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Morning Headlines 5/11/15

May 10, 2015 Headlines 2 Comments

The revolution will be digitized

The Washington Post analyzes the emerging wearables market, the data-tracking consumers driving the increased demand, and the critics that say the “worried well generation” is collecting data that is not necessarily useful or accurate, and that over-monitoring introduces a host of new problems.

Cerner (CERN) Q1 2015 Results – Earnings Call Transcript

Cerner shares drop 4.5 percent on Friday after reporting lower than forecasted Q1 earnings and reducing Q2 expectations. On its earnings call, Cerner CFO Marc Naughton explains that the $50 million shortfall on projected revenue was a result of missed targets within both the Cerner and Siemens business lines.

Allscripts Healthcare Solutions (MDRX) Paul M. Black on Q1 2015 Results – Earnings Call Transcript

Allscripts hosts its Q1 earnings call, in which CFO Richard Poulton explains that the company missed both revenue and EPS projections for the quarter in part because its professional services bookings were down and client service margins were down because anticipated work to support New York’s eRx initiative never materialized.

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May 10, 2015 Headlines 2 Comments

Monday Morning Update 5/11/15

May 10, 2015 News 4 Comments

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Cerner shares fell 4.5 percent Friday after the company reported lower-than-expected revenue for the quarter and also warned of slightly reduced revenue expectations for full-year 2015. From the earnings call, the acquired Siemens Health Services business contributed $176 million in the quarter of the company’s overall revenue, about 18 percent of the total, with “minimal bookings contribution from Health Services” and minimal sales expected for the year. HS is now on track for $1 billion in annual revenue vs. the originally expected $1.1 billion, but Cerner wants to stop talking about that business separately since it now isn’t.

Cerner has set aside $35 million in Q2 for a voluntary separation program that will affect 2 percent of the workforce, which works out to around 400-500 people from both the Cerner and Siemens sides. Cerner also called out its Business Office Services for physician practices, which the company says can display an unnamed cloud-based competitor (presumably Athenahealth) because Cerner’s lower staffing requirements cost 20 percent less and “many of these larger and more sophisticated clients are facing several challenges with our competitor’s solution, such as having 50 to 60 percent of the claims requiring manual intervention because they don’t fit the cloud configuration.” Cerner says three former Siemens clients committed to Millennium in Q1, although it admits that those decisions had probably already been made before the acquisition announcement just sped them up.

Speaking of the Cerner earnings call, a Morgan Stanley stock analyst set a world record by sprinkling the maddeningly meaningless “kind of like” liberally throughout questions that were buried somewhere under an avalanche of verbal crutchery:

You talk about the contract with Intermountain and really kind of like a new way of doing business , so when you think about kind of like other health system that are similar in size, can you just kind of like share with us how kind of like that pipeline is looking and do you need to kind of like first implement all the 22 hospitals of Intermountain or should we expect to see a deal, kind of like that looks at that type of intelligent systems before that? … When we look at kind of like your new contracts, what percent of your new contracts have kind of like a Population Health feature to them? And how should we think about kind of like what is an average Population Health deal in terms of revenue contribution?

Reader Comments


From Interesting: “Re: John Hammergren. He gets a lot of negative press, but this story (which doesn’t identify Kayla Hammergren as his daughter) gives a different perspective on the family life of America’s highest-paid CEO.” A Boston College newspaper article notes the meeting of senior Kayla Hammergren with the four-year-old boy to whom she donated bone marrow in 2013 after she signed up for a donor registry at a campus recruitment drive. Her donation of bone marrow (and later blood) led to the boy’s being declared free of leukemia a year later.


From Greg Marmalard: “Re: Castlight Health. Our company just rolled it out to employees this week. I searched on a common surgery for glaucoma and it came up empty. Then I searched just on glaucoma and got information on eyeglass exams, low back pain, acne surgery, culture bacteria, and vaccines. A teammate looked up follow-up visit costs for PCPs in his area (including his own) and there was some range shown although it wasn’t large. Then he checked out hip replacement surgery and it came back with over 50 hospitals and surgical centers in a 25-mile radius showing the same cost for all of them. It asked for my email address so they can send me endless emails, so I unsubscribed.”


From Barb Dwyer: “Re: MyChart on Apple Watch. Photos attached.”

HIStalk Announcements and Requests


Forty percent of poll respondents say a medical bill has caused them financial hardship within the past two years. Two readers (one Canadian, one on Medicare) said no, while two others said that high-deductible plans put them much more at risk than before. New poll to your right or here, for those who work for a health system: how would you grade your most recent encounter with your employer’s service offerings? I would, of course, love to get more details if you’d leave a comment after voting.

Listening: new from Mikal Cronin, summery but sometimes growly power pop on the trustworthy Merge Records label. Also: addictive melodic ballads from James Blunt, a former British Army captain and current Doctors Without Borders supporter who cranks out pretty amazing music.  One more from a reader: jangly, tied-dyed psychedelic prog from Temples, young English guys who sound like like old English guys did in 1972.

I was thinking about how consumers created a huge but questionable market for herbal and vitamin products whose manufacturers make medical claims without FDA oversight. That happened largely because doctors ignored the demand and refused to educate themselves and their patients about those products, so consumers sensed that traditional medicine was stonewalling them and bypassed the medical system entirely in favor of “alternative medicine” (some of which actually works) and created a great business for chiropractors and other non-physicians who jumped all over the new income source. The same thing happened with weight loss, sexually related products, acupuncture, etc. My conclusion: clinicians need to educate themselves on wearables and health apps because consumers will just sidestep them if they don’t. Unfortunately, short and brusque PCP encounters don’t leave much time for discussions about general health and doctors are often ill prepared to participate in those discussions anyway since their focus is often myopic, standardized, and focused on symptom alleviation via drugs or procedures. For me at least, the ideal team would be a generalist health coach (whose knowledge is broad but not necessarily deep) who is supported when needed by a physician. Many patients don’t believe doctors have the time, objectivity, or economic incentive to serve as their ongoing health partner.

Last Week’s Most Interesting News

  • Cerner and Allscripts turn in unimpressive quarterly results.
  • President Obama nominates National Coordinator Karen DeSalvo, MD to the post of HHS assistant secretary for health, in which she has served in an interim capacity for several months.
  • Harris Corporation restructuring suggests that the company may be planning to divest its healthcare business.
  • Cognizant reports impressive quarterly financial results that were significantly driven by the former TriZetto business it acquired in November 2014 for $2.7 billion.


May 12 (Tuesday) 1:00 ET. “HIStalk Interviews Regina Holliday.” Catch up with Regina Holliday and her recent patient advocacy efforts as she chats with HIStalk’s Lorre and Jenn about the HIMSS conference, The Walking Gallery, her upcoming advocacy events, and her new book. Regina will talk about how providers and vendors are working to make the patient voice heard.

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making

Acquisitions, Funding, Business, and Stock


From the Allscripts earnings call:

  • The company added 200 clients even as revenue declined due to lower professional services sales, a trend the company expects to continue given the lack of new government mandates.
  • Gross margin was “disappointing” because of the decline in client services margin, some of that due to the one-year delay in New York’s mandatory e-prescribing program.
  • The company sold two new Sunrise clients: 51-bed Palo Verde Hospital (CA) and 53-bed Grand Lake Health System (OH).
  • No new international sales were made in the quarter.
  • The company reported severance payments of $6 million during the quarter and told analysts to expect more severance payouts in Q2.
  • The company hopes to have one or two referenceable clients running the full suite of Allscripts products, including Sunrise Financial Manager, by the end of the year.
  • On the possibility of acquiring population health management companies, CFO Richard Poulton said, “That’s definitely an area that is high on our list of areas to invest in. Whether it’s purely an acquisition, though, is a different question. I don’t have to tell you that some of the companies that are out there, fairly immature companies, are with advertised capabilities are trading at crazy valuations. We’ve looked at a bunch and we’ll continue to look at a bunch, but right now, we have a pretty good plan that is not heavily dependent on acquisitions.”



Vince Roach, founder of Technology Management, Inc. and later an executive with Daou Systems, died May 8 in Indianapolis. He was 71.

Announcements and Implementations


A Web petition at urges politicians, providers, and insurance companies to ensure that patients have access to their own health data.

Innovation and Research


India-based Tata Memorial Hospital works with a for-profit company to offer free, evidence-based online second opinions for cancer treatments. Patients submit their medical records online and receive expert opinions within a few days. Commercial partner Navya offers a patented “analysis engine” that reviews best practices, expert opinion, and patient preferences to provide treatment options. Navya co-founder Naresh Ramarajan, MD has a Harvard undergrad, Stanford MD with community health emphasis, and is completing a critical care and pulmonology fellowship at UCLA along with a PhD in medical informatics.


An in-depth Washington Post piece says wearables have become big business, but questions the value of the data they create, especially by “life loggers” who obsessively try to quantify their every move in a quest for “self-perfectability” in the “narcissism of the technological age.” A professor says it’s a lot easier to collect information than to do something useful with it, while the article also points out possible privacy concerns, such as in 2011 when Fitbit users realized that their publicly shared data made it easy to determine the frequency, duration, and vigor of their sexual activity. My most recent pet peeve is people who have their fitness apps set to proudly tweet out their latest run or bike ride, which I can personally guarantee no fellow earthling cares about.

An Esquire writer who tried the Apple Watch says it “seems to be designed to be a thing you can’t get overly excited about” and is mostly useful for ignoring unimportant text messages and for the all-important fanboy bragging rights, adding that the watch itself  has decent battery life but it sucks the iPhone battery dry quickly since it’s conversing via Bluetooth. It will, he says in stating the obvious, become obsolete quickly and will require buying it all over again, also stating the obvious that Apple zealots never seem to mind.



Half the ophthalmologists working for Indiana University School of Medicine have quit since construction of a $30 million eye institute began in 2008, with key issues apparently being a forced practice integration, disputes over their share of the $12 million the eye clinical brings in each year, and aggressive fundraising in which doctors were sent lists of their upcoming appointments by the fundraising director (who is also the wife of the department chair) who flagged high net worth people so they could be given extra attention and hit up for donations. One of the doctors filed a HIPAA complaint over that practice, which the medical school says it has since fixed.

Idiotic lawsuit: a Raleigh, NC police officer who spilled his coffee in his lap is suing Starbucks for the maximum allowed $750,000, saying the emotional damage aggravated his Crohn’s disease and that he was served a large cup without an insulating sleeve as required by the chain’s policy. He told the jury that he really should get $10 million. He didn’t even pay for the coffee since officers in uniform aren’t charged, a benefit he had taken advantage of 50 times in two months. The officer admitted under questioning that after the spill, he went back to the police station to get his truck, drove home, had his wife take pictures of his burn, and finally sought medical attention 2.5 hours later. He says, “I knew it was hot, but not that hot,” indicating his prime candidacy for a Frappucino.

Weird News Andy calls this story “Doctors Acting Badly.” In England, an OB-GYN and his RN wife are charged with slavery after a Nigerian man claims the couple hired him 24 years ago at age 12, but then altered his passport so he couldn’t leave and then forced him to be their unpaid and beaten babysitter and butler.

Sponsor Updates

  • Medicity’s Brian Ahier contributes “5 things we have to do to make health IT work.”
  • Nordic focuses on pharmacy in the sixth installment of its “Making the Cut” video series on Epic conversion planning.
  • MedData offers “Go All In on Early Out.”
  • Versus Technology offers “Nursing’s Impact on Patient Care Transcends the Bedside.”
  • West Corp. offers a Storify tweet recap of its time at ATA 2015.
  • PMD outlines the benefits of “The Developer Carpool.”
  • Netsmart wins the Smile for Team Spirit Award as part of its annual Kansas City Corporate Challenge.
  • Voalte offers “Have faith in nurses.”
  • New York eHealth Collaborative’s Anuj Desai and David Jacobowitz contribute to the third edition of “Medical Informatics: An Executive Primer” from HIMSS.
  • Orion Health offers “The Importance of Chronic Care Management (CCM).”
  • PeriGen offers an interactive history of labor and delivery nursing in honor of National Nurses Week.
  • QPID Health offers “3 Key Insights From Dr. Robert Wachter, Author of ‘The Digital Doctor.”
  • Sandlot Solutions will exhibit at the SoCal HIMSS 7th Annual Clinical Informatics Summit May 15 in Irvine, CA.
  • Shareable Ink and The SSI Group will exhibit at the Ambulatory Surgery Center Association Annual Meeting May 13-16 in Orlando.
  • TeleTracking offers a new blog on “National Nurses Week 2015.”
  • TransUnion hosts Philippine President Benigno Aquino III at its corporate headquarters.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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May 10, 2015 News 4 Comments

Morning Headlines 5/8/15

May 7, 2015 Headlines No Comments

Cerner Reports First Quarter 2015 Results

Cerner reports Q1 results: revenue climbed 27 percent to $784 million, adjusted EPS $0.45 vs. $0.37. Revenue came in below Cerner’s Q1 forecast, due to lower than expected revenue across both its existing business and its new Siemens business.

Allscripts Announces First Quarter 2015 Results

Allscripts reports Q1 results: revenue was down two percent, at $335 million, adjusted EPS $0.08 vs. $0.07, missing expectations on both.

Are bungled VA claims systemic? Senators want agency review

The VA’s notorious claims processing system is back in the headlines. The VA reports that the claims backlog currently stands at 161,00, down from its peak of 611,000 in March 2013, but a VA inspector general review uncovered doctored data at five of the 10 worst performing claims processing centers. Now, a bipartisan group of senators is calling for a wide-scale, GAO-led review of all 56 regional VA claims processing offices.

