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Readers Write: Tips for Selecting EMR Training and Activation Support Vendors

November 20, 2017 Readers Write No Comments

Tips for Selecting EMR Training and Activation Support Vendors
By Kevin Smith


Kevin Smith is CEO of TrainingWheel of Fort Myers, FL.

The contracted EMR vendor often does not deliver experienced staff for the activation. The go-live is the first time some of the vendor’s elbow support resources enter a hospital without being a patient or family member.

Here are a few helpful tips based on lessons learned to save organizations time and money:

  • Know what the organization wants and what it is paying for. Consider more than the proposed training and support cost. For example, the cost may be different because the vendor provides licensed clinicians, while others may provide non-clinical rounders with no hospital for a lower cost.
  • Insufficient planning can lead to less-experienced resources. What recourse does the contract include? If a bank teller or oil rigger joined the firm last week, are they prepared to help the clinicians? A body is not what matters to the clinicians. They want someone helpful to them as they learn how to do their work using new tools.
  • Ask the vendors to provide resumes, CVs, immunization records, background checks, and proof of experience in advance. Vendors often slide inexperienced people into a project and shuffle them around. They want to maintain high resource numbers, but the clinicians are not getting the support.
  • Does the vendor rely on one or more third-party companies to provide trainers and support staff? If so, it will be hard to know what type of resources are being provided. This is important because many vendors subcontract to the same companies. There may be two different bids, but the organization ends up with the same subcontracted company. If the primary vendor can’t answer basic support questions, the organization may already be in trouble. An experienced vendor will match clinical support personnel to support areas based on their clinical role and/or experience.
  • Can the vendor present a full project cost proposal with a support schedule, detailed expense projection, and a list of their proposed resources after one walk-through of the facility? Staffing ratios help, but are not always accurate. If a vendor doesn’t understand the makeup of the organization’s staff and the layout of the facility, how can they give an accurate estimate of clinical support resources?
  • Does the vendor develop curriculum and clinical scenario-based training or does training simply cover system functionality? If training only covers functionality, then users will require more elbow support because they won’t be prepared to use the system for their real-time clinical workflow. The #1 complaint from clinicians in EMR training is that it only teaches them navigation and what each click does. This leaves clinicians anxious and also forces every clinician to come up with their own approaches and workflows.
  • Can the vendor recognize issues in the build and offer recommendations based on past client experiences? The training partner should be an asset to the team, identifying issues in the build that may come up during the training. Better to know this ahead of time and make corrections than during or after the go-live. Make sure the organization and the vendor have a joint commitment to be open and sharing in this regard.
  • Does the vendor pursue continued improvement and feedback? Are they as committed to quality as the organization?

Vendor involvement is an integral part of implementation success. As an organization, ask the necessary questions to guarantee the right vendors are selected.

Curbside Consult with Dr. Jayne 11/20/17

November 20, 2017 Dr. Jayne No Comments

I spent a rare couple of days traveling for non-work business, but through the magic that is the small world of healthcare IT, I ran into a friend I normally only see at HIMSS. It’s always fun to run into people out of context, when you’re trying to make sure they’re really who you think they are before you call out to them. Since I was wandering around the city while my friends were attending a patient safety conference, it was nice to see a friendly face.

I did end up in some healthcare IT conversations over dinner and drinks, however, and I heard some horror stories from a conference panel on HIPAA requirements and security risk analysis. One of my friends admitted that she had her work laptop stolen and didn’t report it to anyone despite it containing protected health information. That sort of thing is one of the perks (or hazards, depending on how you look at it) of owning your own practice and not fully understanding the huge number of laws that impact our practices. At least she realized after attending the conference that she should have taken additional action.

One of my other traveling companions works for a large integrated delivery network, where policy and procedure reign. She shared her thoughts around a session on patient safety and how it relates to impaired or distressed physicians. I agree with her suspicion that we’re going to see more of those types of situations as physician stress and burnout increase. We had a great discussion on addressing the needs of physicians with chronic health conditions that are impacting their ability to deliver care. She’s in a leadership role, and given the size of her organization, has dealt with a number of issues including early-onset dementia, a surgeon with new-onset seizures that began in the operating room, and uncontrolled diabetes leading to a physician collapsing on a patient. She’s approaching retirement and I think she might have a bright future as a storyline consultant for a medical TV show.

We were also entertained by another member of our physician “ladies weekend” party who was trying her hand at social media. Even though her practice has been around for nearly 20 years, they’ve never taken the plunge. She was trying to figure out how to post conference snippets on Facebook and Twitter without being overly obvious or violating any terms of the conference or the social media platforms. They’re concerned about having patients follow them on Facebook and post personal details, revealing that they’re patients. We discussed different ways of controlling posts to their page and how to respond when there are potentially inappropriate submissions. Their practice could be a case study in physician workforce management and advertising: an OB/GYN practice which has recently converted to GYN-only to meet the needs of their “mature” physician staff, but wants to try to grow the practice.

They’re also trying to limit the number of surgical procedures they do, but I don’t think that they realized how challenging it would be to try to build a patient panel to support Well Woman visits that only occur once a year. They are considering the incorporation of some non-core procedures that we see other physicians adding as their demographics shift: facial aesthetic services, leg vein treatments, weight management, and other typically cash-only services. It will be interesting to see how their strategy has evolved when I meet up with her again at a conference we’re scheduled to attend in April. Hopefully by then her social media habits will have matured enough that she’s not obsessing over every “like.”

I returned home to a day in the patient care trenches, which made it seem like I was never on vacation. Work has a way of sneaking up on you like that, and since I was training a new physician assistant as well as keeping my eye on a couple of new patient care techs, it was more stressful than usual. We’re gearing up for a busy pre-holiday week and are starting to see increased volumes from out-of-town visitors. Add in the extra patients from primary care offices that are closing or working shortened hours this week and it will only get busier. Since I don’t travel for Thanksgiving, I usually work multiple shifts around it to allow my partners who do travel to have some breathing room. I’m sure by next Sunday I’ll be dragging, although hopefully some leftover Turkey and dressing will keep me fueled. Our practice has tripled in size over the last two years and there don’t see any signs that things will slow down anytime soon.

I closed out the weekend with some online training for an analytics startup that asked me to do some work. They’re looking for independent review of their overall approach but also of their training curriculum and whether outsiders think it will be as easy to implement as they have convinced themselves that it will be. Although the training was solid, there are definitely some holes in their workflow since they’re making the assumption that everyone in the office will be using the solution at the point of care. The problem is that it’s not embedded in the EHR, so it’s yet another one of those “one more place to go for data” destinations that clinical users struggle to reach. For small practices that don’t have dedicated care coordinators or care managers, the idea of analytics is daunting enough on its own. Add in the assumption that physicians should be doing it while they’re seeing patients and I think it becomes a bit of a non-starter.

I’ll complete my write-up for them later this week and then will have a debrief with their marketing team and training team next week. I’d rather have a debrief with their strategy team and CMIO, but we’ll just have to see where my preliminary findings take us. The startup’s leadership seems pretty convinced they’ve nailed it and I’m not sure how open they are to receiving feedback that isn’t 100 percent in line with their expectations. I’ve been in the startup space before and I know I’d rather receive critical comments from internal and external testers rather than from clients whose expectations we missed.

Is your organization all-in with analytics or just dipping your toes in the water? Email me.

Email Dr. Jayne.

CIO Unplugged 11/20/17

November 20, 2017 Ed Marx 10 Comments

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

New York, New York

I woke up and the sun was glistening off the glass and steel skyscrapers that had become my GPS. Between them, just across the water, there she was, tall and beautiful — Lady Liberty greeting me each morning. A faithful companion reminding me of my roots and our great country. My belongings had shipped the day before, so there would be no run on the Highline today.

I showered, dressed, and began my familiar walk up Church, giving respects to Hamilton, left down Broadway, turning up Wall Street, dancing with tourists marveling at sacred Federal Hall and the Exchange. A final right on Broad where the cobblestone street forced a jump in my step, leading up to 55 Water, where I took my seat alongside my team in our shared space.

A beautiful high-rise vista, we shared views of the East River with its gorgeous bridges connecting us to Brooklyn through the harbor at its edges. We arguably had the best vantage point to observe security logistics whenever dignitaries made their way into Manhattan via heliport. We waved to presidents and popes.

Today was different. This would be my last walk through hallowed grounds of our founding fathers and fellowshipping with my team.

Shy of three years, I was the leader of our team that carried our broken division. If you observed us and knew our outcomes, you think we had been together for decades. Our bonds grew quick and deep. The urgency of our mission, our passion, and the significant time spent huddling after hours hastened our bonds.


Our team included spouses and children who knew one another well. None of us native to this country, we were the perfect mix serving the NYC melting pot. Easily the most painful part in my decision to leave NYC was departing our team. Against all odds, our team did what others failed to do, what many said was an impossible task.

I rarely reference the organizations I serve, but NYC Health & Hospitals was special. I knew I was called here for a season of life and how it all came to pass implied providence. Public health is vital to the greater good and I was honored to make a contribution, however small in the bigger picture.

Reporting to the CEO, the experience opened my eyes to the critical role of public health in our society. The specific NYC mission fills many gaps in caring for everyone regardless of status or ability to pay. We had routine meetings with City Hall to ensure alignment and accountability with municipal leaders. Each time at City Hall I would sneak off and spend time in the rooms set aside to pay homage to our founding fathers. It was sacred ground that reaffirmed my calling to healthcare service.

I grew as a leader during my tenure. Many blogs and ideas were inspired by the experience. The exposure to political nuances was both awe-inspiring and an insightful awakening. I gained appreciation for the inner workings of government and the challenges of balancing the needs and welfare of arguably the greatest city on earth. Frustrating at times, I loved her.

Serving in public health also fulfilled one of the remaining aspects of my career strategic plan that I developed with my 2004 mentor, Mr. Zenty, the CEO of University Hospitals. I intentionally served in academic medical centers, community-based hospitals, integrated delivery systems, faith-based systems, and in for-profit and not-for-profit organizations. I served in a mix of ambulatory and acute care environments. Armed with this experience, I knew without a doubt that my greatest affinity centered on academic medicine. When the opportunity came about to serve as a senior leader of perhaps the greatest health delivery system on Earth, I did not hesitate. Except for my team.


In fact, it has taken me 70 days to express myself via this blog. I am thankful to have visited with my NYC squad several times since leaving as our friendships remain strong. We learned so much on our journey, but perhaps purposefully, enjoying the moment was the most profound. We all tend to rush here and there and mindfulness gets lost in the stress and adrenalin of crisis and deadlines.

We took deliberate time in each meeting to reflect. We took time weekly to be social. We planned time monthly to bring together families and play. Almost quarterly we gathered somewhere around the country to celebrate life. We cried. We laughed. We jumped into frigid oceans. We ate foods that made us cringe. We lifted each other. We saw sports. We saw Broadway. We made mistakes. We shopped. We served. We saw comedy. We saw stars. We danced. We cooked. We walked. We ran. We held hands. We prayed. We screamed. We talked deeply. We consoled. We counseled. We encouraged. We learned. We challenged. We conquered. We played tricks. We accomplished. We smiled. We won.

If you can make it there, you can make it anywhere.


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

Morning Headlines 11/20/17

November 19, 2017 Headlines 1 Comment

VA exploring idea of merging health system with Pentagon

The VA is exploring the possibility of merging the VA’s Choice program, which allows some veterans to receive care from private doctors, with the DoD’s Tricare health insurance program.

