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Morning Headlines 6/5/17

June 4, 2017 Headlines No Comments

The Health Care Industry Cybersecurity Task Force Releases Improvement Report

The Health Care Industry Cybersecurity Task Force, per a Cybersecurity Information Sharing Act of 2015 mandate, releases its report to Congress, detailing six high-level directives over the course of 88 pages.

Health Insurance Startup Bright Health Raises $160 Million

Led by former UnitedHealthcare CEO Bob Sheehy, Minneapolis-based Bright Health closes a $160 million round of financing it will use to expand into new markets via private health insurance exchanges and health system partnerships.

23andMe Asks Customers to Conduct Pain Research at Home

23andMe for the first time enlists customers to help it conduct at-home research on pain tolerance.

OIG Highlights Data Privacy and Security in Semi-Annual Report

The HHS OIG’s Congressional report highlights challenges related to protecting the privacy and security of the data it collects and maintains, as well as those related to “effectively using data to detect and prevent improper payments and to ensure safety and quality of care for program beneficiaries.”

Monday Morning Update 6/5/17

June 4, 2017 News 2 Comments

Top News

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The Health Care Industry Cybersecurity Task Force releases its slightly overdue report to Congress, detailing six high-level directives over the course of 88 pages:

  • Define and streamline leadership, governance, and expectations.
  • Increase the security and resilience of medical devices and health IT.
  • Develop the workforce capacity necessary to prioritize and ensure cybersecurity awareness and technical capabilities.
  • Increase industry readiness through improved cybersecurity awareness and education.
  • Identify mechanisms to protect R&D efforts and intellectual property from attacks or exposure.
  • Improve information sharing of industry threats, risks, and mitigations.

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CHIME has published a far less intimidating 11-page summary of the report’s 100-plus recommendations. HHS officials have thus far been mum on the forthcoming HHS cybersecurity center’s role in fleshing out the recommendations.


Reader Comments

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From Jet Blue: “Re: AirStrip Technologies. I met with a prominent venture capital firm today, and we discussed the many high-flying digital health companies that have been funded over the last few years. I learned that AirStrip Technologies has been acquired by Patrick Soon-Shiong, MD. He intends to combine AirStrip with his other companies such as ISirona and Harris CareFx. Apparently the deal is being kept under wraps.” Unverified. ISirona and Harris are among the eight companies NantHealth has acquired over the last six years. AirStrip has flown fairly under the radar this year, and issued just a handful of press releases in 2016. I interviewed President Matt Patterson, MD last March.

From HIT Apostle: “Re: Integration. We are exploring different options for how to best integrate EHR data into our analytics product suite. This would include becoming HIPAA compliant, hiring an ETL team, and adding data processes to our operating model. Have you ever asked your readers what a ballpark figure cost is for this? Are there more cost efficient options, like working with an integration vendor, such as Redox?” I don’t believe I have, so I’ll invite readers to comment with advice and experiences.


HIStalk Announcements and Requests

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A HIStalk sponsor and Donors Choose supporter asked me to share this survey on EHR services. They plan to double their already sizable donation once they reach 100 responses.

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It’s almost an even split when it comes to the benefits readers believe CommonWell brings to patients, a stat that MC calls into question: “Something very funny happened with this poll. When there were about 80 to 100 responses it was OVERWHELMINGLY leaning towards LESS THAN EXPECTED. Now it is 244 to 252?” April isn’t crazy about how the poll was worded: “Voting ‘less than expected’ (regardless of whether your expectations were very high) leaves the poll results looking like CW isn’t doing anything to benefit patients. ‘More than expected’ indicates you didn’t expect it to do much to begin with. I like the fact that CW is showing steady progress in addressing some of the hardest issues in interoperability. I also like the fact that they opened up the ability for patients to initiate their own record search earlier this year.”

New poll to your right or here: Would you consider switching EHRs if your vendor was involved in a legal situation similar to that of EClinicalWorks? Feel free to add write-in commentary regarding what vendor(s) you would put at the top of your shopping list and how much weight certification would carry.


This Week in Health IT History

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One year ago:

  • Rumors surface – again – that McKesson is considering selling or merging its McKesson Technology Solutions business unit in the face of drug pricing pressures.
  • Intermountain Healthcare, Stanford Cancer Institute, and Providence Health & Services launch a genomic data-sharing network.
  • Vice President Biden forms the Genomic Data Commons, an open-access cancer database that will help researchers collaborate and share information, as part of his Cancer Moonshot.
  • Practice Fusion settles with the FTC over charges that it misled consumers by asking for reviews of their physicians without adequately disclosing that those reviews would be posted publicly online.
  • The House passes the Helping Hospitals Improve Patient Care Act, exempting ambulatory surgical centers from MU and MIPS penalties.

6-7-2012 8-44-30 PM

Five years ago:

  • Microsoft and GE Healthcare complete the formation of their 50-50 join venture Caradigm.
  • Allscripts nominates a three-member board slate to settle a lawsuit and proxy fight brought by key shareholder HealthCor Partners.
  • Kaiser’s Oakland hospital gets hit with a $75K Department of Health fine for a 2010 incident in which nurses ignored a telemetry patient’s tachycardia alarms.
  • Data analytics vendor MedAssurant changes its name to Inovalon.
  • In the UK, Brighton and Sussex University Hospitals NHS Trust is fined $500,000 when hard drives containing the medical information of patients were sold on eBay.

Ten years ago:

  • Healthcare management company MED3OOO becomes a major stakeholder in Scottsdale-based InteGreat Concepts.
  • Allscripts and NaviMedix announce an agreement to provide Allscript’s eRx NOW ePrescribing solution to NaviMedix’s network of more than 190,000 physician customers.
  • David Brailer launches a $700 million private equity fund, Health Evolution Partners.
  • Walgreens licenses kiosk and EMR software from Ethidium Health Systems for use in its Take Care Health Systems retail clinics.
  • Duke Clinical Research Institute concludes that extra pay does not improve hospital performance.

Weekly Anonymous Reader Question

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Last week’s results were slim, indicating that either I asked for too much or that readers don’t have much experience with mentor/mentee relationships (which I doubt given the interest in our webinar on that very topic several weeks ago). Here are the responses I received:

  • I work in a company full of people who are almost all fantastic at their jobs. I try to identify the strongest skills in the people I work with most often, and then I emulate them when in relevant situations. As my assignments change, the people and skills I’m exposed to change, so I continue to develop further.
  • They listen when I have a complaint – about life or work, they listen. Occasionally some wisdom comes back, but they mostly know just to listen and let me be heard.

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This week’s survey: Would you recommend to a relative or colleague that they switch careers to health IT? Why or why not?


Last Week’s Most Interesting News

  • EClinicalWorks will pay $155 million to settle DOJ False Claims Act allegations.
  • Tablet-based patient education and pharmaceutical advertising vendor Outcome Health raises $500 million.
  • Ascension-owned Seton Healthcare (TX) goes back to paper after detecting suspicious activity on its network.
  • 21st Century Oncology (FL) files chapter 11 bankruptcy.
  • The VA’s IT budget is reduced as it grapples with the decision to either modernize VistA or implement a commercial EHR.

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


People

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Aviacode hires David Fong (Gebbs Healthcare Solutions) as VP of marketing and communications, and Jordan Stannard (IMedx) and Byron Triplett (Gebbs Healthcare Solutions) as regional sales executives.


Acquisitions, Funding, Business, and Stock

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Health insurance startup Bright Health raises $160 million in a Series B round led by Greenspring Associates. Co-founded by former UnitedHealthcare CEO Bob Sheehy, the Minneapolis-based company works with health systems looking to package insurance plans with their clinical services.


Decisions

  • The University Of South Alabama Health System (AL) plans To switch from Siemens Soarian to a new Cerner EHR.
  • Buchanan County Health Center (IA) switched from Meditech to Epic in March.
  • Girard Medical Center (KS) outpatient clinics will go live with the Prognosis Ambulatory EHR in Q3 2017.
  • Platte Valley Medical Center (CO) will switch from Siemens Soarian to Epic on May 30.

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


Announcements and Implementations

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Reaction Data publishes a new report on the UK imaging market. Carestream, Sectra, and Agfa Healthcare have the best foothold on enterprise business across the pond.

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Hackensack Meridian Health (NJ) will add Cota Healthcare’s precision medicine technology to its five-month pilot of IBM Watson as a clinical decision support tool for oncologists. The trial will involve 10 physicians and up to 500 patients.


Sales

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Memorial Hospital (IL) will convert from Meditech to Cerner early next year.

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Lewis County General Hospital (NY) considers upgrading to Meditech 6.1. Director of Information Systems Robert Uttendorfsky anticipates that transition will cost at least $1.5 million and take 18 months.

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St. Luke’s Health System (ID) will deploy Voalte’s communications technology across its eight hospitals.

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The Queen’s Health Systems (HI) will integrate Recondo Technology’s ClaimStatusPlus with Epic. The organization got its start in 1859, when Queen Emma and King Kamehameha IV went on a door-knocking tour to raise funds for what would become The Queen’s Medical Center. It is the first (and perhaps only) health system in the US to be founded by royalty.


Government and Politics

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HHS Inspector General Daniel Levinson releases OIG’s semi-annual report to Congress, highlighting challenges related to protecting the privacy and security of the data it collects and maintains, as well as “effectively using data to detect and prevent improper payments and to ensure safety and quality of care for program beneficiaries.”


Privacy and Security

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From DataBreaches.net:

  • Appthority dubs a new backend data exposure risk HospitalGown, outlining in the cheekily titled report above the havoc it could wreak in enterprise environments.
  • Identity management system company OneLogin experiences a data breach, putting the information of the Stanford School of Medicine (one of its biggest customers) at risk.
  • An unspecified IT issue at The Cosmetic Institute in Australia causes a private index of patient data – including pre- and post-surgery photos, Medicare numbers, and other intimate patient details –  to become publicly accessible via the surgery’s website.

Innovation and Research

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MIT Technology Review reports on 23andMe’s decision earlier this month to ask its customers for help in conducting research on pain tolerance. The consumer-friendly genetics company aims to enroll 20,000 people to take surveys on pain tolerance and pain history; 10,000 of those will conduct at-home cold pressor tests, where subjects stick their hand in ice for up to three minutes. The data will likely be used to inform studies on personalized pain medication.


Other

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Doctors of BC President Alan Ruddiman, MD cites a “broken culture” at Island Health and its Nanaimo Regional General Hospital as one of the main reasons for continued physician dissatisfaction with the Vancouver health authority’s $135 million Cerner implementation. According to Ruddiman, such discontent has led to physician burnout and resignations – a state of affairs that will not only affect patient care, but the community, too. “If the medical personnel are hurting and they are uncoupling from this hospital then it’s only a matter of time where this gets known as a community that’s not an attractive place to live and work and that hurts everybody …” he added.

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The local paper casts Judy Faulkner-like aspirations onto VitusVet founder Mark Olcott, an entrepreneurial veterinarian working to make pet health records interoperable, and appointments and prescriptions easier to fill. Focusing on practices with four or more vets, the company hopes to pass the $1 million revenue mark this year after grossing a quarter of that in 2016.