Meaningful Use Stage 2 E-Prescribing Threshold and Adverse Drug Events in the Medicare Part D Population with Diabetes

A study published in the Journal of the American Medical Informatics Association compares medication error rates between handwritten and electronically generated prescriptions and finds that e-prescribing was associated with fewer adverse drug events. The study also found that e-prescribing increased the number of prescriptions that make it to the pharmacy by 12%, and increased the number of prescriptions picked up by the patients by 10%.

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May 7, 2015 Headlines No Comments

News 5/8/15

May 7, 2015 News 8 Comments

Top News



President Obama nominates National Coordinator Karen DeSalvo, MD to become HHS assistant secretary for health, a role she has held as interim (in addition to her ONC duties) since last year. The appointed position, which involves Senate confirmation and a four-year term, is the nation’s highest-ranking public health officer. Howard Koh, MD, the previous assistant secretary, resigned in July 2014 to rejoin the Harvard School of Public Health. DeSalvo will leave ONC if confirmed, which is nearly certain since both she and her HHS boss Sylvia Burwell have widespread political support that crosses party lines. Her nomination was entirely predictable from the moment she was named as interim.

Reader Comments

From Code Jockey: “Re: Siemens. As a Siemens/Cerner HS employee I’d like to gauge the community’s thoughts. Unofficially, 200-300 people took the voluntary separation package, so where does that leave the rest? Should they look elsewhere given the probably layoffs or stick it out?” I’ll open the floor, but if it were me, I’d stick it out. Layoffs are certain but strategic, so the first wave will be in areas of obvious generic corporate redundancy such as marketing, finance, sales, and HR. Second-worst is if you work on a clearly doomed product line but even then someone has to keep the lights on until customers are prodded to move elsewhere. Otherwise, the need for technical experts for existing Siemens products isn’t just going to go away overnight. You’re working for a much more successful and US-based, healthcare-focused company now, and while I would always be keeping my ear to the ground for new opportunities as a general policy, I wouldn’t assume the worst.  Speaking of Siemens, I hadn’t checked lately, but our November 2014 webinar, “Cerner Takeover of Siemens: Are You Ready?” with Vince Ciotti and Frank Poggio has been viewed over 4,000 times on YouTube.

From Ex-McK: “Re: layoffs. Heard more layoffs at McKesson and RelayHealth. How many employees are left on the technology side? Someone told me as many as 500 were let go last week. It’s definitely not the company when Pam was running the company.” Unverified. Another reader reported hearing that 300 were laid off, but I haven’t heard from any of them directly.

From Rumor Mill: “Re: MUS2 attestation date. I’m hearing it may be moved to January 2017. Any idea if this is true?”

HIStalk Announcements and Requests

This week on HIStalk Connect: Apple, in collaboration with UCSF and Mount Sinai, will update ResearchKit to support genome data collection, storage, and sharing. American Well launches a new telehealth app designed to let practices offer remote consultations to their patients. Stanford University researchers have improved on recently developed retinal implant technology and are developing a new prototype that should provide some blind patients with 20/250 restored sight. Online glasses retailer Warby Parker raises a $100 million Series D to expand its physical footprint and to develop an online eye exam that its ophthalmologists can use to prescribe lenses.

This week on HIStalk Practice: Harrington Family Health Center goes live on Athenahealth. AHRQ recommends several areas where pediatric EHRs can improve. HHS announces $101 million in funding for health centers, and prepares for artists and health data activists to converge at its headquarters. CareMore Medical Group goes with Allscripts, while Tandigm Health opts for NaviNet referral tool. Harbin Clinic welcomes a new CIO. Apple Watch users bring new meaning to the phrase "lonely hearts club." Calypso, cowbell, and Jonathan Bush converge. Dr. Gregg shares the HIT challenges of being independent (i.e., non-Borgian).

A reader asks if I listen to any Icelandic music. I do sometimes: Sigur Ros, Of Monsters and Men, and of course Bjork. The reader likes indie pop band Seabear, and having checked them out, so do I. A lot of good music comes out of a country whose population is just 300,000.

It occurred to me that just about everybody who’s salivating at the prospect of never-ending streams of real-time, sensor-powered patient data are businesspeople and technologists rather than hands-on doctors and nurses. The diagnostic value of the information is questionable, the cost of follow-up is significant, and the effect on outcomes and cost is unknown. You often can’t even get an appointment when calling in with an acute condition, so who’s going to jump on an unusual iPhone heart rate sensor value? It makes me uneasy to see the further polarization of healthcare haves and have-nots since it’s already easy to find previously undiagnosed and untreated people without using apps – it’s just that their demographics make them unprofitable and our healthcare delivery system doesn’t get excited about unprofitable public health.

DonorsChoose Project Update


I fully funded these DonorsChoose projects from the generous donations of Cerner and Epic, which I’m listing here so those companies (and Centura SVP/CIO Dana Moore since it was his idea and effort) know where their money went:

  • Books and math flash cards for fourth grade classes in Indianapolis, IN.
  • An iPad Mini for literacy and math stations for an elementary school class in Baltimore, MD.
  • A Common Core math manipulatives set for grades 3-5 in Baltimore, MD.
  • A laptop computer for programming Lego EV3 robots for grades 6-8 in Hartford, KY.
  • Two programmable rover robots for a fifth grade class in Clarendon, TX.
  • Six Makey Makey computer invention kits for K-5 classes in Hull, GA.
  • A Lego EV3 programmable robot and reference books for a middle school robotics competition team in New York, NY.
  • A STEM bundle, three STEM kits, and four engineering centers for first grade recess learning at a bilingual learning school in Columbus, OH.
  • A portable air conditioner for an elementary school classroom in Paterson, NJ.
  • Two iPad Minis for a third grade technology workstation in Tulsa, OK.
  • A math manipulatives library for grades 3-5 in King City, CA.
  • Two Kindle Fires for technology learning for a kindergarten class in Indianapolis, IN.
  • 25 scientific calculators and clipboards for a high school chemistry class in Indianapolis, IN.
  • An iPad Air for reading and math practice for an elementary school in Henderson, NV.
  • Summer school supplies for an elementary school in Norfolk, VA.
  • Educational computer games for a class of pre-K through second grade students with autism in Indianapolis, IN.
  • A library of math books for an elementary school class in Indianapolis, IN.
  • A STEM bundle for grades 4-5 at an elementary school in Fairfield, CA.
  • Two STEM bundles for an elementary school class in Tulsa, OK.
  • An iPad Mini, case, and earphones for a kindergarten class in Aloha, OR.
  • A set of Rekenreks math learning tools for an elementary school class in Indianapolis, IN.
  • Interactive math tools for an elementary school class in Wilder, ID.
  • Math games for first graders at a Spanish immersion school in Minneapolis, MN.
  • Macbook accessories for programming courses at a college prep school in Chicago, IL.
  • Four Kindle Fires for a grade 5-6 math classroom in New York, NY
  • A STEM bundle for a second grade class in Fort Walton Beach, FL.
  • A listening center for grades 3-5 at a Bureau of Indian Affairs school in Hayward, WI.
  • A Bluetooth speaker to play music during gym class at a middle school in Milwaukee, WI.
  • A Samsung tablet and case for reading work at an elementary school in Middleton, WI.
  • Scientific calculators and learning supplies for an at-risk middle school class in Cottage Grove, WI.
  • 20 STEM professional resource books and an iPad Mini for an elementary school teacher in Green Bay, WI


Mrs. Anderson from Colorado sent over photos of the TV and flash drive paid for by our donations. She placed it in the library as the first thing students see when entering or leaving as it runs new book advertisements and school announcements. She reports that students gave it a lot of “oohs and ahhhs” and checked out three new books the first day by 10:30 a.m. even though the books had been sitting untouched on the new book display for the three weeks before the TV went up. Meanwhile, Mrs. McDermott of Brooklyn sent a note about the four Kindle Fires for her math class: “Thank you so much for your incredibly generous donation. I can’t even believe it! I’m currently on Spring Break, and I woke up thinking of all the things I need to do in order to prepare for when the kids come back, and then I see this wonderful email! I appreciate it from the bottom of my heart! Thank you, thank you, thank you! These Kindles are going to be so helpful in my classroom, and the kids are going to be so excited to have some technology JUST for math class. You are an AMAZING human being!” (it’s actually amazing companies donating, so I’ll accept on their behalf).



May 12 (Tuesday) 1:00 ET. “HIStalk Interviews Regina Holliday.” Catch up with Regina Holliday and her recent patient advocacy efforts as she chats with HIStalk’s Lorre and Jenn about the HIMSS conference, The Walking Gallery, her upcoming advocacy events, and her new book. Regina will talk about how providers and vendors are working to make the patient voice heard.

May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making.

Acquisitions, Funding, Business, and Stock


Harris Corp. eliminates the headquarters function of its Herndon, VA-based Integrated Network Solutions business, which includes Healthcare Solutions, as it plans for the integration of defense contractor Excelis, which Harris is acquiring for $4.5 billion. SEC filings suggest that the company may be considering divesting the INS businesses, which in addition to healthcare, include IT services and telecommunications. Harris Healthcare Solutions offers the FusionFX care collaboration suite, FusionIQ analytics, and FusionOS middleware, acquired with its $155 million acquisition of Carefx in 2011.


IMS Health acquires England-based Dataline Software, which offers healthcare cost analytics and develops custom hospital software.


Castlight Heath reports Q1 results: revenue up 90 percent, adjusted EPS –$0.17 vs. –$0.72, beating expectations for both. Shares jumped on the news but are still down 31 percent on the year, valuing the company at $739 million.


The Advisory Board Company announces Q4 results: revenue up 30 percent, adjusted EPS $0.31 vs. $0.34, missing expectations for both. ABCO acquired educational enrollment vendor Royall & Company for $850 million in December 2014 and most of the analyst questions in the earnings call involved that topic.


DrFirst raises $3.5 million in new financing.


Cerner reports Q1 results: revenue up 27 percent, adjusted EPS $0.45 vs. $0.37, falling short of revenue expectations due to “a combination of lower-than-expected revenue from the recently closed acquisition of Siemens Health Services and lower revenue in our existing business.” It’s a rare and somewhat shocking miss for CERN.


Allscripts announces Q1 results: revenue down 2 percent, adjusted EPS $0.08 vs. $0.07, falling short of expectations for both by quite a bit.


Fitbit earns $142 million profit on $745 million in revenue in 2014 and announces plans to IPO after raising $100 million, having valued itself previously at $1.2 billion.  The company also disclosed that its product recall in response to consumer complaints about band-induced rashes cost it $107 million plus settlements for lawsuits both settled and open. Fitbit says less than half of the total devices it has sold are being actively used.


Private equity firm ABRY Partners will acquire pharmacy 340B systems vendor Sentry Data Systems, with an unannounced price that one banker says is more than $200 million.


Population health management vendor Evolent Health files for a $100 million IPO.


England-based urgent care provider Coordinate My care selects InterSystems for care coordination.



Andrew Rhinehart, MD (Johnston Memorial Center for Comprehensive Wound Care) joins Glytec as chief medical officer.


Harbin Clinic (GA) names Andrew Goodwin (Georgia Hospital Association) as CIO.

Announcements and Implementations

Zynx Health announces the annual Clinical Improvement Through Evidence (CITE) Award for nurses leading a clinical decision support team. Nominations are due June 15.

The Indiana Rural Health Association announces that the tobacco referral application by Holon Solutions is being used by 11 clinics and three hospitals, replacing faxed referrals with one-click electronic access.

Government and Politics


The fired head of the Phoenix VA hospital that falsified wait times sues to get her job back, saying she was a scapegoat. In response, Rep. Kyrsten Sinema (D-AZ, above), annoyed that the VA pays terminated employees for months to years of appeals and that it lied about the number of employees it fired related to the scandal, has introduced legislation to hold the VA and its employees more accountable, explaining, “It’s now been over a year and these two are on paid administrative leave. That’s ridiculous. They’ve been sitting at home eating bonbons getting paid and they’ve done jack. Every time I talk to the secretary, I’m like, ‘Why have you not fired more people?’ And the secretary says, ‘Well, the process is very long and there’s due process, there’s all these steps, blah, blah, blah’… This is precisely the type of situation that makes the average citizen lose faith in their government.” The Congresswoman’s bio is fascinating.

Privacy and Security

A Ponemon Institute report (which you ironically can’t read without divulging private information) finds that the number one cause of healthcare data breaches is now criminal attacks, with a 125 percent uptick over five years.


Two unnamed hospitals will test PowerGuard, a medical device malware detection system that looks for unusual power consumption without touching the underlying FDA-regulated hardware and software. The PhDs that started the company found that they could recognize when a computer accessed a particularly website by analyzing its power frequency footprints.

Innovation and Research

Brigham and Women’s Hospital (MA) will validate the offerings of startups in which Rock Health invests.

A UC Berkeley engineering team develops CellScope, a smartphone video blood microscope that can diagnose parasitic worm diseases that are common in Africa. Their work was funded by the Bill and Melinda Gates Foundation.



Here’s a reader-sent photo of folks representing most of the lab middleware vendors (including Liaison Healthcare Informatics, Lifepoint, CareEvolve, and Atlas Healthcare) taken at a recent conference. They talked about issues of mutual concern, including how to get more value from conferences and trade shows.

