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HIStalk Interviews Joshua Newman, MD, Chief Medical Officer, Salesforce

September 2, 2015 Interviews 6 Comments

Joshua Newman, MD, MSHS is chief medical officer and GM of healthcare and life sciences at Salesforce.

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Most healthcare IT systems involve back office functions that are, to patients at least, invisible at best or intrusive at worst. Do you see that changing?

We do. The proof point is that we’ve been doing it already. We’ve been doing it for five or six years. But we also see it changing because the current needs of healthcare seem to be much more around that kind of end-user experience and less about the back office stuff.

If you look at where the reimbursement’s going, if you look at value-based care, or if you just want to look at the competition that’s being caused by the ACA and all the new people with insurance and so on, you see that it’s around patient experience. It’s around consumer expectations. It’s around value-based reimbursement and outcomes. It’s about helping people take care of themselves at home, responding to their text messages, being able to send a message of support, and so on.

Johns Hopkins posted a study saying if you have a relationship with a doctor, you lose more weight. It’s just one example of how relationships, patient outreach, devices, mobility, all of those kinds of things are starting to be the coin of the realm. What I mean by that is not only are they they right thing to do for health, but they’re also being reimbursed.

What are Salesforce’s major efforts in healthcare?

You may know we’re the number one CRM company. We’ve got this very broad platform that does a lot of things. Outside of healthcare, it’s marketing, sales, and service. There’s a Communities app, which is like a portal. We have analytics and an app development platform.

What we want to do for healthcare is what we’ve done for business, which is to enable those relationships. Service Cloud is our product name. It’s like a call center app, but customized for healthcare so that everyone can have that same relationship with the patient wherever they are, on any device, to support healthcare. Not the stuff the EMR does — not medication ordering, laboratory ordering and resulting, or procedure ordering or notes — but the interpersonal communication that supports the success of those other things.

Will it be difficult for providers to make the transition from one-time billed episodes to developing ongoing, health-encouraging relationships with consumers?

It’s funny you ask that question, saying it’s the new thing. The reality is it’s the old thing. It’s the original thing we were doing before we had any technology or anything.

I was trained as a family doc. I had other faculty members, like the wise old family docs, who used to tell me not that long ago, "Write in the margins of the paper record the patient’s occupation, their kids’ names, their pets’ names.” All those things. That was the beginning of my exposure to CRM. Understand who this person really is so you can build a connection and have an impact on them.

I think because the EMRs are so focused on those kinds of fee-per-service, episodic elements, it took away a lot of that. Frankly, those systems weren’t that flexible, so it made it harder to do those things. I think now with this and with the reimbursement that’s facing it and the value of it, people are amenable to it.

The second part of your question, though, are people going to be able to do it? That’s going to be a hard thing to solve. Work flow changes in healthcare, new innovations even when they’re proven … even a medication that’s proven to be great with no side effects still takes five years to diffuse. Something like this that’s a little more complicated, that takes new jobs and new training, is going to be a little harder. Our thought is the technology is going to be able to help people do it.

What we’ve seen outside of healthcare is that when people have really good tools that make it easy to use and to succeed, they’re a little more willing to change. In fact, we see that all the time.

Just so you know, I’m not under any kind of false hope that it’s going to be simple. Healthcare changes slowly.

In healthcare we individually feel that we have a relationship from our providers and caregivers when we’re receiving care, but in that 99 percent of the time we’re not in the ED, an exam room, or a hospital bed, the faceless bureaucracy doesn’t care about us. If hospitals turn this relationship function over to the marketing department, will it feel genuine to patients or will it be like receiving unwanted calls from an aggressive telemarketer?

I’m not seeing this as like cold calls or marketing. I’m seeing this more as when you’re on your bank website, you can’t figure out what to do, and all of a sudden the chat window comes up and there’s someone who can answer your question. It feels really good.

I use an application called TripIt that brings together all my travel plans in one place. I don’t feel like I’m in a herd of cattle running through the airport. I know where I’m going to go. When I land at the airport, if there’s been a delay, I get this alert automatically sent to me saying the gate’s over here, the gate’s been changed, or you’re late, so go here or do that.

Those simple kinds of tools are available. The data is available, although the systems that own it aren’t flexible. But if you put it in something like Salesforce or any kind of modern tool, the possibility exists to make people at least feel like the system is understanding them.

That’s from the technology side, a little more of the impersonal side. Then when you want to add the idea of, if I ever have a question, I can text message a care coordinator. If I ever have a problem, I know who to call and they have instant visibility into my clinical systems; who my informal caregiver is; what language I like to speak; or what my preferences are for communications, whether it’s mobile or email or phone. Even those simple, simple things would be profound in healthcare because they don’t really exist.

It’s going to enable the kind of change of change from where I only care about my doctor and I only relate to my doctor to there’s a whole team that’s willing to talk to me, and by the way Nurse Sally is really sweet and really great and she’s the one I ask questions to because she’s willing to listen.

Salesforce and a lot of other non-healthcare technology companies scaled themselves up by opening up their systems to partners and even competitors to create an ecosystem that benefited everybody. Healthcare hasn’t embraced that concept. Do you see that changing?

Yes. I see it hugely changing. What I see in the marketplace, and what a lot of us think about is, imagine the gates or the walls that have been erected by Epic. There are throngs of companies and experts and innovators and entrepreneurs who are banging on those walls trying to get in in every single healthcare organization in every single market everywhere. They just can’t do it. Sometimes because there’s not enough patients that are using a certain service. Sometimes because the CIOs are afraid of the risk and the cost of building an EMR connection and all that. We’ve already seen it in some cases. We’ve got a use case with UCSF where they’re using a third-party decision support tool to get data collected into Salesforce to make a risk score and have it come back.

The old days of decision support tools were that you put a CD that comes from someone and you put it in your EMR. It’s usually for drug-drug interaction or drug-allergy interactions. You know about the Framingham Study, I’m sure. There’s a guy in UCSF named Jeff Olgin who’s head of the cardiology department. He’s doing an e-heart study, which is going to be a million-person Framingham Study. Gone will be the days when the cardiologist has to remember the journal article that said this or that. They’re going to start using databases of hugely valuable decision support tools. We see it at the National Cancer Institute with some of their cancer data or even this breast cancer study.

We’re moving to a time when people are realizing that a single doc with some information in their head is not enough. Allowing them to take the time to go to different journal articles and figure out what the best treatment isn’t also the best.

We look at mortgage bankers. We see that they use impressive calculations to figure out where people’s risks are. We don’t really have that in healthcare yet and I think we’re going to have it more. Then you include the device managers, you include the rehab centers and the home health agencies, and all the different people that have to collaborate.

There’s no way that’s going to happen unless there is an open system, an ecosystem, and some friendliness between parties who all want the same thing. Fortunately, the money is there and the bundled payments are going to make it a little more likely.

We really have only three large inpatient EHR vendors in Cerner, Epic, and Meditech. Does that make it easier or harder for a company like Salesforce to come in and try to open things up and collaborate outside their walls?

The irony, and it’s a little bit controversial, is the fact that there are three almost makes it like an Irish potato farm. I don’t like that analogy so much because it makes us all look like we’re going to hurt those, but we’re really not. We want to connect to them.

It makes a certain kind of standardization, and to be frank, I think the closed histories of a lot of those vendors … their strengths and weaknesses are all different, but the fact that an organization like Epic has such a mind share among the very top hospitals and yet they don’t have the flexibility to open up gives us a great opportunity to extend what they do, to connect to what they do, and to bring these organizations into a modern technology space.

By the way, we don’t have to worry about working with them directly because middleware solutions are making it easier than ever to get data out and in some cases get data back in, even if it’s in the form of unstructured text or something like that.

I suppose for CRM-type purposes, you wouldn’t need real-time EHR access or for the vendor to provide APIs to everything. You could work around that.

We can start with just an ADT feed just to identify who the person is. You’re right, we can start small. But what’s cool is at a place like UCSF, for example, they started with the ADT feed. Just tell us who they are, who’s taking care of them, and some demographic information. But then they add more data to that pipe and they’re including prescriptions and diagnoses.

It doesn’t take much. We don’t need everything. We certainly don’t need the notes. We don’t need the medication administration record. Between diagnoses and medications and maybe some lab tests, we can do a ton.

That’s how Salesforce works. We’re not like Epic where we’re going to make someone write a $200 million check or a $1 billion check. We’ll start small. We’ll solve problems with the simplest of connections and then we can move on. Frankly, there are some folks who are doing it without an EMR connection. They just use it as their engagement engine, and then over time they grow those kinds of connections to the legacy systems.

Would a typical health system CIO look to Salesforce for solutions? Is it hard to get in front of them since you’re not a traditional healthcare vendor?

If you ask me in a year, I’ll say absolutely yes. I think we’re in a transition period. There are a bunch of CIOs that I talk to who say, "Wow, I had no idea you did healthcare." Frankly that’s our job and that’s one of the reasons why we’re doing this the way we are. But there are a bunch that do know us.

It’s interesting because our pioneering customers, the people that gave us credibility and confidence that what we have is of value in the marketplace, have been organizations that say, I’ve heard of Salesforce,or I know Salesforce, or I used to be a CIO of an insurance company and now I’m the CIO of this big hospital system, I know what you guys can do and relating to my patients is very similar to relating to customers.

There’s a great quote from an academic medical center CMIO friend. He says, "We’ve got to treat our patients like customers. They’re consumers and we may treat them better than we treated them when they were patients." They know we’re useful for this and they want to customize what we have to make it work for them.

Our new product is around making those customizations built into the product so that it’s credible and relevant to healthcare. I think with the new announcement, there’s going to be a real excitement for this because people know we’ve figured out how to do a lot of this stuff.

Salesforce offers the Chatter application. Do large health systems and practices use collaboration tools as well as they should?

They don’t because they don’t have them. They know what the inbox is. One CMIO says, "We keep getting older and the residents keep getting younger. It’s really funny. My residents ask me, where’s the feed? Why do I have to use email? Why do I have to use pagers? We’re the only occupation that still uses pagers. The drug dealers don’t even use pagers."

What’s happened is a lot of these hospital systems and residents have adopted these systems just because they want to. We see the proliferation of a lot of these things that were ground-up or viral and people started using them. Then the CIO will say, "Holy smoke, what can I do here?” They use them because they just work better.

In Salesforce, we’ve gotten rid of like 40 percent of our emails using Chatter. I actually wasn’t that big of a fan of it because I use email and I’m sort of an older guy, but I’ve been convinced by what we’ve seen in Salesforce. Now we’re starting to see people in hospital systems take this up.

When we show it to them, everyone gets it because it looks like Facebook. All these kids know how to do it. They know how to do @ mentions to include other people on the feed. They know how to do other kinds of things from that feed post. Marc Benioff, our CEO, did a lot of work to make Chatter not only something that’s good for communication, but you can do links, polls, forms, fill out all kinds of stuff, and actually do your work in it.

The more helpful it is and the more it saves people time, the more they’re going to use it. We know it’s something people cotton to as an interface. To the extent that it’s helpful for their business, the uptake is going to be significant.

Where do you hope to see healthcare in the next five or 10 years?

The cues or the things that inform my answer are every other industry in the world, on one hand, and then my oath to make health better. What we see in every industry is fluid data. We see open APIs. We see hybrid information systems. We see things coming together in all kinds of ways to solve problems flexibly. If there’s a new genetics test, it should come in there. If there’s a new partner you want to work with, it should go there. If you want to get a coupon for your home health needs. If you want to have someone deliver your bandages by drone. 

Healthcare is still stuck in an earlier era because they’re stuck in this client-server technology that’s not open, that’s not flexible, and that doesn’t give people the confidence that they can safely open up to partners. I see a future where hospital systems are as open and as nimble as Amazon, Gmail, or Salesforce.

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September 2, 2015 Interviews 6 Comments

News 9/2/15

September 1, 2015 News 10 Comments

Top News

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MEA|NEA, whose platform allows providers and payers to securely exchange payment-related electronic documents, acquires The White Stone Group, whose Trace communication tools connect voice, fax, and electronic communication to the patient’s record. With the acquisition, MEA|NEA will create separate business units for its medical and dental customers.


Reader Comments

From Limoncello: “Re: receiving files from patients. Patients of our dermatology practice want to email us their records or use Dropbox. We can’t figure out how to receive them without violating HIPAA or threatening our electronic security. Our Top Five EHR vendor patient portal doesn’t allow patients to upload or attach files. We tried Carebox, but it appears they don’t participate in Direct Trust since test messages in either direction won’t go through. Does any company that’s willing to sign a BAA offer a HIPAA-compliant patient upload file site that scans for malware and accepts image files? We’re also interested whether practices have been able to get their local VA facilities to use Direct messaging instead of faxes. Our biggest barriers to using Direct messaging has been lack of a standard Direct address directory and eClinicalWorks requiring community health centers to buy an interface if they want to use Direct Trust-compliant messages instead of eCW’s Direct web portal. There’s definitely a bias against Direct messaging and towards expensive one-off interfaces at most vendors.”

From Woodpecker: “Re: McKesson. Will announce that its Horizon Clinicals product will not support Meaningful Use Stage 3.”

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From Boisterous Lad: “Re: Capsule Tech. Good sources tell me it’s been acquired by Qualcomm Life, which is expanding its 2Net device and sensor connectivity platform beyond sensors and home medical devices.” Unverified. I didn’t see any SEC filings from Qualcomm.

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From UGMer Roasting Weenies: “Re: Eskenazi Health (formerly Wishard) in Indianapolis. Going with Epic. Seems like a big deal as they are one of the last holdouts using the self-developed system of Regenstrief.” 

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From Creative Differences: “Re: Partners and Epic. I’m on the Partners ambulatory rollout team. We offer practices three options: (a) stick with your current EHR, in which case we’ll integrate as necessary which includes billing for some through our Epic Resolute system; (b) use MyPractice, aka Epic Lite, a slimmed down version that I’ve hear is not fun to use although I’ve not seen it; or (c) go full Epic. This is happening in every city in America where the larger organization buys Epic. A great comment to Paul Levy’s original post reflects my thoughts: what do you suggest the AG tell Epic? Interoperability is better when all parties are on the same vendor no matter who the vendor is. This looks like capitalism at its best. Should the the AG tell Epic they can’t tell prospects about how they can improve interoperability between them and their partners? Should she tell Epic they need to change their product?”

Meanwhile, @Farzad_MD posts a reminder of Jonathan Bush’s Athenahealth earnings call comments about Epic at Yale-New Haven, which I ran in May 2013. Recall that Paul Levy is apparently doing work for Athenahealth these days, Athena is commercializing BIDMC’s WebOMR system, and Bush can’t seem to decide if Epic is evil incarnate or an admired competitor. 

I think we are seeing — particularly the folks who got pregnant with Epic — they’re going to this sort of desperate burn-bright tactics. We heard where Yale-New Haven has told all the doctors that have privileges that they will either buy this piece of shit Epic that none of them want or do you have their privileges revoked. So there’s that kind of tactic going on. "Oh, we can’t interface." I’m like, "What you mean? Epic interfaces all the time. They actually do it really well." So there’s a lot of sort of how are we going to pay for this thing? How are we going to make this thing drive more referrals, more high-profit diagnostics to our hospital? … The folks that have gone off and laid down more money than they have on Epic have, in the back of their mind, that they are going to make a real impact on referral patterns by getting doctors on to Epic that don’t want to be on it.

From Payer Watcher: “Re: Optum Exec Forum. UHG CEO Steve Helmsley declared that unlike Aetna, UHG will not purse the acquisition of other payers. Less important, it was puzzling to see both Colin Powell and Dr. Atul Gawande there.”


HIStalk Announcements and Requests

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The family of a reader who wishes to remain anonymous personally donated $1,000 to my DonorsChoose classroom grants project, triggering matching funds from another anonymous reader as well as other matching funds from specific classroom projects I funded. That means the family’s donation put at least $3,000 into classrooms in need. The donation and matching funds paid for these projects in their entirety.

  • Math activity stations for a low-income elementary school in Oklahoma City, OK in which many students were affected by a tornado last year.
  • STEM materials for a kindergarten class in Chicago, IL.
  • Two Amazon Fire tablets for STEM time exercises for an elementary school class in Tulsa, OK.
  • Ten Android tablets with pre-installed apps for an elementary school class in Mobile, AL that will meet the Bring Your Own Device policy for the children whose families can’t afford to buy them.
  • Hands-on STEM technology (Ozbot, green screen, Makey Makey kit, and Sphero) for Genius Time and MakerSpace activities in an elementary school class in Pensacola, FL.
  • Estes rocket kits and supplies for an elementary school class in Okeechobee, FL.
  • A listening center for an elementary school class in Mobile, AL.

I’ve already received emails from several of the teachers above. Ms. S said, “The math centers that you have funded will allow my students to be provided an interactive approach to the math standards that we are studying in depth this year. The ability for these students to not only hear about, but to apply themselves into a deeper level of learning through a variety of activities is so much more meaningful than sitting and being taught to. You have enabled my students to involve themselves in the teaching of these daily lessons.” Ms. S from Tulsa emailed to say, “Thank you so much for your generous donation! The impact of these items will be huge! I can’t wait to see the look on my students’ faces when they get their new Kindles for the classroom! We will be using these so much during science, accessing digital science materials. The students will have the opportunity to access so many things they wouldn’t have been able to access before. The fact that they’ll also be able to use them to read during their independent reading time is icing on the cake. Thank you so much!! You have made this Teacher’s day and maybe even the whole year!”

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I also received an email from Mr. H at Maynard Jackson High School in Atlanta, to which we earlier donated furniture to create a broadcasting studio news set. He says, “My students use the new resources every day to broadcast the school news. Last year, broadcasting the news was a dream but with our new resources, we are about reach our student population and the community through broadcasting. The new furniture gives students a clear understanding of the layout of a television studio, but at the same time, it allows us to compete with other schools in our district. I can honestly say that the learning levels in my class is at an all-time high and we have over 260 students in the program!”

I noticed that HIStalk page views hit 190,000 in August even though I slacked off a bit this past month given less news. That’s 2.3 million page views in 1.8 million visits in the past 12 months. I appreciate everyone who reads and sponsors HIStalk for making it fun every day for the past 12 years. I have quite a few new sponsors to announce thanks to our usual once-yearly back-to-school new sponsor special offer that Lorre can describe for interested companies, including for former sponsors interested in coming back. Then we buckle down for the always-busy Labor Day to Thanksgiving health IT rush.

