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HIStalk Interviews Fred Powers, CEO, Dimensional Insight

November 30, 2016 Interviews 1 Comment

Fred Powers is president, CEO, and co-founder of Dimensional Insight of Burlington, MA.


Tell me about yourself and the company.

The company was founded back in 1989. There are two founders. We have built the company organically. We have no outside investors.

We tend to focus in industries which have complex data. Our very first customer, in fact, was a dental implants company. Back in 1990, we showed them where their product was being bought and where a competitor was taking away market share.

From that very beginning, we have expanded. About 15 years ago, we entered healthcare, which is now a major focus for us. We are focused on rules and measurements so that we can bring integrity to measures so that they are accurately displayed so that decisions can be made.

What is healthcare’s maturity in using data to make decisions as compared to other industries?

In any industry, you have some that are the leaders and you have some that are bringing up the rear. The sense is that healthcare lags behind industries as a whole. I don’t think that that’s really true.

I think that the difference here is that the data itself is more complex. If you go into a distribution company, you’re basically looking at all of  finance and then you’re looking at product going into the warehouse and product leaving the warehouse.That’s one data domain, and in a typical manufacturing or distribution operation, it’s a finite number of domains.

When you move over into the area of healthcare, it becomes much more complex. Each domain by itself is relatively easy to understand, but when all of a sudden you have 50 of them, you have different stakeholders, and the data crosses these domains — that’s where the complexity comes in.

Healthcare is complex. People have been looking at this problem for a number of years. It’s just taking healthcare a little bit longer to solve some of these complexity issues that don’t exist in other industries. Certainly electronic health records have helped because we’re gathering this data. That would be a change. But if you look even at the electronic records, there are hospitals that have had that for 15 years and some that came on board only a couple of years ago.

Healthcare is getting a bad rap when people are saying that they’re way behind times. It’s just that their data is complex, in terms of all of these different domains and all of the different stakeholders that they have that they have to satisfy. If you’re going into a distribution center or manufacturing, you might only have one or two plants. If you take a look at healthcare, you might have 20 different facilities, maybe more, and all that has to be consolidated, and yet it has to be broken apart as well. There’s a challenge.

What lessons were learned from early healthcare data warehouse projects?

The short answer is that they don’t work, but that’s because you’re attempting to solve a complex problem. Quite often, you’re better off if you chip away at the problem with a collection of data marts. The concept of bringing all of this data together has been around for well over 40 years and it’s always been a problem when you attempt to bring it all together into one place.

I do believe that what’s happening with the data warehouse is it’s going to move more towards a columnar database over a relational database. The reason for that is that you have more flexibility with the columnar database than the relational. It also handles higher volumes of data. Right now, as this data is collected, you have to ensure that you have integrity throughout the process, and the more data that you bring together and attempt to digest, the harder it is for that integrity to take place. You really need to decompose the problem.

Here at Dimensional Insight, we’re using a columnar database for our storage vehicle. If you do research between a relational and a columnar, most of your research is going to come back and say that for a data warehouse-type approach, this is actually a better approach. There is a tremendous amount of momentum in terms of what was done in the past and then bringing that forward.

Just having proper data is really not the issue. You can ensure that you have integrity of data. Your bigger question is, do you have integrity in terms of your rule management? If you’re looking at, let’s say, an admission or a readmit, what are the rules for that? Are they consistent across the hospital? How do the underlying rules relate to the measures that ultimately you’re scoring yourself on? Because something like an admit is used across a whole collection of additional measures. Does your measure equal what CMS says or is your measure slightly different, your rules slightly different?

This is now an area that the hospitals are going to be looking at, where before, they were just saying, “I just have to get some data into my data warehouse.” Then what do you do with that data? How do you measure? That’s where your measures come to bear. We use the term “measures.” Some might use “KPIs.”

The underlying rules are very complex. We could probably spend another half hour just talking about rules management. I can honestly say that these rules are more complex than what we see in industry as a whole. This is going to be the big issue in the future.

It kind of fits under “data governance,” but the word here is “data.” I think it’s probably better if you were to call it “measure governance.” I’s more focused, because if you don’t have these proper measures, how can you manage? This is going to be a real issue as we move forward.

Then they have to be centralized. Hospitals today are buying a lot of what I call point solutions. Each one of these point solutions has some BI in it, some dashboards, and of course this is based on a collection of rules and measures. What happens if those rules and measures in Point Solution A don’t agree with Point Solution B? Which one is right? Do you have a central location for controlling these rules and measures? How does that affect the point solutions?

Over the next two or three years, we’re going to start to see the industry look at this and say, “I’ve really got a management issue here that I didn’t realize I had, because I was pulling the data out of my data warehouse.” Let’s assume they have a data warehouse. The rules were not in there, or if they were in there, it was just piece parts, and now all of a sudden, I don’t have integrity when it comes to those rules. This is going to be some interesting times for these hospitals. In my opinion, they really haven’t given enough thought to that.

How much help do hospitals need in understanding their available data elements and then finding low-hanging fruit to give them a faster payback?

Each hospital is in a different position. Larger systems will no doubt have some form of a data warehouse. They’re wondering how they can maintain it and how they know it has integrity. You move into a smaller hospital, they might have no data warehouse. They have no governance. Depending upon the environment you’re in, it’s going to have a difference in terms of how you approach the problem.

We have some customers that are small hospitals and they’re trying to see their data for the very first time. They’re really not interesting in doing anything that’s fancy. You know, “Just give the numbers. I’ve been blind. Show me the numbers over time so that I can at least see trends.” Then you move into a large entity and they’re interested in doing more because they’ve already crossed that threshold.

That’s another challenge that we have from healthcare. When you go over to industry as a whole, they’re all pretty much kind of at the same level, where when you move into healthcare, that’s just not the case.

Obviously, whether it’s a large entity or a small entity, the goal is to pick some problem that they have and then solve that problem. Then solve the next problem and the next problem. It’s kind of like eating one grape at a time. If you attempt to eat too many grapes at once, if you’ve got a young child, you know that that’s not a good thing. We try to avoid that.

Let’s focus on something that’s important, something that you need today, and then what data sources you need for that. Let’s ensure those data sources have integrity. What rules are required? What measures are required to support that need? Let’s make sure that’s in place.

Let’s ensure that you have the necessary support staff, which I might add, is not necessarily IT. A lot of it will be a nurse practitioner, as an example, or a doctor who has left the fold and now they’re into the analytics and they understand what’s necessary. They understand the data. Quite often an IT professional might not understand that. They’re more a technologist. You need that business manager. This is a real issue because a lot of hospitals don’t have those people.

Is the key to analytics adoption providing pre-built applications or perhaps finding a data-curious department expert or that rare technologist who wants to work with users to answer their questions?

It gets down to where are they on the adoption curve. Let’s assume that this hospital is just starting out. You want to give them a package containing a collection of measures, predominantly CMS, so that they can track where they are. Now, if it turns out that they have history — which they should have, depending upon when they converted, because quite often when you convert, you leave your history behind with the older system — they can go back and look at how those metrics have performed over the last two or three years and which way are the curves going.

Executives obviously like this a lot because they can see the trends. You’ve got to get something in front of the executive quickly, because he or she has to buy into it. They have to see value in it. At the executive level, they’re interested in a certain amount of information and they want the ability dive into the underlying detail. Then your detailed analyst obviously might want even more information, and they become what we call a diver. In other words, they can just go in and they can swim in this data however they choose to understand what they have. But without question, you need the executive.

The other thing that’s happening is herd mentality. We’ve been doing this since 1989 in a multitude of industries. Let’s say that you’ve got an early adopter and they’re doing their thing. Then you’ve got another early adopter and then you’ve got three and four and five. Pretty soon, you start to get this herd mentality, like everybody’s got to do this. That’s what’s happening in healthcare. If you went back 10 years, you still had the problem. People just didn’t recognize that they had to solve the problem.

Now you have a certain amount of herd mentality. “Oh, they’re doing this at this hospital. That’s pretty cool. I think I have to go do that.” You can’t leave the emotion of the decision-maker out of the equation. There’s a lot of emotions in these decisions. Hospitals tend to be very political.

Value-based Care Prompts Glass to Grow Up

November 30, 2016 News No Comments

HIStalk looks at the ways in which smart glasses – once thought to be an over-hyped novelty – are turning into a not-to-be ignored market force aimed at helping healthcare transition to value-based care.


The name “Google Glass” once evoked guffaws aimed at the early consumer adopters (Glass Explorers) who were seen sporting them in everyday settings. “OK Glass” – the command used to jumpstart the wearable’s software – was not, contrary to initial manufacturer expectations, uttered at a rate that demanded further mass consumerization.

Healthcare, however, did express interest, and at least a few headset-wearing folks walked the halls of the HIMSS conference in 2013 and 2014 The Glass hype in healthcare was understandably strong, given the industry’s propensity to create high-tech cures for low-tech problems.


Though privacy and security concerns caused Google to take a step back from the consumer market for Glass, its prospects in the world of business quietly flourished (despite the fact that HIStalk readers voted Glass “the most overrated technology” in the 2014 and 2015 HISsies). Even Apple has taken notice, with rumors resurfacing of its intent to develop an iPhone-compatible pair of smart glasses. Healthcare providers and vendors have also shown increasing interest in the devices, which in turn has helped a number of startups flourish in the face of almost gleeful naysaying.

From Pipe Dream to Readmissions Reducer


San Francisco-based Augmedix has made a name for itself in the smart glasses space, becoming one of the first companies in healthcare to recognize the value this type of technology can bring to physician workflows. Founded in late 2012 by Ian Shakil and Pelu Tran, the company — which offers remote scribing capabilities via smart glasses — has grown from two to over 700 employees.


“In the beginning, people viewed us as a novel hype play,” Shakil admits. “Now that the hype has bled away, people are starting to view us a real, substantive, hard-nosed solver of big problems in healthcare. The problem we’re going after is the sad fact that doctors spend two to three hours a day charting, typing, and clicking. They hate it and the patients hate it. We’ve thrived in the world of volume and paper; doctors are busy and burdened, and so saving them a third of their day with our remote scribing capabilities is very valuable. Those same factors are still true in the emerging world of value-based care. Doctors are scarce, they’re expensive, and their overhead is expensive. Reclaiming those lost hours enables them to focus their energies on spending more time with patients or population health endeavors. Either way, the value translates in both worlds and it’s really starting to be tallied and received by the market, which is feeling a lot of growth.”

Augmedix’s J-shaped growth curve over the last four years is indeed indicative of healthcare market interest, which has helped spawn a number of other competitors. Mountain View, CA-based Drchrono jumped onto the Glass bandwagon in 2014, developing the first EHR-compatible “wearable health record” in partnership with Google and Box.


Founded in 2004, Advanced Medical Applications got into the smart glasses game in 2014 with the first live broadcast of a surgery using Google Glass between two continents. The company, which specializes in mobile technology development for a number of verticals, has managed to find its niche in smart glasses-enabled telemedicine and emergency services.


Austin-based Pristine plays in a similar space. The three year-old startup has focused on creating a telemedicine solution that enables doctors to provide their expertise visually from anywhere at any time.


“The ‘See What I See, Hear What I Hear’ collaboration solution was initially adopted by teaching hospitals, ambulance organizations, healthcare systems that provide care for remote patients, assisted living facilities, and anywhere access to expertise was limited,” explains Pristine CEO Peter Evans. “In the past year, we’ve seen two changes that are accelerating that adoption. First, there has been a shift in approach from Explorers and those kicking the tires on the concept, often funded by grant money, to organizations that have specific pain points and realize that the traditional approaches to providing care are not scalable.”

