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Morning Headlines 8/31/17

August 30, 2017 Headlines 2 Comments

AHA Letter To Representative Pat Tiberi

AHA writes a letter to Rep. Pat Tiberi (R-OH), Chairman of the Committee on Ways and Means’ Subcommittee on Health, calling for the cancellation of Meaningful Use Stage 3.

FDA approval brings first gene therapy to the United States

The FDA has approved CAR-T, a gene therapy treatment for certain types of pediatric leukemia, making it the first gene therapy approved for use in the US. Novartis developed the treatment and has put a $475,000 price tag on the drug, far below analyst expectations. In a clinical trial, a single dose of CAR-T left 83 percent of participants cancer free after three months.

Medtronic invests $40 million in robotics company Mazor

Medtronic announces that it has invested $40 million in surgical robot vendor Mazor Robotics, bringing its total investment in the company to $72 million. Medtronic will now become the exclusive distributor of Mazor’s robotic surgery system.

Aetna scoops up rising star from Wal-Mart’s health group to lead Apple Watch partnership

Aetna hires Walmart’s health division director Ben Wanamaker to lead its joint venture with Apple.

Readers Write: Malware Lessons Shared: Seven Key Questions for Health Leaders to Ask About Cyber Preparedness

August 30, 2017 Readers Write 1 Comment

Malware Lessons Shared: Seven Key Questions for Health Leaders to Ask About Cyber Preparedness
By Joe Petro

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Joe Petro is SVP of engineering for the healthcare division of Nuance Communications.

As business leaders, we must confront a new reality: our organizations are facing an unprecedented threat from cybercrime. The number of cyber incidents is growing and the nature of the attacks is evolving. They are becoming faster, more sophisticated, and more potentially destructive. As the severity of incidents increases, the knowledge to address the technical aspects and manage through an attack has become essential to our skill set.

For those reasons, we think it’s important to share some of the lessons we’ve learned since we were affected by a global malware incident on June 27. Cybersecurity experts later identified the malware as NotPetya, highly sophisticated malware written to provide disruption and destruction rather than to demand ransom. It spread quickly, and unlike some malware, patching alone would not have stopped its propagation.

Our first priority was to contain the incident and protect our customers. This meant immediately commencing shut-down procedures across our global network to contain the spread of the malware. These actions affected our ability to communicate with our customers, employees, and other stakeholders, and we immediately sought alternative ways to alert them to the situation. To ensure they had up-to-date information, we hosted daily conference calls and corresponded via email with affected clients. We regularly posted updates to a dedicated Web page in addition to conducting a very large number of one-on-one client calls and meetings.

Importantly, we were able to tell them that NotPetya does not have the ability to copy or extract file contents from affected systems or allow any unauthorized party to view file contents on affected systems. In other words, no Nuance customer information was altered, lost, or removed by the malware.

After containing the spread of the malware, our focus turned to restoring our clients to full functionality. Our dedicated staff—along with third-party experts in cybersecurity and forensics—rapidly initiated restoration efforts. At the same time, we enhanced our security against similar future incidents to ensure we emerge from this incident with an even more secure operating environment.

We are committed to sharing the knowledge we have gained from our own response and recovery process. The more we know about malware like NotPetya, the more powerful we all can be in combatting future cybercrimes. Early lessons include:

  • Incident notification protocols should be as simple as possible, with multiple layers of redundancy to ensure stakeholder communication can continue at all times. This is particularly critical in the early days of response, when normal channels may not be viable.
  • Increase network segmentation, including adding micro-segmentation.
  • Even fully patched Windows machines remain vulnerable to certain exploits and vulnerabilities. We have deployed a hardening process that disables SMBv1, enables additional blocks on host-based firewalls including blocking unnecessary SMB ports, disables unnecessary usage of WMI and PsExec, disables unnecessary admin shares, increases logging levels, and validates that each system meets a minimum baseline of security measures.
  • Cyberattacks can occur very quickly, challenging even the best prevention systems. Thus, the best strategy is a combination of prevention, detection, and containment.

Healthcare and IT leaders need to ask the right questions now so that they can be better prepared for a malware incident in the future. Below are seven important security questions every leader should consider:

  1. Cybercrime is part of the new reality for every company, organization, and person. What can you be doing now to prepare for this scenario?
  2. How comprehensive are your security policies, and do those policies actually translate into deployed security capabilities?
  3. Have you developed a crisis and disaster plan and communicated it broadly throughout your organization?
  4. How would you communicate to your staff, your board, your customers, and your patients?
  5. What are your primary vulnerabilities? What measures are you taking to ensure patient data is protected?
  6. Do you understand and align with your vendors’ security policies and do you have the appropriate validation and/or risk assessment programs in place?
  7. Have you identified a team of outside experts to help in case of an incident, including cyber security firms?

    Readers Write: Response to Webinar, “3 Secrets to Leadership for Women in Healthcare IT”

    August 30, 2017 Readers Write 1 Comment

    Response to Webinar, “3 Secrets to Leadership for Women in Healthcare IT”
    By Helen Waters

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    Helen Waters is executive vice president of sales and marketing with Meditech of Westwood, MA.

    Recently, I was inspired by a HIStalk webinar, “3 Secrets to Leadership Success for Women in Healthcare IT,” hosted by two female executives of health IT companies, Liz Johnson and Nancy Ham. During the webinar, Ham and Johnson provided valuable advice to women who are interested in progressing in their careers to a leadership position, but who may experience unconscious or conscious gender bias.

    I wasn’t surprised to see that organizations experience higher profits when women represent at least 30 percent of their executive leadership teams. I believe when men and women rid themselves of gender biases and come together at the table, great things will happen.

    There are thousands of women in high-powered positions making a difference around the world every day. Still, as Ham and Johnson pointed out, the percentage of women in leadership positions — particularly in healthcare IT — remains low. In addition, there are thousands of women who are capable of so much more, who would make great leaders and heads of companies, but who lack confidence.

    I wholeheartedly agree with Ham and Johnson’s three secrets  — mastering negotiation, closing the confidence gap, and the networking effect. However, if I could add one more key ingredient to the list, it would be to channel your passion.

    Climbing the corporate ladder and breaking the glass ceiling is no easy feat. It takes focus, drive, the belief that you will succeed, and the passion to make it happen. Not only have passion for what you do and your company, but for your customers and the industry you work in. If you don’t love the company you work for or enjoy your day-to-day life at work, then maybe it’s time for a change.

    When you love what you do and show up to work excited about what you will tackle and overcome each day, the confidence gap will get smaller and smaller. Why? Because when you’re passionate about something, it will be noticed by others. The enthusiasm and positive energy you bring to work and how you treat and communicate with others will have an impact on your ability to inspire and lead others.

    The determination and motivation that passion drives will set you apart, push you to produce your best work, excite others, build awareness, and lead you to your goals, whether it’s a position in management, the C-suite, or on the board.

    My passion, commitment, and love for my company and industry runs deep. My love of healthcare and technology has kept me intrigued and stimulated at my company for over 25 years. I believe in my case, knowing that what I do contributes to keeping people safe in one of their most vulnerable times in life (as a patient) is what keeps me going and gives a great sense of fulfillment.

    My goal is to help my company continue to grow and flourish, but more importantly, to help staff grow. I strive to develop the next generation of leaders who are as passionate and inspired as I am when it comes to healthcare. Hopefully during my tenure, I will have influenced a substantial number of people and contributed to the future of the company through them.

    In my personal life, my family is my passion. I’ve always wanted to show my daughters that anything is possible, to always be open to learning something new, to follow their passion, and do what makes them feel fulfilled.

    What are you passionate about?

    Readers Write: Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 1 of 4)

    August 30, 2017 Readers Write 3 Comments

    Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 1 of 4)
    By Bruce Brandes

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    Bruce Brandes is founder and CEO of Lucro of Nashville, TN.

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    Over my 28-year career selling to health systems, the most common “competitor” to which my companies would lose a deal was the same: Do Nothing. For decision-makers across the country, there are many reasons that deferring buying decisions was historically a wise choice. 

    Rarely was there a compelling reason to make a decision at all. In the past, the economics, competitive pressures, and the underlying business model did not change meaningfully enough to encourage risk-taking. Frequently, if you waited long enough, potential industry changes would often just go away.

    Further, vendors that sell “nice to haves” rather than “have to haves,” assume everyone in every hospital must want to hear their pitch. They create noise that is deafening to decision-makers. Plus, most purchases historically have not yielded the promised benefits or ROI and risk-averse buyers that have been burned before are hesitant to make the same mistake again.

    As a healthcare vendor, the results of all this doing nothing (while trying desperately to find the person who is going to do something) include unclear value from traditional sales and marketing investments and the consequences of unpredictable business forecasting.

    Moreover, there is real concern that the length of healthcare sales cycles discourages bright entrepreneurial minds and innovative investors away from our industry, despite the lure of “disrupting” a three-trillion-dollar annual spend.

    In partnering with long-time hospital operator Charlie Martin, I was heartened to learn that he and his peers also found the ridiculousness of the buying / selling process in healthcare equally problematic. In fact, we’ve spent the past two years collaborating with some of the largest and most influential health systems in the country to gain a deep understanding of their challenges related long decision-making cycles.

