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HIStalk Interviews Gadi Lachman, CEO, TriNetX

August 21, 2017 Interviews No Comments

Gadi Lachman is CEO of TriNetX of Cambridge, MA.

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Tell me about yourself and the company.

I was born in Israel. I served in the Special Forces there. Everybody starts as a soldier and a few become officers. I was lucky to become one.

I studied accounting and law. I turned around my father’s business, which was educational services. He was a big entrepreneur there. Then I came to the United States. I did my MBA at Harvard and was a Baker Scholar. I worked at Lehman Brothers, and after that, a lot of technology IT companies, always in the healthcare space. A lot of healthcare IT, all either in extreme build-out mode and extreme growth or turnaround situations. I live in the Boston area with my wife, my three kids, and my dog.

How is technology changing the clinical trials enrollment process?

It’s technology, it’s data, and it’s a huge desire for change. All good people, all trying to develop therapies for the benefit of patients. Structural problems in that industry make it very hard to be successful, to develop good therapies in a short timeframe and at an OK cost, not at a cost that’s skyrocketing and goes up and up.

The main structural impediment to the success of this industry is the fact that each part of that industry tries to do the best job themselves, but the collaboration between the different industry players has been minimal and tactical. You have hospitals and institutions that have a lot of data, but it has been hard to use that data in an efficient way in the drug development process. You have players that need that information, but develop very tactical relationships with the healthcare organizations on the side.

We are a Novartis vision and a Novartis idea. They wanted to disrupt the clinical trial design space. Some of the reasons that clinical trials fail are good reasons. Some drugs and therapies should never be developed. They’re just not effective. It’s OK and good for those things to fail as soon as possible so people can move on quickly.

But a lot of times, the development of good drugs and good therapies is failing for the wrong reasons. It’s failing because of bad protocol design and bad trial design because the wrong sites are being selected.

We were created to solve the bad reasons for which some of those processes are failing. Novartis’s vision was, and our vision is, that a solution to big problems has to come from collaboration at the strategic level that did not exist before we came. Hence, what we do and what we’re trying to solve and disrupt. We’re building a global network of collaboration between pharma companies and companies that serve them, such as the CROs and HCOs. When I say HCOs — healthcare organizations — those are mega-hospitals, those are big institutions that see a lot of patients and have access to millions and millions of patient records.

The idea was that the only way to solve the big problem is to bring all those players to the table strategically. We are almost a club. Everybody brings different things to that club and gets different points of value from the club. Only by doing something like that, we believe, can you tackle a really big problem.

What can a large health system do differently in being in a network with other players?

By joining a network like that, you help support the process of designing an efficient protocol with real-world data, which is data that has been generated in real care settings as opposed to lab-generated data. You’re going to get more visibility to all the pharma members of that network, which means you’re going to get more study opportunities. You don’t have to take every opportunity pharma is giving you, but now you have the privilege, by joining the network, to see more opportunities in the therapeutic areas that are interesting to you.

A few of the sites that are members of our network got more than 50 trial opportunities from pharma and CROs that they would otherwise not get. Did they elect to participate in all those 50? Absolutely not. But now they can be more selective. They can decide to participate in trials that are interesting to them and try to give more hope to their patients any trials that they think they can be successful in delivering. As an HCO, you become part of a deal flow of studies that are coming your way.

Second, and I didn’t know this when we started the company, we’re living in the era of networks. Because everything is precision medicine, every cohort is getting smaller and smaller. Every therapy is becoming more and more directed at smaller subsets of the population. If you’re just one site — even if you have access to data of three or four or five million patients — it’s just not good enough. You start to look at the rare disease cohorts that you have and it’s not enough to get any insight.

Sites that join us get the privilege to be able to collaborate with other sites and share data, so if there is a rare disease that you have five patients, but you add another five sites to your network, now your researchers at the site can see data from 30 patients and that is very meaningful. That’s another reason they join us – not just to get more business from pharma and CROs, but so they can do a better job researching cohorts that they can’t do by themselves.

A third reason is that we are giving the sites very powerful tools to conduct clinical research. Before we came, their researchers needed to use suboptimal systems with very limited insight. We are giving them a user interface and the ability to query large amounts of data in a way that makes a lot of meaning for those that are interested at the HCO, not just to take care of and treat patients, but also to make progress with research and to move the boundary forward.

What do you think of organizations such as UCSF that are mining the wealth of data from their EHRs and other systems to look for new drug uses or correlations between genomics and disease states?

That’s exactly why we have TriNetX, absolutely. I wholeheartedly believe in that. Everybody who works for me and myself, we’ve all lost family members for therapies that were developed and brought to market a few years later. It’s also relevant for us as people that want to live longer and with high quality. A lot of the data to make a big impact is already available — it’s just no one was able to make it available.

I’ll give you a few numbers. We have more than 55 huge HCOs joining us that have together more than 80 million patients from all over the world. We have sites in the US, Germany, Hungary, Italy, the UK, Israel. We just recently signed Singapore. We’re building global collaboration and we’re giving it back to the researchers because they will come up with the questions and they will come up with the answers. They will find the correlations that no one even thought to ask and no one even thought made sense in the first place.

To do something like that, you’ve got to be able to harmonize tons of data all over the world. Demographics are important in our mission. There are populations from a demographic standpoint that are being under-represented in studies, and therefore the therapies that are being developed could potentially be less relevant for them. By building a global network that has all nationalities and all those different types of patients, you can start finding correlations between things, again, that you didn’t even think to ask.

I feel we hit the market at the right time. Maybe if we tried to do that 10 years ago, people would have been shy about that. Today, it’s the opposite. They are very savvy. They want to collaborate. They want to come together into a gigantic network. Not everybody is fortunate to be a part of the UC system, so you want to be part of something bigger. We are providing them with that opportunity and they get a ton of capabilities in return, exactly like that collaboration that you mentioned.

Will the FDA’s role change as study cohorts become virtual and study methods change?

Absolutely. I think if you look at the history of development of therapies from fighting bacteria to finding a way to live with HIV, things that used to take 50 years then take five and three and two years if everybody’s really in it together and doing things differently. I think the FDA and every regulatory body was doing extremely important work to protect the safety and balance all those different forces from that ecosystem. They’re starting to take a look at those technologies and those access points to data that we provide and figuring out that some things could be accelerated. Some trials could be conducted in real-world settings. There are alternative ways to understand the potential positive or negative impact of therapies and drugs and they are much more accelerated and they’re cheaper, potentially, on massive quantities of data.

If you think about it, there are so many trials being conducted today where nobody is calling them a trial. Every time an off-label drug is being recommended or prescribed, there are a lot of interested parties that would love to know the effectiveness of that off-label behavior, including those that are prescribing it. It just wasn’t able to be a reality a couple of years ago, but our vision is to make this a reality. To be able to take all this data and bring it back to the people that need to see that.

It’s not just the FDA,  just to add another facet to your question. You have people and players that avoided research because they couldn’t afford to be part of that, to license those technologies, or they never had access to the data. But by making it available in such a broader way, you will bring more participants into this research community, and I think only good things will happen from that.

What can we learn from the disproportionate success of Israel-based entrepreneurs and startups?

One is a mindset. I did work on that when I did my MBA, not to say I’m an expert on the entrepreneurial success of Israel and why, but there are structural components to the success there. One, as an example, the lack of natural resources and the need on the military side to compete with enemies that are 10 times your size. If Israel will always have one tank and the nations surrounding it have 10, then it means that one Israeli tank needs to take out 10 tanks in order for Israel to prevail.

How do you trade effectiveness of 1 to 10? The answer is mostly technology. Israel was always forced to take technology to the cutting edge in order to survive. All those military technologies and a lot of that mindset, even if it’s not a military technology, transpires. You have a lot of entrepreneurs and a lot of new ideas.

Also in Israel, everybody has to serve in the military. You get that mindset. When you leave the Army, you still have that mindset. You are OK daring and trying to do new things and trying to get that 1 to 10 ratio that you were taught in the military that that’s what you need to have in order to survive.

Having your back against the wall, the need to be an innovator or die, and the access you had to like-minded people and cutting-edge technology — you can then bring it back and try to do other things with that.

Do you have any final thoughts?

I would love all the players to always, in the end, think of the patient. That should drive every decision they make, more than financial decisions, more than “this is my data and I’m not letting anyone touch it,” more than “I’ll be the biggest I can be, but maybe I don’t need to collaborate with anyone else.” If there’s something I pray for, it’s that alongside corporate decisions, P&L decisions, financial decisions, and this and that, people always go back to that inner soul that they have and that helps drive some of the big decisions as well. I think it will help a lot.

Morning Headlines 8/21/17

August 20, 2017 Headlines 2 Comments

The Appointment Ends. Now the Patient Is Listening.

The New York Times covers the growing trend of patients recording their own medical appointments so that they can revisit the conversation in the future.

Trends in Laboratory Information Systems

A small survey of laboratory managers and directors find that 60 percent are currently looking to replace their existing LIS.

Bedside portal at WellStar reduces patient anxiety, lowers costs

A local paper covers the WellStar (GA) implementation of Epic MyChart across its hospitals.

MCMC may sell visiting health services

Mid-Columbia Medical Center (OR) is considering options for its unprofitable home health agency, which it says is difficult to improve because it runs a different EHR than the hospital, making care coordination cumbersome. The hospital is on Epic, and migrating the agency to Epic would reportedly cost $750,000.

Monday Morning Update 8/21/17

August 20, 2017 News 4 Comments

Top News

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The New York Times reviews patients recording their doctor visit for their later review.

The article notes that one family practitioner records patient visits himself, then uploads the annotated recordings to a secure web platform that patients and family members can review at any time. He says the de-identified recordings could help researchers find ways to improve medical communication.

University of Texas Medical Branch at Galveston buys recorders and batteries in bulk and offers them to cancer patients, with 300 of them accepting the devices each year. The program will be expanded to internal medicine and geriatrics.

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The article describes how a neurosurgeon records his visits on an iPad and posts them to a platform he created called Medical Memory. He says half of the patients watched their videos more than once and its use has cut the practice’s malpractice insurance costs in half. 

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A recently published research proposal describes a Dartmouth project to develop a platform that would store visit recordings and use machine learning to tag their specific elements, such as the treatment plan.


Reader Comments

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From Nutmeg Grater: “Re: Allscripts. This is their new, top-secret EHR. Two years of work and just recently deemed not ready to demo at ACE. I wonder if they forgot about this website?” The Care Otter website doesn’t mention Allscripts specifically, but (a) some of the folks whose bios are listed hail from there, and (b) I found a cached copy of a since-removed API documentation page whose FHIR API license agreement lists Allscripts as the licensor. The company touts its “bleeding edge technology” and data science. The group’s address is, per Google Maps, a defunct steakhouse in Litchfield, IL. Their job postings list technologies such as Azure, Power BI, Apple’s Swift 3, the Xamarin moble app development platform, and reactive programming. Care Otter’s LinkedIn lists 56 employees, including former Allscripts engineering SVP Jeff Franks as president. Here’s a YouTube video highlighting Silicon Valley aspirations with dogs running around the office, free snacks at the bar, impromptu kite-flying, and collaborative slouch-ready furniture in what they call the “SiloCorn Valley.” I like the strategy of putting a creative group in a freewheeling setting far from corporate overseers, although the ultimate success measure is whether Care Otter earns market share.

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From ACD_Fan: “Re: Epic. Our local hospital seems to be moving to it under the Community Connect program of Parkview Health Systems in Fort Wayne, IN. Another Paragon client jumps ship.” DeKalb Health’s web page says it is moving to Epic.

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From Turnaround Failure: “Re: Presence Health. Word on the street is that Presence Health will announce Monday its merger with Ascension. Bet that Advocate, North Shore, and Northwestern will have something to say about that.” Unverified. The struggling 11-hospital Presence, created by the 2011 merger of Provena Health and Resurrection Health Care, announced plans earlier this month to sell two downstate hospitals to OSF HealthCare. I think Presence uses Epic, while Ascension is mostly Cerner.


