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Readers Write: Almost Real, But Not Quite: Synthetic Data and Healthcare

December 20, 2017 Readers Write No Comments

Almost Real, But Not Quite: Synthetic Data and Healthcare
By David Watkins


David Watkins, MS is a data scientist at
PCCI in Dallas, TX.

We all want to make clinical prediction faster and better so we can rapidly translate the best models into the best outcomes for patients. At the same time, we know from experience that no organization can single-handedly transform healthcare. Momentous information hidden in data silos across sectors of the healthcare landscape can help demystify the complexities around cost and outcomes in the United States, but lack of transparency and collaboration due to privacy and compliance concerns along data silos have made data access difficult, expensive, and resource-intensive to many innovation designers.

Until recently, the only way to share clinical research data has been de-identification, selectively removing the most sensitive elements so that records can never be traced back to the actual patient. This is a fair compromise, with some important caveats.

With any de-identified data, we are making a tradeoff between confidentiality and richness, and there are several practical approaches spanning that spectrum. The most automated and private method, so-called “Safe Harbor” de-identification, is also the strictest about what elements to remove. Records de-identified in this way can be useful for many research cases, but not time-sensitive predictions, since all date/time fields are reduced to the year only.

At the other extreme, it is possible to share more sensitive and rich data as a “Limited Data Set” to be used for research. Data generated under this standard still contains protected health information and can only be shared between institutions that have signed an agreement governing its use. This model works for long-term research projects, but can require lengthy contracting up front and the data is still locked within partner institutions, too sensitive to share widely.

What’s a novel yet pragmatic solution to ensure that analytics advancement is catalyzed in healthcare industry? We are exploring “synthetic data,” data created from a real data set to reflect its clinical and statistical properties without showing any of the identifying information.

Pioneering work is being done to create synthetic data that is clinically and statistically equivalent to a real data source without recreating any of the original observations. This notion has been around for a while, but its popularity has grown as we’ve seen impressive demonstrations that implement deep learning techniques to generate images and more. If it’s possible to generate endless realistic cat faces, could we also generate patient records to enable transparent, reproducible data science?

The deep learning approach works by setting up two competing networks: a generator that learns to create realistic records and a discriminator that learns to distinguish between real and fake records. As these two networks are trained together, they learn from their mistakes and the quality of the synthesized data improves. Newer approaches even allow us to further constrain the training of these networks to match specific properties of the input data, and to guarantee a designated level of privacy for patients in the training data.

We are investigating state-of-the-art methodologies to evaluate how effective the available techniques are at creating data sets. We are devising strategies for overcoming technology and scientific barriers to open up an easy access realistic data platform to enable an exponential expansion of data-driven solutions in healthcare.

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Can synthetic data be used to accelerate clinical research and innovation under strong privacy constraints?


In other data-intensive areas of research, new technologies and practices have enabled a culture of transparency and collaboration that is lacking in clinical prediction. The most impactful models are built on confidential patient records, so sharing data is vanishingly rare. Protecting patient privacy is an essential obligation for researchers, but privacy also creates a bottleneck for fast, open, and broad-based clinical data science. Synthetic data may be a potential solution healthcare has been waiting for.

Morning Headlines 12/20/17

December 19, 2017 Headlines 1 Comment


EDIS vendor MedHost is the victim of a ransomware attack that brought down its webpage twice on Tuesday. The company has yet to make a public statement about the attack, and its public-facing webpage has since been restored.

Humana, private-equity firms buy Kindred Healthcare for $4 billion

Humana has partnered with two private equity firms to acquire home-health care and long-term care operator Kindred Health for $4 billion.

Health IT Leader Fortifies Tech and Policy Innovation at Dell Medical School

Former National Coordinator for Health IT Karen DeSalvo, MD joins the faculty at the University of Texas Austin’s Dell Medical School where she will serve as a professor in the Division of Primary Care and Value-Based Health.

It’s Official: North Korea Is Behind WannaCry

Republican White House staffer Thomas Bossert pens a Wall Street Journal op-ed publicly attributing the WannaCry cyberattack to North Korea operatives.

News 12/20/17

December 19, 2017 News 13 Comments

Top News


Medhost’s public website was hacked Tuesday morning, according to a cyber intruder’s message that replaced the company’s usual home page content.

The hacker demanded 2 bitcoin ($37,000), threatening to otherwise “sell the patient data and do a media release regarding the lack of security in a HIPPA [sic] environment.” Medhost offers hosted financial and clinical systems, an emergency department system, a patient portal, and a health and wellness site.

The site had returned to normal by Tuesday afternoon with no acknowledgement of the previous problem on the site or on social media. A Medhost spokesperson did not return my call in which I asked for verification of the hacker’s claim that patient data was exposed.

UPDATE: shortly after the normal home page was restored late Tuesday afternoon, the site was apparently hit again with the “this website has been hacked” message restored.

UPDATE 2: Medhost CISO William Crank reports that the problem has been resolved and no information was compromised:

MEDHOST has full control of the domain, and the restoration of the domain and associated applications has been completed. Depending upon geographic location, sites may already have full access, but it is possible that the DNS restore process could take up to 24 hours to propagate the changes due to TTL. Intermittent application impact may be experienced by end users during that time. MEDHOST wants to reiterate that there is no indication that sensitive information was comprised and the incident didn’t extend beyond the redirection of the MEDHOST DNS to a static site with the message your article referenced. We strive to provide a robust and secure platform for our clients and continue to investigate this incident and its root cause.

Reader Comments


From Athenahealth: “Re: APIs. We have integrations with over 200 innovators and a developer community of 7,000, processing 700 million calls per month. Our single-instance, multi-tenant cloud platform allows a global integration model that allows immediate access to all partners for our clients – where innovators connect once and then are activated at clients with the flip of switch. We agree that talking numbers is interesting, but more so, let’s start to talk about API usability and the downstream impact of API calls.” It’s encouraging that Allscripts, Epic, and now Athenahealth have checked in with big API usage numbers. None of these are surprising – Allscripts (in the form of the acquired Eclipsys) pretty much defined the idea of inpatient systems with “hooks” as we called them in the old days, while Epic and Athenahealth stay current in deploying modern technologies and Athenahealth’s system is based on connectivity. I’m guessing Cerner has impressive numbers although I haven’t seen them.


From Event Attendee: “Re: John Halamka’s installation as Harvard Medical School’s inaugural International Healthcare Innovation Professor of Emergency Medicine. I had the distinct honor of attending and snapped a picture of a few notable CEOs in the room – Jonathan Bush (Athenahealth), Girish Navani (EClinicalWorks), and Hoda Sayed-Friel (Meditech). It’s remarkable that they spent the morning together honoring his lifetime of achievement.”


From Earth Shatterer: “Re: Epic. What exactly is Sonnet?” Sonnet is a streamlined, cheaper, faster-install subset of Epic’s full software suite being developed that will target small hospitals and physician groups, post-acute care facilities, and some international organizations. It will be released in March 2018. Sonnet was announced at HIMSS17 along with Utility, a fast installation program that gets customers live faster with fewer modifications. Epic says Utility implementations started in Q4 2017 (it’s now Epic’s most popular implementation method) and the first Utility-implemented customers will go live in 2018. Judy Faulkner chooses all Epic product names herself and they always contain a subtle reference, in this case with the word “sonnet” as translated from Italian as “little song.” Epic has tried similar rollouts in the past, twice in a partnership with Philips in the early 2000s and another attempt a few years later using the Sonnet name that may have failed because of newly mandated Meaningful Use requirements, but this one seems like a done deal.


From Who Else Remembers?: “Re: selection consultants having a conflict of interest. This is reminiscent of the late 1980s and early 1990s when Arthur Andersen was accused of a similar bias. Back then, the cozy relationship resulted in a string of predictable yet questionable wins for Gerber Alley and Statlan. Anderson would do the selection and inevitably be granted a large advisory and implementation role post award. Notably, Jay Toole and Andersen were crisscrossing the country espousing the virtues of a best-of-breed approach that needed lots of consulting help, for which Andersen was all to eager to offer the brave buyers of these footnotes in HIT history.” It’s a longstanding question of whether consulting firms that sell system services should be asked to help customers choose those same systems, at least without first recusing themselves from earning future business related to the selection. On the other hand, health systems can hire whoever they want and are presumably acting in their best interest. You mentioned Jay Toole, and in tracking him down, I learned that Dearborn Advisors filed Chapter 7 bankruptcy and apparently closed earlier this year. For more about Gerber Alley, see Vince’s HIS-tory.

From Fanny Pacque: “Re: vendor underbidding. Epic underbids (probably to their advantage) relative to their competitors. Implementation services, additional software, etc. always come later and require direct third-party engagement. This is the tick-tock on how you get to projects that go 2-3x over budget. Example: San Francisco Department of Public Health, which is a few months out from choosing Epic and they’re already bidding out voice recognition software, revenue cycle implementation, HIM, and patient outreach. You can see why Allscripts, Cerner, and others might suggest increased transparency on this topic since they provide fully loaded proposals.” San Francisco DPH’s several Epic-related RFPs are here (on the right side of the page as part of RFP 47-2017). I would think a prospect would know to compare apples to apples in choosing a vendor, but sometimes they get so mentally locked in to their favored vendor that they don’t dig deep enough and/or their lack of EHR selection experience makes them unsuited to detect contract land mines.

HIStalk Announcements and Requests

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The efficiency of DonorsChoose is always impressive to see – we funded the teacher grant request of Mrs. A in Michigan on December 10 and her students are already using the STEM kits and experiment books we provided just nine days later, as evidenced by the photos above. She reports, “My students and I are so elated that this project was funded. The excitement they showed when we unwrapped the science kits was unprecedented! I wanted to thank you again for your very generous donation. The students are now able to take science out of the science classroom and bring it in to their homes. Not only have you allowed the students to experience science phenomena, you have also allowed their families to as well! Many of my students and their families do not have access to the items that will enable them to perform these experiments and now they do! You have truly helped to create lifelong memories.”


Welcome to new HIStalk Platinum Sponsor Ellkay, which brilliantly taglines itself as “Healthcare Data Plumbers.” The Elmwood Park, NJ-based company enables interoperability, providing a data pipeline for 45,000 practices and 500 PM/EHRs and connecting hospitals, practices, labs, payers, HIEs, and ACOs using almost any system. Products include connectivity for diagnostic labs; PM/EHR integration and data migration, lab orders and results interfaces; and ACO/HIE connectivity solutions. Its CareEvolve portal and interfaces provide clinical workflow support between laboratories and the point of care, while hundreds of hospitals have used Ellkay’s data extraction, conversion, and archiving services to decommission legacy systems. Black Book included Ellkay on its list of 2017’s most disruptive health IT companies that have top customer satisfaction scores. The company’s “Our Story” page is the most entertaining and fascinating backgrounder I’ve seen and the story about why they installed beehives on the company roof roped me in completely. Thanks to Ellkay for supporting HIStalk and for entertaining and informing me with an unusually cool website.


