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HIStalk Interviews William Winkenwerder, MD, Chairman, Winkenwerder Strategies

January 11, 2016 Interviews 2 Comments

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William Winkenwerder, MD, MBA is chairman and founder of Winkenwerder Strategies. He was formerly president and CEO of Highmark, Inc.; assistant secretary of defense for health affairs for the United States Department of Defense; and has held leadership positions with Blue Cross Blue Shield of Massachusetts, Emory University, Prudential Healthcare, Kaiser Permanente, and the Department of Health and Human Services. He serves on the boards of health IT vendors CitiusTech, Cureatr, and Accreon.

Tell me about yourself and what you do.

I am the chairman and founder of Winkenwerder Strategies. We’re a healthcare advisory and consulting firm. I focus my efforts currently — and our firm does — on innovative healthcare companies. In that vein, I work with a number of leading private equity firms who are investing in healthcare companies, serve on the boards of these portfolio companies, and invest in these companies. In addition to that, I have a group of advisory clients in the healthcare industry.

Prior to this, I served as the CEO of Highmark Health, one of the largest health insurers in the United States. I also served as assistant secretary of defense for health affairs with responsibility for all the healthcare for the US military and the Tricare program. My background prior to that was about 20 years in the healthcare industry working in the managed care sector, both on the health plan side and the provider side.

I’m an internist by background and training, board certified. I also have a business degree from the Wharton School.

What are the biggest challenges and opportunities in healthcare IT?

There are tremendous opportunities today in the area of health information technology. Healthcare continues to pose tremendous challenges for corporate budgets, personal budgets, and our federal budget, not to mention state budgets.

We continue to spend more money each year. We thought for three of four years that the healthcare cost growth might have been tamed, but it appears that it’s taking off again this year. We are spending now over $3 trillion a year on healthcare in the United States, representing about 17-18 percent of our entire economy. What is a really amazing fact is that over the next 10 years, we will spend many trillions of dollars on healthcare, and within 10 years, we’ll be spending over $5 trillion in a single year.

There are tremendous challenges with all of that cost growth to provide healthcare and pay for healthcare in more efficient ways. I firmly believe that health information technology as an enabler of better business solutions and better care processes is critical to that task.

Where do you think we’re spending too much and getting too little return in terms of overall population health?

We’re spending too much inside of institutions, principally in hospitals. The hospital sector is the most single expensive sector of the entire healthcare economy. More recently, we’ve been concerned about pharmaceuticals, especially because of price increases these last two or three years, but pharmaceuticals just represent 10 or 11 percent of the entire healthcare dollar. We’re spending a lot of money in the area of long-term care in caring for people with chronic conditions.

It’s difficult to put your finger on a single sector or single area within the entire healthcare economy that is responsible for most of the problem. It really cuts across all the sectors.

We can do things so much more efficiently. But in order to accomplish that task, there have to be the right financial incentives in place and the right information, not just for clinicians and administrators in the healthcare system, but also the right information for consumers to choose and make decisions about their healthcare in order to create more of an economy for healthcare services.

Until just the past few years, there has not been, in many areas, sufficient information for people to make decisions. There has not been sufficient engagement by consumers. That’s beginning to change. People are beginning to take healthcare decisions more into their own hands, principally because they are now experiencing some of the costs directly themselves through the changes in the benefit designs, which have more high deductibles and more co-insurance and cost sharing.

The individual and the family have a vested interest in getting value for their dollars. Even though that creates some pain right now, it’s a good thing in the sense that it’s going to force more economical provision of care.

You just called out the elephant in the room. Are people realizing that their despite non-profit status and source of community pride, hospitals are looking out for their own interests as they integrate to command more market power?

There are lots of shared and conflicting interests when it comes to the local community hospital or even the regional hospital system of today. The problem is that in many markets — in fact, probably most at this point — there is just one hospital system,  two, or potentially as many as three. This leaves in place a situation where there’s not sufficient competition. This is especially the case when the hospitals and doctors have come together in a community and really are just one force.

It reduces the number of choices that people have. Frankly, I think it creates a situation where there’s not sufficient room for innovation and change in the way that care can be provided. Being a physician, I think some of the most innovative models of care are through physicians driving change. I hope that, in the future, we’ve got physician-driven systems that are able to compete on equal footing with big hospital-based systems.

You worked in the Pittsburgh market, which was a bellwether for what was about to happen everywhere as providers became insurers, insurers became providers, and competition got ugly. You had UPMC as a national and even international brand. Will that also become common, where we’ll see the emergence of regional or national provider brands?

I do see the emergence of regional and national provider brands. To be clear, I don’t believe that this is all bad by any stretch. There are many great organizations that provide great care and that have developed a great brand because of their quality, their service, and their capability.

The problem comes when that entity acquires many of the resources, the assets for care within a given geographic region. Because healthcare is local, that creates a situation where there’s not choice, because people typically can’t drive hundreds of miles to receive services. It’s not like you can get your healthcare on Amazon or get the service delivered through UPS. You have to go to a local institution, a local doctor and so forth.

It’s important that regardless of who owns the assets, the rule book allows healthy competition to take place. In the absence of that, the only vehicle for control, if you will, of pricing is the government. The government typically has not been reluctant to step in to set prices or influence pricing where they can. I would expect that there will be a push to do that in other ways in other ways, pharmaceuticals, for example.

What has been the impact of the Affordable Care Act and what will it be going forward?

The Affordable Care Act has got, at best, a mixed set of results associated with it. On the positive side, we have more Americans who are insured, principally through the expansion of Medicaid, and to some extent, through the creation and operation of exchanges in most states.

The total number of additionally insured people, I think now is in the range of 16 to 18 million. Much of that is through Medicaid. I think the breakdown on that is like 10 to 12 million through Medicaid and six or seven million through exchanges. The target for the Affordable Care Act was in the range of 32 to 35 million. It’s fallen far short of the target. 

At the same time, it’s introduced a lot of requirements and burdens on employers that have not made a lot of employers happy. It’s also created a bureaucratic regulatory infrastructure that I worry introduces unnecessary costs as well as a potential for limiting innovation.

On the positive side, in addition to the newly covered lives, you do have some benefits from the introduction of products on these exchanges that take advantage of things like narrow networks or higher-deductible benefit plans that do, in fact, save costs. These, ironically, are the same things that many people complain about, but they are — from an insurance perspective — the best way to limit the cost to the individual. There’s really a Catch-22 going on with some of these developments.

Certainly this is a highly political issue. It’s been that for six years now, since 2010, and it’s going to be a factor in the 2016 elections. We’ll see where all of that goes. My expectation is that there will be a continuance of certain elements of the Affordable Care Act regardless of who becomes president, but there could be a lot of change to the Affordable Care Act depending upon who gets elected.

The middle class is being hit hardest financially with higher premiums, deductibles, and co-insurance because lower-income families receive federal insurance subsidies and high-income families can afford the higher costs. One ED visit could bankrupt the average family even with insurance. What do you think the average voter wants to happen?

You have to read lots of different polls and you get different answers. People seem to want, in my reading of all of this, coverage to be available that’s affordable, on the one hand. On the other hand, they like to have choice and they would like protection against some of these high costs of healthcare.

It’s really a double bind. There’s no way to provide a really highly affordable coverage plan, for example, in a market where there’s consolidation of providers and not much insurance competition. The cost of care is just going to be expensive.

My hope is that we set the conditions and the incentives into place such that cost of care can be driven down, not just held at bay or made to grow at a slower rate of increase. There’s evidence that care can be delivered at a lower cost than it is today, many times using good technology solutions and putting information into the hands of individuals and providers.

People talk a lot about patient engagement and consumer involvement.  Do consumers have more influence as customers and are providers recognizing that they must operate differently as a result?

I do believe that consumes are more engaged, have more influence on their care, and want more influence on their care. They are able to get their hands, if they’re reasonably educated and interested, on information about their particular condition. That’s available on the Internet. That’s available through information sources that people can easily access. People are driving decisions at a consumer level today in ways that just weren’t happening a decade ago.

People think insurance companies are the bad guys, but what are their challenges in trying to create and manage a risk pool?

This is where CitiusTech comes into the conversation. CitiusTech is a highly innovative health information technology company solely focused on healthcare and working across all sectors, providers, health plans, life sciences, pharmaceutical, and also working even with other technology companies.

What’s needed, as you try to develop new kinds of risk- and performance-based arrangements between the payers, between the health plans and the providers, and even the pharmaceutical companies, you need really good information. You need large databases. You need to be able to integrate the data. Ideally, you’re using the capabilities of the cloud. You’re delivering great information.

That’s what I found so attractive about CitiusTech that caused me to want to work with them. We started out our relationship about a year ago in an advisory capacity and then I was asked to join their board about six months ago. They’re a great example of a new kind of company that’s totally focused on healthcare and as deep knowledge of not just the bits and the bytes of the technology, but of clinical issues, clinical information, and clinical operations. When you take that and marry it to the financial side, the health plan world, you begin to create some tremendous capabilities and the kind of capabilities that people need today.

What kind of health IT companies would get you excited about either advising them or investing in them?

CitiusTech would be one for sure. I love what they do. I’m excited with what they’re doing. I think their focus is great. It’s not just the technology, it’s the services and solutions and great talented people. That’s one example.

Another great company that I’ve had a relationship with in the past, serving as a board director, is Athenahealth. Again, a cloud-based company that is on the leading edge of change in how they do things.

There are some newer companies that are focused in specific areas. Say, for example, companies like Vitalz and ZocDoc that are focused on things like the consumer and consumer choice. They’re companies that are focused on even things like personalized genetic information. That’s going to come into the lexicon and come into people’s consciousness in terms of things they want to know about themselves that may be predictive of their future healthcare issues and needs.

There are just a lot of great companies out there. Cerner is a great company, in my opinion. They just recently won the contract to create the next-generation electronic healthcare record system for the military, partnering, by the way, with Accenture and Leidos. I served as an advisor to them in their effort to win that contract, which they did.

There’s a long list. There’s just a lot of very interesting and exciting companies out there today. Obviously, if you go to HIMSS, you’ll get to see all of them and more. It’s an interesting time.

You led the Department of Defense in building their EHR that’s now being replaced. What was your reaction to its decision and the never-ending pressure on the DoD and VA to integrate their systems?

It needed to. The system that was implemented in 2003-2004 — that’s 12-13 years ago — was an earlier-generation system. It worked, but it was really clunky. It was not sufficiently meeting the needs of the Military Health System on a global basis.

It was a big step forward at the time. It was, at the time, the largest global electronic health record system in the world. People there can be proud of what was accomplished then, but rightly in my opinion, there was a focus on creating a next-generation system utilizing the resources of a world class consulting firm like Accenture along with Cerner and along with Leidos, which was formerly SAIC and had a lot of legacy relationships and had done legacy work for the Military Health System, and so knew and understood a lot of the ground-level issues. When you put those three entities together, I think you’ve got the best-of-breed total solution.

If you were king of healthcare for a day, what would you do to fix it?

Boy. It would take more than a day [laughs]. That’s my first response.

I think of the healthcare challenge in the United States on multiple levels. One is at a political level. The politics of healthcare have to be addressed and navigated. One is at a government level. We have existing government programs in place. They need reform, including Medicare and Medicaid. Then we have a private sector system that is connected to, partly governed by, and heavily influenced by government. They are moving parts and they’re connected. Any solution or set of solutions needs to take all of that into consideration.

At the end of the day, I think that what most needs to happen is policy change at the federal government level to set the Medicare and Medicaid programs on a course of financial sustainability. They’re not sustainable right now. There are policy changes that need to be undertaken, things like extending the age of eligibility to get into Medicare, other changes with Medicare and Medicaid, etc. I won’t go into all of them, but there are important policy changes that need to happen within those federal programs.

On the private side, we have to work to create a competitive system, as I’ve alluded to earlier, where there is competition between and among providers and providers and insurers. A system in which individuals can be engaged financially themselves, but at the same time, it’s a system that people of low income and little means have support and protection. When healthcare is costing $10,000 a year per person, or for a family, $18,000 or $20,000, somebody who makes $30,000 a year literally is not going to be able to afford healthcare. We need a support system for those individuals. We just must be very careful that we don’t create something that is not sustainable. Right now, we’re on a non-sustainable track.

The politics need to take ideas from both parties and it needs to be clear-eyed in its movement forward. One of the biggest faults of the Affordable Care Act is that it did not have a single vote from one member of a party that represents half of the people. It actually had votes against it from within the Democratic party. That’s not a good thing. When you want to make big changes, you really need some level of bipartisanship. I hope, as we look at 2016 and beyond, that there will be more of that mindset applied to try to solve those problems.

I’m ever the optimist. I like to believe that America is an innovative place and we want to do right by everybody, but we need to continue to develop solutions that can provide high-quality care to most or all of the people and do that at a reasonably affordable price. That’s the goal. I believe that health information technology is central to that objective.

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January 11, 2016 Interviews 2 Comments

Monday Morning Update 1/11/16

January 10, 2016 News 4 Comments

Top News

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The Office for Civil Rights declares that it won’t tolerate providers who refuse to give patients copies of their medical records, publishing clarifications of what providers must do, with these examples:

  • Covered entities must provide designated record sets to patients or their designee.
  • They can verify the requester’s identity however they like as long as the verification process doesn’t delay the delivery of the information.
  • They cannot require patients to physically visit their premises or mail a paper form to submit their request.
  • They must offer records delivery by email if requested.
  • They cannot withhold records copies just because the patient hasn’t paid for their services.
  • They must provide requested electronic copies of paper documentation if they have a scanner.
  • They cannot tell patients that, “We have a patient portal, so log in and print your own information.”
  • The patient has a right to obtain all information about them, not just EHR data. That includes images, billing and payment records, claims data, and any information the provider used to make decisions about their care.
  • They must provide electronic copies of information they store electronically if the patient requests electronic instead of paper. They cannot insist that the patient accept paper copies instead.
  • Fees charged must be “cost-based,” which includes the labor required to make paper or electronic copies, supplies, and postage. The fee cannot include the cost of retrieving and verifying the information. This is a big deal since providers impose absurd per-page charges – often through their third party release of information vendor – even when providing information in electronic form. OCR is clear that federal law overrides state law in this case, so extra fees are not allowed even if state law says they are.

The question is what OCR does now that it has clarified the rules. Patients most likely don’t know how to file complaints despite widespread lack of provider compliance with these guidelines.

From my own experience in having filed an OCR complaint six months ago about a hospital that refused to give me an electronic copy of my electronic records resulting in no response, I doubt they are geared up to take fast action even when patients are knowledgeable enough to contact them.


Reader Comments

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From Little Buddy: “Re: President Obama. This quote sounds like someone very much out of the loop who happens to have the solution to healthcare woes with Obamacare.” The President said, “I don’t have a Fitbit yet, but I work out hard. Word is these Apple Watches might be a good companion for my workouts. So I’m gonna see, I’m gonna test it out.” I actually think it’s kind of cool that he’s not afraid to drop some pop culture references and that he takes care of himself with technology help. Speaking of the Watch, I got stuck behind an older lady in the airport security line the other day who was confused about which items to place on the scanner belt, oversharing with the TSA agent, “I have an iWatch.” People apparently don’t even know the name of their expensive, short shelf life gadget, which is not called the iWatch because smart companies had already trademarked the name before Apple.

From Apollo Creed: “Re: health IT companies. Which ones do you like?” I don’t think my opinion is relevant, or if it is, it’s not available. It’s best that prospective investors and employees perform their own due diligence, especially since I’m not an investor or employee of any of them.

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From DC VA Insider: “Re: VA CTO Marina Martin. Will be leaving soon.” Unverified.

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From Rowdy Roddy: “Re: Leidos. I heard a Leidos ad on a Madison classic rock station. They are looking for Epic and Cerner help. Is the world that short of Cerner expertise that they have to find Epic folks, which themselves are in short supply?” I can’t imagine that many Epic youth spend their commute gramps-moshing to “Sweet Emotion” and “Sultans of Swing” in between Leidos commercials. There’s a business opportunity for you: launch an Internet radio station just for Epic or Cerner employees – including company gossip, the cafeteria menu, and customer news interspersed with Justin Bieber and Adele songs — and sell ads to consulting firms that want to poach them.

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From The PACS Designer: “Re: iPhone 7. With Apple reducing the price of iPhone 6 Plus S by 30 percent, soon there had to be a reason. Now,we know why. The iPhone 7 leaks have started and sales will drop as everyone waits for the new model.” The cell phone and services market are changing quickly as competition heats up (thanks, Google, for creating Android). The major carriers are getting better and cheaper as they worry about upstarts and companies selling unlocked phones that use their networks at a discounted rate. A new Consumer Reports survey found that the worst-rated carriers for value are Verizon, AT&T, and Sprint, as smaller providers like Consumer Cellular and Ting top the customer satisfaction scale.


Reader Gripes

  • “Epic’s #6 list of principles says they don’t do deals, yet it’s hard to imagine Mayo wasn’t swayed by Epic’s $46 million offer to buy its data center.”
  • “When I am alone with a patient, one on one, in an exam room and try to show caring and compassion, as I have always done over these many years as a clinician, it gets harder knowing that everyone and everything around this patient is treating them like the latest gold rush or oil boom. Their insurance company, hospitals and their administrators, pharmacies, medication manufacturers, many of my colleagues with their over-testing, etc. I do the best I can. I still think medicine is a noble profession and am proud that both my children wish to become doctors.”
  • “It bothers me that you’ve created yet another forum to complain, like the comments section wasn’t enough. No one comes to HIStalk to hear people crap on companies or news, much less co-workers. I would rather see a Great Box, stories of awesome stuff people are doing in this industry. We don’t hear enough about the outcomes of our work.”
  • “CommonWell members Cerner and McKesson, who claim to be in favor of interoperability, won’t allow us to interface to their systems even if we match the spec of one of their existing interfaces. Even though they interface to our competitors. Even though their own clients request it. Hypocrisy is alive and well.”
  • “People that are more interested in building their fiefdoms than great companies.”

You can sound off about your gripe or you can even say something positive if you’d rather.


HIStalk Announcements and Requests

Thanks to the CIOs who volunteered to raise DonorsChoose funds by making themselves available to donating vendors at a lunch on Wednesday, March 2 at the HIMSS conference. CIOs interested in raising money for education by spending a couple of hours socializing with vendors can contact me.

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About half of poll respondents will attend the HIMSS conference next month. A few more folks who attended in 2015 won’t attend vs. those who will attend, but I don’t think that necessarily portends lower overall attendance. New poll to your right or here: do company funding announcements make you curious to check them out?

