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EPtalk by Dr. Jayne 9/7/17

September 7, 2017 Dr. Jayne 2 Comments


I was interested to hear of Cerner’s formation of an Advisory Group “to provide insights and recommendations in support of Cerner’s work” on the VA EHR program. Although it’s “comprised of distinguished former government, military, and private sector leaders sharing a common interest in Veterans health and wellness,” it’s lacking any “regular” veterans. My former hospital was very progressive in having patients represented on a variety of steering committees and project teams – sitting right alongside the CEO, hospital board members, department chairs, service line directors, and other stakeholders as we made a variety of decisions that impacted patient care. I didn’t fully understand the gravity of having patients (and their caregivers) on those committees until I experienced it myself. Staring a patient in the face while making difficult decisions about EHRs and the management of patient data is very different than making the decision in a room of IT experts. Even though there are distinguished veterans in the group, I would submit that the electronic health needs of the “average” veteran are different from one who is a former Senator/Governor; even though Senator Kerrey does have experience receiving care in the VA system. My local VA is seriously challenged with leadership turnovers, staffing issues, and poor patient care experiences that our veterans do not deserve. Let’s get some patients in the room and see what a difference it makes as Cerner works to move their care forward.


Speaking of patients, just a reminder that all of us will be patients at one time or another. Let’s avoid being patients with influenza – the vaccination season has already started. The CDC website has information on projected strains – my employer requires all staff members to receive a vaccination by the end of next week. The best part of being vaccinated during my last patient care shift was watching my staff decide who was going to get the short straw and have to play “pin the vaccine on the physician.” The worst part was realizing several hours later that my band-aid had fallen off and I had bled through my scrubs and white coat, probably causing patients to wonder what was going on with my arm (although no one mentioned it). The paramedic who administered my vaccine was horrified, but accepted my explanation that it was much more likely due to the daily aspirin I’m taking rather than her technique.

CMS released a new fact sheet that covers mass immunization events and so-called roster billing. Most of my experience has been with traditional office-based immunizations, but I always enjoy learning something new. Definitely something to think about for organizations who provide mass-immunizations and whose practice management or billing systems will support that type of billing.

We’re struggling a little at the office with physician coverage, as several of our physicians recently relocated with spouses that were finishing medical school or residency and moving on to fellowships or other training programs. We’ve always done our own recruiting, but are thinking about using a firm to broaden our reach. Since primary care physicians are in high demand, I often receive recruiting materials and had to bring in a post card from one recruiter as an example of why we shouldn’t consider using them. Rather than lead with the usual comments about patient volume, procedures, availability of scribe coverage, and hospitalist use, it started with “features two private lakes in a wealthy suburb.” Sure, I’d love to relax by the lake between patients, but I’m thinking it’s more likely that some copy editing is in order.


If you’re on the hospital side, CMS will offer a webinar on September 12 covering the Fiscal Year 2018 Inpatient Prospective Payment System (IPPS) Final Rule. This includes clinical quality measures for the Inpatient Quality Reporting (IQR) Program and Medicare/Medicaid EHR Incentive Programs for eligible hospitals and critical access hospitals. It’s difficult to keep up with all the changes to these programs, so having someone help digest the content might be helpful.

If you’re on the vendor side, CMS has opened the self-nomination process for vendors who might want to be recognized as a Qualified Clinical Data Registry (QCDR) or as a Qualified Registry. The window closes November 1, 2017 for the 2018 MIPS performance period. Candidates have to not only submit a self-nomination but also must email CMS when their application is ready for review. There is quite an array of registries out there, and I’ll be interested to see what new organizations come to the table and whether they’re offering anything truly unique.

Things are starting to pick up in the healthcare IT world, and the user conference season is in full swing. Allscripts hosted its clients in Chicago August 8-10, followed by Aprima, which welcomed its customers August 18-20 in Dallas. Epic will host its clients on-campus September 25-28 with a theme of “World of Wizards.” The EClinicalWorks national conference will be held October 6-9 in Dallas; following that, DocuTAP will hold its User Summit in Nashville October 10-12, overlapping Cerner, which will hold its annual conference October 9-12 in Kansas City. NextGen rounds out the season with its annual user group meeting November 5-8 in Las Vegas.


Some year I would love to take a sabbatical from consulting and just go from conference to conference to conference. Pulling off that kind of a feat would require a lot of wardrobe planning and a serious amount of shoes. The other alternative would be to work with my friends at Heelusions to accessorize a pair or two and give them unique looks for the different vendors and events. I’m impressed by their Cerner-specific creation and wonder if anyone will be sporting them in Kansas City. Brand is everything, and this would certainly let employees embrace the company from head to toe (not to mention, it’s rare to see vendor-logo footwear.) HIMSS is coming, so if you’re looking to take your shoes to the next level, you might want to check them out.

What’s your favorite vendor-logo item? What’s the worst you’ve seen? Email me (and of course send pictures)!

Email Dr. Jayne.

Morning Headlines 9/7/17

September 6, 2017 Headlines No Comments

Interoperability 2016-2017 Final Report

The National Quality Foundation issues a report on measuring EHR interoperability, as well as interoperability’s impact on “patient safety, costs, productivity, care coordination, processes and outcomes, and patients’ and caregivers’ experience and engagement,” outlining dozens of ways that interoperability could be measured and improved upon within the US.

IBM pitched its Watson supercomputer as a revolution in cancer care. It’s nowhere close

STAT investigates IBM’s failure to develop Watson into a revolutionary technology for cancer care.

Most Marketplace Plans Included At Least 25 Percent Of Local-Area Physicians, But Enrollment Disparities Remained

A Health Affairs study finds that in 2016, 60 percent of the plans available on individual exchanges included provider networks where at leasts 25 percent of the local provider community was in network, contrary to growing concerns that network consolidation would lead to restricted access to care.

Tenet selling 8 more hospitals as investors debate company breakup

Outgoing CEO Trevor Fetter announces that Tenet will sell eight low-margin hospitals , plus another nine in the UK, to help it reduce debt and appease activist investors that are pressuring the board to break the company into three smaller units.

Morning Headlines 9/6/17

September 5, 2017 Headlines No Comments

FNFV Announces Acquisition of T-System Holdings for $200 Million

Fidelity National Financial will acquire emergency department clinical documentation and coding vendor T-Systems for $200 million in cash.

Cerner Announces Advisory Group to Improve Health Care Delivery for Veterans

Cerner creates an advisory board that will guide its VA implementation, chaired by Nebraska Governor and US Navy Veteran Bob Kerrey. Former VA CIO Roger Baker, former National Coordinator for Health IT Karen DeSalvo, MD, and Jonathan Perlin, MD and CMO of HCA, are among the experts that make up the board.

Veterans Administration Awards Diameter Health and Four Points Technology to Provide Clinical Data Quality Surveillance

The VA will implement Diameter Health’s CCD Analyzer to feed data into its clinical data quality surveillance platform.

Information Is Powerful Medicine

HHS launches a campaign encouraging consumers to access and review their medical records.


News 9/6/17

September 5, 2017 News 5 Comments

Top News


Jeanne Lillig-Patterson, the 59-year-old founder of Cerner’s First Hand Foundation, died Monday of cancer less than two months after death of her husband, Cerner Chairman and CEO Neal Patterson. She was diagnosed with metastatic breast cancer 10 years ago.

Neal Patterson died July 9 of cancer complications. He was 67.

First Hand impacted 300,000 lives in 93 countries and supported health screenings and educational programs that involve one-fourth of students in the Kansas City area.

Lillig-Patterson was Cerner employee #7, earning her the internal nickname “Double O Seven.” She got the job after responding to a 1980 ad by what was then Patterson, Gorup, Illig & Associates, which hired her for her ICD-9 coding background as a hospital admitting department employee. PGI was doing contract work for non-healthcare companies when it was hired by a pathology practice, with the founders, Lillig-Patterson, and other employees scrambling to write the COBOL code that would eventually form the PathNet laboratory information system. Lillig-Patterson suggested Cerner as the company’s name in 1984 after noticing the word in a language dictionary as a group led by Neal Patterson tried to come up with something more memorable than PGI.


Neal Patterson said of her at a 1999 company event in observing Lillig-Patterson’s planned retirement from Cerner, “She has done more jobs than any single person at Cerner. Jeanne began as our office manager and accountant. She started the account manager organization. She led the team converting our entire install base to a new platform, Classic 200 to Classic 300. She started the Cerner Health Conference. She ran professional services for one-half of the United States. She helped start the client-focused team organization, which was the predecessor to the regional branches, helping to start the client services organization. In the recent era, she started the First Hand Foundation and our community relations program. Jeanne is the soul of Cerner.”


