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Monday Morning Update 8/8/16

August 7, 2016 News 18 Comments

Top News

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Hackers breach the servers of Newkirk Products, which issues BlueCross and BlueShield insurance cards in several states, exposing the information contained on the cards of 3.3 million people. This will be one of the largest breaches ever, although the information stolen is not extensive.

Newkirk was acquired in 2011 by IT outsourcer and consulting firm DST, which sold its customer communications business to Broadridge Financial Solutions for $410 million just a few weeks ago.


Reader Comments

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From Jett Cloud: “Re: Epic. I just returned from training and was shocked by the amount of activity that has nothing to do with healthcare, software, or any professional endeavor. There were constantly people playing games outside, sports, Pokemon Go, or similar things. As part of an organization that’s struggled financially and is really stretching to afford Epic, I’m a bit disgusted by the physical lavishness of the campus.” Epic people put in a lot of hours, so I wouldn’t worry that the tiny percentage of its 10,000 employees you saw playing around means they don’t work plenty hard. Most of them don’t even go out for lunch. They’re also mostly in their mid-20s, so just be amazed that despite being the offspring of hovering, overly indulgent parents they show up and get stuff done in what is the first real job many of them have had. I agree that Epic’s campus is unnecessarily extravagant, it’s part of the company’s culture but nobody put a gun to the head of customers to sign those gazillion-dollar Epic contracts that pay for it. At least both customers and Epic employees can enjoy the orchestrated whimsy instead of just the company’s executives – it’s Mahogany Row and reserved parking spots that annoy me. At one of my previous health system employers, we had to keep reminding our executives not to go off script at employee meetings and talk about their reserved parking lots, plush offices, company-paid cars, travel budgets, and big bonuses – they would genuinely forget that those in the room were working for no perks or bonuses, just a paycheck.


HIStalk Announcements and Requests

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Poll respondents were fairly evenly split on whether CMS’s new hospital star rating system has value. Furydelabongo says it’s at least a good starting point even though lower-rated hospitals are predictably shooting the messenger. Mobile Man agrees that if you want healthcare to run like a business, this is how business works. Cosmos disagrees, saying hospitals are too complex to be rated by a single rating, and Michael Murphy explains further that the rating doesn’t reflect procedure volume.

New poll to your right or here: will the cost and quality impact of hospital and medical practice consolidation be good or bad? Vote and then click the poll’s Comments link to explain why.

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We funded the DonorsChoose grant request of Mr. G in Wisconsin, who asked for two tablets and a programmable robot. He reports, “As many of our students are new to the field of computer science, these materials have helped to inspire them to build a strong foundation of programming knowledge as they enthusiastically dive into the content that is being taught, and seek out opportunities to help Dash and Dot complete new challenges. The pair of robots have also been a way to illustrate programming concepts that would otherwise be confined to a computer screen. For many students, this opportunity to observe and interact with the robots is key to mastering these programming skills. Finally, the robots and tablets have served as an excellent incentive to encourage positive behaviors in the classroom.”

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

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Last Week’s Most Interesting News

  • Advocate Health Care Network pays $5.55 million to settle HIPAA charges following an OCR investigation of three 2013 breaches in just a few weeks.
  • Cerner dismisses Athenahealth’s efforts to penetrate the inpatient market in its earnings call.
  • Banner Health (AZ) notifies 3.7 million people that their information was exposed in a breach of its food and beverage systems in one of the largest healthcare breaches ever.
  • Theranos CEO Elizabeth Holmes didn’t address any of the company’s business-threatening issues in her presentation to the American Association for Clinical Chemistry and instead uses her podium time to pitch new blood analyzer hardware that has not yet been released or approved by the FDA.
  • The FTC reverses an earlier decision to drop data security charges against LabMD.
  • Apple publishes a patent that would allow iPhone users to connect with a physician, transmit their HealthKit-collected information, and then initiate a telemedicine session.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Outsourcer Cognizant Technology guides revenue and profit lower due to Brexit, banking, and US healthcare consolidation and spending cutbacks.

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Honor, which matches seniors to home caregivers, raises $42 million, increasing its total to $62 million. One of its VC investors said his firm learned their lesson with Oscar Health, and unlike Oscar, Honor doesn’t just offer online matching – the company remains the intermediary with the user as its customer. It keeps in touch with families with its own app that also populates notes that each assigned caregiver can review. The company also offers a wellness check visit in which observational data is sent back to the user’s doctor. Services are offered only in the Bay Area and Los Angeles, but an expansion to Dallas is planned.

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From the Allscripts conference call:

  • Sales increased 39 percent for the quarter, or 22 percent without the contribution of the acquired Netsmart.
  • The company added one new Sunrise customer.
  • Allscripts expects to sell more consulting services after implementation of the “staggeringly large” number of MACRA and QPP reporting requirements.
  • The company responded to an analyst’s question about how much revenue Northwell Health contributes to the total, with the answer being a single-digit percentage.

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Caradigm provided this response to FlyOnTheWall’s rumor report that I ran Friday in which he said the company let 30 percent of its workforce go this past Wednesday:

Since Neal Singh was named CEO in April 2016, he has worked with Caradigm’s senior leadership team to drive our mission of accelerating the healthcare revolution with innovative solutions to promote better care, smarter spending and healthier people. In keeping with its mission, Caradigm is proactively reorganizing to provide clear accountabilities and streamline efforts to improve teamwork, drive simplicity and deliver quicker results – in order to better serve its customers. Caradigm has reorganized Product teams by key solution focus, with the aim of reducing its customers’ total cost of ownership and reducing time to go-live. Its Services organization has been reorganized to focus exclusively on customer implementations, product support, and driving the relationship and partnership experience that customers have with Caradigm. And in recognition of the fact that customers require deep clinical and technical support and expertise through their lifecycle, Caradigm has expanded the charter of the Care Transformation team. These changes required Caradigm to make difficult layoff decisions. The new organization will put Caradigm on a path for innovation to better support healthcare initiatives and enhance its customers’ experiences. Employees who had their positions eliminated have received both severance and resources to help them with their transition. Caradigm is not disclosing further details about the layoffs.



Privacy and Security

Marin Medical Practices Concepts, a California physician billing and EHR services company, pays a hacker’s unspecified ransomware demands regain access to its data. The company’s medical practice customers, which include the county’s public health clinics, had been unable to access their EHRs for a week.

More breach news from DataBreaches.net:

  • Carle Hospital announces that an unnamed vendor placed files containing the information of 1,185 patients on its procurement document sharing site, unaware that other vendors could also view the information.
  • Nordic Consulting notifies New Hampshire’s attorney general that one of its HR employees emailed current and former employees who were affected by a previous data breach to remind them to sign up for identity theft protection, but inadvertently attached a worksheet containing the demographic and patient information of employees covered by Nordic’s health insurance.
  • Athens Orthopedic Clinic (GA) confirms that hacker The Dark Overlord has placed patient information from its breached system for sale on the Dark Web after the clinic declined to pay $335,000 to keep their records private. The Dark Overlord claims to have already sold the information of at least 5,000 of the 400,000 patients contained in the database he downloaded. He made a good business case to the clinic in pricing his services competitively with the alternative since just offering credit monitoring protection will cost more than his price.

Technology

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Mayo Clinic researchers will climb Africa’s 20,000-foot high Mount Kilimanjaro this week, monitored by sensors from Philips that will help them understand the oxygen deprivation that occurs during both mountain climbing and heart attacks. A drug company is footing the bill.

Apple joins the “bug bounty” movement in which it will pay outside hackers who find and report security flaws in its products. The company will pay $50,000 for bug reports that involve gaining access to iCloud data.


Other

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A New York Times article ponders whether it makes sense for hospitals to include a “did we control your pain” question on their patient satisfaction survey that might encourage doctors to over-prescribe the narcotic drugs that already have led a big chunk of America into addiction. Doctors say patients demand specific drugs and use their satisfaction surveys to retaliate if they don’t get them, cutting into the paychecks of the medical staff whose compensation is partly driven by those satisfaction scores.

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A study finds that heavy, detailed media coverage of mass shootings causes more gun violence almost immediately afterward, as would-be mass killers see the fame earned by the shooter. The researchers suggests following the “Don’t Name Them” campaign in which mass murderers are deprived of their moment in the limelight by not publishing their names, photos, writings, and details about their past. That would be a fantastic idea except for the sorry state of “eyeballs at all costs” American journalism, where indeed if it bleeds it leads and no amount of public goodwill can offset those Internet page views.

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A lawyer credits the autopilot feature of his Tesla Model X for saving his life when he has pulmonary embolism while driving and instructs the Tesla to take him 20 miles to the hospital ED. He’s still not sure that he shouldn’t have called an ambulance instead, but says he figured he could get to the ED faster on his own. Pricing for the Model X starts at $80,000, probably about the cost of his ED visit.

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NPR profiles iNaturalist, a social network for wildlife in which users post photos of animals they’ve seen and share them with other to identify them in a form of gamification. At least one previously unknown species has been identified as a result.

Alameda County, CA replaces its long-time jail healthcare contractor after inmate deaths and allegations of poor care. One of its nurses cited inexperienced management and the implementation of new software that wastes clinician time.

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I don’t think I was aware of this: the Ragon Institute of MGH, MIT, and Harvard, which has been working in HIV/AIDS vaccine research since 2009, is also supporting Zika virus research. I hadn’t heard of the institute, which is funded via a $100 million commitment from InterSystems founder and billionaire Phillip “Terry” Ragon. 

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Drugmaker AbbVie tries to block introduction of a biosimilar drug that is a lower-priced competitor to Humira, which generates 60 percent of the company’s revenue. AbbVie has also filed new patents hoping to delay the entry of the new drug to the market. It’s a good reminder that the sole mission of drug companies is make profits for shareholders, not to perform societal good or to help patients. Companies by definition are not capable of having a collective conscience no matter how much their slick marketing suggests otherwise.

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Somerset, PA police arrest a man caught wandering the local hospital’s halls by a nursing supervisor. He was wearing a white coat and claiming to be a doctor in the IT department, which might have been more convincing if he hadn’t then asked her for directions to that department or responded, “Yeah, are you?” when she asked if he was a doctor. Todd Knisely then claimed to be testing the facility’s security for an online journal write-up. He might be telling the truth: Googling him turns up his alter ego (the not very creative “Shadow”) and Shadows [sic] Government, where he wrote up his planned social experiment. He also offers IT security services and website management. He says he wondered about the hospital’s security when he was a patient a year ago and found that he had free run of the place – including computers and paper patient records – since the hospital had no security officers on duty. Knisely (or is that Shadow?) says his legal research indicates that he broke no laws, an interpretation not shared by officers who locked him up for impersonation, theft by deception, and receiving stolen property.

Vince and Elise introduce their “Rating the Ratings” series and offer one last chance to providers who have read or contributed to a report from KLAS, Black Book, etc. to complete my survey for future installments.


Sponsor Updates

  • Experian Health will exhibit at the Illinois Rural Health Association Annual Education Conference August 10-11 in Effingham.
  • PatientMatters will exhibit at HFMA Arkansas: Summer Institute August 17-19 in Hot Springs.
  • The SSI Group will exhibit at the OASCA Annual Conference and Trade Show August 11-12 in Portland.
  • Stanson Health enables provider compliance with the PAMA imaging clinical decision support mandate.
  • VisionWare achieves Microsoft Gold Partner status.
  • Huron Consulting Group closes its acquisition of HSM Consulting.
  • ZirMed will host its 2016 User Group August 22-23 in Chicago.