Listening: Blackstar, the new album from David Bowie. The Thin White Duke is 69, but he eschews the profitable victory tour of mindlessly mumbling moldy hits in favor of creating complex, fresh music that throws down the gauntlet in setting the pace rather than wheezing to keep up with it. The album came about because Bowie saw a jazz band he liked and decided to perform some musical experimentation them. He just keeps doing his own thing, emerging from obscurity only when he has something new to say musically. The music is among his most experimental, the lyrics are hard to comprehend yet poetic and chilling (especially the title track), and it sounds like a real band with occasional boluses of electronica just to challenge the listener. It won’t change your mind if you don’t like Bowie, but it’s a gift if you do. UPDATE: a few hours after I posted this review, I was shocked to hear that David Bowie has died.

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Mrs. K’s middle school science class in Brooklyn is using the iPad Mini we provided in funding her DonorsChoose grant request for researching STEM projects. She reports, “On behalf of my students, I want to thank you for your generous donation of an iPad mini. This gift will provide our students with real world connections to current research that will support all our ongoing investigations in our classroom. Curiosity and access to technology is the key to our success as productive Americans. Thank you for your support!”

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My Christmas present to myself even though I don’t travel all that much is Global Entry, a known traveler program powered by fingerprint scan that lets you skip the line when entering the US by plane or car. It also includes TSA’s Pre-Check (shorter line, shoes and belt left on, laptop left in bag, metal detector instead of scanner), which is newly important since the days of free “upgrades” to Pre-Check often are about to end. Global Entry costs $100 for five years, only $15 more than Pre-Check alone. Every road warrior should (and probably does) have it. One might quibble that Department of Homeland Security is charging a premium to bypass its intentionally created inefficiency, but arguing that point with everybody else stuck in long lines doesn’t make sense unless you can’t spare $20 per year to save a lot of time and frustration.


HIStalkapalooza

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Sign up to request an invitation for HIStalkapalooza. I have only about 400 requests so far, but I just announced it Friday.


Last Week’s Most Interesting News

  • Henry Schein Practice Solutions pays $250,000 to settle FTC charges that it overstated the database encryption technology used in its Dentrix G5 dental practice management system.
  • Oncology software vendor Flatiron Health raises another $175 million, increasing its total to $313 million.
  • The Rochester, MN paper reports that Mayo Clinic will run Epic hosted from Epic’s Wisconsin data center, while the data center Mayo sold Epic for $46 million will be used only for failover. The organizations will also work together to create new products.
  • Health kiosk vendor HealthSpot shuts down.
  • NantHealth acquires NaviNet to create a payer-provider collaboration network. 
  • Navigant acquires 70-employee consulting firm McKinnis Consulting Services for $52 million.
  • “Brain training” app vendor Lumosity pays $2 million to settle FTC charges that it made unproven claims that its software can reduce age-related cognitive decline.
  • A local paper reports that Epic’s headcount has grown to 9,400, increased by 1,400 in the past year.

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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UltraLinq Healthcare acquires Cardiostream as the companies combine their medical image management expertise.

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Several  Fitbit users sue the company, saying that its fitness trackers cannot accurately record heart rates during intense exercise even though the company markets them for that purpose. One of those users said her Fitbit showed a heart rate of 82 beats per minute when it was actually measured at 160, making the trackers “worthless.” In an interesting response, Fitbit stands by its technology but adds that its trackers “are not intended to be scientific or medical devices.”


Sales

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Mount Nittany Medical Center (PA) chooses paperless electronic forms on demand from Access.


Announcements and Implementations

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MedStar Health adds a “Ride with Uber” button to its home page that will hopes will make it easier for patients to keep their scheduled appointments on time. They should do something similar with discharged patients since, as bizarrely as it sounds, a top reason for extended length of stay is patients who can’t get a ride home and calling 911 for a free ambulance ride only works for those headed to – not from – the hospital.


Government and Politics

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Two Phoenix VA executives who were suspended over scheduling wait times surface in new VA jobs 19 months after they were suspended with full pay and given a notice of termination that never happened.

The IRS says that 1.4 million households may lose their Healthcare.gov insurance subsidies because they they took government tax credits in advance last year but didn’t account for them in their federal tax returns. That means that 30 percent of households that received insurance subsidies handled the tax implications incorrectly. The announcement was made late Friday, when the federal government often releases unflattering information about the administration’s pet projects.


Other

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@Cascadia caught this: Amazon is recruiting for a Leader, Global Healthcare for Amazon Business, the business-to-business supply marketplace it is building.

Nemours is considering IT as one of this areas in which it may reduce headcount.

Donna Walters, CIO of Sharon Regional Health System (PA), is hit by a car as she crosses the street in a crosswalk in front of the hospital. She is apparently OK, suffering a broken wrist. The driver, who was driving with a suspended license, was charged with a felony.

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In bizarre healthcare news:

  • Workers partially demolish a hospital in China that is still being used with patients inside, with locals suspecting that a company working on nearby roads ordered it removed (photo above left).
  • In Russia, hospital security cameras capture a doctor killing a patient in the ED admitting area with a blow to the head after accusing the patient of touching a nurse, the most recent of several incidents in which the doctor used physical force on patients (photo above right).
  • In New York, a patient commits suicide by jumping off a building and lands on Mount Sinai St. Luke’s Hospital’s oxygen tank, forcing its ED to be evacuated.
  • In South Sudan, 10 patients – including premature babies – have died because its main hospital has run out of money to fuel its electrical generators.
  • In Cincinnati, the parents of a recovering seven-month-old baby overdose on heroin in the hospital. The mother died in the baby’s hospital room, while the father was arrested after being found in a hospital bathroom with a heroin needle in his arm and a loaded pistol in his pocket.
  • A San Francisco group sues to halt construction of a new professional basketball arena near UCSF Benioff Children’s Hospital, saying, “Some people will die trying to get to the hospital if this stadium is built next to the emergency room.”

Sponsor Updates

  • Extension Healthcare lists its 2015 awards and achievements.
  • Caradigm publishes an infographic on electronic prescriptions for controlled substances.
  • Valence Health CEO Andy Eckert will present at the JP Morgan Healthcare Conference, taking place January 11-15 in San Francisco.
  • ZeOmega ranks number 54 on the 2015 SMU Cox Dallas 100.
  • Strata Decision Technology publishes “Margin + Mission: A Prescription for Curing Healthcare’s Cost Crisis.”
  • YourCareUniverse receives national recognition for innovative patient engagement tools.

Blog Posts


Contacts

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

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January 10, 2016 News 4 Comments

News 1/6/16

January 5, 2016 News 3 Comments

Top News

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NantWorks and NantHealth acquire eligibility and benefits management software vendor NaviNet, explaining that, “we are now poised to be the nation’s leading healthcare collaboration network by transforming the payer-provider relationship to evolve from transactions to interactions and finally to collaboration,”adding that NaviNet Open will serve as a web portal for cancer patients and providers. NaviNet sold its PM/EHR customer base, which was using rebranded versions of CureMD products, to CureMD in 2013 in continuing its focus on payer-provider collaboration tools. NaviNet was in 2012 acquired by Silicon Valley investor John Doerr’s Essence Healthcare, which I believe still owns ClearPractice and Lumeris.


Reader Comments

From Walter: “Re: health systems moving to Epic or Cerner. If you want to predict those, start with a list of McKesson Horizon and then Paragon clients.” I haven’t seen the numbers of Horizon customers who have followed McKesson’s hopeful suggestion that they replace their now-retired system with Paragon, but I’m guessing they are negligible.

From The PACS Designer: “Re: WiFi HaLow. At the Consumer Electronics show this week, the WiFi Alliance announces a new service called WiFi HaLow. It will bring a longer-range, low-power WiFi application that could benefit the patient engagement initiatives in healthcare as well as applications in other healthcare areas.” HaLow also penetrates walls better, which coupled with longer ranges and less battery drain should make device connectivity (including wearables) more practical. Unlike Bluetooth, HaLow connects devices directly to the Internet, not just to a smartphone.


HIStalk Announcements and Requests

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Quite a few folks in health IT-land like this recent Dilbert, which might be the perfect preview (or replacement for) the HIMSS conference techno-blather.

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Ms. Brown from Michigan sent photos of students in her K-3 special education resource room using the math puzzles and learning centers we provided by funding her DonorsChoose grant request.

I was thinking about the HIMSS conference and that my least-favorite US city — Las Vegas — has the perhaps unique distinction in that its residents indignantly scorn tourists who pronounce its state name correctly as “nev-AH-dah” instead of the local version “nev-AD-ah,” which is probably an ongoing challenge given that 75 percent of the state’s residents were born elsewhere. I suppose it’s like cities whose names we Americanize (i.e., we say it wrong) as we scorn those who say the name correctly (Los Angeles, St. Louis, New Orleans, and probably a bunch more). My go-to example for the odd-but-universal pronunciation is the Empire State Building, which you and everyone else say as “empire STATE building” even though New York is the Empire State and therefore the name should be pronounced “EMPIRE state building.”

Listening: the new and first EP from Cado Young, a couple of young guys (one of whom I’ve met) who have created some polished, hard-edged alternative music that deals maturely with the human condition.


Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Mayo Clinic sells its data center to Epic for $46 million and will lease it back from its EHR vendor. That’s news everywhere except here since reader Sturges said exactly that in as a perfectly accurate Rumor Report from April 6, 2015.

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Navigant acquires 70-employee McKinnis Consulting Services for $52 million to expand its revenue cycle management consulting practice.

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Healthfinch raises $7.5 million in a Series A funding round, planning to use the money to complete development of its EHR “extender tool” that will expand its business beyond automated prescription refill management technology. The 30-employee Healthfinch was founded by biomedical engineer Jonathan Baran and Lyle Berkowitz, MD.

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Minneapolis-based virtual care technology vendor Zipnosis raises $17 million in Series A funding, with Ascension Ventures and Fairview Health Services participating. The company offers a white-label virtual care portal for provider groups in which patients answer online questions and are then triaged to an appropriate clinician.

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Pre-surgery patient portal software vendor One Medical Passport receives a $4 million Series A investment.

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Smart pill bottle manufacturer SMRxT, whose name veers off the “distinctive” roadway into the “utterly unpronounceable as written” swamp, moves its headquarters from New York to Orlando. The company pronounces its name “Smart” in ignoring its own un-clever “Rx” pun and incorrect capitalization that renders the entire nomenclature exercise baffling, making me question whether it employed too much or too little marketing expertise.

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Imaging technology vendor Sectra acquires Sweden-based RxEye, which offers a medical imaging collaboration platform.


People

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Healthwise promotes Adam Husney, MD to chief medical officer.

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Microsoft senior director of worldwide health Bill Crounse, MD retires from the company.


Privacy and Security

Hackers take down three electric power substations in the Ukraine by installing malware packaged as Microsoft Office document macros, with the resulting blackout sure to cause concern that similar actions could affect healthcare facilities if careless employees (was that redundant?) open documents from unknown sources.


Technology

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Twitter will expand the 140-character Tweet limit to as many as 10,000 characters as it had already done for private messages. The downside is that plenty of Tweeters were already stretching the limits of their appeal within their allotted count of 140, now giving them the opportunity to move from “dull” to “insufferable.” On the upside, people were already kludging around the limit by taking screenshots of text anyway. Maybe a compromise would have been to expand the character limit while imposing a tweets-per-day cap.


Other

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Critics question whether BMJ (the cute name that replaced British Medical Journal) has turned itself into a populist magazine rather than a scientific journal with its sometimes poorly researched editorial campaigns. The editor in chief acknowledges that it’s a fine line, explaining, “Some people would say we have gone too far down the magazine route. But we have no doubt that we’ve increased our influence and increased our readership among clinicians.”

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“Brain training” games vendor Lumosity will pay $2 million to settle FTC charges that it made unfounded claims that its software can help reduce age-related cognitive decline.

The bad news is that a year’s worth of a new drug for pulmonary artery hypertension will cost a patient’s insurance $170,000, based on the price set by its manufacturer that expects to sell more than $1 billion worth per year. The good news is that it’s still cheaper than existing drugs for the same condition. The more-bad-news is that insurance companies will surely pass the cost along to the rest of us because that’s how insurance works, meaning everybody is happy except the majority of Americans who don’t have the condition who are paying big premiums without getting much in return.

The New York Times observes that millions of Americans are declining to buy medical insurance since it’s more expensive than the penalties involved in not buying it, capturing some interesting logic from the folks they interviewed:

  • One woman says it’s better to die if something catastrophic happens, defying the government to collect the $1,500 fine she will owe in electing not to buy insurance.
  • A man who doesn’t like poor out-of-network coverage comments, “I’m just going on the hope that nothing bad is going to show up until I get a full-time position somewhere or there’s better choices.”
  • An artist who dropped his $455 per month plan that covered “zero medical expenses” says, “You’re asking a bunch of people to basically just give money into the system when they have an option not to,”
  • A woman who says she just keeps antibiotics in her home rather than buying insurance says, ““I do not believe it serves the public good to entrench private insurance programs that put actual care out of reach for those they purport to serve,” adding that she hopes any disaster happens while driving since her auto insurance covers personal injury.

Sponsor Updates

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  • AdvancedMD staff donates 4,402 pairs of socks to The Road Home, a social services agency that helps the homeless in Salt Lake City.
  • VentureBeat profiles AirStrip’s work with the University of Michigan and IBM to predict when a patient will become ill.
  • Aprima Medical Software donates a record eight tons of food to needy families in the Dallas area as part of its annual food drive.
  • CareSync CEO Travis Bond will speak in March at the South by Southwest Interactive Festival in Houston.
  • The Times of India features CitiusTech HR VP Sowmya Santhosh and her thoughts on accommodating different personalities in the workplace.
  • Divurgent releases a white paper, “Population Data: Healthcare’s Critical Success Factor for Health Management.”
  • E-MDs selects Dell Children’s Medical Center for its 2015 holiday giving program.
  • The local business paper profiles new GE Healthcare CEO Lee Cooper.
  • Greencastle Associates Consulting recounts the part it played in Einstein Medical Center’s EHR rollout.
  • The Huntzinger Management Group ranks number 10 in Consulting Magazine’s list of fastest growing firms of 2015.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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January 5, 2016 News 3 Comments

Monday Morning Update 1/4/16

January 3, 2016 News No Comments

Top News

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The Madison paper reports that Epic’s headcount has increased to 9,400, up 1,400 in the past year. Campus 4 and Campus 5 are under construction and will add 3,500 offices and the company is sharing the cost of expanding Nine Mound Road to four lanes to handle Epic employee traffic. The company also announces that it has 360 healthcare organization customers in 10 countries and booked $1.8 billion in 2014 revenue.


Reader Comments

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From Crank Caller: “Re: McKesson. I agree with your prediction that it will divest its health IT business. I’ve heard from two reliable sources within McKesson that Paragon is for sale, not that anyone would want to buy it.” Unverified, but the company seems to be constantly apologizing for its health IT business, it hasn’t produced great numbers, the Better Health 2020 initiative doesn’t seem to get much airplay after an initial big splash, and the company has shut down product lines like Horizon. With the retirement of Jim Pesce, anything could happen.

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From Simmering Stock: “Re: 2015 share price performance. Some vendors are traded on non-US exchanges.” I intentionally limited my list to companies whose shares trade on US exchanges, but some that don’t are:

Pro Medicus (parent company of Visage Imaging), Australian Securities Exchange: up 191 percent
Craneware, London Stock Exchange: up 68 percent
Orion Health, New Zealand Stock Exchange: down 45 percent

From HIPAA Shake: “Re: your medical records request. Did you ever hear back from the Office for Civil Rights?” I filed a complaint in July with both OCR and the hospital that refused to provide me with an electronic copy of my medical records (the hospital claimed it is required to do so only for providers and patients can only get printed copies). I haven’t heard back from either organization. Good thing I haven’t been comatose for the six months with my doctor anxiously waiting to see what happened during my one-day stay in early 2014.

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From EHR Product Manager: “Re: LA Times op-ed piece on physician working conditions. I left a faith-based academic medical center to work on the vendor side, which definitely has a better work environment. The AMC emphasized work-life balance but I couldn’t get them to let me work remotely even one day a week, which is a given in the vendor world. Is healthcare seeing a brain drain due to perceived lack of perks?” The Stanford medical student’s article says it’s easy to understand why the school’s graduates often forego residency to jump straight into industry in contrasting their environments: the working conditions for low-pay medical residents involve fluorescent lights, endless pages, and cell-like on call rooms, while business school students ride fancy buses to tech companies that provide free gourmet meals, gyms, massages, and on-site services such as bike repair and yoga classes. I would hope that those who choose to pursue professions such as medicine or the ministry don’t expect the eye-popping perks awarded to a tiny percentage of the young workforce who are chosen to work at Google or Facebook (or Epic, for that matter) — I’d rather see the folks who are torn between patient care and Silicon Valley just hire on with Google instead of naively wasting a medical school spot. Excluding poor working conditions for residents, hospital jobs are a mixed bag, especially for non-executives who aren’t eligible for bonuses, fancy offices, and expense accounts. Sometimes the time-off policy is pretty generous and layoffs are less frequent, but otherwise the rewards of hospital work mostly involve the satisfaction of helping people rather than helping yourself. It’s also not a given that people have a choice between the two worlds – hospitals hire lots of people who overestimate their own capabilities in failing to realize that nobody else would want them. My only conclusion is that medical schools should paint a realistic picture of what it’s like being a doctor before offering admission to a student who might have unreasonable expectations, but that’s not their business model — university tuition coffers are filled by students who are destined for a rude awakening when they realize that their expensive degree has little market value or has prepared them for a job nobody would really want.


HIStalk Announcements and Requests

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Cerner and Epic share the lead as the companies for which poll respondents lost the most respect for in 2015. New poll to your right or here: what are your HIMSS conference plans?

I hope everyone enjoyed their most-of-December industry slowdown. The industry rocket is about to blast off now that New Year’s is behind us and HIMSS is just eight weeks away. News was understandably slow last week, so today’s post won’t consume too much of your first-day-back output.


Last Week’s Most Interesting News

  • ProPublica launches a searchable database of health data breaches and privacy complaints.
  • A new law takes effect that allows CMS to fine insurance companies for publishing incorrect provider databases.
  • AMA President Steven Stack, MD names EHRs as the top cause of physician frustration.
  • A New York non-profit rolls out an app that alerts volunteer first responders of nearby medical emergency 911 calls.

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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South Carolina-based Singular Sleep offers $249 home-based sleep apnea studies and $69 online consultations for patients in 13 states.

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The Chicago business paper profiles Prepared Health, which offers a care team communications platform. The company was started by folks formerly with Medicity.


People

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Bruce Matter (AMC Health) joins Banyan Medical Systems as EVP of sales.


Other

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In England, problems with the implementation of CSC/iSoft Lorenzo at Hull and East Yorkshire Hospitals NHS Trust cause extended patient waitlists and short appointment time notices.

