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Morning Headlines 1/13/17

January 12, 2017 Headlines 1 Comment

Merger May Revitalize California’s Flagging Effort To Pool Medical Records

The nonprofit HIE California Integrated Data Exchange will merge with Inland Empire Health HIE, creating an exchange with the medical records of 16.7 million people.

Obamacare is one step closer to repeal after Senate advances budget resolution

The Senate approves a budget resolution that begins the process of repealing ACA.

Arizona Plans to Sue Blood-Testing Company Theranos

The Arizona Attorney General is seeking outside legal counsel as it prepares to sue Theranos, alleging that it defrauded consumers in the state.

HealthTap launches Dr. A.I.— Meet your new, personal AI-powered physician

HealthTap launches an artificial intelligence-powered online symptom checker that “helps route users to doctor-recommended insights and care.”

News 1/13/17

January 12, 2017 News 6 Comments

Top News


The California Integrated Data Exchange (Cal INDEX) will merge with the Inland Empire HIE.

Cal INDEX, which has had statewide ambitions since its 2014 founding by Blue Shield and Anthem, has struggled with lack of participation by providers in a competitive environment who may not be willing to give an insurer-operated HIE their data. Its only health system members are Dignity Health and the just-signed St. Joseph Hoag Health.


Former White House and ONC HIE advisor Claudia Williams has been hired as CEO, Cal INDEX’s fourth since 2014.

Reader Comments

From Ray Wrangler: “Re: Merge Healthcare. GM Nancy Koenig is taking a year-long personal leave of absence and will be replaced in interim by Andy Warzecha. A permanent GM is being considered.” Unverified. I’ve asked the company to confirm but haven’t heard back.


From Snowman: “Re: Epic. Various critical access hospitals in Iowa (such as Virginia Gay in Vinton and Myrtue Medical in Harland) are converting to Epic as part of the University of Iowa Hospital and Clinics Epic Community Connect program. This is being run through an entity called University of Iowa Health Ventures.” Thanks. I had mentioned Myrtue’s conversion recently in my Decisions section from Definitive Healthcare.

HIStalk Announcements and Requests

Signups are still open for the 10th and final HIStalkapalooza, so you won’t want to miss Party on the Moon’s figurative closing rendition of “The Last Waltz.” Meanwhile, I need some help with red carpet duties in a key role, so contact Lorre if you’re a quick-witted, outgoing female willing to spend some time participating in the event instead of spectating. I still need event sponsors, too, for companies interested getting enough tickets to create their own sub-party as well as earning significant industry exposure. Signups so far include 90 CEOs and presidents, 14 CIOs, financial industry bigwigs, and more SVP/VPs than you can shake a stick at (like a post-blackout baby boom nine months later, deals will be announced months from now whose consummation began with a House of Blues twinkle in someone’s eye).

We’ll have another CMIO lunch at the HIMSS conference on Tuesday, February 21, starting at noon at Bistro HIMSS (just off the exhibit hall floor). I’ll buy lunch for up to the 20 attendees we’re allowed and you’ll get to eat something nice while sitting comfortably with CMIO peers. Sign up if you’re interested. Everybody seemed to enjoy it last time.


We funded the DonorsChoose grant request of Mrs. I in South Carolina, who asked for a Chromebook for class science research. She says students are using it for virtual labs and study drills and adds, “I have inquiring, smart, and engaging students and I am planning a new project on encouraging students to focus more on STEAM , which I believe is the way to go in order to produce engaging and inquiring minds that will be able to compete in a global community.”


Welcome to new HIStalk Platinum Sponsor Logicworks. The cloud automation and managed services provider offers secure, compliant cloud solutions in helping organizations architect, maintain, and automate custom Amazon Web Services infrastructure with 24x7x365 support, a team of highly qualified engineers, and 100 percent uptime SLAs. They’ll also help extend the data center to the cloud with their hybrid cloud offering, which includes cloud orchestration, 22 years experience in migrating and managing legacy systems to AWS, security management, and maintaining sensitive information in a private cloud to meet HIPAA, PCI, and SOX mandates while taking advantage of AWS’s scalability. Logicworks offers automation software that helps enterprises get to the cloud faster, fueling their next big ideas by allowing developers to spin up servers in seconds. Cybersecurity is implemented and monitored around the clock by best-in-class security experts. The company has completed 400 cloud projects in its 20 years in business, with deep expertise and an average engineer tenure of six years. Clients include 30 state HIEs, the largest health insurance exchange in the country, leading SaaS clinical software providers, global healthcare systems integrators, and healthcare analytics vendors. It just announced a mind-boggling $135 million funding round led by Pamplona Capital. Thanks to Logicworks for supporting HIStalk.

Here’s a Logicworks overview I found on YouTube. They also did an HIStalk webinar called “Cloud Is Not (Always) The Answer” a couple of years ago.

This week on HIStalk Practice: UnitedHealth buys Surgical Care Affiliates in $2.3 billion deal. Teladoc adds lab testing services from Analyte Health. Aledade raises $20 million. HealthTap debuts Dr. A.I. Emmi Solutions CEO Devin Gross shares patient engagement tips for practices facing resource limitations. Northwell Health launches new practice management business. MedEvolve debuts practice analytics. Humana VP of Provider Engagement Caraline Coats explains the ways in which the payer’s quality rewards program is helping physicians transition to value-based care.


January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Acquisitions, Funding, Business, and Stock


The charitable foundation of the late Helen Diller, who with her husband made billions by investing in San Francisco real estate, donates $500 million to UCSF, the largest gift to a university in history. She had previously funded a cancer research building that bears her name.

Arizona’s attorney general opens bids for law firms to sue Theranos for consumer fraud. Just in case CEO Elizabeth Holmes is reading, she’s leading a couple of HISsies categories, should she be available to receive her honors in person in Orlando (note: wear old clothes).



ID Experts hires Brent VanLoo (HealthSparq) as CTO.

Announcements and Implementations

IBM Watson Health and the FDA will study healthcare data exchange using blockchain technology, initially focusing on oncology data. The two-year project will look at sharing owner-mediated data – from EHRs, clinical trials, genomics, and devices – with researchers.


Telemedicine provider HealthTap launches Dr. A.I., an artificial intelligence-powered symptom evaluator that “converses” with users, matches their subjective information against their health profile, and then uses the company’s data repository to offer care recommendations and “patients like me” suggestions.

Press Ganey and Kronos will study a subset of their shared clients to measure the impact of workforce characteristics on nursing quality indicators.

Government and Politics


President-elect Trump nominates VA undersecretary of health David Shulkin, MD for Secretary of Veterans Affairs, who if confirmed would be the first non-veteran to serve in that role. He is also the first Obama administration holdover nominated by the Trump team. Shulkin is best known in HIT-land as having testified to Congress in June 2016 that the VA and DoD will be fully integrated by 2018 in describing the VA’s proposed digital health platform that may or may not include VistA.  


Another ONC staffer will leave as part of the administration transition – Lucia Savage, JD, chief privacy officer. Deputy National Coordinator Jon White will serve as interim national coordinator with the departure of Vindell Washington, MD.


The Senate votes along party lines to repeal the Affordable Care Act, using the same budget reconciliation process that was used to approve it seven years ago (with similarly partisan support). The House will vote quickly on the resolution, which if approved will give congressional committees the green light to craft legislation to dismantle major parts of the program. The Senate’s vote did not preserve protections for pre-existing conditions or the ability for parents to keep their children on their insurance plans through age 26. President-elect Trump said in his Wednesday press conference that he will roll out his replacement plan as soon as his HHS Secretary nominee Tom Price is confirmed. 

Here’s something to keep in mind as Congress guts the ACA: a new study finds that 60 percent of Americans don’t have enough savings to cover an unexpected $500 expense. I’m not sure subsidized health insurance helps much anyway considering that deductibles often top $7,000 before insurance pays a penny for non-routine care.


ONC announces the Phase 2 winners of its Consumer Health Data Aggregator and Provider User Experience challenges that required using FHIR APIs. Winners in the Aggregator category: PatientLink Enterprises (gathering and managing patient data), Green Circle Health (family health dashboard), and 1upHealth (patient data organizer).


Winners in ONC’s Provider category: Herald Health (alert workflow with push notifications), a team from University of Utah, Intermountain, and Duke Health (baby jaundice clinical decision support), and PHRASE Health (clinical decision support).


John Halamka offers advice to the new administration about health IT:

  1. Create a national health identifier, a national directory of provider electronic addresses, and a baseline privacy policy and data sharing consent  that covers all 50 states.
  2. Don’t dictate provider workflows – let them decide how to use technology to keep people healthy and hold them to some element of quality and cost reporting.
  3. Align incentives while avoiding regulatory ONC zeal and use the only three clinician influence factors that work: pay them more, improve their professional life, or spare them public embarrassment.
  4. Share cybersecurity threat and mitigation information across the industry.
  5. Let EHR users drive product direction instead of forcing it via certification.

Privacy and Security


  • Security experts alert a plastic surgeon and spa owner in Canada that his PHI-containing servers (including photos of unclothed women) are open to web searches. The problem was – as is often the case – an open Rsync device.
  • A two-state cosmetic surgery center is hit with ransomware, but apparently restores its systems without paying.


Security firm Tresorit releases ZeroKit, which will offer developers using Apple’s open source framework CareKit with user authentication and end-to-end data encryption.


A newly published book, “Our Bodies, Our Data: How Companies Make Billions Selling Our Medical Records,” says the “hidden trade” in medical information has become a multi-billion dollar business (mostly helping drug companies push their products) without improving outcomes.



Nearly half of Arizona’s doctors haven’t signed up for the state’s doctor-shopper prescription database, use of which will become mandatory in October. Doctors previously shied away in saying that the system is clunky. One PCP who’s been using it for years say she always checks a patient even though it takes 2-3 minutes.

In Washington, a car crashing into a utility pole on New Year’s Eve takes down the county’s 911 system and the local hospital’s connections to Epic for more than a day. Jefferson Healthcare says it will look for a backup plan in hopes of avoiding future interruptions to the services of its broadband provider, whose cables were damaged in the accident. At least it wasn’t the usual backhoe cut that zapped the hospital’s lifeline to the world.


In Italy, a hospital suspends two of its ED doctors and its director after social media photos show doctors treating patients who were lying on the floor. The hospital had run out of stretchers after loaning several to an ambulance service. Hospitals were swamped after extreme weather and a meningitis scare happened during a holiday weekend when many doctors were on vacation. The director said that treating patients on the floor was better than not helping them at all.


Weird News Andy is singing along to “Parentage by the Cell Phone Light.” Doctors at a hospital in China use their cell phone lights to illuminate their delivery of a baby of a woman who had gone into labor in the hospital’s parking lot. WNA wryly concludes, “Of course there are photos.”

