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Morning Headlines 8/14/17

August 14, 2017 Headlines No Comments

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

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

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

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

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

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

Monday Morning Update 8/14/17

August 13, 2017 News 4 Comments

Top News

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

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

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

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

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


Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

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


This Week in Health IT History

One year ago:

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

Five years ago:

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

Ten years ago:

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

Weekly Anonymous Reader Question

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Responses to last week’s question:

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

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


Last Week’s Most Interesting News

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

Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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


Decisions

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

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


People

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


Announcements and Implementations

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


Other

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Morning Headlines 8/11/17

August 10, 2017 Headlines No Comments

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

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

Remote Workers Vulnerable In Disputes With Company, Say Employees

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

Trump: ‘The opioid crisis is an emergency’

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

NHS England CCIO Keith McNeil resigns

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

News 8/11/17

August 10, 2017 News 6 Comments

Top News

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

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

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

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

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

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


Reader Comments

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

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

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

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

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

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

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

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


HIStalk Announcements and Requests

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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


People

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

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


Announcements and Implementations

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

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

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


Government and Politics

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

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

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

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


Privacy and Security

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


Technology

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


Other

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This should help dispel those negative perceptions of Alabama.

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 8/10/17

August 10, 2017 Dr. Jayne 1 Comment

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 8/10/17

August 9, 2017 Headlines 1 Comment

Jonathan Linkous Departs ATA After 24 Years As CEO

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

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

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

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

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

Campaign to taint courtroom foe costs Saxton post at OHA

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

CIO Unplugged 8/9/17

August 9, 2017 Ed Marx 12 Comments

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

Brokenness in Leadership

I finished my keynote presentation for the New York HIMSS chapter and surrendered the stage back to my host. With Yankee Stadium as the backdrop, the entire day’s event had been spectacular.

Lit, I spoke about customer service. I had no intention of sharing a Top 10 list of things you could replicate in your organization to create a culture of customer service. Rather I aimed to pierce the hearts and souls of each and every person listening. If I pierced hearts, leaders might be transformed and the Top 10 action items would be created and owned by them.

I shared real stories how hearts were pierced – mine and others. Pierced hearts drove us to create, design, and deliver superior customer service, and in turn, improve clinical and business outcomes. It is one big ecosystem, I suspect, a softened heart that beats to serve and changes culture which improves outcomes. The cycle begins with brokenness.

Leaders approached me at the reception with tears in their eyes. Tears glistening on his cheeks, a battle-tested CEO shared how he never cried. But there he stood. Pierced. Changed.

One by one they stood in line, sharing how their worlds got rocked. The big question was, how could I be vulnerable to my teams, let alone strangers? How could I display raw emotion while recounting core-shaking stories? How could they get in touch with themselves at that level and with transparency?

Those are deep questions and I am not sure I have the answer. Perhaps part of the answer involves brokenness. I realize I am a broken person. I have failed as much as I have succeeded. I have been challenged in life and career. I have struggled with work, I have struggled with sport, I have struggled with kids, I have struggled with marriage. I have hit rock bottom. Hard.

I know I am weak. I also know on my own there is no way up. I am a grateful survivor. I realize the gap between my brokenness and my recovery is filled by grace. If karma is real, I am in big trouble. Really big trouble. Grace is my new BFF.

Some are too prideful to admit weakness and resist brokenness. We compete to be better than the pack and hide behind façades. We are pretenders. In pain. We don’t let others see or touch it. In fact, we bully others who show weakness. We resort to over-medication, legally or otherwise.

Ideally, we realize the need to get real and accept our brokenness. Perhaps acceptance is the start. We embrace brokenness as something bigger than ourselves. Acceptance creates capacity for gratefulness. I sometimes tear up because I am so thankful to others. I recognize that my accomplishments are not about me, but because of others.

I also learned compassion and empathy growing up. The youngest of seven, I spent significant time with my mother alone and bonded tightly. Mom suffered her entire life with chronic illness as I watched her deal with pain with a brave face. She was a servant who loved her kids and husband. Days before she traded her earthly rags for robes of righteousness, we talked about it. Why did God allow her to suffer so long? Why was such a great woman taken so early and cruelly?

We never realized the answer, but at the end I whispered in her ear that her quiver full of successful kids, grandkids, and great-grandkids was a testimony of her significant legacy. In her suffering we observed grace and learned empathy. My heart pierced multiple times in her journey.

As I gained experience serving in hospitals, I began to see patients in the normal course of work. Here I was, healthy, while around me was sickness and death. As an anesthesia tech, I assisted in many procedures, including the harvesting of organs. I watched parents surrender their child’s body to medicine in hopes a tragic suicide would bring life to others they could never know.

I passed gurneys that seemed empty except for the body hidden underneath drapes. I experienced poignant reminders that life is fragile. I understood my service was to make people well while also ensuring the dignity of death. Even as I write this, my mind is full of memories. How can I not cry?

Leadership. Through life and circumstances, we become hardened. Work can be tough and family tougher. Life happens. Even the most supple arteries get clogged. Yet to be effective, our hearts must remain pliable and soft.

For me, volunteering weekly in hospitals keeps my heart pure and the blood flowing. Seeing sick children in particular touches me. I regularly shadow clinicians and hide tears. Patients. I have to see patients. They pierce my heart. They re-orient my focus.

As leaders, we must remain vulnerable and transparent. We must demonstrate that it is OK to cry. Emotions are strength, not weakness.

Demonstrate brokenness. Become a vehicle of mercy and grace to others. Once you embrace your brokenness, you are able to lead others through theirs.

edmarx

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Morning Headlines 8/9/17

August 8, 2017 Headlines No Comments

Epic Move: UC San Diego Health Transitions to Cloud Technology

UC San Diego Health announces that it will transition away from traditional data centers and move its EHR to an Epic-hosted cloud environment.

Evolent Health (EVH) Posts Q2 Loss as Expected, Revenues Top

Evolent Health shares fall 17 percent Tuesday, after reporting a Q2 loss and announcing that it was considering a second IPO, in which it hoped to raise $175 million.

Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees And Retirees

A Health Affairs study measuring the impact of offering health services price transparency tools to employees, finds that, “only 12 percent of employees who were offered the tool used it in the first fifteen months after it was introduced, and use of the tool was not associated with lower prices for lab tests or office visits.”

The Man Who Wrote Those Password Rules Has a New Tip: N3v$r M1^d!

Former NIST employee and author of a specification establishing best practices for password security admits that mixed-case passwords that contain special characters are not nearly as secure as longer, phrase-based passwords that are easy to remember but hard to programmatically hack.

News 8/9/17

August 8, 2017 News 18 Comments

Top News

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UC San Diego Health (CA) moves from its self-hosted Epic system to an Epic-hosted, cloud-based system, the first academic medical center to undertake that particular migration.

UCSD says it is shifting away from running its own hosted centers to cloud-based systems because of cost and reliability. The Epic switch involved 10,000 workstations and integration of 100 third-party applications.

UC Irvine Health will move to UCSD Health’s Epic cloud-based instance in November 2017.

UC San Francisco announced a $10 million grant in late July that will fund a project to mine the combined Epic databases of all five UC medical centers to discover new insights and possibly find new uses for existing drugs.