Blog Posts


Contacts

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

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August 7, 2016 News 18 Comments

Morning Headlines 8/5/16

August 4, 2016 Headlines No Comments

Advocate Health Care Settles Potential HIPAA Penalties for $5.55 Million

Advocate Health Care (IL) will pay a $5.5 million HIPAA settlement, the largest in history, stemming from three separate breaches in 2013 that collectively compromised four million patient records.

Cerner Q2 2016 Results – Earnings Call Transcript

In its earnings call, Cerner President Zane Burke reports that 34 percent of sales came from outside the Millennium client base.

SA govt settles unlicensed software lawsuit

In Australian, the government settles a lawsuit brought by patient administration software vendor Global Health, which filed the suit because the government has refused to stop using its legacy software in a dozen public hospitals due to unexpected delays in its Allscripts Sunrise implementation.

Strengthening Research through Data Sharing

Senator Elizabeth Warren (D-MA) publishes an article in NEJM calling for more data sharing in the medical research community, backing a proposal that would require data sharing as a condition of publication in major medical journals.

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August 4, 2016 Headlines No Comments

News 8/5/16

August 4, 2016 News 2 Comments

Top News

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Advocate Health Care Network (IL) will pay $5.55 million to settle HIPAA charges involving three 2013 breaches in its medical group. OCR found that Advocate failed to perform risk assessments, didn’t limit access to its data center, and failed to encrypt a laptop that was stolen from an unlocked vehicle.

Advocate reported three breaches over just a few weeks in late 2013:

  • The theft of four desktops containing the PHI of 4 million people from an office building.
  • The breach of the network of business associate Blackhawk Consulting Group involving 2,000 patients.
  • The theft of an unencrypted containing the information of 2,000 patients.

Reader Comments

From Davadora: “Re: ER holiday shift coverage scam. My daughter was rushed to an in-network ED on Christmas morning. The doctor was not in in network and will not honor any discounts negotiated by my payer. A quick check finds that the provider accepts only one insurance and it’s not even a national one. Could it be a thing that doctors troll for holiday ER shifts to bill out of network?” It’s a patient-unfriendly healthcare system when doctors bill separately from the hospitals from which they provide services and where insurance companies penalize patients who don’t have a choice, leaving patients who by definition are unwell to sort it out instead of focusing on their own medical situation.

From FlyOnTheWall: “Re: Caradigm. Let 30 percent of their workforce go Wednesday.” Unverified. I’ve asked the company to comment but haven’t heard back.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. B from North Carolina, who asked for science activity tubs for her first graders. She reports, “The great thing about these kits is the simple fact that I can use them over and over for classes in the future. We are moving into landforms and characteristics of our Earth. It was great to get a solid foundation about what the Earth is made of. Thank you so much for supplying the funds needed to purchase the materials. I wish I could list everything we were able to do with them. Just know that your donation did not go to waste! You may have sparked a new generation of Earth Scientists.”

This week on HIStalk Practice: Anonymous administrator shares practice’s cybersecurity journey. Healthstar Physicians selects population health management services from Transcend. X-Ray Associates of New Mexico goes live on MedInformatix RIS. The nation’s second-largest school district pilots telemedicine technology. Astellas Pharma, Matter Chicago team up for cancer care innovation competition. Ohio launches $60 million+ CPC program. Stealth startup 98point6 raises $11 million. Nicole Hartung, MD of Minnesota Oncology shares best practices for engaging physicians in OCM-required care redesign.

This week on HIStalk Connect: PerfectServe CEO Terry Edwards weighs in on the Joint Commission’s waffling on texting of orders. Behavioral health company Big Health raises $12 million. Fitbit entices Adam Pelligrini away from Walgreens. IBeat secures $1.5 million.


Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Video visit provider Teladoc reports Q2 results: revenue up 45 percent, EPS $0.38 vs. –$7.20, exceeding earnings expectations but falling short on revenue. TDOC shares dropped sharply on the announcement and have shed 47 percent since the company’s first-day IPO close in July 2015.

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Analytics vendor Inovalon reports Q2 results: revenue up 5 percent, adjusted EPS $0.14 vs. $0.18, meeting earnings expectations but falling short on revenue.  Shares dropped sharply Thursday and are down 25 percent in the past year, valuing the company at $2.25 billion.

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Allscripts reports Q2 results: revenue up 10 percent, EPS –$0.05 vs. $0.01, meeting earnings expectations but falling short on revenue.

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From the Cerner earnings call:

  • President Zane Burke reports that 34 percent of sales came from outside the Millennium client base, which he attributes to an active replacement market and success against Epic.
  • The HealtheIntent population health management solution has been purchased by more than 100 clients.
  • Burke says of Cerner’s small-hospital CommunityWorks service in apparently calling out Athenahealth, “A recent noteworthy win for CommunityWorks was the displacement of a failed attempted go-live by a cloud-based vendor that has been making a push in recent years to expand from the ambulatory market to hospitals. We have several active opportunities to displace this same competitor in both ambulatory and small-hospital settings, suggesting their approach of spending about three times as much on much sales and marketing as they do on research and development may not be the most effective approach for their clients.”
  • The company sold two PHM deals of over $5 million.
  • A new children’s hospital in Dubai was scheduled to implement Epic, but moved to Cerner because of the ITWorks IT management service.
  • CFO Mark Naughton says of clients who had already notified Siemens that they were dropping their systems before Cerner acquired the company, “Every one of those is still writing me their monthly check or owes me their monthly check for their contract duration, which can extend anywhere from three to five more years.”
  • Only 25 percent of customers have bought Revenue Cycle, which the company sees as an ongoing opportunity.

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In Australia, software vendor Global Health settles its lawsuits with SA Health over the health department’s continued use of its 1980-era Chiron patient management software as its last remaining user. SA Health will pay $3.8 million for a five-year license, about the same annual fee it was paying before Global Health refused to extend its support agreement in insisting that the product was dead. SA Health wants to keep using the system due to delays in the EPAS Allscripts Sunrise Clinical Manager rollout at Royal Adelaide Hospital.

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Elation Health, which offers a $299 per provider per month EHR, raises $15 million.


Sales

Wake Radiology (NC) chooses the Vitality IQ imaging practice management tools from Vital Images.

OptumCare signs a 10-year deal to deploy Allscripts Touchworks to its physician practices.


People

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Ray Wolf (Redirect Health) joins Lumeris as SVP of architecture and innovation.


Announcements and Implementations

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Peer60’s new report, “Health System Brand Reputation,” looks at which health systems C-level healthcare executives recognize most for quality, innovation, and overall brand reputation. Mayo Clinic and Kaiser Permanente scored highest on public presence, but Johns Hopkins and Cleveland Clinic have the best overall reputations.

Athenahealth alerts its Miami-area customers that 1,800 of their patients are at risk for Zika virus infection based on CDC guidelines, most of them at a single health care center. 

In Australia, SA Health wins a government innovation award for its use of healthcare integration technology from InterSystems.

IDS will incorporate SyTrue’s NLP OS natural language processing system into its Voice2Dox speech-powered clinical reporting platform.

The Sequoia Project validates ZeOmega’s Jive HIE Connect for use on the eHealth Exchange.


Privacy and Security

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Banner Health (AZ) notifies 3.7 million people that its food and beverage systems were breached by a hacker in June, exposing patient and credit card information.

A former clerk of Tampa General Hospital (FL) is sentenced to three years in prison for using the computer information of 644 patients to file false tax returns that earned her refunds totaling $77,000. She also sold some of the information to others.


Innovation and Research

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Drone delivery vendor Zipline announces plans to begin delivery of medical supplies to remote areas of Maryland, Nevada, and Washington within a year. The company’s 22-pound, GPS-directed drones can carry three pounds of blood products and supplies that hospitals order via text message, with delivery within 30 minutes by parachute drop.

A study finds that hospitals that send the most heart attack and heart failure patients to the ICU have lower quality and worse outcomes, suggesting that the purpose of ICUs is ill-defined and may be driven by non-clinical factors.


Other

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A NEJM opinion piece by Senator Elizabeth Warren (D-MA) on the contentious issue of requiring researchers to share their study data calls for more openness. She recommends:

  • Medical journals should require researchers to share the de-identified patient they used along with their article submission.
  • The government should enforce FDA’s requirement that researchers register their clinical trials via ClinicalTrials.gov.
  • Researchers should include their plans for sharing data when registering their study.
  • Clinical trial sponsors should mandate data-sharing in their contracts, with the grant recipient being responsible for covering the costs from their award.
  • The medical community should find ways to share results from failed trials, which can have significant scientific impact yet are rarely published. 

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Eastern Maine Healthcare Systems lays off 35 of the IT department’s 300 employees as the department tries to cut its budget by $3 million.  The department eliminated 43 jobs in 2014.

In England, Burton’s Queen’s Hospital takes six years to finally go live on an unnamed, $2 million patient records system.

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GE CEO Jeff Immelt makes some refreshingly frank comments in an interview with Vanity Fair:

  • He says the company’s diversification strategy made sense in the 1980s and 1990s when GDP growth was 4 percent, but now, “If I would go out today and say, ‘Guess what? I have a great idea. We’re going to buy a media company,’ I’d get shot. Or if I were to say to you, ‘Hey, look, I was really great at picking jet engines and picking TV shows’—that’s complete bull, really.”
  • He says GE will apply Internet of Things information to improve industrial operations in ways software companies can’t.
  • Immelt says every new GE employee will “learn to code …  whether they join in finance or IT or marketing, they’re going to code.” He’s hoping to create programming and data scientist jobs for employees who have an associate’s degree only.
  • Asked about GE’s succession planning, he says, “In some ways, we are working on succession all the time. You don’t become CEO for what you know. You become CEO for how fast we think you can learn. There’s a whole bunch of things that go into it. How fast can they learn? How resilient are they? How competitive are they? Those are things that really put you in good stead.”

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A study of users of the free digital advance planning tool MyDirectives finds that people can do a better job specifying their own wishes via an electronic interview rather than checking off items on a paper form. The stored advance directives can be looked up by doctors and hospitals and users can even add a video statement via the company’s mobile app. The company makes money by charging health plans for storing the emergency care plans of their members, charging providers and health IT vendors to access the database, and selling de-identified data to third parties.

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The CNN journalism cesspool doesn’t appreciate the irony of placing a story about Facebook’s crackdown on clickbait headlines among its own non-newsworthy clickbait headlines.


Sponsor Updates

  • Intelligent Medical Objects and Obix Perinatal Data Systems will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
  • PDR and Navicure will exhibit at the Greenway Engage user conference August 10-13 in Atlanta.
  • MedData VP of Human Resources Barb Astler is named a finalist for the Crain’s Archer HR Executive of the Year award.
  • Netsmart will exhibit at the MHCAR Annual BH Institute August 9 in Hot Springs, AR.
  • Nordic will sponsor the Collaboration of Revenue Cycle Epic Users Conference August 10-12 in Portland.
  • Elsevier Clinical Solutions, Galen Healthcare Solutions, and Healthwise will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
  • Ninety-nine FormFast customers are named to the 2016 Most Wired list.
  • GE Healthcare President and CEO John Flannery continues his LinkedIn series on “The Top 10 Reasons Transformation is the New Normal for Healthcare.”
  • Healthfinch CEO and co-founder Jonathan Baran joins the Young Entrepreneur Council.

