percent and its board is confident of meeting 2015 expectations.



Good Shepherd Health System (TX) chooses Strata Decision’s StrataJazz for decision support and cost accounting.

Healthfirst (NY) selects InterSystems HealthShare as its HIE and clinical portal.

Providence Health & Services expands its relationship with Kyruus, which offers a doctor web search tool. That’s how I would describe their business, anyway, but if you don’t get enough buzzwords, here’s theirs: “Kyruus is an enterprise healthcare provider solutions company that helps health systems optimize their Patient Access, Referral Management and Care Coordination operations. Leveraging the cloud and a proprietary Big Data approach, the company enables the integration of massive amounts of information to create a single source of truth of providers. Kyruus helps health systems create customizable protocols for referral and scheduling across all channels of patient engagement to improve patient access and patient experience.”



Ralph Keiser (Deloitte) joins Recondo Technology as chief growth officer.


John Glaser (Siemens Healthcare) joins the board of the American Telemedicine Association.


Hayes Management Consulting hires Gay Fright (Coastal Healthcare Consulting) as VP of strategic services.


Huntzinger Management Group promotes David DiChiara to CFO.


Sachin Jain, MD, MBA (Merck) joins care plan CareMore as chief medical officer. He worked for ONC for a short time a few years ago. He said in a talk last week that most health IT startups offer products that are interesting but not really useful because (a) they’re trying to make a quick buck, and (b) they are mostly run by young, prosperous, healthy people and develop products in the context of their peers rather than for the sick, expensive patients that need help. He also said HITECH came about because everybody knew EHRs were good for patients, but hospitals put the interest of their resistant doctors first because they’re the ones who admit patients.


Ken Pool, MD, co-founder of OZ Systems and co-chair of the HL7 Public Health and Emergency Response Work Group, has died, according to a posting on the group’s listserv.

Announcements and Implementations

An article by Brad Swenson of Winthrop Resources Corporation suggests that the total cost of ownership of hospital EHRs should use a 10-year forecast rather than the more common five or seven years. It quotes The Valley Hospital (NJ) VP/CIO Eric Carey, who used a 10-year timeframe to make an upgrade-or-buy decision: “We felt no one should be replacing an EHR platform in less than 10 years unless a catastrophe happens. Also, probably the most expensive part of an EHR project is the army of consultants, staff, and project managers you need to have to pull everything together. Our implementation has involved 20 FTE over at least one year. Most organizations can’t afford to do that more than once.”

McKesson announces Paragon Community Plus, a package that includes its Paragon system, implementation, training, and remote hosting.

Government and Politics


A House Committee on Energy and Commerce work group creates a draft policy that would require HHS to pay for telehealth services at the same rate as in-person visits within four years.

Innovation and Research

Philips gives MIT researchers access to the de-identified records of 100,000 ICU patients who were monitored via its eICU program. The records, which represent about 10 percent of all US adult ICU beds, include vital signs, medication orders, lab results, and severity of illness scores.



Google stops public sales of Google Glass and moves the product from its research lab to a separate business unit led by former fashion and eyewear designer Ivy Ross. Companies and developers will still be able to buy Glass units after the January 19 cutoff date. Google was supposed to release a new version of Glass in 2015 but hasn’t provided specifics. People seem to think this is the beginning of the end for Glass, but I’m not so sure: it desperately needed a reboot, graduation from beta status, and design help for its ugly form factor (which is true of most things Google), so perhaps this is its graduation into the real world, or even away from the consumer market and into the enterprise one.

A guest newspaper article by the CEO of a Missouri public policy organization says the state is still #49 in economic growth despite being one of nine labeled as “the corporate welfare kings of America.” He says of the Missouri’s $1.6 billion subsidy of Cerner’s $4.3 billion new campus, “If Cerner needs a corporate pleasure dome, it should pay for it on its own nickel.”