Co-founder, board chair, and interim CEO Cliff Illig said in an internal email to Cerner employees Monday, “I would remind us all of the image of Jeanne and Neal walking through a hospital lobby carrying the bags that contained all of Jeanne’s medical records to another of her hundreds of doctors’ appointments. As Neal would want us all to recognize, it’s our job to get rid of Jeanne’s bags.”

The Pattersons had two children together – Cortney and Will – as well as Clay Patterson and Lindsey Patterson Smith from Neal Patterson’s prior marriage.

Reader Comments

From Generic Substi-Tooter: “Re: HIStalk. I’ve been a reader for six years. Just wanted to let you know that I appreciate the work you’re doing. Seems like you have a small staff helping as well, so tell them to keep up the good work. You definitely catch a lot of flak from readers about Epic or Cerner bashing, which is funny to read since I’m guessing many of those come from the company that’s had the bad press.” Thanks. People sometimes think the HIStalk team is substantial, so this is a good time to recap. I write every word on HIStalk except when I take time off, during which Jenn covers for me (she also writes HIStalk Practice). Lorre does everything that doesn’t involve writing, including webinars, with occasional help from Brianne. Lt. Dan writes the daily headlines, while Dr. Jayne’s contributions run twice each week. That’s everybody, maybe three FTEs total who each do our own thing without requiring a lot of collaboration. I started HIStalk in 2003 and have been accused nearly constantly since of bashing vendors who would prefer that health IT “news” consist entirely of their shiny, happy press releases that other sites run unchallenged. Like the industry itself, HIStalk can be rough around the edges, but I don’t push back from the computer at the end of the day until I’m reasonably proud of it.


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

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

Acquisitions, Funding, Business, and Stock


Equity investor FNFV acquires ED clinical documentation and coding vendor T-System for $200 million in cash. FNFV plans “multiple acquisitions” to accelerate T-System’s growth.


In Australia, Citadel Group acquires oncology EHR vendor Charm Health from its venture capital owner.



Temple Health (PA) chooses Sectra PACS.


The VA selects Diameter Health’s CCD Analyzer to support clinical data quality surveillance.


Pharmacy benefits manager Magellan RX Management will offer its customers CoverMyMeds for electronic prior authorization.



Michigan Medicine names interim CIO Andrew Rosenberg, MD to the permanent role.


Christopher Rieder (Brookdale University Hospital and Medical Center) joins anatomic pathology practice company Aurora Diagnostics as CIO.


MedeAnalytics hires Kerry Martin (Cerner) as SVP of sales.


Jamie Coffin, PhD (SourceMed) joins genetic screening company Sema4 as president/COO.

Announcements and Implementations


Health Catalyst launches Data Operating System, the result of a $200 million development project that combines vendor-agnostic data warehousing, clinical data repositories, and HIEs into a single platform. Its attributes include reusable logic, real-time data streaming, ingestion of both structured and unstructured data, closed-loop EHR integration, microservice API architecture, machine learning, and an agnostic data lake. 


In South Korea, Gangnam Severance Hospital, Samsung, and virtual reality developer FNI will work together to developer virtual reality technology for mental health, including a VR-powered diagnostic tool.


Datica’s cloud platform for digital health apps earns HITRUST certification for security risk mitigation and PHI protection.


The executive clinic of The Greenbrier resort (WV) will partner with WVU Medicine, including adopting its Epic system.


Lovelace Health System (NM) completes its implementation of Epic.


Diagnostic imaging vendor RadNet partners with two Patrick Soon-Shiong controlled organizations – NantWorks and six-hospital Verity Health – with Verity Health taking over RadNet’s Breastlink business in California and all three organizations collaborating on clinical trials, data analytics, and AI-powered predictive modeling.


UnitedHealthcare announces PreCheck MyScript, which gives prescribers cost and coverage information at the point of prescribing and automates prior authorization for patients covered by the insurer’s health plans. The service being integrated with Allscripts EHRs and DrFirst.

Government and Politics


HHS OCR launches “Information is Powerful Medicine,” a campaign to let the public know that HIPAA gives them the right to view and obtain copies of their health information from their provider.


A New York Times report observes that HHS – which is legally responsible for overseeing the Affordable Care Act – is instead spending taxpayer money to oppose it in promotional videos and is constantly criticizing the law via anti-Obamacare tweets by HHS Secretary Tom Price. According to a law professor, “Here, it’s an agency trying to destroy its own program because it opposes it. It is inconsistent with the constitutional duty to take care that the law is faithfully executed.” The article also calls out the White House’s drastic cutback in insurer-paid funds for signup advertising and the removal of ACA information from the website.


Enteprise customer communications management solutions vendor Smart Communications will integrate its technology with Casenet’s TruCare population health and care management platform to allow health plans to deliver personalized communications to members and providers via their preferred channels.

Cerner creates an advisory group to guide its work on the VA’s EHR project, with members that include former Senator Bob Kerrey; former VA CIO Roger Baker; former HHS Acting Assistant Secretary for Health Karen DeSalvo, MD; former VA secretary James Peake, MD; and former VA Undersecretary for Health Jonathan Perlin, MD, PhD.

Privacy and Security


The Locky ransomware is being spread by a new technique in which a browser user is convincingly warned that a required PC font is missing, with the malware installing itself if the user clicks the update button.



A Boston Globe report finds that rapidly expanding for-profit hospital chain Steward Health Care System has failed to file state-required financial, quality, and merger plan information and has not paid fines that were imposed for its lack of transparency. It has also stopped providing individual hospital data. A Harvard professor says the private equity-owned chain, which is going national, might be trying to hide the reality behind its claimed turnaround of its acquired Massachusetts hospitals.

A study published in Health Affairs finds that insurance company bargaining power has lowered the cost of hospital admissions and of some physician specialties (cardiology, radiology, and hematology-oncology services) in concentrated provider markets, but has not lowered PCP or orthopedist prices. The article concludes, “The policy dilemma that arises from our findings is that there are no insurer market mechanisms that will pass a portion of these price reductions on to consumers in the form of lower premiums.”


A Dallas medical testing laboratory accused by the federal government of a $100 million fraud scheme files a lawsuit to prevent state and federal agencies from revoking its laboratory licenses. Two of the principals of Next Health and Medicus Laboratories also face similar charges for their work at a now-bankrupt doctor-owned hospital chain that prosecutors say paid $40 million in bribes to generate $200 million in paid claims as an out-of-network provider. The executive of one of Next Health’s marketing contractors has been indicted in an unrelated case for giving soldiers Walmart gift cards in return for saliva and urine samples that were used to perform unnecessary tests for which Tricare paid, using a similar method to drum up business for Next Health by approaching people in Whataburger restrooms and offering them $50 gift cards for providing urine samples for a “wellness study.” One patient earned $600 for providing a dozen urine samples that were used to bill UnitedHealthcare Group $217,000, with the Next Health marketing rep bragging that he was earning $100,000 per month for brokering kickback payments to doctors. Next Health told patients they wouldn’t be billed for their part of the cost, fearing that their complaints would trigger an investigation.

In India, police are investigating the perinatal asphyxia deaths of 30 children at a state-run hospital after families complain that the hospital did not give the babies oxygen. This follows a previous incident where 60 children at another hospital died after oxygen supplies were reportedly cut off due to non-payment of the oxygen supply company’s bills.

Here’s another 30-year look back from Vince, who describes the health IT news of September 1987 and what it means today. He would love to hear stories from fellow pioneers, especially if they dig into their own closets for yellowing industry ephemera.

Sponsor Updates

  • Agfa HealthCare publishes a new case study, “Hashemite University leads the way with first ‘Instant DR’ in Jordan.”
  • Besler Consulting will present at the NJ HFMA Regulatory & Reimbursement Educational Program on September 12 in Edison.
  • Datica releases a new podcast, “Emerging Healthcare Data Challenges from Patient-Centric Technologies.”
  • Besler Consulting releases a new podcast, “Patient access strategies to improve collections.”
  • CompuGroup Medical will exhibit at PainWeek September 5-9 in Las Vegas.
  • CoverMyMeds will exhibit at the AAFP Family Medicine Experience September 12-16 in San Antonio.
  • Cumberland Consulting Group will exhibit at the MDRP 2017 Summit September 11-13 in Chicago.

Blog Posts


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HIStalk Interviews Rob Harding, CEO, FormFast

September 5, 2017 Interviews No Comments

Rob Harding is president and CEO of FormFast of St. Louis, MO.


Tell me about yourself and the company.