Sponsor Updates

  • LogicWorks develops a new set of DevOps tools for running applications on the AWS cloud.
  • Inc. Magazine includes Nordic in its list of “Best Workplaces 2017.”
  • NTT Data Services wins the “Deal of the Year” award for its acquisition of Dell Services.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, PatientKeeper, and Wellsoft will exhibit at EHealth Canada June 4-7 in Toronto.
  • Experian Health will host its Connect Health Conference June 6 in Chicago.
  • The SSI Group will host a regional user group meeting June 6-7 in New York City.
  • Surescripts and ZeOmega will exhibit at the AHIP Institute & Expo June 7-9 in Austin, TX.
  • TransUnion publishes “No More Surprises: Increase POS Collections with Pre-Care Cost Estimates.”
  • Versus Technology will host an open house at its new Bayside Education & Visitor Center June 7 in Traverse City, MI.
  • Huron releases a video, Transforming Healthcare, featuring Harvard Business professor and author Clayton Christensen.
  • ZirMed publishes a new e-book, “Leveraging Predictive Analytics to Ensure Professional Revenue Integrity.”
  • Diameter Health publishes a new video featuring Chief Strategy Officer John D’Amore and Kansas Health Information Network Executive Director Laura McCrary.
  • Encore, a Quintiles company, outlines what providers need to become Advanced APMs under MACRA in this white paper.

 

Blog Posts


Contacts

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More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 6/2/17

June 1, 2017 Headlines No Comments

Outcome Health Raises Financing at $5 Billion Valuation to Accelerate Growth and Transform Healthcare

Tablet-based patient education and pharmaceutical advertising vendor Outcome Health raises a $500 million investment round on a $5 billion valuation.

The ADHA wants to link up all of Australia’s health systems

The Australian Digital Health Agency releases a request for tender seeking technology vendors that will help it achieve “a digitally interoperable environment for the Australian health and care system,” over the next five to 10 years.

Accenture to Acquire LabAnswer, Expanding Its Life Sciences and Cross-Industry Research and Laboratory Informatics Capabilities

Accenture acquires LabAnswer, a laboratory research and informatics technology consulting firm, and will combine the business with its existing R&D informatics capabilities to establish the Accenture Scientific Informatics Services division.

Privacy Breach at Beverly Hills Clinic Puts Thousands of Patients, Some Celebrities, at Risk

A former employee of a Beverly Hills clinic steals 15,000 medical records, some of which belong to celebrities, after being fired for stealing from the practice.

News 6/2/17

June 1, 2017 News 9 Comments

Top News

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Doctor office advertising and patient education technology company Outcome Health raises $500 million in funding, valuing the Chicago-based company at $5 billion.

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Forbes estimates that the 31-year-old co-founder Rishi Shah owns 80 percent of the company’s shares, giving him a paper net worth of $3.6 billion.

Forbes also estimates that the company’s annual revenue is $200 million and it’s growing 100 percent per year, with most of the money coming from drug companies anxious to get their message in front of patients at an opportune time.

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Vivek Kundra, the first US CIO, is a company EVP.


HIStalk Announcements and Requests

Tuesday’s HIStalk page views exceeded 10,000, which isn’t a record or even all that much higher than the usual daily traffic, but it’s the highest count during a non-HIMSS week other than June 28, 2016 (when McKesson announced that it would divest its Technology Solutions business) and July 30, 2015 (when the DoD awarded Leidos/Cerner its EHR contract).

I thought it would be interesting to look at the percentage of females serving on the executive teams of the top five healthcare IT companies by revenue as listed on the new Healthcare Informatics 100, which might bring to mind the old Doors song “Five to One”:

  • Optum – 25 percent
  • Cerner – 18 percent
  • Cognizant – 16 percent
  • McKesson – 25 percent
  • Philips – 17 percent

This week on HIStalk Practice: Allergy Partners opts for Medfusion technology. Rhode Island practices unite as Brown Physicians Inc. Outcome Health raises $500 million in a quest to assist 70 percent of practices. Practice Fusion’s Matthew Douglass argues that America’s doctors need net neutrality. HealthTap expands to New Zealand, while Heal heads to Washington, DC. EVisit raises $2 million. US HealthWorks taps AmericanWell to power its new telemedicine service for employers.


Thoughts on the $155 Million DOJ Settlement of EClinicalWorks

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I had these reactions when writing about the company’s settlement.

  • I was curious about how many EPs have attested to Meaningful Use using EClinicalWorks. ONC’s Health IT Dashboard shows around 25,000, making it the #3 EHR vendor (behind Epic and Allscripts).
  • The settlement amount represents 35 percent of the company’s annual revenue of $440 million.
  • The settlement could be only the beginning of ECW’s problems, as it now has to deal with potential customer defections, the inevitable drop-off in sales, and potential class action provider lawsuits. It could possibly be sued by its certifying body, Drummond Group, plus it is required by the settlement terms to implement internal and external review programs.
  • I assume the value of the settlement was based on the MU payments that were made to ECW-using EPs, which I’ll also assume means that HHS won’t go after the EPs individually. The complaint says the federal government is entitled to recover triple the value of fraudulent claims (presumably the MU incentives paid) plus a percentage of the company’s profits that represented “undue enrichment.” Still, as reader Debtor points out, ECW-using EPs could have been paid around $2 billion in Meaningful Use incentives, so as he or she says, “that the DOJ settling for pennies on the dollar and no criminal prosecution is unbelievable.”
  • Does Drummond Group, which certified ECW’s EHR, bear any responsibility (legal or otherwise) for failing to detect that ECW was – according to the complaint – rigging its test results? On the other hand, it could argued that since the certification testing scenarios are public and static, the certification body has no easy way to detect fraud in observing only the desired scenario outputs. Certification testing is not dynamic nor comprehensive – it’s following a script to see if the expected outputs are produced.
  • The $30 million whistleblower payment will surely encourage others to report any similar problems with other vendors.
  • Clearly DOJ was not happy that ECW apparently charged customers for software updates, made it hard and/or expensive for them to migrate from ECW to other EHRs, and did not make it easy for its customers to exchange information with other practices.
  • The kickback portion of the complaint arose from ECW giving users a $500 maintenance credit to refer a prospect who eventually signed on as a customer (those payments totaled $144,000), paying users to host site visits ($249,000), compensating customers to provide good product references, and providing consulting fees, honoraria, and gifts to influential users who pitched its product, with one unnamed doctor earning “tens of thousands of dollars in ‘consulting’ fees.” The complaint makes it clear that manufacturers can’t pay any kind of remuneration to encourage use of their products for which the federal government pays via Medicare and Medicaid. 
  • It’s not clear how the settlement affects ECW-using EPs who could continue attesting under the Medicaid part of Meaningful Use for several more years. Apparently not at all since the product’s certification remains intact.
  • Two ECW technical employees will pay relatively small settlement amounts over the product’s inability to process RxNorm terminology for e-prescribing. One of those employees was the developer in charge of the RxNorm software functionality and the other submitted ECW’s final certification application. The complaint says the certification body certified the product in 2013, heard afterward from ECW employees that the software didn’t really process RxNorm codes, and then re-tested the product with the same protocol in 2015, which ECW passed only because it hard-coded the expected 16 RxNorm codes.
  • The complaint says ECW’s EHR did not use LOINC or SNOMED CT terminology.
  • The complaint says ECW released software without adequate testing, relied on customers to report problems, allowed critical problems to remain unresolved for months or years, and reintroduced previously fixed bugs because its software version control was not reliable.
  • The company’s October 6-9 user group meeting should be interesting.

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The whistleblower in the case was Brendan Delaney, who was a New York City employee implementing ECW at Rikers Island for prisoner healthcare when he noticed software problems. He has also worked on ECW projects for Arcadia Solutions, HSM Consulting, and as a self-employed contractor. His LinkedIn says he’s revenue cycle manager at NYU Langone Medical Center, or at least was before he learned he’ll be pocketing $30 million (but unfortunately for him, whistleblower windfalls are taxed as ordinary income).

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Interesting points from the five-year Corporate Integrity Agreement the company signed with HHS OIG:

  • ECW is required to implement a quality assurance program to oversee software defects, usability problems, and any other issues that affect patient safety or product certification and to post known software problems on its portal.
  • The company is required to create usability and patient safety advisory teams, consisting of at least a doctor, pharmacist, and nurse.
  • ECW is prohibited from using contract language that prohibits customers from disclosing patient safety concerns and agrees that it won’t enforce that requirement in existing contracts.
  • The company must help customers who want to migrate to other EHRs and can’t charge them any fees, penalties, or service charges.
  • ECW is required to contact every customer with an email subject line of “Important information about your EHR software and services. You have new options free of charge to you.” The communication must start with a statement indicating that ECW has settled with HHS OIG to offer them free upgrades to the latest production version.
  • The company must track any payments made to existing customers for marketing purposes and must list all of payments it makes to providers on its website.

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What other vendors should do based on the settlement:

  • Review the certification process to make sure nothing is being faked, talking to the technical people rather than managers anxious to avoid becoming the shot messenger.
  • Don’t provide any kind of incentives for customers or their employees to help make new sales.
  • Make sure customers are notified quickly of software problems that endanger patients or that can cause billing mistakes or certification shortcomings.

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Meanwhile, the law firm that represented the whistleblower in the lawsuit adds a few points:

  • The firm filed Brandon Delaney’s lawsuit against ECW in 2015.
  • The firm’s website includes archived copies of advisories ECW sent to its customers that warned of software problems.
  • Brandon Delaney provided this statement: “I was profoundly saddened and disappointed by the indifference of senior health department officials and investigators for New York City when I provided detailed information about serious flaws in the EHR software that could endanger patients. I am grateful that Phillips & Cohen and federal government attorneys recognized the seriousness of my charges and dug into the matter quickly and thoroughly.”

The Letter EClinicalWorks Sent to its Customers Thursday

Dear Customer:

Yesterday we announced a settlement with the government. As part of the settlement, eClinicalWorks paid $155 million and agreed to bolster its compliance program. The inquiry leading to the settlement primarily centered on technical aspects of the Meaningful Use program and allegations that eClinicalWorks software had technical non-conformities related to some of the criteria, all of which have since been addressed.

eClinicalWorks cooperated fully with the government. We have not admitted any fault or wrongdoing, and our goal as a company is to always make sure we are doing the right thing. We have decided to put this matter behind us and concentrate all of our efforts on our customers and continued innovations to enhance patient care delivery. Importantly, our software remains fully certified under the Meaningful Use program.

One of the technical non-conformities alleged by the government involved the use of RxNorm codes in electronic prescriptions. From 2014 to August 2016, electronic prescriptions sent by eClinicalWorks users included NDC codes rather than RxNorm codes.  During this time period, more than 500 million prescriptions were successfully transmitted and filled, and most major pharmacies did not support RxNorm codes. The failure to include RxNorm codes in electronic prescriptions was completely inadvertent on the part of eClinicalWorks, as our software used RxNorm codes in other parts of the system, such as in C-CDAs. We gained nothing by not including the codes, which are available for free from the National Library of Medicine. We resolved this issue as soon as we learned of it.

Another technical non-conformity identified by the government involved data portability. The 2014 Edition certification criteria require EHR software to “batch export” patient records. There was confusion about the meaning of this requirement, however, prompting ONC in 2015 to issue a clarifying FAQ. When eClinicalWorks was tested for certification in 2013, its authorized certification body (ACB) at the time, CCHIT, determined that our software satisfied this requirement. In 2015, our new ACB, Drummond Group, disagreed and identified this as a non-conformity. eClinicalWorks resolved the non-conformity in 2015, and our software meets all MU Stage 2 data portability requirements.

Historically, technical non-conformities with the MU Program were addressed through an administrative rather than a legal process (visit the ONC’s Certified Health IT Product List (CHPL) website for a list of EHR vendors with non-conformities: https://chpl.healthit.gov/#/search). eClinicalWorks chose to settle this matter to avoid the uncertainty of a prolonged legal dispute which could have been disruptive to our customers, our employees and our company.     

The government also alleged that eClinicalWorks’ customer referral program violated the federal Anti-Kickback statute. Under this program, called “Refer a Friend.”eClinicalWorks granted a credit, typically in the amount of $500, against existing users’ support and maintenance fees. Between 2011 and 2016, eClinicalWorks paid $392,000 to users under this and related programs. While referral programs like this are common in the industry, and while HHS-OIG has provided no guidance regarding them, the government took the position that the payments were improper. We disagreed but have nevertheless discontinued the program.     