“Second, we are seeing a rise in adoption by manufacturers of healthcare products,” Evans adds. “Companies that make complex healthcare technologies, produce pharmaceuticals, and provide other third-party solutions are enhancing their support models to healthcare providers through adoption of augmented reality and smart glass solutions. As an example, we are seeing the implementation of the rep-less model, where sales reps who normally provide in-person, in-theater support for a surgeon or doctor can now provide the same or significantly better support and expertise without having to physically be there. This improves efficiencies and reduces operational costs for both the hospital and vendor, while enabling reps to scale and support multiple clients.”

That accelerated adoption has helped Pristine’s provider customers begin to realize significant operational efficiencies. “Studies by our customers are showing that the ability to get the right skilled knowledge in the right place at the right time in an efficient manner is improving patient care and outcomes. Some of our customers using our solution for telemedicine applications have reduced readmissions by over 17 percent and reduced recovery time by almost 30 percent. We believe that we can be one piece of a complex puzzle that enables providers to be rewarded based on quality on value, not just quantity.”

Following in the Smartphone’s Footsteps


Evans believes that the maturity of the market for smart glasses will grow in lockstep with related hardware. “The hardware is trying to catch up to the applications that users envision,” he says. “While many may be familiar with Google Glass, there is very good technology that has been introduced by companies like ODG, Vuzix, Epson, and Intel with its acquisition of the Recon Jet product.

“The state of smart glass hardware reminds me of the evolution of the smartphone,” Evans continues. “Early versions of the iPhone 2, for example, had hardware shortcomings. It didn’t have a camera, long battery life, GPS, or 3G. However, it had value with initial applications – sending texts, surfing the Web, and core apps that had immediate value. Over time, the hardware became more robust. Richer applications were developed and the incremental value grew. We are witnessing the same maturity of smart glasses and augmented reality solutions for business. The hardware has some limitations, but they are being addressed rapidly.”

Shakil also believes there are lessons to be learned from the world of smartphones. “It’s a vibrant space out there, with more smart glass offerings coming by the day,” he says. “Think back to when the first PalmPilots came out, and then compare that with the iPhone 7 – it’s like night and day. I think we’re going to see a similar progression in smart glass technology. They’re going to become more like normal-looking glasses – lighter, with a better battery life, more comfortable, and more resilient.”

Opening Up Use Cases

Today’s hardware limitations don’t seem to be holding providers back when it comes to reaping the benefits of smart glass technology. Shakil says that Augmedix customers anecdotally report more satisfied and engaged patients. “We’re beginning to see that showing up in the data,” he adds, “but it’s still early days. With our solution, the doctor feels more enabled to go deeper and get more investigative. The whole process becomes more hands-on for provider and patient.”

Customers participating in the OpenNotes initiative are also realizing new use cases for smart glass capabilities. “Sutter is one of our most progressive health system partners,” Shakil explains, “and while they’re very engaged with OpenNotes, they’ve struggled to deploy it operationally because it takes a lot of time and effort to write a beautiful note in rich, comprehensible English, get it into Epic, and then make it available to the patient by the time they get home. The Sutter team has found that, by using Augmedix, the note is almost always done in plain English by the time the visit is over, and is immediately available to the patient. They love being able to offer that. It engages the patient in their own care, helps them identify things they may have initially missed, and improves compliance in all the usual things. We’re really excited about the ways in which we can enable OpenNotes and all the downstream benefits that entails.”

Shakil is quick to add that some of the company’s more progressive end users – particularly those on the forefront of technology-enabled patient engagement efforts – have already expressed interest in taking smart glass capabilities even further. “Some of our health systems have an interest in going one step beyond OpenNotes to open up the visit from Glass itself for later retrieval on the patient portal,” he says. “We’re not doing that anywhere yet. We want to make sure that we have all the secure storage capabilities, opt-ins, and opt-outs from the patient side. Personally, as a patient, I think it would be amazing to go home and relive the appointment with my family – how to use the asthma inhaler, when to come in for refills, instructions on follow-up care. I think it will improve care and engagement in a big way.”

With Scale Comes Management Concerns


The need for complementary solutions is also a strong indicator that smart glass technology is here to stay. VMware AirWatch has added smart glasses management to its line of enterprise mobility management technologies and services, a move the company attributes to increasingly larger pilot programs and the resultant need for assistance with device management.


“We are seeing research being carried out in healthcare to identify use cases from training to documentation to data visualization during surgery,” says VMware Vice-President of Product Marketing Blake Brannon. “Pioneering customers are starting to pilot smart glasses and report gains in productivity and reduction in costs. We have started to see pilots move from less than five devices to a few hundred, or in some cases, a few thousand. When the scope of pilots increases to that extent, that’s typically when IT gets involved and needs a game plan to secure, configure, and deploy them at scale.”

The Cybersecurity Question

Though patients seem to have become more comfortable with smart glasses from a privacy point of view, enterprise adoption comes with its own set of adoption challenges. “Privacy and data protection will definitely come up as potential issues,” says Brannon, “resulting from any local storage of information and transmission of data. I’m not sure cybersecurity concerns will be addressed. They’re more likely to be amplified. We saw issues with Google Glass – not knowing if you were being filmed or having pictures taken of you. There will also be the same concerns as with other mobile devices. What if it gets stolen? Does it have patient information on it? Images? Can they be remotely wiped? Is the software or firmware up to date? Questions like these from our customers prompted us to develop an answer.”

The Future

Though smart glasses seem here to stay, albeit in a very niche capacity, Brannon believes the market still has to do its fair share of growing up. “The market is fragmented right now,” he notes. “There are many manufacturers with different devices that run different versions of Android. Some devices are also running proprietary operating systems. In the short term, we could see certain manufacturers create specific enterprise policies to differentiate their hardware, but, long term, we expect to see more consistency as the core hardware vendors emerge and build to a specific standard.”

Evans takes a more long-term view with the expectation that smart glass technology will become part of a person’s daily routine for work and play. “Some pundits are predicting that in 10 years we will see the demise of the smartphone, as it will be replaced by smart glasses. Anything that can be done on a smartphone or tablet can be done on the same Android operating system on smart glass.”

“Once the hardware becomes lighter,” he emphasizes, “then people will engage others by looking up rather than down at a small screen. Voice-recognition technology, which we’re already seeing with Siri and Alexa, will become a key enabler. We can all speak commands faster than we can type them, after all. Individuals will prompt their smart glasses with voice commands and other external beacons like barcodes and object recognition and will be immediately able to call up any information needed, to be displayed while we continue to interact with the world around us. The days of smartphone-induced disengagement will become a thing of the past.”

Morning Headlines 11/30/16

November 29, 2016 Headlines No Comments

Donald Trump Picks Rep. Tom Price to Lead Department of Health and Human Services

President-elect Donald Trump selects Tom Price to replace Sylvia Burwell as the next HHS secretary.

Trump picks Seema Verma to head Centers for Medicare and Medicaid Services

Seema Verma, a health policy consulting firm CEO with ties to VP-elect Mike Pence, has been chosen to replace Andy Slavitt as the next CMS administrator.

US Department of Veterans Affairs Will Collaborate With Flow Health to Bring Artificial Intelligence and Precision Medicine to Veterans

The VA will work with artificial intelligence software vendor Flow Health to comb through the medical records of 22 million veterans and use the clinical data to help create software capable of offering meaningful clinical decision support and generating personalized care plans.

Big Names Take Hit on Theranos

Rupert Murdock will likely lose $200 million in Theranos investments after his own newspaper, the Wall Street Journal, exposed the company for misleading investors.

News 11/30/16

November 29, 2016 News 3 Comments

Top News

12-16-2011 10-57-52 PM

President-elect Trump nominates former orthopedic surgeon and Affordable Care Act critic Rep. Tom Price (R-GA) as secretary of the 78,000-employee HHS. He would replace Sylvia Burwell.

Price’s Empowering Patients First Act calls for age-adjusted tax credits for those buying health coverage on their own; a one-time credit for starting a health savings account; state-administered high-risk pools for people with pre-existing conditions; tort reform; and allowing insurers to sell policies across state lines. It would also allow individuals to opt out of government plans such as Medicare, Medicaid, and the VA programs and take the tax credit instead to buy their own insurance and would allow small businesses to create their own national insurance buying groups. It would also prohibit HHS from using comparative effectiveness or patient-centered outcomes research to deny federal insurance coverage of specific treatments. However, Price says he’s open to compromise and the only line he draws in the sand is the one opposing the ACA.

Here’s what I quoted Price as saying about the HITECH act back in 2011:

Instead, what does the federal government do and think it’s getting high tech? It is defining every little thing, every box that the physician or nurse has to check every time you see a patient, in order to get an extra 1.5 percent of reimbursement from the government. Or, not getting dinged for an extra 1.5 or 2 percent. These are the Meaningful Use things.  Washington always has these great lines, right, these wonderful Meaningful Use standards. They’re neither meaningful nor useful and they’re so ridiculous that they actually incentivize pathologists to have to ask on every single patient that they care for how old they are, how many allergies they have, what medications they’re on, when was the last time they saw their primary care physician, on and on and on, including of a slide of a patient … the pathologist never actually sees that patient … or a corpse for an autopsy. This is no lie. The federal government wants the pathologist to determine whether or not a corpse has any allergies. How you feeling today, right? This is nonsense.

So what do you do with technology to make it so it actually works for healthcare? I think the proper role of government in the area of technology in healthcare is to say, OK, this is the platform we will use. This is the highway upon which we will ride. Everybody needs to have a system that allows it to speak to another system within these parameters. And not dictate what the docs are doing on a day-to-day basis for a given patient, because it doesn’t make any sense. It’s a waste of time. They can never, ever put in place the right standards for a bureaucrat to determine whether or not the doctor’s doing the right thing.


President-elect Trump also nominates Seema Verma, MPH to serve as CMS administrator, replacing Andy Slavitt. The health policy consulting firm owner is mostly known for her work on Medicaid expansion and her Indiana ties to VP-elect Mike Pence.

Reader Comments


From Dillon Darkbird: “Re: Epic. NYCHHC does business with Epic, which doesn’t even pay its own state taxes.” DD provided a screen shot of New York’s tax warrant system showing that Epic owes the state $626,000, but I repeated the search and turned up nothing, which I assume means that Epic has since paid its tab.

From EHR Nomad: “Re: EHR migration. I’m looking for information moving from one system to another. Conversion is probably not a good option, as indicated by a number of sources that led me to that thought. What other options are there?” This is a hospital-based reader, so I’m thinking this refers to inpatient systems. You’ll probably want at minimum an application retirement system that will allow you to look up previously generated information as needed. It’s probably also both unnecessary and unwise to start with a blank EHR slate, converting at least the basic patient, provider, and clinical information to avoid frustrating users of the new system. However, it’s a good time to start over (at least technically) on order sets and system defaults. Readers with expertise in this area are welcome to respond. EHR Nomad didn’t specify the EHRs involved, but let’s assume they’re moving to Meditech 6.1. UPDATE: EHR Nomad clarifies that the conversion involves a practice the hospital is buying that runs MEDENT and they want to convert them to Allscripts. He’s wondering whether to just take possession of the practice’s server and keep it running or whether there’s a way to extract the information and store it in a logical way in case it’s needed. I think he’s given up on the idea of importing the information into Allscripts.

HIStalk Announcements and Requests


Nordic donated $500 to my DonorsChoose fund, which with the addition of matching money fully funded these teacher grant requests:

  • Three sets of non-fiction books for the first grade classroom of Mrs. G in Saint Paul, MN.
  • Makerspace supplies for the school library of Mrs. G in Middleton, WI.
  • Three Chromebooks for Mrs. J’s first grade class in Lugoff, SC.
  • STEM modeling materials for Mrs. M’s elementary school class in De Soto, KS.
  • Headphones for students with profound disabilities in Mr. P’s middle school class in Oklahoma City, OK.
  • STEM materials for Mrs. W’s first grade class in Easley, SC.

