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Morning Headlines 9/5/16

September 4, 2016 Headlines No Comments

Apple will now start screening medical and health apps more closely

Apple updates its App Store Review Guidelines with new, more stringent language that confirms the company will begin scrutinizing apps that offer inaccurate medical advice or diagnostic tools.

EDPA names 2016 Alabama Innovation Awards winners at state conference

The Economic Development Partnership of Alabama names Birmingham-based digital health startup IllumiCare as its Innovator of the Year for developing an EHR hover bar that gives physicians real-time, patient-specific risk and cost data.

Computer hackers demanded ransom payment from Derriford Hospital

In England, Plymouth Hospitals NHS Trust’s Derriford Hospital is hit with ransomware.

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September 4, 2016 Headlines No Comments

Monday Morning Update 9/5/16

September 4, 2016 News 4 Comments

Top News

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

Apple also announces that it will start removing outdated and technically obsolete apps from the App Store prior to the rollout of iOS10 this fall.


Reader Comments

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

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

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

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


HIStalk Announcements and Requests

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

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

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

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

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

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Last Week’s Most Interesting News

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

Webinars

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


Acquisitions, Funding, Business, and Stock

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

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Medical imaging cloud vendor DICOM Grid renames itself to Ambra.


Privacy and Security

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

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


Innovation and Research

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


Other

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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September 4, 2016 News 4 Comments

Morning Headlines 9/2/16

September 1, 2016 Headlines 3 Comments

Technical problems delay rollout of DoD’s electronic health record

The DoD will delay the go-live of its first Cerner implementations, noting that the current schedule may not be realistic. A new go-live schedule will be published within the next 30 days.

Insurers Move to Limit Options in Health-Care Exchange Plans

A McKinsey analysis of the insurance plans that will be available in 2017 across 18 states finds that 75 percent will likely be HMOs or similar plans with narrow provider networks.

King’s College Hospital launches Allscripts Sunrise

In England, 950-bed King’s College Hospital goes live on Allscripts Sunrise.

UK: Data security incident trends

An analysis of data security breaches in the UK finds that the health sector generates the greatest number of breaches.

Workplace Wellness Programs Are a Sham

A Slate article arguing against employee-sponsored wellness programs reports that they “promote medical tests of dubious value, encourage unnecessary doctor visits, and collect sensitive health information despite often extremely lax privacy policies, with little to no evidence that they improve health outcomes.”

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September 1, 2016 Headlines 3 Comments

News 9/2/16

September 1, 2016 News 5 Comments

Top News

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

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

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

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


Reader Comments

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

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

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

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

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

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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


Sales

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


People

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


Announcements and Implementations

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

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


Government and Politics

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


Privacy and Security

From DataBreaches.net:

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

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

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


Innovation and Research

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


Other

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

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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September 1, 2016 News 5 Comments

EPtalk by Dr. Jayne 9/1/16

September 1, 2016 Dr. Jayne 2 Comments

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I completed my HIMSS registration this week. This year’s registration has a space for attendees to list their Twitter handles so that they appear on registration badges. I don’t remember seeing that last year. I was sorely tempted to appropriate someone else’s handle just to see if anyone noticed, or to see if hilarity ensued. But alas, I went the conservative route and just signed up as myself.

HIMSS isn’t cheap for “regular” attendees. Even the early bird rate is $785, not to mention the mandatory $199 renewal of your HIMSS membership. I can’t complain too much, though, since it’s one of a handful of places that those of us that are board certified in clinical informatics can get our required continuing education credits.

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As I went through the registration process, a couple of things struck me. The first was the addition of the “HIMSS Star Service” option for $149. It’s basically a concierge service offering assistance with booking at the hotels (on a space-available basis, so good luck with that) as well as coat check at the convention center and restaurant reservations. It also offers “help to design your tailored conference agenda, including social events and exhibitor appointments” and “exclusive tours on the exhibit floor based on interest.”

The show floor is already crowded enough with people standing in the aisles oblivious to those around them. I envision a Disney-style guide with a pennant leading a tour group around the hall. Maybe I should put out my shingle and offer “Dr. Jayne’s Tour of Cool Booths.” I already give party planning tips for social events, so it might be a natural next step.

Speaking of party planning, I recently had a negative email from a vendor rep who took issue with the fact that I didn’t mention their company’s upcoming user meeting when I mentioned the events of multiple other vendors. I write for HIStalk on top of my day job of running my own consulting business and my night job of seeing patients. Although I’m pretty good at keeping up with the industry, I don’t keep track of every possible vendor event. The best way to make sure that I know about your event is to tell me – and not with a mass email, but something personalized that shares interesting tidbits about it or helps me understand why it’s noteworthy. For HIMSS, actually inviting me to events exponentially increases the chances that I’ll swing by to visit.

The list of HIMSS events also includes multiple woman-focused events. I’m not sure how I feel about that. Although women are under-represented in many science, technology, engineering, and math fields, organizing events strictly around status as a man or woman seems problematic. Rather than seeing the Women in Health IT Networking Reception, I’d rather see other professional minorities addressed, such as an Ambulatory Informatics Networking Reception or Independent Physician Practice Networking Reception events. The latter is definitely a minority, for sure. There’s also the Most Influential Woman in Health IT Awards Dinner as well as the Disruptive Women Luncheon.

I’m not a fan of the naming of the Disruptive Women Luncheon and would think that its sponsor (a public affairs company that specializes in “creative communication”) could have come up with something better. Disruptive how? In the innovation context? In the grandstanding Jonathan Bush context? In the snapping-your-gum teenage context? In the context I saw this morning, where a disruptive man held an entire meeting hostage and prevented the rest of us from getting through the agenda? “Disruption” is an overused buzzword that needs to go and the whole idea of special women’s events needs to be rethought.

I’ve often joked about putting together a “Textbook of Organizational Pathology” with case studies based on my work life. I’m sure I have enough stories from my time at Big Hospital System to fill at least a dozen chapters, and then there’s the physicians and hospitals I’ve worked with since I started consulting. If I ever write it, there will definitely be a chapter on “The Art of Work Shirking.”

I had a prime example this week when working with a practice support representative at a large health system. The practice support team is charged with fielding questions about EHR use and associated technology that originate from the practices that the health system has gobbled up over the last decade. I’m supposed to be backstopping the department, identifying areas for additional education and assisting in putting together a training program for the new hires.

Due to the group’s growth, some of them are very green, but others are just lazy. I had just done a presentation on HIPAA and the need for appropriate use of secure messaging vs. text vs. email vs. voice mail for the team when I received an email from one of the support reps. She went overboard with praise about my recent talk and then dropped this gem: “I think I’m clear on how to answer the client question below, but wanted to know if you had any additional feedback.”

To be able to provide any “additional” feedback, I might need to know what she planned on advising. However, I suspected her of hoping that I’d just answer the question my own and save her the trouble of formulating a response, so I asked her what her advice was going to be. She responded immediately saying, “I don’t want to bias you with my response, I was just curious what you would advise.” Looking logically at this, I just taught the class on this, which her employers hired me to teach because of my expertise. Yet she thinks my response to a question might be biased by her ideas? It doesn’t even make sense.

I’m happy to help people who genuinely don’t know the answer to a question, who want me to critique their potential response, or who just need help. But then let’s call it what it is, and not try to be coy, using flattery and evasion to cover the fact that either you don’t know the material that was just covered in a class, that you spaced out during said class, or that you’re just lazy. I suspect she was also naïve enough to think I wouldn’t forward the exchange to her supervisor, who was appropriately irritated by her staffer’s actions. I’m continually amazed by the antics people try to pull using email, that I doubt they would try in a face-to-face conversation. They also forget that email is forever and easily forwarded.