I thought sure this was a spoof since it was heavy with Star Trek puns and one of the pictures features a nurse wearing a 1970s-style cap, but apparently the just-started IndieGoGo campaign for the $3,500 Warp 3 Medical Tricorder is for real. It’s not the X-Prize, Scanadu-type consumer Tricorder, though – this China-based one will be just for doctors and will provide vital sign, ultrasound, and EHR functions.



The local paper says that MultiCare Health System (WA) is not only represented on the advisory group IBM and Epic put together to help make their case to the Department of Defense as it selects its $11 billion EHR, but MultiCare will also serve as the pilot site should the IBM-Epic bid be chosen.


A physician’s New York Times editorial observes that 24 of the 141 medical schools in America are now named after big donors, causing graduates to be “embarrassed that there was a rich person’s name on their diploma, with the university name tucked below in small print.” Naming rights cost from $8 million (East Carolina University’s Brody School of Medicine) to $200 million (UCLA’s David Geffen School of Medicine, above). 

Sponsor Updates

  • Imprivata integrates its Cortext secure communications platform with the Citrix XenMobile enterprise mobility management solution.
  • HealthTronics selects AirWatch for enterprise mobility for its 500 employees.
  • ZeOmega is named as one of the 100 fastest-growing Dallas companies.
  • John Stanley of Impact Advisors is quoted in a San Diego newspaper’s article on the pros and cons of EMRs.
  • Divurgent will participate in the HIMSS East Tennessee Summit in Knoxville on January 22.
  • DataMotion covers the important role e-mail plays in file sharing in its latest blog.
  • CompuGroup Medical will participate in the Critical Care Congress in Phoenix, AZ from January 17-21.
  • CommVault expands its relationship with NetApp to offer integrated data protection solutions.
  • TechGig outlines CitiusTech CEO Rizwan Koita’s predictions for 2015 healthcare technology trends.
  • CareSync publishes a new blog on the importance of taking charge of a family’s health records.
  • Dignity Health VP/CMIO David Lundquist, MD offers insight into how to keep patients in mind when discussing the future of healthcare at AirStrip’s Mobile Health Matters blog.
  • ADP AdvancedMD offers “4 surefire signs you need a new EHR for MU2 and beyond” in its latest blog.

EPtalk by Dr. Jayne


It’s been a strange couple of weeks for me. We’re getting ready to go through some major changes at our hospital and everyone is on edge. Teams are being consolidated and it feels like the directors and VPs are playing a giant game of “Go Fish” only instead of cards, they’re playing with people. This comes right on the heels of our hospital’s push to reduce the number of accrued vacation days on the books, which had almost half of our employees taking significant time off during the last month or so.

Everyone is overworked and cranky as we try to make decisions based on forecast scenarios and half-developed plans. Sometimes we start to feel not only like the sky is falling, but that the world is burning down around us. We imagine it can’t possibly be this bad in other places. It’s difficult to reach out to colleagues at other organizations because we don’t want to admit that our own organizations are in frantic disarray.

It was in that frame of mind yesterday that I was trying to catch up on the ridiculous thing that is my inbox. I’m on staff at another hospital that’s not part of my health system. I almost got whiplash doing a double take at one of the emails I received. It was discussing the final steps of a system conversion they’ve been working on for years. They’ve been running dual platforms for the last six months during the transition and are finally pulling the plug on the legacy application.

Despite the robust features of the new system, the email wording left something to be desired. “Many fixes and enhancements have been done to NewApp to make it usable.” The email was sent out under the CMIO’s banner. Knowing him as I do, I’m pretty sure that’s not what he intended. I forwarded it to one of my colleagues – not as a way to humor ourselves at someone else’s expense, but as a confirmation that the people at our competitor across town are likely under the same pressures as we are. No matter how hard and how many long hours we work, things are falling through the cracks.

