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News 8/25/17

August 24, 2017 News 13 Comments

Top News

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Google offers users who search for “clinical depression” on a mobile device an option to take a PHQ-9 online depression test, offered in partnership with the National Alliance on Mental Illness in hopes of increasing the percentage of depressed people who seek and receive treatment.

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Reader Comments

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From CinderFella: “Re: Verity Health. HIStalk had the edge on Hedgeye’s analysis over a month ago, with a reader commenting on the NantHealth purchase of Verity saying that it would buy ‘his Nant-whatever stuff’ and Allscripts products. The real story is that Verity scrapped a year’s worth of evaluations as it was looking to implement a new EMR. The selection process was still finalizing and a go forward choice was TBD, but it wouldn’t have been Allscripts.” I’m a Wall Street lightweight, but I would be uncomfortable as a shareholder of either company with the Allscripts investment in NantHealth, Patrick Soon-Shiong’s personal investment in Allscripts, and now NantHealth’s rumored pushing of the products of both companies on non-profit Verity, especially given that NantHealth seems to have made quite a few “sales” of its own products that looked more like mutual back-scratching than objective purchasing decisions that suggest market momentum. I suppose Verity being forced to choose a product it didn’t want is a legitimate sale, if indeed they have lost that choice, but it smacks of desperation from both companies. Maybe Allscripts also worries about that perception, too, since it hasn’t named Verity as the mysterious new client it signed.

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From HIE Watcher: “Re: Informatics Corporation of America. Hearing it is being acquired by the SSI Group.” Unverified. I’ve sent an inquiry to ICA with no response so far.

From Orange Vest: “Re: LinkedIn. How do you choose which connection requests to accept?” I pretty much accept all invitations, declining only those that are obvious scams (like someone who works for a Chinese air conditioner manufacturer who has no overlapping connections), although sometimes that opens me up to annoying messages from recruiters or overzealous salespeople who I squelch quickly. I really don’t do anything with LinkedIn except (a) look up people who have changed jobs, and (b) sometimes check to see if somebody’s connected with me or is in the reader-started HIStalk Fan Club to decide if I’m willing to reply to their email.

From Dreydel: “Re: Devoted Health. I don’t have access to the full story, but Todd Park’s LinkedIn says he’s the founder. I bet other ex-Athena execs are involved.” I don’t pay for WSJ either, but Athenahealth co-founder Todd Park’s LinkedIn says he’s the co-founder and executive chairman of insurance startup Devoted Health.

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From Publius Tullius: “Re: Epic in Denmark’s Capital Region. The projects are going so poorly that Epic was cut in the first round of the bid process to support the Southern Region. Stories go back to February related to project under-scoping, missing functionality, and budget overruns.” PT provided a ton of links to Danish sites describing Epic project problems, with some Google-translated headlines above.


HIStalk Announcements and Requests

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Blain Newton of HIMSS Analytics sent over another interesting analysis, this one from its Logic database that shows the EHR user count of physicians who are employed by, leased, or managed by health systems. Epic has a four-to-one lead over Cerner and Allscripts in doctor count, nearly equal to all other vendors combined since its customer base is mostly huge health systems. That also means that Epic has displaced a lot of EHR/PM vendors in practices as hospitals acquired them and put Epic in. It also makes InterSystems very happy since they license Cache by concurrent user.

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Blain also provided this graph showing those organizations, both for-profit and non-profit, that have made the most hospital acquisitions in the past 10 years. Such acquisitions drive a good bit of the EHR market as acquired hospitals are moved to the corporate EHR standard.

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This, as they say, resonates with me.

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So does this, since I am always baffled that more people play the lottery when the prize goes up. Are these folks who couldn’t be bothered for only $100 million?

This week on HIStalk Practice: Alaskan providers share challenges, triumphs with HHS Secretary Price. Allscripts makes it easier for physicians to participate in clinical trials. The Institute for Women’s Health succumbs to keylogger virus. Wellpepper CEO Anne Weiler shares why virtual assistants and interactive mobile treatment plans are poised to meet consumer healthcare expectations in a big way. LifeWorks NW VP of Clinical Services Mark Lewinsohn expects new population health management technology to boost its participation in the national demonstration project for Certified Community Behavioral Health Clinics. Behavioral healthcare stakeholders lament telemedicine’s slow progress in MA. Petaluma Health Center becomes data-driven FQHC. DoD honors ChartLogic. Dispatch Health expandsto Arizona. In a new monthly series, PRM Pro Jim Higgins outlines the ways in which physicians can use patient relationship management technology while still maintaining the human touch.

I’m disappointed that nobody bothered to make an Eclipsys-related eclipse pun.

Listening: new from 29-year-old Minneapolis-based hip hopper Lizzo, whose Missy Elliott-style brash confidence includes more explicit lyrics than I like, but I overlook that because her music is a joyous, soulful bridge between the late 1960s Motowners and today’s rappers. I’m also listening with nostalgia to the unparalleled R.E.M., which ceased to exist in its original configuration as a foursome and one of America’s greatest bands 20 years ago, their unexpected high harmonies still giving me chills last night when the family chain restaurant I was in surprisingly played “Fall On Me” on its canned music system.


Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately instead of waiting for reports to be written and double checked for possibly inaccurate information. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

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


Acquisitions, Funding, Business, and Stock

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Agfa-Gevaert is considering spinning off its health IT business that includes vendor-neutral archive, PACS, image sharing, data aggregation, patient engagement, and digital radiography.

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Startup Doc.ai comes out of stealth mode in describing its AI-powered “silicon doctors” medical dialog system. Its CEO is the co-founder and former CEO of Scanadu, which seems to have fizzled out following the retirement of its Tricorder-like vital signs device that earned tons more press than it deserved as technical limitations kept dumbing it down.


Sales

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Pomona Valley Hospital Medical Center (CA) chooses Imprivata’s biometric positive patient identification solution.

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The VA and DoD sign a 10-year contract with Fujifilm Medical Systems USA to make the company’s Synapse enterprise imaging portfolio available to government healthcare providers. The maximum contract value is $768 million.


People

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Grattan Smith (RelayHealth) joins Loyal Healthcare as VP of business development.


Announcements and Implementations

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An Athenahealth survey finds that patients of small physician practices are heavier patient portal users than those of regional and national health systems, with respondents offering these suggestions to improve use:

  • Let patients know that the portal is the primary way the practice will communicate with them.
  • Help patients sign up while they are in the office, creating an email account for them if necessary.
  • Review their labs and chart entries from the portal on a large monitor during their visit.
  • Remind new patients to register on the portal before their first visit.
  • Commit to responding to patient questions within 24 hours.
  • Use services like Solutionreach that text patients when their lab results are ready to view on the portal.

Government and Politics

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The President’s political appointees have turned HHS into a remarkably shrill and partisan White House lapdog, loudly criticizing the laws they swore to uphold. The latest example is this statement from HHS Principal Deputy Assistant Secretary for Public Affairs (and former Koch Brothers employee and aide to former Governor and now VP Mike Pence) Matt Lloyd, who instead of encouraging healthy people to sign up to create better ACA risk pools, dutifully does his part to perpetuate the “let it fail” agenda with campaign slogans instead of responsible statements:

Obamacare failed to create a thriving, competitive market that offers the kind of coverage people want to buy at prices they can afford. On Obamacare’s exchanges premiums continue to surge, insurers continue to abandon wide swaths of the country and choices continue to vanish – an unfortunate reality for the American people who are required to buy Washington-approved health insurance or pay a fine.

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The Supreme Court is reviewing a lawsuit that argues that Google’s trademark of its own name should be nullified because “Google” has become a synonym for “searching the Internet.” The term “genericide” refers to former trademarks that became plain old words because of their non-specific usage, among them “thermos,” aspirin,” and “videotape.”


Privacy and Security

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Aetna exposes the HIV status of 12,000 patients in several states by mailing HIV medication prescription information in envelopes that contain an overly large window.


Other

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MD Anderson Cancer Center (TX) credits its cost management efforts – which include laying off 800 employees – for several straight months of profitability that have swung it into the black for the fiscal year, digging itself out of a $169 million hole.

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Fast Company magazine covers the drug and blood delivery drones being used in Rwanda, where startup Zipline has in its first 10 months’ of service made 1,400 deliveries of 2,600 units of blood using its 15 drones, 25 percent of those involving life-saving emergencies. The service will go live in much-larger Tanzania next year, hoping to make it “the first country in the world to achieve 100 percent in-stock rates at all health facilities and hospitals” for anti-malarial drugs, HIV medication, vaccines, and insulin.

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A nursing home owner pays $13 to acquire a Missouri hospital that BJC HealthCare bought and then closed nine months later, probably hoping that BJC is being overly cautious in warning of potential asbestos problems and high maintenance costs.

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Pharma bro Martin Shkreli, who was famously banned from Twitter for his creepy harassment of reporters, is buying Internet domains that are associated with the names of journalists who have criticized him, then putting up web pages that mock those people. He then offers to sell them back the domains for several thousand dollars, an extortion-like scheme not unlike his Turing Pharmaceuticals pricing strategy in being simultaneously despicable yet legal. Shkreli says, “I wouldn’t call these people journalists. They are the unwitting recipients of liberalism subsidy from large media and telecom companies … only a few notches above the white supremacists we hear so much about these days.”

Colorado and Maine have enacted laws that require veterinarians to check pet owners in doctor-shopping databases in hopes of detecting drug users who obtain addictive drugs through their pets. Some states require vets to perform such a check, while two-thirds of states explicitly prohibit it, with the president of the California Veterinary Medical Association explaining, “I’m a veterinarian, not a physician. I shouldn’t have access to a human’s medical history.” 

Weird News Andy follows up on my mention of CuddleCot, observing that people took photos of their deceased children back in Victorian times because they were unsure of the then-new technology’s role in memorializing their dead loved ones. I recall a movie that led off with a series of photos like these, where it brilliantly added no explanation until it became obvious about halfway through what I was looking at. Memento mori.

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In England, a hospital CEO is criticized for refusing to accept $3,200 donation for ECG equipment, saying that the fundraising team of men who’ve run an annual hospital bed-pushing contest for 25 years are demeaning nurses by dressing in their female uniforms.


Sponsor Updates

  • Nuance announces that 600 healthcare organizations chose Dragon Medical One in the past year, also adding 25,000 users in the past 90 days.
  • EClinicalWorks will exhibit at the NACHC Community Health Institute & Expo August 27-29 in San Diego.
  • Hayes Management Consulting will exhibit at the AHIA Annual Conference August 27-30 in Boston.
  • People: Laura Kanov joins HBI Solutions as SVP of product strategy.
  • Impact Advisors donates more than 5,000 personal care products to active troops overseas.
  • Ingenious Med will exhibit at the SHM-VA Chapter Meeting August 30 in Virginia Beach, VA.
  • InterSystems will exhibit at the annual SHIEC Conference August 27-30 in Indianapolis.
  • ConnectiveRx is a finalist for the 2017 PM360 Trailblazer awards.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 8/24/17

August 24, 2017 Dr. Jayne No Comments

In keeping up with Physician Compare and Hospital Compare, CMS has launched the Hospice Compare website for those looking to evaluate end-of-life care options. I’m fortunate to live in a community with some very well-regarded hospice organizations, but I recognize that there are people out there who prey upon families during a highly vulnerable time. In addition to showing quality metrics for pain management and treatment of other symptoms such as shortness of breath, it also displays whether a hospice is for-profit or not and when they were certified.

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I had the privilege of being in the path of totality for this week’s total eclipse. Although I wasn’t able to get any photos on my own (this one is courtesy of NASA) it truly was spectacular. I’ve seen a partial eclipse before (back in 1979 with a trusty cereal box pinhole viewer) but I have to say, seeing it through filtering glasses was a very different experience. I did make a pinhole projector and showed it off to a couple of kids who needed a dose of low-tech magic. Even with some pre-eclipse reading, I saw things I didn’t expect to look the way they actually did, such as the crescent shadows through the trees and the shadow bands right before totality. The coolest pinhole projector I saw was a colander, which projected dozens of mini-eclipses on the ground.