The Advisory Board Company Stockholders Approve Merger Agreement With Optum

Optum completes its acquisition of the Advisory Board. Optum will retain the Advisory Board’s healthcare business unit, and sell its education business unit to Vista Equity Partners.

Health Giant Sutter Destroys Evidence In Crucial Antitrust Case Over High Prices

A California Superior Court judge finds that Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking, “knowing that the evidence was relevant to antitrust issues.”

Computer system upgrade causing delays at Banner’s Tucson hospitals, clinics

Banner Health’s Tucson-based hospitals are working through operational delays following its October 1 Cerner go-live. John Hensing, MD and chief clinical officer for the health system, says that he expects operations to return to normal by the end of the year.

Monday Morning Update 11/20/17

November 19, 2017 News 3 Comments

Top News


The VA is considering merging its Choice program – which allows veterans who can’t get timely VA appointments to see private doctors — with the military’s Tricare, which offers health insurance to active service members.

A VA statement says that work on the planned VA-DoD single EHR platform led VA Secretary David Shulkin to have conversations with the White House about merging the programs to “provide better care for veterans at a lower cost to taxpayers.”


Some large veteran groups immediately expressed concern with the plan, fearing that it could turn the VA’s direct care model into a DoD Tricare-like insurance program in which private providers deliver services and insured members pay premiums, deductibles, and co-pays.


Shulkin said in a May 2017 White House briefing:

In terms of our Choice Program, we still today only have three Department of Defense facilities that participate in the Choice network. We need to get the Department of Defense and VA to make all their facilities and our facilities open to veterans and to active service members. We certainly have to work with Congress and our veteran service organizations to redesign this Choice Program. It will expire essentially at the end of the year, and we need new legislation — this Congress — to make sure that veterans don’t go back to waiting longer than they need to wait to get care in the community. So we have to pass legislation this year.

Reader Comments


From Logic Pretzel: “Re: MHS Genesis. Deployment can’t continue beyond the four completed pilot sites until an independent assessment of cost and suitability is performed, which may not be finished until a year or more from now. That piles more risk on the VA’s piggyback decision and undercuts the credibility of their rationale that there’s no time to do a proper competitive search.” The DoD says the review will continue through late 2018, meaning that the VA is rushing into its no-bid contract with Cerner without even knowing whether DoD will continue its own Cerner rollout.

From Short Attn: “Re: HIStalk. It’s too long for me to read. I’m glad you at least run headlines to save me time.” I spend many hours each week extracting the health IT news and information that I think is most relevant and interesting, condensing it massively and dividing it into categories for easy skipping. You are free to consume as little or as much of what I write, but someone out there is poring over every word to gain an edge to allow them to steal your job or your customer. It’s good to have all the knowledge you can get when you’re a knowledge worker.


From Chalky Aftertaste: “Re: patient-preferred by whom? Check out this bizarre vanity press release.” A horribly written announcement published on a free press release service – I’d bet a stack of non-American currency that it wasn’t written by a native English speaker – lauds the medical accomplishments of an Indiana neurosurgeon, indisputably proven by a single fawning Facebook quote from an alleged patient and a short list of educational qualifications that includes “CMS Meaningful Use Stage 1 Certification from Epic Care Ambulatory EMR” (has he tapped into an unmet consumer demand for Epic-certified neurosurgeons?) The conferrer of the award is Patient Preferred Physicians and Practitioners, an “exclusive medical society” whose corporate address is a Boca Raton mail drop. Most of its honorees seem to be in late in their careers and I’m guessing their modest social media skills misled them into thinking that buying a vanity award would make them seem hipper.

From Pernicious: “Re: diagnostic apps and sites. Don’t you think these will revolutionize healthcare and that you should mention them more often?” No. Non-clinicians think patients are undiagnosed or misdiagnosed a lot more than happens in real life. We don’t have a diagnosis problem – we’re getting killed (literally) by conditions that have been perfectly diagnosed but are either untreated or expensively held in check at best. From a public health perspective, the last thing we need is wiring up millions of Americans, testing their genes, or poring over images of their innards to detect theoretical problems. That’s why experienced doctors roll their eyes at greenhorns who order tons of lab and imaging studies, with the near-certainty of finding something out of range requiring Whac-A-Mole action that’s not good for anyone except the companies making money off unnecessary tests and treatments. Western culture and medicine looks at illness and death much differently than most of the world, and our fascination with gadgetry and medical heroics that prop up the comforting illusion of immortality instead of taking on less-decisive public health issues has left us with a society that’s #1 by far in healthcare costs, but that barely beats Cuba in WHO’s health rankings.


From IA Taxpayer: “Re: University of Iowa Hospitals and Clinics. Shutting down its Epic Community Connect program. Team members were told on Friday, November 17. The business unit will be integrated into UIHC IT, UIHC is not seeking new Community Connect business, services to existing clients will be cut off, and layoff of 50 percent of the staff (more than 30 FTEs) will happen by July 1, 2018. The message is that the program has a financially flawed business model that provides only a fraction of the ongoing revenue needed to support existing staff. UIHC has negative margins, but within increased focus on patient-centered care, referral patterns from those hospitals that joined the program will be negatively impacted.” Unverified. I’ve emailed a contact there for a comment.

HIStalk Announcements and Requests


The vast majority of poll respondents think the federal government should review whether the AMA-owned CPT procedure code system constitutes a monopoly. An anonymous reader says rather insightfully that it’s not illegal to BE a monopoly, but rather to ACT like one, while John recalls an early copyright misuse claim in which the ruling was that while the federal government may have created a monopoly by mandating the use of CPT codes, AMA didn’t seek that monopoly. Another anonymous reader wonders whether AMA perpetuates the use of E&M codes, which he or she blames on note bloat and lack of usability of clinical documentation functions.

New poll to your right or here: will Cerner’s EHR allow the VA to exchange electronic information with non-VA providers?


I’m fascinated by the small number responses to my poll in which I asked HIStalkapalooza attendees what aspects drew them to the event. #1 by far was the hosts, stage show, and HISsies, which is surprising because the in-person feedback is usually that they couldn’t hear or didn’t care. Only 10 percent of respondents ranked “free food and drinks” as their motivator. Based on that, the ideal event would be open to everyone, feature a less-expensive dance band, let everyone buy their own food and drinks, and carry on the stage show as always. The only aspect I’ll miss (since I’m still not inclined to do it again) is the interesting roster of attendees, which as far as I know is unmatched since it included providers, vendors, professors, government officials, equities analysts, and even people from competing websites and publications.

It seems as though many members of the Greatest Musical generation of the 1960s and 1970s are dying lately as that cohort starts to hit the mortality wall. The latest: AC/DC co-founder, guitarist, and songwriter Malcolm Young, who died of dementia this weekend at 64 in leaving the band with one original member, his schoolboy-uniformed brother Angus Young. A third brother, AC/DC producer George Young, died last month at 70. Meanwhile, David Cassidy (aka Keith Partridge) is apparently also close to death from dementia and organ failure. Life is a (hopefully) long line to the cliff where it will eventually be your turn to be pushed off.

This Week in Health IT History

One year ago:

  • The Gates Foundation issues a grant to create a blockchain-powered medical record.
  • HIMSS and CHIME create an international group to manage programs outside of North America.
  • HHS Secretary Sylvia Burwell warns that a “repeal and replace” approach to the ACA will cause the program to collapse due to insurers pulling out because of uncertainty, leaving 20 million more people uninsured.

Five years ago:

  • HP writes down $9 billion after finding that its recent acquisition Autonomy misstated earnings.
  • The CEO of Quest Diagnostics says the company is “redirecting” its EHR business (ChartMaxx, Care360) to work with enterprise EHR vendors like Cerner, Epic, and McKesson.
  • The National Football League signs a contract with EClinicalWorks to provide an EHR that can support the research and treatment of player head injuries.
  • New sales were announced by Acuo, Merge, 3M, and Humedica.

Ten years ago:

  • A UK survey finds that GP support for the NPfIT project is down to 23 percent.
  • Sunquest, fresh off its acquisition by Vista Equity Partners, announces that it will increase investment in its radiology information system and begin actively marketing it again.
  • Wheaton Franciscan Healthcare VP of IT Tim Belec is shot by a 17-year-old robber in the organization’s parking lot as he leaves work.
  • Dennis Quaid’s newborn twins are given a heparin overdose at Cedars Sinai due to improper stocking of a medication dispensing cabinet.

Last Week’s Most Interesting News

  • VA Secretary David Shulkin asks a House appropriations subcommittee to approve using $782 million of the VA’s budget to kick off its Cerner project while sidestepping member questions about how Cerner will exchange information with community-based providers.
  • A multi-day system downtime leaves CVS Pharmacy unable to fill prescriptions.
  • Meditech announces a cloud-based, subscription-priced version of its EHR.
  • A Black Book survey finds that only 19 percent of post-acute care providers have any degree of EHR capability and that 90 percent of long-term care providers don’t exchange information with referring doctors or hospitals.
  • In England, a migrant rights group challenges an agreement by which NHS makes patient data available to the Home Office for immigration enforcement.


November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

Acquisitions, Funding, Business, and Stock


Drug company Roche will acquire laboratory-focused health analytics technology vendor Viewics. Roche Diagnostics offers laboratory analyzers, inventory software, and middleware and will deploy the Viewics solution to help labs improve profitability and care.


Madison, WI-based image sharing app vendor ImageMoverMD separates from its CEO, hires a former drug rep as president, and brings on a COO (who comes from Epic) and a sales director in hopes of boosting sales. The two physician co-founders are UW radiologists who are also board-certified in clinical informatics.


Eric Topol apparently isn’t convinced that radiologists will be replaced by artificial intelligence, based on the lack of peer-reviewed publications of the companies that offer imaging AI.


Advisory Board closes the sale of its healthcare business to Optum, with CEO Robert Musslewhite staying on.



Glenn Galloway (Children’s Health Network) joins Center for Diagnostic Imaging as CIO. He previously worked as CIO of Children’s Hospitals and Clinics of Minnesota and co-founded Healthia Consulting in 1998, spending several years as SVP of Ingenix Consulting after it acquired Healthia in 2007. Long-time readers will recall that Healthia (and thus Glenn) sponsored the first-ever HIStalkapalooza at HIMSS08 in Orlando, a two-hour cocktail party for around 200 attendees at what was then the Peabody Hotel.

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ZappRx hires Rich Cramer (Upfront Healthcare Services) as VP of commercial operations and names James Cornicelli (UCB) as VP of corporate strategy. 

Announcements and Implementations


Sunquest will integrate its Mitogen laboratory information management system for molecular diagnostics and precision medicine with oncology molecular decision support technology vendor N-of-One. Private pathology lab CellNetix will be the first customer.


South Georgia Medical Center (GA) goes live on Epic, saying that within the first two weeks it had exchanged information with 20 or more facilities.

Government and Politics


The controversial president of the Fresno, CA school board attacks a Center for Health Journalism writer for her newspaper series on sex education and high birth rates. He launches a Twitter tirade, compares her on talk radio to a “child sex predator,” and publishes her work phone number on Facebook in urging others to contact her.


A California state judge rules that Sutter Health intentionally destroyed 192 boxes of documents that were being sought by employers and labor unions who had charged Sutter with market power abuse and charging inflated prices.