HIStalk Announcements and Requests

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I ran a reader’s query last week about the status of Cerner PowerInsight. The company provided this response, although the referenced HealtheEDW does not appear anywhere I could find on Cerner’s website:

PowerInsight Explorer is still available and widely used across Cerner’s US and global client base as a real-time reporting tool for Cerner Millennium. Cerner’s go-forward enterprise data warehouse, HealtheEDW, was released in 2011 and built on the source-agnostic cloud platform HealtheIntent. PowerInsight EDW will be supported in the US and sold globally as Cerner transitions legacy clients to HealtheEDW and stands up the cloud platform in global markets.

I received these responses to the reader’s question about FHIR specs:

  • Much better than HL7’s old-style PDF bundles. Faster to navigate, easier to reference in our own documentation.
  • I’m confused by what Sweet Ride is asking. I’ve done next to nothing with FHIR, having spent most of my career working with 2.x and V3/CDA, so maybe I’m looking at the wrong specs but the FHIR specs I’m looking at on hl7.org (starting with http://hl7.org/fhir/) are HTML and seem to me to be well-organized and easy to use. It’s definitely different than the PDFS HL7 used to use but I find it easier to navigate than previous specs – particularly V3/CDA.
  • Anything is better than the current format.

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It’s probably a lost cause trying to take the term “cloud-based” back to its original technical meaning as companies have turned it into a loosely-defined marketing slogan. Clustered says that while it really just means “in our basement instead of yours” and marketing departments have abused the term, it’s still accurate although incomplete, requiring prospects to perform due diligence.

New poll to your right or here: which of these inpatient EHR vendor companies do you admire most? I’ve hidden the interim results this time to hopefully decrease desperate ballot box stuffing. Feel free to add a comment explaining your choice.

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Welcome to new HIStalk Platinum Sponsor Image Stream Medical. The Littleton, MA-based company’s technology connects providers with visual information and collaborative insight that allows them to make better decisions and to spend more time caring for patients. Solutions include procedure space integration, procedure recording, medical virtual presence for teaching, live video streaming, real-time room status, clinical video and image content management, video editing, and integrating procedure and video images with EHR, PACS, VNA, and other repositories to create a unified patient record. Healthcare systems benefit from increased clinical efficiency, reduced risk, improved patient safety by automating tasks, and reduced infection risk in allowing observers to participate outside the procedure room. The company, acquired by Olympus Corporation of the Americas in May 2017, just announced MedPresence, a virtual presence solution that allows surgical and interventional clinicians to connect and collaborate virtually. Thanks to Image Stream Medical for supporting HIStalk.


This Week in Health IT History

One year ago:

  • Gartner predicts via its Hype Cycle that the technologies that will most quickly find mainstream adoption are machine learning, software-defined anything, and natural language question answering.
  • Promedica (OH) attributes its swing to a big first-half loss on the cost of implementing Epic, while MD Anderson Cancer Center (TX) also blames Epic-caused higher expenses and lower patient revenue for its 77 percent drop in net income.
  • A Medscape physician EHR survey finds that Epic is the most-used by far, Allscripts falls from #2 to far down in the list in user scoring, the VA’s VistA is the top-rated EHR overall, and VistA and Epic lead the pack in connectivity.

Five years ago:

  • NextGen President Scott Decker resigns following the addition of dissident shareholder representatives to the board of parent company Quality Systems.
  • Walgreens announces plans to deploy an customized version of Greenway PrimeSuite as its pharmacy EHR.
  • University of Michigan Health System names Sue Schade as its new CIO.

Ten years ago:

  • Congress gives the VA $1.9 billion for EMR and DoD integration, with the Appropriations Committee calling for blocking any EMR expenditures for software that won’t work with DoD systems and for the VA to work with private software companies to improve interoperability and mobile apps.
  • West Penn goes live on Eclipsys.
  • Misys licenses iMedica’s PM/EHR to get a small-practice system to market quickly.

Weekly Anonymous Reader Question

I got a ton of responses to “best musical group or performer seen live,” so I will excerpt (the asterisked ones were named more than once):

  • Prince*
  • Depeche Mode*
  • Bruce Springsteen*
  • Rolling Stones*
  • Led Zeppelin*
  • Moody Blues*
  • Garth Brooks*
  • U2*
  • Pink Floyd*
  • Billy Joel and Elton John*
  • Paul McCartney*
  • Adele*
  • Santana*
  • Radiohead
  • Nine-Inch Nails
  • AC/DC
  • Journey
  • Tedeschi Trucks Band
  • My Morning Jacket
  • LCD Soundsystem
  • The Who
  • Living Colour
  • Nektar
  • Grateful Dead
  • Genesis
  • Annie Lennox
  • Jason Mraz
  • Dead Kennedys
  • Earl Scruggs Review
  • Train
  • Chicago
  • The Wiggles
  • Soundgarden
  • Bryan Ferry
  • Lindsey Buckingham
  • Ray Charles
  • Paco de Lucia
  • John Prine
  • Arcade Fire
  • Ed Sheeran
  • Mark Knopfler
  • Tragically Hip
  • Meatloaf
  • The White Stripes
  • Kid Rock
  • Styx
  • Beyonce
  • James Taylor
  • Steve Wonder
  • Godspeed You! Black Emperor
  • Kendrick Lamar
  • The Clash
  • Sarah Brightman
  • John Mayer
  • Phish
  • Great Big Sea
  • Shinedown
  • Alanis Morrisette
  • Red Hot Chili Peppers
  • Jethro Tull
  • John Hiatt
  • Steve Winwood and Traffic
  • Savages
  • Jimi Hendrix
  • Neil Young with Booker T and the MGs
  • Uncle Tupelo
  • The Old 97s
  • Gladys Knight and the Pips
  • Big Head Todd and the Monsters
  • Coldplay
  • Brian Wilson
  • J. Geils
  • Air Supply
  • Guns N Roses
  • Clarence Clemons
  • The Rippingtons
  • Metallica
  • Lynyrd Skynyrd
  • Bee Gees
  • Iron Maiden
  • Frank Zappa
  • Melissa Etheridge
  • The Eagles
  • Jimmy Buffett
  • Aretha Franklin
  • Van Cliburn
  • Dixie Chicks
  • Gil Shaham

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This week’s question:  what is the most memorable, creative, or effective thing you’ve seen a HIMSS conference exhibitor do to drive business, establish relationships, or create buzz?


Last Week’s Most Interesting News

  • HIMSS Analytics data shows Cerner holding a slight edge over Epic in overall US hospital count, but Epic handily leading in large-hospital customers, total beds served, and doctors that use its ambulatory EHR.
  • Google buys Senosis Health, which is developing smartphone sensors and apps for diagnosis jaundice, reduced lung function, and low hemoglobin.
  • NIH awards Children’s Hospital of Philadelphia an NIH grant to mine databases to look for causes of pediatric cancer and birth defects.

Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately instead of waiting for reports to be written and double checked for possibly inaccurate information. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

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


Acquisitions, Funding, Business, and Stock

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Investment research firm Hedgeye picked up the rumor I ran last week from reader At Last an Alias that Baylor Scott & White will replace Allscripts with Epic starting in the next few weeks, saying another research company confirmed the rumor with Allscripts. The firm’s tweets say that Allscripts has lost two of its top five Sunrise customers in the last six months (New York-Presbyterian and now BSW, assuming they have confirmed the rumor), with those two health systems representing 12.5 percent of all US Sunrise business with their 19 hospitals and 7,000 licensed beds. They tweeted out the graphic above (click to enlarge) that shows the top 25 Sunrise customers and indicating which are at risk. The elephant in the room is obviously Northwell Health (the former North Shore-LIJ) which along with University Hospitals are the only two of the top six Sunrise customers that haven’t already announced plans to replace it with Epic or Cerner. The former Baylor Health System is the only part of BSW that still runs Allscripts following its 2013 merger with Epic-using Scott & White.

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Meanwhile, Hedgeye speculates on the identity of the puzzlingly unnamed six-hospital system that Allscripts announced as a new Sunrise customer in its August 3 earnings announcement. NantHealth’s Patrick Soon-Shiong bought struggling six-hospital Verity Health in July. The company later worked out a deal that allowed Allscripts to trade back its devalued $200 million investment in NantHealth for the FusionFx software suite and NantHealth’s promise to buy Allscripts products. The Allscripts 10-Q form says its Q1 bookings growth was almost entirely driven by “a large new multi-year relationship with a commercial partner that was executed during the second quarter of 2017.”


Decisions

  • Enloe Medical Center (CA) will switch from Meditech to Epic in 2018.
  • Erlanger Bledsoe Hospital (TN) will go live on Epic in October 2017.
  • Erlanger East Hospital (TN) will go live on Epic in 2017, replacing McKesson.
  • Virtua Memorial Hospital (NJ) will go live on Epic in the spring of 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Announcements and Implementations

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A new Reaction report from a survey of 119 people (most of them lab managers and directors) covers trends in laboratory information systems, concluding that best-of-breed LIS vendors such as Sunquest, SCC, and Orchard are at significant risk as a shocking 60 percent of LIS customers overall say they are considering replacing systems, with many of those likely to move to their EHR vendor’s offering in enterprise decisions made by executives instead of lab managers. Sunquest is listed as having the highest risk of contract replacement and the lowest net promoter score among the best-of-breed vendors as well as the lowest mindshare among all vendors that offer LISs, while the report notes that Epic has massive mindshare despite its KLAS-leading LIS offering that is just five years old. Orchard leads the NPS scores of all vendors by far, but it’s a tiny sample size. The report concludes, “It’s also not unreasonable to expect continued (although modest) consolidation, as the writing may be on the wall for some best-of-breed LIS vendors, causing them to seriously consider finding suitors among the EHR vendors.” Allscripts is now in the LIS business with its acquisition of McKesson EIS that includes a lab system as well as a blood bank module that Epic says it will never develop. Allscripts has previously offered Orchard LIS to its Sunrise customers. 


Technology

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Amazon releases a developer toolkit for Alexa that provides programming interfaces for adding hands-free voice control to software products.


Other

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An Atlanta-area business paper profiles the use by several area WellStar hospitals of Epic’s MyChart Bedside, in which the hospitals give patients a tablet that contains care team bios, meds, lab results, vital signs, and treatment schedules.

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MaineGeneral Medical Center (I detest that spelling) blames a technical error for its sending of nearly 10,000 bills of under $25 to a collection agency.

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US tourists are apparently being served tainted or drugged alcohol at upscale, all-inclusive resorts in Mexico’s Riviera Maya, sometimes resulting in crimes being committed against them. The story says nobody in Mexico really seems to care, including the resorts themselves, as visitors are assaulted, extorted by police, fall victim to drowning, or are regaining consciousness only to find unexplained broken bones or other injuries and no memory of the preceding hours, all after minimal alcohol consumption and often with simultaneous symptoms among group members. The US State Department has issued a Mexico travel warning about tainted alcohol and the Mexican government confirms that up to half the alcohol consumed there is produced illegally. Tourists report frustration at the indifference of the resorts when they report problems, the upfront cash required to obtain medical treatment at hospitals, and the fact that nobody ever gets arrested even though the tourists file reports in person with the local police departments.

When injured tourists turned to police, an instinctive step for many Americans, they were often stonewalled again. For starters, resorts in Mexico don’t typically call law enforcement to the scene. Vacationers have to take complaints to the police station. The few who did encountered further indifference: Nothing to investigate. It was an accident. You were drunk. In one case, a woman who was sexually assaulted by a hotel security guard … said the police chief overseeing her case seemed genuinely concerned and determined to help her … The chief tried to get the Iberostar Paraiso Maya resort to cooperate with the investigation and to provide photos of security staff. Frias was shot dead in his squad car months later. Local news reports said it was likely a killing meant to intimidate law enforcement.

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The money-losing visiting health service of Mid-Columbia Medical Center (OR) says its use of a non-Epic EHR while the hospital uses Epic is hard since physician care plans don’t move electronically, but the service is still not willing to spend $750,000 to implement Epic.

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I’m surprised that the names and logos of these healthcare services companies haven’t earned the attention of Epic’s legal team.