I do completely understand how people damage their eyes, because as the eclipse progressed past the totality phase, I wanted to keep looking at the corona. The brightness made that idea a short-lived one and I went back to my viewing glasses after taking another good look at the shadow bands on the ground as they appeared again on the eclipse’s way out. I’m not ready to become an eclipse chaser, but if you have the opportunity to see a total eclipse, I definitely wouldn’t miss it. An ophthalmologist friend from residency practices in the eclipse pathway and had several patients call his office Monday evening and Tuesday morning wondering about retinal injury. Fortunately, he didn’t see any significant damage.

Tuesday, it was back to the grind, working with a client in the advertising space. I’ve worked with advertising and PR firms before, usually in the context of helping a healthcare organization rebuild their brand, but a couple of times with product launches. This is the first time that the marketing firm has been my client. They engaged me because their efforts to build a healthcare business line have stalled. It seemed like an interesting challenge and they were referred to me by a solid client who convinced them that they needed some tough love from someone in the healthcare trenches. Initially I thought that they just didn’t understand the healthcare business, but as I began to shadow them on calls with their clients, I realized that the root cause may be that they don’t understand marketing.

My past experiences with marketing and advertising firms have followed a fairly predictable course. They begin to understand the client’s business and the client’s goals, then take a survey of the current state. Was the client working with another agency? Were they trying to do their own marketing? What kinds of media were used? What was successful? What flopped? As part of understanding the client’s business, they interviewed stakeholders to understand how the business saw itself, then used that information to build a marketing plan for the organization.

My advertising client is working with a practice that is trying to launch an ambulatory surgery center (ASC), but the project has been one barrier after another and they’re challenged by some occupancy and rezoning issues. Regardless, they want to move forward with a plan to get their name and brand more visible in the community so they can bring providers on board and then launch the services to the community. I thought it should be pretty straightforward, and had no idea what I was about to hear on the call.

My client didn’t go into any of the background about why the practice wants to move into the ASC space and what they hope to achieve. They also didn’t ask what the organization is doing for marketing and what has been successful in the past. They launched straight into a checklist of “what date do you want to start running ads in the newspaper” type items that were completely ineffective.

It was clear that the practice was frustrated since they’re not marketers and that’s why they hired someone to assist. It was clear that the marketing firm had done no research on the client’s current web and social media presence. When the client balked at the checklist approach, my client effectively scolded their own client for their lack of understanding of the process.

They then proceeded to go through a patronizing explanation of the marketing process that was so full of jargon that it was making my head hurt. The practice had no idea what to make of statements like, “You need to give us information that will prime the pump” and “we need you to give us content that will hit the sweet spot.” I was in continuous contact with my client via instant messenger and tried to steer the conversation to keep the practice from hanging up on them, hoping that they could take a step back and get the client talking about why this expansion was important to them.

One of the marketing team actually asked, “What does ambulatory mean?” and I think I laughed out loud. If the practice wasn’t confident about their choice before, I’m sure this sealed the deal. (Pro tip: Google is your friend. Do some prep work.) I struggled through the rest of the hour making plenty of notes for my post-meeting discussion with the marketers. Although they were going to get an earful, I wish I could have given some coaching to the practice as well. First off, I wondered if they even checked references on this marketing firm or whether they went with the cheapest offer, or how they came to work with my client. My client currently has zero referenceable clients, which is why they hired me, and although it’s possible they could have fabricated something, I doubt it.

One of the reasons I went into consulting was to help small to mid-sized practices that were struggling with technology and working with vendors and who wanted outside advice on the best ways to move forward. I’m rarely surprised by lack of business savvy among healthcare providers because it’s not something they typically learn during their training. But I continue to be amazed by the cluelessness of the many vendors that are trying to find the pot of gold at the end of the healthcare rainbow.

How does your organization handle marketing? Email me.

Email Dr. Jayne.

Morning Headlines 8/24/17

August 23, 2017 Headlines No Comments

Funding For Local Public Health: A Renewed Path For Critical Infrastructure

Former National Coordinator for Health IT Karen DeSalvo, MD and George Washington University Health Policy Professor Jeffrey Levi, PhD co-author a Health Affairs article calling for increased spending on public health initiatives.

Presence Health Signs Letter of Intent with Ascension to Join AMITA Health

Ascension Health announces plans to acquire fellow Catholic health system Presence Health (IL).

Henry Ford Hospital CEO Announces Retirement

Henry Ford Hospital CEO John Popovich announces that he will retire at the end of the second quarter 2018, closing out a 40 year career at the hospital.

Medicare to divulge when a doc’s patient is in an ACO

CMS is updating the Medicare website to allow patients to identify their primary care provider so that doctors participating in ACOs will be assigned to their own patients.

Morning Headlines 8/23/17

August 22, 2017 Headlines No Comments

CliniComp Sues Gov’t Over Cerner’s VA Contract

CliniComp files a bid protest against the VA for awarding a no-bid contract to Cerner that will replace its own installations within the VA.

$417 Million Awarded in Suit Tying Johnson’s Baby Powder to Cancer

Johnson & Johnson is ordered to pay $417 million in damages to a woman who successfully argued that baby powder caused her ovarian cancer.

Rush orders up $18M+ fraud lawsuit vs vendor that installed allegedly defective patient monitoring system

Rush University Medical System (IL) sues Draeger after installing its $18 million patient monitoring system to find that it did not perform at the level promised.

Q&A with CEO Ken Comée on what’s next for CareCloud and healthcare IT

Ambulatory EHR vendor CareCloud’s CEO Ken Comée says in an interview with a local paper that going public is part of his plans for the company, explaining “My competitors are 20- and 30-year-old technologies, and I have the best damn platform in the space.”

News 8/23/17

August 22, 2017 News 20 Comments

Top News

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CliniComp files a bid protest lawsuit against the VA, saying that it improperly issued Cerner a no-bid contract for an EHR that will replace VistA. CliniComp’s systems are used in several VA hospitals.

CliniComp prevailed in a similar 2014 lawsuit in which it protested that the VA’s selection process was flawed when it awarded a $4.5 million bid to Picis instead of low bidder CliniComp.

The White House took credit for the VA’s surprise selection of Cerner, apparently believing that interoperability with the Department of Defense will be easier if the organizations use the same vendor’s system. 


Reader Comments

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From Givenchy: “Re: Athenahealth. Their community hospital webpage is misleading customers by claiming financial success for a time period in which it had no hospital customers.” I’m not clear from Athenahealth’s community hospitals web page if the claimed improvement in financial and quality measures is specific to hospitals, but I’m thinking not since, as you observed, the footnote cites customer data “based on a weighted average for Athenahealth clients with valid pre-Athenahealth benchmark data that had their 15 month anniversary with Athenahealth between January 1, 2010, and October 31, 2013.”  Athena didn’t acquire RazorInsights and its small-hospital system until early 2015. They also could be referring to hospital customers that use its other systems in their ambulatory operations.

From Lab Animal: “Re: best-of-breed LIS vendors. I left one of those companies to work on Epic’s clinical solutions in a major medical center. Beaker is now competitive enough to convince enterprise customers to convert. I have seen the advantages of integrated solutions. It’s not a new trend, though – my peers and I are contacted several times each week by recruiters looking for people experienced on the LIS I previously worked on to keep the lights on while the LIS team goes to Epic training and builds Beaker. The best-of-breed writing has been on the wall for years.” Sunquest and SCC (but not so much Orchard from what I can tell) are trying to find runway in the genetics information system business to offset their significant customer losses due to LIS domination by Epic and Cerner. Sunquest has also smartly branched out into lab instrument interface software, specialty pathology applications, and clinician collaboration, although I haven’t seen numbers of how much profit those products contribute or whether revenue is growing significantly. You don’t want to be a best-of-breed vendor these days unless Cerner and Epic don’t offer your particular product (yet, anyway, since Epic’s selling the industry-leading LIS also seemed unlikely a few years ago).

From Boomer: “Re: Medhost. Heard a rumor they are being considered for acquisition by a physician systems vendor that might be interested in entering the hospital market. They are strong with chains like Community Health Systems, which is selling off a bunch of its hospitals.” Unverified.

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From Leftcoaster: “Re: Portland Adventist’s partnership with OHSU and scheduled conversion to Epic. It’s at risk due to a high-profile infant death lawsuit that could place OHSU at risk if the partnership occurs.” 

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From Failed Merger: “Re: Presence Health merging into Ascension Amita. That should be interesting as Ascension is on Cerner, the Resurrection portion of Presence is on Epic, and the Provena part is on Meditech. At one point, Adventist Midwest was McKesson.” Thanks to Turnaround Failure, who tipped me off over the weekend of the merger rumor that I ran in the Monday Morning Update. Ascension proposes to acquire the struggling, 11-hospital Presence Health and operate it within its Amita Health joint venture that includes Adventist Midwest Health, pending regulatory approval.


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Lloyd McKenzie, who is a co-chair of HL7’s FHIR Management Group, provided some background on the FHIR specifications that a reader asked about last week.

There are two mechanisms for sharing FHIR specs. The first is a computable format that uses FHIR itself. It allows sharing system capabilities and expectations; rules around data elements, such as what elements are required, optional, or conditional; what codes are allowed for use for which elements; etc. That format is intended to support automated testing, comparison of system capabilities, software configuration, etc. It can also be rendered for human review. The computable “resource” format is formally defined as part of the FHIR specification. HL7 strongly encourages implementers to expose their capabilities using this format.

The second mechanism is the human-readable rendering of FHIR implementation guides. Typically this is an HTML representation with hyperlinks back to the FHIR specification. HL7 produces tooling to support generating such human-readable rendered views, but does not mandate it. The tooling is also quite flexible, allowing content to be organized in a variety of ways, so it’s certainly possible to find interface documentation of varying quality and expressiveness that is generated using the same tooling. As well, the HL7-maintained IG publisher is not the only set of tooling available. HL7 developed and maintains it because it also needs a way to publish implementation guides and we’re happy for other organizations and implementers to make use of it. Best practices for producing human-readable FHIR interface documentation are far from settled, so expect the tooling to continue to evolve based on implementer feedback.


HIStalk Announcements and Requests

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I questioned as a card-carrying cynic why so many people – many of them ignorant or even dismissive of science and math – would rearrange their lives to watch the moon block the sun for a short period, much like sticking your thumb into the air and obscuring the celestial fireball yourself for 10 seconds of child-like fun. I’ve heard that airlines weren’t able to meet the demand for flying in and out of certain (and hopefully cloud-free) parts of the country and hotels there were charging extortionate room rates for out-of-towners. I’m pretty sure that quite a few fad-following science haters who don’t vaccinate their kids, who don’t think climate change is real, or who argue passionately that the earth is actually flat still confidently uttered “totality” at every opportunity. I took a hooky break and went to the golf course — I’ve never played an actual round of golf, but I like to blast balls unskillfully on the driving range, putt on the practice green while quietly imploring others nearby to “miss it, Noonan,” and then have a burger and beer afterward, which seem to be the best parts of the game anyway – and nobody was paying the slightest attention to the sky or fishing in their golf bag for a flashlight. At least it got folks looking up from their phones long enough to share a rare in-person experience and it gave long-faded singer Bonnie Tyler a chance to sing her 34-year-old hit that has nothing at all to do with an actual eclipse (the writer, who isn’t Bonnie,  says it’s about vampire love).


Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately instead of waiting for reports to be written and double checked for possibly inaccurate information. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

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


Acquisitions, Funding, Business, and Stock

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Vestar Capital Partners acquires health plan network management software vendor Quest Analytics.

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Discharge software vendor SilverVue acquires Ergo Sum Health, which offers preventive care software that supports MACRA payments to providers.