Florida’s Agency for Healthcare Administration takes the next step after heavily redacting nursing home inspection records in claiming threats to the privacy of residents – removing the records from its website completely. Florida newspapers mentioned the censored inspection reports in their coverage of the deaths of 13 seniors in a rehabilitation center after September’s Hurricane Irma, after which the AHCA took all nursing home records offline without notice. Some South Florida counties have also refused to release the emergency management plans they approved for nursing homes – including the all-important sections of how they would keep residents comfortable during power outages –even though they had previously said they were public record.



The local paper says patient appointments at Banner Health’s Tucson hospitals and clinics are being delayed due to its October 1 go-live of Cerner, with Banner’s chief clinical officer admitting that it has been a “painful period.” The health system expects the situation to be resolved by December 31. The Arizona Department of Health Services is investigating complaints about the impact of the new system but won’t provide details. Banner acquired the former money-losing University of Arizona Health Network in 2015, which had  gone live (and well over budget) with its $115 million Epic project less than a year before. Banner’s corporate standard is Cerner.

A JAMA research letter questions whether hospitals are gaming the federal government’s Hospital Readmission Reduction Program in avoiding financial penalties by upcoding severity of illness instead of actually improving care.


County officials question the auditor and CEO of Blount Memorial Hospital (TN) about why they weren’t told that the hospital foundation’s since-fired executive director had embezzled $187,000 over nine years. The employee issued checks to herself using QuickBooks accounting software, then modified the QuickBooks entry to make it appear that the payee was a foundation business partner. The foundation did not require checks to bear a second signature and did not conduct yearly audits. 


In England, a man who proposed to his girlfriend last New Year’s Eve —  the day before he suffered from sepsis-induced brain damage that nearly killed him — proposes again from the rehab hospital, using eye-tracking technology to communicate. His girlfriend said “yes” a second and his therapists and caregivers prepared him to make his way down the aisle in a wheelchair and to place the ring on her finger. The eye-tracking technology is from Eye Gaze, which offers assistive technology and eye tracking human cognition research.

Sponsor Updates

  • Medicity publishes a new report, “HIE Preparedness: Learning from Recent Health Care Disasters.”
  • MedData and Experian Health will exhibit at the Illinois AAHAM Annual State Institute November 29-December 1 in East Peoria.
  • Meditech will exhibit at the West Virginia HIMSS 2017 Fall Event November 30-December 1 in Morgantown.
  • PatientPing announces that its ACO customers achieved $120 million in cost savings in 2016.
  • Navicure will exhibit at HFMA Maine’s Revenue Cycle Workshop November 30-December 1 in Portland.
  • A large health plan upgrades to ZeOmega’s Jiva 6.1 population health management solution.
  • The Technology Association of Georgia recognizes Patientco’s Jason Kuo as 2017 TAG Product Manager of the Year.
  • TransUnion partners with Mercy Home for Boys & Girls to launch the Friends First mentoring program.
  • Verscend Technologies publishes a new white paper, “Thinking inside the box with a provider decision quadrant.”
  • Visage Imaging previews its Visage 7 Enterprise Imaging Platform in a new video.
  • Vocera Communications will present at the Piper Jaffray Healthcare Conference November 28 in November 28.

Blog Posts


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


Morning Headlines 11/17/17

November 16, 2017 Headlines No Comments

Some CVS pharmacies are blocking prescription refills, exec blames ‘internal network’ issues

CVS reports nationwide network outages that prevented customers from being able to refill their medications.

Stjeptan Tot vs. eClinicalWorks

The estate of a deceased cancer patient files a class action lawsuit against eClinical Works arguing that the company’s $155 million settlement with OCR over falsified Meaningful Use certification statements stemmed from missing functionality that compromised patient safety. The suit is seeking nearly $1 billion in damages.

CHIME National Patient ID Challenge

CHIME suspends its National Patient ID Challenge after two years of effort that yielded no meaningful results. A press release announcing the decision explains, “Though we’ve made great progress and moved the industry forward in many ways through the Challenge, we ultimately did not achieve the results we sought to this complex problem.”

News 11/17/17

November 16, 2017 News 4 Comments

Top News


VA Secretary David Shulkin, MD asks Congress to move $782 million from its 2018 appropriations to get its Cerner implementation underway, starting with an immediate $374 million in reprogramming since that’s the maximum that can be moved in the short term.


Committee chair Charlie Dent (R-PA) and ranking member Deborah Wasserman Schultz (D-FL) opened the session by expressing their frustration with previous VA-DoD interoperability efforts, the failure of the VA and DoD to follow the previous directives of Congress to create a single system, and their skepticism that the Cerner project will run as smoothly as the VA is assuring.

Some comments from Wednesday’s session:

  • The committee declined to discuss cost issues in the open session because the Cerner contract has not been signed and the VA is worried about bid protests. Cost was discussed Wednesday in a closed session that followed the public one.
  • Shulkin said that modernizing VistA would have cost $19 billion and would only say that the Cerner project will cost billions less.
  • The VA said it will save 5 percent of the project’s cost if the money is approved quickly so that the VA can align its project with the DoD’s.
  • Wasserman Schultz referred to the VA’s EHR history as, “The unbelievably lengthy process this has been, even for government,“ adding that, “This issue could have and should have been resolved years ago,” and, “It’s no wonder our constituents get incredibly frustrated with the insanity of the bureaucracy of many federal agencies. This is a textbook case.”
  • Wasserman Schultz called the DoD’s selection of Cerner as “problematic” with regard to VA-DoD interoperability given that the VA had committed to modernizing VistA, adding that “the patchwork of the Joint Legacy Viewer has left much to be desired.”
  • Wasserman Schultz said, “I was not thrilled at getting a $782 million reprogramming at the end of October that needed to be acted on by November with no real details. I’m also concerned about how this new system will work with the private sector providers .. I’m concerned that the VA’s foot-dragging and missteps have become our emergency because DoD has gone forward and jumped ahead to what we should have been doing in parallel … that’s not really the fiscally responsible way to do things.”
  • Shulkin reminded the committee that VistA is not a single system, but rather 130 separate systems that cannot continue to function. Those will be shut down one at a time as the Cerner implementation progresses over eight years.
  • Shulkin admitted that previous VA IT projects have not been delivered on time and on cost, but said the Cerner project will be overseen directly by the deputy secretary and the DoD’s lessons learned will be invaluable.
  • Shulkin said, “We’re taking advantage of the private sector CIOs. Mr. Blackburn’s going to be on a call with five of the leading CIOs in the country, getting their advice, asking what mistakes are likely to happen, and essentially using private sector input. I’ve been a private sector CEO. I’ve done EHR implementations.” Specifically named as being consulted in response to a later question were the CIOs of Mayo Clinic, Partners, Johns Hopkins, and Kaiser Permanente, all of which interestingly use Epic rather than the VA’s no-bid choice of Cerner.
  • Shulkin talked up what seems to be CommonWell along with HIEs in response to a committee question about community interoperability, a subject brought up several times by committee members. He added that the VA has just issued an RFI for the Digital Health Platform that will address that issue.
  • The VA’s EHR modernization executive director, John Windom, guaranteed 100 percent interoperability with the DoD in response to a committee member’s rather pointed question.

Reader Comments


From Winter Rye: “Re: Medent sale. I’ve never understood its reach despite the apparently success of its family and 8,000 reported deployments. The resignation of the son-of-the-father CEO may be telling that other family members want to sell after the father / founder died earlier this year. Potential buyers?” The family seems to be angrily split on selling the 260-employee EHR/PM vendor, which is based in Auburn, NY. It claims 8,000 physician users, with ONC placing it at #13 on the Medicare EHR Incentive Program most-attested vendor list with just under 4,000 EPs. It’s not the best environment to be selling an ambulatory EHR vendor given that segment’s consolidation, but it’s all about the asking price and the acquirer’s confidence of either maintaining the revenue stream or converting users to their own product (the former is much more likely than the latter). The worst thing that could happen is that the family members can’t agree whether to sell and the product languishes amidst the bickering.


From Allscripts Curious: “Re: the new Allscripts ambulatory EHR showcased at MGMA. Anyone seen it and have feedback? It claims to offer cloud hosting, usability, interoperability, mobility, and embedded AI, but management was short on details.” I’m interested as well. I assume this is the Allscripts Care Otter project, which after I mentioned it via a reader’s tip in August wondering why it wasn’t ready to be shown at ACE, all online traces of the project were immediately taken down. This reminds me of why I’m skeptical when vendors suddenly claim to have embedded the oh-so-trendy AI in their products, leading me to wonder exactly what that means beyond the usual hard-coded programming logic (the real definition of AI is that the system simulates human intelligence in applying what it learns to complete new tasks, which sounds kind of unlikely for an EHR).

From Nice Hat: “Re: patient access technology. What does that mean, exactly?” It’s less noble than it sounds, usually referring to technology that increases the number of profitable patients that can be cranked through the system.

HIStalk Announcements and Requests


Thanks to Healthfinch, which has upgraded its HIStalk sponsorship to Platinum level.

At least 50 percent of the usage of the possessive “its” that I’ve seen lately incorrectly spelled the word as “it’s,” raising the near-certain likelihood that dictionaries will start listing the misspelling as acceptable in their self-assigned role of being descriptive rather than prescriptive.

This week on HIStalk Practice: CDC announces Million Hearts Hypertension Control Challenge winners. GE CEO John Flannery announces major restructuring. Mynd Analytics makes telepsychiatry acquisition. Nomad Health adds telemedicine to healthcare jobs marketplace. Pacifica Labs adds therapist directory to popular mental health app. Forward brings high-tech primary care to LA. The Iowa Clinic embarks on population health management with help from Lightbeam Health. PRM Pro Jim Higgins outlines how PRM tools can help physicians treat the person inside the patient.


November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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


Here’s the video recording of this week’s webinar titled “How Hospitals and Practices Can Respond to Consumerism by Better Engaging Patients Through Price Transparency and Payment Options.”

Acquisitions, Funding, Business, and Stock


Merck-owned Ilum Health Solutions acquires Teqqa — a partner organization that offers analytics for infectious disease analytics — to enhance its antibiotic stewardship offerings with point-of-prescribing decision support.


Patient adherence message vendor ConnectiveRx acquires Pittsburgh-based Careform, which offers technology for specialty drug access.


Hospital and infusion center scheduling system vendor LeanTaaS raises $26 million in a Series B funding round, increasing its total to $39 million.


Banyan Software acquires Atlanta-based student health EHR vendor Medicat. I was puzzled why the company that developed the Vines networking system would buy an EHR vendor, not realizing that Banyan Systems has been defunct for nearly 20 years.


Fast Company profiles Remedy, a shuttered startup that used technology and human billing experts to help people get their incorrect medical bills fixed. The company says hospitals, practices, and insurers wouldn’t cooperate by giving it access to the billing records of their customers, saying in its goodbye message, “Until the industry begins respecting the rights people have to their own information, it will remain difficult for individuals and their agents to be vigilant against baseless medical bill overcharges.” The article acknowledges that perhaps the company should have done more due diligence before placing investor bets on external data access, but adds that the company’s billing subcontractors were buried in paperwork as hospitals and practices required completing manual forms, lost the submitted forms so they had to be completed again, and incorrectly told them that HIPAA made it illegal to work with the company.


AI-powered patient engagement platform vendor Catalia Health raises $4 million in a pre-Series A round, increasing its total to $7.75 million. The company offers Mabu, a supposedly human-like conversational companion whose robotic voice is about as un-human as it can be, making that a good place to spend some of the new windfall.



Jefferson Health (PA) chooses KyruusOne and ProviderMatch for Access Centers to create and manage a central provider directory that provides visibility into network-wide clinical coverage and provider expertise.