Mrs. J was quick to respond, referring to her class — as teachers often do — as “us,” which gets me every time:

I am absolutely blown away by the generosity of others at this time of year and all year round with DonorsChoose. My students are going to be so surprised when these Chromebooks arrive! My students love technology and your donations and kindness will really make a difference in their learning. Thank you so much for your gift. Words can’t begin to tell you how much your gift means to us.

I don’t intentionally solicit funds for DonorsChoose because I don’t like being strong-armed for donations myself, but readers often send money voluntarily and I’ll always put it to good classroom use. I’ll have another round of funded projects to describe next time thanks to some new donations that came in on Giving Tuesday.


December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

Acquisitions, Funding, Business, and Stock


Canada-based Constellation Software’s subsidiary Harris continues its acquisition spree by buying iMDsoft. Its previous acquisitions include Picis, QuadraMed, MediSolution, DigiChart, and NextGen’s hospital systems business. 


In Australia, the builder of the unfinished Royal Adelaide Hospital is preparing to sue the state government, claiming it has delayed the hospital’s scheduled April 2016 opening to cover up problems with its overdue and over-budget Allscripts-powered EPAS system. The health minister says an independent auditor previously dismissed those same claims.


Austin, TX-based doctor-patient texting app vendor Medici raises $24 million. It pitches itself to doctors with, “Get paid to text with your patients on your schedule.” The 13-employee company tries to create buzz by calling itself the “Uber of healthcare” and “WhatsApp with your doctor.” Hopefully the example screenshot above isn’t representative of the degree of clinical thoroughness involved with those convenient, billable text exchanges.


Orion Health announces first-half 2017 interim results: revenue up 9 percent, operating loss $12 million vs. $19 million in the first half of 2016. Shares dropped 18 percent to a record low on the news and are down 64 percent since the company’s 2014 IPO. While revenue is up, losses are down, and the company projects profitability in 2018, Orion’s cash position has dropped to $17 million after a net cash outflow of $23 million in the first six months of the fiscal year. The company has also expressed some concern that its predominantly US customer base might defer decisions following the presidential election, but it believes healthcare IT initiatives have bipartisan support.


Wall Street Journal owner Rupert Murdoch is likely to lose most of his $200 million investment in Theranos, whose downfall was ironically triggered by investigative articles published by his own paper. Many big, later-stage Theranos investors were individuals and families with little connection to the usual VC vetting process who watched the company’s $9 billion valuation drop to nearly zero. Meanwhile, two more investors file lawsuits against the company claiming they were misled, one of them seeking class action status.



NorthShore University Health System (IL) and Valley Children’s Healthcare (CA) choose Phynd’s provider management system.


New York-Presbyterian Hospital (NY) chooses Mobile Heartbeat’s clinical communications system.



Teleradiology services vendor Virtual Radiologic promotes Shannon Werb to president/COO, replacing departing CEO Jim Burke.

Announcements and Implementations


Community Health Network (IN) expands its use of Kyruus ProviderMatch to its new consumer website.

Boston Children’s Hospital (MA) and GE Healthcare will work together to develop brain scan interpretation software that will be available via GE’s Health Cloud.

Phynd releases version 2.0 of its Unified Provider Management system.

Philips, following GE Healthcare’s lead, will develop medical software for its imaging systems, with its CEO telling investors, “The world does not need much more capacity in scanners, but is especially in need of better interpretation of data” for improving diagnosis.

The VA will partner with artificial intelligence vendor Flow Health to analyze the VA’s 20-year database to identify disease markers, suggest treatments, and discover the influence of genetics on risk, diagnosis, and treatment.


Nationwide Children’s Hospital (OH) and release a seizure diary app for the Apple Watch that allows people to record their seizure data and video, share it with their doctors, and contribute it to a research database.

Marketing and customer service software vendor Pegasystems offers FHIR-powered APIs to connect with its healthcare applications.

Clinical Architecture adds Advanced Clinical Awareness Suite to its new Symedical terminology management platform release, which normalizes patient data from multiple EHRs or virtual medical record formats and applies inference rules to suggest diagnoses, recommend orders, or provide advice or alerts.

Government and Politics

A pending Medicare rule change would require hospitals to discuss nursing home quality data with inpatients who are about to be discharged to one of those facilities. Current Medicare patient choice requirements prohibit hospitals from doing anything more than just handing over a list of nearby facilities that have space available. Hospitals like the idea because they can be penalized for readmissions caused by poor nursing home care.


Kaiser Health News reports that a record 1,455 lobbyists representing 400 companies are trying to convince members of Congress to either pass or reject the 21st Century Cures Act in voting this week, which would increase NIH funding, devote funds to address the opioid crisis, and change the FDA’s drug and device approval standards. Even the US Oil and Gas Association is involved since the Cures Act would be paid for by selling oil from the government’s Strategic Petroleum Reserve. The drug company trade association PhRMA has spent $25 million to support the bill, which would get their expensive drugs to market faster and would also reduce their requirement to publicly report payments made to doctors via the OpenPayments database. The Cures Act still falls far short of the ACA’s record-setting lobbyist activity, when 1,200 companies mobilized their ear-whispering firepower seeking favorable treatment .

Privacy and Security


HHS OCR warns providers that phishing emails are being sent to HIPAA covered entities that include the HHS letterhead and the signature of OCR Director Jocelyn Samuels. The email includes a link that appears to direct readers to a document involving their inclusion in HIPAA audit, but it actually sends them to a cybersecurity firm’s website. HHS OCR says it takes “unauthorized use of this material by this firm very seriously.” I’m not sure in the absence of details whether HHS’s use of the term “phishing” in describing a disguised link is correct since it’s not clear whether the user is asked for confidential information, but obviously they aren’t happy about it.


Trend Micro reports that 35 healthcare organizations, 17 of them in the US, have been scammed in the past two weeks by cybercriminals who spoofed the CEO’s email account and ordered employees who manage wire transfers to send money to their bank accounts.

Innovation and Research


In Australia, Metro North Hospital and Health Service and Queensland University of Technology are building a dedicated 3D tissue-printing facility for the hospital’s OR, predicting that biofabrication can create personalized implants, help with robotic-assisted surgery, and improve surgical training.



The Gates Foundation funds the work of low-cost, rapid-result portable molecular diagnostics vendor QuantuMDx, which is fine-tuning its field tuberculosis testing system.



NPR’s “All Things Considered” finds that biomedical research information is proliferating due to EHR rollouts and well-funded projects like the Cancer Moonshot, but nobody’s actually looking at all that big data. Reasons: the information is not all that robust and reliable due to variations in EHR database usage and much of the good stuff is recorded as free text. FDA Commissioner Rob Califf says the only way to validate the datasets is to get people to participate in studies that try them out, with increased study participation being the #1 FDA big data issue.


Stat profiles Myriad Genetics, which made $2 billion in the 17 years of patent exclusivity it enjoyed for its BRCA breast cancer genetic testing. With competitors offering similar tests for a few hundred dollars instead of the $4,000 that Myriad charges following their successful patent litigation, Myriad has instructed its salespeople to disparage those competitors that it labels as a “public health crisis.” An interesting review by members of the Free the Data consortium compared the results with those of its competitors and found little difference, although patient recommendations from all of them change over time as they gain more real-world data. The group was formed because Myriad refused to share its database with physicians and researchers, so Free the Data gathers the reports downstream directly from participating providers.

Patients at C.S. Mott Children’s Hospital (MI) will receive a custom cardboard virtual reality viewer that can run apps from their own smartphones, including a University of Michigan game day app, courtesy of a $50,000 grant from the Jim Harbaugh Foundation.


A radiologist’s JAMA opinion piece written with Eric Topol, MD suggests that radiologists should emulate pathologists in embracing technologies that can replace much of their work, often more accurately and always more efficiently, and retool their practices as “information specialists” whose job would change from extracting information to managing the information created by those technologies. The authors even suggests that perhaps the pathology and radiology specialties should be merged.

Sponsor Updates

  • Catalyze releases a new podcast, “Why Healthcare Should Expand its View of FHIR.”
  • Black Book announces the top ranked, end-to-end crisis management PR agencies.
  • Forward Health Group is sponsoring the December 7-9 annual conference of the California Association of Public Hospitals and Health Systems in Pasadena.
  • Besler Consulting releases a new podcast, “What healthcare policy might look like under the Trump administration.”
  • Black Book lists the top 20 issues faced by healthcare PR and crisis management firms.
  • CapsuleTech will exhibit at the National Forum on Quality Improvement in Healthcare December 4-7 in Orlando.
  • CoverMyMeds sponsors the Healthcare Association of New York State’s Back to Basics Bootcamp November 29-30 in Tarrytown, NY.
  • Cumberland Consulting Group will sponsor the Health Plan Alliance’s Informatics and Analytics Value Visit December 6-8 in San Antonio.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.


Morning Headlines 11/29/16

November 28, 2016 Headlines No Comments

Republicans reach deal to pass Cures Act by end of year, but Democrats pushing for changes

The House will vote Wednesday on a final version of the 21st Century Cures Act, a $6.3 billion piece of legislation that will target opioid addiction, fund Obama administration research programs for the next 10 years, and speed federal approval of new drugs and devices.

CMS’ star ratings for hospitals linked to social, economic factors

A new JAMA study finds that a hospital’s CMS star rating is “heavily influenced by its location’s socio-economic conditions,” reinforcing longstanding concerns voiced by industry stakeholders.

Theranos Sued for Alleged Fraud by Robertson Stephens Co-Founder Colman

Lawsuits continue to pile up for Theranos, with investment firm Robertson Stephens & Co founder Robert Colman accusing the company of making false and misleading claims about operations and technology during its investment talks.

HIMSS17: Stealing Your Life

Former conman and world renown authority on forgery and fraud, Frank Abagnale, will speak at HIMSS17 at a session called Stealing Your Life that will address data breaches and identify theft within the healthcare industry.

Curbside Consult with Dr. Jayne 11/28/16

November 28, 2016 Dr. Jayne 2 Comments

It was a busy holiday weekend for me, with several days of patient care. I saw several extended families with a “stomach bug” that was more likely to be food-borne illness. It’s never fun to suggest that Aunt Tillie’s cooking make everyone sick, but it does happen. At one point, we had so many patients receiving IV fluids that we had to call for more supplies to be sent from another location.

Although I think I won the prize for fluid administration, several other locations broke records for the number of patients seen in a single day. Not every patient was in need of such urgent attention, though. Dozens had conditions that could have waited or didn’t need to be seen at all. I’ll have fun analyzing the statistics once we complete our month-end close, but the potential root causes are interesting.

Over the last several years, we’ve seen greater patient empowerment, which is generally a good thing, especially when you’re talking about shared decision-making and improved health through greater patient involvement. But it’s less of a good thing when patient empowerment loses the “patient” piece and becomes more of an exercise in instant gratification.

To be clear, I’m not talking about patients with urgent medical needs, such as shortness of breath, chest pain, lacerations needing stitches, strep throat, etc. I’m talking about the folks who have had a cough for one day, who haven’t tried any over-the-counter remedies, and who expect the physician to work magic and get mad when we don’t have much to offer.

We had one patient come in as we were closing on Friday who stated that she was “miserable” with her symptoms, yet she came in at closing time because she was too busy with her Black Friday shopping to be seen earlier. Even her $50 co-pay wasn’t a deterrent. She could have called the after-hours line at her primary care office and received the same advice that I gave her, which was to treat the symptoms using over- the-counter remedies since it was most likely a viral infection. She ended up being upset with my treatment plan and demanded an antibiotic, which I refused to give her. I’m sure she’s going to call our administrators and complain.

