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Readers Write: How Technology Could Aid Amazon’s Prescription Drug Play

November 1, 2017 Readers Write No Comments

How Technology Could Aid Amazon’s Prescription Drug Play
By Thomas Borzilleri

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Thomas Borzilleri is the founder and CEO of InteliSyS Health of San Diego, CA.

Amazon’s plans to enter the healthcare market may not be ready for prime time, but it is high time for the healthcare industry to take Amazon’s threat seriously. A recent report from Goldman Sachs notes that with 2016 prescription spending (net of rebates) topping $400 billion, high repeat purchases, lack of price transparency, and an increasing cost burden on the consumer, it’s no surprise that prescription drugs have attracted the attention of the 800-pound e-commerce gorilla. But the Goldman Sachs report goes on to warn Amazon of the complexity of the drug supply chain and the high barriers to entry for new players.

This is all certainly true. Most patients still buy their drugs the old-fashioned way, at retail pharmacies or through mail order services that reflect negotiated prices between public and private payers and pharmacy benefit managers (PBMs). These relationships will be challenging to break up. But as customers pay more for their prescription drugs, they will increasingly clamor for more price transparency and the ability to shop around, as they are starting to do for other healthcare services. As consumers increasingly drive decisions about their own care, Amazon may well find a path to success. The key is to partner with emerging technologies to bypass prescription drug middlemen and deliver real savings.

Amazon could wade in slowly to the healthcare sector. It could easily sell durable medical equipment online. There is no prescription needed and Amazon could most certainly lower prices if it can capture enough volume. At the very least, the e-tailer could offer free shipping as an incentive to choose Amazon over smaller DME vendors. Amazon could also, reasonably easily, get into the market to sell over-the-counter medicines, as discount clubs like Costco and BJ’s have already done with great success. Again, these purchases do not need to involve insurers or physicians, and Amazon can appeal directly to the consumer.

But this approach only scratches the surface of the opportunity for Amazon. If Amazon wants to go after the big Kahuna—prescription drugs—it will have to meet three essential goals

Inspire Trust

Amazon must inspire trust throughout the healthcare ecosystem, among patients, first and foremost, but also among doctors who agree to write e-prescriptions to a preferred pharmacy. Amazon may also have to inspire trust among insurers if it decides to partner with them to get access to drug coverage, formularies of preferred drugs, and guaranteed patient volume. They must convince all parties that the drugs they will deliver are as safe and effective as those found in retail pharmacies.

Promise Convenience

Amazon must offer added convenience over traditional mail-order pharmacies. The holy grail of two-hour or same-day delivery will require a large number of distribution centers, all of which need to be inspected by the US Food and Drug Administration and will require a high level of security. These demands, including added manpower to run these facilities such as highly-paid pharmacists, will be costly.

Deliver Value

Amazon can only succeed if it can offer a lower price point, and it can only offer better prices if it can capture significant patient volume. If Amazon simply seeks to replace existing pharmacy benefit managers by winning brand-new contracts with insurers, this will be a challenge. Amazon will not, starting out, have the volume-based discounts that PBMs enjoy. Meanwhile it will face a variety of new startup costs. Additionally, Amazon will face a fierce battle from entrenched PBMs.

Amazon must, as it has done in other markets, forge an entirely new path by connecting directly with consumers and offering reliable products conveniently and affordably. Amazon has chosen a fortuitous moment, as the consumerization of healthcare is finally gathering steam. Consumers are paying more out-of-pocket than ever for prescription drugs due to rising deductibles, co-pays, and co-insurance. Meanwhile, most patients have no idea that the price of drugs varies widely and that buying medications retail may be cheaper than their co-pays. This sets up a unique opportunity for Amazon to help lift the veil on drug prices and offer patients lower-priced alternatives.

By operating independently of insurers, Amazon can sidestep a head-on fight with established PBMs. Instead of spending resources trying to pick off patients one insurer at a time, they could choose to woo patients directly, competing on price at the point of care where prescribing decisions are made.

PBMs ostensibly exist to provide volume discounts to insurers on drugs. But in reality, these “discounts” are riddled with padding. Insurers are receiving volume discounts off the manufacturer’s retail price, but PBMs tack on something called “ingredient spread” while also charging a per-transaction fee. Meanwhile, prices vary widely from one pharmacy to the next, even in the same town, and consumers typically have no idea. Consumers who buy their drugs using insurance coverage usually accept the PBM-mediated price at their closest pharmacy because they don’t have the knowledge or the ability to shop around.

Instead of allying with manufacturers and insurers (the supply side of the prescription drug transaction), Amazon would do much better to join forces with the demand side, appealing to consumers and doctors. But how can Amazon get into a doctor’s office? Send sharply dressed salesmen and women like the makers of Lipitor and Viagra? Since the Sunshine Act and other rules regulate interactions between healthcare providers and the pharmaceutical industry, drug sales personnel have less access to providers than ever.

Amazon could instead leverage new technologies that help doctors and patients access real-time drug prices at nearby pharmacies. Amazon’s prices could be listed along those at traditional retail pharmacies to allow patients and doctors to choose the lowest-priced vendor, depending on whether the retail price or the co-pay is a cheaper option. These tools, if accessed seamlessly within the e-prescribing workflow, would integrate Amazon into the existing marketplace of drug retailers and give the e-tailing behemoth a seat right in the exam room alongside the doctor and patient, giving Amazon direct and immediate access to patients across different private health insurers, public payers, and the uninsured/underinsured.

Amazon would still face the challenge of establishing mail order centers and getting them certified by the FDA. But they wouldn’t be seeking to replace one middleman—pharmacy benefit managers—with another. By going straight to the consumer and the provider at the point of care, Amazon would have a unique opportunity to disrupt both the supply chain and the pricing models for prescription drugs. This could potentially have far-reaching benefits for consumers by causing overall downward price pressure and further exposing price-gouging that PBMs engage in, even while promising discounts.

The Goldman Sachs report posits that Amazon’s best chances for success rely on choosing a partner that can help it get into the market, such as an existing PBM. While this approach may be a boon for Amazon, it won’t do much to disrupt drug prices and transparency. If Amazon is serious about remaking the way Americans buy their prescription drugs, the e-commerce behemoth should look to cut out the middlemen—PBMs—and appeal directly to consumers to help tackle the prescription drug affordability crisis in the United States.

Readers Write: Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 3 of 4)

November 1, 2017 Readers Write 3 Comments

Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 3 of 4)
By Bruce Brandes

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

In Part 2 of this series, we discussed the importance of first clearly defining and aligning regarding the problem a buyer seeks to solve before evaluating products. The next key element is to invite trusted colleagues to contribute insights and experience in the context of that problem and possible solutions.

Below we will share more about the type of buying decisions most impacted by a lack of trust and explore how healthcare buyers can gain more confidence in the choices they must make.

There are three buckets of non-labor spend in health systems:

  1. Supply chain — traditionally influenced by group purchasing organizations (GPOs.
  2. Pharma — traditionally influenced by pharmacy benefit management companies (PBMs).
  3. “Everything else,” which falls into a category known as purchased services (traditionally managed less centrally).

Purchased services represent 20-30 percent of a hospital’s expenses and include a wide array of vendors ranging from health IT and digital health to outsourced professional and ancillary support services. Many health systems are seeking to drive standardization, minimize duplication, and realize greater value related to purchased services.

Vendor selections for purchased services are generally complex, collaborative processes. With input required from so many key stakeholders for a purchase commitment of a significant amount, how do risk-averse health systems ever make a buying decision? The challenge is exacerbated by an array of third-party sources of market insight, including consultants, industry associations, purchasing groups, etc., all with their own opinion about the “best” vendor for that area of focus.

If you are responsible for this buying decision, who do you trust? How can you efficiently synthesize so many disparate data points of opinion about the best product in the market to put them all into context to make the right decision for your organization?

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Healthcare buyers take many of these outside opinions with a grain of salt, skeptical of the motivations of some. Vendors may compensate the “non-partisan” organizations to endorse their products. Unsolicited information received from cold calls or spam emails can rarely be trusted.

When you are making a strategic hire to your team, do you ever expect the personal and professional references given you by the candidate to say anything too negative? More commonly, even before an interview, it is wise to do a quick check of LinkedIn to seek common connections that you know will give you more clear and honest insight (this works in both directions for the candidate and organization).