Reader Comments

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From Sister Sledge: “Re: Allscripts. One of the rags ran a map of where McKesson EIS had customers, claiming that geography matters to a vendor and that Allscripts will benefit from gaining more customers in the West. Think so?” I don’t think so. Geography can affect sales, but only for companies that have clear momentum and neither McKesson nor Allscripts have ever had that. My prediction is that Cerner, Epic, and maybe Meditech will benefit most when those customers start looking for replacement systems. It’s not at all similar to when Cerner bought Siemens Health Services and could offer them a lifeline from their rapidly sinking systems to a market-leading one. Allscripts can boast about a higher customer count or wider geographic reach, but a lot of those customers are likely to defect in the next few years as the Cerner and Epic train keeps rolling over everything in its path (accelerated by big hospitals buying smaller ones) and the acquisition encourages those former McKesson customers to review their positions. The direction of change in customer satisfaction post-acquisition will predict a lot. MDRX shares are at the same price as they were in mid-1999, so stock performance won’t create much confidence – Cerner shares are up 322 percent in the past 10 years, McKesson shares are up 167 percent, and the Nasdaq index is up 136 percent, all while Allscripts shares were losing 52 percent of their value. 

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From Lucille Two: “Re: Epic’s response to Politico’s article about Joe Biden. Don’t you find Epic’s PR statement a bit confusing, saying that the VP was ‘consistently polite and positive’ unless it’s to cover their tracks? Wouldn’t Biden’s staffer, who has no reason to disparage him, know him well enough?” Politico excerpted comments from a video made at a conference’s fireside chat by Greg Simon, now president of the Biden Cancer Initiative, who said the VP and Epic CEO Judy Faulkner got into a heated exchange over why Biden might want his own full medical record. I wasn’t there and Simon was, but my observations from watching him tell the story on video are:

  • Simon seemed a bit swaggering and over-the-top in the video, which left me feeling that his comments were more of an entertaining story for the in-person conference audience rather than a trustworthy, verbatim discussion of what was said by others in his presence.
  • Simon’s tone in the remainder of his remarks was clearly anti-EHR vendor. I got the feeling that the Biden story was his chance to take a shot at them. 
  • The conversation between Biden and Faulkner he described took place nearly seven months ago, resulting in zero reaction until the conference video from Simon’s session was published.
  • Simon’s background: aide to VP Al Gore, lobbyist, charity founder, drug company executive. He’s long been a critic of the lack of data-sharing in healthcare, but he originally seemed to blame providers rather than EHR vendors in saying, “The technology of sharing has increased exponentially, but the willingness to share has not.” 
  • Others in attendance (it was not a private meeting) have not corroborated Simon’s account, and in fact have said the meeting was, as Faulkner said, cordial and polite.
  • Even accepting Faulkner’s supposed comments at face value, it’s a leap to assume that her message was dismissive, paternalistic, or defensive about patients accessing their data. Tone is everything and her supposed comment that Biden wouldn’t be able to make sense out of an Epic EHR data dump is generally accurate, although perhaps Biden took offense thinking he was being spoken down to.
  • The bottom line for me is that it’s much ado about nothing regardless of whether Simon’s recap is accurate. It was a fun story for a couple of days, but not necessarily accurate or indicative of any particular trend or practice, especially in the absence of commentary from Biden himself. If he were that riled up, he’s had seven months to say so.

HIStalk Announcements and Requests

I notice that Rolling Stone has a profile of singer-songwriter Khalid mentioned on the cover of the current issue, mostly because I recommended his music in January 2017 with my summary, “Mark your calendars for six months from now – Khalid is going to be big.” 


Webinars

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


Acquisitions, Funding, Business, and Stock

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Pharmacy supply chain technology vendor Swisslog Healthcare acquires Talyst Systems, which offers medication management solutions to acute care and long term care facilities. 

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Evolent Health reports Q2 results: revenue up 89 percent, EPS –$0.13 vs. –$0.25, beating revenue expectations and meeting on earnings. News of the company’s plan to launch a $175 million secondary public offering  sent shares down 17 percent in early after-hours trading Tuesday.


Sales

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Connecticut Children’s Hospital chooses InstaMed’s healthcare payments solution.

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Toronto-based Baycrest Health Sciences selects Caradigm’s single sign-on and context management systems.


People

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Stephen Grossbart, PhD (Stephen Grossbart and Associates) joins Health Catalyst as SVP of professional services.

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Ingenious Med hires Girish Pathria (Visiant) as VP of products and insights and names Nancy Cunningham (Accord Services) as VP of implementations.

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Susan Steagull (Novant Health) joins VCU Health System (VA) as CIO.


Announcements and Implementations

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Fresno Surgical Hospital (CA) goes live on FormFast’s electronic signature solution in its Meditech environment.


Privacy and Security

The now-retired NIST manager who in 2003 was ordered to quickly develop password-setting guidelines says he was wrong about recommending that passwords be required to conform to bizarre rules that require mixed-case letters and special characters. New NIST guidelines recommend that passwords be created from long but easily-remembered phrases. Analysis found that a password like “correcthorsebatterystaple” would require 550 years to crack, while an old-rules version such as “Tr0ub4dor&3” could be broken in just three days. The guidelines also say that passwords need not be auto-expired, with users forced to change their passwords only if they are known to have been compromised.

In India, a hospital IT director and one of his former employees are arrested for stealing hospital data required for accreditation and selling it to other hospitals.


Other

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A study of all US opioid prescriptions issued over a nine-year period finds that doctors who graduated from low-ranked medical schools prescribe a lot more opioids than those who attended top-tier programs, concluding that physician educational outreach might help with overuse. Based on the graph above, it looks like osteopaths (DOs) are a much bigger problem than just about everyone else, including foreign medical graduates, although that wasn’t the subject of the study. I’m not sure I buy the conclusion, however, since it would be interesting to also look at number of years since graduation and the practice location — I would bet that many graduates of top-ranked schools tend to practice locally afterward and have a different kind of peer group and big-hospital oversight that happens mostly in major teaching hospitals with employed doctors. The bottom-ranked schools, in case you are as interested as I am, are Drexel, University of Nevada, Michigan State, West Virginia University, and University of South Carolina, which might be especially concerning if your doctor finished at the back of the pack of his or her graduating class.

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Oopsie.

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A researcher observes with some alarm that post-Millennials are “on the brink of the worst mental health crisis in decades” because they spend all their free time on Snapchat or texting instead of physically interacting with people, with a steep drop-off in time spent with friends even though virtual interaction leaves them less happy. Those who proudly document their activities on social media also cause everybody else to feel left out or to obsess over how many “likes” they earn. In a somewhat related article, a small study finds that AI-powered analysis of Instagram photos (color, comments, likes, posting frequency) is much more accurate at diagnosing depression than face-to-face doctor visits.

Giving employees a healthcare price transparency tool didn’t reduce overall spending, a study finds, noting that only 12 percent of the employees even bothered to look at it. The price tool saved an average of 14 percent of the cost of advanced imaging studies, but only 1 percent of those patients consulted the tool before having the test performed.

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We are so blessed in healthcare IT to have access to a $3,480 report written by obvious experts.

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In Egypt, 10 doctors launch an operating room-themed restaurant that claims its food is safer because of the medical training of the owners.