Griffin Hospital (CT) will implement FormFast’s electronic form and workflow technology along with check printing.


In Australia, Royal Adelaide Health chooses the anesthesia information system of Florida-based IProcedures as part of its Allscripts contract.


Allegiance Health Management (LA) selects Medhost’s clinical and financial solutions, EDIS, and YourCareCommunity patient and provider portal for eight of its facilities.


Banner Health will implement Health Catalyst’s Data Operating System for its outcomes improvement program.


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A UCSD announcement of the go-live of UCI Health on a shared instance of UCSD Health’s Epic system quotes UCSD Health CIO Christopher Longhurst, MD, MS and UCI Health CIO Chuck Podesta.


Protenus hires Megan Emhoff (Curiosity Media) as VP of people operations.

Announcements and Implementations


Apple co-founder Steve Wozniak will headline InstaMed’s 2018 User Conference April 9-11 in Philadelphia.


The Iowa Clinic (IA) goes live on the population health management platform of Lightbeam Health Solutions.


The local paper covers the first US deployment of Netherlands-developed, infection prevention-focused OR Cockpit at Ocean Springs Hospital (MS).

Philips and Nuance will bring AI-based image interpretation and reporting capabilities to radiologists in integrating their respective Illumeo and PowerScribe 360 products.

NextGen adds the IMO Problem IT Terminology diagnosis entry tool by Intelligent Medical Objects to the mobile workflow solution that was part of NextGen’s acquisition of Entrada earlier this year.

Image Stream Medical offers HIStalk readers “Surgery is a Team Sport,” a three-part educational series on improving teamwork, increasing care quality, and expanding efficiency.

In Canada, Canada Health Infoway and OntarioMD will align the privacy and security components of their respective EHR certification programs.



An “internal network infrastructure issue” leaves CVS Pharmacy unable to process prescription refills. Annoyed Twitter users dispute the company’s claim that new prescriptions are being filled normally, saying that the multi-day outage has disrupted all CVS prescription activity and has caused store personnel to suggest they head over to Walgreens.


CHIME suspends its highly publicized, $1 million prize National Patient ID Challenge after two years, saying “a new approach is warranted” with no good solutions found and admitting that “we cannot do this alone.” CHIME President and CEO Russ Branzell also notes that Congress may soften its stance on prohibiting HHS from creating a national patient identifier. CHIME says it will bring together key stakeholders to find a national solution that identifies people with 100 percent accuracy (its million dollars would be safe there for sure).

A woman sues EClinicalWorks for $999 million, hoping to attain class action status in claiming that her husband died because ECW’s EHR left him “unable to determine reliably when his first symptoms of cancer appeared in that his medical records failed to accurately display his medical history on progress notes” without really describing what happened. The complaint cites the certification issues that were listed in ECW’s settlement with the Department of Justice.


In England, a physician’s op-ed piece complains that a private telemedicine provider is advertising itself as a replacement for seeing GPs while excluding more complex patients, thus cherry-picking the easiest ones and threatening GP practices that are paid a fixed $200 per patient per year in which the healthy subsidize the sick. The yearly fees are transferred to telemedicine provider Babylon when a patient signs up for an online visit. The author says his practice can’t provide services to truly ill patients if telemedicine providers skim off the profitable ones:

But while anyone can join its service, the website says it may not be suitable for “complex mental health problems or complex physical, psychological or social needs.” Or if you’re pregnant or older and frail, and as long as you don’t have dementia or learning difficulties or safeguarding issues … We cannot refuse to register patients or advise them to register elsewhere based on age, gender, or disability. If my surgery put a list on its website telling the most ill people in our catchment area we weren’t suitable for them, NHS England would serve us a breach of contract notice and could close us down.

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I mentioned that Thursday night’s “Grey’s Anatomy” winter finale involves a hospital cyberattack, with a sneak preview showing that it’s ransomware. It’s a pretty realistic EHR screen and “Tim from IT” gets a fun line before his day is wrecked in cutting off the nurse’s description of the problem by asking her if she’s tried turning the computer off and back on. Hollywood loves playing sounds when text displays on a screen like a teletype and did so here, which might be desirable for ransomware but not otherwise. The hacker appears to be demanding 4,932 bitcoin, making the ransom at bit steep at $38 million.

Sponsor Updates

  • Elsevier adds an Opioid Epidemic Resource Center to its Connect website.
  • Salesforce offers an e-book titled “How a Mobile CRM Makes You More Successful” and a guided tour of Community Cloud Lightning.
  • Datica CTO Adam Leko and Methodist Le Bonheur Healthcare analytics director David Deas will present a session on eliminating HIPAA compliance as a development barrier at the Amazon Web Services AWS re:Invent conference on November 27 in Las Vegas.  
  • Brava Magazine profiles Healthfinch VP of Finance and Operations Leah Roe.
  • Healthgrades partners with to bring Hour of Code to schools in Atlanta, Denver, Madison, and Raleigh.
  • Healthwise will exhibit at the Next Generation Patient Experience November 28 in San Diego.
  • Iatric Systems releases a preview of its forthcoming Security Audit Manager.
  • Imprivata customer support wins the 2017 TSIA Star Award.
  • The HCI Group partners with the Dubai Health Authority for the DHA Transformation Forum.
  • Consulting Magazine includes Impact Advisors in its list of fastest-growing firms for 2017.

Blog Posts


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


EPtalk by Dr. Jayne 11/16/17

November 16, 2017 Dr. Jayne 2 Comments


Not healthcare IT, but providers will probably have to document conversations on this in the EHR. The US Environmental Protection Agency has approved the release of so-called “weaponized” mosquitoes in parts of the US. They’re officially classified as a “biopesticide” and their creator, MosquitoMate, will be licensed to sell them for five years. The lab-grown male mosquitoes are infected with a bacteria; females mating with them will produce eggs that don’t hatch. The goal is to reduce the spread of diseases such as yellow fever, dengue, and Zika. The modified mosquitos don’t bite and will be on sale to municipalities and individuals. The US isn’t the leader here, with lab-grown mosquitoes already in use in China and Brazil.


I struggle with articles that overly-simplify the challenges we face in healthcare and this one on HealthcareDIVE is a prime example. Trumpeting the headline of, “The healthcare of tomorrow will move away from hospitals,” it tries to boil down discussion from the US News & World Report Healthcare of Tomorrow conference into a few sound bites. First, it states that “locating services in a patient’s home or somewhere close by and easily accessible is more convenient for patients, but also produces more comprehensive and effective care.” This is a gross oversimplification and doesn’t take into account that some of the most convenient sites of care (retail clinics) are also the least comprehensive, as they are sometimes staffed by mid-level providers with limited scope of practice. I see dozens of patients each month who are referred to urgent care because their conditions are out of scope of the retail clinic, resulting in two visits and two charges for the patient.

This also doesn’t take into effect the proven concept that for some situations, regional or specialty centers provide better outcomes than local or community facilities. Complex procedures like cardiac surgery, neurosurgery, high-risk pregnancy, and other similar conditions fall into this bucket. This isn’t supported by their sound bite of, “If you have to go to the hospital, we have failed you.”

As a patient / consumer who has recently faced difficult decisions in this area, it’s not a simple choice. Should I keep going to the local physician-owned imaging center for my mammograms, where they are high quality but lower cost, or move to the hospital because it has a high-risk surveillance protocol and better track record for finding early breast cancer through combined mammography and MRI, but with a higher cost and a higher hassle-factor? I honestly went back and forth on this decision for a couple of months before I decided to go with the hospital option. Should the day come where something is found, however, I’ll be ditching that hospital’s cancer care team for the one at the academic medical center, which has an equivalent track record for finding cancer, but better outcomes in treatment. If these decisions are difficult for a physician, they’re doubly challenging for the average patient.

I agree with the statements that telemedicine needs to become more commonplace – and that means being reimbursed in the same way that we reimburse for face-to-face visits. Whether we’re living in a fee-for-service world or one of value-based care, somehow the physician, mid-level provider, or other caregiver’s time needs to be paid for. I agree that consumers are going to drive many healthcare shifts over the next few years – I look at the growth of my own practice (from five locations to 15+ in a little over two years) as an example that patients are voting with their feet and their co-pays for convenience along with the more full-service experience that we offer. Essentially, we function as a cross between a primary care office and an ED and provide all the services in between plus pharmacy for a fraction of the cost of the ED. We’re not cheaper than primary care and don’t quarterback a patient’s comprehensive care, but if you need to be rehydrated during your gastroenteritis, we’re the hip place to be.

Patients are willing to pay the larger urgent care co-pay in order to not have to wait to get in to see a primary physician (assuming they have a primary physician, which many do not due to the relative primary physician shortage in our area). It’s telling that most of our new staff physicians are former PCPs who have found the urgent care lifestyle more conducive to their humanity as compared to being a primary care doc. We’ve been accused of poaching primary care physicians and making the PCP shortage worse, but this is market economics at work. The idea that a physician is “called” to work long hours for low pay as a PCP has become antiquated as providers vote with their wallets and their free time to work 160 hours a month for the same pay as they were previously working 200 or 240 hours, with less stress.

When you look at it, urgent care provides a similar case mix to what many of us trained for during family medicine residency: acute care, chronic care, and procedures, the latter of which is missing in many primary care practices now that physicians are asked to do more high-level work and less of the procedural work that we found enjoyable regardless of the fact that it could be done by mid-level providers. Of course, we don’t have the continuity of care that originally sought as PCPs, but we have more continuity with our families and our personal lives. The playing field has changed as third-party forces have transformed healthcare from a calling to a job.

I do appreciate the comments from Jason Spangler, MD, MPH, a quality and medical policy director at Amgen. He calls for the industry to “pay and incentivize patients toward high-value care and disincentivize them against low-value care.” Modifying patient behavior is extremely challenging, as anyone who has ever tried to convince a patient to change their lifestyle vs. just taking a pill once a day for high blood pressure knows. I’m sure there was a broader and richer discussion at the conference, but the coverage provided is problematic. Those who try to boil these complexities down to sound bites aren’t doing much to help the situation.


My condolences to the family, friends, and close colleagues of Uwe Reinhardt, healthcare economist and Princeton University professor. He was a master at dissecting the US healthcare system and showing how it defies logic. I once had the chance to meet him as we were assigned to share a car to the airport following a conference where we spoke on separate healthcare panels. He could easily have used the time to check email or catch up on phone calls, but instead he wanted to learn more about me and my thoughts on the US healthcare system from the primary care and CMIO trenches. He was kind, thoughtful, and a good listener, which are qualities we don’t always see among some of the loudest voices in healthcare. If you’re not familiar with his writings, they’re definitely worth a read.

Email Dr. Jayne.

Morning Headlines 11/16/17

November 15, 2017 Headlines 1 Comment

U.S. scientists try gene editing inside a person for the first time, aiming to cure a disease

For the first time, UCSF Benioff Children’s Hospital researchers have injected a patient with a CRISPR-based therapy designed to permanently edit his DNA in hopes of curing his Hunter syndrome, a rare but terminal genetic disease.

HHS cybersecurity initiative paralyzed by ethics, contracting investigation

The top two executives at the Health Cybersecurity and Communications Integration Center, a new HHS office established to help providers protect themselves from cyberattacks, have left the fledgling department amid fraud allegations.

Oversight Hearing – Veterans Affairs Electronic Health Record

VA Secretary David Shulkin, MD testifies before the House Appropriations Committee on its systemwide Cerner implementation.