Similarly, buyers want an efficient, private way to tap into trusted colleagues across their professional network,  those who have experience in tackling this same problem in an organization like theirs.

The time and cost associated with deciphering vendor claims, vs. hype, vs. reality are untenable for the entire industry. With today’s time and financial pressures, physical site visits and reference calls are (finally) antiquated. Thus, it is critical to gain necessary insights from those you trust to reduce the risk associated with strategic vendor selections.

The value of a trusted network is compounded when this collaboration is contextualized with the problem and potential solutions under consideration. As trusted communities come together, the entire industry can benefit.

Morning Headlines 11/1/17

October 31, 2017 Headlines No Comments

The Merit-based Incentive Payment System (MIPS) Advancing Care Information

CMS updates its MIPS information blocking requirements to specify that providers must attest they have not disabled EHR interoperability functions, or intentionally implemented their EHR in a way that limits data exchange, and that they respond to data requests from patients and providers quickly.

MEDITECH Form Q-10

Meditech reports Q3 results: revenue grew 9.8 percent to $122 million, EPS $0.47 vs. $0.68. Product revenue jumped 50 percent while service revenue dropped by three percent.

MCH sees major issues with medical record system conversion

The April 1 Cerner go-live at Medical Center Health System (TX) leads to billing delays that have pushed administrators to hire outside help to reduce accounts receivable prior to the end of the hospital’s FY.

10 percent revived by Narcan in Mass. died within year, study says

Researchers in Massachusetts find that one in 10 residents who were revived from an opioid overdose by Narcan went on to die within a year because their underlying substance-use disorder went untreated. The studies lead author says that hospitals should be referring patients to outpatient rehabilitation treatment centers and immediately prescribing Suboxone or Methadone, but few do.

News 11/1/17

October 31, 2017 News, Readers Write 2 Comments

Top News

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CMS clarifies the information blocking requirement of MIPS for providers. Eligible providers must attest that they:

  • Haven’t disabled the interoperability capabilities of their EHR.
  • Have implemented their EHR without taking any actions to limit interoperability.
  • Quickly respond to requests from patients and other providers who ask for information retrieval or exchange.

CMS advises that no documentation is required to be submitted as part of the attestation. It also notes that while attesting providers aren’t expected to understand or enable the technical side of interoperability, it’s their job to let their implementers and EHR vendors know that they will be attesting and hold them accountable for enabling that capability.


Reader Comments

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From Good-Time Charlie: “Re: Practice Fusion. I didn’t remember until your poll that they were even still around.” They are, but seemingly barely, well out of contention as an ambulatory EHR disruptor despite having raised $200 million from investors under that premise. ONC places Practice Fusion as the #9 most commonly used ambulatory EHR based on attestation data, which isn’t so good given that their product is free (and the products that follow them on ONC’s list aren’t really major-name EHR vendors). The company seemed unstoppable when doctors flocked to its product to collect $44,000 in Meaningful Use money in return for spending nothing, but the company’s business model was questionable, they were selling practice data in less-than-transparent ways (such as not naming who was buying it and for what purpose), its self-reported usage figures were head-scratching at times, and there was always the question of just how deeply practices engaged with the product since they had no skin in the game (no hardware cost, contract, training cost, etc.) The company fired founder and CEO Ryan Howard in mid-2015 right before a planned IPO, promoted a replacement with skimpy credentials for taking a company public, and largely fell off everyone’s radar.

From Dinky McQueen: “Re: GE’s rumored discussion about selling its healthcare IT business. Is it everything from Centricity on down, or just smaller, unaligned divisions such as the GE-Intel Care Innovations JV?” I haven’t heard specifics but would be interested. The health IT business includes the many products labeled as Centricity, workforce management (the old API Healthcare), Health Cloud, diagnostic-related software, and some analytics stuff. It’s hard sometimes to figure out where healthcare IT begins given the overlap with the company’s diagnostic business, which I assume won’t be dealt off. GE has built a poorly managed, unfocused portfolio of acquisitions that will be hard to sell off to a single buyer, which will probably elongate any process to make its unlamented healthcare IT exit.

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From Just Saying: “Re: speech recognition. You mentioned years ago using speech recognition to write HIStalk. Do you still do that?” I don’t. Three or so times I bought the latest version of Dragon and got excited about how much easier it was to “write” HIStalk by talking instead of typing, but the sheen wore off due to Dragon’s heavy system usage, occasional mysterious errors that lost what I had dictated, and the time required for me to fix its mistakes (nearly always caused by my not articulating crisply enough). I’m thinking about trying again with LilySpeech, a cloud-based system that uses Google’s speech-to-text system. I don’t need voice-controlled system automation – I just want to dictate into a text box and paste the result into my editor or Gmail. I’ll give the 30-day free trial a shot.


HIStalk Announcements and Requests

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I enjoyed reading a recent interview with freshly named economics Nobel winner Richard Thaler and was therefore happy to see his “Misbehaving: The Making of Behavioral Economics” pop up as a free Prime Reading Kindle book this week. I was engrossed and entertained by it, to the point that I ordered a softcover version (at full price) just so keep it handy and to be able to lend it out. This book and his earlier “Nudge” explain why humans don’t always follow rational economic thought, which of course has healthcare implications along with big-time business impact. I highly recommended the first book and will no doubt do the same for the second once I’ve read it. He’s a great explainer and pretty funny besides.

The only iOS device I have left is my iPad Mini, but even that is now a little closer to Android – I replaced the default iOS mail app with Gmail and like it much better, especially for deleting endless streams of spam without having to swipe emails individually and trying to recall the difference between “archive” and “move to trash.”


Webinars

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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

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


Acquisitions, Funding, Business, and Stock

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Meditech announces Q3 results: revenue up 9.8 percent, EPS $0.47 vs. $0.68. Product revenue jumped 50 percent, but a slight drop in services revenue and an 18 percent increase in operating expense drove earnings down 31 percent.

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Roper Techologies (Sunquest, Strata Decision Technology, Atlas Medical, Data Innovations, CliniSys) announces Q3 results: revenue up 23 percent, adjusted EPS $2.36 vs. $1.96, meeting revenue expectations and beating on earnings.

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Germany-based Ada Health, which offers consumers an AI-powered health chat app that also connects users to doctors, raises $47 million and announces plans to open a US office.


Sales

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Hospital for Special Surgery (NY) will expand its use of Docent Health to provide customized, whole-person support that addresses each patient’s needs, fears, and concerns.

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Orlando Health chooses Phynd to manage the information of 25,000 providers across nine hospitals.


People

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Geoff Hogan (Imprivata) joins Diameter Health as chief commercial officer.

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Impact Advisors promotes VPs Paula Elliott and Bill Faust to leadership roles over its quality services and strategic implementation services practices, respectively.


Announcements and Implementations

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Casenet’s TruCare is named Best Population Health Management Software Provider in a UK healthcare and pharmaceutical awards program.

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HIMSS announces that Alphabet Executive Chairman Eric Schmidt will deliver the opening keynote at HIMSS18 in the “still seems weird” time slot of Monday, March 5 at 5:00 p.m. PT. Schmidt provided the very long keynote at HIMSS08 in Orlando, where he pitched since-failed Google offerings like Health and Flu Trends. 


Government and Politics

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Politico reports that HHS privacy leader Deven McGraw, JD has left government service to join an unnamed Silicon Valley health technology startup.

Publicly traded, Cincinnati-based Chemed, which owns the country’s largest for-profit hospice chain, will pay $75 million to settle False Claims Act charges that it billed Medicare for services involving patients who were not terminally ill and paid its employees bonuses for recruiting new patients. Three whistleblowers will share in the payout. Trivia: Chemed’s other big holding is Roto-Rooter. 


Other

Vanderbilt University Medical Center (TN) will go live on Epic this week.

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The April 1 Cerner go-live at Medical Center Health System (TX) led to billing delays that left it behind for the fiscal year ending September 30. A consultant’s report says that hospital executives blamed staff for lack of commitment and not paying attention during training, but most employees said that training was insufficient for doing their jobs. 

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A study finds that 10 percent of Massachusetts residents who were revived from opioid overdoses with rescue drug Narcan died within a year, highlighting that only five percent of overdose survivors receive longer-term treatment drugs such as Suboxone.