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Potential jurors being interviewed by attorneys involved in the securities fraud case against pharma bro Martin Shkreli had some interesting comments recorded, although perhaps some of them were just grandstanding to get out of  jury service:

  • I’m aware of the defendant and I hate him.
  • He’s the most hated man in America. In my opinion, he equates with Bernie Madoff with the drugs for pregnant women going from $15 to $750.
  • I just walked in and looked right at him and that’s a snake.
  • I believe the defendant is the face of corporate greed in America.
  • I don’t think I can [judge him impartially] because he kind of looks like a dick.
  • The only thing I’d be impartial about is what prison this guy goes to.
  • I just can’t understand why he would be so stupid as to take an antibiotic which HIV people need and jack it up 5,000 percent. I would honestly, like, seriously like to go over there …
  • It’s my attitude toward his entire demeanor, what he has done to people. And, he disrespected the Wu-Tang Clan.

A hospital visitor in China is detained by police after posting online criticism of the price of the cafeteria’s meals, saying he “wanted to faint” when he saw the small portion of his $2 bowl of noodles, adding, “Poor quality, expensive prices, little food – is this still a hospital for the people?” After the man’s arrest, local police reminded Internet users that it is illegal to post false information online although they didn’t actually say he was lying. The article reminds me of how weird hospital cafeterias are: (a) they are just about the only place other than grocery store food bars to sell some foods by weight; (b) they don’t allow free refills on their overpriced drinks; (c) they are often outsourced to companies accustomed to serving low-bidder meals to prisoners and high school students, outfitting their unsmiling employees in jaunty, chef-like attire to suggest culinary artistry instead of the heating of frozen institutional entrees; and (d) they are passionate about portion control but indifferent to taste, customer experience, and wiping down tables and chairs between occupants, some of them wearing scrubs bearing materials you would not want near you while eating. There’s a challenge for you – send me photos of whatever you find weird about your hospital’s cafeteria.


Sponsor Updates

  • Redox will exhibit at Health:Further August 23-24 in Nashville.
  • Impact Advisors employees donate 385 pounds of personal care products to troops deployed overseas.
  • The SSI Group will exhibit at the NC HFMA Summer Institute August 23 in Myrtle Beach, SC.
  • Sunquest Information Systems will host its users group meeting August 21-24 in Tucson, AZ.
  • Visage Imaging publishes a new whitepaper, “Can you? Visage can. Volume 1: Speed.”
  • Medecision is named to the 2017 IDC Health Insights HealthTech Rankings Top 50.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 8/18/17

August 17, 2017 News 3 Comments

A Start-Up Suggests a Fix to the Health Care Morass

The New York Times profiles Aledade, a startup founded by former National Coordinator for health IT Farzad Mostashari, MD.

Strategic partnership enables physicians to conduct clinical research and offer new clinical therapies to their patients

Allscripts announces a partnership with Elligo Health Research that will allow users to enroll patients in clinical trials managed by clinical research organizations.

Mylan Agrees to Pay $465 Million to Resolve False Claims Act Liability for Underpaying EpiPen Rebates

EpiPen manufacturer Mylan will pay a $465 million fine to settle a false claim act for intentionally misclassifying EpiPen as a generic drug to avoid paying rebates to Medicaid.

Cerner selected as Medical Center’s new electronic health record provider

St. John’s Medical Center (WV) choses Cerner Millennium CommunityWorks as its next EHR.

News 8/18/17

August 17, 2017 News 12 Comments

Top News

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The New York Times profiles Aledade, started by former National Coordinator Farzad Mostashari, MD, ScM.

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The piece calls Aledade a tech startup (it has raised $75 million in investor funding), which seems incorrect since technology is just a tiny part of its ACO program to improve healthcare quality and reduced cost via its primary care doctor participants. The profile was run in the Technology section of the paper.

Aledade gets paid only if it saves Medicare money, which didn’t happen in 2016. Second-year results are due in October and Mostashari says he expects the company to generate revenue then.


Reader Comments

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From At Last an Alias: “Re: Baylor Scott & White. Replacing Allscripts with Epic starting in October, estimated to take 18 months. I think this just refers to the 10 owned facilities. The North Texas ambulatory practices (aka Health Texas Provider Network) converted from Centricity to Epic in October 2016.” Unverified.

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From Sweet Ride: “Re: FHIR. Older health standards are published as PDF or text documents, but FHIR has developed a new format for sharing specs that has the same look, feel, and functionality as the FHIR Standard for Trial Use, which they believe will be preferable to their developer audience. Our organization is trying to decide if we should move fast or slow to this format for our FHIR specs given that most hospitals and vendors aren’t used to FHIR yet and may prefer PDFs. Any chance you could run a survey to get input from your readership?” I set up a survey for those willing to help Sweet Ride out. I don’t know anything about it, so maybe we could all stand some enlightening from those who do.

From BI Watcher: “Re: Cerner PowerInsight. Did they quietly discontinue it? I’m looking at the latest KLAS analytics report and there’s no mention of it. It was listed last year, albeit with dismal scores.” I don’t know, but I bet someone who does will respond.


HIStalk Announcements and Requests

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Blain Newton of HIMSS Analytics is providing great information on EHR vendor footprints, which I appreciate. Here’s his latest, responding to an HIStalk reader who wondered about total inpatient beds served by vendor (click to enlarge). The dominance of Epic and Cerner is obvious.

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Here’s a view comparing 2012 market share by bed count vs. that of 2016. Meditech and Allscripts each lost 15 percent of their bed coverage over those years as hospital EHR uptake was booming, while McKesson customers stampeded for the door (and into the arms of Cerner and Epic) as the company lost nearly half of the beds it was covering in 2012. Both Cerner and Epic gained a lot of business, but Epic jumped most significantly (120 percent) to lead the pack. 

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This last graph shows the utter dominance of Epic in terms of physicians using its ambulatory EHR and the dismal failure of Cerner to make a respectable showing.

I’ve also asked Blain if he can identify the fastest-growing large health systems/chains and which system they use corporately (which would foretell vendor footprint gains for doing nothing but watching their customers grow). It would also be really interesting to add up the total revenue of each vendor’s customer base as an even better indicator of customer footprint, but that sounds like a daunting project. Fascinating stuff. It’s pretty cool that Blain is willing to share this information given that HIMSS Analytics is in the business of selling rather than gifting it. I certainly appreciate it.

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An anonymous HIStalk reader donated to my DonorsChoose campaign. Her money plus matching fully funded the first project below and provided the remaining funds needed to complete the other three:

  • Beginner robotics and STEM activities for Ms. M’s first grade class in Knoxville, TN
  • Tolerance and individuality books and study desks for Mrs. P’s first grade class in Williamsburg, VA
  • Educational materials for teaching tolerance through STEM exploration for Ms. P’s first grade class in Orlando, FL
  • Frederick Douglass autobiography books for the tolerance project of Ms. O’s high school class in San Antonio, TX

I’m growing increasingly impatient at articles – most of them written by inexperienced industry newbies, some of them submitted to me as Readers Write articles aimed at a C-level audience – whose authors think they are insightful in reciting dull, plainly obvious facts, often to pad out questionably valuable articles. I’m a harsh self-editor perpetually in “just the facts” mode and such journalistic flab drives me nuts. Here’s a sampling from some of those sites that elicit an instant “duh” when I read them:

  • Get everyone on the same page.
  • Now is the time to start steering toward actionable information for the sake of clinicians and, even more important, the patients that IT, administrators, executives and caregivers all serve.
  • The barriers to EHR implementation and interoperability are slowly coming down and once they do, vendors will start looking to add more functionalities to the systems.
  • Improved healthcare interoperability is a top priority for providers, policymakers, and patients in 2017.
  • Getting a footing in the health IT industry is more challenging than it looks.
  • Care coordination between healthcare settings can have a significant impact on patient care.

This week on HIStalk Practice: Amazing Charts decides to sunset InLight. AdvancedMD develops physician reputation management tool. HHS celebrates National Health Center Week with grants to centers across the country. Aledade partners with local PCPs to launch New Jersey ACO. DuPage Medical Group welcomes $1.45 billion investment. UnitedHealthcare helps fund telemedicine services at Kansas FQHC. Prescription management and delivery service company Phil raises $10 million. New Jersey Academy of Family Physicians President believesphysicians are shouldering too much of the opioid epidemic blame. AMA President David Barbe, MD shares his frustration with home state of Missouri’s PDMP efforts.

Listening: Ayreon, progressive metal rock opera from a Netherlands-based virtuoso who “casts” singers to portray “characters” that perform only in studio since the “band” never appears on stage. With one exception: they’re playing their first-ever actual concerts September 15-17 in the Netherlands featuring 16 singers, including the incomparable Floor Jansen of After Forever and Nightwish. 


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Vince and Frank put their usual expert and brutally honest spin on “Allscripts’ ‘Repeal and Replace’ of McKesson’s EIS” in Thursday’s webinar. We had a bunch of people watching live and the boys answered their questions at the end, guaranteeing that your one hour of watching the YouTube video will be well spent. I tuned in for a quick look and ended up hooked into watching the entire presentations.


Acquisitions, Funding, Business, and Stock

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Israel-based Medaware, whose technology warns a physician when their drug order appears to deviate from the normal prescribing patterns of similar patients, raises $8 million in Series A funding, increasing its total to $12 million. 

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Revenue cycle technology vendor ESolutions acquires RemitData, which offers comparative analytics.

Forbes names Salesforce as the world’s most innovative company for 2017.

EpiPen maker Mylan will pay $465 million to resolve False Claims Act charges that the company intentionally misclassified the drug product as a generic drug to avoid paying rebates to Medicaid.


Sales

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St. John’s Medical Center (WY) chooses Cerner Millennium CommunityWorks, explaining that it “began seeking an alternative EHR vendor when industry events called into question the hospital’s ability to ensure that support from the vendor would continue to be available.” I believe they are (soon to be were) a McKesson (soon to be Allscripts) Paragon user.

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Gwinnett Medical Center (GA) chooses ROI Healthcare Solutions to provide around-the-clock support for its legacy systems during its new EHR implementation.


People

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The Strategic Health Information Exchange Collaborative names Kelly Thompson (Pennsylvania Department of Health) as CEO.

Verisys hires Joe Montler (McKesson) as SVP of sales.


Announcements and Implementations

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Glytec earns its fourth FDA clearance for components to Glucommander, the core of its patented EGlycemic Management System: a titration module for enteral nutrition patients, an insulin-to-carb ration titration for outpatients, a more streamlined transition of inpatients from intravenous to subcutaneous insulin therapy, and general enhancements to the user interface, workflow capabilities, and messaging.

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Allscripts will offer its EHR users access to clinical trials via integration with the trials recruitment system of Elligo Health Research.

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Sunquest Information Systems will resell automated laboratory testing software from Software Testing Solutions.


Other

A St. Louis podiatrist who owns a company that services nursing homes is sentenced to 90 months in prison and ordered to repay $7 million for creating an EHR that automatically logged diseases and symptoms the patients didn’t have and for pressuring his employed podiatrists to provide unneeded services. His attorney wife is already in prison for the same conspiracy and the company’s CEO and four of its podiatrists are awaiting sentencing.

A 31-year-old restaurant owner is charged with assault after a cardiology clinic’s front desk employee told him his test wasn’t covered by insurance, after which he grabbed her computer monitor (luckily, it was a flat panel) and threw it at her.

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I was amused by this newswire photo, which suggests that VA Secretary David Shulkin, MD rushed right over from hospital rounds to appear in a White House photo op, stethoscope poking conspicuously from his pocket. I have to laugh when doctors who clearly have no use for a stethoscope – such as administrators, psychiatrists, and dermatologists – still drape one over their shoulders or hang it prominently from their pocket to make sure everybody reflexively genuflects. At least Shulkin is an internist and still sees patients, according to some reports. My early experience in rural community hospitals was that the biggest quacks we had on staff – mostly foreign medical graduates back then when standards were low and they didn’t even have to take US boards – were likely to strut around in stiffly starched, name-embroidered lab coats adorned with stethoscopes, perhaps for convenience in pronouncing dead the patients they were mismanaging with a stunning mix of incompetence and arrogance.

A Jackson Memorial Hospital (FL) respiratory therapist is arrested for attempting to view child pornography on a hospital computer that a co-worker had left logged on. There was no happy ending to the story — he couldn’t even see the material he was arrested for seeking because the hospital’s web monitoring software blocked him (doh!)