What’s the worst example of work shirking you’ve seen lately? Email me.

Email Dr. Jayne.

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September 1, 2016 Dr. Jayne 2 Comments

Morning Headlines 9/1/16

August 31, 2016 Headlines 3 Comments

UPMC reports strong year-end financials

UPMC closes its 2016 fiscal year with a positive outlook on its ACA exchange policy, growing its regional market share from 18 to 67 percent. CFO Robert DeMichiei explains, “We did not jump in with low price points. That is what I think happened to the national insurers and to many of the Blues across the country — the idea was to grab market share immediately. We did not do that, and that allowed us to get some clarity about the population and the right pricing.”

The World’s Most Innovative Companies

Forbes names Cerner to its list of world’s most innovative companies, ranking it 37 of 100.

Theranos Halts New Zika Test After FDA Inspection

Theranos withdraws its FDA application for a Zika diagnostic test after regulators found that the company did not include proper patient safeguards during its testing.

Researchers question report alleging vulnerabilities in St. Jude devices

Medical-device manufacturer St. Jude Medical responds to allegations made by investment firm Muddy Waters that its medical devices are vulnerable to life threatening hacks. In a statement released by the company, President and CEO Michael Rousseau says “The allegations made by Muddy Waters and MedSec are irresponsible, misleading and unnecessarily frightening patients.”

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August 31, 2016 Headlines 3 Comments

Keeping Up with Amazon Alexa’s Healthcare Potential

August 31, 2016 News 2 Comments

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

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

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

Straight from the Patient’s Mouth

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

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

From Contest to Market

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

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

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

Bringing Alexa to the Bedside

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

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

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

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

Prioritizing Further Developments

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

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

Gauging Real-World Patient Potential

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

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

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

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August 31, 2016 News 2 Comments

CIO Unplugged 8/31/16

August 31, 2016 Ed Marx 27 Comments

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

My Secret Interview Questions Revealed

I have been blessed to serve with some amazing teams over the years. I have written extensively on teams because I believe that great ones are the key to individual and organizational success.

How do you recruit the right servant for your team? Here are the only three questions I ask in every interview. Yes, only three. I used to ask five to 10, but over the years learned that the answers to these three provide everything I need to determine if the person will be a good fit for our team or not.

Before I reveal the questions, some caveats:

  • These are not foolproof. Despite solid answers to these questions, I have made hiring mistakes. I will make more mistakes.
  • You will have better questions than I do. Share them in the comments section.
  • There are no right answers. That said, the answers you receive do allow for key insights that might determine a good fit for your team.
  • Yes, I have missed hiring some superb teammates given my narrow questioning focus.
  • My existing team makes the final decision.
  • Like all other interview questions, these are imperfect.
  • I know some will have a violent reaction and leave a nasty comment or two. I am OK with this when comments are constructive. However, some people are generally unhappy and will look for any opportunity to vomit. We still post everything. (As an aside, I find it interesting that people who vomit never identify themselves, nor are they willing to contact me for constructive dialogue. They tend to be cowards.)

Here are my questions that have been effective in hiring the right team.

When was the last time you cleaned a toilet? Tell me about it.

  • What am I looking for? I want to know that this person is willing to get their hands dirty, figuratively and in real life. If someone has not cleaned a toilet lately, I become skeptical.
  • Answers I like: People who volunteer to clean toilets. People who admit it is not glorious, but it must be done. People who talk about how it makes them feel to make a toilet sparkly.
  • Insights: A willingness to clean toilets tells me a lot about someone’s service orientation. A willingness to clean toilets tells me a lot about humility.
  • Bottom line: Listen, if someone can’t quickly respond with anecdotes about the mundane things in life, they will be slow to clean up messes the team makes and feel that certain tasks are beneath them. I need teammates who are willing to do anything.

What does your ideal vacation look like?

  • What am I looking for? My teams are action-oriented and if someone’s desire on their time off is strictly to lie around, that becomes a red flag. My teams tend to move at a high pace and slackers will be exposed.
  • Answers I like: Of course you want to sleep in and lay at the beach, but tell me you mix it up and balance with adventure and exploration.
  • Insights: People who visit new places and try new things have key traits I covet. Those who keep going back to the same destination and doing the same things may have the same propensity at work.
  • Bottom line: There is no right answer and everyone is entitled to do what they enjoy on vacation, but those stuck in repetitive actions, avoid action, or who don’t like to try new things will be uncomfortable on my team.

Tell me three historical or contemporary heroes, each of whom I must have heard of.

  • What am I looking for? What the key values of their heroes are. First, this will reflect their personal values and possible impact on the team. Second, answers to this question reveal thought and logical processes.
  • Answers I like: Less important than whom, I focus on the values and traits the candidate brings up. Any succinct summation is key. Bonus if the hero traits coincide with team needs. If the team is up against insurmountable challenges and the candidate discusses someone who won against all odds, that demonstrates likely alignment.
  • Insights: I am keen on the third hero discussed as this is where the person tends to go off script and personality is revealed. I look for a structured thought process. If they jump all over the place or become flustered I know a high-pressure environment is not for them. It also reveals someone who is likely to bullshit under the gun.
  • Bottom line: If the candidate struggles to identify three heroes or has difficulty sharing why they are heroes, they may not have the introspective capabilities required for continuous self-improvement.

I used to be one of those candidates who would research the “50 top interview questions” and memorize my answers. Boy was I good at what I call beauty pageant questions. Strengths and weaknesses? Check. Tell you about the company? Check. Why should you hire me? Check. It didn’t take long to realize that other wise candidates were doing the same thing. The intent of the three questions above is to take people off script and listen to the story inside the story.

There are other great interview questions out there and I encourage you to share your favorite. Now, I need to develop new ones since I shared my secrets!



Ed encourages your interaction by clicking the comments link below. You can also connect with Ed directly on
LinkedIn and Facebook and follow him on Twitter.

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August 31, 2016 Ed Marx 27 Comments

Morning Headlines 8/31/16

August 30, 2016 Headlines No Comments

Winners Announced!

ONC announces the winners of its Blockchain Challenge, a contest soliciting proposals for how Blockchain could be used in healthcare IT.

ARH officials remain tight-lipped in response to computer breach

Beckley Appalachian Regional Hospital and Summers County Appalachian Regional Hospital (WV) both return to paper charting after computers systems are compromised by hackers.

Wayfair Names Doran Robinson Vice President of Operations Product Innovation Team

Doran Robinson, Athenahealth GM of AthenaCoordinator, leaves the company, and healthcare IT in general, to work as the VP of Operations on a product innovation team at an online furniture retailer.

Canadian company puts touchless tool in doctors’ hands

A Canadian startup has created a program that allows doctors to interact with projected PACS images touchlessly, in a sterile surgical environment, leading to a reduction in surgical times.

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August 30, 2016 Headlines No Comments

News 8/31/16

August 30, 2016 News 4 Comments

Top News

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Athenahealth acquires 12-employee, Austin-based care coordination system vendor Patient IO, in which Athenahealth had invested in October 2015 via its More Disruption Please Accelerator program. This is the second company Athenahealth acquired from the MDR accelerator, the first being scheduling system vendor Arsenal Health.

The three-year-old company had raised $4.3 million in three funding rounds. Its app offers collaborative care plans, secure messaging, wearables integration, medication management, and notifications.


Reader Comments

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From Mick Mars: “Re: HIMSS Analytics vs. Definitive Healthcare for primary intelligence for vendors. People at our company hate HIMSS Analytics, but you lose HIMSS points and thus get a worse booth location if you drop them. Both companies are dropping their prices by the day, but it’s still a six-figure decision.” I’ll invite vendor readers to weigh in on the pros and cons of each since as a non-vendor, I haven’t worked with either company.