Brilliant: a company in Japan gives non-smokers an extra six days of vacation, both as an incentive for smokers to quit and to give non-smokers the same amount of non-productive time enjoyed by smokers.

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Weird News Andy helpfully notes that maybe the patient should have considered flossing. Doctors examining a woman with a decades-long history of nosebleeds believed to be caused by rhinitis finally determine the cause – a fully grown tooth embedded in her nasal cavity. Dentists say “supernumerary teeth” can grow in odd spots on the face in the 4 percent of people affected, but having them erupt in the nasal cavity is extremely rare. 


Sponsor Updates

  • Meditech, which has 20 customer sites in Puerto Rico, donates money to United for Puerto Rico.
  • AdvancedMD will exhibit at APTA’s Private Practice Section event November 1-4 in Chicago.
  • HIS 2017 recognizes Agfa Healthcare in the IT Industry category – RIS and PACs during its annual awards ceremony.
  • AssessURHealth publishes a new white paper, “The Missing Piece: Holistic Care through Preventive Screenings.”
  • Bernoulli Health will exhibit at HealthAchieve November 6-7 in Toronto.
  • Besler Consulting will present at the Minnesota HFMA Regulatory Conference November 2 in Bloomington.
  • CSI Healthcare IT completes the first wave of Epic go-lives at Lovelace Health System (NM).
  • Clinical Architecture will exhibit at the AMIA 2017 Annual Symposium November 4-8 in Washington, DC.
  • CoverMyMeds, CTG, and Cumberland Consulting Group will exhibit at the CHIME Fall CIO Forum October 31-November 2.

Blog Posts


Contacts

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

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Morning Headlines 10/31/17

October 30, 2017 Headlines 1 Comment

Hearing Amazon’s Footsteps, the Health Care Industry Shudders

The New York Times explores the industry’s reaction to news that Amazon is quietly building a healthcare business unit. The article points out that Amazon has already secured wholesale pharmacy licenses in 12 states, and argues that the recent effort by CVS to acquire Aetna is, in part, a response to new pressure in the pharmacy market from Amazon.

Technology for a Healthier Future: Modernization, Machine Learning, and Moonshots

Alphabet’s executive chairman Eric Schmidt will deliver the opening keynote speech of HIMSS18. He presides over various healthcare-focused business units within Alphabet, and serves on the boards of the Mayo Clinic and the Broad Institute.

CMS proposed rule opens door to skimpier health plans, higher patient costs

CMS publishes a proposed rule aimed at stabilizing ACA marketplaces that will give states the authority to define the minimum essential health benefits a plan must cover. Advocates hope the change will lure insurers back to the marketplaces and result more affordable plans for consumers.

IBM Watson Health Teams Up With The CDC To Research Blockchain

The CDC will partner with IBM Watson to research blockchain-powered tools to improve secure health data sharing.

 

Curbside Consult with Dr. Jayne 10/30/17

October 30, 2017 Dr. Jayne 1 Comment

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When I first started consulting, I did it as a bit of a “side hustle” on top of my CMIO day job. My initial focus was helping small practices with system selection, since this was in the early days of EHR adoption and many didn’t have the resources, time, or understanding to know where to begin with the process. It was as much about providing a service to my peers and keeping them from being led astray by vendors who would promise them the moon but who were only able to deliver them a lump of gray dust.

I had a fair amount of experience in this area, having been through a process with my first EHR which barely worked and where every question I asked was treated as an “enhancement request.” Of course, I also had some pretty hefty student loans to pay off and wanted to make a larger dent in them than I was able to do with my salary, so I can’t say my motivation was entirely altruistic.

As Meaningful Use launched and the market exploded, my side hustle grew and I learned more about what made different kinds of practices tick, long with a great deal about what turned that ticking into a time bomb. I started to run into work where I would need to help recover what was often billed as a poor EHR installation but turned out to be organizational dysfunction, and started focusing my available continuing education time on change leadership and related disciplines. I moved into optimization work, and as most of you know, was able to eventually quit my day job and go into business for myself.

I’m seeing history repeat itself, though, as the number of requests for assistance with system selection is increasing. Of course, this time around they’re largely system replacements rather than new installations, but the themes I’m seeing are the same.

Even though some practices are reluctant to move forward based on uncertainty around CMS reporting requirements in the coming years, others see the relative relaxation in requirements as a reason to move ahead with a new EHR system for 2018. Although the industry is seeing migration of smaller practices onto hospitals’ community platforms, we’re seeing a good number of groups that want to remain independent but don’t think their current vendor is doing right by them. The largest uptick in interest that I’ve seen is in specialty practices who want to move off of a broader EHR platform onto something that is more specialty specific, which poses its own challenges since the market has been consolidating and quite a few niche vendors have either left the market or have decided not to pursue full certification.

This has been educational as clients bring some vendors forward that I haven’t heard of before let alone interacted with, so there is a general feeling of déjà vu. It’s been a nice challenge to research the different vendor candidates and get to know their products and review the information they provide to sort the wheat from the chaff. This time around there are many more vendors who are willing to give clients short-term access to web-based products so they can kick the tires themselves rather than relying on sales demonstrations or just talk. I’m seeing more willingness for vendors to provide complimentary analysis of financial and claims data and offer recommendations on how to optimize the revenue cycle in preparation for a turnover. Some are offering packages to help work down the accounts receivable in the legacy system as a part of their quote for a new system. I’m also seeing willingness to deliver clinical optimization services as part of the sales process, making sure the prospective clients have the best chance at a successful migration.

None of this comes cheap, though, so vendors are really putting it on the line this time around. Maybe I’m seeing some over-confidence or maybe they have just learned from experience that successful EHR adoption is more than implementation of a system and automation or revision of processes. They want to fully understand where their potential clients are coming from so they don’t get burned by unhappiness after a less-than-successful implementation or wind up with a client who leaves them in five years or so.

In some ways, this is wise, but I’ve seen it play out in different ways with clients depending on what is found in those complimentary analyses. Some shoppers may see it as a chance to work with a knowledgeable vendor who has a vested interest in their future success. Others, however, are seeing it as a chance to go back for a do-over with this current vendor, often asking for complimentary services similar to or in addition to what they have already received from a potential replacement vendor.

This is causing significant stress for vendors at risk for replacement, who are being asked to spend what can be a relatively large amount of resources to retain their clients. For those who aren’t good at managing these expectations, it can accelerate a client’s departure.

I ran into a conflict of interest situation recently, where I was working with a client on a system selection. They wanted to leave a vendor for whom I have previously done some contract consulting, so I was familiar with how the vendor operates. Knowing the strength of the system and the way the client was struggling alerted me to the fact that the client had some non-software operational issues that needed resolution. I pointed this out to the client, but they wanted to proceed anyway and engaged me to attend demos with them and provide objective analysis. One of their prospective vendors also provided some complimentary services, so they decided to ask their current vendor for the same services.

Not knowing the client was working with me on a replacement evaluation, their current vendor reached out to me to try to salvage them. I would have loved to have switched hats and transfer my efforts to fixing the client on their current system since I had pointed out the client-side issues to my client in the first place, but contractual obligations tend to get in the way in situations like this. The client may decide to stop their replacement evaluation and switch gears to a remediation project, in which case I’m going to probably be out of the picture because the client isn’t going to pay me to do what the vendor is offering for free and I’m not comfortable working with the vendor on this particular client since I have specific knowledge of the recommendations of their competitors. I’m fine with it either way. I just want the client to receive what they need to get things moving in the right direction in the most financially responsible way.

I’m afraid this type of engagement may become the new normal as the forces of market consolidation continue to work and as clients become more concerned about the future. It’s often tempting to spend resources on buying a new system rather than spending to fix what you have. Although some might think of the latter as throwing good money after bad, often it’s a more responsible choice if the underlying system is a solid one. We’ve all seen people who spend $40K on a new car because they don’t want the hassle of spending $700 a couple of times a year on an old one, even though $1,400 per year is a lot cheaper than $8,000 a year in car payments plus higher insurance. From an economics perspective, this may not be much different, but the psychology around it is much more challenging. It certainly brings up issues that are challenging and that I’m looking forward to helping clients address.

Are you seeing movement with system replacements? Email me.

Email Dr. Jayne.