    One specific example was illustrated by the head of strategy for a large regional health system in the Southeast. Their organization had identified the need to be in the direct-to-consumer virtual care business. They followed their normal process to pick a partner — formed a committee, engaged a consultant, did an initial survey of the market landscape, sent out an RFI, had a lot of meetings, sent out an RFP, brought in a short list for demos, had more meetings, called references, and finally made a decision on a vendor partner for the project. The decision was made 24 months after they originally identified their business need.

    During the two years of their selection process, the hospital system found that three other healthcare companies (none of which were historically competitive with them) had successfully built and deployed their own direct-to-consumer virtual care platforms in the same market. The incumbent hospital system lost the opportunity to engage, with a modern care alternative, the very community they have traditionally served for decades.

    New industry forces (underlying financial models, competitive pressures, reduced volume, consumerism, etc.) in healthcare now dictate that organizations no longer have years, but months to make strategic buying decisions before the market may pass them by.

    Together with healthcare organizations that collectively operate 20 percent of all the hospitals in the US, we identified three key areas with opportunity for improvement:

    • Alignment
    • Trust
    • Process

    Over the next several weeks, we will detail the learnings that resulted in a new way for healthcare organizations to accelerate and de-risk their buying process.

    HIStalk Interviews Bimal Desai, MD, MBI, Co-Founder, Haystack Informatics

    August 30, 2017 Interviews 1 Comment

    Bimal Desai, MD, MBI is co-founder of Haystack Informatics and AVP/chief health informatics officer at Children’s Hospital of Philadelphia.

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    Tell me about yourself and your jobs.

    I’m the chief health informatics officer at Children’s Hospital of Philadelphia. I came to CHOP for residency and then stuck around, so this is my 18th year with the organization. I have oversight over the clinical informatics program, which includes the physician informaticists who interface with the Epic team. I oversee analytics and reporting as my second area of responsibility. The third program that I oversee is a newly-launched digital health program — we’re celebrating our one-year anniversary this month. 

    The connection to Haystack is that in 2014, CHOP had an internal innovation competition to try to find ideas that were potentially commercializeable. We partnered with Dreamit Health, a health IT accelerator that has a branch in Philadelphia. This idea that I pitched for privacy protection using EHR data was accepted to go to the accelerator. That became Haystack Informatics.

    How often does the privacy monitoring system detect employees doing something they shouldn’t?

    It’s a tricky question. There’s malicious access with intent to identify private information about patients. For example, an employee who’s trying to obtain Social Security numbers and things like that. Then there’s the more casual privacy violations, like your neighbor or a celebrity is admitted, and just out of curiosity, you take a look.

    We’ve learned that every institution has a different culture of privacy. Some institutions take it seriously and will announce formally, “You may have heard the news that we have a celebrity admitted to the hospital. Be aware that we’re monitoring access, and if anyone is found in that chart, they’ll be terminated from the institution.” 

    Some institutions take a hard stance on that and others don’t. It’s hard to say what the scope of the problem is.

    I would think that knowing a hospital has sophisticated access monitoring tools in place would reduce the casual violations.

    I think that’s right. To some degree, just having a privacy monitoring solution can be a deterrent. For example, if I were an employee and I kept getting calls from the privacy office for false positive alerts, “Were you supposed to be in this patient’s chart?” I would start to quickly distrust the privacy office. But if the true positive rate of those alerts in their system was high enough, employees would start to recognize that these guys have a legitimate solution in place. They will be able to find out if I’m snooping around in my neighbor’s chart.

    The other advantage is that privacy officers are required to look through these access logs. There’s no useful way to do it manually. All these technologies that we’ve developed simplify their work, allowing them to focus on the small subset of truly suspicious events.

    We looked at a single patient as a thought exercise, a celebrity who was admitted to the institution. I asked a question — how many rows of audit log data would you expect to see for this patient for a two-week hospitalization? It was hundreds of thousands of rows of data. In the absence of tools, the privacy officer couldn’t do it manually, even for just this one patient.

    That’s the value of these tools. They empower your privacy officer. They also help your staff employees stay on the right side of HIPAA regulations.

    What surprised you most about becoming an entrepreneur?

    The hardest part was understanding how I would continue to maintain my responsibility to CHOP and at the same time be an entrepreneur. I think people underestimate what it takes to start a company. Many physician entrepreneurs probably think that a good idea is sufficient enough. But it’s a lot of sweat equity. It’s a lot of work to build a company.

    I had to work that first year to negotiate time for my employer. Because this was a CHOP-sponsored project in that first year, especially, I was able to take a mini-sabbatical. It’s not something you can really do in your spare time. The one affordance that my employer gave me was two days a week for the first few months to dedicate to Haystack.

    Haystack has a really strong CEO, Adrian Talapan, who understood that I had this line in the sand when it came to conflict of interest and also the amount of time I was allowed to spend on the company based on the tech transfer and intellectual property requirements for the University of Pennsylvania and Children’s Hospital. There was a lot of negotiation that first year. That was probably the trickiest part.

    What technology and innovations are proving to be clinically useful at CHOP?

    I’m biased, but I think the electronic health record is turning out to be the strongest tool in the arsenal for things like supporting safety and quality kinds of initiatives. Not to diminish the work of the safety and quality offices themselves, but when it comes to actually crystallizing a workflow or suggesting that people take the right course of action, we’ve found that the electronic health record ends up really helping.

    In my role as a clinical informaticist, it’s interesting when I hear about institutions that lament or struggle with their EHR implementations. They’re struggling to understand what this tool does to help them standardize care. We’ve been very fortunate. We’ve got a strong partnership between my group of clinical informaticists as well as the offices of quality and safety and medical operations. It’s been fruitful. As much work as they’ve put into the development of the clinical pathways and the clinical quality metrics and tools to standardize care, there’s almost as much work in redesigning the EHR to support that workflow.

    That kind of partnership between informaticists and the people who have clinical design goals in mind has worked to our advantage. That’s probably been the most positive structure that we’ve put in place. We have 20 board-certified informaticists at CHOP. They’re embedded in every kind of quality and safety or workflow redesign project throughout the institution.

    Are most hospitals as successful as CHOP in integrating their own clinical content into the EHR to make it easier for clinicians to do the right thing?

    I’s a heavy lift. That’s the part that’s worrisome to me, that an institution that doesn’t have the kind of informatics resources that some of the big academic medical centers have. It is going to be a heavier lift for them. But their fallback is the content provided by the EHR vendor or external decision support vendors that provide canned order sets, simple protocols and things like that.

    It’s challenging. I don’t know of many other hospitals that have 20 informaticists. We’ve been successful in lobbying for those resources and making the argument for why it’s valuable to have them. But I think that that’s the hardest part.

    We had a meeting in Verona with the Epic leadership a couple of years ago. I remember Carl Dvorak saying that the EHR is a manifestation of your systems of care. The way you take care of patients at some level is reflected in how you design that tool. The double-edge sword of that is that if all of your systems of care rely on the EHR, then it’s really hard when the EHR is down. It’s really hard when you want to transport your model of care to another institution, for example, a partner institution. There is a benefit, but also potentially a vulnerability.

    Do you get pushback  when you roll out changes that the informaticists agree is the right way to care for patients, but that the end user doesn’t understand or receive benefit from in return for any extra effort required of them?

    That’s the trick. Neither part works without the other. Without some sort of EHR representation of a pathway, it’s hard to get people to standardize their work. On the flip side, just introducing a new order set is not going to improve the quality of a clinical process. 

    Our quality office does a good job with this, involving stakeholders and getting people in the right culture of improvement. To say, “We can all agree that we have this clinical quality problem. We can all agree that these are our clinical goals. Here are the tools to help you do it, or at minimum, help us design tools that you would find useful and usable.” It’s a dialog. You can’t really slap it in from the EHR side.

    We have many successful examples, but we’ve got plenty of failures, too, where we didn’t do the grunt work with regards to change management. It’s a common theme in the field. An order set is not just an order set. The way you roll it out is just as important.

    It’s even more of a challenge for hospitals that use mostly community-based physicians whose incentives aren’t necessarily aligned and who are asked to change behaviors.

    I hear that. One of my other hats is that I help teach the board review course in clinical informatics for AMIA. In the course of doing that for the past four or five years, I’ve met hundreds of informaticists and have heard stories from them about how CDS implementations have gone awry or pathways weren’t as successful as they anticipated. You’re right, part of the problem is that if your staff are not employed, that’s a challenge because it’s harder to get people aligned to the right goals.

    Our specific challenge in an academic center is that in some critical areas, you might have a majority of providers that are not employed by CHOP and they’re not pediatricians. If you look at our emergency department, for example, at any given time, less than half of the people there are CHOP emergency medicine docs. The rest might be rotating residents from adjacent adult ER programs, trauma programs, or family practice programs.

    We have put a lot of thought into designing the system to support not just expert users and pediatricians, but anyone. For any physician who steps into the institution — whether they’re a rotating surgeon from University of Pennsylvania or rotating emergency doc from Temple University –this system should be something they should be able to pick up and run with. The ED is probably the one place where we’ve put the most thought into that design for non-pediatricians.