Sponsor Updates

  • Aprima will host its annual user conference August 18-20 in Dallas, TX.
  • Besler Consulting releases a new podcast, “Preparing for the Social Security Number Removal Initiative.”
  • Optimum Healthcare IT publishes a white paper titled “Epic Upgrades are Epic Events.”
  • Nordic publishes a podcast titled “Why change management is critical to a successful EHR transition.”
  • EClinicalWorks announces that users of its EHR have exchanged two million documents in the past 12 months through the Carequality Interoperability Framework.
  • Dresner Advisory Services honors Dimensional Insight with its Industry Excellence Award for business intelligence expertise.
  • Glytec showcases the impact its therapy management software along with connected device systems has on insulin management at the American Association of Diabetes Educators conference.
  • Healthfinch VP of Operations and Finance Leah Roe will speak at Forward Fest Madison August 17-24 in Wisconsin.
  • Influence Health announces the speaker lineup for its Influence! Healthcare Consumer Experience Conference September 27-28 in Orlando, FL.

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 8/8/17

August 7, 2017 Headlines No Comments

Internet-based EHRs gaining some customers but still a small segment

Modern Healthcare reports that cloud-based EHRs are increasing in popularity due to a perceived advantage in staffing and cybersecurity.

Anthem takes harder line on ER visits

In an effort to reduce unnecessary ER visits, Anthem warns its customers that it may start denying non-emergency ER services, leaving patients with the bill.

A shift in the fitness wearables market spells trouble for Fitbit

Fitbit’s share of the wearables market dropped from 27 to 16 percent in the last year, as Chinese consumer electronics manufacturer Xiaomi continues to expand its marketshare.

Tenet Reports Results for the Second Quarter Ended June 30, 2017

Tenet Healthcare Corporation reports Q2 results: revenue dropped 1.4 percent to $4.8 billion, resulting in an overall net loss of $56 million. Adjusted EPS –$0.17 vs. $0.40. Tenet also lowered its forecasted annual revenue, citing low patient volumes, which sent stock prices down 10 percent in afterhours trading Monday.

Curbside Consult with Dr. Jayne 8/7/17

August 7, 2017 Dr. Jayne 2 Comments

I’ve been working on a project involving laboratory interfaces for a mid-sized multispecialty practice that is trying to integrate with multiple local hospitals. They’re valiantly trying to stay independent, which is quite a challenge given the rampant consolidation that is going on in nearly every healthcare market.

The practice’s leadership figures that if they interface with the hospitals in addition to the reference labs they already send to, it will make it easier to manage patients regardless of where they are admitted. As they were putting together this plan, however, they didn’t understand the complexity of working with organizations that aren’t entirely focused on earning the practice’s laboratory business like the national reference labs are.

Since the practice’s previous interface projects took 30 to 45 days, they assumed that working with the hospital would be the same. They also assumed that the hospital laboratory representatives who regularly come to the practice to tell them about new tests would be able to assist them in navigating the entire process, not realizing that those reps were more sales agents than true account managers.

The first surprise came when Hospital One told them it would be a minimum of three months before they could even talk about a timeline for starting a lab interface project, so they would have to stay on paper for the foreseeable future. It would be a fairly straightforward process to create a printable laboratory requisition so we could move the practice away from the hospital’s carbon-paper form and into EHR-based ordering. However, the lack of an interface had already created a significant amount of extra work for the nursing staff who was expected to manually key all lab results that were related to reportable clinical quality measures.

Even though we couldn’t fix the interface problem, I helped them create a new workflow for keying the results, which involved their medical records staff in addition to the nursing staff, so the workload could be better distributed. Cross-training is always a good thing, and assuming adequate training and quality assurance review, there was no reason why the medical records staff couldn’t be part of the workflow. Still, given the nature of the one-off workflow to key results, compared to the interfaces with the reference labs, I didn’t foresee the practice sending any more orders to Hospital One than they had been with handwritten orders.

Hospital Two was a significantly more accommodating, probably in part due to the fact that the practice hadn’t been sending business to its lab previously. Although they didn’t have available staff to assist with a bi-directional interface project, they were willing to set up a results-only interface that would at least allow discrete results to come into the patient chart without the staff needing to be involved.

Unfortunately, the client’s EHR handles this type of situation by creating two orders in the patient chart — one for the actual order and one that is created when the unsolicited result hits the system. This leads to extra work because someone has to reconcile the orders and match them up, and it would leave the practice with the same amount of extra work as the first hospital. When I mentioned the inconvenience and asked if they were willing to help us implement a workaround that would function as a semi-solicited interface, they were eager to hear about what it would take.

Having done it with other clients, I knew the hospital’s lab system was capable of holding the client’s internal accession number, and that keying it on each order would solve the problem. Usually only about half the hospitals I interact with are willing to do this, often citing the risk of error or the magnitude of the extra work for their lab staff. However, this facility jumped at the chance to see if they could make it work in order to obtain a piece of the practice’s business.

They were so eager to move the project forward that they agreed to send someone to the practice to key in the orders for testing so that the practice didn’t have to hardly expend any resources. Once the orders were keyed, they resulted them promptly, faster than almost any hospital lab I’ve ever worked with. The entire testing phase took barely more than a week and they resolved any issues that were found by the end of the next business day. I have to admit, it was a dream project and the entire thing was done in less than four weeks.

Many of us in healthcare are a tiny bit superstitious (never say the word “quiet” in the emergency department) so I knew that given the success of the project with Hospital Two that the next project was likely to be a nightmare. My vague suspicion grew into actual worry when I met the IT project manager the hospital had assigned to the interface project. I could sense the rarified air around him as soon as I walked in the room and had to suffer through his overly complicated explanation of what an interface project entails. I think he assumed that as a physician I didn’t know anything and he totally missed the part where the practice administrator explained that I was their consultant and had assisted multiple clients with interface projects.

He went on for a good 20 or 30 minutes that seemed like a lifetime, talking about all the important work the hospital IT team would be doing to make the interface happen and how little the lab and practice teams would impact the process. When I finally was able to jump in and explain my experience and the practice’s goals and objectives, I was treated to a rainbow of colors on his face as he went from angry red to bilious green to white. I think it had honestly never occurred to him that anyone on the practice side could have a clue how things should be done.

Since he claimed he didn’t have a sample project plan to review with us, I provided him with my own, which produced an outstanding level of pallor as he realized he wasn’t going to be able to put one over on us. We asked him to review the proposed timeline and comment on it and he said he would be able to get back with us in the next couple of weeks. That’s never a good sign, but I couldn’t tell if he was actually backlogged or just being passive aggressive. As time went on and he haggled about everything from the selection of components for the test scripts to the way in which labs would be resulted, I knew it was the latter. The project has been stalled in every imaginable way, with various resources being unavailable or on vacation at various times despite the hospital having agreed to a project plan and timeline.

The practice’s pleas to hospital leadership have fallen on deaf ears. This week I’ll have to have a serious discussion about halting the project. We’ve been using too many resources with little return, and if this is how a hospital acts when a practice wants to send them their business, I doubt they’ll be responsive if there are issues. The other hospital’s semi-solicited interface has been working like a dream, and to the end users, it functions just like the reference labs’ bi-directional interfaces. There are a couple of kinks for the practice’s IT staff every now and then, but overall, it’s been a big success. There simply isn’t much reason to continue working with a competitor hospital that just puts roadblocks in the way.

It will be interesting to see whether the first hospital ever circles back to us or whether a halted project will bring the third one in line. I suppose some hospitals are simply so big that they forget about their base, or maybe leadership just lets certain constituencies run amok. I can’t say that healthcare IT will ever be dull and am grateful that organizations like this create job security for people like me.