Sponsor Updates

  • Medecision Chief Marketing Officer Ellen Dalton will speak at a Technology Association of Georgia Marketing roundtable September 6 in Atlanta.
  • Meditech and Parallon Technology Solutions will exhibit at the HIMSS Summit of the Southeast August 23-24 in Nashville.
  • Navicure will exhibit at the Azalea Health annual user conference August
  • Optimum Healthcare IT interviews Jon Morris, former SVP/CIO of WellStar Health System.
  • Imprivata joins the CommonWell Health Alliance.
  • NTT Data begins accepting applications for its global Open Innovation Contest.
  • Nvoq will exhibit at Aprima’s annual users conference August 18-20 in Dallas.
  • Clinical Computer System, developer of the Obix Perinatal Data System, will exhibit at the Indiana AWHONN State Conference August 25 in Plainfield.
  • Uniphy Health appoints Ken Fishbain (Cardiothoracic & Vascular Surgical Associates) to its health advisory board.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 8/17/17

August 17, 2017 Dr. Jayne 1 Comment

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The Office of the National Coordinator continues to advocate for strengthening the health IT workforce. The September 6 webinar will review workforce training materials that were available to the more than 9,000 people who participated in recent programs on population health, care coordination, interoperability, and analytics. Registration is open, and as a participant in one of the educational programs, I’d say it’s worth a look.

In other government news, the Medicare Quality Payment Program hardship application for the 2017 year is now available. Applications must be submitted by October 1, 2017 to avoid payment adjustments in 2018. I continue to run across providers that aren’t sure if they qualify for a hardship exception or not, so if you’re in the practice management or operations space, do your docs a favor and make sure they understand.

Physicians who are in the know have been very happy with the CMS final rule that makes the use of 2015 Edition certified EHRs optional for Medicaid Meaningful Use in 2018. Depending on vendor status, many practices were looking at having to upgrade their EHRs prior to January 1 so they could complete full-year reporting on a 2015 Edition system. The requirement now calls for a 90-day reporting period for Meaningful Use measures. Although Clinical Quality Measure reporting is still full-year, providers can now use 2014 Edition, 2015 Edition, or a combination of Certified EHR Technologies. It’s a welcome reprieve for organizations that are suffering from change fatigue and who may lack the resources to manage an upgrade along with other clinical and business initiatives. Although that change was documented in a final rule, unpublished guidance seems to indicate that practices that are part of the Next Generation ACO program can use either 2014 Edition or 2015 Edition CEHRT.

It’s been a relatively busy time in governmental circles, with the Department of Veterans Affairs also announcing their new telehealth project, “Anywhere to Anywhere VA Health Care,” which will permit VA providers to treat patients across state lines using telehealth technology. Providers can practice across the country within their designated specialty scope of practice. They also released their new VA Video Connect app. Veterans can use their mobile devices to access 250+ VA providers at nearly 70 sites across the country. Although solutions like the app have the potential to reduce travel hardships for veterans, they assume adequate capacity. If providers don’t have adequate time for patient care, simply shifting away from in-person encounters isn’t going to be a solution.

There’s also been action in the Senate to authorize a CMS Innovation Center project to boost use of certified EHRs in the behavioral health space. Psychiatric hospitals, community behavioral health centers, clinical psychologists, and social workers would be encouraged to expand EHR use along with residential and outpatient mental health and substance abuse treatment facilities. The 2009 HITECH Act didn’t apply to many mental health treatment organizations, which may help explain low rates of information sharing between behavioral health and other providers. A parallel bill has already been introduced in the House. Hopefully both will begin to work their way through the House and Senate committees soon.

One of the exciting parts of being in the healthcare information technology space is watching researchers come up with innovative solutions to difficult problems. Laboratory medicine is a big part of clinical informatics, so I was glad to hear about a new technology for Zika virus testing in the field. Researchers from Washington University in St. Louis are using nanorods to develop a test that can provide results without electricity or refrigeration. Proteins attached to the nanorods change color when exposed to Zika virus-containing blood. Although the initial study was very small, it shows a great deal of promise. I was also glad to see the varied affiliations of the authors – mechanical engineering, anesthesiology, and biochemistry/molecular biophysics. The engineering and biophysics fields are expanding rapidly and make great areas of emphasis for premedical students who aren’t sure about their future in patient care.

Speaking of laboratory medicine, LOINC is looking for experts to join four new special topics workgroups. The groups will meet monthly and provide recommendations to the LOINC Committee. Workgroup topics include: Document Ontology, which looks at the framework for displaying clinical results; LOINC ShortName for addressing situations where LOINC codes need to be stored or exchanged but the ShortName is not appropriate; Cell Marker Naming for review of ambiguous terms; and High-Sensitivity Troponin, which will look at the best way to model cardiac assays in LOINC. Workgroups start August 30 and more information can be found on the LOINC website.

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I haven’t been able to attend the MGMA conference in years, the last time being when it was in San Antonio. For those who can’t make it to Anaheim for MGMA17, there is an opportunity to attend remotely via MGMA 2017 Monday Live. Registration is $350 for MGMA members and includes access to the general session and several breakouts. Advertising collateral mentions the opportunity to not only listen to sessions but to “network with your peers,” which might be a little challenging given the virtual environment.

Virtual environments are less of a barrier for the one-on-one contact of telehealth. Employers are gravitating toward inclusion of telemedicine services in employee benefits plans. The Large Employers’ 2018 Health Care Strategy and Plan Design Survey estimates that nearly 96 percent of employers will offer telemedicine services in states where it is permitted, with more than 50 percent including behavioral health as part of the offering. More employers are also offering on-site health centers. My local school district is piloting an on-site employee clinic that received a fair amount of traffic in its first year. They haven’t made a decision to expand, but will continue to pilot during this academic year.

Do you have access to an employer-based health center? Have you had the occasion to use it? Email me.

Email Dr. Jayne.

Morning Headlines 8/17/17

August 16, 2017 Headlines No Comments

Docs, Hospitals Respond to CMS Retreat on Bundled Payments

CMS announces plans to eliminate several Obama-era bundled payment programs designed to test the impact of bundling some cardiac and orthopedic health services payments.

Healthcare data breaches caused by hacks are on the rise

Cyberattack-related data breaches at healthcare organizations have increased 162 percent so far in 2017, according to data from OCR.

Questions About The FDA’s New Framework For Digital Health

Health Affairs analyzes the FDA’s new Digital Health Innovation Plan.

Express Scripts to limit opioids, concerning doctors

Pharmacy benefits manager Express Scripts intends to limit the number and strength of opioid drugs prescribed to first-time users as part of a broad effort to curb the opioid epidemic.

Morning Headlines 8/16/17

August 15, 2017 Headlines 1 Comment

The Effects of Terminating Payments for Cost-Sharing Reductions

The Congressional Budget Office issues a report forecasting the financial impact that halting federal payment of cost-sharing subsidies to insurers selling plans on public exchanges will have, concluding that premiums would climb 20 percent in the first year, and continue to raise slightly more in years later.

Children’s Hospital of Philadelphia to Lead New Pediatric Data Resource Center for Research in Childhood Cancer and Structural Birth Defects

The NIH is funding a big data project led by the Children’s Hospital of Philadelphia and the Center for Data Driven Discovery to discover causes of pediatric cancer and structural birth defects.

Bolton NHS Foundation Trust selects Allscripts to enhance care and clinical engagement

In England, Bolton NHS Foundation Trust has selected Allscripts Sunrise EHR.

Physicians Healthsource, Inc. v. Allscripts-Misy’s Healthcare Solutions, Inc.

A physician practice, described by an obviously annoyed presiding judge as “a professional class-action plaintiff”, has filed a class action lawsuit against Allscripts for sending junk faxes without opt out instructions.

News 8/16/17

August 15, 2017 News 7 Comments

Top News

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The Congressional Budget Office scores the expected impact of the White House’s threat to stop paying Affordable Care Act-mandated cost-sharing reductions:

  • Insurers would pull out, leaving 5 percent of the country with no access to exchange insurance.
  • Premiums would increase 20 percent in the first year.
  • The federal deficit would increase by $194 billion through 2026.
  • The number of uninsured people would increase slightly in 2018 but then start moving slightly lower in 2020.

CBO qualifies its prediction based on how and when the White House stops making the payments, which the President has incorrectly described as “insurance company bailouts.”

The big takeaway is the deficit estimate. Paying premium subsidies based on income actually saves the country money.

CBO adds that President Trump’s CSR threats alone have already driven premiums up since insurers are required to request approval for their 2018 prices now.

The House of Representatives sued over the ACA’s cost-sharing reductions in 2014, arguing that the payments are illegal since Congress never appropriated the money to fund them. That case remains open.


Reader Comments

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From Keelhauler: “Re: cloud computing. Thought you would enjoy this.” I did, thanks.

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From Surprise!: “Re: Allscripts. Layoffs today of around 60 worldwide. Some senior people had their positions eliminated. Pretty eventful couple of weeks with the Paragon and NantHealth stuff.” Unverified, but reported by several readers. I reached out to the company’s media contact, who responded, “Allscripts does not discuss rumors or speculation,” which leaves the rest of us to do so without its participation.

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From Life’s Changing the Ocean Floor: “Re: [health IT site name omitted]. Seems to be dead.” Sure does. Googling turns up no user outrage or fond reminiscing, which suggests that its demise was not untimely.

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From Pacifico: “Re: Caradigm. LinkedIn shows that several top execs, salespeople, and security team members have left. GE is taking over, cutting headcount and leveraging shared services.” Unverified. I compared the company’s September 2016 leadership page to the current version – the 13 executives are now down to seven, of whom two are new.

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From Gaslighter: “Re: market share by hospital size. Were those numbers for US hospitals only? Wondering since Meditech has a significant presence in Canada.” Blain Newton of HIMSS Analytics, who provided the count, says the numbers cover only domestic hospitals.

From Supine on the Sand: “Re: market share by hospital size. The most meaningful stat is the 500+ bed hospitals since they often take smaller hospitals with them when they choose a vendor, which is why Meditech and Siemens (Cerner) have lost hospitals. Number of beds is most important since it equates better to the number of people – particularly doctors – who use the systems. Meditech is in big trouble because it has no ambulatory presence and Cerner, too takes a hit with ambulatory. Epic is much stronger than Cerner because of its 500+bed dominance and its ambulatory market share. I would love to see market size by beds and by ambulatory doctor count.” I mentioned your interest to Blain and he’s going to analyze EHR vendors by total beds and total physicians, so watch for that. I think Meditech can maintain its relevance for those hospitals that can’t manage the complexity or afford the cost of Epic or Cerner, but I agree that Meditech waited too long to conclude that the offering of partner LSS – which Meditech later bought – wasn’t the integrated ambulatory answer many of its clients and prospects were looking for. All three companies have common traits: they offer single-platform products for nearly every hospital service, they rarely acquire companies (“never” in the case of Epic), and they run on a single database. Those characteristics seem obviously desirable with 20-20 hindsight, but were lost on now-lagging competitors who were busily milking their cash cows, buying and nameplate-integrating anything that moved, and waltzing with Wall Street.

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From EclipsysGal: “Re: Chad Eckes. Glad to see an IT leader move into the CEO role.” Chad takes the CEO role at Pinnacle Dermatology, a private equity-backed dermatology practice in the Midwest that hopes to expand to 100 locations. He has served time as CIO of Cancer Treatment Centers of America and EVP/CFO of Wake Forest Baptist Medical Center (NC).

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From Vaporware?: “Re: MHS Genesis pilot sites. I found this testimony from March that says interoperability at Fairchild is through the legacy JLV portal via logging into AHLTA. Future plans include moving the legacy portal into Genesis. Fair to take that as a ‘no’ on CommonWell?” I’ll invite knowledgeable readers to chime in since I don’t know much about the DoD and the planned interoperability with the VA once they’re both on Cerner. It may be that workarounds are necessary until Genesis is live at all DoD facilities.

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From Eco Chambers: “Re: nonsensical terminology. I submit ‘ecosystem’ or ‘hyper-convergence.’ Where does this stuff come from?” I suspect someone (probably folks aspiring for cleverness in their books or articles) spends a lot of time coming up with words they hope will spread virally. Unfortunately, that sometimes happens, replacing perfectly serviceable and accepted words with cute new ones that only a marketer could love. 