    Would that technique be valuable for institutions where community-based physicians have admitting privileges and things like that? I don’t know if I know the answer for that, but I would think that probably yes. Designing for all users is probably a good thing.

    Do you have any final thoughts?

    I’ve been working in the EHR field straight out of residency since 2004. Across the country, we’re not universally successful, but we at least know some of the pitfalls of what makes clinician decision support useful and what makes it a challenge at different institutions.

    The next wave of interesting questions will deal with what you can do with all these data you’ve amassed. Once you’ve had an electronic health record in place for a decade, you’ve got terabytes of data that you can plow through. A lot of it is machine data, a lot of it is clinical data. The useful analytics derived from the EHR data and other sources. Genomic information, for example, is intriguing.

    We also haven’t yet figured out how to pull patients and families into their care. The portals are a snapshot or a window, but I don’t think we yet know the best techniques for participatory medicine and involving patients and families in their care. For us in pediatrics, we’ve got an interesting opportunity. All of our patients and their parents are, for the most part, digital natives. We don’t have to persuade them to use a smart phone to get access their health records. In fact, they’re asking us, when can we see this information on a mobile view or in a tablet? 

    We’re going to keep pushing some of that at CHOP to see where it goes and to try to demonstrate the value of things like telemedicine and inpatient portals and connected devices. It’s the next wave. We know about order sets, pathways, and decision support. Where else can we start to derive value from using technologies?

    Morning Headlines 8/30/17

    August 29, 2017 Headlines No Comments

    Advisory Board to sell healthcare, education units in $2.58 billion deal

    The Advisory Board confirms rumors that it will sell its healthcare and education units to UnitedHealth Group. Its healthcare business was valued at $1.55 billion in the deal.

    In Times of Crisis, We’re Better Together.

    Direct-to-consumer telehealth vendor MDLive announces free medical consultations to residents of Texas and Louisiana who have been evacuated or otherwise affected by Hurricane Harvey.

    Medical Journals Have a Fake News Problem

    Bloomberg covers the FTC investigation of predatory pay-for-publication scientific journal Omics International, which claims to publish more than 50,000 articles annually in medicine, technology, and engineering, but which academics and federal investigators claim is undermining public trust in scientific inquiry by publishing questionable or sloppy research.

    Medicare Shared Savings Program Accountable Care Organizations Have Shown Potential for Reducing Spending and Improving Quality

    An HHS OIG investigation finds that the Medicare Shared Savings Program has saved nearly $1 billion in the last three years, while improving quality on most of the individual quality measures reported.

    News 8/30/17

    August 29, 2017 News No Comments

    Top News

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    The Advisory Board Company will sell its healthcare business to UnitedHealth Group’s Optum. The education part of its business will be acquired by Vista Equity Partners. The breakup and acquisitions were accurately rumored in early July.

    The healthcare business drew $1.3 billion of the $2.58 billion total deal value.

    Advisory Board said in February that it would explore strategic options after an ownership stake was taken by activist investor Elliott Management, which is now exerting similar pressure on Athenahealth.


    Reader Comments

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    From Athenahealth Spokesperson: “Re: Givenchy’s comment from the 8/23/17 HIStalk regarding financial success metrics for community hospitals. Thank you for bringing this to our attention. The metrics listed were a carryover from the previous iteration of the page and speak to our results on the ambulatory side. We have removed the numbers to avoid any confusion.” I speculated in my original response that the metrics probably weren’t related to hospitals, especially since they were footnoted to suggest all Athenahealth customers excluding hospitals since the company wasn’t in the inpatient business during that pre-RazorInsights benchmark period.

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    From Whassup: “Re: MDeverywhere breach. The newly listed breach affects E-MDs since it merged with MDeverywhere. Looks like they are trying to keep it hush hush, along with the fact that E-MDs is up for sale.” HHS is investigating an unauthorized access / disclosure incident of MDeverywhere that was reported August 10, 2017. Marlin Equity Partners acquired E-MDs in March 2015 and merged it with its existing portfolio company MDeverywhere, which offers revenue cycle management and credentialing services. I found a breach notice sent by an MDeverywhere customer that says that the company and its customers use a messaging board to exchange patient information and worksheets, but the customer found on June 6, 2017 that any Internet user could log into the message board without entering a name and password. The non-clinical information of just 1,396 people was involved, so it’s pretty unexciting as healthcare breaches go.

    From Josh: “Re: potential changes to E/M visit codes. It’s buried in a large article, but CMS has opened a public comment window until September 11, 2017 saying they have heard from stakeholders that E/M visit codes are outdated and a source of audit vulnerability and administrative burden. CMS wants public input.” A snip of the proposed Medicare rule – which is rather startlingly insightful and technologically current — says:

    We continue to agree with stakeholders that the E/M documentation guidelines should be substantially revised. We believe that a comprehensive reform of E/M documentation guidelines would require a multi-year, collaborative effort among stakeholders. We believe that revised guidelines could both reduce clinical burden and improve documentation in a way that would be more effective in clinical workflows and care coordination. We also think updated E/M guidelines coupled with technological advancements in voice recognition, natural language processing and user-centered design of EHRs could improve documentation for patient care while also meeting requirements for billing and population health management. We recognize that achieving the goal of reduced clinician burden and improved, meaningful documentation for patient care will require both updated E/M guidelines, as well as changes in technology, clinician documentation practices and workflow …We are specifically seeking comment on how we might focus on initial changes to the guidelines for the history and physical exam because we believe documentation for these elements may be more significantly outdated, and that differences in MDM are likely the most important factors in distinctions between visits of different levels. We are also specifically seeking comment on whether it would be appropriate to remove our documentation requirements for the history and physical exam for all E/M visits at all levels. We believe medical decision-making and time are the more significant factors in distinguishing visit levels, and that the need for extended histories and exams is being replaced by population-based screening and intervention, at least for some specialties. In addition, an increase in the utilization of EHRs, and to some extent, shared health information via EHRs, may have changed the character of extended patient histories since the guidelines were established. As long as a history and physical exam are documented and generally consistent with complexity of MDM, there may no longer be a need for us to maintain such detailed specifications for what must be performed and documented for the history and physical exam (for example, which and how many body systems are involved). We are seeking comment on whether clinicians and other stakeholders believe removing the documentation requirements for the history and physical exam would be a good approach.


    HIStalk Announcements and Requests

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    Texans need our help, so I invite you to do as I did in making generous donations to The Salvation Army of Houston, the Houston Food Bank, and the Houston SPCA. The best thing you can do is to send money to reputable local organizations – it’s just too hard to deploy well-intentioned contributions of physical items and those organizations need the flexibility to use their buying power to provide the most benefit. Houston has a marketing problem – it’s the nation’s fourth-largest city, yet few of us visit there on vacation or attend a conference there, so we don’t really have much of a connection to it. As was the case with Hurricane Katrina, the extent of the death and destruction there won’t become evident until days after the floodwaters recede and public health issues – such as food and housing shortages – take over the shrinking headlines and outlast by years the nation’s short attention span.

    Meanwhile, in a discussion that mimics our country’s healthcare debate, a Politico report blames the federal government’s subsidized flood insurance program for encouraging people and developers to build and re-build homes in known floodplains and to pave over drainage areas. More than half of the country’s “repetitive loss properties” are located in Houston, second only to New Orleans, as the federal flood insurance program is running $25 billion in the red. One federally insured home in Mississippi has flooded 34 times in 32 years, with federal taxpayers paying $663,000 for claims involving the $69,000 home, while members of Congress have voted to delay charging homeowners actuarially sound premiums following complaints about inevitably higher prices from coastal communities. Only 15 percent of Houston homes are insured against flooding since such insurance isn’t required for most mortgages and people either can’t afford the premiums or play the odds that they won’t experience a loss.


    Webinars

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

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


    Acquisitions, Funding, Business, and Stock

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    Surgery management system vendor ExplORer Surgical raises $3 million.

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    India-based technology vendor Tech Mahindra names Jacksonville, FL as its global healthcare headquarters following its $110 million acquisition earlier this year of Jacksonville-based The HCI Group. 

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    A Stanford drop-out distances his startup from Theranos in describing its own in-home finger-prick blood analyzer. The co-founders of Athelas are 20 and 22 years old. Their Amazon Echo-like technology, which has yet to earn FDA approval, uses machine learning to analyze blood cell images that pathologists have interpreted and then applies that knowledge to new high-resolution images of a patient’s home blood sample. Their target market is oncology patients who require frequent blood tests.

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    Columbus, OH-based PriorAuthNow increases its funding to $3.6 million to expand its hospital procedure prior authorization system.


    Sales

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    Yale New Haven Health System (CT) will add pharmacogenomic decision support from ActX to its Epic EHR.


    People

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    Marc Milstein (University of Texas System) joins University of Texas Southwestern Medical Center (TX) as VP of information resources.


    Announcements and Implementations

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    Allscripts will integrate Vidyo’s video visit technology into its FollowMyHealth patient portal.

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    Cedars-Sinai launches a 20-month, $25,000 executive master’s degree program in health delivery science that emphasizes analytics, health IT implementation, quality and safety, and cost-effective service delivery.