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A jury orders Johnson & Johnson to pay $417 million to a woman who blames her use of the company’s baby powder for her ovarian cancer, extending a string of verdicts against the company of $110 million, $55 million, and $72 million despite a lack of evidence that the product is unsafe. That’s a lot to pay out from revenue of a product that sells for $3 at Walgreens.


Sales

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University of Utah non-profit reference lab ARUP Laboratories will offer physician users Illumicare’s Smart Ribbon to display cost and risk of patient harm on EHR screens.


People

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Andy Page (23andMe) joins Livongo as president and CFO.


Announcements and Implementations

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Rush University Medical System (IL) sues Draeger for fraud, claiming the $18 million patient monitoring system it bought issued unreliable alarms, erased log data, and lacked the promised capability of automatically switching from wired to wireless monitoring during patient transport. Rush replaced the system for $30 million last year.

Datica posts a “Rethinking Health Technology” ebook that includes contributions from several industry luminaries, including St. Luke’s Health System VP/CIO Marc Chasin, MD and University of Wisconsin Health Center SVP/CIO Jocelyn DeWitt, PhD.

In the UAE, Al Jalila Children’s Specialty Hospital goes live on Vocera’s secure text messaging and hands-free voice communication platform.

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A Department of Justice-funded project at Penn State’s nursing school will use telehealth technology to support rural sexual assault nurse examiners, offering them live physical exam mentoring, peer review, and education.


Government and Politics

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The DoD proposes spending $250 million to build a five-bed hospital at Guantanamo Bay that would serve 5,500 residents and 41 prisoners. The Senate Armed Services Committee has asked for an analysis of why a tiny remote hospital would cost $50 million per bed.  


Privacy and Security

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Patient rights groups complain to insurer Wellmark that one of its executives described at a local Rotary Club meeting how a 17-year-old’s hemophilia cost the company $1 million per month to treat in trying to explain that health insurance doesn’t work actuarially if only people who are already sick sign up. The group claims that the remarks constitute a HIPAA violation, which might be the case since she cited the patient’s specific age even though she didn’t step over the HIPAA line in providing geographic information that is more granular than state level.


Other

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A DC magazine profiles Meghan Buck, a former political consultant who formed Veda Data to apply machine learning to keeping physician directories updated.

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This is either heart-wrenching, morbid, or both. A St. Louis hospital buys Cuddle Cots, a refrigerated bassinet that allows parents of stillborn or deceased babies to “put time on hold” in allowing them take photos and dress the body instead of moving it directly to the morgue. An article from earlier this year profiles families who spent up to two weeks with their deceased child’s body, taking it home and going for stroller walks as part of their grieving process.

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The Miami paper runs a Q&A with CareCloud, whose CEO Ken Comee says the company will go public because, “My competitors are 20- and 30-year-old technologies and I have the best damned platform in the space.”

In India, the dean of a medical school’s hospital is placed on leave for trying to sabotage the parent company’s enterprise patient record and imaging project in favor of the hospital’s preferred vendor.

A Forbes Africa report finds that trained doctors are forced to work as restaurant servers and call center operators due to restrictive government policies and lack of coordination between the Department of Health and individual provinces, even as hospitals struggle with a shortage of practitioners.

In India, the government denies that a reported drop in oxygen levels killed three hospitalized babies. This follows an incident in which 60 babies died when another hospital’s oxygen supply ran out due to non-payment of bills. This time, a NICU doctor noticed low levels in the oxygen storage unit and called the hospital operator, who didn’t answer and was later arrested for being drunk and asleep on the job. The hospital says parallel systems kept the oxygen flowing to the wards while the problem was resolved, blaming the deaths on natural causes and therefore declining to perform autopsies, triggering the predictable complaints of a cover-up.  

Weird News Andy isn’t elevated by this news. In Spain, a 25-year-old woman who had just delivered a daughter by C-section is crushed to death when a hospital elevator malfunctions on the way to the maternity ward. Her daughter was on the same gurney, but was unharmed.


Sponsor Updates

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  • Attendees at Aprima’s annual user conference make and donate 150 blankets to the Children’s Medical Center in Dallas.
  • Datica announces self-service onboarding and free trials of its updated platform.
  • Besler Consulting releases a new podcast, “Utilizing data and technology to manage your EPM programs.”
  • Nine healthcare organizations select Nuance solutions to replace legacy radiology systems.
  • ClinicalArchitecture and Diameter Health will exhibit at the SHIEC Conference August 27-30 in Indianapolis.

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  • The CoverMyMeds hockey team wins the league championship.
  • CTG will exhibit at the AI Summit August 24-25 in Cincinnati.
  • Cumberland Consulting Group raises over $2,000 for the Center for Family Services Project Backpack initiative.
  • Ohio Business Magazine includes Direct Consulting Associates in its list of Best Places to Work in 2016.

Blog Posts


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Morning Headlines 8/22/17

August 21, 2017 Headlines No Comments

Q&A with Rucker: Giving patients modern access to their health data

In an interview with Modern Healthcare, National Coordinator for Health IT discusses information blocking, the future of API-based interoperability, and the role patients will play in getting data where it needs to be.

Community Health Systems investor calls for replacing CEO Wayne Smith

ASL Strategic Value Fund, an investor in CHS, calls for the ouster of CEO Wayne Smith, arguing that the $7.6 billion acquisition of HMA was poorly executed and directly led to a downward spiral in CHS stock prices.

Pharmacy and medical practice accused of using San Diego Marines in $67 million healthcare fraud

A doctors office in Tennessee and a pharmacy in Utah have been implicated in a scheme to defraud Tricare, the insurance provider for the military, of $67 million by generating fraudulent prescriptions for expensive compound medications.

Innovation is the future of health care

Hackensack Meridian Health (NJ) is launching a $25 million incubator program to spinoff healthcare technology companies.

Curbside Consult with Dr. Jayne 8/21/17

August 21, 2017 Dr. Jayne No Comments

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My practice values service to the community and often does workshops for scout groups. Sometimes we’re teaching essentials of CPR and sometimes it’s first aid.

This weekend, I had the chance to help one of my partners put on a workshop for the Medicine merit badge for his son’s Boy Scout troop. He’s an official merit badge counselor and asked me to help a couple of months ago. My brother is an Eagle Scout, so I remembered seeing the merit badge booklets around the house and thinking that they had all kinds of interesting information. Apparently now they’re full color and you can also get electronic copies, so I was glad to see that scouting is keeping up with the times.

There are also a host of unofficial sources for information. My partner steered me to a website that had a PDF workbook for the items that the boys were expected to cover. I grabbed a copy of the actual book from the library, but ended up procrastinating the actual preparation until a couple of days ago, thinking I could just do my parts of the presentation off the top of my head

When I finally hit the merit badge website Thursday night to prepare and cracked open the paper booklet, I noticed that the last update to the book was 2002 (although the website mentioned that the requirements were updated in 2005). I figured I’d be in for some entertainment as I read about how medicine was portrayed to scouts 15 years ago. I was surprised, though, with how well the materials have held up. The healthcare professionals portrayed in the booklet represent a diverse workforce and are filling a variety of roles in medicine. I realized as I was reading that much of the information provided should be required reading for people entering medical fields or for people who want to better understand the medical people they work with.

Game time came too quickly for someone who had procrastinated their preparation. I found myself Saturday morning in our break room in front of a group of teenagers eager to show their knowledge medicine. During the first part of the requirements, the scout has to do a great deal of research on historical medical figures – individuals like Hippocrates, Florence Nightingale, Louis Pasteur, Jonas Salk, Marie Curie, and more. I was impressed by the boys’ ability not only to throw out interesting facts about their subjects, but to talk about why those contributions are important to healthcare even today. (A note to the Boy Scouts: if you consider updating this, let’s think about throwing in Larry Weed for his contributions to patient care and healthcare IT).

We next moved into my part of the morning, which was to teach the boys how to take a pulse and perform a blood pressure measurement. I was quickly cast aside by an older scout who asked if he could teach the group because he had volunteered at a blood pressure screening. I’m not sure why I was even there (other than to prevent them from doing goofy things with the blood pressure cuffs, which may or may not have happened) because the scout did a great job using the EDGE method, which includes explaining, demonstrating, guiding the student, and enabling their success. Since I spend a great deal of my time dealing with processes that have gone wrong, it was so gratifying to see a teenager taking charge and getting things done. Frankly, he was a better teacher / trainer than some of the folks I work with on a daily basis. I suspect that he is going to have a great future regardless of the field he chooses.

I was also tasked with talking to them about the instruments we use in the office, including EKG machines, pulse oximeters, spirometers, and more. We talked a little about electronic health records and how information sharing works in healthcare today, and I gave a little plug for careers in healthcare IT. I don’t think any of them had ever been exposed to a clinical informaticist before (not that I would expect them to have been) and I could see a couple of the boys perk up when we started talking about the technology. They perked up the most when we talked about defibrillating people and what that process actually entails. The drama of shouting “clear” and shooting electricity through someone’s body is well-portrayed on TV and they were definitely interested in learning more about it.

Another requirement is for the boys to discuss what makes a good screening test and why tests aren’t always perfect. Listening to them tell me about specificity and sensitivity and how patients had to be informed consumers so they didn’t spend a lot of money on tests that wouldn’t do them any good truly warmed my heart. These kids are clearly growing up in a world where being an informed patient is going to be critical to staying healthy and they were embracing it.

They branched off into a little discussion on the Affordable Care Act and how people didn’t understand that it was the same thing as Obamacare and why it was a mess. I knew these kids would be informed (one of the other requirements is to research the healthcare delivery systems in Sweden and China and compare them to the United States health system) but I was impressed. I know some of them have been working with my partner individually on the requirements, but they’ve clearly done their research.

The badge also requires the scout to discuss the roles of medical societies, the government, and the insurance industry in how they influence the practice of medicine in the US. From the presentation one of the scouts gave, I suspected we had a ringer in the group who had a physician in the family. It turns out that his mom is a family medicine physician, and he talked about how much his mom’s group struggles with Meaningful Use and other programs. That was an eye-opener for some of the other boys, whose only exposure to healthcare may have been at their own doctor’s office or through what they had read in the merit badge booklet and at our workshop.

They also have to explain how their state monitors healthcare quality and how it provides care to patients who don’t have insurance. These are pretty deep subjects for the average adult, let alone for a 12-18 year old boy, and I was impressed by the fact that the badge dug into it. The boys also had to present on different types of healthcare providers along with their training and educational requirements, as well as different subspecialties and what it takes to become a physician in those disciplines. It was entertaining to hear what the boys thought some of the specialties do vs. what we actually do – paperwork and charting were never mentioned in any of their synopses.

The scouts also had to research the Hippocratic Oath and explain it, along with comparing the original to a more modern version. They had to “discuss to whom those subscribing to the original version of the oath owe the greatest allegiance” (for those of you who haven’t read it lately, it’s not the patient). That led to a discussion of the patient-physician relationship and how it’s important in delivering quality care.

We also discussed the role of patient confidentiality and HIPAA. A couple of the boys in the group are 17 and will be adults soon, so I was able to talk to them a little about deciding whether to include their patients to be able to receive information when they go to the doctor and who they would want to make decisions for them in the event that they couldn’t. These are topics that most parents don’t cover with their young adults before they head off to college. It was a little bit outside of requirements, but it was a valuable discussion.

The scouts also have to volunteer at a health-related event in the community that they’ve had approved by my partner. Some of them have already done their volunteer work and it was interesting to hear what they did – handing out health flyers at a community event, volunteering at a free clinic, and working as a teen aide at the hospital. A couple more are planning to work at an upcoming blood drive and then they’ll be able to earn their badges. Looking at the information they had to explain, discuss, and tell about during the workshop (more than an hour and a half of discussion for each scout) plus the additional research to prepare for their presentations and the documentation they all brought, it seems like this might be one of the more intense merit badges the boys are exposed to. According to my partner, the Public Health merit badge has even more requirements.