Morning Headlines 10/30/17

October 29, 2017 Headlines No Comments

Merck Announces Third-Quarter 2017 Financial Results

Merck reports a $135 million in lost Q3 sales and $175 million in additional costs associated to its recovery from the Petya ransomware attack.

Quality Systems, Inc. Reports Fiscal 2018 Second Quarter Results

QSII, parent company of NextGen, reports 2018 results: revenue grew four percent to $132.6 million, adjusted EPS $0.22 vs. $0.23, beating expectations for both.

Tenet Healthcare to lay off about 1,300 employees

Tenet Healthcare will lay off 1,300 employees, one percent of its total workforce, as business leaders look to cut costs by $150 million over the next year.

Health IT Investment on Record Pace through Q3

A Healthcare Growth Partners report on heath IT investments says that $8 billion has been invested globally in health IT startups through Q3 of 2017. The report says that investment activity is continuing to grow, despite a slowdown of M&A activity, noting “total capital invested globally in HIT has increased at an annual rate of 46% since 2011.”

Monday Morning Update 10/30/17

October 28, 2017 News 4 Comments

Top News

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From the Cerner earnings call following announcement of Q3 results that fell short of expectations for both revenue and earnings:

  • The company blames its bookings shortfall on “several large deals that were forecast for the quarter that did not come through,” with ITWorks complete outsourcing providing deals being a big contributor to the shortfall.
  • Cerner notes that the lack of Meaningful Use-driven customer urgency is making it harder to create reliable sales forecasts.
  • The company says it is seeing success against Epic as customers focus on return on investment and notes that new hospital EHR entrants “have over-promised and under-delivered.”
  • The company expects to sign its contract with the VA by the end of the year, in which Cerner will function as the prime contractor with subcontractor partners to be announced later.
  • President Zane Burke expects that the VA contract terms will involve a series of task orders that will provide percentage-of-completion payments over several years.

Cerner shares dropped 8.43 percent Friday after the earnings report.

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Above is the five-year share price of CERN (dark blue, up 68 percent) vs. the Nasdaq (light blue, up 125 percent).


Reader Comments

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From Snowman: “Re: Citrix. Hearing 40 percent increases in maintenance fees when renewing. That’s another $300,000 per year for our medium-sized facility. Does that make them a monopoly?” Unverified. Anyone else seeing big maintenance jumps? Citrix isn’t exactly a monopoly since alternative virtual desktops exist, but its product is deeply embedded into the infrastructure and software vendor contracts of most hospital IT shops. I would be interested to hear from hospital CIOs who switched successfully from Citrix to something else for their core healthcare-specific apps and whether they experienced support issues.

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From IT Maven: “Re: University of Washington. UW Medicine has had three chief health system officers in less than a year. Does this have anything to do with their decision no to go with Epic?” I doubt Epic was a key consideration for an executive of that level. The new CHSO’s predecessor lasted less than a year before stepping down in a mutual decision, replaced by an interim that I assume the reader is counting as the third person to hold the job since November 2016.

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From Master of Startup Puppets: “Re: Crunchbase series. I think HIStalk readers would enjoy it.” The series called “A Startup Takes Flight” is an interesting fictional case study that covers early-stage funding, venture capital deal terms, and what happens when a startup sells.

From Not A Client: “Re: Medi-Span data. Has been removed from RxNorm at the request of Wolters Kluwer. Not sure if this is newsworthy since I’ve seen nothing outside the NLM site.” The October 2 RxNorm release notes verify that Medi-Span data was removed from RxNorm at the company’s request. NLM has just announced that the September 2017 RxNorm release expanded the Medi-Span data set.

From The PACS Designer: “Re: LiFi Mobile. LEDs can act as transmitters of signal in wireless systems. LiFi is high speed, bi-directional networked and mobile communication of data using light. LiFi comprises of multiple light bulbs that form a wireless network, offering a substantially similar user experience to Wi-Fi except using the light spectrum.” It sounds interesting, but line-of-sight requirements, as well as possible interference from ambient light, would seem to limit usefulness.


HIStalk Announcements and Requests

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Poll respondents are mostly skeptical that IBM Watson will make a healthcare splash.

New poll to your right or here: which ambulatory EHR vendor has fallen hardest from HIT front-runner status? I recognize that Allscripts and GE Healthcare aren’t just ambulatory EHR vendors, but their presence there earns them a poll spot.

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


This Week in Health IT History

One year ago:

  • A poor McKesson earnings report sends shares down 23 percent, while competitors Allscripts and Cerner also post lackluster earnings.
  • A Politico article says that Epic and EClinicalWorks are impeding data-sharing with public and specialty registries.
  • CMS approves continuous 90-day reporting period for its EHR Incentive Program and eliminates specific objectives and measures.

Five years ago:

  • McKesson talks up its MedVentive and MED3OOO acquisitions in its earnings call, hints that the company might work with Athenahealth following its acquisition of PSS World Medical, and admits that some Horizon customers are passing on the chance to migrate to Paragon.
  • A Wells Fargo Securities analysis finds that the lowest-percentage hospital EHR attestation vendors are GE Healthcare, QuadraMed, NextGen, and McKesson.
  • CHIME President and CEO Rich Correll announces plans to move to a COO role.
  • SCI Solutions founder John Holton retires from the company.
  • Humana acquires Certify Data Systems.

Ten years ago:

  • CSC acquires First Consulting Group.
  • Perot Systems conducts massive layoffs.
  • ZDNet declares MIsys to be an open source health IT competitor to Medsphere.
  • ONC funds a significant grant to have definitions developed for the terms EHR, EMR, PHR, HIE, and RHIO.
  • Virtua Healthcare (NJ) says its $500 million, 368-bed new medical campus will use technology to transform healthcare.
  • Philips announces plans to sell its 70 percent stake in MedQuist. 

Last Week’s Most Interesting News

  • Cerner falls short of Wall Street expectations for both revenue and earnings in its quarterly report, sending shares down hard.
  • CVS is rumored to be in talks to acquire Aetna.
  • GE explores selling its healthcare IT business.
  • A second former executive of Cleveland Clinic Innovations is arrested for fraud involving spinoff Interactive Visual Health Records.

Webinars

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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Quality Systems (NextGen) announces Q2 results: revenue up 4 percent, adjusted EPS $0.22 vs. $0.23, beating analyst expectations for both. From the earnings call:

  • The company says it was hit by turnover in its sales team as “a number of legacy sales resources and managers elected to move on,” with the resulting loss of client relationships hurting the close rate for larger deals. The company confirmed that 13 of 70 salespeople have left and have been replaced.
  • The company is still trying to salvage one unnamed large client that has threatened to defect.
  • NextGen is emulating Athenahealth in offering pricing based on a percentage of net collections.

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Above is the five-year share price of QSII (dark blue, down 19 percent) vs. the Nasdaq (light blue, up 125 percent).

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Tenet Health will lay off 1,300 employees.

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A Healthcare Growth Partners report finds that health IT investment is continuing at a record pace even as M&A activity has stagnated. The quarter’s big M&A deals were the merger of Navicure and ZirMed, the sale of The Advisory Board Company’s healthcare business to Optum Health, and the sale of WebMD. The big investment theme was genomic medicine. The article notes that the industry must be assuming that total addressable market and M&A activity will increase to absorb the 46 percent annual growth rate in investment that has occurred since 2011.


Sales

Everest Rehabilitation Hospitals (TX) chooses Medhost for two hospitals to be constructed.


People

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Aviacode CEO Keith Hagen takes on the additional role of board chair.


Announcements and Implementations

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Medecision launches 10 care management apps for care, utilization, and disease management; network management; and care coordination.

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T-System says 70 percent of its new contracts involve its hosted solutions for episode-based care, which includes hospital EDs, freestanding EDs, and urgent care centers.

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Definitive Healthcare adds retail health clinics and assisted living facilities to its healthcare provider database.

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Akili Interactive, Propeller Health, Voluntis, and WellDoc launch the Digital Therapeutics Alliance to support clinically validated solutions.  


Privacy and Security

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Drug maker Merck says it lost $135 million in Q3 sales and spent $175 million in direct cost due to its Petya ransomware attack in June. The company said in the earnings call that its Q4 results will be similarly impacted, raising the cost of its ransomware attack to at least $620 million.