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    MDLive offers free non-emergency telephone or video visits to people impacted by Hurricane Harvey from August 25 to September 8.

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    T-System offers its T Sheets disaster relief documentation templates at no charge to hospitals and freestanding EDs in areas affected by Hurricane Harvey.


    Government and Politics

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    The Senate’s HELP committee will hold hearings early next month in hopes of creating legislation to stabilize and then improve the Affordable Care Act individual insurance marketplace. Leaders Senator Lamar Alexander (R-TN) and Senator Patty Murray (D-WA) have successfully collaborated previously on the 21st Century Cures Act. The committee will take the unfortunately refreshing approach of holding actual committee hearings and seeking input from lawmakers on both sides of the political wall. Alexander wants to quickly get legislation on the books to guarantee the federal government’s payment of legally challenged insurance premium subsidies, hoping to reduce the number of insurers pulling out of the individual market or raising premiums due to uncertainty.


    Privacy and Security

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    System downtime at Scotland’s NHS Lanarkshire is being blamed on a new variant of Bit Paymer ransomware, which demands payment of an unusually high ransom of $218,000 for the return of “private sensitive data.” Mass media articles say the malware is spread by phishing emails, but technical sites say it is manually installed following brute force password attacks on insecure Remote Desktop Protocol connections, after which the size of the ransom is set by the hacker’s perception of the victim’s ability to pay.

    A former ED employee sues Northwell Health for firing her for looking up Justin Bieber’s medical records, claiming she didn’t do it and instead was fired just because she’s female. Somehow I suspect Northwell’s audit logs contain information that implicates her beyond her gender.


    Innovation and Research

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    Non-profit digital health lab Pulse@MassChallenge — which is backed by the Commonwealth of Massachusetts and industry partners (Microsoft, AARP, BIDMC, Cerner, etc.) — seeks startups for its next class. Early bird applications are due September 15 and the application fee is discounted 100 percent using code “2018HISTalk100.”


    Other

    A Salesforce research paper covers the potential of translating natural language questions into database SQL queries, which could allow users to ask database questions without knowing SQL syntax.

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    A Department of Defense video shows how Walter Reed National Medical Center (MD) makes prostheses.

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    Bloomberg Businessweek covers predatory journal publisher Omics International, an India-based open access journal publisher that charges “publish or perish” academics to run their often poorly prepared research papers as well as those of drug companies that want to disseminate favorable but sloppily researched studies. The founder of Omics calls the FTC’s investigation into his company – which took in $11.6 million in publishing and conference revenue in 2016 – as “fake news.” The article questions whether the company’s journals that feature papers that are “rife with grammar glitches and low-resolution headshots” are confusing drug companies that publish research in them or whether they really don’t care. Omics has 2,000 employees who occupy 250,000 square feet of office space in Hyderabad. Academic and business speakers pay more than attendees to participate in its conferences, which says a lot, while all attendees get 50 percent of the publishing fee for their next research masterpiece. I bet quite a few healthcare organizations are unwittingly underwriting this ego-boosting crap in sending people off to fun destinations under the guise of academic achievement. The company repeatedly accepts hilariously fake article and conference presentation abstracts, one that was submitted as a test being “Evolution of flight characteristics in avian-porcine physiology” that purports to explain how pigs fly. Another author submitted a journal article consisting of 10 pages of the repeated phrase, “Take me off your $&%#! list,” which was happily accepted pending payment of a $150 publishing fee by The International Journal of Advanced Computer Technology.


    Sponsor Updates

    • AssessURHealth and Intelligent Medical Objects will exhibit at Greenway Engage17 September 7-10 in Orlando.
    • Besler Consulting releases a new podcast, “Key takeaways from the FY 2018 IPPS Final Rule.”
    • FormFast publishes a new case study featuring Duncan Regional Hospital (OK).
    • Healthgrades and Gartner publish “Beyond Healthcare CRM: Changing the Paradigm of Patient Communication.”
    • Healthwise will exhibit at the 2017 HCEA Conference September 6-8 in Salt Lake City.

    Blog Posts


    Contacts

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

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    Morning Headlines 8/29/17

    August 28, 2017 Headlines No Comments

    Defray – New Ransomware Targeting Education and Healthcare Verticals

    Cybersecurity vendor Proofpoint describes a new ransomware campaign called Defray that is targeting specific industries, including healthcare, education, and manufacturing.

    Pfizer Rare Disease Launches Two First-of-Its-Kind Innovative Technologies for People Living with Hemophilia at National Hemophilia Foundation Annual Meeting

    Pfizer releases a Minecraft-based gamification app designed to help children living with hemophilia.

    2017 HIMSS Cybersecurity Survey

    HIMSS releases results from a survey conducted with 126 health IT professionals on cybersecurity threats and the defensive best practices emerging within the industry.

    Stabilizing the Individual Health Insurance Market

    Oliver Wyman publishes analysis of several current legislative proposals aimed at stabilizing the individual insurance markets.

    Curbside Consult with Dr. Jayne 8/28/17

    August 28, 2017 News No Comments

    My heart goes out to the people of Houston along with the many other areas impacted by Hurricane and Tropical Storm Harvey. In addition to residents who weren’t able to leave the area before the flooding, there are scores of out-of-town patients stranded after traveling to Houston for care at facilities such as MD Anderson Cancer Center.

    Working in the ED and urgent care space, I’m connected to my community’s emergency preparedness efforts. Natural disasters can strike anywhere at any time and I would encourage everyone to take this opportunity to make sure your family has a preparedness plan. Keeping a small stock of non-perishable food and bottled water is a good idea for everyone. Even if you don’t live in a flood plain, tornado alley, fault zone, or wildfire hazard area, there’s always a chance of losing power or other essential services.

    Healthcare organizations large and small should also have preparedness plans, including resources to support staff who might become stranded at work. My area is prone to ice storms, and although I always keep bottled water and energy bars on hand when I have to go out in bad weather, I can’t assume that my staff is likewise prepared. The leftover pizza and freezer-burned Hot Pockets aren’t going to go very far if we ever encounter a catastrophic weather event. I’m not advocating that everyone needs to constantly live in Doomsday Prepper mode, but our society has embraced the just-in-time and convenience culture so thoroughly that many people and organizations haven’t given much thought to basic preparedness in the face of a calamity.

    The schools in my state now require education in CPR as a high school graduation requirement. I’d love to see a little coverage given to basic emergency preparedness. We do have a teen CERT (Community Emergency Response Team) program along with an adult program and there is always a waiting list for people to attend. If you can’t get into a community offering or your area doesn’t have one, there are some great educational resources available through the Ready.gov website.

    I had two client-facing trips cancel due to the weather, so I’ve been using the opportunity to play catch-up and try to get ahead for the busy times that are surely coming. Although there has been a relaxation in the requirements to have 2015 Edition Certified EHR Technology in place before January 1, I’m not seeing my clients take the foot off the gas as far as preparing for upgrades and workflow changes. I think they’ve already done so much work to get ready they just want to see things through and get the decks cleared for the next thing that gets thrown at them. I’ve also got several clients moving forward aggressively with Patient-Centered Medical Home initiatives, and since I haven’t been to formal training yet for the 2017 NCQA standards, I’m trying to become more familiar with the requirements.

    Although there are a lot of details to learn, many of the principles are straightforward. Sometimes those are the hardest to bring into daily clinical practice, not only because they require people to change, but because they require attention to efficiency and detail. Take for example the daily huddle. In its simplest form, it’s the opportunity for the care team to look at the daily schedule and anticipate specific needs related to each patient appointment. It could be basic things like ensuring there is an extra chair in the exam room for an interpreter or family member, or it could range to issues like tracking down lab results or reviewing needed clinical preventive services and counseling.

    I’ve seen a lot of daily huddles derailed by the lack of an effective meeting strategy. The team needs to show up on time, someone needs to be the leader, someone needs to be the timekeeper, and someone needs to document and manage the follow-up. The reality in many medical offices across the country is that these skills are lacking, and if the practice wants to be successful, the skills need to be taught and reinforced. If staff members are habitually late, it needs to be addressed. If huddle attendees aren’t paying attention and things need to be repeated, it needs to be addressed. Staff discussion needs to stay on topic and sidebar conversations should be stopped.

    I see practice leaders sometimes struggle to address these issues, which is why bringing in an outsider to help with change leadership activities is tempting. It’s also easier to let someone else be the lightning rod, which sometimes happens. One group I’m working with in preparation for an aggressive PCMH rollout has a provider and a nurse manager who are very difficult. The provider often makes changes to his schedule without telling anyone (I’d revoke his access to the scheduling system in a heartbeat) and the nurse manager enables the bad behavior by making everyone else dance around trying to accommodate the last-minute changes. The provider frequently overloads his schedule by double- and triple-booking appointment slots, which makes the entire day run badly and frustrates the staff. The practice doesn’t have a good understanding of their true capacity to see patients, and I suspect some of their panels need to be adjusted by shifting patients from busier PCPs to more accessible PCPs on a given care team. The provider in question is resistant to this change, and although I understand his wanting to maintain patient relationships, it shows that he is not embracing the concept of PCMH and that the practice will continue to suffer until this is addressed.

