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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

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

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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.

Monday Morning Update 10/23/17

October 21, 2017 News 9 Comments

Top News

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Athenahealth shares jumped over 8 percent Friday following Thursday’s announcement of mixed financial results, layoffs, office closures, and a cost reduction plan.

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From Friday’s Athenahealth earnings call:

  • Jonathan Bush says that the company’s slowing growth rate is due to “lackluster market conditions in the post-Meaningful Use era” as overall buying activity has dropped off. It hopes to generate 15 percent revenue growth for 2018.
  • The company blames its revenue expectations miss on having one fewer working day in Q3 as well as hurricane-related usage decreases. It also notes that visits per provider are dropping.
  • Workforce reductions of 9 percent of the company’s total headcount will be completed by the end of 2017, with the goal of removing management layers and increasing employee engagement. The company “right-sized” sales and marketing and “rationalized” general and administrative support.
  • Bush says “We’re sharpening our focus, taking action to operate in a significantly more efficient way, and move faster on our highest-value strategic objectives.”
  • The company will close its San Francisco and Princeton, NJ offices, rent out office space freed up by the layoffs, and sell its Challenger 300 jet.
  • The company is still recruiting an independent board chair, CFO, and president.
  • Athenahealth has 56 small hospitals live and has retained 95 percent of the hospitals brought live on AthenaNet since entering the market three years ago.
  • Bush credits the pressure brought by an activist investor for causing the management team to “look at the company through different eyes” and for “helping us find our way.”
  • Population health and Epocrates are not keeping up with the core business growth.
  • The company expects to connect with 100 percent of Epic’s installed based and 45 percent of Cerner’s this year.
  • Bush said hospitals say, “I hope somebody buys Epic or whatever it is after me so I don’t have to be the last guy who went and put half a billion dollars into enterprise software in 2017.”

HIStalk Announcements and Requests

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Two-thirds of poll respondents say not having a national patient identifier is a pretty big problem.

New poll to your right or here: How much impact will IBM Watson have on healthcare?

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Ms. B reports that her North Carolina middle schoolers “couldn’t keep their hands off” the science activity tubs we provided in funding her DonorsChoose teacher grant request.


This Week in Health IT History

One year ago:

  • McKesson says it will take a $290 million write-down of its Enterprise Information Systems business as it continues to seek a buyer for the division that includes Paragon.
  • Vocera acquires Extension Healthcare.
  • Jonathan Bush admits in the Athenahealth earnings call that followed a revenue miss that shifts in the market mean the company cannot maintain 30 percent bookings growth.

Five years ago:

  • An OIG report finds that the VA paid $6 million for 400,000 PC encryption licenses but has installed them on only 65,000 devices.
  • Apple announces the iPad Mini.
  • Allscripts sues Aprima for using the MyWay name in advertising aimed at getting those customers to switch to Aprima.
  • Athenahealth confirms that is negotiating with Harvard University to purchase the 11-building Arsenal on the Charles complex in Watertown, MA.

Ten years ago:

  • Misys creates an open source division to which it contributes its Connect software.
  • Misys announces MyWay, a hosted EHR it licensed from iMedica.
  • Medsphere CEO Mike Doyle predicts that the company will be the largest healthcare IT vendor.
  • Microsoft and HIMSS announce an overseas expansion of the MS-HUG conference.

Last Week’s Most Interesting News

  • Athenahealth announces big layoffs and planned expense reductions in response to pressure from an activist investor.
  • CVS and Epic will implement Epic’s Healthy Planet software to give prescribers point-of-care formulary and pricing information.
  • President Trump signs two executive orders to further destabilize the ACA, declaring that Obamacare no longer exists.
  • A state audit finds that University of Utah violated state procurement laws in its dealings with Patrick Soon-Shiong’s Nant companies.

Webinars

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

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Global health research network operator TriNetX will expand its Cambridge, MA office space as its headcount has expanded from 20 to 75. The new 20,000 square foot space will also include a network operations center.

Harris Healthcare acquires practice management software vendor Clinix Medical Information Systems.


Sales

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Population health management services provider HMC HealthWorks will implement Medecision Aerial applications that include analytics, financial performance dashboards, care management, evidence-based clinical programs, and personal health record.

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In Dubai, UAE, Latifa Hospital for Women and Children chooses Vocera’s intelligent communication technology.


Decisions

  • Fort Madison Community Hospital (IA) will replace Greenway’s ambulatory EHR with Meditech in 2018.
  • Women’s Healthcare Associates (OR) will switch from GE Healthcare to Epic’s ambulatory EHR in May 2018.
  • Palmetto Health (SC) will replace McKesson Star with Cerner revenue cycle management in October 2018.

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


Announcements and Implementations

ZeOmega launches a Jiva certification program for third-party consultants


Government and Politics

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Wisam Rizk, former CTO of Cleveland Clinic Innovations spinoff Interactive Visual Health Records, is arrested for defrauding the clinic of $2.8 million. The charges came nine days after former Cleveland Clinic Innovations Executive Director Gary Fingerhut pleaded guilty and agreed to serve federal prison time for accepting $469,000 from Rizk in return for lying to the FBI during their fraud investigation. Prosecutors say Rizk created a shell company that he hired to develop IVHR’s medical charting product at an inflated price, then contracted with an offshore company to do the actual work and pocketed the difference.


Privacy and Security

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Computer systems of FirstHealth of the Carolinas (NC) have been offline for several days following a ransomware attack that it attributes to “a new form of the WannaCry virus.”

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An interesting research project finds that anyone willing to pay $1,000 for online ads can track a mobile phone user’s movements, their precise location in near real time, and the apps they use, as long as they can obtain that person’s mobile advertising ID by examining their phone or eavesdropping on their wireless connection. The target doesn’t even need to click the ads – just having the ads displayed on their device records the information. Advertisers are already receiving this information, of course.


Other

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Anesthesiologist and Georgia state representative Betty Price, MD – who is married to fired HHS Secretary Tom Price – asks a state public health official in a public meeting if it would be legal to prevent the spread of HIV by quarantining people who have it. She flaunts clinical expertise in noting that dead HIV sufferers can’t spread it: “It’s almost frightening the number of people who are living that are … carriers with the potential to spread. Whereas in the past, they died more readily, and then at that point, they’re not posing a risk. So we’ve got a huge population posing a risk if they’re not in treatment.”


Sponsor Updates

  • Liaison Technologies makes its Alloy platform available in Europe.
  • MedData will exhibit at the Ohio AAP 2017 Annual Meeting October 27 in Columbus.
  • Colquitt Regional recognizes the benefits of Meditech’s EHR in a new video.
  • Navicure and Surescripts will exhibit at the Centricity Healthcare User Group Fall 2017 October 26-28 in New Orleans.
  • Madison Magazine recognizes Nordic President of Managed Services Vivek Swaminathan as an innovative leader.
  • Experian Health will exhibit at the HFMA First Illinois Fall Summit October 24-25 in Oakbrook Terrace.
  • Patientco CEO Bird Blitch aims to make the company a “Best Place to Work in Atlanta.”
  • T-System will exhibit at the 2017 Urgent Care Fall Conference October 26-28 in Anaheim, CA.
  • ZirMed will exhibit at the 2017 MedTrade Fall Conference October 23-26 in Atlanta.

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 10/20/17

October 19, 2017 Headlines No Comments

athenahealth Reports Third Quarter Fiscal Year 2017 Results

Athenahealth announces Q3 results: revenue climbed 10 percent to $304.6 million, adjusted EPS $0.56 vs. $0.60, beating earnings expectations but falling short on revenue. In response to activist investor pressure, the company announced a cost-savings program on Thursday that included layoffs for more than 500 of its staff members, amounting to nine percent of its workforce.

Utah audit finds legal violations in university’s deal with Patrick Soon-Shiong

A Utah legislative watchdog committee publishes an investigative report on the University of Utah concluding that it violated state procurement laws when it accepted Patrick Soon-Shiong’s $12 million donation, explaining that it had “allowed the donor’s specifications to steer the contract to his company, which we believe is a violation of Utah Administrative Code.”

JDRF Announces New Initiative to Pave Way for Open Protocol Automated Insulin Delivery Systems

JDFR, a charitable foundation focused on funding type 1 diabetes research, announces a new initiative that will work to establish open protocols for artificial pancreas technology.

IFHS Investigates Cybersecurity Breach Of Clinic’s Computer System

Unalaska’s Iliuliuk Family and Health Services clinic (AK) announces that a ransomware attack breached it servers in August. It does not specify whether it paid a ransom to restore access, but promises a detailed report on the breach will be made public in the coming weeks.

News 10/20/17

October 19, 2017 News 2 Comments

Top News

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Athenahealth announces Q3 results: revenue up 10 percent, adjusted EPS $0.56 vs. $0.60, beating earnings expectations but falling short on revenue.