HIStalk Announcements and Requests

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I thought my old Plantronics USB headset was failing since my new laptop wouldn’t recognize it (it wasn’t failing, as it turned out – I fixed the problem by deleting and reinstalling the latest version of the motherboard’s audio driver). I wanted a more comfortable headset since I often listen to music for hours while writing HIStalk and remembered that the best one I’ve owned was a gamer version. My solution: the fantastic EasySMX PS4 for $18.99 (for some reason, it’s gone up to $28.99 since last week). The driver-free headset’s deep ear cushions eliminate room noise while pumping out impressive bass from its 40mm driver with a cool option to vibrate as well, which I like. I’m rocking out to the much richer sound.

Listening: new from former Oasis singer-songwriter Liam Gallagher, whose Lennon-like brilliance is tempered by bizarre behavior that should make him a top pick in the rock dead pool. I’m also enjoying the immensely talented Sia, who is suddenly a global superstar at 41 (you’ve surely heard her stunning tropical house hit “Cheap Thrills” or “Chandelier”) after writing songs for other stars and battling personal demons.

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The healthcare relevance of the folks HIMSS chooses for keynote speakers often puzzles me and Magic Johnson is no exception. His accomplishments, as far as I can tell, were (a) surviving HIV when most other patients didn’t, and (b) getting rich off basketball and the business deals he struck after he retired (I’ll skip his awful 1998 TV talk show, whose low quality and alarmingly short tenure was eclipsed only by the pitiful late-night efforts of Chevy Chase and Pat Sajak). At least he has directed some of his attention toward social causes and that alone will probably make his speech interesting. He’s on the agenda for Friday of HIMSS week, with the absence of most of us dearly departed attendees providing an intimate setting for those stalwarts can never get too much time at conferences or in my least-favorite city.

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Thanks to HIStalk sponsors EClinicalWorks and ZappRX for upgrading their Gold sponsorship to Platinum.

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Thanks to Nuance, which apparently dropped their long-held HIStalk Founder sponsorship by mistake and have reconnected as Platinum since their original spot had already been snapped up by the time they realized it.


Webinars

August 17 (Thursday) 2:00 ET. “Repeal and Replace McKesson’s EIS.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The brutally honest and cynically funny Frank and Vince will analyze the Allscripts acquisition of McKesson’s EIS business. They will predict what it means for EIS’s 500+ customers, review what other vendors those customers might consider, describe lessons learned from previous industry acquisitions, and predict how the acquisition will affect the overall health IT market. Their 2014 webinar on Cerner’s acquisition of Siemens Health Services has generated over 8,000 YouTube views.

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


Acquisitions, Funding, Business, and Stock

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Credentialing technology vendor Silversheet raises $5 million in Series A funding, increasing its total to $10 million. I interviewed CEO Miles Beckett, MD just over a year ago since I was fascinated that he created the “lonelygirl15” web series that ruled YouTube in 2006-2008.

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A Goldman Sachs report says Amazon’s initial healthcare ambitions may involve partnering with a pharmacy benefits manager to optimize prescription ordering and delivery. The report also speculates that Amazon could provide patient monitoring and telemedicine visits via its Echo that would then allow patients to order the drugs prescribed. It also says Amazon could be interested in using the patient data it collects to cross-sell products, which wouldn’t be the day’s best privacy news.

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Google buys Seattle-based Senosis Health, which was developing apps that use smartphone sensors for diagnosing newborn jaundice, reduced lung function, and low hemoglobin levels. Those apps have yet to earn FDA’s marketing clearance.

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Medication management technology vendor Swisslog Healthcare makes an unspecified investment in managed telepharmacy solutions vendor PipelineRx. 

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Personalized health behavior change technology vendor Happify Health raises $9 million in funding.

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Dublin, Ireland-based Clanwilliam Group makes its 13th medical technology acquisition in three years in buying digital dictation vendor Medisec Software, which is a supplier to NHS.

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CHOP spinoff Haystack Informatics closes an additional funding round to expand the rollout of its privacy solution, which analyzes EHR activity logs to identity potentially inappropriate user activity.

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Clinical research organization PRA Health Sciences will pay $520 million to acquire Symphony Health Solutions, which resells prescription data of 280 million US citizens to drug companies who use the information to market their products to doctors.


Sales

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St. Luke’s University Hospital (PA) will implement MModal’s Fluency Direct EHR-integrated clinical documentation as it moves to Epic in 2018. St. Luke’s CMIO James Balshi, MD calls MModal’s platform “cloud-based but not cloud-dependent.” 

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Children’s Hospital New Orleans (LA) selects Vocera’s smartphone app for secure text messaging and hands-free communication.

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Saint Luke’s Health System (MO) will expand its FormFast implementation in rolling out the company’s electronic signature product.

In England, Bolton NHS Foundation Trust chooses Allscripts Sunrise.

MIT’s student and faculty ambulatory care center chooses Cerner Millennium and HealtheIntent.


People

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Libby Curtis Webb (Copatient) joins ZappRX as SVP of product.


Announcements and Implementations

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Children’s Hospital of Philadelphia (PA) will run an NIH-funded project to mine big data to look for causes of pediatric cancer and birth defects, with partner organizations running several data portal, genomics standards, and analytics sub-projects that will combine clinical and genetic sequence data from several cohorts into a centralized database.

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PatientPop – which offers practice-building tools – adds the ability for Google searchers to schedule an appointment directly from the practice’s Google My Business listing that shows up to the right of the search results.

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Navient subsidiary Xtend Healthcare buys HIM and revenue cycle consulting firm Elipse.

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A technology paper profiles Phynd, with founder and CEO Tom White explaining its provider data management solution. The company’s Phynd a Doc consumer search function is used on Duke Health’s website (above).

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The Tennessee Hospital Association and Audacious Inquiry launch ConnecTN, which will share real-time ED visits and hospital admissions among THA’s hospital members and TennCare.

Apple is reportedly talking to Aetna about making the Apple Watch available for free or at a discount to the insurer’s customers, which would extend the program beyond Aetna’s wellness program that covers its 50,000 employees.

Optimum Healthcare IT opens a managed services office in Duluth, MN and is profiled in the local paper.

OpenEMR enhances its open source EMR to operate as an out-of-the-box cloud services solution using Amazon Web Services, providing benefits that include automatic scaling of computational resources for cost effectiveness, cutting edge network security, zero hardware maintenance, easy software deployment, and robust backup and recovery solutions.


Privacy and Security

The Department of Justice demands that web hosting company DreamHost turn over the personal information of 1.3 million visitors to an anti-Trump website, ordering the company to provide IP address, contact information, photos, and emails.


Technology

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Microsoft defensively downplayed a Consumer Reports estimate from last week that 25 percent of its Surface tablets and laptops experienced problems – which caused CR to withdraw its “recommended” rating – but internal Microsoft documents suggest that Microsoft was fully aware that the Surface Pro 4 and Surface Book have high customer return rates. Here’s some easily-remembered advice: never buy hardware from Microsoft other than keyboards, mice, joysticks, and Xbox components. The rest of their lineup is stuff other companies sell better and cheaper (unless you still believe the Zune was a great digital media player and subscription music service).


Other

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The HR SVP and an interim hospital CEO of Broward Health (FL) quit following the resignation of an SVP who had been accused of overpaying a politically connected marketing company by $1.7 million in a secret side agreement. The health system’s then-CEO committed suicide 18 months ago, after which the board ignored the candidates presented by its search firm and instead gave a fellow board member the $650,000 job. That CEO is a nurse whose only graduate degree was issued by a notorious diploma mill that has since closed.

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I hadn’t seen this: Physicians Healthsource sues Allscripts under the Telephone Consumer Protection Act for sending junk advertising faxes without opt-out instructions. The plaintiff claims it received 36 faxes from 2008 through 2011 and seeks class action status. The judge labeled Physicians Healthsource as a “professional class-action plaintiff” that has filed several similar “junk fax” class action lawsuits using he same law firm and notes that fax machines have mostly been replaced by computer software, meaning that recipients expend little money or time in discarding unwanted faxes even though federal law still allows filing such lawsuits. The judge also noted that Allscripts had previously been sued by a physician’s office for the same issue and paid $600,000 in legal fees plus whatever settlement they agreed to, concluding that Allscripts “should adjust its marketing strategy a bit, or at the very least, stop sending faxes to what might be one of the more litigious businesses, in terms of junk fax litigation, in the country.” The court also notes that the maximum penalty for junk faxing is $500, but such class action lawsuits can create a windfall for the law firm as both sides pay expensive attorneys to argue over the small sum. The judge’s comments are entertaining and cynical, showing obvious disdain in the ruling above for a Congress-created law that he clearly thinks is ridiculous.


Sponsor Updates

  • UnityPoint Health (IA) is optimizing its EHR build by using LogicStream Health’s Clinical Process Improvement solutions to review sepsis screenings and to compare protocol usage to evidence-based best practices in real time.
  • EClinicalWorks supports National Health Center Week and the 700 Community Health Centers that use its systems. The company was also named as a Frost & Sullivan customer value leadership award winner for its RCM services.
  • Kyruus will integrate its ProviderMatch for Consumers with Binary Fountain’s online patient reviews to enhance its online search directory pages.
  • Besler Consulting will present at the HFS Provider User Meeting August 18 in New Orleans.
  • Gartner includes Dimensional Insight and its analytics applications in three healthcare research reports in July 2017.
  • IDC Health Insights includes Medecision in its HealthTech Rankings Top 50.
  • Glytec CMO Andrew Rhinehart, MD discusses Glytec’s contributions to value-based reform.
  • Ingenious Med will exhibit at the HFMA NC Summer Institute August 23-26 in Myrtle Beach, SC.
  • InterSystems will exhibit at the Sunquest User Group meeting August 21-24 in Tucson, AZ.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 8/15/17

August 14, 2017 Headlines No Comments

Google Verily Unit Acquires Senosis Health

Verily, Alphabet’s life sciences business, acquires Senosis Health, a smartphone-based medical condition monitoring app. Financial terms were undisclosed.

MIT Medical Selects Cerner’s Integrated Health Care Technology for Care of Students, Faculty and Staff

MIT Medical, which serves MIT students, faculty and family members, selects Cerner as its next EHR.

Coverage For Mental Health Via Telemedicine Soars At U.S. Employers

56 percent of US employers plan to offer telehealth-based behavioral health services in 2018, more than doubling availability compared to 2017 rates.

Curbside Consult with Dr. Jayne 8/14/17

August 14, 2017 Dr. Jayne No Comments

I work all over the country, so I see both national and regional trends. For a while now, we’ve seen private equity firms sinking money into larger practices, particularly in the profitable subspecialties such as dermatology and oncology. In these larger organizations, the private equity involvement usually starts around capital expenditures, such as opening surgery centers, infusion centers, or purchasing equipment. The organizations themselves are already fairly well developed and may be looking to expand or merge with another practice, but they’re typically pretty savvy about running a business and how to interact with financial backers. Recently though, I’ve seen a couple of scenarios play out where smaller organizations have gotten themselves involved in with private equity money and the practices are clearly in over their heads.

The first organization I saw this with was a primary care group that had a decent number of physicians, but at 50 or so providers, was in no way a large group. They were located in Texas and had delusions of expanding their group statewide and had gotten some backing to do so. I was working with them peripherally through a consulting subcontract with their laboratory vendor, so was able to watch it play out from the sidelines. I watched the practice administrator threaten leadership from their EHR vendor, using phrases around their plan to “triple in size” and to become “a force to be reckoned with.”

First off, even if they tripled in size, that would put them in the 150-physician range, which their vendor doesn’t even remotely see as a “large” client. The practice had failed to realize this before making their demands for free services and free software in preparation for their growth. They also failed to understand that primary care practices rarely have the footprint or financial ability to become a force as they envisioned unless they are very large or have very tight ties to key subspecialties.

The practice administrator had sold her physicians a bill of goods and they were all buying into the illusion that someday they would be the pre-eminent primary care practice in Texas, and by bringing in some PE financing, they were on their way. The physicians didn’t understand that once you bring PE into the mix, you lose a fair amount of control because you’re spending someone else’s money. I never had the opportunity to read the agreement, but it was clear that either they gave away more rights than they understood or that the PE group was taking advantage of them.

The administrator, who is from Detroit, and the PE leader, who hailed from New York, also failed to understand Texas culture. They never could quite figure out why small practices and independent providers weren’t interested in merging with them. Having spent several years living there and dissecting the culture as a relative outsider, I could have given them some pointers.