It was exciting to see the leaders of tomorrow motivated to learn about our field and willing to spend time serving their community. It gives me hope that even as complicated as healthcare is, we have bright young people eager to try to figure out the best ways to serve patients in the coming decades.

Have you talked to young people about your career in healthcare IT? Email me.

Email Dr. Jayne.

HIStalk Interviews Gadi Lachman, CEO, TriNetX

August 21, 2017 Interviews No Comments

Gadi Lachman is CEO of TriNetX of Cambridge, MA.

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Tell me about yourself and the company.

I was born in Israel. I served in the Special Forces there. Everybody starts as a soldier and a few become officers. I was lucky to become one.

I studied accounting and law. I turned around my father’s business, which was educational services. He was a big entrepreneur there. Then I came to the United States. I did my MBA at Harvard and was a Baker Scholar. I worked at Lehman Brothers, and after that, a lot of technology IT companies, always in the healthcare space. A lot of healthcare IT, all either in extreme build-out mode and extreme growth or turnaround situations. I live in the Boston area with my wife, my three kids, and my dog.

How is technology changing the clinical trials enrollment process?

It’s technology, it’s data, and it’s a huge desire for change. All good people, all trying to develop therapies for the benefit of patients. Structural problems in that industry make it very hard to be successful, to develop good therapies in a short timeframe and at an OK cost, not at a cost that’s skyrocketing and goes up and up.

The main structural impediment to the success of this industry is the fact that each part of that industry tries to do the best job themselves, but the collaboration between the different industry players has been minimal and tactical. You have hospitals and institutions that have a lot of data, but it has been hard to use that data in an efficient way in the drug development process. You have players that need that information, but develop very tactical relationships with the healthcare organizations on the side.

We are a Novartis vision and a Novartis idea. They wanted to disrupt the clinical trial design space. Some of the reasons that clinical trials fail are good reasons. Some drugs and therapies should never be developed. They’re just not effective. It’s OK and good for those things to fail as soon as possible so people can move on quickly.

But a lot of times, the development of good drugs and good therapies is failing for the wrong reasons. It’s failing because of bad protocol design and bad trial design because the wrong sites are being selected.

We were created to solve the bad reasons for which some of those processes are failing. Novartis’s vision was, and our vision is, that a solution to big problems has to come from collaboration at the strategic level that did not exist before we came. Hence, what we do and what we’re trying to solve and disrupt. We’re building a global network of collaboration between pharma companies and companies that serve them, such as the CROs and HCOs. When I say HCOs — healthcare organizations — those are mega-hospitals, those are big institutions that see a lot of patients and have access to millions and millions of patient records.

The idea was that the only way to solve the big problem is to bring all those players to the table strategically. We are almost a club. Everybody brings different things to that club and gets different points of value from the club. Only by doing something like that, we believe, can you tackle a really big problem.

What can a large health system do differently in being in a network with other players?

By joining a network like that, you help support the process of designing an efficient protocol with real-world data, which is data that has been generated in real care settings as opposed to lab-generated data. You’re going to get more visibility to all the pharma members of that network, which means you’re going to get more study opportunities. You don’t have to take every opportunity pharma is giving you, but now you have the privilege, by joining the network, to see more opportunities in the therapeutic areas that are interesting to you.

A few of the sites that are members of our network got more than 50 trial opportunities from pharma and CROs that they would otherwise not get. Did they elect to participate in all those 50? Absolutely not. But now they can be more selective. They can decide to participate in trials that are interesting to them and try to give more hope to their patients any trials that they think they can be successful in delivering. As an HCO, you become part of a deal flow of studies that are coming your way.

Second, and I didn’t know this when we started the company, we’re living in the era of networks. Because everything is precision medicine, every cohort is getting smaller and smaller. Every therapy is becoming more and more directed at smaller subsets of the population. If you’re just one site — even if you have access to data of three or four or five million patients — it’s just not good enough. You start to look at the rare disease cohorts that you have and it’s not enough to get any insight.

Sites that join us get the privilege to be able to collaborate with other sites and share data, so if there is a rare disease that you have five patients, but you add another five sites to your network, now your researchers at the site can see data from 30 patients and that is very meaningful. That’s another reason they join us – not just to get more business from pharma and CROs, but so they can do a better job researching cohorts that they can’t do by themselves.

A third reason is that we are giving the sites very powerful tools to conduct clinical research. Before we came, their researchers needed to use suboptimal systems with very limited insight. We are giving them a user interface and the ability to query large amounts of data in a way that makes a lot of meaning for those that are interested at the HCO, not just to take care of and treat patients, but also to make progress with research and to move the boundary forward.

What do you think of organizations such as UCSF that are mining the wealth of data from their EHRs and other systems to look for new drug uses or correlations between genomics and disease states?

That’s exactly why we have TriNetX, absolutely. I wholeheartedly believe in that. Everybody who works for me and myself, we’ve all lost family members for therapies that were developed and brought to market a few years later. It’s also relevant for us as people that want to live longer and with high quality. A lot of the data to make a big impact is already available — it’s just no one was able to make it available.

I’ll give you a few numbers. We have more than 55 huge HCOs joining us that have together more than 80 million patients from all over the world. We have sites in the US, Germany, Hungary, Italy, the UK, Israel. We just recently signed Singapore. We’re building global collaboration and we’re giving it back to the researchers because they will come up with the questions and they will come up with the answers. They will find the correlations that no one even thought to ask and no one even thought made sense in the first place.

To do something like that, you’ve got to be able to harmonize tons of data all over the world. Demographics are important in our mission. There are populations from a demographic standpoint that are being under-represented in studies, and therefore the therapies that are being developed could potentially be less relevant for them. By building a global network that has all nationalities and all those different types of patients, you can start finding correlations between things, again, that you didn’t even think to ask.

I feel we hit the market at the right time. Maybe if we tried to do that 10 years ago, people would have been shy about that. Today, it’s the opposite. They are very savvy. They want to collaborate. They want to come together into a gigantic network. Not everybody is fortunate to be a part of the UC system, so you want to be part of something bigger. We are providing them with that opportunity and they get a ton of capabilities in return, exactly like that collaboration that you mentioned.

Will the FDA’s role change as study cohorts become virtual and study methods change?

Absolutely. I think if you look at the history of development of therapies from fighting bacteria to finding a way to live with HIV, things that used to take 50 years then take five and three and two years if everybody’s really in it together and doing things differently. I think the FDA and every regulatory body was doing extremely important work to protect the safety and balance all those different forces from that ecosystem. They’re starting to take a look at those technologies and those access points to data that we provide and figuring out that some things could be accelerated. Some trials could be conducted in real-world settings. There are alternative ways to understand the potential positive or negative impact of therapies and drugs and they are much more accelerated and they’re cheaper, potentially, on massive quantities of data.

If you think about it, there are so many trials being conducted today where nobody is calling them a trial. Every time an off-label drug is being recommended or prescribed, there are a lot of interested parties that would love to know the effectiveness of that off-label behavior, including those that are prescribing it. It just wasn’t able to be a reality a couple of years ago, but our vision is to make this a reality. To be able to take all this data and bring it back to the people that need to see that.

It’s not just the FDA,  just to add another facet to your question. You have people and players that avoided research because they couldn’t afford to be part of that, to license those technologies, or they never had access to the data. But by making it available in such a broader way, you will bring more participants into this research community, and I think only good things will happen from that.

What can we learn from the disproportionate success of Israel-based entrepreneurs and startups?

One is a mindset. I did work on that when I did my MBA, not to say I’m an expert on the entrepreneurial success of Israel and why, but there are structural components to the success there. One, as an example, the lack of natural resources and the need on the military side to compete with enemies that are 10 times your size. If Israel will always have one tank and the nations surrounding it have 10, then it means that one Israeli tank needs to take out 10 tanks in order for Israel to prevail.

How do you trade effectiveness of 1 to 10? The answer is mostly technology. Israel was always forced to take technology to the cutting edge in order to survive. All those military technologies and a lot of that mindset, even if it’s not a military technology, transpires. You have a lot of entrepreneurs and a lot of new ideas.

Also in Israel, everybody has to serve in the military. You get that mindset. When you leave the Army, you still have that mindset. You are OK daring and trying to do new things and trying to get that 1 to 10 ratio that you were taught in the military that that’s what you need to have in order to survive.

Having your back against the wall, the need to be an innovator or die, and the access you had to like-minded people and cutting-edge technology — you can then bring it back and try to do other things with that.

Do you have any final thoughts?

I would love all the players to always, in the end, think of the patient. That should drive every decision they make, more than financial decisions, more than “this is my data and I’m not letting anyone touch it,” more than “I’ll be the biggest I can be, but maybe I don’t need to collaborate with anyone else.” If there’s something I pray for, it’s that alongside corporate decisions, P&L decisions, financial decisions, and this and that, people always go back to that inner soul that they have and that helps drive some of the big decisions as well. I think it will help a lot.

Morning Headlines 8/21/17

August 20, 2017 Headlines 2 Comments

The Appointment Ends. Now the Patient Is Listening.

The New York Times covers the growing trend of patients recording their own medical appointments so that they can revisit the conversation in the future.

Trends in Laboratory Information Systems

A small survey of laboratory managers and directors find that 60 percent are currently looking to replace their existing LIS.

Bedside portal at WellStar reduces patient anxiety, lowers costs

A local paper covers the WellStar (GA) implementation of Epic MyChart across its hospitals.

MCMC may sell visiting health services

Mid-Columbia Medical Center (OR) is considering options for its unprofitable home health agency, which it says is difficult to improve because it runs a different EHR than the hospital, making care coordination cumbersome. The hospital is on Epic, and migrating the agency to Epic would reportedly cost $750,000.

Monday Morning Update 8/21/17

August 20, 2017 News 4 Comments

Top News

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The New York Times reviews patients recording their doctor visit for their later review.

The article notes that one family practitioner records patient visits himself, then uploads the annotated recordings to a secure web platform that patients and family members can review at any time. He says the de-identified recordings could help researchers find ways to improve medical communication.

University of Texas Medical Branch at Galveston buys recorders and batteries in bulk and offers them to cancer patients, with 300 of them accepting the devices each year. The program will be expanded to internal medicine and geriatrics.

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The article describes how a neurosurgeon records his visits on an iPad and posts them to a platform he created called Medical Memory. He says half of the patients watched their videos more than once and its use has cut the practice’s malpractice insurance costs in half. 

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A recently published research proposal describes a Dartmouth project to develop a platform that would store visit recordings and use machine learning to tag their specific elements, such as the treatment plan.


Reader Comments

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From Nutmeg Grater: “Re: Allscripts. This is their new, top-secret EHR. Two years of work and just recently deemed not ready to demo at ACE. I wonder if they forgot about this website?” The Care Otter website doesn’t mention Allscripts specifically, but (a) some of the folks whose bios are listed hail from there, and (b) I found a cached copy of a since-removed API documentation page whose FHIR API license agreement lists Allscripts as the licensor. The company touts its “bleeding edge technology” and data science. The group’s address is, per Google Maps, a defunct steakhouse in Litchfield, IL. Their job postings list technologies such as Azure, Power BI, Apple’s Swift 3, the Xamarin moble app development platform, and reactive programming. Care Otter’s LinkedIn lists 56 employees, including former Allscripts engineering SVP Jeff Franks as president. Here’s a YouTube video highlighting Silicon Valley aspirations with dogs running around the office, free snacks at the bar, impromptu kite-flying, and collaborative slouch-ready furniture in what they call the “SiloCorn Valley.” I like the strategy of putting a creative group in a freewheeling setting far from corporate overseers, although the ultimate success measure is whether Care Otter earns market share.

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From ACD_Fan: “Re: Epic. Our local hospital seems to be moving to it under the Community Connect program of Parkview Health Systems in Fort Wayne, IN. Another Paragon client jumps ship.” DeKalb Health’s web page says it is moving to Epic.