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

Acquisitions, Funding, Business, and Stock


High-profile Silicon Valley investor Bill Gurley – an early Uber backer whose startup Brighter was just acquired by Cigna – launches Stitch Health, a Slack-like care team coordination and patient engagement platform. The Connect team communication system costs from $6 to $18 per user per month depending on features. Stitch CEO and co-founder Bharat Kilaru is a 2015 Harvard MBA graduate and ran a Nashville clinic for the underserved until 2013.


Pittsburgh-based specialized outpatient clinical documentation vendor Net Health will be acquired by two private equity firms and the company’s management team.


Humana and two private equity firms will acquire home health and long-term care operator Kindred Healthcare for $4 billion, continuing the trend of insurers moving into direct patient care.


A New York Times review of proposed health system mega-mergers contains some interesting quotes:

  • “Hospital executives are realizing that someone else, including an insurance company employing the nurse at a walk-in clinic or the doctor at a surgery center, wants to take over their relationship with patients — and the potential revenue that those patients represent.”
  • “But many point to the promises of past mergers as reason to doubt whether the hospital mergers allow much more than an ability to demand higher prices from insurers. After the last wave of mergers that took place a few years ago, the hospitals didn’t use that opportunity to bring their costs down.”
  • “The challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. You’re taking a zebra and a zebra … what they want to become is a unicorn.”


Silicon Valley, meet Bubble 2.0: SoftBank will invest up to $300 million in a dog-walking app vendor that has already raised $40 million.



Mercy Health chooses PatientPing for real-time patient care coordination.



Recondo Technology hires Craig Niemiec (AxisPoint Health) as CFO.


Patrick Neil Mescall, PhD (Businessolver) joins VirtualHealth as SVP of channel development.


Former National Coordinator Karen De Salvo, MD, MPH, MSC joins Dell Medical School at the University of Texas at Austin as a professor, with appointments in internal medicine and population health.

Announcements and Implementations

A survey of a few dozen hospital CIOs finds that the biggest jump in deployed mobile strategy components over the next three years will be in critical test result alerts, clinical decision support alerts, and care team assignments. Respondents also indicated that their investment in communications technologies will be slightly more driven by system integration capabilities than by end user needs.

I’ve never heard of CHIME’s 2014 spinoffs AEHIS, AEHIT, and AEHIA – which seem to have been created primarily to help CHIME to lasso new dues-paying members who don’t meet the job qualifications to join CHIME since they aren’t CIOs (security executives, CTOs, and application leaders, respectively) – but for those CHIME members who are interested, they’re waiving dues for 2018. I don’t quite understand why a prominently posted press release on the site of AEHIS (that’s the security group) is “Fujifilm Captures New Customers for its Synapse Enterprise Imaging Solutions,” but then again I don’t usually like providers and vendors sharing an association-provided membership bed even when a logical connection exists. As readers have observed, CHIME is mimicking HIMSS in seemingly trying to get bigger, more vendor-friendly, and more executive-compensating, but its members are apparently OK with that and that’s all that counts.

Government and Politics

Americans say healthcare is the country’s second-biggest problem behind the government, Gallup finds. Healthcare hasn’t been one of the top two problems since 2007, when it finished a distance second to Iraq.

Privacy and Security


White House Homeland Security Advisor Tom Bossert says in a Wall Street Journal op-ed piece that North Korea launched the WannaCry malware attack earlier this year that hit hospitals hard, adding, “Pyongyang will be held accountable.”

A Black Book survey finds that 84 percent of healthcare provider organizations don’t have a chief information security officer, 54 percent don’t conduct cybersecurity risk assessments, and 39 percent don’t perform regular firewall penetration testing. The survey also finds that few boards of directors actively discuss cybersecurity.

Yet another exercise proves that de-identifying patient data doesn’t really work, as a university in Australia (as several have done) matches up a publicly released Australia Medicare database and re-identifies patients by linking their information to other publicly available databases. The Australian government is considering laws that would make re-identifying government data illegal, which is an interesting (and not in a good way) approach.



A reader whose company has nothing to do with healthcare consulting was surprised to have it shortlisted among the “Top 10 Healthcare Consulting Firms 2018,” which comes with a (free) certificate and (not free) interview reprint rights from a magazine called Enterprise Services Outlook. The magazine shares a telephone number and street address with shady magazines (CIO Review and Healthcare Tech Outlook) published by Bangalore-based marketing firm SiliconIndia. I’ve previously noted the hilarious misspelling of HIPAA on the cover of Healthcare Tech Outlook and the fact that its covers always feature males. It has published an article by UC Health CIO Steve Hess (which also appeared word for word in Becker’s Hospital Review under a different UC Health author’s name) and by other health system CIOs like Marc Probst and Dan Waltz who probably don’t even realize who they’re writing for. The magazine invites readers who “skimp” [sic] its questionable vanity content to join its august roster of contributors.


Jenn ran this fun item on HIStalk Practice: an Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own epinephrine and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”


Moxe Health founder and CEO Dan Wilson reads “’Twas the Night Before Go-Live,” an HIT-focused song parody written by Jay Rath. Jay fascinates me because in addition to having spent time with Epic, he’s a former staffer at “The Onion,” a contributor to “Mad” magazine, and has a broad background in theater and radio comedy.


Wendy from Bellin Health (WI) sent a photo of the Epic Willow team’s holiday-decorated cubicle area in the IT department that creatively adds a fireplace inside and a welcome mat out front. The coats inside prompted me to check Green Bay’s weather forecast – Tuesday was to be sunny with a relatively balmy high of 40 degrees and a low of 11, but Christmas will be biting as temps struggle to rise to zero (Fahrenheit, just to be clear).

Sponsor Updates

  • The InstaMed team delivers over 900 presents to the Children’s Hospital of Philadelphia.
  • Definitive Healthcare adds visual dashboards to its hospital and provider databases.
  • Elsevier Clinical Solutions publishes a new white paper, “Build or Buy: Considerations when adding a new Clinical Decision Support System.”
  • FormFast publishes a new case study, “East Alabama Medical Center Saves Time and Cuts Costs with FormFast’s Leading Form Design Technology & Services.”
  • Healthfinch publishes a new case study featuring Valley Medical Group.
  • Data analytics from Arcadia Healthcare Solutions supports a New York Times skin cancer investigation.
  • T-System President and CEO is recognized at D CEO’s “Excellence in Healthcare” awards program.
  • Besler Consulting releases a new podcast, “Perspectives on the Alex Azar nomination for HHS Secretary.”
  • Mphasis Eldorado and Change Healthcare expand their partnership to include integration between Javelina and Change Healthcare’s payment integrity services.

Blog Posts


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


Morning Headlines 12/19/17

December 18, 2017 Headlines No Comments

CDC director tells staff ‘there are no banned words,’ while not refuting report

CDC Director Brenda Fitzgerald sent an internal email this week assuring staff that the agency would always be a science-based institution and noting that reports that the Trump administration released a list of banned phrases for the CDC, including “evidence-based” and “science-based” were not entirely accurate and would not impact the agency’s work. In a Sunday morning tweet she reiterated that “there are no banned words at CDC.”

Highmark, Penn State Health officially sign off on partnership deal

Highmark finalizes a $1 billion partnership with Penn State Health that will establish a Central Pennsylvania health network that will use Highmark’s insurance data and Penn State’s delivery network to build a cost effective care delivery model.

ONC launches tool to collect patient demographic data

Responding to reports that a vast majority of medical errors occur because of erroneous patient data, ONC and the CMMI Institute release the Patient Demographic Data Quality framework, a collection of best practice recommendations on collecting and improving patient data.

FDA takes more aggressive stance toward homeopathic drugs

The FDA is taking a tougher stance on homeopathic drugs, specifically those containing potentially harmful ingredients or being marketed for cancer, heart disease, or opioid and alcohol addictions.

Curbside Consult with Dr. Jayne 12/18/17

December 18, 2017 Dr. Jayne No Comments

I worked my last clinical shift of the year this weekend. We had several families come in for care and nothing stresses the system like trying to work up two parents and four preschoolers at the same time, especially when vomiting is part of the picture. There’s a nasty gastroenteritis going around (aka “stomach flu”) along with actual influenza, so I spent most of my day in a mask and cover gown, marinating in alcohol foam every free minute I had.

I had a scribe for a couple of hours during the worst part of the surge, and although we had never worked together, we felt like old friends by the time the shift was over. He’ll be headed off to medical school next summer and was interested to hear about my clinical informatics work in the couple of blocks of downtime that we had. He had spent a couple of years in West Africa, first doing economic development work and later working in a rural hospital, but had never heard of the specialty.

He had some great stories (and even better pictures) of his time with a general surgeon whose skills spanned everything from plastics to OB/GYN due to lack of colleagues. My scribe had spent some time as a first assistant during multiple surgical procedures and figured it would give him a leg up when he gets to medical school. Since he’s been accepted to several highly-competitive schools, he’ll have to fight off dozens of fellows, residents, interns, and students to get to the operating table, but hopefully his knowledge will get him noticed. If there are any cases involving hyena attack victims, he will definitely be able to contribute.

Having a scribe during a record-breaking shift is more than just having someone to help click the boxes. It can mean reminders to include directions you didn’t happen to verbalize when talking to the patient or having an extra set of hands to call around to pharmacies to see who has any Tamiflu left.

We did see several situations where the cost of that particular antiviral medication was out of control, with one family being quoted $750 per patient to have a script filled that typically retails for $120 in our area. The use of Tamiflu is somewhat debatable, but many patients want it in hopes that it will shorten the course of influenza or help protect them from a contagious family member. Most of the local pharmacies were out of pediatric formulations weeks ago, so trying to find it for a child was nearly impossible.

Since we have in-house, cash-only medication dispensing, we’re pretty savvy to the price of drugs because patients typically ask whether it’s going to be cheaper to get it from us rather than using their insurance. Depending on co-pays and deductibles, we’re largely competitive. Often patients who pay cash for their prescriptions are better off getting their medications from us – for one common generic pneumonia drug, we’re nearly $25 cheaper than the local big-box store.