The company announced that it will lay off 9 percent of its workforce in cutting a reported 450 jobs. Boston newspapers cited sources who said they saw security officers escorting people out of the company’s Watertown, MA offices Thursday morning.

Athenahealth is undertaking a strategic review, pressured by an activist investor, expecting to generate up to $115 million of annual pre-tax savings by the end of 2018.

As part of the cost-cutting program, Athenahealth will close its offices in San Francisco, CA and Princeton, NJ, both of which house employees of Epocrates, the drug information app company that Athenahealth acquired for $293 million in January 2013.

Anonymous people posted on an Internet layoff discussion board that the company is selling its jet as well as the 387-acre Point Lookout resort in Maine that it bought for $7.7 million in 2011 as a training and entertainment venue.

ATHN shares dropped 4 percent during Thursday’s trading and were down another 4 percent in early after-hours trading.


HIStalk Announcements and Requests

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NYC Health + Hospitals took exception to my mentioning a recent article in the New York Post headline above, with its complaints below. I’m sympathetic since I don’t usually run one-sided lawsuit recaps, especially of the “he said, said” variety, but several readers had sent this link over with obvious interest and I saw it popping up in a lot of places, so I simply recapped the Post story.

  • “The lawsuit had nothing to do with sexual harassment.” That’s true and I’ve corrected my wording. I said in considerable detail that the lawsuit was related to wrongful termination, but I worded the part poorly where I referred to sexual harassment – the Post article focused on that, but the lawsuit itself didn’t.
  • “The former IT director was never deposed.” The Post story said he was and quoted what it said was his sworn testimony directly, so I had no reason to doubt that.
  • “The actual lawsuit alleging wrongful contract termination was dismissed.” That wasn’t mentioned in the Post article, which references an “ongoing gender discrimination case” that doesn’t make it clear whether she filed one lawsuit or two. I don’t have access to court records unless I can turn something up by Google searching for something that isn’t behind a paywall, which I didn’t in this case. I did turn up the OIG report item not mentioned in the Post article that was mostly favorable to the health system and summarized that, which the Post article did not.
  • “You make it appear as though it is your original reporting, which would be WRONG, WRONG, WRONG.” I linked to the Post article like I do all news item I cite, so I can’t imagine anyone thinking I was writing from a New York courtroom instead of my stereotypical blogger’s spare bedroom.

Listening: The Tragically Hip, thoughtfully rocking with an intact lineup as the pride of Canada since 1994 until this week, when front man Gord Downie died of brain cancer at 53. Reaction to his death has overtaken the Toronto newspaper, but an article written last year about what turned out to be the band’s final tour is the most poignant. Prime Minister Justin Trudeau delivered a tear-filled tribute to Downie, declaring, “We are less as a country without Gord Downie.”

Amazon’s continuous rollout of features amazes me. Last night I received a text message indicating that my package had been delivered, complete with a driver-taken photo of the item sitting on my doorstep. I’m not sure why I need it other than that it answers the question of whether the delivery went to the mailbox or to the doormat, but it’s cool.

This week on HIStalk Practice: EHR-related medical malpractice claims continue to increase. PatientPop ramps up Google-related physician marketing capabilities. Health Affairs offers context around OIG’s ACO analysis. Pine Rest Christian Mental Health Services goes with Epic. Walgreens brings 300 jobs to staff its new technology center of excellence. Medsphere acquires Stockell Healthcare Systems. Texas Medical Association begins doling out disaster relief funds to wiped-out practices. PRM Pro Jim Higgins offers practical solutions for physician tech-integration challenges.


Webinars

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

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Medsphere acquires its long-time revenue cycle implementation partner Stockell Health Systems, which will retain its name as a division of Medsphere.

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Population health management system vendor BaseHealth receives an $8.5 million investment in a Series C funding round, increasing its total to $18 million. 

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Medical image virtual reality software vendor EchoPixel raises $8.5 million in a Series A funding round, increasing its total to $14.5 million. I declared it the coolest product I saw (and played around with) at HIMSS16.


Sales

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Community Health Network (IN) will implement Stanson Health’s clinical decision support and analytics.

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Liberty Regional Medical Center (GA) and Veterans Memorial Hospital (IA) will replace an unnamed vendor (a reader with HIMSS Analytics access says it is Athenahealth) to return to the Evident Thrive EHR of CPSI. CPSI will also gain two McKesson/Allscripts Paragon customers as Thrive EHR users – Jenkins County Medical Center (GA) and Monroe Regional Hospital (MS).

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Holy Name Medical Center (NJ) will use CareCloud’s EHR/PM in its 35 ambulatory medical practices. The hospital’s inpatient systems were mostly developed in-house, which is an outlier in this day and age.


People

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Infor promotes Dann Lemerand to VP of strategy and product management of its CX Suite customer.

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Kansas state representative Erin Davis joins Cerner as senior government strategist, raising questions about possible conflicts of interest that the company dismisses with the explanation that she will be involved with government sales only in the Northwest.

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Secure health information exchange and claims attachment system vendor Vyne hires Robert Patrick (Carestream Dental) to the newly created position of president of its dental division. He will report to Lindy Benton, who remains president and CEO of Vyne.

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John Mangano (Digitas Health) joins Healthgrades as SVP of business intelligence.


Announcements and Implementations

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Lexmark announces GA of Downtime Assistant for Healthcare, which refreshes the hard drives of the company’s multi-function printers with EHR-generated reports, forms, and checklists that are needed for patient care when the EHR is down.

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Treatment guidance solution vendor WiserTogether adds reporting and analytics to its Return to Health product, giving healthcare organizations insight into patient behavior that can be used to create pathways.

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Intel launches its Health Application Platform platform that is integrated with a stable, secure Android edge device from Flex to connect consumer health monitoring devices to support remote care delivery.

Apple and GE release a software development kit for GE’s Predix Internet of Things platform that will allow developers to create industrial IoT apps for the iPhone and iPad. GE will also promote Macs for its 330,000-employee workforce, which would surely be the largest corporate deployment of Macs ever if they actually swap them all out.


Government and Politics

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A state audit finds that University of Utah violated procurement laws in accepting a $12 million donation from Patrick Soon-Shiong that required the university to spend most of that money buying genetic sequencing tests from Soon-Shiong’s Nant companies. Auditors said the university let Soon-Shiong create specifications that assured a no-bid contract, also noting that competing companies could have provided the same genetic sequencing services for one-third the price.

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The FBI arrests “Dr. Dave,” a Fort Worth personal trainer who registered as a CMS provider under 19 phony names in fraudulently billing $25 million to insurance companies. 


Privacy and Security

Iliuliuk Family and Health Services (AK) acknowledges that it was hit by ransomware that “temporarily blocked” access to its systems in August, but doesn’t say if it paid the demanded ransom.


Innovation and Research

JDRF announces an initiative to encourage innovation and family involvement in open-protocol artificial pancreas systems, where it will provide funding and regulatory advice to bring do-it-yourself and reverse engineered diabetes management technology projects to market.

Other

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A JAMA editorial questions whether an oversupply of ICU beds has caused overutilization, noting that 1 percent of the entire United States gross domestic product is spent on ICU care, representing half of all US hospital expenses.

In England, a BBC review finds that the registered organ donor wishes of one-third of newly deceased people are not respected because of family objections. The law recognizes only the legal consent of the donor, but NHS says family objections – usually involving the time the process requires — are always upheld, denying hundreds of people the organ transplants they need. A 17-year-old registered donor says, “What’s the point of signing up if I could be overruled anyway?”

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A Kaiser Health News report finds that 90 percent of Indiana’s nursing homes have been leased or sold to hospitals that are using a Medicaid loophole to earn a 30 percent higher payment, which in the case of leased facilities is shared with the city or county government owner. Advocates say that rural hospitals use the profit to remain solvent, while critics argue that hospital operators keep residents longer and the federal government is paying more for quality that hasn’t improved. Indiana Medicaid spends two-thirds of its long-term care budget on nursing homes vs. the US average of less than half, but as a state, Indiana is ranked among the worst for nursing home quality. A hospital CEO acknowledges that it makes money from putting more patients into its nursing homes, explaining, “Welcome to healthcare. It’s a complex and confusing environment where we have all different competing incentives.”

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A local paper’s review of Vermont’s history as a health IT hub gives a nod to Rich Tarrant and Robert Hoehl’s Burlington Data Processing — later renamed to IDX Systems and then sold to GE Healthcare in 2006 for $1.2 billion – whose profits allowed some employees to fund new startups. Companies mentioned include Ona, ThinkMD, OhMD, Galen Healthcare Solutions, and Physician’s Computer Company.