How does your hospital earn business from independent practices? Email me.

Email Dr. Jayne.

Morning Headlines 8/7/17

August 6, 2017 Headlines 1 Comment

Allscripts announces second quarter 2017 results

Allscripts reports Q2 results: revenue increased 10 percent to $426 million, adjusted EPS -$0.85 vs. $0.05. The company announced it would write off $145 million of its $200 million investment in NantHealth, due to NantHealth’s poor stock performance.

Siemens, DHS warn of “low skill” exploits against CT and PET Scanners

Siemens warns customers of four software vulnerabilities in its molecular imaging systems that would allow hackers to gain remote control of the systems.

WannaCry hero Marcus Hutchins could face 40 years in US prison

The cybersecurity expert that stopped the WannaCry global cyberattack has been arrested in the US, where authorities say he helped create and sell malicious software that targeted bank accounts. He faces up to 40 years in prison if convicted.

‘Pharma bro’ Martin Shkreli found guilty of 3 of 8 charges, including securities fraud

Martin Shkreli has been found guilty of defrauding investors of his two hedge funds and paying them back with stock and cash that he stole from his biotech company, Retrophin.

Monday Morning Update 8/7/17

August 5, 2017 News 5 Comments

Top News

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Allscripts will write down $145 million of its $200 million investment in NantHealth, whose shares have dropped 77 percent since the investment. Allscripts said in its earnings announcement, “This impairment is based on management’s assessment of the likelihood of near-term recovery of the investment’s value.” Shares in NH, which closed at $18.59 on their first day of trading in June 2016, are now at $4.20, valuing the company at $510 million.

Allscripts says it will exchange its NantHealth ownership stake for “certain technology assets and client relationships” of NantHealth as well as a commitment that NantHealth will buy Allscripts software and services.

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Other items from the Allscripts earnings call:

  • Allscripts CEO and long-time Cerner executive Paul Black opened the call by offering his condolences to Neal Patterson’s family and colleagues.
  • Black says executives have been talking for some time about the need to boost the company’s inpatient EHR market share, with the McKesson EIS acquisition adding hundreds of new inpatient clients who present cross-selling opportunities for systems for EHR, post-acute care, population health management, and precision medicine.
  • The company signed the largest Sunrise agreement since 2011 with a six-hospital system.
  • President Richard Poulton said in response to an analyst’s question about why the company would take on the risk of buying McKesson EIS, “This is an industry that is going to continue to transition. You can go around the horn for both inpatient and outpatient competitors and you’d find several of them are either for sale actively, have been recently for sale, or will be for sale most likely in the not too distant future … as the market matures, consolidation is a natural occurrence and it’s inevitable.”
  • Poulton says what’s left of the retired Horizon business will wind down within two quarters of the acquisition’s closing.
  • Allscripts hopes to improve the McKesson customer defection rate that started when it announced plans to exit healthcare IT.
  • The company says it will recommend Paragon for under-200 bed hospitals with simple product and service lines and Sunrise for larger, more complex health systems. Poulton admits that the company found it hard to sell Sunrise into small hospitals because of the effort required to implement it and the difficulty for a small hospital to get full value from it, adding that competitors have reached the same conclusion.
  • Asked which McKesson solutions might appeal to Sunrise customers, Black listed lab, blood bank, surgery, anesthesia, the OneContent document management system, and supply chain.

Reader Comments

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From Tater Consultancy: “Re: Epic. The contract from a just-signed Epic site says Care Everywhere is licensed via a transaction fee for each CCD exchanged with a non-Epic EHR. Epic made a big deal at HIMSS15 about waiving the $2.35 per record fee due to industry pressure. Looks like not much has changed, although a specific fee isn’t mentioned in the contract.“ Judy Faulkner said at HIMSS15 that data exchange via Care Everywhere would be free “at least until 2020.” Fees prior to that were $0.20 for each message sent to an HIE and $2.35 per year for a given patient for whom messages were received from foreign EMRs regardless of the message count. About that time, Athenahealth said it would pay customer fees for participating in CommonWell indefinitely and Cerner promised to do the same through at least 2017. I’m happy to run any fee updates from Epic, Athenahealth, or Cerner customers. I summarize with my common conclusion: Q: Why do vendors charge xxx? A: Because they can, and because customers keep signing those contracts. UPDATE: an Epic spokesperson says the company has not broken the 2020 promise — CCD exchanges are free, also adding, “In our new contracts, CCD exchanges with non-Epic EHRs are free indefinitely, and this is a standard we are applying to both new and existing customers, regardless of what their contract says.”

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From Confused Consultant: “Re: Summa Health. Cutting 300 jobs to cover a $60 million operating loss. Implemented Epic from Catholic Health Partners last year while claiming they want to remain independent as the city’s largest employer, turning over what is likely their largest non-personnel expense line to a larger IDN who might be a likely purchaser. I’m not saying it’s the case here, but some mega systems wield Epic as an instrument to influence referral patterns or M&A activity, and industry narrative that has been largely unnoticed by trade media.” Summa made a PR and professional mess of its ED staffing change early this year and large physician groups started sending patients elsewhere due to quality concerns, both of which gave it a community black eye even before this latest financial bombshell. It’s also located in Akron, an industrial city whose population is declining and skewing older. Still, I agree that a larger, Epic-provisioning organization might get first dibs at acquiring a given hospital that uses its services. That could be for several reasons: a successful, non-competitive working relationship; the smaller hospital’s willingness to outsource a key service and its underlying motivation to do so; more transparent referral patterns; and if the organizations indeed express acquisition interest, access to better due diligence data and a potentially smoother transition afterward. My conclusion is that large health systems are acquiring smaller ones that stumble operationally or financially and technology makes it more attractive. Good or bad, we seem to be heading toward big regional and national health systems owning most hospitals, a situation that is almost universal in every industry outside of healthcare.

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From Art O. Deal: “Re: VA. The taxpayer watchdog in The Hill makes the same point you’ve made about Shulkin (Trump) giving away leverage by no-bidding the VA.” The president of Taxpayers Protection Alliance says no-bid contracts have become the rule rather than the exception at many federal agencies, observing that the Department of Defense spent more than $100 billion in 2016 — more than half of its spending — via non-competitive contract awards. It questions the assertion of Secretary of Veterans Affairs David Shulkin that the VA “can do this cheaper for the taxpayers by essentially moving forward quickly without a lengthy process” when he has no idea how long the project will take or what it might cost. President Trump and White House advisor Jared Kushner both bragged on pushing the VA to choose Cerner without exploring the only viable alternative (Epic) or sticking with VistA, with Shulkin obediently framing the choice as obvious since the DoD is already implementing Cerner. The Trump clan brags about being skilled deal-makers – at least when it’s their money and not that of taxpayers —  but telling a vendor they’ve been chosen without first hashing out a contract is about as amateurish as you can get. I think everybody, especially Congress, was just sick of DoD and VA making excuses why they can’t exchange information, with active service military members starting over with a nearly blank page after transitioning to veteran status. 

From Compromized Consumers: “Re: Optum 360. Will obtain patient records of UnitedHealthcare members and dependents, not just claims and EOB, but also labs and prescriptions. They will then build a personal health record similar to Microsoft HealthVault. To avoid regulator and consumer rights backlash, they will partner with someone like Apple or Experian, with the final solution marketed as a consumer convenience under the partner’s name. This update will be shared with VIPs attending the Optum event in DC this week.” Unverified.