I’m a resident of Franklin, Tennessee, along with my wife. I have a daughter in the area. We moved here to enjoy the benefits of the healthcare greatness in the community. I’m in the 25th year of working with my company, FormFast, which I started because I knew a great deal about hospital printing and paperwork from a previous employer.

What is the role of electronic forms as hospitals and practices are expanding their use of electronic health records?

Many of our customers and IT experts had stated that there would be no role for forms, whether electronic or otherwise, and that all of this would be handled by communicating with a database, EMR, or some other completely automated, unrelated type of departmental software. So we’ll start this conversation by saying that I’m a guy in a business that isn’t supposed to exist any more. 

We are now going through the tail-end of conversions through Meaningful Use, where the larger companies said five or six years ago that we would not have any paper forms or forms of any type. We have a 10-hospital chain on the West Coast that has 10,000 paper forms that we do for them on demand. We have in the mid-Atlantic region a client with eight hospitals and around 7,000 forms that we are generating for them. Recently one of the most prestigious institutions in the Northeast has come to us with 4,200 forms. We are now getting RFPs from large healthcare systems and IDNs saying, we need to organize and standardize thousands of forms. They are beginning to realize that these forms are still there and need to be managed.

We’ve recently been calling up medical records folks and asking, what do you think about scanning forms? Because even if you have all this data in a database and have immediate access to it, if there is a great deal of paper, these items have to be scanned into a document management system. The soonest that anybody we interviewed said that these forms were scanned and available for viewing by clinicians was 12 hours, going from there to a week. How are they operating? How are they using all this immediate information from the electronic medical record, yet don’t have any kind of access to a great deal of the clinical data? That something that we’re trying to understand.

EHR designers were initially criticized for designing screens that looked like paper forms, but nobody complains about a paper form being unusable like they do EHR screens. Is the physical paper form or its on-screen metaphor still viable?

We’ve had a lot of high-level discussions about a data-centric view of getting information — putting it in a database — versus the form- or document-centric approach.

The documents we work with have a lot of formatting. The information is presented in a sequence. A lot of the documents need signatures, either wet signatures or at least an original or electronic signature. They need to go to multiple people for approval.

The database system is a vertical system, while forms are more like a horizontal processing. We have built systems — and other companies have, also — for doing workflows that will move these forms around for signatures, approvals, or addition of data. That has not been the focus of the major electronic medical record companies. 

There was no reason that everything going on in the hospital couldn’t have been automated. When we look at piles of forms and we look at all the transactions that are taking place — some of them very specific transactions, transactions that change very frequently, you know, forms are changed very frequently – it’s a huge challenge to automate this and connect it to all these other processes.

FormFast’s solutions allow a customer to very quickly design a form, attach data elements to it, and put it into play. To be able to create it quickly and remove it quickly. That’s been one of the approaches. You have a secondary class of automated e-forms. We’re searching, and that now that our customers are asking questions about this and looking for answers, we’ll be able to get better feedback about how these problems can be addressed.

Hospitals will always have paper forms such as employment applications, invoices, and patient-completed forms that won’t be managed by their IT systems. What are examples of automating those paper forms and putting process automation or integration around them?

There has been a lot of demand for, as an example, risk management systems. The risk management paperwork is clinical paperwork, but it’s not part of the electronic medical record and it needs to be distributed to a large number of individuals for feedback. Items like that. We’ve done check approvals that have to go through several transitions — if its over a certain dollar amount, it needs to go to a certain individual for approval. Most hospitals don’t have a fully functioning human resource system, so things like evaluations for employees, collection and approval of budget data, requisitions. We have created 50 workflows covering those areas and we’re always learning more.

Where do you expect the company and the electronic forms industry to be in the next 5-10 years?

There’s a couple of directions it can go. Existing companies may expand into some of these areas, but I’ve not seen any indication that that’s a priority. We have in addition to the on-demand forms a lot folks using our form fill. Its available to fill in a form, submit the data, and put a copy of the form into an archive.

I mentioned the workflow, which is not a simple form being submitted, but a process. For the last three years, we’ve been focusing the forms, the signatures, the consents — the kinds of things needed for pre-admission processes for patients and for discharge. It started out that forms could be approved. Then we added tasks that the patients should be doing prior to admission, or things that the family needed to do after discharge.

Those have been combined into a this newer and much larger product type. There’s a requirement for huge amount of protection under HIPAA for anybody finding or looking for data. Salesforce is a platform and that seems to be something that’s moving into the healthcare environment. All the things we’re doing are on a common development platform. 

I’m sure there will be many changes in direction as the years go by. We look at hospitals that have spent 10 or 20 million dollars to automate an electronic medical record and have processes that are not part of this record that are 10 years old. There are piles of paper and thousands of forms. I’d say that we are just beginning to see those things looked at and addressed and realized. Folks in hospitals who have been so busy with other requirements are just beginning to ask that question.

Do you have any final thoughts?

I won’t say how many years I’ve been involved in paper and electronic forms in the healthcare environment, but my desire is to make things better for our customers. These problems around forms are not insignificant, with half of the data being in an EMR that is instantly available and half of it being on paper that is available days later. It’s going to be really fun to participate with our partners and customers to make that happen.

Morning Headlines 9/5/17

September 4, 2017 Headlines No Comments

Jeanne Lillig-Patterson, wife of Cerner CEO Neal Patterson, dies at 59

Jeanne Lillig-Patterson, founder of the First Hand Foundation and wife of Cerner co-founder Neal Patterson, dies at the age of 59 after losing her battle with cancer. Jeanne’s death follows her husband’s by less than two months.

Moment of truth arrives for Obamacare repeal

The Senate parliamentarian has ruled that Republicans face a September 30 deadline to pass an ACA repeal bill with only 50 votes, noting that the availability of the budget reconciliation process Republicans were using to fast-track the bill will pass when fiscal year 2017 ends on September 30.

Dual Canadian/Chinese Citizen Arrested for Attempting to Steal Trade Secrets and Computer Information

A Canadian/Chinese citizen is being charged with attempted theft of trade secrets after the CEO of Massachusetts-based Medrobotics Corporation saw him sitting in a conference room at 7:30pm with three laptops open. When questioned by the CEO, the man admitted that he was not an employee or contractor of the company, and claimed to be visiting a Medrobotics employee.

Novartis names American Vasant Narasimhan as its new CEO

Swiss pharmaceutical giant Novartis announces that its CEO, Joseph Jimenez, will step down effective February 1, noting that he is “ready to return to Silicon Valley and the US.”  Vasant Narasimhan, MD, the company’s current CMO, will take over.

Morning Headlines 9/4/17

September 3, 2017 Headlines No Comments

Harvey Evacuees Leave Their Belongings – and Health Records – Behind

Wired describes a frustrating situation in Texas and Louisiana, where the lack of EHR interoperability is in the national spotlight as Hurricane Harvey evacuees seek care from new doctors who have no access to their medical records.

Speech Recognition in Cardiology

A survey of 147 cardiology clinical and administrative staff finds that cardiology is lagging behind radiology in adopting voice recognition technology into clinical workflows.

Alphabet’s Verily and Google found a potential new test for heart disease using AI

Verily researchers have developed an AI-based algorithm that can analyze retinal images to calculate a patient’s risk of heart disease. The algorithm scans for key indicators in the retinal images that correlate to age, gender, smoking status, blood pressure, and blood sugar levels, and then uses this information to calculate the patient’s heart disease risk level.

How to Regulate Artificial Intelligence

A New York Times Op-Ed piece by an Artificial Intelligence researcher proposes a framework for regulating the emerging technology.

Monday Morning Update 9/4/17

September 3, 2017 News No Comments

Top News


An article in Wired says that despite widespread use of electronic medical records, people with medical needs aren’t faring any better after Hurricane Harvey than following Hurricane Katrina in having their medical history available to first responders and new providers.

The article blames lack of interoperability and EHR downtime caused by flooding and power outages.


The author describes PULSE (Patient Unified Lookup System for Emergencies), an HHS-funded pilot project to create a data-sharing network that can be activated in a crisis. A January 2017 HHS announcement describes the California pilot that uses technology from Audacious Inquiry:

PULSE is currently being built to facilitate exchange during a declared emergency by extending interoperability across disparate technologies to support health information exchange. PULSE will allow Alternative Care Facilities (think of these as aid stations or MASH units set up during an emergency) so that EMS and authenticated volunteer providers can quickly get access to often life-saving data, when and where they need it. In the future, the PULSE system could facilitate patient lookup capability in an ambulance.