Sponsor Updates

  • Rock Health awards Medicity’s Brian Ahier with the Digital Health Evangelist of 2017 award. Snowed in and unable to accept the award in person, Ahier posts his acceptance speech from his blanketed driveway.
  • Iatric Systems will exhibit at the MUSE Executive Institute January 15-17 in Newport Coast, CA.
  • AlleyWatch includes MedCPU in its list of the nine largest health tech startup fundings in New York City in 2016.
  • Meditech releases a new case study, “It’s in Their DNA – Avera Health Drives Precision Medicine at the Point of Care.”
  • Nordic Consulting releases a new podcast, “What the best health IT consultants do at the end of their contracts.”
  • PokitDok CEO Lisa Maki weighs in on the possible repeal and replace of the ACA on Bloomberg News.

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.


EPtalk by Dr. Jayne 1/12/17

January 12, 2017 Dr. Jayne 1 Comment


The American Board of Preventive Medicine announced the retirement William Greaves, MD, who has been its executive director since 2012. Greaves helped guide the Board’s inclusion of the Clinical Informatics subspecialty. Benson Munger, PhD will serve as interim executive director. Munger was deeply involved in the creation of the AMIA Clinical Informatics Board Review Course and the informatics community is enthusiastic about his role as the ABPM begins its search for a permanent executive director.

Speaking of physicians considering retirement, Massachusetts General Hospital has a 100-year-old physician who is still coming into work after 65 years. Dr. Walter Guralnick spends his time teaching residents rather than seeing patients. With a strong belief in equal access for all, Guralnick led the charge for dental insurance and founded what became Delta Dental.


ONC has released the updated Certified Health IT Products List. In addition to the list of products on the “nice” list, there are now two pages for products that are no longer certified and developers who are blocked from certifying health IT products. The “developer ban” page is blank and the “decertified products” page has a lot of 2015 edition software, so it’s hard to know what you’re really looking at.


Lots of reader mail this week.

From Daredevil: “Re: E&M coding. My hospital made an interesting choice to bill facility charges but no professional fees in its busy (hospital-owned) pediatric urgent care. As such, the providers were not burdened with counting elements in their documentation. We could simply document items required for clinical care and/or general risk management. This made it easier to focus on managing the patient, especially during high-volume times. The providers were compensated based on covered hours and procedures performed. The providers were eventually incentivized for throughput and had plenty of opportunities to work extra hours at a reasonable rate, so things seemed generally equitable. I would love to see E&M billing go away. The surgeons have it right with global billing. Their notes — at least in the hospital setting and for post-op visits — while seemingly sparse, stick to the facts. There is no endless scrolling to see what they are thinking.” This flat-fee approach is similar to what many cash practices do and what my urgent care does for self-pay patients. It’s not hugely profitable, but it keeps the lights on and allows the staff to deliver valuable and often much-needed care. It’s an interesting approach and I will be interested to see what some of my local colleagues think.

From End of Shift: “Re: complexity of the patients at the end of a shift. I found more than once that the last patient on a Sunday evening was the most perplexing or complex for the day. The tendency to want to expedite that patient who made it in right before the doors locked was also met was often met with the reality that this patient / family was the one who was home all day debating whether their concerns warranted a visit to the urgent care. I saw more than a few who needed a trip to the emergency department. It doesn’t seem to matter which setting we are practicing medicine in these days, but there seems to be constant pressure to do more in less time. I think we would all be better clinicians with better outcomes if we had the chance to slow things down a bit.” Thinking about patients debating whether their condition is significant enough for a visit certainly puts a different spin on things. We’re also seeing patients holding off on care due to rising copays. Last year, most urgent care copays were at $50 but we’re seeing a lot this year that are $75 and $100, which means their ED copays are probably $150 or $200. The price point alone is going to have an impact in shifting where care is delivered, even if it doesn’t change the nature of the care required.


Illinois healthcare organization Presence Health has been fined $475,000 for lack of timely breach notification. The fine centers around an incident in October 2013 where paper operating room schedules went missing from a surgery center. They didn’t notify OCR until January 2014 and the investigation showed that patients were not notified within 60 days of discovery as required. Over 800 patients were affected, so a media notification would also have been required. Details of the investigation reveal similar notification delays from breaches in 2015 and 2016.

The new year seems to be bringing new jobs for many, at least according to my LinkedIn updates. I’m also seeing people update their profiles, potentially in search of new jobs. Pro tip: disable notifications before you start doing a bunch of updates so you don’t look like you’re getting ready to jump ship. I’m helping a client try to expand their EHR support team so I can offer some other job hunting tips based on the resumes I’m seeing:

  • Be sure you meet the minimum qualifications listed in the job posting or explain what equivalent skills you have that make you an attractive candidate. I’ve had more than 40 people apply for a physician informaticist position who are not physicians. My client might consider a nurse or pharmacist, but these folks had literally no clinical credentials. Similarly, if the posting requires five years experience, you might squeak by if you’ve been in the field for four, but if you have never worked in the field, it’s a better idea not to apply and waste people’s time.
  • Spell check your resume and have someone else review it for flow, consistency, and whether it makes sense. One candidate’s “summary” paragraph took up half a page and was a rambling incoherent explanation of why they appeared to job-hop every 18 months. Another’s was riddled with typos. Some include every job the applicant has had since high school, which just adds clutter.
  • Don’t expect clients to relocate you if the posting doesn’t mention relocation assistance. I have an ambulatory client in a small Midwestern city that is looking for a full-time billing office manager. Several people have applied from across the country. Since they were good candidates, we did phone screens, hoping to hear stories about people looking for jobs because they were relocating to be close to family, move with a spouse, etc. At least two of them asked about relocation packages, which is out of character for a 10-doctor practice. Understand your audience and your potential employer.
  • Make sure your contact information is professional. Your email address might have seemed like a good idea when you were in college, but it’s a terrible idea when you’re trying to be a professional adult.

What’s your best employee recruiting story? Email me.

Email Dr. Jayne.

Morning Headlines 1/12/17

January 11, 2017 Headlines No Comments

A Senate Vote-a-Rama Primer, in Case You Plan to Sleep Tonight

Wednesday night, the Senate will vote on a budget resolution that will begin the process of repealing ACA.

IBM Watson, FDA to explore blockchain for secure patient data exchange

The FDA signs a two-year joint-development agreement with IBM Watson to investigate the use of blockchain technology for securely sharing patient data from EHRs, clinical trials, mobile devices, and other sources.

Health care must ditch its attachment to outdated software

Athenahealth CEO Jonathan Bush publishes an op-ed in STAT encouraging health systems to ditch legacy health IT software, while acknowledging that there will be no government subsidies to help providers buy more software under the Trump presidency.

Trump ‘Just Killed’ Paul Ryan’s Obamacare Repeal-And-Delay Strategy

Despite progress on ACA repeal efforts, President-elect Trump reported during a press conference Wednesday that the repeal and replacement of ACA would happen simultaneously.

HIStalk Interviews Jay Desai, CEO, PatientPing

January 11, 2017 Interviews 2 Comments

Jay Desai, MBA is co-founder and CEO of PatientPing of Boston, MA.


Tell me about yourself and the company.

Prior to starting PatientPing, I worked at Medicare at CMMI, the CMS Innovation Center. There I worked with a team to help implement the ACO program, bundled payments, and a lot of the other new payment models coming out of CMMI. The goal was to preserve the PPO model. No prior authorization, no utilization management, no traditional managed care control, no differential co-pays out of network, no PCP as a gatekeeper. Let patients go wherever they want to go. But risk.

Therefore, we needed to come up with an attribution model that was based on alignment, not necessarily membership enrollment. In that model, when a patient goes somewhere to receive care, you don’t really have too much control over them staying in network or even coordinating the care after they finish their episode, because you don’t know about it.

That created a major pain point for providers in this new model. A very basic problem emerged, which was, "Just tell me where my patients are” in real time — when they go to the hospital, ED, SNF, home health agency, or wherever they go. After scanning around the country and looking at the solutions that were available to providers, it felt like there was an important opportunity to build something that was focused and lightweight that could help providers know in real time where their patients are.

It seems as though it should be easy to send ADT notifications. Why wasn’t that happening already and what allowed you to turn that into a significant business?

A big part of the complexity in building this business is in the need for broad market adoption. Let’s say you’re an IPA. You get your list of patients and you want to know where they’re going. There may be 10 hospitals that represent a majority of them, and then there’s a long tail of other hospitals. On top of that, there’s 300 skilled nursing facilities, 200 home health agencies, 50 FQHCs and community health centers, a bunch of LTACs, and a spattering of other community providers. That’s a big list.

Building connectivity to all of those participants requires not only the technical implementation, but engagement and a reason to do this. You need to engage them not just as data senders or data providers. For any of those sites that’s a referral site for an IPA,  you need to engage them as data providers, but also as participants in the community to engage in the coordination of care with those other endpoints. That’s hard to do because it’s easier to sell a technology to one group and not worry about all the other places that they’re going to be a part of.

Our solution is about that. It’s about building the network, building the community for everybody to engage. Designing something that is light enough and gets broad participation and lift very quickly without being intrusive and with organizations that create constituency groups to do it was part of the challenge. How do you create something that’s elegant that still gets buy-in across the continuum of care, where sometimes there’s competitive dynamics that block information sharing, but still break down some of those barriers for folks to work with one another?

Who pays you, what sharing agreements do providers sign, and do they have to get patient consent?

There’s no cost to send the data. We only charge to receive information, what we call it pings. You pay to receive pings. That’s the real-time notifications.

There’s a lot of other bells and whistles to the service that I’m not describing now, but fundamentally that’s how it works from a business model perspective. It’s lightweight, it’s low cost, and it gets everybody in the community connected as both the sender and a receiver. You can join the community as a sender. You don’t necessarily need to receive, and in that world, it would be free.

For patient consent, we adhere to whatever the state rules are. In Vermont, for instance, we have a blacklist of patients who have opted out of data sharing and we will make sure not to share information on them. What we’re sharing isn’t very rich clinical information — we’re not sending lab results or behavioral health information. We provide the notifications. That could be on patients with behavioral health disease. The fact that they’re at the emergency room is what we would tell them, not necessarily that they’re there with a flare-up of a substance abuse issue or anything like that. The fact that they’re in the emergency room is something that we would be able to notify behavioral health providers about.

My point is that it’s a light level of data sharing. We seek consent in any instance where we have to. We have our own strict policies around how long is one considered a covered entity and how long is one considered a provider so that we’re not sharing data with people who aren’t allowed to see it.

As a provider, what’s my workflow when I get a ping?

There’s a lot of variability to how any given end user is going to act on a notification. They’re further variability in terms of the destination of where the patient is receiving care that will determine how they act on it.

For instance, if I’m an ACO care coordinator and I receive a notification that a patient is in the emergency room, a workflow may be in place to call the emergency room provider and call the patient to make sure that emergency room provider is aware of any case management services that may be available for the patient. Just to engage them in care coordination or case management upon discharge. They may also let the emergency room provider know that there are other supports for them in case they don’t want to admit the patient and want to take them out of the emergency room, to the extent that that’s an option for the patient and the emergency room provider feels like that’s the right thing to do.