Blog Posts


Contacts

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

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August 4, 2016 News 2 Comments

EPtalk by Dr. Jayne 8/4/16

August 4, 2016 Dr. Jayne No Comments

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Even though we’re 10 months past the compliance date, CMS keeps sending me ICD-10 updates. They’re promoting “official coding resources that can help you maintain your ICD-10 progress.” I’m not sure exactly how one wouldn’t maintain their ICD-10 progress unless (a) they started seeing workers’ compensation patients that are still billed under ICD-9; (b) they started a cash practice; (c) they just came back to work after an extended sabbatical; or (d) some other extenuating circumstance.

The links direct back to the ICD-10 home page, which is topped by a February blog post by Andy Slavitt. Current events, indeed. The email did feature these funny icons and the first thing that popped into my head looking at the bottom one was “Sergeant Swaddle.” Between that and the baby bump one, I think they need a better graphic designer.

In other news, CMS announced the regions for its Comprehensive Primary Care Plus (CPC+) initiative and opened the application cycle for practices that would like to participate. CPC+ starts in January 2017 and is a five-year primary care medical home model. Up to 5,000 practices will be selected (2,500 in each of two tracks) to participate. Fourteen regions were announced including some full states. They were selected based on “payer alignment and market density to ensure that CPC+ practices have sufficient payer supports to make fundamental changes in their primary care delivery.” A list of payers that have been provisionally selected to partner is found within the FAQ document.

Practices can apply until September 15, and those applying to Track 2 must have a letter of support from their health IT vendors that outlines vendor commitment to supporting via “advanced health IT capabilities.” CPC+ counts as an Advanced Alternative Payment Model for MACRA purposes, so I suspect there will be a lot of interest. Selected regions are:

  • Arkansas
  • Colorado
  • Hawaii
  • Greater Kansas City area (KS and MO)
  • Michigan
  • Montana
  • New Jersey
  • North Hudson-Capital Region (NY)
  • Ohio (and Northern KY)
  • Oklahoma
  • Oregon
  • Greater Philadelphia area
  • Rhode Island
  • Tennessee

CMS has definitely been busy this week, also releasing a proposed rule that expands bundled payments into the realm of cardiac care. It also extends the current bundled payment model for hip replacements to include other hip surgeries. The cardiac elements aim to increase the utilization of cardiac rehabilitation services, which have been shown to lead to better patient outcomes.

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CMS isn’t the only government agency that’s been busy, though. The US Department of Agriculture will fund distance learning and telemedicine projects in 32 states, helping rural communities to connect with medical and substance abuse experts. USDA will award more than $23 million in grants to support 45 distance learning projects and 36 telemedicine projects. Eligible applicants include: most state and local governmental entities; federally-recognized Tribes; non-profits; for-profit businesses; and “consortia of eligible entities.” Sounds like pretty much everyone is fair game.

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A colleague forwarded me an article describing an observational study that appears to show “no overall negative association” of EHR implementation on short-term inpatient mortality, adverse safety events, or readmissions. It looked at the Medicare population across 17 hospitals that had go-live dates during the observation period compared to 399 control hospitals. It just came out this week so it only has one comment on it, which interestingly comes from a physician practicing in the United Arab Emirates.

Federal statistical agencies use the Standard Occupational Classification SOC) code system to classify workers into occupational categories. I learned from an AMIA blast this week that there’s finally a code for many of us: Health Information Technology, Health Information Management, and Health Informatics Specialists and Analysts. Right now it’s just a proposal which will hopefully be released for use beginning in 2018.

I had to make a last-minute trip this week to replace a subcontractor who flaked out on me. It was bad enough that my entire week was going to be disrupted, but even more, I wasn’t thrilled about the $1,000 airfare, nor was I thrilled about having a Monday morning flight. The TSA recommendation for my airport right now is to arrive at least two hours early. The travel gods must have been smiling on me at least a little bit because I arrived at the airport to find exactly no one in the TSA pre-check line. It was a beautiful thing, even though I ended up with a flight delay.

My client was cool about the last-minute substitution. It turns out that she only sees patients until 2 p.m. each day. After that, the office becomes a ghost town, so I’ve been able to keep up with other client engagements and even made it to the beach briefly. There’s something about having sand between your toes to rejuvenate you.

What gives you a little boost? Email me.

Email Dr. Jayne.

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August 4, 2016 Dr. Jayne No Comments

Morning Headlines 8/4/16

August 3, 2016 Headlines No Comments

Massive Cyber Attack at Banner Health Affects 3.7M Individuals

Banner Health (AZ) confirms that hackers gained access to a payment processing system used to process credit card transactions at food and beverage outlets across its facilities, compromising the information of 3.7 million individuals.

Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014

A national survey of seniors over 65 years old finds little growth in digital health adoption, including minimal gains in the percent of seniors using technology to fill prescriptions, communicate with a clinician,  search for health condition information, or manage health insurance issues.

CHS now selling 12 hospitals, two more than originally planned

Community Health Systems (TN) is negotiating the sale of 12 hospitals, two more than originally planned, which will bring it an expected $850 million in proceeds.

Drones will begin delivering blood and medicine in the US

Zipline, a startup using drones to deliver medicine and blood in remote areas of Rwanda, is launching a similar program in the US that will bring drone delivery to rural areas in Maryland, Nevada, and Washington.

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August 3, 2016 Headlines No Comments

Morning Headlines 8/3/16

August 2, 2016 Headlines 4 Comments

How I Was Wrong About ObamaCare

Former White House advisor Bob Kocher, MD calls attention to growing hospital consolidation within healthcare as an unfavorable effect of ACA, citing research suggesting that “savings and quality improvement are generated much more often by independent primary-care doctors than by large hospital-centric health systems.”

Cerner Reports Second Quarter 2016 Results

Cerner reports Q2 results: revenue climbed eight percent to $1.13 billion, adjusted EPS $0.58 vs. $0.52, meeting revenue and surpassing earnings forecasts.

Aetna latest insurer to question Obamacare’s future

Aetna announces that it will cancel its ACA insurance exchange expansion plans and will reassess its involvement in the 15 states where it currently offers plans on exchanges. Humana made a similar announcement last month shortly after the Justice Department filed a lawsuit aimed at blocking a proposed Aetna-Humana merger.

GSK and Verily to establish Galvani Bioelectronics – a new company dedicated to the development of bioelectronic medicines

Verily, Google’s life sciences business, partners with drug maker GSK to form jointly-owned Galvani Bioelectronics which will create miniaturized, implantable medical devices that will “modify electrical signals that pass along nerves in the body” to treat arthritis, diabetes, and asthma. The companies will invest $700 million in the venture over the next seven years.

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August 2, 2016 Headlines 4 Comments

News 8/3/16

August 2, 2016 News 6 Comments

Top News

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Theranos CEO Elizabeth Holmes could have spoken on many interesting topics at AACC — the company’s troubled Edison finger-stick analyzer, her CMS death penalty for running labs, the lab results that were “recalled” because they were wrong, the spectacularly failed relationship with Walgreens, and the government’s criminal probe – but instead uses her American Association for Clinical Chemistry conference podium time to pitch a new product, the Theranos MiniLab, which contains the same old specimen processing equipment that other vendors sell, just squeezed into a smaller box.

I doubt the assembled laboratorians gave her a standing ovation since they already have all the equipment and the specimen volume they need. It’s also not likely going to be less expensive than existing analyzers. Surely the only people even more puzzled than the assembled lab multitudes were the irrationally exuberant investors who pumped money into the company thinking it was a Silicon Valley high flyer but now realizing that it is, at best, a hardware huckster whose only potential revenue can be blocked by CMS and the FDA.

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For her speech, the empress wore physical clothes at least, but not her traditional black turtleneck. She should have come out in it and then done the Steve Jobs “one more thing” move to intro the MiniLab.

That sounds like an embarrassing pivot to me, wasting the time of a ton of scientists to talk up a hardly revolutionary work-in-progress, non-FDA approved gadget that may never see the light of day (and reading sing-song from a PowerPoint script in her slightly disturbing voice besides). Shame on AACC for giving her stage time without requiring her to provide the usual slides, data, and publications in advance to justify it. The best part of the day came as she was introduced to the Rolling Stones song “Sympathy for the Devil,” of which the aggregated volume from the packed auditorium wouldn’t have filled a Nanotainer.


Reader Comments

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From Connecting the Dots: “Re: Aledade. Its founder Farzad Mostashari and its primary funders are undertaking a public lobbying campaign. I assume they’re doing a lot of back-channel lobbying with CMS as well. They may be right on the merits, but the changes they propose will benefit them financially as well.” Mostashari opines that “CMS needs to halt the march to health care gigantism,” while Venrock partner, Aledade board member, and former White House advisor Bob Kocher tells the WSJ audience “How I Was Wrong About ObamaCare” in staying on the same message. Both articles say that hospital and medical practice consolidation is bad for cost and quality, not to mention Aledade’s bottom line as a small-practice ACO operator. They were happy to encourage industry consolidation in their former government jobs and are now using that employment history to gain a public platform from which to offer their potentially profitable penance. That doesn’t mean they are wrong, but it does indicate that perhaps less-vested experts from outside the same White House administration would provide a more objective opinion.

From Night Train: “Re: health IT news outlets. The other sites repeat their articles and overlap each other. They also don’t investigate much – they just repeat news releases. I only read HIStalk in depth (for the amusing commentary, if nothing else). I scan the headlines in other outlets and only follow a link to a topic that might be interesting.” Peer60 helped me do a CIO/CMIO survey of where health IT people get their news and one CIO respondent emailed this comment afterward. I’m very happy with the results so far. Nobody’s ever done anything like that as far as I know. Thanks for responding or at least for not sending me a nasty message for invading your personal inbox space, which I found from my earlier Epic survey happens every now and then. It takes 2 seconds to delete an unwanted message vs. 60 to craft an indignant response, so I’m a bigger fan of the former.

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From Spillway: “Re: grammar pet peeve. Business people using ‘incent’ and ‘incentivize’ as an ugly substitute for ‘encourage.’” I’m struggling with “incent” being wrong since that leaves “incentive” without a verb form. At least it’s better than one of my most-hated IT non-words, “administrate.”

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From Straight Talk: “Re: Vince Ciotti’s analysis of ratings services. How much longer are vendors going to be held hostage to these companies and pay the exorbitant fees? Everybody complains about how much they charge and how little value they derive from the reports, yet they continue to purchase the drivel they publish.” They are volunteers rather than hostages, free to stop paying anytime they want. Therefore, I would challenge the assertion that they don’t receive value, even if it’s the extortionate kind where they’re afraid how they will be ranked if they don’t pony up. I’ve received quite a few responses from my survey of hospital and practice executives who have read those reports or contributed data to them. The most striking answer so far matches my experience – people feel pressured to complete a survey even though they aren’t the organization’s best-qualified  person. I still feel ashamed that many years ago, I provided an IT-centric view of a radiology information system to KLAS even though I had no hands-on experience with the product as a user.