An employee of the Broward County, FL sheriff’s office faces 15 years in prison for attempting to extort $7,000 from a doctor she met on “married but dating” site

Weird News Andy titles this, “Not Exactly Wearable.” University students design seat-based airplane heart rate sensors that could allow flight attendants to identify passengers who are anxious or ill.  

Report from the American Telemedicine Association Conference
By Bill Rieger, CIO, Flagler Hospital


The ATA conference, held this week in Los Angeles, was the largest in the 20-year history of the association. What is the ATA? American Telemedicine Association, of course. Did you know that association existed? Sadly, until last year, I wasn’t aware of it. Historically, unless you were dealing with the challenges of rural healthcare, you may not have had the desire or need to think about telemedicine. A couple of industry dynamics are changing that.

First, some definitions for those of you like me who are just awakening to the world of telemedicine. Telemedicine refers to the use of video or telephone technology used to reach those who would not normally have easy access to healthcare. Telehealth, a newer term that is more personal, is the use of technology to deliver healthcare. This can be wearables, remote monitoring, or even going to Dr. Oz’s website to get health tips that can impact your life. The terms are not really interchangeable, although they are commonly used that way. The conference was full of education and vendor booths that supported both concepts.

I went this year because we are trying to leverage both telehealth and telemedicine within the construct of our ACO. We have plans to use telemedicine to both reduce readmission rates and provide additional benefits to employers as we look to contract directly with them in our community. This is now common in most cities as the use of clinically integrated networks grows . In addition to ACOs driving use of telemedicine, the change in technology itself makes a case for increased use. Remote monitoring of patients in the least-expensive setting of care is just plain smart. Monitoring at home was a huge focus at the conference and the technology used to do this is exploding.

There were two main issues discussed in the keynote panel discussion and they were both excellent topics. The first one was interoperability. That’s right, that $10 word thrown around at HIMSS for the last few years. Well, that word did not even make  it to the showroom floor at ATA. When I walked around and talked to vendors, their technology was great, but the data resided in their individual cloud servers that could only be accessed through their proprietary Web-based or mobile application. Ugh!

Frustration filtered through me as I walked around and heard this repeatedly. Some of them mumbled something about HL7, but it clearly wasn’t a focus or priority. This is problematic for the industry as we look to consolidate data through the increasing use of private and public HIE strategies. It will be left to the health systems leveraging these technologies to assimilate the data into their EMR and HIE systems.

The other issue debated was standards of care. I was happy to hear about the new partnership between the ATA and the AMA. The AMA is starting to understand the potential of telemedicine and has determined that they needed to partner with this rapidly growing initiative and ensure there is a focus on patient safety, quality, and coordination of care. I look forward to seeing this relationship grow.

Eventually, I anticipate Joint Commission-like standards being put in place for the use of telemedicine. That will have to be done for the physician office and the hospital. Sprinkle some MU-like regulations for vendors that focus on interoperability and you will have just what we need — more innovation stifled by bureaucracy. Personal feelings aside, it seems too loose and Wild West right now, especially in the telehealth arena. Maybe I have been a part of the establishment too long to recognize the strength in loosely managed innovation. At the end of the day, a patient is involved, so no matter how cool or innovative, patient safety, quality, and coordinated care has to be addressed in some fashion.

The trip was well worth it. The conference was well run, although there were some minor hotel issues. There were minimal booth babes there, mostly telemedicine techno geeks that loved to talk. I learned a lot about telemedicine and telehealth and how different organizations are leveraging these technologies across the globe to improve access of care. I definitely recommend attending next year in Minnesota.

Sponsor Updates

  • DocuSign will exhibit at Microsoft Ignite through May 8 in Chicago.
  • Extension Healthcare celebrates National Nurses week with a #NursesRock Twitter contest.
  • ZirMed’s ZUG 15 user conference will be held August 17-18 in Chicago.
  • Galen Healthcare offers “eRX Refills – Just Click the Button, Right?”
  • Hayes Management Consulting offers five things to know after EHR implementation.
  • SyTrue CEO Kyle Silvestro is quoted in an article titled “Unlocking Unstructured, Qualitative Data Is Key to Analytics.”
  • HealthMEDX will host its user group meeting May 12-14 in St. Louis.
  • Healthwise offers “Apps and APIs: A Positive Step for Patients.”
  • Access customer Hilo Medical Center says the company’s electronic patient signature helped it attain HIMSS EMRAM Stage 7 and saved it $200,000 annually on consent forms.
  • Holon Solutions will exhibit at the New England Regional MGMA Meeting May 13-15 in Rockport, ME.
  • Impact Advisors offers “Revenue Cycle Management – What Does it Encompass?”
  • Aspen Advisors publishes “Transforming Care Delivery: The Power of Clinical Variation Management.”
  • Ivenix offers a new white paper entitled, “Improving Intravenous Therapy: Opportunities for Designing the Next Generation Infusion System, Part 1: Supporting Medication Safety.”
  • Logicworks publishes “Managing Hybrid Clouds: What Team Do IT Leaders Need?”
  • Medecision’s Aerial InCircle mobile application is named a finalist for Dorland Health’s 6th Annual Case in Point Platinum Awards in the patient engagement category.


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

More news: HIStalk Practice, HIStalk Connect.

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May 7, 2015 News 8 Comments

EPtalk by Dr. Jayne 5/7/15

May 7, 2015 Dr. Jayne 2 Comments


I’ve received quite a bit of reader mail this week, mostly in response to two recent pieces. One discussed people who wear the same thing to work every day. One software engineer talked about a very relaxed work environment where he wears a uniform of jeans and a collared shirt. In summer, they’re allowed to wear shorts and sandals. Although he’d prefer a t-shirt, he agrees the collared shirt is “more appropriate.”

The sandals issue is always a tricky one. I’ve been in offices where this has been allowed and have seen everything from a nicely manicured foot in a dressy sandal to platform flip flops that could cause a serious workplace injury. If you’re going to allow sandals, it’s hard to legislate what kind. Are Keen water shoes OK? What about Birkenstocks? Tevas? Flip flops? How much of the foot has to be covered? What about sandals and black dress socks like my grandfather used to wear? It’s a slippery slope for sure.

I’ve also received a significant number of emails on my recent trip to the hospital with a friend. Mr. H suggested I have my friend request a copy of her medical record to see what it costs, how long it takes to be delivered, and what it contains. It might be an interesting exercise, but I can tell you that two months later she still hasn’t received a bill from the hospital where she was initially treated. You’d think that with many of their patients being vacation-related injuries they’d be more vigilant about timely billing than say a small community hospital. I’ve also asked to take a tour of her Explanation of Benefits statements and any bills she gets since I always find them interesting. She did show me a recent statement from her PCP which actually detailed charges that were more than two years old and had been settled months ago. The current statement was for a $25 vaccine coinsurance, yet they had printed out every service and payment since 2013. The bill wasn’t even in date order. As a professional, I could barely figure it out.

Some of the reader comments have patient stories that are truly heart (or gut) wrenching:

A reader passes out after standing quickly at a restaurant. She is taken to a hospital while she is out, and when she realizes what is going on, starts to worry about the ramifications of her high-deductible health plan. Her workup is unremarkable. Two hours later, she is presented with a patient balance and asked how she’d like to pay it. She requests an itemized bill and copies of her records, which the hospital can’t produce unless she returns another day to request them or has a physician request them on her behalf. My favorite quote from her account: “I smile again, and I realize that I am fake-smiling so she won’t think I’m ‘that girl’… The thought that I would fake-smile at any other person in the world that just handed me a bill for $1,000 without telling me what it was for and ask me for my credit card is absurd.” My own observation is this: If a restaurant can provide an itemized point of sale bill for a party of 20, why can’t the ED give an itemization for a single patient?

An out-of-town patient visits a community hospital emergency department after his health plan triage nurse suspects kidney stones. This is confirmed via bedside ultrasound, which also finds kidney cysts. He is told to follow up with a urologist when he returns home, but forgets to ask for a copy of the ultrasound. Before flying home, he leaves a letter with a family member to take to the hospital to request the records. Radiology agrees to make a copy, but when the relative returns to pick it, up she leaves empty handed, being told that radiology doesn’t manage ED ultrasounds. Medical records doesn’t have it, either. The ED administrator doesn’t know how to get it and has to ask others, which delays the process for a day or two. The return call states that the request has to be notarized (which had not been required by radiology) but no one really knows how to copy the ultrasound or print pictures. A reply is promised, but never comes. The kicker: the hospital advertises point of care ultrasound as the first bullet point on its ED website.

A patient goes for a complex procedure that requires two different surgeons. Neither specialty uses the hospital EHR for outpatient notes. The post-op nurse provides discharge directions that conflict what the surgeons told the patient regarding home medications, requiring clarification with the physicians. The medication list includes every medication the patient has taken in the last three years and has not been reconciled despite the patient handing an updated medication list to both surgeons and multiple pre-op personnel. Discharge instructions were cut and pasted, not only from two different sets of physician instructions, but also from a previous procedure during a different hospital stay. They also contradicted each other. “At the end of the day – I was saved because I am an experienced and knowledgeable healthcare consumer. However, it takes a lot of energy, stress, and worry.”

I appreciate the reader comment that says I’m probably one of the 0.01 percent of physicians that have the interest and patience to write up the experience. He or she goes on to say, “For any hospital executive, she’s just provided a service that a consultant would charge $50K for (if you catch them on a cheap day) – lay out in plain view the issues that make modern medicine intolerable for the average consumer. And things were not that different in the pre-EHR era.” That’s more truth to that than most of us care to admit. A good percentage of EHR implementations don’t address underlying workflow issues or organizational culture. They just threw tools at it.

One reader summed it up: “We have a long way to go.” I agree completely. Some of these things are not rocket science – they’re basic processes that could be handled through checklists and protocols. However, maybe we should go to the rocket science approach. After all, if we can put a man on the moon, we should be able to figure this out.

Email Dr. Jayne.

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May 7, 2015 Dr. Jayne 2 Comments

Morning Headlines 5/7/15

May 7, 2015 Headlines No Comments

Dr. Karen DeSalvo to leave ONC if confirmed for new HHS post

Karen DeSalvo has been nominated for the permanent position of assistant secretary for health, a role she has held as interim along with her National Coordinator position since October 2014.

Dramatic results for Banner Health’s telehealth pilot

Banner Health announces that it has reduced its hospitalizations by 45 percent, and its cost of care by 27 percent through its new telehealth pilot with Intensive Ambulatory Care pilot program.

Lack of Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

A study published in the Journal of the American College of Cardiology designed to measure any correlation between improved ischemic stroke outcomes and the use of EHRs finds no such correlation.

FDA launches UDI database website

Three years after Congress called for medical devices to be tracked with unique identifiers, the FDA has launched a website where consumers can look up information on devices sold in the US by its unique ID.

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May 7, 2015 Headlines No Comments

Readers Write: Is Health IT Guilty of Being a Worm in Horseradish?

Is Health IT Guilty of Being a Worm in Horseradish?
By Nick van Terheyden, MD


A survey conducted at HIMSS15 found that patient satisfaction and patient engagement rank among the top priorities for CIOs. In fact, they rank above improving care coordination, streamlining operational efficiencies, and achieving Meaningful Use.

The tides are clearly changing. We’ve all been talking about what the shift to a value-based care model means for healthcare organizations. What we haven’t been talking about is how this shift is transforming our patients into “prosumers.”

There’s a saying, “To a worm in horseradish, the world is horseradish,” meaning we are predominantly aware of that which we are surrounded by on a daily basis. Health IT, in all its intricacies and expansiveness, has become hyper focused on making sense of its nebulous infrastructures, working hard to prepare healthcare organizations for next new wave of regulations. Our world, while not horseradish, is composed of goals and milestones that are 100 percent contingent upon these systems.

But, as yet one more unintended consequence of this pursuit, we have become myopic. The business of healthcare is no longer simply confined to a hospital or an IDN site map.

Patients are reaching for their phones, not to call their doctors, but to research their symptoms. They’re educated buyers, looking up reviews before seeing a new specialist, just as they would before buying the latest gadget on Amazon. And, as we enter the era of the Internet of Everything (IoE), they want their wearable devices to meaningfully connect as simply as when they use their phones to play songs from the playlist on their laptop.

It becomes a challenge of sustaining the momentum of the moment. As the wearable trend continues to grow, it is not merely enough to count steps or measure the amount of UV rays absorbed. That won’t keep patients engaged. We need statistics and personal health trends that can be used to foster a richer, ongoing dialogue between patients and their physicians.

Consider the positive health implications for patient who receives a treatment plan from her doctor, which is entered into the EMR during the visit and connected to a three-question daily check-in for three months via a mobile device. The patient could provide a thumbs-up, thumbs-down, or neutral rating (think Pandora playlist) on how the treatment is working, with perhaps an option to enter free text should she choose to expound upon her responses. These daily reports could be aggregated into trends and reviewed by a clinician to make adjustments to the treatment plan as needed, extending patient care beyond confines of the four walls and the 12 minutes of an office visit.

Connectivity and personalization is the zeitgeist. CIOs know this. We are all unique snowflakes, and as more and more people submit their genes for analysis and mapping, we’re proving the increased drive for individuality. While the industry is pushing for population health (a laudable vision indeed), patients are looking not to be considered in aggregate, but to be treated with the same personalized attention they experience when they go to a favorite restaurant where the wait staff recalls their usual order or when they go to a website that remembers all their previous preferences. It’s about not starting from square one every time.