Price transparency is important for many of our patients, and we found over the past year that trying to get the information through our EHR was a nightmare. The cost information, which was scaled by number of dollar signs, wasn’t detailed enough for our patients to make decisions. It was based on average wholesale pricing and didn’t take into account co-pays, deductibles, or pharmacy benefit manager incentives. We keep our cost information the new-fashioned way, on an intranet document that’s basically the equivalent of taping up a cheat sheet at the care team pod.

It would be great if we could get real-time cost information for our patients and then they could make the decision whether they want to purchase their prescription from us because it’s cheaper, or whether it’s worth paying a little more to have it immediately and not have to make another stop.

Sometimes they choose to have the script sent to the pharmacy and then call us back a few hours later, asking if they can come back and pick it up at the cheaper price. This illustrates the challenges we face with patient engagement – we’re empowering them with more information than they’ve had in the past, but sometimes it’s not all the information they need or it might not be correct. I know as a patient having had multiple arguments with providers about the fact that I shouldn’t be paying co-pays the rest of the year and few of them being willing to honor the payer letter that I carry around, that it’s not just about prescription coverage. (Incidentally, I hope the practices that refuse to trust my “don’t charge this patient a co-pay” letter enjoy processing my refund requests, because I make them as soon as I see the Explanation of Benefits.)

If we aren’t able to provide good information on the smallest decisions, it’s a leap to expect people to make decisions on larger health concerns without experiencing stress and uncertainty. I think this is why some patients trend back towards the old days of physician paternalism, where they want a provider to tell them what to do. Or better yet, what the provider himself or herself would do when confronted with the same situation. Having those kinds of conversations requires rapport, which requires interaction over time and the building of trust, which are difficult to do in this era of six-minute visits and fragmented care.

Although the care team approach should theoretically help, in some cases I’ve seen it make things worse as the patient has to now build trust with multiple care team members rather than just with the provider who they’ve chosen (or been assigned) as their primary care physician.

I did have a couple of patients this weekend who specifically said they were at the urgent care because their insurance companies sent letters saying that emergency department visits would no longer be covered for non-life-threatening issues. Fortunately, none of them were emergencies and we were able to handle them. On the flip side, we had patients whose definitive care was delayed by choosing urgent care over a higher-acuity setting. We’re not the best place for actual heart attacks and we just increased your time from symptoms to angioplasty. Same for stroke, when the golden hour really is golden.

I didn’t get a chance to get into the psychology of why they came to urgent care rather than the ED since I was too busy taking care of their ambulance transfers and ED handoffs, but I’m always suspicious about cost being a factor.

I’m hoping that the New Year brings wisdom to our policymakers and greater patience for everyone in our healthcare system, from patients to providers to payers to politicians. I’m skeptical about the last group, but after all this is the season of hope, so I’ll send happy thoughts their way.

What are you looking for in the New Year? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/18/17

December 17, 2017 Headlines No Comments

UPDATED: Tampa health IT company lays off 120 in Georgia

An Atlanta business paper updates a story it published on Greenway Health’s layoffs last week, clarifying that the EHR vendor is only closing its Atlanta offices but will keep its Carrollton, GA offices open.

McKesson unit wins $400 million U.S. defense contract: Pentagon

McKesson wins a $400 million contract to provide DoD a digital imaging network.

John Halamka Celebrated as Inaugural International Healthcare Innovation Professor

BIDMC CIO John Halamka, MD is named International Healthcare Innovation Professor byHarvard Medical School.

Cigna Acquires Brighter, a Leader in Digital Engagement of Health Care Consumers

Cigna acquires patient engagement vendor Brighter. Co-founder Jake Winebaum comments, “We set out to use technology and consumerism to improve the health insurance experience and reduce unnecessary costs. Our experience with Cigna as a partner over the past two years has proven that those goals can be accomplished.”

Monday Morning Update 12/18/17

December 17, 2017 News 6 Comments

Top News


The Atlanta business paper has corrected its story that stated Greenway is closing its Atlanta and Carrollton, GA offices, now indicating that only the Atlanta office will close.

The company is moving some functions from Carrollton to Tampa, but a spokesperson says 500 employees of Greenway Revenue Services and other customer-facing functions will continue their work in Carrollton.

Greenway will also hire another 100 revenue cycle management employees for that location in the next few weeks and is actively hiring for its Tampa office.

The Georgia WARN act site indicates that the Atlanta office will be closed and 24 employees laid off, while the Carrollton layoff involves 96 Greenway employees.

Reader Comments


From Portland Liquid Sunshine: “Re: Cambia Grove. The director, program director, and others have left in the past few months. The new director has no background in innovation.” I don’t know anything about the Seattle healthcare innovation and investment workspace, but comparable offerings elsewhere have struggled.


From Associate CIO: “Re: UIC, Epic, and Cerner. The main issue that Cerner has (and I am surprised that Allscripts isn’t protesting as well as they finished third) is that the state of Illinois has a very strict procurement process. Final bids have to be all-inclusive, which Cerner’s was, but Epic’s was not since it included only licensing. The cost of Epic could end up being twice that offered by Cerner.” I extracted and summarized Associate CIO’s comment left on last week’s post since it interests me a lot.

From Slick Willie: “Re: UIC, Epic, and Cerner. The project was baked as soon as UIC hired Impact Advisors because (a) they always choose Epic, and (b) they always help with the implementation of Epic. Cerner has valid points.” Unverified. Statistics would  prove how often an Impact Advisors-led EHR selection results in an Epic decision and a follow-up implementation contract, but I assume that only the company could provide those numbers and I don’t expect that to happen unless the state of Illinois requests them as part of its review of Cerner’s protest.


From Aaron Iota: “Re: API transaction counts. Does that really matter?” Not to me. Prospects and observers should focus on: (a) whether open APIs are offered and to what outside systems; (b) which third-party vendors are using them; and (c) whether the APIs are meeting customer needs in giving them functionality they would not have otherwise had. A high transaction count simply validates that the APIs are functional and capable of scaling. It’s also true that customers of EHR vendors that offer a broader solution will find less value in APIs to outside systems that they may not require. High API usage means that the market wants interoperability and is getting it, which is the biggest takeaway. It might be interesting also to know whether the EHR vendors are charging for those services since “available” doesn’t necessarily mean “free.” 


From In the Know: “Re: Athenahealth. This is a little old news (October), but I don’t remember you mentioning it. Another Athena exec is gone as now-former CMO Todd Rothenhaus has been replaced by Kevin Ban. Seems like the only one left from one year ago is JB, and I wonder for how much longer?” It’s mostly a new management crew with the exception of Paul Armbrester (chief product officer since 2015) and Paul Merrild (SVP of sales since 2011).

HIStalk Announcements and Requests


The most common forms of on-the-job sexual harassment reported by poll respondents are inappropriate public comments, unwelcome touching, and seductive behavior. The comments are enlightening — if not entirely encouraging — with regard to male behavior. Perhaps the “glass half full” takeaway is that few respondents reported outright sexual assault or the insinuation that their hiring or advancement was predicated on their sexual submission. Note: please don’t misinterpret those percentages – the poll targeted only those who have been sexually harassed and multiple choices were allowed, so that 36 percent “degrading comments” figure means that one-third of the votes (not of participants) involved it. In other words, it is not correct to infer that 36 percent of all female readers have experienced degrading comments at work.

New poll to your right or here: which do you surreptitiously check most often on your phone during meetings? I’m always curious what drives people to tune out of meeting participation and instead steal sly glances at their phone held just below table level (as though the other attendees can’t tell that they are either screwing around with their phone or contemplating their crotch). Is it being invited to a meeting that you didn’t really need to attend, tuning out when you have nothing to contribute, or just being helplessly lured to the distraction machine that is so readily available?


Consider giving some closure to 2017 by completing my one-yearly reader survey. The results help me plan for 2018, and even though I can’t implement every suggestion or idea and I don’t make decisions by committee, there’s never been a year that I didn’t use quite a few suggestions to reapportion my HIStalk time. I’ll also randomly draw some responses from folks who will get a $50 Amazon gift card.

RIP Pat DiNizio, the 62-year-old Smithereens singer / songwriter who died last week at 62. I shall play the fabulous “Behind the Wall of Sleep” and “Blood and Roses” in his memory.

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Reader Vicki made a generous donation to my DonorsChoose classroom project fund, which with matching money from my anonymous vendor executive and other sources fully paid for these teacher grant requests:

  • A robotics construction kit for Ms. C’s second grade class in Asheville, NC.
  • Math and science games for Mrs. T’s elementary school class in Merrill, MI.
  • Science kits for Mrs. C’s elementary school class in Hamilton Twp, NJ.
  • A microscope, safety goggles, and an elementary mixtures science kit for Ms. T’s elementary school class in Washington, DC.
  • A Rube Goldberg Machine engineering kit for Ms. Ms. H’s sixth grade class in Blaine, MN.

Last Week’s Most Interesting News

  • Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health.
  • Greenway Health announces the layoff of 120 employees and the closing of its Atlanta offices as it moves some operations to Tampa.
  • For-profit oncology operator 21st Century Oncology will pay $26 million to settle DOJ charges that it submitted fraudulent Meaningful Use documentation and paid its doctors to refer patients to its lab and radiation businesses.
  • CliniComp sues Cerner for infringing on a 2003 patient right after it loses its challenge to the VA for choosing Cerner in a no-bid contract.
  • The White House leads a half-day introductory meeting on EHR interoperability.


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

Acquisitions, Funding, Business, and Stock


Ability Network raises $545 million in debt financing.


Cigna acquires health plan digital engagement platform vendor Brighter. The price was not disclosed, but the company had raised $49 million in funding and had apparently pivoted from its original business of offering an online marketplace for discounted dental care.


The Department of Defense chooses McKesson to provide a $400 million digital imaging network.


  • Memorial Hospital (IL) will switch from Meditech to Cerner in January 2018.
  • Mountain View OB-GYN (PA) will replace EClinicalWorks with Epic’s ambulatory EHR in 2018.
  • Medical Specialists of St Luke’s (MO) will replace EClinicalWorks with Cerner’s ambulatory EHR in June 2018.
  • Fillmore County Hospital (NE) will move from NextGen to Cerner’s EHR in 2018.
  • Cass County Memorial Hospital (IA) went live with Epic in November 2017.

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



John Halamka, MD, MS is installed as Harvard Medical School’s first International Healthcare Innovation Professor, where he will focus on emergency medicine.

Announcements and Implementations


Microsoft announces a private preview of an AI-powered healthcare chatbot project, with partners including Aurora Health Care and UPMC.