ProPublica covers Denmark’s 1992 elimination of medical malpractice lawsuits, replaced by a national compensation program in which patients file claims that are reviewed by independent experts who set compensation in return for gaining access to the details for ongoing improvement. The two most-used criteria there are: (a) was care of substantially lower quality than a specialist would have provided; or (b) did the patient experience a rare medical event, such as an unusual drug reaction. The average paid claim is $30,000, but citizens there file seven times the number of claims as in the US and four times more patients per capita receive awards. Doctors there are also legally required to tell patients when they’ve been harmed during medical care. The president of a US association of malpractice lawyers hates the idea, of course, fretting that “those with economically viable cases would take pennies on the dollar when their case is worth substantially more.” He left unstated the obvious two last words of the sentence that motivates him: “to me.”


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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January 3, 2016 News No Comments

News 12/30/15

December 29, 2015 News 10 Comments

Top News

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ProPublica launches HIPAA Helper, which allows searching government data to see if a given provider or insurer was named in privacy complaints, breaches, or violations. The organization calls out frequent offenders , none of which have been assessed penalties by the Office for Civil Rights. 


Reader Comments

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From The PACS Designer: “Re: fluorescent camera pills. As we get smaller technology in the form of camera pills, the innovations become exciting. Florescent technologies are now so small that they can be inserted into a swallowed form that includes a camera that can now detect cancer without using an endoscope. The sensor used is called the single photon avalanche detector (SPAD) and it can detect single light photons given off by the molecules in human tissue.”

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From Dorm Fridge: “Re: saying ‘no problem.’ I say it to indicate that whatever I did wasn’t a burden. It makes just as much sense as ‘you’re welcome.’” “You’re welcome” indeed doesn’t make much sense (nor does “thank you,” for that matter – why not “I thank you?”) but at least it’s traditional. Just about everybody I’ve heard say “no problem” — or its even more annoying variant, “not a problem” — is under 30, so I certainly wouldn’t use the phrase when trying to sell something to curmudgeonly older executives. I’ve also noticed that younger folks have unnecessarily raised the gratitude gamesmanship by embracing “thank you SO MUCH,” oddly pronouncing the “so” more like “soul.” Here’s a compromise: expressions of gratitude don’t require a reply, especially the call-and-raise response of thanking that person back, so just let it ride unchallenged or give a slight smile or nod. It’s all weird, of course, just like saying “goodbye” or “bye,” which originated as a shortened version of “God be with you,” which technically a non-believer shouldn’t be saying. I’m also intrigued that non-Texans are using “howdy” for some reason.


HIStalk Announcements and Requests

RIP Motorhead and Hawkwind singer Lemmy, who has died of cancer at 70.

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A reader who wishes to remain anonymous donated $250 to my DonorsChoose project, which was matched by the Bill & Melinda Gates Foundation and then again by my anonymous vendor executive. That allowed me to fund $1,000 worth of teacher grant requests, all of which carried additional matching funds to stretch the donation value to fund $2,000 worth of projects:

  • Three sets of ear buds and wireless mice for Mrs. Steele’s kindergarten class in Huntland, TN.
  • Two programmable robots for Mr. Willet’s elementary school digital lab in Asheville, NC.
  • Five MP3 players to form a listening center so that Ms. Johnson can read books for her first grade class in Oklahoma City, OK, in which the student poverty rate is 100 percent and 98 percent are English Language Learners.
  • A Chromebook, case, six sets of headphones, and a wireless mouse for Ms. Johnson’s third grade class in Philadelphia, PA.
  • An iPad Mini, Apple TV, case, and display adapter for Mrs. Robles’ middle school math class in Phoenix, AZ. She replied almost immediately, “Oh my God! Because of you, all my underprivileged students will be beaming with smiles and their brains full of knowledge that they will be eager to engage in and learn. It is because of wonderful people like you that our children have equal access to success and in becoming someone in this world! The kids have had to deal with the lack of the proper tools to learn. This will definitely be a game changer. They will not feel left out in the technological world and will be super proud to come and learn in my room. Over 150 students will now feel part of a new era of learning.”
  • A laptop and Ethernet switch for a student-led project in which the West Covina, CA school’s robotic team will recruit new members by demonstrating their robots to fellow students and parents on Saturdays. As the students who made the request summarized, “This year, our robotics team won the 2015 Chezy Champs Competition and we are ready to win it again! Just like a football team, after high school seniors graduate, we have to rebuild the team. Without enough team players and support, we are at risk of losing our robotics program … With a new notebook and Ethernet switch, we will be able to showcase our previously built robots! We want to be able to show how exciting robotics is, and be able to present this without having any embarrassing hiccups.”

Webinars

January 13 (Wednesday) 1:00 ET. “Top 5 Benefits of Data as a Service: How Peace Health Is Breathing New Life Into Their Analytics Strategy.” Sponsored by Premier. Presenter: Erez Gordin, director of information management systems, Peace Health. Finding, acquiring, and linking data consumes 50 to 80 percent of an analyst’s time. Peace Health reduced the time analysts were spending on data wrangling, freeing them up to create new actionable insights.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

I took a look at how publicly traded health IT-related stocks fared in 2015 from best to worst. For the year to date, the S&P 500 was up less than 1 percent, Nasdaq around 7.5 percent, and the Dow down less than 1 percent.

  1. MedAssets: up 56 percent
  2. Nuance: up 43 percent
  3. Aetna: up 38 percent
  4. Leidos: up 34 percent
  5. Allscripts: up 21 percent
  6. UnitedHealth Group: up 19 percent
  7. Vocera: up 18 percent
  8. Cognizant: up 17 percent
  9. Athenahealth: up 13 percent
  10. Teladoc: down 8 percent (since its June IPO)
  11. Premier: up 4 percent
  12. Quality Systems: up 4 percent
  13. McKesson: down 3 percent
  14. The Advisory Board Company: up 3 percent
  15. Cerner: down 5 percent
  16. Imprivata: down 14 percent
  17. CPSI: down 17 percent
  18. Evolent Health: down 34 percent (since its June IPO)
  19. Castlight Health: down 64 percent
  20. Streamline Health: down 68 percent

Government and Politics

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A new law that goes into effect this week allows CMS to fine insurance companies whose provider directories contain mistakes that can cause patients to inadvertently receive out-of-network care. California fined Anthem Blue Cross and Blue Shield of California last month after discovering that 25 percent of the doctors in their directories either didn’t accept their insurance or had moved, while Blue Shield has paid $38 million to cover out-of-network bills that were caused by its inaccurate doctor listings. Critics say the provider directories are full of doctors who are dead, moved, retired, no longer accepting insurance, or not accepting new patients. Insurance companies say directory management is a nightmare since doctors often don’t return their calls and 30 percent of them change affiliations in a given year. CMS originally required insurance companies to call every doctor monthly to verify their listings, but changed that to quarterly since as MGMA says, “The last thing physicians want is for hundreds of health plans to call them every month.”


Privacy and Security

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This won’t help the argument for a national patient identifier: the TSA may stop accepting driver’s licenses issued by several states that refuse to comply with federal standards. Federal law requires states to check documents that verify the identity of applicants, equip the license with a chip or magnetic stripe containing the information collected, and to share information with other states and the federal government. The Department of Homeland Security wants to implement the $3.9 billion program to more carefully check travelers and to prevent identity theft, while critics say it’s the equivalent of a national ID card and the recent hack of the Office of Personnel Management raises concerns about storing too much personal information in one location.

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Mainstream media have picked up on a Financial Times report that simply added up the number of hacked US medical record records for 2015 and reached the unsurprising total of 100 million, nearly 80 million of which resulted from the Anthem breach alone. FT repeats the hacker motivation in which a credit card record fetches only $1 on the black market, while a complete medical record is worth $2,000.


Technology

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The first non-beta release of Google Glass will occur in mid-2016, says a newspaper that ran purportedly leaked photos of the device obtained from FCC filings. It will now be sold only to businesses under the name Google Glass Enterprise Edition, available only from companies that will pre-load their software on it. Features include a sturdier hinged design, an external battery pack, a larger screen but at least one model that won’t include a screen at all, and eventually a clip-on model for people who wear glasses. Excited Glassholes who paid $1,500 for the previous version – most of whom abandoned it quickly due to limited functionality and unlimited public scorn — probably aren’t thrilled that the Glass development team now refers to their premature technology investment as “little more than a scuba mask attached to a laptop.”

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St. Jude Children’s Research Hospital scientists develop ProteinPaint, a free Web application and dataset that allows scientists to analyze and contribute information on genetic mutations that cause pediatric cancer.


Other

An interesting article questions the AMA’s interest in requiring competency testing for aging physicians. Some experts say evidence is scant that older doctors are less competent or less likely to follow modern standards and therefore any new competency testing should be applied to all doctors. This is a brilliant quote: “It’s a growing concern now that 26 percent of active physicians in the US — about a quarter million docs — are over 60. Fears they will soon go running for the exits and create a physician shortage are competing with fears that they will stick around forever and create a quality performance gap.”

In Pakistan, a government official angry at the IT department of a local hospital gives it until February 15 to go live with its computer system after the project was delayed for five years.

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The $1,000 per pill hepatitis C drug Sovaldi costs only $4 in India after Gilead Sciences licenses 11 India-based companies to produce generic versions that aren’t available here. You’re welcome, India (or should that be “no problem?”) That nicely illustrates how product pricing that would be entirely reasonable in every other industry (charge whatever people are willing and able to pay) is infuriating when being an un-wealthy citizen of a purportedly wealthy (but deeply in debt) country means you can’t afford to get something that would make you healthier.

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Researchers find that contrary to perception, Britons have better teeth than Americans, mostly because they have access to publicly funded medical and dental care and we don’t. We’re mid-pack in global dental health, which is a lot better than we fare in overall health in every category other than spending.

A senior manager at a company that specializes in “changing health behavior” (meaning being paid to push paid advertising at doctors) urges colleagues that “we must rely in EHR technology to capture data and use it to target our messages effectively … Our promotion can be just as successful as [wrestling promoter] WWE.” You can bet that sort of nonsense will neither raise physician EHR satisfaction nor lower US healthcare costs, but the fact is, it works, because doctors aren’t nearly as smart as they think in resisting the siren song of billion-dollar industries willing to do anything to wrest control of their prescribing pen or keyboard.

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It’s puzzling to me why some experts – doctors, CIOs, and health IT people – seem to structure their entire professional lives around Twitter and Facebook as though whatever they do there constitutes a professional accomplishment worth including on their LinkedIn profile. As evidence, note the unconvincing “7 Social Media Platforms Every Urologist Should Use,” which suggests that “it’s becoming essential for every healthcare professional to cultivate an online presence” and adds that following lame conference tweets is as good as actually attending. The author says every urologist should use Facebook, LinkedIn, Doximity, Twitter, Figure1, Instagram, and Periscope. I think it’s probably an uncommon urologist whose social bleatings would prove entertaining or informative, so perhaps the blanket recommendation that all of them take to the airwaves should be tempered with the reality that not all of them are well suited for it. Self-proclaimed “King of the Urology Twitter World” Ben Davies, MD  (@daviesbj) is an obvious exception, although he shares stuff that patients might not need or want to see.


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 29, 2015 News 10 Comments

20 Top Stories of 2015, 20 Predictions for 2016

December 28, 2015 News 3 Comments

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It’s not too hard to choose 2015’s big stories, but I’m annoyed by people who make obvious “predictions” that are intentionally vague enough to evade accountability, like psychics who boldly proclaim that their client will have “a change in fortune” or “family developments, some good and some bad” in hoping desperately not to lose business by being proved clearly wrong. My predictions will be specific and I’ll publicly recap them this time next year even if they make me look silly.

What are your predictions for 2016? Send them my way and I’ll list them here.

Stories

  1. The Department of Defense chooses the team of Leidos, Cerner, Accenture, and Henry Schein for its $4.3 billion EHR project.
  2. High-flying Theranos and Turing Pharmaceuticals go down in flames, at least temporarily.
  3. NantHealth continues its acquisition streak and PR push, but temporarily shelves its IPO plans.
  4. ICD-10 finally goes live with barely a ripple thanks to the in-the-trenches folks who modified systems to accommodate it.
  5. The Supreme Court upholds the Affordable Care Act, but poor-performing state exchanges, increased insurance company costs, and increasingly higher deductible and narrower networks leave the middle class footing the bill for a bold experiment that has mostly helped providers gain paying patients without improving overall health.
  6. Just about everybody pushes back on Meaningful Use Stage 3, either by complaining to Congress or exiting the program, and doctors increasingly say their EHRs are the top source of their dissatisfaction.
  7. Industry mergers increase dramatically at all levels – health systems, health IT vendors, drug companies, and insurance companies.
  8. Epic CEO Judy Faulkner pledges to donate her multi-billion dollar fortune to a charitable foundation upon her death or direction.
  9. Epic and Cerner continue to dominate the inpatient systems market at the expense of their only significant competitor, Meditech.
  10. Data breaches become commonplace, including hackers who accessed the identities of 80 million people associated with Anthem.
  11. Cerner completes its acquisition of the former Siemens Health Services, but sees its financial results tarnish slightly immediately following.
  12. Athenahealth acquires software from RazorInsights and Beth Israel Deaconess Medical Center as it increases its push into the inpatient market.
  13. CVS and Walgreens continue to lead health IT with innovative apps and services.
  14. Epic wins several impressive customers, but struggles in the UK, loses the DoD contract, and will be displaced with Cerner following Banner Health’s acquisition of financially strapped University of Arizona Health Network.
  15. The OpenNotes project to allow patients to review clinician documentation gains ground with positive study findings and new funding.
  16. Expectations increase for the FHIR standard as the best way to integrate EHR information with other systems.
  17. ONC releases its Interoperability Roadmap that calls for EHR vendors to expand their API support and for the government to streamline privacy and security policies.
  18. Mobile apps show considerable promise for diagnosing and monitoring mental health conditions, especially depression.
  19. Apple announces ResearchKit for clinical study enrollment.
  20. Major healthcare systems and payers pledge to migrate most of their business to value-based payments by 2020.

Predictions

  1. The cooled-off IPO and funding markets will leave nearly all of the unprofitable startups that graduated from the overabundance of accelerators and incubators in the past few years struggling to gain or maintain momentum and customers. Companies with IPO intentions will postpone their plans due to market conditions, but Health Catalyst will do so anyway with decent but comparatively unspectacular initial share price results as wary investors wait for a couple of good quarters to convince them.
  2. Healthcare costs will become a contentious topic in the 2016 presidential elections as the millions of Americans who purchased health insurance are stung by low utilization and high costs due to high deductibles and co-insurance, leaving them both poorer and less healthy than before. Medical bankruptcies will increase significantly and hospitals in particular will find it difficult to collect the money owed by under-insured patients. At least one presidential candidate will timidly suggest cost controls – both provider and pharma – as the only remaining option in trying to manage the increasingly damaging costs of healthcare in the US. Provider mergers will continue and national brands such as Kaiser Permanente that combine insurance and care delivery will gain prominence.
  3. Consumers will lose interest in fitness trackers and wearables as 2015’s Christmas presents gather January dust just like they did last year.
  4. The CEOs of Epic, Cerner, and Meditech will start to pull back from day-to-day company involvement as they approach retirement.
  5. ONC and Meaningful Use will become increasingly less relevant and more contested as ONC replaces Karen DeSalvo with a new National Coordinator who lacks her experience and bipartisan support.
  6. Several mid-tier consulting firms will be downsized or acquired as their implementation and advisory business dries up.
  7. At least three big health systems will experience a data breach that results in exposure of the information of 100,000 or more their patients. The industry will realize that collaboration to identify and mitigate breach threats is essential and of mutual benefit. The government and organizations such as HIMSS will attempt to create and manage an information sharing and risk assessment platform.
  8. The VA will announce plans to eventually replace VistA with a commercial product. Congress will push Cerner since the Department of Defense will be implementing it, but the VA will favor Epic just to be different.
  9. At least one Epic and Cerner customer will switch to the other company’s product in trying to get a better deal on crippling software maintenance fees. Epic will also expand its hosting service to compete with Cerner’s successful offering.
  10. The terms “telemedicine” and “mobile health” will become antiquated as they simply become another accepted aspect of care delivery. “Information blocking” will also fade away as a hot term when everybody realizes the concept involves speculation without proof, but consumers will increasingly demand that their providers share their information – both with their other providers and with themselves – without charging per-page fees for information that exists in electronic form.
  11. IBM Watson will continue to produce mostly hype. No convincing studies will demonstrate its value, but newly announced, high-profile partnerships will keep IBM shareholders hopeful.
  12. The dark horse publicly traded company best positioned to succeed in health IT and related areas without a lot of fanfare will be Premier.
  13. Athenahealth won’t get much inpatient traction with the former RazorInsights and BIDMC’s WebOMR.
  14. McKesson will consider packaging and divesting its many health IT offerings as non-core business.
  15. Epic will not join CommonWell, but will leapfrog its competitors in offering APIs and slowly building a carefully controlled third-party ecosystem.
  16. Software for population health management and analytics will enter Gartner’s Trough of Disillusionment as providers implement it poorly and without a commitment to truly change their profitable business models.
  17. Cerner and Epic will continue to poach the business of Meditech, CPSI, and best-of-breed vendors whose small-hospital customer bases are being acquired by larger health systems.
  18. “Big data” will support a few meaningful clinical studies performed using only aggregated electronic information, but “little data” will provide more impressive but less-publicized results as doctors design the treatments of individual patients by reviewing the outcomes of similar patients.
  19. Consumer healthcare apps will continue to be plagued by inconsistent use, questionable design, and an unremarkable impact on health or outcomes.
  20. CHIME and AMIA will follow the HIMSS model of increasing conference attendance and revenue by catering to high-paying vendors willing to buy access to prospects.

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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December 28, 2015 News 3 Comments

Monday Morning Update 12/28/15

December 27, 2015 News 9 Comments

Top News

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AMA President Steven Stack, MD says EHRs are the #1 frustration of doctors, explaining,

We live in a world where a 2- or 3-year-old can pick up a smartphone and use it with no instructions. If you’re not careful, they’ll order from Amazon and have something delivered to your house two days later. But we have graduate-educated physicians who are being forced to use software that looks like it’s on an old-fashioned, DOS-based system, a Tandy, an Atari, the kind of software you can only see in a museum. And that’s the software we’ve been given to manage patients’ health and well-being. So you have physicians whose efficiency is decimated. Their ability to communicate with each other is completely crippled. And then they’re told you’re not doing a good job.


Reader Comments

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From Coal-Bearing Santa: “Re: Marshfield Clinic. I’ve heard that CareCloud has made a deal for its Cattails system and will white label it as an additional CareCloud product.” I forgot that the organizations announced a deal in April 2015 to sell software and services to large physician groups.