I thought about how fortunate I’ve been that during most of my time as a CMIO I’ve been surrounded by colleagues who are competent, confident, and motivated. I’ve always felt like they have my back and in turn I’ve had theirs. Over the last year and a half, however, it seems that everyone has been stretched thinner and thinner. We’re to the point where we can barely support ourselves, let alone each other. Although we’re certainly experienced in delivering the impossible, it’s become harder and harder to make it a reality.

Looking at the last few months in particular, not only has our energy been sapped, but we’ve lost some of our support structures. Our standing team meetings have been fragmented as we’re pulled in countless directions by competing demands. Those were our opportunity to update each other on our projects, potential risks, and needs. We received feedback and encouragement as well as ideas to remove blockers or handle difficult situations. Colleagues who had been in similar situations provided pointers and tips and lists of “gotchas” to look for.

I should have taken that email as a warning to stay vigilant. By the end of the day today, I watched one of my key projects go off the rails. In hindsight, I should have seen it coming, but I didn’t. Although ultimately it’s no one’s responsibility but mine, I can’t help but think that if we weren’t all so scattered and overwhelmed that someone else might have picked up on subtle signs that I missed. I spent most of the day with an impending feeling of doom and heartburn that made me want to eat a box of chalk.

I realized that given our current state of being overextended, under-resourced, and fatigued that it’s likely this isn’t going to be the last time something like this happens. This is an uncharted place that I’ve never had to operate in before. I’m officially working without a net and it doesn’t feel very good. But given the state of our industry today, I’m sure I’m not alone.

Do you have tips for how to work without backup? Email me.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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January 15, 2015 News 5 Comments

Morning Headlines 1/15/15

January 14, 2015 Headlines No Comments

Athenahealth Acquires RazorInsights

Athenahealth acquires RazorInsights, an inpatient EHR vendor that has been selling its cloud-based system in the critical access and community hospital market since its 2010 launch.

BT to Offer Medsphere’s OpenVista Electronic Health Record

Medsphere announces that it will partner with BT to begin offering hosted OpenVista systems.

GAO kicks off review of HIE performance

Senators Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) have asked the General Accounting Office to evaluate the effectiveness of state health information exchanges as the federal government’s $600 million effort to support their implementation winds down.

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January 14, 2015 Headlines No Comments

Book Review: “The Patient Will See You Now”

January 14, 2015 Book Review No Comments


I enjoy reading articles and tweets by technology fanboy Eric Topol, MD. He’s focused and intense. He’s always whipping out a smartphone-equipped EKG gadget on a plane or sticking a smartphone otoscope in Steven Colbert’s ear on TV. A lot of the tools he digs up seems to be of the “hammer looking for a nail” category and he’s created a nice gig for himself as a geeky critic of the medical establishment (even taking the AMA to task), but sometimes he comes up with ideas that might make a difference someday.

Topol is an undisputed thought leader. I like what he has to say even if I’m often skeptical.

Topol’s new book, “The Patient Will See You Now,” is an impressive (some might say “undisciplined”) romp through the healthcare technology garden. However, it fails to live up to its title, which suggests that savvy, responsible patients armed with cool smartphone EKG devices and fitness trackers have quietly wrested control of healthcare from the government, corporations, and providers of “eminence-based medicine” that make up the plodding and oppressive medical establishment. It’s a cute and gimmicky title, but it contains more hype than the book can deliver.

In fact, it sounds a lot like his earlier book (which I didn’t read) called “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” That one is three years old, so maybe everything in it came true and he moved on.

The book wanders around so much that the only overall sense I could make of it required me to summarize each chapter, as follows:

  1. Technology is widely adopted. Patients know their own bodies better than anyone.
  2. Doctors are trained to feel superior and to control the flow of medical information.
  3. The smart phone is like the Gutenberg press in democratizing and disseminating knowledge.
  4. Angelina Jolie’s decision to undergo a double mastectomy because of genetic testing was earth-shattering, but the FDA tried to shut down 23andMe because that testing completely ignored FDA’s inquiries about its marketing and its offer to help the company comply with US laws.
  5. I glazed over on Chapter 5 because it was a complex and questionably relevant primer on how genes work and how they can be used to personalize medicine. The bottom line: we should be doing more genetic testing for research and individualizing treatments.
  6. Silicon Valley darling Theranos is revolutionizing lab testing. People have the right to see their own information. They should also be informed about the radiation dosage in diagnostic imaging.
  7. Patients should be able to see their medical records. OpenNotes and Blue Button give that capability, but only 36 percent of patients can access their records and EHRs are primitive.
  8. Prices for hospital services and drugs are irrational and vary widely, especially when comparing high US prices to those the rest of the world pays. We have a lot of waste and spend a lot on treating complications.
  9. Telemedicine is cost effective and convenient, but doctors resist new technology just as they did the stethoscope when it was invented.
  10. Hospital stays, which are expensive and error-prone, are declining as surgeries move to outpatient. Technology allows care and monitoring to be moved to the home.
  11. People are willing to share their medical data for research, which will allow collecting and collating information to discover new research and best practices.
  12. People are selling and stealing medical data.
  13. Sensors can predict and track medical conditions.
  14. Cheap smartphone-connected technology will democratize medicine to less-developed countries.
  15. People own their medical data. Big employers should be using it to squeeze big insurance companies, but none have actually done that. Consumers haven’t mobilized. CMS and other administrative waste takes a lot of resources out of the system. Other countries will do better because of our archaic payment and regulatory model.

My frustration is that while the exhausting scattershot of technology nuggets is interesting (although hardly original since I’d heard of nearly all of them), it doesn’t prove the title’s hypothesis. It may well be that a few tech-savvy and demanding patients can convince their individual providers to let them get more involved in their care, but nothing suggests the presence of an unstoppable movement. In fact, while healthcare takes heat for being episode-based, a significant portion of consumers are even more episodic – they pay attention to their health mostly when something is bleeding, hurting, or swelling and then show up expecting a TV-like quick fix. The majority (especially the medically expensive ones) aren’t quantified-selfers or fully engaged participants.

A lot of people have smartphones, health apps, and fitness trackers, but those gadgets haven’t proven to make them healthier. Capturing and tracking information is just a tiny and easy part, as evidenced by the significant penetration of bathroom scales in the homes of overweight people. Patients (or consumers or whatever you want to call the 100 percent of us who will seek medical care at one time or another) can make consumer-like demands on their doctors, hospitals, and insurance companies, but I’ve heard few examples of where that actually accomplished anything other than possibly getting themselves labeled as a troublemaker.

People who receive medical services aren’t really pure consumers, so it’s not realistic to assume that the healthcare cheese can be massively moved by technology as happened in banking and entertainment. Patients don’t usually pay all their own bills. They go to whatever doctor and hospital the party that does pay (the insurance company) dictates, so threats to take their business elsewhere are usually hollow no matter how unpleasant or Luddite their doctors may be. Strap 10 smartphones with cool apps on your belt, pass out OpenNotes articles in the waiting room, and warn hospitals that they had better not make a medical mistake during your admission – your influence is still minimal despite being informed.

Topol’s broad observations and complaints aren’t really actionable. Patients have little control over the items listed above. The book title suggests that patients are in charge, and yet it’s still insurance companies authorizing payments, doctors entering orders and performing procedures, and the much-maligned medical establishment standing between patients and their maker. The healthcare system (or more correctly, the healthcare industry) was built around everybody except the patient. That establishment isn’t just going to step aside because patients carry iPhones. Any plan that requires people to voluntarily stop doing what they’re well paid to do will fail.

A few tech-powered concierge practices, retail clinics, and drug chains are threatening the status quo. They aren’t really scaring anyone. They may cherry pick a tiny bit of profitable business, but they aren’t much of a threat to health systems that keep buying up more providers and using their political influence as big employers to make sure they aren’t pushed away from the table. That’s the best hope for quick innovation that will reverberate through the hallowed walls, such as the real threat that Theranos will force high-margin hospital labs to either increase their efficiency or survive on a fraction of their current business.