During a recent demonstration by Audacious Inquiry, the contractor that developed the PULSE technology, the program’s benefits become readily apparent. In the event of an earthquake, or forest fire (like the one that recently ravaged Eastern Tennessee), first responders (defined under PULSE as any of six provider types, including doctors, nurses and EMTs) can query PULSE with standard eHealth exchange patient demographics—including name, date of birth, and gender.  PULSE then sends out data tendrils to California-based HIEs, health systems and hospitals, for instance, looking for a match to the query. PULSE then enables first responders to see recent care notes from treating providers – including hospital discharge summaries and the Consolidated Clinical Documents (CCDs).

As PULSE is being developed, we have tried to ensure that it can be a model for other states to use. To support future scalability, PULSE is utilizing industry standards when communicating with HIEs and hospitals.

HIStalk Announcements and Requests


Poll respondents are OK with — clinicians with or without formal informatics credentials — calling themselves “informaticists” and are equally accepting of non-clinicians who have earned a graduate degree in informatics, but draw the line at a non-clinicians whose only credential is work experience. Harry suggests calling technically focused people “informaticists” and those specializing in clinical applications and user experience “informaticians.” Kelley says a challenge in public health is separating informatics from IT.

New poll to your right or here: What is the primary reason hospitals don’t exchange patient information freely?

This Week in Health IT History

One year ago:

  • CMS offers providers four “pick your pace” Quality Payment Program options for 2017.
  • St. Jude Medical sues a medical security services vendor, claiming its pacemaker vulnerability testing was not only improperly performed, but also part of stock short-selling scheme.
  • Apple announces the iPhone 7.
  • In England, NHS announces a digital exemplar grant program for trusts.

Five years ago:

  • Merge Healthcare hires an investment bank to review strategic alternatives.
  • Vocera announces its public offering.
  • Harris Corporation investigates potential US bribery law violations by its Carefx China division, whose employees were found to have provided gifts and payments to prospects.
  • A computer hacker in Italy shares his brain cancer-related medical records on the Internet in seeking help in a project he calls “My Open Source Cure.”

Ten years ago:

  • Ingenix acquires Healthia Consulting.
  • Athenahealth prices its IPO.
  • Allscripts announces its largest EHR sale in its history to Columbia University Medical Center.
  • A UK hospital blocks employee access to Facebook after heavy use degrades its network performance.
  • Health Evolution Partners, started by former National Coordinator David Brailer, MD, PhD, begins its search for investments.

Last Week’s Most Interesting News

  • FDA announces a voluntary recall of St. Jude Medical pacemakers to install a firmware update to fix cybersecurity vulnerabilities.
  • CHIME and DirectTrust announce plans to promote universal deployment of the Direct network.
  • Advisory Board announces plans to sell its healthcare business to UnitedHealth Group.
  • Texas hospitals struggled with flooding from Hurricane Harvey.


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

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


  • Mercy Medical Center (MD) will replace Meditech with Epic.
  • Southeast Health Center Of Stoddard County (MO) changed from Medhost to Evident in June 2017.
  • Integris Canadian Valley Hospital (OK) replaced Cerner with Epic in May 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.



Orion Health hires Terry Macaleer (Anthelio Healthcare Solutions) as president of its US operations.


Henry Mayo Newall Hospital (CA) hires Ray Moss (Cedars-Sinai) as VP/CIO.

Announcements and Implementations


A new Reaction report finds that only one in four cardiology facilities use speech recognition, with far less enthusiasm and effort than their counterparts in radiology, but cardiology use is increasing quickly. Nuance and MModal hold 89 percent of that market.

Cerner and its customer HealthSouth will work together to develop tools to manage post-acute care patients.

Privacy and Security

A university in Canada loses $12 million to scammers who impersonated an employee of its construction company vendor in requesting that checks be sent to their new address that was actually that of the scammers.



Artificial intelligence researcher Oren Etzioni proposes in a New York Times op-ed piece that AI be regulated in three ways, based on Isaac Asimov’s 1942 “three laws of robotics”:

  • Companies that deploy AI systems must be held accountable for any illegal behavior that results.
  • The AI system, such as a chatbot, must disclose that it is not a human in any conversations with humans.
  • AI systems must not retain or disclose confidential information they receive, such as background audio recorded by Amazon Echo.


Google’s Verily life sciences company develops a way to predict cardiovascular risk factors by analyzing a person’s retinal image with a machine learning algorithm instead of performing blood tests. The model showed high accuracy in using only the retinal image to predict age, blood pressure, body mass index, gender, and smoking status.


A federal judge certifies as class action a lawsuit covering all Medicare recipients who were hospitalized but categorized by the hospital as observation patients, which means that as outpatients without necessarily knowing it, they pay more for drugs, co-insurance, and nursing home care.

Sponsor Updates

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
Get HIStalk updates. Send news or rumors.
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Morning Headlines 9/1/17

September 1, 2017 Headlines No Comments

Health IT Now Letter To ONC

An industry group comprised of AMIA, Athenahealth, and others asks ONC to provide guidance around information blocking.

Firmware Update to Address Cybersecurity Vulnerabilities Identified in Abbott’s (formerly St. Jude Medical’s) Implantable Cardiac Pacemakers: FDA Safety Communication

The FDA issues a voluntary recall of St. Jude Medical implantable pacemakers due to cybersecurity vulnerabilities in the devices firmware. The FDA suggests that patients coordinate with care providers to discuss the need to have their firmware updated.

Bipartisan Governors Blueprint

A bipartisan group of eight governors sends a letter to Congress with recommendations on how to stabilize the individual health insurance exchanges.

Limited Waiver of HIPAA Sanctions and Penalties During a Declared Emergency

HHS Secretary Tom Price issues a 72-hour waiver on HIPAA privacy rules for hospitals responding to the aftermath of Hurricane Harvey in Texas and Louisiana.

Regulator Wants Stronger Oversight Of Private Health IT Firm That Gets Public Funds

Vermont’s Green Mountain Care Board, which oversees the state’s medical industry, says the state’s HIE is failing to meet the needs of providers in the state and warns that it will need to improve to justify continued public funding.

News 9/1/17

August 31, 2017 News 4 Comments

Top News


A Health IT Now stakeholder group made up of several member associations (including AMIA) and health IT vendors ask ONC and HHS OIG to provide guidance around information blocking:

  • What are examples of behaviors that the federal government will interpret as being information blocking?
  • How is “should have known” defined?
  • How will patient access be measured?
  • How does the law interact with HIPAA and medical malpractice laws?
  • What reasonable business practices and contract terms are exempt from information blocking requirements?
  • How will the $1 million per violation vendor penalty be defined?
  • What mitigation opportunities will be offered before incidents are turned over to HHS OIG for investigation and penalties?

Reader Comments


From Harvey Headbanger: “Re: HIPAA. The HHS secretary has waived HIPAA Privacy Rule provisions for hospitals in Texas and Louisiana for 72 hours after their disaster protocol has been activated. So you’ve got a hospital in a disaster area with problems including, but not limited to, rolling power outages, floating fire ants, looting, a looming public health crisis, and of course all the flooding compounded with strained emergency and utility services. The Secretary graciously expects that after three days, I have to create a semi-manual process for distributing and capturing NPPs and managing requests for privacy restrictions in an environment where communication is already very difficult, workforce shortages are common, and I’m trying to determine how to triage the unusual influx of patients. Not seeing it. Thoughts and prayers to the people of SE Texas and Louisiana.”


From Geaux Texans: “Re: your Houston donations. Why not the Red Cross?” I’m not a fan of that organization since they don’t earmark donations for specific causes, multiple reports exist over years indicating that they are dismissive of local volunteers, and my unscientific observation is that they seem to take advantage of global natural disasters to promote themselves and their fundraising. They also get a score of 83 on Charity Navigator, which isn’t so great. I know that their fundraising machine will allow them to do mass-scale work, leaving me to support more local efforts without feeling guilty. I donated to the Salvation Army of Houston because Salvation Army is my favorite charity overall and I trust their mission and stewardship even though as a religious-based organization they aren’t rated by Charity Navigator. Houston Food Bank earns a Charity Navigator score of 100 and the Houston SPCA gets a 97, both of those being local organizations that I’m pretty sure will quickly do the right thing without much bureaucratic overhead. Please donate, but be careful – scammers abound during high-profile disasters when donors are anxious to help quickly. Donate directly from the verified home pages of charities you’ve first checked on Charity Navigator. This isn’t the time to click shady Facebook “donate here” links or to send money to GoFundMe projects.

HIStalk Announcements and Requests


The inaccessibility and loss of paper medical records during Hurricane Katrina kicked off the uptake of EHRs (and led New Orleans health commissioner Karen DeSalvo, MD, MPH, MSc to the National Coordinator role). I’m wondering if Hurricane Harvey will provide the impetus for adoption of other technologies, perhaps telemedicine or even drone delivery of drugs and medical supplies.