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From Turnaround Failure: “Re: Presence Health. Word on the street is that Presence Health will announce Monday its merger with Ascension. Bet that Advocate, North Shore, and Northwestern will have something to say about that.” Unverified. The struggling 11-hospital Presence, created by the 2011 merger of Provena Health and Resurrection Health Care, announced plans earlier this month to sell two downstate hospitals to OSF HealthCare. I think Presence uses Epic, while Ascension is mostly Cerner.


HIStalk Announcements and Requests

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I ran a reader’s query last week about the status of Cerner PowerInsight. The company provided this response, although the referenced HealtheEDW does not appear anywhere I could find on Cerner’s website:

PowerInsight Explorer is still available and widely used across Cerner’s US and global client base as a real-time reporting tool for Cerner Millennium. Cerner’s go-forward enterprise data warehouse, HealtheEDW, was released in 2011 and built on the source-agnostic cloud platform HealtheIntent. PowerInsight EDW will be supported in the US and sold globally as Cerner transitions legacy clients to HealtheEDW and stands up the cloud platform in global markets.

I received these responses to the reader’s question about FHIR specs:

  • Much better than HL7’s old-style PDF bundles. Faster to navigate, easier to reference in our own documentation.
  • I’m confused by what Sweet Ride is asking. I’ve done next to nothing with FHIR, having spent most of my career working with 2.x and V3/CDA, so maybe I’m looking at the wrong specs but the FHIR specs I’m looking at on hl7.org (starting with http://hl7.org/fhir/) are HTML and seem to me to be well-organized and easy to use. It’s definitely different than the PDFS HL7 used to use but I find it easier to navigate than previous specs – particularly V3/CDA.
  • Anything is better than the current format.

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It’s probably a lost cause trying to take the term “cloud-based” back to its original technical meaning as companies have turned it into a loosely-defined marketing slogan. Clustered says that while it really just means “in our basement instead of yours” and marketing departments have abused the term, it’s still accurate although incomplete, requiring prospects to perform due diligence.

New poll to your right or here: which of these inpatient EHR vendor companies do you admire most? I’ve hidden the interim results this time to hopefully decrease desperate ballot box stuffing. Feel free to add a comment explaining your choice.

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Welcome to new HIStalk Platinum Sponsor Image Stream Medical. The Littleton, MA-based company’s technology connects providers with visual information and collaborative insight that allows them to make better decisions and to spend more time caring for patients. Solutions include procedure space integration, procedure recording, medical virtual presence for teaching, live video streaming, real-time room status, clinical video and image content management, video editing, and integrating procedure and video images with EHR, PACS, VNA, and other repositories to create a unified patient record. Healthcare systems benefit from increased clinical efficiency, reduced risk, improved patient safety by automating tasks, and reduced infection risk in allowing observers to participate outside the procedure room. The company, acquired by Olympus Corporation of the Americas in May 2017, just announced MedPresence, a virtual presence solution that allows surgical and interventional clinicians to connect and collaborate virtually. Thanks to Image Stream Medical for supporting HIStalk.


This Week in Health IT History

One year ago:

  • Gartner predicts via its Hype Cycle that the technologies that will most quickly find mainstream adoption are machine learning, software-defined anything, and natural language question answering.
  • Promedica (OH) attributes its swing to a big first-half loss on the cost of implementing Epic, while MD Anderson Cancer Center (TX) also blames Epic-caused higher expenses and lower patient revenue for its 77 percent drop in net income.
  • A Medscape physician EHR survey finds that Epic is the most-used by far, Allscripts falls from #2 to far down in the list in user scoring, the VA’s VistA is the top-rated EHR overall, and VistA and Epic lead the pack in connectivity.

Five years ago:

  • NextGen President Scott Decker resigns following the addition of dissident shareholder representatives to the board of parent company Quality Systems.
  • Walgreens announces plans to deploy an customized version of Greenway PrimeSuite as its pharmacy EHR.
  • University of Michigan Health System names Sue Schade as its new CIO.

Ten years ago:

  • Congress gives the VA $1.9 billion for EMR and DoD integration, with the Appropriations Committee calling for blocking any EMR expenditures for software that won’t work with DoD systems and for the VA to work with private software companies to improve interoperability and mobile apps.
  • West Penn goes live on Eclipsys.
  • Misys licenses iMedica’s PM/EHR to get a small-practice system to market quickly.

Weekly Anonymous Reader Question

I got a ton of responses to “best musical group or performer seen live,” so I will excerpt (the asterisked ones were named more than once):

  • Prince*
  • Depeche Mode*
  • Bruce Springsteen*
  • Rolling Stones*
  • Led Zeppelin*
  • Moody Blues*
  • Garth Brooks*
  • U2*
  • Pink Floyd*
  • Billy Joel and Elton John*
  • Paul McCartney*
  • Adele*
  • Santana*
  • Radiohead
  • Nine-Inch Nails
  • AC/DC
  • Journey
  • Tedeschi Trucks Band
  • My Morning Jacket
  • LCD Soundsystem
  • The Who
  • Living Colour
  • Nektar
  • Grateful Dead
  • Genesis
  • Annie Lennox
  • Jason Mraz
  • Dead Kennedys
  • Earl Scruggs Review
  • Train
  • Chicago
  • The Wiggles
  • Soundgarden
  • Bryan Ferry
  • Lindsey Buckingham
  • Ray Charles
  • Paco de Lucia
  • John Prine
  • Arcade Fire
  • Ed Sheeran
  • Mark Knopfler
  • Tragically Hip
  • Meatloaf
  • The White Stripes
  • Kid Rock
  • Styx
  • Beyonce
  • James Taylor
  • Steve Wonder
  • Godspeed You! Black Emperor
  • Kendrick Lamar
  • The Clash
  • Sarah Brightman
  • John Mayer
  • Phish
  • Great Big Sea
  • Shinedown
  • Alanis Morrisette
  • Red Hot Chili Peppers
  • Jethro Tull
  • John Hiatt
  • Steve Winwood and Traffic
  • Savages
  • Jimi Hendrix
  • Neil Young with Booker T and the MGs
  • Uncle Tupelo
  • The Old 97s
  • Gladys Knight and the Pips
  • Big Head Todd and the Monsters
  • Coldplay
  • Brian Wilson
  • J. Geils
  • Air Supply
  • Guns N Roses
  • Clarence Clemons
  • The Rippingtons
  • Metallica
  • Lynyrd Skynyrd
  • Bee Gees
  • Iron Maiden
  • Frank Zappa
  • Melissa Etheridge
  • The Eagles
  • Jimmy Buffett
  • Aretha Franklin
  • Van Cliburn
  • Dixie Chicks
  • Gil Shaham

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This week’s question:  what is the most memorable, creative, or effective thing you’ve seen a HIMSS conference exhibitor do to drive business, establish relationships, or create buzz?


Last Week’s Most Interesting News

  • HIMSS Analytics data shows Cerner holding a slight edge over Epic in overall US hospital count, but Epic handily leading in large-hospital customers, total beds served, and doctors that use its ambulatory EHR.
  • Google buys Senosis Health, which is developing smartphone sensors and apps for diagnosis jaundice, reduced lung function, and low hemoglobin.
  • NIH awards Children’s Hospital of Philadelphia an NIH grant to mine databases to look for causes of pediatric cancer and birth defects.

Webinars

September 13 (Wednesday) 1:30 ET. “How Data Democratization Drives Enterprise-wide Clinical Process Improvement.” Sponsored by: LogicStream Health. Presenter: Katy Jones, program director of clinical support, Providence Health & Services. Providence is demonstrating positive measurable results in quality, outcomes, and efficiency by implementing clinical process improvement solutions in arming operational and clinical stakeholders with unlocked EHR data. Providence’s army of process engineers use their self-service access to answer questions immediately instead of waiting for reports to be written and double checked for possibly inaccurate information. The presenter will describe practical applications that include antibiotic stewardship, hospital-acquired infections, and comprehensive knowledge management.

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


Acquisitions, Funding, Business, and Stock

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Investment research firm Hedgeye picked up the rumor I ran last week from reader At Last an Alias that Baylor Scott & White will replace Allscripts with Epic starting in the next few weeks, saying another research company confirmed the rumor with Allscripts. The firm’s tweets say that Allscripts has lost two of its top five Sunrise customers in the last six months (New York-Presbyterian and now BSW, assuming they have confirmed the rumor), with those two health systems representing 12.5 percent of all US Sunrise business with their 19 hospitals and 7,000 licensed beds. They tweeted out the graphic above (click to enlarge) that shows the top 25 Sunrise customers and indicating which are at risk. The elephant in the room is obviously Northwell Health (the former North Shore-LIJ) which along with University Hospitals are the only two of the top six Sunrise customers that haven’t already announced plans to replace it with Epic or Cerner. The former Baylor Health System is the only part of BSW that still runs Allscripts following its 2013 merger with Epic-using Scott & White.

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Meanwhile, Hedgeye speculates on the identity of the puzzlingly unnamed six-hospital system that Allscripts announced as a new Sunrise customer in its August 3 earnings announcement. NantHealth’s Patrick Soon-Shiong bought struggling six-hospital Verity Health in July. The company later worked out a deal that allowed Allscripts to trade back its devalued $200 million investment in NantHealth for the FusionFx software suite and NantHealth’s promise to buy Allscripts products. The Allscripts 10-Q form says its Q1 bookings growth was almost entirely driven by “a large new multi-year relationship with a commercial partner that was executed during the second quarter of 2017.”


Decisions

  • Enloe Medical Center (CA) will switch from Meditech to Epic in 2018.
  • Erlanger Bledsoe Hospital (TN) will go live on Epic in October 2017.
  • Erlanger East Hospital (TN) will go live on Epic in 2017, replacing McKesson.
  • Virtua Memorial Hospital (NJ) will go live on Epic in the spring of 2018.

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


Announcements and Implementations

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A new Reaction report from a survey of 119 people (most of them lab managers and directors) covers trends in laboratory information systems, concluding that best-of-breed LIS vendors such as Sunquest, SCC, and Orchard are at significant risk as a shocking 60 percent of LIS customers overall say they are considering replacing systems, with many of those likely to move to their EHR vendor’s offering in enterprise decisions made by executives instead of lab managers. Sunquest is listed as having the highest risk of contract replacement and the lowest net promoter score among the best-of-breed vendors as well as the lowest mindshare among all vendors that offer LISs, while the report notes that Epic has massive mindshare despite its KLAS-leading LIS offering that is just five years old. Orchard leads the NPS scores of all vendors by far, but it’s a tiny sample size. The report concludes, “It’s also not unreasonable to expect continued (although modest) consolidation, as the writing may be on the wall for some best-of-breed LIS vendors, causing them to seriously consider finding suitors among the EHR vendors.” Allscripts is now in the LIS business with its acquisition of McKesson EIS that includes a lab system as well as a blood bank module that Epic says it will never develop. Allscripts has previously offered Orchard LIS to its Sunrise customers. 


Technology

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Amazon releases a developer toolkit for Alexa that provides programming interfaces for adding hands-free voice control to software products.


Other

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An Atlanta-area business paper profiles the use by several area WellStar hospitals of Epic’s MyChart Bedside, in which the hospitals give patients a tablet that contains care team bios, meds, lab results, vital signs, and treatment schedules.

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MaineGeneral Medical Center (I detest that spelling) blames a technical error for its sending of nearly 10,000 bills of under $25 to a collection agency.

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US tourists are apparently being served tainted or drugged alcohol at upscale, all-inclusive resorts in Mexico’s Riviera Maya, sometimes resulting in crimes being committed against them. The story says nobody in Mexico really seems to care, including the resorts themselves, as visitors are assaulted, extorted by police, fall victim to drowning, or are regaining consciousness only to find unexplained broken bones or other injuries and no memory of the preceding hours, all after minimal alcohol consumption and often with simultaneous symptoms among group members. The US State Department has issued a Mexico travel warning about tainted alcohol and the Mexican government confirms that up to half the alcohol consumed there is produced illegally. Tourists report frustration at the indifference of the resorts when they report problems, the upfront cash required to obtain medical treatment at hospitals, and the fact that nobody ever gets arrested even though the tourists file reports in person with the local police departments.