This is hard to believe: an inmate with the porn-like name Dustin Lance sues the county jail for $5 million, claiming staff ignored his pleas for medical help after he swallowed a pill given to him by another inmate that caused him to have a painful erection that lasted 91 hours.


Sponsor Updates

  • Optimum Healthcare IT publishes an infographic titled “Rules of Thumb, Benefits, and Dangers of EHR Alerts.”
  • EClinicalWorks will exhibit at the 2017 TAHP Managed Care Conference & Trade Show October 23-24 in Houston.
  • FormFast will exhibit at the 2017 Fall HCP Hospital & Healthcare IT Conference October 18-19 in Chicago.
  • MModal is named 2017’s s health IT innovation leader by the Pittsburgh Technology Council.
  • Healthwise will exhibit at the HealthTrio 2017 Users Group Conference October 25-27 in Tucson.
  • Greg Walton of Next Wave Health Advisors, a Huntzinger Management Company, becomes a Life Fellow Member of HIMSS.
  • Iatric Systems will exhibit at the Midwest Fall Technology Conference October 22-24 in Indianapolis.
  • Surgical Products nominates Image Stream Medical’s MedPresence solution for the 2017 Excellence in Surgical Products Awards.
  • Impact Advisors VP Lydon Neumann becomes a CHIME Foundation Certified Healthcare Executive.
  • Imprivata collaborates with Welch Allyn to enhance security for medical devices
  • InterSystems will exhibit at RSNA 2017 October 26-November 1 in Chicago.
  • Kyruus will present at the Healthcare Internet Conference October 23-25 in Austin.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/19/17

October 19, 2017 Dr. Jayne 1 Comment

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With the growth of my business, I’ve been trying to recruit some additional consultants to the fold. We’re busy enough now to support employees along with our contractor consultants, which is a good problem to have although I don’t like the additional administrative work that comes with it. Fortunately, my partner takes care of a lot of it, but I still get pulled into a fair amount.

We are using a variety of sources to find people and have found a couple of additional contractors that I would love to hire full time. Unfortunately, they have other ongoing work that they don’t want to give up, so I’m happy for them to work with us in a relative state of 1099 bliss.

Finding contract consultants seems to be fairly easy. We see quite a few who have strong backgrounds with major firms who either want to slow down the pace or who are semi-retired. We have one consultant who was a hard-charging leader at one of the big firms who took time off for family and wants to put a toe back in the water. There’s a lot of variety. The only downside we’ve seen to working with these folks is coordinating availability around other projects. Some of them are great to work with on physician engagements because they are willing to do calls and web conferences in the evenings after physicians are done seeing patients (and after the consultants are done working with other clients during the day). Although we have to pay contractors more than we might pay an employee, even with benefits at play, we’ve been fortunate to have some high-quality players working with us.

Finding consultants as employees is a little different. Although we’ve gotten lucky with a couple of hires, there are a lot of people out there who fancy themselves as consultants but who really don’t have any experience as actual consultants. I blame this on the proliferation of the word “consultant” into job titles far and wide. At a local department store, the sales team members are “retail consultants.” At some EHR vendors, trainers are now referred to as “implementation consultants” even though they are simply delivering prescribed checklist-based training with no consultative aspect to it at all. There’s a thought that because people are great trainers, or great support analysts, or call center reps, that they’ll naturally be good consultants. I’ve found that I can train people on different EHR platforms or different revenue cycle systems far easier than I can train them to be consultants.

Being a consultant is more than being a deep subject matter expert or having process improvement skills. You have to have a large toolbox and know when to use which techniques to help move your client forward. You have to be part expert, part salesperson, part therapist, and part janitor at times. Often, we’re thrown into messy situations with lots of dysfunction, and have to push past the obvious list of projects we’re supposed to tackle to address the root issues that will prevent any of them from being successful. We have to help clients understand who on their teams is working for them and who is actually working against them and what changes they need to be successful. We have to convince people to do things they adamantly do not want to do, or to get their buy-in that at least if they won’t do what we ask them to do, that they won’t sabotage us as we try to move others through a process.

I’ve been weeding through countless resumes of people with “consultant” in their employment history who don’t seem to have practical skills for actual consulting. I’m also finding that people have trouble reading and processing a job description and mapping their qualifications to the potential role. For example, our posted job description is fairly specific about wanting to see actual consulting experience, along with at least two years working for a mid-size to large healthcare organization. I’m looking at a resume right now for someone who has only worked in ambulatory physician offices and never at a group larger than five providers. He’s also looking like a bit of a job-hopper, having moved about every 18 months over the last six years. Once can attribute a short tenure somewhere to “bad fit” or “took something because I had to,” but not when you see it repeated over and over. There’s usually something else going on there.

One of the positions we’re recruiting for is strictly clinical and we need applications to have an actual clinical credential of some kind. They can be a medical assistant, nurse, pharmacist, paramedic, etc. and we’re flexible about it, but they do have to have a credential or equivalent work experience if they worked in a situation where a credential was not involved (sometimes we see this with our military applicants). We continue to have applications by people who have been EHR analysts or EHR trainers whose only clinical experience is working with clinicians. Needless to say, I’m not impressed by their ability to read and comprehend if they apply without a credential and without some kind of other documentation of experience that would explain why they are applying without a credential. It seems like they aren’t reading for detail and that’s definitely not someone I’d want to try to build into a consultant.

I continue to be surprised by the number of just mechanically bad resumes I see. Mismatched fonts that make them look like a ransom note, failed formatting, typos, absent or overdone spacing, and more. (pro tip: emojis do not belong in a professional resume). I also see some pretty over-the-top cover letters. One applicant talked about his “excitement to take the reins of your organization and steer its future in the right direction.” He seemed to have missed the part where I was recruiting for a field consultant, not a CEO. Another resume listed a degree that I didn’t recognize and couldn’t find on Google, which is a direct trip to the recycle bin. If you have an unusual or international credential, a brief explanation would be appreciated (although I’m still suspicious that I couldn’t find it on Google).

Another applicant is a desktop support rep and has been deploying laptops to end-users for a large corporation. No mention of EHR or clinical skills and can only travel half-time despite the position being posted for at least 75 percent travel. One applicant said she could travel 10 percent. Another has been in sales for the last five years, mostly with behind-the-scenes hospital systems like autoclaves and laundry machinery. Before that, she was a real estate broker. I understand that people may be in difficult circumstances and are applying for anything that might remotely fit, but a lot of time is wasted by applications that appear to be spammed out without respect to the actual job description.

My favorite application is one from a gentleman who boasted of “creative use of accounting systems to identify opportunities to address reporting issues.” As a business owner, I usually don’t want to see the words “creative” and “accounting” in the same sentence. I’m sure he was trying to convey that they used the accounting systems in a novel way or used accounting to address a clinical problem, but we’ll have to wait and see. I scheduled a phone interview with him just out of curiosity. Other than the potential verbiage concern, he meets all the other posted criteria and has been consulting for a couple of years. Sometimes you just have a to take a chance on someone.

Have any good tales from the hiring manager trenches? Email me.

Email Dr. Jayne.

Morning Headlines 10/19/17

October 18, 2017 Headlines No Comments

Tom Marino, Drug Czar Nominee, Withdraws in Latest Setback for Trump’s Opioid Fight

A 60 Minutes and Washington Post investigative report exposes a multi-year effort by drug distributor lobbyists to push an industry-friendly bill through Congress that ultimately undercut the DEA’s drug distribution enforcement options at the height of the opioid epidemic. Rep. Tom Marino (R-PA), President Trump’s Drug Czar nominee, withdrew his name from consideration after the report called him the “chief advocate of the law that hobbled the DEA.”

IBM shares up after earnings beat

IBM reports Q3 results: $19.15 billion in revenue and $3.3o adjusted EPS, beating analyst expectations on both, but marking its 22nd straight quarter without revenue growth. The company’s AI business unit brought in $4.4 billion in revenue, up 4 percent.

Virtual Therapists Help Veterans Open Up About PTSD

Wired covers the use of teletherapy in the treatment of PTSD among veterans.

White House says Trump opposes Senate’s bipartisan Obamacare deal

In a reversal, the White House now says it opposes the bipartisan deal drafted by Senators Lamar Alexander (R-TN) and Patrick Murray (D-WA) that would stabilize ACA marketplaces and restore the payment of cost-sharing subsidies.

Morning Headlines 10/18/17

October 17, 2017 Headlines No Comments

Trump gives go ahead for Congress to work on bipartisan Obamacare deal

HELP Committee Chairman Sen. Lamar Alexander (R-TN) and Sen. Patty Murphy (D-WA) have negotiated a bi-partisan healthcare deal that will grant authorization to continue paying insurers the cost-sharing subsidies that underpin ACA individual markets for the next two years. President Trump has come out in support of the negotiations.