Other

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A vascular surgeon testing the FDA-cleared Butterfly IQ ultrasound device for smartphones decides to scan his sore throat, the result of which reveals that he has a since-treated cancerous mass.

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Microsoft ends production of its Kinect 3-D mapping and body movement sensor that in addition to is main purpose as an Xbox game controller was used in some healthcare applications, such as those for physical therapy, rehab, and health screening. Part of Kinect’s technology has been rolled into Microsoft’s Hololens.

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Medical device executive David Mortara, PhD donates $25 million to the UCSF School of Nursing to fund a center that will study alarm fatigue and overly sensitive ECG machines that contribute to it. Mortara sold his diagnostic cardiology and patient monitoring device company to Hill-Rom for $330 million in cash in January 2017.

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Actress and investor Eva Longoria helps introduce a virtual visit kiosk that will be offered to residents of an affordable workforce housing community in Texas.

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An interesting article looks at the big business of scrubs, worn every day by the nearly one in five Americans employed in healthcare who generate $10 billion in annual sales, mostly to wearers who buy their own. The latest innovation beyond adding licensed cartoon characters and form-flattering designs: scrubs impregnated with antimicrobials to help reduce the spread of infection.

In Scotland, the Royal Pharmaceutical Society says community pharmacists don’t have access to the electronic medical records of patients as they were promised, requiring them to call an NHS hotline to obtain the information they need.

Thomas Health (WV) lays off 10 IT employees following consolidation of systems it didn’t name. The hospital announced plans last year to move from Cerner/Siemens Soarian and Meditech Magic to Meditech 6.1.

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Weird News Andy is weirded out by this story covering the largely unregulated “tissue banks” that offer free cremation – sometimes in cahoots with funeral homes who invest in the companies — in return for donating organs to “advance medical studies.” It calls out Southern Nevada Donor Services, whose employee was caught using a garden hose in the parking lot of its warehouse to thaw a human torso, sending tissue and blood into a gutter. Most of the known “body brokers” are for-profit companies, one of which earned $12.5 million in three years. The companies were launched for as little as the $100,000 needed to buy a van and freezers, with some of the more frugal ones using a chainsaw instead of the much more expensive surgical saw to disassemble their donors into marketable components.

Vince takes us back to November 1987, when pre-adult Tiffany (who is now 46 years old) ruled the pop charts with “I Think We’re Alone Now” and a surprising health IT vendor’s ad bragged on being backed by a $5 billion company (which, like most big companies dabbling in healthcare, didn’t stick around long).


Sponsor Updates

  • Forward Health Group founder and CEO Michael Barbouche is named to Madison Magazine’s M List of health innovation leaders and will speak at a reception and dinner on November 9.
  • ZappRx will attend the CHEST conference October 28 – November 1 in Toronto and the North American Cystic Fibrosis Conference November 2-4 in Indianapolis. The company will also exhibit at the PFF Summit November 9-11 in Nashville.
  • Aprima will exhibit at the American College of Phlebology’s 2017 Annual Congress November 2-5 in Austin, TX.
  • Surescripts will exhibit at the Digital Quality Summit November 1-3 in Washington, DC.
  • T-System sees swelling demand for its hosted healthcare solutions.
  • TriNetX will exhibit at the AMIA Annual Symposium November 4-8 in Washington, DC.
  • Mazars USA elects Cody Cass, Julie Petit, and Kristen Walters partners.
  • The Boston Globe features ZappRx CEO Zoe Barry in a profile on women in technology.

Blog Posts


Contacts

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

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Morning Headlines 10/27/17

October 26, 2017 Headlines No Comments

President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis

President Trump declares the opioid epidemic a “public health emergency”, but falls short of declaring a national emergency which would have unlocked immediate funding to help address the situation. Officials assured critics that the administration would be requesting additional funding to support expanded treatment efforts shortly.

How Health Care Providers Can Help End the Overprescription of Opioids

Harvard Business Review covers the opioid epidemic, calling for mandated use of PDMPs and improvements in their integration with EHRs.

Cerner’s busy earnings call: more government deals, stock falls hard, no CEO yet

Cerner reports Q3 results: revenue climbed eight percent to $1.28 billion, adjusted EPS $.52 vs. $0.49, missing on both. Shares fell eight percent in after-hours trading. On its earnings call, COO Michael Nill noted that a new CEO had not yet been identified, but offered some assurances, explaining that “The company is being run by a very solid team. The board is going to take their time and go through that process in a very careful manner.”

CVS Makes Blockbuster Aetna Bid

CVS is reportedly in talks to buy Aetna at a $66 billion valuation, sending share prices up 11 percent in after-hours trading.

News 10/27/17

October 26, 2017 News No Comments

Top News

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President Trump declares a public health emergency to address the country’s opioid crisis, drawing fire from critics for not allocating new funding to address the epidemic. Key takeaways:

  • Expanded access to telemedicine services.
  • Easier appointments of temporary HHS officials who will help redirect programs and resources.
  • Refocusing resources within HIV/AIDs programs to help give patients access to substance abuse treatment.
  • Issuing grants to help workers displaced from the workforce by the opioid crisis – a somewhat nebulous benefit subject to available funding.

HIStalk Announcements and Requests

This week on HIStalk Practice: Greenway announces corporate, software overhaul. Oklahoma physicians prepare for major business changes ahead of looming Medicaid cuts. AMA President-Elect argues for less spending on hospitals, and more on primary care. AMA continues to eschew digital health snake oil comments with launch of new forum. CoinMD looks to create a cryptocurrency-based healthcare membership network. Pennsylvania helps prescribers connect EHRs to PDMP. Delaware taps HMS to help it better integrate behavioral health and primary care. Drchrono develops urgent care-friendly health IT.


Webinars

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q3 results: Revenue up 8 percent, adjusted EPS $0.61 vs. $0.59, with bookings down due to projects delayed to the fourth quarter. President Zane Burke is optimistic the company will achieve its projected 2017 earnings and revenue growth, adding that, “we continue to gain share in the Electronic Health Record replacement market and still have meaningful growth opportunities in revenue cycle and population health.”

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Another one bites the dust: HIMSS acquires the rights to the Disruptive Women in Healthcare media company. I’m not sure how much disruption will occur now that it’s been gobbled up by HIMSS, which plans on incorporating its content into its own female-focused media efforts.

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Tenet Healthcare (TX) decides not to put itself up for sale, though it will move forward with a strategic review of operations as it struggles to deal with $15 billion in debt. Sources believe the company has instead decided to focus on selecting a new, permanent CEO.

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GE considers selling its healthcare IT and transportation businesses in an effort to meet a self-inflicted goal of divesting $20 billion in assets under the watchful eye of fairly new CEO (and former head of GE Healthcare) John Flannery.


People

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John McLean (Best Doctors) joins Kyruus as CFO.

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American Well hires Harry Kim (Samsung Health) as SVP of strategic partnerships.


Sales

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Hackensack Meridian Health (NJ) and Riverside Medical Center (IL) will implement Omnicell medication management and safety solutions including the Epic-friendly XT Automated Dispensing Cabinet.

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HCA’s HealthOne (CO) health system selects Philips Wellcentive’s cloud-based informatics platform.

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To help improve sepsis outcomes, Mosaic Life Care selects Wolters Kluwer Health’s POC Advisor clinical surveillance and analytics software.

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MultiCare Health System (WA) will spend $25 million on a staggered Epic implementation across its three Spokane facilities next year.

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Navicent Health (GA) will implement Outcome Health’s patient education technology at its physician group locations.


Technology

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NantHealth develops a companion medication adherence app for its Vitality GlowCap smart pill bottle.

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ZeOmega announces Medicare Advantage-specific enhancements to its Jiva population health management platform.


Announcements and Implementations

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Ozarks Medical Center (MO) implements emergency management communications technology from LiveProcess across its hospital, clinics, and home health providers.

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With help from IDSolutions, Henry Ford Health System (MI) adds Vidyo’s virtual visit technology to its Epic workflow.

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Pella Regional Health Center will go live on Meditech 6.15 November 1.

Partners HealthCare works with Validic to test out adding blood pressure monitoring data from patient home health devices to its EHR and provider workflows. The organizations plan to move forward with broader device integration and data gathering early next year.