HIStalk Announcements and Requests

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We provided a programmable robot kit for Media Specialist Ms. B in South Carolina in funding her DonorsChoose grant request. She added the robot to the media center’s MakerSpace, where students can program it on the iPad.


Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Cerner announces Q2 results: revenue up 8 percent, adjusted EPS $0.58 vs. $0.52, meeting revenue expectations and beating on earnings.

Drug maker GSK and Verily Life Sciences (the former Google Life Sciences) will invest $700 million to create Galvani Bioelectronics, which will develop miniaturized implantable devices to alter nerve impulses in treating chronic conditions such as arthritis, diabetes, and asthma.

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The patent office awards McKesson Health Solutions a patent for the inner workings of McKesson Provider Manager. My eye was drawn to the spelling of “HIPAA” as “HIPPA” inside and its reference to Portico Systems, the provider management system vendor McKesson acquired in 2011. 

A study finds that a small group of biosimilar drugs — which are nearly identical versions of patented biologics — are as safe and effective as their expensive counterparts that have caused 54 percent of the growth in prescription drug spending since 2010. The study addressed the anti-tumor necrosis factor drugs Enbrel, Humira, and Remicade, which collectively sell $20 billion worth each year. The top eight biologic drugs whose patents are about to expire are projected to generate $200 billion per year for drug companies by 2020, but biosimilars will cost considerably less.


Sales

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Salinas Valley Memorial Healthcare System (CA) will add Web Ambulatory and Oncology to its Meditech 6.1 migration, while Meadows Regional Medical Center (GA) will upgrade to 6.1 and add Critical Care, Web Ambulatory, Surgical Services, and BCA. 

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East Jefferson General Hospital (LA) chooses Kaufman Hall’s Axiom Software for budgeting, long-range planning, capital planning, and performance reporting.

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Wyckoff Heights Medical Center (NY) chooses Allscripts Sunrise and Staff Augmentation. According to the hospital’s website, Meditech is the current vendor.

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Stormont Vail Health (KS) selects Orion Health’s Rhapsody Integration Engine.


People

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Michael Saad is named VP/CIO at University of Tennessee Medical Center after serving as interim.

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London-based cancer survivor and Cerner trainer Robin Chard dies of a heart attack Sunday while riding in the Prudential RideLondon charity bike event to raise money for cancer research. He was 48. Donations to his Just Giving pledge page, from which he hoped to raise $500 for Cancer Research UK, have reached $77,000 since his death was announced.


Announcements and Implementations

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VMware AirWatch announces AirWatch Express for fast setup of apps, email, and Wi-Fi on mobile devices. The cost is $2.50 per device per month and the company offers a 30-day free trial.

Clockwise.MD announces that 10 million patients have used its online scheduling service.

Stanley Healthcare uses InterSystems HealthShare to integrate its RTLS product with hospital EHRs.


Government and Politics

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Former White House healthcare policy adviser Bob Kocher, MD says in a Wall Street Journal op-ed piece that he was wrong in favoring hospital and medical practice consolidation to improve quality. Now he says that having providers owned by a single organization is “more likely to be a barrier to better care” as independent primary care doctors create more savings and quality improvement than big, hospital-centric health systems. Kocher also says he underestimated the time it would take for doctors to effectively use EHRs, with his estimated 3-5 year timeline lengthened by delays demanded by organized medicine. He concludes, “Large health systems deliver ‘personalized’ care in the same way that GM can sell you a car with the desired options. Yet personal relationships of the kind often found in smaller practices are the key to the practice of medicine.” Reader comments were sometimes savage, pointing out that the never-practiced physician Kocher was all for government meddling in healthcare until he left to work for VC firm Venrock and small-practice focused Aledade and only then published his pseudo-apology for it in suggesting even more government regulation that is also self-serving.

Aetna joins other big insurers in threatening to cut back on its money-losing exchange-sold policy business, saying those patients are seeking more care than the company expected and that drug costs are a big problem.

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A New York doctor is convicted of Medicare fraud after billing the government for submitting $25 million in claims for surgeries he didn’t actually perform, some of them on patients who had died. Most interesting to me, other than the magnitude of the fraud that took HHS a long time to uncover, is that nobody asks Medicare patients to validate the services they supposedly received. It seems to me they should have some responsibility for reviewing the bill and perhaps even being rewarded for seeking less care that is questionable or unnecessary. CMS might also want to watch daytime TV to see what products are pitched to seniors as being free by companies that make it clear they know how to check the right boxes (accurately or not) to get Medicare to foot the bill. Anyway, back to this case — the Pakistani-born weight loss and wound care doctor was previously reported as billing Medicare $85 million in just two years, of which the government obligingly paid $7.7 million. He billed 600 surgeries on one 81-year-old woman, making $300,000 on her alone. His lawyer proclaims his innocence, blaming the doctor’s poor handwriting and lack of knowledge about CPT codes.


Privacy and Security

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A Ukrainian hacker downloads 100,000 internal Word and PDF documents of a urology group owned by Mount Carmel Health System (OH), some of which contained PHI. All of the practice’s documents are freely available on the hacker’s shared Google Drive. 


Technology

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It’s always interesting when technology does nothing but make readily available information more available, such as when people cry “privacy invasion” when Zillow reports home and tax data that it mostly gets from less-obvious but still-public government files. Homeowners are going ballistic over Google’s phone GPS apps Waze and Maps, complaining that they are sending high traffic volume through their shortcut streets that few people knew about before.  Neighbors are falsely reporting street blockages to the Waze app and erecting homemade “No Through Traffic” signs hoping to force re-routing, although Waze says that practice doesn’t work because other drivers will instantly report that they don’t see the accident , also warning that it will suspend users who file false reports. The company says its job is to spread traffic most efficiently over the available road grid even though homeowners don’t like having their secret shortcut exposed. 


Other

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Nebraska Orthopaedic Hospital (NE) postpones surgeries Friday and Monday after unspecified computer downtime.

Hospital ICUs are loosening their ICU visiting hours after studies find that patients do better with their families around. That’s hardly a surprise, and given the frequency of hospital mistakes, it’s good for everyone for patients to have visitors to serve as a second set of eyes. Hospitals are just about the last organizations to limit visitor hours like prisons or 1960s college dorms.


Sponsor Updates

  • Aprima will host its user conference August 5-7 in Dallas.
  • CapsuleTech, Clinical Architecture, and CoverMyMeds will exhibit at the Allscripts Client Experience August 9-11 in Las Vegas.
  • CenterX will exhibit at the NCPDP Workgroup Meeting August 3-5 in Cincinnati.
  • Optimum Healthcare IT achieves the top rating among consulting services vendors in the KLAS Midterm Performance Review, earning a score of 94.9. 
  • Crossings Healthcare releases the latest edition of its newsletter.
  • The local newspaper interviews new CTG President and CEO Bud Crumlish.
  • Cumberland Consulting Group completes Revitas implementation for BPO client Ferring Pharmaceuticals in 90 days.
  • Vital Images is showcasing its imaging interoperability solutions at AHRA in Nashville this week.

Blog Posts


Contacts

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

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August 2, 2016 News 6 Comments

Morning Headlines 8/2/16

August 1, 2016 Headlines No Comments

Theranos Founder Elizabeth Holmes Introduces New Blood-Testing Device

During a speech at the annual meeting of the American Association for Clinical Chemistry, Theranos CEO Elizabeth Holmes announces that her lab test startup has invented a new analyzer that uses small amounts of blood and performs more tests than the company’s Edison analyzer.

Struggling To Stabilize: 3Rs Litigation And The Future Of The ACA Exchanges

Health Affairs recaps the numerous lawsuits being brought against the federal government by insurers and co-ops struggling to maintain profitability on the ACA marketplaces.

Identification of 15 genetic loci associated with risk of major depression in individuals of European descent

Researchers using 23andMe’s genome database to look for genetic variants associated with major depressive disorder find 15 previously unknown mutations that correlated with an increased risk of depression.

CMS selects markets for new primary-care payment initiative

CMS will launch the Comprehensive Primary Care Plus program in 14 regions, including  Arkansas, Colorado, Hawaii, Kansas City (MO) Michigan, Montana, New Jersey, North Hudson Valley (NY), Oklahoma, Oregon, Rhode Island, Tennessee and parts of Ohio and Kentucky.

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August 1, 2016 Headlines No Comments

Curbside Consult with Dr. Jayne 8/1/16

August 1, 2016 Dr. Jayne 3 Comments

I was recently hired to help a large health system migrate their ambulatory platform. They previously ran a best-of-breed system, with different vendors for their inpatient and ambulatory platforms. I’ve been working with them for some time now, although my previous engagements were around optimizing their outpatient workflows and helping them bring on new specialties and practices as the employed physician group expanded. Due to problems with their inpatient vendor, however, they decided to go for a single-vendor solution.

Their idea of a system selection process was pretty sad. They didn’t even really go to market. The decision had been made without much input from anyone except the CIO and the CFO. Of course, the employed physicians were upset, especially since they were happy using their current software and felt a bit like the health system had thrown the baby out with the bath water. It’s hard enough to do a migration when you have a legacy system that providers hate, but trying to do one with a legacy system that providers actually like and use efficiently is another challenge altogether.

My client’s parent organization doesn’t have a CMIO at the corporate level, although it has several medical directors who work together to fill that function across the different areas – ambulatory, inpatient, home care, hospice, etc. Although they’re a great group of physicians and dedicated to making systems work better for users, they’re unfortunately all part-time informaticists. Between their clinical practices and current EHR-related duties, none of them really have time to spearhead the migration efforts.

This led to an understandable amount of chaos as the IT department steamrolled ahead making decisions about architecture and setup. The IT department also made determinations on what clinical data should be migrated and what shouldn’t, without getting any kind of clinical approval. No one even knew it was going on until an analyst sent a conversion file to one of the physicians to ask a question about the data.

The physician informaticists demanded an immediate halt to any conversion or migration work until they were pulled into the loop. That’s how I was tapped to assist, since I’ve assisted with plenty of migrations off their soon-to-be legacy system. I haven’t done much work with this receiving vendor, however, and it’s been an eye-opening experience, especially since they’re one of the big three vendors that purports to have their act together. What I’ve seen behind the scenes has been concerning, with occasional episodes of being thoroughly horrified.

To start with, the vendor didn’t provide any recommendations on what kinds or how much clinical data should be brought into the new system. They left it completely up to the health system to define. The vendor’s front-line teams weren’t prepared to have any conversations around what similar clients have done or how things worked for them. They also didn’t make any recommendations on how to clean up the MPI for the most successful conversion of patients, which is a recipe for filling the new system with junk.

I’m not expecting a vendor to make detailed recommendations, but some basics, such as, “You may want to only consider bringing active patients in to the new system” might be helpful. I’m not sure if their lack of recommendations is truly systematic since I’ve only been working with a couple of vendor employees, but they’ve been less than helpful.

From the clinical side, the health system had decided to “bring everything over” on their patients regardless of data integrity or usefulness. Part of this was driven by the fact that they didn’t want to pursue an archive solution for the legacy patient records, which was in turn driven by cost concerns. I’m not sure those concerns are well founded, especially when you look at the potential risks of bringing across so-called “dirty data” due to an ineffective migration plan. Plus, do you really want to populate your new system with expired patients and those who have moved away? Do you really want to fill your brand new charts with 10 years’ of medication history?