From CEO Cynic: “Re: KLAS. We stopped paying their ransomware fees last year.”

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From Mobile Man: “Re: farming tech bubble. I find interesting similarities with our approach to healthcare IT. I wonder what would happen if we had Meaningful Use money for agriculture?” A Fortune article describes technology companies that create expensive sensors and data tracking software for farm equipment while keeping the data rights for themselves so they can sell it to fertilizer and equipment vendors. Venture capital firms are investing hundreds of millions of dollars in Silicon Valley-designed agtech such as GPS-guided tractors and aerial imaging drones that farmers aren’t buying, with experts saying farmers just need basic technology to track people and equipment, digitize their paper notes, and to display history of previously recorded problems. The market is soft because startups have bailed out and left farmers holding expensive equipment, the systems can be difficult to install and use, and those systems often don’t tell the farmer anything they don’t already know. At least some farmers already have their form of Meaningful Use in which they, like doctors, are paid by taxpayers to reduce their productivity (leaving fields unplanted or seeing fewer patients, respectively). We’re lucky government market interference doesn’t lead us into either starvation or death from unmet medical needs.

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From Chilblains: “Re: Athenahealth. This is kind of a big deal – Doran was a huge asset and his departure, along with that of Ed Park, makes me wonder whether Kyle Armbrester and the new CTO can fill the holes.” Athenahealth GM of AthenaCoordinator Doran Robinson leaves the company to work for an online furniture company. ATHN shares have slid 6 percent in the past year vs. a 13 percent gain in the Nasdaq.


HIStalk Announcements and Requests

Here’s my ingenious, semi-technical solution for patient engagement. Insurers look you up on Facebook to find your friends and family members, then bribe them secretly to encourage your healthy behaviors by applying peer pressure in the form of, “That’s a lot of wine for a weekday,” or, “You might want to sew on those shirt buttons with fishing line so they don’t shoot off under pressure and put someone’s eye out.”

I ran a comment last week from a reader who observed staff at Suburban Hospital (MD) operating under downtime procedures for a handful of hours. I’ve found that the problem wasn’t Epic, it was a connectivity problem among Johns Hopkins hospitals due to a power surge that overheated conduit. It’s interesting to me that hospital systems have become reliable enough that when someone says “XX system was down,” it’s usually not the system itself but rather the connectivity to it or a workstation-related issue. It’s not much consolation that a given system is running perfectly even though users can’t access it, but that is the case most of the time these days except during application software upgrades.

Listening: the new single from the Pixies, preceding the September 30 release of their new album, their first without Kim Deal. Their new stuff is familiarly full of droning guitar riffs and the quirky pop culture references of Charles Thompson IV (aka Black Francis, Frank Black). I can never get this song out of my head, nor do I wish to. 


Webinars

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


Acquisitions, Funding, Business, and Stock

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Digital engagement vendor Zillion raises $28 million in a Series C funding round. I interviewed President Bill Van Wyck in May 2016. He summarized Zillion’s market position then as:

The differences in the market exist where healthcare has been trying to build vertical silo products to address specific conditions. The reality is that patients don’t typically have just one condition. They are overweight and may have depression, or they may be diabetic and need other types of procedures and support. There are co-morbidities and multiple chronic conditions that exist in the real world.  Having a common backbone platform like Zillion where you can design, create, and deploy programs to patient populations and then refine and refine and modify those programs at scale is a differentiator for healthcare stakeholders. When you look at what they’ve been building, typically none of them interact with existing systems. They’re not interoperable. They don’t always reach patients on the devices and the technology that they use day to day.

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Cardinal Health acquires 18-employee Iowa City, IA-based telepharmacy software vendor TelePharm, which allows pharmacists to verify prescriptions and counsel patients by video from any location.


People

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Col. Mike Regan, former VP/CIO of Lower Bucks Hospital (PA) and an executive with Siemens Healthcare while he also pursued a 35-year career in the Air National Guard, is named Deputy Adjutant General-Air of the Pennsylvania National Guard.


Announcements and Implementations

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Cerner will use episodes of care software from 3M Health Information Systems in its HealtheIntent population health management system.

In Australia, two northern Queensland hospitals go to market for for a clinic and hospital EHR, with $26 million budgeted. Cairns Hospital, the major health system, is already live on Cerner, which probably places it in a strong bidding position.


Government and Politics

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ONC announces the winners of its Blockchain in healthcare challenge, which drew 70 submissions. The 15 winners from which up to eight will be selected to present at the ONC/NIST workshop September 26-27 are:


Privacy and Security

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Two West Virginia hospitals owned by Appalachian Regional Healthcare go back to paper when their computer systems are infected by unspecified malware. The systems went down last weekend, and according to a Tuesday update on AHR’s site, are still down.

A judge rules that a lawsuit brought by the mother of a murdered TV news anchor against two hospital employees who viewed her medical records can proceed, although the judge finds that the hospital is not liable for the actions of its employees.


Innovation and Research

Researchers question whether physicians should order more diagnostic imaging tests or inform patients when their studies turn up incidental findings of unknown significance. The authors say genetics testing may provide a model that’s applicable to radiology, where patients decide upfront how much they want to know and their medical experts don’t disclose minor, low-risk findings. Others caution that it’s not practical in a litigious malpractice environment to withhold information of unknown future significance, especially when a lot of diagnostic imaging tests are performed purely to avoid malpractice claims. 


Technology

Huffington Post covers the hospital use of virtual reality as an alternative to drugs for pain management and relaxation.  

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Two radiologists in Canada create Tipso, which projects PACS images onto a surgical drape so that surgeons can manipulate them with their hands without breaking the surgical field. Tests suggests that the system can reduce surgery time by up to 15 percent.


Other

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A former Mount Sinai School of Medicine researcher who was fired in 2010 for data fraud and then sued the school unsuccessfully for discrimination shoots two men outside a Chappaqua, NY deli, one of them the dean of the medical school, in an apparent revenge attack. Both the dean and a bystander suffered non-life threatening injuries.

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A Gallup poll finds that healthcare, pharma, and the federal government take the bottom three spots in consumer perception. Restaurants and the computer industry top the list.

Researchers find that one-fifth of genetic research papers whose authors used Microsoft Excel to analyze their data contain incorrect gene names, as the authors fail to notice that the worksheet software automatically translates symbols (SEPT2) to dates (September 2).

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In China, a state-run newspaper covers a hospital’s Internet addiction treatment center that has used electroshock on 6,000 people, mostly teenagers who are sent there by their parents. The patients are forced to attend ideological education and military training and are given shock treatments for breaking any of 86 rules, which include not taking their meds on an empty stomach and not sitting in the dean’s chair. Such treatment would be equally popular with providers here if insurance would pay for it.


Sponsor Updates

  • Gibson Consultants publishes “Independence remains a rewarding choice for doctors” by Aprima CEO Michael Nissenbaum and Chadwick Prodromos, MD.
  • Arcadia Healthcare Solutions analytics earns NCQA PCMH pre-validation.
  • Impact Advisors is recognized as one of the largest healthcare management consulting firms. 
  • KLAS recognizes Nordic as a top performer in optimization services.
  • Besler Consulting publishes a “2017 IPPS Final Rule Analysis.”
  • Leadership Columbus selects CoverMyMeds Communications Manager Mike Bukach for its Signature Program Class of 2017.
  • The Mental Health Association of Erie County will honor CTG for its contributions to the cause at its annual Benefactor Society Reception on September 7 in Buffalo, NY.
  • Elsevier Clinical Solutions receives a Merit Award for Patient Education from Health Awards.
  • Fortune features comments from Extension Healthcare CEO Todd Plesko in an article on WhatsApp.
  • Built in Colorado profiles Healthgrades CTO Bill Bell.