Government and Politics

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HHS opens up applications for its Opioid Code-a-Thon, which will be held December 6-7 in Washington, DC. Prizes of $10,000 each will be awarded for solutions that focus on opioid treatment, usage, and misuse prevention.


Innovation and Research

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The UCSF Health Informatics team analyzes the movements of 85,000 hospitalized patients seen over three years by mapping EHR patient location and timestamp data. The information was then compared with hospital-acquired infection data in hopes of uncovering unknown transmission hotspots within the hospital. The team realized that patients who entered a particular CT scanner used in the ED were more than twice as likely to become infected with C. Diff than the baseline patient population. As a result, ED staff have been re-trained on how to properly sanitize the scanner.

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A majority of hospital CMOs report that post-implementation tech support will be a driving factor in their health IT purchasing decisions next year, according to new research from Black Book. Fifty-three percent of survey-takers believe their current EHR vendor is providing sub-par support. Cerner, Allscripts, Meditech, and McKesson received top support marks, while Stoltenburg Consulting was cited as a top third-party support firm.


Other

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Tesla team members install a solar array that has helped restore power to San Juan’s Hospital del Niño. Tesla founder Elon Musk has said the power project is the first of many that will help Puerto Rico recover from two September hurricanes that have left the island without vital resources.

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San Diego city officials come under fire for the enlisting the pro bono services of PR firms as they sought to stop the hepatitis A outbreak among the city’s homeless. Critics were especially surprised when the PR reps began attending government planning meetings. “You bring in stakeholders who have an interest in the subject at hand,” said one, “but you don’t usually bring in PR people who can spin it afterwards.”


Sponsor Updates

  • MedData and Meditech will exhibit at the ACEP Scientific Assembly October 30-November 2 in Washington, DC.
  • Netsmart will exhibit at LeadingAge October 29 in New Orleans.
  • Nordic will lead focus groups at the CHIME Fall CIO Forum October 31-November 3 in San Antonio.
  • NTT Data Services achieves premier-level service provider status in VMware’s Cloud Provider Program.
  • Parallon Technology Solutions and PatientSafe Solutions will exhibit at the CHIME Fall CIO Forum October 31-November 3 in San Antonio.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal-Neonatal Symposium October 30 in Williamsburg, VA.
  • Experian Health will exhibit at the Delaware Healthcare Forum October 31 in Dover.
  • PatientPing hires Brad Shaw (Wayfair) as director of engineering.
  • PokitDok achieves HITRUST CSF Certified status.

Blog Posts


Contacts

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

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EPtalk with Dr. Jayne 10/26/17

October 26, 2017 Dr. Jayne 2 Comments

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I had some additional adventures in patient-land this week when I went for a trip through the MRI scanner. Although it wasn’t a portal to adventure like some of the pediatric imaging suites I’ve seen, it did have its moments. The radiology department was running behind schedule due to short-staffing, which they promptly attributed to the hospital’s upcoming Epic go-live. Apparently, they need to get all the technicians through the training by the end of the month in order to meet the required training timelines. I was having a fairly specialized study that must not be done very often, and the only technician trained for the positioning needed was working in the emergency department, so I had to wait for her to arrive despite having been on the schedule for weeks. The study went off without a hitch, although you know you’re sleep-deprived when you sleep through your MRI despite all the banging noises. When it was time to assist me off the table, the tech let slip that she was glad the images turned out well because it’s the first time she’s performed this particular study. Not a confidence builder but I’m glad my results were unremarkable. I get to do it again in a year, so hopefully they’ll be through their Epic issues and have a little more experience with specialized MRIs under their belts.

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The ONC Annual Meeting is coming up, from November 30 to December 1 in Washington, DC. This year’s theme is “Tackling Barriers to Interoperability and Usability.” After a keynote from the National Coordinator, attendees can choose from a variety of breakouts on topics such as the Trusted Exchange Framework, standards, data infrastructure for patient-centered outcomes research, and reducing provider burden. There will also be a panel discussion on improving health IT usability. The hotel block expires Sunday, so make your reservations now.

I had to take some annual training this week for one of my clients, including HIPAA, fraud and abuse, harassment, and a charming refresher on how to use fire extinguishers. There were a few other courses required of all hospital employees and contractors. Fortunately, I could do them online while watching my favorite new show on Netflix, The Doctor Blake Mysteries. The HIPAA course reminded me of a recent article about a Capitol Hill pharmacist who commented publicly about some of his prominent patients, although he later retracted this to say he was talking speculatively. In addition to serving Congressional staffers and lobbyists in the community, his pharmacy delivers medications to the Capitol’s Office of the Attending Physician. Even if he was joking as he says he was, it’s a bad idea for a healthcare professional to put himself in this type of position.

I had never heard of the Office of the Attending Physician before the article, which apparently serves as a mini-concierge practice staffed by Navy physicians, nurses, and ancillary personnel. Lawmakers pay around $600 annually for the physician services, although the prescriptions are billed to insurance like they would be for any other patient. The Office has an annual budget of $3.7 million, which is certainly more than many of the primary care physicians I know who are carrying thousands of patients in their panels. The article mentions that the Office doesn’t yet use e-prescribing, which most of the rest of us have been forced to adopt, but rather that the physicians call prescriptions to the pharmacy by phone, which slows his business.

The justification for the Office is to allow lawmakers to receive care without interrupting their busy schedules, but I think that maybe if our legislators had to juggle physician visits like the rest of us do, they might be more sympathetic to the plight of the average patient. If they had to wait for physicians who were running late due to multiple competing priorities, overloaded panels, and clunky EHRs, they might have a different feeling about mandating how physicians practice. And if they had to sit on hold while making an appointment, then wait a few weeks for the visit, put in a time-off request, take off work, hand-off their responsibilities to a co-worker, clock out, sit in traffic, and barely make it to the office on time for their appointments, they might have a better understanding of the healthcare system they’re trying to fix legislatively.

Speaking of who should tell physicians and other healthcare professionals how to practice, I enjoyed this piece by New York Times op-ed writer Sandeep Jauhar. I had previously enjoyed his book “Doctored” about physician disillusionment, and so was interested to hear his thoughts on whether physicians or business leaders should make decisions about care in our hospitals. He notes that 90 percent of the nation’s hospitals are run by leaders without medical training, along with the increasing focus on profitable service lines regardless of the general medical needs of a community’s patient population. I’ve seen that in my own city where hospitals compete brazenly for orthopedic and cardiac procedures while running other service lines with a skeleton crew.

Jauhar notes that physicians are partly to blame for their loss of authority at hospitals: “If we had taken better care of our institutions, perhaps there would not have been a need for others to manage them for us.” It’s something to think about as we consider the many forces impacting patient care, not only for physicians but for other clinicians – we have lawmakers, payers, regulators, attorneys, accountants, and technology vendors driving our interactions with patients and with our peers. It’s certainly not going to get any better unless we do a better job advocating for our patients, our colleagues, and ourselves.

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Weird news of the week, just in time for Halloween: A patient is diagnosed with hematohidrosis, a condition in which she literally sweats blood. The write-up appeared in this week’s Canadian Medical Association Journal. With only 18 documented cases in the last five years, it’s not surprising that we haven’t heard more about it, but it’s a condition you certainly wouldn’t miss if you ever came across it.

Email Dr. Jayne.

Morning Headlines 10/26/17

October 25, 2017 Headlines 1 Comment

Cerner EHR implementation at VA to take ‘7 to 8 years’

VA Secretary David Shulkin, MD told the House Committee on Veterans’ Affairs that the transition from VistA to Cerner will take seven to eight years, with the first go-live anticipated 18 months after contracts are signed.

CRISPR 2.0 Is Here, and It’s Way More Precise

Published in both Nature and Science, researchers from the Broad Institute of MIT and Harvard describe a new gene-editing technique that improves on CRISPR-Cas9. The new approach rearranges atoms within a DNA strand to repair mutated chemical bases, rather than cutting and replacing the problematic area of the DNA, resulting in a more precise editing tool that could one day treat a range of inherited diseases, some of which currently have no treatment options.

Judge rejects bid by 18 states to revive Obamacare subsidies

In San Francisco, US District Judge Vince Chhabria upholds President Trump’s executive order stopping cost-sharing subsidy payments to insurers.