Trump says Obamacare is ‘dead’

Despite failing to either repeal or replace the ACA, President Trump declares a legislative victory just the same, exclaiming “Obamacare is finished, it’s dead, it’s gone. It’s no longer. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.”

Vinod Khosla on A.I., Health, and the Future of Working (or Not)

Venture Capitalist Vinod Khosla follows up on his now six-year-old blog arguing that doctors would one day be replaced by algorithms with an interview explaining, in more detail, how he sees AI supporting and, in some cases, replacing doctors.

CVS Health and Epic Announce Initiative to Help Lower Drug Costs for Patients by Providing Prescribers with Expanded Visibility to Lower Cost Alternatives

CVS, which runs Epic across its retail pharmacies, will implement Epic’s Healthy Planet population health and analytics platform to study dispensing patterns and medication adherence.

News 10/18/17

October 17, 2017 News 9 Comments

Top News

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Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) release their bipartisan plan to stabilize the health insurance exchanges in the short term. It quickly earned President Trump’s blessing “to get us over this immediate hump.”

Reported terms of the plan, announcement of which without specific draft language sent healthcare stocks flying on Tuesday, include:

  • Payment of the ACA cost-sharing reductions that the President just ordered to be stopped would be reinstated for two years.
  • $100 million of ACA sign-up assistance would be restored.
  • The waiver process for states that want to customize ACA rules would be simplified.
  • The availability of high-deductible, less-expensive policies would be expanded to all ACA enrollees, not just those under 30 years of age.

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Vocal ACA supporter Andy Slavitt, former CMS acting administrator, is a fan of the Murray-Alexander proposal (even though he frets that it won’t get passed or that Senate Republicans won’t stop their quest to repeal the ACA entirely) since it would:

  • Preserve the ACA.
  • Reverse some of the White House’s ACA “sabotage.”
  • Provide new affordable plan options that, while not for everyone, are still better than no insurance.
  • Bring healthier people into the market.
  • Give states the flexibility they have been demanding while protecting lower income and sicker populations.

Reader Comments

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From Lingua Frank: “Re: grammatical errors. I recently heard a cyberscurity expert talking about ‘security tenants,’ which I assume was supposed to be ‘tenets.’ An HIT project manager described dividing a project into ‘epics’ instead of ‘epochs.’” I was about to rail about colleges that graduate students who are poor writers, but I realized that the real culprit is a culture that accepts poor grammar and writing, as well as sloppy presenters and writers who indignantly insist that we stop grammar Nazi-ing them and instead serve as their auto-correct by proxy. Facebook has taught me to immediately stop reading posts from people I don’t know personally that feature misspelled words or hideously bad grammar since I have to assume that the person is equally lazy in their logic and execution. We all make mistakes, but only some of us care enough to fix them. I’m not as militant about mistakes like these two examples since it’s easy to misuse similar-sounding words especially when you hear them more often than you read them, and if you don’t know the difference between the words, no amount of spell-check will help.

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From Peony: “Re: Allscripts. The press release mangles the name of their new customer, Catholic Medical Center.” Indeed it does, but at least only after listing the name correctly six times. “Care Medical Center” is actually a pretty good name.


HIStalk Announcements and Requests

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I was curious about the five-year share price performance of some of the publicly traded health IT vendors. Buying Cerner or Athenahealth would have earned you a five-year return of around 85 percent, while Allscripts and Quality Systems were dead money and buying CPSI would have lost you 40 percent over five years. With 20-20 hindsight, you would have passed on these and instead bought index funds for the S&P 500 (up 78 percent) or the Nasdaq (up 120 percent), both of which provided great returns without the white-knuckle share price rollercoaster thrills along the way. Click the chart above to enlarge.

Listening: new from Mostly Autumn, an English progressive rock band (Pink Floyd-ish at times) formed in 1995 mostly known for near-constant touring, not signing with a big record label, and having a considerable turnover of personnel that has necessarily changed their sound over time. YouTube made a good related suggestion in 4th Labyrinth, which in addition to playing decent pop-tinged prog rock, has one of the most mesmerizing bass players you’ll ever see in Claudia McKenzie (they do a nice cover of “Locomotive Breath.”)


Webinars

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

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CNBC reports that Apple was recently considering acquiring its on-site medical clinic operator Crossover Health or national primary care clinic One Medical, although the sources did not indicate whether Apple’s interest was in running health clinics (which would be huge mistake and one that Apple is too smart to make) or partnering with them in an unstated technology role. The article describes Crossover Health  as a startup, which might stretch the term since the venture-backed company was founded in 2006 by Medsphere co-founder Scott Shreeve, MD after Medsphere bizarrely fired and sued him and his Medsphere co-founder brother Steve for publicly releasing source code, an odd move for an open source software vendor. Crossover Health has raised $114 million, runs four locations in Silicon Valley and one in New York City, and Scott remains as CEO, which I think takes it beyond the “startup” label.

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Non-profit accelerator BioEnterprise Corp.will take over management of Cleveland’s county-owned, money-losing Global Center for Health Innovation. The building, which is attached to a convention center, changed its name from the less-sexy Medical Mart before it opened to a collective yawn in 2013. HIMSS signed on early as the anchor tenant.

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Eye Care Leaders, which sells EHR/PM for ophthalmologists and optometrists, acquires competitor IMedicWare.


Sales

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Adventist Health System will implement Glytec’s EGlycemic Management System at 39 of its hospitals.

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Three hospitals in Belgium choose Cerner Millennium, although the company already announced University Hospital of Antwerp early this year.

CVS – whose MinuteClinic and specialty care management programs use Epic — will implement Epic’s Healthy Planet population health and analytics platform to give prescribers point-of-care information about drug formulary status, suggest lower-cost alternatives, and perform electronic prior authorization. The integration will also send a patient’s non-prescription drug purchases made via digital store front to their record in Epic’s EHR .

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China-based Internet technology vendor Tencent – whose messaging apps are used by two-thirds of China’s population – will offer its users evidence-based consumer healthcare information from Healthwise that it calls “the best health information in the world.” 

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Catholic Medical Center (NH) will implement Allscripts CareInMotion for population health management.


Announcements and Implementations

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The American Medical Association launches its Integrated Health Model Initiative that will attempt to create a physician-developed holistic common data model around topics such as function, state, and goal to apply medical knowledge and improve interoperability. Initial communities are hypertension management, diabetes prevention, asthma functional status and patient goals, and defining wellness. Collaborators include AAFP, the American Heart Associaation, AMIA, Apertiva, BioReference Laboratories, CareCloud, Cerner, Clinical Architecture, IBM, Intermountain Healthcare, PCORI, PCPI, Prometheus Research, and SNOMED International. The announcement contained a lot of vague, lofty statements, so what AMA will actually do is not obvious.

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Bernoulli Health will expand into Canada to offer its device integration, continuous monitoring, and clinical surveillance solution.

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Healthgrades publishes its 2018 analysis of the top quality US hospitals and its “Report to the Nation.” It finds that if all hospitals performed as well as its five-star hospitals, 220,000 lives would be saved each year. Also released is the company’s National Health Index that lists the country’s 25 healthiest cities, with Minneapolis-St. Paul, Denver, Sacramento, Cincinnati, and Portland, OR taking the top five spots.

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Voalte and Lightning Bolt Solutions will integrate their respective caregiver communications and hospital physician scheduling systems.


Government and Politics

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President Trump declares in a Monday cabinet meeting that the term Obamacare is obsolete, explaining, “Obamacare is finished. It’s dead. It’s gone. It’s no longer. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare any more.” I’ll take all wagers that the President himself will tweet that term within a few weeks in trying to blame someone else for the inevitable “Trumpcare” meltdown.

Meanwhile, UnitedHealth Group says it’s excited about selling short-term medical plans again per the President’s executive order that extends their maximum coverage period from three months to one year. Investors loved the company’s reaction, which probably means prospective customers should be wary given the history of those policies excluding of pre-existing conditions (even if the insured person doesn’t know about them) and generating consumer complaints and lawsuits.

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Politico reports that Seema Verma and Scott Gottlieb have fallen off President Trump’s short list to replace Tom Price as HHS secretary, with the frontrunner now being Alex Azar, a former HHS deputy secretary (basically HHS’s COO) who ran drug maker Lilly’s US operations until he left the company in January.

Three New York City doctors are sentenced to two years in prison for accepting cash, strip club tabs, and sex acts in exchange for referring patient blood samples to a private New Jersey lab company. Fifty people have been convicted so far, 36 of them doctors, for a bribery scheme run by Biodiagnostic Laboratory Services that improperly steered $100 million in Medicare and insurance payments to the company.


Privacy and Security

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Chase Brexton Health Care (MD) notifies 17,000 patients that four of its employees fell for a phishing scam by filling out a phony email survey that gave hackers access to their email accounts. The hacker re-routed the paychecks of those employees to their own bank account. In terms of exposed PHI, the FQHC said the employee email accounts contained a lot of it that triggered the breach notice, but didn’t explain further.