I was brought in largely to help ask the hard questions around these topics, plus to help the client’s team of informaticists to learn what they don’t know so they can start to take on some of the migration tasks. I was able to help them focus their specifications on what they wanted to bring across. 

We started with medications, since those are typically straightforward given the preponderance of NDC and RxNorm codes in most systems. Although we had a couple of blips, we were able to finally get a good data set of medications which have been active in patient charts over the last 18 months. The entire medication history will be pulled as well, but it will be turned into a PDF document that will be stored in their scanning solution rather than inserting all that data into the prescribing module.

We are now working on the patient problem lists, immunizations, and diagnosis history data. The latter is unfortunately complicated by the recent migration to ICD-10, so there’s a fair amount of duplicative data that we’re still trying to figure out. At the same time, I’m lobbying the leadership to reconsider an archive solution for some of the other data, including all the patients who are never going to be seen in the new system.

I’m surprised by how difficult this fight has been, but I need to learn to not be surprised by anything from clients. Once you think you have them figured out, there’s always something that comes up to remind you that you haven’t thought of everything.

In parallel, there have been rapid design sessions going on where the physicians are supposed to be designing their future-state workflows. The build environment that was set up by the vendor included data from previous clients, which was easily identifiable (physician and facility order sets) and for the “vanilla” content from the vendor, I’m surprised by how rudimentary it was. With the availability of high-quality order sets and clinical decision support, I’m surprised they’re not incorporating more in their base installation.

The expertise of vendor reps in some of these design sessions has been lacking. They’re still working as if they’re bringing up new clients who have never been on EHR and haven’t been prepared to address the issues faced by organizations that have been live on a system for years. It’s as if their implementation process is stuck in 2002.

The project continues to suffer from scope creep, which is OK for me as a consultant since the client has asked to extend and expand my engagement. Job security in this economy is important and it will keep me busy for several months. Even better, it’s in a great location. I might just have to conduct more onsite visits than I might otherwise do for a project like this. Best of all, the client-side people I work with are not only helpful but fun, which is an asset for any consultant.

Where’s the most fun place you ever worked and why? Email me.

Email Dr. Jayne.

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August 1, 2016 Dr. Jayne 3 Comments

Morning Headlines 8/1/16

July 31, 2016 Headlines No Comments

Methods of Treatment and Diagnosis Using Enhanced Patient Physician Communication

Apple files a patent suggesting that it is interested in integrating telehealth technology into its mobile devices.

What Happens When Underperforming Big Ideas in Research Become Entrenched?

A JAMA editorial argues against funding “big idea” projects like the Precision Medicine Initiative without also developing mechanisms to sunset these projects if they underperform, and instead calling for funding to be used to launch more broad-based preventative public health efforts.

Commission Finds LabMD Liable for Unfair Data Security Practices

The FTC reverses an earlier decision to dismiss charges against LabMD for failing to maintain adequate data security practices.

Meditech Form 10-Q

Meditech reports Q2 results: total revenue climbed three percent to $120 million, EPS $0.44 vs. 0.46.

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July 31, 2016 Headlines No Comments

Monday Morning Update 8/1/16

July 31, 2016 News 6 Comments

Top News

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A newly published Apple patent suggests that the company is interested in allowing iPhone users to connect with a physician, send the doctor their HealthKit-collected information, and then initiate a telemedicine session from their iPhones.

The inventor is Todd Whitehurst, MD, PhD, a former Apple director of hardware development who now holds the same position at Google Life Sciences. He has previously worked on implantable devices for glucose monitoring, drug infusion, and neurostimulation. Whitehurst holds more than 50 patents involving implanted medical devices and has applied for many dozen more.


Reader Comments

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From Frank Poggio: “Re: evidence-based medicine. It’s really evidence-based political medicine, as evidenced by the mammography battle three years ago. Every doctor and patient should read ‘Snowball in a Blizzard’ by Steven Hatch, MD. It says doctors are guessing all the time but have led the public to believe the Marcus Welby / Dr. House version of their role, making patients and families angry when there is a misdiagnosis or treatment failure. It will take a very long time and big attitude change to reverse the misconception.” Hatch wrote the book following 2009’s guidelines by the US Preventive Services Task Force that called for a reduction in mammograms because their diagnostic value is less than previously believed, which cause outrage in women (and in providers who make a lot of money performing mammograms) who felt the recommendation was a form of rationing. Interestingly, Hatch concludes that doctors pay less attention to patients with symptoms that are hard to interpret because the doctors are frustrated by their own limitations.

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From Hundred Dollar Baby: “Re: Covenant Health. I looked up attestation data to see which systems their hospitals use.” This is great, thanks. According to the attestation data, seven of Covenant’s hospitals (including the big ones) run McKesson Horizon, one uses Meditech 6.0, and one is a Medhost user. All of the systems will apparently be replaced with Cerner. Hospitals that bought McKesson’s sketchy vision of integrating all of its acquisitions to form a cohesive system are paying big to correct their mistakes, but on the other hand, evidence was ample to predict the current state.

From Specific Gravity: “Re: Preservation Wellness Technologies. Rumor has it that the patent troll, which lost its infringement lawsuit against Epic, is now suing Epic’s customers.” Unverified. The company doesn’t even bother to run a website in pretending that it’s a real business rather than a patent troll. I provided some background a couple of months ago:

The “inventor” apparently runs Carlo Coiffures, a beauty salon in New York. The lawsuit was brought by a Texas corporation with a Texas mail drop address that filed the suit in the rural Eastern District of Texas, which attracts 25 percent of the patent lawsuits filed in the entire US because that district’s troll-friendly practices make it hard for defendants to get a ridiculous lawsuit dismissed. A fascinating episode of “This American Life” describes a building in Marshall, Texas (population 24,000) whose long corridors contain locked offices representing the only physical presence of companies whose entire business is filing frivolous patent infringement lawsuits.


HIStalk Announcements and Requests

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Thirty-seven percent of hospitals told AHA surveyors that they allow patients to electronically submit their own information to the hospital, but only 12 percent of my survey respondents reported having that option as patients. New poll to your right or here: as a patient, how much value would you place on CMS’s hospital star rating system? Click the poll’s Comments link after voting to explain why you do or don’t trust CMS’s data as a predictor of hospital quality.

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Vince Ciotti is working on his review of healthcare software rating services such as KLAS, Black Book, and others. If you work for a hospital or medical practice and have read a software rating report in the past year from any company, can you take a couple of minutes to complete my survey to give Vince a broader look at that market? You’re also welcome to send me your thoughts. Thanks.

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We funded the DonorsChoose grant request of Mr. F in Florida, who asked for programmable robot for his elementary school technology class. He reports, “Thanks to your donations, my students were able to bring their coding skills to practical use by controlling the Sphero robot. Not only did my students wait desperately for their turn with the Sphero, but they used their time to learn how to code it to do even more. I thank you for your generosity and faith in my class as well as myself to put your donations to good use.”

I had another busy day of unfollowing low signal-to-noise Facebookers who post frequent political rants, relentless mugging selfies, and updates about teams and sports that don’t interest me (which is all of them). I rarely look at Facebook but it felt good to take action, sort of like that dashboard-mounted toy that releases stress by letting you shoot imaginary death rays at bad drivers. 

I’m wondering if death rates rise early in each calendar year among people who buy their health insurance through Healthcare.gov or state exchanges. Open enrollment runs November 1 through January 31 and many folks have to start over because their insurer pulls out or changes the plans it offers. They have to:

  • Try to find a decently qualified PCP who will take a new patient.
  • Get a “new patient” appointment sooner than several months out with that new PCP.
  • Obtain referrals for ongoing conditions if the new plan requires it or if their old specialist doesn’t take their new insurance.
  • Hope for no surprises that their maintenance meds, especially the expensive specialty ones, are covered by their new plan (since insurance companies  can’t tell you cost or coverage until the policy takes effect, they’re buying blind).
  • Avoiding getting medical care because of the multi-thousand dollar deductible that resets January 1, meaning they have to pay every expense out of pocket.

Listening: new from reader-recommended Look Park, mellow, folky-style pop with lots of hooks by Chris Collingwood from the unfortunately defunct Fountains of Wayne. I’m also pondering the definition of “country” music – it seems you just stick a cowboy hat on a random musician’s head (some not even US-born, like Keith Urban), add fiddle and pedal steel to the otherwise pop mix, and dumb down the lyrics to include only mournful warblings or throaty backwoods swagger affecting a fake Southern accent. I’m not entirely sure it’s even a real genre any more except as an easier route to pop stardom, where the faux country trappings are quickly dropped (see: Taylor Swift).


Last Week’s Most Interesting News

  • CMS adds star ratings to its Hospital Compare website, with some highly regarded hospitals performing poorly and criticizing CMS’s methodology as flawed, especially for academic medical centers and hospitals in economically challenged areas.
  • Consumer health site Sharecare acquires the population health business of Healthways.
  • A report finds that 88 percent of known Q2 ransomware infections involve healthcare organizations.
  • ONC announces funding availability for a cyber threat information sharing service as previously called for by the White House.
  • University of Mississippi Medical Center pays $2.75 million to settle HIPAA charges related to the 2013 theft of a laptop.
  • Athenahealth announces poor quarterly results and the planned year-end departure of EVP/COO Ed Park.

Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Recent webinars and their associated YouTube video views are:


Acquisitions, Funding, Business, and Stock

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Meditech reports Q2 results: revenue up 3 percent, EPS $0.44 vs. 0.46.  Product revenue was flat while service revenue increased 4 percent.

Cognizant acquires Toronto-based digital design firm Idea Couture.


Sales

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UNC Health Care (NC) chooses Phynd to manage and share the information of its 20,000 providers across six hospitals.

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Beacon Health System (IN) will implement Cerner’s Millennium Revenue Cycle.


People

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Colleen McFarlane (US Preventive Medicine) is named CEO of radiology best practice platform vendor Radiology Protocols.

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Arno Laeven, who founded the Philips Blockchain Lab in the Netherlands in January 2016, will leave the company, according to reports.

Stanson Health promotes Jeremy Orr, MD, MPH to chief medical officer.


Announcements and Implementations

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In Canada, Interior Health is recognized as the first health authority in British Columbia to provide patients with online access to their records, using Meditech’s MyHealthPortal.

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National Decision Support Company will incorporate appropriate imaging criteria from the National Comprehensive Cancer Network in its CareSelect Imaging.

A Navicure survey finds that while most healthcare organizations value data analytics and reporting, 55 percent don’t have such a solution, although half of those are planning to implement one. Nearly three-fourths of respondents say data analytics help them improve cash flow by reducing A/R days.


Privacy and Security

I’m giving public credit to DataBreaches.net, which has become my go-to source for breach reports and from which most of the items below originated. It’s brilliantly run by an anonymous mental health professional.

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Crozer-Keystone Health System (PA) notifies 900 bariatric surgery patients that their information was exposed when an employee emailed all of them using CC: instead of BCC:. I’m beginning to think that the average hospital employee isn’t sharp enough to trust with a fully capable email client. Maybe they should either have to pass a competency exam or be forced to use a dumbed-down email client that protects the organization from their inattentiveness since the “we trust everybody to do the right thing with Outlook” isn’t working too well. The reduced functionality front end could restrict the ability of users to:

  • CC more than a handful of recipients.
  • Click embedded links to sites that have not been previously whitelisted.
  • Open attachments from external senders that have not been previously whitelisted.
  • “Reply to all” to more than a handful of recipients (that’s not a privacy risk, just an annoying practice, especially when they start emailing everyone to angrily tell them to stop emailing everyone).