There is a silver lining to this settlement. Today, eClinicalWorks has a more robust compliance program, and we continue to invest our resources and energy into making sure the products and services we deliver serve our customers well in the long run. We paid the settlement amount using cash on hand and have the resources to continue to grow and innovate.

It is our privilege to serve you. I am committed to enhancing our products and services. We will be releasing V11 later this year as planned and seeking certification for Meaningful Use Stage 3.   

We founded this company 17 years ago with the mission of improving healthcare together. The settlement does not change that.

Sincerely,

Girish Navani, CEO


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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Medical image viewing system vendor TeraRecon acquires machine learning vendor McCoy Medical Technologies and creates a new company that will distribute trained machine learning algorithms for clinical decision support, also offering researchers and hospitals an easy way to distribute their algorithms for research or commercialization.

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Accenture will acquire 250-employee laboratory informatics consulting firm LabAnswer, which it will fold into the newly created Accenture Scientific Informatics Services. 


Sales

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Carilion Clinic (VA) chooses Influence Health’s directory listings management system to monitor its online presence, provide accurate online location listings, and call out unofficial social media pages.

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Memorial Sloan Kettering Cancer Center (NY) and Intermountain Healthcare (UT) will use the genomics platform of Philips for cancer research and treatment.


People

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Children’s of Alabama (AL) hires Bob Sarnecki (ClearData) as interim CIO.

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In England, Beverly Bryant (NHS Digital) will join System C as COO.

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SurveyVitals, which offers digital patient experience surveys, hires Robert Harrington, Jr., MD (Reliant Post-Acute Care Solutions) as chief medical officer.

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Rob Bart, MD (LA County Department of Health Services) joins UPMC as CMIO.


Announcements and Implementations

An Ellis and Adams research report reviewing the impact of hospital acquisitions on quality finds that the average quality score of an acquired hospital slipped 5 percentage points in the first year.

DrFirst launches new solutions for Meditech users – SmartSig to manage free text prescription instructions and integration with prescription drug monitoring program databases.


Privacy and Security

The medical records (including photos) of 15,000 patients of a Los Angeles plastic surgery clinic – some of them celebrities – have been stolen by a fired employee.

In India, the Mumbai health department’s online birth and death registry is taken offline following complaints that its lack of security was allowing anyone to look up random names and print their birth or death certificates. A government official complains that only the medical health officer is now allowed to use the system and “he cannot keep printing certificates for everyone” in keeping up with the city’s daily workload of 400 births and 200 deaths.

Australia’s health department decides that the records of people who opt out of its My Health Record system won’t be deleted, but rather hidden from providers, allowing those who opt out to change their minds later.


Other

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Australia’s Digital Health Agency issues a request for tender for developing a plan to connect all health-related systems over 5-10 years.

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A five-sentence letter published in NEJM in 1980 concluding – without much evidence – that opiates aren’t addicting when prescribed for chronic pain has been cited more than 600 times since, with references to the article spiking after OxyContin was brought to market in 1995. The authors note that most of the citations misinterpreted the information or mischaracterized the letter’s conclusions in encouraging doctors to use long-term opiate therapy that contributed heavily to today’s national addiction, leading to their recommendation that authors cite previous studies carefully.

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Facebook is hosting an invitation-only meeting next week to court drug companies as advertisers.


Sponsor Updates

  • ECG Management Consultants publishes its “2017 Thought Leadership Compendium.”
  • EClinicalWorks will exhibit at the California Primary Care Association Region IX Clinical Excellence Conference June 4-6 in Lahaina, HI.
  • FormFast and Imprivata will exhibit at EHealth Canada June 4-7 in Toronto.
  • Aprima wins Frost & Sullivan’s product leadership award for its RCM platform.
  • HBI Solutions publishes a new white paper, “Turn Data Science into Value: The Four Key Requirements.”
  • The Atlanta Business Chronicle profiles CFO of the Year finalist and Ingenious Med Chief Compliance Officer and CFO David Lamm.
  • InterSystems’ TrakCare tops global EHR deployments, according to a new KLAS report.

Blog Posts

HIStalk sponsors were listed in the Healthcare Informatics 100 highest-revenue healthcare IT companies, representing 38 of the vendors named:


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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HIStalk Interviews Jason Krantz, CEO, Definitive Healthcare

June 1, 2017 Interviews No Comments

Jason Krantz, MBA is CEO of Definitive Healthcare.

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Tell me about yourself and the company.

I’m the CEO of Definitive Healthcare. We started about six years ago. We provide detailed information and analytics on the healthcare provider market. We track data on everything from hospitals to physicians to imaging centers. Our goal is to have the best data on every facility and provider of healthcare in the US.

Does your business overlap with that of HIMSS Analytics?

HIMSS tracks a lot of data on technologies within hospitals. We do that as well. We’re much more broad. We tie the technology back to the analytics on what’s actually happening at the hospital. Things around readmission rates are very important to our clients. We track a lot of data on affiliations and how these organizations refer patients back and forth across the continuum of care.

How much of the information that you collect in having conversations with people in health systems hasn’t been publicly announced?

A lot of the really interesting stuff that we get is through conversations with IT directors and CIOs at hospitals, as well as people on the finance side. Probably 30 percent to 40 percent of our data is from a completely proprietary source that has not been announced anywhere else.

I assume a significant part of your market is vendors looking for marketing and sales data. What kind of information do they want?

The uses are changing over time. Six years ago, it was, do they have an EHR system? Which one? That is still a very important element of what they want to know, but it’s for a different reason. Oftentimes they’re trying to think about how to bolt on technology.

As the technology is becoming more sophisticated and EHR systems are becoming more ingrained with what they’re doing every day, a lot of our clients are interested in what the healthcare ecosystem looks like in a particular market. Who are the players, who owns who, who works with who and aligns with who. All of that is incredibly important to the technology players because the EHR system being at one hospital is interesting, but where it becomes really useful to healthcare is when everybody can talk to each other.

A lot of the vendors now are thinking about, how do I expand my reach beyond the hospital or the health system to link in all of the imaging centers and the most important physician groups and all of that? Our data helps paint a picture of what that ecosystem looks like and where the informal partnerships and alliances exist. That helps them think about, what is our go-to-market strategy? Who are the important players to get involved that are the influencers and can drive change within that market?

Other things they’ll think about is, depending on what their technology is, the revenue cycle guys will try to understand not only what’s in there today, but the collection process for that hospital and who the important people are for that collection process. The care coordination people want to understand the ACOs that are in partnership with the hospitals. All of that arms them with the information that they need to go have an intelligent conversation with a CIO or a CFO.

Does your conversation touch on user satisfaction with a given product or a potential system replacement?

We don’t go so far as to say somebody is unhappy. There’s some inferred satisfaction with the fact that they’re making a change or looking for a new technology, which is the type of things that our data will pick up. A lot of the people that we’re speaking to on a day-to-day basis are not going to go out on a limb and say, we’re flat-out unhappy with a vendor. Therefore, we don’t necessarily ask that question.

A lot of the product decisions must be driven by new affiliations, where a hospital or practice didn’t necessarily acquire or become acquired, but partnered with another organization in a non-ownership model.

There’s so much of that. Obviously mergers and acquisitions is a pretty tremendous trend within the market right now. We track something like one merger-related piece of news per day, a major piece of news.

Informal alliances are becoming increasingly important because there’s a limit to how far you can take the M&A game, especially as these markets become a bit more concentrated with ownership already. As everything moves to outpatient, it’s a lot less expensive to start this stuff up on your own.

Urgent care is a great example. You can have a couple of physicians who band together and create an urgent care clinic or two or three or four that can become extremely profitable very quickly. The hospitals may end up buying those up over time, but those are sprouting up so quickly that you need to create alliances with those organizations, even if you’re not in a direct ownership situation. The move to outpatient is spreading out the care so much that the need to have these informal alliances is becoming more and more important.

What other big trends are you seeing?

Something that comes up a lot that is nascent but that our clients are particularly interested in is the move towards mobile and telehealth. It’s almost like the Internet was in 2000. Telehealth is finally starting to come to its time in the spotlight. Telehealth has been around for a while and mobile health’s been around for a while, but the tools didn’t exist for it to get exciting — better phones, better cameras, and the ability of wearables that can collect information. All of a sudden all of these technologies can actually work, whereas with the Internet in 2000, it was Pets.com and in 2002, that company went out of business and everybody said, “That was the stupidest idea ever.” Now there’s Chewy, which is a billion-dollar company selling pet food online.

The mobile and telehealth stuff is finding its way now after trying to for many years. We’ve seen a lot of interest and a lot of questions around, what are people doing? What’s working? What’s not? A lot of that is just because it is still such a new market that there’s a lot of interest in how to make it work.

Are health systems forming relationships with turnkey companies like Teladoc that has their own doctors or are they more interesting in creating a service that features their own medical staff and brand identity?

Where we’re seeing health systems attacking is much more around chronic diseases. How do you manage that better? If you think about a capitated payment model where the health systems are taking some of the risk for things like diabetes care, if you can keep people out of the hospitals, obviously that’s a tremendous benefit to you. Things around wearables that can measure blood glucose and technologies like that are very interesting to them,  to be able to get that data in real time and essentially get in front of any issues before they become a big issue.

Along the same lines is medication adherence. That’s a little bit out of pure telehealth and more into apps. How do you engage that patient on a regular basis and ensure that they are taking their medications? Once you release somebody from your hospital, how do you make sure that they don’t come back in for the same reason? Payment structures are driving them to think about things like that.

The classic telehealth, the doctor on the phone, is still struggling. Where we’ve seen a lot of success is around more behavioral, psychology, and psychiatry.

Are you detecting budgetary caution around the possibility that many patients could become uninsured with Affordable Care Act changes?

There’s a lot of talk of it. We haven’t completely seen that come through. We haven’t really noticed our clients saying that budgets are getting cut or projects need to be pushed down the line. It is potentially coming. There’s just still so much unknown that nobody’s hit the panic button quite yet.

And, the need for change is so high within the healthcare system that there’s no stopping it. They need to drive down structural costs still applies, whether there’s uninsured or not. On the one hand, you don’t want to spend as much money. On the other hand, you need to change your system quickly enough to be able to deal with lower payments if that’s what’s going to happen in the future.

What’s it like running a research-based business?

The most important thing that we think about is innovation. It’s absolutely essential. How do you get information that nobody else has been able to find, do it in an efficient way, and present it in a way that people can take tomorrow and go utilize? Within healthcare specifically, there’s just so much data that’s out there that it can quickly become noise if you’re not innovating and showing clients, here’s what you should draw from the information. Here’s how you can go use it tomorrow. Here’s data that you just can’t find anywhere else.

It’s an extremely difficult business. It’s competitive. The way to stay in front of the competition is to continue to innovate and do things nobody else is doing. It changes so fast. Every day we’re rethinking about, how do we do this better? That’s essential to staying at the place that we’ve been able to get to.

EPtalk by Dr. Jayne 6/1/17

June 1, 2017 Dr. Jayne No Comments

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I took a break from writing over the Memorial Day weekend due to having the privilege of participating in events honoring our nation’s veterans. On Saturday, I assisted with an Honor Flight, welcoming 22 veterans and their families back from a trip to Washington, DC, where they visited the monuments dedicated to their service.

Along with active duty service members, we lined the airport terminal to salute the veterans as they were transported from the gate to the baggage claim area. There they emerged from a tunnel of American flags to greet family and well-wishers in a celebration complete with a USO-style band. These gentlemen, most of whom are in their late 80s and early 90s, helped save the world. I am honored to have been able to work with them.