Geneia will integrate its cost and quality analyics solution with Salesforce Health Cloud.


In South Australia, a clinical hematologist from Royal Adelaide Hospital – testifying at a coroner’s inquest into the deaths of several patients who were underdosed on chemotherapy – warns that a problematic Allscripts rollout has caused the planned 2009 implementation of electronic chemotherapy ordering to remain on hold, exposing patients to the risk of error-containing handwritten orders.


Weird News Andy says there’s a very dark comedy somewhere in this story. Organizations that offer doctors hands-on training sessions involving cadavers sometimes hold them in hotel ballrooms – including those of Disney, Hilton, and other big names — with a few sheets of plastic laid over the carpet to catch the inevitable spills and flying bone fragments. Reuters reporters saw cadavers being delivered via the hotel’s main passenger elevators, gore-covered doctors wandering hallways trying to find someplace to wash their hands, conference organizers setting up snack stations near the cadavers, and vacated ballroom trash cans overflowing with bloody materials and used syringes. Doctors are cutting downstairs and amateur porn auteurs are filming in the rooms, so don’t crawl on the carpet or use the comforter as a blanket.

Sponsor Updates

  • Liaison Technologies leads the market in data regulatory compliance with its award-winning Alloy platform.
  • Huffington Post profiles TriNetX.
  • ZirMed’s Crystal Ewing joins the WEDI 2018 Board of Directors.
  • PM/EHR vendor Chart Talk will offer its users patient engagement and communication capabilities from Solutionreach.

Blog Posts


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


Morning headlines 12/15/17

December 14, 2017 Headlines 1 Comment

Software firm protests upgrade contract for UI’s Chicago med school

Cerner is protesting the University of Illinois medical center’s decision to award Epic a $62 million, seven-year contract.

21st Century Oncology To Pay $26 Million To Settle False Claims Act Allegations

21st Century Oncology will pay $26 million for fraudulently attesting to Meaningful Use, noting that “its employees falsified data regarding the company’s use of EHR software, fabricated software utilization reports, and superimposed EHR vendor logos onto the reports to make them look legitimate.”

120 people affected in health IT company Georgia facility changes

Greenway Health announces that it is laying off 120 employees and closing its Atlanta and Carrollton, GA offices as it moves to consolidate its headquarters in Tampa. UPDATE: the local paper reporting this news has updated its story. Greenway is eliminating some jobs at the Carrollton office, but it will remain open.

Preliminary Survey Findings: Impact of the Trump Administration on Health IT and Is Health IT in a Bubble?

A Health Growth Partners survey investigating the Trump Administration’s impact on health IT finds that 72 percent of respondents do not feel that the current administration has had any impact on business.

News 12/15/17

December 14, 2017 News 11 Comments

Top News


Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health, which uses both systems.


Cerner says its bid was lower and that it was not allowed to demonstrate its product during the selection. It also says that UI Health hired as its IT selection consultant Impact Advisors, which it says could benefit from an Epic selection, a charge Impact Advisors denies in saying it works with clients of all three UI Health bidders (Epic, Cerner, and Allscripts).

UI Health chose Epic in September 2017 with plans to replace systems from Cerner, Allscripts, and McKesson in a late 2019 go-live.

The health system responded to the protest by saying that it has experienced Cerner problems in the past; that Epic beat Cerner on RFP scoring; and Cerner wasn’t invited to do a demo because it failed a technical review.

UI Health says it twice tried to roll out Cerner ambulatory and failed both times due to system performance problems that it claims Cerner has admitted. It also notes that Cerner is ranked well below Epic by KLAS. Cerner pointed out that its academic medical center market share is significant and raises the question of how it failed the technical review, noting also that UI Health hasn’t upgraded its systems per Cerner’s recommendations.

Reader Comments


From Considerable Girth: “Re: White House EHR meeting. It’s interesting that as it was happening, the VA seemed to be digging deeper into Cerner’s interoperability capability as their planned contract signing data passed. Could it be that Cerner downplayed the idea of interoperability to make the case that the VA’s only hope of connecting to the DoD was to also buy Cerner? Rumor is that politicians and even some White House folks are puzzled at how Epic has connected to dozens of VA and DoD sites and 100 percent of Epic sites that are interested in sharing information.” Unverified. The VA, which planned to have its fast-tracked, no-bid Cerner contract signed by now, seems to be suddenly realizing that theoretical interoperability with the DoD and community-based providers isn’t necessarily a reality. That’s the kind of information that should have been fleshed out in performing due diligence, dictating strong contract terms, and convening stakeholders to define mutually agreeable goals, all of which seemed to have been skipped in the VA’s White House-pressured rush to sign a Cerner contract. Both the VA and DoD have awful track records in choosing, planning, and executing IT contracts and allowing cash-flush vendors and consulting firms to pull wool over their eyes, so somehow I don’t think everybody (especially veterans) lives happily ever after just because Cerner is running in both places. I have heard speculation from a couple of folks that Cerner might have de-emphasized interoperability to the VA to make its product seem like the only logical choice for connecting to the DoD, and while that’s just talk, the VA seems to be parroting that concept.


From Gert: “Re: MedKeeper. Was recently acquired, but the mystery is who bought them.” Unverified. The IV workflow technology company lists no press contacts or other ways to reach it beyond product sales or support, so I couldn’t ask.

From FormerCIO: “Re: Dirty Dirge’s data on CHI is incorrect – they have only 103 hospitals and the allocation of systems is also incorrect.” I don’t have access to the Definitive Healthcare database to which that reader referenced, so I can’t say, although he or she seemed pretty solid on the details.


From Bet on Black?: “Re: Allscripts. Paul Black claims 1 billion third-party API calls to Allscripts in 2017. Vendors such as Athenahealth, Epic, Cerner, and Meditech – what is your apples-to-apples comparison?” That’s an interesting question, although the admirable “openness” could be a measure of the business necessity of supporting a narrower product line. It also depends whether common integration – such as simply displaying another company’s external clinical reference information via an Infobutton – should be counted vs. sharing data with actual transaction systems. Or for that matter, if transaction count in general is more a function of client volume than technical capability. Putting out a press release invites competitive comparisons. UPDATE: Epic says they’re handling 900 million transactions per month via public APIs, 415 million per month to power customer-developed services, and 21 billion connections to/from Epic-provided services (such as mobile apps and MyChart). So we have Allscripts at 83 million transactions per month to external systems and Epic at 1.3 billion – Cerner, Meditech, and Athenahealth, you’re up, at least if you believe that interoperability is about competing vendors rather than simply being happy that the market has demanded and received API access to EHRs.

HIStalk Announcements and Requests


Welcome to new HIStalk Gold Sponsor Formativ Health. The company’s technology-agnostic patient access, revenue cycle, and practice operations services help patients feel like people and helps providers streamline operations, reduce leakage, improve insurance verification, and empower physicians to focus on keeping patients healthy. The 10-state, 450-employee company, based in New York City and a spinoff of Northwell Health, serves 3.5 million patients. It was selected a couple of months ago to provide management services to independent physicians via the Pennsylvania Medical Society’s Care-Centered Collaborative. Thanks to Formativ Health for supporting HIStalk.

This week on HIStalk Practice: 21st Century Oncology again finds itself in hot legal waters. HHS announces opioid code-a-thon winners. Clinicient acquires Keet. Infinity Behavioral Health Services acquires Health Assets Management. Greenway announces Georgia closures, layoffs. Alivio Medical Center joinsVillageMD. The FTC warns privacy-conscious consumers about at-home DNA testing kits. PRM Pro Jim Higgins shares five technological advances improving primary care communication.


I sometimes cringe upon reading negative comments left on my annual Reader Survey, no different than a mother being told by a stranger that her child is ugly. Still, I take some comfort in the many positive observations and the fact that even critics are apparently still reading HIStalk despite the flaws they perceive. I spend many hours each day writing it and ask only that you spend maybe three minutes completing the once-yearly, one-page survey to provide hopefully constructive input. You get the pride of participating in the democratic process, the satisfaction that you didn’t have to wait in a freezing voting line, the freedom from being harassed at the polls, and the hope of winning a $50 Amazon gift certificate. I’m secretly hoping that the Russians try to rig the vote.


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

Acquisitions, Funding, Business, and Stock


The struggling Lifespan (RI) and the struggling GE (in the form of GE Healthcare) will collaborate in trying to save the health system $182 million over six years by identifying inefficiency using “cutting-edge analytics and tools.” Recently tanking GE shares are trading at their 1997 prices after a couple of bursts of misplaced investor enthusiasm, the Dow’s biggest loser since 2001 when Jeff Immelt took charge.


One-time high-flyer Greenway Health will close its Atlanta and Carrollton, GA offices in January and lay off 120 employees there as it moves operations to its Tampa, FL location. Greenway announced in October that it would merge functionality from all of its EHR/PM products into a next-generation product, but also said at that time that it would leave customer support intact in Carrollton while moving some functions to Tampa. The company was ironically recently named as Atlanta’s “Top Workplaces 2017” by the Atlanta newspaper. Greenway Health was created in 2013 as a repackaging of three holdings of its new private equity owner – publicly traded Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. Vitera was formerly Sage Software, which had purchased the former Medical Manager PM/EHR from Emdeon. Carrollton, population 25,000, is now stuck with an albatross of a street name since the soon-to-be vacated Greenway headquarters building sits on a street also named Greenway. UPDATE: the local business paper’s report that I cited was incorrect and has been updated. Greenway is moving some jobs from Carrollton to Tampa, but that office will remain open. More information is in the 12/18 Monday Morning Update.


New York EHealth Collaborative chooses Verato’s Auto-Steward for automating the correction of MPI patient mismatches on the SHIN-NY HIE.

In Canada, six-hospital CHAMP will implement Meditech’s Web EHR.



Peter Pronovost, MD, PhD — Hopkins Medicine SVP for safety and quality and perhaps healthcare’s most influential quality expert — will join insurer UnitedHealthcare as SVP of clinical strategy.

Announcements and Implementations


The HIMSS-owned Personal Connected Health Alliance releases new Continua Design Guidelines that support patients sharing data with providers.

Meditech will offer the patient electronic signatures solutions of Access in its cloud-based Web EHR subscription offering.

Government and Politics


Florida-based cancer treatment center operator 21st Century Oncology will pay $26 million to settle federal charges that submitted false Meaningful Use attestations that included falsified EHR usage data and phony utilization reports onto which it Photoshopped EHR vendor logos. The settlement also covers whistleblower-reported alleged Stark Law violations involved with paying doctors based on how many patients they referred to company-owned labs and radiation centers. 21st Century Oncology filed Chapter 11 bankruptcy earlier this year to protect itself from creditors and several fraud lawsuits.