    I’m planning a series of leadership discussions where try to solidify provider buy-in and discuss the benefits that being a patient-centered practice can provide. If we can’t get everyone to arrive at a place where they can at least agree not to obstruct efforts, however, I’m going to recommend that they seriously consider placing the initiative on hold until we can figure out how to get people on the same page. Simply saying “this is what our practice is going to do” hasn’t been enough for them to be successful thus far. Change is hard, but it’s the reality for medical practice in the years to come. I’ll be on site with them in a couple of weeks, so we’ll see how things go.

    What’s your strategy for keeping staff sane during times of change? Email me.

    Email Dr. Jayne.

    HIStalk Interviews Luke Bonney, CEO, Redox

    August 28, 2017 Interviews 1 Comment

    Luke Bonney is co-founder and CEO of Redox of Madison, WI.

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    Tell me about yourself and the company.

    I grew up in upstate New York in a small town in the Finger Lakes. I went to school at Cornell, graduated in 2008, and worked at Epic for six years on the implementation team. That was where I cut my teeth.

    Our goal for Redox is to drastically accelerate the adoption of technology by eliminating integration as a barrier. We want to make all data in healthcare available and usable.

    Right now, we talk about the exchange of data. What we care about is how to empower developers and technologists to take that data and turn it into useful information for patients and providers. We do that with our engine and the services that we provide with our engine through our platform.

    In an age where modern web developers are used to building tools in the cloud, people expect to be able to exchange data with a single endpoint and a single platform. Today, that doesn’t really exist in healthcare. We have a number of standards that people have to learn. We have a fragmented ecosystem where each health system has their own version of their EHR and their legacy systems.

    Two important trends have occurred – rapid, aggressive adoption of EHRs and healthcare starting to accept cloud as the direction of overall technology adoption. We represent that by offering up a single platform and a set of APIs that any Web developer can connect to.

    Are non-technologists who assume that APIs can solve all interoperability problems overlooking important details?

    I don’t think APIs by themselves are the answer. Standards bodies such as HL7 and others are primarily solving for the use case of how to help health systems exchange their own data. Because of that, you have to consider the extreme edge case, where your unique cocktail of legacy systems — lab systems or whatever it might be – requires you to have highly extensible format.

    The developer thrives on consistency. That’s what they want and what they need. They want to be able to build something and scale it aggressively.

    For us, it’s not really about a APIs by themselves. It’s about offering APIs on top of a platform where we can both connect you to all the different health systems you need to connect to and then normalize that data down to the data models that we provide. Talking about APIs unto themselves is only thinking about part of the problem.

    What is the universe of data you can access and how does a developer use your system as the bridge?

    Our goal is to make the way we exchange data easy and available as anybody would expect it. The short answer to that question is go to developer.redoxengine.com, where you can read the exact data that we support today. I think it’s 17 data models – core clinical data, core registration and practice management data, device data, all the way down to financial data.

    We’re customer driven. We build out data models and offer APIs based on what our customers need. Each time we build out a new data model, we make it available to everybody.

    Our promise is that you connect to us through a single end point. You tell us the scope of information that you need. Then we’re going to normalize data within the health systems you need to exchange with back down to that data model.

    Do startups hit a dead end when companies that hold the data they need, such as EHR vendors, decline to share it?

    Lots of things are moving in the industry that relate to this question. The core problem we solve is the relationship between the application and the health system. That’s where the problem lies. You have physicians or patients who want to turn on a tool. They want to have access to that technology. They want to use it and use it quickly. That’s where we focus and spend our time. Solving that problem is where there’s the most value. Turning it on and having data being exchanged. That’s the frame through which we think about the relationship with vendors, whether that is Allscripts, Athena, Epic, Cerner or anybody else.

    Lots of good things are happening in that area. Groups are starting to offer marketplaces and thinking about what rolling out FHIR would mean. People are starting to embrace the idea that developers and third parties can add a ton of value. There’s also the continued signaling that we’re headed toward the cloud, which is great.

    EHR vendors have to struggle with, how open do you want to be? At the core of that question is, how open are you going to be for third parties that might compete directly with some of the core functionality that you provide?

    We’ll see how it shakes out over time. Where we focus is solving problems in connecting applications to health systems.

    What about policies that wrap around the technology, such as legal agreements between those who hold the data and those who want to use it?

    Our belief is that the data belongs to the patient. That patient is the one who is receiving care. But today, that data is an asset to the healthcare organization that provides care. So at the very core, you need to make sure that you have a business associate agreement set up with any organization that you would ever consider exchanging information with. You need to make sure you’re secure in HIPAA compliance, whether that’s through HITRUST certification or SOC 2 certification or something like that. That’s the table stakes at this point. 

    I think the question you’re asking is, how do the agreements shake out with some of these vendors that are starting to offer up their own APIs? We see a lot of experimentation, both in what they’re asking people to sign and with the business models they’re thinking about. Redox’s role in all of that is to provide feedback. We tell people what’s working and what’s not working because we see all of it. If there’s an opportunity to bring people together to talk about what’s working and what’s not working, we’ll try to have that conversation. But at the end of the day, we’re going to play by the rules, and if the rules don’t make sense, we’re going to figure out how to make them make sense for everybody involved.

    How has investment funding and the involvement of outside investors change the company’s strategy and operations?

    We had angel investing at the very beginning and then two rounds of venture investing. The way we look at funding is, is the opportunity big enough and the problem painful enough where you need to go faster than you would otherwise be able to go if you were constrained by a cash flow? The opportunity we see to solve a massive problem in healthcare helped us decide very early on that we wanted to be a venture-backed company. Any group, starting from the very beginning, has to ask themselves that question. It’s not an inevitable decision. It should be made with some intentionality.

    We were thoughtful on who the investors were that we decided to work with. Whether it was luck or skill, we did pretty good there. Our investors – .406 out of Boston, Flybridge, Dreamit, and HealthX — were in our first round. Then in the most recent round, we brought in RRE and Intermountain. Each of those groups has been absolutely fantastic to work with. They’re not just investors — they also bring a huge amount of strategic advice and valuable networks to the table.

    How does the startup environment in Wisconsin compare to that of Atlanta, Chicago, or the other traditional health IT centers?

    I could not be more excited about what’s going on in Wisconsin. We have an opportunity in Madison – the Madison-Milwaukee corridor, more specifically — to do something huge in healthcare. Judy and Carl of Epic have been a recruitment machine and have brought incredibly smart people, incredibly hard-working people who are passionate about healthcare IT, into this area. It’s on the community to figure out how to take advantage of that and to turn it into what I think could be the major health tech hub in the country.

    Before Redox, the two other founders and I worked on a healthcare IT incubator here in Madison. We started seven digital health companies. Redox came out because those companies were all going to need the services we provide with Redox. But the reason we started that incubator — it was called 100health — is because we thought that Wisconsin and  Madison were poised to have a huge impact. I’m super excited about it and the community here is super excited about it as well, all the way up to the president of the Chamber, up to the full group here.

    Do you have any final thoughts?

    Healthcare IT is officially the sexiest place to be when you think about being a technologist and building great companies. It’s incredible because there’s so much opportunity based on progress to date and seeing what we have in front of us. 

    If I was a developer, if I was a health system executive, what I would see is that in the time you spend here, not only can you have a significant impact and make significant progress, but unlike any other industry, we’re all participants in healthcare. Because of that, you can see the impact of the work you do in your life, in the lives of friends and family, and in the lives of the people you love. If you’re trying to figure out what you want to spend your time on, working in this space is absolutely fantastic.

    Morning Headlines 8/28/17

    August 27, 2017 Headlines No Comments

    Harvey Brings Catastrophic Floods to Houston; at Least Five Reported Dead

    Power outages in Houston are forcing local hospitals to evacuate patients and implementing flood control systems, as Texas Medical Center CEO William McKeon explains “Those submarine doors were locked yesterday afternoon when we started to see the rain.”

    ‘Stay away from hospital’: Patients told to avoid Lanarkshire A&Es after cyber attack

    In Scotland, a ransomware attack on the computer network at NHS Lanarkshire has forced clinicians back to paper workflows and prompted hospital officials to urge patients not to come to the hospital unless it is essential.

    Doctors are burning out because electronic medical records are broken

    Lloyd Minor, MD and Dean of Stanford University School of Medicine argues in an op-ed that EHRs are one of the leading causes of physician burnout, calling for a major revamp of EHR design, with doctors taking a leading role in the process.

    Philips to build health technology center in Tennessee

    Royal Philips announces plans to build a health technology center in Nashville that local officials expect will create more than 800 jobs over the next two years.

    Monday Morning Update 8/28/17

    August 27, 2017 News No Comments

    Top News

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    Southeast Texas continues to be hammered by the stalled remnants of Hurricane Harvey, which has already dropped 25 inches of rain on Houston and continues to linger over the state in what could be the most expensive natural disaster in US history. Rivers exceeded their historic high-water levels by as much as 10 feet. At least five people are known dead, but the toll will certainly rise when conditions allow the storm’s damage to be assessed.