HIStalk Announcements and Requests

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Poll respondents give their largest local non-profit health systems mixed marks on serving patients selflessly, with 44 percent grading them A or B, 29 percent a gentleman’s C, and 27 percent going with D or F.

New poll to your right or here: who will benefit most from the proposed acquisition of McKesson EIS by Allscripts?

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HIStalk readers funded the DonorsChoose teacher grant request of Ms. M in Missouri, who asked for science books and weather kits. She reports, “You have awakened a love for science in my classroom! Our new materials have allowed us to get knee-deep into our content. Having the chance to put together a pulley system gave students the opportunity to really see how they work, and to decide for themselves that they do lighten the amount of work it takes to lift an object. The power of seeing this first-hand really helped the concept to stick! In the same way, the model we put together to show how the moon rotates around the earth gave rise to a number of interesting discussions. Students were able to seek answers to their own questions and share these with their classmates. This went so far beyond what a normal paper-and-pencil lesson could have done.”


This Week in Health IT History

One year ago:

  • Theranos CEO Elizabeth Holmes announces in her AACC Q&A session that the troubled company will pivot into manufacturing the MiniLab sample processing machine.
  • Drone delivery vendor Zipline says it will deliver medical supplies to areas of Maryland, Nevada, and Washington within a year.
  • Senator Elizabeth Warren’s NEJM opinion piece recommends that underlying data from submitted journal articles, as well as from both successful and failed clinical trials, be shared openly.
  • Hackers breach Newkirk Products, which issues BCBS insurance cards in several states.
  • A New York Times article questions whether “did we control your pain” hospital satisfaction survey question encourages doctors to over-prescribe opiates since satisfaction scores impact their bonuses.

Five years ago:

  • Massachusetts announces that it will create a statewide HIE, paid for by the federal government.
  • McKesson announces Cardiology Inventory and Surgical Point-of-Use Integration Module.
  • The VA begins implementing the first sites of its $543 million RTLS contract, with HP as the prime contractor.
  • Allscripts CEO Glen Tullman says in an earnings call after the company fell short on earnings that Sunrise Financial Manager will be released in Q4, it expects to win more hospital business as competitors step away, and that demand for the company’s open, less-expensive hospital systems will grow.

Ten years ago:

  • The CEO of Lawson Software says software-as-a-service won’t live up to its hype.
  • Perot Systems acquires JJWild for $89 million in cash.
  • IMedica reports that its customer base grew 76 percent in the first six months of the year.

Weekly Anonymous Reader Question

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Responses to last week’s question:

  • Chased love, laughter, and friendship, not money and fame. Crossed the finish line a WINNER.
  • You can never have enough rope!
  • Appears he didn’t hear us yell “Duck!”
  • That reminds me of a story…
  • When I die at the age of 103: “Life – like me – was short, but sweet.”
  • The “Clean up Woman.”
  • She put the fun in dysfunctional.
  • Have a drink on me. (with a bottle opener mounted on the tombstone).
  • When I am dead and gone and my time on earth has passed, I hope they bury me upside down, so my critics can kiss my a$$.
  • I told you I was sick!
  • It’s too hard not to have a good time.
  • And now, for something completely different…
  • Oh what a tangled web we weave when first we practice to deceive.
  • Faithful to us here, we loved him to the last.
  • He left life better than he found it.
  • He found love, joy. and peace in family.
  • S/He was born at a young age, and lived until the end.
  • Adventure.
  • Cheer up, there’s no hope.
  • The measure of what a human being could be.
  • He had nothing, but gave it his all.
  • I told you so.
  • Made a positive difference in numerous lives by being alive and was a great friend.
  • She made a difference.
  • Smart from the start, caring and overbearing, made a difference with little deference.
  • The most difficult thing she ever did was live when all she wanted was to die.
  • Veni, vidi, vici.
  • That was fun!
  • Mostly sorry for before 25. I spent the next 50 working to even the balance.
  • Left this world wondering what difference she made. Hopefully will find out now.
  • He tried every day to be the man his dog thought he was.
  • Been there, done that.
  • A joyful scoundrel gone, not forgotten.
  • This was harder than I thought!
  • Life is too important to be taken seriously. Smile.
  • No situation is so bad that it can’t get worse.
  • I tried really hard.

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This week’s question: of the places you’ve experienced, where would you choose to live if job or money wasn’t a factor?


Last Week’s Most Interesting News

  • Allscripts announces that it will acquire McKesson’s Enterprise Information Solutions business for $185 million in cash.
  • The VA announces expansion of its telemedicine program, including allowing its employed providers to conduct sessions across state lines.
  • A Politico report claims that then-VP Joe Biden scolded Epic CEO Judy Faulkner in a January 2017 meeting for her questioning him as to why he would want his complete medical records, which Epic says is an “inaccurate and misleading” description of his meeting with EHR vendors.
  • Drug maker Merck warns that its manufacturing process is still being disrupted by its June 27 malware attack and warns of potential drug shortages and unknown financial impact.
  • Athenahealth announces that it will target $100 million in cost savings and strips Jonathan Bush’s president and board chair titles in recruiting replacements.
  • Quality Systems says it has received a Civil Investigative Demands letter from the Department of Justice and says it has heard of other vendors receiving the same letter, which involves a false claims investigation such as the one that cost EClinicalWorks a $155 million settlement.
  • The White House’s opioid crisis committee recommends that state doctor-shopping databases be connected and that the government relax the HIPAA requirement that prevents addiction treatment professionals from sharing patient information with other providers without consent.
  • A $10 million donation will fund the launch of a UCSF institute that will perform analytics-based drug discovery using a newly created dataset covering all five UC system medical centers.

Webinars

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


Decisions

  • Wadley Regional Medical Center At Hope (AR) will go live with Cerner in December 2017.
  • Sartori Memorial Hospital (IA) will switch from McKesson to Cerner in October 2017. Its clinic will remain on an Epic ambulatory EHR.
  • Hereford Regional Medical Center (TX) will switch from Healthland (a CPSI company) to Cerner next month.
  • Select Specialty Hospital – Danville and Gainesville (PA) plans to switch to Epic.
  • Regency Hospital Of Central Georgia will go live with Epic in 2019.

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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The Madison business paper profiles the recent launch of Datica’s Digital Health Success Framework that helps startups get their products to market.


Privacy and Security

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It’s tough to stay on the pedestal once placed there. The security researcher who single-handedly stopped the May 2017 WannCry ransomware attack is arrested at the Las Vegas airport while boarding a plane back home to the UK after attending the DefCon hacking conference, charged with creating and then selling malware that targeted banks in 2014-2015.

Siemens warns users of several of its molecular imaging systems that those systems could be easily hacked remotely because of bugs in their Windows web server and HP Client Automation Service software. The company is working on a patch, but recommends in the meantime that the Windows 7-powered machines be disconnected from the network or run on isolated network segments. 


Other

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Pharma bro Martin Shkreli is convicted on three counts of securities fraud charges, for which he faces up to 20 years in prison. Prosecutors say Shkreli ran a Ponzi-like scheme in which he convinced people to invest in his hedge funds by falsely claiming he knew what he was doing, then lost a lot of their money and diverted some of the funds to start up a drug company while falsely claiming positive returns and giving the runaround to investors who wanted to cash out. All of that is unrelated to his turmoil-filled time at Turing Pharmaceuticals, which bought an old, cheap drug that is still sometimes useful in treating AIDS and raised its price by 5,000 percent. As I observed above: Q: Why do vendors charge xxx? A: Because they can. Behavior that some might find despicable isn’t necessary illegal.