I used to become more aggravated at situations like that, but they’ve unfortunately become par for the course. When my administrators look at the overtime that was paid out handling her care, I’m sure they’ll be a bit less sympathetic to her complaints.

I also had several patients who were there because they were worried about symptoms they did not yet have. One was a college student planning worried about getting sick before finals, because she had been having a runny nose for a few hours. Her mother was more concerned about “what could possibly be causing those dark circles under her eyes?” than listening to my discussion of needing plenty of rest, plenty of fluids, and some over-the-counter medication from Target. I recommended that she obtain a flu vaccine when she gets back to school on Monday (we have already exhausted our supply) and she stated that she refuses to go to the student health service because they didn’t have “real doctors” there. Her mother heartily agreed. I knew at that point there was no reasoning with them.

Some of these situations are the unforeseen consequences of shifting healthcare policy. My practice is big on price transparency. That’s part of our marketing since we’re significantly more affordable than the local hospital emergency departments. We’re not cheap, though – self-pay physician visits are right around $100 with testing and treatment on top of that.

Patients paying out of pocket tend to have better judgment when deciding to come in, and most of them have conditions that legitimately need a prescription treatment or other intervention. The majority of patients who don’t really need to be there have insurance and are somewhat insulated from the real cost of care. Even those with high-deductible plans tend to come to care a little more frequently than I’d expect, knowing that the charges will be billed through to insurance first so there isn’t a direct correlation between care and payment.

My dad recently found some old physician office fee tickets from the 1970s that made for interesting reading. I remember going to those physician offices. They didn’t have big billing staffs or revenue cycle management agreements or contracts experts or any of that overhead. They had a physician, a nurse or assistant, and a receptionist who also collected the payments at the time of service. Even adjusting for the wages of the day, the charges were reasonable.

I look at my practice (which is right at MGMA benchmarks) and see how many people are supporting me from a revenue cycle standpoint compared to how many are actually helping me deliver patient care and it’s disheartening. We have so many layers between the patient and the payment that are contributing to costs, and yet no one seems intent on reforming the insurance industry or their extreme profits. Back when I ran my own practice, I once calculated that the costs of managing the payer-related workflows in my practice (charge entry, payment posting, working denials, collections, office management functions related to those workflows, etc.) were nearly 30 percent of my overhead.

People are working hard in the realm of healthcare technology to streamline those processes and make them efficient as possible. The practice management system I use now leaves the one I had in 2005 in the dust and it’s significantly easier to use as well. We’re automating ways to get the most out of the healthcare system, but the underlying problems aren’t getting much better. In some ways they’re becoming more complex, as we now have to manage prospective payments, capitated payments, fee-for-service, increased patient-pay amounts, and other arrangements.

I recently watched a practice spend nearly $100,000 in staff and consulting hours on a project to address write-offs and refunds largely related to inefficiencies in payer processes. I guarantee that practice had more patient-centric priorities they could have spent that money on, but they were hemorrhaging money with their previous process and needed to fix things so they could move forward.

Even with our major shifts in healthcare policy, it often doesn’t deal with some areas of urgent need. I saw one patient who was actively delusional, yet had nothing to offer her because she wasn’t a danger to herself or others. Mental health services are so strapped in our community that unless you meet the latter criteria, it may take months to see someone. I spent nearly an hour trying to come up with a plan for her, which ended up being pretty pathetic compared to the care she really needed. But at least I was able to refer her electronically and with an associated C-CDA so when she does finally have an appointment, the receiving care team will have my data.

My next few patient care shifts are in non-holiday, non-weekend time blocks, so maybe I’ll see more typical urgent care cases that will help reset my psychology around the work I do and how it plays into the grand scheme of things from a healthcare reform standpoint. In the mean time, I’ve got some last minute HIPAA-related security risk assessments to work through for consulting clients that like to wait until the last minute to get things done. After that, I’ll start helping clients get ready for end-of-year data gathering and preparing their attestations for various payer programs as 2016 winds to a close. The end of the year used to be a slow time, but no more.

What’s your busiest time of the year? Email me.

Email Dr. Jayne.

Readers Write: 5 Common Clinical Information Blind Spots

November 28, 2016 Readers Write No Comments

5 Common Clinical Information Blind Spots
By Sandra Lillie


The growth rate of data moving into VNAs is exploding – expected to reach 1.4 billion objects by 2017 – and approximately 75 percent of these objects will be non-DICOM assets. To date, many hospitals don’t have a formal strategy addressing how to identify, import, and manage non-DICOM images and video as part of core image management and security efforts. This puts the organization at risk of exposing PHI (protected health information).

Moreover, these assets often aren’t included in or accessible from the EHR (electronic health record). These holes in the health record provide clinicians with an incomplete picture of the patient that can negatively impact diagnoses, treatment plans, and ultimately, outcomes.

With increased scrutiny being placed on the healthcare organizations to tighten up security efforts to protect patient data, and an industry-wide movement toward greater interoperability and patient-centered care, the need to establish centralized insight and control of non-DICOM assets has never been more important. However, this can be a significant challenge because of all the systems, devices, and media throughout an HDO (healthcare delivery organization) on which these images reside.

The departmental nature of care delivery in the past has created a plethora of locked and blocked silos that contain critical clinical images an organization may be unaware even exist. Identifying and consolidating these assets as part of an enterprise imaging strategy allows for the deployment of a more complete EHR while reducing costs locked in departmental system solutions. The key is to identify areas throughout the HDO where the largest numbers of unconnected and potentially valuable non-DICOM images are likely to reside. Bringing these images into the fold first can address some the biggest risk areas while adding the most clinically relevant patient information to the health record.

The following are five of the biggest sources of non-DICOM blind spots in hospitals and health systems.

1. Visible light images and video. This source is fairly convoluted because of all the areas of the hospital where visible light images and video are captured and stored. However, they are all important, whether they’re endoscopy or colonoscopy images from gastroenterology; ureteroscopy or cystoscopy images from urology; or laparoscopy images from OR/surgery. It’s vital to identify all of the producers of visible light images and video throughout the hospital and implement technology solutions that allow those assets to be captured and imported in their native formats from a wide range of video scope systems and processors.

2. Dermatology and plastic surgery. Many dermatology and plastic surgery departments have specialized imaging systems that capture high-definition (and sometimes 3D-rendered images) of everything from routine skin conditions to complex reconstructive surgery. These images are important pieces of the clinical narrative that are often missing from a patient’s electronic health record because of the isolated and proprietary nature of many of these systems.

3. Ophthalmology. Ophthalmology departments also routinely leverage specialty systems that capture images of the retina, cornea, and other features of the eye. A complete picture of a patient’s eye health can only be obtained by including images from these specialty systems in an overall enterprise imaging strategy.

4. Mobile devices. The healthcare industry today is increasingly mobile. Clinicians at the point of care (especially in emergency rooms) routinely capture images of wounds, allergic reactions, skin anomalies, and more in the exam room on their smartphones and tablet devices. Capturing, consolidating, and managing these photos as part of an enterprise imaging strategy can be challenging, particularly in healthcare environments that have adopted a BYOD (bring your own device) mobile policy. A technology that can be installed on mobile devices to encrypt and route medical images from these devices to a central PACS, VNA, or EHR while ensuring no image data is saved to the device camera roll is essential.

5. CD/DVD media. This is another convoluted source of non-DICOM (and potentially even DICOM) images and video. Practically any medical department that leverages imaging in some way, shape, or form has (at one point or another) stored old patient images on CDs or DVDs. These images are likely rarely, if ever, accessed by clinicians and are completely disconnected from the EHR. It is important that the pertinent historical imaging data contained on this media is imported into an enterprise imaging platform and reintroduced to the patient record.

These five sources of medical imaging clinical blind spots are just a sample of the areas to keep in mind in pursuing an end-to-end enterprise imaging strategy. As the industry moves further down the path toward delivering true personalized medicine, other emerging areas – such as pathology and genomics – will be important to consider in an effort to produce and maintain a comprehensive patient record for clinical use.

Furthermore, HDOs also sometimes forget that additional unstructured information (such as documents) exist within other departmental systems and provide another source of important clinical information. A well-articulated and focused enterprise imaging and healthcare content management (HCM) strategy with a reputable partner capable of delivering the necessary interoperability requirements can put an HDO on the path for delivering a truly comprehensive EHR.

Sandra Lillie is industry manager for enterprise imaging for Lexmark Healthcare.

Morning Headlines 11/28/16

November 27, 2016 Headlines No Comments

Cyber security and resilience for Smart Hospitals

The European Union Agency for Network and Information Security publishes cybersecurity recommendations for healthcare executives.

Incoming Regenstrief Institute president Embi named chair-elect of AMIA board of directors

Regenstrief Institute president and CEO Peter Embi, MD is selected as the chair-elect of the board of directors of AMIA.

Governor Baker Establishes Massachusetts Digital Healthcare Council

In Massachusetts, Governor Charlie Baker creates a digital health advisory council comprised of leaders healthcare technology, insurance, medical devices, healthcare delivery, life sciences, academia, and government.

Independent doctors say hospital thwarts competition

In Vermont, local providers are complaining that UVM Medical Center operates as a monopoly, filing lawsuits against new local practices to shut down competition.

Monday Morning Update 11/28/16

November 27, 2016 News No Comments

Top News


The European Union Agency for Network and Information Security makes security recommendations for “smart hospitals” that rely on interconnected IT assets, especially those that are based on the Internet of Things, recommending that they:

  • Establish effective enterprise governance for cybsersecurity, including performing a cost-benefit analysis for IoT components, developing a BYOD and mobile device policy, and identifying how each component connects to other components or to the Internet.
  • Implement state-of-the-art security such as smart firewalls, network monitoring, intrusion detection, encryption, and authentication and authorization.
  • Publish IT security requirements for IoT components.
  • Create a community for hospitals to share security information.
  • Have an independent firm to conduct penetration testing and auditing.
  • Support the adoption of information security standards by hospitals and have hospitals certified by independent experts as meeting those standards.

HIStalk Announcements and Requests


LinkedIn dwarfs other social media sites for professional use by poll respondents, with Twitter coming in a far-distant second. New poll to your right or here: how interested are you in health IT news from outside the US?

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.


It must be end-of-year housecleaning – I know of at least three companies that have quietly replaced their CEOs in the past couple of weeks. Announcements will be forthcoming, I assume.

Listening: new from New Zealand-based No Wyld, which crafts darned good haunting, catchy hip-hop rock. I’m also desk-drumming to the new release from Finland’s legendary rockers Remu and the Hurriganes, which has played no-nonsense, American-sounding, pre-Beatles bluesy rock and roll since 1971.


HIStalk reader Mike left health IT eight years ago, but still reads regularly to stay in touch. He sent a $500 donation to my DonorsChoose fund, which was magically magnified by matching money to fund these teacher grant requests:

  • An iPad videography kit for documenting the engineering design process in Mr. C’s middle school class in San Jose, CA.
  • Two tablets for Mrs. M’s second grade class in Newport News, VA.
  • A programmable robot for the library of Mrs. E’s elementary school in Greenwood, SC.
  • Science books and kits for Ms. M’s elementary school class in Kansas City, MO.
  • Replacement bulbs for the Smart Board projectors of Ms. L’s seventh grade class in Brooklyn, NY.
  • A listening center and dry erase boards for Ms. M’s elementary school class in Houston, TX.
  • A BreakoutEDU pre-calculus problem solving kit for Mrs. S’s high school class in Independence, MO.
  • A document camera for Mrs. W’s elementary school class in Phoenix, AZ.
  • Computer speakers and a tablet for Mrs. D’s elementary school class in McKees Rocks, PA.
  • Supplies to run a writing master class taught by an award-winning author at the library of Ms. H’s high school in Long Island City, NY.