When injured tourists turned to police, an instinctive step for many Americans, they were often stonewalled again. For starters, resorts in Mexico don’t typically call law enforcement to the scene. Vacationers have to take complaints to the police station. The few who did encountered further indifference: Nothing to investigate. It was an accident. You were drunk. In one case, a woman who was sexually assaulted by a hotel security guard … said the police chief overseeing her case seemed genuinely concerned and determined to help her … The chief tried to get the Iberostar Paraiso Maya resort to cooperate with the investigation and to provide photos of security staff. Frias was shot dead in his squad car months later. Local news reports said it was likely a killing meant to intimidate law enforcement.

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The money-losing visiting health service of Mid-Columbia Medical Center (OR) says its use of a non-Epic EHR while the hospital uses Epic is hard since physician care plans don’t move electronically, but the service is still not willing to spend $750,000 to implement Epic.

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I’m surprised that the names and logos of these healthcare services companies haven’t earned the attention of Epic’s legal team.

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Potential jurors being interviewed by attorneys involved in the securities fraud case against pharma bro Martin Shkreli had some interesting comments recorded, although perhaps some of them were just grandstanding to get out of  jury service:

  • I’m aware of the defendant and I hate him.
  • He’s the most hated man in America. In my opinion, he equates with Bernie Madoff with the drugs for pregnant women going from $15 to $750.
  • I just walked in and looked right at him and that’s a snake.
  • I believe the defendant is the face of corporate greed in America.
  • I don’t think I can [judge him impartially] because he kind of looks like a dick.
  • The only thing I’d be impartial about is what prison this guy goes to.
  • I just can’t understand why he would be so stupid as to take an antibiotic which HIV people need and jack it up 5,000 percent. I would honestly, like, seriously like to go over there …
  • It’s my attitude toward his entire demeanor, what he has done to people. And, he disrespected the Wu-Tang Clan.

A hospital visitor in China is detained by police after posting online criticism of the price of the cafeteria’s meals, saying he “wanted to faint” when he saw the small portion of his $2 bowl of noodles, adding, “Poor quality, expensive prices, little food – is this still a hospital for the people?” After the man’s arrest, local police reminded Internet users that it is illegal to post false information online although they didn’t actually say he was lying. The article reminds me of how weird hospital cafeterias are: (a) they are just about the only place other than grocery store food bars to sell some foods by weight; (b) they don’t allow free refills on their overpriced drinks; (c) they are often outsourced to companies accustomed to serving low-bidder meals to prisoners and high school students, outfitting their unsmiling employees in jaunty, chef-like attire to suggest culinary artistry instead of the heating of frozen institutional entrees; and (d) they are passionate about portion control but indifferent to taste, customer experience, and wiping down tables and chairs between occupants, some of them wearing scrubs bearing materials you would not want near you while eating. There’s a challenge for you – send me photos of whatever you find weird about your hospital’s cafeteria.


Sponsor Updates

  • Redox will exhibit at Health:Further August 23-24 in Nashville.
  • Impact Advisors employees donate 385 pounds of personal care products to troops deployed overseas.
  • The SSI Group will exhibit at the NC HFMA Summer Institute August 23 in Myrtle Beach, SC.
  • Sunquest Information Systems will host its users group meeting August 21-24 in Tucson, AZ.
  • Visage Imaging publishes a new whitepaper, “Can you? Visage can. Volume 1: Speed.”
  • Medecision is named to the 2017 IDC Health Insights HealthTech Rankings Top 50.

Blog Posts


Contacts

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

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Morning Headlines 8/18/17

August 17, 2017 News 3 Comments

A Start-Up Suggests a Fix to the Health Care Morass

The New York Times profiles Aledade, a startup founded by former National Coordinator for health IT Farzad Mostashari, MD.

Strategic partnership enables physicians to conduct clinical research and offer new clinical therapies to their patients

Allscripts announces a partnership with Elligo Health Research that will allow users to enroll patients in clinical trials managed by clinical research organizations.

Mylan Agrees to Pay $465 Million to Resolve False Claims Act Liability for Underpaying EpiPen Rebates

EpiPen manufacturer Mylan will pay a $465 million fine to settle a false claim act for intentionally misclassifying EpiPen as a generic drug to avoid paying rebates to Medicaid.

Cerner selected as Medical Center’s new electronic health record provider

St. John’s Medical Center (WV) choses Cerner Millennium CommunityWorks as its next EHR.

News 8/18/17

August 17, 2017 News 12 Comments

Top News

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The New York Times profiles Aledade, started by former National Coordinator Farzad Mostashari, MD, ScM.

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The piece calls Aledade a tech startup (it has raised $75 million in investor funding), which seems incorrect since technology is just a tiny part of its ACO program to improve healthcare quality and reduced cost via its primary care doctor participants. The profile was run in the Technology section of the paper.

Aledade gets paid only if it saves Medicare money, which didn’t happen in 2016. Second-year results are due in October and Mostashari says he expects the company to generate revenue then.


Reader Comments

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From At Last an Alias: “Re: Baylor Scott & White. Replacing Allscripts with Epic starting in October, estimated to take 18 months. I think this just refers to the 10 owned facilities. The North Texas ambulatory practices (aka Health Texas Provider Network) converted from Centricity to Epic in October 2016.” Unverified.

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From Sweet Ride: “Re: FHIR. Older health standards are published as PDF or text documents, but FHIR has developed a new format for sharing specs that has the same look, feel, and functionality as the FHIR Standard for Trial Use, which they believe will be preferable to their developer audience. Our organization is trying to decide if we should move fast or slow to this format for our FHIR specs given that most hospitals and vendors aren’t used to FHIR yet and may prefer PDFs. Any chance you could run a survey to get input from your readership?” I set up a survey for those willing to help Sweet Ride out. I don’t know anything about it, so maybe we could all stand some enlightening from those who do.

From BI Watcher: “Re: Cerner PowerInsight. Did they quietly discontinue it? I’m looking at the latest KLAS analytics report and there’s no mention of it. It was listed last year, albeit with dismal scores.” I don’t know, but I bet someone who does will respond.


HIStalk Announcements and Requests

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Blain Newton of HIMSS Analytics is providing great information on EHR vendor footprints, which I appreciate. Here’s his latest, responding to an HIStalk reader who wondered about total inpatient beds served by vendor (click to enlarge). The dominance of Epic and Cerner is obvious.

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Here’s a view comparing 2012 market share by bed count vs. that of 2016. Meditech and Allscripts each lost 15 percent of their bed coverage over those years as hospital EHR uptake was booming, while McKesson customers stampeded for the door (and into the arms of Cerner and Epic) as the company lost nearly half of the beds it was covering in 2012. Both Cerner and Epic gained a lot of business, but Epic jumped most significantly (120 percent) to lead the pack. 

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This last graph shows the utter dominance of Epic in terms of physicians using its ambulatory EHR and the dismal failure of Cerner to make a respectable showing.

I’ve also asked Blain if he can identify the fastest-growing large health systems/chains and which system they use corporately (which would foretell vendor footprint gains for doing nothing but watching their customers grow). It would also be really interesting to add up the total revenue of each vendor’s customer base as an even better indicator of customer footprint, but that sounds like a daunting project. Fascinating stuff. It’s pretty cool that Blain is willing to share this information given that HIMSS Analytics is in the business of selling rather than gifting it. I certainly appreciate it.

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An anonymous HIStalk reader donated to my DonorsChoose campaign. Her money plus matching fully funded the first project below and provided the remaining funds needed to complete the other three:

  • Beginner robotics and STEM activities for Ms. M’s first grade class in Knoxville, TN
  • Tolerance and individuality books and study desks for Mrs. P’s first grade class in Williamsburg, VA
  • Educational materials for teaching tolerance through STEM exploration for Ms. P’s first grade class in Orlando, FL
  • Frederick Douglass autobiography books for the tolerance project of Ms. O’s high school class in San Antonio, TX

I’m growing increasingly impatient at articles – most of them written by inexperienced industry newbies, some of them submitted to me as Readers Write articles aimed at a C-level audience – whose authors think they are insightful in reciting dull, plainly obvious facts, often to pad out questionably valuable articles. I’m a harsh self-editor perpetually in “just the facts” mode and such journalistic flab drives me nuts. Here’s a sampling from some of those sites that elicit an instant “duh” when I read them:

  • Get everyone on the same page.
  • Now is the time to start steering toward actionable information for the sake of clinicians and, even more important, the patients that IT, administrators, executives and caregivers all serve.
  • The barriers to EHR implementation and interoperability are slowly coming down and once they do, vendors will start looking to add more functionalities to the systems.
  • Improved healthcare interoperability is a top priority for providers, policymakers, and patients in 2017.
  • Getting a footing in the health IT industry is more challenging than it looks.
  • Care coordination between healthcare settings can have a significant impact on patient care.

This week on HIStalk Practice: Amazing Charts decides to sunset InLight. AdvancedMD develops physician reputation management tool. HHS celebrates National Health Center Week with grants to centers across the country. Aledade partners with local PCPs to launch New Jersey ACO. DuPage Medical Group welcomes $1.45 billion investment. UnitedHealthcare helps fund telemedicine services at Kansas FQHC. Prescription management and delivery service company Phil raises $10 million. New Jersey Academy of Family Physicians President believesphysicians are shouldering too much of the opioid epidemic blame. AMA President David Barbe, MD shares his frustration with home state of Missouri’s PDMP efforts.

Listening: Ayreon, progressive metal rock opera from a Netherlands-based virtuoso who “casts” singers to portray “characters” that perform only in studio since the “band” never appears on stage. With one exception: they’re playing their first-ever actual concerts September 15-17 in the Netherlands featuring 16 singers, including the incomparable Floor Jansen of After Forever and Nightwish. 


Webinars

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

Vince and Frank put their usual expert and brutally honest spin on “Allscripts’ ‘Repeal and Replace’ of McKesson’s EIS” in Thursday’s webinar. We had a bunch of people watching live and the boys answered their questions at the end, guaranteeing that your one hour of watching the YouTube video will be well spent. I tuned in for a quick look and ended up hooked into watching the entire presentations.


Acquisitions, Funding, Business, and Stock

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Israel-based Medaware, whose technology warns a physician when their drug order appears to deviate from the normal prescribing patterns of similar patients, raises $8 million in Series A funding, increasing its total to $12 million. 

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Revenue cycle technology vendor ESolutions acquires RemitData, which offers comparative analytics.

Forbes names Salesforce as the world’s most innovative company for 2017.

EpiPen maker Mylan will pay $465 million to resolve False Claims Act charges that the company intentionally misclassified the drug product as a generic drug to avoid paying rebates to Medicaid.


Sales

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St. John’s Medical Center (WY) chooses Cerner Millennium CommunityWorks, explaining that it “began seeking an alternative EHR vendor when industry events called into question the hospital’s ability to ensure that support from the vendor would continue to be available.” I believe they are (soon to be were) a McKesson (soon to be Allscripts) Paragon user.

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Gwinnett Medical Center (GA) chooses ROI Healthcare Solutions to provide around-the-clock support for its legacy systems during its new EHR implementation.


People

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The Strategic Health Information Exchange Collaborative names Kelly Thompson (Pennsylvania Department of Health) as CEO.

Verisys hires Joe Montler (McKesson) as SVP of sales.


Announcements and Implementations

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Glytec earns its fourth FDA clearance for components to Glucommander, the core of its patented EGlycemic Management System: a titration module for enteral nutrition patients, an insulin-to-carb ration titration for outpatients, a more streamlined transition of inpatients from intravenous to subcutaneous insulin therapy, and general enhancements to the user interface, workflow capabilities, and messaging.

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Allscripts will offer its EHR users access to clinical trials via integration with the trials recruitment system of Elligo Health Research.

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Sunquest Information Systems will resell automated laboratory testing software from Software Testing Solutions.