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I’m watching “Narcos” on Netflix, which I like even though I’m distracted by the cheesy 1970s mustaches and the fact that Pablo Escobar looks like Andy Kaufman.

Note to providers: I’m perfectly aware that I should call 911 if this is a medical emergency, that my call may be recorded, and that the menu options have changed. You don’t have to waste 20 seconds of my time telling me that every time I call and then get put on hold.


How to Do a Webinar

We get asked a lot about doing webinars. Sometimes companies take our advice, sometimes not.  Here are some tips as requested by a reader.

  • Present a webinar to educate without obsessing about getting sales leads. A webinar that is mostly a company promo piece or demo is going to draw as attendees only people who want to buy your product. Don’t be surprised when only eight people register and none of those are prospects. It’s like a timeshare pitch without the free Chili’s gift certificate.
  • Nobody wants to hear a company’s marketing VP deliver a webinar, or for that matter, anyone from the company as a primary speaker. You earn a lot more credibility letting a happy customer do the talking about their real-life experience, assuming you have one.
  • Make sure the presenters have seen the slides and understand the topic ahead of time. The fact that I have to even say this tells you how poorly planned some webinars are.
  • Choose a snappy title that succinctly describes what the webinar will cover.
  • Don’t provide insultingly obvious background about the state of the industry in the abstract. Ditch the flowery language and just say what you’re going to cover and why people should attend.
  • Don’t include a roster of every hospital job description in the “who should attend” section. Sure you don’t want to turn people away, but your in-depth technical overview isn’t really going to appeal to most CEOs and floor nurses.
  • Don’t pitch the company or product for more than two minutes. We get a lot of complaints from attendees who are annoyed that the presented ignored our advice to keep the sales job at a minimum.
  • Don’t require a bunch of registration information. I’ve done polls here before and people are like me in refusing to give a bunch of information (phone number, job title, etc.) to nosy companies who will lose signups or just encourage to enter fake information to avoid the inevitable cold calls.
  • Record the video for later review. Our webinars get a lot more views on YouTube than they did in the live session. That’s why we do it.
  • Presenters, don’t read your presentation.
  • Don’t include slide transitions or animations, which may indeed look super cute when viewing locally but are painful to watch in a slowed-down live webinar.
  • Don’t fall into the trap of making PowerPoint a teleprompter. You already have your talking head, so add graphics or other visual to make what they say clearer and more memorable. If your slide contains full sentences, you don’t know what you’re doing.
  • Spread material over multiple slides so that no single slide is on the screen for more than 1-2 minutes. The attention of attendees wander when someone just drones endlessly with no visual break.
  • Lock down the title, presenters, and abstract at least 2-3 weeks before live day to give people time to sign up.
  • Deliver a presentation of no more than 30-40 minutes to leave time at the end for questions.
  • Have attendees submit their questions via the webinar platform’s chat box to allow the moderator to choose the best ones and to avoid having an attendee hijack the presentation with self-indulgent prattling.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

We’re doing a September 22 webinar with The Breakaway Group, who filmed a commercial for “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements using Simple but Predictive Adoption Metrics.”

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Ivenix secures $42 million in funding to continue rollout of its next-generation smart infusion pump.

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Cardiopulmonary Corp., which offers the Bernoulli medical device integration, alarm management, and virtual ICU applications, will merge with medical device integration vendor Nuvon. 

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Patient portal vendor Medfusion raises $3 million in venture funding after announcing new patient responsibility collection tools.


Sales

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Western Connecticut Health Network chooses Cerner’s Millennium EHR, will upgrade its Soarian revenue cycle applications, and implement Cerner’s HealtheIntent population health management system.


People

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Alexander Eroe (LinkEHR) joins Health Data Specialists as business development executive of the Cerner/Siemens practice in the Western region.


Announcements and Implementations

A Nuance survey finds that Millennials (ages 18-24) are more likely to choose a PCP based on the recommendations of friends and family members, are quicker to tell friends about their doctor experiences, and are more likely to look up doctors on online review sites.

Craig Hospital (CO) implements a clinical communications and mobile alerts solution that integrates its Draeger and Connexall alarm systems with the mobile network of PatientSafe Solutions, allowing clinicians to access alerts, secure messages, voice communications, and patient information from a single device.

Mayo Clinic Center for Social Media will offer a “Social Media Basics for Healthcare” online certificate program for healthcare professionals that includes CME credits. The four-hour course is free for members ($495 per year) or $400 otherwise.

Tenet, Dignity Health, and Ascension will take over management of Carondelet Health Network and connect it with the Arizona Care Network in the turbulent  Southern Arizona market.

InterSystems will release a next-generation laboratory business management system in early 2016.


Government and Politics

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The Dayton, OH newspaper profiles the Cincinnati VA’s tele-ICU service, which has expanded from monitoring 72 Ohio beds to 213 beds in several states.


Technology

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Google unveils its new logo (old on the left, new on the right). The font veers dangerously close to Comic Sans territory.


Other

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Jewish Hospital (OH) reduced ICU length of stay by 28 percent in a pilot that used GE Healthcare’s nutrition monitoring software that works with its ICU ventilators and sends nutrition measurements to the EHR. The software was being used in other countries and earned FDA approve in June.

UC Health (OH) will run a six-month pilot in which patients can get free video consultations with physicians after scheduling a time slot in advance.


Research Implications of the Conversion to ICD-10

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I spoke with Andrew Boyd, MD, assistant professor in the Department of Biomedical and Health Information Sciences at the University of Illinois at Chicago, who has published several articles about the impact of the conversion to ICD-10 on medical research. He predicts problems when researchers conduct studies spanning the October 1, 2015 switch, as researchers miss patients because the code logic has changed. He even speculates that some researchers may avoid performing historical studies because they may fear that the pre-October 1 codes are unreliable or because they won’t want to invest the time required to double check the codes and data queries.

Andy says researchers are generally aware of the upcoming ICD-10 problem, but haven’t necessarily grasped its significance or the effort and uncertainty required to use information originally entered as ICD-9 codes. He’s also concerned that analytics vendors are underestimating what will be lost if they just perform simple one-to-one ICD mappings.

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ICD-10 mixes concepts that were separate under ICD-9. He gives as an example “sickle cell crisis,” which maps to the ICD-10 code for “sickle cell disease with crisis unspecified.” That looks fine on paper, but there were two associate ICD-9 codes that mapped backwards to it. Some researchers might want to look at all sickle cell crisis patients and would therefor have searched for all three codes, while others might only care about sickle cell crisis with acute chest, for example. Every data query will need to be analyzed by a researcher who knows what they’re looking for, not a junior analyst who only knows the old and new codes.

I asked Andy if he thought new studies might reach incorrect conclusions because of either researcher ICD mistakes or improperly converted data. He said he wouldn’t be surprised.

There’s also the issue that the US version of ICD-10 (ICD-10-CM) is more complex than the versions the rest of the world has used for years. For instance, Canada has 20,000 ICD-10 codes while our ICD-10-CM has 68,000. It will be easier in some ways to graduate to the same ICD level as the rest of the world, but anyone performing international studies will have to do their ICD mappings all over again.

Andy also points out that the ways hospitals code under ICD-10 may make them appear safer than they really are, unintentionally or otherwise.

Andy concludes that in a few years we’ll wonder how we got along without ICD-10, but the transition will be rough for researchers and medical research may temporarily suffer.

Some of Andy’s articles covered:

Cohort discovery in ICD-10-CM
Patient Safety Indicators in ICD-10-CM
Discriminatory cost of ICD-10-CM transition between clinical specialties


Sponsor Updates

  • CTG is ranked as one of the largest healthcare management consulting firms.
  • Orion Health is named the “New Zealand Healthcare IT Company of the Year.”
  • Santa Rosa Consulting is named as one of the “Best Places to Work in Healthcare.”
  • AdvancedMD announces the six winners of its video contest. 
  • Eric Venn-Watson of AirStrip Technologies is featured in a San Diego Source profile of tech innovations.
  • CapsuleTech receives the Surgical Information Systems Partner of the Year award for its DataCaptor and SmartLinx Medical Device Information System solutions.
  • Extension Healthcare wins the Indiana Innovation Award.
  • Anthelio is included as a sample vendor in two Gartner hype cycle reports in the legacy decommissioning category.
  • CitiusTech will exhibit at the Smart Healthcare Technology Summit 2015 September 9-10 in Dubai.
  • Surescripts announces that 20 Epic health systems have implemented its CompletEPA electronic prior authorization service.
  • CoverMyMeds will exhibit at the EpicRx Annual Stockholders Meeting & Trade Show September 11-13 in Fort Lauderdale.
  • The Tennessean features Cumberland Consulting Group in its profile of workplace culture at local healthcare technology companies.
  • MedCPU CMO Yoni Ben-Yehuda is featured in an IBM/CMO Club marketing study.

Blog Posts


Contacts

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

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September 1, 2015 News 10 Comments

Monday Morning Update 8/31/15

August 29, 2015 News 17 Comments

Top News

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Former BIDMC CEO Paul Levy urges the attorney general of Massachusetts and her counterparts in other states to launch an anti-trust investigation into Epic, saying that agreements such as the one between Partners HealthCare and Epic “box out the competition” as the organizations act on their own mutual self interest. He gives this play-by-play:

  1. Partners spends $1.2 billion to implement Epic.
  2. Partners and Epic tell affiliated (not owned) medical practices that they have to replace their existing EHRs with Epic because they won’t be interoperable with the Partners (Epic) systems otherwise.
  3. Partners tells those practices that it won’t work with them if they don’t use Epic.
  4. Partners locks in its affiliated practices and dominates its market even further, while Epic forcefully displaces its EHR competitors, benefitting both organizations.

I hadn’t heard much about Levy since he parted ways with BIDMC (a Partners competitor) in January 2011 several months after admitting to an inappropriate relationship with a female employee (his MIT academic advisee hired as his chief of staff). Levy is working for a negotiating company, married his former chief of staff, and co-authored with her How to Negotiate Your First Job: 8 Steps That Will Create Value for You and Your New Employer.

Levy adds interesting commentary in response to a reader’s question: “Note above that BIDMC desire was to provide interoperability to the Atrius doctors. Brigham and Women’s Hospital, part of Partners Healthcare System, had had a referral relationship with Atrius for the previous 20 years. They had often promised to give Atrius that capability but stubbornly refused to provide it. There was nothing about what Halamka set up in roughly 60 days that BWH could not have at some point during the two decades. But providing interoperability was counter to the PHS strategic plan. This point was actually made by PHS at a financial briefing to bond investors in NYC–where they used the fact that interoperability was NOT available as a feature securing their finances–by making movement of patients out of their network more difficult. Folks on Wall Street found that an attractive strategy, too.”


Reader Comments

From Skeptical Shrink: “Re: blood test and app to predict suicide risk. Many promising genetic findings and biomarkers have been touted in the past, but failed to replicate. The app just incorporates known risk factors, so there’s nothing new there, although one unique thing is that it doesn’t rely on the patient’s self-report about suicidal ideas or plans. The bigger caveat is that the app won’t be helpful because it predicts suicide ideas in the next year, but in the ED, you need to know what’s going to happen soon to decide whether to hospitalize them. You’ll already know if they need a mental health referral, so the app doesn’t help you there. The study may or may not be a starting point in predicting suicidal behavior, but I don’t see the genetic test or app as ready or helpful for clinical use.” It does seem odd to think that suicidal behavior has a genetic basis that can be measured with high correlation. I like the behavioral apps that measure mood or that allow patients with known suicidal or depressive thoughts to “check in” each day with an assessment of their well being to allow outreach when indicated. 

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From I Want My Taxpayer Money Back: “Re: getting a clinical summary. I received a clinical summary after my specialist visit, hoping to use it to remind me about what we talked about and what I should be doing. It contained only the information I already knew from previous visits (meds, allergies, problems). I asked how I could get a copy containing his actual notes from this visit and they said I wasn’t the first person to ask. What good is CMS making sure EPs provide a clinical summary if the doctor’s notes aren’t included since they haven’t otherwise documented anything yet? Am I supposed to call or send a portal message days later to get the comments he made?” CMS’s Meaningful Use standards define a clinical summary as containing “relevant and actionable information and instructions” that mostly involve updated copies of the same basic information (meds, vitals, procedures, problems, and future visit instructions) along with “instructions based on clinical discussions that took place during the office visit.”  I don’t believe CMS requires sharing physician notes (that would be more the purview of the OpenNotes project, which I wholeheartedly support) although your doctor might be falling short of the documentation requirements if your summary didn’t include the instructions you were given verbally. Readers most likely can elaborate further, but from a technical and personal experience standpoint. I’ve been pretty happy with those I’ve received even though I don’t find much useful information in them, but I wouldn’t say they include every suggestion, observation, or aside that comes up in conversation. My suggestion would be to ask your specialist if it’s OK if you record your visit on your phone for later review, although some doctors will resist due to malpractice liability concerns. A good compromise would be to bring paper and a pen and take notes of what your doctor is saying – that creates shared ownership, and since most of us have kinesthetic and visual learning styles and therefore need more than just spoken words, you’ll remember almost everything even before you leave the office.

From The PACS Designer: “Re: Universal Data Link. You will be hearing about the Universal Data Link (.udl) application. Microsoft will be leading this effort since Windows Server 2003 reached end-of-life support last month with Windows XP next. Using the Microsoft Universal Data Link will simplify connecting to the numerous databases in existence today when doing database software upgrades of servers.”

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From We’ve Always Been At War With East Asia: “Re: Glens Falls de-installation of Epic. Judy Faulkner has been saying to large audiences that it doesn’t count as Epic’s losing a customer since they had only ambulatory. How does a company lose a customer while claiming its record is still unblemished?” I think Epic’s “we’ve never lost a customer” statement should be retired. It was already asterisked with “except in the case of acquisition” and now would require a second asterisk to say “and except for ambulatory-only sites.” Glens Falls will replace Epic ambulatory with Cerner, which it was already using on the inpatient side.


HIStalk Announcements and Requests

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Poll respondents say the ICD-10 switch in 4 1/2 weeks could go just about any way, with 29 percent saying CMS won’t be ready and payments will be delayed, the same percentage stating that providers won’t be ready, and 18 percent each predicting that just a few providers won’t be ready or that the conversion will occur with no major problems. Joe says the real problems will surface on October 15 as providers see reduced payments due to incorrect or non-specific ICD-10 coding, with the latter being acceptable to payers because non-specific codes pay less. New poll to your right or here: have you personally seen a health IT vendor software contract that contained a non-disparagement (“gag”) clause?

Dr. Jayne’s description of a practice scrambling to recover from a bad ICD-10 related update raised questions – email me with your experience:

  • Have you seen problems as Dr. Jayne described where an ICD-10 software  change will cause clinical (rather than billing) consequences?
  • For vendors, when was your final ICD-10 software update released?
  • For vendors, how many of your customers have installed the latest ICD-10 software update?
  • For customers, are you scrambling to get consulting help or your vendor’s attention as we wind down the last month of ICD-9’s existence?

I was thinking about the WDBJ shooting and the guy’s long record of work-related performance and anger issues, wondering if his previous employers disclosed his known problems when they were asked for a reference. My experience in hospitals is that you never say anything negative when asked for a reference (except perhaps acknowledging “not eligible for rehire”) for fear of being sued, even if the employee was caught stealing drugs, committing shocking medical errors, or threatening co-workers (it’s the HR version of software contract gag clauses). The best example is nurse Charles Cullen, whose several hospital employers strongly suspected he was killing their patients but let him quit with no blemishes on his record just to get rid of him quietly, allowing him to ply his trade by killing patients at new hospitals. He confessed to murdering 40 inpatients using common Pyxis-stored drugs (digoxin, potassium chloride, and insulin), but experts think he really killed hundreds.

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We’ve booked nearly all of the available sponsorship spots for HIStalkapalooza except the top one, the “Rock Star CEO” package that includes a bunch of invitations, an on-stage role, all-access passes, and a swanky private lounge in the House of Blues Las Vegas for entertaining prospects and guests. Contact Lorre.

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Ms. I sent photos of her Washington state kindergartners using the Microsoft Surface Pro 3, iPad Mini, and related accessories for math skills review that we bought via the DonorsChoose project (made possible by vendor donations – thanks!) She says the students use them every day. Companies can contact me to donate and have their money matched by an anonymous vendor executive who loves supporting STEM education in schools.

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

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Last Week’s Most Interesting News

  • CMS says its latest round of ICD-10 claims submission tests indicate that it’s ready for the October 1 switchover.
  • The VA awards Systems Made Simple and Epic a seven-year, $624 million contract to implement Epic’s Cadence patient scheduling system.
  • Banner Health confirms that it will convert its acquired University of Arizona Health Network from Epic to Cerner.
  • Health Catalyst shuffles its executive team in what appears to be preparation for an IPO.
  • CVS announces plans to extend its telehealth reach via pilot projects with American Well, Teladoc, and Doctor On Demand.

Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Announcements and Implementations

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Providence, RI-based Sproutel will introduce Jerry the Bear in September, a “smart teddy bear” that gives kids a medically validated curriculum for diabetes and other chronic conditions. They learn by feeding Jerry a healthy diet, matching insulin doses to carb intake, administering insulin, and listening to Jerry describe how he feels when his blood sugar is high or low.

Twenty-five bed Aspen Valley Hospital (CO) will implement Epic through Denver’s University of Colorado Health.


Technology

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A former Arizona State University rugby player who suffered an on-field concussion develops FITGuard, a smart mouthpiece that uses a player’s medical history and the measured force of hits to the head to light up concussion warnings. The connected app then automatically walks coaches or medical personally through a concussion assessment to make sure they get medical care if warranted.


Other

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The Madison, WI paper predicts Carmageddon-level traffic this week as Epic’s user group meeting brings in 9,000 visitors and local schools begin classes on Tuesday. It’s going to be warm in Verona, with highs near 90 each day and high humidity.

Yelp, which will now feature more information about hospitals, admits that it’s hard for the company to manage Internet shaming that poses as reviews, such as those reviling the dental practice of lion-shooting dentist Walter Palmer by non-patients (removal of which triggered a free speech protest despite their irrelevance to his dental capabilities) and a “review war” of Democrats vs. Republicans on the Yelp page of a pizza restaurant whose owner was photographed hugging the President. The insightful article predicts the creation of a “shame economy,” where consumers threaten business with negative reviews and businesses hire reputation management firms to fight them. Yelp claims it, too is a victim since it’s at the mercy of user-generated content, but it didn’t complain about making money for doing little more than creating a platform for free contributions.