From Frisbee Golfer: “Re: Claritas Mindsciences. The three-person firm (everybody is a consultant), which makes the Craving to Quit app, has asked consultants to work for half their normal rates and is struggling to pay vendors after they failed to raise funds for operations in December.” Unverified. Their executive page still lists four people, but what drew my attention is that the company spelled its own name incorrectly on the exec page and sometimes uses “Mindscience” instead of “Mindsciences.”

From John: “Re: NHS. They have the top Christmas song!” In England, the Lewisham and Greenwich NHS Choir beats out Justin Bieber for the top Christmas song. Bieber encouraged his Twitter followers to buy the record instead of his own, which sent it to the top of the sales chart. Proceeds will be donated to charities.


HIStalk Announcements and Requests

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Three-fourths of poll respondents say they had at least as good a year in 2015 as they did in 2014. Pablo says he left the health IT staffing market because business is dying due to EHR vendors expanding their own internal consulting teams, a saturated and commoditized market, and staffing companies that failed to transition into advisory services.

New poll to your right or here: which company did you lose the most respect for in 2015? Vote and then click the poll’s Comment link to explain.

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I’ll be closing my reader survey shortly, so you’ll have done your good deed for the next year if you take two minutes to complete it. I’m already contemplating one change as suggested by a reader who would like to see more in-depth reporting in particular areas.

My latest pet peeves: (a) people who say, “I get that” in subtly but indignantly correcting someone who they perceive believes otherwise;  (b) those folks, mostly younger, who respond to a thank you with, “No problem,” thereby devaluing the act that triggered my gratitude by suggesting it wasn’t much effort for them; and (c) Facebook users who excitedly “like” obviously phony stories without bothering to check Snopes.com first, like photos of the Egyptian pyramids covered by snow after a freak storm.

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We funded four tablets for three pre-K classrooms in New York via DonorsChoose. Mrs. Martin says many of her students had never seen a tablet. They watch videos on them, trace on-screen letters with their fingers to learn to write, and play educational games. That’s a pretty strong ROI for tablets that cost only $41 each.

An anonymous donor sent $500 for my DonorsChoose project, which was matched by the Bill & Melinda Gates Foundation in a one-day funding special and then the $1,000 total was matched again by my anonymous vendor executive, allowing me to fund these projects (some of these had additional matching funds applied as well):

  • 10 sets of headphones for Mr. Ohlinger’s middle school science class, Canton, OH
  • A Bluetooth robotic arm, a solar powered robot, and a BoeBot robot kit to create a robotics team at Ms. Sobosan’s high school in Las Vegas, NV
  • 15 scientific calculators for Mr. Cho’s Bureau of Indian Affairs high school class in Lower Brule, SD
  • Math story books for Ms. Livingston’s third grade class in Las Cruces, NM
  • Headphones, whiteboards, privacy partitions, and paper supplies for Mrs. Heinrich’s elementary school class in San Jose, CA
  • Three tablets for Ms. W’s second grade class in Oakland, CA

Anonymous Epic QA donated $100, with multiplied into $400 due to Gates Foundation and my vendor exec matching money to buy these items:

  • Engineering toys and team building sets for Ms. Medina’s first grade class in Los Angeles, CA
  • 25 sets of headphones for Mrs. Riley’s second grade class in Baltimore, MD
  • An iPad Mini for Mrs. Ulhaque’s first grade class in Houston, TX

I had a little bit of extra money in the account, so I decided to buy a Chromebook, wireless printer, and supplies for Mrs. Hamilton’s fourth grade class in Carson, CA. I also realized that when I announced that donations had funded $22,000 worth of projects in 2015 that I was off considerably – all of the recent donations were via gift cards and those show on the donor’s totals, not mine. The actual total is a lot higher and even that doesn’t take into account matching funds from foundations.


Last Week’s Most Interesting News

  • The Department of Defense expands the scope of the DHMSM project in giving Leidos/Cerner a no-bid hosting contract, saying Cerner’s systems won’t work properly unless the company hosts them itself.
  • Medicare releases a dashboard showing its drug-specific spending.
  • Martin Shkreli is arrested on securities fraud charges and fired as CEO of the two drug companies in which he holds substantial ownership.
  • Congress passes a blanket Meaningful Use hardship exemption.
  • Vanderbilt University Medical Center announces that it will replace McKesson’s Horizon Expert Orders, which VUMC originally developed as WizOrder, with Epic.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

A watchdog’s report finds that McKesson paid the most money in misconduct penalties of all Department of Defense contractors since 1995. McKesson paid $2.05 billion in penalties for 24 instances of misconduct while earning $6.2 billion of the Pentagon’s business.

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The Greenville, SC paper profiles local personal health records startup ChartSpan, which says it will grow from 20 employees to more than 200 within the next two years.


People

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Eric Alper (Lifespan) is named VP/chief clinical informatics officer at UMass Memorial Health Care.

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Firelands Regional Medical Center (OH) promotes Denao Ruttino to AVP of operations.


Other

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New York-based non-profit United Rescue is spending $2 million to train and equip volunteer first responders in Jersey City, NJ who will be notified via a smartphone app when someone nearby calls 911 with a medical emergency, allowing them to render aid to the victim before paramedics arrive. The program is modeled after one in Israel where 3,000 volunteers respond to 700 emergencies each day for a program cost of $7 million per year.

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Impact Advisors sent over photos from their holiday employee gatherings across the country, including this one from Chicago.


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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December 27, 2015 News 9 Comments

News 12/23/15

December 22, 2015 News 6 Comments

Top News

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ONC releases its 2016 Interoperability Standards Advisory that lists federally recognized interoperability standards and guidance.


Reader Comments

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From Ambient Occlusion: “Re: homegrown EHRs. Regenstrief/Eskanazi signed up for Epic earlier this year.” Somehow I was thinking Marshfield Clinic and my fingers typed Regenstrief instead when I was trying to think of the last few health systems that are using homegrown EHRs (BIDMC is the other) now that Vanderbilt is moving away from WizOrder/Horizon Expert Orders in favor of Epic. I replied as such to Ambient Occlusion, who then pondered what Marshfield will do after pumping so much money into Cattails. He added a theory that they’ve probably capitalized some of their software development costs and would therefore not only need to spend big money to replace their self-developed product, but even more to write down whatever of its depreciated costs that remain on the books. Marshfield has tried to commercialize Cattails, but given that the newest press release on their site is from 2010, I’m guessing it’s not burning up the EHR charts.

From Benign Growth: “Re: HIStalk. I’m new here and I can’t figure out who’s writing what.” That’s easy – every word you read in an HIStalk news post is mine (Mr. HIStalk, aka Mr. H) unless I’m taking a rare day off and Jenn is covering for me. It always amuses me when people refer to the HIStalk “team” as through there’s a bunch of us working full time in an office. I write HIStalk, Jenn writes HIStalk Practice, Lt. Dan writes the HIStalk headlines and HIStalk Connect, and Lorre handles the webinars and sponsor activities. We each do our own thing with minimal contact with each other since we’re spread out and don’t need much supervision. Our past and present day jobs didn’t often support the creativity and fun we enjoy here. It will be 13 years in June since I started HIStalk and I still can’t wait to start filling the blank page every day.

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From Rough Taxpayer Sex: “Re: DHMSM. SPAWAR has added a sole-source hosting agreement to Leidos/Cerner. This looks like a total scam. Either they lied in the RFP about what they could provide or they’re lying now.” DoD awards Leidos a no-bid Cerner hosting contract that it claims won’t cost more than $5 million per year, explaining the need to modify the scope of the $4.3 billion award as follows below. Note that it’s nobody’s fault according to the wording – Leidos didn’t suggest that service and the government people involved could not have anticipated the need for it (I expect this excuse to be re-used for future expensive scope changes):

While Leidos solution meets the contract requirements, many of the capabilities of the DHMSM EHR cannot be fully realized unless they are hosted in the Cerner environment. In order to fully enable these functionalities, the DHMSM EHR requires direct access to proprietary Cerner data, which is only available within Cerner-owned and operated data centers. The proprietary data consists of quantitative models and strategies which are the result of extensive Cerner-funded research and development efforts conducted over 15 years. The models are based on analysis of clinical, operational, and financial data associated and incorporate vast amounts of actual longitudinal patient data and information collected through other Cerner applications. Forward deploying the DHMSM EHR into any other hosting solution would prevent access to these models and data. Significant functionality exists within the required system that utilizes machine learning and computational statistics to enable predictive analysis and decision support that directly impact patient outcomes. Therefore, no other contractor can satisfy the requirement. Prior to awarding this performance-based contract, the Government could not have anticipated this solution-specific need, which is why this scope was not included in the original RFP.


HIStalk Announcements and Requests

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I use the responses from my once-yearly reader survey figure out what I’m doing well and not so well. I would appreciate two minutes of your time to complete it. That will also place you in the running as the randomly chosen recipient of a $50 Amazon gift card. I used previous survey results to make changes that became into some of the most important attributes of HIStalk, so your time will not be wasted. I get a lot of great ideas from the survey, although I have to be careful not to: (a) fix something that isn’t broken; (b) do something that isn’t true to my personality or passions; (c) take on more work than I can handle effectively; or (d) do something that would make writing HIStalk less fun so that I would be tempted to quit doing it.

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An anonymous Epic developer donated $200 for my DonorsChoose project, to which I applied matching funds from my anonymous vendor executive as well as from private foundations to purchase these items:

  • Fraction, decimal, and percent learning tools for Mrs. Sutton’s third grade class in Herrin, IL
  • A Chromebook for Ms. Marlowe’s kindergarten class in Charlotte, NC
  • Math games and learning materials for Ms. Osborne’s elementary school class in Columbia, SC
  • Math games and a learning center rug for Mrs. Begg’s middle school class of learning and emotionally disabled students in Baltimore, MD

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Ms. Osborn’s Florida second graders, many of whom are children of immigrants and frequently-moving military families, are working in teams using the STEM materials we provided via DonorsChoose to solve real-world engineering problems.

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Also checking in is Ms. C from South Carolina, who teaches a class of severely intellectually disabled seventh and eighth graders for whom our DonorsChoose donation provided a library of around 100 high-interest, low-readability books. She provides background on the student in the photo above as an example: “The picture of the boy reading a book with my Dr. Seuss hat on is a child from a low-income family. He will come to school hungry and is usually very sleepy because he can’t sleep at night. He is very capable of reading better than he does right now. He loves to go over to my little classroom library and pick out a book to read. The other day he told us that he is actually leaning something this year. Until this project was funded, I really didn’t have enough books for a classroom library, but now I do.”

It’s that time of year where we’ve now gotten past the shortest day (December 21) and spring and the HIMSS conference aren’t far away. I’ll probably take this Friday and next off since I doubt many folks will be reading on Christmas and New Year’s eve and day. I expected to be mostly loafing around for most of December since it’s usually slow, but I’ve been pretty busy with fresh news and lots of companies are signing up as HIStalk and HIStalkapalooza sponsors. It’s good to keep busy, for which I thank every person who reads HIStalk and every company that supports it.

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

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Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel


Acquisitions, Funding, Business, and Stock

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Invoice Cloud acquires Imagevision.net, which offers the HealthPay24 point-of-service payment product used by 100 hospitals.

The professional regulator in England bars two former finance directors of one-time NHS software supplier iSoft (now owned by CSC) from practicing accounting for eight years for their involvement in the company’s financial irregularities nearly 10 years ago. Four company executives were acquitted in 2013 of securities charges.


Sales

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Northern Arizona Healthcare chooses Cerner Business Office Services for its ambulatory clinics and ACO, apparently replacing Athenahealth.


Announcements and Implementations

Summit Healthcare releases a Cerner-specific version of its domain compare-and-sync platform that supports data extraction, analysis, regression, and testing.

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Halifax Health (FL) goes live with Wolters Kluwer Health’s POC Advisor for real-time, data-driven sepsis alerts and advice.


Government and Politics

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CMS releases the Medicare Drug Spending Dashboard that includes the top 15 drugs by overall annual cost and per Medicare user as well as the drugs whose price jumped the most in 2014. The $1,000 per tablet hepatitis C drug Sovaldi topped the list as Medicare spent $3.1 billion on it at an average per-patient cost of $94,000. The most expensive drug per patient was Remodulin, used to treat pulmonary arterial hypertension, which cost an average of $134,000 per patient per year. You will recall that the Affordable Care Act prohibits Medicare from negotiating drug prices, a carrot added by the White House to appease drug companies who otherwise would have used their political clout to kill its administration-defining initiative.

Kansas state auditors say the state’s delayed Medicaid system rollout was due to unrealistic timelines and unmet functionality promises from contractor Accenture. Federal taxpayers are footing most of the cost of the Accenture contract that is worth $135 million upfront and $50 million for ongoing maintenance. Auditors predict that the project will run $46 million over budget, with nearly all of that bill also being passed along to federal taxpayers.

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CMS is investigating complaints filed by two former Theranos employees who claim that the lab company instructed its employees to continue using its proprietary testing technology despite “major stability, precision, and accuracy” problems. The former employees said results varied widely and that quality control checks of the testing method often failed. Theranos says the former employees are just disgruntled. The company continues to claim that it will publish peer-reviewed data proving its claims, but says they aren’t yet ready.


Other

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Baseball data analysis expert and Harvard-trained statistician Paul DePodesta, played as a composite character by Jonah Hill in the movie “Moneyball,” joins Scripps Translational Science Institute in a part-time, unspecified role. He says in an interview conducted by his new co-worker Eric Topol, MD:

If there’s a player who has been in the Major League for say five years, we have an awful lot of data on that player. So when we’re making a decision on that player, we may largely be using data to make that decision. Go to the total opposite end of the spectrum – a 15 year old playing in Maracaibo, Venezuela – we don’t have a whole lot of data on him. We have some, what I would call sort of outside data. We know about players form that area, we know players of his size, his strength, his age, his position. Not necessarily specific things about him, but we can create general conceptions about what that player could be expected to do based on all these other players have done who are similar to him in same fashion … people are trying to get their arms around uncertainty and trying to make better decisions for the future and realizing that data can really help them do that. Whether it’s financial services or trucking or farming, I mean there are all sorts of different industries that I never even dreamed of back when the book first came out and even when the movie came out that have reached out to us — to me or to Billy or to others — and have said, “We’re doing this now and it’s really helping — do you have other ideas about what we might be able to do?

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Speaking of “Moneyball,” I’ll say again that of the many conference speakers I’ve seen, the best was Billy Beane of the Oakland Athletics. If you haven’t seen the movie, here’s a recap. Beane’s team didn’t have the money to sign or retain big-name players who made occasional crowd-pleasing plays yet failed to achieve consistency, so he measured and analyzed available player performance data to choose lesser-known and therefore less-expensive players who produced consistent but unspectacular results, like getting on base a high percentage of the time, and then managed using those specific strengths to produce team wins. I thought it was bizarre that Health Catalyst chose Beane as a keynote speaker for its first Healthcare Analytics Summit in the fall of 2014 until I heard him.

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A USC report predicts that Medicare spending will double to $1.2 trillion by 2030 as per-beneficiary costs rise 50 percent, caused by aging baby boomers who — much more than in previous generations — are overweight, disabled, and suffering from chronic conditions. In other words, people who might have died from now-preventable heart disease will live longer and more expensively in requiring treatment of cancer and Alzheimer’s disease.

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CMS identifies at least five drugs whose cost doubled in 2014 from the new Medicare Drug Spending Dashboard that I mentioned above, with the ridiculously unoriginal Vimovo (two old generic drugs combined, naproxen and esomeprazole, the first for pain and the second to reduce side effects caused by the first) leading the list after a new company bought the drug and raised its price 500 percent. Ancient drugs captopril and digoxin were among the leaders, which cries out for some sort of action to stop companies from buying the rights to old drugs and then jacking up their prices to yield pure profit without the inconvenience of performing research studies or creating something new that might benefit patients rather than shareholders.

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I also note that Vimovo maker Horizon Pharma is using a now-common drug company trick to increase patient demand while raising societal costs overall – its “support card” promises that patients will pay little or nothing as co-pays even while the company is sticking their insurance company for the inflated cost. Medicare spent $39 million on this lame drug in 2014, which of course means doctors prescribed it quite a bit for reasons that probably aren’t entirely rational.

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It hasn’t been a great week for Martin Shkreli, who in addition to being arrested on securities fraud charges and then fired as CEO of Turing Pharmaceticals, has now been fired as CEO and board member of KaloBios, the drug company he bought just a few weeks ago. Meanwhile, Shkreli tells the Wall Street Journal that the government trumped up securities charges in desperately trying to find something to arrest him for. He also claims that his over-the-top behavior is “a social experiment” that makes him an undeserving target. He would make an ideal HIStalk interview, although I’m not holding my breath.

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This image has been used so many times without attribution that I can’t tell where it came from, but I saw it on LinkedIn and liked it.

Gallup’s annual poll of most honest and ethical professions finds nurses, pharmacists, and physicians taking the top three spots. The last-place finishers are members of Congress, telemarketers, and lobbyists.


Sponsor Updates

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 22, 2015 News 6 Comments

Monday Morning Update 12/21/15

December 19, 2015 News 7 Comments

Top News

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Vanderbilt University Medical Center will implement Epic, replacing the sunsetted McKesson Horizon Expert Orders. VUMC developed WizOrder and sold it to McKesson in 2001, which commercialized it as HEO. VUMC announced in April 2015 that it would choose between Epic and Cerner. It says none of the functionality it self-developed in WizOrder will be lost. I can’t think of any other homegrown systems still in use other than at Beth Israel Deaconess Medical Center and perhaps at Regenstrief.


Reader Comments

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From Below the Beltway: “Re: Meaningful Use. A blanket hardship exemption was not included in either the omnibus or the extenders package passed and the matter seemed settled for this year. Surprisingly, the Legislature came to an agreement on a bill with several Medicare reforms, including a change to the hardship exemption on a bill with several other Medicare reforms. The bill, S. 2425, passed the Senate Friday morning and the House Friday afternoon by voice vote and unanimous consent, respectively.” The full text of the bill is here.

From The PACS Designer: “Re: EDWs. TPD isn’t a vendor neutral archive advocate. More VNAs only complicate the storage issues and can result in arguments about what can be put in a VNA. A better idea is the electronic data warehouse (EDW), which encompasses not only using internal data sources, but also can include external ones and can bring more value to the decision-making processes. EDWs are also a better way to communicate with an HIE. What do you think?”

From Spiffy Tie: “Re: Cerner. My organization is a Cerner client and my perception of the company has fluctuated widely over the past 10 years. I’ve been especially disgusted by Cerner’s business plan. Their software has improved in many respects, but to make it functional requires a lot of customization. Cerner will gladly sell consulting time to multiple organizations to make the same changes rather than building it into the base product. Issues that would be bugs or defects in other software is typically said to be WAD (working as designed). If you want it fixed, you can pay for the customization yourself or submit an ‘idea,’ which is almost always rejected as ‘not aligned with current priorities.’ Other new features that are essential (to correct prior defects, safety issues, or gaps in content) are incorporated into new packages that have to be purchased separately rather than being a part of already-purchased upgrades. Despite my disgust with Cerner’s overall approach, I also have very positive feelings about Cerner in terms of their employees. Virtually everyone I’ve worked with is knowledgeable, professional, and willing to go the extra mile to make things work for our staff and our patients. I have very high regard for them and enjoy working with them very much. I think it’s especially egregious that Cerner would turn on its best asset, their employees, with this forced arbitration clause. If other companies and our judicial system have engaged in or supported such abusive extortion of hard-working individuals, then shame on them too.”