Patients aren’t going to tolerate the disconnect in healthcare forever. And as digital natives, some generations won’t tolerate it at all. The day is coming where a patient will ask her doctor, “Did you notice that that my headaches seemed to lessen on those days I go to the gym? I’m wondering if there’s a connection?” If her physician isn’t paying attention to her, she will find a physician, or perhaps even an intelligent medical assistant, who will.

Nick van Terheyden, MD is CMIO at Nuance Communications.

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May 6, 2015 Readers Write No Comments

Readers Write: Big Data, Small Data, Meta Data, See Ya Latah

Big Data, Small Data, Meta Data, See Ya Latah
By Jim Fitzgerald


It’s the RESTful, object store, file and block make me snore, it’s still bits and bytes to me……(sorry, Billy)

I just got back from HIMSS. Big data, like savoir faire, is everywhere. The cynical side of me says that technology vendors just want to sell more disk or flash drives. The analytical technical businessperson somewhere inside me says that the real play for the people trying to sell you and me on big data is in the tool suites for managing, monitoring, sorting, searching, and processing big data. We will be lured in with open source tools like Hadoop, and then when the hook is deep enough, the vendor community will point out to us why we need their quasi-proprietary toolkit to enhance the “limited feature set” and “programmer required” aspects of Hadoop.

Don’t read me wrong. I think I am a fan of this. Why the qualification? Big data, taken to its logical extreme and paired with some artificial intelligence, can help my doctor process all the environmental, social, and lifestyle data related to me and correlate it with the highly structured “small data” in my electronic health record to zero in on, and advise on, the real underlying issues behind my health that go well beyond the “sick care symptom” I am presenting that day.

The vague and slowly clarifying healthcare zeitgeist around population health and “well care” probably won’t be realized without employing big data management techniques as an everyday tool. This apparent service to humankind will be aided and abetted by small and large chunks of data streaming up to the cloud from the “personal Internet of things” that I already own and the things I am considering, like Apple Watch.

The cautionary note comes from my informed-paranoid fear of Big Brother. I have Orwellian visions of the healthcare police showing up at my house and herding me into the quarantine van for a stint of “voluntary rehab” after some warehouse full of seemingly disconnected Facebook posts, Yelp reviews, sensor numbers, and Whole Foods Market receipts mistakenly puts me on a high-risk list for the next pandemic. I won’t even go off into the potential side rant on all my voluntary and involuntary surrenders of my privacy rights along the way, although I do think the court system should brace itself for the onslaught.

Let’s hope my paranoia amounts to nothing more than the receptionist not being a bit surprised that I showed up in the doctor’s office that day because the data-lake-fed-AI predicted I would and had already authorized my insurance and sucked all the available fresh data on me into a useful visualization for my clinicians.

What’s the difference between big data and small data? The short version is that big data is generally considered to be an unstructured collection of data objects. Unstructured in this usage implies that there is no classic structured database format imposed on the data. The unstructured data could be a song captured as MP3 or AAC, a simple list of my last 20 temperatures stored in my Apple Watch, or a photo just taken in the ED of the festering wound on my right leg.

Big data is generally big because it is a vast collection of objects. Sometimes big data is big because the individual objects are prodigious on their own, and are also known as BLOBs or binary large objects – for example, your favorite “Breaking Bad” episodes that are still sitting on your iPad. It could really be anything, including a file that has a structure and order of its own, but is being considered as part of a greater set of data molecules in a “data lake.”

Storing data as objects, most commonly done on the Internet with RESTful storage protocols, is an increasingly normal trick in the world of data storage and management. When we store data as objects, we don’t care all that much about structure, or about the nature of the data, or about its accessibility by a particular file system or operating system. That problem is shifted from its traditional place in the OS or the storage array and is moved to the app. (notice I did not say “application.”)

To the extent that we care about the objects in an object store (an allegedly safe place to put objects) we may tag them as they go in with meta data, which everyone who has followed the Edward Snowden story knows is “data about the data.” In fact, the object might get multiple tags. One might be a lookup address or unique ID in the object store and one or more others might be some common descriptor of what is in the object itself. Hence the chaos of unstructured data may in fact, have some external structure imposed on it by some rules-based system ingesting the data objects.

In truth, small data is still where the rubber meets the road in today’s healthcare information systems. The organization or structure of that data by the HCIS in a pre-defined database provides the accuracy and confidence clinicians need to treat me and administrators need to bill me. It generates the endless arguments and the grossly inefficient cottage industry that has sprung up around HIEs. (do we really need to argue on what the “first name” field means?)

Big data can provide inferential context for small data, but it cannot supplant the precise articulation or definitive metrics collected and presented, in context, to help treat me. Small data is so important that we protect it not only in context of its integral structure in a database, but also in some cases at the file system, operating system, and storage subsystem levels. In many cases via RAID technology, backups, and replicas we have so many copies of the same small data that it is really not very small at all; but hey, in the days of petabyte and zettabyte data lakes, a few terabytes looks more like a data puddle.

There is, however, an economic force in play here. Depending on whose numbers you believe, big data on object stores is four to 20 times cheaper to manage than an equivalent amount of small data being managed by a production application in a Tier 1 SAN. The “apps” which are slowly arriving in healthcare (and may continue to arrive) may be happy just to slam a bunch of tags on an object and call it a day. Then we will have “tag oceans” and “tag bagging” toolsets with cute animal logos, and the circle of data will continue to self-perpetuate.

Jim Fitzgerald is technology strategist and EVP at Park Place International.

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May 6, 2015 Readers Write 2 Comments

HIStalk Interviews Susan Newbold, PhD, RN, Owner, Nursing Informatics Boot Camp

May 6, 2015 Interviews No Comments

Susan Newbold, PhD, RN-BC is the owner and a faculty member of Nursing Informatics Boot Camp.


Tell me about yourself and what you do.

I am a PhD prepared informatics nurse. I’ve been in the field for many, many years, since the early 1980s. I conduct something I call the Nursing Informatics Boot Camp. It’s a two-day course. I travel around the country and the world giving that course, mostly for nurses, but for other clinicians as well. I’ve pretty much always been an educator. It’s my goal to teach every nurse about informatics.


Are the educational and experiential expectations changing to be able to call yourself an informatics nurse?

It is changing. When I started, I was self-taught. There are still people now that are self-taught. I’m still finding that.

People don’t have traditional coursework in informatics, so that’s why the boot camp that I do is valuable in one respect, because sometimes it pulls it together for the nurses that have been in the field without the education. It makes them realize that they are an informatics nurse. According to the American Nurses Association, you can only call yourself an Informatics Nurse Specialist if you have a degree and everybody else can be an informatics nurse.


Training options include your boot camp, 10×10, certificate programs, and graduate programs. If I’m a BSN working in informatics, what education might I pursue?

If one has a bachelor’s degree already, they could pursue a master’s degree specifically in nursing informatics. There are at least 43 programs available, many or most of them online. There are many, many options for education. Also, health informatics, because they’re not just restricted to nursing informatics. They could go into more of healthcare informatics, which is broader.


As an informatics nurse, what organizations and publications do you find most relevant?

I like CIN, which used to be called Computers, Informatics, and Nursing. It’s available in hard copy and online. I have had the privilege of being able to be part of many books related to informatics. In fact, two of them just came out at HIMSS. One of them is a HIMSS book called, “An Introduction to Nursing Informatics: Evolution & Innovation.” That’s new, hot off the press. That’s for people that may be nurses and wonder what informatics is all about, so it really is a good intro. I think people in the field can benefit from it as well.

I was also privileged to be a part of the newest edition of Saba and McCormick’s “Essentials of Nursing Informatics, 6th Edition.” I always think when a book is in a later edition, it always gets better, and this one is better. It’s one of the newest and latest books out there. I was privileged to edit the international chapters, so it’s not just a US perspective, it’s international as well.

And of course, HIMSS. Everybody has to be a member of HIMSS. Some people that are in academic medical centers may go toward AMIA, which used to be the American Medical Informatics Association.


Speaking of the HIMSS conference, how were informatics nurses represented there compared to previous conferences?

We are lucky in that there’s a one-day symposium on nursing informatics. If you want to be drawn toward nursing informatics topics, then be with a network and have education surrounding nursing informatics, we do have that one-day symposium. That’s excellent. Otherwise, the topics are very broad, and I know — well, that’s probably the wrong word — not very nursing focused. But that’s OK. We can pick and choose and find topics that are of relevance to us as nurses and clinicians.


Do you think there’s any movement to make the HIMSS conference more relevant to nurses?

I can speak from a chapter level. When I first moved to Tennessee, I said, hey, you guys are all consultants talking to vendors. That seemed to be what Tennessee HIMSS was. They said, well, Dr. Newbold, you can change that, and we will make you vice-president of professional development for Tennessee HIMSS. Because of that, I had the opportunity to bring in more clinical aspects of our programming.

I think we have that opportunity within HIMSS. I really think that HIMSS is us. HIMSS is me. I have that opportunity to make suggestions and have things more nursing focused.

But of course, we just don’t look at nurses. We focus on the patient, so all things clinical are of interest to us. I recommend that every nurse who’s interested in informatics joins HIMSS because there is plenty for nurses. The online drills, the webinars. I’m doing a webinar during Nurses Week on the pioneers in nursing informatics. We have plenty of opportunities.


Do you see vendors paying more attention to what happens to their products when they’re put out in the field for nurses to use or getting input on product design from nurses?

I think vendors are getting better. I did work for a couple vendors along the way. The smarter vendors now have things like usability labs and have nurses that are employed by them. Vendors like Cerner have hired me to see that they can get their nurses are certified in nursing informatics. That’s a huge gold star for that vendor. They see the importance of nurses and have hired hundreds of nurses. That’s a big thing.

We still have a long way to go as far as usability is concerned, but some of the vendors are getting it and starting to hire nurses and utilize nurses and focus groups, usability labs. We’re getting better. It is a little bit frustrating that it’s taken so long. You know, I’ve been in the business for over 30 years. When are we going to get products that accurately reflect our workflow?

But then part of the problem is nurses. We don’t all do things the same way, even two units in a hospital. “Oh, we do things differently because we’re special.”


It sometimes seems that the attributes that make a good nurse doesn’t necessarily make a good technologist. Do you see that changing with the educational requirements?

I think it is changing. Most nursing programs are now required to include nursing informatics. That’s a good thing. We’re using more technology in our everyday life. Even the smartphone is technology that we didn’t have a few years ago. We’re using it, we’re integrating it into our everyday life, it’s there in our organizations. There are nurses now who have always documented using electronic means.


Do you see more opportunities for nurses to take leadership roles within health systems and informatics?

Oh, definitely. The only thing that’s holding us back is ourselves. We can be chief nursing informatics or information officers. We can be CIOs.


When you say nurses are holding themselves back, what should they do differently if they aspire to those leadership roles?

If we want to be a CIO, we can figure out what the path is to get there. I don’t really see that there’s a glass ceiling that doesn’t allow us to get there. Most of the people in healthcare IT these days are men, definitely, but that doesn’t mean we’re held back from getting those CIO top-level jobs.


What would be the ideal background for a nurse to get into that CIO-type position?

I always think it’s easier to take a nurse and teach them the technical aspects than to take a technical person and teach them the healthcare aspects. So the first thing is being a nurse. Then there are plenty of degree programs so you can get more of that technical aspect. We do, as nurses, need to know more about technology than we do. I think we need to be a little bit more technical ourselves and not leave that up to somebody else on the team.


Are nurses actively involved in patient engagement enough to make a difference?

I think we’re trying to figure it out. It’s funny. When I do my boot camps, I say, “OK, how many people have patient portals?” and they may have it, but they don’t use it. We should be the role models — the nurses. Every nurse should be engaged personally in a patient portal so then we can encourage patients to be part of the patient portal.


Do you have any concluding thoughts?

Besides education, one of my issues with nursing informatics is that it may be hard for us to define who we are and tell others who we are because we have so many titles. As in hundreds of titles, not just a dozen or so. We have hundreds of titles, so it’s hard to say who we are as informatics nurses. I think that’s one thing we have to work on — to try to get it down to manageable numbers so we can convey to others outside of nursing who we are and what we do.

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May 6, 2015 Interviews No Comments

Morning Headlines 5/6/15

May 5, 2015 Headlines No Comments

Cognizant Earnings Top, Fueled By TriZetto Buy

Cognizant reports Q1 results: revenue up 20 percent to $2.9 billion, EPS $0.62 vs. $0.57, beating analyst estimates on both. The company’s stock price climbed 10.8 percent, to a record high $65.55, following the results.

Imprivata Achieves Revenue Growth of 32% for the First Quarter of 2015 and Raises Annual Guidance

Imprivata reports Q1 results: revenue up 32 percent to $25 million but still resulted in an overall net loss of $6.7 million, EPS –$0.28 vs. –$2.29, beating expectations for both.

Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

In a New Yorker piece, Atul Gawande, MD discusses the tendency to overtreat patients in the US, citing a study suggesting that, every year, at least 25 percent of Medicare patients receive high-cost tests that are well known to be wasteful.

Apple Has Plans for Your DNA

Apple will begin offering DNA testing to some iPhone owners to support current and future ResearchKit initiatives. UCSF and Mount Sinai Hospital are planning ResearchKit-based studies that involve DNA testing.