Several of the teachers above emailed after receiving notice Sunday that I had placed the donation, with Ms. L describing how important something as simple as replacement projector bulbs can be:

Thank you so very much for your generous donation to my science classes. I would have been forced to change my entire curriculum if it was not for your help. Due to the struggling economy, it is difficult to supply the classroom with all of the necessary materials. The Smart Board projector is such a valuable education tool that you have returned life to once again. You truly did a wonderful thing. Your assistance means so much to me but even more to my students. Thank you from all of us.

Last Week’s Most Interesting News

  • UMass pays $650,000 to settle HIPAA charges over a 2013 malware infection in one of its component organizations that was not properly defined as part of UMass’s hybrid organization status.
  • HIMSS and CHIME form HIMSS-CHIME International to manage their programs outside of North America.
  • The Gates Foundation funds a project in which Factom will create a secure, transportable, patient-managed medical record powered by blockchain technology.
  • President Obama expresses concern about maintaining a cohesive society and democracy as technology empowers its developers but marginalizes the value of other types of work, citing radiologists potentially losing their jobs to artificial intelligence.
  • A study finds that conveniently located retail clinics don’t reduce unnecessary ED visits for minor “treat and release” conditions.


December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.


ProMedica (OH) chooses Sectra’s cardiology imaging module.



AMIA selects incoming Regenstrief Institute President Peter Embi, MD, MS as chair-elect.

Announcements and Implementations

Massachusetts Governor Charlie Baker forms the Massachusetts Digital Healthcare Council to advise him on accelerating digital health innovation in the state.


Physical therapy telehealth platform vendor In Hand Health releases a new version of its patient engagement app that includes the ability for therapists to create video exercises on their smartphones, send them to individual patients, and track their exercise activity between visits. A 400-patient license for up to six physical therapists costs $800 per year.


Israel-based imaging analytics vendor Zebra Medical Vision announces a service in which patients can upload their medical images to receive an automated analysis for conditions such as osteoporosis, compression fractures, and emphysema, although the company notes that “our analysis does not replace a physician or a proper medical examination” and the service is not available in the US.

GE Healthcare announces several products at RSNA that include patient-controlled mammography pressure, an imaging collaboration suite, and enhancements to Centricity Solutions for Enterprise Imaging.

Privacy and Security


  • The Fancy Bears hacking group that previously published the medical information of US Olympic athletes publishes internal emails from doping organizations that it obtained by phishing, with some of those emails suggesting that certain athletes were blood doping or using cocaine to lose weight.
  • CHI Franciscan Health warns an unspecified number of patients that a laptop stolen from an employee contains their medical information. The employee’s stolen backpack also contained a day planner in which the employee had recorded his or her user ID and password.
  • A security magazine warns that hackers might not only steal data, but intentionally change information to either make the data owner look bad or to benefit from the effects the altered data will cause, such as in stock market manipulation. ponders whether the next generation of hackers might go beyond ransomware attacks and instead change some patient records and offer sell the provider a list of the “before” and “after” values so they can correct them.
  • Thieves place skimming devices on ATMS in four New York City hospitals, using tiny cameras to collect credit card information that they used to steal $46,000 from at least 75 people.
  • A Georgia surgical practice notifies patients that its server was breached repeatedly over a six-month period by a hacker using a compromised EHR vendor’s password.
  • In Canada, Nova Scotia’s Information and Privacy Commissioner recommends implementing electronic referrals after investigating several incidents in which mental health referrals were faxed by practices to a private business instead of a mental health clinic due to misdialing. The commissioner also recommended that physician practices identify one person to send faxes, pre-set the clinic’s number in their fax machines, set a reminder to check regularly that the clinic’s fax number hasn’t changed, and use cover sheets.


A security expert’s test finds that his new Wi-Fi $55 security camera was infected with malware just 98 seconds after it was installed, attacked by a worm that used the hidden, hard-coded default login and password.

A man sues CNN for airing photos of him taken in a hospital as he recovered from a gunshot wound that he says was inflicted by his friend, former pro football player Aaron Hernandez.


The Burlington, VT newspaper reviews the difficulty providers have had in attempting to launch services that compete with University of Vermont Medical Center, which uses its legal clout and political and business connections to protect its business interests. A group of eye doctors trying to open the state’s second ambulatory surgery center had their project killed by an antiquated certificate-of-need process and a developer’s lease that required them to ask another client of the developer — UVM Medical Center — for permission to build their surgery center,  which the hospital opposed. Another doctor who attempted to build a similar center was opposed by the Vermont Association of Hospitals and Health Systems, which complained that its members would be hurt financially and that a market-driven ASC would undermine payment reform. UVM Medical Center complained that the ASC wasn’t needed because hospitals already have adequate capacity, warned that the ASC would create its own demand, and questioned how the hospital would get the ASC’s medical records if its patients showed up in the hospital’s ED with complications after hours.


A Wall Street Journal report notes that drug companies are increasing prices for specific drugs in lockstep with those of competing products, with examples being Viagra and Cialis (now at around $50 per tablet vs. $20 in 2013) and insulin that now retails for over $400 per month. The practice isn’t illegal as long as the drug companies haven’t agreed in advance to pursue such a strategy. 


The cash crunch caused by India’s demonetization has driven a big uptick in telehealth visit volume as consumers seek services for which they can pay electronically.


Actor Chuck Norris, who I note with surprise is now 76 years old, describes improvements being made in the VA, specifically noting some of its technology projects:

In a 2015 briefing by VA Chief Information Officer Stephen Warren, it was pointed out that more than half of the VA’s proposed 2016 technology budget was earmarked toward delivering better outcomes for vets; to build out a tech infrastructure that supports customized health care tools for veterans. These tools were to include mobile and telehealth technologies, advanced electronic health records, and a new scheduling system. Also included was the beginning of a pilot program for a major 10-year investment in updating the VA’s aging telephone system. Warren described the programs as an enhanced part of “mission delivery” and a move to “veteran-focused outcomes versus an organizational-focused” outcomes. Progress on these efforts need to be reviewed and the public must be kept apprised.


Alabama internist Richard Snellgrove, MD is indicted for prescribing the opioids that killed 3 Doors Down lead guitarist Matthew Roberts in August 2016. Roberts was found dead in a Hampton Inn hallway with fentanyl patches applied to his body and filled Lortab and Xanax prescriptions in his backpack. The federal complaint cites a close friend who said Roberts was addicted to prescription painkillers and who told police, “If you want to arrest the drug dealer who killed [him], arrest his doctor.” The doctor, who had been described as a celebrity junkie who Roberts called “Snelly,” wrote a prescription for 240 methadone tablets for Roberts that cause other doctors to question his prescribing habits when they looked Roberts up in the state’s doctor-shopper database. The PDMP database also showed that the doctor wrote at least 31 controlled substance prescriptions for Roberts without a corresponding office visit, as evidenced by the lack of claims filed by the practice to his BCBS insurance.

Sponsor Updates

  • Qpid Health and Visage Imaging will exhibit at RSNA November 27-December 2 in Chicago.
  • Data Center Knowledge profiles TierPoint CEO Jerry Kent.
  • AdvancedMD donates 600 necessity bags to Ronald McDonald House Charities.
  • Agfa Healthcare and Elsevier Clinical Solutions will exhibit and present at RSNA November 27-December 2 in Chicago.
  • Besler Consulting releases a new podcast, “Three Ways to Succeed Under Emerging Payment Models.”
  • HIMSS features Caradigm’s Michelle Vislosky’s thoughts on population health management capabilities.
  • EClinicalWorks releases a recap video from its annual conference.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.


Morning Headlines 11/23/16

November 22, 2016 Headlines No Comments

UMass settles potential HIPAA violations following malware infection

UMASS will pay $650,000 to settle a HIPAA violation stemming from a 2013 malware infection that led to the disclosure of 1,670 records. The breach exposed names, addresses, social security numbers, dates of birth, as well as insurance, diagnosis, and procedure data.

Repealing Obamacare With No Replacement Will Cause Chaos, Obama’s Health Chief Warns

HHS Secretary Sylvia Burwell warns that repealing ACA without enacting a replacement would wreak havoc on health insurance markets.

Ireland to go-live with national maternity electronic record

In Ireland, Cork University Maternity hospital will go live with Cerner on December 3 as the nation moves forward with plans of consolidating all of its 19 maternity hospitals on one system.

Novartis backs off from 2016 date for testing Google autofocus lens

Novartis cancels plans to test the autofocus contact lenses it is co-developing with Google, citing technical issues and declining to comment on when testing would begin.

News 11/23/16

November 22, 2016 News 3 Comments

Top News


UMass will pay $650,000 to settle HHS OCR HIPAA charges over a 2013 Trojan malware infection of a single workstation at its Center for Language, Speech, and Hearing that exposed the information of the PHI of 1,670 people.


OCR found that UMass had chosen a “hybrid” status — which requires it to designate in writing which of its components perform HIPAA-covered functions and which do not – but had failed to list the Center and some other components. UMass also failed to implement a firewall at the Center and had not performed a risk analysis at the time of the incident.

HIStalk Announcements and Requests


ST Advisors donated $500 to my DonorsChoose fund as part of their annual charitable giving, which through the magic of matching money funded these classroom projects:

  • Strategic thinking, economics, and entrepreneurship games for Mrs. D’s middle school gifted class in Springdale, AR.
  • Robotics programming kits for Mrs. F’s STEM high school class in Lincoln, KS.
  • A microscope and other science materials for Mrs. M’s third grade class in Newport News, VA.
  • A document camera for Mrs. R’s second grade English as a second language class in Englewood, NJ.
  • Math manipulatives for Mrs. O’s second grade class in Kansas City, MO.
  • A programmable robotics kit for Mrs. R’s third grade class in Brooklyn, NY.
  • Headphones for Mrs. M’s school library in Bronx, NY.
  • A Chromebook for Mr. G’s high school class in Bluejacket, OK.
  • Math manipulatives for Ms. P’s middle school class in New Orleans, LA.

In addition, reader Bill sent a nice note and donation that funded a Kindle Fire and headphones for Ms. W’s kindergarten class in Los Angeles, CA.

I have another donation or two that I’ll apply later this week. Thanks to everyone who supports STEM learning in our schools. Watch this space for photos and teacher reports. I know the teachers are excited because I received emails from all of them within a few of hours of funding their projects, such as this one from Ms. W:

What an awesome way to start the day to know that an important project was funded by an awesome donor! Thank you from the bottom of my heart for your very generous donation! My students will be so excited to hear this news! They are so fired up about protecting the environment. This project will help further ignite that passion! Have an amazing and warm Thanksgiving.


December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

Acquisitions, Funding, Business, and Stock


Oracle acquires domain name services provider Dyn, which was the subject of an October 21 distributed denial-of-service attack that rendered major websites unavailable to much of North America and Europe, for a rumored $600 million. Ironically, Dyn serves as the authority on Internet downtime and data blocking by monitoring web traffic and offering companies a rerouting service to make sure their visitors get through.


Symantec will acquire consumer identity protection LifeLock for $2.3 billion. LifeLock has paid more than $100 million in FTC fines for false advertising and reports found that its previous CEO, who was featured in endless ads listing his Social Security number with a challenge to hackers to try to steal his identity, was found to have had that identity stolen at least 13 times. At one point, the company’s main way of trying to prevent fraud was to place a red flag every 90 days on the credit files of its subscribers (who pay from $10 to $30 per month) as though someone might have compromised their accounts, with its reps calling Experian up to 15,000 times per day on their toll-free number and filing the same fraud alert that consumers could have requested on their own at no charge. Experian, which offers a competing service, sued and won.