Blog Posts


Contacts

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

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August 30, 2016 News 4 Comments

Morning Headlines 8/30/16

August 29, 2016 Headlines No Comments

Health Insurers’ Pullback Threatens to Create Monopolies

Analysis from the Kaiser Family Foundation finds that health insurer pullback from ACA marketplaces will leave 19 percent of 2017 enrollees with only a single plan available in their area, while another 19 percent will have to chose between just two plans.

CMS proposals would alter ACA marketplaces, risk adjustment in 2018

Following months of complaints from insurers about the methodology used to calculate risk adjustment payments in ACA exchange plans, CMS publishes a proposed rule stating that it will begin including patients’ current medications as part of the risk adjustment criteria used to calculate payments.

athenahealth Acquires Patient IO to Accelerate Patient-Centered Care

Athenahealth acquires patient engagement app developer Patient IO for an undisclosed sum. Athena initially invested in Patient IO in October 2015, when it accepted the startup into its More Disruption Please accelerator program.

Teladoc Secures Second Consecutive Win in Patent Dispute

Teladoc wins its legal challenge against fellow telehealth vendor American Well after the US Patent and Trademark Office invalidates major elements of American Well’s telehealth patent.

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August 29, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 8/29/16

August 29, 2016 Dr. Jayne 1 Comment

Many of us who work in the informatics space full time are attached to academic medical centers, large hospitals, large physician groups, or vendors. We’ve been working with electronic health records, billing systems, and interfaces a long time.

In my case, I was fortunate to work with a large health system that saw the value of electronic health records and data exchange long before Meaningful Use or any kind of payer incentive programs. We decided to move forward with technology because it was the right thing for us, allowing better data capture and the ability to track towards better outcomes.

Although I worked for a large health system, many of our employed physicians ran offices that looked a lot more like private practices than anything else. When I went into consulting, that was naturally one of my sweet spots, working with small to mid-sized practices that might not know much about informatics or the forces changing healthcare.

I still do work for large health systems as well, but my partner and I are fielding more requests from independent practices than we can handle. Quite a few of the requests involve things that most of us take for granted, such as lab interfaces. My most recent client has three physicians and six support staff. They outsource their billing functions and revenue cycle and use a major vendor’s EHR and practice management software on a hosted platform. Their installation is pretty vanilla, with very few customizations. They haven’t participated in the Meaningful Use program in the past, but with the increasing penalties for failure to do so, they have decided to start increasing their use of the system. They’re still not sold on MU, but want to be closer to ready in case they decide to take the plunge.

I’m not sure why they didn’t implement a lab interface when they went live. They are an internal medicine group and order a large volume of labs. I’m guessing that at the time they installed their system, they had been managing well with their paper orders workflow and basically just automated it. They do order their labs in the EHR, but print a paper requisition and either send it with the patient to the lab, or send it in the pouch with blood drawn in the office. The laboratory vendor delivers results through a Web portal, which they had been using pre-EHR and were comfortable with it. They print the labs, scan them into the EHR, and then the physicians manage them either through a telephone messaging template or by sending a letter to the patient.

It’s fairly efficient, although you can’t graph or track or trend the results. You also can’t mine them for outreach purposes, which is the key driver of their interest in having a lab interface.

Working with someone who knows why they want a particular feature and what they hope to achieve by implementing it is always a pleasure. There are plenty of groups who embark upon technology projects due to penalties or fear of penalties, and that makes it more difficult because the team may not have a sense of buy-in or understand why the extra work needed is valuable or important. This group wants to be able to easily identify patients whose lab values show that the patients need extra attention or need to be brought back into care. Most of us take this functionality for granted, so it’s been refreshing to work with someone who is seeing it through new eyes.

Although at times there has been a sense of wonder, there has also been significant frustration. The EHR vendor hasn’t been terribly helpful. The EHR vendor supports multiple lab vendors, but didn’t make it clear that some of the lab vendors have multiple business units with different lab compendia, so my client downloaded the wrong one. The client doesn’t have any dedicated IT resources and the vendor didn’t require the client to attend any training prior to attempting to install a lab interface, so they immediately wound up off track.

They hadn’t talked to their lab vendor about installing an interface prior to starting work with the EHR vendor, either. They got in touch with their lab account rep to figure out which business unit they were using, and the lab sent the required test plan as they normally would during an interface project. When the practice saw it, the project ground to a screeching halt because they didn’t feel they had the resources to take on a testing effort while doing their regular work.

The project stalled for several months until one of the partners decided to push it again, and obtained some referrals for consultants. There are at least a dozen consulting companies that work closely with the EHR vendor, so I’m surprised that no one on the vendor side had suggested that the practice go that route to get the project moving. They ended up contacting me because I was local, which ended up not really mattering since I’m not doing anything for them in person. All they really needed was someone to run interference with the vendors and help execute the test plan. Since they were already ordering and managing tests in the EHR, there was maybe 30 minutes of training to do for the staff.

I put together a bid and they were surprised at how small the effort really was. I quoted them 15 hours to complete the project from their side and it ended up only taking 12 hours over less than two weeks to get them live. However, when you don’t know what you’re getting into or how to accomplish what needs to be done, that 12 hours is a mountain. It stood in their way for months because they didn’t know how to get over it. Guides were available, but they didn’t know how to find them and their vendors didn’t suggest ways to get help.

I’m glad I was able to help them, but it’s sad that it took so long to get a simple interface live. There are hundreds of practices facing similar issues every day, and unfortunately they’re choosing to sell out to big hospitals or health systems because they don’t know where else to turn and are weary of trying to figure it out.

It’s like the Benjamin Franklin quote about the kingdom being lost for want of a nail. Having come from private practice roots, I don’t like to see physicians give up and sell because they feel there isn’t another option. They are struggling with things that many of us find routine, and that’s sad since the knowledge is out there it’s just not in the right place at the right time. Some feel it’s better that we move into larger organizations and the Accountable Care movement certainly supports that. But we’re losing a little bit of our identity as physicians along the way.

What do you think is the answer for small practices to keep up with technology? Email me.

Email Dr. Jayne.

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August 29, 2016 Dr. Jayne 1 Comment

HIStalk Interviews Hank Jones, III, Technology Lawyer

August 29, 2016 Interviews No Comments

Henry W. “Hank” Jones, III is an attorney in private practice and owner of Intersect Tech. Consulting of Houston, TX.

Tell me about yourself and your firm.

I’m a 36-year lawyer in information technology who works as a midwife, birthing transactions and products, usually software or e-commerce. I’ve been in six companies, full-time on the exec team of three in blended roles doing firefighting, utility infielder multi-department tasks, sales, and product design. Coming from an intellectual property background, then doing more and more in healthcare over the 36 years.

We first connected from your comments about market research firms. What do you think about their methodologies and potential conflicts of interest?

Too many customers of IT in every domain, medical or otherwise, are unfortunately naïve that market research is both necessary and insufficient, at least for significant transactions, for multiple reasons. Number one, their methodologies and, therefore and their goals and missions are limited. Number two, there are necessary data, if you’re trying to be safe and excellent and surviving on transactions for a long time, they’re really beyond the market research companies’ skills or traditional efforts. In particular, failure analysis, customer disputes, litigation, and government regulatory filings.