Other

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Venture capitalist Vinod Khosla famously said years ago that computers would replace doctors, which I thought was arrogant, clueless blather until I read this new interview with him that goes beyond the sound bite in elaborating on his thought process. Snips:

  • [On why he said we need algorithms rather than doctors] “I tore my ACL skiing … I did an MRI and I took it to three different docs and they recommended three different things. I said, this is stupid. There’s one right answer. When I talked to them about probability, they didn’t understand probability, and these are really good docs.”
  • “NNT (number needed to treat) is an incredibly important number that few doctors are aware of … If (medicine) was a science, for any given patient, you’d always have the same answer no matter who you ask, even if it is a probability distribution of outcomes. My goal became to change the practice of medicine, which is pretty damn good, into the science of medicine.”
  • “We don’t even measure the stuff that doctors can’t directly understand. We’re starting to run into this a little bit because in genomics, you might get 1,000 data points and no doctor can look at 1,000 data points. So in the past, we didn’t measure anything humans couldn’t consume, which meant they can at best look at a few numbers. We should have thousands of numbers per patient, per episode.”
  • “Anything that’s computing-based is near zero cost eventually. Which is why we spend way more compute cycles on a two-cent ad on Google than $10,000 medical decisions like, do you need a meniscus repair? … Let’s say you’re dealing with something serious like colon cancer. Does he know what each of the thousands of mutations could be? No, he doesn’t. So when he’s sitting down with the patient and saying, ‘You’ve got this cancer mutation,’ does he remember the 5,000 papers published in oncology journals recently? No, he doesn’t. He can’t.”
  • “There’s a company in Israel called Zebra Medical Vision (note: Khosla is an investor in the company)… In India today, they are offering reading any image for a dollar. Now that’s impactful. There aren’t enough radiologists in India … you have the analysis done almost immediately, if you are connected, for a dollar .. we will see better results than a radiologist and way faster. Higher quality, faster, and dirt cheap. The radiologist couldn’t do a phone call for a dollar. What else do you need?”
  • “There’s no reason an oncologist should be a human being. The right kind of oncologist isn’t the research oncologist. They know the most, but the guys who know how to take care of a patient are the community oncologists in Fresno or Stockton. They cannot always read all these journals, but they care for patients … They can be assisted with a virtual tumor board or an AI oncologist.”
  • “Watson could do AI. IBM has the scientific talent to do AI, but they chose to package Watson and market it for what it wasn’t. I think they can do much more, but the early efforts have been less than successful because they over marketed its capabilities.”

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A federal judge invalidates the expired patent of drug maker Allergan for dry-eye treatment drug Restasis, allowing the sale of generic products despite Allergan’s attempt to protect its patent by transferring it to an Native American tribe to shield it from administrative review. Allergan offered the St. Regis Mohawk Tribe $13.5 million upfront and $15 million per year as long as the tribe used its sovereign immunity to keep the patent intact, a tactic the judge slammed as a “scheme to evade their legal responsibility.”

Bloomberg reviews the history of short-term medical plans that would become legal to sell again under President Trump’s executive order, recalling that those policies generated a lot of patient lawsuits for refusing to cover the cost of pre-existing conditions. A woman bought a short-term policy to cover her between jobs, was diagnosed with breast cancer, and was left on the hook for the $400,000 treatment cost when the insurer refused to pay even though she wasn’t aware that she had cancer until after she signed up. An attorney of a patient whose insurer refused to pay for treatment of his newly diagnosed throat cancer said more insurance choices isn’t necessarily a good thing: “With insurance it, doesn’t work that way. You’ve got to put everyone in the same pot.” Everyone could save a fortune by buying barebones insurance (or none at all, for that matter) if only they had a functional crystal ball, but until that happens, health systems should assume they’ll be eating a lot more cost as patients who can’t afford the patient portion of their low-coverage insurance will still show up demanding care. My biggest frustrations in the insurance debate are: (a) lack of political will to look at provider and pharma costs means every solution is just another form of cost-shifting and rationing; and (b) politicians seem clueless about how insurance and charity care works in declaring that nobody should be forced to buy insurance they don’t need, raising the question of how they know they won’t need it or who pays for the care they will demand if they guess wrong.

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I ran a sample quote for United Healthcare’s short-term medical insurance, assuming a 40-year-old, non-smoking resident of Chicago under today’s underwriting policies. The company’s best Golden Rule-issued plan would cost $94 per month and would carry a $10,000 deductible, 60/40 co-insurance, 20 percent co-pay, and a $10,000 out-of-pocket maximum. The maximum lifetime coverage is $2 million. All payments, including ED and hospital, require the insured to pay the $10,000 deductible. No prescription benefit is included, nor is any out-of-network coverage at all (I would probably buy relatively inexpensive travel insurance with medical coverage while traveling on business or on vacation). Pre-existing conditions aren’t covered at all, defined as those for which the insured sought diagnosis or care in the previous 24 months or if the insured had symptoms for which “an ordinarily prudent person” would have sought care in the previous 12 months (at least you know upfront if that’s you). The price is great, you get United’s much-lower negotiated prices instead of paying provider list prices for cash, and people who can absorb the financial risk will be OK as long as they don’t get a new diagnosis of a chronic disease. Those with any existing or newly diagnosed chronic medical problems or who have less than $10,000 in liquid assets might not fare as well unless the ACA plans remain available so they can jump back in the next enrollment period (which isn’t really the way insurance is supposed to work).

EHR consultant Loretta Gallagher sues NYC Health + Hospitals, with a former IT director testifying that AVP Al Garofalo polled peers at a holiday party about which female consultant they would like to have sex with. The plaintiff sued NYC H+H last year, claiming her company was fired after she was refused to falsify a monthly Epic progress report as the CMIO ordered, although the health system’s OIG recommended her termination in 2015 after finding that her aunt – an HHC employee – improperly arranged to hire her and other family members.

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Pretty funny.


Sponsor Updates

  • Black Book names MModal the leading vendor in transcription technology solutions and services as well as a top industry disruptors and challenger.
  • Spok welcomes 150 customers to its Connect 17 annual conference in New Orleans.
  • Diameter Health posts a podcast titled “Quality Measures Past, Present, and Future.
  • Meditech’s 6.1 and Client/Server EHR platform and portal earn Infoway’s certification for meeting standards in Canada. 
  • Ability Network announces the top-performing home health agencies in its annual HomeCare Elite program.
  • Agfa Healthcare releases “Enterprise Imaging crosses The Tipping Point – Episode 1.”
  • Aprima will exhibit at the Academy of Integrative Pain Management Annual Meeting October 19-21 in San Diego.
  • Besler Consulting will present at the MAPAM Annual Fall Conference October 23 in South Yarmouth, MA.
  • CarePort will exhibit at the Florida Association of ACOs annual conference October 19-20 in Orlando.
  • Clinical Architecture joins the AMA’s new Integrated Health Model Initiative.
  • The Jacksonville Business Journal recognizes CSI Healthcare IT CEO Rafe Sanson as a 2017 Ultimate CEO.
  • Direct Consulting Associates and Dimensional Insight will exhibit at the HIMSS Midwest Fall Conference October 22-24 in Indianapolis.

Blog Posts


Contacts

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

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Curbside Consult with Dr. Jayne 10/16/17

October 16, 2017 Dr. Jayne No Comments

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I work with a fair number of dysfunctional organizations and hear regularly from readers that they can see pieces of their own organizations in my writings. I hope not too many of you see yourselves or your employers in this week’s installment, which deals with the subject of accountability.

Generally defined as responsibility, in some organizations, it has become little more than a corporate buzzword. Some groups like to throw accountability around without much mention of its companion, governance. Especially when you’re dealing with projects that are a combination of clinical/technical or operational/technical elements, governance is key.

I actually like what Wikipedia has to say about it, that “accountability is the acknowledgement and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the scope of the role or employment position and encompassing the obligation to report, explain, and be answerable for resulting consequences.”

The line about being within the scope of the role is particularly key, as I see many examples where organizations expect employees to be accountable for things beyond their control. Asking a manager to be accountable for the output of their team is fairly common, as long as it’s clearly part of the job responsibilities and the manager is given the tools needed for the team to be successful. All too often I see organizations asking leaders to be responsible for work product that is outside the expertise of their teams or to try to produce results with wishful thinking as their principal tool.

When my clients start throwing around accusations of lack of accountability or engaging in finger-pointing, I like to introduce them to tools that their leadership teams can use to better understand how accountability and responsibility really work. My favorite is the RACI matrix, although I’ve worked with different variations such as RACIQ and RASCI.