I passed on a modestly interesting news item today because the company has so much high-falutin’ gibberish on its website that I couldn’t figure after several minutes exactly what it is they do. Marketing people convince company executives that their painfully wrought, committee-driven aspirational BS prose is what users want, but I say it’s a big fail if their site doesn’t quickly tell me what they’re selling and why I should care.I envisioned the result of that company’s marketing brain trust being cut loose on some kid’s lemonade stand, with the resulting tagline being, “Refreshment, realized” and a mission statement of:

Katy’s Lemonade Stand is a regionally recognized, trusted partner for implementing a diverse portfolio of innovative products, strategies, and frameworks that enhance synergistic hydrationary outcomes and provide an exemplary customer experience that inspires human achievement.

I’m also annoyed by companies that add a customer service chat box to their websites, which is intrusive but not super annoying, but then double down by including a loud “look down here at our cool automated chat agent” sound effect that makes me jump a foot off my chair. Websites should not automatically play any sound or auto-start a video that includes audio. Sites are killing off traffic in jamming poorly performing video, overlay ads, pop-ups, and slow-loading third-party content on their sites (CNN and other news sites along with the usual clickbait sites – was that redundant? — are prime examples).

This week on HIStalk Practice: Texas officials fast-track licensing permits for out-of-state physicians looking to help after Harvey. Indica MD launches medical marijuana telemedicine services. Florida law enforcement implements new heroin overdose tracking software. Harvey relief efforts tap into Medicare data to identify at-risk patients. Marathon Health adds behavioral health services. PeakMed Direct Primary Care raises $5.5M. Oklahoma officials call for more funding, better MD use of statewide PDMP. AI-generated facial emojis could be coming to a telemedicine visit near you. West’s Allison Hart discusses the importance of technology in ambulatory care for chronic disease management. The MAVEN Project looks to connect community health centers with telemedicine services.


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

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

Acquisitions, Funding, Business, and Stock


Kevin Mullin, chair of the Green Mountain Care Board that oversees Vermont’s medical industry, demands that Vermont Information Technology Leaders improve its operations to justify its public funding. VITL gets the money generated from a health insurance claims assessment that ends this year, as lawmakers will decide whether to end the tax or send its proceeds elsewhere. Mullin, who was a state senator when the tax was approved, says, “VITL was oversold to legislators. I regret ever selling the claims tax.” 


Drug pricing analytics vendor Truveris raises $35 million in a Series D funding round. 


Madison-based ImageMoverMD, which offers a secure image-sharing app for doctors, raises $1.2 million.



Penn Medicine (PA) chooses the LiveProcess emergency management system for universal employee notification and response during disasters, cyberattacks, and everyday coordination, bringing it into compliance with CMS’s emergency preparedness rule.


My Health My Resources of Tarrant County (TX) selects Netsmart’s EHR.

Announcements and Implementations


Experian Health announces its Pandora data quality platform that can ingest, index, and cleanse data from one or many data sources.


Non-profits CHIME and DirectTrust will jointly promote the universal deployment of the Direct network for secure information exchange.

Canada’s PrescribeIT national e-prescribing service will begin its rollout in Ontario “in the coming weeks” in eventually covering six provinces, 2,600 drug stores, and an unstated number of EHR vendors using technology from Telus Health.

Government and Politics


A bi-partisan group of eight state governors makes recommendations to Congress for stabilizing the individual insurance market, including:

  • Committing to continuing paying cost-sharing reduction payments.
  • Creating a temporary stability fund for states to create reinsurance programs.
  • Exempting insurers from federal health insurance taxes from exchange plans sold in counties designated as underserved.
  • Keeping the individual mandate until a credible replacement can be devised.
  • Continuing the funding of outreach and enrollment efforts that encourage younger, healthier people to sign up.
  • Shortening grace periods and verify special enrollment to make sure people aren’t waiting to sign up for insurance until they are about to incur expenses.
  • Addressing unsustainable increases in the cost of healthcare services by paying providers based on quality rather than quantity of care, including a committing to support value-based healthcare purchasing.


Meanwhile, the White House on Thursday violated the fifth point above in announcing that President Trump will cut ACA signup advertising spending by 90 percent and in-person assistance funding by 39 percent, saying that Americans already know about the ACA. Critics say insurance risk and thus pricing will increase in a “let it fail” strategy” with fewer healthier, younger people being reminded to sign up to balance the risk pool. Former CMS Acting Administrator Andy Slavitt said in a tweet that the change won’t save taxpayers money because the costs are paid by insurance company user fees. An HHS press secretary (she was previously Congressman Tom Price’s press secretary and before that executive assistant at The Beer Institute) said ACA is a “bad deal” and isn’t working because premiums have doubled and half of US counties have only one coverage option.

Privacy and Security


FDA issues a voluntary recall of 465,000 St. Jude Medical pacemakers, recommending that patients return to their doctor or hospital to have their device’s firmware updated to address cybersecurity vulnerabilities.


Security firm Barracuda says it has logged 20 million ransomware attack attempts in the past 24 hours that uses a spoofed “from” address and the attachment’s name in the subject line, attempting to lure the recipient into clicking the attachment, which then begins encrypting the device.

Innovation and Research


Inova Personalized Health Accelerator offers a free educational program for first-time health technology entrepreneurs. The topics are interesting but the program is limited to folks who can attend seven, 90-minute on-site sessions in Fairfax, VA.



Health system consolidation continues as UNC Health Care and Carolinas HealthCare announce plans to form a jointly operated system that will have 52 hospitals, nearly 100,000 employees, and $13.4 billion in annual revenue. The health systems insist that the proposed transaction is a partnership rather than a merger since they will not combine their assets to create a new entity.


An article in the Joint Commission’s journal describes the newly revised, ONC-published SAFER (Safety Assurance Factors for EHR Resilience) Guides and offers implementation advice for provider organizations, written by Dean Sittig, PhD and Hardeep Singh, MD, MPH.


A California Healthline article explains why it made sense for Santa Barbara County to send an employee who needed surgery to a hospital 250 miles away near San Diego. Answer: Scripps Hospital charged $62,000 for a surgery that would have cost more than double that amount at the two local hospitals. Scripps priced its services via bundled pricing as contracted through startup Carrum Health. The county waives employee co-pays and deductibles and pays travel costs for a luxury resort. The program is at risk since CMS is proposing eliminating bundled payments under the Trump administration in accusing Medicare –as have anxious hospital trade groups — of overstepping federal authority and interfering in the doctor-patient relationship. Insurance premiums in Santa Barbara County are 27 percent higher than those of Los Angeles, with a county HR executive saying, “The only difference between our two hospitals is one is expensive and the other is exorbitant.”


A Cleveland Clinic neurologist says the movie “Moneyball” showed that baseball uses more decision-making analytics than his own field, but that a wealth of EHR data and availability of disease-modifying therapies for multiple sclerosis will allow better treatment choices than the previous tools of physical examination and patient self-assessment. He notes the use of an iPad-powered performance test, new MRI and blood tests, and EHR-enabled doctor-patient collaboration.


In England, Royal Devon and Exeter NHS Foundation Trust sues ATOS for $10 million for selling it an EHR scanning and document management system that is slow and buggy, problems the vendor attributes to the trust’s network and hardware.


University of Michigan researchers develop Verdict, a database tool that learns from each user-submitted query to deliver answers 200 times faster with 99 percent accuracy. The software stores each query as a query synopsis and breaks it up into snippets that are used to create a mathematical model of questions and answers, allowing it to then target newly needed data efficiently or even to deliver results directly from its own stored information. Medical research and business decision-making are likely use cases.


FDA approves the first gene-altering drug for treating leukemia, with manufacturer Novartis declaring Kymriah a bargain at $475,000, especially since it will charge only if the drug works. The company claims it cost $1 billion to bring Kymriah to market.

The Wall Street Journal reports that 27 Gulf Coast hospitals have closed or evacuated patients since Hurricane Harvey made landfall and another 25 have reported storm-related problems that may prevent them from seeing new patients. Those that are open are expecting to be overwhelmed as roadways clear.

Some employers in the Louisville, KY area have stopped performing pre-employment drug tests because the high number of failures leaves too few candidates to fill their open positions. Other companies report that half of job candidates drop out of the hiring process once they realize they’ll be tested for drug use.


In India, an OB-GYN and anesthesiologist are suspended after an employee-recorded video goes viral that shows them engaging in a heated, insult-filled argument while standing over their C-section patient.