HIStalk Announcements and Requests

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The vast majority of poll respondents see Cerner’s requirement that employees sign arbitration clauses to continue eligibility for merit increases as negative. Some readers say it’s not just Cerner doing it and perhaps adding the $500 in stock options as a legal “consideration” was required to make the unilateral contract change legal. Several respondents predict that the company will lose good employees who will resent the strong-arm tactics and whose talent gives them career options elsewhere. New poll to your right or here: how was your 2015 compared to 2014? Click the Comments link after voting and explain why.

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Readers always enjoy the HCIT Family Tree that shows the acquisition history of all the health IT vendors. Creator Constantine Davides, senior healthcare analyst with AlphaOne Capital Partners, has updated it. Here’s a trivia question I randomly chose from Constantine’s chart: which company owns the former Medifor?

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I’ve been using a third-party Rumor Report form for years, never quite getting around to making the easy switch to the form design tool I already own that would have saved me $20 per year. The choice was made for me, which you may have noticed if you tried to use the form recently – the tiny company that hosted it lost their server and didn’t have a backup, so they shut the service down without letting users know. Try the new form instead.

My latest pet peeve: software companies that claim to be “population health management” vendors instead of “population health management software” vendors.

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Mrs. Schmidt’s California fourth graders can’t wait to start using the STEM lab kits and library we provided via her DonorsChoose grant request. Also checking in was Mrs. Marler of Alabama, whose third graders are using their new wireless document camera to explain their thought process to the class.

Not much will be happening over the next couple of weeks, so I’ll have less to write about. Then it will get crazy as it always does between New Year’s Day and the HIMSS conference, a frantic 10 weeks.

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It’s time for my annual reader survey. Take a couple of minutes to fill it out and you’ll be: (a) helping me, and (b) entering yourself into a random drawing for a $50 Amazon gift card.


Last Week’s Most Interesting News

  • Cerner requires its employees to sign away their rights to sue the company in return for remaining eligible for merit increases.
  • Robert Wood Johnson Foundation releases a dataset containing details of all marketplace-offered insurance plans for 2015 and 2015.
  • CMS gives doctor selection website Amino access to provider-level quality and cost data.
  • Five foundations donate $10 million to the OpenNotes initiative.
  • National Coordinator Karen DeSalvo, MD, MPH calls for health IT stakeholders to commit to providing consumer access, avoiding information blocking, and following standards
  • Dell is again rumored to be trying to sell the former Perot Systems for $5 billion to help pay for its EMC acquisition.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel

Here’s the video of Wednesday’s webinar, “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support,” sponsored by Wolters Kluwer Health and featuring guest presenter Rick Corn, VP/CIO of Huntsville Hospital (AL).


Acquisitions, Funding, Business, and Stock

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Columbus, OH-based Aver, which offers software that allows providers to calculate bundled prices based on past claims, raises $11 million, increasing its total to $22 million.

New York’s Capital Region loses its bid for $500 million in state money that would have supported an investment of $100 million to $200 million to create a population health technology hub, but IBM Watson Health and other participants say they will continue their efforts without the state funds.


Sales

China-based Luye Medical Group chooses the InterSystems TrakCare EMR.

University Hospital Southampton NHS Foundation Trust chooses Hyland OnBase for enterprise content management.


Other

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Pharma bad boy Martin Shkreli, who was arrested Thursday on securities fraud charges and then resigned (or was fired) as CEO of Turing Pharmaceuticals on Friday, spent Friday just like any other day: vainly live-streaming himself on YouTube as he exchanged messages with fans and critics, played his electric guitar, looked for women on dating sites, and played online chess. Magazines such as Vanity Fair are digging deeper beyond his cartoonish villain personality to acknowledge his brilliance, bluntness, and seldom-mentioned charitable side. Meanwhile, shares in biotech company KaloBios Pharmaceuticals, which Shkreli acquired a few weeks back via shrewd Wall Street betting, were halted on the news of his arrest, having shed half their value in pre-market trading. They had jumped from under $1.00 per share to as high as $40 after Shkreli’s involvement was revealed, all in less than four weeks. His stake in the company, once worth $80 million, is now valued at around $50 million, at least until trading resumes. He is apparently still serving as CEO of KaloBios. A UCSF medical school professor and author reminds those who expressed glee at seeing Shkreli perp walked that his infamous Daraprim price hike wasn’t illegal and in fact still stands:

It easy to demonize him. But if you’re going to let the market drive the pharmaceutical industry, it shouldn’t surprise anyone that he wants to maximize profits. There’s no law that he has to be ethical. His job is not to make drugs available and save patients. His responsibility is to make a profit for his shareholders.

Colorado puts single-payer coverage on the ballot, where the state would pay the medical bills of all citizens not covered by Medicare or military programs. Wage earners would pay 3 percent of their net income with their employers kicking in another 7 percent, with the new taxes covering the program’s estimated cost of $25 billion per year. Critics point out that Vermont already abandoned a similar plan because the state couldn’t afford it.

A California nursing home with a history of quality problems stops the IV antibiotic of a patient transferred from a local hospital after three days instead of the ordered four weeks due to a nurse’s order entry error.

France tackles anorexia head on by requiring models to obtain a doctor’s certification that their weight is healthy. The new law also requires magazines to clearly indicate when photos of a model have been Photoshopped to suggest a larger or smaller waistline, with fines of up to $40,000 for failing to do so.


Sponsor Updates

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  • Forward Health Group’s PopulationManager earns the highest preliminary rating scores in the KLAS population health management technology report.
  • KLAS names Wellcentive among its top five population health management platform vendors.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 19, 2015 News 7 Comments

Morning Headlines 12/18/15

December 18, 2015 Headlines No Comments

Report To Congress: Challenges and Barriers to Interoperability

ONC’s Health IT Policy Committee publishes its congressionally-mandated report on interoperability, covering the technical, operational, and financial barriers to interoperability.

Most Cerner employees are giving up the right to sue — to stay eligible for merit raises

Cerner has reportedly persuaded 93 percent of its 17,000 employees to sign arbitration agreements with the promise of $500 in stock options for those that agree, and the threat of withheld merit-based raises for those that refuse.

Shkreli, Drug Price Gouger, Denies Fraud and Posts Bail

Turing Pharmaceuticals CEO Martin Shkreli is arrested by the FBI on fraud charges stemming from his time as a hedge fund owner and manager.

HHS wants more states to data-mine for Medicaid fraud

HHS reports that few states have taken it up on its offer to receive federal funding to bolster data-mining programs in state Medicare fraud units, despite fraudulent payment rates continuing to climb.

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December 18, 2015 Headlines No Comments

News 12/18/15

December 17, 2015 News 2 Comments

Top News

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ONC’s Health IT Policy Committee issues its congressionally-mandated interoperability report that includes these recommendations:

  • Create outcomes measures that reward well-coordinated and affordable care, such as not paying for performing duplicate lab tests.
  • Publish EHR vendor interoperability scores based on actual customer use.
  • Add Medicare payment incentives for technology-driven care coordination.
  • Convene a summit meeting to start the operationalization of ONC’s Interoperability Roadmap and the recommendations in the document.

Reader Comments

From Fair and Balanced: “Re: Epic. Our support rep has been asking questions about one of our projects, saying Epic recently started an intra-company contest for writing news stories about positive client developments. She and I both speculate that Epic is looking for stories to feed to actual media outlets. If that’s the case, I’m uneasy that Epic is going to this length to promote itself in relying on its own employees for good news rather than for it to come about via independent parties noticing it.” Unverified. I’m not sure I would find that practice objectionable other than it seems to violate Epic’s unconvincing insistence that it doesn’t practice sales and marketing. Industry magazines and sites will cover anything that a vendor or provider hands them on a silver platter regardless of news value, but it’s a tougher sell to newspapers. I was once approached by the local big-city newspaper about a story that their highly visible technology reporter was writing about mobile devices. As I was taking him around to interview people at our hospital, I was surprised at how clueless and generally weird he was (he carried what looked like a purse and stopped every five minutes to squirt drops into his eyes, plus he didn’t seem to know much about technology). The resulting piece was superficial and not insightful since he simply regurgitated selective quotes from our folks, which is probably why I’m disdainful of former reporters who proclaim themselves health IT experts simply because they’ve spent a few years working at that superficial level.


HIStalk Announcements and Requests

This week on HIStalk Practice: AMA opens up its Physician Innovation Network to beta testers. Connecticut physicians detail their telemedicine challenges. Wisconsin joins the Interstate Medical Licensure Compact. Clinicians don’t seem convinced when it comes to HIE ROI. Stericycle VP Lyn Triffletti offers physicians tips to get a handle on HIPAA. Kaiser Permanente Northwest offers members urgent care video visits. Telemedicine keeps operations running smoothly at the North Pole. Dr. Gregg describes his user experience of e-prescribing in the dark.

This week on HIStalk Connect: Rock Health publishes its annual VC funding report which says that digital health startups raised $4.3 billion in investment capital this year, matching 2014’s total. Google partners with Johnson & Johnson to launch a new surgical robot solutions business. Medtronic partners with Samsung to develop smartphone apps for patients receiving neuromodulation therapy. Four foundations invest $10 million to fund the expansion of the OpenNotes program nationally, with a goal of reaching 50 million patients within the next three years.

Listening: Intronaut, LA-based jazzy progressive rock whose sound ranges from a jamming Alice in Chains to a heavier Tool. Also, one of my favorite bands, Zip Tang, masters of complex progressive rock now evolved to a power trio with the departure of the amazing Marcus Padgett (saxophone, keyboards, vocals, and most relevant to health IT, SVP of Experian Health).


Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Insurance company/PPO Clover Health, which analyzes insurance claims to target high-risk patients with specific care manager interventions, raises $35 million in Series B funding led by Sequoia Capital, increasing its total to $135 million.

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Data-driven physician performance website MD Insider raises $12 million, increasing its total to $24 million. The round was led by Summation Health Ventures, an investment fund started by Cedars-Sinai and MemorialCare Health Systems, with Cedars-Sinai CIO Darren Dworkin joining the company’s board.

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California startup Kumba Health launches a marketplace for consumers willing to pay cash to choose physicians, labs, and imaging centers.

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Oration, which offers prescription buying tools for the employees of large, self-insured companies, releases its first app and announces $11.2 million in Series A funding.

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Toronto-based customer management software vendor NexJ Systems spins off its population health management software business into a new company, NexJ Health Holdings.

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WellDoc, which offers a prescription-only diabetes management app, raises $22 million in Series B funding, increasing its total to $27 million.

Cerner says 93 percent of its 17,000 US employees have  signed away their right to sue the company in return for $500 in stock options and ongoing eligibility for merit increases. An expert says it’s the only example he’s seen where a company will limit future merit increases to employees who decline to sign its arbitration clause.


Sales

King’s College Hospital NHS Foundation Trust chooses Allscripts Sunrise.

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The VA contracts with Cogito Corporation, which sells voice guidance technology for telephone salespeople, for software that can assess the mental health of participating veterans by analyzing their telephone conversations.


People

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Paul Kleeberg,MD (Stratis Health) joins Aledade as medical director. He served on the HIMSS board from 2011 through 2015 and was its chair through June 2015.

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Practice Fusion hires Steve Filler (Oliver Wyman) as COO and promotes Octavia Petrovici to SVP of product management.

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Dan Orenstein (Athenahealth) joins Health Catalyst as general counsel.

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Divurgent promotes Shane Danaher to national partner of client services.


Announcements and Implementations

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Robert Wood Johnson Foundation releases a dataset of all insurance plans offered on health insurance marketplaces in 2015 and 2016, supporting state-by-state analysis of premiums, deductibles, and other plan attributes. For example, the dataset shows that prices increased an average of 10 percent for all tiers in 2016, while silver plans in Alaska saw the largest jump at 35 percent to an average premium of $643.

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LauraLynn, Ireland’s children’s hospice, goes live on Oneview Healthcare’s patient engagement solutions in providing entertainment for patients and bedside access to clinical applications for clinicians.

Health information service provider MedAllies will use IBM-owned Merge Healthcare’s iConnect Network Services for image ordering and results delivery for its members. 

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Columbus, OH-based CrossChx launches its Queue fingerprint-based check-in kiosk for hospitals that it says reduces wait times by 80 percent. The company says it links a fingerprint to hospital EHR data to provide interoperability when its customers check in somewhere else. Founder and CEO Sean Lane is a former Air Force intelligence officer and NSA fellow who served five tours in Afghanistan and Iraq before founding Battlefield Telecommunications Systems.


Government and Politics

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CMS names Amino as its second national Qualified Entity, giving the doctor selection website access to Medicare’s provider-level quality and cost data. Amino has raised $20 million in three funding rounds.

HHS says few states have accepted available federal money to support data-driven Medicaid fraud detection even as improper payments have nearly doubled to 10 percent. The states that were contacted by Modern Healthcare gave several reasons: they have their own data mining efforts, they are trying to figure out if it would help, or they’re waiting to see what other states do before jumping in.


Privacy and Security

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LifeLock will pay $100 million to settle FTC charges that it overstated its data protection capabilities and engaged in deceptive advertising.


Innovation and Research

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Researchers at NYU Langone Medical Center release a free app that uses Apple’s ResearchKit to track the symptoms of concussion patients.


Other

Madison magazine reviews the impact of Epic on Wisconsin, observing that it attracts huge numbers of liberal arts degreed young professionals who often leave the company after a few years but remain in the Madison area, giving Wisconsin an enviable population of high-achieving Millennials.

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Turing Pharmaceutics CEO Martin Shkreli, the most-hated man on the Internet for hiking the price of old but important drug Daraprim by 5,000 percent after acquiring it, is arrested by federal agents and charged with securities fraud. Prosecutors claim Shkreli played a Ponzi-like financial shell game while with Retrophin, a drug company he started before Turing that eventually fired and sued him. Shkreli had previously mocked the lawsuit, saying, “The $65 million Retrophin wants from me would not dent me. I feel great. I’m licking my chops over the suits I’m going to file against them.” A wag observed that Shkreli was arrested only after he bought a rap album and started wearing hoodies, another dubbed him “Karma Bro,” while The New Yorker’s satirical piece was headlined, “Lawyer for Martin Shkreli Hikes Fees Five Thousand Per Cent.”

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Former BIDMC CEO Paul Levy writes that news media misreported details about President Jimmy Carter’s cancer, running click-baiting headlines that gave credit to a “miracle drug” (which has actually performed poorly in clinical trials) while downplaying the likely impact of surgery and radiation therapy. Levy quotes a freelance health reporter’s comments at a medical summit in 2009 that sums up the state of medical and health IT journalism pretty well:

It is not our job to satisfy you [physicians], but to keep our readers reading and our viewers viewing. The more responsible the press becomes, the less readers seem to like it.

A fourth co-conspirator pleads guilty to impersonating a Cerner employee in selling medical equipment and $6 million in investments from 50 physicians.

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Kaiser Permanente will start its own medical school that will train students on its integrated style of care. The California-based Kaiser Permanente School of Medicine will admit its first class of 48 students in 2019.

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Another medical helicopter goes down as two crew members die in an Arizona crash. It was operated by the publicly traded, Colorado-based Air Methods, the self-styled “defenders of tomorrow” that operates medical transport services as well as its 60-aircraft helicopter tourism operation (the recently acquired Blue Hawaiian in Hawaii and Sundance Helicopters in Las Vegas). It also runs a billing company for other medical transport companies, including EMS agencies and ambulance services. The company earned $741 million in revenue where it staffs its own aircraft with medical personnel and bills the patient directly, as well as $162 million from hospital contracts. It earns an average of $12,000 in net revenue per patient transported. As the pie chart above illustrates, federal taxpayers provide 60 percent of the company’s patient revenue. Air Methods likes healthcare reform, predicting that more widespread insurance to pay for its transport services will increase its annual revenue by $31 million. The company’s investor presentation lists its #1 operational challenge as “accidents.” The Glassdoor reviews of Air Methods are pretty bad, with a common theme being that it isn’t really focused on the safety of patients and staff. It has a commendably obtuse and high-falutin’ but questionably punctuated mission statement: “To be the dominant global expert of comprehensive, vertically-integrated, critical care access solutions supporting patient logistics—the movement of patients and their medical analytics.”


Sponsor Updates

  • Medicity is positioned in the Leaders category in the 2015 IDC MarketScape.
  • LiveProcess is selected as one of 50 Most Promising Healthcare Solution Providers for 2015.
  • Medication management solutions vendor HighFive will replace manual mapping of data with SyTrue’s natural language processing and terminology tools.
  • CareSync founder and CEO Travis Bond will speak at an SXSW Interactive Festival session titled “Apps and Better Medical Outcomes: Real Solutions.”
  • Orion Health launches version 6.2 of its Rhapsody integration engine.
  • T-System names five of its ED customers as winners of its client excellence award.
  • MedData celebrates its 35th anniversary.
  • Inc. Magazine names Lexmark as a new corporate logo that went viral in 2015.
  • RedHat makes Glassdoor’s list of companies with the happiest employees.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 17, 2015 News 2 Comments

Monday Morning Update 12/14/15

December 12, 2015 News 9 Comments

Top News

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Alphabet’s Verily – the just-renamed Google Life Sciences – launches Verb Surgical, which will develop surgical robots in conjunction with Johnson & Johnson.


Reader Comments

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From Dickey Ascot: “Re: CareTech Solutions. COO Pat Milostan resigned last week. He follows the resignations of CFO Rob Johnson and Controller Dan Lincoln. Karl Graham, formerly in charge of its service desk, has been reassigned. Since the company was acquired by HCT Global Services of Chennai, india, six executives have resigned as its operation focus has been cost cutting and relocating customer services offshore.” Unverified. The company’s executive page still lists Milostan, Johnson, and Graham in the same roles, as do their individual LinkedIn profiles.

From Bill Duck: “Re: occupations. What would you have been if not a hospital IT person?” I wish I had the skill and personality to be a band manager like Shep Gordon, but since I don’t (and besides, I don’t tolerate prima donnas well), I would probably fall back on some solo endeavor that involves creativity, working mostly alone, a lack of convention, and not working for people or causes I don’t respect. My early days as a clinical analyst hit all of those except the last one, which was a partial match. Actually I guess I have that with HIStalk, which is maybe why I’ve stuck with it for so long. I would probably be a pretty good book editor, especially for non-fiction books.