The occasional project leader, IT manager, sourcing "professional," or even worse, healthcare professionals venturing into an IT transaction for the first time, don’t know what they don’t know. Unknown unknowns can be mission critical in choosing what the scope of the transaction should be, how you do the selection exercise, and what negotiating plan or terms and conditions you need. The market research firms vary among themselves significantly on their skill, their processes, and how they get paid. Even then, to do any kind of medium- or large-sized transaction, it’s not enough.

How common is it that companies have legal skeletons in their closets that prospects should know about?

Actual lawsuits are intermittent, but necessary market knowledge. The real question is, what’s the risk profile for the individual transaction and proposed solution? Which involves, number one, looking at other competing vendors’ track records. Number two, disputes that never got to litigation, which always outweigh the quantity that actually get to litigation. Number three, arbitration and mediation. Most stuff never goes to court. Number four, the latest move to automation with the stimulus money, etc.

Many IT customers don’t understand that there’ve been massive sea changes in how the technologies get built upstream and under the hood. They don’t know that every deliverable is a hybrid with many components from many owners. Many don’t know that a lot of what gets delivered was designed using tools and languages that come from third-, fourth-, fifth-tier removed vendor who built good stuff, but it may or may not be available long term. It may or may not have been customized to a significant degree. Further, there’s open source in everything now. Not only in testing activity, but actually in the deliverable.

Too many customers are using 1980s and 1990s assumptions that were then valid regarding software development and content that are archaic and therefore somewhat dangerous now. You wouldn’t use old virus scanning software on your PC for your house to know what’s on the inside. Similarly, the procurement processes and the project plans, negotiation skills, the contract provisions and exhibits that healthcare providers want now should reflect modern, appropriate technology norms, which have changed in the last five or 10 years.

How often do company executives or founders get into legal disputes with their boards or investors?

It depends on the size and age of the company. It’s very common to have a founder displaced after taking an additional round of investment. It’s common to have management teams nudged out, and often financially rewarded for it, after a merger as opposed to an initial venture cap round. It’s even more common in software now.

A third factor that’s newer is the large software-only private equity firms, which have a ton of gunpowder. There’s three or four or five of them that only do software company acquisitions and radical overhauling. They take best practices with an elite specialist consultant team and then do mash-ups. We’re seeing that with the McKesson and e-MDs products getting smooshed together on an ambulatory level, for example. 

In Austin, where I just moved from, there’s a PE company with $16 billion who are doing 20 or 30 transactions a year. Many of them are mid-sized companies, but including some whales like Misys out of London, the deal they did a while ago. Greenway got taken private, so we don’t know their financial disclosures any more.

Everyone should assume that the vendor isn’t who it will be at the end of the expected useful duration of a product. My metaphor is that you and your significant other go out for dinner and a movie and the babysitter has outsourced and subcontracted by the time you come back. Somebody else is watching over your kids.

Is it fair for publications to sensationalize the details about a lawsuit that’s just been filed even though they have only one side of the story at that point?

There’s a problem of inadequate business journalism. There are tons of interesting action items for HIT managers in those 960 Epic-Tata pleadings, but it takes a lot of effort, and frankly, domain expertise, to sift and parse and differentiate what’s normal or not in the legal environment. The splash — yellow journalism would be the technical term — is a problem, but I would say the larger problem is inadequate follow-up and inadequate domain translation. There’s another problem too, which is that things get sealed, although I’ve had some success over the last couple of negotiations with judges later having them unseal some things, one of which was a medical software OEM deal.

What are your thoughts about Epic, Cerner, and other companies that make their employees agree to arbitration rather than labor lawsuits as a condition of ongoing employment?

I’m not a labor lawyer, so I don’t think my comments are that useful. It’s clear that in all parts of US industry, arbitration has been a mega-trend. There’s been push-back in every industry of it being, in some contexts, suppressive and unrealistic.

Real business people and lawyers, however — back on health transactions and other IT transactions in every industry — know that a careful scalpel in contracting, meaning a sharp pen, is a useful tool because what you want is to see prevention processes, governance clarifications, and then dispute-handling processes. The IT outsourcing, multi-year contracts have for years contained customized processes to deal with disputes. Over a period of time, priorities, technology, and the leadership economics are going to shift somewhat.

What people should be doing — and a few smart, creative ones do, but most don’t — is port the transactional tools, the terms, the rules of a contractual relationship, from outsourcing into pure software licensing, on the argument that the software’s going to change, ownership may change, the features are going to change, the security specs are going to change. Why not treat software not as a physical product, but as an evolving thing that it realistically is? Particularly in healthcare where you’ve got changing regulations, security specs, and patches that are more important from the privacy stuff. ADR should be for us in HIT a detailed, customized, thoughtful exhibit in every contract, rather than a two-sentence paragraph that nobody looks at. That’s like ignoring anesthesia in a prep for surgery.

Are patent trolls a big problem in health IT?

Yes. There’s lots of economics, there’s studies on that. The America Invents Act did not solve it. The Eastern District of Texas is still a whorehouse. Not La Grange, where the film with Burt Reynolds and Dolly Parton came from. The judges went to the Dallas bar and recruited the work. There’s not yet a legislative fix. It’s a problem that’s broader, although most visible in technology. A lot of people have worked on that. 

I used to be vice-president of intellectual property development for a $3.5 billion revenue per year company. I’m not really a patent specialist, but I know and work intermittently with people who really are deep in this. It’s still a problem that in healthcare is inadequately understood by customers who don’t know that a shotgun, financially speaking, could be placed to the head of their supplier. In particular, do the hospitals require due diligence by their people and then contractual warranties and insurance purchasing by providers, because patent expenses and threats to their vendors upstream from these third parties are a realistic business concern. It’s not even on the checklist.

A big HIT transaction is like a major surgery. A pacemaker installation, if you want to be metaphorical about it. Have they worked up the patent risk and risk mitigation scenario of each prospective vendor and worked that into their spreadsheet or their evaluation? Some vendors are, and some vendors aren’t, holding their own tools, munitions, and ammo in terms of patents and patent licenses or membership in patent-sharing defense arrangements. There’s a publicly traded company that all it does is provide a shared defense. That tells you that the need is that large, that people could commercialize this reactive requirement.

Do you have any final thoughts?

My hunch — and my possible book, as I look at expanding that 3,000-word article about avoiding health software heart attacks — is whether the industry has a problem with assigning, in effect, pre-med students to do neurosurgery. The observation by many HIT specialists is that a lot of providers only plan and then procure their solutions intermittently. Therefore, they attempt to negotiate against vendors who are professional and have a different set of objectives.

I had a software manager at a very large academic institution come to me and say, "Please help us. My sourcing people know sutures and Band-Aids, but not medium- or large-scale software transactions." It’s a minority of transactions that get done well, resulting in HIT organizations having operational health risks that don’t happen in other industries.

There’s a majority view that’s whispered or shared over drinks that because so many healthcare organizations are relatively new at automating, they have the naiveté of thinking that it’s like any other skill. CIOs  who are fine human beings, very smart, or physicians who aren’t careerists in IT might not have the transactional, life cycle, and vendor management experience that CIOs do in other industries. This is hard. You could argue that health software and health IT is harder because it’s in an environment different than other industries, with more regulation, more change, more third-party roles, government paying for some, and health privacy.

You need more skills and ruggedness in your contracts, supply planning, and IT strategy than in finance, manufacturing, or consumer goods. Maybe I can find some non-profit funding and lure some graduate students to work on their practicum or internships to do records requests. Some of the contracts that I’ve pulled from government hospitals under sunshine laws show work and current supply chains that extend maybe to the dangerous degree that would be unacceptable to the boards of companies in other organizations.