Three brothers were on the flight, having served in WWII, Korea, and Vietnam. They lifted a beer at the Vietnam Memorial to honor fallen friends. The picture of that moment shares more than a thousand words. WWII veterans are passing on at a rate of 640 per day, according to VA data. Most of the veterans I’ve worked with over the years don’t want to talk about their service, but saying thank you is always appreciated.

Sunday was a little more sobering when I volunteered with a group charged with placing flags at all graves in our National Cemetery as well as on the graves of veterans buried at a dozen Jewish cemeteries. Our local post of the Jewish War Veterans of the USA provided breakfast for over 500 of us before we set out on our task. After the flag is placed, it is saluted. Each veteran’s name is read and they are thanked for their service.

Our small group placed over 1,000 of the 200,000 flags that went out that day. A small commitment compared to what those we honored have given. If you’ve never done this and have the opportunity, I would strongly encourage you to take part. Every one of those flags has a story and it’s something to think about on days when we’re tempted to complain about spotty cell service and slow lines at Starbucks.

I saw patients on Memorial Day itself since many of my partners are former military officers and having the rest of us work allowed them to participate in local remembrances. It was a busy shift due to the three-day weekend.

I experienced something I haven’t seen before, which was having a parent drop off a 12-year-old at the urgent care and then leave him in the exam room to run errands. Of course, we can’t treat a child without a parent there to provide consent, so we had to wait. After an hour, I was wondering at what point it becomes child abandonment when the parent returned, acting like his actions were no big deal. I hope the patient wasn’t too scared about being left alone. We tried to check on him regularly while waiting for Dad to turn back up.

Tuesday sent me fully back into the healthcare IT fray, mopping up after a client who decided to try to install an upgrade over the weekend despite their vendor’s support desk being closed for the holiday. While I was re-running and monitoring the upgrade scripts, I had a chance to catch up on some articles that friends and readers had sent my way.

One caught my attention with its headline that “Patients Fare Worse with Older Doctors, Study Finds.” It cites research from Harvard Medical School looking at Medicare data for over 700,000 hospital admissions. The patient mortality rate rose for each decade of physician longevity, ranging from 10.8 percent for physicians under age 40 to above 12 percent for physicians over age 60. However, physicians who saw large volumes of patients didn’t seem to have a change in mortality rates due to age, rather those rates remained consistent for higher-volume physicians. Seeing more patients may force physicians to stay current, but it could also be that lower volume physicians see fewer patients because they are less knowledgeable.

The article offers some other interesting conclusions, but I’d be interested to hear what readers think. One 74-year-old physician keeps current by reading multiple medical journals each day. That kind of volume would be hard for me to do, so I applaud him for being what he describes as “addicted to keeping up to date.” He’s a medical school dean, so I’m not surprised.

Another piece from Boston’s NPR new station chronicled one burnt-out doctor’s decision to leave medicine. The author notes that while many people ask why she left, virtually no physicians ask her that question. They instead ask how the transition worked.

I’ve had numerous physicians approach me over the last few years asking about clinical informatics as a potential way to get out of clinical practice but still be able to positively impact patient care. I would be dishonest if I didn’t acknowledge that I leveraged the move to full-time informatics as a way to get out of paying for supplemental liability insurance (so-called “tail coverage”) as well as a way to get free of a restrictive non-compete clause. In my situation, those were beneficial side-effects of the move, however, rather than incentives.

The article was sent to me by a former residency colleague who is trying to formulate her own exit strategy. She was one year behind me in training and we caught up recently for drinks. Out of the 13 family medicine residents in our two classes who we’ve kept up with:

  1. Clinical informatics: 1
  2. Residency faculty: 1
  3. Retrained in another specialty: 1
  4. Cosmetic/age-reversing medicine: 2
  5. ER/urgent care: 2
  6. Concierge practice: 1
  7. Left medicine to care for family: 1
  8. Part-time practice: 1
  9. Incarcerated: 1
  10. Full-time primary care: 2

Those are some sobering statistics for physicians who aren’t even 20 years out of training. They also paint a different picture of the primary care shortage, one where lack of training slots are not the problem.

I hate to see my friend consider leaving medicine, as she practices in a relatively underserved area and also serves as the medical director for a home hospice organization. Those vital services aren’t easily replaced. She has already stopped delivering inpatient care and next week marks the end of her hospice practice. Her eight-year plan gets her children nearly through college while letting her only sit for Board recertification exams one more time. I’m glad that she’s designing a strategy that lets her keep seeing patients while trying to address potential burnout. I will be supportive no matter which way she decides to go.

Are you thinking about leaving healthcare or healthcare IT? Email me.

Email Dr. Jayne.

Morning Headlines 6/1/17

May 31, 2017 Headlines No Comments

Electronic Health Records Vendor to Pay $155 Million to Settle False Claims Act Allegations

eClinicalWorks will pay a $155 million to settle a Department of Justice investigation alleging that it misrepresented the capabilities of its software during the EHR certification process.

Soon-Shiong appointed to health IT committee

House Speaker Paul Ryan appoints Patrick Soon-Shiong, MD  to the 25-member Health Information Technology Advisory Committee, despite a recent STAT investigation alleging that Soon-Shiong orchestrated inappropriate financial transactions between his businesses and his non-profit research organization

Health information exchanges reduce redundant medical procedures

A Brookings Institute report, co-authored with researchers from SUNY Buffalo and the University of Connecticut, finds that the implementation of a health information exchanges in western New York was associated with a decrease in the number of repeated therapeutic procedures performed, but had no impact on the number of diagnostic procedures performed.

Swedish double-booked its surgeries, and the patients didn’t know

A Seattle Times investigation finds that Swedish Health neurosurgeons routinely double-booked themselves, running multiple operating rooms at the same time.

EClinicalWorks Will Pay $155 Million to Settle DOJ False Claims Act Allegations

May 31, 2017 News 31 Comments

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EClinicalWorks will pay $155 million to settle a federal False Claims lawsuit alleging that ECW misrepresented its EHR product and paid customers kickbacks for promoting it, the Department of Justice announced today.

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The government claims that ECW fraudulently obtained certification for its EHR by hard coding some of the testing elements as provided to its certifying entity. It also says ECW’s software did not accurately maintain a user audit log, did not reliably record diagnostic imaging orders, failed to perform drug interaction checks, and failed to meet interoperability requirements, thus causing false claims for HITECH incentive payments to be paid by HHS.

According to ONC’s Certified Health IT Product List, ECW’s Authorized Certification Body is Drummond Group.

The company and three of its founders will pay the $155 million settlement.

ECW also entered into a five-year HHS OIG Corporate Integrity Agreement that requires the company to have its software quality control systems externally audited and reported to HHS OIG. The company also agreed to provide prompt notice to customers of any EHR-related safety issues, to make software updates available at no cost, and to assist customers in migrating to other EHRs without charging them. ECW is also required to hire an Independent Review Organization to certify that the company’s agreements with providers comply with anti-kickback laws.

The whistleblower lawsuit was filed by Brendan Delaney, a software technician with New York City Division of Health Care Access and Improvement, who will receive $30 million of the settlement.

I’ve run several reader-provided rumors about the Department of Justice investigation, going all the way back to late 2015.

Digital Health Trends – 2Q17

Digital health updates are written by LoneArranger, an anonymous industry insider.

Digital health capabilities are increasingly becoming more integrated with core healthcare platforms and provider workflows, leading to major changes in the way healthcare is being delivered. There have been several recent developments in the application of technologies such as artificial intelligence, virtual and augmented reality, and wearable devices that have been disruptive, have the potential to change the practice of medicine and transform population health management and precision medicine.

Innovations in areas such as mobile apps, the Internet of Things (IoT), machine learning, and artificial intelligence are being incorporated directly into healthcare applications. As the digital health industry moves into the next wave of innovation, the following areas are those that many healthcare providers, payers, vendors, and digital health startups are targeting for development.


Artificial Intelligence (AI)

AI capabilities will become increasingly accepted and used by healthcare professionals as a clinical decision support tool to identify potential risks, mitigate errors, recognize patterns, and improve disease diagnosis and treatment. AI and Machine Learning will increasingly drive population health analytics, clinical decision support, and scientific research.

Blockchain

This technology framework has the potential to allow hospitals, doctors, and insurance companies to share data more securely, assuming the role of a trusted gatekeeper. Using the concept of a shared ledger, it makes it possible to share information selectively with others. Digital records can be stored with variable access controls and digital assets can be exchanged with minimal friction. Organizations are expressing increased interest in the significant potential blockchain has for improving healthcare information management.

Genomics

A substantial amount of funding has gone into the study of genes as researchers and providers pursue new disease treatment options and patients seek more tailored and personalized healthcare plans. Pharmaceutical companies are leveraging genomics research to develop new medications for cancer and other serious conditions as well as other therapeutic compounds for advanced immunotherapy treatments. Many EMRs are now configured to maintain genomic data in the patient record, along with existing medical data, to provide a more complete picture for providers.

Internet of Things(IoT)

The use of data from portable devices and sensors has given providers more real-time information on patient health status and patients the ability to have tailor-made strategies to combat illnesses and to take a more proactive role in managing their health. The connectivity of healthcare solutions and devices improves patient management, disease management, and the outcome of treatments. Since patients and providers both benefit from IoT, it will have a bigger presence and impact within the healthcare sector over time.

Mobile Apps

The major shift in this area is the evolution from standalone applications to ones that are more tightly integrated with legacy healthcare platforms and the clinicians who use them. Apps that connect providers and patients are gaining traction. These are being used to help coordinate and manage patient care, increase patient engagement, and support more effective treatment of chronic disease conditions.

Telemedicine

As technology becomes more affordable, remote treatment options continue to grow in popularity for both doctors and patients. For the elderly and those living in rural areas, telemedicine provides increased access to healthcare services that otherwise might not be possible, from remote diagnostics and monitoring to medical education and outpatient services. Both public and private payers are also starting to provide increased reimbursement for telemedicine services and state laws are changing to remove restrictions and facilitate the provision of telemedicine services.

Virtual and Augmented Reality

The use of VR and AR technologies will expand in healthcare for medical education and training, surgical support, other types of decision support, and pain management. They can be used for simulation of scenarios, decision support for providers performing procedures, and distraction, education, and entertainment of patients.


These technologies are enabling a variety of new applications in areas such as:

Behavioral Health

Behavioral health conditions are increasingly prevalent and challenging to treat. The insurance industry and self-insured employers recognize that the costs of treating mental health conditions, including depression, are increasing. Although long-term efficacy has yet to be demonstrated for most digital solutions, insurers and employers are increasingly willing to pay for digital behavioral health pilots. It is increasingly reimbursed by Medicare and investors are beginning to fund this sector. The hope is that more engagement and interaction, facilitated by digital technologies, may help patients with depression, anxiety, substance abuse, PTSD, and other behavioral health conditions.

Chronic Disease Care Management

Chronic care interventions use a combination of health, behavioral, and contextual data – such as glucose levels, sleep patterns, weight, food consumption, activity, social factors, time of day, and weather — to improve patient treatment plans. Digital health tools can also be used to improve care team communication and coordination. These applications have demonstrated such compelling clinical efficacy that insurance companies are starting to pay for them because of improved patient outcomes at reduced cost. Pharmaceutical companies are also interested in integrating digital interventions with their drugs to improve outcomes, differentiate their products, and engage directly with patients.

Data Aggregation and Analytics

In the past few years, there has been a dramatic increase in the amount of digitized health data stored in EMRs and ancillary systems, fitness and health data captured from mobile devices and wearables, and genomic data. There are many potential uses for this explosion of new healthcare data. Insurance companies and companies that pay for employees’ health care directly can use additional data to help refine actuarial models. Physicians can use analysis of this data for diagnosis, quality improvement, and decision support. Patients may benefit from the mining of data for predictions of their propensity for acquiring certain health conditions. As a result, real-time alerts and guidance to patients and healthcare providers are becoming more feasible and useful.