Prosthetic & Orthotic Care (MO) notifies patients that hacker The Dark Overlord hacked its systems on July 9. DataBreaches.net brings up an interesting point – should OCR require the covered entity to tell patients that their information is for sale on the Dark Web as it is in this case? The Dark Overlord used his signature method to gain access, a zero-day exploit in Microsoft’s Remote Desktop Protocol.

Also experiencing a breach via remote access is Jefferson Medical Associates (MS).

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The FTC reverses overrules a previous decision to drop data security charges brought against lab testing firm LabMD, now saying that LabMD’s security practices failed to address even basic security to protect the information of 750,000 patients, resulting in undetected installation of file-sharing software that left the information of 9,300 patients freely available for 11 months. Note that this action plus ONC’s observation that only FTC has jurisdiction over non-covered entities and you might infer increased FTC involvement going forward. Above is Friday’s response by LabMD President and CEO Michael J. Daugherty. My November 2015 summary of the original ruling was:

The first incident was reported by Tiversa, a security vendor who was trying to sell its services to LabMD. A former Tiversa sales manager said its warning to LabMD was “the usual sales pitch” and said no breach actually occurred. The second involved documents recovered in an identity theft investigation. The judge ruled that any consumer risk was theoretical and scolded the FTC for relying on Tiversa’s “unreliable” claims. It appears that Tiversa is still in business selling peer-to-peer cyberintelligence services, while LabMD shut down after being buried in court costs and customer defection due to the now-dismissed charges. LabMD was never charged with a HIPAA violation, only with deceptive trade practices, which seems to make little sense in this case (as the judge validated).


Other

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Another medical transport aircraft goes down as a Cal-Ore Life Flight plan crashes in Northern California, killing the pilot, flight nurse, medic, and patient. The flight’s operator was Air Medical Group Holdings, which was acquired by a private equity firm last year for $2 billion.

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A bravely brilliant JAMA editorial questions whether it makes sense for NIH to be spending so much money on precision medicine research, which in 2016 earned $15 billion of NIH’s $26 billion in grant funding. It notes the general failure in trying to apply complex genetic information to clinical practice even in relatively simple forms, such in sickle cell anemia where detection of the causative gene 60 years ago still hasn’t provided any treatment options. It questions whether NIH should instead refocus on blue sky research that has obvious public health benefits instead of projects that are “constrained by current narratives” (in other words, chasing the latest shiny scientific object). Other points made in the article:

  • The financial and clinical benefits of EHRs haven’t materialized due to lack of interoperability, the poor quality of information they collect, and their high cost.
  • Most of the improvements in mortality, morbidity, and life expectancy have come from public health efforts, not medical research or interventions.
  • Genetic research will probably not create big-picture improvements in care and outcomes since it will at best create high-cost, highly targeted interventions for small numbers of people, not even counting the inevitable overdiagnosis and overtreatment that intensive monitoring encourages.
  • The authors recommend that NIH engage independent assessors to review the value received for research that promised specific deliverables, such as personalized medicine.
  • The article questions whether NIH should be spending federal taxpayer money in funding projects to discover new drugs, tests, and technologies or instead leave that work to private industry.

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I’m impressed that John P.A. Ioannidis, MD, DSc of Stanford Prevention Research Center had the courage to challenge the precision medicine-driven funding frenzy that has taken federal money away from public health programs that could have provided an immediate and far greater ROI on public health. As I’ve said many times, the US is great at heroic, expensive (meaning: profitable) medical interventions that suck up ever-increasing chunks of our federal and state budgets, but we lag much of the world in public health, exporting most of our public health expertise. Check out his interview earlier this year with “Retraction Watch” and his “Evidence-based medicine has been hijacked” article from March 2016, in which he fearlessly criticizes the trend:

As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money. Diagnosis and prognosis research and efforts to individualize treatment have fueled recurrent spurious promises. Risk factor epidemiology has excelled in salami-sliced data-dredged articles with gift authorship and has become adept to dictating policy from spurious evidence.

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A NEJM article advocates expanding the five rights of medication ordering (right patient, drug, dose, time, route) to six, requiring prescribers to provide an indication (what the medication is for). The authors say it would reduce errors (where pharmacists might see “hydroxyzine” with an indication of “hypertension,” allowing them to call to see if they really meant “hydralazine”) and to educate patients on what each medication is for. Another strong point for me would be to allow researchers to determine from electronic data sets why a particular drug was chosen, or for payers to be able to detect prescribing without a valid diagnosis or vice versa. Challenges include extra prescriber effort, privacy concerns, how to code (if at all) the indication and how to handle multiple indications, and the system redesign required to handle the extra data element. I’ve been a fan of this idea for many years going back to when it was included on paper standardized order forms and it makes perfect sense. In fact, just as physicians are supposed to be planning discharge upon admission, maybe they should indicate and reaffirm the desired endpoint of the drug prescription, i.e. when might it be stopped based on patient response instead of just putting people on drugs for life with nobody really remembering why, which should be a big help to continuity of care since nobody likes taking responsibility for blindly discontinuing someone else’s order.

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I bet attendees of the American Association for Clinical Chemistry could scalp tickets to Monday’s 45-minute talk and the following Q&A by Theranos CEO Elizabeth Holmes. My prediction is that she’ll be so scared and over-coached to avoid referencing information that is proprietary or related to the company’s criminal probe that she will either cancel with a medical or other emergency excuse or will deliver a glossy performance to an audience expecting facts and humility who will rebel at the absence of both. Maybe a black turtleneck is the opposite of a white lab coat. The damage is already done to AACC for inviting her in the first place, as pathologist Geoff Baird, MD, PhD says, “Would you have Al Capone come and talk about his novel accounting practices? Is it acceptable to allow someone to talk about science if they’ve used that science so horribly inappropriately?”

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A Florida pediatrics practice mails letters to eight mothers who had criticized it on Facebook, telling them to find a new pediatrician. The mothers were appalled that they were no longer welcome at the business they had flamed, running to the local TV station to complain, with one dramatically telling the reporter in milking her moment in the limelight, “I just started stressing, and I got dizzy, and I fainted” (obviously she’s challenged by the concept of replacing a doctor she didn’t like anyway). Lots of people have courage only of the Internet kind, confidently bold in their online commentary but meekly shamed by its real-life result. The practice – like an accountant, lawyer, or plumber – can choose whoever they want as customers (if only teachers had that same right). This is like writing a Yelp restaurant review complaining that all the food was inedible, and not only that, the portions were too small.

Maybe these folks are goofing on healthcare with all those lame apps out there. Media people swoon, hundreds of people sign up for the email list, and would-be Silicon Valley investors fill the inbox of Pooper, “the Uber for dog poop,” in which app users snap a photo of the dog’s excrement to summon a Prius-driving scooper to clean it up. People keep emailing the company looking for scooper jobs. The app is an elaborate prank from a couple of guys who plan to do more of them, who explain, “We’re going to continue to put content out there that makes people question what they’re reading in the news, what they’re looking at online, and on a deeper level, what their relationship is to technology … people should be thinking about it and questioning what roles apps and the gig economy play in their lives.”


Sponsor Updates

  • KLAS names HealthCast as the top-rated single sign-on vendor in its 2016 midterm report, with the company earning a score of 92.
  • T-System will exhibit at Symposium by the Sea August 4-7 in Naples, FL.
  • Talksoft is rated highest in the KLAS Patient Outreach 2016 Performance Report.
  • TeleTracking will celebrate its 25th anniversary and record-breaking registrations at its annual client conference October 9-12 in Naples, FL.
  • Valence Health Vice President of Market Solutions Ryan Smith contributes an article on hospital employee health plans to Trustee magazine.
  • Huron Consulting Group will exhibit at the Studer Group’s What’s Right in Healthcare Conference August 2-4 in Chicago.
  • ZeOmega publishes a case study on how SignalHealth uses its Jiva HIE to deliver patient information to its provider network.
  • Xerox is a Health 2.0 Ten Year Global Retrospective nominee.
  • Experian Healthcare will host a West Regional User Conference August 4 in San Diego.
  • The local paper features PatientPay in its look at fintech startups in the Research Triangle area of NC.
  • The local business paper cites Peer60 in its profile of Agfa HealthCare.
  • The SSI Group will exhibit at the FHCA Annual Conference & Trade Show August 7-11 in Orlando.
  • Sunquest Information Systems will exhibit at the AACC 2016 Annual Meeting & Clinical Lab Expo July 31-August 4 in Philadelphia.
  • Surescripts will exhibit at the Aprima 2016 User Conference & VAR Summit August 4-6 in Dallas.
  • InterSystems will exhibit at the AACC Annual Scientific Meeting and Clinical Lab Expo July 31-August 4 in Philadelphia.
  • Intelligent Medical Objects will exhibit at Aprima’s 2016 User Conference + VAR Summit August 4-6 in Dallas.
  • Pittsburgh Magazine interviews MedCPU President and Co-Founder Sonia Ben-Yehuda.
  • NEA Powered by Vyne announces the release of version 4.1 of its FastAttach electronic claims attachment health information exchange solution.

Blog Posts


Contacts

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

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July 31, 2016 News 6 Comments

Morning Headlines 7/29/16

July 28, 2016 Headlines No Comments

Adverse inpatient outcomes during the transition to a new electronic health record system: observational study

A study published in BMJ following EHR implementations at 17 hospitals finds no increase in patient mortality, readmission rates, or adverse events.

McKesson Reports Fiscal 2017 First-Quarter Results

McKesson reports Q1 results: revenue grew five percent to $49.7 billion, adjusted EPS $3.50 vs. $3.14. While overall revenue was up, revenue generated within the Technology Solutions business fell two percent due to declining hospital software sales.

Hospital profits soar under ACA

The Oregon Health Authority releases a report concluding that the net income of the state’s hospitals climbed 58 percent in 2015, driven by expanded Medicare coverage that reduced charity care and bad debt by $342 million across the state.

An informatics research agenda to support precision medicine: seven key areas

Inspired by the Precision Medicine Initiative, JAMIA publishes a list of seven key areas health informaticists should focus their research.

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July 28, 2016 Headlines No Comments

News 7/29/16

July 28, 2016 News 1 Comment

Top News

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CMS adds star ratings to its Hospital Compare website, which also offers a data download option. Of the 78 New York City hospitals listed, one (Hospital for Specialty Surgery) earned five stars, while 29 hospitals have a one-star rating.

University of Miami Health System, which earned one star, predictably argues that the methodology is flawed and that its patients are sicker, complaining that academic medical centers and safety net hospitals are treated unfairly by the rating system.

Two hospital systems that made US News & World Report’s “Best Hospitals” list earned only two stars from CMS – UPMC and Barnes-Jewish Hospital. Both point out that scores vary among their similarly run hospitals, in their minds proving that ratings are skewed by patient demographics of the hospital’s geographic area.