A Chicago Tribune report finds that medical regulation is so lax in Illinois that “even the most desperate of doctors can find financial reward,” pointing out the fraud-filled home health industry that finds it easy to swindle Medicare and Medicaid. It notes that anyone can start a home health business by just paying a $25 license fee with no criminal background check required, leaving them free to troll public areas to recruit patients which, under Medicare rules, don’t have to be certified for care first.

HHS OIG approves a small pilot project in which medication management pharmacists employed by a Medicare Advantage plan will receive real-time discharge information from the hospital’s EHR to help reduce readmissions, which OIG says won’t run afoul of anti-kickback rules.


A former Johns Hopkins Health System patient appointments supervisor files a False Claims lawsuit claiming that he was ordered to “fill the plane” with patients from outside Maryland to skirt state limits on revenue paid by residents. The plaintiff says the health system’s medical concierge service prioritizes appointments for out-of-state patients as directed by top brass.

The FCC, as expected, reclassifies broadband providers as information services rather than telecommunications, reversing its 2015 ruling and freeing those companies from FCC oversight and thus allowing them to selectively prioritize or price traffic to any given website as long as they disclose their practices. Several states have already announced lawsuits challenging the decision. The broadband providers have declined to promise that they won’t do exactly what everyone fears, and unlike money-grabbing cable providers that can be easily fired, there’s no much of a cord-cutting option for the Internet unless you count cellular data. The only tiny consolation is that they didn’t abuse their customers too much before 2015, but that was a long time ago in Internet years.



Eighty percent of the 500 C-level health IT executives surveyed by Healthcare Growth Partners report no impact on their business from the Trump administration’s activities and potential ACA changes, although the report notes that provider IT capital budgets were already in place for 2017 by Election Day. The number of executives who believe health IT is in an investment bubble increased from to 36 percent from 29 percent on 2015.

In Scotland, outpatients at Glasgow hospitals miss 12 percent of scheduled appointments, with 20-something men being the least reliable. NHS Greater Glasgow plans to enhance its automated text and call reminder system to require patients to respond to prevent their appointment from being given to another patient.


Texas medical resident Rachel Pearson, MD/PhD pens an Onion-worthy letter to the editor of a magazine, complaining that none of her patients have worked a day in their lives, they are ungrateful, they vomit and pee on her, and they have to be bribed to be examined. It’s a tongue-in-cheek reference to the still-unfunded federal CHIP program that insures most of her pediatric patients.


A hospital in China suspends a radiologist after she is caught on video playing a phone game while performing a CT scan.

Sponsor Updates

  • AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.
  • Spok publishes an explainer video for its Care Connect product.
  • Medhost customer Mt. San Rafael Hospital (CO) becomes one of the country’s first to meet MU Stage 3 objectives.
  • Liaison Technologies awards its second Data-Inspired Future Scholarship to AI-focused high school senior.
  • Leidos Health publishes a white paper titled “From Good to Great: Strategic EHR Optimization Can Get You There.”
  • Clinical research network TriNetX adds Natural Language Processing to extract information from physician notes and clinical reports, link it to other EHR data, and then present the combined information to researchers who can then design studies and identify potential patient participants.
  • Logicworks launches targeted professional services portfolio for AWS.
  • PokitDok becomes the first healthcare technology company to achieve CAQH CORE Phase IV Certification.

Blog Posts


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


EPtalk by Dr. Jayne 12/14/17

December 14, 2017 Dr. Jayne 1 Comment

When we think about healthcare IT systems, I think most of us probably overlook some of the quasi-healthcare vendors that patients have to deal with to handle their medical bills. A friend vented to me about his company’s choice of a new benefits administrator, which needs to use to access his flexible spending account. This is the same company his employer used in the past, but switched to another benefits administrator last year, and is now switching back to the first one.

He received a message to establish his account to be ready for 2018, but when he tried to execute on it, he received a duplicate warning and was referred to customer support. The site then generated a password reset link, which didn’t help him due to the duplicate accounts. After opening a second help ticket, he received a secure message notification in his employee email, which required him to create a secure messaging account on the benefits website, using his work email as the user name and creating a new password.

Despite having the same login as the benefits site (as well as the same look and feel) the secure messaging portion of the site is entirely independent, and the messages he had been sent were not useful. Returning to the benefits site, he tried again to have his account unlocked, and four days later, finally received a secure message that his duplicates were resolved.

Once he was able to access the benefits site, he discovered there is no linkage to the secure messages from that side either, so users have to go in and out of two different systems if they need customer support. I’m going to go out on a limb with the idea that maybe this is intentional, since money left in flexible spending accounts is forfeit if not used. If the system is difficult to navigate, there’s a chance it will prevent employees from using their benefits.


Speaking of difficult to navigate, I tried to complete my HIMSS18 registration today since the early bird discount is ending. It kept replacing the name of my company with “DX” for no apparent reason, forcing me to log in and out a couple of times. I also had trouble getting the name badge fields to correctly show my city, since I wanted it to display Big City instead of Nameless Suburb in the field. I finally gave up and will try again tomorrow. It looks like my hotel of choice is sold out, so I’m glad I made my reservations a couple of months ago.

I’ve already started building my agenda for the week, including at least one BFF Booth Crawl. Although I’m not fond of Las Vegas, I do enjoy catching up with my healthcare IT friends. For the third year HIMSS is hosting a reception for Millennials. I’m tempted to sign up just to check it out and see how the conversations differ from the other events such as the Women’s Networking reception. I’m too old to pass for a Millennial, but I bet I could pass for a hip older coworker.


It’s the time of year when holiday cheer abounds. I was surprised to receive a notice about the American Medical Association’s “Joy in Medicine” modules and the fact that the American Board of Family Medicine is going to provide Performance Improvement Credit for providers who complete them. I’ve focused most of my Maintenance of Certification and Continuing Medical Education activities on being a competent, compassionate, and culturally-sensitive physician and have completed more than enough credits for 2017. The idea that physicians need to complete coursework to learn how to find the joy in medicine again is a sad commentary on healthcare today. The course is promoted as having tools “to guide the executive leadership teams in creating a joyful practice environment and thriving workforce.”

I gave it a glance, and it does touch on physician burnout but not on the high rate of physician suicide – I guess that wouldn’t be very joyful, but it is a reality. I’ve lost two colleagues with bright futures to suicide and agree that we need to have better support structures, not only for physicians, but for all caregivers and people trying to work in our crazy healthcare system. The module advocates creating a “wellness infrastructure” with a chief wellness officer reporting directly to the CEO or equivalent to other leaders such as the COO or CMO “and is resourced accordingly.”

It goes on to say that “this leader should ensure all leadership decisions consider the potential effect on workforce wellness.” Even though it offers a calculator to estimate the true cost of physician burnout, I don’t see this playing in most of the arenas where physicians are employed. Especially in the under-20-provider practice, it’s going to be hard to create that infrastructure. I’m working with a five-doctor group now that can’t even agree on how overnight call should be distributed, so getting them to have a conversation on workforce wellness would be quite the trick.

Speaking of pipe dreams, Aetna wants to create a healthcare hub at CVS pharmacies to help patients navigate the healthcare system. Likening it to Apple’s Genius Bar, Aetna CEO Mark Bertolini explained it as a cross between the Patient-Centered Medical Home model and a retail establishment where people can walk in and get help.

It’s this kind of over-simplification of patients’ true needs that gets my blood pumping. The infrastructure required to truly make this work is vast, and although CVS trots out its MinuteClinic retail clinic sites as part of the solution, it’s more complicated than it seems. My practice sees many patients who are beyond the narrow care protocols in place at MinuteClinic, and the referral of their patients to a second visit at Urgent Care actually adds to the healthcare system. Do we really think that CVS is going to triage customers away from its clinics to competitors, or are they going to try to expand into the primary care and urgent care space? Or do as they do, and see the patient first, then refer to a higher level of care? Will they send the patient to their primary care physician or offer to sell over-the-counter remedies? I’m hoping the former, but since retail profits are important, the balance might be tricky.

The simplicity of comparing healthcare to the Apple Store also masks the complexity of patients. Where Apple offers service on a set number of products, the number of “models” walking into a healthcare environment is infinite. Although basic processes can be put into place to handle subsets of patients and conditions, I hope CVS and Aetna folks truly engage with their stakeholders to create the model. First and foremost, this needs to be about doing what’s right for patients rather than shareholders. I’ll remain skeptical until I see drafts of their pilot plans. Or, if they’re looking for an anonymous physician blogger to give them advice, I’m available.

What do you think of the Aetna/CVS merger? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/14/17

December 13, 2017 Headlines No Comments

This Startup Wants to Democratize CRISPR Gene Editing Research By Making It Free

A Venrock-backed startup called Inscripta is releasing an alternative CRISPR-Cas9 enzyme that scientists can use for free to conduct research. CEO Kevin Ness reports, “You can go right to the website, download the sequences instantly, even get a user guide.”

A health care paradox: measuring and reporting quality has become a barrier to improving it

A STAT opinion piece explores the conflicting dynamic between “patient-centered care and the administrative burdens that measurement imposes on physicians, hospitals, and health systems.”

New CDC head faces questions about financial conflicts of interest

CDC Director Brenda Fitzgerald recuses herself from decisions involving health IT and cancer detection because her and her husband are legally required to retain equity in companies involved in both markets.  Senator Patty Murray (D-WA) is questioning her ability to function in her role if she is unable to engage in conversations around cancer care, the second leading cause of death in the US.

Email is the biggest source of data breaches

A new survey finds that email is the leading cause of data breaches in healthcare, contributing to 73 breaches thus far in 2017, affecting 574,000 people.

HIStalk Interviews Eric Ritchie, COO, Minnie Hamilton Health System

December 13, 2017 Interviews No Comments

Eric Ritchie is COO of Minnie Hamilton Health System in Grantsville, WV.


Tell me about yourself and the organization.

We’re a Federally Qualified Health Center that owns and operates a Critical Access Hospital and rural health center in Grantsville, West Virginia. It’s an unusual designation, only of about one of three in the country where an FQHC owns and operates a Critical Access Hospital. I’m originally from the area that we service.

Minnie Hamilton has been operating this way for approximately 21 years. We operated as a standalone clinic prior to 1996 before taking over responsibility for the recently-closed Calhoun General Hospital, which had serviced the area prior to that for the previous 30-plus years.