Ireland’s Health Services Executive says the recently publicized national imaging system bug that caused the “less than” symbol to be omitted from reports was discovered in January 2016 by the system’s vendor, Change Healthcare, who didn’t let customers know about the problem until it was fixed in August 2016. Change Healthcare became the vendor in its recent merger with most of McKesson’s health IT business. The company’s Canadian subsidiary, McKesson Medical Imaging, reportedly sent out a field safety notice this week to all customers, many of which are in the US.

Here’s the next-to-last installment of Vince’s series on Cerner from a few years back.


Sponsor Updates

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  • The Summit Healthcare team sorted through 10,000 pounds of food while volunteering at The Greater Boston Food Bank.
  • The SSI Group will exhibit at the HFMA Region 8 conference August 7 in Kansas City, MO.
  • ZappRx is nominated for Xconomy’s inaugural Life Science Awards
  • A Datica podcast features an interview with Naomi Fried, PhD on digital health companies supporting drug company innovation. 

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 8/4/17

August 4, 2017 Headlines 1 Comment

Allscripts to acquire McKesson’s Enterprise Information Solutions business

Allscripts will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million cash, planning to offer Paragon to small hospitals while continuing to market Allscripts Sunrise to larger health systems.

Remarks by President Trump at Department of Veterans Affairs Telehealth Event

The VA will expand its telemedicine program, already the country’s largest, with VA Video Connect.

Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals;

CMS will allow hospitals to submit only one quarter of data for 2018 incentive payments and will allow using 2014, 2015, or a combination of CEHRT to satisfy requirements for CY 2018.

News 8/4/17

August 3, 2017 News 4 Comments

Top News

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Allscripts will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million cash. McKesson EIS offers Paragon EHR, Star, Series, Healthquest, Lab Analytics and Blood Bank, and OneContent.

Allscripts plans to offer Paragon to small hospitals while continuing to market Allscripts Sunrise to larger health systems.

McKesson announced in June 2016 that it was exploring strategic alternatives for the EIS business as it merged most of its IT offerings with Change Healthcare. It wrote off $290 million in October 2016 related to the EIS business. McKesson will apparently retain RelayHealth and its recently acquired CoverMyMeds, both network-focused, high-growth communications products that are aimed more at pharmacies and insurance companies than health systems.

Meanwhile, Allscripts reports Q2 results: revenue up 10 percent, adjusted EPS $0.15 vs. $0.14, meeting earnings expectations and beating on revenue. MDRX share priced dropped 18 percent in the past year in valuing the company at $2.1 billion.

Allscripts shares rose 16 percent in after-hours trading immediately following the acquisition and earnings announcements.


Reader Comments

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From Bow Tie Is Really a Camera: “Re: EClinicalWorks interview. Will it lose a lot of customers following the Department of Justice settlement?” I highly doubt it. While various reports claim that a big chunk of ECW’s customers are considering mass defection, I don’t think that will ever happen since the incident doesn’t affect them personally. They either like the system or they don’t and the high-profile settlement doesn’t provide any new incentive to expensively rip-and-replace even though ECW is now on the hook to provide migration assistance should they choose to move to a new system. It’s not like painlessly boycotting a brand of soda by just reaching two shelves over for the nearly identical sugar water. In fact, the DOJ’s mandated company changes will probably make ECW’s software and support better. People subconsciously try to please a surveyor and to express indignation that they rarely act on. Customers might also appreciate the little-observed fact that ECW paid $155 million in settlement partly to protect them from having to individually repay their Meaningful Use incentives. I don’t think the settlement is going to have much effect on the somewhat stagnant ambulatory EHR market.

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From Broken Tiller: “Re: the HIMSS-owned publication. How did they mistake Amazon’s healthcare projects as building an EHR?” There’s so much to dislike about this clickbait piece: the gratuitous “Wait! What?” plea for attention, calling Amazon’s rumored healthcare projects an “investigation,” and claiming in the headline that the companies are building EHRs when nothing in the CNBC article that they reworded into a lame story suggests any such thing .

From Weezy: “Re: Allscripts acquiring McKesson EIS. Why?” Good question. They bought it cheap, apparently, like day-old bread that the store is anxious to get rid of while it’s still sellable. I have to assume that the net present value of the EIS maintenance revenue stream will cover most of the acquisition price. I see no product synergy whatsoever and I seriously doubt that many Paragon, Star, or Series customers will have an interest in moving to Sunrise, just like users of the mothballed McKesson Horizon product – like the market in general — nearly universally passed on Paragon in favor of Epic and Cerner. Maybe the bottom line is that Allscripts just likes to acquire companies (Eclipsys, Misys, Jardogs, dbMotion, etc.) in hoping that it will either all come together or that investors will remain interested in a healthcare vendor that, like McKesson in years past, runs itself like a health IT mutual fund.


HIStalk Announcements and Requests

Listening: new from Alice Cooper, which has some pretty good tracks until things get even better in the final two songs, which feature the surviving members of the original Alice Cooper band, formed by the five Phoenix high school friends in the mid-1960s and named after a minor character in the “Mayberry RFD” TV series of that era. There’s also stunning new EP from Canada grungers Theory of a Deadman that brilliantly and savagely attacks our drug-happy culture. Finally, I’m enjoying outstanding old power pop from The Posies.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Medical imaging and data management vendor UltraLinq Healthcare acquires Northern Ireland-based Intelesens, which offers wearable vital signs monitoring devices.

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Viome, which offers at-home kit that monitors  gut microorganisms to recommend diet changes, raises $15 million in a Series A funding round. Twice-yearly stool sampling and metabolic challenge tests cost $700 per year.

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Aurora Behavioral Health signs a $20 million contract South Korea-based EZCareTech, which will create a US version of its hospital information system that is used by Seoul National University Hospital called Best Care 2.0B. They exhibited at HIMSS17, which I summarized as:

I was interested in Best Care, a Korea-based inpatient EHR whose monitors showed a cool-looking product that they are apparently trying to market to US hospitals. I tried to strike up a conversion with the stern guy standing there and he wouldn’t really talk to me. I tried again with another guy and all he said was that company is “from Korea, like K-pop” and then didn’t say anything else. I tried a third time in asking a different person on the other side of the booth if it was OK if a snapped a photo of the screen and they shooed me away. I think the company had best hire some US sales talent if they want to sell here.

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Theranos settles the $140 million breach of contract lawsuit brought against it by Walgreens over its in-store Theranos lab sample drawing sites.


Sales

Cedar Valley Medical Specialists (IA) chooses EHR and population health solutions from EClinicalWorks.


People

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Sutherland Healthcare hires Shailja Dixit, MD, MS, MPH (Intercept Pharmaceuticals) as chief medical officer and global head of digital innovation.

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Health Systems Informatics hires Mary Beth Seaman (Pivot Point Consulting) as VP of business development.

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Michael Jackman (GE Healthcare) joins imaging systems vendor Mach7 Technologies as CEO.


Announcements and Implementations

Caradigm integrates Insignia Health’s self-management survey into its Care Management solution.

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Community Hospital Anderson (IN) goes live on Imprivata PatientSecure biometric patient verification.

Parallon Technology Solutions leads the migration of the two hospitals of Thomas Health (WV) to Meditech 6.15 from Meditech Magic and Siemens.