From All R. Base: “Re: mHealth News. HIMSS Media is shutting it down in favor of recently acquired MobiHealthNews.” I don’t have a reaction since I don’t read either site. As far as I can tell, none of the folks involved have any healthcare or technology background, which is fine when they’re just rewording press releases to sound like expert reporting, but not so fine when they forget that they’re just watching the actual athletes perform as nacho-eating fans.

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From Schmarbitration: “Re: arbitration clauses. There was a great series of articles several weeks ago in the NY Times diving into arbitration agreements. The main reason companies do this is to make class actions go away and that has been upheld in pretty much all courts. Sounds like Cerner did this in response to associates being classified as exempt. Epic did the same a few years ago, but with no carrot and a very large stick. People mock frivolous class action suits, but ultimately, they are one of the only tools to keep companies in line when a small amount of damage is spread over large numbers of people.” The article says big companies are eliminating their lawsuit risk by adding a one-sentence arbitration clause (so-called “get out of jail free” cards for corporations) to their agreements, with examples being cable companies, cell phone providers, and online stores. Their customers are unlikely to have the money to pursue arbitration individually rather than signing up with an existing class, so the company gets its way, just like the Wall Street-led credit card companies and retailers intended when they masterminded their protective loophole. A federal judge concludes, “Ominously, business has a good chance of opting out of the legal system altogether and misbehaving without reproach.” An example is Cerner’s Kansas City neighbor Sprint, which charged $20 roaming fees to customers who never left home, but pocketed the millions because each customer would have been required to hire an expert witness at up to $1 million just to get back their $20. The Supreme Court upheld arbitration clauses starting in 2011, led by Chief Justice John Roberts, who as a private attorney for Discover Bank had been involved in creating them in the first place.


HIStalk Announcements and Requests

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It was just about a 70-30 poll respondent split as to whether their job is a significant part of their identity vs. just a way to pay the bills. Two percent said the most important part of their life is their employment. Furydelabongo would love to become a patient advocate but keeps working as a “disruptive innovator” after realizing that his/her employers in care delivery and healthcare IT don’t keep patient interests foremost. Mobile Man says his need to support the most important thing in his life – his family – has overemphasized his work as part of his self identity. Cassie admits that she associates the majority of her personal value with her work, but wishes she could stop and move into the “it just pays the bills” group.

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New poll to your right or here: What is your reaction to Cerner employees becoming ineligible for future pay raises if they refuse to sign an arbitration agreement? Answer and then click the poll’s Comments link to explain, especially if your employer already has such an employment clause in effect. Tick, tock.

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Ms. Catoire sent photos from her urban Virginia high school earth sciences class, for which we provided a Chromebook and printer supplies via her DonorsChoose grant request. Her school can’t earn accreditation because it lacks supplies for interactive and hands-on learning, with our donation allowing her to improve individual learning by supporting individual learning styles. She adds, “Just a few of the activities that I use in my class include having the students create animated presentations, movies, mock assessments, and virtual labs, all which have been made possible by your donation … it is because of your generosity that both the students and myself find the teaching and learning process to be so exciting and fulfilling.”

I was thinking about the ridiculous situation where a patient’s in-network hospital has all kinds of out-of-network people running around sending them bills their insurance doesn’t cover. Instead of those “not this one” markings surgeons make to ensure that they don’t amputate the wrong leg, patients need to write in Sharpie on their foreheads, “no out-of-network providers.” Or, perhaps bring their own single form (vs. the mountain of them the hospital requires them to sign) in which the hospital agrees to provide no out-of-network services without prior authorization. It’s pathetic that hospitals take no responsibility for using providers who bill separately without accepting the same insurance. It’s like paying for a pricey restaurant meal and later finding your credit hard hit for charges from the chef, florist, and exterminator.


The Meaningful Love Program

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I hereby propose that the federal government turn over responsibility for managing the IRS’s “married filing jointly” tax break. Couples can expect these changes.

  • Couples who want to file jointly will be required to participate in the Meaningful Love program, in which they will document the quality of their relationship using  government-certified software called Electronic Marital Records (EMRs).
  • Conversations and other intimate encounters must be documented via a series of EMR checkboxes and predefined text strings as entered on ever-present computers positioned between them at all times, with the administrative burden estimated at eight distracted minutes of the average 12-minute encounter.
  • Heartfelt handwritten cards and murmuring phone calls will be eliminated in favor of email templates (CPOE, or Computerized Partner Outlook Entry) composed by choosing from a series of government-approved drop-down phrases to improve legibility and standardization.
  • Marital decision support will be used to provide evidence-based recommendations such as anniversary reminders, suggested behavioral changes based on menstrual cycle tracking, and time-since-last-sex alerts.
  • Each couple must maintain a marital problem list that they reconcile during each encounter.
  • EMR records must be sent electronically upon request to anyone with whom either partner might wish to arrange an outside dalliance or in the case of divorce where the new partner would benefit from having the old partner’s EMR data. This will improve the urgent “unconscious person in my bed – what do I do without a history?” scenario as long as all US couples participate despite a lack of incentive for doing so. Future program enhancements will provide the other partner a real-time alert when the tryst has been scheduled.
  • The amount of the tax break will be pro-rated based on mutual attestation that the relationship is loving, the surveyed satisfaction of both people, and their romantic performance as benchmarked against other couples.
  • The Eligible Pair (EP) must submit their EMR-generated marriage quality data to the appropriate state and federal agencies and for the benefit of unmarried researchers who are trying to understand how relationships work.

These requirements are being protested by the American Marital Association and the EMR vendor-sponsored social media campaign #LetLoversBeLovers, but in the mean time, couples who are unwilling to share their marital bed with Uncle Sam just to avoid a few dollars in penalties can opt out by filing individual tax returns.


Last Week’s Most Interesting News

  • Cerner tells employees to sign away their right to sue the company or else they will never be given pay increases.
  • Ascension Health buys almost half of Accretive Health and signs a 10-year revenue cycle agreement with the company.
  • UL acquires IT accreditor InfoGard, which certifies EHR and EPCS systems.
  • National Coordinator Karen DeSalvo, MD tells a group that public health receives only 3 percent of federal health expenditures vs. 97 percent paid to deliver medical services even though 80 percent of health doesn’t involve doctors and hospitals.

Webinars

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Sales

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Kaleida Health (NY) chooses Ascend Software for accounts payable document imaging.


People

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Baptist Memorial Healthcare (TN) adds CIO to responsibilities of Beverly Jordan, RN, its VP/chief clinical transformation officer.


Announcements and Implementations

Versus Technology announces a new Wi-Fi locating platform and asset tags.


Government and Politics

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National Coordinator Karen DeSalvo, MD, MPH calls for health IT stakeholders to commit to providing consumer access, avoiding information blocking, and following standards to support her vision of a connected health system that includes an app store of FHIR-based consumer tools.

An essay in the Wall Street Journal says the Affordable Care Act is “neither the triumph trumpeted by its proponents nor the disaster suggested by its critics.” ACA’s positives include reducing the number of uninsured patients, its possible effect on slowing healthcare spending growth, the upcoming Cadillac tax that encourages employers to control low-value spending, and the creation of a more cost-conscious market than existed with employer-provided insurance. Its negatives are rising numbers of insured thanks to Medicaid expansion that is “more like welfare for the medical-industrial complex than support for the needy” and being promoted as budget-neutral when it isn’t. The article concludes, “Both sides also need to recognize that the changes in incentives necessary to bend the cost curve will be highly unwelcome to many Americans. Markets for health care are the perfect example of the old saying that ‘every dollar of waste is someone’s income.’”


Technology

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Several high-profile Silicon Valley technology entrepreneurs, including Tesla’s Elon Musk, donate $1 billion to launch non-profit OpenAI, which will develop artificial intelligence technologies that benefit humanity without worrying about profit. They might be surprised to find that healthcare’s use of AI and other technologies always has profit first and foremost, with benefit to patients coincidental.

The Chicago Tribune observes EHR-caused doctor burnout, focusing on doctors turned into data entry clerks and patient visits that emphasize clicks and drop-downs rather than paying attention to what patients tell them.


Other

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Turing Pharmaceuticals CEO Martin Shkreli is getting the publicity exposure of his life and not just for raising Daraprim prices 5,000 percent and buying $2 million rap albums. Shares in the failing biotech company he bought a few weeks ago for $1.50 are now trading at $28 as investors express confidence that newly named CEO Shkreli will figure out a way to rape the system. Apparently he has – the company has exclusively licensed a drug not available in the US that is used to treat an uncommon parasitic disease. The drug sells for $50 per course of therapy and Shkreli says he’ll raise the price to the $60,000 to $100,000 range. About 300,000 people in the US have the disease, almost all of them Latin American immigrants who entered the country with it, and Shkreli estimates that 3,000 to 7,000 of them will need treatment each year. Even if the market doesn’t pan out, Shkreli has another path to quick profits – he is petitioning the FDA to grant him a fast-track research voucher that he can resell to another drug company for up to $350 million, which benefitted Shkreli’s previous drug company that sold one of the free FDA vouchers for $245 million. I admit that I would invest in his companies since his entire focus is on enriching himself and his investors without letting altruistic emotions interfere with his lust for profit.

A new Missouri law addresses the physician shortage by eliminating residency requirements, allowing newly graduated medical students to start practicing immediately. Medical associations don’t like the law, saying medical schools aren’t set up to prepare their graduates to start practice immediately, perhaps forgetting that residencies were neither mandatory or common for non-specialists outside of urban areas in the early 1980s. So far no new graduates have taken advantage of the change, however, probably realizing that it’s a career gamble that won’t pay off if other states don’t follow suit.

A former part-time employee of New York cardiologist Hussain Khawaja, MD sues him, claiming he fired her looking up her computerized hospital records to determine that she was pregnant. She says the doctor told her while recruiting for other positions that he doesn’t hire applicants with children.

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New York’s tax department notifies 1,900 taxpayers who worked for Erie County Medical Center in 2012 that they owe the state money because miscoded hospital W2 forms gave them a pension deduction to which they weren’t entitled. The hospital found a bug in its payroll system and says it will pay the interest, fees, and penalties for those affected and will even provide up to $200 to those who hire a tax preparer to amend their 2012 tax forms.

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Medical helicopters seem to crash a lot given their small numbers, with 78 deaths in the past decade. In a new example, a patient and three rescue personnel die when a SkyLife air ambulance goes down in fog and rain in California. I’ve known folks on hospital helicopter teams and it’s a funny business, with such high cost for so few deployments that ROI (other than for dramatic hospital photos) is tough to justify. I would guess in the vast majority of countries where healthcare is a service rather than a private industry the number of such helicopters is low. As was eloquently stated in “The Right Stuff” even though it wasn’t talking about insurance companies or taxpayer subsidies, “no bucks, no Buck Rogers.”

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Magician Penn Jillette turns into a pitchman for Withings after using the company’s smart scale and blood pressure monitor to lose 120 pounds in switching to a plant-based diet.  He explains, “It’s just making it automatic and instant. It doesn’t allow a guy like me to spin information — something I’m normally very good at. A little tool, a little bit of a nudge, can make a huge difference.” Penn will be all set if Withings invents a scale to monitor his still-overweight obnoxiousness.


Sponsor Updates

  • TransUnion Healthcare identifies more than $1 billion in insurance payments for hospitals.
  • Versus joins the Cisco solution partner program.
  • Freakonomics author Stephen Dubner will keynote Zynx Health’s Care Guidance 2016 event May 23-26, 2016 in New Orleans.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 12, 2015 News 9 Comments

Morning Headlines 12/11/15

December 10, 2015 Headlines 6 Comments

Maryland fires firm upgrading Medicaid technology, may seek money back

Maryland fires and then sues CSC for unacceptable performance during a $300 million Medicaid computer system upgrade contract.

Cerner Corporation offers US employees tough choice: Agree to arbitration or give up merit raises

Cerner is asking employees to sign an arbitration agreement that bars them from filing lawsuits against the company for any reason. Those that refuse are being told they will give up merit-based raises, while those that comply are being given $500 in stock options.

LabMD Loses Sanctions Bid Against Tiversa Over Info Leak

A judge denies LabMD’s request for sanctions against Tiversa, the cybersecurity firm that illegally breached its network and then reported the breach to the FTC.

Patient data compromised after cyberattack hits MaineGeneral Health

The FBI notifies MaineGeneral Health that an undisclosed number of patient records has turned up online after a cyberattack on its network last month.

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December 10, 2015 Headlines 6 Comments

News 12/11/15

December 10, 2015 News 2 Comments

Top News

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Maryland fires Computer Sciences Corp. from a $300 million Medicaid computer contract for unacceptable performance and may sue the company to recoup some of the $30 million it has already spent. It had suspended the contract in February. The state’s track record for health IT projects isn’t so good: it also threatened to sue Noridian Healthcare Solutions, the contractor of its health insurance exchange that failed within minutes of its October 1, 2013 go-live, but instead settled for $45 million in July 2015. Most of the wasted money for both Maryland projects, more than $200 million, came from federal taxpayers, although Maryland’s tally is less impressive than Oregon’s squandering of more than $300 million of federal money for an insurance exchange that never even went live. CSC’s record isn’t great, with state Medicaid system problems in North Carolina and a key role in the massive failure of NPfIT in England.


Reader Comments

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From Rude Boy: “Re: Greenway. Taking direct aim at NextGen in this mailing sent to customers.”

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From Clam Chowdah: “Re: Brigham and Women’s. Apart from cost overruns, the main operational issues have been because of radiology and one of their legacy systems. Overall, Epic has performed well.”

From Memphis Hank: “Re: executives of big software companies who not only studied, but also taught software engineering or computer science. Along with Epic, there’s also Adobe, SAS, and ESRI. An interesting follow-up analysis would be: what happens to products and customers when geek founders are replaced by private equity and other finance-centric executives?” Big companies run by technologists are about as rare as big health systems run by clinicians.

From Hot Tub Club: “Re: funny video. Remember this one you wrote up years ago?” I remember the dry-humored, four-part video from 2009 in which a slick but clueless salesperson (“I’m not really familiar with what our software things do”) meets with an annoyed and sometimes profane CIO. I was trying to recall the animation tool used and finally remembered that it was Xtranormal, which shut down in 2013.


HIStalk Announcements and Requests

I took my car in for an oil change and got a rare look at daytime TV with a laugh-inducing sight: Dr. Oz wearing scrubs on a talk show as though he might be called upon to perform an impromptu, on-screen surgery on one of the incessantly chatty hosts.

Watching: Jane the Virgin, a witty, fast-paced, and non-profane comedy that has Season 1 on Netflix. I had to give up on American Horror Story because of its overreliance on profanity and graphic violence in Season 2, but that’s OK since I rarely watch TV anyway.

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Nick van Terheyden followed up on his observation that HIStalk is blocked by the government in United Arab Emirates, which I thought might be a technical issue instead since several of my Dubai readers say they can read it just fine.  Dr. Nick asked the Emirates Integrated Telecommunications Company to unblock it, but they said it’s intentional per Telecommunications Regulatory Authority. Beats me why.

Last chance to nominate your choices for the HISsies awards. I’ll be emailing ballots to the people who have signed up for HIStalk updates in the next few days. It’s easy to spot the company-encouraged employee responses because the respondents skip most of the categories except Best Vendor and Best Leader and enter their company and CEO names there.

This week on HIStalk Practice: Physicians in rural West Virginia feel the effects of high-speed broadband connections. Hattiesburg Clinic and HealthNet receive HIMSS accolades for their use of health IT. Performance Physical Therapy CEO Michelle Collie outlines the health IT challenges faced by PT practices. Allscripts breaks ground on a new office tower. MediKey partners with Teladoc and EDocAmerica. WebPT expands into new Phoenix digs. Brazilian physicians lead the way in communicating with patients via WhatsApp. Everseat CEO Jeff Peres details the impact of unfilled practice seats.


Webinars

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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Express Scripts will invest $25 million in revenue-generating health IT companies related to drug adherence and personalized care. Actually the announcement says the investments will focus on “prescription drug adherence,” so I assume those who are addicted to street drugs are already adhering just fine on their own.

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India-based Tata Consultancy Services will join Vanderbilt University Medical Center’s CTTC commercialization group to develop products related to bioinformatics, care management, and analytics.

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Goldman Sachs and other investors provide $41 million in funding for doctor search site Vitals, raising its total to $86 million.


Sales

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Adventist Health System chooses Athenahealth’s EHR, PM, and patient engagement services for its 1,600 employed physicians.

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Ascension Health signs an exclusive, 10-year revenue cycle agreement with Accretive Health and will invest $200 million in the company. That’s an interesting development given that Ascension tried to buy Accretive this past June, was turned down by Accretive, and then announced that it would not renew its contract with Accretive that was to expire in 2017, forcing Accretive to “undertake a review of strategic alternatives” at the prospect of losing a customer that represented 50 percent of its business. Accretive shares jumped around 50 percent following the latest announcement, but are trading at 90 percent less than their mid-2011 price and at about half the share price at the time Ascension offered to buy the company. Accretive’s market cap is $300 million, so a $200 million investment must represent at least a 50 percent stake.


People

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LogicStream Health names Jack Hauser (Ability Network) as CFO.

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Scripps Health (CA) names Andy Crowder (MaineHealth)  as SVP/CIO.

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Gurpreet Singh (MD Revolution) joins CareSync as VP of interoperability. The company says it has hired 60 employees since it announced $18 million in Series D funding in October.

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HIMSS and CHIME name Craig Richardville, SVP/CIO of Carolinas HealthCare System, as John E. Gall, Jr. CIO of the Year.


Announcements and Implementations

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SCL Health (CO) offers $40 physician video visits via Doctor On Demand.

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Orion Health launches Amadeus, a data platform that offers predictive modeling and machine learning to support precision medicine. It also features open APIs for developers to create additional services.

Idaho HIE goes live on a clinical portal from Orion Health.


Government and Politics

CMS says that 2.8 million people have signed up for insurance via Healthcare.gov, one million of them first-timers. Healthcare.gov CEO Kevin Counihan say 80 percent of consumers can find coverage for less than $75 per month after government subsidies.

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The White House announces mental health hackathons and data sprints on Saturday, December 12 in Boston, Chicago, New York, San Francisco, and Washington, DC.


Privacy and Security

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A federal judge denies LabMD’s request for sanctions against security vendor Tiversa, which LabMD said intentionally breached its systems and then threatened to report the company to the government if it didn’t buy Tiversa’s security services, resulting in LabMD’s eventual shutdown after a long Federal Trade Commission fight. Meanwhile, Tivera’s CEO, stung by accusations of extortionate sales practices in LabMD’s case, writes a Wall Street Journal letter titled, “Tiversa Was a Good Samaritan, Not a Bully” in which he states that the company sent LabMD a services proposal at the company’s own request without any threat that it would otherwise tell the FTC about the exposed information. He blames a former Tiversa employee turned whistleblower who has “a history of not telling the truth.” He says Tiversa is suing LabMD and its former employee for defamation. 