Other

A St. Louis podiatrist who owns a company that services nursing homes is sentenced to 90 months in prison and ordered to repay $7 million for creating an EHR that automatically logged diseases and symptoms the patients didn’t have and for pressuring his employed podiatrists to provide unneeded services. His attorney wife is already in prison for the same conspiracy and the company’s CEO and four of its podiatrists are awaiting sentencing.

A 31-year-old restaurant owner is charged with assault after a cardiology clinic’s front desk employee told him his test wasn’t covered by insurance, after which he grabbed her computer monitor (luckily, it was a flat panel) and threw it at her.

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I was amused by this newswire photo, which suggests that VA Secretary David Shulkin, MD rushed right over from hospital rounds to appear in a White House photo op, stethoscope poking conspicuously from his pocket. I have to laugh when doctors who clearly have no use for a stethoscope – such as administrators, psychiatrists, and dermatologists – still drape one over their shoulders or hang it prominently from their pocket to make sure everybody reflexively genuflects. At least Shulkin is an internist and still sees patients, according to some reports. My early experience in rural community hospitals was that the biggest quacks we had on staff – mostly foreign medical graduates back then when standards were low and they didn’t even have to take US boards – were likely to strut around in stiffly starched, name-embroidered lab coats adorned with stethoscopes, perhaps for convenience in pronouncing dead the patients they were mismanaging with a stunning mix of incompetence and arrogance.

A Jackson Memorial Hospital (FL) respiratory therapist is arrested for attempting to view child pornography on a hospital computer that a co-worker had left logged on. There was no happy ending to the story — he couldn’t even see the material he was arrested for seeking because the hospital’s web monitoring software blocked him (doh!)


Sponsor Updates

  • Medecision Chief Marketing Officer Ellen Dalton will speak at a Technology Association of Georgia Marketing roundtable September 6 in Atlanta.
  • Meditech and Parallon Technology Solutions will exhibit at the HIMSS Summit of the Southeast August 23-24 in Nashville.
  • Navicure will exhibit at the Azalea Health annual user conference August
  • Optimum Healthcare IT interviews Jon Morris, former SVP/CIO of WellStar Health System.
  • Imprivata joins the CommonWell Health Alliance.
  • NTT Data begins accepting applications for its global Open Innovation Contest.
  • Nvoq will exhibit at Aprima’s annual users conference August 18-20 in Dallas.
  • Clinical Computer System, developer of the Obix Perinatal Data System, will exhibit at the Indiana AWHONN State Conference August 25 in Plainfield.
  • Uniphy Health appoints Ken Fishbain (Cardiothoracic & Vascular Surgical Associates) to its health advisory board.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 8/17/17

August 17, 2017 Dr. Jayne 1 Comment

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The Office of the National Coordinator continues to advocate for strengthening the health IT workforce. The September 6 webinar will review workforce training materials that were available to the more than 9,000 people who participated in recent programs on population health, care coordination, interoperability, and analytics. Registration is open, and as a participant in one of the educational programs, I’d say it’s worth a look.

In other government news, the Medicare Quality Payment Program hardship application for the 2017 year is now available. Applications must be submitted by October 1, 2017 to avoid payment adjustments in 2018. I continue to run across providers that aren’t sure if they qualify for a hardship exception or not, so if you’re in the practice management or operations space, do your docs a favor and make sure they understand.

Physicians who are in the know have been very happy with the CMS final rule that makes the use of 2015 Edition certified EHRs optional for Medicaid Meaningful Use in 2018. Depending on vendor status, many practices were looking at having to upgrade their EHRs prior to January 1 so they could complete full-year reporting on a 2015 Edition system. The requirement now calls for a 90-day reporting period for Meaningful Use measures. Although Clinical Quality Measure reporting is still full-year, providers can now use 2014 Edition, 2015 Edition, or a combination of Certified EHR Technologies. It’s a welcome reprieve for organizations that are suffering from change fatigue and who may lack the resources to manage an upgrade along with other clinical and business initiatives. Although that change was documented in a final rule, unpublished guidance seems to indicate that practices that are part of the Next Generation ACO program can use either 2014 Edition or 2015 Edition CEHRT.

It’s been a relatively busy time in governmental circles, with the Department of Veterans Affairs also announcing their new telehealth project, “Anywhere to Anywhere VA Health Care,” which will permit VA providers to treat patients across state lines using telehealth technology. Providers can practice across the country within their designated specialty scope of practice. They also released their new VA Video Connect app. Veterans can use their mobile devices to access 250+ VA providers at nearly 70 sites across the country. Although solutions like the app have the potential to reduce travel hardships for veterans, they assume adequate capacity. If providers don’t have adequate time for patient care, simply shifting away from in-person encounters isn’t going to be a solution.

There’s also been action in the Senate to authorize a CMS Innovation Center project to boost use of certified EHRs in the behavioral health space. Psychiatric hospitals, community behavioral health centers, clinical psychologists, and social workers would be encouraged to expand EHR use along with residential and outpatient mental health and substance abuse treatment facilities. The 2009 HITECH Act didn’t apply to many mental health treatment organizations, which may help explain low rates of information sharing between behavioral health and other providers. A parallel bill has already been introduced in the House. Hopefully both will begin to work their way through the House and Senate committees soon.

One of the exciting parts of being in the healthcare information technology space is watching researchers come up with innovative solutions to difficult problems. Laboratory medicine is a big part of clinical informatics, so I was glad to hear about a new technology for Zika virus testing in the field. Researchers from Washington University in St. Louis are using nanorods to develop a test that can provide results without electricity or refrigeration. Proteins attached to the nanorods change color when exposed to Zika virus-containing blood. Although the initial study was very small, it shows a great deal of promise. I was also glad to see the varied affiliations of the authors – mechanical engineering, anesthesiology, and biochemistry/molecular biophysics. The engineering and biophysics fields are expanding rapidly and make great areas of emphasis for premedical students who aren’t sure about their future in patient care.

Speaking of laboratory medicine, LOINC is looking for experts to join four new special topics workgroups. The groups will meet monthly and provide recommendations to the LOINC Committee. Workgroup topics include: Document Ontology, which looks at the framework for displaying clinical results; LOINC ShortName for addressing situations where LOINC codes need to be stored or exchanged but the ShortName is not appropriate; Cell Marker Naming for review of ambiguous terms; and High-Sensitivity Troponin, which will look at the best way to model cardiac assays in LOINC. Workgroups start August 30 and more information can be found on the LOINC website.

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I haven’t been able to attend the MGMA conference in years, the last time being when it was in San Antonio. For those who can’t make it to Anaheim for MGMA17, there is an opportunity to attend remotely via MGMA 2017 Monday Live. Registration is $350 for MGMA members and includes access to the general session and several breakouts. Advertising collateral mentions the opportunity to not only listen to sessions but to “network with your peers,” which might be a little challenging given the virtual environment.

Virtual environments are less of a barrier for the one-on-one contact of telehealth. Employers are gravitating toward inclusion of telemedicine services in employee benefits plans. The Large Employers’ 2018 Health Care Strategy and Plan Design Survey estimates that nearly 96 percent of employers will offer telemedicine services in states where it is permitted, with more than 50 percent including behavioral health as part of the offering. More employers are also offering on-site health centers. My local school district is piloting an on-site employee clinic that received a fair amount of traffic in its first year. They haven’t made a decision to expand, but will continue to pilot during this academic year.

Do you have access to an employer-based health center? Have you had the occasion to use it? Email me.

Email Dr. Jayne.

Morning Headlines 8/17/17

August 16, 2017 Headlines No Comments

Docs, Hospitals Respond to CMS Retreat on Bundled Payments

CMS announces plans to eliminate several Obama-era bundled payment programs designed to test the impact of bundling some cardiac and orthopedic health services payments.

Healthcare data breaches caused by hacks are on the rise

Cyberattack-related data breaches at healthcare organizations have increased 162 percent so far in 2017, according to data from OCR.

Questions About The FDA’s New Framework For Digital Health

Health Affairs analyzes the FDA’s new Digital Health Innovation Plan.

Express Scripts to limit opioids, concerning doctors

Pharmacy benefits manager Express Scripts intends to limit the number and strength of opioid drugs prescribed to first-time users as part of a broad effort to curb the opioid epidemic.

Morning Headlines 8/16/17

August 15, 2017 Headlines 1 Comment

The Effects of Terminating Payments for Cost-Sharing Reductions

The Congressional Budget Office issues a report forecasting the financial impact that halting federal payment of cost-sharing subsidies to insurers selling plans on public exchanges will have, concluding that premiums would climb 20 percent in the first year, and continue to raise slightly more in years later.

Children’s Hospital of Philadelphia to Lead New Pediatric Data Resource Center for Research in Childhood Cancer and Structural Birth Defects

The NIH is funding a big data project led by the Children’s Hospital of Philadelphia and the Center for Data Driven Discovery to discover causes of pediatric cancer and structural birth defects.

Bolton NHS Foundation Trust selects Allscripts to enhance care and clinical engagement

In England, Bolton NHS Foundation Trust has selected Allscripts Sunrise EHR.

Physicians Healthsource, Inc. v. Allscripts-Misy’s Healthcare Solutions, Inc.

A physician practice, described by an obviously annoyed presiding judge as “a professional class-action plaintiff”, has filed a class action lawsuit against Allscripts for sending junk faxes without opt out instructions.

News 8/16/17

August 15, 2017 News 7 Comments

Top News

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The Congressional Budget Office scores the expected impact of the White House’s threat to stop paying Affordable Care Act-mandated cost-sharing reductions:

  • Insurers would pull out, leaving 5 percent of the country with no access to exchange insurance.
  • Premiums would increase 20 percent in the first year.
  • The federal deficit would increase by $194 billion through 2026.
  • The number of uninsured people would increase slightly in 2018 but then start moving slightly lower in 2020.

CBO qualifies its prediction based on how and when the White House stops making the payments, which the President has incorrectly described as “insurance company bailouts.”

The big takeaway is the deficit estimate. Paying premium subsidies based on income actually saves the country money.

CBO adds that President Trump’s CSR threats alone have already driven premiums up since insurers are required to request approval for their 2018 prices now.

The House of Representatives sued over the ACA’s cost-sharing reductions in 2014, arguing that the payments are illegal since Congress never appropriated the money to fund them. That case remains open.


Reader Comments

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From Keelhauler: “Re: cloud computing. Thought you would enjoy this.” I did, thanks.

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From Surprise!: “Re: Allscripts. Layoffs today of around 60 worldwide. Some senior people had their positions eliminated. Pretty eventful couple of weeks with the Paragon and NantHealth stuff.” Unverified, but reported by several readers. I reached out to the company’s media contact, who responded, “Allscripts does not discuss rumors or speculation,” which leaves the rest of us to do so without its participation.

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From Life’s Changing the Ocean Floor: “Re: [health IT site name omitted]. Seems to be dead.” Sure does. Googling turns up no user outrage or fond reminiscing, which suggests that its demise was not untimely.

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From Pacifico: “Re: Caradigm. LinkedIn shows that several top execs, salespeople, and security team members have left. GE is taking over, cutting headcount and leveraging shared services.” Unverified. I compared the company’s September 2016 leadership page to the current version – the 13 executives are now down to seven, of whom two are new.

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From Gaslighter: “Re: market share by hospital size. Were those numbers for US hospitals only? Wondering since Meditech has a significant presence in Canada.” Blain Newton of HIMSS Analytics, who provided the count, says the numbers cover only domestic hospitals.