If the provider receives a notification of a hospital discharge, they may initiate their medication reconciliation workflows or their transitions of care management workflows to get them in for a follow-up visit with a PCP or a specialist. If they get a notification that a patient is in a skilled nursing facility, they may have a regular rounding schedule or a clock that sets the timeline around when they should reach out to manage the length of stay at the SNF, largely to make sure that they’re supported with home care if that’s what’s required after the rehab period at the SNF. Again, that will be a function of the workflows.

They may want to make sure upon discharge that the patient is getting to the right post-acute care facility that’s part of a preferred network or deemed to be a high-quality provider. Another example is that if you’re a skilled nursing facility, your patient leaves your SNF, and you’re paying to receive the service when the patient bounces back to the ED, you would get notified. You may use the notification to call the emergency room to let the emergency room provider know that the patient is eligible to come right back to the SNF without a three-day hospital stay, for instance. That way, the emergency room provider can send them back into the community as opposed to admitting them to the hospital.

I can go through a long list of how our users are acting on the notifications. Home health agencies may go to the patient’s home on Day One to set up home care. They’ll show up on Day Three and nobody’s there because the patient’s caregiver never told the home care provider that they went back to the hospital. So the home health agency may use it to verify that the patient is still at home and that they can continue to deliver services. Or if they go to the emergency room, they can reach out to the emergency room and let them know that the patient has home care if they want to send them back out into the community.

Is it always providers who are at risk that buy your service or would it ever be an insurance company?

There are case management services that are being offered by insurance companies that want to initiate their workflows when their patients show up at the hospital and the emergency room. They may use their prior authorization processes as a data source, but a lot of times the ER data is not readily available on a real-time basis because the billing clerks for the emergency room will batch bill or do them later, so it won’t be as real time as an ADT message. We have some health plan case management services that are receiving the notifications.

In the example I gave you of a home health agency getting a ping, they’re not at risk, necessarily. They are just providing their home care services. Being able to know the patient’s whereabouts allows the home care provider to deliver a high quality of care.

Other groups that are interested in our services are homeless shelters and social service agencies that are providing case management. This is the big reason that I started this company. At CMS, a lot of our work was to bridge the community providers with the acute care setting. I worked a lot on some of the preventative services as well, around getting social supports — whether it’s housing supports or Meals on Wheels — also included within the care coordination workflows. The emergency room is a vulnerable time for the patient and an opportunity to engage them in their follow-up to make sure that they’re getting the right care.

What did Silicon Valley investors see in the company that made them want to invest $40 million?

I’d love to ask them the same question. [laughs] I’d love for you to ask them that question as well.

We are entirely mission-driven. We are maniacally focused on connecting providers to seamlessly coordinate patient care. Patients get care from a lot of providers — seven providers on average for a Medicare patient — and they’re across a lot of unaffiliated and disparate organizations. That results in a lot of cost, a lot of excess use, and redundant procedures. That’s the value of coordination.The work that needs to happen to prevent some of that redundant work is not complicated. It’s straightforward.

What we’ve done is design a solution that meets the provider community where they are, with a straightforward, low-cost, non-intrusive, easy-to-use solution that connects them in a way that they haven’t experienced in the past. We think that the investor community is excited about us bringing our services and spreading our mission to the rest of the country and we’re thrilled to be able to do that.

Of the syndicate that we formed here, Todd Cozzens of Leerink Transformation Partners is extraordinary. The folks at Andreesen Horowitz – Vijay and Jeff Jordan – are just incredible people. What we’re excited about is the opportunity to bring the best of two very different approaches to building healthcare IT businesses. There’s the Silicon Valley approach of hyper growth and product and network effects, which is a big component of what we do, but we are serving the provider community. We don’t make any allusions about the fact that the workflows are complicated. I’m a healthcare person. I’ve worked in the healthcare industry for over a decade. I’m not a Silicon Valley tech outsider coming into this industry.

I’m very familiar with businesses like the ones that Todd has built and the folks at Leerink have built. There’s a certain discipline to focusing hard on delivering a clear ROI to your provider organization customer, being very sensitive to the regulatory environment, and making sure that we are hyper focused on the integrity of our data and patient consent. Not just not trying to hack our way through an industry that is designed the way that it is for good reason. This is patients that we’re talking about. There’s a good reason for the bureaucracy. There’s a good reason for the slower processes and change cycle.

That said, there is some wisdom from the Valley around a product orientation. A real love for creating outstanding user experiences. I just love learning from the folks in Silicon Valley, specifically Andreesen Horowitz. They’re outstanding.

It is bringing together multiple worlds to create what I think is going to be a better company. There’s aspects of Silicon Valley that healthcare can benefit from, and there’s aspects from healthcare that Silicon Valley needs to learn. I think we’re going to be able to bring both of that into this organization.

How do you see the company evolving, especially if interoperability starts to encroach on what you’re doing?

I hope that we are able to see a lot more progress on interoperability. Whether it’s through CommonWell, Carequality, or some of the other efforts happening with the established networks that may exist out there doing a lot more around clinical interoperability. I would be excited if some of that work accelerated because what that means is that there’s a switchboard or a network pulling together all of these disparate systems. Network alone doesn’t solve the problem. It needs to be network plus workflow, a really important transaction that’s delivered in a way that engages the end user uniquely.

Right now, to the extent we can rent another network, we’re certainly more than happy to do that. We partner with a lot of health information exchanges in markets where they are established and stakeholder organizations that have pulled together the data. We’re very good at taking that information and bringing it to life by getting users to adopt and love and tend to lighten the experience of using our application to solve a very important problem. But in the markets where there isn’t any network that’s the chassis, we will build it, and we have done that in many markets.

Both the network and workflow need to exist for this particular problem that we’re solving to be done well. If interoperability were to make a huge amount of progress, then that would be exciting for us, to be able to help realize the vision of the problems we’re trying to solve in healthcare that interoperability will facilitate.

Do you have any final thoughts?

I think the quote is, "I would have written a shorter book if I had more time." Building an elegant solution that seems simple requires a lot of deep understanding of the constituent organizations within the healthcare ecosystem. We’re proud that after three years, we’ve been able get to this place where what we are doing works.

We’re in six states. We have 44 more to go. We’re going to connect the whole country. We’re excited to go as fast as we can and support provider organizations out there to achieve some of the aims that they have for their organizations around improving care and lowering costs.

Morning Headlines 1/11/17

January 10, 2017 Headlines 7 Comments

Biden, Obama attack lack of meaningful use

Politico quotes Vice-President Biden as saying “you guys in the health care industry are the least sharing people in the world,” going on to say that he’d like to have the Secret Service lock the CEO’s of the major EHR vendors in a room and keep them there until he got answers.

Cleveland Clinic doctor’s anti-vaccine column: Q&A explainer

The VP of Content for, the website that inadvertently ran an anti-vaccine piece by a Cleveland Clinic medical director, says that the Clinic’s communications team was setup as a trusted publisher and uploaded the controversial op-ed on its own without oversight or warning. and  Cleveland Clinic’s ability to publish articles to the site has now been revoked.

Iatric Systems Announces New FlexButtonTM Application to Bring Third-Party Patient Data into the EHR Workflow

Iatric launches FlexButton, an EHR bolt-on solution that pulls relevant patient data from other EHR systems into clinical workflows with the push of a button.

Siri, Am I About to Have a Heart Attack?

In a Wall Street Journal op-ed, hedge fund manager Andy Kessler blames EHR vendors, Epic in particular, for the lack of EHR interoperability in healthcare.

News 1/11/17

January 10, 2017 News 12 Comments

Top News


Politico quotes an obviously frustrated Vice-President Biden as saying healthcare industry players are the least-willing of all to share information, leading him to threaten to lock the CEOs of big EHR vendors in a room until they hear his message. “You think I’m joking. I’m deadly earnest and deadly frustrated as a lot of you are.”

Meanwhile his boss, President Obama, also said in an interview this week that EHRs are his biggest Affordable Care Act disappointment, explaining that healthcare still runs on mountains of paperwork, patients are sent bills they don’t understand, and doctors and nurses are wasting time entering data.

The president slipped in referring to “digitize” as “digitalize,” which means to dose patients with the heart drug digoxin.

Reader Comments

From Tabulator: “Re: the HIStalk Decisions section. It would be helpful to know if any of the product switches are due to an acquisition.” I don’t know that Definitive Healthcare has that information from their hospital user conversations, but I expect they’ll start providing it if so since you mentioned it.

HIStalk Announcements and Requests


You can still sign up for HIStalkapalooza, but not for much longer. Some comments left by folks who want to come:

  • HIStalkapalooza, Still the place to be seen, The home of the stars, Time for drinking and dancing, and schmoozing with czars.
  • At some point, HIStalk will stop taking applications and IBM Watson Health will just predict who should receive an invitation. Until then, hope to see you soon.
  • Glad it’s back in Orlando. In Vegas, half the crowd left before the end, which is a disgrace to the event and the band. Pretty sure I have been last person out of every HIStalkapalooza ever.
  • What a party! The bash was probably responsible for a few HIMSS blisters — from my dancin’ shoes — but they were welcome ones (nicer than the kind developed from trudging around the exhibit hall).
  • I didn’t attend HIMSS last year and the one thing I missed most was HIStalkapalooza.
  • I only get to dance once a year! After Histalkapalooza, I turn into a pumpkin. Yours, Cinderella.

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Mrs. P says her Kentucky kindergartners are putting the tablets we provided in funding her DonorsChoose grant request to good use:

My kindergarten students use them in partner activities and individual activities working on letters, letter sounds, rhyming, reading fluency, counting, number identification, shapes, colors, following directions and basic math like addition and subtraction. With these hands on tools my students are becoming more responsible and independent, which is an incredible skill for students to master at a young age … Many have seen these but never had their own opportunities to use them or truly benefit from them … Some of my students have even come to school wanting to share things they found and learned at home using the apps and games I have told the parents about. Again, I couldn’t be more grateful and appreciative of this incredible gift and the sparks of excitement for learning you have helped create!


Welcome to new HIStalk Platinum Sponsor Harris Healthcare. The 900-employee company’s health IT brands operate individually but are interoperable, including such names as QuadraMed EMPI indexing and cleanup, QCPR EHR, AcuityPlus staffing, Enterprise Scheduling, Enterprise Self-Service (patient access and engagement), ERP, RCM, TeamNotes clinical team documentation, and specialty solutions for the ED and perioperative suite, practice management, public health and health education, and several that are specific to the Canadian market. Analytics and business intelligence are provided at every level and the company offers professional and technical services. Thanks to Harris Healthcare for supporting HIStalk. 