Towards a genomics-informed, real-time, global pathogen surveillance system

A Nature article explores the possibility of combining sequencing of pathogen gene sequencing to help epidemiologists bring about innovative digital disease detection platforms.

Readers Write: How Hard Is It?

November 15, 2017 Readers Write No Comments

How Hard Is It?
By Frank Poggio


Frank Poggio is president and CEO of The Kelzon Group.

In the October 28, 2017 issue of HIStalk, Mr. H made this critical observation and raised an important question. He wrote (finishing with tongue in cheek):

For those with short memories or short healthcare IT careers, it’s time to relearn the oft-repeated lesson that big companies dip their toes into and out of the healthcare IT waters all the time with little loyalty to anyone except shareholders. McKesson bailed out this year and now GE is apparently mulling its exit after wrecking a slew of acquisitions over many years. Siemens is long gone. Nothing good ever comes from conglomerates licking their chops at what they naively think is easy money and higher growth than their other verticals (see also: Misys and Sage). How hard could this healthcare thing be?

GE of course isn’t alone, but they may hold the prize for most kicks at the can. This will be their third time since 1970 — three tries and billons later and nothing to show for it. Ironically, GE has had great success in medical devices, so one could assume they know more about the healthcare business than a Revlon, Apple, IBM, NCR, Martin Marietta, Lockheed, Oracle, SAP, Microsoft, et al.

After some 45 years working in the healthcare IT arena, I believe I have the answer to Mr. H’s query. My qualifications in support of my response are:

  • Over four decades, I was a hospital CFO and CIO at a major teaching hospital.
  • I spent two intermittent decades as an industry consultant working with healthcare providers and system vendors of all sizes.
  • In the middle of my career, after my CIO stint, I founded a HIT startup that built both clinical and administrative systems, went public, and was later acquired by one of today’s major vendors.
  • Most importantly, I have designed clinical and administrative software systems, led installations, and written more than my share of program code.

To summarize, I have seen it from all four sides; buyer, builder, advisor, and patient.

There are four reasons that make healthcare IT hard, really hard.

Organizational Structure

Many people new to the healthcare readily compare it to commercial industry. Why can’t hospitals do as banks, or airlines, or Google, or…?

One reason is they are not organized like these entities. What other industry has as its primary customer the same person that sells and then performs the core services? That same person also defines the product and further determines how it is delivered and implemented. That person is the doctor. The PhDs at GE do not make the final decision on how to make a jet engine or how to deliver it. GE is run by a CEO and the buck stops there. Hospitals are run by a troika (or committee) of the board, the administrative CEO, and the chief medical officer.

In 1974, Professor William Dowling, University of Washington, published the book “Prospective Reimbursement for Hospitals,” which did research on hospital operations. His studies showed that the CEO of a typical community hospital directly controls only 25 percent of the resources and operations. The other 75 percent is controlled by the doctors. They decide what tests to run, when to run them, and what happens next. The fastest way for a CEO to lose his job is to directly challenge the medical staff.

What other industry is organized like this? If you are in the business trying to build and sell million-dollar systems, you had better understand this organizational dynamic and accept the fact it will take years to generate an acceptable return on investment.

Regulatory Quagmire

All businesses are struggling with regulation. I submit that healthcare far exceeds all others.

Case in point: in what other industry does the payer define the structure and content of the bill down to the very last data element? One that comes closest is the defense industry, and many of its idiosyncrasies are incorporated in healthcare regulations. In 1999, Price Waterhouse CPAs completed an analysis of how many pages in the federal register addressed income tax laws. They compared income tax against the number of regulatory pages need to create a payable UB bill for all payers in a given state. The results were 11,000 pages of regulations for taxes and over 50,000 for a hospital bill.

A further complication is the person receiving the care is not the one paying the bill. Sometimes the patient never sees the full bill, and when they do, they are inevitably confused.

Training, Structure, and Definition

Computer systems thrive on definition and structure. The easiest applications to develop are those where the target domain has a history and library of definition and structure. Lack of definition and structure are a programmer’s nightmare. Today there are many tools to help address gray areas, such a fuzzy logic and neural networks, yet learning and applying these tools significantly raises the complexity of the system, thereby increasing development time and costs.

A doctor’s adherence to medical terminology and structure is highly dependent on which medical school they attended. As an example, a study at the Milken Institute SPH at George Washington University found that physicians whose residencies were in higher-spending regions spent 29 percent more on average than their peers who had trained in lower-spending areas of the country. Different protocols for different regions based on training. The federal government spent $30 billion on EMRs and yet we still have wide gaps in medical lexicons, protocols, and the structure and content of EMRs.

Moving Targets

In IT, this is classically called a rolling design, again a developer’s nightmare. But the delivery of healthcare and the practice of medicine are rife with this burden. Medicine is in constant change, with new protocols, test procedures, quality measures, etc. presented every week. Old protocols are challenged on a routine basis, e.g., mammography screening, PSA testing, knee replacements, tonsillectomies, and more.

What if you were assigned to develop a production management system for an auto manufacturer and every month the manufacturing engineers told you that process A — which we coded last month — has now changed to process B? The solution in commercial industry is to freeze the design by freezing the process. Can’t do that in medicine — freeze your protocol and tomorrow it could be the basis of a malpractice suit.

Medicine has always been in constant change, and with personalized medicine around the corner, variation and complexity will grow by leaps and bounds. Scientists have been trying to reverse engineer the human body since the first autopsy a thousand years ago. If only when you were born your mother gave you a 5,000-page human spec sheet with schematics and diagrams, a user’s manual, a troubleshooting guide, and a 1-800 number to call when all else fails. They exist for every car, dishwasher, plane, and other device and sure make software development a lot easier.

When I was a CIO at the end of a difficult IT implementation, the dean of our medical school said to me, “There is a reason we called it the practice of medicine. If we practice long and hard enough, someday we’ll get it right.”

Many of these issues exist in other industries and disciplines. I submit that the depth and interaction to which they exist in medicine and healthcare is what makes IT development hard, very, very hard. All those big companies (and many small) that came into the healthcare industry failed because they did not allow for the depth and interaction of these challenges, and hence they did not prepare for them, lost patience and millions, then chose to cut their losses and run.

From the outside looking in, healthcare is twenty percent of the gross national product, which could support a very attractive business opportunity. It’s a beguiling number which has proved to be siren song for many a big and small firm.

Readers Write: Six Myths Debunked: The True Significance of Social Determinants of Health

November 15, 2017 Readers Write No Comments

Six Myths Debunked: The True Significance of Social Determinants of Health
By Erin Benson


Erin Benson is director of market planning with LexisNexis Health Care of Alpharetta, GA.

Predicting future health risks has always been important, but the ongoing move toward value-based care and the emphasis placed on health outcomes is driving the need for greater prognostic accuracy.

At least 25 cents of every healthcare dollar goes toward the treatment of diseases or disabilities that result from potentially changeable behavior. If you can identify risk factors in patients, you can potentially intervene and initiate change. That’s where social determinants of health come in, but first it’s important to separate the myths from the truth.

Myth #1: Adding socioeconomic data to the patient file causes information overload and makes it difficult for providers to zero in on what’s important and relevant.

Medical care determines only 20 percent of overall health, while social, economic, and environmental factors determine 50 percent, making them too significant to ignore. The National Quality Forum, Centers for Disease Control, and World Health Organization have all acknowledged the importance of socioeconomic data.

Incorporating the data into existing workflows and integrating it with electronic health record (EHR) systems makes risk assessment more efficient, not time-consuming. A Socioeconomic Health Score, for example, can provide an immediate picture of unforeseen and avoidable risks. It can then drive informed decisions regarding that patient’s care, as well as offer opportunities for patient-provider discussions about lifestyle.

Myth #2: Social determinants of health include everything related to a person’s lifestyle, environment, situation, and behaviors.

Only certain types of data have been clinically validated to predict health outcomes. Even when attributes are clinically validated, they may correlate to different outcomes with different accuracy strengths.

Improving predictive ability is not just a matter of adding more data. It is a science to determine which datasets enhance predictive power and how they should be weighted in drawing insights about a patient.

Myth #3: A patient’s socioeconomic attributes considered individually allow you to make accurate predictions about a patient’s overall health risk.

Any attribute examined on its own is not adequate to develop an accurate risk score understanding. A combination of relevant attributes—ranging from social and community circumstances to economic stability and education, to neighborhood and built environment—provide context and are critical to developing a complete, holistic picture of the patient.

Myth #4: Socioeconomic data comes from demographic data or must be gathered through the use of surveys.

Demographic data may be too limiting and census data tends to get outdated quickly. Survey data, too, can become outdated. Furthermore, the value of survey data depends on the accuracy of the patient supplying the information and on the staff member who manually enters the results into the system.

Research has shown that public records are a better source of socioeconomic data. Those records are vast, comprehensive, and reliable. Clinically validated information on social determinants of health can be extracted from these records to paint a picture of a patient’s social, environmental, and economic situation and predict future health outcomes.

For healthcare providers who have traditionally relied only on medical and pharmacy data, socioeconomic data can now help fill gaps in understanding the patient and provide actionable insights that can be used to improve patient care.

Myth #5: To personalize care for a patient, you can rely on aggregated data at the ZIP code or census level.

Aggregated levels of data can be useful for expanding a health system’s market share or determining resource allocation. They are not, however, suitable for predicting a patient’s individual health risk.

Within a single ZIP code can be a wide variety of income levels, crime rates, and other factors that are critical components of social determinants of health. An individual’s actual address allows for the collection of social determinants that are more accurate indicators. However, even address data alone are not effective predictive tools. They ignore the influences of education, economic stability, social context, and other important variables that impact health.

Myth #6: Socioeconomic data must be used in combination with clinical data and is not an effective risk predictor on its own.

Even in the absence of clinical data, using socioeconomic data has proven to more accurately predict risk based on total cost than traditional age/gender predictions alone. Small increases in accuracy of as little as a percent or two can have a substantial impact and should not be ignored.

Because higher-risk patients account for the majority of healthcare costs, using socioeconomic scores to more accurately identify them gives providers an opportunity to proactively address their care. The result can be a 10-20 percent savings over traditional age/gender model risk stratification alone.

Healthcare is on the brink of a significant transformation largely driven by the availability of vast amounts of socioeconomic data and advanced analytics. Now that we’ve separated fact from fiction, it should be apparent social determinants of health have great value as a reliable predictor of healthcare risk.

The truth is we’ve only scratched the surface of what can be learned and how the insights gained can be applied. What is clear now is that organizations that embrace using social determinants of health will be better able to understand and manage health risk in their patients, resulting in improved outcomes and reduced healthcare costs.

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

November 15, 2017 Readers Write No Comments

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


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

We have previously discussed the impact of organizational misalignment and lack of trust on slowing the buying cycle in healthcare. Once you decide which projects are worth tackling and you streamline getting the scoop from your trusted network, now you must challenge and simplify the deeply-rooted, legacy workflow to make a decision.

Let’s illustrate two examples of antiquated steps in most every vendor selection process in healthcare and discuss potential solutions.

Meetings about Meetings


For projects that require alignment and collaboration across many key stakeholders, unnecessary, unproductive meetings complicate and delay making a decision.

Politics and mistrust may artificially swell the number of required participants (healthcare is more than a catered buffet away from adopting Amazon’s two-pizza rule). Something as simple as setting a date for a meeting when everyone is available can push a process out by weeks, if not months. Inevitably, some important contributors will have a last-minute conflict. The original meeting agenda often devolves into a pontification session with distracted participants checking emails on their phones and little advancement toward a decision.