From Supine on the Sand: “Re: market share by hospital size. The most meaningful stat is the 500+ bed hospitals since they often take smaller hospitals with them when they choose a vendor, which is why Meditech and Siemens (Cerner) have lost hospitals. Number of beds is most important since it equates better to the number of people – particularly doctors – who use the systems. Meditech is in big trouble because it has no ambulatory presence and Cerner, too takes a hit with ambulatory. Epic is much stronger than Cerner because of its 500+bed dominance and its ambulatory market share. I would love to see market size by beds and by ambulatory doctor count.” I mentioned your interest to Blain and he’s going to analyze EHR vendors by total beds and total physicians, so watch for that. I think Meditech can maintain its relevance for those hospitals that can’t manage the complexity or afford the cost of Epic or Cerner, but I agree that Meditech waited too long to conclude that the offering of partner LSS – which Meditech later bought – wasn’t the integrated ambulatory answer many of its clients and prospects were looking for. All three companies have common traits: they offer single-platform products for nearly every hospital service, they rarely acquire companies (“never” in the case of Epic), and they run on a single database. Those characteristics seem obviously desirable with 20-20 hindsight, but were lost on now-lagging competitors who were busily milking their cash cows, buying and nameplate-integrating anything that moved, and waltzing with Wall Street.

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From EclipsysGal: “Re: Chad Eckes. Glad to see an IT leader move into the CEO role.” Chad takes the CEO role at Pinnacle Dermatology, a private equity-backed dermatology practice in the Midwest that hopes to expand to 100 locations. He has served time as CIO of Cancer Treatment Centers of America and EVP/CFO of Wake Forest Baptist Medical Center (NC).

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From Vaporware?: “Re: MHS Genesis pilot sites. I found this testimony from March that says interoperability at Fairchild is through the legacy JLV portal via logging into AHLTA. Future plans include moving the legacy portal into Genesis. Fair to take that as a ‘no’ on CommonWell?” I’ll invite knowledgeable readers to chime in since I don’t know much about the DoD and the planned interoperability with the VA once they’re both on Cerner. It may be that workarounds are necessary until Genesis is live at all DoD facilities.

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From Eco Chambers: “Re: nonsensical terminology. I submit ‘ecosystem’ or ‘hyper-convergence.’ Where does this stuff come from?” I suspect someone (probably folks aspiring for cleverness in their books or articles) spends a lot of time coming up with words they hope will spread virally. Unfortunately, that sometimes happens, replacing perfectly serviceable and accepted words with cute new ones that only a marketer could love. 


HIStalk Announcements and Requests

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I thought my old Plantronics USB headset was failing since my new laptop wouldn’t recognize it (it wasn’t failing, as it turned out – I fixed the problem by deleting and reinstalling the latest version of the motherboard’s audio driver). I wanted a more comfortable headset since I often listen to music for hours while writing HIStalk and remembered that the best one I’ve owned was a gamer version. My solution: the fantastic EasySMX PS4 for $18.99 (for some reason, it’s gone up to $28.99 since last week). The driver-free headset’s deep ear cushions eliminate room noise while pumping out impressive bass from its 40mm driver with a cool option to vibrate as well, which I like. I’m rocking out to the much richer sound.

Listening: new from former Oasis singer-songwriter Liam Gallagher, whose Lennon-like brilliance is tempered by bizarre behavior that should make him a top pick in the rock dead pool. I’m also enjoying the immensely talented Sia, who is suddenly a global superstar at 41 (you’ve surely heard her stunning tropical house hit “Cheap Thrills” or “Chandelier”) after writing songs for other stars and battling personal demons.

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The healthcare relevance of the folks HIMSS chooses for keynote speakers often puzzles me and Magic Johnson is no exception. His accomplishments, as far as I can tell, were (a) surviving HIV when most other patients didn’t, and (b) getting rich off basketball and the business deals he struck after he retired (I’ll skip his awful 1998 TV talk show, whose low quality and alarmingly short tenure was eclipsed only by the pitiful late-night efforts of Chevy Chase and Pat Sajak). At least he has directed some of his attention toward social causes and that alone will probably make his speech interesting. He’s on the agenda for Friday of HIMSS week, with the absence of most of us dearly departed attendees providing an intimate setting for those stalwarts can never get too much time at conferences or in my least-favorite city.

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Thanks to HIStalk sponsors EClinicalWorks and ZappRX for upgrading their Gold sponsorship to Platinum.

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Thanks to Nuance, which apparently dropped their long-held HIStalk Founder sponsorship by mistake and have reconnected as Platinum since their original spot had already been snapped up by the time they realized it.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Credentialing technology vendor Silversheet raises $5 million in Series A funding, increasing its total to $10 million. I interviewed CEO Miles Beckett, MD just over a year ago since I was fascinated that he created the “lonelygirl15” web series that ruled YouTube in 2006-2008.

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A Goldman Sachs report says Amazon’s initial healthcare ambitions may involve partnering with a pharmacy benefits manager to optimize prescription ordering and delivery. The report also speculates that Amazon could provide patient monitoring and telemedicine visits via its Echo that would then allow patients to order the drugs prescribed. It also says Amazon could be interested in using the patient data it collects to cross-sell products, which wouldn’t be the day’s best privacy news.

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Google buys Seattle-based Senosis Health, which was developing apps that use smartphone sensors for diagnosing newborn jaundice, reduced lung function, and low hemoglobin levels. Those apps have yet to earn FDA’s marketing clearance.

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Medication management technology vendor Swisslog Healthcare makes an unspecified investment in managed telepharmacy solutions vendor PipelineRx. 

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Personalized health behavior change technology vendor Happify Health raises $9 million in funding.

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Dublin, Ireland-based Clanwilliam Group makes its 13th medical technology acquisition in three years in buying digital dictation vendor Medisec Software, which is a supplier to NHS.

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CHOP spinoff Haystack Informatics closes an additional funding round to expand the rollout of its privacy solution, which analyzes EHR activity logs to identity potentially inappropriate user activity.

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Clinical research organization PRA Health Sciences will pay $520 million to acquire Symphony Health Solutions, which resells prescription data of 280 million US citizens to drug companies who use the information to market their products to doctors.


Sales

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St. Luke’s University Hospital (PA) will implement MModal’s Fluency Direct EHR-integrated clinical documentation as it moves to Epic in 2018. St. Luke’s CMIO James Balshi, MD calls MModal’s platform “cloud-based but not cloud-dependent.” 

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Children’s Hospital New Orleans (LA) selects Vocera’s smartphone app for secure text messaging and hands-free communication.

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Saint Luke’s Health System (MO) will expand its FormFast implementation in rolling out the company’s electronic signature product.

In England, Bolton NHS Foundation Trust chooses Allscripts Sunrise.

MIT’s student and faculty ambulatory care center chooses Cerner Millennium and HealtheIntent.


People

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Libby Curtis Webb (Copatient) joins ZappRX as SVP of product.


Announcements and Implementations

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Children’s Hospital of Philadelphia (PA) will run an NIH-funded project to mine big data to look for causes of pediatric cancer and birth defects, with partner organizations running several data portal, genomics standards, and analytics sub-projects that will combine clinical and genetic sequence data from several cohorts into a centralized database.

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PatientPop – which offers practice-building tools – adds the ability for Google searchers to schedule an appointment directly from the practice’s Google My Business listing that shows up to the right of the search results.

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Navient subsidiary Xtend Healthcare buys HIM and revenue cycle consulting firm Elipse.

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A technology paper profiles Phynd, with founder and CEO Tom White explaining its provider data management solution. The company’s Phynd a Doc consumer search function is used on Duke Health’s website (above).

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The Tennessee Hospital Association and Audacious Inquiry launch ConnecTN, which will share real-time ED visits and hospital admissions among THA’s hospital members and TennCare.

Apple is reportedly talking to Aetna about making the Apple Watch available for free or at a discount to the insurer’s customers, which would extend the program beyond Aetna’s wellness program that covers its 50,000 employees.

Optimum Healthcare IT opens a managed services office in Duluth, MN and is profiled in the local paper.

OpenEMR enhances its open source EMR to operate as an out-of-the-box cloud services solution using Amazon Web Services, providing benefits that include automatic scaling of computational resources for cost effectiveness, cutting edge network security, zero hardware maintenance, easy software deployment, and robust backup and recovery solutions.


Privacy and Security

The Department of Justice demands that web hosting company DreamHost turn over the personal information of 1.3 million visitors to an anti-Trump website, ordering the company to provide IP address, contact information, photos, and emails.


Technology

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Microsoft defensively downplayed a Consumer Reports estimate from last week that 25 percent of its Surface tablets and laptops experienced problems – which caused CR to withdraw its “recommended” rating – but internal Microsoft documents suggest that Microsoft was fully aware that the Surface Pro 4 and Surface Book have high customer return rates. Here’s some easily-remembered advice: never buy hardware from Microsoft other than keyboards, mice, joysticks, and Xbox components. The rest of their lineup is stuff other companies sell better and cheaper (unless you still believe the Zune was a great digital media player and subscription music service).


Other

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The HR SVP and an interim hospital CEO of Broward Health (FL) quit following the resignation of an SVP who had been accused of overpaying a politically connected marketing company by $1.7 million in a secret side agreement. The health system’s then-CEO committed suicide 18 months ago, after which the board ignored the candidates presented by its search firm and instead gave a fellow board member the $650,000 job. That CEO is a nurse whose only graduate degree was issued by a notorious diploma mill that has since closed.

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I hadn’t seen this: Physicians Healthsource sues Allscripts under the Telephone Consumer Protection Act for sending junk advertising faxes without opt-out instructions. The plaintiff claims it received 36 faxes from 2008 through 2011 and seeks class action status. The judge labeled Physicians Healthsource as a “professional class-action plaintiff” that has filed several similar “junk fax” class action lawsuits using he same law firm and notes that fax machines have mostly been replaced by computer software, meaning that recipients expend little money or time in discarding unwanted faxes even though federal law still allows filing such lawsuits. The judge also noted that Allscripts had previously been sued by a physician’s office for the same issue and paid $600,000 in legal fees plus whatever settlement they agreed to, concluding that Allscripts “should adjust its marketing strategy a bit, or at the very least, stop sending faxes to what might be one of the more litigious businesses, in terms of junk fax litigation, in the country.” The court also notes that the maximum penalty for junk faxing is $500, but such class action lawsuits can create a windfall for the law firm as both sides pay expensive attorneys to argue over the small sum. The judge’s comments are entertaining and cynical, showing obvious disdain in the ruling above for a Congress-created law that he clearly thinks is ridiculous.


Sponsor Updates

  • UnityPoint Health (IA) is optimizing its EHR build by using LogicStream Health’s Clinical Process Improvement solutions to review sepsis screenings and to compare protocol usage to evidence-based best practices in real time.
  • EClinicalWorks supports National Health Center Week and the 700 Community Health Centers that use its systems. The company was also named as a Frost & Sullivan customer value leadership award winner for its RCM services.
  • Kyruus will integrate its ProviderMatch for Consumers with Binary Fountain’s online patient reviews to enhance its online search directory pages.
  • Besler Consulting will present at the HFS Provider User Meeting August 18 in New Orleans.
  • Gartner includes Dimensional Insight and its analytics applications in three healthcare research reports in July 2017.
  • IDC Health Insights includes Medecision in its HealthTech Rankings Top 50.
  • Glytec CMO Andrew Rhinehart, MD discusses Glytec’s contributions to value-based reform.
  • Ingenious Med will exhibit at the HFMA NC Summer Institute August 23-26 in Myrtle Beach, SC.
  • InterSystems will exhibit at the Sunquest User Group meeting August 21-24 in Tucson, AZ.

Blog Posts


Contacts

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

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Morning Headlines 8/15/17

August 14, 2017 Headlines No Comments

Google Verily Unit Acquires Senosis Health

Verily, Alphabet’s life sciences business, acquires Senosis Health, a smartphone-based medical condition monitoring app. Financial terms were undisclosed.

MIT Medical Selects Cerner’s Integrated Health Care Technology for Care of Students, Faculty and Staff

MIT Medical, which serves MIT students, faculty and family members, selects Cerner as its next EHR.

Coverage For Mental Health Via Telemedicine Soars At U.S. Employers

56 percent of US employers plan to offer telehealth-based behavioral health services in 2018, more than doubling availability compared to 2017 rates.

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