A clarification on Bibb Medical Center’s (AL) August 2016 go-live on Athenahealth as reported earlier this week in the “Decisions” section. While BMC is a previous Prognosis Innovation Healthcare EHR user, they dropped that system some years ago and went back to paper, so technically Athenahealth didn’t replace Prognosis. 


January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock


Telemedicine software vendor SnapMD raises another $3.25 million in its Series A round, increasing its total to $9.15 million.


Clinical surveillance software vendor PeraHealth raises $14 million in funding.


Wireless heart failure monitoring platform vendor Endotronix enters into a $12 million financing agreement. The company has raised $34 million in funding through its July 2016 Series C round. 


Accretive Health renames itself R1 RCM, ditching a memorable name (although stench-ridden due to widely publicized data theft, heavy-handed collections practices, and earnings restatement) in favor of something generic and less Google-friendly.



Duncan Regional Hospital (OK) will upgrade to Meditech’s Web EHR.



Intelligent Medical Objects promotes Eric Rose, MD to VP of terminology management.


CHIME and HIMSS name Children’s Health (TX) SVP/CIO Pam Arora as their John E. Gall, Jr. CIO of the Year.

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CareSync hires Joy Powell, CPA (Healthways) as COO; Mike Hofmeister (Allscripts) as sales SVP; and Allison Guley, JD (All Children’s Hospital) as general counsel. Former COO Amy Gleason, RN has taken a new role as chief of staff.

Announcements and Implementations

Iatric Systems launches FlexButton, which allows users of several EHRs to view relevant patient information stored in other systems as part of their workflow.

Government and Politics

National Coordinator Vindell Washington, MD and FDA Commissioner Rob Califf, MD – both of whom were fairly recently appointed to their government roles and had expressed hope that they would be allowed to stay on – will leave their jobs after failing to convince the Trump administration to retain them.

Privacy and Security


  • Presence Health (IL) will pay a $475,000 HIPAA settlement for taking too long to notify 836 affected patients that it lost paper-based OR schedules in October 2013.
  • Security researchers find another unsecured MongoDB healthcare database, with the sleep disorder records of patients at Womack Army Medical Center (NC) exposed to Internet searches.


HHS OCR notifies Virginia State Senator Siobhan Dunnavant (who is a nurse and a physician) that she violated HIPAA by sending political emails to her patients during her 2015 campaign, then deleted the information from a campaign computer when she realized that she had violated the privacy of her patients. HHS OCR says she won’t be fined or penalized since she tried to mitigate the damage.

A California Department of Insurance investigation concludes that the 2015 breach of insurer Anthem, which exposed the information of 79 million people, was perpetrated by a hacker hired by an unnamed foreign government. The company will pay $260 million for security improvements and remedial action even though the report says its advance preparation was reasonable and its remediation plan were sufficient to allow its fast, effective response. The breach was caused when an Anthem employee opened a phishing email.


Marijuana dispensaries all over the country delay appointments as “seed to sale” tracking software from MJ Freeway – whose use is mandated by several states — is apparently taken offline by hackers. The site of the vendor whose systems are used by 500 dispensaries is still down.


A Wall Street Journal article says Apple is not only failing to produce much innovation these days, it has made itself a follower to Amazon, Google, and Microsoft in the all-important rollout of artificial intelligence despite its own groundbreaking rollout of Siri five years ago. The article warns, “AI-powered voice assistants can directly replace interactions with mobile devices. It isn’t that screens will go away completely, but screens unattached to objects that can listen, talk back, and operate with autonomy will rapidly become obsolete.”


Accenture names its health technology challenge winners:

  • QuiO (smart home injection devices and monitoring)
  • CaptureProof (a medical camera for creating a visual patient narrative)
  • UE Life Sciences (a hand-held breast lesion detection system for health agencies)



The New York Times profiles Nuna, a San Francisco-based, 110-employee startup that has combined the Medicaid databases from the disparate systems of individual states into a single cloud-based platform of de-identified data that researchers can use to explore patient behavior. The company has raised $90 million in funding. Co-founder Jini Kim — a former product manager for the failed Google Health and a participant in the fixing of – calls the company her “love letter to Medicaid” because her autistic brother’s care is paid for by the program. The article notes that nearly half of the children born in the US receive Medicaid benefits.


Video artist ZDoggMD – aka Zubin Damania, MD, founder and CEO of members-only primary care practice Turntable Health – shuts down the so-called Healthcare 3.0 practice following the failure of the Nevada Health Co-Op in 2015 that led to loss of insurance for the practice’s patients. It had also received funding from Zappos CEO Tony Hsieh as part of his downtown Las Vegas revitalization project. Damania says Turntable Health will live on as an “ethos, brand, and movement” without a physical presence, noting that he’ll still be selling company apparel. Its EHR will be used internally by its partner Iora Health.


Twitter suspends the account of pharma bad boy Martin Shkreli after he announces that he has a crush on a Teen Vogue reporter, adding a Photoshopped photo of the woman and her husband in which Shkreli replaced the husband’s head with his own. He said it was innocent fun and that the woman had harassed him previously, then urged her followers to report him to Twitter when he responded. He also invited her to attend the presidential inauguration with him, which she declined by saying that she would rather eat her own organs.


Abington Memorial Hospital (PA) will pay $510,000 to settle a Department of Justice investigation into the theft of 35,000 doses of controlled substances by a now-jailed pharmacist who manipulated the hospital’s electronic drug tracking system. The hospital has also spent $2 million upgrading its drug inventory systems.


Research and Markets apparently foresees a very small RTLS market.

image, the Cleveland Plain Dealer affiliate that ran the firestorm article on vaccine preservatives written by the medical director of Cleveland Clinic’s wellness center, says the Clinic’s corporate communications director electronically published the piece without notifying the site so it could be reviewed, then pulled it down after negative social media reaction, surprising the site’s editor both times. The site has since rescinded the ability of Cleveland Clinic to manage its own content. A reader comment says the Clinic “runs this town and all the media and politicians do as they say” in noting how many former journalists now work for the Clinic and the fact that the site allows some contributors to post content directly. Meanwhile, PCPs are already dreading the amount of time they’ll have to spend explaining vaccines to patients all over again.


A Johns Hopkins bioethicist describes his opioid addiction that followed several post-accident surgeries, saying physicians are inadequately trained on narcotic prescribing (they receive less pain management training than Canadian veterinary students) and helping their patients wean off the drugs. He says pain management specialists see their jobs as prescribing and not following their patients to manage withdrawal, while the fragmented healthcare system makes it unclear who “owns” a patient at any given time. 


A Wall Street Journal opinion piece written by a former hedge fund operator singles out Epic as being primarily responsible for lack of EHR interoperability, calling the company “chief obfuscator.” He notes a friend’s personal experience in trying and failing to have their hospital records sent from Boston to Miami, Epic’s non-participation in CommonWell, his claim that Epic charges four cents per message sent (“even Apple isn’t that greedy,” he says), and his own failure to retrieve his Epic hospital records in any form other than PDF. He concludes, “Make firms like Epic look at interoperability as an incremental profit center rather than an opening for competitors. The dream of smart machines crunching health info is real. Don’t let the dream walk with paper.” Everything seems simple when you don’t understand them to any degree of detail, so my best and gentlest counterpoint would be this – have any Epic hospitals exchanged information with each other or provided electronic information to patients? If so, then it’s not Epic’s problem that his two anecdotal experiences weren’t positive.

A hospital pharmacist’s letter to the editor of P&T magazine makes mistakes in trying to explain interoperability challenges from the pharmacy department’s perspective:

  • It says the main cause of data siloes is that hospital EHRs use non-relational databases. Not true – plenty of systems use relational databases and that underlying technology is not at all a barrier to interoperability regardless. The pharmacy department wants to extract EHR information to create their own pharmacy-specific applications, which is not what most people think of as interoperability. It would be easy but not necessarily technologically sound to query a live EHR database in real time, which is why HL7 interfaces were developed for systems such as automated dispensing cabinets, pharmacy drug tracking systems, and robotic packaging technology. I understand the frustration in not having easy access to live data, but it’s not because of a sinister vendor plot.
  • The author states, “We prefer to stay with our current EMR to avoid going through the pain of a conversion.” I think his hospital (St. Joseph’s in Irvine, CA) runs Meditech, but I’m not certain, and I’m not sure the hospital’s failure to move to a different system (of similar architecture) is based on conversion avoidance.
  • The author talks about Microsoft Amalga, which was spun off and renamed under Caradigm nearly four years ago and no longer has any Microsoft ownership.


Weird News Andy snickers at the story he titles “Hospitals from Mars.” Candy manufacturer Mars is buying publicly VCA – which operates 800 pet hospitals and the Camp Bow Wow doggie day care chain – for $7.7 billion. WNA wonders if acquiring the company, which trades under the symbol WOOF, is a conflict of interest since chocolate is poisonous to dogs. Probably not — I was surprised to learn  that Mars already owns pet brands Banfield Pet Hospital, Eukanuba, Iams, Pedigree, Whiskas, and several others. Banfield is the pet equivalent of a chain of medical practices, employing 4,000 veterinarians (around 9 percent of the total number of US vets who treat pets). Another Mars business offers pet DNA testing. Those of us working in people healthcare can only envy the efficiency, aligned incentives, effectiveness, and patient satisfaction of our animal-treating peers. They are also better EHR users and are better at population health management in a competitive environment.

Sponsor Updates

  • Optimum Healthcare IT posts a white paper titled “Avoiding Common EHR Implementation Mistakes.”
  • PokitDok achieves EHNAC cloud-enabled and outsourced services accreditation for health information exchange.
  • Arcadia Healthcare Solutions hosts its annual users conference in Boston.
  • Besler Consulting releases a new podcast, “A Preview of Healthcare Policy in 2017.”
  • ONS Connect features Carevive Chief Clinical Officer Carrie Stricker, RN.
  • Meditech posts a case study titled “Avera Uses Pharmacogenomics, Meditech EHR to Drive Precision Medicine.”
  • Nashville Medical News include Cumberland Consulting Group CEO Brian Cahill in its list of Nashville healthcare leaders.
  • Dimensional Insight will exhibit at the Muse Executive Institute January 15-17 in Newport Coast, CA.
  • Healthgrades compiles a 2017 industry insider list for hospital marketers.

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 1/10/17

January 9, 2017 Headlines No Comments

St. Jude releases cyber updates for heart devices after US probe

St. Jude Medical, which was recently acquired by Abbott Laboratories for $25 billion, releases a software patch intended to address cybersecurity vulnerabilities discovered in its heart implants. The vulnerabilities were made public several months ago by short-selling firm Muddy Waters and security firm MedSec, and nearly derailed the acquisition.

ICD-10 Section

CMS reports that the 2017 ICD-10 code update will prevent it from processing data reported for certain quality measures during Q4 2016, and as a result says that it will not apply PQRS payment adjustments to those affected.