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The FBI finds patient information from MaineGeneral Health online and alerts the health system, which says radiology patient information is at highest risk. Employee and prospective donor information was also taken.

A hospital employee and his wife are charged with stealing the information of 80 patients to take over their credit card accounts and fraudulently charge $300,000 worth of upscale fashions and accessories.


Technology

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A study finds that two-thirds of doctors in Italy and nearly 90 percent in Brazil communicate with their patients via the WhatsApp messenger app.

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Shriners Hospital for Children (UT) tests its new telemedicine system by offering children video chats with Santa Claus.


Other

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A Mayo Clinic Proceedings article looks at physician burnout, which it unsurprisingly concludes is getting worse. It should have added a third axis of average income by specialty, which would have shown that internal medicine and family medicine have high burnout paired with lower incomes compared to their equally burned out but higher-earning peers in orthopedic surgery and radiology.

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A Kansas City TV station reports that Cerner is requiring its employees to sign an arbitration agreement that prevents them from suing the company for any reason, offering them $500 in stock options if they signed by December 8 but denying them future merit pay increases if they didn’t. Employees had previously filed two class action lawsuits claiming they were incorrectly classified as salaried employees and thus were denied overtime pay. The arbitration clause would eliminate the possibility of such lawsuits. An anonymous Cerner employs speculates on Reddit (not entirely convincingly) that Cerner is trying to work around terms of its Siemens HS acquisition that require it to use Siemens service years to calculate severance pays in the case of Malvern layoffs.

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Regina Holliday is running a GoFundMe campaign in hopes of raising $10,000 toward her expenses in creating The Walking Gallery jackets. I should also mention her excellent book, “The Writing on the Wall,” that came out earlier this year. I see it’s now available for Kindle as well as softcover. I thought it was superb and I strongly recommend it.

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The mystery buyer of the one-of-a-kind Wu-Tang Clan rap album — the most expensive in history at $2 million for the only copy that will ever be sold — is revealed to be the most-hated man on the Internet, Turing Pharmaceuticals CEO, pharma bad boy, and aspiring rap producer Martin Shkreli. Shkreli says be bought it hoping he can hang out with celebrities who want to hear the album (he’s hoping for Taylor Swift), but when asked if will stream it free for Wu-Tang fans, he replied with the same logic that’s behind his 5,000 percent price hike for Daraprim, “Why would I pay millions of dollars just to let everyone listen to it for free?” He says he may commission more bands to make albums for his ears only just because he can.

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Weird News Andy predicts “Sold Out in Chicago,” as FDA approves commercial sale of a former military-only device that injects sponges into a bullet wound to stop bleeding in 20 seconds. The sponges are tagged with radiopaque markers so they can be detected and removed later.


Sponsor Updates

  • PerfectServe adds Robert Rinek of Paper Jaffray and Brant Heise of Memorial Care Innovation Fund to its board.
  • Health Catalyst is named a “best place to work” on three lists, two national and one regional.
  • PeriGen’s Emily Hamilton is published in the American Journal of Obstetrics & Gynecology.
  • Streamline Health Solutions signs a reseller agreement with outsourcing solutions provider Himagine Solutions.
  • InterSystems receives the HIMSS Middle East Integrated Health Innovations Award 2015 – mHealth category.
  • MedCPU will host four US-based hospital CIOs December 14 in Israel as part of a CHIME/Israel Export & International Cooperative Institute event.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

 

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December 10, 2015 News 2 Comments

News 12/9/15

December 8, 2015 News 4 Comments

Top News

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Acting Assistant Secretary for Health and National Coordinator Karen DeSalvo, MD, MPH tells a group that US public health is “marginalized and under-funded” as 97 percent of available federal money is spent on delivery of medical services even though 80 percent of health factors don’t involve hospitals and doctors’ offices. She adds, “The notion of population health doesn’t end with a geographic boundary … it’s everybody in the community,” giving the example that parts of Baltimore have worse health than North Korea.


Reader Comments

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From The Freshman Whisperer: “Re: Hour of Code. I was at a ninth-grade career fair last week telling students the story of technology and how the healthcare industry needs help. As a part our booth, we had students try Hour of Code. I was happy to hear that many students had tried coding before (lots even enjoyed it) and were considering a career in computer science. I wasn’t offered any coding classes in high school. Thumbs up for teachers teaching young coders. My company can’t hire enough of them!”

From Health Dataphile: “Re: HCA’s inpatient and outpatient facilities in the Southeast. Meditech went down over the weekend and, as far as I know, is still down as of Monday morning.” Unverified. Usually an outage of that magnitude would be related to data center communications or some type of network failure, which HCA might be prone to since it deploys Meditech and other systems regionally. That might be a lesson for everyone anxious to get out of the operations business and move to a cloud provider – cloud systems are probably better architected, but they can still go down or you can lose access to them if something happens to your real-world connectivity. A reader in an HCA hospital in Florida says the ICU nurses didn’t know the downtime protocol they were supposed to be following, but on the bright side, doctors fell back to writing and dictating orders instead of entering them into the computer, allowing them to leave for home earlier than ever. The nurses were worried about medication reconciliation between the MARs and Pyxis machines.

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From This Is Just Silly: “Re: Judy Faulkner’s letter on exhibit at the Smithsonian. I would have rather seen the letter or email she sent to George Halvorson at Kaiser Permanente when she turned down KP’s interest in buying Epic.” The National Museum of American History’s just-opened “Giving in America” exhibit includes the letter Faulkner wrote in pledging that she will donate 99 percent of her $3 billion fortune to charity. I was just thinking that Epic must be one of very few hugely valued companies where both top executives studied computer science.

From Unscheduled: “Re: McKesson’s scheduling software. I’m hearing it is ending support. Do you know if that’s true?” I don’t, but anyone who does is welcome to comment.

From Ground Pounder: “Re: salary survey. Cute infographic hides terrible methodology.” It’s puzzling why reasonably smart people will believe a dumbed-down graphic instead of paying attention to what it’s based on, although far less puzzling why crappy “news” sites run the graphic as clickbait. The members-only report is based on a survey of only 700 people who were apparently self-selected, meaning any conclusions it attempts to draw are not believable, especially when it tries to segment the responses into subcategories. Here are some headlines the self-promoting report drew by sites that simply reworded the press release, with extra points for the first entry (which turned it into a “listicle” like you’d see on celebrity gossip sites) and the last entry (which seems to attempt a Donna Summer song pun):

  • Health IT professionals think they’re underpaid: This and 9 more findings on IT salaries
  • Average healthcare IT salary tops $87,000, job tracker survey finds
  • Average Health IT Salary Down, but Job Satisfaction Up, Report Finds
  • Health IT Professionals Report High Salaries, Job Satisfaction
  • Survey: HIT workers get lower salaries than desired
  • Infographic: Health IT workforce paid well, but perhaps not enough
  • Health IT Pros See High Salaries Due to Increased HIT Needs
  • Working Hard for the Money

HIStalk Announcements and Requests

HISsies nominations will remain open for a few more days. The best nomination I’ve received so far is in the “smartest vendor action taken” category, where someone offered, “Hiring hookers to seduce my COO.” Athenahealth has obviously put the word out to employees as indicated by both boilerplate nominations in several categories and repeated IP addresses that are dominating the responses, but that’s OK since the final ballot will be delivered by the unstuffable ballot box of direct email.

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Ms. Lam from California says she assigned her first graders, most of whom are from immigrant families in which English is their second language, to work with fourth-grade partners using the hands-on Make Wonder programming and robotics kit we provided by funding her DonorsChoose grant.


I wrote earlier this week about a friend who keeps working for her vendor employer even while fighting the cancer that will almost surely kill her because she’s worried she isn’t replaceable at work. It resonated with a reader who sent me an internal executive email exchange from a few years ago. An employee of a large health IT vendor was determined to keep working despite having cancer (of which she died shortly after) so that her retirement plan could vest for her surviving family. I’m paraphrasing the exchange below:

[Executive to CFO]: The employee thinks she needs to push through and keep working even though it will be one of the last things she will do on this Earth. Without being too nosy, can we vest the retirement even though the dates haven’t arrived?

[CFO] I want to make this happen and will approve the change under my board-delegated authority. Consider this as my approval. This is the only time I have ever approved such an action, but it seemed appropriate. A great example of why it feels great to work at [vendor name omitted].

[CEO] I am in complete agreement. Today is a gift – that is why they call it the present. 


Webinars

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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San Diego-based MD Revolution raises $23 million. It offers a patient engagement platform that allows providers to bill Medicare for delivering chronic care management services.

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UL acquires InfoGard, an IT accreditor whose offerings include certification of EHRs and electronic prescribing of controlled substances systems.

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EClinicalWorks will spend $30 million in India to build a data center and increase its 1,000-employee headcount there by at least 300 in the next three months. The company will offer consumers in India an app to view lab results, find doctors, maintain personal health records, and schedule appointments. The company has already signed 40 hospitals and 20 practices in India.

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The Wall Street Journal summarizes the strategy behind the turnaround of Valeant Pharmaceuticals that has brought criticism as well as a 4,000 percent share price increase that gave its CEO $2 billion in holdings:

  • Cut research and development expense.
  • Take over dozens of drug companies.
  • Buy undervalued drugs and raise their prices.
  • Focus on skin treatments, mostly just redesigning old ones rather than researching new ones, knowing that dermatologists are responsive to drug salespeople and prescribe by habit.
  • Sell its dermatology products through a now-closed mail order pharmacy that used aggressive sales tactics.

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Twine Health, which offers health coaching software developed at MIT, raises $6.75 million.

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San Francisco-based concierge medicine provider One Medical Group raises $65 million to expand its service area and to further develop its enterprise and mobile technology solutions, increasing its total to $182 million.

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Google has renamed many of its business and does the same with Google Life Sciences medical device group, now known as Verily. Meanwhile, GV (formerly known as Google Ventures) says it is less interested in seed-stage investing and will instead pursue more mature companies, with an ongoing emphasis on healthcare and life sciences firms.

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Harris Computer Systems relocates its QuadraMed EMPI Solutions business to a high security office in Plano, TX that can house up to 100 employees.


Sales

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Weirton Medical Center (WV) chooses Besler Consulting’s Transfer DRG Revenue Recovery Service.

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Scripps Health (CA) chooses the Health Gorilla Clinical Network to provide patients with access to imaging and lab information.


Announcements and Implementations

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Intelligent Medical Objects announces GA of its 2.0 release that includes silent terminology updates, support for natural language processing, quarterly refreshes of major dictionaries, and a CQM dashboard.

PatientPay announces that customer Greenwood Pediatrics (CO) reduced its billing costs by 47 percent by switching from paper to the company’s online bill review and payment.

Cloud hosting provider Infinitely Virtual announces that it has passed the HIPAA audit that allows it to offer health IT hosting plans, including a $10 per month option for full-disk encryption for each virtual machine.

Telemedicine services company Virtual Radiologic announces that it has applied artificial intelligence to data from the 90,000 head CTs it performs monthly to create a real-time warning to its teleradiologists that a patient might be experiencing intracranial hemorrhage.

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A Finland-based software vendor licenses a web-based geriatric assessment system developed by the University of Queensland in Australia. The software records and monitors the progress of elderly patients before, during, and after hospital stays and can be used to deliver telehealth services. The CeGa Online system is already offered by Queensland Health. The same researchers have also developed a residential care version.

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SAP announces software for medical data analysis and clinical trials recruitment.


Government and Politics

The White House enlists ZocDoc and Oscar Health Insurance Corp. to provide free advertising that will urge uninsured people to buy insurance via Healthcare.gov in the final week of open enrollment. ZocDoc will target customers who have paid cash for the appointments they booked through its scheduling service, while Oscar chas reated an explainer video that it will distribute in the handful of states where it sells plans.


Privacy and Security

A physician-written editorial in the Journal of American Physicians and Surgeons says that patient privacy is an illusion because of electronic medical records that make data available without patient consent for oversight and research. The psychiatrist, Susan Israel, MD, wants EHRs redesigned to give patients control of their information via consent requirements “regardless of cost and complexities involved.” 


Innovation and Research

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Google patents a needle-free blood draw system that uses compressed gas to pierce skin and then draw the resulting blood into a collection chamber. The patient covers two possible devices, one for diabetic finger-sticks and the other worn as a wristband. Companies seem to be enchanted with the idea that patients need an alternative to needles and the collection volume of standard blood draws, but for me, that’s far less important than avoiding the inhospitable long waits at LabCorp and Quest drawing centers full of people whose NPO stomachs growl as they watch awful TV shows that working people rarely see.


Technology

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Carequality releases its interoperability framework (legal terms policies, technical specifications, and governance processes) that allows organizations to quickly establish data sharing agreements with partners.


Other

Brigham and Women’s Hospital misses its budget surplus target for FY2015 by $53 million, which it blames on weather, employee retirement costs, and the cost of transitioning to Epic. The hospital had budgeted $47 million for its Epic conversion, but instead spent $74 million. Revenue also fell short by $13.5 million as employees didn’t code cases correctly on Epic.

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A summary of McKinsey’s previous healthcare consumerism studies concludes that while patients say their outcome is the most important factor in their satisfaction with providers, it’s actually clinician empathy (especially from nurses) and the information they are given before and after treatment that is most closely correlated to satisfaction. Access to medical records wasn’t all that important and neither was the perception of value received. A study also found that while 40-50 percent of patients aged 18-34 want to use technology to speak to their provider by phone, schedule appointments, and check health status, the percentage drops sharply for those aged 35-55. Respondents are also willing to share health monitoring data capture with their PCPs, but not very many would do so with friends, family, insurance companies, and employers.

Researchers mine EHR databases at two hospitals to detect a previously unknown correlation between the use of androgen deprivation therapy and later development of Alzheimer’s disease. The study used text-based data mining methods developed by one of the authors that were patented by Stanford University. The hidden value of a study like this is that researchers can look at the entire patient population of a health system rather than just individual patients who opt in for a study that was designed to test a particular theory.

A study in England proves that patients are as clueless about antibiotics as doctors keep saying. Two-thirds of them expect to get an antibiotic prescription for a cold or flu, one-third think they should stop taking antibiotics once they feel better, and three-quarters believe it’s the human body rather than bacteria that grow resistant to the drugs. Doctors who apply sound science to writing antibiotic prescriptions are seeing their patient satisfaction ratings fall, with a 3- to 6-percentile drop for every 25 percent reduction in prescriptions. The other GPs just keep cranking them out to keep patients happy, with half of those patients receiving an inappropriate antibiotic prescription. 

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A Florida woman is jailed for hit and run when her car’s crash-triggered electronic monitoring system automatically calls 911. The operator, suspicious of the woman’s insistence that nothing had happened when the device clearly showed that it had, dispatched police, who found her car damaged with the airbag deployed.


Sponsor Updates

  • Forrester Research ranks AirWatch as an enterprise mobile management leader.
  • TransUnion Healthcare announces that its eScan product has found patient insurance coverage worth $1 billion in hospital payments that would have otherwise been written off to bad debt and charity care.
  • Sixteen Influence Health clients receive eHealth Leadership Awards.
  • LiveProcess exhibits at the National Healthcare Coalition Preparedness Conference through December 4 in San Diego.
  • Oneview Healthcare launches an internship competition.

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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December 8, 2015 News 4 Comments

HIStalk Interviews Kim Sell, President, Clinical Computer Systems, Inc.

December 7, 2015 Interviews No Comments

Kim Sell is president of Clinical Computer Systems, Inc. of Elgin, IL.

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Tell me about yourself and the company.

I started working in healthcare in 1992 for our predecessor company, Peritronics. I left that company in 1997 and started a service company, Clinical Computer Systems. In 2001, we acquired Peritronics and have grown it since then. Today we are a 100 percent employee-owned company that is focused on OB data systems. We have about 100 employees and plan to grow that another 10 percent this year.

How does an employee-owned company work and how does that impact the company’s philosophy and strategy?

We can focus on the things that we think are important to our company culture, to our customers, and to our employees. We don’t have outside shareholders or an exit strategy that we have to worry about with a three- to five-year horizon. We can do what we feel is right for customers and employees at different times without the constraints of outside capital. I don’t think outside capital is wrong — we have evaluated outside capital at different times for ourselves — it just has to be done at the right time for the right reasons.

Obix is FDA approved as a medical device. How does that change how your developers work?

I don’t know that it’s a massive change, but it definitely does introduce a different level of internal review and consideration of what we’re doing for the patient, for the customer. It also helps to define the market a little bit more, where it is a market that has some risk that sometimes a larger company or a different type of company wouldn’t want to enter this space. There are some differences that it does create and it’s risk. You have a government entity that could basically walk in at their choosing and shut down or challenge the company’s premise at any time.

I think we have a more stringent review process and a more stringent testing process that goes out. Also, it gives our customers another voice. If they’re not happy with how we perform, we also have to be aware that there’s a government regulatory body that they can go to to complain about us, challenge how we do things and how we’re satisfying them. Risk review and risk evaluation.

What are the clinical and legal issues faced by your perinatal technology users that are different from the rest of the hospital?

It’s one of the few, if not the only, area of healthcare where it’s really not an illness. Having a baby, having a pregnancy in and of itself is not something that is not a defined illness. A patient goes into a hospital in that condition and exits usually even happier.

The risks that go with that, though, are that it’s also one of the most litigious or most expensive areas of the hospital. The last stat I I saw behind anesthesiology is that it’s the most litigious part of the hospital in terms of settlements and risk management. It’s an area where they have to make sure they’re covering their bases and making sure that they’re doing the right things not to create exposure for the hospital. We help with that, making sure the care protocols are right, that they’re following the right care paths, and are evaluating the patients appropriately.

Do most L&D areas use software to assist them in the perinatal process or do some still use paper?

It’s a replacement market for us. I would say probably ninety percent of hospitals that have a labor and delivery department have a central monitoring system. We maybe run into one or two a year that do not.

Where does Obix go from here?

Our history has been focusing on services and integration with enterprises. The last few years with ACA and Meaningful Use, we’ve been focusing on trying to create a product that’s fully integrated, where you almost can’t tell the difference between our product and what is … everybody’s driving towards a single source of truth type of product and trying to support that strategy and make that useful for the users.

The enterprise products, many times, aren’t developed for the work flows and some of the unique situations for certain critical care areas of the hospital, L&D being one of those. We try to tailor our product to help support the user, support that big investment that the hospital has made in the EMR.

How do you convince a hospital that it’s a good idea to go with Obix rather than a product from their EHR vendor?

Other than Cerner, the other primary vendors really don’t have an OB product. Our competition at that level isn’t the EMR, but other perinatal specialty companies or companies that have perinatal products.