Bankrupt Hutcheson Medical Center (TN), which re-opened its closed OB unit this past December with fancy hardwood floors, Wi-Fi, HDTV, and iPads, shuts the unit back down again after the upgrades failed to attract enough business.


Sponsor Updates

  • The SSI Group and TeleTracking will exhibit at the California Association of Healthcare Admissions Management event through September 2 in Sonoma.
  • Surgical Information Systems recognizes clients and partners including Abington Health (PA), Robert Wood Johnson Health Network (NJ), Susquehanna Health System (PA) and CapsuleTech with its Perioperative Leadership Awards.
  • T-System will exhibit at the 2015 GHIMA Annual Meeting September 2-4 in Jekyll Island, GA.
  • Recondo Technology integrates its BenefitPlus patient estimation tool with Epic’s Benefit Collector, increasing point-of-service collections by an average of 12 percent in a multi-state health system.
  • The Children’s Home Society of Missouri honors TriZetto with its Visionary for Children Award.
  • Valence Health releases results from its annual US Attitudes Towards Health Insurance and Healthcare Reform survey.
  • Forbes ranks Verisk Analytics the 18th most innovative company in the world.
  • Vital Images will exhibit at HIMSS AsiaPac15 September 6-10 in Singapore.

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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August 29, 2015 News 17 Comments

HIStalk Interviews Richard Helppie, Chairman and CEO, Santa Rosa Holdings

August 26, 2015 Interviews 4 Comments

Richard Helppie is chairman and CEO of Santa Rosa Holdings, chairman of Sandlot Solutions, and founder and managing partner of Vineyard Capital Group.

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With Meaningful Use implementations winding down, ICD-10 almost done, and the Department of Defense EHR bid issued, is the industry poised to contract?

No. The reason would be — anticipating your follow-up question of “why is that” — I sense that healthcare pivoting to business needs now away from some of the forced march on regulation. That is a ripe opportunity.

Which of those business needs will create the most need for products and services, such as consulting?

On the provider side, you have legacy and very well-run organizations that are designed around fee-for-service and volume. They have been constructed in the way that the business is organized, the way people are trained, the way that their IT systems are designed and deployed, and have been around fee-for-service. Those systems are mostly passive. They’re mostly tabulation systems. They wake up when there’s an admission or a registration, then they count stuff or they move a little bit of information around.

Then you have this other tower over here on the payer’s side that is also set up just for fee-for-service. It says, "Gosh, you shouldn’t have done that service that you want a fee for or maybe you should have done another service." But again, those systems — pre-authorization and registration aside — wake up when there’s a claim, then they do their thing and try to process it.

When I talk to CEOs in this industry, on both the payer and provider sides — which as you know are coming together — I pose this question to them. I ask them how many employees they have. The last one told me he has 28,000. I say, “You have 28,000 people today coming to work who don’t really know it, but they’re doing fee-for-service medicine.” One hundred percent of the time, I get the nods. “Yes, that’s exactly what my problem is.”

You’re going to see very rapid change in the next few years. I’m very excited to be part of it at this stage.

Hospitals have performed poorly in doing what’s now expected of them, managing costs and health. Will they be able to change their direction and stay on top or will new competition overcome their money and influence?

This will sound like I’m avoiding the question, but I’m not. The answer is “and both.” When you think about what that healthcare enterprise of the future is going to look like, you’ve got to have hospitals and facilities to put the very sick and the very injured in. You need to have a well-developed physician network. You need to have some kind of risk-bearing entity.

Those components are going to come out of the traditional, hospital-centered health systems who have evolved their businesses a lot in the last couple decades. Some will come out of physician groups, some will come out of payers, and certainly there’s going to be new players. As you turn to IT and you think about the confluence of those factors along with the change in the payment methods and the availability of technology, there’s going to be new players out there on the frontier for both care delivery and technology.

I’m sure other folks have views on this, I look at it around that adage that IBM didn’t invent Google. They were the largest computer company in the world. Why didn’t they invent Google? It went against their old business model. You’re going to see some of that in care delivery, in risk management, and certainly with IT.

What factors determine which technology startups will have the best chance to succeed?

It’s always going to come down to scale. Scale is going to come from distribution. Distribution is going to come from dealing with that very specific business issue.

By way of example, you see some things on the periphery that I don’t think are going to work. Somebody made a little app for the Apple watch. You say, "How big can that market be?" Well, first of all, how many people are using an Apple product versus an Android product? How many people are going to buy the watch? How many people are technologically adept to do that? It getting smaller and smaller. You go, that’s going to be an interesting project, it’s going to contribute to the body of experience and body of knowledge that we have as an industry, but it’s not going to be something ubiquitous that’s going to move the needle.

The frontier is about true interoperability. Many people have said that we have mountains of data, but what we don’t have is interoperability. We have folks that have business models that aren’t built for that, both folks that are using those systems — the traditional healthcare industry participants — as well as the vendors. Both of those have been in a fee-for-service type of mentality, so it’s not in their business model to go to interoperability.

People want to talk about interoperability. They talk about bi-directional. Interoperability is omni-directional. It’s not planned interfacing. I’m Vendor A and I’m going to go communicate with Vendor B and vice versa. Interoperability is this: I use my systems, you use yours, and our information is translated seamlessly and it’s done in real time.

The operative question that I like to ask when it comes to interoperability is this. The person you love the most is in front of the doctor. What information do you want the doctor to have? What do you want the doctor to have to do to get that information?

That’s what we have to be driving toward as an industry. Long way around, when I think about things that are going to be very successful in the future, they’re going to address that question of making all that data interoperable and in a contextually relevant way and serving it up where it does the most good, which is at the point and the moment of care.

I asked Grahame Grieve what his one wish would be for interoperability and he said it’s that clinicians would consider it a clinical problem and apply the same level of enthusiasm as the IT people. I also asked him who creates the demand and incentive for sharing data and he didn’t have a clear answer.

First of all, I love the quote. I think he’s really on to something. That’s a terrific insight.

You’ve got two questions there. Looking at it as a clinical issue, I’m chairman of a company called Sandlot Solutions, arguably the best interoperability play in the industry today. One of our physicians, who’s been a pioneer in it and is a GI doctor, says this is the most important invention in the time that he’s been practicing medicine, and he’s well into his 60s. He goes through all the different medical devices. It comes down to, when he goes to treat a patient, he knows about them.

One of his many stories is a fellow coming into get polyps removed form his colon. He’s a Medicare patient, very well organized, and he hands the physician a list and says, “Here are all the meds I’m on.” The doctor, because he’s on Sandlot, looks in his own EMR, and he says, "Hmm, I’ve got something here that says you were put on Coumadin two weeks ago, the blood thinner." He says, "You’re right. I forgot to add that to my list." That is a medical disaster avoided because of interoperability. Even well-organized patients don’t do a great job of transferring that information. I’m above average at it and I don’t do a great job at it. I’m not an MD or a DO.

That’s where the demand can come from. From doctors saying, give me a full suite of information, a full payload, and give that to me at the point and moment of care. Give it to me in my workflow. Give it to me within my EMR. You guys quit fighting. I don’t care what enterprise it came from. I don’t care what brand of system sourced it. I want to be able to know where it came from, but I don’t want to go find it. I don’t want to have to go look in five or six places for it, which is what a lot of this first wave of so-called interoperability did.

Now to your second part of your question, which is how do you get people to participate? My experience in doing this now for almost four years is that everybody wants to be first to be last. Let me explain that. If you go to any provider in Memphis and you say to any provider, we want you to connect to a system that has all the other providers in town seamlessly moving information around. Right in your EMR you’ll get all of the data from the other folks within your enterprise, and within your affiliations, and with any public health data we have. It will be delivered into your EMR in the format you’re used to looking at it.

In exchange, as you treat this patient, within the consent laws, your information will be shared. One hundred percent of people would agree to do that. That’s the barrier right there.

It’s less about incentives and more about leadership. There are some good stories forming out there about leadership, so back to your first point, who creates the demand? It’s going to come down to leadership in our industry.

What did you think about the DoD contract and what are your thoughts on how Leidos will execute it with Cerner and the other partners that are involved?

It was a very thoroughly vetted process. They certainly had the right players that were going down the stretch drive.

Everybody in the industry wants to see them be successful. We don’t want some of the fits and starts like we’ve seen in the NHS experience. I just hope that they go about it in a methodical way and create value along the way.

I do hope that they have an open mindset and enough openness in the architecture to connect to the information systems stacks that are out there. I hope that we’re able to demonstrate better healthcare for our veterans and our service men and women.

What does the future hold for Allscripts, Cerner, Epic, and Meditech?

Individually, clearly Cerner, Epic, and Meditech are the three that we see in the market doing well. All are vigorously competitive. All three have very substantial customer bases. They all have their very loyal fans. They all have the ability to engineer and deliver product. 

It’s going to be the ones that operate in conjunction with all the other technology out there are going to be the most successful. Again, I’d go back to the IBM-Google type of dynamic that is coming up in our industry.

This industry needs to start paying today’s price for IT. That’s not client server, that is cloud. Secure, private cloud, not just random cloud because of the privacy and security that we have. When those players — the major ambulatory and physician-based vendors — are truly operating in an interoperable world, open to the other data sources and places they need to provision data, especially down to the patient level, I think they’ll all be very successful.

All three of those companies are going to be part of the fabric of the next wave of healthcare. There will be other technologies that will leverage them and make them even more value, but all three of those are going to do rather well.

IBM is doing a lot with Watson. Will precision medicine have a significant impact on healthcare or is IBM just trying to find a lucrative market?

Time will tell on that. It’s a grand scheme and I’m wondering how they can bring it down to a granular level.

You asked at the top of our conversation if things were going to stall and I think not. Business requirements are going to drive IT. The question will be whose business requirement is going to bite off something that big, that complex, that far out on the edge, and that unproven?

I hope that they can move the needle and we get the best research driven to the point of care, but I see that there’s a gap between the demands of the market that I see arising today and the power of what may — but isn’t guaranteed — to come out of that collection of that technology. I think we have to wait and see.

Along those lines, NantHealth is investing a lot of money to nibble around the edges of healthcare IT. Do you think they are for real?

It’s an interesting collection of point solutions. Period.

Have you seen any startups that will be able to work their way into the enterprise?

Let me tell you what we haven’t seen. I don’t see anybody out there that is necessarily the silver bullet. I think what the industry is driving for right now is meaningful information in a contextually relevant way – both in the clinical setting and in the management of risk — and in dealing with the financial case. This is something that goes beyond the boundaries of the enterprise.

The way I look at it, there’s a continuum of that data capture. On the back end is analytic reporting. We have a number of analytic companies that are doing quite well, but they’re analyzing data that’s really bad. Healthcare has been accustomed to having data that is incomplete, developed for another purpose, and old. But now we have on one end of the spectrum analytic companies developing reports around that. Now we have better reports on really bad data.

I’ve been in the IT business 41 years and it’s still garbage-in, garbage-out. We see now the awakening for, "Let’s get to better sources of data." If one end of the spectrum is analytic reporting, the other end — the front end — is the interoperability, the capture, the curation, the collection, and the merging together of data, both at a patient level and at a population level. Between those two points, you have care coordination, referral management — both being done in very archaic ways — and care management for your chronically ill patients.

That’s the continuum that I see. I see a lot of work being done on the analytical reporting end, though I do see the folks that have been using those awakening and saying, "We’ve got better reports, but we still don’t have very good data." That’s what we have to do as an industry — connect from that source during that workflow of that actual patient encounter back through the big data analytics.

What should small companies know if they’re going to succeed in healthcare IT?

Innovation comes before standards. We have people that chase standards and regulation, and if standards ever did what they should do — which is make things cheaper and faster — it would work, but they rarely do.

I would encourage them to look more at innovation and look at a business reason for doing something versus trying to define a standard or drive a regulation and then answer that. That would be my advice to them — innovation before standards. Standards should fall out of innovation, not innovation being driven toward a standard, because we don’t know exactly how we’re going to get there.

Do you have any final thoughts?

We have a very important mission to do in healthcare. It’s not only demographic with the aging of the country, but it’s also very personal. Ultimately, this is the system that will take care of us and our loved ones. We need to make sure that we do a great job so that we have the best healthcare system possible.

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August 26, 2015 Interviews 4 Comments

Morning Headlines 8/26/15

August 25, 2015 Headlines 4 Comments

Medical Appointment Scheduling System (MASS)

The VA awards Lockheed Martin-owned contractor Systems Made Simple and its software supplier Epic a seven-year contract worth as much as $624 million if all contract options are exercised.

Banner aims to cut costs from UAHN as earnings lag

Banner Health will convert its newly acquired University of Arizona Health Network from its existing Epic systems to Banner’s Cerner platform. UAHN implemented Epic in 2013 at a cost of $115 million.

Pacific Northwest Health Care Organizations Join CommonWell Health Alliance

Five Cerner customers in the Pacific Northwest will begin exchanging health records with local AthenaHealth and Greenway practices through the CommonWell Health Alliance.

Practice Fusion Surpasses 600th Partnership Deal Becoming the Most Integrated Cloud-Based EHR Platform

Practice Fusion announces that it will integrate lab results from Theranos and imaging results from RadNet into its freeware EHR.

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August 25, 2015 Headlines 4 Comments

News 8/26/15

August 25, 2015 News 1 Comment

Top News

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The VA awards its Medical Appointment Scheduling System (MASS) bid to one of its often-used contractors, Lockheed Martin-owned Systems Made Simple, which earns a seven-year, $624 million contract. The software supplier will be Epic, which gives the company a big win following the Leidos-Cerner-Accenture DoD selection. The VA issued its RFP for a commercial patient scheduling system in November 2014 following a nationwide patient wait time scandal. Lockheed Martin acquired the government healthcare IT contractor in October 2014 for an undisclosed price.


Reader Comments

From 4nER: “Re: Optum’s international push. It has dwindled – their UK-based CEO has left, Brazil acquisition Amil is struggling, and Virgin Care has beaten Optum in many NHS bids.” Unverified.

From You Don’t Need a Weatherman: “Re: Meditech. Opinion is they got into ambulatory and Web too late. As sites wait for MU Stage 3 and evaluate their vendors, Meditech is being evaluated by those sites. The timing may be perfect as Web EHR and Acute will be rolling out of 6.X as Stage 3 progresses.”

From Mark Pro: “Re: marketing people. You complain a lot about them. Don’t they do anything well?” As in most professions, the few incompetent, inexperienced, or overworked ones give the others an undeserved black eye. My favorite MBA topic by far was marketing (my second favorite was finance, strangely enough) and I really enjoyed learning about product positioning, channels, how marketing differs from advertising, etc. Marketing done right is education, collaboration, and orchestrating the intersection of product supply and customer demand. What puts a healthcare IT marketing person on my bad side:

  • Putting out incomprehensible announcements that are a BS buzzword tsunami clearly assembled by a roomful of people who are trying to advance their personal company stature rather than create clarity.
  • Expecting instant responses to their banal emails, always “circling back” because I’m too busy doing something important (like writing HIStalk) to respond immediately to their unsolicited questions. Just because you sent something I didn’t ask for doesn’t mean I’m obligated to acknowledge that I received it or to do anything more than hit “delete.”
  • Trying to do everything by committee, bugging Lorre to get on a call with a roomful of their people and then flooding her inbox with emails from each of them asking and re-asking questions she already answered. Usually that happens after they fail to read what she sent them earlier, preferring instead to waste everybody’s time in having it read to them over the phone.
  • Not following my rules, such as checking off the Readers Write submission box that says the article hasn’t appeared elsewhere, but then I find it posted on their company blog (I always Google before I run a guest post). That usually gets them banned.
  • Asking me to interview a brand new CEO (who doesn’t even know where the restrooms are yet) or an executive involved in a product launch (gee, wonder if they’ll say anything controversial?)
  • Not understanding the dynamic that I alone decide what I write, who I interview, or which products or news I consider worthy of reader time. I’m fine with companies suggesting that I interview their CEO, but I won’t allow marketing or PR people to participate. Lorre books most of the interviews for me and warns them upfront, “If he gets on the interview call and people other than the CEO are on the line, I guarantee you he’s going to hang up.” I like that nobody can whine over my head about my decisions – it’s just me, I have a long memory, and I won’t even pretend to like people who annoy me.

The marketing people I consider peers:

  • Are not new to healthcare IT, having paid their dues and learned the business, which probably means they have lost their youthful, chirpy innocence and can communicate as professionals.
  • Enjoy HIStalk and follow it even after they change jobs, often keeping in touch afterward.
  • Offer me what I need instead of what the company wants, perhaps offering to arrange an interview with a customer instead of a company executive who I’d turn down (I only interview CEOs except in rare occasions.)
  • Know not to waste my time with ghostwritten, worthless Readers Write articles that I’ll reject anyway.
  • Apologize when I call out an announcement, a newly rebranded product, or a company action as idiotic – sometimes they agree it’s bad, but explain that were overruled by the empty suits above them.
  • Request and accept my advice about how to improve an announcement, design and promote a webinar, or eliminate obvious mistakes or omissions in their web pages. I don’t volunteer to do that sort of thing, but if if someone asks and then ignores my input, I’m not going to jump at the chance to do them another favor.

HIStalk Announcements and Requests

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Jenn covered Monday’s post for me since I needed a long weekend, so I told her I’d set up a new poll when I returned. Last week’s poll respondents forced to make a big company investment would choose Health Catalyst by far, followed by NantHealth and Evolent Health. Mobile Man says Nant shows how little even smart people know about healthcare, while JR commented that some of the companies have decent prospects but he isn’t sure you’d get your money back investing in any of them at this point in their trajectory. New poll to your right or here: what will happen following the scheduled October 1 switchover to ICD-10?

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Welcome to new HIStalk Platinum Sponsor Stanson Health, which is also sponsoring HIStalk Practice at the Platinum level. The Los Angeles-based company provides easily implemented intelligent clinical decision support delivered at the point of care. Evidence-based content targets unnecessary tests and treatments while supporting Choosing Wisely and PQRS, while analytics helps organizations understand ordering patterns and identify opportunities. Of particular interest is the company’s advanced imaging content that works with any source of appropriate use criteria to reduce unnecessary imaging, inspecting 30 patient-specific data elements to minimize interruptions while tripling the inappropriate order cancellation rate compared to competitors. Cedars-Sinai Health System is saving $6 million per year after adding Stanson-powered Choosing Wisely recommendations into Epic (example: ordering an antibiotic for a patient with bronchitis issues a reminder that they don’t work for viral infections). The company also understands that patients may resist the “less medicine is sometimes better” message and has licensed content from Consumer Reports to provide them with friendly educational material. Stanson Health was co-founded by Scott Weingarten, MD, MPH (formerly co-founder and CEO of Zynx Health, now SVP/chief clinical transformation officer at Cedars-Sinai) and Darren Dworkin (SVP/CIO of Cedars-Sinai). I notice that Rick Adam is president and COO – he’s been in the industry forever as founder of Recondo Technology and New Era of Networks as well as being an executive in the early health IT days of Travenol (later Baxter). Thanks to Stanson Health for supporting HIStalk and HIStalk Practice.