Main Line Health (PA) selects Bernoulli for medical device integration as it transitions to Epic.


Spectrum Health (MI) chooses MModal for speech-driven clinical documentation.

In England, Royal Free London NHS Foundation Trust signs a five-year agreement for the Streams acute kidney injury event notification system from Google-owned DeepMind.



Canada-based mental health software provider Ehave hires Prateek Dwivedi (University Health Network) as president and CEO.

Announcements and Implementations

HIMSS and CHIME form HMISS-CHIME International, which will work together on their existing programs outside of North America. That raised my curiosity about CHIME’s finances. Its recent financial report shows total revenue of $6.5 million, of which $1.7 million came from conferences and sponsorship, $480,000 from dues, and $4 million from grants from what is labeled “Collegehlth Mgmt Exec Foundation,” which I assume is where the vendor checks are collected. There’s also the for-profit CHIME Technologies, which sells speaker services and provides vendors with advisory groups. CEO Russell Branzell earned $437,000 and his two EVPs made $162,000 each.


In Ireland, Cork University Maternity Hospital will go live on Cerner next week, with all 17 of the country’s hospitals expected to be live on Cerner by the end of 2017. Following that is the rollout of a single national EHR for oncology hospitals and another for acute care hospitals if funds are approved. Cerner is also providing national laboratory information system. Ireland prepared for single health record by implementing a universal patient identifier in August.


A new Peer60 report finds that 81 percent of respondents create patient reports using radiology speech recognition vs. the 12 percent that still send off dictation for transcription, with that number jumping to 96 percent of high-volume sites. Nuance was used by 85 percent of respondents, with the small remainder being divided among MModal, Dolbey, and Agfa. Nearly 75 percent of sites that aren’t already using speech recognition plan to do so, with the only holdouts being smaller sites. Net Promoter Scores are fairly high, making the replacement market unattractive.


The Mount Sinai Hospital (NY) goes live on a clinical research VNA from Vital Images that offers researchers a de-identified view of the fully detailed patient data used by clinicians on the same system.


Hardeep Singh, MD, MPH and the Houston VA Patient Safety Center win the VA’s research impact award for their work on delayed diagnoses, delayed test follow-up, and EHR safety.

Government and Politics

HHS Secretary Sylvia Burwell warns that a “repeal and replace” approach to the Affordable Care Act that would require years to offer a replacement program is really a repeal since it will cause collapse of the exchanges as the remaining insurer participants would pull out in 2018 in the uncertainty about what’s next. It would also leave 20 million people without insurance. Burwell is concerned that signups during open enrollment through December 31 may suffer because people are confused that the program is going away on Inauguration Day. Meanwhile, President-Elect Trump’s YouTube video in which he describes his highest priorities did not include repealing Obamacare, which he previously promised would happen the day he took office.



Drug maker Novartis says its Alcon eye care division will miss its goal of performing clinical trials on Google-designed smart contact lenses that can correct far-sightedness and measure blood glucose levels.



The Wall Street Journal profiles the “fentanyl billionaire” whose company, Insys Therapeutics, is charged with bribing doctors to overuse its drug. John Kapoor, PhD, who’s worth around $2 billion, made his first fortune by spending $50,000 to buy a drug company selling an old AIDS drug, after which he quadrupled its price and netted $100 million when he sold the company. He then started Insys, which hired salespeople he called PhDs (poor, hungry, and dumb) who were paid little in base salary but who received a cut of every prescription issued by their doctor-clients, encouraging the reps to push high doses and large quantities. Two Alabama doctors are charged with making $40 million in illicit gains by prescribing $4.9 million worth of the drug for their Medicare patients alone in 2013-2014, also earning $271,000 in “speaking fees” from the drug company and millions more by having the prescriptions filled at a pharmacy they owned. One of the company’s reps, who was hired as a kickback to the doctor who confessed “a certain affection” for her, made $700,000 in two years from just the prescriptions written by the two doctors.


Stat ponders why President-Elect Trump recently met with drug billionaire Patrick Soon-Shiong, who is possibly under consideration to privatize Vice-President Biden’s cancer moonshot (which Soon-Shiong co-opted in forming his own Cancer MoonShot 2020 that mostly involves drug companies). Stat notes that not everyone is a Soon-Shiong fan, quoting a geneticist who summarizes, “A hype merchant propping up a lucrative empire with almost no real substance.” NantHealth shares have dropped 36 percent since their June 2016 IPO, while those of NantKwest are down around 75 percent since the company went public in July 2015.

In England, an NHS trust IT director pleads guilty to accepting a bribe to issue an ED software contract to the company of a local man who has also pled guilty.


ED physician Keith Pochick, MD pens a great, poetic opinion piece titled “Handheld electronic devices are the thieves of our meaningful moments,” describing a conference’s challenge to disconnect attendees from their smartphones:

On the second day, he invited us to turn off our handheld devices and put them into a basket at the front of the room. Most of us were able to do it, although quite a few participants needed to peek at their lifelines during breaks to ensure that the world was still spinning. Each of our respective loved ones knew exactly where we were, and would have had no trouble contacting us, yet the thought of “de-vicing” initially brought an incredible amount of angst. As the final two days of the conference developed, it became more and more liberating for me to be free from the chains of my digital master. While the conference wound down, we were each asked to list a few specific changes we’d make to enrich our lives and break behavior patterns which we believed were holding us back. I obviously couldn’t help but consider how many meaningful moments my constant accessibility and connectedness were stealing from me. I had become a slave to email, text messaging, instant Internet and YouTube access, and Facebook.


Cleveland Clinic CEO Toby Cosgrove disputes the many studies showing that hospital consolidation raises prices via their increased market power, saying instead that hospital mergers will prevent struggling facilities from closing by improving their efficiency. He also says that insurance must remain available for the 20 million people who buy theirs via the exchanges to prevent hospitals from having “major economic problems.”


New York-Presbyterian Hospital gave its former $3 million per year president another $6.4 million in severance when in September 2015 he abruptly resigned after having an extramarital affair.


Upworthy profiles “hippie turned doctor” Larry Brilliant, MD, MPH, who was motivated as one of only 60 attendees at a 1962, six-hour Martin Luther King, Jr. speech to later help cure smallpox, create the Seva eye charity that has restored sight to 4 million people, win a TED prize, and fight global pandemics. Brilliant’s just-released book is titled “Sometimes Brilliant: The Impossible Adventure of a Spiritual Seeker and Visionary Physician Who Helped Conquer the Worst Disease in History.” From his 2013 commencement speech to the Harvard School of Public Health:

As for my generation of young radicals, we had prejudged a mostly conservative profession, assuming they couldn’t be good doctors for being out of touch with the great social upheaval of the time, for not understanding the needs of the marginalized, not seeing the patterns and linkages between disease and poverty, the relationship between social justice and life expectancy, and how the battle then as now was about dignity and human rights. And here is the point as you go forward. Somehow, these two sides of our national health debate—one outward looking at social justice and inclusion and one inward looking inward at high quality patient care that is exclusionary—met then and must meet now on sacred ground, sharing the profound obligation and great joy of improving the health of the people …

Imagine that arc of history that Martin Luther King inspired is right here with us. The arc of the universe needs your help to bend it towards justice. It will not happen on its own. The arc of history will not bend towards justice without you bending it. Public health needs you to insure health for all. Seize that history. Bend that arc. I want you to leap up, to jump up and grab that arc of history with both hands, and yank it down, twist it, and bend it. Bend it towards fairness, bend it towards better health for all, bend it towards justice. That’s your noble calling of public health.

Sponsor Updates

  • Huntzinger Management Group announces a strategic partnership with DCCS Consulting.
  • GetWellNetwork announces that more than 100 hospitals are using its Marbella data collection tool for rounding and collecting patient and staff feedback, with 20 new customers added since July 2016.
  • HCI Group posts a podcast titled “EMR Training: What Goes IN to Achieving High Levels of Adoption.”
  • Sutherland Healthcare Solutions announces its investments in healthcare analytics that include development of its SmartHealthSolutions portfolio, the acquisition by its parent company of big data analytics firm Nuevora, and a partnership with IIA.
  • Optimum Healthcare IT is named a top 10 RCM provider.
  • Baptist Health South Florida realizes $45 million in increased appropriate reimbursement following its implementation of Nuance Clinical Documentation Improvement.

Blog Posts


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More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 11/22/16

November 21, 2016 Headlines 4 Comments

The Bigger Story, and Agenda, Behind GOP Changes to Obamacare, Medicare and Medicaid

Kaiser Family Foundation president and CEO Drew Altman outlines the GOP proposal to repeal and replace ACA and reform the Medicare and Medicaid programs, plans he describes as “the biggest changes in the direction of federal health programs since the passage of Medicaid and Medicare.”

Top Management and Performance Challenges Facing HHS

OIG lists the top ten challenges facing HHS in the coming year, with health IT coming in third on the list.

UAE Ministry of Health and Prevention Renews Relationship with Cerner to Provide Electronic Health Record

The UAE’s Ministry of Health continues its system-wide implementation Cerner with a contract extension that will add anesthesia management and medication barcode scanning to from Cerner.

US government releases official guidelines for smart guns

The Department of Justice releases voluntary guidance for firearms manufacturers outlining the kinds of “smart gun” safety technology it would like to see in pistols. While adopting the recommendations is optional, DOJ reports that the features will be part of the baseline specifications for law enforcement service pistols. 

Curbside Consult with Dr. Jayne 11/21/16

November 21, 2016 Dr. Jayne 5 Comments


One of the challenges of running a business is managing your brand. While branding is associated historically with artisans burning their marks onto products and with ranchers applying brands to livestock, modern brand management can be a tricky thing. While we often associate brand management with consumer goods, an increasing number of healthcare organizations aggressively manage their brand identities.

Where many faith-based organizations traditionally named themselves after saints, the last decade has seen those identities give way to more broadly-appealing concept-based names: Memorial, Dignity, Unity, Mercy, Ascension, and more. Corporate initials have become prefixed to the names of even more facilities, a change that is deliberate and belies a deeper strategy. Health systems have gone beyond the traditional mission and vision statements to create marketing taglines that are specifically designed to evoke a certain feeling about the facility and its services. As “patients” have become “consumers,” we’ve seen more and more health organizations that are looking at market share, competitive intelligence, and brand differentiation.

Hospitals often have aggressive marketing campaigns around their emergency department wait times, the luxury of their labor and delivery suites, the availability of hotel-like accommodations, and more. The competition for market share has long trickled down to individual physician practices, where being affiliated with a given health system can generate more business or greater prestige. Although these may have been loose affiliations in the past, they’re becoming more solid as groups of providers shift into Accountable Care Organizations and other risk-sharing arrangements. Organizations that understand their brand and how they are perceived by the community can make stronger plays in the market than those who can’t.

As I work in physician offices across the country, the differences in brand awareness are striking. Many physicians don’t understand how important having a corporate identity can be, or conversely what a disaster it can be if you don’t have one. Does the staff wear uniforms that match and have a practice logo? If there isn’t a uniform, is there a dress code? Or do staff just wear whatever scrubs are at the top of the clean laundry? It amazes me when practice leadership hasn’t given this any thought. Having a uniform appearance (which doesn’t necessarily mean there must be uniforms) can convey to the patient that their experience is going to be organized and predictable.

Even though my practice has a strict dress code, we sometimes struggle with this. Different team leaders have different levels of tolerance for deviation from the dress code, which can result in consequences when the CEO, COO, or a medical director arrives unannounced. The fact that there are penalties associated with failure to adhere to the standard makes a difference, though, and it quickly becomes clear that if leadership isn’t going to tolerate straying from the dress code, they’re not likely to tolerate deviation from our customer service or patient care standards, either.