What are your biggest challenges in running the health system?

The biggest challenge is definitely related to our rural location. We service an area that doesn’t have a lot of industry — actually it has no measurable industry — so it is an aging population. A lot of the younger generations, to provide a lifestyle for themselves, move beyond our service area. Our average patient age goes up every year, according to the demographic.

The lack of infrastructure that comes with being in rural West Virginia makes it challenging. Your patients have difficulty getting out to get their healthcare needs satisfied. When they do come to our facility, if they need a more specialized facility or a bigger hospital, there’s always a logistical challenge getting them out in a timely manner to meet those emergent situations.

The rural location is probably our number one biggest challenge and the disadvantages that come with that. Definitely in the state of West Virginia, it’s well-documented that our infrastructure, from an IT standpoint, is challenged. We also deal with that as well.

What are your most significant IT systems?

When we selected Athenahealth as our EHR, it was our goal to try to get it all under one umbrella from an IT standpoint. Athena is primarily it. We have standalone dental software that runs our dental clinics. We also operate a long-term care facility that has its own system. Beyond that, it’s just our traditional phone system. We have a partnership with Microsoft that we leverage their Office suite free of cost because we’re a not-for-profit.

What are you doing with population or community health?

We are the continuum of care for most of our patients. We put a lot of focus on identifying, as our patient demographic ages, what their predictable needs will be in the coming years. As a facility, we have evolved over the last 20 years, as our demographic has aged, to make sure that we are providing services that prevent them from having to make that hour, hour and a half commute.

A big population in our area has diabetic needs, so we’re looking at what’s coming down the pike. A need for dialysis, more so than there is right now. That was the reason why we opened the dental clinic, to address the younger population that does exist. The long-term care was another one of those solutions.

We have a pretty simple formula. We do quarterly analysis on the referrals that we are having to send out to other facilities because we don’t provide a service. When we see a need rise up to the level affecting a measurable percentage of our population, we start exploring ideas on how to bring that service here locally, whether it’s something that we provide under our umbrella or that we simply provide space for another entity to come in and perform those services here.

You are surrounded by WVU Medicine and the trend nationally is that the big systems are getting bigger. How do you see the future of Critical Access Hospitals, both in West Virginia and across the country?

It’s very interesting and a popular topic among the Critical Access Hospitals when they get together and talk. In West Virginia, we see two predominant, large entities that are acquiring Critical Access Hospitals. WVU Medicine to the north, which is acquiring different practices up there, and then Charleston Area Medical Center to the south.

We have a good relationship with both. Right now we’re partnering with WVU Medicine, where they are sending specialists to our facility to hold office hours. They take care of the billing, so they’re not working under the Minnie Hamilton umbrella, but they are bringing much-needed services to our areas, eliminating the need for our patient population to drive extended miles to receive that service.

It really comes down to, in our experience, open communication. This is what our needs are. This is how we can help each other. Our loyalty stops at our patient population, so whatever is in the best interest of that patient population, we are going to use that as our guiding light to determine how we should move forward.

There’s always a balance where a big health system could provide resources, but they if they were to acquire the hospital, they might decide it’s not worth keeping open or they might not respect its original mission.

Based on the conversations that we’ve had with those larger entities, I think there is a real shift in the view of how a larger entity partners with a Critical Access Hospital. Our patient population is predominantly Medicare or Medicaid. That’s a financial benefit for us because of being a Federally Qualified Health Center. It doesn’t make as much sense financially for a bigger entity to become servicing a population that is predominantly Medicare or Medicaid.

What everyone is starting to realize, or at least in our experience, is that it makes more sense if we can provide the care here locally and keep that patient population close to their home place. But we are dependent on those bigger entities to provide the knowledge and the skill sets. Rather than taking over and starting to operate a Critical Access Hospital under their umbrella, I think it benefits them in the long run if they can simply be recognized as a partner to an existing Critical Access Hospital who is servicing the rural part of America. But at the same time, not overwhelming their own systems with a patient population that they can’t handle.

They want those beds. They want the ability to make sure that care is being provided. But they can’t afford to continue to expand and just increase their bed count. It makes more sense for a standalone entity like Minnie Hamilton to take care of the daily, routine illnesses or chronic illnesses that can be monitored and managed. When that special occasion comes up that exceeds our skill set, we have a direct line to a solution that can come and be a part of that care team.

The advantage big systems have is that they have other sources of revenue, while you are at the mercy of what happens in Washington, DC.

You really are. That is a burden carried by all Critical Access Hospitals. Even the bigger entities have that concern, but our reimbursement and our ability to remain operational goes as Congress and the legislature decide to fund the healthcare programs. We can in no way be profitable without that federal supplement. We just don’t have the volume to generate the revenue that’s required to run the facility as we have it set up now.

The alternative is that if a facility like ours ceased to exist in our service area, we’re looking at a two-hour time lapse for an emergent situation. We all know what numbers end up being when you’re taking 120 minutes to respond in an emergent situation.

Government officials, elected officials, those bigger entities all want to be a part of a solution that allows rural America to continue to be served by a staff capable of taking care of an emergency situation, as well as those that have chronic illness or the routine acute type settings. So they aren’t required to travel an hour and a half or  two hours for care.

You had some previous problems with revenue cycle management and the cost of your IT systems. What are the lessons learned from that experience?

With a smaller entity like Minnie Hamilton or many of the Critical Access Hospitals, you need to stay very current on the rules and regulations governing reimbursement. Insurance companies continue to become more and more business-like in the sense of identifying ways and criteria that all of us have to be well-versed in and know how to apply it to maintain a level of reimbursement that we have historically experienced.

One of the ways that Minnie Hamilton is navigating that right now is that we’re making sure that we partner with vendors that bring something to the table with regards to knowledge of those ever-evolving rules and regulations. We feel it’s best for us not to bear that responsibility solely by ourselves. There’s just too much at stake.

You make partnerships. You look for vendors who have a vested interest in not only understanding those rules and regulations, but helping you as the client understand those rules and how best to leverage them. Keeping you compliant with the ever-changing regulations that are being passed down annually, whether it’s MIPS, MACRA, UDS reporting, or HEDIS reporting. For us, that is the guiding principle behind identifying possible vendors and then ultimately selecting vendors. That has to be a component of that relationship.

Given the challenges your health system has, what makes you want to keep coming to work every day?

We’re fortunate at our facility because we’re smaller. Our executive team at Minnie Hamilton all grew up within 30 miles of this facility. The patients we are serving are our family members, extended family members, or friends of family members. It’s easy for me, and really all of our staff, to recognize why we do what we do and why we deal with the headaches that we deal with.

In my experience in West Virginia, even in the bigger entities, a lot of the folks that I deal with on a daily or weekly basis are from the area or are from areas that have a lot of similarities to the demographic makeup of the state. At the core, almost anyone I’ve met in healthcare started out at more of an introductory level. At the heart of it, they’re motivated solely by that moral compass of just wanting to do right by the patient population.

Morning Headlines 12/13/17

December 12, 2017 Headlines 1 Comment

Health IT company that sued VA goes after Cerner’s patents

Following a failed legal attempt to block the VA’s no-bid Cerner deal, CliniComp is now suing Cerner directly, citing patent infringement of a 2003 patent that describes remote hosting of a hospital IT system.

Aetna wants to create a ‘Genius Bar’ at CVS, and it could forever change the way Americans access healthcare

On a recent earnings call, Aetna CEO Mark Bertolini described plans to roll out CVS-based ‘health hubs’ that would provide patient navigator services. He likens the service to Apple’s Genius Bar, and explains that in this case, employees would be “preparing them for their visits, setting up appointments, eliminating prior ops, doing all those other sorts of things to help navigate that system for them.”

Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

An cross-sectional analyses of 32 deep learning algorithms designed to review pathology images concludes that seven deep learning algorithms performed better than “a panel of 11 pathologists in a simulated time-constrained diagnostic setting.”

NewYork-Presbyterian and Walgreens Collaborate To Bring World-Class Care Through Telemedicine

NewYork-Presbyterian will begin offering telehealth services provided by its ED doctors to non-emergency patients at local Walgreens.

News 12/13/17

December 12, 2017 News 5 Comments

Top News


CliniComp, fresh off its failed legal challenge of the VA’s choice of Cerner in a no-bid contract, sues Cerner for patent violation.


CliniComp says Cerner violated its 2003 patent for a remote hosted hospital system.

Reader Comments


From Dirty Dirge: “Re: big health system mergers. Who wins, Epic or Cerner?” I would instead ask whether the potential benefits of standardizing systems justify ripping and replacing existing EHRs when their sites cover a big swath of geography without much service area overlap. Maybe it’s OK to limit patient information exchange to the basics, like CCDs, since patients rarely seek care outside their local area. The most compelling argument would be populating a single database that can support analytics, operational analysis, research, and best practices, but that could theoretically be done on the back end with a lot of semantic data translation. The only comparably sized  model is the Kaiser’s use of Epic, but their implementation happened a long time ago; they have more focused corporate control than I would expect of newly merged health systems that can’t even name a single CEO; and Kaiser controls more of the patient experience as an insurer as well as a provider. Perhaps most at risk are Allscripts ambulatory or Meditech in sites included in the merger plans. My guess would be that the highest-priority system projects would involve administrative systems to allow executives to get a handle on their sprawling enterprises. We are really entering uncharted territory since most “huge” health systems have revenue of $2-5 billion vs. the dozens of billions that the proposed mega-mergers would create. Lower-tier vendors should take note – as hard as it already is to sell systems, it’s about to get a lot harder when you have to earn face time with a CIO who controls the IT strategy and budget of more than 100 hospitals (in comparison, Kaiser has only 39 hospitals).

Associate CIO provides these merger-related figures from Definitive Healthcare:

  • Dignity Health’s 48 hospitals run Cerner Millennium.
  • Catholic Health Initiative’s 153 hospitals use Cerner (61), Epic (65), and Meditech (27), also on the ambulatory side running McKesson (4) and Allscripts (21).
  • Ascension Health’s 132 hospitals use Cerner except for Providence and Wheaton Franciscan, which use Epic.
  • Providence St. Joseph’s 58 hospitals use Epic (37), Meditech (19), and Allscripts (3).

In terms of dominant vendor in the two proposed mega-mergers, it’s obviously Cerner over Epic (109 vs. 65 and 130 vs. 39, respectively). Here’s a fun opportunity for Definitive or HIMSS Analytics to list the major systems (beyond just the EHR) used by these health systems that are contemplating merging.