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Thinking about Rick Adam sent me to the online archives, where I turned up this exclamation-point filled 1986 THIS ad from Computerworld. I haven’t been able to track down Frank Russo, who took the company through a few more gasping iterations before turning the keys over to Jeff Goodman, who was axed after the company was sold to HBOC in 1994.

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Mr. S wrote that his third grade class in Herminie, PA benefited from our contribution of STEM learning material (with matching funds from Chevron) just as the school year ended, giving his students new materials to master tricky topics that had come up through the year. He adds, “It is very important to give students every means possible of succeeding in life. Not every child learns the same way and not every child is interested in the same topics. These materials have allowed my students to succeed in my classroom in new ways and new topics. Thank you for caring about education and specifically caring about my classroom!” I still have matching money available from a generous vendor executive for companies that would like to contribute to other DonorsChoose projects via HIStalk now that the new school year is underway.

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Also from my DonorsChoose project, Teach for America teacher Ms. S in Illinois, who offers an extracurricular programming class that tries to boost the numbers of female, black, and Hispanic students interested in technology, says her kids responded with “soooo cool!” to see the MacBook accessories we purchased (SuperDrive, external hard drive, case, and cables). Our funding of $264 paid for the entire setup plus the optional donation to DonorsChoose.


Webinars

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.

Frank Poggio and Vince Ciotti delivered another brutally honest and opinionated HIStalk webinar on Tuesday, talking about the DoD EHR bid and how it will affect Cerner, Epic, and everybody else. I sponsored this one (meaning nobody paid anybody, in other words) and I’d be surprised if you don’t find it at least entertaining because people who’ve been in the business for a long time like Frank and Vince tend to have lost most of their muzzle and say whatever’s on their mind. If you have a non-commercial, informative, educational message that readers would enjoy, let me know and maybe you can do a webinar of your own.


Acquisitions, Funding, Business, and Stock

Cardinal Health will acquire 71 percent of Nashville-based post-acute care services and analytics vendor NaviHealth for $290 million in cash.

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Zephyr Health, which offers drug companies analytics to predict new product success using public and private databases, raises $17.5 million in funding led by Google Ventures, increasing its total to $33.5 million.


Sales

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The fire and ambulance services of Alameda, CA will use the Mediview patient care records, charting, and telemedicine pre-hospital application from Beyond Lucid Technologies.

Legacy Health (OR) chooses StrataJazz Continuous Cost Improvement as part of its five-year renewal for the full suite of Strata Decision’s products.

Missouri Delta Medical Center (MO) chooses PatientMatters for help with patient access, registration, and scheduling.

Vantage Oncology selects Wellcentive’s quality reporting and population health management solution for PQRS reporting.

Phynd Technologies recaps the six health systems that have recently signed for its Unified Provider Management Platform: Cone Health, Mount Sinai Medical Center, Kettering Health, Dayton Children’s Hospital, SCL Health System, and Presence Health.

Abington-Jefferson Health (PA) chooses the Paymode-X network from Bottomline Technologies to automate vendor payments.

Meridian Health (NJ) selects labor management solutions from Avantas.


People

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WeiserMazars LLP brings on Todd Heckman (PwC) and Jonathan Stromberger as consulting principals.

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Northern Inyo County Hospital (CA) hires Kevin Flanigan, MD, MBA (MaineCare) as chief medical officer/COO/CIO.

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Lisa McVey (McKesson) is named EVP for technology and operations at the newly opened Atlanta office of health improvement technology vendor BioIQ .

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Thomas Graf, MD (Geisinger Health System) joins The Chartis Group as national director of population health management.

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Renowned Texas surgeon James H. “Red” Duke, MD died Tuesday at 86. He was an Army veteran, professor, trauma program developer, TV personality, and cowboy folk hero. He treated President John F. Kennedy and Governor John Connally at Dallas’s Parkland Memorial Hospital on November 22, 1963 while a surgical resident. Those of a certain age will remember him from a riveting episode of the groundbreaking 1978-1979 NBC reality medical program “Operation: Lifeline” and his 15-year stint as a nationally syndicated health reporter.


Announcements and Implementations

Cerner and Hospira will further integrate the former’s EHR with the latter’s smart IV pumps using Cerner’s CareAware iBus.

Imprivata launches PatientSecure, the palm vein scanning biometric patient ID system it acquired as part of its April 2015 acquisition of HT Systems. 

Five Cerner clients in the Pacific Northwest will use CommonWell to exchange information with practices using Greenway, Athenahealth, and other systems connected to CommonWell.

Modern Healthcare names its 2015 Best Places to Work, which like every healthcare magazine’s “list” has as its primary objective selling advertising rather than conducting useful, scientifically valid research. Still, I’ll mention those HIStalk sponsor companies so named since (a) they like the recognition; (b) the awards really are driven by employee surveys; and (c) they’re good companies in multiple ways at least from the folks I know from each one: Burwood Group, CoverMyMeds, CTG Health Solutions, Cumberland Consulting Group, Divurgent, Galen Healthcare Solutions, Hayes Management Consulting, Health Catalyst, Impact Advisors, Imprivata, Park Place International, Santa Rosa Consulting, The Advisory Board Company, and The Chartis Group.

Practice Fusion will connect to Theranos for labs and RadNet for imaging in two states, collecting fees from those companies in return for connecting them with its users (that and selling supposedly de-identified patient data and pushing ads at doctors are its main revenue sources). We’ll see some interesting figures if the 10-year-old company ever does an IPO given its suggested market value of $700 million. All of that revenue requires keeping its free EHR users happy, so perhaps the incentives are well aligned for everyone.

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Medical kiosk vendor HealthSpot will roll out a new Samsung blood chemistry analyzer that will give patients their results for certain blood tests in seven minutes. It’s fascinating how quickly the tedious lab draw and results reporting process is disintermediating, just as dramatically as when lab techs were mostly replaced with sophisticated high-volume instruments, which in return came about because of regulations and when big reference labs convinced individual medical practices to stop running their own labs. With Theranos already doing tests without a doctor’s order in Arizona, the whole process may soon be in the hands of consumers.


Government and Politics

A US appeals court says hotel operator Wyndham Worldwide can be sued by the Federal Trade Commission for allowing hackers to breach its systems in stealing the credit card information of 619,000 customers. Wyndham argued that the FTC had exceeded its powers similar to being allowed to “regulate the locks on hotel room doors,” while the court responded, “Were Wyndham a supermarket, leaving so many banana peels all over the place that 619,000 customers fall hardly suggests it should be immune from liability.”


Privacy and Security

An interesting article (with healthcare consumer implications) says future currency will be data, not money, and everybody’s personal data is being taken by social networking companies whose terms of service allow them to steal photos and files under the pretense of improving their product. The interesting conclusion: perhaps individuals (and patients) should create their personal API that puts the ownership and control of the information back into the hands of the person to which it pertains. The discussion was triggered by new terms of service from streaming music Spotify, which requires users to give the company access to their photos, contacts, and device locations.


Technology

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A web ad piqued my curiosity about PillPack, a Boston-based online consumer pharmacy that just raised $50 million to expand its reach in offering individual prescription dose packs broken out into time due. The company manages all aspects of the prescription, from packaging and shipping to insurance, and will use its new funding to open brick-and-mortar storefronts and to roll out an app that will connect patients to pharmacists. The founder-pharmacist, described as looking like “the guy who you might buy pot from at a Dead concert,” says, “We should probably hire a finance guy.”


Other

A Tennessee company that runs skilled nursing and rehab facilities is forced into restructuring after implementing an EHR that caused billing delays and cash flow problems that led to its defaulting on a loan. The acting CEO, a partner with the company hired to turn the company around, says he’s seen paper-to-digital conversions cause financial problems across the country.

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This is an unusual Craigslist ad.

BIDMC CIO John Halamka, MD says that in planning for FY16, clinicians spend too much time documenting in poorly designed EHR tools that were designed for capturing information, not managing customer relationships. He adds that consumer apps have raised user expectations and those will have to be bolted on to EHR transaction capabilities because “the difference between the $2 app and the $2 billion EHR is that the $2 app is easier to use, more convenient, and possibly even more useful.”

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Phoenix-based Banner Health, which bought Tucson’s University of Arizona Health Network in February and isn’t happy with that organization’s losses, will convert UAHN from Epic to its own Cerner system as everybody expected and will cut $100 million of UAHN’s overhead over the next three years. UAHN spent at least $115 million implementing Epic with a November 2013 go-live, which may be the only case where an over budget EHR implementation caused such significant financial woes that an academic medical center had to sell out to a competitor.

Texas physicians will be paid for school-based telemedicine consultations with Medicaid-enrolled students whose parents have signed consent forms starting September 1. Proponents say it will keep kids in school and parents at work instead of sending them both home, while opponents question why non-Medicaid students are excluded and whether remote physicians will have enough information about the students to treat them properly.

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Google shuts down its Flu Trends tracker, which got people excited for some reason back in 2008 even though its premise was ridiculous – that it could detect worldwide flu outbreaks by looking at search term patterns in a crude form of big data analysis. Not too shockingly, it didn’t work, and even if it had been able to identify outbreaks, the information would have done little to stop their spread. 

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Stanford University offers its online-delivered, $3,500 Genetics and Genomics Certificate. Just added to the curriculum is the elective course “Personal Genomics and Your Health,” which can be taken for $495.

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A bookkeeper of Buffalo, MN-based mammography informatics vendor PenRad Technologies is charged with stealing $700,000 from the company and using it to pay personal expenses and to buy silver bullion bars she stored in her house.

LA County’s second-highest-paid employee made $790,000 in 2014 without working a single day. The former chief medical officer of Harbor-UCLA Medical Center earned the money as a partial settlement after he was fired for unstated reasons (rumored to be related to his medical credentials), sued the county for defamation, then turned down its job offer and retired.

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New York’s Beth Israel Medical Center wiggles out of a $95 million lawsuit brought by the family of a wealthy heiress who claimed she was detained in a private room for several years solely to extract money from her when the statute of limitations runs out. The lawsuit charged the hospital with keeping the perfectly healthy woman in a $1,200 per day private room while hitting her up constantly for donations, including a $3 million painting the family said she donated under pressure.

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A state health department in Malaysia is investigating a doctor who posted a photo of herself flashing the peace sign along with a patient in labor whose genitals were fully exposed. The doctor had a reputation for taking perioperative selfies.

It’s not HIT-related, but if you need your spirits raised, check out this video sent over by The PACS Designer of the United States Navy Band performing hits by Frankie Valli and the Four Seasons.


Sponsor Updates

  • ZirMed Chief Data Scientist Paul Bradley, PhD will present at two upcoming big data conferences.
  • PatientSafe Solutions posts “Medication Reconciliation Safety Concerns Linger Even with EHRs.”
  • KLAS’s 2015 mid-year report ranks MModal’s Fluency for Imaging as the highest-ranking front-end speech recognition solution for diagnostic imaging.
  • Black Book Rankings names the Looking Glass enterprise content management system from Streamline Health Solutions as number one in financial management and content management solutions.
  • AdvancedMD offers “PRM Software Capabilities, part 2 of 2.”
  • Awarepoint offers a video on caregiver enablement via healthcare technology.
  • Besler Consulting offers “IPPS Advisor: In-depth review of the FY 2016 IPPS Final Rule.”
  • Bottomline Technologies will exhibit at the California Association of Healthcare Admissions Management event August 30-September 2 in Sonoma.
  • CoverMyMeds Director Julie Hessick is named a finalist for Technology Innovator of the Year at the Next-Generation Pharmacist awards.
  • Stanson Health will exhibit at UHC’s annual conference in Orlando and will participate in its Member Innovation Expo and Reception on October 1.
  • Culbert Healthcare Solutions offers “The Defining Moments Leading Up to ICD-10.”
  • MedCPU takes home the 2015 Interactive Media Award for Best Website in Healthcare from the Interactive Media Council.

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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August 25, 2015 News 1 Comment

Morning Headlines 8/25/15

August 24, 2015 Headlines 4 Comments

Inovalon to Acquire Avalere to Drive Strategic Expansion Into Pharma/Life Sciences

Inovalon, a healthcare-focused data analytics vendor, will acquire Avalere Health, a data-focused consulting firm, for $140 million in cash and restricted stocks.

VA’s Backlog of Disability Claims Falls to 8-Year Low

The VA announced this week that its disability claims backlog has dropped 84 percent to 98,000, its lowest point since record-keeping began in 2007.

100 Most Influential People in Healthcare – 2015

Modern Healthcare unveils 2015’s Most Influential People in Healthcare list, which includes: Epic’s Judy Faulkner (#31),  ONC’s Karen DeSalvo, MD (#35), McKesson’s John Hammergren (#73), and Cerner’s Neal Patterson (#99).

July 2015 EHR Incentive Program

CMS publishes the July 2015 Meaningful Use update: 306,000 EPs and 4,400 EHs have attested to MU Stage 1, while 56,000 EPs and 1,500 EHs have attested for Stage 2. $31.3 billion has been paid out to date.

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August 24, 2015 Headlines 4 Comments

Monday Morning Update 8/24/15

August 23, 2015 News No Comments

Top News

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Mercy Health (OH) implements Premier’s integrated pharmacy and care management program to advance population health management initiatives at its 23 hospitals across Ohio and Kentucky.


Last Week’s Most Interesting News

  • Practice Fusion promotes Tom Langan to interim CEO, replacing founder Ryan Howard, who will move to board chair.
  • The executive exodus continues at NYC Health & Hospitals Corporation, with Paul Contino departing following an investigation of its $764 million Epic implementation.
  • Gene-sequencing company Illumina forms Helix, a business that will offer free genome sequencing to consumers and then monetize the data by selling portions of it back to patients as they need it.
  • ZocDoc raises a $130 million funding round on a $1.8 billion valuation, making it one of the most highly valued venture-backed companies in New York.
  • Leidos wins a $900 million contract to support R&D efforts within the US Army’s Medical Research and Materiel Command.
  • Epic is selected as the replacement EHR vendor for Finland’s Hospital District of Helsinki and Uusimaa, in a $424 million contract budgeted to grow to $635 million over 10 years.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience.

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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San Francisco-based Zephyr Health lands $17.5 million in a funding round led by Google Ventures, with help from existing investors Icon Ventures and Kleiner Perkins Caufield Byers. The med device and biopharma analytics firm has raised $33.5 million since its founding in 2011.


People

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James Rossiter joins NextGate as CFO.

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Dawn Van Dyke (The Advisory Board) joins The Sequoia Project (fka Healtheway) as marketing director.

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Dean Schorno (Adaptive Biotechnologies) joins 23andMe as CFO and head of operations.


Sales

Cone Health (NC), Mount Sinai Medical Center (FL), Kettering Health (OH), Dayton Children’s Hospital (OH), SCL Health System (CO), and Chicago-based Presence Health sign on to the Unified Provider Management Platform from Kearney, NE-based Phynd Technologies.


Announcements and Implementations

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Cerner shop EvergreenHealth becomes the only hospital in Washington to avoid paying a hospital readmissions penalty for the fourth year in a row. The two-hospital provider achieved HIMSS Stage 6 recognition last month.

NHS facilities in Wye Valley and Salisbury announce plans to move from decades-old patient administration systems to “electronic patient record systems” over the next two years. Wye Valley will spend over $23 million on a system from IMS MSXIMS, while Salisbury NHS will continue spending money with CSC on its Lorenzo platform. CSC has earned a tainted reputation as part of the boondoggle that was the National Programme for IT (NPfIT), which imploded in 2011 due to project overruns, mismanagement,and resultant budget-busting.


Technology

ZeOmega releases an annual clinical content update for its Jiva population health platform.

Validic adds RxRevu prescription intelligence software, including prescription drug delivery options and a price transparency tool, to its digital health platform.


Government and Politics

A 68-page report from the President’s Council of Advisors on Science and Technology determines that more work is needed from federal agencies such as HHS, NIH, NIST, and the National Science Foundation to promote and utilize open standards and interfaces to leverage data analyses for healthcare delivery and biomedical research. The report recommends without a hint of irony that “NIH and HHS should create funding mechanisms that will encourage accelerated deployment, testing, and evolution of translational IT systems for clinical use.”

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The White House issues a fairly broad call to stakeholders for ideas on how to move its Precision Medicine Initiative forward, outlining 10 potential categories of ways to treat disease and improve health that have precision medicine potential. Feedback is due September 21.

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The American Red Cross honors female community leaders and volunteers who contributed significantly to the recovery of New Orleans and Louisiana after Hurricane Katrina at its inaugural Power of Women luncheon. National Coordinator and Acting Assistant HHS Secretary Karen DeSalvo, MD was among the honorees for her work as city health commissioner and senior health policy advisor to New Orleans Mayor Mitchell Landrieu from 2011-14.


Research and Innovation

Oregon Health & Science University’s Knight Cancer Institute partners with Intel to launch the Collaborative Cancer Cloud, a network that will enable providers to securely share genomic data for more personalized medicine and tailored cancer research. OSHU plans to go live in the first quarter of next year with two additional cancer centers to pilot the new technology, plus make open source its Trusted Execution Technology to ensure patient privacy.


Other

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Nancy Snyderman, MD will make her first public appearance since leaving NBC earlier this year when she hosts a discussion next month with New Jersey hospital CEOs during the Princeton Regional Chamber of Commerce Healthcare Symposium. Snyderman left the network after facing criticism for violating a voluntary agreement with the CDC to stay out of public areas after reporting from Liberia during the Ebola epidemic. Keyspeakers.com notes that her speaking fees are nothing to sneeze at.


Sponsor Updates

  • Huron Consulting offers “A Modern Commentary on Medicare at 50.”
  • The SSI Group will exhibit at the 2015 MidAmerica Summer Institute Region 8 August 26-28 in Minneapolis.
  • Streamline Health rings the Nasdaq opening bell in New York City.
  • T-System offers “ICD-10 Leniency from CMS: What You Need to Know.”
  • TeleTracking offers “One Team … Unlimited Success.”
  • Verisk Health offers “Talking Cost Drivers: How Employers Can Stop Rising Medical Costs.”
  • VitalHealth Software offers “Healthcare Outcomes: Our First Executive Forum.”
  • Voalte offers “Lessons from mHealth History.”
  • Xerox “Helps State Medicaid Organizations Reduce Costs, Improve Care.”
  • ZirMed offers “Less Than 50 Days to ICD-10: Tips to Help You Prepare.”