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May 5, 2015 Headlines No Comments

News 5/6/15

May 5, 2015 News 3 Comments

Top News


Cognizant reports Q1 results: revenue up 20 percent, EPS $0.62 vs. $0.57, beating expectations for both and boosting the stock to a record high Monday. The company’s healthcare unit, which includes its November 2014 TriZetto acquisition for which it paid $2.7 billion, increased revenue by 43 percent year over year. CTSH shares are up 32 percent in the past year. Cognizant says it has added 500 consultants and 300 developers to the former TriZetto business and was selected for $200 million worth of synergy deals, which it says proves its expectations of $1.5 billion in post-acquisition revenue synergies. TriZetto had closed 2014 at $729 million in revenue with single-digit growth rates before the acquisition. Cognizant CEO Frank D’Souza added that while the TriZetto integration continues, the company would consider another acquisition of similar size.

Reader Comments


From Compadre: “Re: Athenahealth. Its core offering is data entry, not software. They have thousands of people scanning, typing, and following up on claims. The actual software is just a Web front end that drives little profit margin. Let’s do some math. One MD internist collects $25K per month. Athena charges 7 percent ($1,750) to perform billing services, allowing it to book annual revenue of $1,750 x 12 months so the top line revenue looks like it’s growing. However, the cost is $1,500, leaving $250 per month for busy work. That’s not cloud computing. The street has caught on to this and it’s starting to show in investor sentiment. Finance rule 101: not all revenue is created equal.” A Forbes analysis says Athenahealth, like Allscripts, is facing low and declining ambulatory EHR margins compared to Cerner and says ATHN struggles with “evaporating profits, competitive struggles, and fading tailwinds” even as its share price climbs, making it ripe for implosion.

From BestBets33: “Re: Dr. Jayne’s report on her friend’s hospitalization. I often wonder why discharge planning and education is so disorganized. They do these things every single day, yet everywhere I’ve been it is such a cluster. Think about confused patients and nurses chasing things that should have been taken care of with a short checklist.” It is ridiculous that award-bragging hospitals can’t drive their policies and technologies down to frontline staff, meaning patients are at the mercy of whatever the individual nurse or doctor decides to do given their other priorities. Any other high-volume, high-revenue business would collapse from the lack of standardization and consistency – can you imagine shopping at a Walmart or eating at a McDonald’s that is run like a hospital? I suggested to Dr. Jayne that she ask her friend to request a copy of her medical record to see how closely it matches reality, not to mention finding out the cost and time required to get it. The hospital has a $200 million EHR, but from Dr. Jayne’s account, they’re using it poorly. Here’s my theory: hospital executives all over the country have fooled themselves into thinking they offer great care because they’ve walled themselves off from reality. They don’t eat their own dog food — when they themselves are forced into the patient role, they either go elsewhere due to privacy concerns or they get the swanky suite treatment far away from the huddled masses who pay their huge salaries. I would bet that every one of us who has been hospitalized was appalled at the inefficiency, clinical errors, and lack of consistent humanity. We ought to be embarrassed as an industry at what we’ve let ourselves become while pretending otherwise, but on the other hand, just acknowledging the opportunity for improvement is the first step.

From Picky Eater: “Re: Jeremy Bikman’s comments about KLAS. One report I saw recently costs $16,000 and it surveyed only a few dozen people. That’s not sustainable, especially considering that its methods are not statistically valid.” KLAS’s business model is brilliant – by ranking vendors, it creates a profitable maelstrom as the higher-ranked ones pay it fees to brag on their accomplishment (no matter what its statistical validity) and the lower-ranked ones pay the company for whatever insight it can offer to help them move up the food chain. I contributed to KLAS as a provider almost from the day they opened and my summary is that I rarely quibble at their best- and worst-ranked vendors – it’s the ones in between that are always duking it out. It was most useful when I was looking at a product I knew nothing about because otherwise the reports only validated what I already knew. I wasn’t as interested in the rankings or even the scores as much as I wanted to read customer comments, but even then you can’t put too much stock in them since you don’t know either the organization or the background of the commenter.

From Sam: “Re: Ed Marx. I like reading his submissions because he seems like a CIO with a philosophy. I’m curious if he resigned to work for a new organization and which one it might be.” I’ve heard indirectly that he has a new job, but I’ll leave it up to him to announce it when he’s ready.

HIStalk Announcements and Requests


This is Ms. Sheppard’s Texas third-grade class using the drawing tablet, response buzzers, and iPad projector adapter bought with our DonorsChoose donation. She says the students now want to do all of their work using the response system since they enjoy competing. Maybe the buzzers should be used at some of the HIMSS snoozer sessions, or perhaps at executive meetings after being wired to provide an electrical shock to the presenter if the majority of attendees are bored.

I also got a fun thank-you card from a high school student who is happy with the algebra calculators we purchased for the class. It reads, “You’re my hero. You’re like the Superman of my math class today. For years now my brain has had one thought … I hate math. But now it is a lot easier for me to do basic and hard math because of the technology you have donated. I still don’t like math, but it’s not the worst thing in the world.” It apparently isn’t, because the student ended with a PS that included a complicated math problem and the challenge, “See if you can solve this.” It’s great seeing the benefit of donations firsthand, knowing that the impact wasn’t diluted by middlemen salaries and wasteful corporate overhead (which is why I would never donate to a hospital).


Meanwhile, Epic has generously donated $4,500 towards our classroom projects, so I’ll be funding quite a few new ones this week. I have to look at our total donated, but I think it’s $20,500, and that funds a lot of important activities. Thanks to Epic for helping a bunch of kids  – I will make it a point to look for Wisconsin teachers in need.

Listening: reader-recommended Tame Impala, a one-man band from Australia that sounds like Sergeant Pepper-era John Lennon jamming with the children of Pink Floyd at the home of Tears for Fears.

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



May 19 (Tuesday) 2:00 ET. “Lock the Windows, Not Just the Door: Why Most Healthcare Breaches Involve Phishing Attacks and How to Prevent Them.” Sponsored by Imprivata. Presenters: Glynn Stanton, CISSP, information security manager, Yale New Haven Health System; David Ting, CTO, Imprivata. Nearly half of healthcare organizations will be successfully cyberhacked in 2015, many of them by hackers who thwart perimeter defenses by using social engineering instead. The entire network is exposed if even one employee is fooled by what looks like a security warning or Office update prompt and enters their login credentials. This webinar will provide real-world strategies for protecting against these attacks.

May 20 (Wednesday) 1:00 ET. “Principles and Priorities of Accountable Care Transformation.” Sponsored by Health Catalyst. Presenter: Marie Dunn, director of analytics, Health Catalyst. Healthcare systems must build the competencies needed to succeed under value-based payment models while remaining financially viable in the fee-for-service landscape. This webinar will outline key near-term priorities for building competency at successfully managing at-risk contracts, with a particular focus on the importance of leveraging data to drive effective decision making.

Acquisitions, Funding, Business, and Stock


Imprivata announces Q1 results: revenue up 32 percent, EPS –$0.28 vs. –$2.29, beating expectations for both.


Visiting Nurse Service of New York chooses Cureatr for secure messaging and care coordination.

CareMore Medical Group of Nevada signs up for the chronic care management program of Allscripts.

Grady Health System (GA) selects Strata Decision’s StrataJazz Continuous Cost Improvement.



Penny Wheeler, MD, president and CEO of Allina Health, joins the board of Health Catalyst, replacing Larry Grandia.


Kathleen Brenk (Trust Company of America) joins Recondo Technology as chief human resources officer.


Former HHS Innovation Fellow Zac Jiwa joins healthcare API vendor MI7 as CEO. He had been an advisor to the company.

Announcements and Implementations

Raintree Systems will offer its customers patient billing solutions from PatientPay.


Telehealth service vendor American Well releases a telehealth app for providers who want to see non-urgent patients via high definition video visits and Apple HealthKit connectivity. It also allows patients to choose a particular doctor or to take first-available and for doctors to invite their patients to a telehealth visit.

IBM, Epic, and Mayo Clinic will collaborate in using IBM’s Watson to analyze EHR information.

CompuGroup Medical announces CGM Analytics, a data aggregation and analytics solution.

Government and Politics


Rep. Ted Poe (R-TX) introduces a bill that would prohibit HHS from implementing ICD-10. He’s been a hater from the beginning (mostly of anything Democrats favor), but his previous legislative attempts to stop ICD-10 haven’t gained traction and probably won’t this time either since he doesn’t have much Congressional clout. At least he’s apparently given up on his repeated attempts to prove that President Obama isn’t a US citizen.



Beth Israel Deaconess Hospital – Plymouth (MA) declares “Email Free Fridays,” urging employees to stop emailing each other for a least one day per week, get out from behind their desks, do real work, and communicate with co-workers face to face.


Atul Gawande says in a New Yorker article that performing unnecessary tests and procedures is expensive and risky to patients, but it’s hard hit the sweet spot between doing too little and doing too much, especially in an environment that pays doctors for unnecessary care and penalizes them (via satisfaction scores and lawsuits) for lapsing into inadequate care territory. My interest is something he doesn’t emphasize much – what voice does the patient have in those decisions? We always assume patients want their doctors and hospitals to be aggressive with their procedures and prescriptions, but I suspect doctors aren’t always good at explaining the long-term benefit or recommending only those treatments that they themselves would choose.

A three-hospital study finds that while physicians often blame demanding patients for running up healthcare costs, less than 9 percent of oncology patients ask for specific tests or treatments, nearly all of those are clinically appropriate, and physicians very rarely comply with the inappropriate ones.

An MIT Technology Review article says Apple will recommend genetic testing to certain iPhone users, arrange for the tests to be run by academic partners, and then allow people to share their results with each other or with researchers via ResearchKit. UCSF and Mount Sinai Hospital are planning studies that will involve DNA collection.

The family of deceased Ebola patient Thomas Duncan says the donation of $125,000 by Texas Health Resources as part of its settlement with the family is “not nearly enough,” expressing shock that THR didn’t provide the $5 million the family asked for to build a hospital in Liberia.


Legacy Health System (OR) goes to an emergency operations plan when an apparent power surge takes its systems down for 12 hours.


A New York Times article covers the rise of air ambulance services that are raising their rates dramatically and pressing harder for patient payment even as insurance companies reduce coverage. A glut of medical helicopters has caused usage to drop and an industry trade group is trying to convince the federal government to increase their Medicare payments, warning that “it’s about access to healthcare.” Billion-dollar operator Air Methods, which operates 450 helicopters and airplanes in 300 locations, charges an average of $40,000 per flight. It’s another of those healthcare things that sounds like a fairly good idea to doctors and patients until everybody finally realizes what it costs.


Weird News Andy offers a thumbs-up on the just-published “The Thrilling Adventures of Lovelace and Babbage: The (Mostly) True Story of the First Computer,” which he describes as “fun, smart, and very entertaining / informative.” It’s a mix of fact and fiction for “the whimsical intelligentsia,” a group to which we all surely aspire to belong.

Sponsor Updates

  • Extension Healthcare wins the Health Tech Award from Indiana’s TechPoint.
  • A team from Nordic will ride in the Madison Tour de Cure benefit for the American Diabetes Association on May 16.
  • PatientSafe Solutions CEO Joe Condurso is interviewed by The Wall Street Journal about health app development.
  • Ingenious Med is named as one of Atlanta’s 100 fastest-growing companies.
  • Medecision asks, “Who is Responsible for Patient Engagement?”
  • Cumberland Consulting Group Managing Partner Jeff Lee is featured in a PharmaVoice article on technology.
  • Culbert Healthcare Solutions offers “3 Strategies for Retaining and Attracting Top-Notch Physicians.”
  • Capsule Tech offers “Are your medical devices configured to reduce alarm fatigue?”
  • ADP AdvancedMD offers “Spring Cleaning for ICD-10” tips.
  • TransUnion Healthcare President Gerry McCarthy is quoted in an article that addresses uncompensated care.


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

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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May 5, 2015 News 3 Comments

Morning Headlines 5/5/15

May 4, 2015 Headlines No Comments

Imprivata Acquires HT Systems to Expand its Authentication and Access Management Platform to Patients

Imprivata acquires HT Systems, a palm-vein based biometrics vendor focused on the patient identification market, for $19.1 million in cash and $6.9 million in potential performance bonuses scheduled to be paid out over the next two years.

Athenahealth Looking Like A Very Unhealthy Stock

Forbes contributor David Trainer forecasts additional losses for athenahealth stock , citing slowing revenue and after-tax profit growth, and a 35 percent decline in stock value since its peak in February 2014.

Why Your Next Doctor’s Visit Might Be Through An iPhone

Telehealth vendor American Well launches a new telemedicine application designed to help doctors provide telehealth services to just their own local patients. The new app is designed to help doctors working through regulatory restrictions on remote consultations.

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May 4, 2015 Headlines No Comments

Startup CEOs and Investors: Bruce Brandes

All I Needed to Know to Disrupt Healthcare I Learned from “Seinfeld”: Part V – Yada Yada Yada
By Bruce Brandes


Most every company talks about their elevator pitch, which is intended to be a brief summation of the business to intrigue one to want to learn more. My question is this: exactly how long are the elevator rides some people are taking? More broadly, in any sort of business interaction, how to you best balance brevity vs. meaty detail?

The Webster’s definition of the phrase “yada yada” is "boring or empty talk often used interjectionally, especially in recounting words regarded as too dull or predictable to be worth repeating." Anyone still recovering from the HIMSS conference can likely recall many conversations where yada yada would have been a very welcomed interjection.


Our old friend George Costanza once dated a woman who often filled in her stories with the expression yada-yada, leaving out much of the detail. Jerry praised her for being so succinct (like dating USA Today) but not knowing the full picture drove George crazy. So opens the debate: is yada yada good, or is yada yada bad?