For those of you who may not have worked with a RACI matrix, it’s basically a chart of who does what in a business process. It helps clarify roles and responsibilities and can prevent the kind of “not me” conversations we see when things are not progressing according to plan. RACI illustrates that as much as we like to think about the proverbial buck-stopping with a singular individual, department, or team, the one-man-show rarely works in modern business.

RACI breaks down overall responsibility/accountability into the following subgroups:

  • Responsible. The people or teams who actually perform the work.
  • Accountable. The individual who answers for the completion of the work, which may be delegated to others or to a team. They have to approve the work done by the responsible group. To be successful, accountability needs to be owned by a single person, although I see entirely too many examples of failed attempts at shared accountability.
  • Consulted. The people who are subject matter experts or otherwise have an opinion about the work being done. Conventionally this can include legal, compliance, or other professionals who don’t have to actually do the work but whose policies may dictate how it’s done.
  • Informed. The people who need to understand the progress of the project or process. Often this may be notification that a project is complete.

We’ve all been part of projects where we find out too late that there was someone who should have been in the Consulted group, but we didn’t bring them into the process until things were too late. This results in rework, frustration, and low morale when projects have to be redone or revised.

Unless the use of a tool like RACI is baked into a company’s culture, teams may not spend enough time during planning phases to identify what inputs are needed or what communication needs to occur. The idea here is that time should be spent in deliberate thought around making sure project stakeholders are identified. When you first start doing it, it seems time-consuming and artificial to classify tasks and deliverables but after you’ve done it a few times it starts to feel natural and flows more quickly. It’s a way to prevent surprises that becomes worth the effort.

It’s also a way to help counter the siloed work that sometimes happens in larger organizations. When you have a process that forces you to actively think about who should be informed, it helps the clinical people remember to talk to the technical and operational people and so forth. It reduces the chance of a project leader being asked, “Why didn’t I know about this?” or, “How long has this been going on?” The key, however, is to have the process discipline to make sure that you’re thinking about the various parts of a project and not skipping quickly through the matrix, or just doing enough of the matrix to be able to say that you’ve done it. Leaving blanks in the chart isn’t desirable, but can be done to allow a project to move forward with near-term follow up to resolve the empty field.

One of the keys to RACI is that it can identify the way responsibility and accountability shift throughout the lifecycle of a project. At one stage, a group may simply be informed or consulted, where in a subsequent stage, they may be responsible. Accountability may move from a design manager to a build manager to a marketing manager to a sales manager as a project moves to market. Simply having the matrix as part of organizational processes can bring people together around common definitions. I’ve worked with groups who have varying definitions of accountability, which can lead to confusion and disappointment. Bringing everyone onto the same page is always a strong move towards ensuring project success, and if you’re going to use a responsibility matrix, it’s a must.

I’ve been working recently with a consultant who hails from Australia. I love learning different idioms and phrases he uses to describe situations that are common no matter where you work. In talking about ways to help organizations through their dysfunction, he introduced me to a new one that fits right in with what RACI is trying to accomplish. I think I’m going to steal his description for the next time I have to teach it to a client. Because who doesn’t like a tool that can help keep you from acting like a jellyfish at a disco?

What’s your favorite idiom? Email me.

Email Dr. Jayne.

Morning Headlines 10/17/17

October 16, 2017 Headlines 1 Comment

Trump says opioid emergency will be declared next week

President Trump indicates that he will formally declare a national emergency over the opioid epidemic as soon as next week.

VA Secretary Shulkin Has White House Interview To Head HHS

VA Secretary David Shulkin, MD heads to the White House to interview for the role of Secretary of HHS.

Apple explored buying a medical-clinic start-up as part of a bigger push into health care

CNBC’s Christine Farr reports that Apple considered entering the healthcare provider space by acquiring Crossover Health, which works with employers to build and run on-site medical clinics. Apple was reportedly in earlier talks with One Medical, but neither deal materialized.

AMA to Unleash a New Era of Patient Care

AMA announces a project to develop a shared framework for organizing health data in collaboration with IBM, Cerner, Intermountain Healthcare, American Heart Association, and American Medical Informatics Association.

HIStalk Interviews G. Cameron Deemer, President, DrFirst

October 16, 2017 Interviews 1 Comment

G. Cameron “Cam” Deemer is president of DrFirst of Rockville, MD.

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Tell me about yourself and the company.

I’m president of DrFirst. I’ve been with the company for about 13 years. DrFirst originally began as a standalone e-prescribing vendor about 17 years ago. Since then, we’ve migrated into a technology platform vendor serving over 300 EMRs. We have a large chunk of the hospital market, which typically uses our medication history services and our discharge prescribing. We’re now migrating also into the patient-facing application space.

What challenges remain for e-prescribing now that adoption is nearly universal?

At this point, most of the physicians who are ready to adopt have access to e-prescribing. There’s a couple of pockets that we found that are still issues. A lot of this came up when New York implemented the I-STOP program and suddenly we found pockets of physicians all over the state who had not yet adopted e-prescribing for one reason or another.

For instance, think about surgeons who typically write a very limited number of scripts. They don’t really see the need for an EMR. They’re not going to see the patients on a repeated basis, things like that. There were still those pockets out there where they still had a use for standalone e-prescribing because they’re not strongly committed to EMR use yet.

The other one is physicians after hours and away from the EMR who are still writing scripts on paper or calling it into the pharmacy because they don’t have a good mobile solution. That’s a problem we’re trying to solve right now.

What is the role of technology in addressing the opioid issue?

There’s an interesting transition happening literally right now. For the first time, state PDMP data — the controlled substance registries — are being made available in the workflow for physicians through a few vendors. I would say it’s experimental right now, trying to figure out what works best for the physicians. It’s the first time they haven’t been asked to go to a separate portal, log in, enter patient information, and go through all that, which they were reluctant to do.

Instead, in the process of writing a prescription, you’re able to see all the fills the patient has had for opioids. From a physician perspective, our experience has been they love that. It just becomes part of their workflow. They don’t have to do anything special to consume it.

What I believe will happen over time is that as physicians become more aware of patient behavior, the problem will shift back to illegal drugs. States must have some strategy there to nail down that side of the issue as well.

I think we can get the legitimate drug prescribing side well under control as we move this into the workflow.

The market has shown strong interest in tools for price transparency, electronic pre-authorization, specialty drug prescribing, and especially the electronic monitoring of drug adherence. How do you see that layer of intelligence that’s built on top of e-prescribing moving to the next level?

One of the most exciting things right now is price transparency. If you look at surveys, usually the number one complaint of patients is, I have no idea how much this is going to cost. Regularly you see that pricing issues and affordability are the top reasons for patient non-compliance.

If we’re going to deal with outcomes, we need to get price transparency under control. We’ve done quite a lot of work around that in the last couple of years. Humana rolled a program out nationally with us and we gained experience in how physicians respond. Since then, it brought several additional payers into that space to contribute their information.

Payers have tried to do that to some degree, but they are reluctant to share their actual drug costs with prescribers, they don’t necessarily have access to insurance-specific charges, and they struggle to account for differences in dose forms such as a tablet vs. a liquid.

You really nailed the problem. Until now, e-prescribing vendors and EMR vendors have had access to basic formulary and benefit information as a result of participating in the e-prescribing networks. That gave us a general understanding of how drugs are covered, but without patient-specific or employer-specific information. It varies dramatically among pharmacy benefit managers, PBMs, even with the same formulary. Certainly it does not include pricing information.

We knew we had to get better than that. How do you get the real information, down to the penny, of what the patient is going to pay? The only way to do that was to do an actual adjudication of the prescription before it is sent to the pharmacy. Let the physician know that this is the exact impact, specifically for this patient under whatever part of the patient’s coverage plan they happen to be in at the moment and considering everything that’s happened before with that patient.

The PBM is the only one that knows that, so you must do an adjudication. The real challenge for us and for the PBMs was, how do you do that? It’s different. They’re used to adjudicating pharmacy claims using the data that comes from a pharmacy. They’re used to receiving certain fields and responding with certain fields in a certain way. They’ve been doing that for years.

Now you’re moving upstream to the physician. Physicians don’t prescribe the same way the pharmacies dispense. For instance, a physician isn’t concerned with a specific NDC code as a pharmacy would be, but it’s a representative NDC. They just pick one that represents that drug name and that’s typically what we send to the pharmacy. The PBM is going to need something more specific than that to adjudicate it properly in their system.

There also can frequently be mismatches, where the EMR may not have kept its drug database up to date. The PBMs generally do, but they may not sync with what the EMR is using. There might be a difference in drug compendia, where the EMR is using one set of drug databases while the PBM uses one from a different company. Nobody’s done the work to sync that up or make sure they even know which compendium is being used.

The other challenge is about how physicians write quantities in prescriptions. The physician may have a way of describing the quantity of a drug that the pharmacist understands, but that is not what the PBM requires to adjudicate a prescription rather than a claim.