You don’t want to buy the first car off the manufacturing line of a new model. You don’t want to be a first patient of a newly-minted surgeon. Do you want to be a manager of a healthcare provider where the EHR was the first and only IT transaction by somebody? It’s hard.

I know one systems integration vendor who says CIO secretly stands for Career Is Over, because the demands are greater than the time, the funding, and the commercial support in a lot of cases. Unlike some other industries, people haven’t gone and done the epidemiology, the autopsies. In other industries, the selection exercises are way more diligent. They are larger than the selection process. The planning on the front end. Exhibits are process specific, twice as long than in other types of transactions.

What happens is that in a lot of these EHR deals, the customer becomes a captive. That’s evidenced, literally, by the documents that have surfaced in some of the materials that I’ve hunted up and would be the anchor or the database of my possible book. All that’s before the regulatory changes, the more open source software in there. Doctor Gawande’s great book “Better” is the watchword for all of us. A lot of organizations, at least in HIT, are not even at “good” yet. They’re trying to be competent and they’re striving, but whether they’ve gotten to good, much less any best practices, is a real question. Particularly when you drill down and do the lab tests on the actual documents that people are actually operating under.

I’ve pulled out some half a billion dollar, 10-year EHR deals to smaller ambulatory ones and specialty groups. It’s scary how weak the supply chain is in healthcare software as opposed to some other industries. You wouldn’t rely, you wouldn’t invest in it if you knew the standards of others knowing the delta of the difference.

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August 29, 2016 Interviews No Comments

Morning Headlines 8/29/16

August 28, 2016 Headlines No Comments

Epic EHR costs push ProMedica into the red

Ohio health system ProMedica reports a $1.9 million loss in its first-half 2016 financial statements, attributing the poor performance to “significant expenses due to the implementation of the Epic electronic health record launch,”

Schedule of Events For Board of Regents’ Meeting

M.D. Anderson Cancer Center reports a 77 percent drop in net income that it attributes to higher expenses and reduced patient revenue associated to its Epic implementation.

Medscape EHR Report 2016: Physicians Rate Top EHRs

Medscape publishes EHR ratings based on physician satisfaction, finding that the VA’s CPRS system was rated higher than any other system, including Epic, Cerner, and Meditech.

Citius, Altius, Fortius: Announcing 6 new pilot projects across 10 states

NIST announces its first six NISTIC pilot projects focused on exploring options for deploying national trusted identities for use on the Internet, including a $1 million grant to Cedars-Sinai Medical Center (CA).

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August 28, 2016 Headlines No Comments

Monday Morning Update 8/29/16

August 28, 2016 News 15 Comments

Top News

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Promedica (OH) attributes its first-half 2016 losses to the cost of its Epic implementation. The 12-hospital health system swung from a $43 million operating surplus in the first half of 2015 to a $2 million loss in the same period of 2016. Higher employee costs also contributed.

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University of Texas says  M.D. Anderson Cancer Center’s 77 percent drop in net income (down $405 million) in the past 10 months was due to higher expenses and reduced patient revenue, both resulting from its implementation of Epic. MDACC went live on Epic in March 2016 and says it anticipated the negative financial impact, but hopes to “return to normalized operations by year-end.”


Reader Comments

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From Carl Kolchak: “Re: Suburban Hospital (part of Johns Hopkins). My father is a patient there and the whole Epic system was down. They are on downtime procedures, which is interesting to watch.” Unverified.


HIStalk Announcements and Requests

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More than 80 percent of poll respondents think hospitals should be required to bill uninsured patients at the lowest prices they offer to insurers or anyone else. Sally B says it’s just plain wrong that those who can least afford it are expected to pay the most, while Mind Blown offers personal experience of an $85,000 hospital stay that his or her insurance company negotiated down to $16,000, something the average person wouldn’t have been able to do. Ron is encouraged that local health systems are offering big upfront discounts for elective procedures, although they take a long time to return calls. Mindy also has personal experience, in her case a $2,400 CT scan that despite not having hit her insurance deductible, cost her only $808 thanks to her insurer’s negotiated price. Nick says a benefit of forcing hospitals and health companies to offer everyone the same rates they accept from big insurers would be the creation of a price book that would allow people to comparison shop.

New poll to your right or here: who is most responsible for high US healthcare costs?


Last Week’s Most Interesting News

  • In Canada, grocery and drug store operator Loblaw offers $132 million for EHR vendor QHR Technologies, which holds 20 percent of that market in Canada.
  • Fast Company discovers that Apple acquired consumer EHR data collection and sharing startup Gliimpse earlier this year.
  • CommonWell Health Alliance adds patient-facing services that several vendors have committed to incorporating into their EHRs.
  • The Office for Civil Rights announces that it will expand its investigations into data breaches involving the information of fewer than 500 people.
  • Canada-based Harris acquires OB/GYN EHR/PM vendor DigiChart.

Webinars

None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel. Some recent ones that are available for replay:


Acquisitions, Funding, Business, and Stock

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Verisk Health renames itself to Verscend Technologies. Veritas Capital acquired the now-independent business from parent company Verisk Analytics in April 2016. The company hired Emad Rizk, MD (Accretive Health) as CEO and board director two weeks ago.


People

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Scott Newton, DNP, RN (The Johns Hopkins Hospital) joins TeleTracking as VP of care model solutions.

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Lisa Elias (Leidos) joins Orchestrate Healthcare as area VP.


Announcements and Implementations

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Summit Healthcare launches Provider Alert, which allows hospitals to send electronic notifications and documents to physicians whose patients have been treated in the hospital. Parkview Medical Center (CO) will implement it.

In England, Yeovil District Hospital NHS Foundation Trust goes live on InterSystems TrackCare.


Government and Politics

NIST’s National Strategy for Trusted Identities in Cyberspace funds six new pilot projects that include a $1 million grant to Cedars-Sinai Medical Center (CA) to implement single sign-on and two-factor authentication for both patients and providers to simplify transition to post-acute care settings. The project was awarded in partnership with ONC.


Technology

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Vital Images is exploring the use of Microsoft’s HoloLens in its enterprise visualization solution, with use cases that include guided surgery and education, telemedicine, and virtual care.

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Business Insider covers the problems DocGraph and its CEO Fred Trotter had last week when Google automatically shut down the company’s access to its storage and analysis services due to suspected hacker activity, which turned out to be justified because the company’s misconfigured server had allowed a hacker to use it to launch denial-of-service attacks. Experts say Google’s cloud services are immature compared to those of competitors such as Amazon, to which Trotter has turned as a backup in case Google’s cloud becomes unavailable again.

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A photo of Donald Trump’s doctor – who admits that he spent only five minutes dashing off a bizarre, hyperbolic assessment of the health of the candidate, who has not released his actual medical records — apparently uses a Windows XP computer in his office, based on video from NBC.


Other

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Medscape’s 2016 physician EHR survey finds some interesting facts:

  • Epic is by far the most widely used EHR, beating out Cerner 28 percent to 10 percent.
  • Allscripts, which came in at #2 most used in the 2012 survey, didn’t even place in the top five this time.
  • The top-rated EHR is the VA’s VistA, beating Epic. The lowest-rated is another government system,  the DoD’s multi-billion dollar AHLTA.
  • Hospital-based and independent practice doctors both rate NextGen as the worst system.
  • The highest-rated EHRs for satisfaction are Practice Fusion, Amazing Charts, and VistA.
  • VistA and Epic lead the pack for connectivity, while Amazing Charts, Greenway, Practice Partner, and NextGen hold the bottom four spots.
  • Half of the respondents say the EHR takes away from their face time with patients and reduces the number of patients they can see.
  • Forty-two percent of doctors say they copy and paste EHR information “often” or “always.”