First off, although Texas is legally a single state, when you travel around it and meet lifelong residents, you quickly realize that it might as well be multiple states. I know people who live in Dallas and Fort Worth who have never been to the other city despite them being only about 30 miles apart. For those folks, crossing that gap might as well be a trip to the moon, which is a shame when you consider what each of the cities has to offer.

When you look at the cities that are farther apart physically, the differences are even more striking. The drive from Brownsville in the South to Texline in the north is almost 900 miles and you cross through multiple cultural traditions on the way. Parts of Texas think they’re in the old south, parts of it think they’re in the Old West, parts of it think they are in old Mexico, parts of it think they’re “big cities,” parts of it ooze small-town charm, and parts of it are just weird (Austin, you know I love you). Oh yeah, and then there’s the Gulf Coast.

To think that you’re going to be able to understand and accomplish expanding to physician practices across that broad of a spectrum within 12 months seems like a long shot. Some of us can’t even get physicians to agree across county lines, let alone across cultural divides and geographic barriers. I’m not saying it can’t be done, but it’s going to be expensive and psychologically exhausting as you try to address the distrust that people have of each other when they’re coming from different perspectives.

Eventually, the practice burned through a lot of money trying to figure out the expansion and the PE group became frustrated. In the end, they were snapped up by a hospital system that they had previously shunned.

Another group I worked with more recently was a procedural subspecialty practice in the Midwest. They had been wooed by a PE firm promising market dominance and expansion, which resonated with the practice’s leadership. Although they’re just trying to achieve regional expansion and grow from their 30-physician size, they didn’t understand that the face they were presenting to the market they were trying to conquer wasn’t a nice one.

My first exposure to them was a meeting where the head of the practice opened with expletives and started shouting at the vendor in front of the PE team. Never a good sign. This guy would go out to practices they were looking at “merging” with (code for acquiring) and behave inappropriately. I once watched him threaten prospective partners and promise that they would be sorry if they didn’t align with his group. I felt like I was in a 1920s-era gangster movie and expected to see Robert De Niro walking around the room with a bat.

I was somewhat gratified to see both his administrative and IT teams begin to ally themselves with the PE team against him. This continued for weeks and he never had a clue that the axe was going to fall until they walked him out the door. In the aftermath, the physicians feel hoodwinked, and frankly I don’t think they wanted to expand that much at all but were relatively powerless to block the actions of the administrator because of their previous corporate setup. They clearly didn’t want to give up as much autonomy as they did for the promise of being the top dogs. If they thought their schedules were oppressive before, they are certainly not enjoying the MBA-level micromanagement that is now going on behind the scenes. I don’t doubt that the practice will eventually grow, but the PE managers have a vested interest in tightening the collective belt so that they spend as little of their own money as possible.

Anyone who doubts that medicine has become a business needs only to look at these types of examples to understand what is going on. Medical schools have done a great job adding courses in patient engagement and complimentary / alternative medicine to their curricula. Now they need to add solid business courses. If they don’t, then physicians need to seek this knowledge on their own just like they would learn a new procedure or therapeutic regimen. There are plenty of smooth-talking individuals looking to work with physician groups and all too easy for them to be on higher ground.

How does your group learn about trends in practice management? Have you had private equity interest? Email me.

Email Dr. Jayne.

Morning Headlines 8/14/17

August 14, 2017 Headlines No Comments

As losses mount, Soon-Shiong’s NantHealth to lay off dozens, reduce headcount by 300

NantHealth announces a fresh round of layoffs following its poor Q2 results. Some of the affected employees are being re-assigned to Allscripts as part of previously announced product acquisitions.

ONC’s Rucker hones agency mission around 21st Century Cures Act

Speaking at the Allscripts Client Experience conference, National Coordinator for Health IT Don Rucker, MD discusses the need to give consumers more control of healthcare spending, explaining “We know how to do pay-for-value as consumers when we’re spending our own money. If there’s anything Americans are good at, it’s knowing how to shop.”

Distributed Ledger Technology in Healthcare: Update from the Delaware Blockchain Initiative

The Medical Society of Delaware is working with blockchain technology company Symbiont to develop a blockchain-based solution to address the challenge prior authorization requirements pose.

Monday Morning Update 8/14/17

August 13, 2017 News 4 Comments

Top News

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NantHealth shares dropped 14 percent on Friday after Thursday’s announcement of poor financial results, a 300-employee layoff, and re-acquisition of heavily devalued NH shares previously purchased by Allscripts. NH shares closed Friday at $3.49, valuing the company at $424 million.

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Above is the one-year share price chart of NH (blue, down 71 percent) vs. the Nasdaq (green, up 19 percent).

CEO Patrick Soon-Shiong said in the earnings call that acquisitions had swelled NantHealth’s payroll to 1,000 employees. He says synergies, a refocusing on artificial intelligence and decision support products, and transferring some employees to Allscripts as part of its purchase of NantHealth’s patient-provider portal product will enable the 30 percent headcount reduction.

Soon-Shiong says the FusionFx product that Allscripts is buying is non-core business because the company can exchange clinical documents without its interoperability component and that “this middleware that actually talks to EMRs was merely a tool and not really core and was better in the hands of an organization with hundreds of salespeople calling on customers during EMR implementations.”

NantHealth’s FusionFx was part of its July 2015 acquisition of Harris Healthcare Solutions, which had previously acquired the former CareFx in early 2011 for $155 million in cash. That offering included HIE, patient and provider messaging, and single sign-on. 


Reader Comments

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From Ciro Cumulus: “Re: the question of whether Epic is a cloud-based system. Based on your criteria, I would say yes.” CC provided this review of Epic’s offering:

  • It connects via the Internet.
  • The user organization doesn’t pay capital expense, just a cost per concurrent user with license fees to InterSystems.
  • The standard term is five years with renewals.
  • Epic uses software-defined networks and state-of-the-art virtualization across compute, storage, and network.
  • Customers can scale up or down on the fly.
  • Epic manages the infrastructure and applies upgrades, although with more coordination than the typical cloud provider since application software requires more testing, training, and integration review.
  • Epic provides service-level agreements for performance and uptime.

HIStalk Announcements and Requests

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Poll respondents are not really sure who will benefit most from Allscripts acquiring Mckesson’s EIS business, but the customers of both companies top the list. New poll to your right or here: what kind of term is “cloud-based?”

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Blain Newton, EVP of HIMSS Analytics, was kind to answer my question about hospital count by bed size in providing the worksheet above. The information should dispel the notion that the inpatient EHR market is a wide-open race with many participants. My takeaways:

  • Cerner, Epic, and Meditech are far ahead of the pack in terms of overall hospital count.
  • Epic has nearly double the number of 500+ bed hospitals as Cerner.
  • The good news for Allscripts (sort of, anyway) is that McKesson had twice as many hospitals as Allscripts pre-acquisition, but most of those are under 150 beds.
  • I consider 250 beds to be the minimum size hospital to provide significant revenue opportunity and that race is all Epic (38 percent), Cerner (31 percent), and Meditech (14 percent).
  • Allscripts, which was touted by a reader as being a major, competitive player that generated my original question, is not – they have just 6 percent of the 250+ bed hospital market and only 3 percent of hospitals overall vs. Cerner’s 24 percent, Epic’s 23 percent, and Meditech’s 19 percent.
  • The unstated factors involve the “which modules” question — running a full suite of available products vs. just a few key systems from a particular vendor – as well as the overall trend in switching from one vendor to another. Hospitals are often all in with Cerner, Epic, and Meditech, but I suspect much less so with Allscripts given its more limited product line (although Allscripts has a strong ambulatory presence). There’s also the issue of which hospitals are running a system vs. who is paying for it and how much, which then gets into how health systems buy software corporately.
  • Regardless of the slicing and dicing applied, I’ll stand by my long-held conclusion that it’s all Epic and Cerner with Meditech as the dark horse when it comes to inpatient EHRs. Everybody else is eating their dust and likely to lose business due to hospital consolidation and a shift toward the most successful vendors as much as all of us who – for our own reasons – wish that weren’t the case. We need more and better competition.

It’s a slow news time every year from early August through Labor Day. After that, everybody puts their nose back to the grindstone, conferences gear back up, and a flurry of work kicks in that lasts until Thanksgiving. Until then, the news is mostly an occasional big announcement (like acquisitions and quarterly earnings reports) and a product sale every now and then.


This Week in Health IT History

One year ago:

  • Karen DeSalvo, MD, MPH resigns as National Coordinator, replaced by Vindell Washington, MD but continuing in her full-time role as Assistant Secretary for Health.
  • Bon Secours Health System (VA) notifies 665,000 patients that a revenue cycle optimization vendor’s mistake left their information freely discoverable on the Internet.
  • Patient advocate Jess Jacobs dies.
  • The FTC resolves its patient privacy complaint against Practice Fusion, which it accused of soliciting patient reviews about their doctor and posting them to its website without adequate warning.

Five years ago:

  • SAIC completes its acquisition of MaxIT Healthcare.
  • The Surgeons of Lake County (IL) reports that its system was attacked by ransomware.
  • Arkansas Heart Hospital signs a $10 million deal to implement Siemens Soarian.
  • CMS publishes requirements for Meaningful Use Stage 2.

Ten years ago:

  • The first screenshots of Google Health are leaked.
  • Healthcare billing company Verus shuts down following a string of system breaches.
  • CompuGroup wins the bidding for taking over iSoft.
  • Epic opens its $100 million, barn-red learning center as Campus 2 construction begins and the company’s revenue hits $422 million.
  • Walmart announces plans to open 400 in-store medical clinics.

Weekly Anonymous Reader Question

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Responses to last week’s question:

  • I would love to live in Maui — mild weather, beautiful landscape, and friendly people.
  • The Tuscany countryside.
  • Boulder, CO.
  • Fiji has the most wonderful people I have ever encountered, and it’s beautiful. New Zealand is also beautiful, has wonderful people, and is progressive. I’m buying a house in both places.
  • Near my family and my (hopefully) eventual grandchildren.
  • Madison, WI.
  • San Francisco.
  • A restored Vanderbilt mansion in Newport, RI in the summer and a hut on Little Palm Island near Key West in the winter.
  • A beach house in Playa del Carmen.
  • Notre Dame du Pre, France.
  • London.
  • Scandinavia or Holland.
  • Paris.
  • La Jolla, CA.
  • New Zealand! Tropical beaches, rainforests, mountains, glaciers, and volcanoes all within driving distance (long ferry ride potentially required).
  • Jacksonville, FL.
  • Captiva Island, FL, the Caribbean island in the US.
  • Denver.
  • Oahu, Hawaii — slower pace of life, great weather, great people, great natural world, but still has modern world amenities.
  • US Virgin Islands.
  • Right where I already am – on the North Shore of Lake Superior.
  • Moorea, FP.
  • Curacao or the Bahamas.
  • Jekyll Island, as close to Driftwood Beach as I can get.
  • Alaska.
  • Fairhope, AL on the bay.
  • In a giant fifth-wheel, exploring the country (and probably spending a lot of time in New England and California)
  • Byron Bay, Australia.
  • Western Montana.
  • London on the Northern or Western ends so I can still have trees around me, and since money isn’t a factor I’m going to have a little cottage on the lower Cape, maybe Eastham or Orleans. Water, but set way back so my house won’t fall into the ocean for at least 20 years.
  • Coastal Southern California.
  • Lauterbrunnen, Switzerland or some other spectacular Alpine town. Clean water, clean air, solar power and living life in person instead of through an electronic device.
  • Florence, Italy.
  • Carmel, CA.
  • St. John, USVI.
  • Destin, FL.
  • San Diego, CA.
  • Goodyear, AZ.
  • Chicago downtown.
  • Chapel Hill, NC.
  • Paris.
  • Vegas, with summer trips to the rest of the world.
  • Encinitas, CA.
  • Auckland.
  • SoCal rocks.
  • Carlsbad, CA.
  • Jackson, WY.
  • Boston.
  • Munich, Paris, NYC.
  • Redmond, OR.
  • Coronado Island Calfornia. The best climate in the country year round and a beautiful beach! Can’t beat it.
  • St. Maarten.
  • Mobile Bay, AL.
  • San Diego. Best of all worlds n the US. Vancouver for Canada.
  • Hands down – Ireland (just got back – amazing), also Wyoming, Ft. Myers, FL.
  • London.
  • Florence, Italy near the Ponte Vecchio.
  • I would live a nomadic life in a class B motor home. Then I would really more deeply experience places I’ve visited that caught my eye. Durango, CO, Travelers Rest SC, Venice FL, Seattle, WA, Saranac Lake, NY.
  • With George Clooney. Before he was married and had kids.
  • San Francisco or Seattle.
  • The house I grew up in. There I knew happiness and love.
  • San Diego.
  • Big Island, Hawaii.
  • Costa Rica. It’s an amazing place with amazing people. Have been there five times and am overdue for a trip back!
  • Hawaii.
  • Santa Fe.
  • London.
  • The Alaskan Bush.