We work at messaging what the strength of our product is in terms of uptime and in terms of service and support. Service and services are a big part of what the company was founded on, has evolved with, and will always work to stay with in the future to make sure that it’s not just about dropping a product in place and saying, “There you have it” and walking away, or, “Issue a purchase order for more services.” We have a very integrated solution where it’s purchase the product, issue a support agreement, and we provide all the services around that. That’s really all a hospital has to provide.

Who makes the decision to buy your product?

That’s a trend that has changed a lot over the time I’ve been in the industry. When I first started, it was a lot of the doctors. Then it went to the nurses, nursing staff, went to IT. Now, honestly, we’re mostly in administrative decisions because of the purchasing cycles that things are bought in. We are starting to see physicians to have a larger voice again, but that’s a more recent trend.

You mentioned malpractice. Do you have plans to integrate a video record of what happens in the delivery room?

Not for us. I would suggest that’s another specialty area. When you get into recording the actions of what happens in the room, there’s a whole different set of issues that a hospital’s concerned about that I think are best dealt with a different specialty company and product if that’s a direction a hospital would decide to go into.

Is remote access important?

Oh, very important. I don’t know that we even think about it as remote access any more. It’s just access to information. The access to the information has to be the same in the patient room as it is for a doctor that’s at home at three o’clock in the morning trying to access the information.

Our biggest challenge around that is keeping customers up to date with our most current releases that have the better functionality around that. We have a number of customers that implemented software 10 years ago and really struggle to encourage them to keep upgrading the software and keep it current.

Obix has won the KLAS rankings quite a few times in a row. How do you use the feedback from users that KLAS provides?

It’s a big part of the sales process. It’s a big part of our business process, though, too.

We take a look at the KLAS comments. It’s not just the comments about us., it’s the comments of our competitors. We try to learn from everybody ourselves and our competitors and see what the industry is saying because it is a good way to get an unvarnished set of information and feedback from customers. To pay a market research group to do your own research sometimes gets some biases involved with it, where you’re looking for some specific things. I don’t always agree with some of the things that KLAS comes out with, but it does give us some good feedback to change how we operate as a business and to try to provide the services and functions that our customers are looking for.

Where do you take the company from here? Do you just keep working to gain market share or start thinking about developing other products?

We’ve considered a number of different avenues down that path. We have decided to stick with being a niche vendor in the obstetrical space. We are looking at other products and functions down this line, but I don’t see us growing out and trying to become another multi-disciplinary, multi-area vendor. I think it’s important for us to try to hold on to our specialty and focus on creating a best product and best services in that area.

Do you have any final thoughts?

I’m very thankful for the people that we have in the company. Of all the things that we deal with — with people, industry, and customers — finding and recruiting good and talented people within the company is one of the most challenging things we do. We work at improving that every day.

I see a lot of challenges coming forth, though, for our hospitals and healthcare organizations that we support. You’re seeing consolidation or trading of organizations in enterprises to consolidate market share. That’s going to create some new and different challenges both for the hospitals and the vendors that support them. Some of it’s good, some of it’s bad in terms of what that concentration does to different companies. We are making changes in our organization to support that. We’re trying to make our product lighter, faster, and easier to implement.

We just brought a new feature online called Obix University, which is an LMS platform that allows us to change our education process to be a continuous education process that’s online all the time, or it will be shortly. It’s something that helps reduce the implementation cost as well. There’s a number of other services that we’re looking at to do that. Again, trying to support that enterprise view, because part of it is about getting new customers, but part of it is also about retaining the customer base that we have and making that upgrade path a lot easier for them.

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December 7, 2015 Interviews No Comments

Monday Morning Update 12/7/15

December 5, 2015 News 11 Comments

Top News

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Kaiser Permanente will acquire Group Health Cooperative, a Seattle-based provider and insurer with 600,000 members and annual revenues of $3.5 billion. Kaiser will pay $1.8 billion upfront and says it will spend another $1 billion over the next several years in creating its Washington Region. The 70-year-old Group Health offers innovative member technologies, but has struggled with budget cuts and layoffs for several years.


Reader Comments

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From Billy Gladstone: “Re: HIMSS. You pulled their self description from their latest press release. What happened to it being a “mission-driven not-for-profit?” This announcement contained more ambitious wording that aggressively pitches its data services. The latest Form 990 I could find for HIMSS was for FY2013, in which it reported a loss of $2.6 million on revenue of $82 million, of which $30 million came from the annual conference, $16 million from publishing and conferences, and $10 million from membership dues. It paid some big salaries for an organization of that size, many multiples of what a tiny hospital with $82 million in revenue would pay its executives.

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HIMSS paid consultant Jack Beaudoin, formerly of HIMSS Media: $567,000. It also paid $1.4 million to Armin Scheuer Consulting, which I assume is related to its 2011 acquisition of his former company, Berlin-based So2say Communications. It reported $250,000 in lobbying expenses. HIMSS finished its acquisition of MedTech Publishing in 2013 and made it a disregarded entity to protect its own tax-exempt status, with the renamed HIMSS Media bringing in $14.4 million.

From Not From Me: “Re: Charles Sorenson, CEO of Intermountain Healthcare. Will step down as CEO effective fall 2016.” Unverified.

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From RegularReader: “Re: Daughters of Charity in California. Gets AG approval to sell itself to a for-profit company.” A hedge fund will be allowed to invest in the struggling non-profit health system with the option to buy it outright after three years in the largest non-profit hospital transaction in California history. The hedge fund names its management company Integrity Healthcare without apparent intentional irony (although the “charity” part of the name would be equally ironic under its involvement). Looking on the bright side, yet another example of unapologetic, bare-knuckles profit-seeking on the backs of sick people just might — as in the case of Martin Shkreli’s Turing Pharmaceuticals — force the country to realize what a mess it made of its healthcare system starting in the mid-1960s and where that’s left us 50 years later.

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From Sunquester: “Re: new Sunquest offices. I’m really looking forward to the new office. During the dark days of being private equity owned, little was done for employees.” I agree – other than an extended commute for some employees, it’s nice to get a fresh workspace with a view. Google Earth shows the new building in the foothills of some 8,000-foot Tucson mountains near many plush resorts and restaurants, which should upgrade the lunch options quite a bit. I’ve inhabited everything from a windowless hospital basement to a private office with a beautiful lake view, and while you quickly lose awareness of your surroundings through familiarity, it does indeed give you a sense of your value to your employer and their priorities. My one non-hospital job was working for a vendor whose ever-deepening financial distress was caused by ever-deepening management incompetence. Maintenance to our beat-up old office building was always being deferred until future good times that never came. Our salvage yard-quality cubicles were constantly being reconfigured to support the latest executive emissions that dribbled down from their top-floor, mahogany-walled bunker. The director of my area decided that we would all become energized by staying after work on our own time (it was mandatory) to paint the interior walls of our floor, complete with the jaunty stripes that he envisioned as being reflective of our newfound swagger and inevitable success. The company provided the paint and a terrible fried chicken dinner that — not surprisingly given our executive track record of cluelessness and questionable allocation of resources — was ordered in insufficient quantity to feed the people who gave up hours of their free time to perform menial labor, suffer through faux camaraderie, and elbow each other aside in a vulture-like attempt to snag a chunk of poultry carcass before it ran out (which was probably an apt metaphor for what it was like working there – those in the back of the line who found the chicken bowls empty heatedly accused those who preceded them of taking extra pieces). One week later, the company conducted its next round of layoffs and reorganizations, leading one of the managers who was fired and forcibly marched out of the building to declare bitterly afterward, “The worst part is that I wish I hadn’t painted those damned walls.”


HIStalk Announcements and Requests

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Ninety percent of poll respondents will get their medical insurance through their job or via family coverage, with just five percent buying it directly from insurance companies or Healthcare.gov. Mak says he had to postpone retirement for a year because individual health insurance is now so expensive, adding, “Like all massive government programs, the cost is astronomical when compared to the number of individuals benefitting.” Lgro’s employer doesn’t offer a group plan, so he’s paying $14,000 for family insurance whose coverage doesn’t kick in until he has spent $8,000, doubling what he paid in his previous job that offered insurance. Jeff says Obamacare isn’t perfect but at least he can get family insurance from Healthcare.gov until a better option becomes available.

New poll to your right or here: what role does your job play in your existence? Vote and then click the poll’s Comments link to explain since I’m really interested in how people view their work as part of their overall lives.

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Speaking of work and life, a friend who has barely survived repeated, horrific bouts of cancer was telling me that she plans to keep working at her health IT vendor employer because she’s worried that the large company can’t replace her even though her remaining lifetime will probably be short. That’s the saddest thing I’ve heard lately — expressing unconditional employer devotion under the misguided belief that such fealty is mutual and not recognizing that “irreplaceable employee” is an oxymoron regardless of your org chart altitude. You might be surprised at how quickly you are forgotten and how little difference your absence makes if strategies change, money gets tight, or you run afoul of someone who outranks you. I’ve never mistaken a paid job for a loving, supportive relationship and I hope others don’t – life is too short to place your entire identity and sense of well-being in the hands of a company (for-profit or otherwise) that is by definition incapable of returning the favor. Tombstones don’t contain job titles and hearses don’t pull U-Hauls full of meaningless company awards and unspent retirement funds. I recall the answer Ivo Nelson gave me in a 2009 interview when I asked him why he was starting another company (Encore Health Resources) when he was already immeasurably wealthy from selling Healthlink to IBM:

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.

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I’m thinking about hiring someone part time to critically review journal articles related to health IT. Ideally it would be an informatics grad student with a clinical background, access to an online medical library, and the ability to critique research methods and conclusions for a general audience. Email me.


HIStalkapalooza

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People are already emailing me about the February 29 event. Here’s what is happening.

  • “I want to come” signups will start very soon for HIStalk sponsors, then for everyone in early January.
  • We won’t be able to accept new event sponsors after next week because we need to move our focus to planning.
  • I am still looking for a single “rock star CEO” sponsor who wants a significant HIStalkapalooza presence and involvement with private space, bar, and food to entertain 100 people or so.

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Have you ever dreamed of playing your music on a big music hall stage in front of a bunch of cheering people screaming “Free Bird?” We’re exploring the idea of starting HIStalkapalooza early with music provided by volunteer health IT people who also have a significant musical history. Send Lorre a link to your video or audio and tell me what you would play on stage if chosen. You’ll have to bring any instruments you need unless we can work something out with HOB or the band. I remember years ago at HIMSS when the opening session started with a really good band that turned out to be Dave Garets, Jonathan Teich, and some other industry folks who had at one time paid the bills as musicians.

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One last item: HISsies nominations are open. Nominate your choices and I’ll put the most-nominated ones on the final ballot that will be emailed to HIStalk subscribers in a couple of weeks. It’s like the presidential primary: vote now or don’t complain about the choices made by more responsible voters. I’ve added a new item just for fun, “Industry figure you’d most like to see on stage at HIStalkapalooza,” figuring maybe I can get someone famous if they know readers want to see them there.


Last Week’s Most Interesting News

  • Welltok acquires Silverlink to expand its patient engagement capabilities.
  • Private equity investor and former Vitalize Consulting Solutions Chairman and CEO Bruce Cerullo joins Nordic Consulting as chairman and CEO.
  • MIT Hacking Medicine announces that it will publish reviews of digital health tools.
  • The Health IT Policy Committee’s API Security Task Force holds its first meeting.
  • NantHealth postpones its planned IPO because of unfavorable market conditions.

Webinars

December 9 (Wednesday) 12 noon ET. “Population Health in 2016: Know How to Move Forward.” Sponsored by Athenahealth. Presenter: Michael Maus, VP of enterprise solutions, Athenahealth. ACOs need a population health solution that helps them manage costs, improve outcomes, and elevate the care experience. Athenahealth’s in-house expert will explain why relying on software along isn’t enough, how to tap into data from multiple vendors, and how providers can manage patient populations.

December 9 (Wednesday) 1:00 ET. “The Health Care Payment Evolution: Maximizing Value Through Technology.” Sponsored by Medicity. Presenter: Charles D. Kennedy, MD, chief population health officer, Healthagen. This presentation will provide a brief history of the ACO Pioneer and MSSP programs and will discuss current market trends and drivers and the federal government’s response to them. Learn what’s coming in the next generation of programs such as the Merit-Based Incentive Payment System (MIPS) and the role technology plays in driving the evolution of a new healthcare marketplace.

December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of innovation lab and VP of clinical development and informatics for clinical software solutions, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

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India-based Indegene Lifesystems announces the acquisition that I mentioned was imminent last week, the SmartCare population health analytics platform from Vantage Point.

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The Economist observes that despite the competition that the Affordable Care Act was supposed to create, America’s five biggest health insurers have seen their share prices triple in the past five years and all are making huge profits that are still trending upward after ACA’s implementation. They’re being helped by the federal government, which is handing off Medicare and Medicaid healthcare to insurance companies. The article concludes, “The vast expense and unintelligible complexity of American healthcare may be a national disgrace, but they are a huge opportunity for firms that can navigate the system and minimize costs.” I graphed the five-year share performance of Cigna (blue, up 273 percent), Humana (red, up 202 percent), Aetna (teal, up 244 percent), Anthem (pink, up 130 percent), and UnitedHealth Group (purple, up 221 percent) vs. the S&P 500 (blue, up 68 percent). Don’t bet against statistical experts.

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Lee Equity Partners sells PDR Network to Genstar Capital. PDR Network was formed from Physician’s Desk Reference, Healthcare Notification Network, and LDM Group in moving the print-based publication to a digital business.


People

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Premier, Inc. names David Vorhoff (Deloitte Corporate Finance) as SVP of corporate development and strategy.

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Ingenious Med names David Lamm (United Allergy Services) as CFO.

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Southeastern Health (NC) names consultant Steve Milston as CIO.


Announcements and Implementations

The American College of Cardiology, Geisinger Health System, and xG Health Solutions will develop software based on ACC’s guidelines and Geisinger’s methodology.

Allscripts and TeleTracking will integrate their products and sell each other’s offerings.


Privacy and Security

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@CandidCIO found a fascinating security breach buried in the SEC filings of wireless networking vendor Ubiquiti Networks. The company discovered a phishing attack in June 2015 in which $47 million of its money had been transferred to the overseas accounts of scammers. Its ever-vigilant auditors concluded after the fact that, “the Company’s internal control over financial reporting is ineffective due to one or more material weaknesses.”

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University of Rochester Medical Center will pay $15,000 to settle HIPAA charges after it gave one of its nurse practitioners a worksheet containing the names, address, and diagnoses of the 3,400 patients she had treated there. She gave the worksheet to Greater Rochester Neurology, at which she had accepted a new job, who mailed the patients letters announcing that the NP was joining them. URMC received patient complaints about the letters and fired the nurse practitioner.


Technology

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I use Bitdefender and received an email pitching its Bitdefender Box, a router-attached, smartphone-controlled security appliance that protects every device that’s connected to a home network in what the company calls the “Security of Things.” It costs $199 upfront and then $99 per year for updates, which is a pretty good deal since it theoretically replaces a houseful of individual antivirus and firewall subscriptions. It works on Windows, Apple, and Android devices and also provides a personal VPN service to extend its security to wherever a mobile device is being used. I won’t buy it just yet until they get the bugs worked out, but I think this is the future of malware protection. It might be something hospitals make available to employees or doctors that work offsite or on personal mobile devices since they are often the network’s weak link. 


Other

Cerner and several Kansas City groups are sponsoring programming events for 400 female students this week, hoping to change their perceptions of technology careers. Two of the six locations are Cerner campuses. I hadn’t heard of the non-profit Hour of Code, but it’s pretty cool: anyone can organize an event and 150 million students worldwide have participated as the organization strives to improve diversity in computer science.

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A Wells Fargo Securities report titled “Does Epic Own the Future?” finds that while the average physician EHR user is 49 years old, Epic’s user base is a little bit younger (by a year or so) and Practice Fusion has the highest average age of 51.7. The report theorizes that recent graduates are increasingly going to work for big, Epic-using health systems, while Practice Fusion’s free EHR attracts older doctors who don’t want to spend money or effort on an EHR close to their retirement. I don’t disagree with the theories, but the age spread isn’t enough to get too excited about, I doubt it signals anything important, and it doesn’t distinguish between inpatient and ambulatory use or physicians who are forced to use multiple systems. Slightly interesting is the statement that Epic has more than a 25 percent market share among new graduates vs. all of its competitors that are bunched up at between two and 10 percent.

The EDs of Cleveland’s hospitals will phase out ambulance diversions, which should be interesting presuming they occasionally had valid reasons for not taking new ambulance patients in the first place.

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Flooding in the technology hub of Chennai, India causes its premiere, 1,000-bed hospital to lose power and life support systems, killing at least 18 inpatients in a Hurricane Katrina-type situation. Caregivers kept some patients alive by ambu bagging them for up to 48 hours. All communications were down and roads to the hospital were submerged under six feet of water.

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This is fun: world traveler and Dell CMO Nick van Terheyden, MD tweets from Dubai that the United Arab Emirates government has blocked Internet access to HIStalk.

A Harvard Business Review article by Frederick Cerise, MD, MPH, CEO of Parkland Health and Hospital Systems (TX) says large, publicly supported safety net health systems like Parkland have an advantage because they are driven by community needs and give clinicians a greater voice in decision-making. He says Parkland has been operating like an ACO since 1989, receives 36 percent of its budget as a county allocation rather than for billing more services, and can resist the financial temptation to offer high-paying but questionably beneficial services. He mentions that the hospital’s tele-dermatology service loses money since half of its patients are uninsured, but it still offers an efficient way to deliver services.


Sponsor Updates

  • HealthLoop publishes “5 Things You Need to Know About CMS’s First-Ever Mandatory Bundled Payment Program.”
  • TierPoint will host an open house December 10 in Marlborough, MA.
  • Visage Imaging debuts several products and enhancements at RSNA 2015.
  • VitalHealth Software and Zynx Health will exhibit at the IHI National Forum on Quality in Healthcare December 6-9 in Orlando.
  • Voalte releases a new case study, “How Avera McKennan Achieved Efficient Caregiver Communication with Voalte Platform.”

Blog Posts


Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us or send news tips online.

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Reader Comments

  • Other Anonymous Ex-Epic: I find it funny to think that 50 years from now, long after everyone has moved from Epic/Cerner to the next EHR, Epic's ...
  • Anonymous Ex-Epic: Epic wasn't doing anything that many other companies weren't also doing. They are also a perfect target for cases that c...
  • TPD!: The debate about "vendor-agnostic"or "vendor-neutral can go one for ever with no one winning the debate. TPD prefers th...
  • Keith McItkin, PhD.: @andy_slavitt With all due respect, interoperability is a goal, but the safety, usability, and efficacy of these devi...
  • Jayne Martin: Very interesting! Excited to see this company grow...

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