    • Several hospitals evacuated patients or closed.
    • Driscoll Children’s Hospital in Corpus Christi air transported 10 NICU babies to a hospital in Fort Worth, fearing that a power outage would disable their ventilators.
    • Five of 11 Memorial Hermann hospitals in Houston reported spikes in newborn deliveries, with barometric pressure changes doubling the usual number of births in some hospitals.
    • Several Houston-area hospitals closed the flood doors they had installed after Tropical Storm Allison in 2001, hoping to protect their basements and ground floors.
    • MD Anderson closed its campus and advised employees and patients to stay home Sunday morning due to impassable roads, with on-site staff assigned to remain at work until conditions improve.
    • Clinicians at DeTar Hospital Navarro volunteered to stay at the hospital instead of at home with their families.
    • 911 lines were jammed as families in danger took to Twitter seeking rescue from anyone nearby.

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    Behrouz Zand, MD posted this picture of MD Anderson’s lobby on Twitter.

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    This Twitter-posted photo is of Aransas Pass Care Regional Medical Center, which was heavily damaged when its roof blew off, after which it was burglarized.

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    A Twitter user reported that these guys walked five miles in the water to respond to a Twitter plea for a help from a family with a sick baby.

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    The mother of a baby delivered as the storm approached land at Corpus Christi Medical Center Doctors Regional decided to name the boy Harvey.


    Reader Comments

    From Gladiolus: “Re: The Advisory Board. After information leaked out in July about the company’s split and UnitedHealth Group purchasing the consulting side, no further public information has been provided.” The company said in its August 8 earnings call that it would not comment on the board’s strategic review process. ABCO shares dropped sharply after the earnings miss, but they’ve still kept pace with the Nasdaq index over the past year.


    HIStalk Announcements and Requests

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    The results of last week’s poll are interesting, although IP address analysis doesn’t inspire much confidence in their validity.

    New poll to your right or here: which backgrounds entitle someone to call themselves an “informaticist?” I ran a similar poll in 2010 and it stirred up quite a bit of discussion, such as whether a nurse doing EHR implementation and support work is an informaticist.

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    HIStalk readers funded the DonorsChoose teacher grant request of Nevada middle school PE teacher Mr. H, who asked for shot puts and relay batons so the track and field team can practice for meets.

    Thanks to these companies for their recent support of HIStalk. Click a logo for more information.

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    This Week in Health IT History

    One year ago:

    • The systems of two West Virginia hospitals go down in a malware attack.
    • The Department of Defense pushes back its first scheduled go-lives of MHS Genesis.
    • Apple tightens App Store requirements for health-related apps.

    Five years ago:

    • SAIC announces that it will split itself into two publicly traded companies.
    • ONC says it will not allow EHR vendors to drag their feet in supporting data exchange with competing EHRs.
    • HL7 announces that it will make its standards available at no charge to increase their use.
    • Technology investor Vinod Khosla says computers will eventually replace 80 percent of doctors.

    Ten years ago:

    • Acer buys Gateway Computers.
    • MedAssets files for its IPO.
    • A lawsuit brought against McKesson for its involvement in setting inflated drug cost benchmarks is certified as class action.
    • The builder of Epic’s $100 million, 5,300-seat learning center posts photos of the project online.
    • HIMSS offers its second Virtual Conference.

    Weekly Anonymous Reader Question

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    Responses to last week’s question:

    • Misys gave away a car a couple of times. Created buzz, not sure if it created sales.
    • The most memorable I’ve seen is when Medicomp launched Quipstar – I think at HIMSS 2011. There was a tremendous amount of buzz. Of course it also helped that they helped sponsor HIStalkapalooza that year.
    • HIMSS Orlando 2017 Watson. Simple, bright booth with actual physicians and researchers demonstrating their work throughout the day. The individuals around the booth were knowledge, including marketing representatives, not just hourly booth babes. Admittedly, they can’t all be like this as the distraction of infotainment, gadgets, and snacks is occasionally welcome throughout the day.
    • Epic’s cartoon books and tights-wearing WebMan.
    • Iatric had a magician at a trade show who was quite memorable for his tricks and demeanor.
    • Richard Simmons at the booth for a “Thin Client” promo for either IDX or Cerner. Way back in the late 90s.
    • The urinal screens with advertising by ???? Guess it wasn’t that effective over the really long term. What, four years ago?
    • Cold-emailed me to offer me shots at the bar!
    • A Vermont-based vendor offering cans of Heady Topper, which is one of the top IPAs in the world and accessible only within a 25-mile radius of Waterbury, VT.
    • Can’t beat the OnBase Bar in the middle of the vendor floor.
    • Ivo Nelson’s Pub Night. Long after the show floor is closed, the dinners and parties are over, most in the know head to Ivo’s pub night. An informal gathering to see old friends and build new relationships. Much work gets done.
    • Years ago Arthur Andersen distributed jazz CDs at HIMSS in New Orleans. I still play the CD today and it’s loaded on my mobile devices.
    • HIMSS itself, conducting the annual Interoperability Showcase.

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    This week’s question: who is the most inspirational health IT or healthcare person you interact with regularly?


    Last Week’s Most Interesting News

    • Google offers a link to a depression questionnaire to mobile users who search on “clinical depression.”
    • CliniComp files a bid protest with the VA for choosing Cerner in a no-bid contract.
    • A reader calls attention to Care Otter, which is apparently an Allscripts project to develop a new EHR, after which Care Otter’s web page, Twitter account, and YouTube channel are taken down.
    • Investment research firm Hedgeye speculates that the new, unnamed six-hospital Allscripts Sunrise customer is Verity Health, owned by Allscripts investor Patrick Soon-Shiong.
    • HIMSS Analytics provides detailed information on inpatient EHR market share by hospital count, total beds, and the number of physician users.

    Webinars

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

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


    Acquisitions, Funding, Business, and Stock

    Philips will create a Nashville health technology center that will add 800 jobs.


    Decisions

    • Roane Medical Center (TN) will switch from McKesson to Cerner in 2018.

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


    Announcements and Implementations

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    Sunquest announces GA of Mitogen, a laboratory information management system and genetic software suite for molecular diagnostics and precision medicine.


    Privacy and Security

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    In Scotland, NHS Lanarkshire urges people with non-emergent conditions to avoid its ED due to a malware incident that has taken its systems down. The same trust was hit hard by the WannaCry ransomware this past May. 

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    Salina Family Healthcare Center (KS) notifies 70,000 patients that its computer systems were infected with ransomware in June. Afterwards, a patient who hadn’t been seen there for 13 years complained that his records should have been purged and that outdated addresses on file means the breach notices will be sent to the wrong people.


    Innovation and Research

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    A new Reaction report covers the Allscripts acquisition of McKesson’s EIS business. The report finds that McKesson already had a high rate of users interested in replacing its systems, a process that may speed up with the acquisition.


    Other

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    Epic CEO Judy Faulkner makes the “Forbes Richest People in Tech” list, coming in at #73 with an estimated net worth of $3.4 billion. Rishi Shah, the 31-year-old CEO of waiting room advertising company Outcome Health, was #69 at $3.6 billion.

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    Lloyd Minor, MD,  dean of Stanford’s medical school, blames EHRs for physician burnout and says that they (along with shorter office visits) “turn medical practice into a regimented, one-size-fits-all endeavor.” He says EHRs should add diagnostic support functions and use speech recognition, while doctors should use scribes to free up their time. 

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    The Las Vegas paper covers the fire department’s deployment of RNs to staff its emergency call line for less-urgent medical calls, where the nurses follow software-driven to decide whether to roll an ambulance or to call Lyft to take the caller to a hospital or urgent care center. The pilot project’s return on investment might be questionable – nurses work from 9 a.m. to 6. p.m. and take just six calls per day, costing $300,000 per year.

    In Australia, a cancer survivor blames the lack of interoperability between the EHRs of two hospitals for her missing follow-up visits. A member of parliament says he has received several complaints that Sunshine Coast University Hospital cannot access patient histories since it does not use the state-wide, Cerner-powered IEMR system and instead uses a scanning-based system while it plans its transition to IEMR.

    Weird News Andy can’t visualize why some clueless eclipse-watchers who weren’t able to get protective glasses decided that their next-best option was to put sunscreen on their eyeballs.


    Sponsor Updates

    • Medicity publishes a new white paper, “Interoperability 2.0: Solving Health Care’s Data Aggregation Problem.”
    • ZeOmega’s Jiva population health management platform earns NCQA certification.
    • Experian Health will exhibit at AAHAM California August 27-30 in Rancho Palos Verdes, CA.
    • Patientco recognizes Houston Healthcare (GA) as its Client of the Quarter.

    Blog Posts


    Contacts

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

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    Morning Headlines 8/25/17

    August 24, 2017 Headlines 1 Comment

    There is now a Google test for depression and mental ill health

    Google has partnered with the National Alliance on Mental Illness to begin offering depression screenings directly within its search results when users search “clinical depression” from a mobile device.

    Filled With Blood And Drugs, These Delivery Drones Are Saving Lives In Africa

    Fast Company profiles Zipline, a startup using drones to deliver life-saving medical supplies at a national scale in Rwanda. The copmany has made 1,400 commercial deliveries since its launch 10 months ago, 25 percent of which delivered life-saving supplies.