Government and Politics

A new CMS rule will allow hospitals to submit only one quarter’s worth of eCQM reporting requirements for incentive payments in 2018 vs. the previously required full year. It also allows hospitals to use either a combination of 2014 and 2015 Editions of CEHRT or either individual edition to satisfy 2018 eCQM certification requirements for CY 2018. CMS says it will determine requirements for CY 2019 and future years “in future rulemaking.”

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The VA will expand its telemedicine program – the largest in the country — with VA Video Connect in a collaboration with Jared Kushner’s American Office of Innovation, offering virtual visits from 300 VA medical providers at 67 hospitals and clinics. President Trump said in a statement Thursday,

Today, I’m pleased to announce another historic breakthrough that will expand VA services to many more patients and veterans.  We will do this through telehealth services.  It’s what it’s called — telehealth services.  

We’re expanding the ability of veterans to connect with their VA healthcare team from anywhere using mobile application on the veteran’s own phone or the veteran’s own computer.  This will significantly expand access to care for our veterans, especially for those who need help in the area of mental health, which is a bigger and bigger request — and also in suicide prevention.  It will make a tremendous difference for the veterans in rural locations in particular.  

We’re launching the mobile app that will allow VA patients to schedule and change their appointments at VA facilities using their smartphones.  So this is something they were never able to do.  Technology has given us this advantage, but unfortunately we have not taken advantage of that until now.

CMS withdraws its plan to require hospital accreditors such as The Joint Commission to publicly list the problems they find and the steps being taken to fix them. CMS says federal laws prohibit it from disclosing inspection reports and fears such a requirement could be viewed as an attempt to circumvent the law.

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Attorney General Jeff Sessions announces formation of a Department of Justice unit that will seek out opioid-related healthcare fraud by reviewing prescribing and dispensing data for suspicious patterns. The DOJ will also fund 12 assistant US attorneys for three years who will focus exclusively in investigating and prosecuting opioid-related healthcare fraud.

The GAO announces its 15 appointees to the HIT Advisory Committee that will make recommendations to ONC as established by the 21st Century Cures Act. The first five members listed were already appointed b HHS or as consumer advocates:

  • Cynthia Fisher (entrepreneur)
  • Anil Jain (IBM Watson Health)
  • Steven Lane (Sutter Health)
  • Steve Ready (Norton Healthcare)
  • Patrick Soon-Shiong (NantHealth)
  • Michael Adcock (University of Mississippi Medical Center)
  • Christina Caraballo (Get Real Health)
  • Tina Esposito (Advocate Health Care)
  • Brad Gescheider (PatientsLikeMe)
  • John Kansky (Indiana HIE)
  • Kensaku Kawamoto (University of Utah Health)
  • Denni McColm (Citizens Memorial Healthcare)
  • Brett Oliver (Baptist Health)
  • Terrence O’Malley (Massachusetts General Hospital)
  • Carolyn Petersen (Mayo Clinic)
  • Raj Ratwani (MedStar Health)
  • Sasha TerMaat (Epic)
  • Andrew Truscott (Accenture)
  • Sheryl Turney (Anthem Blue Cross Blue Shield)
  • Denise Webb (Marshfield Clinic Health System)

ONC announces a five-year plan to switch from its own custom EHR certification testing tools to industry-developed replacements.


Privacy and Security

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A New York Health + Hospitals IT employee is arrested for using the hospital’s computer and network to download child pornography. Daniel Sherlock, 28, is on probation from a similar 2015 case in which he pleaded guilty. The conditions of that case prevented him from owning a computer, he told authorities, so he used his HHC one instead. He avoided registering as a sex offender in the previous case because his low IQ classified him as intellectually disabled, a situation that apparently did not prevent him from holding a $62,000 corporate account management job at HHC.


Other

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A Politico report quoting a single source claims that Epic CEO Judy Faulkner told Vice-President Joe Biden at a private January 2017 Cancer Moonshot meeting, “Why do you want your medical records? They’re 1,000 pages, of which you understand 10,” to which Biden was reported to have responded, “None of your business. If I need to, I’ll find someone to explain them to me and, by the way, I will understand a lot more than you think I do.” The source was Greg Simon, now president of the Biden Cancer Initiative and a cancer survivor. Politico’s source material was apparently this video from Simon’s fireside chat at MedCity Converge conference this week in Philadelphia. I transcribed his full comments from the video:

I think everybody here is familiar with the problem with EHR companies, which is they’re billing systems, and yet we rely on them to track doctors’ visits, our treatments, our outcomes. But they’ve never been designed to be patient friendly. They’ve never been designed to be shared. They’ve never been designed to be interactive with other systems.

The EMR companies blame all that on their customers, the hospitals primarily, and large provider networks, and they have some guilt here as well. But the Cures act that passed in December requires data from electronic medical records to be shared in a digital, longitudinal way that can be used by patients.

When we had a meeting just before we left the White House with several EMR companies, hospitals, and others,  we had, as they say in the State Department, a candid exchange. The head of a company that won’t be named – Epic – said to Vice President Biden – I should have sold tickets to this part – “Why do you want your medical records? They’re 1,000 pages, of which you understand 10.” So Biden said what I knew he would say, “None of your business. If I want to nail them to the walls of my kitchen, that’s my business. I don’t have to understand 1,000 pages. I want my records. If I need to, I’ll find someone to explain them to me, and by the way, I’ll understand a lot more than you think I do because people with cancer and their families and their friends and themselves learn a lot. So don’t make assumptions.” And it went downhill from there …

How can I as patient make better use of my medical records than having them sit in my doctor’s office? … if your financial advisor says, “Why do you want your statement?” run to the nearest police station .. we did spend tens of billions of dollars to encourage people to buy their products and we made billionaires of the executives of these companies. They’ve had fun – now it’s our turn.

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An Epic spokesperson sent me this response to the Politico article:

The recount of a portion of the January 2017 White House meeting is inaccurate and misleading. Vice President Joe Biden was consistently polite and positive to every person, including every vendor, in the meeting. Epic supports patients’ rights to access their entire record, something they have been able to do for decades. In the meeting, Judy raised an issue regarding the 21st Century Cures Act that would potentially require a patient’s EHR information be transmitted in a way that was “easy to understand.” She said that a requirement to translate EHR medical terminology into patient-friendly language could be a barrier to getting the medical record out to patients. Vice President Biden agreed, saying, “That’s actionable” and requested that one of his staff get the requirement fixed.

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A fascinating Bloomberg article profiles the 20-something brothers from rural Ireland who started credit card processing Stripe and built it into a company worth $9 billion and made themselves billionaires. The company just announced a deal in which it will process some of Amazon’s transactions in its goal to “increase the GDP of the Internet” and expanding its product line to help businesses incorporate, pay workers, and detect fraud so that “two people in a garage [will have] the same infrastructure as a 100,000-person corporation.” The frugal brothers moved the company into San Francisco office space previously occupied by Dropbox, immediately getting rid of the Lego room, sofa swings, and gourmet meals cooked to order, explaining, “It’s slow and indulgent to wait for food.” One of the brothers keeps a countdown clock on the wall that estimates how much time he has left to live, explaining, “When you talk to people who are old, some wish they had enjoyed themselves more, but not many wish they had wasted more time … It’s not that I don’t enjoy TV. If I had infinite time, I would watch it. This might be the entirely wrong optimization.” It’s Atlas division offers a startup toolkit that provides Delaware incorporation, a bank account, a Stripe account, and both free and discounted professional advice.