New Payer Models

A recent and intriguing area of investment in digital health is in alternative insurance companies. These startups often compete directly with major industry players, which have also been exploring and deploying digital health solutions. However, these new insurance industry entrants have some advantages over the incumbents. These entrants are unencumbered by existing infrastructure and relationships and thus can establish tighter relationships with provider networks and provide more flexibility. They can also build their technology stack from the ground up which enables them to more effectively use digital health data and solutions to target specific, stratified patient groups. Their primary challenge is achieving sufficient scale and differentiation to compete effectively against the larger, more established payers.

Provider Workflow Enhancement

Digital technologies can help give time-constrained healthcare professionals the ability to see more patients in less time, while delivering a better patient experience, by using data analytics for decision support, more efficient workflow, and different forms of mobile communication and collaboration.

Additionally, the cost curve can be shifted by leveraging less expensive resources. Given decision support tools, artificial intelligence, and data analytics, primary care physicians should be able to do some of the work specialists currently do. Nurses and case managers will be able to reduce a physician’s workload, and increasingly, patients will be able to manage their own care at home with mobile devices.

Collectively, these new applications will dramatically transform the delivery of healthcare services.

Recent Investment Trends

According to a recent report from CB Insights, large technology companies are increasingly focusing on investing in new initiatives in the healthcare domain. Since 2012, the top 10 tech corporate players in the US invested $6.2B over 143 healthcare deals according to CB Insights. Deals and funding into the sector with participation from these corporate entities has increased every year since 2012 to hit a high of 41 deals last year and $2.7B in funding, triple the funding total in 2015. In their report, CB Insights summarized the healthcare activities of the major tech companies:


Google

Google is the most active tech corporate investing in healthcare in the United States. Virtually all of its activity has gone through GV. CapitalG, Google’s growth equity fund, has made investments into Oscar Health and Practo Technologies while Google itself has co-founded Calico Life Sciences and acquired Lift Labs. Lift Labs develops a swiveling spoon that makes eating easier for patients with neurodegenerative hand tremors.

Recent GV investments include everything from health insurance (Clover Health) to gene therapy (Fulcrum Therapeutics) to vaccine development (SpyBiotech).

Google has not been shy about investing in therapeutics. In addition to Fulcrum Therapeutics, GV has made deals to Magenta Therapeutics, Spero Therapeutics, Arcus Biosciences, and Forty Seven all in the last year. Magenta is working on stem cell transplantation, Spero is focused on bacterial infections, and Arcus Biosciences and Forty Seven develop cancer immunotherapies.

GE

Once focused on lighting and electricity, the modern GE is a multinational conglomerate operating across many sectors. It is also one of the most active healthcare investors among US-based tech corporates. Recently, the company has made deals to HealthReveal, which monitors and predicts adverse health events, EMR data analytics company Arcadia Healthcare Solutions, and primary care provider Iora Health. The largest deal with GE Ventures participation was the $220M Series B of genome sequencing company Human Longevity in 2016.

Apple

Apple has made very few investments in healthcare startups despite diving into the sector internally with services such as HealthKit, CareKit, and ResearchKit. Apple has made two recent acquisitions in the space, however. In August 2016, the company acquired Gliimpse, developers of a personal health data platform, and in May 2017 acquired Beddit, which developed a sleep monitor that tracks heart rate, breathing, snoring, and sleep quality.

IBM

IBM has invested through both its corporate entity and the IBM Watson Group. While IBM Watson is an natural language AI platform, the company has made deals to both pharmaceutical and genomics companies such as Pathway Genomics (2014, 2016), Lodo Therapeutics (2016), and Petra Pharma (2016), and ApoGen Biotechnologies (2016).

Amazon

Amazon’s only healthcare investments in the past four years have been cancer diagnostics company GRAIL and baby monitoring startup Owlet Baby Care, the latter being backed by the Amazon Alexa Fund. Steve Rabuchin, VP of Amazon Alexa, has stated that the company will integrate Owlet with Alexa. In March of this year, Bezos Expeditions and Amazon participated in GRAIL’s $914M Series B.

Intel

All of Intel’s investments in healthcare startups have gone through its venture arm, Intel Capital. The corporate entity has made two acquisitions in healthcare, Basis Science (2014) and IDesia (2012). Basis Science develops heart rate and activity monitors, while IDesia offers security identification technology based on a person’s unique heartbeat. Intel has participated in numerous rounds to both CareCloud and Sotera Wireless. CareCloud is a provider of cloud-based medical record and billing software, while Sotera Wireless develops wireless devices for in-patient monitoring of blood pressure, heart rate, oxygen saturation, and other biometrics.

Others

Facebook, Amazon, Microsoft, Cisco, and Oracle have all demonstrated limited private market activity in healthcare since 2012. Below are listed a few deals with participation from these corporate entities.

  • In 2014, Facebook acquired Finland-based Protogeo, a developer of fitness tracking apps.
  • Microsoft has made two healthcare deals since 2012, one from the corporate entity into Advanced Dental Cloud,and one through Microsoft Ventures to Livongo Health. Advanced Dental Cloud makes software for modeling dental implants and Livongo Health combines coaching and connected devices to improve diabetes management.
  • Oracle has made one acquisition and one equity investment into healthcare startups since 2012. It acquired clinical trial management software provider ClearTrial in 2012 and participated in Proteus Digital Health‘s $45M Series F in 2013. Proteus has raised on four other occasions since then, with no disclosed Oracle participation.
  • Cisco has made no equity investments in healthcare companies since 2012. The one deal shown on the social graph above refers to a grant made to Teslon in January 2017.

According to CB Insights, funding this year has already reached over $1.5B spread across 18 deals. That’s already more dollars to the sector so far this year than in 2015. At the current run rate, 2017 is on track to reach $4B across 48 deals, a five-year high for tech corporates participating in deals involving healthcare startups. The historical and current participation of these companies in healthcare industry investments is summarized below.

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Conclusions

Healthcare is increasingly being impacted and disrupted by digital health innovations. The digital health sector has moved beyond the first wave of simple wellness devices and applications to integrated solutions from companies that are beginning to have a deeper understanding of how technology can be used to make healthcare more effective and efficient. Consumer companies such as Fitbit, Apple, and Samsung are beginning to partner with major payers, providers, and pharmaceutical companies. As shown above, major technology companies are also investing large sums in the healthcare sector to augment their existing products and support new strategic initiatives.

Despite this shift, many experts agree that there are too many companies targeting the same narrow problems. Many digital health founders have come from the technology industry and try to solve a problem that they have personally encountered within the imperfect healthcare system, whether it is truly widespread or not. Others may have just graduated from college and have limited business exposure, let alone any healthcare experience, and don’t understand the relevant use cases very well.

The entrepreneurs who research and fully understand the complexities of this industry — including the relevant use cases, current workflows, the needs of providers and patients, and who will ultimately pay for these innovations — will be far more successful. Regardless of what digital health product or services startups offer, they will need to demonstrate a real value proposition and generate some evidence that outcomes are improved, revenues are increased, or costs are reduced or no one will pay for their solution or expend time and effort trying to integrate it within their existing health IT infrastructure.

HIStalk Interviews Andrew Kanter, MD, Chief Medical Officer, Intelligent Medical Objects

May 31, 2017 Interviews 1 Comment

Andrew Kanter, MD, MPH is chief medical officer of Intelligent Medical Objects and assistant professor in clinical biomedical informatics and clinical epidemiology at Columbia University.

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Tell me about yourself and the company.

I’m an internal medicine physician and a global health specialist. I’ve been  with IMO since its founding in 1994. I’m the chief medical officer. I’ve also spent time as president and chief operating officer and I’m a previous board member for the company. I’ve been full time with IMO since the onset of ICD-10-CM and Meaningful Use.

In 2008, I joined Columbia University and the Earth Institute to help Jeffrey Sachs bring health information technology to less-developed countries. We’re trying to achieve the Millennium Development Goals.

IMO started as a computer science department. We evolved electronic health records, which is now being sold as Allscripts Professional. We’ve taken the company from primarily being a consulting firm and a terminology product company to now a solutions company. We recently received a major investment from Warburg Pincus, which is the fifth-largest private equity firm.

My job as chief medical officer is to ensure that the content and lessons that we’ve learned over the last two decades at IMO transfer to our customers and to our vendor partners. IMO partners with most of the EHR vendors. Our installed base covers about three-quarters of the acute and primary care sites in the United States. Over a half-million doctors use us in the US alone.

Our primary mission is to improve care by helping the health information systems capture clinical intent in the most accurate, specific way possible. We’re about paving the semantic highway and driving downstream workflows and secondary use of data.

Coding and terminology drives billing, but what are the patient and societal benefits?

It’s very much about capturing that clinical intent for these downstream processes, including things like population health, risk management, and predictive modeling. We’re trying to improve care as well as bend the cost curve. It’s through capturing the clinical descriptions — what physicians actually think about in their heads – that is so essential to teasing out that value proposition.

Many people think of it in terms of the big chronic disease areas like diabetes, coronary artery disease, and so on, which certainly does have a reimbursement or billing implication. But for trying to improve care, we’re trying to identify exactly the patients who can most benefit from therapy and the most accurate treatment possible.

Using the high level of granularity that clinicians have to take care of their patients can be used probably even more for driving the identification of high-risk patient groups or specific patients who will benefit from treatment, therefore significantly improving the quality of care.

Assuming that providers are willing and able to physically exchange information, what terminology and semantic interoperability problems remain?

That’s one of the areas that people have often missed in the strive to develop the electronic data interchange part, but not necessarily the semantic interoperability part.

What we’ve seen is that as information tends to move around the health information system ecosystems across enterprises, a lot of that semantic fidelity gets lost. Systems have been designed primarily to support single-term, single-code relationships. With FHIR and CCDA, where more information is going to be transferred, if that fidelity is not maintained, there’s a lot of loss of good data and the ability to act on it.

One of the things that IMO has worked pretty hard on is to first initially capture that clinical intent, but then ensure that it’s maintained as information moves around the health ecosystems. As a matter of fact, IMO has been working with the Structured Documents Group of HL7 to ensure that there’s an approved method of sending the IMO lexical identifier within all of those interoperability messages — whether it’s CCDA or FHIR — to ensure that the full color is not lost.

IMO’s terminology frequently has more than one reference map, whether it’s SNOMED, ICD, or LOINC. We have about 80 maps that come off of our clinical interface terms that ensure that all of those terms are maintained as information moves through the ecosystem.

What’s the best solution for codifying information for specific purposes while retaining the patient narrative to avoid losing the underlying context?

Over the last 20 years, there’s been a lot of lessons learned about forcing physicians into structured data collection. We have the scars on our backs to remember those lessons.

There is a balance between structured and unstructured, although it’s a little bit of a false dichotomy. If you focus on capturing clinical intent and using interface terminology, it should be possible — through structured data and unstructured data — to capture the right content in a clinically granular way.

We work closely with many natural language processing companies to ensure that those engines are able to identify these pre-coordinated or highly physician-friendly terms within both narrative, unstructured text as well as structured text. It’s a key thing to remember that it’s not always in the places that we expect to find that information, where key information will be determined.

There has to be a balance between maintaining the full clinical story in the narrative text as well as the highly codified structured text.

Should clinicians have the ability to electronically highlight the structured or unstructured information that they find most useful so that a colleague covering that patient or receiving a referral could make quick sense of a patient’s chart?

That’s a difficult question. That assumes that the information that clinicians are dealing with within the health information systems is hard to decipher and that their information is not clearly available or can be recognized quickly.