    MD Anderson back in the black for the fiscal year

    MD Anderson, which was running a $169 million defecit earlier in the year, is now operating in the black year-to-date thanks to cost cutting measures that included major staff reductions.

    Insurer’s mailing to customers made HIV status visible through envelope window

    Aetna is being sued after 12,000 people with HIV received letters that may have exposed their HIV status through an unnecessarily large window in the envelope.

    News 8/25/17

    August 24, 2017 News 13 Comments

    Top News

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    Google offers users who search for “clinical depression” on a mobile device an option to take a PHQ-9 online depression test, offered in partnership with the National Alliance on Mental Illness in hopes of increasing the percentage of depressed people who seek and receive treatment.

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    Reader Comments

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    From CinderFella: “Re: Verity Health. HIStalk had the edge on Hedgeye’s analysis over a month ago, with a reader commenting on the NantHealth purchase of Verity saying that it would buy ‘his Nant-whatever stuff’ and Allscripts products. The real story is that Verity scrapped a year’s worth of evaluations as it was looking to implement a new EMR. The selection process was still finalizing and a go forward choice was TBD, but it wouldn’t have been Allscripts.” I’m a Wall Street lightweight, but I would be uncomfortable as a shareholder of either company with the Allscripts investment in NantHealth, Patrick Soon-Shiong’s personal investment in Allscripts, and now NantHealth’s rumored pushing of the products of both companies on non-profit Verity, especially given that NantHealth seems to have made quite a few “sales” of its own products that looked more like mutual back-scratching than objective purchasing decisions that suggest market momentum. I suppose Verity being forced to choose a product it didn’t want is a legitimate sale, if indeed they have lost that choice, but it smacks of desperation from both companies. Maybe Allscripts also worries about that perception, too, since it hasn’t named Verity as the mysterious new client it signed.

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    From HIE Watcher: “Re: Informatics Corporation of America. Hearing it is being acquired by the SSI Group.” Unverified. I’ve sent an inquiry to ICA with no response so far.

    From Orange Vest: “Re: LinkedIn. How do you choose which connection requests to accept?” I pretty much accept all invitations, declining only those that are obvious scams (like someone who works for a Chinese air conditioner manufacturer who has no overlapping connections), although sometimes that opens me up to annoying messages from recruiters or overzealous salespeople who I squelch quickly. I really don’t do anything with LinkedIn except (a) look up people who have changed jobs, and (b) sometimes check to see if somebody’s connected with me or is in the reader-started HIStalk Fan Club to decide if I’m willing to reply to their email.

    From Dreydel: “Re: Devoted Health. I don’t have access to the full story, but Todd Park’s LinkedIn says he’s the founder. I bet other ex-Athena execs are involved.” I don’t pay for WSJ either, but Athenahealth co-founder Todd Park’s LinkedIn says he’s the co-founder and executive chairman of insurance startup Devoted Health.

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    From Publius Tullius: “Re: Epic in Denmark’s Capital Region. The projects are going so poorly that Epic was cut in the first round of the bid process to support the Southern Region. Stories go back to February related to project under-scoping, missing functionality, and budget overruns.” PT provided a ton of links to Danish sites describing Epic project problems, with some Google-translated headlines above.


    HIStalk Announcements and Requests

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    Blain Newton of HIMSS Analytics sent over another interesting analysis, this one from its Logic database that shows the EHR user count of physicians who are employed by, leased, or managed by health systems. Epic has a four-to-one lead over Cerner and Allscripts in doctor count, nearly equal to all other vendors combined since its customer base is mostly huge health systems. That also means that Epic has displaced a lot of EHR/PM vendors in practices as hospitals acquired them and put Epic in. It also makes InterSystems very happy since they license Cache by concurrent user.

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    Blain also provided this graph showing those organizations, both for-profit and non-profit, that have made the most hospital acquisitions in the past 10 years. Such acquisitions drive a good bit of the EHR market as acquired hospitals are moved to the corporate EHR standard.

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    This, as they say, resonates with me.

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    So does this, since I am always baffled that more people play the lottery when the prize goes up. Are these folks who couldn’t be bothered for only $100 million?

    This week on HIStalk Practice: Alaskan providers share challenges, triumphs with HHS Secretary Price. Allscripts makes it easier for physicians to participate in clinical trials. The Institute for Women’s Health succumbs to keylogger virus. Wellpepper CEO Anne Weiler shares why virtual assistants and interactive mobile treatment plans are poised to meet consumer healthcare expectations in a big way. LifeWorks NW VP of Clinical Services Mark Lewinsohn expects new population health management technology to boost its participation in the national demonstration project for Certified Community Behavioral Health Clinics. Behavioral healthcare stakeholders lament telemedicine’s slow progress in MA. Petaluma Health Center becomes data-driven FQHC. DoD honors ChartLogic. Dispatch Health expandsto Arizona. In a new monthly series, PRM Pro Jim Higgins outlines the ways in which physicians can use patient relationship management technology while still maintaining the human touch.

    I’m disappointed that nobody bothered to make an Eclipsys-related eclipse pun.

    Listening: new from 29-year-old Minneapolis-based hip hopper Lizzo, whose Missy Elliott-style brash confidence includes more explicit lyrics than I like, but I overlook that because her music is a joyous, soulful bridge between the late 1960s Motowners and today’s rappers. I’m also listening with nostalgia to the unparalleled R.E.M., which ceased to exist in its original configuration as a foursome and one of America’s greatest bands 20 years ago, their unexpected high harmonies still giving me chills last night when the family chain restaurant I was in surprisingly played “Fall On Me” on its canned music system.


    Webinars

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

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


    Acquisitions, Funding, Business, and Stock

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    Agfa-Gevaert is considering spinning off its health IT business that includes vendor-neutral archive, PACS, image sharing, data aggregation, patient engagement, and digital radiography.

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    Startup Doc.ai comes out of stealth mode in describing its AI-powered “silicon doctors” medical dialog system. Its CEO is the co-founder and former CEO of Scanadu, which seems to have fizzled out following the retirement of its Tricorder-like vital signs device that earned tons more press than it deserved as technical limitations kept dumbing it down.


    Sales

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    Pomona Valley Hospital Medical Center (CA) chooses Imprivata’s biometric positive patient identification solution.

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    The VA and DoD sign a 10-year contract with Fujifilm Medical Systems USA to make the company’s Synapse enterprise imaging portfolio available to government healthcare providers. The maximum contract value is $768 million.


    People

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    Grattan Smith (RelayHealth) joins Loyal Healthcare as VP of business development.


    Announcements and Implementations

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    An Athenahealth survey finds that patients of small physician practices are heavier patient portal users than those of regional and national health systems, with respondents offering these suggestions to improve use:

    • Let patients know that the portal is the primary way the practice will communicate with them.
    • Help patients sign up while they are in the office, creating an email account for them if necessary.
    • Review their labs and chart entries from the portal on a large monitor during their visit.
    • Remind new patients to register on the portal before their first visit.
    • Commit to responding to patient questions within 24 hours.
    • Use services like Solutionreach that text patients when their lab results are ready to view on the portal.

    Government and Politics

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    The President’s political appointees have turned HHS into a remarkably shrill and partisan White House lapdog, loudly criticizing the laws they swore to uphold. The latest example is this statement from HHS Principal Deputy Assistant Secretary for Public Affairs (and former Koch Brothers employee and aide to former Governor and now VP Mike Pence) Matt Lloyd, who instead of encouraging healthy people to sign up to create better ACA risk pools, dutifully does his part to perpetuate the “let it fail” agenda with campaign slogans instead of responsible statements:

    Obamacare failed to create a thriving, competitive market that offers the kind of coverage people want to buy at prices they can afford. On Obamacare’s exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country and choices continue to vanish – an unfortunate reality for the American people who are required to buy Washington-approved health insurance or pay a fine.

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    The Supreme Court is reviewing a lawsuit that argues that Google’s trademark of its own name should be nullified because “Google” has become a synonym for “searching the Internet.” The term “genericide” refers to former trademarks that became plain old words because of their non-specific usage, among them “thermos,” aspirin,” and “videotape.”


    Privacy and Security

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    Aetna exposes the HIV status of 12,000 patients in several states by mailing HIV medication prescription information in envelopes that contain an overly large window.


    Other

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    MD Anderson Cancer Center (TX) credits its cost management efforts – which include laying off 800 employees – for several straight months of profitability that have swung it into the black for the fiscal year, digging itself out of a $169 million hole.

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    Fast Company magazine covers the drug and blood delivery drones being used in Rwanda, where startup Zipline has in its first 10 months’ of service made 1,400 deliveries of 2,600 units of blood using its 15 drones, 25 percent of those involving life-saving emergencies. The service will go live in much-larger Tanzania next year, hoping to make it “the first country in the world to achieve 100 percent in-stock rates at all health facilities and hospitals” for anti-malarial drugs, HIV medication, vaccines, and insulin.

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    A nursing home owner pays $13 to acquire a Missouri hospital that BJC HealthCare bought and then closed nine months later, probably hoping that BJC is being overly cautious in warning of potential asbestos problems and high maintenance costs.