Healthcare is like your car (at least if your car was built in this century). Your car is loaded with sensors (some of which, like the speedometer, you may conveniently ignore) and requires a computer to analyze its internal computer data stream. You can’t diagnose and fix it yourself when the idiot light comes on. You can study up all you want, but your only real decisions involve (a) whether you want to get it fixed, and (b) who you choose to fix it given your available options. You sit impatiently until the mechanic hands over a grease-stained list of procedures he or she performed along with a bill (as in hospitals, the computer that creates the bill is the most powerful one). All of that technology and data didn’t benefit you very much – it just generated more business for the mechanic, allowed him or her to work more effectively, and maybe avoided even more expensive repairs down the line. That’s pretty cool, but it’s hardly a revolution in empowering car owners.

That’s my takeaway from the book. Most of the technologies listed help doctors provide better care, assuming they are willing and able to use it. The role of their patients is, at best, to push for them to actually think about using genomics, following evidence-based medicine practices, reviewing their own outcomes information, and staying current on new medical developments. Patients, however, won’t usually voluntarily leave a doctor just because they don’t use an EMR or other gadgetry – that’s the art rather than the science of medicine – so it’s not really much of a threat.

Consumer choice in healthcare involves choosing the “best” provider to interpret, order, and perform procedures (or at least the “best” one willing to see you that your insurance covers). A doctor might be willing in the seven minutes you’re allotted for a return visit to look at your fitness tracker information, sit beside you as you Google your condition, or describe their charges to the price list from the MinuteClinic down the street. Don’t count on it. You’re only as empowered as is convenient for them.

Cardiologists make a great living and Eric Topol is no doubt excited to see his Scripps patients embracing technology and participating in their care, but it just doesn’t work that way for most doctor-patient encounters. People don’t get as broadly excited about health-related technologies as they might with social networking or music since the personal payoff is slower and less certain. Fitness trackers motivate and inform people who are already motivated and informed. Those aren’t the folks running up most of the country’s medical expenses.

Topol’s confidence that abundant technology will upend the US health system in favor of patients seems wildly simplistic. We can all – as patients and industry insiders – make a long list of what’s wrong with healthcare. That doesn’t mean we can change it through our individual actions. Healthcare is like the government in that it’s easy to identify what’s wrong, but hard to even agree on a solution, much less impose it against the will of far more influential people and corporations who are pretty happy with the present arrangement.

That doesn’t mean the book isn’t worth reading as a concise overview of what technologies are on the horizon. It’s good for that, at least for the next six months until it becomes outdated. It also doesn’t mean that Topol isn’t a passionate visionary because clearly he is. However, he could raise an army of fist- and smartphone-waving readers of his book who are upset with how most of us are treated as patients and health-seekers, but that alone won’t get our broken healthcare system fixed.

That’s my disappointment with “The Patient Will See You Now.” Reading it makes it easy to see what the future could be while knowing it probably won’t really happen, at least not in this country. I give it 3.5 stars out of five, docking it a half-star for an unrealistic title. Each chapter would have made a great blog post or magazine article, but I’m not finding them as compelling or entertaining in aggregate.

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January 14, 2015 Book Review No Comments

CIO Unplugged 1/14/15

January 14, 2015 Ed Marx 2 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Leadership and the Paradox of Shame

Ninety percent of successful business executives are driven by shame. Psychology Today defines shame: the painful feeling arising from the consciousness of something dishonorable, improper, ridiculous, etc., done by oneself or another. It’s an attitude toward self. Nobody needs to look long to see the roots and vines of shame snaking through my life.

Shame is a powerful motivator. I was afraid to being a failure, so I graduated in the top 20 percent in the corps of engineer officer academy. I dreaded being last in any race, so I drove my body until I reached Team USA status. I feared disappointing my parents, so I strove to be a senior vice-president. One boss told me I wore the wrong clothes, so I revamped my wardrobe to keep from being harassed. Shame became my identity.