I see physicians who struggle with their own idea of a dress code – white coats that are filthy at the cuffs and elbows, rumpled clothes, dirty scrubs, and shoe covers with holes worn through them. They may be brilliant in their field, but they’re missing the fact that their personal brand screams “messy” and “disorganized” rather than “capable” and “professional.” This concept of personal branding becomes even more concerning when it extends to a physician’s social media presence. Where some are skilled at keeping personal and professional personas separated, others offer up a confusing mix of messages that may be concerning to patients or potential patients.

Even those physicians who may do a good job managing their own personal branding and social media presence often struggle with managing how their employees present themselves. Do employees use the practice platform to promote their own interests? Does the practice have any say in how physicians and employees present themselves on platforms such as Doximity and LinkedIn? I’m seeing more organizations that are interested in trying to get a handle on these external platforms, making sure their employees help support the professional perception of the organization. Some may require employees that blog to add a statement that the opinions featured in the blog are not those of the employer. Others don’t seem to notice that their employees have social media profiles. Case in point: the marketing director of a local Catholic healthcare organization was wearing a shirt that said “sex, drugs, and rock & roll” in his LinkedIn picture while prominently featuring his employer’s logo on his profile. I’ve also seen plenty of non-clinical people wearing scrubs in their photos, which always baffles me.

Hospitals and healthcare delivery organizations aren’t the only ones in our world that are spending significant resources managing their brands externally. Many healthcare IT companies are actively managing their brands, even though those that may not admit to having a marketing department. Although some efforts can be counterproductive (remember the Siemens Healthineers debacle?), others have had significant success. HIMSS is the big game of healthcare IT marketing and it’s clear to see who brought their A game to the exhibit hall.

In dealing with many vendors in the course of my consulting work, however, I wish more of them would pay attention to internal branding and ensuring employees other than the marketing team can deliver a consistent message. I work with one vendor that often communications information directly to their client base without communicating the same information to their employees, which as you can imagine results in a lot of misunderstandings, particularly when the communications include release dates or break/fix information. Even though they’re a relative start-up, there’s no excuse for not having a communication plan that allows your internal team to be educated before you start sharing information with your customers.

There’s also no excuse for not having consistent, professional website bios for your senior leadership, but I can’t say I didn’t warn them. When nine of 10 execs have professional headshots and the other has a selfie from his most recent fishing trip, that’s probably not the image you want to convey, unless you are a vendor that runs a fleet of charter fishing boats.

What’s your brand? Email me.

Email Dr. Jayne.

HIStalk Interviews Bill Anderson, CEO, Medhost

November 21, 2016 Interviews 1 Comment

Bill Anderson is chairman and CEO of Medhost of Franklin, TN.


Tell me about yourself and the company.

I have been associated with Medhost for about seven years. I’m currently the chairman and CEO. Prior to that, I was involved in a number of different businesses. Going back to 1990s, I was an early participant in writing home banking software.

The company is in two businesses. We’re in inpatient healthcare IT and consumer engagement solutions, including the website.

You have a fair number of small and rural hospitals as customers. What does their world look like today?

The world is tough in the community hospital market. We divide the hospital world into three buckets. The large tertiary care hospitals that are building communities of care — it’s largely Cerner and Epic territory up there. There are the small standalone facilities that are probably under 50 beds that are CPSI and Athena territory. We compete in the middle market, which is a full-service hospital, but without the complexities of the tertiary care hospital.

They’re not under as much financial stress as the smaller hospitals, although they clearly have more financial stress than the big tertiary care hospitals, which financially are doing much better. Still, there are a number of suburban rural hospitals that are under stress right now with the decline in inpatient volume, the increased fixed costs for regulation, and the insurance risk that they’re having to take on with readmission penalties and things like that.

Does economy of scale favor the huge health systems to the point it will become impossible for small communities to keep their full-service hospitals?

Clearly there are economies of scale. One would like to think that at some point in time, there would be allowances made for that. I’m not sure that’s literally going to happen.

There’s clearly overcapacity in the industry. I think as many as 40 percent of the total hospitals and 30 percent of the beds will probably be taken out of the system ultimately.

When people question that, I go back to the 1980s, when I was in the financial services industry and banking business. There were about 18,000 banks in the United States. Today, there are about 6,000. A lot of the same things were happening. Technology is changing how people use their hospitals, just like they did with banks. I would ask people, "When was the last time you stood in a teller line?" You had increasing regulation, and with the technology, place became less important.

I think there’s going to be a lot of disruption in the hospital market. Still, there are going to have to be geographically convenient locations. In the middle market, there will be winners and losers, but in general, we’ll continue to have a robust community hospital market.

Hospitals provide community pride and large-scale employment to a different degree than banks. Who’s going to figure out the economic answer to having access in communities that can’t support what they already have?

There are two answers to that. There were economic issues and community pride that were involved in the banks that went away also. Economics tend to override those types of things.

One of the reasons we offer our community engagement solution is that hospitals are going to have to build an affinity with consumers outside their normal community. There’s no reason that a hospital can’t build the same type of relationship with a consumer that’s 50 miles away that they did with people in their local town. You just can’t do it by putting billboards up. You have to be able to move into the modern age, do digital marketing, things like that. Not every community is going to have one, but you’re still going to be able to have a sense of community with your community hospital.

Consumers are going to welcome self-service, just like they have in other parts of the economy. For many things where you’ve had to have hands-on visits with a clinician, due to the shortage of clinicians and due to the inconvenience involved, you’re going to see things like telemedicine starting to take a real position in the marketplace. There are going to be alternative delivery channels, not just stand-alone EDs and urgent care centers, but also, the Minute Clinics and those types of things. You’re going to see a diversification of healthcare delivery that’s going to improve the convenience and hopefully the adherence with patients.

One of the things that I thought was interesting recently, because we have a condition management program, is that the federal government has allowed the YMCAs to get reimbursement for things like chronic conditions like diabetes. You can go on the YMCA sites and see that they run diabetes management programs to try to help pre-diabetics. This would probably not have been something that the healthcare delivery system would have been in favor of years ago, but it’s a consumer-friendly type of initiative. Let’s move these types of preventative programs and maybe even some care programs out into other venues so that consumers have better access to them.

The last time we talked, you identified McKesson Paragon and Meditech as your EHR competitors. How has that changed?

If anything, it is firming up. In the large tertiary care hospitals, the battle is probably over. Cerner and Epic largely own that space. It’s based upon the fact that those particular type of big facilities are building communities of care that do complex types of procedures. They offer robust products.

At the smaller end, in particular in the critical access hospitals, they can’t afford a lot. They have to look at total cost of ownership. Somebody could give them a program, but because of the total cost of ownership with training and these types of things, IT requirements, they need a pretty straightforward solution. We’re in between there. We have pretty robust product. We would have what I would call segment-appropriate features and we’re focused on trying to meet the needs of that segment. The battle lines are pretty much in place.

One issue that should be interesting to people in the industry is that we are currently in a lawsuit with Epic. Epic has an interoperability platform called Care Everywhere that is essentially sold with the full suite of Epic products. They’ve got a trademark on it. The trademark, of course, relates to an interoperability product. We have a product called, which is an online health and wellness content site, which the Patent and Trademark Office was getting ready to issue a trademark on. Epic is taking us to federal court to block the PTO from issuing that trademark.

In our opinion, the trademark law doesn’t support that. In our investigation of it, we found some other interesting examples. For example, there’s a primary care physician group in Kentucky called Primary Care Everywhere and Epic is also going after them. There’s a company called Access Technology in Texas that has a product called Powering Care Everywhere that does billing for home health that they went after and Access filed for a declaratory judgment in Texas to keep them from doing that.

This is just another example of Epic’s bad behavior of using their market position to bully people around, or at least in my opinion. What they’re trying to do is to broaden their trademark in the courts as opposed to in the PTO, where they wouldn’t be able to do that. Given that your readership is largely people in the industry, they’re probably reasonably interested in Epic’s continuing bad behavior.

What was your reaction when McKesson announced that it was looking for a buyer for its enterprise business that includes Paragon?

I understand why McKesson did that. The RelayHealth business was a terrific business, and I think the deal they’ve done with Change is, for McKesson shareholders — from somebody who’s not an expert but is looking from the outside — a great deal. What they have left, though, is a collection of assets — it’s not really a company — of which Paragon is one. Paragon has about 198 facilities — not that thought about it very much [laughs] –and on the average, they’re smaller than our facilities. In a world where scale is important, that’s a sub-scaled business.

Probably the most interesting thing to happen lately was that Cerner, Meditech, and Medhost all exhibited at the Insight conference. McKesson, for obvious reasons, withdrew their support. The fact that that actually happened is indicative of where the Paragon product is going.

How are modest-sized health systems addressing population health management and consumerism?

We certainly hope they’re addressing consumerism by working with us, with co-branded sites, marketing services, condition management, and things like that. Population health is a term that means what individuals think it means. There are  two aspects of it. One is managing the population. There are hospitals doing that in the analog way out there in our market today. They’re having things like diabetes clinics and clinics to help people with heart disease and COPD. They’re trying to help people and manage the population in the analog world. We’re trying to give them tools to help do that.

The other side of that is, I’m going to take the insurance risk on these. When you hear about population health products from our competitors or other participants in the industry, what they’re really talking about is, how do I analytically manage populations that I have insurance risk on? How can I identify high risk people? How can I reach out to them? How can I see if they make progress?  In the middle market, that’s less of a need today than it may be in the future.

If I’m a big urban hospital, chances are at some point in time, I’m going to be part of an ACO, or because I’m big in things like hip replacements and I’m getting bundled payments, so there will be more need to be able to manage these types of bundled payments and things because they do more sophisticated systems. The needs for population health depends on what kind of facility you are operating.

Everybody agrees that managing a population requires data from outside the four walls, and lack of that data can be interpreted either as a reasonably evolving market state or an indication that someone is intentionally blocking data. Does data blocking exist?

I do in fact believe that there is data blocking. Some of it is not with bad intent. Some of it is a natural result of the tort law system we have in the United States. Nurse notes and physician notes could be pretty sensitive  in the context of potential litigation. People have legitimate reasons for wanting to manage the information flow.

Having said that, ultimately people are going to have to recognize that this is the patient’s data. The patient is going to get care in a number of different venues. It’s probably not going to be a supportable decision to say, I’m going to block the patient’s access to their information in a convenient way that allows them to pick their venue of care. It may take one of these lawsuits that I’m not particularly fond of to establish that that’s a dangerous thing to do.

For instance, if someone comes into an emergency room and there is information available that is being blocked that would affect the care and something happens to that patient, arguably the person who blocked the information contributed to whatever bad happened. The regulations and the laws support the fact that that’s the patient’s information and this whole Balkanization of data is a bad thing. I don’t think it’s actually been driven home to some of the providers that there is exposure in that.

Can the argument be made that interoperability would create the same universally beneficial outcomes in healthcare as it did in banking?

Yes and no. People are sensitive to banking information, too. Interestingly enough, when I was at H&R Block, I had the first credit card that allowed you to download transactions. There were actually two, the Web card and the CompuServe card. In fact, I have a patent on that, which Block never enforced.

At the time we set that up, people said, "I don’t understand why anybody would want to download transactions. Just geeks would want to do that." The reality was that everybody that ordered through a catalog — nobody was ordering online back then — wanted to know when their stuff was shipped, so they watched their credit card bills. There were economic reasons that the average person wanted to be able to see that transaction.

There are going to be reasons that the average person is going to say, "I have to be able to get access to my medical records." The easiest one is, I go to a new primary care physician or I go to an urgent care center and the first thing I have to do is I have to fill out 20 pages of information about my health history. I should be able to have access to my medical records and my health history so that I don’t have to do that, because I will probably as an individual do not such a great job of that.