President Obama talks to Vox about Obamacare’s future

In an interview with Vox, President Obama discusses his disappointment with the pace of digitalizing and sharing medical records, saying “it’s a lot slower than I would have expected; some of it has to do with the fact that it’s decentralized and everyone has different systems. In some cases, you have economic incentives against making the system better; you have service providers — people make money on keeping people’s medical records — so making it easier for everyone to access medical records means that there’s some folks who could lose business. And that’s turned out to be more complicated than I expected.”

Sylvia Burwell Remarks at the National Press Club

In her farewell speech, departing HHS Secretary Sylvia Burwell warns against repealing ACA without having a comprehensive replacement in place.

Curbside Consult with Dr. Jayne 1/9/17

January 9, 2017 Dr. Jayne 2 Comments

I spent most of this weekend seeing patients and generally being crushed by surging influenza cases. Increasing family togetherness led not only to the spread of infection, but to families coming together to the urgent care for testing and treatment. When multiple groups of three or four are arriving at the front desk at the same time, it makes for a high-pressure work environment. Fortunately my staff rose to the challenge and we were able to call in some reinforcements as well.

My EHR has some fairly decent template features as far as being able to set standard defaults for physical exam findings. In reality, many influenza patients appear clinically similar, so this was a great opportunity to put those features to the test. Tired-appearing male/female in mild distress, normal eye exam, clear to yellow nasal discharge, normal oropharynx, normal ears, etc. The lung exam differs from person to person, but my template was generally accurate throughout the surge.

Unfortunately, at the end of my last shift, I had a surge that templates wouldn’t help. Four people came in within 15 minutes of closing time, all needing lacerations repaired. Every one of those patients has a unique story and unique exam, although I skipped a lot of the documentation at the time so that I could get the wounds repaired, the patients home, and my staff off the clock.

That left me this morning with charts left to complete. Although that usually doesn’t happen, it gave me a chance to reflect on how tedious some of the documentation requirements are. E&M coding requirements have been around a long time, much longer than Meaningful Use or MIPS. In looking at an era of increasing requirements and mandates, it leads one to reflect on where we might be in 10 or 20 years, or if we’ll ever get it right.

Having come out of a couple of fairly conservative training programs that were pretty good about teaching physicians how to control costs and use resources efficiently, the need to document certain exam findings and history elements in order to be paid for my services is aggravating. The requirements are higher for new patients vs. established ones. Although the information can be easy to gather (think patient history questionnaire), the requirements are often clinically irrelevant.

My training programs taught me not to order tests that weren’t going to change the management plan and not to order procedures that weren’t necessary, but E&M coding requires me to collect a host of information that may or may not be relevant. That might make sense in a continuity practice, or in the light of a second opinion consultation where every fact might contribute, but it doesn’t make sense when you are an urgent care physician with a two-year-old in front of you who split his head open on the dresser.

Meaningful Use, MIPS, PQRS, and other federal incentive programs involve data collection on steroids. Providers are so afraid of missing something and being penalized that they try to gather all the information on all the patients, much like we have been doing with E&M coding. We’ve been conditioned to this by decades of regulation, and many physicians can’t afford to say no.

In the situation of the child with the cut on his forehead, I need to know what happened, if he got knocked out, if he’s generally healthy, if he’s allergic to any medicines, if he’s ever had a reaction to local anesthetic, and whether he’s up to date on his tetanus immunization. I don’t need to know his complete family history and whether there are smokers in the home, because there is no information that can be provided that would change whether I stitch him up or not. I’m repairing his wound regardless.

Unfortunately, the EHR is configured out of fear, so this information is required to ensure we don’t miss something. Multiply this times the four patients that came in at the end of shift, and the level of tedium increases. Vendors have been so focused on making sure providers can document the federally required fields that they miss the ones we really need.

I have yet to see an EHR with a checkbox for “smell of alcohol on breath” even though that’s something we see fairly often in the ED and urgent care setting. I had to document it at least twice yesterday, one time being with the gentleman who somehow stabbed a chef’s knife into his palm but couldn’t detail how he actually got hurt. I described the wounds in narrative detail, even though a picture would have been a better way to document. But you don’t get credit for having a picture in your note — you have to have discrete data.

It’s only going to get worse as the programs get more complex. Regarding the flexibility in MIPS, providers are stymied by the large number of activities from which they can choose. Flexibility is a blessing and a curse, with many of my clients asking me to just tell them what they should do. They don’t want to look through a list of 90 different potential selections and make choices — they just want to know the path of least resistance to making sure they don’t get penalized. They want to know how they can check the box with a minimum of cost and minimum of staff effort. And of course, a minimum of risk that they’ll miss something or get penalized.

I’ve had several clients ask me about opting out of Medicare entirely. Although that seems like a solution, it may not be for everyone depending on your volume of Medicare patients. Additionally, many commercial payers follow Medicare’s lead for these sorts of things (including the above mentioned E&M coding) so opting out of Medicare doesn’t guarantee you won’t have to do it anyway.

I’ve had several discussions with clients about moving to a cash-only practice, which is becoming increasingly attractive to physicians. Given the increase in high-deductible plans and narrow networks, more patients are incurring out-of-network costs. Seeing a cash physician is more attractive when you’re paying out of your own pocket than when you’re being insulated from the cost of care by insurance.

In the end, I documented all the checkboxes because I do like being employed and don’t want a nastygram from our billers. Being rebellious and not documenting an office visit code isn’t going to be a positive career move, so I did it. I gave in just like physicians across the country have done with the expanding mess of programs.

I did my charts after I went home, like many physicians have started doing since the advent of electronic documentation and remote access. The patients were all seen, I hit a new personal record for cases in a single shift, and I also tied more stitches than I’ve ever done in a single day. But I still can’t help but wonder about a future state where data isn’t a thorn in my side.

Are you surviving influenza season? Email me.

Email Dr. Jayne.

Morning Headlines 1/9/17

January 8, 2017 News No Comments

Repealing the ACA without a Replacement — The Risks to American Health Care

In a NEJM opinion piece, President Obama makes a case against Republican efforts to repeal ACA without coming to an agreement on what its replacement will be.

Cleveland Clinic doc apologizes for anti-vax column, hospital promises discipline

The medical director, and COO of Cleveland Clinic Wellness Institute comes under fire after publishing an op-ed piece on questioning the safety of vaccine preservatives and recommending that parents consider alternative vaccine schedules for their children. The op-ed has since been taken down and Cleveland Clinic has promised disciplinary action.

Patient power through records

The Boston Globe profiles the work of Harvard Medical School professor Warner Slack, MD, who in the mid-60s pioneered the idea of storing medical records on computers and sharing them with patients.

Monday Morning Update 1/9/17

January 8, 2017 News 2 Comments

Top News


President Obama says in a NEJM opinion piece in which he denounces Republican intentions to repeal the Affordable Care Act before offering a solution of their own,

This approach of “repeal first and replace later” is, simply put, irresponsible — and could slowly bleed the healthcare system that all of us depend on. (And, though not my focus here, executive actions could have similar consequential negative effects on our health system.) If a repeal with a delay is enacted, the healthcare system will be standing on the edge of a cliff, resulting in uncertainty and, in some cases, harm beginning immediately. Insurance companies may not want to participate in the Health Insurance Marketplace in 2018 or may significantly increase prices to prepare for changes in the next year or two, partly to try to avoid the blame for any change that is unpopular. Physician practices may stop investing in new approaches to care coordination if Medicare’s Innovation Center is eliminated. Hospitals may have to cut back services and jobs in the short run in anticipation of the surge in uncompensated care that will result from rolling back the Medicaid expansion. Employers may have to reduce raises or delay hiring to plan for faster growth in healthcare costs without the current law’s cost-saving incentives. And people with preexisting conditions may fear losing lifesaving healthcare that may no longer be affordable or accessible. Furthermore, there is no guarantee of getting a second vote to avoid such a cliff, especially on something as difficult as comprehensive healthcare reform.

Reader Comments

From Caraway: “Re: selling software to hospitals. What are the most important factors or strategies?” I’m not a salesperson, but my experience on the other end of the transaction leads me to these conclusions:

  1. Figure out my likely problems without wasting my time probing me to discover them. It’s not my job to tell you what to sell me. Instead, ask what’s in my strategic plan since that’s where the money will be going.
  2. Bring success stories from hospitals like mine.
  3. Tell me tactfully about the weaknesses of competitive products, but don’t slam those companies. Salespeople switch jobs often and it’s embarrassing all around when you show up with a shiny new business card of a company you were trashing six months before.
  4. Figure out who has influence in the hospital. It’s a lot easier to align with an IT director or informatics person who knows the hot buttons and can devote research time, thus earning a recommendation and faster track to the CIO’s office.
  5. Be respectfully persistent without being a pest. The squeaky wheel earns some grease, but only the point that the noise becomes so annoying that it gets replaced.
  6. I might glance at your white papers and other marketing material, but the only thing that will convince me is conversations, preferably with customers.
  7. Don’t expect me to get excited about an offer to be a pilot site for a product under development. Even free systems involve a lot of headaches and the potential for both the vendor and the IT person to take a black eye
  8. Don’t bring a solution that doesn’t address one of my biggest problems or that won’t pay for itself. You are competing with a lot of important projects. Your star fades considerably if a capital investment is required since that’s a long-term, highly competitive budgeting process.
  9. Don’t try to sell around me. Give me the courtesy as an IT person to let me know who you’re talking to so I don’t get blindsided. You can create demand that will end up in my lap, but I still have some degree of technology veto power if you try to box me out.
  10. Don’t be in a hurry. We don’t usually slam-bam in health systems no matter how much your quarterly numbers need a boost.

HIStalk Announcements and Requests


HIStalkapalooza sign-ups are open. Some fun comments added by those requesting tickets:

  • HIStalkapalooza 2016 was my favorite evening event HIMSS last year! Skills I can contribute to the event: willing to sample all the food at the buffet to make sure it is tasty; also will get out on the dance floor with some really mediocre moves to make everyone else feel more confident about their dancing.
  • A frigid sales rep from ‘Sconsin, Longed for a ticket to yon sun. He daily read HIStalk, Its insight he unlocked. That his legacy nev’r be undone.
  • I like to dance; I manage HIT interoperability partnerships with 35 partners. HIStalkapolooza is a righteous ton of fun.
  • I read HIStalk every day and it’s an important part of why I’m effective at my job. Basically, I’m a big fan. Another haiku about HIMSS since you liked it last year: Gray suits and gray hair, Your booth’s fireplace is too much, No one wears color.

To answer questions asked in the requests: (a) Party on the Moon will indeed be on stage again; (b) shoe-related activity will abound; and (c) based on response so far, it appears that, as in the last couple of years, I’ll be able to invite everyone who requests a ticket (but if I don’t, providers come first).