As discussed in an earlier column, most pitches are too long and generic. A little yada yada to help you explain your company in 60 seconds or less is very good. In calculating how to consolidate your elevator pitch, reread the Webster’s definition above and be sure to yada yada overused, now almost meaningless buzzwords like “patient engagement,” “big data analytics,” or “telemedicine.”

Instead, focus on concisely describing why your company exists, what problem you solve, and how you deliver that solution in a way that is clearly superior or more simple than the masses. Even 60 seconds might seem like a long elevator ride to your audience if you do not make a compelling initial impression in the first 15. Without the yada yada, you are not getting a first meeting.

Better yet, if your solution is as vastly unique and compelling as you may perceive, perhaps its simplicity speaks for itself. Did Apple need to yada yada when it introduced the iPad?  In his book “Insanely Simple,” Ken Segal describes the cultural foundation which led to Apple’s development of transformational products so simple and obvious that a two-year-old or a 90-year-old could just intuitively understand them.  

For real game-changing solutions, an unspoken yada yada is implicit. For example, in philanthropy, the Human Fund’s mission statement – “money for people” – enticed Mr. Krueger with its understated stupidity.

However, the buyers of and investors in healthcare technology solutions are remiss to not press for the substantive details and validation of claims glossed over by the yada yada. How many HIStalk readers been burned by extrapolating assumptions from high-level vendor assertions only to later recognize in the fine print that some important information was omitted by a yada yada?

  • Q: Where does your system get all the data you are showing in your demo?
  • A: Once you sign the contract … yada yada yada … we integrate seamlessly with your EMR.

  • Q: How do you achieve your revenue projection of growing 20x in two years?
  • A: We had meetings with people at both HCA and Ascension about doing pilots … yada yada yada …. we forecast 300 hospitals next year.

Let’s try to yada yada some of the memorable events in healthcare IT history.

  • We acquired five more companies which will be integrated by next quarter … yada yada yada … we beat our forecasted revenue numbers. (every HBOC quarterly earnings call in the 1990s)
  • We closed on our acquisition of HBOC … yada yada yada … our market cap dropped $9 billion today. (McKesson 1999)


  • We are putting out an RFP to evaluate vendors and purchase a new enterprise electronic medical records system … yada yada yada … we bought Epic. (any academic medical center in the past 10 years)
  • We are making great progress on our successful Epic rollout … yada yada yada … we are announcing major budget cuts to protect our bond rating. (that same academic medical center three years later)

I contend that yada yada is both good and bad. Mastery of this notion leads to knowing when to use the figurative yada yada to establish appropriate interest, rapport, and trust. It is equally important to know how and when to effectively press for critical information which the symbolic phrase may be concealing.  

Bruce Brandes is managing director at Martin Ventures, serves on the board of advisors at AirStrip and Valence Health, and is entrepreneur in residence at the University of Florida’s Warrington College of Business.

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May 4, 2015 Readers Write No Comments

Startup CEOs and Investors: Michael Burke

The Shifting Incentives of Startups
By Michael Burke


Mr. H asked a few startup CEOs to give his readers an “inside baseball view into a world that a lot of us will never see as employees” — the world of starting and running a startup company. In this post, I’ll try to honor the spirit of that request by describing how incentives in an early-stage startup create an environment that is simultaneously thrilling, rewarding, and terrifying. We’ll then discuss the challenge of maintaining a startup’s culture while these incentives change.

I’ll start first with a sweeping generalization:

An early-stage startup company’s incentives are more purely aligned with their customers’ incentives than any other size, stage, or structure of business.

Think about it. At this stage, it really doesn’t matter whether the founders want to build a great company, make the world a better place, or make a big pile of cash. They can’t do any of these things if they don’t focus exclusively on the success of their early customers. This singular focus is a luxury not afforded to companies of other stages. These purely aligned incentives create an environment of productivity and creativity like no other.

Does this alignment of incentives guarantee success? Absolutely not. I’ve noted in an earlier article that the odds of success for a startup are low. There are a million things that can go wrong. The alignment of incentives does, however, mitigate the risks to some degree.

Now I know that most companies of various stages consider their customers important and would assume on the surface that their interests are aligned with those of their customers. But until they’ve pledged their house and savings to guarantee a loan for working capital, they don’t know what a real incentive feels like. That’s the terrifying part.

Shifting Incentives and OPM

Incentives often change as a startup grows. The really great companies find a way to maintain the positive elements of their culture during these periods of change. It’s not easy to do.

There’s a phenomenon in the startup world that is repeated time and time again. A scrappy startup that was efficient with the little bit of capital it had gets a big chunk of money from a VC. Then they start to suffer from OPM (Other People’s Money) syndrome. They start to think that they really need those golf bags emblazoned with the company logo. They over-hire. They move away from making small, responsible bets to Vegas-style gambles. It’s not entirely their fault. Their incentives have shifted.

Because of their new outside investors (who may now have a controlling interest but almost certainly have preferential exit terms), they now have to hit a grand slam. The fund needs to generate a 10X return in 3-5 years. A base hit, double, or triple might cover the VC’s vig, but it won’t put any money in the founders’ pockets.

In order to generate this sort of return, companies are strongly incented to focus exclusively on short-term revenue growth and ignore long-term investments in people, product, and process. In a parallel universe, big public corporations often find that their incentives diverge with those of their customers when it comes to the obsession with quarterly earnings, sometimes at the expense of similarly necessary investments in people, product, or process.

Some companies manage to maintain their focus and keep their culture intact through these and other changes. As a result, they often deliver exceptional value to their customers.

Freedom and Responsibility

Most successful startups are usually characterized by a culture with freedom and responsibility at its foundation. The freedom isn’t just a cultural choice; it’s a requirement. Top-down management structures just don’t work in a startup. The glacial speed of command and control environments is absent the requisite flexibility, productivity, and creativity. Distributed, self-organizing environments are required in the early stages to learn quickly, fail quickly, and adapt quickly.

Responsibility is the opposite side of the freedom coin in a startup. It makes the selection of the startup team absolutely critical. Folks who are attracted to working in an early-stage startup seem energized by this environment of responsibility. There’s just no place to hide in a startup, and nearly every decision is important. You need folks who are willing to act and to take responsibility for their actions.

In the early days, this culture of freedom and responsibility often emerges organically as a byproduct of the nature of the work and the requirements placed on the team. As a company grows, however, it needs to be much more intentional if it wants to keep the magic going. When we were a few founders in a room, we didn’t have to worry about vacation policy. No one planned to go anywhere until the work was done anyway. Now, when we hire a new employee, we need to have an intelligent answer to the question. So our answer is: take whatever time you want. We care about results, not about punching the clock.

One of the really great things about a startup is that you get to collectively define a culture with a relatively small group of folks. That’s a very exciting and fulfilling process. Contrary to popular belief, this definition of culture doesn’t come from the top down. Don’t get me wrong — a founder/CEO can single-handedly screw up a company’s culture, but the CEO can’t define it unilaterally. A founder/CEO can be a part of the process of a company’s emerging culture, but only a part. In my view, the most influential part a CEO can play in the intentional cultivation of culture is in hiring decisions. Secondarily, a CEO can make sure the policies of the company appropriately support the required culture of freedom and responsibility. Policies are fine, but in a startup, it matters much more what you do than what you say.

No Shortcuts

The bottom line is that startups can’t focus on the finish line if they want to be successful. They have to find a way to set aside the numerous distractions and shifting incentives of fund raises and exit strategies and simply focus on building a great company that delivers great value to customers. Protecting their company’s culture is a big part of this. If they can maintain this focus, they increase their odds of long-term success dramatically.

Michael Burke is an Atlanta-based healthcare technology entrepreneur. He previously founded Dialog Medical and formed Lightshed Health (which offers Clockwise.MD) in September 2012.

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May 4, 2015 Readers Write No Comments

Curbside Consult with Dr. Jayne 5/4/15

May 4, 2015 Dr. Jayne 5 Comments


Jayne Goes to the Hospital

I’ve enjoyed reading the posts this week from our patient advocate HIMSS attendees. They all have interesting stories to tell from the patient perspective.

Recently I took off my doctor coat and became a patient advocate as I accompanied a coworker through her knee reconstruction process. Although she didn’t have it done at my hospital, she had it done at one that is part of a large multi-state health system that advertises its relentless focus on quality. It was eye-opening to see behind the curtain at someone else’s facility and to look at what goes on in a typical patient’s experience.

Her journey started after an ill-fated adventure vacation when she called me for an orthopedic recommendation. Since we work together, I asked why she didn’t go with one of the surgeons we know well. Her answer – privacy concerns – didn’t surprise me. She was able to get an appointment the day after returning home and was immediately scheduled for an MRI. Unfortunately, her surgeon’s office didn’t tell her she needed to schedule an appointment to receive the results, so she ended up calling a couple of days after the MRI only to be told she’d have to come in the following week.

That’s the kind of patient aggravation that’s totally avoidable. I had previously referred hundreds of patients to this particular practice as a primary care doc and never had that kind of complaint before. I did some digging with colleagues, and it turns out the practice was recently acquired by a health system that requires them to use a centralized scheduling service. Apparently the ball gets dropped a lot. It didn’t make me confident since I had referred her, but at that point, what can you do?

After receiving her results, she was scheduled for surgery at a hospital across town. I asked her why she selected it since the surgeon operates at multiple places. Her response this time did surprise me: that’s the first choice they gave her and she really didn’t consider other options. It just goes to show that no matter how much we think patients agonize over quality scores and other factors, sometimes they really don’t care.

Since she’s single, she asked if I would go with her and stay at her place the night after the procedure until she was sure she could get around the house. I agreed and we spent the night before sharing a bottle of wine and laughing about being young, sassy, and having your own personal notarized advance directive. After years of hospital work, she said she wasn’t crossing the threshold without it.

As we were leaving the house the next morning, the hospital called asking if she could come any earlier. Not likely since her scheduled arrival time was in 25 minutes and the hospital was 20 minutes away. It kind of surprised me that they’d bother calling patients to come early if it was likely that they’d already be on their way. That should have been a harbinger of the adventures we were about to have.

We arrived on time, only to find the parking lot where she was told we should park to be marked with “no surgery center parking” signs. Twice around the block and several one-way streets later, we made it to a parking garage.

The surgery center lobby was vacant except for patients and a sign-in kiosk. She registered and it took more than 15 minutes for anyone to call her up. So much for the need to arrive early!

The first question she was asked was whether she had traveled to West Africa in the last 21 days. The second was whether she was ready to pay her estimated patient portion in advance since she’d get a discount if she paid pre-op. Once her credit card was swiped, she was handed a laminated HIPAA and consent document (which had to be 8-point font) and told to “sign the signature pad when you’re ready.” There’s no way patients who are already nervous about a surgery are going to actually sit there and read it. I wonder if it would even hold up under legal scrutiny given the way it was presented.

By this point, I was totally taking notes on my phone since I knew a blog entry was likely to come out of this. The registrar asked if I’d like to receive text updates during the surgery, which I thought would be interesting to see how it worked.

With the paperwork done, we headed back to the outpatient surgery holding area. After being specifically told to keep her undergarments on (a fact which will become pertinent later, I promise), she changed into her low-fashion hospital gown and revealed the fact that she had marked her opposite knee with “NO!!!” in Sharpie. The nurse immediately jumped on this and belittled her, saying that she shouldn’t have done that because it would be confusing to the OR staff. Making a patient feel bad because they have a genuine (although humorously stated) concern about the risks of wrong-site surgery should never happen. She finished the intake process (after asking again about West Africa but never about the advance directive) and scurried off.

Luckily the anesthesiologist was a little more sensitive, kindly explaining that they have never had a wrong-site case at the facility and describing the multi-step process that they have in place to prevent it. The surgeon would meet with the patient, review the consent, sign the correct knee with “YES” and his initials, and this would be witnessed by patient and staff before the patient received any medications. They would repeat the process once the patient was anesthetized and before the surgeon started the procedure.

He was reassuring, but also stated we’d need to remove the “NO!!!” so it wouldn’t confuse the OR team. She agreed, but I wondered if the OR team couldn’t tell the difference between YES/initials and NO!!! that there might not be other issues at play.

We joked about the buffalo plaid sheets on the outpatient surgery gurneys. Our hospital has plain white, so we were snapping pictures. A second nurse came in and asked if the first nurse had finished the intake process. Um, I don’t know, since I don’t know what your intake process is. Wasn’t it in the chart? Apparently it wasn’t.

The second nurse finally logged in to see what had been charted, then proceeded to ask my friend specifically what the first nurse had done: Did she listen to your lungs? Did she use lidocaine when she started the IV? I pasted my best quizzical look on my face to see if she’d notice, but she was too busy charting another professional’s work to pick up on it. After copious clicking had gone on, the first nurse returned, asking “Oh, are you doing my charting?” and the second nurse admitted to it. I wonder what values she charted and whose login was used?

Shortly after that, the OR holding area called for my friend, so they got ready to wheel her off. The problem was the surgeon hadn’t come by yet. The nurses also realized they hadn’t completed some of the pre-op orders, but didn’t want to mess up the schedule, so off they went. I was given the option of carrying her bag of clothing with me or putting it in a locker – of course I chose the locker. I walked with her to the doors of the OR holding area and crossed my fingers that they would write on the correct knee.