Sponsor Updates

  • Logicworks opens a new office in Denver.
  • Navicure will exhibit at Greenway Health Engage17 September 7-10 in Orlando.
  • IDC names Nuance as the market share leader among global device and print management vendors.
  • NTT Data Services publishes a new case study, “Two health systems in Qatar partner on a nationwide EHR to enhance quality of care.”
  • Healthwise adds enhanced visual design to its Patient Instructions.
  • Experian Health will present at the HFMA/AAHAM Western PA conference September 7 in Farmington.
  • Vocera announces that 15,000 care team members of Franciscan Alliance are using its secure text messaging and hands-free communication system.
  • The SSI Group and ZirMed will exhibit at the CASA 2017 Annual Conference September 6-8 in Indian Wells, CA.
  • Nuance Communications wins the 2017 Star Performer and Implementation Awards at Speech Technology Magazine’s annual awards event.
  • Solutionreach publishes a new case study, “Dr. York Yates Plastic Surgery Triples Their Response to Review Requests.”
  • Verscend Technologies publishes a new infographic, “Analyzing 2017’s risk adjustment valuation to improve 2018’s processes.”
  • McLaren Flint (MI) avoids a $1 million capital expense for new IV pumps by tracking its pump inventory using Versus Advantages Asset Management.
  • Visage Imaging will exhibit at SIIM/NYMIIS 2017 September 7 in New York City.
  • Huron partners with the Red Cross to support relief efforts for victims of Hurricane Harvey.

Blog Posts


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


EPtalk by Dr. Jayne 8/31/17

August 31, 2017 Dr. Jayne No Comments


I’ve received quite a bit of correspondence lately, so it’s time to open the reader mailbag.

From Coastal but not Coasting: “Re: great article. It came at the perfect time for my practice. We just received PCMH recognition, level 3, so we are currently beaming! But it has not been easy. There have been many challenges, including staff burn-out and frustration over all of the change. We had to get them to buy in to it without always knowing WHY the change needed to occur. Sometimes the WHY is very involved and time-consuming and we were trying to fast track recognition.” I agree that sometimes sorting out the “why” and the “what’s in it for me” can be challenging, especially when trying to work through things quickly or when trying to meet specific regulations that don’t always mesh 100 percent with how the organization has been running. There are times when I’m working with clients where I just want to say, “Because I said so, and your boss is paying lots of money for my expertise,” but that would rarely go well. There’s an art to balancing buy-in vs. top-down rulemaking and I applaud organizations that have figured out how to do it well.

From Back to School: “Re: huddles. Have you ever met anyone that runs a family huddle? Thinking about my family and children and the chaos of school around the corner made me pause to consider if we might benefit from a more set time / agenda to nail down logistics. We communicate well, but sometimes it’s frequent and distracting with our own work days.” Why yes, I do! One of my good friends from Big Health System takes her process improvement work home with her. They have a family huddle during dinner where they run through the activities for the next day and outline what equipment, supplies, and transportation are needed. Thinking back to the one I witnessed, it’s a lot like a practice huddle. They also maintain a family Google calendar so everyone can see it from their phones. Time management is an important skill that many of the client employees I work with struggle to master. Developing those skills during the adolescent and young adult years would definitely serve one well in the working world.

From John Showalter: “Re: staying sane. I thought you might be interested in learning more about a book I helped write. I think focusing on shared outcomes helps keep everyone sane. I totally agree with you about the meeting skills.” Several of the topics covered in the book caught my interest. What motivates physicians, why a lack of education about revenue cycle and population health impedes their ability to see how improving administrative processes positively impacts the patient, and approaches to creating actionable knowledge that will enable increased collaboration. I struggle regularly with providers that aren’t in tune with the business side of healthcare and don’t fully understand how their world will be impacted by big data. May be a good read for my next book club.

From Cowtown: “Re: private equity in physician practices. Interesting that you notice this pattern. I have had in mind that health systems buying up doctors seemed to be getting fairly smug fairly quickly. It kind of feels like the hospital leadership thinks, we’ve got 300 head of PCP out grazing in the North Region. This attitude belies the fact that doctors (non-competes notwithstanding) hold their own licenses and can take their acts elsewhere. Perhaps there seems to be little will to break away amongst the traumatized mid-career types and the debt-ridden youngsters. Nonetheless, the ongoing evolution of IT, along with the availability of capital as you note, make it entirely comprehensible.

It is a shame, though perhaps expected, that the first forays you’re seeing are aggressive, hubristic moves that misunderstand power – market and otherwise. I believe that successful ventures for primary care will center around:

  • Building physician culture, with an eye towards work-life balance.
  • Operational excellence, with an emphasis on IT and measurement through data.
  • Patient satisfaction, leading toward the basics of customer experience – business hours, asynchronous communication, basic physical plant and services.

Oh, and did I mention, I think these should be primary-care only entities? The specialists can build out their own models, with operational excellence centered on procedures with bundled payments – it’s a different business. PE is the flavor of the day because of the tax advantages for the fund partners. It is usually looking for an exit, which if it is selling out to the hospital, likely becomes a destruction of value event. I hope that capital remains available to physicians, especially PCPs who want to do this the right way.” In many markets, physicians at all levels feel trapped, not just those with debt or feel beaten down. Although they can theoretically take their panels and licenses and go elsewhere, sometimes the choice is between bad and worse. My region has several major health systems; although some used to have distinguishing features (such as the willingness to enter into joint ventures with physician groups for surgery centers or diagnostic imaging) they’ve become fairly homogenized with their relative unwillingness to negotiate with physicians. Narrow networks are making physicians nervous about losing market share, so I see them staying in situations they wouldn’t have tolerated several years ago. The hospital-owned medical groups definitely don’t seem interested in building physician culture or work-life balance although they are trumpeting “operational excellence” through statistics pulled from their EHRs. They’re also treating subspecialists the same as primary care physicians (albeit with larger paychecks) which is adding to the negativity as the procedural subspecialists get a taste of what the rest of the physician base has been experiencing all along.

As a result, we’re starting to see increasing numbers of physicians headed to the direct primary care model. Those who are remaining in traditional physician groups are starting to opt out of Medicare in an attempt to regain autonomy. I’ve heard people talk about it for years but it seems to be actually happening, which will be interesting with the aging patient base in our community. I don’t make it to the hospital physician lounge very often but when I do, the conversations are always lively.

Has private equity shown interest in your practice? Email me.

Email Dr. Jayne.

Morning Headlines 8/31/17

August 30, 2017 Headlines 2 Comments

AHA Letter To Representative Pat Tiberi

AHA writes a letter to Rep. Pat Tiberi (R-OH), Chairman of the Committee on Ways and Means’ Subcommittee on Health, calling for the cancellation of Meaningful Use Stage 3.

FDA approval brings first gene therapy to the United States

The FDA has approved CAR-T, a gene therapy treatment for certain types of pediatric leukemia, making it the first gene therapy approved for use in the US. Novartis developed the treatment and has put a $475,000 price tag on the drug, far below analyst expectations. In a clinical trial, a single dose of CAR-T left 83 percent of participants cancer free after three months.

Medtronic invests $40 million in robotics company Mazor

Medtronic announces that it has invested $40 million in surgical robot vendor Mazor Robotics, bringing its total investment in the company to $72 million. Medtronic will now become the exclusive distributor of Mazor’s robotic surgery system.

Aetna scoops up rising star from Wal-Mart’s health group to lead Apple Watch partnership

Aetna hires Walmart’s health division director Ben Wanamaker to lead its joint venture with Apple.

Readers Write: Malware Lessons Shared: Seven Key Questions for Health Leaders to Ask About Cyber Preparedness

August 30, 2017 Readers Write 1 Comment

Malware Lessons Shared: Seven Key Questions for Health Leaders to Ask About Cyber Preparedness
By Joe Petro


Joe Petro is SVP of engineering for the healthcare division of Nuance Communications.

As business leaders, we must confront a new reality: our organizations are facing an unprecedented threat from cybercrime. The number of cyber incidents is growing and the nature of the attacks is evolving. They are becoming faster, more sophisticated, and more potentially destructive. As the severity of incidents increases, the knowledge to address the technical aspects and manage through an attack has become essential to our skill set.

For those reasons, we think it’s important to share some of the lessons we’ve learned since we were affected by a global malware incident on June 27. Cybersecurity experts later identified the malware as NotPetya, highly sophisticated malware written to provide disruption and destruction rather than to demand ransom. It spread quickly, and unlike some malware, patching alone would not have stopped its propagation.

Our first priority was to contain the incident and protect our customers. This meant immediately commencing shut-down procedures across our global network to contain the spread of the malware. These actions affected our ability to communicate with our customers, employees, and other stakeholders, and we immediately sought alternative ways to alert them to the situation. To ensure they had up-to-date information, we hosted daily conference calls and corresponded via email with affected clients. We regularly posted updates to a dedicated Web page in addition to conducting a very large number of one-on-one client calls and meetings.