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This week’s question, which isn’t really work related but interesting to me personally since all work and no play makes Mr. H a dull boy:  which musical group or performer is the best you have ever seen in a live, in-person performance?


Last Week’s Most Interesting News

  • Allscripts swaps its mostly devalued NantHealth shares for NantHealth’s provider and patient engagement solutions.
  • NantHealth announces poor quarterly results and a restructuring that involves laying off 300 employees.
  • UC San Diego Health migrates from its self-hosted Epic implementation to an Epic-hosted version.

Webinars

August 17 (Thursday) 2:00 ET. “Repeal and Replace McKesson’s EIS.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, HIS Professionals. The brutally honest and cynically funny Frank and Vince will analyze the Allscripts acquisition of McKesson’s EIS business. They will predict what it means for EIS’s 500+ customers, review what other vendors those customers might consider, describe lessons learned from previous industry acquisitions, and predict how the acquisition will affect the overall health IT market. Their 2014 webinar on Cerner’s acquisition of Siemens Health Services has generated over 8,000 YouTube views.

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


Acquisitions, Funding, Business, and Stock

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Nordic expands its Madison, WI office, adding space for another 60 employees. The company says the new space won’t last long as it rapidly expands beyond its 800 employees and 2016 revenue of $180 million.

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Technology company The Bitfury Group and Baltimore-based AI startup Insilico Medicine will work together to develop blockchain applications for healthcare.


Decisions

  • Dukes Memorial Hospital (IN) will replace McKesson with Cerner in 2018.
  • Dupont Hospital (IN) will go live with Cerner in 2018.
  • Carroll Hospital (MD) will replace McKesson with Cerner in 2018.
  • UMass Memorial – HealthAlliance Hospital (MA) will implement Epic in October 2017, replacing Siemens.
  • Bryan Medical Center – East (NE) will go live on Epic in March 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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Santa Rosa Consulting hires Mike Ragan (NTT Data) as chief revenue officer.


Announcements and Implementations

HIMSS Analytics expands its Logic health IT market intelligence platform with international data, increasing its coverage to 380,000 facilities in 47 countries, including 100 percent of US hospitals. 


Other

In India, the head of a state-run medical college is suspended after the deaths of 60 children in the past week – at least 30 of them on Thursday and Friday alone — that local newspapers claim were due to the hospital’s oxygen vendor cutting off the hospital’s supply after it accumulated $90,000 worth of unpaid bills. The administrator says he repeatedly warned the state that the hospital didn’t have the money to pay the overdue oxygen bills but was ignored. Witnesses say doctors handed out manual resuscitator bags to family members asked them to pump it themselves as many of them watched their children die needlessly.

In Ireland, Mater Hospital’s storage-area network fails, forcing the hospital – which is among the country’s busiest – to divert ambulances and cancel appointments.

Here’s Vince’s final HIS-tory installment on Cerner, closing out a nice look back on the company’s history.


Sponsor Updates

  • Forrester Research names Salesforce Service Cloud a leader in its latest report on customer service solutions for enterprise organizations.
  • Surescripts will present at ONC’s 2017 Technical Interoperability Forum August 15-16 in Washington, DC.
  • T-System joins Athenahealth’s More Disruption Please program.
  • Wake Forest Baptist Medical Center joins the TriNetX Global Health Research Network.
  • ROI Healthcare Solutions hires Jeff Powell as director of business development.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 8/11/17

August 10, 2017 Headlines No Comments

NantHealth Files An 8-K Entry into a Material Definitive Agreement

Allscripts trades its 15 million shares in NantHealth stock for the company’s provider and patient engagement solutions,

Remote Workers Vulnerable In Disputes With Company, Say Employees

Remote transcriptionists working for Nuance are claiming that managers offered them incentives and overtime pay in exchange help working through the transcription backlog that accrued during the company’s malware-related downtime, but Nuance later refused to pay, claiming that the incentives were only approved for a small handful of highly-impacted teams.

Trump: ‘The opioid crisis is an emergency’

President Trump declares the opioid crisis a national emergency, a designation that will offer states and federal agencies more resources to combat the epidemic.

NHS England CCIO Keith McNeil resigns

Keith McNeil, chief clinical information officer for NHS England, has resigned after 13 months in the role. He will return to Australia, working as the CMIO at Queensland Health

News 8/11/17

August 10, 2017 News 7 Comments

Top News

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Allscripts will trade its significantly devalued 15 million shares in NantHealth for most of NantHealth’s provider and patient engagement solutions. That includes NantHealth’s FusionFx business, unstated “components of the NantOS software connectivity solutions,” and a guarantee that NantHealth will book an unstated minimum value of Allscripts product sales over a 10-year period.

The NH shares for which Allscripts paid $200 million two years ago are worth around $50 million. The company announced in last week’s quarterly earnings report that it will write down $145 million of its investment.

NantHealth’s FusionFx was part of its July 2015 acquisition of Harris Healthcare Solutions, which had previously acquired the former CareFx in early 2011 for $155 million in cash. That offering included HIE, patient and provider messaging, and single sign-on. 

NantHealth’s Patrick Soon-Shiong personally invested $100 million in Allscripts shares in the mid-2015 deal. He is down around $8 million as MDRX shares have fallen almost 10 percent since.

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Meanwhile, NantHealth announces Q2 results: revenue up 17 percent, EPS –$0.58 vs. -$0.54. The company’s quarterly losses increased from $87 million to $111 million. NantHealth said in the earnings announcement that it will reduce headcount by 300 in a restructuring that will focus on cancer machine learning systems.

Soon-Shiong’s other publicly traded company, NantKwest, IPO’ed in July 2015, with a first-day closing share price of $34.64. NK shares now trade at $5.67.


Reader Comments

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From Captain Beefheart: “Re: the term cloud-based. Several publications used this term for UCSD’s move to an Epic-hosted system. Epic isn’t really a cloud-based system just because they run the same product from their data center.” Health IT has long blurred the definition once it devolved from a technical term to a marketing one, simply renaming “hosted” systems (which also include the various forms of “just a longer cord” such as Saas, ASP, etc.) as being “cloud-based,” the same way “software” became “solutions” without changing anything. Googling didn’t turn up a firm definition of cloud-based systems, but here’s my best summary that begs for more technically astute readers to weigh in, with my interpretation being that calling Epic a “cloud-based system” is incorrect even though I’m guilty of having done so in UCSD’s case without really thinking about it:

  • Connection to the remote system is via the Internet.
  • The user organization doesn’t pay capital expenses but rather is billed at regular intervals based on a fixed monthly expense or for metered services.
  • The hosting data center uses a shared pool of infrastructure (multi-tenancy) that can be managed virtually and provisioned on the fly. It is not simply moving the customer’s servers to a more distant data center owned by someone else.
  • Customers can add or decrease system capabilities (bandwidth, server processing power, storage) on their own in flexing their metered capacity to their needs.
  • The host manages the infrastructure and applies updates without using the customer’s resources.
  • The host guarantees service levels for response time and downtime.

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From Gene Gene: “Re: HIStalkapalooza. Wondering if you had reconsidered since we’re planning our own event and don’t want to compete.” I haven’t reconsidered. It’s a ton of work and a great financial risk for me personally without any benefit. I thought about it again a few months ago when: (a) we devised a new invitation/admission idea that would have eliminated much of the work, and (b) a company expressed interest in underwriting much of the cost in reducing my risk, but it didn’t work out. I have just one FTE (Lorre) for non-writing tasks and she spends ridiculous hours starting in early January trying to get event sponsors so I don’t go broke and arguing over who gets invited, not to mention that while we’re trying to set up and run our own little HIMSS booth, people are messaging both her and me nearly non-stop asking silly event questions or making unreasonable demands that reek of self-entitlement. RIP HIStalkapalooza, whose life reached its timely end at 10 years of age. HIMSS might actually be fun for us without all those headaches.

From Bilge Pump: “Re: Paragon. Why don’t you think Allscripts can sell it?” McKesson wasn’t having much luck selling it, so the question then becomes whether Allscripts has the sales force and channel to outperform McKesson in getting 150-bed hospitals to sign up for Paragon instead of Meditech, CPSI, Athenahealth, or even hosted Epic or Cerner systems that are admittedly overly complex for their needs. And while I admire the company’s upfront demarcation line of saying that Paragon will be pushed only for hospitals with fewer than 250 beds that offer no specialty services (of which there are quite a few), my cheap-seats experience is that vendors with overlapping products struggle with sales team infighting and confused prospects. Maybe Allscripts can move some of the Series and Star users to Paragon or the larger Paragon customers to Sunrise, but that won’t be a slam dunk – a project of that cost and magnitude requires a look at the other vendors who often win those deals and McKesson failed to accomplish that as well. They had better act quickly since the number of independent under-250 bed hospitals seems to be decreasing fast as they are acquired by health systems that mostly use Cerner and Epic. I would be interested in the customer count by bed range for all the inpatient EHR vendors if anyone has access to that information, although Cerner and Epic are playing the Electoral College-type strategy in focusing on enterprise size rather than a simple count of hospitals. 

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From Denizen: “Re: Carequality. Our organization of long-term acute care hospitals was quoted $400,000 per year to onboard to Carequality as an implementer so we can get patient information from short-term acute care facilities, more than half of which run Epic. We don’t receive Meaningful Use incentives to help pay for this technology and we feel the costs are excessive given that the data belongs to the patient and it would allow us to provide them with better quality and safer care.” I contacted the non-profit Sequoia Project, which runs the eHealth Exchange, Carequality, and RSNA Image Share Validation. Their spokesperson explained:

Carequality is designed to connect networks and is not intended to be a network that providers directly join. As a result, the Carequality fees that you saw apply to the networks themselves, not to provider organizations who participate in a data sharing network. The assumption is that providers like this are already connected to a health data sharing network of some kind. If their “home network” is a Carequality implementer, then the provider should be readily able to connect to other Carequality connections. There are a number of health data sharing networks available in the market that this hospital may already be leveraging. Some of these networks are geographic-centric, such as regional and statewide HIEs. Others have a more nationwide focus, such as eHealth Exchange, Surescripts, and CommonWell Health Alliance. While still others are facilitated by the health IT vendor that the provider uses. Providers that would like to share health data via Carequality need to contact their participating network. If their network is not an implementer, they can encourage their network to implement the Carequality Interoperability Framework to dramatically expand their connectivity options.

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From Non-Annoying Vendor: “Re: Stanford Health Care CIO position. Accepted by [name omitted].” I’ve emailed the person whose name I omitted for confirmation since it’s not cool to run unverified job changes. UPDATE: Verified. Eric Yablonka, VP/CIO of University of Chicago Medicine, emailed me to confirm that he will start at Stanford at the end of September. He replaces Pravene Nath, MD, who is now an executive in residence at Summation Health Ventures.

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From Roman Hands: “Re: CHIME. It’s paying President and CEO Russell Branzell $500K per year, which seems like a lot for a non-profit whose revenue is less than $7 million.” Basically all of the $529K in member dues CHIME took in for FY2015 went toward Russ’s paycheck. It collected $1.6 million from conference registration and vendor advertising and $4.27 million from the CHIME Foundation. I’m not interested in doing compensation research, but one study I saw said that non-profit CEOs of organizations with budgets of $5 million to $10 million are paid an average of $100K. I remember doing some legwork years ago on Steve Lieber’s HIMSS compensation vs. similarly-sized member associations and he was certainly at the top of the chart (the current median is about one-fourth of what Steve makes). Whether either is worth the lofty salary is up to members to decide, not just in the amount of their dues, but how comfortable they are being pimped out to high-paying vendors that contribute most of the revenue.