Note: the overly large photo above serves as an eye-catcher – every year, people (usually executives or their assistants bristling with self-importance) waste my time in claiming they religiously study every single HIStalk word I write, yet somehow missed the many, many times I mentioned that signups are open and thus didn’t request the ticket they absolutely must have. I’ll just send them a screenshot of the announcements like this. The party is for readers and I feel no obligation to someone who clearly isn’t one. Your life (and certainly mine) won’t be irreparably damaged if you have to find something else to do Monday evening because you weren’t paying attention.


Three-fourths of poll respondents say doctors should be held accountable for patient satisfaction results. A couple of folks question why it’s just physicians and not the front office and billing people who are on the hook, while others think it’s OK to measure and report patient satisfaction but not OK to tie the results to compensation. Others note that patients are subject to the usual maddening human variability (see: Yelp reviews) and will ding the doc because their hospital meals were under-salted or they were told to lose weight. Meltoots gives examples of risking satisfaction survey retribution by doing the right thing – making patients get out of bed and refusing their demand for narcotics, no different for scoring a teacher highly because they never give homework.

New poll to your right or here: When did you last earn a significant promotion or leave for a better job? Some explanation would be nice – click the Comments link after voting.


Welcome to new HIStalk Gold Sponsor Sphere3, a Gartner Cool Vendor that offers the Aperum patient experience management platform. It integrates patient perception with nurse call system activity to provide insight into patient satisfaction, caregiver workload management, and patient safety. Nursing administration gains visibility into patient needs, workload, and the voice of the customer. Aperum’s Hot List identifies patients whose behaviors increase their fall risk, while the nursing department enjoys reduced call lights and response times. Clients have reported an 18 percent increase in patient experience domain scores, a 24 percent reduction in call light activity, and a 10 percent increase in HCAHPS response to call light. Check out  their white paper “Reinventing Nurse Call to Enable the Real-Time Health System.” The Kansas City, KS-based company will exhibit in the Startup Area at HIMSS17, where you can meet CEO Kourtney Govro. Thanks to Sphere3 for supporting HIStalk.

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Mrs. M reports that students in her New York media classroom are using the headphones we provided in funding her DonorsChoose grant request for online learning and test-taking.

I was annoyed but unsurprised this week when I needed to send my doctor an insurance form and they said it had to be faxed – they don’t have the ability to accept a scanned document attached to an email. The person’s tone suggested that they are the innovators and I’m the Luddite for not having a fax machine at my eIbow. I pictured them tending their time capsule technology dressed in No Fear shirts, singing along with Right Said Fred, and stroking their Beanie Babies.

Listening: new from The Dogs, an apparently nearly unknown Norway-based punk rock band whose raw, angry sound is reminiscent of the Pixies but with more sonically rich musical hooks, a fantastically growly organ, novella-like lyrics, and a killer stage presence. This is the antidote to lip-synching, fading divas and tedious, Auto-Tuned hip-hopper collaborations. If you don’t see puddles of sweat in front of the singer, you didn’t get your money’s worth. The Dogs earns my highest recommendation and would be amazing headlining my future low-rent version of HIStalkapalooza in a vacant lot with kegs and barbeque. I’m binge listening their whole catalog on Spotify and it’s exhilarating. Judging from their albums and concert video, this has to be one of the best bands in the world.

Last Week’s Most Interesting News

  • The Advisory Board Company announces layoffs and office closures following a post-election slowing of customer activity.
  • CTG says it will counter the slide in post-Meaningful Use EHR work by focusing on optimization and application services.
  • A Black Book consumer survey finds a rapidly growing “digital divide” in which patients don’t trust providers to protect their data, don’t know how to use technology such as patient portals, and withhold information from their doctors due to privacy concerns.
  • Security researchers report a spate of cases in which improperly secured MongoDB analytics databases are being hijacked by hackers who are holding the information for ransom.
  • Senate Republications introduce an aggressive timeline for dismantling the Affordable Care Act without proposing an alternative.


January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock


Tax, advisory, and business consulting firm WeiserMazars renames itself Mazars USA.


Coding and compliance services vendor Aviacode acquires facility coding outsourced services vendor Revant Solutions.


Genetic information company Invitae acquires AltaVoice, which hosts Patient Insights Networks that connect researchers with patients, for $15 million.


Detroit Lions defensive back Glover Quinn invests in PeerWell, whose app supports physical therapy rehab patients with exercise programs and the ability to perform their own range-of-motion measurements at home. The company has raised $2.1 million in a single November 2016 investment.


Prime Healthcare chooses Phynd to gather, manage, and share data on its 75,000 providers across 43 hospitals.


  • Myrtue Medical Center (IA) will switch from Medhost to Epic in October 2017.
  • Heart Hospital Of Lafayette (LA) will move from Cerner to Epic in September 2017.
  • Bibb Medical Center (AL) migrated from Prognosis to Athenahealth in August 2016 and will go live on its ambulatory EHR in 2017.
  • Nash General (NC) will replace Cerner with Epic in 2018

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


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Huron Consulting Group promotes John Kelly to EVP/CFO and names EVP/COO Mark Hussey as interim healthcare practice leader. Hussey replaces Gordon Mountford, who has left the company. HURN shares are down 17 percent in the past year, valuing the company at $958 million. 


Healthgrades hires Eric Jensen (Avia) as EVP of health systems products and strategy.

Announcements and Implementations

ZH Healthcare (never heard of them) launches a “new unified brand” of blue EHR , unleashing a torrent of buzzwords: “enhance the power of world-leading malleable and customizable EHR … The brand stands for stability, strength and trust that clients place in our solution. The color blue speaks to infinite capabilities.” Kudos to whatever marketing firm profitably convinced the company that they ‘re adding value in cooking up this gibberish, although slipping in “malleable” was pretty cool assuming it doesn’t refer to frustrated users beating their PCs with a hammer.



Eric Topol, MD is unhappy with the way reporters hype a tiny decline in cancer deaths over nearly 60 years in hyping a 25 percent decrease since 1991.


A rant by the medical director/COO of the Cleveland Clinic Wellness Institute highlights the awkward situation that can result when a traditional, respected medical institution launches a trendy alternative / integrative medicine operation whose beliefs are not only different, but sometimes scientifically sketchy. Daniel Neides, MD says he is “tired of all the nonsense” as government and businesses force us “to live in a toxic soup.” He should have stopped in that weird but safe ground, but then launched into a Jenny McCarthy-like tirade against the preservatives in vaccines, confidently opining that ADHD is a thing not because it has been defined as a disorder and parents encourage overdiagnosis, but because “something(s) are over-burdening our ability to detoxify.” He doesn’t suggest refusing vaccinations, at least, only recommending that parents talk to their doctor about timing of the injections for their children. A predictable firestorm ensued, with Cleveland Clinic issuing a terse statement that Neides won’t be doing interviews and that his opinion piece doesn’t reflect its position.


The Boston Globe profiles Warner Slack, MD, a medical school professor who developed a patient computer questionnaire in Wisconsin in the mid-1960s. One of his students was Epic CEO Judy Faulkner. The article debates whether interoperability will ever be prevalent, quoting Slack as saying he’s disappointed that EHRs aren’t providing more benefits to patients.

Sponsor Updates

  • Validic CEO Drew Schiller presents at CES 2017.
  • ZeOmega releases a white paper, “The Value of an Advanced Predictive Analytics Approach in Population Health Management.”

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 1/6/17

January 5, 2017 Headlines 1 Comment

The Advisory Board Company Aligns Health Care Capabilities to Enhance Efficiency and Drive Future Growth

The Advisory Board Company announces “workforce restructuring and office closures” within its healthcare business that will culminate with layoffs for 220 employees and four offices being closed.

Castlight Health Announces Strategic Acquisition of Jiff

Castlight Health announces it will acquire competing health benefits platform vendor Jiff. Castlight Health stock dropped 13 percent after the announcement.

Athenahealth plans big tech jobs expansion at Ponce City Market

Athenahealth announces that it will grow its Atlanta-based campus to about 1,000 workers by 2018.

Form 8-K: Computer Task Group Inc.

In a letter to shareholders, CTG’s Board of Directors explains that it is working to reduce overhead costs while shifting its focus from EHR implementation services to optimization and performance improvement services, application management services, and service desk staffing.

News 1/6/17

January 5, 2017 News 3 Comments

Top News



The Advisory Board Company will restructure its healthcare business, laying off 220 employees and closing four offices. It will exit its businesses of care management workflow, nursing workforce and infection control analytics, and two niche consulting practices.

The company blames its November-December sales slowdown on the election, as health system customers paused to contemplate potential changes under the Trump administration.

ABCO shares didn’t react much on the news, but are down 26 percent in the past year, valuing the company at  $1.4 billion.

Specific products – such as Crimson platform or ABCO’s Clinovations consulting group – were not specifically mentioned. The company says the businesses they’re shedding generated $18 million in 2016 revenue vs. $14.5 million of expense, so they should interest potential acquirers if that’s the company’s plan.

Reader Comments


From Puffer: “Re: your Mr. H avatar. Get rid of the pipe.” Every year since I started writing HIStalk in 2003, a few folks who feel blessed with extra-special insight note (often with smugness) that a site about healthcare shouldn’t feature a smoking doctor (like I somehow didn’t notice the irony until a newbie clued me in). I specifically had the avatar designed with a pipe – right down to describing how I wanted the wafts of smoke to appear – as my version of a pirate’s Jolly Roger warning that this is not the usual health IT pablum written by corporate cheap-seaters. You would be surprised to see how many dignified executives have someone take their picture embracing my happily smoking doc standee at the HIMSS conference. 

From Stud IT Director: “Re: promotion. I’m 42 years old and have been IT director for nine years, seven under the CIO who was brought in not long after I was promoted. How do I know if I should stay or seek greener pastures?” My thoughts:

  • You already failed to be promoted when your boss was hired, so you may be permanently branded as mid-level management material better suited for a corner in the IT cube farm instead of Mahogany Row. Some places just don’t like promoting internal candidates for C-level jobs.
  • Are you the favored child among your peers? If not, forget it and move on.
  • Have you been given any indication that you’re next in line, or for that matter, that the CIO isn’t going to hang around for another 10 years as your window closes? Not many first-time CIOs are in their 50s.
  • Are you sure you’re qualified to be a CIO? If it hasn’t happened by 42, maybe it’s not in the cards or you’re being wasted in the wrong place. It’s common for IT directors to think they can do everything their CIO boss can do, but they miss the point that the most-valued skills aren’t the obvious ones. It’s not technology, but the ability to earn the trust and respect of peers, being able to take the big-picture view beyond bits and bytes, and leading a team). It’s more than checking boxes for education, experience, and results. Maybe your boss is an incompetent doofus,but if he or she is still holding the position, someone important must not think so and maybe you are missing something.
  • Are you willing to bet a lot on your abilities? If so, connect with a recruiter and groom yourself to be hired as a CIO, probably in a struggling hospital or godforsaken part of the country that’s less attractive to better-pedigreed candidates.