Maybe some vendors are closer to becoming “the Uber of healthcare” than they think: Uber has lost at least $1.2 billion so far this year. A business professor who questions Uber’s high valuation summarizes, “You won’t find too many technology companies that could lose this much money this quickly. For a private business to raise as much capital as Uber has been able to is unprecedented.”

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A Milwaukee Brewers fan blogger proposes that Epic CEO Judy Faulkner offer to move the team’s AAA affiliate from Colorado Springs, CO to Verona, WI and building it an indoor stadium that could also be used for Epic meetings. Otherwise, the Sky Sox are headed to San Antonio in 2019 if the owner can convince city taxpayers to buy him a stadium. Cerner’s Neal Patterson has his soccer team, so it would be fun for Epic to have its own baseball team.

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This brilliant graphic tells you everything you need to know about why our absurdly high US healthcare costs involve throwing money at the wrong (but highly profitable) health determinants. That tiny patch of green on the left shows how little the delivery of healthcare services influences overall health despite what hospitals and practices would have you believe. That hugely dominant patch of aptly colored green on the right shows that, like bank robber Willie Sutton, profit-seekers have gone where the money is (hint: it’s not in prevention or teaching people better lifestyle habits). “Healthcare” is not even vaguely synonymous with “health.” You also can’t have “public health” when the public in question would rather fund hospital bills than self-examine their eating, drinking, smoking, drug-taking, and exercise habits.

In Ireland, several dozen job candidates who had been offered positions with GE Healthcare are talking to lawyers after the company rescinds all of its job offers the day before the new hires were scheduled to start work. Some of them are now unemployed since they had quit their old job. The company says its labor unions are at fault for balking at its plans to change work schedules.

Vince and Elise continue their “Rating the Ratings” series. They subjectively rank the 1-2-3 finishers among KLAS, Black Book, and Peer60 using criteria they describe.

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Weird News Andy notes the death of man whose but often-played but never-cleaned  bagpipes infect his lungs with fungi that cause hypersensitivity pneumonitis. WNA puts an upbeat spin on the story with his favorite bagpipe jokes:

  • What is perfect pitch with bagpipes? 20 yards into a lake.
  • What is the difference between bagpipes and a lawn mower? You can tune a lawnmower.
  • What is the difference between bagpipes and a trampoline? You take off your shoes to jump on a trampoline.

Sponsor Updates

  • Experian Health and The SSI Group will exhibit at CAHAM August 28-31 in La Jolla, CA.
  • Christus Trinity Mother Frances Health System CIO Mike Eckhard discusses its use of PatientSafe smart phones on the local news.
  • WRAL Tech Wire interviews PatientPay CEO Tom Furr.
  • Network World interviews Red Hat CEO Jim Whitehurst.
  • The local business paper covers GE Healthcare’s donation of medical equipment to the Olympic and Paralympic games in Rio.

Blog Posts


Contacts

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

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August 28, 2016 News 15 Comments

Morning Headlines 8/26/16

August 25, 2016 Headlines No Comments

This Princeton health economist thinks Obamacare’s marketplaces are doomed

Uwe Reinhardt, a professor and health economist from Princeton University, calls ACA public health insurance exchanges doomed because premiums continue to climb while the penalty for failing to have insurance is less than the premiums.

From health care capital to innovation hub: Positioning Nashville as a leader in health IT

A Brookings Report finds that despite its abundance of hospital management corporate headquarters, Nashville continues to falter in its effort to become a health IT hub.

JPP’s fireworks debacle could now cost ESPN millions

A Florida judge allows NFL defensive end Jason Pierre-Paul’s invasion-of-privacy lawsuit against ESPN to move forward. The case was filed after ESPN published an article about a fireworks-related hand injury that included images from Pierre-Paul’s private medical records.

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August 25, 2016 Headlines No Comments

News 8/26/16

August 25, 2016 News 8 Comments

Top News

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States begin approving insurance company rate increase requests for ACA-sold policies, with premiums of those issued by Tennessee’s largest insurer jumping an average of 62 percent. Other states are approving hikes of 20 to 43 percent.

HHS says cost-based federal subsidies will soften the blow for most consumers, with three-fourths of those who buy insurance from Healthcare.gov paying less than $75 per month. Tennessee’s insurance commissioner says she had to approve huge increases because high insurer claims cost would have forced them to pull out of the ACA market completely otherwise.

Meanwhile, Princeton economist Uwe Reinhardt says the federal insurance marketplaces have entered a premium-increase death spiral. Similar programs in other countries are run by non-profit insurers offering a standard package of benefits that carry harsh penalties for citizens who don’t sign up. He summarizes,

The natural business model of a private commercial insurer is to price on health status and have the flexibility to raise prices year after year. What we’ve tried to do, instead, is do community rating [where insurers can’t price on how sick or healthy an enrollee is] and couple it with a mandate. When you do this as the Swiss or Germans do, you brutally enforce the mandate. You make young people sign up and pay. But we are too chicken to do that, so we allow people to stay out by doing two things: We give them a mandate penalty that is lower than the premium. And we tell them, If you’re really sick, we’ll take care of you anyhow.


Reader Comments

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From FlyOnTheWall: “Re: American Well. Cut half its sales team, going from 10 to five.” Unverified.


HIStalk Announcements and Requests

I get a lot of press releases, interview offers, and sponsorship information requests from folks who work for marketing, PR, and advertising companies, but I’m embarrassed to admit that I’ve never really kept any records other than what’s in my sent emails. If you work for one of those companies and work with health IT vendor clients, enter your contact information and we’ll keep in better touch.

I was reading a Reddit about seemingly cheery pop songs that have dark lyrics about stalking, murder, and rape (both violent and statutory) that listeners fail to note. Example: Foster the People’s “Pumped Up Kicks,” to which clueless hipsters dance joyously to a whistly song about a teen planning to kill his classmates who can’t “outrun my gun.” It’s not quite as creepy as Ringo’s “Only Sixteen” or as opposite in meaning than people think about “Born in the USA,” but everybody misses it.

This week on HIStalk Practice: Dr. Gregg does the MACRA-rena. HHS awards $100 million to help health centers improve quality, HIT utilization. ONC commemorates HIPAA’s 20th anniversary. Safety Net Connect offers CCD workaround for community health centers. PMA Medical Specialists signs on with Aledade. South Carolina physicians cozy up to telemedicine. Alpine Foot & Ankle rolls out new ECW portal. Culbert Healthcare Solutions President Brad Boyd offers seven tips to help practices mitigate revenue risk during IT implementation.

This week on HIStalk Connect: Honor raises $42 million to expand its home care services from California into Texas. Big data startup Innovaccer raises a $15.6 million Series A. Smart pregnancy wearable company Bloomlife will use its latest round of funding to commercialize its first product. Accolade raises a $70 million Series E.


Webinars

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

Sensato CEO John Gomez always puts on an excellent webinar and his HIStalk-sponsored one from earlier this week was no exception. Above is the recording of “Surviving the OCR Cybersecurity & Privacy Pre-Audit.”


Acquisitions, Funding, Business, and Stock

European regulators approve creation of a joint health IT services venture between McKesson and Blackstone. I assume that’s the JV that will take over most of McKesson’s health IT business and combine it with Blackstone-owned Change Healthcare.

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McKesson will sell its San Francisco headquarters building and lease it back, freeing up capital. The value of comparable properties suggests that the building is worth around $300 million.

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Home care agency software vendor ClearCare announces a $60 million growth equity investment, increasing its total to $76 million.