Bipartisan health-care bill would reduce deficit by $4B over 10 years

The CBO says the bipartisan Alexander-Murray bill, designed to stabilize the ACA individual marketplaces, would reduce the deficit by nearly $4 billion over the next 10 years.

Morning Headlines 10/25/17

October 24, 2017 Headlines No Comments

Imprivata Acquires Identity and Access Management Business of Caradigm to Expand its Solutions

Imprivata expands its secure user access product line in acquiring Caradigm’s identify and access management business. Financial terms were not disclosed.

Nuance Files Patent Infringement Lawsuit Against MModal

Nuance sues rival speech recognition vendor MModal, alleging that MModal products violate six Nuance patents related to speech recognition, computer-assisted physician documentation, and transcription technology.

UCSF Innovators Use EHRs to Track Hospital-Acquired Infection

A study published in JAMA Internal Medicine conducted by the UCSF Health Informatics team analyzes the movements of 85,000 hospitalized patients seen over three years by mapping EHR patient location and timestamp data. This information was then compared with hospital acquired infection data in hopes of uncovering unknown transmission hotspots within the hospital. The team did identify that patients who entered a particular CT scanner used in the Emergency Department were more than twice as likely to become infected with C. Diff than the baseline patient population. As a result, ED staff were re-trained on how to properly sanitize the scanner.

Cleveland Clinic CEO sees ‘total restructuring’ ahead for health care business

At the Cleveland Clinic’s 15th annual Medical Innovation Summit, CEO Toby Cosgrove, MD predicts that the shift to value-based care will require a “total restructuring” of the healthcare industry, saying, “I think as we do that we’re going to see the quality improve, we’re going to see the cost come down, and hopefully that will allow us to look after more and more people across the United States. But this is an enormous transition we’ve been at it now nine years, and we’re just beginning to see the effects of this.”

News 10/25/17

October 24, 2017 News No Comments

Top News

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Imprivata acquires Caradigm’s identity and access management business for an unspecified amount. Caradigm, a GE Healthcare company, has been in the process of streamlining operations for several years now. It announced workforce reductions in April, and August 2016.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor WiserTogether. The Washington, DC-based company’s treatment guidance platform improves outcomes and satisfaction while lowering cost. People and populations use its Return to Health solution to select the most appropriate and effective personalized treatment option in sharing decision-making with their provider. Condition, symptom, and demographic information is assessed against clinical efficacy and guideline content, treatment costs, provider ratings data, and time-to-recovery guidelines to present treatment options labeled as Poor, Good, and Best. Nearly 90 percent of users choose effective treatments, reducing the use of ineffective tests and treatments by 25 percent in creating a 400-900 percent ROI. The company just announced enhancements that include analytics and reporting that allows healthcare organizations to understand how patients make treatment decisions and which options they are likely to choose. Thanks to WiserTogether for supporting HIStalk.

I came across this video describing how patients can use WiserTogether’s Return to Health tool to find evidence-based treatments that are cost effective.


Webinars

Here is the recording from today’s webinar with ZappRx on improving care and saving time with streamlined specialty drug prescribing.

October 25 (Wednesday) 1:00 ET. “Delivering the Healthcare Pricing Transparency that Consumers are Demanding.” Sponsored by: Health Catalyst. Presenter: Gene Thompson, director, Health City Cayman Islands. Health systems are unlike every other major consumer category in not providing upfront pricing information. Learn how one health system has developed predictable, transparent bundled pricing for most major specialties. Attendees will gain insight into the importance of their quality measures and their use of actual daily procedure costing rather than allocated costs. They will also learn about the strategic risk of other market participants competing with single bundled pricing. The organization’s director will expand how its years-long process is enabling healthcare delivery reform.

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

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


Acquisitions, Funding, Business, and Stock

Select Medical Holdings will combine its Concentra occupational and urgent care company with California-based Dignity Health’s US HealthWorks subsidiary as part of an expanding partnership that includes the joint development of a 60-bed hospital and operation of 12 outpatient clinics in Las Vegas.

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Life insurance company John Hancock dangles $25 Apple Watches to lure customers into its Vitality health and wellness program. Members who exercise regularly for two years will avoid having to pay off the typically $300 device in installments.

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Nuance points the legal finger at MModal, alleging in a lawsuit that MModal products violate patents pertaining to transcription, speech recognition, and computer-assisted physician documentation technology. The lawsuit comes four months after Nuance suffered a malware attack on its cloud-based services that led to a $15 million loss in Q3.

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Newton, MA-based Devoted Health raises $62 million, bringing its total to $69 since launching earlier this year. Company founders Ed and Todd Park (brothers of Athenahealth fame, among other illustrious health IT roles) plan to offer concierge-style Medicare Advantage plans beginning in 2019 that will incorporate house calls and virtual visits.

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Amazon receives 238 bids from 54 states, provinces, and territories all vying to attract the company’s second headquarters. Amazon plans to invest $5 billion in the new facility, which will employ 50,000. Given its recent interest in health IT, it will be interesting to see if “Amazon HQ2” lands in a health IT-heavy town. As one would expect, city officials have dangled tax breaks and other incentives in front of the world’s largest online retailer. Outside of Atlanta, City of Stonecrest Mayor Jason Lary has promised to develop the city of Amazon and appoint Jeff Bezos as its lifelong mayor. 

Reuters reports that Siemens has enlisted three banks to lead the organization of an early-summer IPO for its Healthineers unit.


Announcements and Implementations

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Regional Health (SD) goes live on Epic over the weekend.

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Swedish Bellevue Primary Care (WA) becomes the fourth Swedish location to roll out Versus Technology’s real-time locating system.

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Definitive Healthcare adds retail clinics and assisted living facilities to its market research database of providers.

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Thibodaux Regional Medical Center (LA) implements electronic signatures and forms technology from Access.


People

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Tom Visotsky (HCS) joins Kno2 as VP of vertical market sales.

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Cancer informatics company Inspirata names Josh Mann (Mann Consulting & Ventures) VP of its Cancer Information Data Trust Program.

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Vikram Natarajan (Medfusion) joins SPH Analytics as SVP of development and IT.

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Tenet Healthcare names Executive Chairman Ronald Rittenmeyer interim CEO. He takes over from Trevor Fetter, who announced his resignation in August after a two decade career at the Dallas-based health system. Tenet has been exploring strategic options recently, including the potential sale of parts of the company, and has been in the public eye over disagreements with investors over strategy, takeover rumors, and board-level resignations.


Technology

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Medecision debuts new care management apps related to population analytics, EHRs, financial performance, risk scoring, and care coordination. The company will launch apps for care engagement and operational efficiencies later this year.


Government and Politics

Ft. Lewis, WA-based Madigan Army Medical Center goes live on Cerner, the fourth major installation of the DoD’s MHS Genesis program. The center is the largest of the program’s inpatient facility implementations, and the final one in the Pacific Northwest. I like that they’ve gotten a patient to host their tutorial videos, the first of which is accompanied by an 80’s-era soundtrack that will have you reminiscing about Jazzercise and GI Joe quicker than you can say “New Coke.”

A federal court dismisses CliniComp’s August lawsuit against the VA, which alleged that the administration had improperly issued Cerner a no-bid contract for a VistA replacement. CliniComp CEO Chris Haudenschild has vowed to appeal, adding that the company “simply wants the chance to prove that it can do the job cheaper, faster, and better.” The company’s systems are used in several VA hospitals.


Innovation and Research

The COPD Foundation, Geisinger (PA), GSK, and Jvion embark on a project that will identify COPD patients at risk of hospitalization and/or readmissions. Funded by GSK, the two-phased project will pair the foundation and Geisinger’s clinical expertise with Jvion’s AI-based patient risk stratification technology.

Black Book survey-takers rank Navicure as the top RCM technology vendor, with Experian, Patientco, Change Healthcare, InstaMed, and NThrive also scoring high for end-user satisfaction.


Other 

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The New Yorker digs into the pharma moguls of the Sackler family (apparently known more for their philanthropy than to the development of OxyContin) and their ties to the rise of pharmaceutical advertising, which some physicians feel account for the lion’s share of today’s opioid epidemic.

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This is a breach of a different kind: Saline Memorial Hospital staff receive an unexpected (and no doubt unruly) visitor when a deer crashes into its courtyard, prompting Arkansas Game and Fish to come and remove the animal.