This is something that we’ve been working on a lot. How to organize the data now that we’ve collected it in such a clinically-friendly, granular way. How to then semantically group that to drive various kinds of workloads. How to visualize the problems or the information in the record in a way that’s most relevant to me as a provider, based on my specialty and my experience with that patient. Trying to not lose information that may not be as relevant, but organize it in such a way that it doesn’t distract me, but it also doesn’t hide things that I might be interested in in the medical record.

That’s a real challenge. We don’t always know what is going to be the most relevant for you in the record.

Also, as you start to semantically organize and group things together, you’re going to use that information to drive all sorts of downstream workflows. Things like clinical decision support, which hopefully will help prompt providers for things that they shouldn’t overlook or that would be most relevant to them. As well as driving quality improvement programs, population health, clinical research, and so on.

IMO is spending a lot of time in developing those services. It’s not just about tagging things in the medical record, but about using those tags meaningfully to help organize the data in a better way.

Are patients receiving the expected benefits from the migration to ICD-10?

ICD-10 certainly was a huge burden in the transformation from ICD-9. The 80,000 or so codes added would have normally been a disaster for many providers to deal with.

Most people don’t have to deal directly with the ICD-10-CM codes, so it’s not so much those codes that are improving patients. It’s the clinical concepts and the clinical terminology that are really most relevant to providers and t patients.

There’s no question that the evolution to more granular coding systems will benefit both patients and providers by giving more specific care and being able to perhaps group or subset patients based on more granular concepts. ICD-11 and SNOMED CT are looking to be much more closely integrated so that those two use cases — the billing use case and the secondary use case — will overlap.

That’s going to take a long time, for us in the US in particular, to move to. In the interim, it’s up to vendors like ourselves to try to focus on the level of granularity and information that is most needed by the providers and for the patients. That will improve the quality of care.

You have a background in public health and global social causes, having served as president of Physicians for Social Responsibility. What optimism can you offer in looking at the US healthcare system and our social policy when it’s so easy to find negatives?

There’s an interesting parallel. For me, if we want to get the most value from data — whether it’s big data or small data — it’s about accurately capturing what’s happening with the patient. What we currently suffer from is a distorted view of that reality. Everything that we’ve been trying to do — whether it’s our clinical decision support dashboards or health information technology in general – it’s just not going to perform well if we can’t see the world clearly.

IMO and other organizations are trying to facilitate patient-doctor communication to accurately capture and see the world. It’s through that joint solution that we can transform healthcare.

For me, for someone who’s so active in trying to save the world from global poverty, climate change, and nuclear war, healthcare is actually the easy part. If we establish that pattern of behavior — the ability to share information clearly and focus on solving the problems — we could use that technology and the lessons we’ve learned from working together globally to solve these other grave threats to our society.

Morning Headlines 5/31/17

May 30, 2017 Headlines No Comments

Characterizing the Source of Text in Electronic Health Record Progress Notes

A study published in JAMA analyzing 23,000 Epic progress notes finds that 82 percent of the note is computer generated or copied forward from elsewhere in the chart, while only 18 percent is entered by the author.

Seton hospitals monitoring ‘suspicious activity’ on computer network

Ascension-owned Seton Healthcare (TX) goes back to paper after detecting “suspicious activity” on its network. Hospital officials are offering no details, but are reporting that “no devices have been reported as encrypted by ransomware.”

Court Documents Shed Light on Theranos Board’s Response to Crisis

Two former Theranos directors, former US Navy Admiral Gary Roughead and former US Secretary of State George Shultz, say they did not question Elizabeth Holmes or other Theranos leaders after allegations were made that the company was not using its own proprietary analyzers to process blood tests.

Insurance CEO: I’m raising Obamacare premiums because of Trump

The CEO of Blue Cross Blue Shield North Carolina reports that the ACA exchange in his state is stabilizing, but because the Trump administration is threatening to withhold cost-sharing subsidies, the organization is requesting 22.9 percent premium increases.

News 5/31/17

May 30, 2017 News 5 Comments

Top News

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An internal UCSF study finds that 82 percent of the text in a typical Epic progress note comes from copying/pasting or importing from other sources. Clinicians physically enter only 18 percent of the note.

Several hundred of the 24,000 notes reviewed contained no human-entered text at all.

The study is especially interesting because it used a new text analysis tool – apparently provided by Epic – to determine the source of every character of text in the note.


Reader Comments

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From Jack Fruit: “Re: CommonWell. Who were the original members?” CommonWell Health Alliance was founded in March 2013 by Cerner, McKesson, Athenahealth, Greenway, and RelayHealth (which is also owned by McKesson) as the Epic fears of the publicly traded competitors intensified to the point that they cooperated (and pony up a rumored $2 million each) to have something to announce at HIMSS13. Since then, McKesson has mostly pulled out of healthcare IT by spinning off Change Healthcare and looking for a buyer for its enterprise business and Greenway Medical Technologies was taken private by Vista Equity Partners a few months after the CommonWell announcement. Athenahealth shares are up 38 percent since the announcement, those of Allscripts are down 10 percent, and Cerner shares have risen 41 percent as all the founding companies have tried to diversify themselves out of a HITECH-free EHR market. CommonWell later added CPSI (now Evident) and Sunquest as founding members in mid-2013, but Sunquest is no longer listed as such on its site even though Sunquest’s site still says it’s a member.

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From Kathy: “Re: CommonWell survey. It would be most accurate for me to vote that it performed exactly as I expected – which was very little. CommonWell was never going to work. It was a political and business tactic.” Above are the early poll results.

From Tammy: “Re: CommonWell. I work for RelayHealth supporting the CommonWell network. CommonWell is not one EHR, it’s a network. It brings together multiple health IT systems and helps to solve the challenge of connecting disparate software run by different companies, using different technology. People’s definitions of numbers are different depending on what and how they count. What really is important is that we are all working towards helping providers and people get access to important health data that they previously couldn’t. CommonWell is definitely moving the meter in the right direction on this. What is different about what CommonWell is doing is that providers don’t have to search for records and guess where they might be located. They also don’t have to download and store every document for their patients – we’re about making it more efficient to get the data that is most valuable to the provider when they need it. Providers can query and view what documents are available, similar to a search engine, and only download those they need. I have seen 2x the volume of query and retrieval growth in the past year.”

From David McCallie (Cerner): “Re: CommonWell. It seems like a case of apples to oranges – it would be bad math to compare numbers that aren’t measuring the same thing. For Cerner, CommonWell queries are a small (but important) fraction of Cerner’s overall document exchange interoperability. We don’t know exactly what counts as a ‘record’ or gets included in Epic’s CareEverywhere statistics, but for Cerner, document exchange includes not only CommonWell, but also many existing point-to-point query interfaces (via Cerner Resonance, including many connections to Epic clients) as well as local HIE-based document queries, and data routed to providers through the ‘Cerner Hub’ services.  Cerner also supports a growing Direct-based document exchange.  To the clinician, these are all equally available sources for external documents and data. In general, the user interface does not distinguish the means of transport. CommonWell in many ways represents a national-scale ‘back stop’ for data that can’t be found via local queries. Now that CommonWell and Carequality have committed to mutual interchange, we expect that the number of CommonWell-mediated transactions will grow, since CommonWell will provide a common gateway to both its own network as well as any requested Carequality sites. CommonWell automatically bundles an MPI and a national Record Locator Service, so the clinician does not need to spend time deciding where to look for documents that aren’t local. Don’t count CW out … the network is growing, and any numbers they report represent a very high quality of interoperability use case.”

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From Spiker: “Re: health IT writing. Biggest problem is advertiser-friendly puffery. And mistakes like this one.” I disagree. The biggest problem is writer naiveté even in the absence of advertiser bias (unintentional or otherwise). Gushy, “world peace” kinds of health IT articles are always written by folks who have never actually worked in a health IT or clinical leadership role and thus have not learned from hard-won experience to distrust vendors, politicians, and health system executives until they provide a reason to believe otherwise. They’re also scared of being called out for lack of knowledge, so their writings tend to be harmless little bubbles floating aimlessly above the fierce, patient-impacting HIT battles being fought. The bar I set for everything I read regularly (especially if it expresses editorial opinion) is:

  • Does the writer enough knowledge and experience to be trusted?
  • Does the article tell me something I didn’t already know?
  • Can I really use the information?
  • Does the writer present the information clearly, concisely, and at my level, without time-wasting padding or distractingly unskilled writing?
  • Am I entertained, amused, or emotionally motivated in a positive way that makes me want to read more by the same writer?
  • And for the specific user-provided example above, make sure the author knows the difference between “pared down” and “parsed down” and doesn’t misstate “rev cycle” as “rest cycle.”

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From FlyOnTheWall: “Re: Mary Piepenbrink, RN. Joined a startup called Pieces Technologies as SVP of sales. What do you know about them?” I’ve heard of the Dallas predictive analytics company, but only barely. They’re a Parkland Health spinoff as I recall. Founder and CEO Ruben Amarashingham, MD, MBA has good credentials in informatics. The company raised $21.6 million in a single Series A round just over a year ago and apparently has earned a couple of customers.


HIStalk Announcements and Requests

The web hosting company is migrating the site to a bigger server, so let me know if you see anything weird, other than the fact that I’m posting this later than usual to accommodate the switch.

You’ll see some inarguably huge news related to a Meaningful Use-related EHR vendor settlement coming out, possibly as early as later today. The financial terms are mind-boggling. More to come once the Justice Department’s announcement is released.

Listening: The Stanfields, Nova Scotia-based hard-working rockers who wrap thoughtful, lyrically rich biographical stories with searing guitar (and mandolin) riffs. like AC/DC covering an Irish pub’s house band. It’s sonically spectacular poetry. You’re a poser rather a musician if you can’t play and sing acoustically in a bare room, to which I submit the amazing “Vermilion River.”


Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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Health management software vendor Mediware Information Systems acquires Kinnser Software, which offers home health and hospice systems.

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Two former Theranos board members – former US Navy Admiral Gary Roughead and former US Secretary of State George Shultz – say they didn’t ask founder Elizabeth Holmes about media reports stating that the company wasn’t running many tests on its proprietary Nanotainer finger stick technology but instead was using commercially available analyzers. Legal experts question whether the company’s board failed to meet their responsibilities in providing checks and balances to Holmes, who controls 98.3 percent of voting shares. To paraphrase “Animal House” in work-friendly terms, “You messed up … you trusted us.”

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Consumer health information site Sharecare, founded in 2010 by Dr. Oz and WebMD founder Jeff Arnold, receives an unspecified investment from Summit Partners, increasing its total to more than $300 million.


Announcements and Implementations

Google launches the free Data Gif Maker, a data illustration tool aimed primarily at journalists who need to tell data-driven stories but potentially useful to a wider social media audience. 

Medisolv chooses CloudWave’s OpSus Healthcare Cloud for making its quality management system available to customers as a SaaS offering.

Nordic announces that it has grown to 700 consultants serving 200 clients.

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Reaction Data publishes a new report on patient referrals and self-scheduling.


Government and Politics

The CEO of Blue Cross Blue Shield North Carolina says that the ACA marketplace is stabilizing in price, utilization, and risk to the point that an 8.8 percent premium hike would have sufficed for 2018, but instead the company has filed for a 22.9 percent increase because the White House keeps saying that it may not continue paying the premium subsidies that have been challenged legally. “The information we’ve seen coming from the administration actually creates more uncertainty,” the CEO says.


Privacy and Security

Ascension-owned Seton Healthcare (TX) says it has identified “suspicious activity within our network,” but provided no details, although it sounds like a ransomware attack. Meanwhile, patients report to the local TV station that the hospital has gone back to paper after warning employees to shut down the computers.

Other

A study finds that hospital EDs charge an average of 3.4 times the Medicare-paid rate for services they provide, providing as an example EKG interpretation, for which Medicare pays a median of $16 but for which hospital EDs charge other patients anywhere from $18 to $317, averaging $95. The highest-charging hospitals are for-profit, mostly in the South and Midwest, and serve more uninsured and minority patients.