How can we ensure fewer meetings, using our precious time together to be true decision-making events to advance a project? The most common answer to date has been an untenable volume of fragmented emails, spreadsheets, SharePoint files (people really still use this!?), and other databases that do not spur action.

A better solution is to enable a more efficient platform for asynchronous collaboration among key contributors. Ideas, comments, and assessments can be solicited and shared at the availability of each stakeholder and captured in context of the problem statement, current solutions, or potential solutions being considered. Project owners control the appropriate balance of privacy and transparency to minimize duplication of effort across the organization.

Better asynchronous collaboration can ensure fewer people physically attend fewer meetings and calls,  and when they do, key information and opinions will be understood in advance, reserving meeting time to make decisions that more rapidly advance a project. Let’s stop having meetings about meetings that don’t offer any action items or decisions and ensure everyone’s time is spent more efficiently.



In an effort to de-risk a decision, get a fair price, and discern truth amid vendor marketing claims, we in healthcare add months to a procurement process with a request for proposal.

The greatest advance in the healthcare RFP process over the last 15 years is replacing FedEx’ing boxes of binders with emailing word documents and spreadsheets. Not exactly disruptive innovation on the most universally dreaded, antiquated step in the buying process (drawing disdain from both healthcare organizations and vendors alike).

Every RFI or RFP is created and sent as if it were being done for the first time and yet rarely is an original question asked. Just ask the vendors who jump through clerical hoops to nuance their library of prepared answers to meet the requirements and format of each set of questions, always wondering if they are wasting resources on a CYA exercise for a decision that has already been made.

Further, manual effort for project owners to cut and paste siloed answers among Word documents, spreadsheets, and PowerPoint to score, assess, and present results amplifies frustration.

How can health systems ensure the diligence and risk mitigation benefits of an RFP without the exorbitant time, resources, and costs associated with their current methodology?

A network of engaged healthcare organizations that share common challenges and opportunities can collectively engage with vendor partners in a new way that is more efficient and effective for all involved. Common questions and answers can be crowdsourced to minimize unnecessary duplication.

The future state of an RFI can be little more than an appropriate search and application of filters to instantly identify a relevant shortlist. For a deeper dive, posing general RFP-like questions in a common platform (with appropriate privacy controls) can help buyers ensure a more comprehensive question set while helping vendors avoid answering the same topic more than once. Enhanced by automatic comparison, simplified assessments and flexible analysis of results, the expectation is we can minimize decision-making risk for more vendor selections being made without the formal RFP we know today.

By reimagining meetings and RFPs, the healthcare industry can simplify and antiquated process and enable decisions to be made with significantly fewer resources, less elapsed time, and lower costs.

Morning Headlines 11/15/17

November 14, 2017 Headlines No Comments

Transforming Medicine Through Innovation: Looking Beyond the Chaos of the Moment

At its Interim Meeting this week, American Medical Association EVP/CEO James Madara, MD calls for more clinically-organized EHR workflows, improved interoperability, and inclusion of the patient’s own feedback in charts, all leading to more context and meaning to the clinical data now available to providers. Describing the current healthcare landscape, he says, “we confront oceans of data, but only puddles of clinical meaning.”

MEDITECH Introduces MaaS, a Cloud-Based EHR Subscription

Meditech announces availability of a cloud-hosted EHR aimed at the critical access hospital market.

Health records vendor looks to settle lawsuit with VA

CliniComp, the plaintiffs in a suit filed against the VA for selecting Cerner as its next EHR in a no-bid contract, offers to settle its appeal in exchange for the opportunity to prove to the non-partisan General Services Administration that its system “can be delivered cheaper, faster, and better than the alternative.”

Humana Elects Karen DeSalvo, M.D., to Board of Directors

Humana adds Karen DeSalvo, MD, former Assistant Secretary of HHS and National Coordinator for Health IT, to its Board of Directors.

News 11/15/17

November 14, 2017 News 7 Comments

Top News


American Medical Association EVP/CEO James Madara, MD pitches AMA’s recently announced Integrated Health Model Initiative at the organization’s Interim Meeting. He criticized the poor organization of clinical data sets; the lack of clinical usefulness of EHRs; the need for meaningful interoperability; and “oceans of data, but only puddles of clinical meaning.” His overriding message was that useful information is scattered throughout the EHR, it lacks context, and its needs to include patient-reported data and perceptions.


Meanwhile, AMA President David Barbe, MD cites AMA’s major wins at the same conference in which he urges attendees to recruit new AMA members. “We successfully fought to postpone a mandate for physicians to upgrade their EHRs … We are fighting to prevent IT vendors from blocking information or making it expensive for physicians to share data, and we are making progress. We are fighting physician burnout and the time crunch by working to improve EHRs, mobile devices, and interoperability, and again, those efforts are showing signs of success.”


AMA is protective of its membership count – omitting the actual number from its otherwise detailed annual report — but admits that its small growth in the past few years is due to offering low-dues options to groups and for partial-year trial memberships. Some observers estimate that the percentage of American physicians who are members has dropped from 75 percent in the 1960s to as low as 15 percent today. Most of AMA’s $324 million in annual income is from publishing, selling databases such as CPT codes, and profits from its insurance agency.

Reader Comments


From LinkedOut: “Re: LinkedIn. You said it’s inexcusable not to have a LinkedIn profile. I have found it useful only for networking, primarily to land your next job. Most profiles are outdated. I’m happy in my current position and don’t have a profile. I prefer anonymity and a quiet inbox. If you are in a long-term relationship with someone with an updated EHarmony profile, you’ve got a surprise coming.” I dislike LinkedIn for many reasons: endless spam; slow page load time; user-written vanity pieces; and preening profiles full of questionably accurate credentials. All that aside, I look people up there all the time there for both work and non-work reasons (where did my cousin John Smith ever end up?) My comments specifically referred to executives, where not making a bio and headshot available there is a bad PR move. I also believe that everybody should be open to employment inquiries, which they are free to accept or reject as a business decision unrelated to receiving them in the first place. It’s a lot harder to desperately market yourself after your once-beloved employer has escorted you off their property and your current LinkedIn headline turns into “seeking the next great HIT opportunity” or you declare yourself a first-time, self-employed consultant because nobody’s hiring you. Anonymity and a quiet inbox are great until the paychecks stop, and trust me when I say that your employer’s EHarmony profile is always current even if yours isn’t. 


From Smoove B: “Re: HIStalkapalooza. Since you aren’t doing it at HIMSS18, you can put your name on our company’s event and we’ll give you some invitations to use.” I don’t really see any point to that, but it reminds me of something I’ve always wondered just in case I ever consider doing it again: why did people attend HIStalkapalooza? If you were there, complete this one-answer poll about why and I’ll report back. So far I’m not feeling nostalgia for the massive personal financial risk, the never-ending search for sponsors to help cover the cost, and the ugliness of the self-impressed who insist that their party presence is mandatory. HIMSS has plenty of parties, so mine shouldn’t be missed much.


From Hinrika: “Re: UAE. Thought you would be amused at what happened when I tried to read HIStalk in Dubai this morning.” I’m always happy to be blocked, although it’s best when a paranoid vendor tries to hide unflattering news and opinions from their employees. That usually has the opposite effect — they simply read from home or on their phones out of curiosity to see what their employer wishes they wouldn’t. I don’t know what I wrote that got me banned in the UAE, but I’m probably proud of it.

From GoLiveSupport: “Re: [health system name omitted]. [consulting company name omitted] was chosen to help with its Epic go-live and brought in buses of foreign resources who could not speak English. The health system was so unhappy with the inexperienced resources that they made all of them take an assessment and then immediately walked off all 300 of them off the property and kicked the company off the project entirely.” Unverified and likely to stay that way since neither the health system nor the vendor is likely to confirm, so I’ve expunged the names.

From Timothy: “Re: SOAPware. It’s not new news that the EHR vendor is shutting down effective February 2018, but they’ve sent clients a memo suggesting they transition to Athenahealth. Apparently they had established a marketing agreement that I’m sure Athena paid some good $$ for.”


November 15 (Wednesday) 1:00 ET. “How Hospitals and Practices Can Respond to Consumerism by Better Engaging Patients Through Price Transparency and Payment Options.” Sponsored by: Change Healthcare. Presenters: Kathy Moore, president, Moore Martini Medical; Linda Glidewell, VP of business development, consumer payment solutions, Change Healthcare. Healthcare consumerism and high-deductible health plans require providers to offer upfront estimates and payment options throughout all points of service. In his webinar, we’ll discuss consumerism as a critical area of opportunity in revenue cycle management and review numerous areas across the revenue cycle where your staff interacts with patients and leaves lasting impressions. From your first interaction with patients on the phone to discuss financial responsibility; to collecting payments at all points of service; to offering payment plans and various payment options — these are all areas that can be game-changing. With the right approach to consumerism, you can improve patient collections and optimize revenue from the start while also improving the overall patient experience.

November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

Acquisitions, Funding, Business, and Stock


ED notification technology vendor Collective Medical raises $47.5 million in a Series A funding round. The Salt Lake City company, founded in 2006 by a couple of BYU computer science graduates, is now run by a Bain Capital private equity guy (and BYU grad) in his first CEO job.


Syapse, which offers an oncology precision medicine and data sharing platform, raises $30 million in Series D financing, increasing its total to $70 million.


Israel-based Medigate, which offers a cybersecurity platform to inventory and protect connected medical devices, raises $5.4 million in a seed funding round. The three co-founders were all officers in the Israeli Defense Forces Intelligence Corps.


Coding and compliance services vendor Aviacode acquires an unnamed, India-based medical coding company to extend its coding staff and available hours.


A state judge denies a request from investors in Outcome Health who had asked the court to freeze $225 million that was due to be paid to the company’s founders. The investors’ lawsuit claims that the doctor waiting room advertising technology company, whose valuation rose to more than $5 billion, defrauded them by falsifying advertiser metrics. The complaint was amended Sunday to note that 22 high-level executives have left Outcome or have been placed on leave so far this year, with the investors also noting that they are receiving Justice Department subpoenas and expect the SEC to get involved. 



Healthcare economist Uwe Reinhardt of Princeton University died Monday at 80. His seminal Health Affairs article, “It’s the prices, stupid: why the United States is so different from other countries” pointed out way back in 2003 that we spend more than any other country on healthcare only because healthcare goods and services cost a lot more here, an issue that remains unaddressed by policy-makers fixated with cutting insurance benefits and reducing the number of people able to buy plans (guess who’s got more lobbyists?) 


Humana appoints former National Coordinator Karen DeSalvo, MD, MPH, MSc to its board.

Announcements and Implementations


Meditech announces a cloud-based subscription version of its Web EHR that targets critical access hospitals. The company says hospitals can go live within six months of signing.


A Black Book survey finds that only 19 percent of inpatient post-acute providers have any kind of EHR capability, with 91 percent of administrators reporting that they have no money budgeted for technology acquisitions and improvements. Nearly 90 percent of long-term care providers are not exchanging information with referring hospitals, doctors, or home health providers, while only three percent of them have analytics capability. Netsmart is Black Book’s top-performing post-acute care technology vendor based on user satisfaction.


Casenet releases TruCare ProAuth, which allows providers to process prior authorization requests.


A Change Healthcare study finds that at least 40 states are pursuing value-based payment programs.

UPMC touts its kidney failure detection EHR alert that monitors serum creatinine trends, although the big-picture mortality improvement has been modest.

Mediware adds billing capability to its MediLinks rehab EHR.