From Comprn: “Re: Lifepoint Health. RIF including multiple VPs, about 25 FTEs, due to lower-than-expected earnings.” Unverified. The 72-hospital company cut its revenue and profit forecasts in late October due to fewer-than-expected admissions for the fiscal year. LPNT shares are down 15 percent over the past year vs. the Nasdaq’s gain of 27 percent, valuing the company at $2 billion. It’s probably tough competing with systems bigger than yours that don’t pay taxes and that are equally profit-motivated.


From Trust but Verify: “Re: White House EHR meeting. A news site says [publication name omitted] broke the story but I saw it two days before on HIStalk.” Correct. An anonymous reader sent me the agenda via my Rumor Report online form and I posted the information in Sunday night’s post. Nobody else ran anything that I saw until at least Monday morning, so I’m pretty sure all mentions were triggered by reading it on HIStalk. One site that emailed me late Sunday ran their item (with the agenda that I sent them) Monday morning, but didn’t give credit. I’m also surprised at news organizations that cite one particular health IT website as a source when it’s pretty much like Wikipedia, with no original content.

HIStalk Announcements and Requests

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Cumberland Consulting Group’s employee volunteer and community action group donated $1,000 to my DonorsChoose project, which with matching funds from my anonymous vendor executive and other sources funded the entire cost of these projects for high-need classrooms:

  • Take-home family math activities for Ms. D’s elementary school class in Houston, TX.
  • Hands-on math games for Ms. K’s first-grade class in Indianapolis, IN.
  • Games for science game night for Mrs. S’s elementary school in Gautier, MS.
  • Microscopes, telescopes, and science kits for Mrs. B’s elementary school class in Gulfport, MS.
  • Take-home science activity kits for Mrs. M’s elementary school class in Chattanooga, TN.
  • STEM kits for Mrs. M’s elementary school class in Paterson, NJ.
  • STEM books and activity kits for Mrs. H’s elementary school class in Sugar Creek, MO.
  • Programmable robots for Mrs. G’s elementary school class in Brownsville, TX.
  • After-school science kits and supplies for Mrs. P’s elementary school class in Pocatello, ID.
  • 200 sets of headphones for Ms. C’s elementary school class in Provo, UT.
  • STEM project kits for family game nights for Ms. M’s elementary school class in Fayetteville, NC.
  • Programmable robots and a Chromebook for Mrs. G’s elementary school class in Miami Gardens, FL.
  • STEM kits for Ms. T’s elementary school class in Bronx, NY.
  • STEM project kits for family game nights for Mrs. H’s elementary school class in Canyon, TX.
  • Programmable robots for Mrs. F’s high school class in Glen Dale, WV.
  • STEM activity kits for a student-led STEM gender and ethnic diversity project of Mrs. I’s high school class in Orangeburg, SC.
  • Math and science resources for Ms. S’s first-grade class in Dayton, OH.
  • Headphones for the technology lab of Ms. W’s elementary school class in Memphis, TN.


Can you please take 3-5 minutes to complete my once-yearly, one-page HIStalk reader survey? I’ll use the results to plan for 2018, but if you need even more motivation, I’ll be randomly drawing respondents to win a $50 Amazon gift card. Thank you.


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

Acquisitions, Funding, Business, and Stock


Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.


Physician scheduling system vendor QGenda acquires ED physician scheduling software vendor Tangier.


Aetna CEO Mark Bertolini tells investors that he envisions that a merger with CVS would allow placing health hubs in pharmacies that would serve as health system navigators, especially for the 60 percent of people who don’t have a regular doctor. He says it could work like the Genius Bar in Apple Stores.


Nashville-based health IT staffing firm ALKU acquires Holland Square Group, a health IT consulting firm also based in the Nashville area. Holland Square Group is a DoD MHS Genesis subcontractor under Leidos.



OhioHealth (OH) chooses Casechek’s implant supply chain automation.



Hans Morefield (Experian) joins substance use disorder technology vendor Chess Health as CEO. The company’s executive chair is industry long-timer John Holton.


CTG hires Jeff Gerkin (Manpower Group) as EVP of sales.


Brett Jarvis (LinkedIn) will join Solutionreach as SVP of customer success.

Announcements and Implementations


Mental and behavioral screening software vendor AssessURhealth offers its app on the Athenahealth Marketplace.


New Jersey’s state medical society brings its OneHealth New Jersey HIE live.


Legacy Data Access will offer its 800 hospital customers a hosted, AI-powered clinical data service in partnership with Life2.


Firelands Regional Medical Center (OH) goes live on Meditech’s Web EHR.


New York – Presbyterian installs telemedicine kiosks in some of its New York-based Duane Read drugstores, making its ED doctors available to review problems that are not life-threatening.


Ground was broken this week on what would have been Cerner CEO Neal Patterson’s 68th birthday on the Patterson Health Center, a $41 million critical access hospital on the Kansas-Oklahoma border that is mostly funded by the Patterson Foundation. The facility, which combines two existing hospitals that merged on November 1, will offer a 15-bed hospital, health clinic, rehab services, a wellness center, and public green space. The family was represented by Neal’s nephew Alan Patterson:

Uncle Neal never really left the farm. He came back to Harper County just about any chance he had. Even after he was a big shot on the cover of Forbes Magazine, he came home at harvest to drive a combine, bring meals to the field, and hang out with the guys when the work was done. If you drove by the farm, you would often see him running the company from a laptop while sitting on the front porch of the farmhouse where he grew up. To me, he was a big kid who was 30 years older than me but enjoyed doing the same things I did. He was like another high school buddy would come back to visit his parents and hang out …  Neal traveled the world and he saw something troubling that most of us don’t see. He saw that small towns were in a healthcare crisis and they were being left behind. He saw that people in rural areas had poorer overall health compared to people in bigger communities. Little hospitals were not the most profitable areas of the business, nor the ones that would help ensure his company made quarterly earnings… but he did not care. He knew that good healthcare facilities and technology were important to rural communities

Government and Politics


A Wisconsin judge dismisses the revenue cycle system lawsuit that Agnesian Healthcare filed against Cerner, noting that Agnesian’s contract requires it to submit to arbitration in Cerner’s home state of Missouri instead of suing. Anesian claimed in the now-dismissed September 2017 lawsuit that a botched RCM conversion from McKesson to Cerner in 2015 cost it $16 million in revenue and $200,000 per month due to coding and billing errors, while Cerner insists that it fixed the problems in 2016.


CDC Director Brenda Fitzgerald is recusing herself from issues related to health IT and oncology because she is legally required to keep her illiquid investments in LLCs involving Greenway Health (EHRs) and Isommune (cancer detection). Fitzgerald – a former OB-GYN, Air Force major, and commissioner of Georgia’s Department of Public Health – and her ED physician husband reported assets valued at up to $16 million.


The New Yorker profiles “Estonia, the Digital Republic,” describing how the post-Soviet republic of 1.3 million people transformed itself into a digital society that embraces robots, a personalized chip ID, making nearly all business and personal information available online, giving every person ownership of data recorded about them, and a “once only” policy that pulls in existing information for everything from buying a house to seeing a doctor.  The country is reconsidering the definition of “population” by connecting virtual talent in an “e-residency” program that allows citizens of other countries to become residents of Estonia with access to digital services without ever setting foot in the country. Some snips from the fascinating article:

“I’ll show you a digital health record,” she said, to explain. “A doctor from here”—a file from one clinic—“can see the research that this doctor”—she pointed to another—“does.” She’d locked a third record, from a female-medicine practice, so that no other doctor would be able to see it …  E-ambulance is keyed onto X-Road, and allows paramedics to access patients’ medical records, meaning that the team that arrives for your chest pains will have access to your latest cardiology report and ECG. Since 2011, the hospital has also run a telemedicine system … Rita Beljuskina, a nurse anesthetist, led me through a wide hallway lined with steel doors leading to the eighteen operating theatres. Screens above us showed eighteen columns, each marked out with 24 hours. Surgeons book their patients into the queue, Beljuskina explained, along with urgency levels and any machinery or personnel they might need. An on-call anesthesiologist schedules them in order to optimize the theatres and the equipment … She logged on with her own ID. If she were to glance at any patient’s data, she explained, the access would be tagged to her name, and she would get a call inquiring why it was necessary. The system also scans for drug interactions, so if your otolaryngologist prescribes something that clashes with the pills your cardiologist told you to take, the computer will put up a red flag.

Privacy and Security


An Accenture-conducted, AMA-sponsored survey of 1,300 physicians survey finds that 83 percent have experienced cyberattacks and want cyber hygiene tips, a guide on conducting a risk assessment, and easy-to-understand HIPAA instructions. The survey’s methodology isn’t the best, however:

  • Respondents were apparently self-selected and only completed an online survey.
  • If only AMA members were polled (the report doesn’t say), that would be only a tiny, non-representative subset of all US doctors.
  • Respondent demographics were not provided, such as the size of their practice site or whether they work for a health system.
  • Half of respondents say they have an in-house security official, although the question wasn’t asked about that person’s time allocation and credentials.
  • More than one-fourth of responding physicians say they have outsourced security management, but the survey didn’t ask what that means.
  • More than half of respondents say someone clicked on a phishing link, which doesn’t really seem like a cyberattack unless it resulted in downtime.
  • Only 37 percent reported that an employee inappropriately accessed PHI, which is surely low.



Apple will launch the IMac Pro this week at an entry price of $5,000 for 32 GB of memory and 1 TB of storage and up to $17K for a fully loaded machine, testing the limits of just how much of an Apple tax even professional users are willing to pay. It’s not an Apples-to-apples comparison, but my Acer laptop has 16 GB, 1 TB (along with a 128 GB SSDD for running Windows 10) and cheap available upgrades and I only paid a bit more than $500. Even that capacity is excessive since nearly everything I use is on the Web.



Two-thirds of the few dozen interviewed patients who got their lab results via a clinic’s patient portal weren’t given further explanation, sending most of them to Google to try to figure out what the results mean. The article concludes that just displaying lab numbers on a portal isn’t enough, especially for patients with abnormal results.


In Canada, all-digital Humber River Hospital opens a Meditech-powered, 4,500-square-foot Command Centre in which staff monitor real-time incidents such as delayed care and provider workload issues. It also contains a 26-panel GE Wall of Analytics with live video feeds from patient care areas.


A just-published review of a 2016 Netherlands bake-off of 32 algorithms that analyze tissue slides to detect breast cancer metastasis finds that seven performed better than a panel of 11 pathologists when limited by typical workflow time constraints. The best algorithms performed equal to the pathologist panel when time constraints were removed. 