It begins in youth. We are shamed by parents, educators, coaches, friends, and clergy. If we chose to believe the lies, our identity falls prey to …

The paradox of shame. On one hand, it’s an emotional prison. On the other, it’s a fuel for success.

I was led to believe I was never good enough. Never as smart as my eldest brother and sister. I never could score as many soccer goals as my middle siblings. For every mistake and failure to meet his expectations, Dad shamed me. If a scoop of ice cream slid off my cone, Mom called me an idiot. They labeled my adolescent tomfoolery criminal. They didn’t know any better.

The year I earned my master’s degree and got promoted to Army captain was a big deal for me. Yet my mother exclaimed, “You still have to prove yourself.” Shame was my parents’ subconscious method of motivation.

Following their ingrained model, I leveraged shame to my advantage. I had to prove to men that I was a man. I had to prove to women that I was desirable. I had to prove to the world that I was worthy of accolades. Shame drove me to accomplish some amazing things. In order to feel good about myself, I had to be number one in everything. All false beliefs.

I even used shame in my leadership practice. I’d shame others to get the results I desired. I subtly made people feel bad under the label of motivation. While the intent was OK, the technique was pitiful. I would belittle and criticize others openly. Often, it was not so much what I said but my body language. I would make others feel bad until they relented and did things as I wanted them done.

The day someone exposed my shame, I embraced it. Twisted thinking! I loved the benefit. The power. If I let go of shame, what would happen to my drive? How would I motivate my staff? Would I still be number one? Would I still accomplish great things? Would men still admire me and women find me attractive?

Crazy, right? It’s called deception.

Shame infiltrated my DNA. Can I reverse the curse? Yes! But at what cost? At what benefit? Is it worth the risk? What if I fail? What if I lose the admiration of friends, family and industry? What if it costs me all that I have gained?

I’ve really been searching and examining myself. How do I escape shame? How do I stop shaming others?

It comes down to releasing myself and others to be who they were created to be. If that means I’m not president of the United States, so what? If I don’t make the team, so what? If people no longer seek me out, so what? Easier said than done.

Truth: better to live in freedom than in bondage to a lie. Shame creates a void that will never be filled despite the drive it creates. And for a leader, the higher status you attain, self-deceit can spiral out of control. The only way to escape this vortex of deception is to jump. Forget what others think. It is about you and me being who we really are, despite title.

Then how do we fill the void once we denounce shame? It zeros back to identity. Figure it out and live who you were created to be. To be self-reliant is to dig a deeper hole and still never be good enough. Instead, reach out for help. Continuously explore faith. You’ll be a work in progress, as am I. Messy, yet loveable. Redeemable. Worthy.

Thoughts on work relationships and the keys to escape:

  • Acknowledge shame-driven ways (you might need to ask a friend).
  • Apologize for manipulating through shame.
  • Replace shame with sincere encouragement.
  • Do not tolerate shame from others.
  • Exhort your teams to be all they can be, no strings attached.
  • Tell them it’s OK to be something different than what you may have wanted
  • Surround yourself with truth-tellers who will call you out on shame tactics.
  • Hold fast to your true identity.
  • As you become free, they will become free
  • When you remain imprisoned, so do they.

One more thing. I believe it is probable that by operating in the opposite spirit of shame, your teams will shine brighter than you ever envisioned! They may not look or act like you, but they’ll be free to be their best. Better to be mortal and free rather than super successful and emotionally imprisoned.

Shame is the new “Hotel California.” You can check out any time you want, but you can never leave.

Thankfully, there is an escape route out of the vortex. Break free with me.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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January 14, 2015 Ed Marx 2 Comments

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  • Cerner Reader: Mr. H, you have no idea how many spontaneous internal emails I got about this poll, mostly from people who read HIStalk ...
  • John Lynn: Great suggestions. I think email is such an underestimated tool for communicating with them. Although, not all email l...

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