HIStalk Announcements and Requests

HIStalkapalooza sign-ups are open. About 400 people have put their names in the “I want to come” hopper so far, many of whom provided a fun bonus in entering witty comments on their forms.

I’ve received around 150 responses to my annual reader survey, the results of which drive most of my agenda for the year. Weigh in here, which will also enter you in the running for a $50 Amazon gift card. I’ll deal with the creative tension cause by the usual polarizing results, such as the “I love rumors” vs. “I hate rumors” responses. I like that a couple of readers say that reading HIStalk is their guilty pleasure, although the “guilty” part means I won’t gain many readers via word of mouth.

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Mrs. S from Virginia says her second grade class is using the Osmo math and language apps we provided in funding her DonorsChoose grant request to learn in small groups and to compete as teams, with some students who were behind in math using the tool to catch up.

This week on HIStalk Practice: Private practice MDs in Massachusetts react to new HIE integration law. Duane Reade clinic closures point to market saturation. Kareo’s Lea Chatham explains the ways in which physician independence trumps hospital employment. EarlySense adds American Well consults to its consumer-facing remote-monitoring platform. Trade groups sound off on potential ACA repeal/reform. Carena’s Ralph Derrickson makes telemedicine predictions for 2017. Athenahealth shakes off its layoff doldrums. MDGuidelines’ Joe Guerriero sees steady sailing for the future of value-based care. CompuGroup Medical adds genomic decision-support tools to its EHRs. Drchrono’s Michael Nusimow outlines the ways in which MACRA will impact physician compliance in 2017.


January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Charlotte Brien, MBA, solutions consultant, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

Acquisitions, Funding, Business, and Stock

McKesson and Change Healthcare announce that the new health IT company they’re creating will be called Change Healthcare, so decided after “a thorough strategic and creative review process.” 


Health benefits platform vendor Castlight Health will acquire competitor Jiff. Castlight President/COO John Doyle will become CEO of the new company, Jiff CEO Derek Newell will become president, and Castlight CEO Giovanni Colella will leave the executive suite but remain in the boardroom as executive chair. Jiff is a much smaller company with just $7 million in annual revenue vs. Castlight’s $102 million. Castlight shares dropped sharply on the announcement. They doubled on the company’s IPO day in March 2014,  but have dropped 89 percent since, valuing the company at $443 million.


Health data aggregation and analytics technology vendor Arcadia Healthcare Solutions receives a $30 million growth capital investment from Merck Global Health Innovation Fund, GE Ventures, and existing investors. I asked CEO Sean Carroll when I interviewed him in late 2015 where he wanted the company to be in five years:

We’re very dedicated to the notion that clinical data in particular — for the next five years and perhaps beyond — aggregated from electronic health record, is fundamental to an effective data strategy. A data strategy is fundamental to being successful in value-based care. We’re focused on that.  We certainly understand the necessity to deliver on the full outcome, but our focus will remain on solving this important and fundamental challenge that organizations have, which is, "I’ve made huge investments in my electronic health record strategy. I need the information out of all of them. I need it timely. I need to be able to then process it right it away in much broader ways, including looking at the full population that I serve. That’s the only way that I will be effective in executing in any sort of risk model."


A letter to shareholders from CTG says that the company’s mandate-fueled EHR work has slacked off, so it will move its focus to high-margin work in optimization, performance improvement, application management, and service desk and will focus its staffing offering on higher-margin work.


Athenahealth will double its Atlanta-based workforce to nearly 1,000 by next year in the Ponce City Market. Athenahealth was the first office tenant of the former Sears, Robuck and Co. regional headquarters that then served as City Hall East for 20 years. I’m fascinated by the list of tenants in the Central Food Hall.


Vancouver Island Health Authority selects Vocera’s smartphone solution for secure text messaging, voice communications, and alerts.

The Department of Defense chooses Vocera for wireless hospital communication in a $14 million contract, the company’s largest ever.


Medical Center Health System (TX) engages QuadraMed’s Professional MPI Clean-up Services in preparation for its Cerner go-live in the spring.


Piedmont Healthcare (GA) chooses patient-provider matching solutions from Kyruus.


Melissa Memorial Hospital (CO) chooses Athenahealth, presumably for ambulatory although the local paper’s recap doesn’t actually say. The chatty story says Cerner was the losing bidder and that annual costs for Athena will be $221,000.

J. D. McCarty Center (OK) chooses CPSI’s Evident EHR.



AHIMA installs Ann Chenoweth, MBA (3M Health Information Systems) as president and chair of its 2017 board.


Dave Miller, MHSA (HCCIO Consulting) joins Access Community Health Network (IL) as CIO.


Kelley House (Jackson & Coker) joins Culbert Healthcare Solutions regional sales VP.

Announcements and Implementations

Ingenious Med releases a value-priced edition of its system for organizations whose primary need involves charge capture.


CompuGroup Medical US will integrate real-time genomic decision support tools from ActX into its EHR.

Privacy and Security


  • A single hacker has hijacked 3,500 unsecured MongoDB databases and is demanding around $200 to release them, one of them apparently belonging to Emory Healthcare.
  • changes its publicly shared folders after a security researcher finds that information contained in them is visible in Internet searches.
  • Creative ransomware authors add new features: (a) one variety decrypts the files of an infected user who passes the ransomware on to friends; (b) the Jigsaw malware deletes files every hour until the ransom is paid; and (c) Koovola restores encrypted files if the victim agrees to stop downloading unsafe files and reads two suggested ransomware articles.
  • New Hampshire’s health commissioner apologizes not only for breach that exposed the information of 15,000 people, but for upsetting relatives of deceased individuals who received breach notification letters addressed to them. I’m not sure there’s a good answer to this unless it’s possible to reliably cross-reference to Social Security death records. Or, do family members have a right to know anyway?



An interesting article in The Economist ponders whether artificial intelligence can “crack biology” and thus help treat or cure disease. A snip:

Pharmaceutical companies are finding it increasingly difficult to make headway in their search for novel products. The conventional approach is to screen large numbers of molecules for signs of pertinent biological effect, and then winnow away the dross in a series of more and more expensive tests and trials, in the hope of coming up with a golden nugget at the end. This way of doing things is, however, declining in productivity and rising in cost … The trouble is that too much new information is being produced to be turned quickly into understanding … This is where AI comes in. Not only can it “ingest” everything from papers to molecular structures to genomic sequences to images, it can also learn, make connections and form hypotheses. It can, in weeks, elucidate salient links and offer new ideas that would take lifetimes of human endeavor to come up with. It can also weigh up the evidence for its hypotheses in an even-handed manner. In this it is unlike human beings, who become unreasonably attached to their own theories and pursue them doggedly.

The health-related products honored with the CES conference’s Innovation Award are:


Aipoly Vision — tells blind people what their phone camera is pointed at.


EyeQue – home vision testing from which eyeglasses can be ordered.


K’Track G – real-time blood glucose monitoring using a skin sensor-powered, wrist-worn device.


ReSound ENZ02 – a hearing aid whose attributes can be changed from an iPhone.


This article seems to be shocked and appalled that a drug company’s “senior management pressured employees to convince customers to order its key medicine in order to meet financial targets.” Isn’t that what senior management and salespeople are supposed to do? The fact that it’s healthcare is, from a business standpoint, irrelevant. It is surprising to me that people expect profit-driven businesses (drug companies, physician practices, medical device vendors, insurers, supposedly non-profit hospitals, etc.) to voluntarily behave differently only because their particular widget involves sick people. People do what they’re paid to do and our healthcare system richly rewards profit-maximizing behavior.


Here are some interesting thoughts by Pamela Wible, MD.


I’m thinking of the healthcare possibilities of the wearable passenger medallion that Carnival Cruise Line is rolling out. The quarter-sized, credit card-linked sensor – carried in a pocket or worn like jewelry – provides touch-free credit for buying high-margin onboard products, opens cabin doors on approach, is tied into the new high-tech casino system. identifies passengers to iPad-carrying waiters and other staff who can then then address them by name, and allows users to tailor their on-board experience to their interests. Carnival will install 7,000 sensors per ship that allow apparently allow it to track passenger movements. It would be pretty cool if a sensor loaded with healthcare and preference information were used to reduce the depersonalization that occurs in healthcare settings. 


The Houston paper notes that Ron DePinho, MD, president of “financially ailing” MD Anderson Cancer Center, has been awarded a $208,000 bonus for the year, boosting his total 2016 compensation to $2 million even as the medical center lost $110 million in the last quarter alone. Commendably, he’s donating his bonus back to the institution. One element of his performance review was implementation of Epic, which MDACC says has hurt its short-term bottom line. This is our health system conundrum – executives take a PR beating if their hospital (a) loses a lot of money, or (b) makes a lot of money, with whatever else the institution accomplishes playing secondary importance (maybe because they pay CEOs so much). Meanwhile. MDACC announces that it will lay off up to 900 employees immediately in trying to stop its bleeding.

Sponsor Updates

  • Philips Wellcentive ranks highest in flexibility of meeting customer needs in KLAS’s population health management report.
  • PatientKeeper releases a new video, “Why Billers & Coders Love PatientKeeper Charge Capture.”
  • KLAS rates Health Catalyst the highest among early “preliminary data” population health companies in its new population health management report.

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.


EPtalk by Dr. Jayne 1/5/17

January 5, 2017 Dr. Jayne No Comments

Going back to work in 2017 was more difficult than I expected since I’ve been either completely off or working a drastically reduced schedule for more than two weeks. It’s been a good break, spending time with friends, de-cluttering in preparation for the new year, and of course seeing patients.

Cold and flu season has hit with a vengeance, and several of our offices had to call in additional providers to handle the surge. We’re in a good position to deal with situations like that because we have a large number of part-time providers who are willing to work an extra few hours here and there to help move patients through more quickly. We had patients calling from the waiting rooms of other urgent care and hospital facilities asking what our wait time was, which was a new experience for some of our reception staff. Hopefully what’s going around will start waning, because it’s hitting people hard and making them pretty miserable.

Consulting has been busy, with quite a few potential clients calling for Meaningful Use attestation assistance. I’m glad they’re reaching out early in the cycle instead of waiting for the last minute. About half of the people I’ve talked to have their materials largely in order, but the rest of them are trending more towards the train wreck category. If you’re not even sure how to run your quality reports, and haven’t been running them throughout the year, you need a little more than just some attestation help.

For those folks, I’m requiring them to engage for 2017 in a comprehensive way along with the engagement for 2016. We’re happy to help, but I’m not going to enable next year’s fire drill. It may cost me some business, but I’ve reached the point where I’m happy to make less money rather than being part of someone’s disaster.

The rest of the healthcare IT world seems slow, which is typical for this time of year. Vendors are holding their major releases and announcements until closer to HIMSS, which is sad because then they are lost in the hustle and shuffle along with everyone else’s supposedly big news.