There are differences in healthcare, but once the consumer gets involved with managing their own care — which is starting to happen in a big way right now — they’re not going to tolerate this Balkanization of data in healthcare any more than they would have tolerated it in other places.

One of the most bizarre things that you see out there is that a patient may be getting care from the same entity in three or four different places. Let’s say I go to an inpatient facility, I go to a specialist, I go to my primary care physician. They may all work for the same company, but I may have three patient portals. Only in healthcare would you ever see something like that.

Morning Headlines 11/21/16

November 20, 2016 News 1 Comment

Factom, Inc. Receives Grant to Create Secure Medical Records Using its Blockchain Technology

The Bill and Melinda Gates Foundation issues blockchain vendor Factom a grant to build a tool to secure electronic medical records with blockchain technology.

NHS trusts overshoot maximum annual deficit in just six months

Six months into its fiscal year, the NHS has passed its permissible deficit for the year and is on pace to end the year $3 billion over budget.

What Does the Trump Presidency Imply for Healthcare and Healthcare IT?

John Halamka, MD discusses the impact President-elect Trump will likely have on health IT.

Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits

A study investigating the relationship between availability of local retail clinics and ED utilization finds no decrease in the use of emergency services for low-acuity conditions.

Monday Morning Update 11/21/16

November 20, 2016 News 2 Comments

Top News


The Bill & Melinda Gates Foundation awards a grant of unspecified value to blockchain technology vendor Factom to create a secure, transportable medical record using blockchain.

According to the company’s CEO, “Our goal with this new partnership is to demonstrate how global identity and record-keeping as a public utility is possible. We hope to show how individuals can manage important, private records like medical records using very simple tools and a lot of backend cryptography. My belief is that the blockchain will be used more and more over time for these aims. If we all follow these core beliefs, we will get to a very, very good place in this world.”

Reader Comments


From John: “Re: MGMA and HIMSS booth sizes. RSNA’s exhibit hall demonstrates where the real money is made.” RSNA’s exhibit hall floor plan shows that three companies bought space of 20,000+ square feet, or about a half acre: GE Healthcare, Philips, and Siemens Healthineers, with Toshiba and Hitachi not far behind. Providers who order excessive numbers of imaging studies to pay for the machines they bought are also underwriting that kind of excess, as are we taxpayers who are stuck with Medicare and Medicaid bills. In addition, every one of those big-booth vendors are foreign companies, taking the profits from our screwed-up healthcare system back to England, Netherlands, Germany, and Japan. The WHO health system performance ranking of their home countries is not only better than ours (coming in at #18, 17, 25, and 10, respectively, vs. our pitiful #37) but a lot less costly, a fact the starry-eyed RSNA attendees are not likely to appreciate since our ridiculous healthcare costs fund their nice incomes and conference attendance.

HIStalk Announcements and Requests


About 60 percent of poll respondents expect their companies to fare as well or better under a Trump presidency than now. CIO Looking says the ACA cost him his job because his financially stable community hospital was forced to join a larger health system, so he or she at least expects to be employed under a Trump presidency. HITgeek says the real problem is Congress and Trump’s appointments and urges people to take advantage of the Notice of Proposed Rule-Making comment period by adding thoughtful, fact-based responses.

New poll to your right or here: which social media services do you use professionally? “Use” means whatever you want it to mean – maybe you post content on a particular site or maybe you just check it out for business purposes occasionally.

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We provided math manipulatives for Mrs. B’s first grade class in Texas by funding her DonorsChoose grant request. She reports, “With these games, we have been able to further our addition and subtraction skills. My students love playing these games and work very well together while playing them. Kids today need hands-on manipulatives that excite and motivate them to learn.”

Meanwhile, a generous vendor has provided significant matching funds to double the impact of donations (actually it’s more like quadruple in some cases since many DonorsChoose projects already include match offers). You can donate as follow:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

Last Week’s Most Interesting News

  • Cerner CEO Neal Patterson makes a surprise appearance at the company’s user conference, saying that his experience as a cancer patient has inspired him to make EHRs faster and safer and to incorporate more patient involvement.
  • CMS releases an API that gives developers access to information from its Quality Payment Program.
  • A new ONC report makes recommendations on the safe use of EHR pick lists for selecting patients and medications.
  • The Social Security Administration connects its disability system with the VA’s medical records to speed up processing time for the applications of veterans.


December 6 (Tuesday) 1:00 ET. “Get Ready for Blockchain’s Disruption.” Sponsored by PokitDok. Presenter: Theodore Tanner, Jr., co-founder and CTO, PokitDok. EHR-to-EHR data exchange alone can’t support healthcare’s move to value-based care and its increased consumer focus. Blockchain will disrupt the interoperability status quo with its capability to support a seamless healthcare experience by centralizing, securing, and orchestrating disparate information. Attendees of this webinar will be able to confidently describe how blockchain works technically, how it’s being used, and the healthcare opportunities it creates. They will also get a preview of DokChain, the first-ever running implementation of blockchain in healthcare.

December 7 (Wednesday) 1:00 ET. “Charting a Course to Digital Transformation – Start Your Journey with a Map and Compass.” Sponsored by Sutherland Healthcare Solutions. Presenters: Jack Phillips, CEO, International Institute for Analytics; Graham Hughes, MD, CEO, Sutherland Healthcare Solutions. The digital era is disrupting every industry and healthcare is no exception. Emerging technologies will introduce challenges and opportunities to transform operations and raise the bar of consumer experience. Success in this new era requires a new way of thinking, new skills, and new technologies to help your organization embrace digital health. In this webinar, we’ll demonstrate how to measure your organization’s analytics maturity and design a strategy to digital transformation.

Acquisitions, Funding, Business, and Stock


Salus Telehealth chooses a new board of directors following its merger last month with VideoMedicine.



  • Central Washington Hospital (WA) will switch from Cerner to Epic in 2017.
  • St Joseph Memorial Hospital (IL) will switch from Meditech to Epic in mid-2017.
  • Houston Methodist St. Catherine Hospital (TX) will switch from Meditech to Epic in February 2017.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.

Announcements and Implementations


A study finds that extended, continuous cardiac monitoring using the Zio system of IRhythm Technologies performs better than Holter monitoring in detecting arrhythmias. Patients wear the Zio Patch for 14 days, then mail it in for analysis. Shares in the company have jumped 23 percent since their October 20 IPO, valuing it at $644 million.

The University of Toronto profiles its researchers who tested their lab-on-a-chip measles and rubella screening technology at a refugee camp hospital in a remote part of Kenya. They created their system using 3D-printed components and open source hardware. The 15-member digital microfluidics team, which ranges from undergrads through post-docs, wants to create a rugged, solar-powered system that locals can transport on motorcycles and operate themselves.

The American Medical Association adopts principles regarding mHealth applications, acknowledging the need for clinical evidence to help weed out the unsafe ones. The principles are fairly predictable, including AMA’s insistence that apps maintain the physician-patient relationship and that doctors who provide services through the app be licensed in the state where the patient is located.

Government and Politics

John Halamka, MD weighs in on the impact of a Trump presidency on health IT. He predicts:

  • Lowered taxes, simplified regulations, and moving Medicaid closer to individual states could spur innovation.
  • Free market competition could increase.
  • Health insurance exchanges will probably be an early target, but other parts of the ACA will live on.
  • FDA scrutiny and enforcement may be dialed back.
  • Funding for NIH, the Cancer Moonshot, precision medicine, and CMS’s Center for Medicare and Medicaid Innovation may be cut back.
  • The transition to value-based purchasing and the rollout of the Quality Payment Program will continue.


President Obama describes the country’s technology-assisted employment challenges in an excellent post-election New Yorker article and interview:

But at some point, when the problem is not just Uber but driverless Uber, when radiologists are losing their jobs to A.I., then we’re going to have to figure out how do we maintain a cohesive society and a cohesive democracy in which productivity and wealth generation are not automatically linked to how many hours you put in, where the links between production and distribution are broken, in some sense. Because I can sit in my office, do a bunch of stuff, send it out over the Internet, and suddenly I just made a couple of million bucks, and the person who’s looking after my kid while I’m doing that has no leverage to get paid more than ten bucks an hour.

Privacy and Security


  • Live streaming video of patients having sleep studies performed by a California sleep clinic are found to be viewable online due to an improperly secured camera.
  • A financial counselor at Hennepin County Medical Center (MN) is sentenced to probation for keeping cash co-pays and charging the amount to a different patient’s credit card.

Innovation and Research


Yale startup Spring, which offers a 10-minute machine learning-powered online questionnaire that suggests the best antidepressant for a given patient, wins the Harvard-Yale Pitchoff.



Perhaps this headline’s error was a Freudian slip suggesting either hospital body area specialization or mediocrity.

In England, NHS trusts are running over their maximum allowed annual deficit six months into the fiscal year and despite an $1.1 billion emergency government infusion. The CEO of NHS Confederation blames budget cuts, especially in the areas of social care, mental health, and public health. On the positive side, 142 trusts reported a YTD deficit through Q2 vs. 182 in the same period last year and total expense has been reduced by 2.9 percent.


Drug maker Pfizer sues the Texas Health and Human Services Commission for providing Medicaid rebate data to to state lawmakers, saying the agency compromised the company’s trade secrets and will harm the state’s Medicaid program because Pfizer may stop offering the rebates if other large purchasers demand the same prices.

A study finds that nearby retail clinics don’t reduce the number of unnecessary ED visits for “treat and release” conditions such as flu, respiratory infections, and urinary tract infections. The authors note that their numbers may have been skewed by patients who wouldn’t have sought treatment at all until retail clinics came along, the number of patients seen in a retail clinic whose conditions required an ED visit anyway, and the fact that most of those clinics don’t accept Medicaid.

Sponsor Updates

  • Xerox Healthcare features PokitDok in the first episode of its Health Future podcast.
  • Catalyze CEO Travis Good, MD interviews Georgia Tech health informatics professor Mark Braunstein, MD in a podcast titled “Healthcare in the Age of Interoperability.”
  • Voalte publishes a video of a mother describing her firsthand experience with the benefits of the company’s smartphones during her premature delivery.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.


Morning Headlines 11/18/16

November 17, 2016 Headlines No Comments

Neal Patterson’s Remarks from CHC

Cerner CEO Neal Patterson speaks at the Cerner Health Conference, discussing his ongoing cancer treatment and his new perspective of EHRs as a patient.

Theranos Whistleblower Shook the Company—and His Family

The Wall Street Journal’s John Carreyrou tells the story of Tyler Shultz, the inside source that broke the Theranos story to the media and government officials.

Obamacare startup faces losses

Tech-savvy insurance startup Oscar Insurance continues to lose money on public exchanges, its primary business. The startup is now exiting a number of exchange markets in efforts to diversity its revenue stream.

CMS launches new online tool to make Quality Payment Program easier for clinicians

CMS releases an API that will give developers access to Quality Payment Program data.

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Reader Comments

  • HIT Girl: That NYTimes piece on women being given anticoagulants at a lower rate due to implicit bias is incredible. Estrogen is ...
  • Seargant Forbin: RE:PM_From_Haities I think you missed the entire point of what VFJ said. The constitution is an old outdated piece of pa...
  • PM_From_Haities: Re: VFJ - so are you saying you're opposed to the Constitution ? First 3 words of the US Constitution "WE THE PEOPLE". ...
  • HIT Girl: Tim Draper sounds completely delusional, and has no business around any company that has anything to do with patient car...
  • Tango #2: Couldn't agree more with your HIMSS Media Lab sentiment (though I struggle to liken them in any way to the Salvation Arm...

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