Reader Comments

From Gordie Gecko: “Re: NantHealth. Check out its progressive tanking in the market. Patrick Soon-Shiong is trying to announce new deals, but one success doesn’t mean he’ll always be successful. People on the inside still don’t know what the future is.” NantHealth went public a couple of months ago with a first-day closing share price of $18.59, but shares have since dropped 45 percent to around $10. Allscripts bought 15 million shares right after the IPO, so the company is down around $50 million in just a few weeks. NantHealth hasn’t filed its first earnings report yet, but its IPO documents showed an annual loss of $72 million on $58 million in revenue.


HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mr. D in Pennsylvania, who asked for three iPad Minis and cases. He reports that his students are using them to work on math and reading skills, to log their science activities, and to do research for their social studies assignments.

This week on HIStalk Practice: Cerner VP of Population Health Services Mike Heckman explains the role healthcare tech plays in managing on-site clinics for employers. Practice Fusion CMO & VP of Informatics Richard Loomis, MD shares interoperability advancement plans. Zoom+ VP defends the company’s executive exodus. AristaMD closes an $11 million Series A. Athens Orthopedic Clinic alerts patients to The Dark Overlord’s hack. Medstreaming acquires Physician Billing Partners. Epic, Allscripts, EClinicalWorks lead the vendor way in EP MU attestations. American Well CTO Jon Freshman outlines the ways in which vendors must differentiate themselves if they want to survive telemedicine’s bubble.


Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

McKesson announces Q1 results: revenue up 5 percent adjusted EPS $3.50 vs. $3.14, falling short on revenue expectations but beating on profit. Revenue for the Technology Solutions business was down 2 percent, but still generated a profit of $179 million. Shareholders again voted down a proposal that would have limited executive golden parachutes, which in CEO John Hammergren’s case, involves several hundred million dollars if the company changes hands. This is probably the last time I’ll report MCK’s earnings since they are scurrying quickly away from healthcare IT.

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AristaMD, which offers a referral management system, raises $11 million.

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Consumer health site Sharecare, founded in 2010 by Dr. Oz and WebMD founder Jeff Arnold, acquires the population health business of publicly traded Healthways. The business and its 1,700 employees will remain in Franklin, TN. Healthways announced in 2015 that it was exploring strategic alternatives.

Oracle will buy ERP vendor NetSuite for $9.3 billion. Oracle Chairman Larry Ellison already owned nearly half of NetSuite’s shares, having funded the company when it was founded by a former Oracle executive.

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Leidos announces Q2 results: revenue up 2 percent, adjusted EPS $0.68 vs. $0.77, meeting revenue expectations but falling short on earnings.

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Cambia Health Solutions makes a strategic investment of unspecified amount in medical procedure buying site MDsave. I tried the four-year-old site and found that few providers offer services on it – searching for a flu shot in Cleveland turned up a handful of doctors in Tennessee and Virginia and seeking a bargain-priced colonoscopy in San Diego showed the closest willing provider at 331 miles away in Nevada.

LabCorp will acquire prenatal genetic testing company Sequenom for $302 million in cash.

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Struggling would-be health insurance disruptor Oscar will cut its New York provider base in half for 2017, trimming its network from 77 to 31 hospitals as it raises rates significantly. I predict Oscar will be gone within 24 months, with one of its big insurance competitors spending very little to buy the smoking wreckage.


Sales

I mentioned that Covenant Health (TN) has chosen Cerner, and based on information I found on the  Web, I concluded that the health system is a Meditech customer. I was wrong – while Cumberland Medical Center does indeed run Meditech as I had found, the rest of Covenant does not. Covenant bought CMC in 2014.


People

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Dorothy Fisher, MD (Sentara Quality Care Network) joins Forward Health Group as chief clinical officer.

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HBI Solutions hires Alan Eisman (Information Builders) as SVP of sales and business development.

Accretive Health names Doug Berkson (Berkson Consulting) as SVP.


Government and Politics

A state report finds that Oregon hospitals boosted their aggregate profit by 54 percent in 2015 because of the Affordable Care Act’s Medicaid expansion, which turned their charity care into revenue-generating work whose cost was mostly footed by federal taxpayers.


Privacy and Security

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Fertility app vendor Glow urges users to change their passwords after it finds a problem with the “connect a partner” feature that could expose the user’s data to third parties.


Other

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A review of the rates of mortality, readmissions, and adverse events in 17 hospitals immediately before and after their 2011-2012 EHR go-live finds no significant negative impact. That’s not really surprising since common go-live problems (late meds, missed charting entries, staff confusion) aren’t going to kill patients even though they make their encounter less pleasant.

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A JAMIA article defines the work required for informatics research to support precision medicine:

  • Implement electronic consent and specimen tracking.
  • Develop data standards to support integration and exchange.
  • Develop ways to discover and translate clinically relevant biomarkers.
  • Use rules and technology to ensure the quality of large datasets to make sure they will continue to be useful in the future.
  • Create a precision medicine knowledge base.
  • Extend EHRs with APIs that can integrate external data and that will support the development of third-party workflow and data visualization tools.
  • Engage consumers outside of provider settings with user-friendly data collection tools.

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Greater Madison Chamber of Commerce launches its HealthTech Capitol program and website, which “is working to establish Greater Madison as the world-class leader for health technology.” It lists 18 companies as members, with annual dues running $260 to $1,010 depending on membership level and company headcount.

ZDoggMD reflects on his medical career in his latest video, set to the tune of by Lukas Graham’s “7 Years.” EHRs get an unflattering mention.


Sponsor Updates

  • Crossings Healthcare Solutions publishes its Q2 newsletter.
  • Catalyze delivers HITRUST CSF certified compliant cloud solutions for Amazon Web Services workloads.
  • Besler Consulting releases a new podcast, “Auditing and monitoring for compliant physician documentation and coding.”
  • Boston Software Systems releases a new podcast, “Mass Updates to Your Meditech System.”
  • CompuGroup Medical will exhibit at the AACC Scientific Meeting & Clinical Lab Expo July 31-August 4 in Philadelphia.
  • Extension Healthcare will exhibit at the 2016 Defense Health Information Technology Symposium August 2-4 in Orlando.
  • The HCI Group is again listed on the Jacksonville Business Journal’s list of “50 Fastest Growing Private Companies.”
  • Healthgrades announces the 2016 Women’s Care Award recipients.
  • Healthwise is certified as a Great Place to Work.
  • Santa Rosa Consulting launches a Transition Management Office service.

Blog Posts


Contacts

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

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July 28, 2016 News 1 Comment

EPtalk by Dr. Jayne 7/28/16

July 28, 2016 Dr. Jayne No Comments

I’ve said it before, but those of us that work in the healthcare IT realm have a skewed sense of reality when it comes to participation in federal incentive programs. We tend to think that “everyone’s doing it,” but the reality is that just over half the eligible providers in the US were reflected in the 2015 Meaningful Use attestation data.

With that in mind, I wasn’t surprised that only half of practicing physicians have even heard of MACRA. Based on conversations in various physician lounges, I’d argue that even those who have heard of MACRA see it as a fix to the SGR problem with physician payment rather than another quality and incentive program. The survey seems to confirm this, with 32 percent of respondents only recognizing the name.

Not surprisingly, employed physicians were less aware than independents. However, physicians with large Medicare panels weren’t any more aware than those with smaller panels. Also not surprisingly, 80 percent of physicians prefer traditional fee-for-service arrangements.

Often people jump on this as proof that rich and greedy doctors just want to preserve their cash flow. For many in the trenches, though, it’s no different than any other occupation wanting to be paid for the work that they do. We wouldn’t have many car mechanics if their pay was linked to how well people maintain and drive their cars, and sometimes I think the practice of medicine has become a lot like being a mechanic lately. If nurses were docked part of their shift pay because their patients died or were otherwise noncompliant, you would see an open revolt.

I’ve been doing some long-term work for a health system that requires me to use their laptop and VPN connection. It also requires me to use their desktop support team, which has been a struggle. We open tickets via email and often it takes days for anyone to respond. Once they do respond, it’s often apparent that the technicians haven’t even read the ticket. This is particularly irksome for someone like me who puts lots of screenshots and attachments with their tickets, so that the problem is clear in the hopes someone can resolve it more quickly.

I’ve had some difficulty getting some of their applications to run correctly, since apparently they aren’t supported across browsers. One requires that you use Chrome, another Firefox, an another will only run on Internet Explorer. Doesn’t seem very 21st century to me, but the rest of the organization seems to be OK with it.

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I’m always interested to see how other nations handle various healthcare delivery problems, so this headline about Finland’s newborns sleeping in cardboard boxes caught my eye. Finland’s infant mortality rate is less than half the US rate. The box is provided to all pregnant women, with the condition that they have a medical exam during the early months of the pregnancy. It also contains various baby care and clothing items, including those needed for chilly winters. (I’ve never seen a baby balaclava, but apparently there is such a thing.)

Finland offers a lot of other benefits for parents, including a paid 10 month leave and a guarantee that full-time caregivers can return to their jobs within the first three years of the child’s life. At the urging of a non-profit organization that provides boxes in Minnesota, that state’s legislature considered a bill to provide them for low-income women. Seeing a baby asleep in a box reminds me of my grandmother’s story that she slept in a dresser drawer for the first few months of life, having been born early with no nursery preparations. Necessity is definitely the mother of invention, whether your baby sleeps in a box, a basket, or a drawer.

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Medicare’s Hospital Compare “star ratings” are now live, and as expected, creating confusion. Now that we’ve had a chance to actually review the data, I agree with most detractors that it doesn’t really help consumers. I plugged in the three excellent hospitals in my area where I would actually have care or send a family member and couldn’t find any appreciable differences despite the fact that they received two, three, and four stars respectively. The two-star hospital is actually ranked top 10 in the nation for dozens of clinical programs, and if I ever had a serious medical problem, that’s where I’d want to be. Small community hospitals in my area scored highly despite the fact that they have no recognizable differentiators.

The star ratings do nothing to help patients evaluate quality of care for specific clinical programs, such as oncology or cardiovascular surgery, where volume and expertise really matter. I searched up quite a few specific hospitals, including every one where I’ve worked. Some that received four or five stars fall on the list of places I would never want a family member to go to for care – but not every family has a physician, so I feel for the patients who actually take the star ratings seriously.

The best part of the ratings is reading the reader comments in my local newspaper:

  • This rating system is crap. (from a patient who goes on to explain the life-saving care, research protocol, and ultimately the organ transplant they underwent at a two-star hospital).
  • This hospital rating system is misleading, especially when lives depend on it. My husband picked his hospital by ratings and it cost him his life.
  • So according to this list, if I have a life-threatening illness, I should seek care at Tiny Community Hospital instead of at Big Medical Center which happens to be affiliated with one of the best medical schools in the world…. Seems legit.
  • What does the government know about running and rating hospitals…. They run the worst hospitals in the country. #VA.
  • The only government run hospital (VA) in the area didn’t get rated. The irony….
  • Until Big Medical Center can get the uninsured patients that swamp their ED to follow up, they will continue to score low. The onus was put on the hospitals to manage their patients, but you can’t manage patients outside the hospital. The same people show up over and over for the same thing. Even with call centers making hundreds of calls a day trying to get patients to go get a test, get an exam, exercise, eat right, check on their mood and behaviors, it still comes down to the people on the other end to do what they’re asked.
  • CMS couldn’t find its butt if its hands were glued to it.