Importantly, we were able to tell them that NotPetya does not have the ability to copy or extract file contents from affected systems or allow any unauthorized party to view file contents on affected systems. In other words, no Nuance customer information was altered, lost, or removed by the malware.

After containing the spread of the malware, our focus turned to restoring our clients to full functionality. Our dedicated staff—along with third-party experts in cybersecurity and forensics—rapidly initiated restoration efforts. At the same time, we enhanced our security against similar future incidents to ensure we emerge from this incident with an even more secure operating environment.

We are committed to sharing the knowledge we have gained from our own response and recovery process. The more we know about malware like NotPetya, the more powerful we all can be in combatting future cybercrimes. Early lessons include:

  • Incident notification protocols should be as simple as possible, with multiple layers of redundancy to ensure stakeholder communication can continue at all times. This is particularly critical in the early days of response, when normal channels may not be viable.
  • Increase network segmentation, including adding micro-segmentation.
  • Even fully patched Windows machines remain vulnerable to certain exploits and vulnerabilities. We have deployed a hardening process that disables SMBv1, enables additional blocks on host-based firewalls including blocking unnecessary SMB ports, disables unnecessary usage of WMI and PsExec, disables unnecessary admin shares, increases logging levels, and validates that each system meets a minimum baseline of security measures.
  • Cyberattacks can occur very quickly, challenging even the best prevention systems. Thus, the best strategy is a combination of prevention, detection, and containment.

Healthcare and IT leaders need to ask the right questions now so that they can be better prepared for a malware incident in the future. Below are seven important security questions every leader should consider:

  1. Cybercrime is part of the new reality for every company, organization, and person. What can you be doing now to prepare for this scenario?
  2. How comprehensive are your security policies, and do those policies actually translate into deployed security capabilities?
  3. Have you developed a crisis and disaster plan and communicated it broadly throughout your organization?
  4. How would you communicate to your staff, your board, your customers, and your patients?
  5. What are your primary vulnerabilities? What measures are you taking to ensure patient data is protected?
  6. Do you understand and align with your vendors’ security policies and do you have the appropriate validation and/or risk assessment programs in place?
  7. Have you identified a team of outside experts to help in case of an incident, including cyber security firms?

    Readers Write: Response to Webinar, “3 Secrets to Leadership for Women in Healthcare IT”

    August 30, 2017 Readers Write 1 Comment

    Response to Webinar, “3 Secrets to Leadership for Women in Healthcare IT”
    By Helen Waters


    Helen Waters is executive vice president of sales and marketing with Meditech of Westwood, MA.

    Recently, I was inspired by a HIStalk webinar, “3 Secrets to Leadership Success for Women in Healthcare IT,” hosted by two female executives of health IT companies, Liz Johnson and Nancy Ham. During the webinar, Ham and Johnson provided valuable advice to women who are interested in progressing in their careers to a leadership position, but who may experience unconscious or conscious gender bias.

    I wasn’t surprised to see that organizations experience higher profits when women represent at least 30 percent of their executive leadership teams. I believe when men and women rid themselves of gender biases and come together at the table, great things will happen.

    There are thousands of women in high-powered positions making a difference around the world every day. Still, as Ham and Johnson pointed out, the percentage of women in leadership positions — particularly in healthcare IT — remains low. In addition, there are thousands of women who are capable of so much more, who would make great leaders and heads of companies, but who lack confidence.

    I wholeheartedly agree with Ham and Johnson’s three secrets  — mastering negotiation, closing the confidence gap, and the networking effect. However, if I could add one more key ingredient to the list, it would be to channel your passion.

    Climbing the corporate ladder and breaking the glass ceiling is no easy feat. It takes focus, drive, the belief that you will succeed, and the passion to make it happen. Not only have passion for what you do and your company, but for your customers and the industry you work in. If you don’t love the company you work for or enjoy your day-to-day life at work, then maybe it’s time for a change.

    When you love what you do and show up to work excited about what you will tackle and overcome each day, the confidence gap will get smaller and smaller. Why? Because when you’re passionate about something, it will be noticed by others. The enthusiasm and positive energy you bring to work and how you treat and communicate with others will have an impact on your ability to inspire and lead others.

    The determination and motivation that passion drives will set you apart, push you to produce your best work, excite others, build awareness, and lead you to your goals, whether it’s a position in management, the C-suite, or on the board.

    My passion, commitment, and love for my company and industry runs deep. My love of healthcare and technology has kept me intrigued and stimulated at my company for over 25 years. I believe in my case, knowing that what I do contributes to keeping people safe in one of their most vulnerable times in life (as a patient) is what keeps me going and gives a great sense of fulfillment.

    My goal is to help my company continue to grow and flourish, but more importantly, to help staff grow. I strive to develop the next generation of leaders who are as passionate and inspired as I am when it comes to healthcare. Hopefully during my tenure, I will have influenced a substantial number of people and contributed to the future of the company through them.

    In my personal life, my family is my passion. I’ve always wanted to show my daughters that anything is possible, to always be open to learning something new, to follow their passion, and do what makes them feel fulfilled.

    What are you passionate about?

    Readers Write: Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 1 of 4)

    August 30, 2017 Readers Write 3 Comments

    Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 1 of 4)
    By Bruce Brandes


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


    Over my 28-year career selling to health systems, the most common “competitor” to which my companies would lose a deal was the same: Do Nothing. For decision-makers across the country, there are many reasons that deferring buying decisions was historically a wise choice. 

    Rarely was there a compelling reason to make a decision at all. In the past, the economics, competitive pressures, and the underlying business model did not change meaningfully enough to encourage risk-taking. Frequently, if you waited long enough, potential industry changes would often just go away.

    Further, vendors that sell “nice to haves” rather than “have to haves,” assume everyone in every hospital must want to hear their pitch. They create noise that is deafening to decision-makers. Plus, most purchases historically have not yielded the promised benefits or ROI and risk-averse buyers that have been burned before are hesitant to make the same mistake again.

    As a healthcare vendor, the results of all this doing nothing (while trying desperately to find the person who is going to do something) include unclear value from traditional sales and marketing investments and the consequences of unpredictable business forecasting.

    Moreover, there is real concern that the length of healthcare sales cycles discourages bright entrepreneurial minds and innovative investors away from our industry, despite the lure of “disrupting” a three-trillion-dollar annual spend.

    In partnering with long-time hospital operator Charlie Martin, I was heartened to learn that he and his peers also found the ridiculousness of the buying / selling process in healthcare equally problematic. In fact, we’ve spent the past two years collaborating with some of the largest and most influential health systems in the country to gain a deep understanding of their challenges related long decision-making cycles.

    One specific example was illustrated by the head of strategy for a large regional health system in the Southeast. Their organization had identified the need to be in the direct-to-consumer virtual care business. They followed their normal process to pick a partner — formed a committee, engaged a consultant, did an initial survey of the market landscape, sent out an RFI, had a lot of meetings, sent out an RFP, brought in a short list for demos, had more meetings, called references, and finally made a decision on a vendor partner for the project. The decision was made 24 months after they originally identified their business need.

    During the two years of their selection process, the hospital system found that three other healthcare companies (none of which were historically competitive with them) had successfully built and deployed their own direct-to-consumer virtual care platforms in the same market. The incumbent hospital system lost the opportunity to engage, with a modern care alternative, the very community they have traditionally served for decades.

    New industry forces (underlying financial models, competitive pressures, reduced volume, consumerism, etc.) in healthcare now dictate that organizations no longer have years, but months to make strategic buying decisions before the market may pass them by.

    Together with healthcare organizations that collectively operate 20 percent of all the hospitals in the US, we identified three key areas with opportunity for improvement:

    • Alignment
    • Trust
    • Process

    Over the next several weeks, we will detail the learnings that resulted in a new way for healthcare organizations to accelerate and de-risk their buying process.

    HIStalk Interviews Bimal Desai, MD, MBI, Co-Founder, Haystack Informatics

    August 30, 2017 Interviews 1 Comment

    Bimal Desai, MD, MBI is co-founder of Haystack Informatics and AVP/chief health informatics officer at Children’s Hospital of Philadelphia.


    Tell me about yourself and your jobs.

    I’m the chief health informatics officer at Children’s Hospital of Philadelphia. I came to CHOP for residency and then stuck around, so this is my 18th year with the organization. I have oversight over the clinical informatics program, which includes the physician informaticists who interface with the Epic team. I oversee analytics and reporting as my second area of responsibility. The third program that I oversee is a newly-launched digital health program — we’re celebrating our one-year anniversary this month. 