Even after a couple of years, the industry is still experimenting with that, to be able to make sure that the results get closer and closer to working every time rather than erroring out because something wasn’t understood. It’s getting much better as we allow people to experiment.

The other thing, how are they going to adjudicate that claim? The PBM industry has for years had the concept of a dummy claim. A pharmacy system vendor or a pharmacy could send a dummy claim just to make sure things were adjudicating correctly. Theoretically, you could run a physician’s prescription through that same process. Once you’ve cleaned up the prescription enough that it will process through that function, how do you connect to that function? It’s usually a different connection than what we would use out of an EMR or an e-prescribing system. It’s an NCPDP claims connection.

The response may not come back fast enough since it could be a slow system. If it does come back fast enough, you still only have one answer and you need several. You need to know not just that drug, but other drugs the physician could choose from that might have more favorable pricing for the patient if they want to see alternatives.

The dummy claim system isn’t made for that. It’s not made to hit it over and over and over and over with transactions. It’s made for occasional transactions. There’s some cost on the PBM side of building their system slightly differently to allowing a transaction to process multiple times for multiple drugs that are all related, but are more preferred than the drug that was submitted.

It’s a more complex logic involving systems that have a higher requirement on them. They still need to return their response very fast before the physician loses interest and moves on.

Is there opportunity in connecting technically sophisticated pharmacy chains like CVS and Walgreens back to prescriber systems?

That’s an interesting question. With what we’ve just been discussing about price transparency, that doesn’t quite apply in the same way, but there is a connection there.

What we’ve been discussing so far was getting plan information from the PBM. On the pharmacy side, there are other options for patients. Many of the pharmacies belong to programs that provide favorable cash pricing for a patient. A patient wouldn’t necessarily know anything about that favorable pricing if they have to pay cash, and today, many plans have shifted to high deductibles and HSA-based plans. In that kind of an environment, patients are often going to be out of pocket on their drug costs, so the ability to know that a discount would apply is very important.

That’s one of the things that we combine in our price transparency solution. Not just the PBM response, but also when applicable, discount information for the patient on some of the other networks that pharmacies participate in. In that sense, we’re bringing something that’s unique to the pharmacy into the physician workflow as well.

We address the general question of communication through a secure messaging solution that we’ve been implementing at pharmacies as well as in physician offices. They can have a two-way back and forth very efficiently.

Drug chains offer patients the chance to pay cash if that would be cheaper than their co-pay, often offering the patient coupons from third-party companies like GoodRx that offer PBM-type discounts. Should that be a factor?

We’ve partnered with those companies to make those plans available to patients, but we’ve moved it upstream. Instead of the pharmacist having to take time to do that, we let the patient walk in with that information ahead of time. That’s exactly what I was talking about — the discount programs the pharmacies have available.

Where do you see the company’s opportunities going forward?

Whenever something new like this enters the industry, it’s always interesting because there are incumbents in the industry. There are people who would like to play a bigger role and everybody tries to jump in on what’s new.

Two things slow down innovation. One is attempting to drive exclusive arrangements. They assume, “If I can get every payer to be exclusive with me, then all of the physicians will have work with me as well.” It’s a way to corner the market on physicians.

The problem with that, of course, is that everyone who would like to play in the price transparency space has only part of the market attached to them. Because of that, to drive these technologies out quicker and to get more innovation in the space, it’s much better to have non-exclusive relationships, where everybody can play with everybody for the role they can provide.

That’s a very important part of helping price transparency blossom in the country. We’ll see how it develops over time. Generally, people are uncomfortable with exclusive arrangements, but that’s the ugly business side of this space that people should be aware of when they’re deciding how they want to play here.

To get back to your question about possibilities, one of the neat things we’ve seen is that in addition to increasing the rate of compliance for patients because they’re already prepared for what they’re going to see at the pharmacy, it has a real strong tie into electronic prior authorization as well. Instead of thinking of it as price transparency, think of it as understanding how to maximize the use of your benefit or maximize the use of your plan.

If the physician is writing a drug that has a prior authorization component, maybe quantity limits, in the old days before this real-time connection, nobody really knew if any individual patient had already met the criteria. When you adjudicate the prescription real time and come back with the benefit information, you know exactly whether the patient has already PA’d on that drug, or if it’s step therapy, if they have already completed the first part of the step therapy. The PBM knows that already and can just say, prior auth is not required on this one.

We’ve seen a huge decrease in prior authorization requests as a result of freeing up this benefit information from the PBMs. That’s one of the things we’re exploring. How do we apply this pricing transparency workflow to reduce the number of times something else would take the physician out of the workflow?

I was talking about how everything happened at the pharmacy previously and now we’re moving that upstream into the physician, so that when they’re writing the prescription, they can consider price. We’re also moving it downstream to the patient. Maybe the physician was busy and didn’t take the time to have a conversation with the patient about their options. It may end up that sticker shock at the pharmacy causes the patient to decide just not to get the drug and not tell the doctor that they didn’t fill their prescription.

We’re taking that same pricing information out to the patient to let them better understand their options for different venues where they could consume the drug. Maybe they get a better deal at a preferred pharmacy, or maybe a home delivery has a more favorable price. Maybe it’s one of their local pharmacies that has a better cash price than the patient can get with their plan.

We feel that patients deserve a shot at the information as well. We’re getting a huge response from patients who love the ability to see that and then have a conversation with their doctor if they see something they think would work better for them in terms of affordability.

Do you have any final thoughts?

This is an exciting new opportunity. It’s too soon to squeeze it into a one-size-fits-all space. A lot of talk in the industry is about trying to make everyone use a standard transaction for this. It’s really not the time for that. People are experimenting with APIs and different formats for prescriptions. We really ought to let it bloom and let innovation flow. This is so important that we must get it right, and the best way to get it right is to try a lot of different things.

Morning Headlines 10/16/17

October 15, 2017 Headlines 2 Comments

The CBO predicts Trump’s move to end ObamaCare subsidies will hike premiums, uninsured rate, deficits

President Trump signs an executive order ending the payment of cost-sharing subsidies to insurers to support ACA’s individual markets.

Andy Slavitt to Serve as Special Advisor to General Atlantic

Former CMS Acting Administrator Andy Slavitt accepts a position at private equity firm General Atlantic, where he will focus on healthcare investments in underserved populations.

New London family doctor, 85, says state forced her to give up medical license

An 85-year-old primary care provider in New Hampshire claims she is being forced to retire for refusing to implement an EHR, while the State Board of Medicine says she agreed to surrender her license “in light of an investigation into her record-keeping, prescribing practices, and medical decision-making.”

North Korea behind WannaCry attack which crippled the NHS after stealing US cyber weapons, Microsoft chief claims

Microsoft President Brad Smith blames North Korean hackers for launching the WannaCry cyberattack that infected several NHS hospitals earlier this year. He says, “I think at this point that all observers in the know have concluded that WannaCry was caused by North Korea using cyber tools or weapons that were stolen from the National Security Agency in the United States.”

 

Monday Morning Update 10/16/17

October 15, 2017 News 2 Comments

Top News

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President Trump continues the dismantling of his predecessor’s programs without Congressional involvement by signing an executive order that would prohibit HHS from paying legally required (but also legally challenged) premium-lowering payments to insurers.

A CBO report from August predicted that such an order would increase premiums 20 percent immediately and increase the federal deficit by $194 billion over ten years, but would not significantly increase the number of people without insurance.

The immediate effect on the open enrollment period that starts in just over two weeks will vary by insurer and state. Some insurers built the expected action into their new premium prices, others advised insurers to assume the payments would be made in setting their prices, and the timing of the executive order makes it unlikely that insurers can get re-filed rates approved before enrollment begins, raising the possibility that they will pull out of the market.

Eighteen states have sued the White House over the executive order.

HHS Acting Secretary Eric Hargan and CMS Administrator Seema Verma release a statement supporting the order and criticizing the laws they swore to uphold, saying that “Obamacare is bad policy” and that cost-sharing reduction payments were authorized in an unlawful “unconstitutional executive action” (which is arguably true and the subject of the legal challenge).