Government and Politics


CliniComp offers to drop the appeal of its dismissed lawsuit against the VA – for choosing Cerner in a no-bid contract — if the VA agrees to test its product head to head with Cerner and let the non-partisan General Services Administration judge which system performs best against existing VistA-to-DoD interoperability benchmarks. They don’t have a chance in this political climate, but its offer throws some justified shade on the VA for declaring that it’s in the best interest of taxpayers to sling no-bid billions at Cerner instead of looking at competitors, of which Epic would be a lot stronger than CliniComp despite the former’s lack of success implementing the Coast Guard and bidding for the DoD.  


The DoD’s MHS Genesis will celebrate completion of the initial deployment of Cerner in a Facebook Live event from Madigan Army Medical Center (WA) Wednesday at noon ET.

The VA issues a $158 million contract to CSRA to convert the paper health records of 7 million veterans to digital form as part of its conversion to electronic claims.



FDA approves the Proteus “digital pill,” a skin patch that will report to doctors when a patient takes a digitally enabled dose of the psychiatric drug Abilify. The system may improve adherence, although no studies have proven that, and it may prevent psychotic episodes if the patient is historically forgetful rather than deliberate in skipping doses. Still, some experts note the irony of giving a “biomedical Big Brother” to delusional patients as well bringing up the privacy implications of being monitored (although patients can opt out). An alternative is already available – once-monthly injectable aripiprazole. 

A London scientist develops a camera that highlights temperature hot spots on the feet of diabetics, allowing early detection of foot ulcers.



A Boing Boing article that contains no new research (but admirable snark) calls IBM Watson for Oncology “a human-driven engine masquerading as an artificial intelligence” that simply relays the results of a manual case review by Sloan Kettering experts. It notes that IBM hasn’t allowed an independent study of how Watson for Oncology works; its misleads doctors into thinking they will get a data-driven, global recommendation instead of the opinion of a handful of peers; it can’t accurately import patient records; and its outcomes haven’t been studied to see if its recommendations are any good.


A research article concludes that “psychological mass persuasion” — using an individual’s digital footprints such as Facebook likes or Twitter activity to target social media advertising that pushes their specific hot buttons — is effective in altering their behavior, measurably influencing their purchasing and voting behaviors. That confirms (to me, anyway) that stories about social media influencing elections miss the most important point – that Americans aren’t smart enough to realize when they are being manipulated, are too lazy or too embracing of information that matches their beliefs to vet their information sources, and are too quick to launch personal attacks at anyone whose opinion (or especially factual information) contradicts what they want to hear. American adults of today sometimes seem like American children of yesteryear – self-indulgently watching cartoons, playing with toys, enviously watching what their friends are doing, and throwing temper tantrums, except now it’s all online. Let’s hope we don’t get invaded since the only resistance will be people getting in the way by holding up phones hoping to post the first Facebook selfies.

An interesting public health issue: Colombian “soda cartels” threaten and attack consumer advocates who support a 20 percent tax on sugary drinks that are cheaper than water, convincing the government to threaten supporters with fines. Colombia’s obesity rate has tripled since 1980. 

A hacker breaches the hospital’s computer system in this Thursday’s “Grey’s Anatomy,” forcing the TV doctors “to get creative in their methods to treat the patients.” I’m certain it will be far from realistic, even omitting the standard hospital executive post-incident assurance that the system that was expensively purchased with claims that it would improve patient care puzzlingly didn’t negatively impact that same care when it tanked.

Sponsor Updates

  • PokitDok earns HITRUST CSF certification and accreditation for OSAP-HIE and CEAP.
  • Kern Health Systems (CA) goes live on ZeOmega Jiva 6.1.
  • LogicStream Health moves into a larger Minneapolis office after doubling its FTE count since 2015.
  • Definitive Healthcare is included in Deloitte’s Technology Fast 500 list.
  • Meditech celebrates Canada’s Digital Health Week.
  • Agfa Healthcare publishes a new white paper, “Augmented Intelligence – The Next Frontier.”
  • Black Book’s latest survey ranks Netsmart as the top-rated HIT platform across post-acute settings for the third consecutive year.
  • Arcadia Healthcare Solutions and Cumberland Consulting Group will exhibit at the 2017 HPA Clinical Informatics Value Visit November 15-17 in Kissimmee, FL.
  • Besler Consulting releases a new podcast, “Healthgrades 2018 Report to the Nation.”
  • Carevive will present at the Navigation & Survivorship Conference November 16-19 in Orlando.
  • CoverMyMeds will exhibit at the Norcal HIMSS Annual CXO Summit November 16 in Santa Clara, CA.
  • Diameter Health President John D’Amore presents the the 2017 Digital Quality Summit.

Blog Posts


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Morning Headlines 11/14/17

November 13, 2017 Headlines No Comments

Trump Chooses Alex Azar for Health and Human Services Secretary

Former Eli Lily executive Alex Azar has been nominated as the next Secretary of HHS. Azar has a law degree from Yale University and served as a deputy within HHS under President George W. Bush.

Dr. John Halamka voices thoughts on precision medicine and the road ahead

MedCity News interviews John Halamka, MD and CIO of Beth Israel Deaconess Medical Center on EHRs and precision medicine.

Why I’m Digging Deep Into Alzheimer’s

Bill Gates launches the Dementia Discovery Fund, a $50 million private fund that will invest in a diverse selection of research efforts aimed at identifying new treatments for dementia.

New Opioid Addiction-Documentation Tip Sheet from AHIMA

AHIMA publishes a tip sheet to help improve physician documentation of opioid use, abuse, and dependency.

Curbside Consult with Dr. Jayne 11/13/17

November 13, 2017 Dr. Jayne No Comments

Since I work with so many different healthcare organizations, I have a variety of behind-the-scenes views into various non-clinical applications. When we think about healthcare IT, most of our brains automatically jump to systems like EHR, laboratory information systems, PACS, etc. But there’s a lot more to keeping healthcare organizations and IT vendors on their feet – systems like scheduling, payroll, client management, accounting, and more.

One of the things that is often surprising to me is the variability with which various systems have been implemented, often to the detriment of their users. I’ll be working with a group that complains bitterly about how they have to log their hours, only to run across a different group happily using the same system.

One of the major pitfalls I see when comparing disparate installations of the same system is the level of customization or configurability available during implementation. Just as we see with clinical systems, those making the decisions on business systems often jump right to customization before even going live. Rather than using the implementation of a new system as an opportunity to refine work streams and reassess processes, I see organizations simply move their old data over and create more modern versions of the same old messes. Although we often see this with patient accounting systems when clients want to move their old accounts receivable to the new system so that they can decommission the legacy system more quickly, I recently saw it with a general ledger conversion, where the health system wanted to bring more than 15 years of accounting records into the new system.

The engineers involved were struggling with data integrity concerns about moving data that had been converted previously, as the organization was on its fourth accounting system in 20 years. They also had concerns about system performance and the size of some of the data tables. I asked about the business case for bringing that data across rather than archiving it, since most businesses don’t keep records in their current system longer than required by the law or generally accepted accounting principles. The engineers didn’t believe that there was a compelling business case since the old system was going to be archived, but were forced to go along with the project as scoped. The project also has other issues, such as being more than a year behind schedule, but that is a topic for another day.

I also see process improvement opportunities with respect to time-keeping software. Many of the time clock solutions out there are straightforward, but when you get to the point of having engineers and analysts log time against multiple concurrent projects, I’ve seen some messy systems. The most efficient systems seem to be those that can cross reference standard work streams against multiple clients or projects. The worst are those that require a subset of work streams be created under each client or project, resulting in potential errors in item creation and challenges for people trying to find the item where they need to enter their time. I saw that recently when a work item was misnamed when creating it under a new project and no one could find where to log their time because they were searching for “Requirements Creation” rather than “Create Requirements.” At a minimum, organizations need documented procedures and job aids for creating these types of entries so they don’t cause chaos for downstream resources.

One of my favorite vendors to hear people talk about is SAP. First, people don’t realize that SAP has multiple products. They also don’t realize that each product can be implemented in different ways. Corporate policy can also influence how a product is used and what level of access different users have. These types of policy differences can result in a graceful process to follow when mistakes are made or one that is arduous. They can result in empowerment for end users or multiple layers of control. It’s not just SAP, though – I hear the same types of comments about Kronos, Oracle, and pretty much anything that comes from IBM. Like many of our clinical and billing systems, there are significant dependencies on how these systems are implemented and how they are managed.

When I work with healthcare organizations, most of my billing is done through work orders, against which I document the hours my team renders based on assigned projects. Some organizations want third parties to work directly in their systems, logging hours as we go just like their employees do. This is where it gets interesting since they usually require a Social Security Number to set up an employee and there’s not a compelling reason for a third-party employee to necessarily provide that information. Once we get through the setup phase, the real fun starts, as we try to figure out project hierarchies and how to work through what can be less-than-straightforward instructions. As much as we champion role-based training for clinical and practice management systems, I don’t see it as much on the business / financial / management side. I’ve had to sit through trainings on parts of project management and time entry that I will never use. Although they’re not a great use of their time, it is sometimes fun to see what goes on in different kinds of organizations.

The other challenge I see in the behind-the-scenes world is having multiple systems in which employees have to work. There may be a payroll system, a time and attendance system, a credential management system for clinical employees, an internal help desk ticketing system, an expense reimbursement system, and a travel management system. Other organizations also add project management systems, customer relationship management software, external help desk systems, secure messaging, collaboration platforms, and more. And of course, there are the requisite email and calendaring systems that most of us use, along with instant messenger and other communications tools.

Sometimes we don’t think a lot about these systems, but they should be on the list when we think about competing priorities that our healthcare partners may have when they’re trying to perform major EHR upgrades, implementing new features, or other projects. I wouldn’t want to do an EHR go-live at the same time as a new time and attendance system. And if I was doing a new practice management system, I’d want to make sure other accounting systems are stable.

At one health system where I worked, the IT organization supported over 900 systems. The average user had permissions for between 15 and 20 of these. I’m curious how many systems an end user has to access in other organizations.

Are you taking steps to simplify and consolidate these functions, or just soldiering through? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Zoë Barry, CEO, ZappRx

November 13, 2017 Interviews 4 Comments

Zoë Barry is founder and CEO of ZappRx of Boston, MA.


Tell me about yourself and the company.

I founded ZappRx in 2012. I came at it from the patient perspective. My youngest brother was diagnosed with severe epilepsy and couldn’t get on medication for almost a year and a half. This led to him to have a stutter, a learning disability, short-term memory loss, and he couldn’t remember what happened the day before. It was absolutely devastating as a family.

I was working on Wall Street at the time and had some familiarity with what was going on in healthcare technology. I guess you could say I became prescription obsessed. I started diligencing all of the problems with prescriptions, the different types of prescriptions, and tools that could be used to prescribe these medications. Ultimately, I found that there was no real product in the marketplace.

I jumped into founding ZappRx in 2012. I have made it my mission and the company’s mission to make it better, faster, and more transparent for high-risk patients to access lifesaving medications.

Why was such obvious inefficiency overlooked by other companies that might have tackled the problem?

I think it’s because the volume is so low for specialty drugs. When Meaningful Use came out, the first order of priority was to get doctors using EHRs. The second order of priority was to tackle prescriptions. E-prescribing came to the market and focused on the high-volume transactions. If you look at the drug market, there are 3.7 billion prescriptions written annually. E-prescribing focused on the ones that are spent at retail pharmacies that are covered by pharmacy benefit. That’s the bulk of the prescription volume in the United States.