HIStalk Announcements and Requests

This week on HIStalk Practice: The American Telemedicine Association looks for new leadership. A Chance to Change invests in telemedicine for behavioral health patients. Delaware physicians hope blockchain will speed up the prior authorization process. WellAve expands mobile dermatology clinic business. Colorado physicians up in arms over delinquent Medicaid reimbursements. ApolloMed takes a minority equity stake in LifeMD. Cow Creek Health & Wellness Center Clinic Director Dennis Eberhardt details the ways in which a new commercial EHR will better serve patients. Independent MDs express extreme dissatisfaction with MACRA. Buoy Health raises funding for symptom checker software.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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The New York Times profiles Eko Devices, started by three UC Berkeley undergrads. The company has sold 6,000 digital stethoscopes and will this fall introduce the FDA-cleared Duo, a prescription-only version for home use that collects EKG readings and heart sounds to send to doctors. One of Eko’s founders says the product should work like “Shazam for the heartbeat” in being able to recognize unusual heartbeat patterns just like the Shazam app can “listen” to a song being played and then display its title and artist. The Duo is intended only for heart patients and will cost $350 plus $45 per month. The Duo’s main competitor will be AliveCor’s Kardia, a $99 smart phone add-on that records EKGs.


People

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Justin Diehl (Healthware Partners) joins Parallon Technology Solutions as VP of Epic services.

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NHS England’s first chief clinical information officer, Keith McNeil, MBBS resigns after 13 months, returning to Australia to become CMIO of Queensland Health.


Announcements and Implementations

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AdvancedMD launches AdvancedReputation, which automatically emails or texts patients a one-question satisfaction poll following their office or telemedicine visit and invites those who score positively to post their feedback on the practice’s Google business profile. Those who score negatively are asked to describe their experience to be posted privately to the provider’s dashboard.

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Christus Health reports its results from implementing Epion Health’s iPad appointment check-in system: collections per encounter increased 3.5 percent, patient portal sign-ups increased 300 percent, and 21,000 patients opted in for text messages. Epion CEO Joe Blewitt graduated from the United States Air Force Academy, was on active duty in the Air Force for 10 years, then spent 17 years as an Air Force Reserve pilot at McGuire Air Force Base.

Change Healthcare adds the capability of adding attachments to dental claims submissions.


Government and Politics

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The Austin, TX paper reviews the state’s lawsuit against Xerox, which the state says did shoddy pre-authorization reviews for Medicaid dental services. The company hired high school dropouts and gave them just a one-hour training session. One of them responded to a deposition question about the definition of severe handicapping malocclusion, “Not a clue. Their teeth are messed up.” Records show Xerox ran the process like a high-pressure boiler room where supervisors ordered employees – many of whom worked from home and thus couldn’t even see the records that had been submitted by dentists – to “push those keys as fast as you can.” Xerox hired just one dentist to review hundreds of requests each day, with one such review being clocked at exactly six seconds. HHS OIG ordered the state to repay it $133 million for services it had paid that didn’t pass pre-authorization rules. Records show the state knew about the rubber-stamped authorizations but did nothing for several years, eventually culminating in the firing of Xerox and the lawsuit brought against the company in hopes of covering the HHS repayment.

President Trump declares the opioid crisis a national emergency, contradicting a statement made two days ago by HHS Secretary Tom Price, who said such a declaration is unnecessary. 

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Australia’s government approves automatic sign-up of citizens for its My Health Record provider and patient e-health system, formerly known as PCEHR. People will have to opt out if they don’t want their information shared. The government hopes to approve interoperability standards in 2022 and to make secure provider-patient and provider-provider communication universally available the same year. The government published its national digital health strategy this week. Reports suggest that the government has spent at least $1 billion on My Health Record, which has struggled with poor patient and provider participation.

Oregon’s governor demands and receives the resignation of the head of its health authority following leaking of a document describing her planned smear campaign against a Medicaid provider who sued the state claiming that the agency’s rate-setting process is not fair.


Privacy and Security

Princeton Community Hospital (WV) is still down from its June 27 malware attack, saying it is dealing with a transcription backlog and interfaces that aren’t working yet following its complete rebuilding of systems.


Technology

CNBC covers the potential use of the Amazon Echo for helping homecare patients with medication reminders, instructions, and staying connected with family. It mentions voice startup Orbita, which offers an Amazon Alexa skill and a graphical development tool for Amazon Echo, Google Home, and other voice platforms.


Other

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This should help dispel those negative perceptions of Alabama.

In South Australia, 20 percent of surveyed doctors say the government’s EPAS electronic health record is causing medication errors, critical delays, and pathology mistakes, with one-third of respondents saying the Allscripts system has caused near-misses. 

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State auditors accidentally find that a struggling 15-bed Missouri hospital was apparently used as a shell company to bill $90 million worth of lab tests that were performed by other hospitals run by the same management company that installed its president as the hospital’s CEO. The auditors also found that the CEO and his company were paid nearly $1 million in the first 10 months of the agreement, the hospital paid $10.6 million to the hospital company’s lab division in just three months, and the hospital was covering the salaries of 33 phlebotomists of other company-run hospitals. The state, which is considering a corruption investigation, says decisions made by the hospital’s management and board were “astounding in their irresponsibility.” The CEO has charges pending against him in Louisiana related to a another managed hospital’s claims that he forged checks made out to another management company he owned. The state auditor says the hospital did no background checks and minimal due diligence before turning its operations over to the management company and CEO.

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A Texas Public Radio report covers the dispute between Nuance and its remote workers following its extended malware-caused downtime, during which the company’s transcriptionists say they were promised overtime and incentive pay that was later rescinded. The report reviewed the recording of a management conference call for transcriptionists in which Nuance clarified that the incentives it had offered (and that its managers had promised) were not intended for all transcriptionists, but said its message was misunderstood because its communications systems were also down due to the malware. One employee who worked more than 12 hours per day saw that her expected $3,000 extra payment ended up being just $21. The recorded call also captures a Nuance manager who explained that the error was widespread, adding, “We blew it. We completely blew it.” The article concludes that it’s tough for remote workers to react to employment conditions since they can’t band together to protest in person. They may still get their chance – several lawyers added their contact information to the article’s comments.


Sponsor Updates

  • CSI Healthcare IT completes its at-the-elbow support for the Epic ambulatory go-live at Atlantic Health System (NJ).
  • Meditech will exhibit at the Mid-South Critical Access Hospital Conference August 16-18 in Nashville.
  • Spok announces that all 20 of the hospitals on US News & World Report’s list of best hospitals as well as all 10 of the best children’s hospitals use its solutions for enterprise healthcare communications.
  • Netsmart will exhibit at the FADAA/FCCMH Annual Conference August 16 in Orlando.
  • Experian Health will exhibit at the HFMA Arkansas Summer Conference August 16-18 in Hot Springs.
  • PatientPing names former Medicare deputy administrator and director Sean Cavanaugh as an advisor.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
Contact us.

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EPtalk by Dr. Jayne 8/10/17

August 10, 2017 Dr. Jayne 1 Comment

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My HIMSS planning is officially underway and I’m happy to report securing my preferred hotel for my preferred dates for the first time in several years. The shifted schedule (Monday through Friday) always throws me off when we’re in Las Vegas. The updated schedule now shows Magic Johnson as the closing keynote speaker on Friday, but I’m sure that quite a few of us will be departing before then.

Much of the agenda is similar to years past, but I did note the addition of a fee-based session for Thursday. “Rock Stars of Emerging Healthcare Technologies” is a $295 additional charge and purports to cover disruptive and innovative technologies. I’d be interested to see who is in the lineup, but I’m not eager to spend that much money.

I’ve been catching up on medical reading and continuing education. Many of our readers would be happy to know of a new report linking moderate drinking to cognitive health in old age, at least for some demographic groups. Although it found that patients who consumed a moderate amount of alcohol on a regular basis were more likely to live to age 85 without cognitive impairments or dementia, it’s hard to know the exact nature of correlation vs. causation. The study ran for 29 years and used the standardized Mini Mental Status Examination to gauge cognitive health. Adults with “moderate to heavy” alcohol intake five to seven days a week were twice as likely to stay cognitively intact than those with little alcohol intake. Wine-drinking tends to correlate with higher income and education levels that are accompanied by reduced rates of smoking and greater access to healthcare. The majority of study participants were Caucasian and from a middle-class suburb of San Diego.

The Agency for Healthcare Research and Quality (AHRQ) is seeking nominations for public members of its National Advisory Council. The Council advises the AHRQ Director, the Secretary of Health and Human Services, and other bodies on national health services priorities. Nominees must be willing to serve a three-year term, meeting in Washington, DC three times per year. Desired qualifications include medical practice, other health professional experience, researchers, healthcare quality experts, and health economists, attorneys, or ethicists. Additional information is available in the Federal Register.

There has been a lot of chatter in the physician lounge about Anthem’s recent statements that they will not cover non-emergency conditions when patients seek care in the emergency department. Primary care physicians who have a large number of Anthem patients are starting to worry about capacity and creating plans to care for an influx of patients. Retail clinics and urgent cares are eager to accept the overage. Anthem has piloted this in several states and is in the progress of expanding it to others.

We already see plenty of patients in the urgent care setting who could be easily treated with over-the-counter remedies, so it will be interesting to see how this impacts the patient mix in states where it is a factor. In my area, a visit to the local pharmacy’s clinic runs 40 percent less than a comparable physician office visit and about a quarter of what is charged in the urgent care setting. All are significantly less than the $800-900 typically charged for a basic visit in the emergency department.

Wearing both my family medicine and urgent care hats, the missing piece is education and triage. It’s one thing to simply tell a patient that their bill won’t be covered unless it’s a true emergency, but it would be even better if the payer spent a little bit of the anticipated cost savings educating patients and providing after-hours nurse lines where patients could seek advice. Lots of people surf the Internet for information or get their advice from Dr. Google, but education is still a great value in the long run. My insurance carrier has serious limitations on emergency visits, but offers nothing in the way of other support to triage patients to the appropriate care setting. At our urgent care, we sometimes see patients who started at the retail clinic but couldn’t be treated there due to limited scope-of-practice agreements, which leads to an additional and more costly visit with us.

There has also been a fair amount of chatter around the recent JAMA research letter about Maintenance of Certification (MOC) and Board Recertification fees. Although the medical specialty boards are supposed to be non-profits, they’re taking in significant amounts of money from examinees and those required to demonstrate participation in MOC activities. According to the research, the amount of income from exam fees is out of proportion to the amount it actually costs to administer the exams.

For those of us who are board certified in multiple subspecialties, the expenses can add up. Even for those of us board certified in clinical informatics, we are required to maintain a primary specialty board certification. This seems rather unfair to the large number of clinical informaticists who no longer see patients and might be inclined to allow their primary certifications to lapse. Current policies also exclude a number of clinical informaticists who had already discontinued their primary certifications before the clinical informatics certification became a reality.

I’m due to retake my primary boards in 2019 and figure I’ll have to take them at least twice more before I retire unless something changes. I’m not looking forward to the time commitment or to studying information that has no bearing on my practice, such as obstetrics. I failed to buy a lottery ticket for this week’s Powerball, so it looks like I’ll be in the trenches for the foreseeable future.

Email Dr. Jayne.

Morning Headlines 8/10/17

August 9, 2017 Headlines 1 Comment

Jonathan Linkous Departs ATA After 24 Years As CEO

American Telemedicine Association CEO Jonathan Linkous resigns after 24 years leading the organization. ATA COO Sabrina Smith, MD is filling in as interim CEO until a new CEO is hired.

A Big KO to Germs: Robot Enhances Hospital Safety by Killing Infection-Causing Microbes

Saint Peter’s University Hospital (NJ) is piloting an ultraviolet wave-emitting robot to reduce hospital acquired infections in its facility.

Walgreens, CVS sued over claims co-pays were clawed back

Both Walgreens and CVS are being sued in California for letting customers pay deductibles on prescriptions covered by their insurance that were significantly higher than the actual cash price of the medication. The customers argue that they should have been informed that buying the medications outright was less expensive than paying the co-pay negotiated by their insurer.

Campaign to taint courtroom foe costs Saxton post at OHA

Oregon Health Authority director Lynne Saxton is fired after an OHA plan designed to damage the reputation of a Portland health care organization was made public.

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