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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August 23, 2015 News No Comments

News 8/21/15

August 20, 2015 News 10 Comments

Top News

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Investors and genome sequencing company Illumina form Helix, an app store-like service that will sequence and store a user’s DNA for free, but then offer the user pay-as-you-go apps to access it in the future. A customer might pay $20 to see if they have a specific genetic variant, then Helix will additionally sequence all of their medically relevant variants at their own cost of $500, hoping to sell the customer other information they need later without requiring a second round of sequencing. Partners such as LabCorp and Mayo Clinic will be paid a royalty-type fee, both for getting customers to submit their initial DNA sample and for each app they sell.

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San Diego-based Illumina sold $1.8 billion of DNA equipment and tests last year and is hoping to penetrate the market for consumers, who so far have shown little interest in having their DNA sequenced. The FDA may weigh in with regulatory requirements. As the excellent MIT Technology Review concludes, “With Helix, says Flatley, companies won’t have to invest in starting a laboratory any more. Instead, he says, any developer with a computer will be able to start a genomics company.”


Reader Comments

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From Gotham Growler: “Re: NYHHC. Glen Tullman was right in the Allscripts lawsuit.” The 2012 Allscripts lawsuit had nothing to do with the current investigation into HHC’s payments to consultants or how it has managed (or mismanaged, depending on who you believe) its Epic project. Allscripts claimed that HHC’s choice of Epic over Allscripts was unfair because HHC incorrectly calculated the total cost of ownership of Allscripts, which the company says was $500 million less than the number HHC used to choose Epic. The Allscripts analysis from its lawsuit (above) shows that HHC pegged the cost of all three options (Epic, Allscripts, or doing nothing) at around $1.4 billion, which is where the project estimate stands today. The lawsuit backfired, with Allscripts earning negative publicity from an industry generally puzzled at what the company hoped to gain by suing a prospect after losing a selection — HHC responded publicly in stating that the Allscripts TCO claims were “absurd,” that Allscripts was getting beaten soundly in the market by Epic because it “lacks a truly integrated solution,” and that the lawsuit was “an ill-fated attempt to reassure investors and inflate its sagging stock price.” Allscripts filed the lawsuit on December 13, 2012. Six days later, the company announced that it had failed to find a buyer for itself and had instead hired Paul Black as CEO and fired its executive team of CEO Glen Tullman, President Lee Shapiro, Chief Client Officer Laurie McGraw, and EVP of Culture and Talent Diane Adams. Allscripts dropped the HHC lawsuit three months later. MDRX shares are up 30 percent since Black took over, although they significantly trail the Nasdaq’s 64 percent overall rise over that time.

10-13-2012 6-23-27 PM

I went back to my October 2012 post about HHC’s original Epic decision, where I now recall that the $1.4 billion project cost was clearly spelled out to documents prepared for HHC’s board. That suggests that newspaper reports that the project is running double the expected costs of $700 million are incorrect – HHC estimated $1.4 billion from the beginning. The most interesting aspect of the lawsuit is that it disclosed that Epic’s software license fees represented $303 million of the $1.4 billion project, which is pure profit to Epic since the software carries no incremental costs. People always observe that Epic gets only a small portion of a total project cost of $500 million or $1 billion as license fees, but the lawsuit indicates that it’s around 25 percent. The Epic financial magic is high license fees, billing out freshly graduated liberal arts majors at multiples of their $50 hourly salary, and charging a significant portion of the license fees as annual maintenance with rebates for behaving in ways that Epic likes (applying updates, not bad-mouthing the company, and following Epic’s consultant hiring processes, for example.) Not too much different than any other vendor except for using newbies and putting lots of restrictive clauses in the contracts.

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From Quality is Job Open: “Re: Quality Systems/NextGen. They let CTO Steve Puckett go, but are also swapping out all of their development leadership to create an Office of the CTO with an SVP of engineering, chief architect, and chief product officer.” Unverified, but the recruiter’s email I ran across seems to confirm that newly appointed CEO Rusty Frantz is retooling the whole product development group.

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From Fly on the Wall: “Re: MediGain. The CEO and chairman are gone after a series of lawsuits claiming financial improprieties. As reported on HIStalk on 10/29/14, MediGain received an investment of $38 million from Prudential Capital Group. The latest lawsuit was filed by MedVision in January 2015, claiming that MediGain failed to pay the founders the monies due them.” Unverified, but the bios of Greg Hackney and Dinesh Butani have been removed from the executive page of the coding and revenue cycle vendor’s site.

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From Don: “Re: Theranos shout-out. I’ve used the service for nine months in Phoenix. No DMV type experience – draw stations are at Walgreens and have weekend hours. Great for people without insurance coverage, with PT/INR at $2.70 vs. $99.50 hospital bills Medicare, who pays $4.98. Fast turnaround and results are available via web, smartphone, app, and PDF download. Tests drawn at PCP are available in four hours and are available on his eClinicalWorks system and patient portal. No lab order required in Arizona. As long as Theranos meets CLIA-88, CAP, JCAHO, and other regulatory requirements, we will use them whenever possible. My only concern is that convenience and pricing could deteriorate as the company expands to meet financial viability.”


HIStalk Announcements and Requests

This week on HIStalk Practice: Circle Health launches new practice business model in San Francisco. Telemedicine comes to a pet near you. Urgent Clinics Medical Care implements DocuTap tech at Houston facilities. Millenials may not be as averse to primary care office visits as their addictions to devices would have you believe. HHS encourages health IT-savvy practices to submit nominations for the 2015 Million Hearts Hypertension Control Challenge. Palliative care via telemedicine makes a difference in rural California. Large group practices weigh in with favored vendors based on customer satisfaction.

This week on HIStalk Connect: Doctors working at Al-Shifa Hospital in the Gaza Strip have developed a 3D-printed stethoscope that can be produced for 30 cents and performs as well as modern commercial alternatives. Nutritional supplement startup WellPath announces new integration points with both Fitbit and 23andMe in an effort to enhance its ability to personalize nutritional supplements. Finnish designers have launched a Kickstarter campaign to fund the Oura Ring, a ring that tracks activity levels, caloric burn, heart rate, respiration rate, and sleep cycles.


Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

September 9 (Wednesday) 2:00 ET. “Need to cleanse, unify and manage the provider data in your EMR master file and other IT systems?” Phynd’s Unified Provider Management platform allows healthcare organizations to maintain a single, verified, customized profile for each provider across legacy IT systems. This 30-minute presentation will explain how Phynd’s system can help synchronize internal provider information in real time; create provider interoperability among systems; and manage, update, and analyze provider information with workflow tools to improve revenue cycle and clinical communication.

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Physician-patient matching service Grand Rounds raises another $55 million in financing, increasing its total to $106 million. Companies provide the service to their employees, who can seek second opinions, find insurance-covered doctors and have appointments made for them, and ask for medical help while hospitalized. The company digitizes and stores the medical records of its users within its app. The co-founders are Owen Tripp (co-founder of Reputation.com) and Rusty Hoffman, MD (chief of interventional radiology at Stanford Hospital).

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Doctor appointment booking app ZocDoc is valued at $1.8 billion from its most recent funding round, earning them the already-overused and annoying “unicorn” label by people whose lips are too busy to say “billion-dollar valuation.”


Sales

NeuroPsychiatric Hospitals (IN) chooses Medhost’s clinical and financial solutions.


People

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Kennedy Health (NJ) promotes Tom Balcavage from VP/CIO to SVP of technology and program services, where he will oversee ambulatory, product line, dialysis, patient experience, and imaging as well as IT.

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Consumer healthcare expense management system vendor CoPatient names Tom Torre (Alegeus Technologies) as CEO.

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William Tierney, MD (Regenstrief Institute) is named inaugural chair of population health for Dell Medical School at the University of Texas at Austin.

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Healthcare software vendor Ability Network names board chair Mark Pulido (BenefitPoint) as CEO. He was CEO of McKesson until the company fired him along most of the executives involved in its 1999 acquisition of book-cooking HBO & Company for $14 billion, with the June 1999 hit list including Pulido, Chairman Charlie McCall, CFO Richard Hawkins, Al Bergonzi, David Held, Jay Lapine, and Mike Smeraski.


Announcements and Implementations

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Allscripts will use CoverMyMeds as its prescription electronic prior authorization (ePA) solution. That’s how I read this somewhat vague announcement, anyway – Allscripts announced in December 2014 that it had developed its eAuth product for Express Scripts patients, so perhaps this agreement expands its reach.

Cerner will integrate the CoverMyMeds ePA solution with Millennium.

Cancer diagnostic vendor Guardant Health and oncology IT vendor Flatiron Health will develop a cloud-based platform to integrate liquid biopsy-based genetic testing results from Guardant’s equipment with clinical treatments and outcomes information to improve the targeting of cancer therapies.


Privacy and Security

The health minister of the Netherlands will propose that doctors be forced to turn over the medical records of patients to disability fraud investigators, although planned European Union privacy legislation may override that requirement by giving individuals more control over information about them, especially their health records. That new EU regulation will impact England’s NHS, which is making the data of non-opt-out patients available to researchers, drug chains, and private companies.

Carilion Clinic (VA) reprimands or fires 14 employees in unspecified roles for accessing patient records without legitimate need.

A former Florida TV news anchor sues his former employer, claiming he was fired for covering a story about paper medical records found in an abandoned storage unit whose contents were auctioned off. Matthew Dougherty says the station’s news director ordered him to “kill the story” when he found that the owner of the records was his own family physician, threatening him with statements that he had violated HIPAA.


Other

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The Kansas City paper writes a surprisingly insightful article on the lack of EHR interoperability, opening with a brilliant question: “Why, then, does a windowless office in Truman Medical Center need to scan 2.9 million pages of paper medical records that started out as electronic ones?” That’s pretty eloquent for a site that co-features the usual eyeball-pandering cute dog video right next to it. I like its term of “digital dead ends,” which it summarizes as, “All that scanning springs from institutional rivalries over control of your medical data. Records emerging from all that scanning give your doctor the digital age version of something pieced together with duct tape — and rendered less valuable in the process.”

It isn’t just a US problem that nobody likes taking a pay cut: China passes a law prohibiting doctors from selling drugs to patients at a markup, so to offset their loss of income, the doctors doubled the rate of inpatient care. As the abstract concludes, “The reform had an unintended consequence: China’s healthcare providers have sought new, potentially inappropriate forms of revenue.”

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Cleveland Clinic kicks McDonald’s out of its food court after years of trying to cancel the company’s lease, apparently convinced that the people who eat there (many of whom its own clinical employees) can’t be trusted to choose their food wisely during the very few hours each lifetime they’re inside the hallowed Clinic’s food court walls rather than everywhere else in Cleveland, which has 25 surviving McDonald’s. They should have instead used their copy of the franchise as a living laboratory to learn how to shift consumption to the healthier options that McDonald’s offers and that nobody buys, like salads, apple slices, and non-sugary drinks. McDonald’s, like Walmart and drug dealers, meets consumer demand that won’t go away no matter how much finger-waggers try unsuccessfully to legislate away the supply.


Sponsor Updates

  • MedData offers “The ABCs of ICD-10: Background and New Features.”
  • Navicure will exhibit at the 2015 Community Health Institute & Expo August 23-25 in Orlando.
  • ESD is included on the Inc. 500. Nordic also made the list, as did The HCI Group.
  • Netsmart offers “Leading the Interoperability Charge with Local Health Departments.”
  • Direct Consulting Associates opens its new exhibit in the Technology Showcase at the HIMSS Innovation center in Cleveland.
  • Nordic will exhibit at NeXXpo August 25 in Madison, WI.
  • SyTrue CEO Kyle Silvestro is featured in “Five Things You Never Suspected About Your Healthcare Data.”
  • Park Place International offers “Approaching VDI.”
  • Experian Health/Passport will exhibit at the National Association of Chain Drug Stores Total Store Expo August 22-25 in Denver.
  • Patientco offers “Learn How a Meditech Hospital Boosted Patient Revenue 17% by Bringing Patient Payments In House.”
  • QPID Health is identified as a sample vendor in the NLP-Clinical Enterprise category of Gartner’s Hype Cycle for healthcare technologies.
  • PMD offers “The Many Faces of Android Devices.”
  • Anthelio Healthcare Solutions is named to the HCI 100.
  • Point-of-Care Partners offers a presentation on “Advancements in Technology to Streamline and Expedite Patient Access.”
  • EClinicalWorks will exhibit at the Collaborative Care Summit 2015 August 20-21 in San Diego.
  • Extension Healthcare offers “Imitation is the Sincerest Form of Flattery.”
  • Galen Healthcare Solutions posts “Reducing Complexity in Healthcare IT: Part 2 … Preparing to move forward.”
  • Greenway Health offers “Patient Engagement: Is Fear of Commitment Keeping Your Patients From Getting Engaged?”
  • Healthfinch will exhibit at the NeXXpo: Business in Fast Forward event August 25 in Madison, WI.
  • Healthgrades offers “A Day in the Life of a Web Developer.”
  • HealthMedx will exhibit at the Missouri Health Care Association Annual Convention August 24-25 in Branson.
  • Healthwise offers “Exploring the relationship between plain language and ethics.”
  • Ingenious Med will exhibit at the HFMA Mid-America Summer Institute August 26-28 in Minneapolis.
  • InstaMed offers “The Top 3 Essentials of Payment Security in Healthcare.”
  • InterSystems publishes “Redefining Relationships: Information Sharing Among Frenemies.”

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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August 20, 2015 News 10 Comments

News 8/19/15

August 18, 2015 News 14 Comments

Top News

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CTO Paul Contino leaves NYC Health & Hospitals Corporation, the fourth high-ranking IT HHC official to depart following an investigation of its $764 million Epic implementation. HHC previously fired CIO Bert Robles, two other employees, and seven consultants. Several of the project’s top positions being filled in interim by Clinovations (acquired by The Advisory Board Company in February 2015), which was given a $4 million, 15-month contract to manage the project. HHC is investigating reports of consultant overbilling on the project that is 18 months behind schedule. Internal documents suggest an actual project cost of $1.4 billion, nearly double the announced cost. HHC chose Epic in January 2013 at an announced contract price of $302 million. It hopes to bring it live system-wide by 2018.


Reader Comments

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From Former PF Employee: “Re: Practice Fusion’s interim CEO. Ryan Howard was never going to make it as CEO through an IPO. He had too many issues and wasn’t able to temper them enough. An IPO may happen but isn’t as imminent as the PR team says — that was a tactic to distract people from the need to change CEOs. It wasn’t supposed to be this sudden, but that’s how Ryan is and part of why this is a good decision overall. Side note: why does everyone think PF only generates revenue from ads and selling data? Ads are maybe 30 percent and data actually isn’t sold (while ‘insights’ from the data are sold, that’s less than five percent too).” Unverified.

From Duluth Dilettante: “Re: Practice Fusion’s interim CEO. I agree, you don’t put in an interim CEO to prepare for an IPO. A lot of venture money was poured into both Practice Fusion and CareCloud, both of which changed CEOs. The ‘broken’ healthcare space offers opportunities but is complicated, especially when competing with incumbent vendors like Epic and Cerner. Once you take VC money, the game changes to achieving lofty financial goals or getting kicked out by impatient investors.” I can’t imagine the learning that’s required of a startup CEO who faces a tough investor grade card at each revenue milestone. Think about Neal Patterson guiding Cerner from a picnic table conversation to a huge corporation and what he had to learn along the way. CEOs who are afraid of losing their job let boards convince them to maximize short-term profits even at the expense of long-term potential, so risky innovation isn’t encouraged, like Cerner spending a fortune developing Millennium in the late 1990s. One might postulate that every publicly traded company would have been better, but not necessarily bigger, if it had stayed private and stuck with a non-quarterly mindset like Epic, InterSystems, Meditech, and quite a few other health IT companies that are still run by their very successful founders after decades.

From Hospital Money Man: “Re: CMS. Cutting it awfully close for the 2015 MU modification / alignment rule. Reporting periods need to start no later than October 2 assuming the provision sticks. There’s no time for vendors to respond and QA is the first to get cut. Some vendors will hedge in assuming NPRM will pass as written, but there’s obvious risk. Just in case anyone wonders why we’re in the position we’re in with consensus that EHR functionality is in shambles and calls for program postponement.”


HIStalk Announcements and Requests

My latest gripe: referring to provider payments as noble-sounding “reimbursement,” an especially embarrassing euphemism when the reimbursee books an annual “surplus” of hundreds of millions of dollars. Also, publications that say Congress prohibits use of a National Patient Identifier, which isn’t exactly true – it only prohibits HHS spending government money to implement it.


Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Wolters Kluwer will acquire physician CME provider Learners’ Digest International for $150 million in cash.

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Denver-based predictive analytics vendor NextHealth Technologies raises $1 million in funding from investors that include Nuance Healthcare President Trace Devanny.

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Medical coding services vendor Aviacode receives a $16 million investment to further develop its marketing and technology. David Jensen founded the company in 2000.

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Rehab therapy software vendor WebPT acquires Therabill, which offers a Web-based practice management system for therapists.

Bold, insightful investment firms set a consensus target share price of $7.05 for Merge Healthcare, no doubt acting independently of the news that IBM will acquire the company for $7.13 per share.


Sales

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Hospital District of Helsinki and Uusimaa in Finland chooses Epic’s $424 million bid to replace its patient care system. Epic outscored CGI based on price, functionality, usability, and interoperability. HUS has 21,000 employees and nearly 3,000 beds.


People

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St. Jude Children’s Research Hospital (TN) names Keith Perry (University of Texas MD Anderson Cancer Center) as CIO.

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Froedtert & the Medical College of Wisconsin hires William Showalter (Wellmont Health System) as SVP/CIO.

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Steve Puckett, EVP/CTO of Quality Systems (NextGen), resigns “by mutual agreement with the company.” His duties will transition to COO Daniel Morefield.

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Meg Aranow (The Advisory Board Company) joins SRG Technology as SVP of technology.

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CareTech Solutions President and CEO Jim Giordano is appointed vice chairman of Ascension Michigan’s board.

RightCare Solutions names Jeff Edgin (Siemens Medical Solutions) as SVP of business development.