Reader Comments

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From Faith-Based Hill: “Re: Outcome Health. Overstating claims and fudging numbers will get you hundreds of millions in investment that you can use to buy time to hopefully turn things around. Too often the poor schmucks who try to build legitimate, ethical business get no such boost. The VC/PE world is ripe for such perverse incentives. A $5.5B valuation for putting TVs in doctors’ offices so Rx companies can prey on (cough, cough) I mean advertise to patients? How is this innovative? How is this going to actually benefit patients, lower costs, and (as their name ironically suggests) really improve outcomes? Sorry for ranting, but these Theranos-esque shysters make EHR vendors look like friggin’ Mother Teresa by comparison.” I’ll be interested to see how Outcome Health, as a privately held company, proceeds and how investors and customers react. Companies usually fire a few mid-level executive serving as scapegoats (giving them big go-away money and an ironclad NDA to prevent them from saying what really happened); apologize; and claim that the public penance marks a new chapter in the newly reinvented company’s inevitable destiny. The worst thing about Outcome’s business model of promoting drugs to patients at their vulnerable moments is that it works – doctors naively think they are immune from pharma propaganda and irrational patient pressure, but prescribing data proves otherwise. The most important “outcome” is boosting pharma’s bottom line. It’s distasteful to be reminded constantly that healthcare is like all other industries in being driven almost exclusively by profits, which was inevitable going back to the 1960s, when Medicare made the potential economic scale interesting to investors.

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From Desperado: “Re: Cerner. Next CEO is … Zane Burke.” Unverified, but hardly shocking if true. CERN shares appeared (from my quick graph look) to have hit an all-time high after a nice run-up last, week, closing Friday at $73.57 as the company’s market cap approaches $25 billion. I’m happy that Burke at least earned an advanced degree (MBA) since so many healthcare executives rose through the sales ranks where graduate education is seen as a waste of time.

From ImageEnabler: “Re: Philips. Now requiring customers migrating away from their iSite PACS solution to use their third-party migration vendor of choice. Who owns the data again?” Unverified.

From Dr. Trump: “Re: ACA. Will Trump’s repeal of the health insurance subsidies and encouraging cheap individual health plans benefit Oscar Health, Joshua Kushner’s startup?” I expect so. The struggling Oscar was on the wrong side of Trump’s ACA wrath when he was elected since the company sold ACA plans, but it announced in April that it would start selling the kind of individual plans that will probably gain business from the executive order.


HIStalk Announcements and Requests

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Incumbent HHS Secretary “None of the above” remains the favored candidate of poll respondents, although readers expressed tepid enthusiasm for having HUD Secretary Ben Carson swap chairs.

New poll to your right or here: what is the clinical and healthcare business impact of not having a national patient identifier?


This Week in Health IT History

One year ago:

  • Allscripts acquires CarePort.
  • AHIMA announces its plans to offer a health informatics certificate.
  • The Internet goes dark in many parts of the country when hackers hit DNS routing company Dyn.

Five years ago:

  • Wolters Kluwer announces that it will acquire Health Language.
  • NYC H+H’s board minutes explain why it chose Epic to replace QuadraMed CPR, a decision that led Allscripts to sue the health system for giving Epic the bid in what it claimed was improper procurement.
  • Google shares drop sharply when its financial printing firm releases the company’s SEC Form 8K in the middle of the day instead of after hours.
  • An IOM report finds that a health system co-managed by the DoD and VA s is spending an extra $700,000 per year for pharmacists to enter prescription data, required because their separate EHRs cannot create a sequential prescription number.

Ten years ago:

  • Medsphere settles its $50 million trade secrets and contract breach lawsuit brought against founding brothers Scott and Steve Shreeve.
  • Eclipsys announces plans to move its headquarters from Boca Raton, FL to Atlanta.
  • A Misys report concludes that doctors don’t use EMRs because they are expensive and hard to use.

Last Week’s Most Interesting News

  • A Wall Street Journal report says that waiting room digital advertising company Outcome Health misled investors about its advertising performance as fresh investment sent its valuation soaring to $5 billion.
  • President Trump signed an executive order that allows people to sidestep exchanges to buy less-expensive but less-comprehensive policies, a move that threatens to further destabilize ACA insurer risk pools.
  • Express Scripts announces plans to acquire EviCore Healthcare for $3.6 billion.

Webinars

October 19 (Thursday) noon ET. “Understanding Enterprise Health Clouds with Forrester:  What can they do for you, and how do you choose the right one?” Sponsored by: Salesforce. Presenters: Joshua Newman, MD, chief medical officer, Salesforce; Kate McCarthy, senior analyst, Forrester. McCarthy will demystify industry solutions while offering insights from her recent Forrester report on enterprise health clouds. Newman and customers from leading healthcare organizations will share insights on how they drive efficiencies, manage patient and member journeys, and connect the entire healthcare ecosystem on the Salesforce platform.

October 24 (Tuesday) 1:00 ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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.


Sales

Pine Rest Christian Mental Health Services (MI) chooses Epic.


People

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Former CMS Acting Administrator Andy Slavitt joins growth equity firm General Atlantic as special advisor, focusing on healthcare investments in underserved populations. HIStalk readers are cited in General Atlantic’s announcement for voting Slavitt as their “Healthcare IT Industry Figure of the Year” for 2016.


Announcements and Implementations

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Hospital operator Mercy’s IT organization and device maker Medtronic will work together to capture de-identified data from heart failure patients to analyze their response to cardiac resynchronization therapy. Medtronic, based in Ireland after a controversial 2015 move of its US headquarters to Dublin to dodge US taxes, sells an implantable device that offers that therapy.


Government and Politics

Two senators write to President Trump to inquire why he declared on August 10, 2017 that “the opioid crisis is an emergency and I’m saying officially right now it is an emergency” without following through on the legal rather than the rhetorical declaration that is required to take federal action.


Privacy and Security

A Microsoft executive says that the government of North Korea was responsible for using stolen NSA tools to create the WannaCry malware that hit hospitals hard earlier this year.


Other

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A 28-year-old New York man and self-described “serial data tracker” says his two-year-old Apple Watch saved his life by alerting him that his heart rate had jumped, which turned out to be a symptom of a pulmonary embolism that was successfully treated.

An 85-year-old New Hampshire pediatrician says the state is shutting her practice down for not using an EHR and therefore not checking the state’s doctor-shopper database before prescribing, although she fails to note that she willfully signed an agreement to close the practice after an investigation into poor documentation and questionable decision-making. The Poland-trained doctor claims that New London Hospital, with which she is affiliated, is trying to steal her patients. She doesn’t believe in technology:

I cannot practice medicine because the system practices with electronics. The computer is giving the diagnosis and telling them what medicine to prescribe. They practice medicine, and I practice medical art. They manage the patient, and I treat the patient … It’s fine if you are with the system. If you are not, you are an enemy of the system.”

Patients in England report that their doctors are ridiculing and threatening patients who research their issues on the Internet before a visit.

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CNN finds that drug companies are making hundreds of millions of dollars each year – much of it paid by Medicare – on Nuedexta, intended for treating a relatively rare condition that causes laughing and crying in multiple sclerosis patients, but being aggressively marketed by salespeople for dementia patients in nursing homes. Its manufacturer has also paid many millions to doctors in honoraria and consulting fees, with doctors who have received those payments being responsible for nearly half of the Medicare claims paid for the drug. Nuedexta, which costs over $9,000 per year, contains two ancient, dirt-cheap drugs – dextromethorphan (in over-the-counter cough syrups) and quinidine sulfate (a bark-derived heart drug that’s so old that nobody can remember when it was first used). The unfortunately not-rare condition it causes rather than cures is excessive pharma laughing all the way to the bank.

A visitor is stabbed to death in his son’s hospital room at Johns Hopkins Hospital (MD), with police investigating a domestic issue trying to determine whether it was murder or suicide.

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In India, a bystander captures on video a hospital dumping its medical waste into a river.

Weird News Andy is singing “Sole Man” while failing to identify a good ICD-10 code after reading this story. A man in England goes into cardiac arrest after swallowing a six-inch Dover sole, saved by a first responder who was able to remove the fish after six tries. The man claimed that the fish spontaneously leaped from the water into his mouth, but a friend told the first responder that the intrepid angler was fooling around by putting the just-caught fish over his mouth, only to be rendered speechless when it wriggled down his throat.


Sponsor Updates

  • Harris Healthcare will exhibit at AHAAM’s Annual National Institute Conference October 18-22 in Nashville.
  • Vocera will exhibit at the ANIA DFW Clinical Informatics Academy October 18 in Grand Prairie, TX.
  • Black Book ranks ZeOmega number one for care management workflow applications, and includes it on its list of Top 50 Disruptive Health IT Companies.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Reader Comments

  • AynRandWasDumb: Who cares? Does anyone actually believe that Kushner or this administration is going to have a meaningful impact on the ...
  • Publius: Can someone provide more information/background on why Epic did not attend the Kushner meeting? Politico reported that "...
  • meltoots: LMAO, Genius Bar at CVS? Yeah. is this a comedy routine? Has any of these bright idea folks ever been to a CVS? I cannot...
  • Urban confusion: What, exactly, did Uncle Neal do for rural hospitals and healthcare? Was this the focus of the Patterson foundation?...
  • Tim Donovan: Good case study. James Groton authored an article in the December 2009 issue of "Alternatives" a publication of the Int...

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