A review of 1,300 clinic visits finds that patients asked their doctors for specific lab tests, referrals, pain meds, other medication an average of once per visit; the doctor agreed to write the order for what they wanted 85 percent of the time; and those patients who were turned down gave the doctor lower satisfaction scores.


Javon Bea, CEO of five-hospital Mercyhealth (WI), was paid $8.38 million in 2016, far more than basically any charity or health system. The newest tax form I found was from 2014 and even then the CIO made over $750,000. Maybe nobody wants to live in Janesville, WI or work for Mercyhealth if they have to pay that much. Axios notes that even under his previously slightly lower pay, Bea earned $72 per patient day, although he told the local paper that his then-$3 million paycheck had no impact on healthcare costs even as he increased the system’s revenue from $33 million to $1 billion. 

Sponsor Updates

  • Spok launches a library of stories illustrating the ROI of clinical communication technology.
  • Optimum Healthcare IT completes its work as primary partner for UCI Health in its Epic Connect strategic partnership with UC San Diego Health.
  • Change Healthcare SVP of Product Development and Technology Michael Wood joins the 2018 Class of the Nashville Health Care Council Fellows.
  • AssesURHealth raises $2,700 for the American Foundation for Suicide Prevention as part of the Out of the Darkness Tampa Bay Walk.
  • Change Healthcare will integrate Tibco’s Connected Intelligence product line with its products.
  • Besler Consulting releases a new podcast, “S10 changes you should know about.”
  • Glassdoor includes CoverMyMeds in its list of Best Places to Work in 2018.
  • Diameter Health achieves NCQA Certification for all 2017 e-measures.
  • Vyne’s Trace and FastAttach solutions earn HITRUST CSF certification.
  • EClinicalWorks will exhibit at the New York Society for Gastrointestinal Endoscopy 41st Annual New York Course December 14-15 in New York City.
  • The “I Love Madison Podcast” features Healthfinch VP of Finance and Operations Leah Roe.
  • Technology Headlines Magazine names Intelligent Medical Objects CEO Frank Naeymi-Rad one of the 50 Most Admired CEOs of 2017.
  • ConnectiveRx publishes a new white paper, “Boost prescriber knowledge and confidence using in-EHR formulary-status messaging.”

Blog Posts


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Contact us.


Morning Headlines 12/12/17

December 11, 2017 Headlines 1 Comment

Hopkins taps Duke executive to head medical system

Johns Hopkins Health System names Kevin Sowers, current president and CEO of Duke University Hospital, as its next president.

More delays, cost overruns hit Vancouver electronic health project

In Canada, a local paper profiles the Cerner implementation at Vancouver Coastal Health, the Provincial Health Services Authority, and Providence Health Care, which executives say is now $130 million over budget and a year behind schedule.

HHS announces the winners of the HHS Opioid Code-a-Thon

HHS announces winners from its Opioid Code-a-Thon, an innovation challenge that attracted 50 teams comprised of programmers and public health advocates that worked together for 24 hours to create data-driven tools that could be used to combat the epidemic.

OIG Advisory Opinion No. 17-07

HHS OIG approves a pilot program that will allow a pharmaceutical manufacturer to fund and implement integration points between a community hospital and community pharmacists so that pharmacists would gain real-time access to patient discharge information.

Curbside Consult with Dr. Jayne 12/11/17

December 11, 2017 Dr. Jayne 4 Comments

At times, being a consultant feels more like being a therapist than a business person. We see clients at their best and at their worst and try to help them figure out how to replicate the good times and how to avoid repeating the bad times. Some days, I really feel for the vendors trying to work with these clients.

In recent engagements, we seem to be increasingly leaned on to try to mediate between vendors and clients or at least mitigate situations that are starting to turn bad. These situations tend to illustrate a variety of organizational pathologies, whether it’s the client and vendor not being able to work well together or the client (or vendor) having internal dysfunction.

Case in point: one of my clients hired their EHR vendor to build some content for custom clinical workflows in a specialty that the EHR vendor doesn’t support. There were plenty of meetings to define the scope of the project, outline the proposed build, obtain stakeholder signoff, etc. The vendor’s team performed the build and delivered it to the client environment for testing. While the build was occurring, the client re-prioritized its projects and failed to provide any client-side resources to perform user acceptance testing on the delivered work product.

There were a lot of back-and-forth communications that were fairly ineffective and some loud chatter at the client about whether the work was authorized or whether they were going to pay for it. The vendor was at the mercy of the dysfunctional client, with time spent creating templates and the vendor now wondering if they were going to be paid.

I worked with some of the client core team to explain that their counterparts on another team had authorized the build and had generated a work order to the vendor, based on leadership requests to enable documentation tools for that specialty so they could retire their paper charts. The core team members didn’t seem to understand that the initiative was even going on, and once they were pulled in to be a part of it, they took their anger at their peers out on the vendor. It didn’t seem like the different teams at the client site were able to realize that there might be more to the story, and my team had to step in to get them talking.

The ensuing conversations revealed that probably the not all the stakeholders were included in the project and that the templates might not meet the practice’s needs. Word on the street was that there was a good likelihood that the vendor was going to have to go back to square one.

What was really disturbing about this situation was the client’s assertion that it was the vendor’s fault and that the vendor should perform the re-work for free. The vendor’s customization team provided all kinds of documentation, meeting minutes, build specification signoff, etc. that showed client approval of the project as it moved through various process tollgates. But the people signing off weren’t the “right” people and the client failed to see that the problem was its own fault and not the vendor’s mistake.

The vendor tried to meet the client in the middle and offered a 50 percent discount on the services needed to restart the project and ensure the newly-identified “right” resources were involved, as a gesture of their partnership, but the client dug its heels in and refused to participate until the vendor agreed to perform the as-yet-undefined future services for free.

I can’t fault the vendor here. What the client did is tantamount to ordering something at a restaurant, eating the whole thing, and then deciding it wasn’t what you wanted or that it wasn’t any good. Even worse, instead of asking for a different entrée, you ask for the restaurant to agree to give you however many items you might want off the menu to make up for your decision, without boundaries.

From a business perspective, it doesn’t make sense, but the client continued to push it despite the vendor’s willingness to meet them halfway. The client continued to behave badly, trotting out the threat that maybe they should consider a different vendor since their current one didn’t offer the specialty in question. The vendor reacted as expected, explaining that they’ve never claimed to support that particular specialt, and had worked diligently to meet the client’s needs. The client wasn’t having any part of it, though, and continued to assert that everything was the vendor’s fault.

Since my team was hired to implement the new specialty, I had a vested interest in getting the client to get on board with what the vendor had proposed as a remediation strategy. There were several 1:1 conversations with various client leaders and managers to try to get them to understand what had happened to date in a neutral conversation without the finger-pointing and blame-laying that we might see in a group discussion. Then I tried to bring them to the table to discuss it as a team and to figure out how to move forward.

Meanwhile, the implementation timeline continued to slip as did the practice’s confidence in the ability of anyone to get them onto the system with the rest of their colleagues. The group meeting was a lesson in coaching angry people how to have a productive conversation to move an initiative forward, regardless of how they felt about it or whose fault they thought it was. I was having flashbacks to the behavioral therapy components of my residency training. We would agree to baby steps to move the project forward and then someone would say something that inflamed someone on the other side of the table and we would take two giant leaps backwards.

Eventually we agreed to have the physicians in question take a look at the workflows that had been created and identify how far off they were from the mark. Since at least one of the physicians was involved in signing off on the build, I hoped they were at least partially usable. It turned out they just needed a few tweaks and the creation of one additional workflow for a clinical scenario that wasn’t represented in the original set, and due to the small amount of work needed, the vendor offered to do it for free just to get things back on track. Still, it was a tense four weeks as we tried to work this out, and previously decent relationships were damaged without good reason.

As painful as situations like this are, as a consultant, they are our bread and butter, not only because we can help resolve the situation, but because they identify future work that needs to be done. In this case, there clearly needs to be a review of how they want to onboard new specialties and how stakeholders will be identified when custom content is requested. There also needs to be discussion about how these projects will be socialized by the leadership team to the management team and whether certain criteria need to be met for them to move forward.

We’ll see if they want to engage with a formal project in this area, but due to the budget constraints many organizations face, there’s usually not a lot of money for process initiatives because they’re sometimes considered “soft skills.” I guarantee that what they would spend on a small process project would still be less than the cost of the delays, wasted time, and loss of forward momentum exhibited here.

A new fiscal year is coming, so we we’ll see if it makes the budget.

Have any stories about “soft skills” projects your company needs but continues to avoid tackling? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/11/17

December 10, 2017 Headlines No Comments

The White House will convene a meeting on EHR interoperability this Tuesday

Jared Kushner and CMS Administrator Seema Verma will chair a half-day session that addresses interoperability, authentication, and accelerating progress.

Philips expands its Population Health Management business with the acquisition of VitalHealth

The Netherlands-based, 200-employee population health management software vendor was co-founded by Mayo Clinic and Noaber Foundation in 2006.

Hospital Giants in Talks to Merge to Create Nation’s Largest Operator

Ascension and Providence St. Joseph Health are reportedly discussing a merger that would create a 191-hospital system with $45 billion in annual revenue.

Historical Perspective on Health System Modernization Contracts and Update on Efforts to Address Key FITARA-Related Areas

A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA.

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Reader Comments

  • Money Doc: Come on, Dr. Nguyen. You are talking about "lost revenue" but you don't worry about gaps in patient care? Are you reimbu...
  • Anonymouse: You are ultimately responsible for not properly vetting your provider and signing the contract that probably states the ...
  • Conrad Black: That will happen at the same time my doctor starts reimbursing me for a two hour wait in his office or a mistaken/late d...
  • Conrad Black: The same people that pay for any other services/products the organization provides...
  • Anonymous: The SamSam ransomware has been around for 2 years... shame on Allscripts for not patching their main servers to allow at...
  • Anonymous Reply: Kathy: Anti-Ransomware protection?? lol, Its a joke because the programmers that are making the protection, always hav...
  • John Jones: Who pays to notify all these patients of a potential breach of their protected health information? Someone do that math ...
  • Don't think twice it's alright...: It isn't surprising that the State of Illinois procurement office rejected Cerner's shortsighted protest of Epic winning...
  • Thomas Nguyen: I am one of the many doctors affected by this. If allscripts had any ethics, they would reimburse the doctors affected f...
  • Kathie: As of August 4, 2017, hackers accounted for 75 healthcare breaches and in November 2017 Ransomware knocked out North Car...

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