Announcements and Implementations

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Peer60 publishes “IT Infrastructure Trends in Medical Imaging 2015.” It’s interesting that hospitals are nearly equally split between wanting to buy PACS or VNA hardware on their own vs. choosing a turnkey solution. Preferred hardware vendors were Dell and HP.

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Clinical Architecture announces Content Cloud, a cloud-based terminology update service.

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Novant Health (NC), which has the highest Epic MyChart engagement in the US with 50 percent of its users logging into the portal at least monthly, will integrate user wearable data into MyChart using Apple HealthKit.

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Capital BlueCross (PA) announces that enrollees can start using its American Well-powered physician video visits on January 1, 2016.


Government and Politics

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Leidos wins another big military medical contract, earning a 10-year, $900 million bid to support US Army medical research.

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FDA, CDC, and NLM will convene a free public workshop on promoting semantic interoperability between diagnostic devices and EHRs/LISs on September 28, 2015 at the FDA’s Silver Spring, MD campus.


Privacy and Security

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The State of Colorado apologizes for sending 1,600 PHI-containing letters intended for Medicaid recipients to the mailing addresses of other people due to a vendor’s programming error.


Innovation and Research

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MIT researchers develop a cognitive assessment in which smart pens analyze the way a person draws a clock, automating a manually interpreted test and potentially allowing earlier detection of dementia.


Technology

An article about the Internet of Things says consumer and other light uses (some of them absurd, like refrigerator and trash can sensors) can’t be profitable since they communicate via expensive cellular networks.


Other

In England, local media get worked up after their Freedom of Information requests reveal that a hospital paid a cardiologist $17,000 to cover three, eight-hour holiday shifts, or compensation of $708 per hour.

UK investors complain that digital health innovation is stifled there by NHS, whose bureaucracy controls nearly all health-related spending even as NHS says its future success depends on innovative technology. A frustrated English startup CEO who moved his company to the US despite being named a NHS Innovation Accelerator Fellow says, “The NHS is optimized for people with large sales organizations and/or specific knowledge about how the system works. Although US healthcare has its problems and there are some messed-up incentives, at least there are incentives.” You can imagine a similar situation here if the federal government ran healthcare even more than it already does.

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A study of 96 medical specialists in Massachusetts finds that most are unaware of the state’s 2012 medical transparency law that requires them to provide consumers with self-pay prices within two business days. Dentists were the most accommodating, presumably because they have many patients without insurance. One ophthalmology practice quoted $140 for an eyeglass exam, but raised the price to $327 when told the patient would be paying cash. Price estimates for a colonoscopy that includes facility and anesthesiology charges ranged from $1,300 to $10,000. Some practices told the surveyor that they weren’t allowed to give prices by phone, while others were “downright rude.” The president of the state medical society blames “the complexity of the payment system.”

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The Kansas City paper digs back into Cerner history in comparing Amazon’s “brutal” workplace to Neal Patterson’s infamous 2001 threatening employee email that sent CERN shares down 20 percent after it went public. I’ve changed my opinion about the email over the years as several then-Cerner employees have said Neal was right – employees were taking advantage of the company’s management sloppiness and he had to skip those layers to get his point across directly and unequivocally. It must have worked since shares have increase somewhere around eightfold since then vs. the Nasdaq’s doubling. Still, it’s fun to run his spitting nails email every couple of years.

The New York Times publishes a great article called “How to Know Whether to Believe a Health Study.” It says the problem with randomized trials is that they focus on narrow populations of people who are most likely to benefit from the particular treatment, often also excluding older patients and children. However, it fails to mention what I see as the biggest problem – studies are often sponsored by companies that suppress publication of the negative or even inconclusive ones. The author likes observational studies in which large, existing databases are mined for new insights as long as they cover broad populations and not just people who chose to receive a particular treatment.

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Lenny Robinson, who sold his cleaning business and made a full-time job of visiting hospitalized children in Maryland costumed as Batman, was killed Sunday when his stalled Batmobile was struck by another car on Interstate 70. He was 51.


Sponsor Updates

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  • Aprima announces attendance of 800 at its user conference earlier this month.
  • Caradigm and iHT2 publish “12 Things You Need to Know About Value-Based Reimbursement.”
  • MEA|NEA is named to the Inc. 5000.
  • AdvancedMD offers a look at its new ICD-10 website.
  • AirWatch becomes a founding sponsor of the new Center for the Development and Application of Internet-of-Things Technologies at Georgia Tech.
  • Strata Decision Technology participates along with Costs of Care in a national story contest called “The Best Care, The Lowest Cost: One Idea at a Time.”
  • Aventura offers “A Nurse’s Perspective: Shifting the Focus from the Computer to the Patient.”
  • Awarepoint posts “Protect Patients, Cut Costs & Increase Compliance with Real-time Temp Monitoring.”
  • Besler Consulting offers “Medical Necessity and Ambulance Services.”
  • Cumberland Consulting Group and Divurgent are named to the Inc. 500 I 5000 list.
  • Recondo Technology will exhibit at the HFMA Region 8 Mid-America Summer Institute August 26 in Minneapolis.
  • Practice Unite offers “Achieving High Adoption of Patient Engagement Apps.”

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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August 18, 2015 News 14 Comments

Monday Morning Update 8/17/15

August 16, 2015 News 13 Comments

Top News

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Practice Fusion promotes Tom Langan to interim CEO, replacing founder Ryan Howard, who will move to board chair. That’s a bizarre move given that Langan has no CEO experience (he’s always been in sales) and he joined the company only a year ago. Practice Fusion is planning an IPO that could be imminent, but that plan seems faulty with this move. Sounds fishy to me, but then again that’s been said about the company’s free (as in advertiser-sponsored and data-selling) EHR business model from the beginning. They seemed awfully anxious to get Howard out of the CEO chair without having a viable replacement identified.


Reader Comments

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From Jed: “Re: your medical records saga. I came across PicnicHealth and I see you mentioned them back in 2014. The demo account looks pretty slick.” PicnicHealth, like CareSync, offers to manually obtain and input all of a patient’s records into its online system, which is presented in timeline form. They charge $19.95 per month for twice-yearly collection or $39.95 per month for constant updates. The company absorbs any records fees charged by providers, although it’s not clear from their site whether they obtain hospital records as well as those from practices. I mentioned PicnicHealth in August 2014, noting that they had five employees working from a San Francisco apartment or office above a Western wear store, sharing an address with the headquarters of sex party operator Kinky Salon. PicnicHealth raised $2 million in April 2015. I would be a bit concerned that its director of medical informatics, called “Doctor” throughout, is actually an ND (naturopathic doctor), although it probably doesn’t really matter for a consumer site. Still, that’s why the form “Dr. XXX” should never be used in writing, and when it is (incorrectly), I check the degree and school every time — it’s the folks trying to hide something that don’t state their actual degree or who conferred it.

From Digger: “Re: press releases. You mentioned that other sites basically rewrite them to look like news. I notice they also don’t link to them.” Of course they don’t – that would make it obvious that they did no original research or added no value at all. I always link to the source so you don’t have to take my word for it.

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From Terry: “Re: summer Sunday haha. Saw this on LinkedIn.” As you suspected, I like it.


HIStalk Announcements and Requests

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Seventy-one percent of poll respondents say Meditech’s competitive position is worsening. Reader comments include  Bread_Butter_Site: Meditech has too many platforms, got into ambulatory too late, took too long to release a Web version, and sacrificed agility to maintain their legacy platforms. PFS_Guy: Meditech offers the cheapest option for small to medium-sized facilities, but those are getting bought up by larger systems who replace it with their own system. Previous Medical User: decreasing product sales will force Meditech to raise support fees and limit product development. It’s Just Business: HCA considered moving to Epic but chose to stay on Magic.

New poll to your right or here: in which company (some publicly traded, some considering it) would you invest $10,000 if forced to choose one? I predict somebody will, as they always do, add a comment suggesting, “You should have put a ‘none of them’ response,” which of course would be irrational given the question.

Listening: new from Toto, decades-polished hard rock/progressive that stands as excellent on its own without even thinking about their late 1970s/early 1980s hits “Rosanna,” “Africa,” and “I’ll Supply the Love.” They aren’t just guys pushing 60 riding off into the sunset atop their ancient hits – the guitarist still shreds. They’re on tour now with Yes, who I say with sadness (having seen them many times as one of my favorite bands ever) is just topping off the grandchildren’s trust funds by cashing in on yet another tour as a sloppy, wooden cover band with no original members or creative energy left to do anything other than issue a zillion live albums from the band’s nearly 50 years.

Pet Twitter peeve: I’m scrolling through an endless list of utter Twitter crap, mostly retweets from the 134 people I follow (who often get maddeningly off-topic sidetracked in tweeting about baseball, a guy wearing a kilt, and pet issues like their personal airline gripes or their photography hobby) when I finally see something interesting and click on a link. Twitter then resets the very long list back to the beginning, forcing me to restart the endless scrolling. It’s time for another round of un-following.


Last Week’s Most Interesting News

  • Premier adds to its analytics arsenal by acquiring Healthcare Insights for $65 million.
  • Teladoc releases its first post-IPO quarterly report that shows a significant telemedicine usage ramp-up, but huge losses.
  • ONC announces that its IT safety center – assuming Congress changes its mind about not funding it — will be named the Health IT Safety Collaboratory.
  • A Vancouver newspaper’s investigation finds that IBM was fired from a large clinical systems transformation project and has been replaced with its subcontractor Cerner.
  • AHA complains that the FCC’s decision to open up some frequency bands to wireless microphones will interfere with Wireless Medical Telemetry Services in hospitals.
  • A GAO report finds that the VA and Department of Defense are missing key interoperability dates but are making progress, with the great unknown being how the DoD’s new Cerner project fits in.

Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Wireless and needle-free continuous glucose monitoring technology vendor Echo Therapeutics proves the difficulty of turning an idea into a business: the company loses $11 million in the quarter after deciding to abandon plans to license its technology and instead focus on its own product development by working with a China-based technology company. Echo’s largest investor, an arbitrage fund, agreed to invest another $4 million in the company in December in return for having the company’s board replace three of its members with its own people. The fund had previously sued the company for mismanagement, while its former CEO received a settlement from the company after suing for wrongful termination. ECTE shares peaked at around $800 in 2000 but are priced at $1.51 today, valuing the company at $17 million.


People

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Ross Martin, MD, MHA (AMIA) joins the Maryland HIE CRISP as program director.


Announcements and Implementations

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Medhost will convene “The Nashville Experience” at Nashville’s Music City Center on September 16, featuring speakers Hayley Hovious (Nashville Health Care Council), Nicholas Webb (futurist and author), Farzad Mostashari, MD (former National Coordinator and current Aledade CEO), attorney Steve Blumenthal, and Jitin Asnaani (executive director, CommonWell). Registration is $250 including meals with an optional $150 ticket to the Taste of Nashville Gala.


Government and Politics

The protest period for the DoD’s EHR bid has expired, so the contract stands with the winning team of Leidos, Cerner, Accenture, and Henry Schein. Competing bidding consortia that included partners Epic and Allscripts were rumored to have been underbid by $1 billion by the ultimate winner, making their protest unlikely since a win would require them to do the work for a lot less money than they estimated.


Privacy and Security

NHS England will give chain pharmacies access to the summary care records of all patients (excepting those few who have opted out) this fall following a pilot project involving 140 pharmacies. The records, which are on file for 96 percent of the country’s residents, contain medications and diagnoses. The pharmacist is required to ask the patient for permission to view their record during their drugstore encounter. Only 15 patients responded to surveys during the pilot, so few that their input was discarded. Pharmacists have expressed some confusion about when they need the patient’s permission and how to obtain it.

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University of Virginia announces that a China-based cyberattack affected its IT systems on June 11, but didn’t affect the UVa Health System.


Technology

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The Nashville paper suggests that hospitals and other business consider deploying beacon technology rather than apps that require installation and updates. Beacons use Bluetooth Low Energy to broadcast to nearby Android or iOS smartphones, displaying the desired information to the user and reporting back information to the business. The advantage to customers is that their location is encrypted and push notifications aren’t sent when they are out of range or their phones are turned off. Beacons cost only around $20 are even sold at Target for finding lost devices with beacons attached. Theoretically beacons could replace some hospital RFID functions or even to transmit vital signs information, although that probably strays into FDA approval territory.


Other

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The Donald is finding that it’s hard to hide from past idiocy that lives forever in social media. Many such cases!

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A reader sent over the full-text JAMIA article that bizarrely concludes that HITECH had no impact on EHR adoption. The public health professor authors used some kind of diffusion model to determine that EHR adoption was imitative rather than innovative, then wanders off to a seemingly unrelated conclusions about lack of positive EHR impact on productivity and interoperability. I think what they’re trying to prove is that HITECH drove EHR adoption for the wrong reasons and may have stifled innovation as a result, with the billions of taxpayer dollars spent on HITECH returning little value in clinical outcomes or costs. That’s just guessing since I really can’t figure it out. I’m surprised JAMIA’s editors let this run without asking for more clarification.

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The new $1.3 billion Parkland Hospital (TX), twice the size of the old building across the street, includes an interactive patient care system, Wi-Fi throughout, palm vein scanning for patient ID, and a more comprehensive ICU monitoring system.

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Graduate diploma and associate degree nurses of a struggling for-profit college chain break into tears at their first look at their licensure exam when they realize they were poorly trained, causing the community college exam proctors to bring in a mental health counselor and to hand out information about a suicide hotline. Brown Mackie College faces national fraud charges for using unqualified instructors (the Arizona campus instructor for anatomy and physiology is a lawyer) and skipping practical instruction for tasks such as starting an IV, which students tried to learn on their own by finding YouTube videos. Parent company Education Management Corporation lost more than $2 billion in 2012 to 2014 as the government cracked down on for-profit colleges marketing themselves hard to students who didn’t know better and who were likely to default on federal student loans, taking away 90 percent of the potential school profits. The Pittsburgh-based Education Management Corporation also operates Argosy University, The Art Institutes, and South University. Taxpayers will pay billions of dollars to cover the defaulted loans of students whose schools shut down as students demand that the federal government cancel their loans because they allowed themselves to be swindled. It’s not just a problem with for-profit colleges, as private and public colleges and universities woo students with the idea that they should rack up dozens or hundreds of thousands of dollars of debt in studying whatever interests them despite the almost certain likelihood that they’ll end up with no increase in employability or earning power as a result.

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Combat communications airmen with the US Air Force’s 35th Combat Communications Squadron from Tinker Air Force Base, OK rebuild the Internet connectivity of a Honduras hospital as part of a joint training exercise. The hospital had been offline for three years. Tech Sgt. Jasmine Matus says the team focused on the archives room that holds paper medical records since the hospital is hoping to migrate to digital storage. A 15-member Air Force medical team also participated, supporting classroom and drinking well construction teams from the Air Force’s 823rd Red Horse Squadron from Hurlburt Field, FL and the 271st Marine Wing Support Squadron from Marine Corps Air Station Cherry Point NC.

Employees of Willis Knighton Proton Therapy Center (LA) surprise 12-year-old spinal cord tumor patient Sophia with a flash mob dance (practiced on their own time) to celebrate the completion of her advanced proton therapy.

Weird News Andy titles this story “Jettisoned Evidence,” in which scientists study how bacterial populations differ around the world by extracting samples from the sewage holding tanks of commercial jets.


Report from the Allscripts Clinical Experience
By Joe Adkins, Clinical Pharmacist
Springhill Medical Center, Mobile, AL

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I changed my mind last week about what a healthcare IT conference is really all about.

When I made plans for the Allscripts Client Experience (ACE) held August 5-7 in Boston, I had no idea just how much my world view would be changed about what lies ahead for our industry. I planned to attend the usual technology sessions to learn about product roadmaps and functionalities.

But after experiencing the opening session, I realize what I’m doing now in my role as a clinical pharmacist is helping to build the future for healthcare’s new era of personalized medicine.

From the opening session featuring Allscripts President and CEO Paul Black along with NantHealth founder Patrick Soon-Shiong, MD, I realized that this conference isn’t just about software. It’s about saving lives, thinking big, and finding a path to predictive medicine from our current reactive medicine mode. When it comes to treating cancer and other complex diseases, genomic sequencing is going to change the game – and sooner than we know.

I was given access to some of the great thinkers on health information technology (HIT), and a view into where we’re headed not next year, but five, 10, even 15 years down the road. It was interesting to see just how far Black and Soon-Shiong are planning beyond what we even know as healthcare IT today.

What I heard them saying is that the medications we use to treat and target cancer and other complex diseases are becoming more personalized and predictive thanks to nearly commonplace access to genomic sequencing. The advances in cancer treatment alone are moving ahead by leaps and bounds that we couldn’t imagine just two years ago. All of us in HIT must step up to ensure that the clinical information needed to treat patients is available in real time at the point of care just as quickly as discoveries are made.

For example, a handful of medications treat cancer well in ways we couldn’t envision just a few years ago. Eventually, there will be several dozen types of drugs to select from, and eventually, thanks to genomic sequencing, we’ll know which one works best for each individual.

The development pathways for those types of drugs have become much, much more compressed and the industry currently has no answer for how to keep up.

But Black and Soon-Shiong provided an interesting sneak peek into the future, and they are making some bets that NantHealth has the answer. It’s a little bit of a gamble, but I think it’s a calculated, good one. We don’t know yet whether this is the direction to go, but I’m glad Allscripts and NantHealth are investigating a new path to the future of HIT.

We can save more lives if we get this right. And I’m all in for that.