Ireland’s Healh Services Executive warns physicians that a bug in its image archive omits the less than symbol (<), so that reviewing a result that lists stenosis as “<50 per cent” would be displayed as “50 per cent.” At least 25,000 images are affected. The HSE CIO resigned right after the story ran, but HSE says his departure is not related to the glitch.

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Hurley Medical Center (MI) will identify patients with food insecurity via two EHR questions, with positive responses generating a referral to the hospital’s food pharmacy that will dispense a two-day supply of healthy food. The hospital hopes to provide assistance to its Flint patients who don’t necessarily live in poverty, but whose financial circumstances may require them to choose between buying medications and buying food.

In England, a Business Insider investigative article finds that Google-owned DeepMind has paid Moorfields Eye Hospital $144,000 in expense reimbursement in a project to apply artificial intelligence to optical coherence tomography scans, hoping to automate the early detection of diabetes-related macular degeneration. The hospital performs 3,000 of the tests each week.


Sponsor Updates

  • ROI Healthcare Solutions is sponsoring the RocketShot 5K on August 12 in Roswell, GA. 
  • Learn on Demand Systems CEO and Chief Product Architect Corey Hynes receives the Microsoft Most Valuable Professional Award.
  • Inc. profiles Logicworks CEO Ken Ziegler.
  • Forrester names Salesforce Health Cloud a leader in its latest report on enterprise health clouds.
  • MedData and Experian Health will exhibit at the HFMA Region 8 – MidAmerican Summer Institute August 7-9 in Kansas City, MO.

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 8/3/17

August 3, 2017 Dr. Jayne No Comments

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The Food and Drug Administration releases guidance allowing Institutional Review Boards to waive informed consent requirements for clinical studies that have minimal risk. This is a major win for researchers trying to use big data to look at populations as well as those working on precision medicine investigations. Informed consent has been in issue when you’re looking at large banks of biological specimens and the clinical data that goes with them, or just large volumes of clinical data that are needed to identify trends and other areas for potential research. The FDA reserves the right to modify its guidance as needed, but this is a good thing for many of us.

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In other government news, CMS announces that it has changed the name of the Social Security Number Removal Initiative (SSNRI) to “New Medicare Card.” Seems like something that should have been an obvious solution from the beginning, but who wants to miss out on another non-pronounceable cluster of letters?

CMS also recently released the 2016 Open Payments data. A couple of my colleagues are apparently raking it in, but most of the folks I work with all had less than $100 in annual payments. Looking at the local landscape, Novo Nordisk and Pfizer were the cheapest lunch players, followed by GlaxoSmithKline. Salix Pharmaceuticals led the pack with an average lunch cost of $24. I’m sure their mealtime presentations on their diarrhea and constipation drugs was a real showstopper.

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I know I’m a card-carrying member of the Grammar Police force, but I want to again stress the need for people to be proficient in writing. I’ve been doing a little CMIO augmentation work and was presented with some documentation from a recent consulting engagement. Not only were there font and spacing issues in the document (to the point of being distracting), but there were basic grammar issues that never should have seen the light of day. There is a difference between “it’s” and “its” and also between “there,” “their”, and “they’re.” If you’re only doing spell check and not a grammar check, you’re missing out. And if you embed Excel cells into a Word document, you’re going to miss out there as well.

These are small errors, but frankly they reduce the credibility of your work. I know I’m guilty of sometimes letting a blog get out the door with some errors, but I don’t have the luxury of peer review and am usually writing from a plane, train, or automobile if I’m not writing from a half-crashed state in a hotel room. If you are charging $300 per hour for your work, you had better read it carefully and consider having a friend look it over before you send it to a CMIO. I can’t take you seriously when your work looks like it was styled by a middle school student.

The CMIO whose shoes I am filling passed away unexpectedly and at a young age. It’s been a heartbreaking assignment, because she was clearly loved and respected. Despite the depressing circumstances, people have been extremely accommodating as I begin to get up to speed and work through my plans to sort through the projects that urgently need my attention.

A search process is in full swing, but I suspect they will have challenges trying to fill the position based on how it is funded. It’s cobbled together with 40 percent administrative funding, 40 percent IT funding, and 20 percent clinical funding. The ideal candidate needs to not only have experience and knowledge, but be willing to try to serve three different masters whose needs are sometimes at cross purposes. I’m just covering the administrative and IT functions and that’s been hard enough.

We have some interviews scheduled over the next several weeks, so I am interested to see if they find someone who is up to the challenge (and also wants to relocate to a mid-sized market and to a role that does not have an associated academic appointment). If you’re on my interview schedule, may the odds be ever in your favor.

At HIMSS17, I was invited to join a virtual book club with a great bunch of women from across the country. Every month we read something and then get together on a conference call to talk about the selection. It’s a diverse group of people, with several from the healthcare IT space, one from engineering, a couple of entrepreneurs, and a retired educator. One of them mentioned that she just started reading the most recent MACRA offering in the Federal Register. She said she was thinking of making it her book club selection and giving everyone a section to read and provide a cheat sheet and their interpretation. I’m pretty she just subconsciously wants to be ousted from her book club president role, but I know most of us who have had to read it wish we could have assigned it to someone else. This month we’re discussing the book I picked, so I hope it hit the mark and they don’t vote me off the virtual book club island.

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I spend an insane amount of time on the road, so I keep my eye out for services or products that can make my life easier. I have to say I am seriously intrigued by DUFL, a service that stores your business wardrobe and then ships it to your destination. As you depart, you ship it back to them for laundering so it’s ready to go again. The DUFL app displays photos of your catalogued clothes so you can pack your virtual bag for shipping. They charge $99 per trip to pack, ship, retrieve, and launder your clothes and $9.95 per month for storage. Depending on whether you’re going to have to pay to check a bag and how many items you may have to have dry cleaned when your trip is finished, the return on investment calculation looks pretty good. That doesn’t even include the time needed to pack your clothes so they don’t end up a wrinkled mess. They also offer a sports service to ship your equipment with care. I’d be interested to hear from any readers who may have experience with DUFL, because I hate going to the cleaners, as the pile of clothes on my dining room chair can attest.

Email Dr. Jayne.

Allscripts Will Acquire McKesson’s EIS Business for $185 Million

August 3, 2017 News No Comments

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Allscripts announced this afternoon that it will acquire McKesson’s Enterprise Information Solutions health IT business for $185 million in cash.

The products acquired include the Paragon EHR, Star, Series, Healthquest, Lab Analytics and Blood Bank, and OneContent.

Allscripts CEO Paul Black said in a statement, “Adding these assets to Allscripts existing portfolio enables us to better serve our clients, increase our scale and further drive our investment in innovation. This transaction is expected to directly benefit our existing clients and our shareholders, as well as the Enterprise Information Solutions clients and team members we’ll welcome to our family. Allscripts is a critical strategic partner to thousands of healthcare organizations and our highest priority is to successfully meet their highly complex needs of today and in the future, as we enable them to lead the change to smarter care. The healthcare IT market remains highly fragmented. Today’s announcement is a proactive and strategic measure to maintain Allscripts long-term leadership and position Allscripts for continued growth.”

Allscripts says it will continue to offer Paragon to small hospitals while continuing to sell Allscripts Sunrise to larger health systems.

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