    The connection to Haystack is that in 2014, CHOP had an internal innovation competition to try to find ideas that were potentially commercializeable. We partnered with Dreamit Health, a health IT accelerator that has a branch in Philadelphia. This idea that I pitched for privacy protection using EHR data was accepted to go to the accelerator. That became Haystack Informatics.

    How often does the privacy monitoring system detect employees doing something they shouldn’t?

    It’s a tricky question. There’s malicious access with intent to identify private information about patients. For example, an employee who’s trying to obtain Social Security numbers and things like that. Then there’s the more casual privacy violations, like your neighbor or a celebrity is admitted, and just out of curiosity, you take a look.

    We’ve learned that every institution has a different culture of privacy. Some institutions take it seriously and will announce formally, “You may have heard the news that we have a celebrity admitted to the hospital. Be aware that we’re monitoring access, and if anyone is found in that chart, they’ll be terminated from the institution.” 

    Some institutions take a hard stance on that and others don’t. It’s hard to say what the scope of the problem is.

    I would think that knowing a hospital has sophisticated access monitoring tools in place would reduce the casual violations.

    I think that’s right. To some degree, just having a privacy monitoring solution can be a deterrent. For example, if I were an employee and I kept getting calls from the privacy office for false positive alerts, “Were you supposed to be in this patient’s chart?” I would start to quickly distrust the privacy office. But if the true positive rate of those alerts in their system was high enough, employees would start to recognize that these guys have a legitimate solution in place. They will be able to find out if I’m snooping around in my neighbor’s chart.

    The other advantage is that privacy officers are required to look through these access logs. There’s no useful way to do it manually. All these technologies that we’ve developed simplify their work, allowing them to focus on the small subset of truly suspicious events.

    We looked at a single patient as a thought exercise, a celebrity who was admitted to the institution. I asked a question — how many rows of audit log data would you expect to see for this patient for a two-week hospitalization? It was hundreds of thousands of rows of data. In the absence of tools, the privacy officer couldn’t do it manually, even for just this one patient.

    That’s the value of these tools. They empower your privacy officer. They also help your staff employees stay on the right side of HIPAA regulations.

    What surprised you most about becoming an entrepreneur?

    The hardest part was understanding how I would continue to maintain my responsibility to CHOP and at the same time be an entrepreneur. I think people underestimate what it takes to start a company. Many physician entrepreneurs probably think that a good idea is sufficient enough. But it’s a lot of sweat equity. It’s a lot of work to build a company.

    I had to work that first year to negotiate time for my employer. Because this was a CHOP-sponsored project in that first year, especially, I was able to take a mini-sabbatical. It’s not something you can really do in your spare time. The one affordance that my employer gave me was two days a week for the first few months to dedicate to Haystack.

    Haystack has a really strong CEO, Adrian Talapan, who understood that I had this line in the sand when it came to conflict of interest and also the amount of time I was allowed to spend on the company based on the tech transfer and intellectual property requirements for the University of Pennsylvania and Children’s Hospital. There was a lot of negotiation that first year. That was probably the trickiest part.

    What technology and innovations are proving to be clinically useful at CHOP?

    I’m biased, but I think the electronic health record is turning out to be the strongest tool in the arsenal for things like supporting safety and quality kinds of initiatives. Not to diminish the work of the safety and quality offices themselves, but when it comes to actually crystallizing a workflow or suggesting that people take the right course of action, we’ve found that the electronic health record ends up really helping.

    In my role as a clinical informaticist, it’s interesting when I hear about institutions that lament or struggle with their EHR implementations. They’re struggling to understand what this tool does to help them standardize care. We’ve been very fortunate. We’ve got a strong partnership between my group of clinical informaticists as well as the offices of quality and safety and medical operations. It’s been fruitful. As much work as they’ve put into the development of the clinical pathways and the clinical quality metrics and tools to standardize care, there’s almost as much work in redesigning the EHR to support that workflow.

    That kind of partnership between informaticists and the people who have clinical design goals in mind has worked to our advantage. That’s probably been the most positive structure that we’ve put in place. We have 20 board-certified informaticists at CHOP. They’re embedded in every kind of quality and safety or workflow redesign project throughout the institution.

    Are most hospitals as successful as CHOP in integrating their own clinical content into the EHR to make it easier for clinicians to do the right thing?

    I’s a heavy lift. That’s the part that’s worrisome to me, that an institution that doesn’t have the kind of informatics resources that some of the big academic medical centers have. It is going to be a heavier lift for them. But their fallback is the content provided by the EHR vendor or external decision support vendors that provide canned order sets, simple protocols and things like that.

    It’s challenging. I don’t know of many other hospitals that have 20 informaticists. We’ve been successful in lobbying for those resources and making the argument for why it’s valuable to have them. But I think that that’s the hardest part.

    We had a meeting in Verona with the Epic leadership a couple of years ago. I remember Carl Dvorak saying that the EHR is a manifestation of your systems of care. The way you take care of patients at some level is reflected in how you design that tool. The double-edge sword of that is that if all of your systems of care rely on the EHR, then it’s really hard when the EHR is down. It’s really hard when you want to transport your model of care to another institution, for example, a partner institution. There is a benefit, but also potentially a vulnerability.

    Do you get pushback  when you roll out changes that the informaticists agree is the right way to care for patients, but that the end user doesn’t understand or receive benefit from in return for any extra effort required of them?

    That’s the trick. Neither part works without the other. Without some sort of EHR representation of a pathway, it’s hard to get people to standardize their work. On the flip side, just introducing a new order set is not going to improve the quality of a clinical process. 

    Our quality office does a good job with this, involving stakeholders and getting people in the right culture of improvement. To say, “We can all agree that we have this clinical quality problem. We can all agree that these are our clinical goals. Here are the tools to help you do it, or at minimum, help us design tools that you would find useful and usable.” It’s a dialog. You can’t really slap it in from the EHR side.

    We have many successful examples, but we’ve got plenty of failures, too, where we didn’t do the grunt work with regards to change management. It’s a common theme in the field. An order set is not just an order set. The way you roll it out is just as important.

    It’s even more of a challenge for hospitals that use mostly community-based physicians whose incentives aren’t necessarily aligned and who are asked to change behaviors.

    I hear that. One of my other hats is that I help teach the board review course in clinical informatics for AMIA. In the course of doing that for the past four or five years, I’ve met hundreds of informaticists and have heard stories from them about how CDS implementations have gone awry or pathways weren’t as successful as they anticipated. You’re right, part of the problem is that if your staff are not employed, that’s a challenge because it’s harder to get people aligned to the right goals.

    Our specific challenge in an academic center is that in some critical areas, you might have a majority of providers that are not employed by CHOP and they’re not pediatricians. If you look at our emergency department, for example, at any given time, less than half of the people there are CHOP emergency medicine docs. The rest might be rotating residents from adjacent adult ER programs, trauma programs, or family practice programs.

    We have put a lot of thought into designing the system to support not just expert users and pediatricians, but anyone. For any physician who steps into the institution — whether they’re a rotating surgeon from University of Pennsylvania or rotating emergency doc from Temple University –this system should be something they should be able to pick up and run with. The ED is probably the one place where we’ve put the most thought into that design for non-pediatricians.

    Would that technique be valuable for institutions where community-based physicians have admitting privileges and things like that? I don’t know if I know the answer for that, but I would think that probably yes. Designing for all users is probably a good thing.

    Do you have any final thoughts?

    I’ve been working in the EHR field straight out of residency since 2004. Across the country, we’re not universally successful, but we at least know some of the pitfalls of what makes clinician decision support useful and what makes it a challenge at different institutions.

    The next wave of interesting questions will deal with what you can do with all these data you’ve amassed. Once you’ve had an electronic health record in place for a decade, you’ve got terabytes of data that you can plow through. A lot of it is machine data, a lot of it is clinical data. The useful analytics derived from the EHR data and other sources. Genomic information, for example, is intriguing.

    We also haven’t yet figured out how to pull patients and families into their care. The portals are a snapshot or a window, but I don’t think we yet know the best techniques for participatory medicine and involving patients and families in their care. For us in pediatrics, we’ve got an interesting opportunity. All of our patients and their parents are, for the most part, digital natives. We don’t have to persuade them to use a smart phone to get access their health records. In fact, they’re asking us, when can we see this information on a mobile view or in a tablet? 

    We’re going to keep pushing some of that at CHOP to see where it goes and to try to demonstrate the value of things like telemedicine and inpatient portals and connected devices. It’s the next wave. We know about order sets, pathways, and decision support. Where else can we start to derive value from using technologies?

    Morning Headlines 8/30/17

    August 29, 2017 Headlines No Comments

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