USA-based Syria medical aid group UOSSM launches Syria Solar, a project to install solar power systems in the country’s hospitals, which run generators that use erratically available diesel fuel. Much of Syria’s electrical grid has been destroyed by bombing, leaving already struggling hospitals to deal with power outages for incubators, dialysis machines, and other vital equipment. 

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Rapidly rising drug prices are hitting seniors hard with higher co-pays even as Medicare’s share of the Part D cost has become its fastest-growing expense.  Novartis AG has raised the price of cancer drug Gleevec 77 percent in the past five years, increasing Medicare’s annual cost from $500 million to $1.23 billion and leaving the average Medicare patient paying $4,400 per year out of pocket.

I’ve read that Europe has become even more overrun with summer tourists in the past few years because huge-population countries like China and India are moving up the economic food chain and their now-wealthier citizens are joining the lines in Rome, Paris, and London. A New York Times article says that’s also true in healthcare, as frustrated, affluent citizens of China are bypassing the country’s overloaded hospital system and paying cash for care in the US and other countries despite the inevitable problems with transoceanic care coordination.

A Wall Street Journal article questions whether towns should continue operating tax-supported nursing homes, seven percent of which are government-owned. Their financial losses are increasing due to a glut of Baby Boomer residents, a high proportion of Medicaid residents as those with more assets seek out tonier facilities, and the White House’s proposal to cut Medicaid by nearly a trillion dollars. Cities are selling their nursing homes to private operators with mixed experience. The article profiles the city-owned, 45-bed nursing home in Cape Cod’s Nantucket, MA, which is losing $3 million per year, needs major repairs as the city grapples with other huge infrastructure upgrades, and attracts only the financially struggling year-round residents who would have to move out if the city’s only nursing home shuts down or raises rates.


Sponsor Updates

  • AdvancedMD publishes a MIPS Improvement Activities fact sheet.
  • Aprima will exhibit at the Associated Professional Sleep Societies Annual Meeting June 5-7 in Boston.
  • Audacious Inquiry publishes a series of white papers on what HIOs need to know about the 21st Century Cures Act.
  • Bernoulli publishes a new case study, “Achieving medical device connectivity across a multiple-hospital enterprise.”
  • Datica will present at the Wisconsin Entrepreneurs’ Conference June 6-7 in Madison.
  • Carevive Systems will exhibit at the ASCO Annual Meeting June 2-6 in Chicago.
  • Casenet will exhibit at AHIP Institute & Expo June 7-9 in Austin, TX.
  • Docent Health is featured in Redox’s “Digital Health Done Right” series.
  • The Jacksonville Business Journal includes CSI Healthcare IT in its list of “Best Places to Work 2017.”
  • Dimensional Insight will host its annual User Conference June 5-8 in Boston.

Blog Posts


Contacts

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

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Morning Headlines 5/30/17

May 29, 2017 Headlines No Comments

Silicon Valley is trumpeting A.I. as the cure for the medical industry, but doctors are skeptical

CNBC interviews six physicians on their opinion of artificial intelligence and its potential use in healthcare.

Two years in, what has Apple ResearchKit accomplished?

STAT covers the short history of Apple’s ResearchKit as scientists incorporate the platform into increasingly more complex studies.

VA looks at cut in tech funding

The VA’s IT budget is reduced as it grapples with the decision to either modernize VistA or implement a commercial EHR. VA Secretary David Shulkin is reportedly comfortable with the budget decrease, saying “What I think you’re seeing in this budget is a recognition that we do not want to continue to ask for more money and invest more money in fixing broken systems.”

Rebuilding the foundation of health care under MACRA

Deloitte and Network for Excellence in Health Innovation co-author a paper on the anticipated challenges health systems will have implementing MACRA.

Morning Headlines 5/29/17

May 28, 2017 Headlines No Comments

Better Healthcare for Albertans

In Canada, a report by the Albertan auditor general questions expected return on investment for the province’s proposed $1.2 billion clinical information system implementation because it does not incorporate primary care doctors and relies on view-only software that does not support real-time analytics. .

Speeding prescription process brings success to CoverMyMeds

A local paper profiles prescription prior authorization startup CoverMyMeds, which was acquired by McKesson for $1.1 billion. CEO Matt Scantland says the startup’s success was based on a simple formula, “Start with a big problem and solve it not by disrupting anything but by finding a way that everyone wins.”

Vanderbilt LifeFlight launches app for emergency responders

Vanderbilt LifeFlight launches an Uber-like app that allows first responders to request a helicopter and then sends the location of the emergency directly to dispatchers.

Ft. Myers-Based 21st Century Oncology Files For Bankruptcy

21st Century Oncology (FL) files chapter 11 bankruptcy, noting that the move will reduce more than $500 million of their long term debt. The company’s 2016 data breach exposed over 2 million records, leading to 13 federal class action law suits.

Monday Morning Update 5/29/17

May 28, 2017 News 6 Comments

Top News

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In Canada, a report by Alberta’s auditor general says the government’s $1.2 billion proposed project to replace the clinical and administrative systems of Alberta Health Services with a single system is not likely to generate the expected $900 million in cost savings because it doesn’t include primary care practices.

The project, announced a year ago, would replace 1,300 individual AHS systems.

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The report notes that Albertans pay the highest healthcare costs of all provinces in Canada, yet the quality and integration recommendations of previous reports have been mostly ignored. It observes that despite claims of how good healthcare is in Canada, it’s almost as bad as in the US, which finishes dead last among 11 developed countries despite spending far more than any of them.

The Auditor General also notes that fee-for-service payments have hampered accountability and integration. It also says that health leader turnover is high due to political cycles, with the average AHS hospital CEO lasting just 1.2 years.

Province physicians use at least 12 incompatible EHRs. Canada-wide, 94 percent of hospitals use IT only for administrative tasks.

The report observes that if banks used IT like Alberta Health Services:

  • Each branch bank would have its own systems that can’t communicate with other branches.
  • Systems at some branches would be so prone to failure that paper files would be kept ready.
  • Tellers, mortgage officers, and investment specialists wouldn’t be able to access each other’s information.
  • The only access to banking information would be via faxing.
  • Customers would be required each time they visit a branch to fill out the same form asking for name, address, employment information, and financial history.
  • Traveling customers could not withdraw money without opening an account first because the branch would not know who they are.
  • Applying for a mortgage would require visiting each prospective lender individually and completing their proprietary application package.
  • Online banking would not exist.
  • Obtaining an account balance would require making a written request and waiting two weeks for the mailed information to arrive.
  • Bank managers would not have enough information to understand the performance of individual branches.
  • The banks would spend $600 million per year to maintain IT systems but without a plan to standardize them and keep them up to date.

Reader Comments

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From More Math: “Re: CommonWell’s 60,000 documents downloaded. Looking at the latest from Epic’s website, it appears that Care Everywhere hits CommonWell’s lifetime exchange number every 15 minutes. Sounds like Epic is willing and able. Bigger question is whether the CommonWell is drying up.” CommonWell’s March 2017 fact sheet says that 5,100 provider sites have gone live and have generated 85 million queries, although I don’t know how “queries” translates into “documents.” The quoted figure of 60,000 documents retrieved doesn’t indicate the time frame involved, but if that’s all of them since CommonWell’s beginning in 2013, that’s a pretty anemic number. Cerner said in a HIMSS16 presentation that it had 4,000 providers live on CommonWell, which suggests that almost all live CommonWell members are Cerner users; that those providers enrolled only an average of 50 patients each; and that only eight documents per provider were actually retrieved. EHR vendors pay a per-transaction cost to CommonWell and providers don’t really like sharing their patient information with competitors, so there’s not a lot of economic incentive for anyone other than the patient to use CommonWell’s services.

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From Laura Palmer: “Re: Cure Forward. Has shut down, according to its site.” The Boston startup offered a platform that matched patients with clinical trials, although previous announcements suggest that its system may never have graduated from beta testing status. The company raised $19 million in a June 2015 investment and nothing since. Sole investor Apple Tree Partners has expunged Cure Forward from its website, omitting the company from its “legacy investments” section and removing previous Cure Forward press releases (thereby practicing the investing world’s legendary 20-20 hindsight). Cure Forward founder Martin Naley, who launched the company as a entrepreneur in residence at Apple Tree Partners, says on his LinkedIn profile that the company “ceased operations at the end of May 2017 due to financing difficulty.”


HIStalk Announcements and Requests

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Readers funded the DonorsChoose grant request of Mrs. M in Ohio, who requested math fluency games and fitness-related “brain breaks.” 

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Two-thirds of the 247 poll respondents who say they have certification or fellowship credentials don’t list them on their business cards or in their email signatures. KG says credentials should be listed only on CVs other than for practicing clinicians, while Sue says her earned credentials are important to her work and her clients use them as well. John opines that healthcare people deploy “a fruit salad of acronyms” such that the more of them someone lists, the less he believes what they say.

New poll to your right or here: to what extent has CommonWell benefited patients since its 2013 founding? I appreciate your vote and, even more so, your comments explaining it.

Gregg Allman died Saturday at 69, leaving zero of the two brothers who founded the Allman Brothers Band in 1969 still alive (also making Cher the ex-wife of two deceased celebrities). I’m not a fan at all of the retired band’s music since I really dislike Southern boogie and country music even when it’s bluesy (other than Lynyrd Skynyrd, anyway), but it’s apparent that hard living took its toll on the founding members — Duane Allman died at 24 in 1971 in a motorcycle accident, bass player Berry Oakley died a year later in the same manner and location, and drummer Butch Trucks killed himself earlier this year. That leaves guitarist Dickey Betts (73) and drummer Jaimoe Johanson (72).

I’ve had problems for years where I leave the laptop running and Firefox is open to pages that refresh (like Twitter or news sites) – Firefox gets sluggish and Windows Task Manager shows it eating up a huge amount of memory and CPU, requiring me to hard-cancel it. The solution – I finally switched to Chrome for everything browser related, which makes even more sense now that I’m using a Chromebook and an Android phone. My only non-Google technology is an iPad Mini and the Windows laptop, both of which will move to a Google platform when it’s time to replace them.


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In Flanders Fields
By John McCrae, MD (1872-1918)

In Flanders fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.


This Week in Health IT History

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One year ago:

  • Forbes revises its estimate of the net worth of Theranos founder Elizabeth Holmes from $4.5 billion to zero.
  • An ONC study finds that 84 percent of US hospitals are using at least a Basic EHR, a nine-fold increase since HITECH’s adoption in 2009.
  • DrFirst acquires Meditech-focused consulting firm The IN Group.
  • CHIME awards $30,000 each to the two finalists in the concept round of its national patient ID challenge, with those contestants moving to the final $1 million round.

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Five years ago:

  • Allscripts caves in to a proxy fight and adds three new board members advocated by key shareholder HealthCor Partners, which had publicly called for Allscripts to fire CEO Glen Tullman.
  • Three-fourths of respondents to my poll disagree with Neal Patterson’s assertion that Cerner and Epic will end up being the only hospital EHR survivors.
  • Fired HCA doctors say the hospital chain hired huge numbers of physicians to prepare for an ACO environment, then terminated those whose practices weren’t profitable.

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Ten years ago:

  • A research article finds that few hospitals are using bedside barcode-checking of medications and that nurses bypass those systems frequently.
  • An article describing problems with Kaiser Permanente’s shuttered kidney transplant program blames information management problems and its paper-based systems.
  • A rumor suggests that Misys is trying to sell its hospital systems.
  • Former National Coordinator David Brailer launches the $700 million private equity fund Health Evolution Partners.
  • MED3OOO takes a majority ownership position in InteGreat.