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In Australia, personalized dosing software vendor DoseMe closes $2 million in Series A financing, increasing its total to $15 million. The company plans to expand to the US market and integrate its product into EHRs.

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Panama City, FL-based wait time software startup Jellyfish Health will add 100 employees over the next three years. The founder, president, and CEO is industry long-timer Dave Dyell, who founded iSirona in 2008 and sold it to NantHealth in 2014.


Sales

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Carilion Clinic (VA) chooses LogicStream Health’s clinical content optimization platform to reduce catheter-associated UTIs and venous thromboembolism by monitoring the clinical decision components that enable standardized care.

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Four-bed Southern Inyo Hospital (CA) will implement the OpenVista EHR from Medsphere, which will also manage the hospital’s IT services via the company’s Phoenix Health Systems division that it acquired in April 2015.

Receivables management vendor Specialized Healthcare Partners chooses Armor’s cloud platform to earn HITRUST certification.


People

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Pivot Point Consulting hires Brett Meyers, MD, MS (Meyers Consulting Services) as CMIO.

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MaineHealth names Marcy Dunn (Catholic Health Services of Long Island) as SVP/CIO.


Announcements and Implementations

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NVoq makes its SayIt speech recognition and work flow solutions available to healthcare customers in Canada.

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Healthwise earns Washington state certification of two of its patient decision aids as one of the first companies in the country to obtain such certification. The non-profit company offers 170 decision aids covering a variety of topics.


Privacy and Security

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A Florida judge approves the invasion of privacy lawsuit brought against ESPN and reporter Adam Schefter by professional football player Jason Pierre-Paul, whose surgery schedule was tweeted as a photo by Schefter as part of his story involving Pierre-Paul’s loss of a finger in a July 4, 2015 fireworks accident. The judge agreed with Pierre-Paul that while his injury was a public issue, his chart was not despite Shefter’s insistence that he needed the image to prove his story. Two employees of Jackson Memorial Hospital (FL) were fired over the incident.

From DataBreaches.net:

  • A stock short seller claims that medical devices made by St. Jude Medical are susceptible to cyberattacks, sending the shares he had bet against down 8 percent Thursday.
  • An Indiana clinic notifies an unstated number of patients that an upgrade to a server containing EHR data left it unprotected, a situation hackers took advantage of in breaching its systems.
  • California-based SCAN Health Plan announces that its sales contact sheets were accessed “for unauthorized purposes.”
  • Millennium Hotels & Resorts warns customers to review their credit card statements the food and beverage sales systems of 14 of its hotels were breached due to a vulnerability in the third-party system they use. That sounds similar to Banner Health’s food and beverage systems breach reported earlier this month that exposed the information of 3.7 million people.

Technology

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Fortune notes that nearly 90 percent of doctors in Brazil communicate using Facebook-owned, cross-platform consumer messaging app WhatsApp. It recently added end-to-end encryption that even many healthcare-specific, HIPAA-compliant apps don’t have (WhatsApp itself can’t read messages sent on its system). Facebook paid $14 billion for the company in 2014 and some experts think it could be worth up to $100 billion once Facebook monetizes it, which is already happening as Facebook just announced that it will use WhatsApp user information to target Facebook ads.

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Google announces Duo, a simple, cross-platform video calling app that employs end-to-end encryption and requires only a telephone number. The Android version has been downloaded 5 million times from the Google Play store.


Other

I wrote in July about the huge price increases and opportunistic marketing employed by Mylan Pharmaceuticals in increasing sales of allergy auto-injection EpiPen to $1.2 billion per year, fueled by jacking up the price of the decades-old drug by 500 percent, mandating sales of two-packs instead of single pens, lobbying to have the drug placed in all schools, and shortening its expiration date to one year. Hero-villain Martin Shkreli, who exposed drug pricing absurdities by raising the price of old but vital Turing Pharmaceuticals drug Daraprim by 5,000 percent just because he could, defends Mylan since they make only an eight percent profit overall. He says insurers should love paying the full $300 cost (without a patient co-pay) because it saves a $20,000 trip to the ED to get the same drug. Shkreli’s solution to unjustified generic drug prices – and it’s a pretty brilliant one — is for the federal government to create a generic drug company of its own and run it like a utility, leaving drug companies to sell only their patented drugs (he probably doesn’t even realize the benefit of fixing the never-ending hospital generic drug shortage problem). Shkreli is boyishly charming, shockingly outspoken, and ingeniously capitalistic, all prized characteristics except in the schizophrenic world of the business of healthcare where we don’t like being reminded of the enormous profits being made on the backs of those who are temporarily or permanently living the role of patient.

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I like this poetic discussion of the fact that 75 percent of Americans want to die at home although only 25 percent actually do so because of poor planning, written by HealthLoop founder Jordan Shlain, MD:

In contradistinction to your bed, please meet the mechanical, rigid, railing-bolstered hospital bed. Comfort be damned, it is a tool designed to protect medical vessels (a.k.a. patients) from falls, or to give nurses and doctors that ability to move you up and down like a car on a jack. In essence, it’s not really a bed. It doesn’t know you, nor does it like you. It hasn’t held you for years, it isn’t lonely without you. It sees you as a place-holding slab of flesh to be manipulated — until it meets another slab … For the foreseeable future, we cannot afford to view life as a simple game of winning or losing. Rather, it’s a process with a beginning, a middle, and an end. While some people’s ‘end’ happens in the beginning, and some in the ‘middle’, the natural end deserves, at minimum, a modicum of dignity. The last place I want to wage and lose a war in my twilight moments is in the bed(lam) of a hospital.

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A Brookings report reviews Nashville’s ambitions to become a leader in health IT. It notes that while Vanderbilt University performs a lot of health-related research, most of it occurs outside the university’s IT department, has limited IT applicability, and generates only a small number of patents given the dollars spent. The report also notes that Nashville is second to last among peer metro areas in the number of  software developers and analysts. Brookings calls Nashville’s health IT ecosystem “thin and inconsistent” with modest venture capital investment, especially in funding beyond the B round. Brookings recommends expanding the innovation infrastructure, building the health IT skills base, and fostering the health IT innovation ecosystem.

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The two big Orlando hospitals announce that they won’t charge survivors of the Pulse nightclub shootings in June for the medical services they received. It’s always interesting when hospitals decide to magnanimously write off bills for high-profile patients while aggressively chasing down money owed them by less-famous ones. Few non-profits outside of our screwy healthcare non-system bill consumers directly, but those who do don’t generally brag on allowing some of them to skip paying and leaving others to fund their expansive bottom lines and million-dollar salaries.

The Pew Charitable Trusts is looking for a health IT expert to work on safety and interoperability research that includes patient matching, data standards, a national health IT safety center, and post-implementation EHR testing.

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Weird News Andy says he hopes the cutting-edge surgery puts the end to the “sworded” affair of a man in India who swallowed 40 knives due to a “wild urge to consume metal” that he likened to alcohol or drug addiction. Surgeons removed the knives and suggested he eat spinach if he feels a need for iron. My first thought was whether the sight of the scalpel made his stomach rumble.


Sponsor Updates

  • Healthfinch asks, “Who’s Most Likely to Fix Healthcare?” in an election parody survey.
  • FDB will make its drug knowledge available to participants in the Health 2.0 SF Code-A-Thon September 24-25 in San Francisco.
  • The local paper recaps Xerox Healthcare Chief Innovation Officer Tamara StClaire’s presentation at the Health:Further conference in Nashville.
  • SyTrue’s Kyle Silvestro will serve on the Branding Panel/Entrepreneur Spotlight at the Brand Entrepreneurs 2016 Annual Business Bootcamp for Entrepreneuers – SFO Edition on September 6.

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