That last comment gave me my smile for the day, so I’m going to sign off on that note.

What’s your favorite local comment about star ratings? Post it below, or email me.

Email Dr. Jayne.

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July 28, 2016 Dr. Jayne No Comments

Morning Headlines 7/28/16

July 27, 2016 Headlines No Comments

First Release of the Overall Hospital Quality Star Rating on Hospital Compare

Despite industry pushback on its methodology, CMS publishes its “Overall Hospital Quality Star Rating” on the Hospital Compare website.

Solutionary SERT Q2 Report: 88 Percent of All Ransomware Is Detected in Healthcare Industry

A cybersecurity report finds that 88 percent of reported Q2 ransomware attacks targeted the healthcare industry because the industry tends to pay ransoms to retrieve patient data quickly, and because hospitals rely on an abundance of systems, each of which represents a potential access point.

Huron Consulting moves to acquire IT consultant HSM

Chicago-based healthcare management consulting firm Huron Consulting will acquire health IT firm HSM Consulting for an undisclosed sum.

Declining Admission Rates And Thirty-Day Readmission Rates Positively Associated Even Though Patients Grew Sicker Over Time

A Health Affairs study finds that hospitals that are successful in reducing admissions may be penalized as their inpatient populations become sicker and therefore have higher readmission rates.

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July 27, 2016 Headlines No Comments

Morning Headlines 7/27/16

July 26, 2016 Headlines 12 Comments

HHS issues funding opportunities for Information Sharing and Analysis Organization for health and public health sector

ONC announces availability of a $250,000 grant for cyber threat information sharing services, authorized under the recently enacted Cyber Information Sharing Act. Karen DeSalvo, MD and national coordinator for health IT, explains that “Establishing robust threat information sharing infrastructure and capability within the Healthcare and Public Health Sector is crucial to the privacy and security of health information, which is foundational to the digital health system,”

Athenahealth Announces Industry’s First MIPS Guarantee

Athenahealth guarantees that its clients will meet MIPS national performance thresholds and avoid payment penalties, and promises to reimburse any MIPS penalties incurred.

Certified Health IT Vendors and Editions Reported by Hospitals Participating in the Medicare EHR Incentive Program

ONC publishes new MU hospital attestation numbers by vendor, showing that Cerner has the most attestations, followed by Meditech and Epic.

AMA, Omada Health, Intermountain Healthcare Partner to Reduce Incidence of Type 2 Diabetes

Omada Health partners with Intermountain Healthcare and AMA to begin

offering digital diabetes prevention programs designed to support the population health management efforts of large health systems across the country.

Covenant Health Selects Cerner’s Enterprise-Wide Clinical, Financial and Population Health IT System

Covenant Health (TN) will implement Cerner across its 9 acute-care hospitals and 100 ambulatory centers.

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July 26, 2016 Headlines 12 Comments

News 7/27/16

July 26, 2016 News 1 Comment

Top News

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ONC issues $250,000 in funding opportunity announcements for a cyber threat information sharing service. The application package indicates an award date of September 16 and indicates that it will choose an organization that is already performing similar cyber threat services. It expects the program to be self-funding since those organizations already charge fees for their services.

A second $150,000 cooperative grant has been issued from the Assistant Secretary for Preparedness and Response.

The grants were issued is response to a 2015 executive order that promoted private sector cybersecurity information sharing via Information Sharing and Analysis Organizations.


Reader Comments

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From Pierre La Terre: “Re: health IT rag pointless stock photos. Who’s the miscreant in the green shirt?” Publications think we’re not smart enough to read news unless there’s a picture, so they struggle when there’s nothing relevant to run given that they’re just re-wording press releases and crafting zippy headlines from afar. This particular well-worn photo of a green-shirted volunteer undergoing a mock sobriety field test in 2009 came from Wikimedia Commons and lives on as an uncredited breaking health IT news photo. Any resemblance to anyone involved in the HHS fraud case is unintentional.

From Grammar Warrior: “Re: grammar pet peeve. To ‘insure’ is to protect against financial loss. To ‘ensure’ is to make sure something happens. Ensure you get it right, people!” My recent peeves aren’t new: the use of “anymore,” which despite appearing in some dictionaries, will never look right to me instead of “any more.” I’m also annoyed at the phrase “build out” in trying to give physical attributes to some abstract IT concept, like “building out the EHR” (even if you like the analogy, which I don’t, the “out” is superfluous). Also, using “that” to refer to people (“people that complain bug me”) or using “who” to refer to organizations (“the vendor who screwed up is well known.”)

From Todd Margaret: “Re: top health IT Twitterati. One of the winners lists HIStalk among ‘critical community leaders’ whose primary means of disseminating information isn’t Twitter.” I glance pretty regularly at Twitter to get a quick read on what people are thinking, but most heavy Twitter users aren’t all that influential except maybe to each other. The “influence” equation must address reader reach, reader decision-making authority, and the writer’s ability to provide information that changes the minds of those decision-makers. Twitter is best at quickly capturing prevailing opinion about big-bang events rather than influencing anyone directly.


HIStalk Announcements and Requests

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We provided the elementary school class of Ms. Johnston in Colorado with five tablets and headsets in funding her DonorsChoose grant request. She provides an update: “My students could not believe that someone would give us such a great gift and they took great pride in the care of our technology. In fact, one of my students, was so moved by the donation that she was designated as a classroom tech. She was excited to carry the role as she checked on their battery powers every morning, she cleaned the technology station, she wiped the headphones down at the end of the day, and she took leadership to ensure that other students were being careful. Thank you so much for this wonderful gift. These students have been given a rare opportunity to learn and apply technology in new and creative ways. This was a memorable experience for each of us. Thank you.”

Vince Ciotti is putting together “Rating the Ratings,” a series that will review the services offered by KLAS, Black Book, HIMSS Analytics, and others. Vince would be happy to incorporate your anonymous thoughts and experiences if you send them my way. Readers have made quite a few comments over the years about their company being suspiciously overlooked, being asked to buy something to be included, and wondering why specific clients were chosen when participating in some of the services.


Webinars

August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketchum, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Recode profiles Nomad Health, a startup whose site matches doctors to temporary assignments.

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Huron Consulting Group will acquire Healthcare Services Management, with HSM CEO David Devine joining Huron as managing director. 

Venture capital-backed Boston hospital operator Steward Health Care earns its first profit, although all of it came from changes in how it funds pensions. The company still refuses to submit state-mandated financial statements, however, saying its information is proprietary.


Sales

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Covenant Health (TN) chooses Cerner’s clinical, financial, and population health management systems. I think they’re a Meditech shop.

Memorial Sloan Kettering Cancer Center chooses HealthLoop for patient engagement in its newly opened surgery center.

Meditech lists several customers that are moving forward with its new Web EHR.


People

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Former Military Health System CIO Eric Huweart joins government contractor Apprio as VP of military and veteran healthcare.

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Wyman F. Bowers, JD, MBA (Midlands Orthopedics) is named the first CEO of the South Carolina Health Information Partners HIE.

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Staffing provider AMN Healthcare hires Matt Zubiller (McKesson) as SVP of corporate strategy.


Announcements and Implementations

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Athenahealth issues its MIPS Guarantee that its customers won’t lose money under the final MACRA rule, but the terms contain catches: (a) it’s only for new AthenaOne clients who go live on AthenaNet; (b) the customer gets only monthly service credits rather than cash and the total can’t exceed the amount of their monthly payment; and (c) if the customer drops Athenahealth, they forfeit their remaining credit. It’s a good marketing strategy to ramp up the customer count that Wall Street is watching intently.

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Medication management app vendor Medisafe releases a version of its product for drug companies that addresses adherence, patient engagement, dose reminders, and study recruitment.

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HealtHIE Nevada will offer community-based providers such as diabetes educators and behavioral health therapists subscriptions to Kno2, which will allow them to exchange documents with doctors and hospitals via Direct messaging to improve continuity of care. The Boise-ID-based company offers a $20 per month, one-user plan that provides a Direct address, allows address book searches, supports messaging and document routing, and allows creation of Direct messages from scanners and multi-function printers.

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Crossings Healthcare Solutions will resell Cerner real-time end user experience monitoring from Goliath Technologies. 

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Intermountain Healthcare, the AMA, and online health coaching vendor Omada Health will work together to offer diabetes prevention programs for the at-risk patients of large healthcare systems across the country.


Government and Politics

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An HHS OIG survey of 400 hospitals finds that half have experienced unplanned EHR downtime, and of those, one-fourth report that it delayed patient care. Software was not the cause of downtime in any reported case – the most prevalent downtime issues were hardware failure, loss of Internet connectivity, and power failure. Only a third of respondents have a read-only EHR backup system in place that alerts users visually that the main system is down. OIG repeats its previous recommendation that OCR implement a permanent audit program to assess HIPAA compliance.

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ONC updates its Health IT Dashboard with the latest count of MU-attesting hospitals by inpatient system vendor. Cerner, Meditech, and Epic lead the pack.

Former National Coordinator and Aledade CEO Farzad Mostashari, MD says in a an editorial in The Hill that MACRA will speed up consolidation of hospitals and practices without necessarily improving cost or outcomes. He recommends that CMS allow small practices to join together in virtual networks, compare small practices only against each other, and cap the potential losses under MACRA that as written can be more than 100 percent of a practice’s Medicare revenue.


Privacy and Security

Healthcare leads all industries in ransomware infections, according to a security firm’s quarterly report, making up 88 percent of all detected ransomware incidents.


Innovation and Research

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The California Cancer Registry pilots real-time data collection of de-identified patient data from pathologists at 12 hospitals. They are using electronic reporting forms developed by the College of American Pathologists to capture discrete data elements rather than free text information. Public health officials hope to publish real-time surveillance data, identify cases for research, and improve quality.


Other

The Pharmaceutical Research and Manufacturers of America, which has tried to convince Congress that drug companies charge high prices only to support desperately needed research, accepts as members two companies that spend next to nothing on R&D. Horizon Pharmaceuticals bought an old drug and raised its price 600 percent the same day, with the former $2 pain pill now costing nearly $40. New member Jazz Pharmaceuticals makes nearly all of its money from a single drug whose price it doubled in two years. Actually neither company should be admitted to an organization that includes “of America” in its name since both “moved” to Ireland after acquiring companies so they could dodge paying US taxes.

In Australia, a newborn dies and another suffers permanent brain damage after a hospital contractor mistakenly installs nitrous oxide in an oxygen outlet.

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In England, NHS geriatrician Kate Granger, MBChB dies of cancer at 34. Her cancer experience with an impersonal health system motivated her to create the widely adopted #HelloMyNameIs campaign that urges doctors and nurses to introduce themselves to patients and to make eye contact before treating them. She donated all of the proceeds from sale of her books and other activities to Yorkshire Cancer Centre, having hit her $328,000 goal just three days ago. She had previously received the MBE and, just before she died, a handwritten thank you letter from England’s new prime minister that started with, “My name is Theresa.”


Sponsor Updates

  • Lexmark Healthcare is selected as one of eight imaging technology vendors to participate in RSNA’s Image Share Validation Program.
  • PM/EHR vendor MedEvolve will offer its physician practice customers payment solutions from InstaMed.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.Send news or rumors.
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July 26, 2016 News 1 Comment

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