Weekly Anonymous Reader Question

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Last week’s results: job promotion factors.

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This week’s survey: what is the role of the person you most value as a mentor and/or professional peer, how did you connect with them, and how do you maintain the relationship?


Last Week’s Most Interesting News

  • The Wall Street Journal notes that uncertainty surrounding the Affordable Care Act has forced some health IT startups to change their strategies.
  • Five hospitals in Australia experience an IT incident cause by applying security patches to protect against WannaCry ransomware.
  • Apple acquires sleep monitoring sensor and app vendor Beddit.
  • The Congressional Budget Office estimates that the Affordable Health Care Act would increase the number of uninsured Americans by 23 million by 2026 in reducing the deficit by $119 billion.
  • The Bipartisan Policy Center calls for private-public efforts to improve health IT safety, but does not mention ONC’s proposed EHR safety center.
  • The director of Denmark’s equivalent of the FDA warns that big US tech companies like Google and Apple are rolling out health apps without demonstrating their efficacy and safety and that those companies are gaining permanent access to patient data.
  • The local paper says that Erie County Medical Center’s ransomware infection is still affecting the hospital six weeks after the hospital decided not to pay the demanded $44,000 ransom, also running a screenshot provided by a hospital employee that suggests that the culprit was Samas, the same malware that took down MedStar Health in 2016. 

Webinars

June 22 (Thursday) 1:00 ET. “Social Determinants of Health.” Sponsored by Philips Wellcentive. Presenter: David Nash, MD, MBA, dean, Jefferson College of Population Health. One of the nation’s foremost experts on social determinants of health will explain the importance of these factors and how to make the best use of them.

June 29 (Thursday) 2:00 ET. “Be the First to See New Data on Why Patients Switch Healthcare Providers.” Sponsored by Solutionreach. As patients pay more for their care and have access to more data about cost and quality, their expectations for healthcare are changing. And as their expectations change, they are more likely to switch providers to get them met. In this free webinar, we’ll look at this new data on why patients switch and what makes them stay. Be one of the first to see the latest data on why patients leave and what you can do about it.

July 11 (Tuesday) 1:00 ET.  “Your Data Migration Questions Answered: Ask the Expert Q&A Panel.” Sponsored by Galen Healthcare Solutions. Presenters: Julia Snapp, manager of professional services, Galen Healthcare Solutions; Tyler Suacci, principal technical consultant, Galen Healthcare Solutions. This webcast will give attendees who are considering or in the process of replacing and/or transitioning EHRs the ability to ask questions of our experts. Our moderators have extensive experience in data migration efforts, having supported over 250+ projects, and migration of 40MM+ patient records and 7K+ providers. They will be available to answer questions surrounding changes in workflows, items to consider when migrating data, knowing what to migrate vs. archive, etc.

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


Acquisitions, Funding, Business, and Stock

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Debt-ridden Florida-based clinic operator 21st Century Oncology – which was breached by hackers in 2016 in exposing the records of 2.2 million patients and resulting in at least 13 federal class action lawsuits – files Chapter 11 bankruptcy. As companies tend to do, 21st Century calls the bankruptcy a “positive development,” brags that it is “fundamentally strong and profitable,” and claims that “very little, if anything, should change during the Chapter 11 process,” calling into question either the credibility of the company or of the US bankruptcy process that is often used as a shrewd corporate strategy to legally screw employees and creditors for the benefit of executives.


Decisions

  • Fitzgibbon Hospital (MO) will replace Meditech and GE Healthcare with Cerner in November 2017.
  • Pinnacle Hospital  (IN) will go live with Prognosis Innovation Healthcare in June 2017.
  • Illinois Valley Community Hospital (IL) will implement Athenahealth’s EHR in November 2017, replacing McKesson.
  • Pioneers Medical Center (CO) will go live with Athenahealth in 2017.
  • Riverside Tappahannock Hospital (VA) will replace Siemens with Epic in June 2017.

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


Announcements and Implementations

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Vanderbilt LifeFlight develops an Uber-like app to allow first responders to request a helicopter, sending the service an the GPS coordinates and and requestor information while giving the emergency responder a real-time flight map and estimated arrival time.


Other

A co-founder of startup Iodine — which published patient-submitted experience with medications — says his company, as well as other digital health startups, were naive in thinking that their technology could create a healthcare revolution. Iodine quietly sold itself off to drug discount coupon publisher GoodRx a few months ago. Thomas Goetz says not only did disruption not happen, it probably never will, because:

  • Healthcare regulation hinders rapid transformation.
  • Entrenched players are huge and have their hands in multiple aspects of healthcare.
  • Nobody cares about better-faster-cheaper in healthcare.
  • There’s no ability to shop prices.
  • The government is the biggest customer.
  • Incentives are misaligned.

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The Columbus, OH paper profiles prescription prior authorization system vendor CoverMyMeds, the first local startup to sell itself for at least $1 billion (to McKesson in January of this year for $1.1 billion, this case). CEO Matt Scantland says the company’s formula for success was, “Start with a big problem and solve it not by disrupting anything, but by finding a way that everyone wins,” adding that it wasn’t the first company to tackle the problem, but rather the first to develop a scalable solution. The article notes that CoverMyMeds has over 500 Columbus-based employees who get a free gourmet lunch each day and have a virtual reality room to play video games with peers in its Cleveland office. I interviewed Matt in September 2014 when the company had just 73 employees and $19 million in revenue, but he was predicting bigger things:

Prior authorization seems like a very niche thing. It kind of is, but at the same time, it’s also right at the intersection where a doctor is making a decision about the tradeoffs between the cost of a treatment and its efficacy. We think that that’s a fundamental problem in healthcare. We have built both the network and the connectivity and then also the relationships with pharma, payers, pharmacies, and providers. We think we can help doctors make more intelligent consumption decisions. We think is a very large opportunity, starting with drug, but helping to get to more personalized medicine in terms of prescribing, and then also other procedures as well. Because of the growth of the size now, we have a lot of interest from the financial and strategic partners. We’re always willing to listen. We think this is a very big standalone company on its own.

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He went down, under. In Australia, a member of Parliament laughs so hard while watching the US TV show “Veep” that he chokes on his sushi, passes out, and stumbles through his house before falling face-down unconscious into his granite kitchen island, leaving him with a black eye, three stiches, and a get-well tweet from star Julia Louis-Dreyfus.


Sponsor Updates

  • Encore, A Quintiles Company publishes a white paper titled “Care Management Framework – The Critical Path to Implementing a Care Management Strategy.”
  • QuadraMed, a Harris Healthcare company, will exhibit at the NYHIMA Annual Conference June 4-7 in Rochester.
  • Salesforce announces strategic agreement with Dell Technologies.
  • Solutionreach expands leadership team with new promotions.
  • Summit Healthcare and Access will exhibit at the 2017 International MUSE Conference May 30-June 2 in Dallas.

Blog Posts


Contacts

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

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Reader Survey Results: Job Promotion Factors

May 27, 2017 News No Comments

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I asked what factors affected a job promotion.


Being humble, but speaking up in meetings (especially with solution ideas for important problems).


Many factors worked together to promote me through three levels in five years. An ability and willingness to drive change and tackle challenges in areas traditionally labeled as “impossible” because they required revamping entrenched negative habits. An unflinching determination to get tasks done on time (with no short cuts) and work out compromises even with the most difficult stakeholders. The ability to get to the root cause of an issue and focus on how to avoid future snafus with education and documentation without dwelling on placing blame. Consistently keeping EVERYONE very well aware of a projects progress and problems – so everyone felt in the know. Taking copious and diligent notes so as to instill trust and confidence when making statements at meetings, allowing decision makers to move forward more quickly. It also didn’t hurt getting another master’s degree specializing in a key niche area! Never let your skills become stale or your attitude become obstinate.


Proving myself works in getting more responsibilities. Moving to a new company was required to get a promotion.


Paying attention. I don’t believe in random luck, I believe that if you keep your mind open, you will be able to see the opportunities that are all around you. Luck is the ability to see the doors that are already open, waiting for you to step through. Also, be kind and generous.


I do not seek a promotion as something to have, a title to add to my business card or resume. I do not seek a promotion as a reward for time served or deeds already done. I seek a promotion for the opportunity to connect with new people to share ideas, the ability to move forward with new kinds of projects, the ability to tap into new resources. If you can articulate your desire for promotion in the context of moving forward instead of looking backward (a reward) or appearance (new business cards), then your organization will see you as a part of their future as well.


Always doing what I think is the right thing,and the best things for my customers. Always be honest and when I see a problem or an opportunity for improvement, regardless if I am responsible for it or not, I try to identify a solution.


Not looking for the promotion and focusing on making my boss(es) look good. Supporting their ideas and approaches.


I’ve had three offers to get a significant bump in salary and/or role. Every time was when I threatened to quit.


Receiving offers from other companies willing to pay me more.


Job changes, willingness to take on new projects, show value and communicate it.


Building relationships and consistently delivering results.


Who you know and certifications. Also geographical location seems to be a factor — if the person who is doing the hiring is from the same area of the country as you, then that helps with a connection.


Being better at the job than all the other people around me.


I’m a white male. I am also smart, talented, and hard working. But judging from my colleagues, being a white male is often all that is needed to climb the ladder. Competency does not seem to be a requirement.


A good boss. There are ideas, and there is doing. Do. Prompt responses to your boss and your boss’s boss.


#1: Asking for them. Having competing offers (that helped with salary level). Having (at the time) a relatively unique background with IT and medical experience. Having the right networks of people who give your request credibility


Company laid off one-third of people. We all applied elsewhere, they begged us to stay. To stay, I requested improved salary, vacation, and title. They obliged.


Leaving.


Most of my promotions have occurred when I’m working for someone who gets things done and cares about my career. Lesson: Think about who you are aligned with professionally.


Self-sufficiency and a willingness to figure things out on my own.


The ability to lead others, even if not in an appointed leadership role. Last promotion to Lead Analyst role earned by demonstrating ability to assist new and current co-worker analysts to achieve positive results. Sometimes though one is born with an innate nature to lead and enjoy doing so (without be overbearing – i.e., “bossy”). One can always possess a technical ability to perform job duties, but needs guidance and mentoring to achieve success.


My ability to smile while professionally dealing with the jackasses that infest our fine HIT industry.


Being a woman. Just kidding!


My top 3: specific measureable business results from work. The ability to communicate effectively with both non-IT and IT people. Reasoned risk-taking.


Integrity, dedication to performing at the best of my ability, and respect for everyone’s role and contribution to delivering quality services.


Being in the right place at the right time. Having a track record of delivering results. Being helpful and useful. Thinking critically and anticipating my next action. Dressing nice, being well groomed and presentable, speaking clearly and confidently, having a sense of humor, and being able to relate to everyone, not just my peers.

Morning Headlines 5/26/17

May 25, 2017 Headlines 6 Comments

Health-Tech Startups Pivot as Obamacare Uncertainty Mounts

The Wall Street Journal profiles health IT startups funded during the ACA boom, and how they are pivoting their business models to survive the ongoing legislative uncertainty around ACA’s repeal.

Townsville Hospital responds to major cyber incident

In Australia, five hospitals within Queensland Health suffer network downtime stemming from issues installing the WannaCry security patch.

Synopsys and Ponemon Study Highlights Critical Security Deficiencies in Medical Devices

A survey of medical device manufacturers finds that 67 percent believe that an attack on one of their devices is likely to occur in the next 12 months,  but despite the risk only 17 percent are taking significant steps to prevent cyberattacks.

Health Care Providers Must Stop Wasting Patients’ Time

Harvard Business Review profiles Kaiser Permanente’s efforts to coordinate care outside of the hospital setting effectively enough to discharge surgical patients earlier, in many cases on the same day of the patient’s surgery. .

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