Sponsor Updates

  • The SSI Group will exhibit at the 2015 MS HFMA Summer Workshop August 19-21 in Philadelphia, MS.
  • Streamline Health will ring Nasdaq’s opening bell August 19.
  • Surescripts Chief Administrative and Legal Officer Paul Uhrig is featured in a Boston Global article, “E-scrips seen as a way to combat opioid abuse.”
  • T-Systems offers “Leading with Passion: Check Your Resilience.”
  • TeleTracking posts “The Value of Time” in optimizing hospital operations.
  • TransUnion writes its first corporate social responsibility report.
  • Valence Health will exhibit at the World Congress on Health and Biomedical Informatics August 19-23 in Sao Paulo, Brazil.
  • VitalHealth Software offers, “The Patient Centered Medical Home: Will the Demonstration Projects Fail?”
  • Voalte offers a preview of VUE15, its first user experience conference, November 10-12 in Sarasota, FL.
  • West Corp. offers, “The New Healthcare Paradigm: “Think Whole Person.”
  • Xerox Healthcare explains how “Data Analytics Transforms Virginia Medicaid.”
  • ZirMed will host its 2015 UGM, ZUG 15, August 17-18 in Chicago.
  • Navicure offers “Shifting Attention: Value-Based Reimbursement Gains Traction.”
  • Nordic offers “HIT Breakdown 10 – Patient Engagement possibilities with MyChart.”
  • NTT Data posts “5 Reasons Your Cloud is About to Become a Legacy System.”
  • Oneview Healthcare offers “Yelp Comes to Healthcare.”
  • Orion Health writes “Does greater patient control equate to a better healthcare experience?”
  • Park Place International offers “Sustaining Virtual Desktop Infrastructure.”
  • Summit Healthcare reports the experience of its client Valley Regional Healthcare (NH), which is using the company’s downtime reporting system.
  • Patientco publishes a new white paper, “3 Strategies for Increasing Self-Service Patient Payments with PatientWallet.”
  • PatientKeeper offers “Relieving a Practice’s ICD-10sion.”
  • Phynd Technologies writes “Merger Mania in the Healthcare Industry.”
  • PMD submits “Digital Health: A New Haven for Physicians.”
  • RelayHealth posts a new case study, “Focusing on Patients, not Dollars, makes Cooper Bend Pharmacy unique.”
  • Sagacious Consultants offers a “Q&A with David Hammer: How Consolidation and Unified Reimbursement will Change Revenue Cycle Management.”
  • Sandlot Solutions will exhibit at the iHT2 Health IT Summit August 18-19 in Seattle.

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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August 16, 2015 News 13 Comments

News 8/14/15

August 13, 2015 News 4 Comments

Top News

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Premier acquires financial analytics vendor Healthcare Insights for $65 million in cash. 


Reader Comments

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From Bean Enumerator: “Re: North Shore-LIJ’s JV with Newport Health. Newport says it has experienced and innovative health IT talent, but the only person listed as working for the company has no relevant experience whatsoever. It’s a bad sign when an investment banker starts a health IT company. How did Allscripts lose this one given their supposedly tight partnership with NS-LIJ and their population health management aspirations?” I couldn’t find much of anything on Newport Health other than it’s apparently connected to Newport Private Group with a real office in Newport Beach, CA and mail drawer addresses in New York and Texas. The site contains nothing that suggests why they would make a good partner for NS-LIJ or anyone else for that matter.

From Divine: “Re: Cerner. Have you heard anything about them pulling their Intermountain team back to Kansas City?” I have not.

From ACOver: “Re: Aledade. You didn’t mention that the company is expanding.” Farzad’s Aledade has nothing to do with health IT, which some of the HIT sites can’t quite grasp in confusing his former job with his current one. Non-HIT sites with healthcare reform and insurance followers are the place for that kind of story rather than HIT sites that just reword Aledade’s press releases without adding any value whatsoever.

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From GeneInsight SchmeneInsight: “Re: Sunquest and Partners HealthCare marketing GeneInsight software. While the GeneInsight investment may be helping, I spoke with two folks (Meridian Health, NJ and Main Line, PA) each doing due diligence on enterprise systems to include ripping out Sunquest. Epic and Cerner are being vetted at both sites.” Unverified. The challenge with being a best-of-breed vendor is that your fervent, enterprise-resistant users don’t have the final word when health systems consider buying a broad, good-enough integrated product line from a company that supports it all. Those dominoes have been falling for years – lab, radiology, and pharmacy are moving (or being pushed) to Epic and Cerner from their favorite departmental systems. I haven’t seen any evidence that patient outcomes or costs have suffered as a result despite the dire predictions from the folks in those departments whose niche systems were, in their minds, integral to their unique mission.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor YourCareUniverse. The Franklin, TN-based company offers cloud-based technology and expertise in consumer relationship management, putting consumers at the center of the health system’s strategy. Patient-facing modules include YourCareHealth (personal health records), YourCareWellness (a wellness portal), YourCareEverywhere (consumer health content), and YourCareNavigation (rules-based care and wellness plans). Provider-facing technologies include a patient education content repository for clinician prescribing, community risk stratification analytics, an HIE and HIE connector, a patient transfer application, a Salesforce-integrated consumer marketing system, and a referral management system. The company also offers strategic consulting to guide organizations through transformational change. YourCareUniverse quickly signed up 38 customers after it was launched early this year, with its first go-live last month at Mount San Raphael Hospital (CO), which is using the patient engagement capabilities to promote its brand to consumers. Thanks to YourCareUniverse for supporting HIStalk.

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The YourCareUniverse folks are excited to present their two-day “Transvisional Forum: Transforming the Health of Consumers Through Engagement” conference September 16-17 at the Music City Center in Nashville. Topics of the nine educational sessions include cultivating consumer loyalty, managing the digital patient, analyzing big data, and increasing volume. Keynote speakers are Nicholas Webb (author of “The Digital Innovation Playbook”), Farzad Mostashari, MD (former National Coordinator and CEO of Aledade), Steve Blumenthal, JD (health IT attorney and all-around HIStalk pal), and Jitin Asnaani (executive director, CommonWell Health Alliance). Early bird registration is $795 through this Saturday, August 15.

This week on HIStalk Practice: Texas physicians struggle to keep their doors open and spirits up. HelloMD pivots its telemedicine services to medical marijuana. The Senate approves the Electronic Health Fairness Act, while HHS gets a black eye over breaches. Kathryn Evans offers best practices for leveraging technology to ensure reliable disposal of hazardous drugs at physician practices. HHS Secretary Sylvia Burwell announces $169 million in funding for new health centers. CSI rolls out Doctor on Demand telemedicine services. SecurityMetrics develops a HIPAA Dashboard for physician practices.

This week on HIStalk Connect: Google X Labs partners with DexCom to develop a miniaturized, disposable continuous glucose monitor. Twitter introduces an API exposing its entire 500 million tweet history to software developers. A Cambridge, MA-based genetics startup raises a $120 million Series B to advance its research into CRISPR-Cas9 gene editing therapies. A consortium of European researchers is developing a "smart mirror" that will screen users for early signs of chronic diseases.

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My love-hate affair with Windows 10 continues after one of its silent updates trashed my laptop’s Wi-Fi connectivity yesterday due to what I initially thought was device driver incompatibility. I spent a couple of hours trying to fix it before giving up and taking it to the repair shop (which I’ve never had to do since I can usually fix things myself). The shop owner left a message last night saying he had spent hours of analysis without figuring out a solution, with the only option he could suggest being to downgrade back to Windows 8.1. I returned his call this morning and he had experienced some sort of nocturnal epiphany and fixed the update-corrupted Windows networking components by matching up individual DLLs with versions and dates and then reinstalling and registering them one at a time. It’s back on my desk working fine. The $89 cost was worth it and I’m pretty happy to keep Win10, although I’m annoyed at the exasperation and expense of fixing the damage it caused and fearing the havoc the next update will wreak. The repair shop owner has added my problem to his Win10 issues folder, which is rather thick after just two weeks of its availability. He’s probably thrilled at the business uptick.


Webinars

August 25 (Tuesday) 1:00 ET. “Cerner’s Takeover of Siemens: An Update (Including the DoD Project).” Sponsored by HIStalk. Presenters: Vince Ciotti, principal, HIS Professionals; Frank Poggio, president and CEO, The Kelzon Group. Vince and Frank delivered HIStalk’s most popular webinar, "Cerner’s Takeover of Siemens, Are You Ready?" which has been viewed nearly 6,000 times. Vince and Frank return with their brutally honest (and often humorous) opinions about what has happened with Cerner since then, including its participation in the successful DoD bid and what that might mean for Cerner’s customers and competitors, based on their having seen it all in their decades of experience. 

Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Roswell, GA-based Tea Leaves Health, which sells hospital marketing software, will be acquired for $30 million by consumer health website publisher Everyday Health. Tea Leaves Founder Reuben Kennedy will make a pile of money he doesn’t really need given his LinkedIn endorsement of a car detailing company that attends to his “five Ferraris, several Porsches, and a Lamborghini.”

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PokitDok, which offers 16 healthcare transaction APIs for application developers, raises $34 million.

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DispatchHealth, which offers cities a mobile acute care alternative to dispatching an ambulance in response to 911 calls, raises $3.6 million. Dispatchers route non-urgent calls to the company, which sends out cars with a clinician, a mobile lab, medical equipment, medications, and Internet connectivity. The company was previously known as True North Health Navigation. It doesn’t indicate pricing, but a FAQ on its old site suggests $200 to $300 per visit with insurance accepted.  

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Freshly IPOed telehealth vendor Teladoc reports Q2 results: revenue up 78 percent, EPS –$7.20 vs. -$2.15. The company warns that it expects to lose $50 million in the fiscal year. Teladoc reports that 83 percent of its revenue comes from the per-member, per-month fees paid by employers, health plans, and health systems, with the remaining 17 percent coming from visit fees averaging $40. Teladoc made reference to future possibilities that include behavioral health, dermatology, second opinions, at-home testing and biometrics, post-discharge monitoring, and wellness programs.

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In a strange business shift, HelloMD, which previously offered expensive, cash-only video visits with big-name medical specialists, relaunches itself as a seller of $49 video consultations for medical marijuana cards. Note that the site says “Approved in 20 mins,” which suggests that a minimal amount of clinical rigor is applied during the video visit. The lady on its home page indeed seems to have been relieved of all her medical suffering and is now in a blissful state of deep-breathing wellness, surrounded by clouds.


Sales

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BayCare Health System (FL) chooses Legacy Data Access to retire its SoftMed application.

New England Healthcare Exchange Network chooses Cognizant and its TriZetto subsidiary to manage its technology infrastructure.

University Hospitals (OH) will use Sectra’s vendor-neutral archive.

Cambridge Health Alliance (MA) chooses Imprivata’s two-factor authentication for e-prescribing of controlled substances.

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Athol Hospital (MA) will implement Medhost’s ED information system.


People

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Cureatr appoints former Highmark CEO William Winkenwerder, Jr., MD to its board.

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Bill Wallace (Kansas HIE, BCBS of Kansas) takes over as interim CEO of the Kansas Foundation for Medical Care.

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University of Iowa Health Care names Maia Hightower, MD, MBA, MPH (Stanford Health Care) as CMIO. She replaces Douglas Van Daele, MD, who will serve as executive director of University of Iowa Physicians.


Announcements and Implementations

InterSystems will use technology from Validic to integrate user-generated and wearables data into its HealthShare interoperability suite.

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HIMSS brags on its Cleveland conference center and its role in helping its vendor members market their products as it trolls for “collaborators” (i.e., paying tenants). The upcoming events list isn’t very compelling with mostly small HIMSS meetings and vendor presentations for attendees yearning for a junket to Cleveland. I’m starting to think that from my experience with health systems and member organizations that the concept of non-profit (meaning “non-taxpaying”) organizations should be eliminated.


Government and Politics

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A GAO analysis finds that the VA and DoD are working on interoperability between their systems, but are missing dates and won’t be finished until 2018.


Privacy and Security

The Economist ponders whether databases can remain useful after being anonymized, or if in fact real anonymization is even possible given the relative ease of matching one database to another to re-identify the information. Possible solutions include releasing data only to researchers rather than to the general public, making data recipients sign use contracts, making re-identification illegal, encrypting data queries as a package so that researchers can’t see the underlying data rows, and dividing the database among multiple hosts.

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The Greater New York Hospital Association bans filming in the city’s hospitals without the the prior written consent of patients, embarrassed by a 2012 episode of “NY Med” that captured the ED death of a patient whose family recognized him on TV despite his digitally obscured face.


Innovation and Research

I can’t see the full article since I don’t subscribe to JAMIA, but I would question the methodology of this study, which concludes that HITECH didn’t change the EHR adoption trajectory – it was just practices without EHRs imitating those that had them.


Other

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Peer60 publishes a “Rapid Reaction Report” on IBM’s planned acquisition of Merge Healthcare, collecting thoughts from 130 healthcare leaders in the two days following the announcement. One-third of the Merge customer contacts said the acquisition will be negative, but 20 percent said they will expand their use of Merge’s solutions under IBM’s ownership. Radiology and non-CIO IT folks felt pretty good about the announcement, but 60 percent of CIOs see it as negative. The main concern seems to be whether IBM is too big and too light on PACS knowledge to keep Merge customers happy while they try to sex up Watson with Merge-supplied “eyes.”

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A British newspaper profiles EMIS Health Managing Director and former Misys Healthcare executive Duane Lawrence, noting that he was the #1 territory sales manager for Coca-Cola at 22 years of age before deciding, “I wanted to do something that was going to make a difference.” I can’t think of any positive healthcare difference Misys ever made other than getting out of it, but perhaps he has finally found his calling.

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The shrill shrieking for Internet attention has unfortunately encouraged the proliferation of witless, intellect-insulting puns in headlines, I’ve noticed. The reporter’s credentials suggest he should know better, although maybe I’m expecting too much since he also contributes to “Painting and Wallcovering Contractor.”

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Nice job spell-checking, Health Gorilla (or is that Health Gorrila?)

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The former network manager of Yukon Kuskokwim Health Corporation (AK) is indicted for collecting and distributing child pornography over the hospital’s network after investigators find 29 terabytes of images and videos.

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An Accenture analysis of 900 digital health IT startups labels half of them as “zombies” that are likely to fail in their first two years, creating a “vulture capital’ market in which better companies pick at their carcasses for people and technologies. The report identified the zombie startups as those “dead but unaware of it” companies that raised up to $50 million from 2008 through 2013 but haven’t had new financing in the past 20 months. I’m not as optimistic as Accenture that those struggling newcomers have people or intellectual property worth poaching, but we’ll see. They left out the most interesting part – the list of those companies they targeted as zombies. It would be fun to run a death pool contest.

In Australia, a state review of the new Queensland children’s hospital finds that patients were endangered in the rush to open the facility quickly before medical equipment, computer systems, and even hand sanitizers were in place. Employees didn’t meet each other for the first time until the day of opening. Everyone agrees now that the hospital needed another two months before opening its doors.

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I winced when I saw the “register for HIMSS16” subject line in my inbox. The pushed-back Chicago version was like Daylight Saving Time – it was great having the extra weeks before last year’s conference, but now we’ll all pay as the clocks are set forward for Las Vegas and the dreaded week comes all too quickly (you’re likely an HIT newbie or anything-to-miss-work conference junkie if you actually look forward to it). Early bird member registration runs $765. Las Vegas always requires messing up the familiar schedule to accommodate the busloads of gamblers that the hotels and casinos won’t displace over the weekend, meaning the HIMSS conference runs Monday through Friday instead of Sunday through Thursday. The opening keynote will be at 5:00 p.m. Monday and the exhibit hall won’t open until Tuesday morning. HIStalkapalooza will be Monday night as usual, so hopefully the opening keynote will be as unappealing as in the past several years so people can bail out to arrive at my event on time. The closing keynote will be delivered by noted healthcare IT expert Peyton Manning, who will face a Friday afternoon audience smaller than at a Denver Broncos closed practice scrimmage. Hotel rates are, as always, jacked up for expense account attendees, with the same Treasure Island room running triple what it would cost to go next week in the miserably hot Las Vegas summer. In case you forgot, HIMSS announced earlier this year that the conference will alternate between Las Vegas and Orlando, having outgrown all the more interesting places.


Sponsor Updates

  • E-MDs offers a free ICD-10 Survival Kit.
  • Extension Healthcare offers “Market Trends: Counting Down to Alarm Safety Readiness.”
  • Galen Healthcare offers “Healthcare Interoperability Musings: Incentives, Barriers, Blocking.”
  • Access demonstrated its electronic forms and signatures solutions at Meditech South Africa’s event in Johannesburg.
  • Greenway Health posts “Electronic Prescribing of Controlled Substances: a Convenient Tool to Improve Patient Care and Safety.”
  • Hayes Management Consulting offers “Secure Messaging – Why It Makes Your Job Easier & Your Patients Happier.”
  • ZeOmega earns NCQA’s disease management certification.
  • The HCI Group publishes “4 Steps for Success: ICD-10 Training for Physicians and Non-Clinicians.”
  • HDS offers “FDA Warns of Medical Device Hacking.”
  • Cumberland Consulting Group is named to the Inc. 5000.
  • Healthfinch says “Document, Document, Document!”
  • HealthMedx offers “Proposed CMS rules set new destinations for SNFs … but where’s the path?”
  • Healthwise offers “Engaging Moms on Medicaid.”
  • Iatric Systems posts “EHR Optimization: Go-LIVE Marks the Beginning.”
  • VitalWare is named to the Inc. 500/5000.
  • Impact Advisors is recognized by KLAS for service performance.
  • InstaMed offers “In Healthcare Payments, EMV May be a Driver, But Dodging PCI is the Benefit.”
  • InterSystems and Leidos Health will exhibit at the Defense Health Information Technology Symposium August 18-20 in Orlando.
  • Liaison Technologies is named a finalist in the 2015 North Carolina Healthcare Information and Communications Alliance Health IT Transformation Awards.

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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August 13, 2015 News 4 Comments

Morning Headlines 8/12/15

August 11, 2015 Headlines 1 Comment

Newport Health Solutions, North Shore-LIJ Sign Letter of Intent to Pursue Joint Venture to Further Develop “Health Connect” Network Technology in NY

North Shore-LIJ Health System (NY) and population health vendor Newport Health Solutions have signed a joint venture agreement to deploy and further develop Newport’s platform across the North Shore-LIJ system, and then collaboratively market the platform commercially.

Health minister says he read riot act to IT leaders over megaproject problems; IBM out, Cerner in

In Canada, British Columbia’s health minister Terry Lake reports that IBM has been fired from the province’s 10-year, $640 million integrated EHR project, and that Cerner has been named as the replacement vendor.

Castlight Health Announces Second Quarter 2015 Results

Castlight Health reports Q2 results: revenue increased 76 percent to $18.5 million but the company still closed out the quarter with an adjusted net loss of $17.6 million and adjusted EPS –$0.19 vs. –$0.21.

UNC Health Care on pace to double budgeted operating income

UNC Health Care reports that it is closing out its fiscal year with $120 million in operating income, 142 percent higher than the $50 million it had forecasted. The health system gives partial credit for the financial turnaround to its now complete Epic implementation, which it says has had a positive impact on its overall financial performance.

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August 11, 2015 Headlines 1 Comment

News 8/12/15

August 11, 2015 News 6 Comments

Top News

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North Shore-LIJ Health System signs a joint venture agreement with population health management system vendor Newport Health Solutions. The new company will complete the installation of Newport’s Health Connect throughout NS-LIJ, then try to sell it commercially. The only listed officer of Newport is Sophia Teng, whose experience is entirely in investment banking rather than healthcare.