The hospital has the same waiting room for the inpatient and outpatient surgery areas, but there was no one at the desk. I selected a seat close to an electrical outlet and started catching up on some work. A few minutes later, I received a text that she was “now in the operating room.” A few minutes after that, a staffer in scrubs and a cover gown arrived and asked for the “Jane Doe Family” and I raised my hand. She walked over and handed me a clear Ziploc bag stating “she forgot to take off her underpants” in a loud stage whisper. Luckily the rest of the room couldn’t hear her over the Shark vacuum infomercial that was playing on the communal TV, but I know my friend would have been horrified.

As she left, a hospital volunteer arrived to staff the desk and explained the monitor they have on the wall that shows the patients’ initials and a color-coded bar that says where they are in the grand scheme of things – pre-op, OR, procedure in progress, procedure complete, recovery, post-op, etc. I liked the idea and I liked even better the family member that interrupted, asking for the remote control. They found an episode of “Gunsmoke,” which was much more appropriate for this particular waiting room demographic.

I received a “procedure has started” text and set my timer so I could plan the rest of my afternoon. I was able to accomplish a massive email cleanup with very few distractions from Marshal Matt Dillon, then took a break for lunch.

The cafeteria was chock full of motivational posters for staff as well as banners celebrating their “Top 10 Hospital” recognition from an organization I had never heard of. Regardless, it was nicer than my own hospital and the food was better, so I gave the experience a 10 myself. I continued to receive “the procedure is still in progress” texts every hour or so. Once I returned to the waiting room, I also received hourly updates from the waiting room volunteer who actually said, “She’s still in surgery – whoop de do, I know” at least twice. It has to be boring saying the same thing all day and she was sweet, but nevertheless I doubt the hospital would appreciate it.

Once I received the “patient is now in recovery” text, I found a good stopping point and packed up my laptop. The surgeon came out (wearing rubber rain galoshes with his scrubs, which was a new one for me) and went through her surgical photos with me. I have to say, the innards of her knee looked pretty ragged in the “before” photos and much more glamorous in the “after” shots. He told me she’d be “going home on crutches” and that he’d leave a script for pain medication.

I knew he was straight out of fellowship, but he looked even younger than expected. Despite feeling old, I figured that being proficient in the latest and greatest techniques outweighed any concerns about duration of practice – I wasn’t even aware the procedure she was having existed before she told me about it.

The volunteer stepped away and asked that someone answer the phone if it rang. It did, and I was told to “go back to the outpatient holding area.” I went back to the outpatient surgery lobby and it was closed with a sign directing me to the front desk. I figured going to the front desk would be more hassle than finding my way to the holding area, and made it there after only two wrong turns. My friend was in a holding bay and awake, so I stepped to the bedside and immediately received a look of annoyance from the nurse. “She just got here. We’re not ready for you yet.” I apologized and told her that I had been instructed to come up and backed away. They didn’t tell me where to go, so I just stood there feeling stupid.

Once I was allowed back at the bedside, my friend was still pretty doped up. The staff offered the ubiquitous eight-ounce can of Sierra Mist and her choice of Cheez-Its or pretzels. Another nurse yelled, “We’ve been out of Cheez-Its for months,” which set the stage for our tour through the post-op process. The staff printed her discharge instructions and went through them with me, explaining that she had received two nerve blocks in her leg and they would last for at least 18 to 24 hours. That was news to both of us! I started wondering how I was going to get her out of the car and into the house since managing stairs, a tall lanky athlete, and a dead leg might be quite the trick.

As we went through the instructions, we found several conflicts on dressing changes and showering. I had questioned the “leave dressing on until showering” and “shower after seven days,” which resulted in a call to the OR to clarify with the surgeon, who had started his next case. Next was a search for the prescription, which the nurses assumed I had been given in the waiting room. A call to the OR revealed the surgeon had taken it with him. Last, there were no instructions for how often and how long to use the high-tech ice water therapy machine he had ordered for her (which incidentally insurance didn’t cover, but we have enough mutual friends with sports injuries to scrape one up from someone with better coverage). Yet another call to the OR. I can only hope that as a young surgeon, he’ll learn to double check things or develop a process, because three calls to the OR to clarify orders is too many. On the other hand, maybe his hospital’s $200 million EHR might have an order set?

Since she had been drinking fluids, eating solids, and not feeling nauseated, the nurses announced she could get dressed and go home. That was when my radar went up. In my post-op universe on the other side of town, we want to have a patient complete some critical functions (such as emptying the bladder) after they’ve had general anesthesia and a bladder catheter. I didn’t consider three pretzel sticks to be “eating solids” and my friend was still pretty dopey, not to mention completely unable to move or even feel her leg. I asked about the crutches since the surgeon said she’d be going home on crutches and they said he didn’t order any. I gave the quizzical look again and she said that even if they had an order, they couldn’t dispense them because it was after 4:30 p.m. and the physical therapists had gone home, so no one could do crutch training. Then she added that I could rent them at the pharmacy if I wanted them.

I reminded the nurse that my friend had zero control of her leg and I had no idea how I was going to get her out of the car and into the house. What did they suggest? Another nurse chimed in and said, “I don’t think crutches are a good idea anyway. They’re not stable. She really needs a walker.” I asked if we had an order for that. She said no, but they had a walker she could try. I suggested that maybe we try the walker on the way to the bathroom since she hadn’t been yet.

She barely made it the 20 feet to the bathroom since her toes were dragging and she had to lift the leg from the hip to get it to swing through as she advanced the walker. I couldn’t believe that as a facility that does this every day, they had no plan for this. I guess maybe all the other patients bring their own crutches or walker. I took the opportunity while she was in the bathroom to start calling septuagenarian relatives who have had knee replacements to see if anyone had a walker I could pick up on the way home. I was grateful for success on the first attempt.

While she was in the bathroom, she figured out that she was missing some clothing she had been wearing pre-op. She asked where it was and was not amused by my answer that they brought them to me in the waiting room. I dug them out of my laptop bag while we strategized on getting her dressed. She wasn’t keen on having the nurses assist, so I helped her wrestle the dead leg (with its huge bulky dressing and rigid brace) into her clothes. While the bay curtain was closed, we overheard the nurses buzzing around since someone had taken their specialty wheelchair that is set up for a patient with their leg locked in an extended position. One never wants to hear, “We’ll just have to rig something” when you’re being discharged from the hospital.

Being out of the hospital gown (and also free of mind-fuzzing medications) must have been empowering because my friend started to let the staff know how much she was not amused by the discharge process, the multiple order conflicts and omissions, and the apparent lack of a plan for what is likely a common set of events. A supervisor stepped in and I slipped away to get the car, knowing she could handle herself. I pulled into the circular drive as instructed and discovered it was full of cars left for the valet but not addressed. I had to double-park in the traffic lane and go back in, where I found the nursing supervisor offering her best service recovery tactic. It involved (no kidding) a “XYZ Hospital” mug with a can of soup, tied up with cellophane and a bow. I actually laughed out loud at this point.

Soup in hand, our patient announced she was ready to go and the supervisor wheeled her out, taking a route which required me to manually open two doors on the way so she could wheel the patient through. I guess there is no way to take a patient out in a wheelchair that either uses automatic doors or assumes the family will be there to open them. What if I was out waiting with the car? It’s a small thing, but if there’s anything that the events of the day proved, the small things count.

Our patient immediately became nauseated upon trying to get into the car, resulting in a frantic run by the nurse. Luckily we avoided any actual vomiting, but I guess it’s something the family should be ready to handle.

We headed into the sunset to pick up the walker, drop off the prescriptions (couldn’t she have been given the script at the pre-op appointment when she scheduled the surgery?) and wrestle the dead leg into the house. Luckily she’s an athlete and was able to do some kind of parallel bars lift and twist maneuver to handle the steps, but I worried about her banging the dead leg around. She made it to the sofa and we fired up the ice therapy machine. I ran out to pick up her prescriptions and provisions. Three bags of ice, 90 Percocet, two Red Box flicks, and a medium pizza later, we were stocked.

The night passed uneventfully, although I couldn’t resist snapping photos of her wearing compression stockings with her walker. Some day when we’re of “Golden Girls” age, we’ll look back and have a lot of laughs. The dead leg started waking up after 8 a.m. the next morning but it was more than 24 hours before she could really move it. I violated the post-op orders and changed her dressing the next day since they had three battlefield dressings on there. It was so thick I didn’t think the ice therapy was making it anywhere near her knee. and once she was no longer numb, it was confirmed.

After two days. she ditched the walker for crutches (borrowed from the high school basketball player up the street) and started physical therapy a few days after that. Her overall prognosis looks great and I have successfully resisted the urge to ask her if I can examine what has got to be a seriously rock solid knee. It will be a while before she’s wearing stilettos again, although if there’s anyone who could manage them on crutches it would be her.

I still wonder though what other people do in these situations. Do they really leave a grapefruit-sized dressing on for seven days? Or do they just call the office? Do they bring their own crutches to surgery? Do they know to ask for the post-op prescriptions in advance? Do they know to bring something for possible carsickness? Are they savvy enough to take off all their clothes even when told to leave some of them on?

I wasn’t the patient, but for a healthcare system that increasingly demands quality, the whole process was certainly something. The next time I am asked to review post-op order sets or pre-op protocols, I’m going to look at them with a new perspective.

What’s your patient-side story? Email me.

Email Dr. Jayne.

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May 4, 2015 Dr. Jayne 5 Comments

HIStalk Interviews Jeremy Bikman, CEO, Peer60

May 4, 2015 Interviews 3 Comments

Jeremy Bikman is founder and CEO of Peer60 of American Fork, UT.

10-14-2011 7-27-00 PM

Tell me about yourself and the company.

I used to be at KLAS, running research sales strategy for seven years. Now I am in my apology tour, doing atonement to the industry with Peer60.

Our whole goal with Peer60 is to enable companies to get whatever data they need from customers and the market directly, with no one in between besides the platform. This lets them get tons of data a lot faster and hopefully have all the control they want from the information.


Why can’t vendor executives talk to their customer counterparts directly instead of hiring somebody else to do it for them?

I was talking with someone at my company yesterday about the management consulting thing. The cliché is, "All they do is interview people at the company that they consult with, then just repackage the answers." When I used to do some consulting, I would think the same thing. I would go, geez, all of the strategy for what this company should do is already contained in the minds of its own people, so why don’t they just go talk to the people?

I always wonder if it’s simply because it’s almost like in a war — everyone is in a foxhole and bullets are going overhead, so they can’t really step back and think strategically. Is that part of it? Is that just what happens? Do you need a third-party consulting firm or just a different set of eyes to look at it? Is it a case of “measure twice, cut once?”

That may be the reason why there are so many research firms out there. Maybe they have the connections. The companies don’t have the expertise themselves, or  the time or the know-how to actually go do it, so they turn to that.

Is it a case of everybody loves being ranked? People obsess about, "Where I fit in comparison to everyone else?" I think everyone does that in life — we are always comparing ourselves to each other. Is that natural thing now happening and the research companies just leverage that to pump up a lot of interest to be able to sell? I know when I was at KLAS I took that angle. You’d say, "Here is where you are and here is where your competitors are, and hospitals are using it for this." It would generate a fervor that would build on itself. That’s how I would sell in some cases. Some of that still permeates.


Along those lines, are companies just looking for a customer-friendly "you’re doing a great job" validation or are they really looking for things they need to improve?

It depends on who you are looking at. Typically when you are talking to people who are in sales — and I’m a former salesperson, so I’m indicting myself in some aspects with this statement — those people are usually pretty tactical, where I’m thinking in the moment, "How can I get something done?" and I run off.

You have some exceptions out there. Some of the salespeople at Epic are exceptionally aggressive. I think Judy’s mandate was, "Just don’t lose a deal." They really get into it and they think strategically. There are obviously some other salespeople that think like that.

Within the organization, there are some people who care about the data, who care about the feedback. A lot of them also say, "I just care where we rank. I don’t care how truly accurate this information is. Is this statistically significant? I don’t care. I don’t care what this company’s research methodology is — look where we sit." Of course they take it and market it like crazy.

Is that accurate? No, but people are acting on it. My grandpa used to say, "Never confuse what should be done with what, frankly, is being done."


Do KLAS rankings and awards mean anything?

I think they do. KLAS does their best. Their data is not remotely statistically significant. When you go out and you’re talking to 15, 20, or 30 of someone’s customers over a 12-month period, that’s not relevant, but it is the voice of the customer. That is one thing that they are gathering. Those 30 or 40 hospitals they talk to for GE or Allscripts or anybody else — that is legitimate information, but is it a highly accurate rank about what is actually happening? Not necessarily.

It’s not just KLAS – it’s Black Book or anybody else who comes out with it. They are asking questions to CMIOs that CMIOs don’t know, such as work flow, and lower-level IT where their IT analysts can’t answer it. They’re also asking CMIOs some hardcore interoperability questions and maybe security that they may know in a secondary and a cursory way, but not primary themselves. A lot of its “opinuendo,” but it’s not just KLAS — it’s pretty much every research firm out there. That’s how they do it.


The most important information that you don’t see is who they’re talking to. If I want product-specific information, I’d want to talk to the person who works with it every day. But if I want to know from a marketing standpoint, “Is my customer going to fire me?” I’d want to talk to the person who has the clout to make that decision. Do they talk to the right people?

It’s obviously too much of a mix. Again, I just need to make clear that it’s every research firm. I haven’t come across a research firm that really does it right. But it’s part of the model, too. If KLAS, Black Book, MD Buyline, or anyone else were to say, "We have to segment our questions. Operational finance questions go just to people who are in operations and finance, IT questions go only to IT people and clinical workflow questions go just to those clinicians." They would have to do so much research that their cost would go through the roof.