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    Pharma bro Martin Shkreli, who was famously banned from Twitter for his creepy harassment of reporters, is buying Internet domains that are associated with the names of journalists who have criticized him, then putting up web pages that mock those people. He then offers to sell them back the domains for several thousand dollars, an extortion-like scheme not unlike his Turing Pharmaceuticals pricing strategy in being simultaneously despicable yet legal. Shkreli says, “I wouldn’t call these people journalists. They are the unwitting recipients of liberalism subsidy from large media and telecom companies … only a few notches above the white supremacists we hear so much about these days.”

    Colorado and Maine have enacted laws that require veterinarians to check pet owners in doctor-shopping databases in hopes of detecting drug users who obtain addictive drugs through their pets. Some states require vets to perform such a check, while two-thirds of states explicitly prohibit it, with the president of the California Veterinary Medical Association explaining, “I’m a veterinarian, not a physician. I shouldn’t have access to a human’s medical history.” 

    Weird News Andy follows up on my mention of CuddleCot, observing that people took photos of their deceased children back in Victorian times because they were unsure of the then-new technology’s role in memorializing their dead loved ones. I recall a movie that led off with a series of photos like these, where it brilliantly added no explanation until it became obvious about halfway through what I was looking at. Memento mori.

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    In England, a hospital CEO is criticized for refusing to accept $3,200 donation for ECG equipment, saying that the fundraising team of men who’ve run an annual hospital bed-pushing contest for 25 years are demeaning nurses by dressing in their female uniforms.


    Sponsor Updates

    • Nuance announces that 600 healthcare organizations chose Dragon Medical One in the past year, also adding 25,000 users in the past 90 days.
    • EClinicalWorks will exhibit at the NACHC Community Health Institute & Expo August 27-29 in San Diego.
    • Hayes Management Consulting will exhibit at the AHIA Annual Conference August 27-30 in Boston.
    • People: Laura Kanov joins HBI Solutions as SVP of product strategy.
    • Impact Advisors donates more than 5,000 personal care products to active troops overseas.
    • Ingenious Med will exhibit at the SHM-VA Chapter Meeting August 30 in Virginia Beach, VA.
    • InterSystems will exhibit at the annual SHIEC Conference August 27-30 in Indianapolis.
    • ConnectiveRx is a finalist for the 2017 PM360 Trailblazer awards.

    Blog Posts


    Contacts

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

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    EPtalk by Dr. Jayne 8/24/17

    August 24, 2017 Dr. Jayne No Comments

    In keeping up with Physician Compare and Hospital Compare, CMS has launched the Hospice Compare website for those looking to evaluate end-of-life care options. I’m fortunate to live in a community with some very well-regarded hospice organizations, but I recognize that there are people out there who prey upon families during a highly vulnerable time. In addition to showing quality metrics for pain management and treatment of other symptoms such as shortness of breath, it also displays whether a hospice is for-profit or not and when they were certified.

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    I had the privilege of being in the path of totality for this week’s total eclipse. Although I wasn’t able to get any photos on my own (this one is courtesy of NASA) it truly was spectacular. I’ve seen a partial eclipse before (back in 1979 with a trusty cereal box pinhole viewer) but I have to say, seeing it through filtering glasses was a very different experience. I did make a pinhole projector and showed it off to a couple of kids who needed a dose of low-tech magic. Even with some pre-eclipse reading, I saw things I didn’t expect to look the way they actually did, such as the crescent shadows through the trees and the shadow bands right before totality. The coolest pinhole projector I saw was a colander, which projected dozens of mini-eclipses on the ground.

    I do completely understand how people damage their eyes, because as the eclipse progressed past the totality phase, I wanted to keep looking at the corona. The brightness made that idea a short-lived one and I went back to my viewing glasses after taking another good look at the shadow bands on the ground as they appeared again on the eclipse’s way out. I’m not ready to become an eclipse chaser, but if you have the opportunity to see a total eclipse, I definitely wouldn’t miss it. An ophthalmologist friend from residency practices in the eclipse pathway and had several patients call his office Monday evening and Tuesday morning wondering about retinal injury. Fortunately, he didn’t see any significant damage.

    Tuesday, it was back to the grind, working with a client in the advertising space. I’ve worked with advertising and PR firms before, usually in the context of helping a healthcare organization rebuild their brand, but a couple of times with product launches. This is the first time that the marketing firm has been my client. They engaged me because their efforts to build a healthcare business line have stalled. It seemed like an interesting challenge and they were referred to me by a solid client who convinced them that they needed some tough love from someone in the healthcare trenches. Initially I thought that they just didn’t understand the healthcare business, but as I began to shadow them on calls with their clients, I realized that the root cause may be that they don’t understand marketing.

    My past experiences with marketing and advertising firms have followed a fairly predictable course. They begin to understand the client’s business and the client’s goals, then take a survey of the current state. Was the client working with another agency? Were they trying to do their own marketing? What kinds of media were used? What was successful? What flopped? As part of understanding the client’s business, they interviewed stakeholders to understand how the business saw itself, then used that information to build a marketing plan for the organization.

    My advertising client is working with a practice that is trying to launch an ambulatory surgery center (ASC), but the project has been one barrier after another and they’re challenged by some occupancy and rezoning issues. Regardless, they want to move forward with a plan to get their name and brand more visible in the community so they can bring providers on board and then launch the services to the community. I thought it should be pretty straightforward, and had no idea what I was about to hear on the call.

    My client didn’t go into any of the background about why the practice wants to move into the ASC space and what they hope to achieve. They also didn’t ask what the organization is doing for marketing and what has been successful in the past. They launched straight into a checklist of “what date do you want to start running ads in the newspaper” type items that were completely ineffective.

    It was clear that the practice was frustrated since they’re not marketers and that’s why they hired someone to assist. It was clear that the marketing firm had done no research on the client’s current web and social media presence. When the client balked at the checklist approach, my client effectively scolded their own client for their lack of understanding of the process.

    They then proceeded to go through a patronizing explanation of the marketing process that was so full of jargon that it was making my head hurt. The practice had no idea what to make of statements like, “You need to give us information that will prime the pump” and “we need you to give us content that will hit the sweet spot.” I was in continuous contact with my client via instant messenger and tried to steer the conversation to keep the practice from hanging up on them, hoping that they could take a step back and get the client talking about why this expansion was important to them.

    One of the marketing team actually asked, “What does ambulatory mean?” and I think I laughed out loud. If the practice wasn’t confident about their choice before, I’m sure this sealed the deal. (Pro tip: Google is your friend. Do some prep work.) I struggled through the rest of the hour making plenty of notes for my post-meeting discussion with the marketers. Although they were going to get an earful, I wish I could have given some coaching to the practice as well. First off, I wondered if they even checked references on this marketing firm or whether they went with the cheapest offer, or how they came to work with my client. My client currently has zero referenceable clients, which is why they hired me, and although it’s possible they could have fabricated something, I doubt it.

    One of the reasons I went into consulting was to help small to mid-sized practices that were struggling with technology and working with vendors and who wanted outside advice on the best ways to move forward. I’m rarely surprised by lack of business savvy among healthcare providers because it’s not something they typically learn during their training. But I continue to be amazed by the cluelessness of the many vendors that are trying to find the pot of gold at the end of the healthcare rainbow.

    How does your organization handle marketing? Email me.

    Email Dr. Jayne.

    Morning Headlines 8/24/17

    August 23, 2017 Headlines No Comments

    Funding For Local Public Health: A Renewed Path For Critical Infrastructure

    Former National Coordinator for Health IT Karen DeSalvo, MD and George Washington University Health Policy Professor Jeffrey Levi, PhD co-author a Health Affairs article calling for increased spending on public health initiatives.

    Presence Health Signs Letter of Intent with Ascension to Join AMITA Health

    Ascension Health announces plans to acquire fellow Catholic health system Presence Health (IL).

    Henry Ford Hospital CEO Announces Retirement

    Henry Ford Hospital CEO John Popovich announces that he will retire at the end of the second quarter 2018, closing out a 40 year career at the hospital.

    Medicare to divulge when a doc’s patient is in an ACO

    CMS is updating the Medicare website to allow patients to identify their primary care provider so that doctors participating in ACOs will be assigned to their own patients.

    Morning Headlines 8/23/17

    August 22, 2017 Headlines No Comments

    CliniComp Sues Gov’t Over Cerner’s VA Contract

    CliniComp files a bid protest against the VA for awarding a no-bid contract to Cerner that will replace its own installations within the VA.

    $417 Million Awarded in Suit Tying Johnson’s Baby Powder to Cancer

    Johnson & Johnson is ordered to pay $417 million in damages to a woman who successfully argued that baby powder caused her ovarian cancer.

    Rush orders up $18M+ fraud lawsuit vs vendor that installed allegedly defective patient monitoring system

    Rush University Medical System (IL) sues Draeger after installing its $18 million patient monitoring system to find that it did not perform at the level promised.

    Q&A with CEO Ken Comée on what’s next for CareCloud and healthcare IT

    Ambulatory EHR vendor CareCloud’s CEO Ken Comée says in an interview with a local paper that going public is part of his plans for the company, explaining “My competitors are 20- and 30-year-old technologies, and I have the best damn platform in the space.”

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