Sponsor Updates

  • Besler Consulting releases a new podcast, “Reducing Medicare spending through electronic health information exchange.”
  • Carevive wins the 2017 Cerner Emerging Partner of the Year Award.
  • Centrak will exhibit at LeadingAge October 29-November 1 in New Orleans.
  • CoverMyMeds will exhibit at the CBI Electronic Benefit Verification and Prior Authorization Summit October 24-25 in San Francisco.
  • Dimensional Insight will exhibit at the Hospital Quality Institute November 1-3 in Monterey, CA.
  • EClinicalWorks will exhibit at the Connected Health Conference October 26-27 in Boston.
  • FormFast, HealthCast, Impact Advisors, InterSystems, and Intelligent Medical Objects will exhibit at the CHIME CIO Fall Forum October 31-November 3 in San Antonio.
  • Healthwise will exhibit at the HealthTrio 2017 Users Group Conference October 25-27 in Tucson.
  • Optimum Healthcare IT publishes a new case study, “Epic Help Desk and Call Center Support at The Guthrie Clinic.”
  • Iatric Systems will exhibit at the HCCA Regional Conference October 27 in Chicago.
  • AdvancedMD, Clinical Architecture, and CompuGroup Medical join CommonWell.
  • Nordic releases a new podcast, “How to communicate effectively during your EHR transition.”

Blog Posts


Contacts

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Get HIStalk updates. Send news or rumors.
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Morning Headlines 10/24/17

October 23, 2017 Headlines No Comments

Fetter Leaves Tenet Healthcare As CEO

Tenet CEO Trevor Fetter resigns after a two decade career at the health system. His last day will be March 15, 2018, or when a successor is named, whichever comes sooner. Tenet has been exploring strategic options recently, including the potential sale of parts of the company, and has been in the public eye over disagreements with investors over strategy, takeover rumors, and board-level resignations.

Olathe lawmaker’s job as a government strategist raises ethics questions

The Kansas City Star questions the whether a senior government strategist for Cerner should be simultaneously serving as the 15th district Kansas state representative.

Leidos Partnership for Defense Health Supports Advancement of Military Health System through Deployment of MHS GENESIS at Madigan Army Medical Center

Ft. Lewis, WA-based Madigan Army Medical Center goes live on Cerner, the fourth major installation of the DoD’s MHS GENESIS program.

Iowa withdrawing Obamacare alternative plan

Iowa Insurance Commissioner Doug Ommen announces that the state will withdraw its proposal to revamp policies governing its ACA marketplace for the 2017-2018 enrollment year, despite warnings that without the plan, up to 22,000 Iowans will drop out of the individual insurance market.

 

Curbside Consult with Dr. Jayne 10/23/17

October 23, 2017 Dr. Jayne 2 Comments

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I’m a big fan of former Surgeon General Vivek Murthy, MD and of his willingness to explore popular culture and current trends to further public health. (If you haven’t seen him talk with Elmo about vaccinations, it’s worth a watch.) His recent contribution to the Harvard Business Review addresses the “loneliness epidemic” that is a growing health issue for many people. He notes that although we are technically more connected than ever before, greater numbers of Americans report feeling lonely.

This isn’t the first time someone has written about the concept of loneliness. The Atlantic broached the idea that social media was making us lonely back in 2012. Even five years ago, it described us as “living in an isolation that would have been unimaginable to our ancestors, and yet we have never been more accessible.” I got a kick out of rereading the article, which described a world prior to the Facebook IPO. It addressed ideas that behaviors such as passive consumption of social updates and individuals broadcasting updates to the world links directly to feelings of disconnectedness. Reading the carefully curated updates of others has also been linked to depressed mood.

Of course, Facebook and other social media platforms aren’t always passive. I ran into a situation today with one of my hobbies, where I ran into an issue that could only be described as a calamity. A quick post to a hobby group had an answer for me in exactly 53 minutes, from someone I have met a couple of times and trust but don’t feel I know well enough to pick up the phone and call. We had some back-and-forth about the issue and my project, and I felt like I now know her well enough that next time I might just pick up the phone. After a couple of other people weighed in on my issue, I walked away with a greater feeling of connectedness rather than loneliness. This underscores the need to not paint technology as the culprit with too broad a brush.

Murthy takes these concepts and builds on them in a public health context. He notes the impact of loneliness on members of all age groups and socioeconomic backgrounds, citing it as one reason people become involved with violence, drugs, and gangs. He highlights a direct connection of loneliness with mortality, citing a study comparing it to cigarettes and obesity as a cause of shortened lifespan. It has also apparently been linked to higher risk for heart disease, dementia, depression, and anxiety. I have to admit, I haven’t seen any public health programs in my community that are specifically deigned to combat social isolation. Loneliness is also linked to burnout, which is something we’re seeing increasingly in healthcare. From a workplace perspective, Murthy notes that it “reduces task performance, limits creativity, and impairs other aspects of executive function such as reasoning and decision making.” He goes on to note that employers play a role in driving change by “strengthening connections among employees, partners, and clients but also by serving as an innovation hub that can inspire other organizations to address loneliness.”

I haven’t run across any employers yet who are specifically addressing the idea of loneliness, but I’m seeing organizations try to develop greater relationships between employees. They may be going beyond traditional team-building activities to spinning up employee support groups, such as those for new hires, working parents, telecommuters, veterans, and more. Given the number of hours that we see people spending in the workplace, it makes sense that it might be supplanting community organizations as a hub of social engagement. He notes that particular types of employment including telecommuting and contracting engagements lower the opportunities for direct interactions, but that “even working at an office doesn’t guarantee meaningful connections.”

Murthy steers the essay back to his public health roots, noting that loneliness causes stress, which can elevate the hormone cortisol, along with inflammation that can damage blood vessels. Stress can also impair brain function including emotional regulation and decision making. Social connections can lead to workers who are less likely to be sick and who can produce more quality work. He goes on to detail specific actions that can aid social connections in the workplace:

  • Evaluate the current state of connections in the workplace.
  • Build understanding of high-quality relationships.
  • Make strengthening social connections a strategic priority.
  • Encourage coworkers to reach out and help others.
  • Create opportunities to learn about the personal lives of your colleagues.

He expands on those actions by talking about concepts that we don’t consistently see in many workplaces, such as a culture of kindness and identifying the building of high-quality relationships as a priority. I’ve been privileged to work for people who embrace these ideas, encouraging colleagues to get to know each other beyond our roles as workers and more as people. At one office we were encouraged to personalize our workspaces, where another restricted display of non-approved decorations. It isn’t hard to guess which one led to greater personal conversations and understanding, and helped build some of the relationships that keep me sane on a regular basis. In other workplaces I’ve seen employees intentionally pitted against each other, or treated so unequally that most people would have significant challenges trying to build relationships in those environments. I try to include a review of workplace culture as an element in many of my engagements, and it’s good to see a respected source like Vivek Murthy give credence to the need to address what people often consider the “soft” disciplines.

Murthy closes citing a concern that “if we cannot rebuild strong, authentic social connections, we will continue to splinter apart.” We’re certainly seeing plenty of splinting in our world today, and in many workplaces. I hope his efforts to bring a discussion of loneliness to the fore garner some real attention. I’d be interested to hear whether any of the clinical informaticists out there are pursuing work in this area, or whether loneliness and social connections are being addressed in your workplace.

Have strategies to bring people together? Email me.

Email Dr. Jayne.

Morning Headlines 10/23/17

October 22, 2017 Headlines No Comments

athenahealth’s CEO Jonathan Bush on Q3 2017 Results

Athenahealth shares jump 8 percent on news of the company’s layoffs and cost reduction plan. In its earnings call, CEO Jonathan Bush attributes slow sales to “lackluster market conditions in the post-Meaningful Use era.”

FirstHealth Computer Network Threatened by Malware Virus

On Tuesday, a ransomware attack at FirstHealth of the Carolinas forces end users onto downtime procedures. Security analysts have identified the malware as a new form of the “WannaCry” virus.

Cleveland Clinic spinoff company executive arrested, charged with defrauding hospital out of $2.8 million

The former CTO of a Cleveland Clinic Innovations spinoff is arrested on fraud charges just nine days after the former director of Cleveland Clinic innovations Gary Fingerhut was arrested in connection with the same scheme.

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