I received an email from HIMSS regarding corporate focus groups, which I’ve participated in from time to time. One of the items in the email struck me (and not just because it was in bold font and highlighted in yellow). They’re limiting attendance at each focus group to the first 12 people who show up, even if they’ve invited more than 12 people. I get the fact that they want to manage around no-shows, but it just seems strange. Maybe it will pit potential attendees against each other gladiator style as they wrestle for the last chair left in the room. We can only hope for such entertainment.

I’ve been to some focus groups that have been lackluster, but last year attended one where the presentation team was imploding. Apparently one of their key participants had resigned before HIMSS and was pulled from the trip, without management acknowledging that there was no one else who knew anything about the topic or who was prepared to run a focus group. How do I know this? Because the remaining presenters aired their laundry in front of the group, expressing their frustration as they apologized for the fragmented content. It was painful to watch, and I felt for the survivors, but it would have been more humane to just cancel.

I’m also starting to make preparations for my annual booth crawl traditions with some of my BFFs that I only see once a year. I’m heading to Orlando a day early for some preparatory downtime with a friend who lives on the coast, which will make for a much more relaxed start to HIMSS than last time it was in Orlando. I was delusional enough to run the Disney Princess half-marathon on the opening day of HIMSS, which is a choice I wouldn’t make again. It’s exhausting enough without starting out tired, so I think this year’s plan is much more solid.

A few people have asked what I’m going to be looking at in the exhibit hall and the answer is I’m not sure. What I am sure of though is that there will be plenty of buzzwords such as population health, with everyone using it differently. My favorite part of HIMSS is visiting with the smaller vendors, who often have some real innovation. I’ve got a couple of EHRs that I’ve been following over the years, and I’ll check in with their websites from time to time to see if they’re still around or where they’re focusing.

I was sad to see that one of them recently dropped its multi-specialty focus, but was pleased to learn that they’re focusing on the behavioral health space where good platforms are definitely needed. There are challenges with group visits, enhanced confidentiality, and data sharing that some larger vendors don’t do a great job with. I noticed also that they’re no longer certified, which I’m sure factored in to the change.

There are a couple of changes to the HIMSS agenda. A designated exhibit floor social hour on Monday promotes sampling drinks while touring the exhibit floor. I’m not sure how that’s really different from the booths that historically sponsor happy hours, other than they’re probably paying more for conference-level promotion rather than doing it themselves.

Another special exhibit area is the Population Care Management Knowledge Center, which proposes to help attendees “discover the answers you need to design and implement a successful care coordination and care management programs for your unique populations.” Although most of the session offerings do center around population health, there are some others included that make me wonder if they didn’t have anywhere else to put them: “Helping Patients Find NCI-Supported Cancer Trials” and “Building Consumer Loyalty.” I also noticed one offering that may not be new but I certainly haven’t noticed it before, and that’s registration being offered at the airport. Since I’m staying off the main convention drag, I’m hoping to take advantage.

What are you looking forward to at HIMSS? Email me.

Email Dr. Jayne.

Morning Headlines 1/5/17

January 4, 2017 Headlines 1 Comment

Learning From CBO’s History Of Incorrect ObamaCare Projections

Forbes revisits the Congressional Budget Offices’ faulty cost and enrollment estimates as Congress moves forward with the process of repealing the law, which will likely require new estimates from the CBO.

2016 Year End Funding Report: A reality check for digital health

Digital health VC firm Rock Health publishes its year-end report on health IT investment activities, noting that the year ended down on total dollars invested, but number of deals continued to climb.

Greek prosecutor raids Novartis Athens offices in bribery probe

Novartis offices in Athens are raided after government authorities were tipped of by media reports that the company has been paying bribes to local providers to increase their prescription rates.

Cleveland Clinic inks five-year agreement with IBM

IBM signs a five-year contract to provide IT design, support, and security expertise for Cleveland Clinic.

CIO Unplugged 1/4/17

January 4, 2017 Ed Marx 5 Comments

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Presentations Gone Bad

As I look at my leaders’ (and my own) developmental needs, the ability to speak and persuade is an area ripe for improvement. I am leading our organizational internal version of Toastmasters (we call it Bagelmasters) and was thinking of some of my worst moments. Why do we fear presentations more than death? These real-world examples from the last couple of years explain why.

Glitter (2016)

Our new CEO had just started. My team members were experts at ensuring that our monthly governance meeting was effective and conducted without a hitch. The pressure was higher this time, given the change of command and the CEO’s first exposure to our operations.

Before heading to the meeting, I placed a small wrapped Christmas gift from my staff into my man bag. I did not notice the gift’s decorative ribbon, which was generously adorned with glitter. I sat to the right of the CEO and pulled out my laptop.

A minute before the meeting began, staff discreetly asked what was on my face. My deputy came to me and tried to wipe the glitter off of my cheeks and forehead. My oily skin did not want to give up its treasure. With no time left, everyone took their seats and it was show time. The meeting went well, but I had never been so self-conscious.

When the meeting ended, the CMO pulled me aside and said, “Marx, I appreciate your style, but the glitter is over the top.”

Frozen (2015)

One of my pet peeves is being late, so I am careful to set the example when it comes to timeliness. If there is a quorum, I will start meetings no matter who is missing.

When I was late to the IT Steering Committee meeting that I co-chair, I walked in as discreetly as possible. Even though it was obvious I was late, I tried to maintain a low profile and pretended to be invisible. As I sat next to the chairperson, I softly pulled out my laptop and slouched in my seat.

I quickly realized that the room was completely silent, not even a sneeze. I slowly looked up and the entire room was frozen (think mannequin). I started to break into a sweat until they all broke form and started laughing. They turned my propensity for doing practical jokes on unsuspecting victims and punked me big time. My face turned red and we all had long-needed belly laughs. I love our culture, which allows leaders to feel comfortable playing jokes on one another. And I was never late again.

Touched (2013)

When you serve with the same people who take care of you physically, awkward situations are unavoidable. Our top 20 or so executives gathered in preparation of a special board meeting. As I surveyed the room, I counted the number of clinicians around the table, hoping we had a healthy balance of clinicians and administration.

On a level deeper, I began to realize that not only did I have business relationships with all the doctors, but physical ones as well.There was my triathlon teammate doc who spontaneously had me drop my drawers in his office when I expressed concern that my Ironman might be in jeopardy because of a hernia. Turned out to be a groin muscle pull. My primary doc was there – and trust me, he has seen and felt me in places nobody else has. Also in the room was my mountain climbing partner / expedition physician who once prescribed me Viagra when I suffered from high altitude pulmonary edema.

When it was my turn to speak, I could not hit my groove because I kept envisioning scenes from the past. I completely lost my focus. I finally confessed this to my colleagues, who laughed with me, then allowed me to regain my composure so I could finish my talk.

Elevator (2012)

The Joint Commission was in town and I was up after the morning break to describe our organization’s IT journey. It was the opening session for their week-long survey and behind our six evaluators sat our entire officer cohort. Per tradition, I went to grab my pre-speech Frappuccino from the lobby Starbucks 15 stories down. Plenty of time.

With my venti cup of deliciousness in hand, I went back to the elevators. Only one elevator was working. I nervously looked at my watch to evaluate the risk of waiting versus taking the stairs. Down to five minutes, I relented and chose the stairs. I walked in winded as our CEO reconvened the large group. I became self-conscious, as I had broken into a sweat. Then my breathing increased and I became nervous.

I sensed I was losing my audience and lost my normal cadence, so I finally stopped and confessed. TJC was merciful. I took a few deep breaths as people laughed and felt my pain.

Napkins (2008)

I was rehearsing my presentation for my very first board meeting. I got out of the shower and grabbed the box of gauze I had been using to cover and protect my newly minted Ironman tattoo on my right calf. The wound was still fresh and required lotion and covering to keep the red ink and blood from staining my clothes. The box was empty.

I was desperate and certainly did not want to have my tattoo ruin my suit nor risk infection. I frantically searched the bathroom for large Band-Aids or anything that would work. Desperate, I grabbed the only material visible: my wife’s sanitary napkins. I cut one down the middle and splayed it open. In the garage, I found duct tape and strapped my makeshift bandage around my calf. I put on my suit and I was good.

Every time I even considered getting nervous speaking that day, I reminded myself that I had a feminine napkin wrapped around my calf with duct tape. I had to smile the entire speech. When I removed the napkin later that evening, I had a perfectly imprinted Ironman logo on the napkin itself. My wife and I had a good laugh. I have never been short of gauze since that day.

Panel (2010)

I don’t do panels any more. Here is why. I was asked to speak on a panel of a university where I sat on the advisory board. The dean asked for each of the panelists to introduce themselves and share 2-3 key areas of focus for the year. We were allotted five minutes each with the expectation we would then go into traditional panel / audience Q&A mode.

Two of us finished on time and the third panelist pulled out a PowerPoint. After 10 minutes, I began to alternate looks between my watch, the presenter, and the dean. Fifteen minutes later I started a sidebar with the other panelist. After 20 minutes I literally stood up and discreetly walked off the stage and sat in the audience. Finally, at 30 minutes, I left the venue.

I had a couple of less-dramatic but equally frustrating panel experiences, but this event convinced me I should no longer participate in panels. The key to successful panels is a skilled moderator.

Translation (2014)

I was invited to speak to the leadership of all the government-operated hospitals in China. It was an amazing cultural experience I will never forget. I started my presentation, which was simultaneously translated into several Chinese dialects via headsets. My host was forward-thinking, and under each of my PowerPoint bullet points, he had the direct Mandarin translation.

About halfway through, I realized he had inadvertently removed all the English bullets and I was only left with the Mandarin. Since I had pictures or graphs on each slide, I was able to remember the concepts and winged my way through. However, they never invited me back. Now my presentations are almost exclusively pictures. They paint a thousand words in every language.

I am certain I will have more presentations gone bad in the future. While they happen, they are no fun, but in hindsight, I am reminded never to take myself too seriously and to just laugh. If there is one area for any leader to focus on, it is presentations. I have a long way to go.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Morning Headlines 1/4/17

January 3, 2017 Headlines No Comments

Healthcare’s Digital Divide Widens, Black Book Consumer Survey

Black Book releases results from a national poll of 12,000 consumers designed to measure patient adoption of consumer-facing healthcare technology.

Senate Initiates Steps to Repeal Health-Care Law

On its first day back in session, the Republican-controlled Senate introduces legislation that will begin the ACA repeal process, using a budget reconciliation tactic that requires only a simple majority vote to pass.

The Health Data Conundrum

In a New York Times op-ed piece,  Eric Topol, MD and Kathryn Haun, JD argue that medical records should not be stored in large centralized databases that make easy and attractive targets for cybercriminals, suggesting instead that patients and caregivers should own and store their own records in a decentralized storage model.

Japanese white-collar workers are already being replaced by artificial intelligence

In Japan, 34 health insurance claims workers are being replaced with “IBM Watson Explorer” which will scan hospital records to calculate insurance payouts.

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