Specialty drugs are only 2 percent of the volume, about 70 million prescriptions total, although they make up about 40 percent of the drug spend. You need a very different software and product that handles specialty prescriptions and you need a very different business model for something that accommodates only 2 percent of the market.

If I had to pick a comparable company, I might say CoverMyMeds, which brilliantly improved clinician efficiency and patient access while getting drug companies to pay for its product. Is is still reasonable to create a business that assumes drug companies will provide revenue?

CoverMyMeds is very smart. My understanding is that they have two customer channels, pharma and payers. Those are the two stakeholders that have skin in the game in terms of getting patients on certain therapies and getting them on as quickly and as efficiently as possible. If you look at the other two stakeholders that are users of CoverMyMeds — doctors and pharmacies — it doesn’t make a lot of sense to have doctors or pharmacies pay for prior authorization. It makes more sense for the pharma companies and the payers to do that.

That’s a great analogy, because we look at it very similarly. Our software connects specialists with specialty pharmacies, but our business model focuses — similar to CoverMyMeds – on pharmaceutical companies and payers.

How do you get your message in front of that small percentage of specialty drug prescribers that your product is good for them, they don’t have to pay for it, and it’s easily implemented?

We raised venture money in order to build the company. I had very little money. Even though obviously it sounds like a lot when you raise a couple of million dollars, it goes really fast. I focused our Series A funding on getting the product right and getting the top key opinion leaders using the product. I focused on a couple of the highest-volume prescribers at the top institutions and I was able to get them on board. 

It’s sort of a waterfall effect. You start at the top and those doctors and their staff became incredibly vocal about how amazing our product was, how much time it was saving for the nurses who were managing all of this paperwork, and how much faster patients were getting onto therapy. Therefore, how much healthier the patients were. Even though it was a small subset, those doctors were able to underscore their experience. 

We ended up hiring a director of sales to then take those early adopters and go out and seed more of the market. Then something really amazing happened, which we did not expect at all. As more doctors adopted, they started going to pharma ad boards and saying, “I will never want to write a prescription any other way other than via ZappRx ever again.” It’s that huge moment you have to pinch yourself when you’re a founder, you had this crazy vision, and you dropped everything and put all of your time and effort — blood, sweat, and tears — into building a company. When a doctor who is a new user who signed up r on their own says that to a pharma customer, it is just amazing.

We just closed our Series B funding. In our life as a startup, our Series A funding was focused on getting the product right — the right feature set, the technology, and the core partnership. Our Series B is now focused on growth. We’ve hired our own sales team. We’re striking more partnerships. We’re going to grow from that more organic growth to much more at scale nationwide.

Technology companies often mistakenly think that a lack of technology usage in healthcare means it’s an easy target for disruption. What lessons have you learned in trying to breach the healthcare fortress?

It’s definitely hard. I’ve often joked in the startup ecosystem that if you’re going to be a healthcare entrepreneur, you have to raise enough money to not go bankrupt while you’re iterating on your idea and getting that first user. If anyone had told me it would take two and a half years from when I founded ZappRx to getting that first prescription out the door, I would’ve said you’re crazy. But it really did take that long.

Healthcare is reactive, not proactive. The amazing thing is, if you can survive that valley of death and you can get your foot in the door, you can be much stickier. It’s hard to kick you out once you get in. There are pros and cons to that. In the tech ecosystem, if you have a consumer model, it’s much more fickle. You get users really quickly, but you lose them just as fast.

What are the good and bad aspects of finding investors, working with them as mentors, and getting them involved in the company’s decisions?

Not all money is equal shades of green. There are investors that will come in that will add a huge amount of value. They’ll be thought partners with you. They’ll mentor you. They’ll coach you. Our board functions much more as a board that says, where are you blocked? What’s going badly? What’s going wrong? Where are you stalled? How can we help?

We needed to bring in more tech talent and we hired a bunch of engineers out of Google — we just got backed by Google. If it’s iterating on biopharma, we have access through GSK as one of our investors to speak with pretty much anybody on the biopharma side, any disease areas that we want to brainstorm. What’s the pain point? Is our product scaled immediately from pulmonology to rheumatology, or are there some extra features we may add to accommodate a new therapeutic category?

Conversely, a lot of startup companies have some bad experiences with investors that are just not thought partners. They come in only looking for an ROI. They’re investors that will not roll up their sleeves and actually do the work to help a company mature and grow and de-risk. That’s where you start seeing so much of these horror stories in the news or on blogs or companies that seem to be doing really well and then all of a sudden implode.

Some experts say founders shouldn’t dilute their equity by bringing investors in early, but on the other hand, their companies don’t get access to the expertise, contacts, and credibility those investors might bring to the table. If a founder doesn’t want to give equity but instead likes the idea of bootstrapping, what options does he or she have?

I’ve seen that with other companies that are tackling areas of specialty. What they’ve done is a more transaction-based business model. They’ll go out and say, I’m going to solve one small problem. They find the customer that would pay them to solve that problem. They have more of a bootstrapped approach, where they go the customers directly.

There’s pros and cons to that. You can pull in some money, you can pull in a customer, and you can iterate off the product, but you’re also bound by only that perspective of the customer. It’s unlikely that you’ll have a massively disruptive technology or business. It’s more likely that you’ll cover your costs and you’ll solve a small problem. It’s not something that’s going to fundamentally change the way healthcare operates today because you can’t build it agnostically.

We’re agnostic to all drugs. We’re agnostic to all specialty pharmacies. We’re agnostic to all payers. We strive to have all the drugs, all the steps, and every stakeholder connected to ZappRx. If I had taken money only from pharma early on, then I would be perhaps at odds with other pharma companies that compete in the same space, or other stakeholders that have competing interests to biopharma.

How does a first-time entrepreneur with a cool idea decide whether to just slowly build a stable, profitable business versus rolling the dice by taking investor money and thus being pushed to either succeed or fail quickly?

There are a couple of things, and they may not be immediately obvious. One of them is that you have to be in an environment where you have access to capital that is a thought partner. There are reasons there are hotbeds where startups are birthing these incredibly disruptive technology plays, whatever industry it is. Those typically tend to be Boston, San Francisco, and New York. There are other areas of innovation that are spawning throughout the country.

But if you’re in some small area in the backwaters of Florida, it’s probably unlikely that you’re going to be able to build a very disruptive play and think outside of the box. You just won’t have access to the intellectual capital that you need to think differently. You’re going to be more likely to surround yourself with people who are thinking, I don’t have a lot of money. I don’t have a huge nest egg or savings. I don’t have access to angel investors who can even just help me cover legal bills to incorporate the company, so I’d better find a customer really fast. That’s where you wind up with the bootstrapped mentality. Which, by the way, there’s always a place for every type of company.

You’ve said that accelerators are a farce. Why do you think that?

I did not go through any accelerators or incubators. I did one program that was remote coaching and focused on women, which is something I’m very passionate about enabling. That program is called Springboard and they did it very well.

I have a vendetta against these incubators that are only three or four months long. They take 7 percent equity as the typical amount for three to four months of “coaching.” Let me tell you, there is nothing that happens in three to four months that is worth 7 percent equity in a company. You just cannot change that much. Usually the grant that they give you is $100,000. You have to be a three- or four-person team to even apply. You’re not at ideation stage. It’s just unrealistic, and candidly, greedy.

Furthermore, I believe that there are a lot of entrepreneurs who have to go through the experience of building the company. Accelerators often enable entrepreneurs who can’t. They take these premiums and then they spew out some mediocre ideas that suck up the capital or bandwidth for companies that have true potential.

Everybody and his brother runs an accelerator or incubator and has to fill their classes. Does that encourage questionable startups to think they’ll be successful just because they got in?

I would agree with that. There’s a reality that some startups aren’t aware of yet. If you go into an accelerator or an incubator, you get to demo day, and you wind up with no term sheets afterward, you are screwed. Because other investors are going to look at that and say, wow, you got into one of these fancy accelerator incubators. You sent us the investor weekly update. You’ve been sharing all this progress that you were supposedly making — which was really probably just a distraction — and now all the investors that I look to to make qualified decisions have passed on this investment. What are they seeing that I don’t see? Obviously I’m not going to invest also. Then your startup is dead.

I know several companies that went through that. They were not well-structured accelerators. It wound up being a three- to four-month distraction. Nobody gave them a term sheet. It was the kiss of death. They couldn’t raise money after that. They would have been so much better off just bootstrapping themselves or tinkering themselves and getting some of their own angel money for three to four months, focusing on where they were seeing traction and validation in the marketplace and then eventually raising money from an investor versus this silly accelerator.

Successful startups have to figure out what’s next, trying to balance board member interest or maybe even replacing the passionate founder with someone who has experience taking companies to the next level. How do you see growth changing ZappRx?

We focused initially on growing up. The lowest-hanging fruit was some of the most critical, focusing on culture and what your values are. We had been in a WeWork for the last two years. It’s one of these Uber or Airbnb type multi-billion dollar value cap companies. They take over office buildings and turn them into co-working spaces. A company can get one office, they can get 10 offices. We had a third of a floor at one of their locations. It enables you as a small company to have only a month-to-month lease. You can grow or shrink the number of offices as your company grows or shrinks, like happens in startup land.

They have conference rooms, kitchens, and all this stuff. You get to appear as though you are much further along than maybe you actually are. You have a doorman, more security, sign in, all of that stuff. It’s a lot of fun. They play music in the kitchen and they have kegs on every floor, ping pong tables, and all that startupy stuff. It’ great when you’re in ideation phase. You’re working crazy long hours, you’re throwing stuff at the wall and seeing what sticks, you’re pivoting, and you’re iterating. You need that fun, happy-go-lucky mindset.

But then once something sticks, you need to very quickly transition into focus and execution. I’m going to wash, rinse, and repeat. I am going to be laser-focused on making this the best that it possibly can be. Product, customer experience, pulling in the revenues, etc.

We moved offices and now have our own office, our own culture, and it’s 9,000 square feet. We’re really proud of it. Still legitimate security and all of that. But that’s where the maturation process starts. People are laser-focused and they’re not throwing ideas at the wall and iterating. They’re now tweaking and refining. You put your head down and you march forward. Your investors can sense that, too. They know when you’re in ideation phase — when it’s hopes and dreams — and they know when you’re in execution phase. They will come with you.

There are lots of growing pains. There are people who don’t make that transition. There are early-stage people, mid-stage people, and late-stage people. Every time I raise money, I look in the mirror and say, are you still fit to be CEO? I am the second-largest shareholder in the company after our largest investor, so I have the most incentive to either do well or find someone else who can do better than me. So far as the CEO of the company, I’ve done very well in that role, executing beyond what we’ve set out to do. We set some lofty goals and it’s kind of crazy to look back on that, but I haven’t done it alone. I’ve hired an amazing team. I’ve been working with a CEO coach. I work with my board. I have a whole group of mentors. I have outside resources, like a CEO group,that I lean on. But I focus on it a lot. When I do that, I see my team doing it as well.

Do you have any final thoughts?

Something that doesn’t get highlighted a lot that I’m really, really proud of is our gender balance at ZappRx and how many women leaders we have on the team. We are 50 percent women, which for tech companies in general is an astounding statistic. Even if you look forward at where I hope we’re growing — which is the Fortune 500 list — there are not a lot of women CEOs or management teams that are a chock-full of women. So I’m really proud to be 50 percent women. I mentioned that we are executing above and beyond. I think there’s something to do with that having a gender-balanced team, and a very diverse team at that.

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