People complain about how much KLAS costs right now. That’s nothing if they had to get a lot of data per user per that specific context that you really should be talking about. Like I said, operations questions to operations people, just limit it to that. It would be very, very difficult.

If you look in the fine print with KLAS, it says, “This is overall just the voice of customer.” They have little things in there, like confidence level isn’t with a C, it’s with a K. If you read the fine print — and they’ll admit it — this is voice of the customer. For the most part, the KLAS rankings do a pretty good job. Is it perfect? It is completely accurate? No way. No research I’ve seen out there is. It’s one the reasons why we started this platform.

If a company wants to go out and get feedback from the customers or the market in Europe and North America, they’re getting hundreds and sometimes thousands of responses within a week or two. In that, stats mean something. The questions get very specific. IT to IT people. Operations to operations people. Finance to finance. Of course, this is their data, it’s not going in the market.

We’re producing these free reports just because it’s so easy for us to get the data. We did this clinical purchasing report. We got 25 percent of the hospitals in the US in three weeks. It’s very fast and easy for us to get the data. You’ve seen our reports. They’re pretty basic. Just, “Here’s the data.” We don’t really do much analysis. We’re not into the vendor rankings. Just, “Here’s interesting information.”

Our customers use that to get far more information far faster. Then they can do whatever they want at that point. We hope that they do it to improve, but we’re never going to rank vendors. That’s not who we are.


The source that I liked most, at least of those who provided their information without requiring payment, was CapSite.  HIMSS Analytics bought them. How do you see HIMSS Analytics fitting into the market research world?

You know what I always wanted someone to do? I talked to HIMSS a couple years ago. They’re just too big. They can’t get out of their own way. Their data is pretty reasonably accurate to some extent. We buy it sometimes to make sure we have demographics for hospitals. Definitive’s doing a good job there, too.

I always thought some of these guys should go out and do what’s called an "ideal fit." You have a report come out that bashes Meditech from somebody, but Meditech is still selling. What about those smaller hospitals that don’t have very sophisticated IT environments? They don’t have much budget. They’re not going to sell out to one of the big IDNs or to a health plan or something like that. Meditech is a really good fit for them, but you don’t get that in “one size fits all” research. I remember telling HIMSS, "I know you guys are really trying to get more into this primary research, more away from just demographic information. Why don’t you go that direction?”

I hope someone does it. That would be way better for the market to rank vendors on where they actually play well. Why in the world are we comparing Meditech to Epic in a large hospitals? That doesn’t even make sense. That’s not where they play. They get crammed in and it does a big disservice to the market.


It would be like Consumer Reports saying that the best car is Rolls Royce and just leaving it at that. Healthcare has a list of best products and another list of all the types of hospitals — maybe the job of consultants is to arbitrage the information by matching them up.

That’s very good way to put it, actually. There are some consultants that can do that, real domain experts. They’ll take available data that’s out there. They’ll get a KLAS report, MD Buyline, whatever. Then they need to do primary research themselves. The hospital does, too. No hospital will go, "Oh, they rank #2 in this report – done. We’ll do it." They’re going to do site visits and they’re going to do calls. They have to go through their normal decision-making process. Money still means something. How much money do we have? Our internal capabilities still mean something from an IT and informatics perspective, biomed. These things mean things, so they will factor that into it. The “one size fits all” report does not do that. It lumps everybody together.

Just because of my background in working for a major research firm, every meeting I had at HIMSS, and I probably had 50 meetings, every person would go, "I hate this report. What do you think about this report?" I said, “I don’t really work there any more and I don’t really know that other research firm, but you have to quit trying to take these reports” … everyone is coming at it the wrong way. They anticipate that this should be an apples-to-apples comparison. They’re not apples-to-apples comparisons. You have to get that out of your head. The lens through which you view this has to be that there are both fruits or vegetables. It’s an apple to a kumquat or it’s like a fruit salad. That’s really what these reports are. Obviously there needs to be way more analysis that’s done and it’s probably like you said — that’s probably a time where some consultants need to step in and they can probably add real value.


f you’re talking to someone on the provider side who doesn’t really understand the vendor world, how would you describe what market research means to a typical healthcare IT software vendor?

It’s a crutch. Buying reports is a crutch. It’s an easy way out. Is that inflammatory enough? [laughs]


If you’re a vendor trying to formulate a market strategy, how important is market research? What else goes into that mix of saying, "What do we do for the next five years?"

Market research is great, but you need to it yourself. It needs to be primary. You don’t want it filtered.

There’s a saying that I’ve heard before. "If you drink from a stream, get as close to the source as possible." When you’re getting it filtered through a research firm and it’s anonymous, you have no idea who said what or anything like that. You’re getting an inherent bias coming from the research firm. No matter what they try to do — and you can read all the philosophy of Immanuel Kant and those other ones out there that talk about this, those German philosophers — there can’t be anything truly objective.

It becomes far less objective when it’s filtered through somebody else. Someone else made the calls. Someone else is now analyzing the information. They’re trying to keep it as pure as possible, but they’ll see some phrases and the natural tendency is to try to clean it up. It’s like the Bible. the Bible has been translated how many different times? From Aramaic into Greek, into Latin, into German, into whatever. How much stuff gets lost in that translation? Same thing happens.

Market research is absolutely critical. Research and getting data from the customers is critical. But get it directly from them and get a lot of it. Get it repeatedly. Make it easy for them. That’s the reason I say market research reports are a crutch. Hiring a research firm to do custom research for you is a little bit better than that, but still you are ceding control to somebody else.

It’s as if you hired someone else to do this interview and they didn’t give you a direct transcript. They’re going to change it. That’s the way research works. You get it and go, "This is interesting," but you can tell it’s bland. You can tell something’s have been changed rather than getting it unfiltered.


You talked about Epic’s sales and marketing. They claim they don’t do marketing and they don’t ever talk about their sales. Does Epic do sales and marketing?

Oh, my gosh, they are the best in healthcare. It’s brilliant.

Have you seen the show “Usual Suspects?”  It’s a brilliant show. There is a guy Verbal Kint played by Kevin Spacey. The main villain is this guy named Keyser Soze, this super evil global Mafioso boss who no one has ever seen. Verbal says, "The greatest trick the Devil ever pulled was convincing the world he did not exist.”

It’s brilliant, that line. Every time someone says Epic doesn’t sell or market, I laugh about it. They are brilliant at it. By virtue of saying they don’t market, that is different. It sets them apart. What is that? That is marketing. You just established a brand.

They’re not traditional though. They’re very thoughtful. They’re very extremely aggressive, but they do it in a very calculated way that’s not offensive and doesn’t feel like sales is coming across. They’ve earned a lot of it, too.

I want to preface that out front. When you have companies like KLAS ranking them constantly and other publications are constantly publishing the rankings, you are using that to your advantage. When other people market for you, that is way better than when you’re doing it yourself. 

Epic absolutely markets. They just do it in the early Silicon Valley way. The rest of healthcare needs to catch up, which is have other people market, be almost counterculture. That is really Epic. They are just brilliant at it. Absolutely brilliant at it.


Epic somehow always seems to slide across from being on the other side of the table to their customer’s side. The customer feels that Epic is their partner and defends them. How would you create something like, that where both contractually and morally, the customer feels the imperative to be their vendor’s advocate?

You see that in Silicon Valley. Look at Apple. I like Apple just because it’s stable so I don’t really care, but people are violently defensive of Apple. Epic does the same thing. It’s not about the solution. 

When I was at KLAS, people would complain, "Epic can’t get this — they have older technology." I would say, “Yes they do — it’s not about the technology.” As long as the technology is stable and does the basics, it’s all about the people. It’s the the relationship and the feeling. My dad used to say, "Son, you only sell two things in life — solutions and good feelings.”

That’s correct. Epic solves a problem. Companies solve problems and how you feel about that. Epic is really good, like you said, at getting themselves on that same side of the table. They don’t talk about their tech a lot — they talk about the problems they are solving and the benefits they are providing. Apple did that. Steve Jobs always talked about “why we do what we do,” not all the features. Those will come later. They would build this whole culture. That is really what Epic has done.

Can another company do it? I don’t think they can if they don’t start out that way. You’d have to do a scorched earth. Before Siemens got bought out by Cerner, to turn it around, John Glaser would have to come in and say, "I’ve got to fire everybody. Anyone that’s been hired here previous to two years that doesn’t have a lot of neural plasticity, doesn’t have a lot of bad habits — we’re just going to get rid of everybody. We’re going to start from the ground up.“

I don’t know how a company pivots. I haven’t seen a company pivot like that. Maybe you have, I just haven’t seen someone. You have to start out like that. You can obviously improve, but you also need to be yourself. Epic is Epic because of Judy and Carl. You don’t have to be like that. Cerner is highly successful and you wouldn’t really say their culture is very similar to Epic.


What are the most interesting trends you took away from the HIMSS conference?

The most interesting trend that I’ve seen — this is a bit tongue in cheek — is how fast marketing moves. Products move at glacial speed in comparison to marketing. I am absolutely blown away that pretty much every company out there can do accountable care, care coordination, population health management, patient engagement, and data analytics. It’s amazing. It was like a forest just crept up over the last two years.

I may be underselling everybody, but their marketing departments are in full bloom. I’m not sure the R&D is there. I spent so much time just meeting with people. It was hard. That was just one of my takeaways, "Wow, everybody does everything and nobody is standing out because of it."


In our 2011 interview, you predicted that Epic and Cerner would lose some dominance, best-of-breed would make a comeback of sorts, and smaller vendors would upset the apple cart. Do you still think that will happen?

Because the government is in, no, I don’t. I was wrong.

The big are going to get stronger because what the government has done is going to enable it. It makes it tougher. When you have government-required mandates that somehow map well to the “one size fits all” big integrated vendors, how do you fight that?

Imagine if you are in Silicon Valley and all these B2C companies. The government came in and said, "Here are all the different mandates you have to do." How many new startups could crop up and really be successful? 

I underestimated the impact and the staying power of what was enacted through HITECH legislation. When it comes to enterprise, maybe in 10, 15, or 20 years, but nothing soon. The governments has enabled this to happen and smart vendors like Epic and Cerner absolutely jumped on it and have done exceptionally well. It’s not like they haven’t done a good job anyway, but there is no doubt it certainly helped.


In that regard, is there irrational exuberance with mobile health and the unprecedented amounts of money being invested in innovative companies?

I love the energy. When you have a lot of companies coming in and competing, hopefully you can get to something that is really usable, specifically for patients, that really engage them without having hospitals having to do the heavy lifting, which is happening now. What if the government steps in there and starts putting all these mandates around that? It is just going to empower the incumbents. That still isn’t good for innovation or for patients. I hope that it stays the Wild West for a while.


What will the health IT market look like over the next five years?

Big getting bigger. You are going to see a lot more consolidation. There are some pretty cool startups and a lot of cool companies. You are going to see a lot more consolidation. I don’t think that Athena and some other guys are even close to being done, snapping up different companies and rounding things out. Salesforce is coming in in a big, big way. Amazon is coming in. I just got an email from a guy at a major IDN saying, "Hey, you’ve got watch out for Amazon — they’re doing some amazing things. They are moving stuff to the cloud and are starting to bring all these different apps no one is even talking about.”

I kind of love that, but I don’t know if they are going to stick around. We’ve seen the hokey pokey dance go on in healthcare for decades, where guys jump in and jump out. I’m sure hoping that a lot of these guys will stick in – Salesforce, etc. — and really help out. An argument could be made that guys like Salesforce need to be in there. If you are really going to engage patients and you’re really going to manage populations, CRM-like technology may be absolutely critical. Can the big incumbents in healthcare really develop a CRM? I don’t know. I don’t think so, but they certainly could.


Did the FDA really come look at your fake crack booth giveaway at HIMSS?

They did. Did I tell you my marketing guys didn’t take a picture of it? They did a great job. I said, I’d have given you an A+ because it was such an awesome event, the booth, everything, the traffic, but the FDA came by after hearing, "What’s this? You guys are giving away dime bags?" Do you really think we are giving away illegal substances at a trade show? Besides, it would be cheaper for us to give away iPads. We should have gotten a picture.

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May 4, 2015 Interviews 3 Comments

Morning Headlines 5/4/15

May 3, 2015 Headlines No Comments

Former IT program manager Chao retires from CMS

Henry Chao, CMS deputy director of the Office of Information Services and program manager of the troubled rollout, retires after 21 years of government service.

Almost half of Obamacare exchanges face financial struggles in the future

The Washington Post reports that nearly half of the 17 state-run health insurance exchanges are struggling financially. Some are considering increasing fees imposed on insurers, while others looking into cost sharing arrangements with other states or shutting down completely and migrating exchange services to

athenahealth’s (ATHN) CEO Jonathan Bush on Q1 2015 Results – Earnings Call Transcript

Athenahealth hosts its Q1 earnings call, with CEO Jonathan Bush providing his own style of commentary on the company’s recent performance and projects. This quarter the company added 2,300 providers, and sold a number of new inpatient systems through its recently acquired EHR RazorInsights.

Erlanger Chooses Epic Software For New $100 Million Electronic Medical Records System; CEO Judy Faulkner To Visit Chattanooga

Erlanger Health System chooses Epic as its next EHR vendor, beating out Cerner as the other finalist. The system will be implemented over a two-year period and will cost $100 million.

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May 3, 2015 Headlines No Comments

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