Reader Comments

From EMRYouThere: “Re: EMR. One of our physicians runs two clinics for underserved patients in Guatemala. He would like to get them on an EMR but they are under-resourced. Suggestions?” The first ones I thought of were the open source OpenMRS, FreeMed, and iSante, but certainly others are available. I assume that Internet connectivity may be unreliable or slow, but if that isn’t the case, a cloud-based solution would probably require less setup and maintenance. I’ll invite readers to weigh in.

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From Ian: “Re: Sandlot Solutions. Ten to 15 people laid off, CTO Telly Shakelford has left.” I asked Rich Helppie (above), chairman and CEO of Santa Rosa Holdings, which includes Sandlot Solutions, Santa Rosa Consulting, InfoPartners, and Fortified Health Solutions. Rich says there was no material event – the company is fine-tuning its resources to match customer needs and is still hiring. He wouldn’t comment on specific current or former employees, but Telly’s bio has been removed from the company’s executive team page.

From J. Ferguson: “Re: Dim-Sum. I just read the HIStalk Dim-Sum reports, each and every one across 2014. He is hilarious, opinionated, and smart. This guy (I am assuming here) seems bright, on his game, and very aware of how IT works in the medical environment. I am surprised that more people did not initiate, demand, or at least ask for ongoing commentary via HIStalk because it is the perfect forum for someone that is informed and willing to express an opinion. I found nothing on-line about DHMSM that was compelling or interesting until this guy.  He seems like a person that could help initiate discussions and perhaps even be a catalyst for positive change in our industry. I have been in IT for a long while, most of it in healthcare, and he is spot on with occasional sarcasm, but it is entertaining and more than 95 percent accurate. I listened to the commentary via the webinar and his knowledge is very impressive, better than people that will be managing DHMSM I’m sure. Good luck and someone should hire this guy before he wanders off into anonymity.” I agree, his writings (here, here, here, and here) and webinar were outstanding. We haven’t spoken for some time, but last I heard he was hoping I would start some regular feature or site that covers the DoD’s progress.


HIStalk Announcements and Requests

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It appears that my unblemished streak of Windows 10 success has ended. Windows automatically applied an update to my laptop today, after which I couldn’t access the Internet. I tried everything I could think of – repairing the connection, flushing the DNS cache, tethering to my phone instead, rolling back to an older Wi-Fi adapter driver, de-installing and re-installing the Wi-Fi adapter, and checking the TCP-IP configuration. I gave up and called the computer repair place and the guy says he’s fixed half a dozen PCs with the same problem since the July 29 Win10 release date because of incompatible Wi-Fi adapter drivers. It will cost me around $100 to diagnose and fix (probably involving a new Wi-Fi adapter with a known Win10-compatible driver), I wasted a couple of hours of troubleshooting time, and I had to drag out my Win8 desktop while the laptop is in the shop. At least I was lucky enough to be home when it happened and not stuck elsewhere without an alternative.

My latest Internet gripe: those scroll-happy, overly wordy web pages that tell long stories when a short news item would suffice, especially when those painfully overwrought pieces masquerade as news but aren’t dated. 

Listening: new from Jack + Eliza, a college student duo that sounds like sunny, trippy 1960s groups like the Cowsills or Mamas and the Papas. I needed an antidote to all that cheery music, so I turned to Atlanta-based Mastodon and their upcoming tour-mates Corrosion of Conformity


Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Medical device Olympus, whose redesigned but not FDA-approved duodenoscopes have been implicated in spreading bacteria that in some cases killed patients, reports a record-breaking $130 million profit and a 14 percent sales increase in the devices, for which it holds an 85 percent market share. The Department of Justice has subpoenaed the company over the infections. Olympus is also being investigated for corruption in South America and has set aside $450 million to settle US kickback charges. Feel free to insert your own GI tract-related punch line.

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Castlight Health announces Q2 results: revenue up 76 percent, adjusted EPS –$0.19 vs. –$0.21, missing earnings expectations. Shares swirled even deeper around the bowl on the news, with the graph above showing CSLT shares dropping 85 percent since the company’s high-flying March 2014 IPO as its market cap has dropped to just over $500 million. The investor conference call covered just about every vanity metric and excuse buzzword.

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Data integration and cloud vendor Informatica goes private in a $5.3 billion deal that includes secondary funding from Microsoft and Salesforce.

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Sunquest’s year-old investment in Partners HealthCare subsidiary GeneInsight is paying off, the company says, as Sunquest has gained knowledge that it is incorporating into its anatomic pathology product and GeneInsight gets access to Sunquest customers.


Sales

The US Coast Guard chooses InterSystems HealthShare to provide a comprehensive, longitudinal EHR view across its disparate systems.

Christus Health will expand its use of Wellcentive’s value-based care and population health management solutions to most of its US operations.

Providence Health & Services chooses QPID Health to automatically search and interpret free text patient information for quality reports and registry forms.


People

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Orion health promotes Cheryl McKay, PhD, RN to chief nursing officer.

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Mark McMath (Indiana University Health Bloomington Hospital) joins Methodist Le Bonheur Healthcare as CIO.

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PatientSafe Solutions hires Balaji Sekar (Sutherland Healthcare Solution) as CFO.


Government and Politics

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A presentation to the Health IT Policy Committee on Tuesday seems to suggest that ONC’s proposed health IT safety center will be called “Health IT Safety Collaboratory.” I can’t decide if that’s innovative or annoying, but I’m leaning toward the latter.

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Also from Tuesday’s HITPC meeting: hospitals blame other providers for their lack of information exchange, with 59 percent saying their partners lack the technology. The AHA-sponsored survey questionably concludes that hospitals would love to exchange information with their competitors if only the technology supported it.

Meanwhile, ONC seeks a consumer-patient representative for the HIT Policy Committee and several members for the HIT Standards Committee.

A software error in the VA’s eligibility system has caused 35,000 combat veterans to be denied enrollment. Combat veterans are automatically entitled to free care for five years, but the VA’s system rejected their applications if they didn’t fill out a family income form. Nearly half of those who were rejected had applied more than five years ago, meaning their eligibility has since expired without their receiving any benefits.

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CMS awards Booz Allen Hamilton a five-year, $202 million contract to run Healthcare.gov. 

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HELP Committee member Senator Patty Murray (D-WA) urges President Obama to issue an executive order that would guarantee paid sick days to 28 million federal contractors, saying, “Our nation needs it.” She could just save time and propose raising the minimum wage to $100 per hour, which will be (as is true with all government tinkering with employee compensation terms) fantastic for everybody left standing after companies lay off enough people to pay for their newly mandated largesse.


Privacy and Security

The SEC brings charges against two Ukrainian hackers who breached the systems of three press release companies (PRNewswire, Marketwired, and BusinessWire) and sold pre-release, market-moving company earnings announcements to 30 stock traders around the world who bought or sold shares minutes before the news went public, earning the traders $100 million in illegal profits. The hackers created a video of themselves breaching the systems to sell their services to the traders, who sometimes agreed to give the hackers a percentage of the profits.

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Some patients who were among the 3.9 million whose information was exposed in the Medical Informatics Engineering breach complain that they are confused by the online form to request credit monitoring and can’t get through on the telephone hotlines provided. Experian has added call center agents and online signup tips.

A cybersecurity expert notes that it’s easy to look up physician credentials in public databases, then use them to sign up for access to the national electronic registries for births and deaths. The hacker can then file a death certificate that allows someone to collect life insurance or change the age on a birth certificate.


Other

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A freedom of information request by the Vancouver newspaper finds that the health minister fired IBM in April 2015 from its $640 million, province-wide clinical systems transformation project and has now replaced it with Cerner. The 10-year-old project involves 1.2 million patients. Cerner’s deal extends through 2026. IBM’s problems included unmet deadlines, too many consultants and too few informaticists involved, and the rejection by clinicians of every treatment plan IBM designed. Cerner was already providing most of the systems involved. It’s interesting that IBM gets fired as prime contractor with Cerner as its sub in Canada, then loses the US DoD bid to the Leidos-Cerner team when partnered with Epic. Equally interesting is that while large-scale health IT projects fail with alarming regularity (generally because incompetent government bureaucrats are running them), the largest successful health IT project is arguably Kaiser Permanente’s Epic rollout, which happened only after KP fired IBM. Maybe they need to rethink that old saying that nobody gets fired for buying IBM.

Medsphere President and CEO Irv Lichtenwald quotes my interview with Grahame Grieve in an editorial titled “FHIR will not save us. We need national patient identifiers.” He cites the automobile industry’s well-financed, self-serving resistance to implementing VIN (vehicle identification numbers) that stood until the federal government insisted that it be put in place to track theft, accidents, and recalls. He adds, “This is disconcerting. On the one hand, the current Congress is passing legislation like the 21st Century Cures Act that mandates interoperability without mandating a certain standard. On the other, a previous Congress avoided the responsibility of creating the prerequisite for interoperability in a national patient identifier.”

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Brennan Spiegel, MD, MSHS, director of health services research at Cedars-Sinai, says that as a clinical front-liner, he knows digital health is harder than technology companies believe and is in fact still in its infancy. He urges rigorous research rather than self-proclaimed success to figure out where digital health really proves value and says its imperative to interview real patients, adding a tremendously insightful conclusion: “Next time you read a forward-reaching statement about the glory of digital health, ask yourself whether the author has ever placed a digital device on an actual patient.” He gives some Cedars lessons learned:

  • Streams of data often make no sense until you talk to the patient about what they were doing and feeling at the time.
  • Patients won’t wear sensors that must be applied to a specific part of the body or that are visible.
  • Some technologies, like virtual reality goggles, sound great in theory but won’t necessarily be accepted by patients in distress.
  • Patients lose devices and misuse them in ways that seem impossible.
  • Humans react to designs, even simple aspects like colors and method of attachment, in unpredictable ways.
  • Build it and they won’t necessarily come – Cedars got endless publicity (including from Apple’s Tim Cook on the stage) for its HealthKit and wearables integration with Epic, but of the 80,000 MyChart users who were invited to sign up, only 500 (or 0.6 percent) uploaded their information even once.

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UNC Health Care (NC) reports that its operating income for the first 11 months of the year is $121 million vs. the $50 million it expected, which it attributes to the opening of new facilities, better expense management, and its implementation of Epic.

I keep reading about companies determined to be “the Uber of healthcare” in offering on-demand, smartphone-requested house calls. Note to those companies: there’s a nearly endless supply of potential Uber drivers, but not of licensed physicians. You’re going to run out of doctors (and thus runway) as everybody chases the same idea. Our medical education model restricts — intentionally or otherwise — the number of physicians it produces and many of those are opting out of practicing after graduation, which is why it seems that at least a third of the doctors listed on any insurance company’s list weren’t born in the US. Video visits hold more promise since they are geographically indifferent (other than archaic state-by-state licensure), ideal for part-timers, and more efficient overall than traipsing around to the houses of individual callers.

I find this hard to believe: American Academy of Family Physicians endorses HealthFusion’s EHR to its members, but claims it wasn’t paid to do so.

Coca-Cola funds a new non-profit that will fund the research of scientists trying to prove that obesity is due to lack of exercise, not guzzling the gallons of obscenely sugary water sold under Coke’s nameplate. One of the fund’s main researchers is the dean of the public health school of West Virginia University, located in the state that perpetually battles Mississippi for obesity bragging rights.

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Anaheim, CA and other cities are running pilot projects in which nurse practitioners accompany paramedics on non-urgent 911 calls, diagnosing and treating the callers in their homes instead of taking them to overcrowded ED. A third of Anaheim’s medical 911 calls are from people reporting non-urgent situations such as headaches and stomach aches, all of whom would have otherwise ended up in the ED.

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A Kim Kardashian Instagram post in which she extols (with the obligatorily enthusiastic “OMG”) the virtues of a drug sold by a company “that I’m partnering with” without including the drug’s mandatory risks earns the manufacturer an FDA warning. The company responds (I’m paraphrasing) that Kardashian is an airhead celebrity of questionably earned fame who probably thinks a package insert is an OMG-cool sexual practice and it will muzzle her appropriately. FDA insists that, “To the extent possible, corrective messaging should be distributed using the same media, and generally for the same duration of time and with the same frequency that the violative promotional material was disseminated,” which I paraphrase as, “She needs to retake that selfie holding up the warnings and precautions, preferably with the same OMG so her dimwitted followers can understand their folly in taking medical advice from a reality TV star.”


Sponsor Updates

  • First Databank adds a new column titled “Little Known Facts About Drugs” to its company blog.
  • KLAS scores Impact Advisors services as an overall 92.8 in its mid-year report.
  • The Chartis Group publishes “Consortium Model Networks: Evaluating the Potential of Collaboration.”
  • Zynx Health adds transitions of care content to its ZynxCarebook mobile care coordination solutions.
  • AdvancedMD offers “Level the financial data playing field.”
  • AirStrip offers “Midwives and Technology: Maximizing Local Care.”
  • Anthelio Healthcare Solutions CEO Asif Ahmad discusses healthcare technology trends driving development of products and services in a new video.
  • Besler Consulting offers “The CCJR is distinctly different from other bundled payment models.”
  • Billian’s HealthDATA offers “Trends in Healthcare Finance.”
  • Caradigm posts “Engaging High-Risk Patients through Care Management.”
  • CareTechSolutions’ Jim Giordano presented the “Whatever IT Takes” award to Sammi Goulet, who worked 22 hours straight on a recent go-live
  • CenterX will exhibit at the National Council for Prescription Drug Programs Workgroup Meeting August 12-14 in Minneapolis.
  • Clinical Architecture offers “A Meaningful Scavenger Hunt.”
  • CoverMyMeds posts “Pelotonia Fundraiser ‘Bump, Set, Cure!’” D
  • Divurgent offers “Why Cerner? Reflecting on DoD’s EHR Decision & The Role of Cyber-Security.”
  • PracticeUnite offers “Developing User Friendly UI for Secure Texting Patient Apps.”

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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August 11, 2015 News 6 Comments

Monday Morning Update 8/10/15

August 9, 2015 News 2 Comments

Top News

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The American Hospital Association complains that the FCC’s decision to open up TV and 600mHz bands to unlicensed devices such as wireless microphones places hospitals at risk since Wireless Medical Telemetry Service uses 608-614 mHz. The FCC denied AHA’s request for a delay but agreed to increase the geographical buffer zone to several hundred meters, leaving it up for hospitals to figure out how to enforce it to avoid interference with their vital signs and cardiac monitors. Hospitals request the buffer zone by registering each device in a central AHA database that unlicensed devices are supposed to check in finding a vacant frequency.


Reader Comments

From PollyWantACracker: “Re: Yale Physician Services. I played golf with two of their MDs. They both stated that Epic had a terrible rollout, they are still trying to figure it out, and they wished they hadn’t switched.” Sounds like par for the course (no pun intended) following an EHR rollout. I thought Epic had been live there for some time, so either they still aren’t over it or perhaps their practice was implemented later in the cycle.

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From Howdy Partner: “Re: Microsoft’s US partners of the year. Will be announced soon, but here’s the slide from their user group meeting last week announcing the winners.” Hopefully Microsoft will realize that it spelled the name of its Rising Star Partner of the Year incorrectly – Health Catalyst is two words.

From Will Bloom: “Re: cloud. I ran across your 2008 article. It was pretty forward thinking then.” I had to dig to figure out which one the reader was referring to. I think it’s this one, where I argued for SaaS and connected networks in opining:

In other words, I don’t need a loaded PC any more than I need a gas generator, a TV antenna, or an outhouse. The grid is better, cheaper, and more reliable to meet those needs. All I need is a connected appliance. But more importantly, the network adds tremendous value. You contribute a little by joining, but you get a lot in return … The Holy Grail is to pull data back out in a way that lets hospitals learn something actionable, like which antibiotics work best or which lab values correlate with genomic profiles. Few hospitals have the capability to even get that kind of information from their own locally stored data. Fewer still can tap into the collective knowledge of their fellow IDN members. And nearly none can focus the accumulated intelligence of hundreds of peers when making important clinical and business decisions … It will soon make good sense to shut down the endlessly duplicated silos of locally maintained hospital IT and get on the grid instead.

From Hacky Sacker: “Re: hackable medical devices. You mentioned the FDA’s warning about wirelessly controlled infusion pumps that can be taken over by hackers. Here’s a live demo of an actual IV pump hack as performed at the recent BlackBerry Security Summit.” The live hack of a PCA pump is sobering, although hackers have limited incentive to prowl security camera-equipped hospital hallways looking for medical equipment to hack. The demo hacker connects the PCA pump to his laptop via Ethernet, uses hacker tools to see what network services and ports the pump is using, uses unsecured Telnet and FTP to gain root access to the pump, then finds the wireless network name and unencrypted WEP passwords to log into the pump wirelessly as well. He installs malware into the pump’s firmware and changes settings freely, such as increasing the narcotic dose to a level that would have killed the attached patient.


HIStalk Announcements and Requests

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Poll respondents minimized Cerner’s contribution to the DoD win by Leidos, Accenture, Cerner, and Henry Schein, with 42 percent of them crediting the DoD’s incumbent vendor Leidos, 26 percent saying the selection was due to political influence, and 17 percent suggesting that  DoD chose the Leidos team strictly on price. New poll to your right or here, triggered by my report on Meditech’s latest financials and the company’s ensuing response: is Meditech’s market position getting better or worse?

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Welcome to new HIStalk Gold Sponsor Bernoulli. The Milford, CT medical device integration company has been a leader since 1989 in real-time data integration and patient safety surveillance for clinical areas, ICUs, and telemedicine settings. Bernoulli Enterprise offers an enterprise, vendor-neutral medical device integration platform; alarm management; a virtual ICU; remote patient monitoring with built-in dashboards and viewers; and analytics that provide clinical decision support and outcomes analysis. Customers with some of the company’s 35,000 installed beds include Duke University Medical Center and Memorial Sloan-Kettering Cancer Center. The company’s CEO is industry long-timer Janet Dillione, who many folks will remember used to run Siemens Health Services and Nuance Healthcare. Thanks to Bernoulli for supporting HIStalk.

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Elementary schoolteacher Mrs. F from Wisconsin sent a thank-you note and photos about the STEM professional development library and iPad Mini we funded via vendor donations (with matching funds from the  Bill & Melinda Gates Foundation). She says neither she nor her school district could have afforded the 20 books that she’s studying on her own time this summer in a pilot project to prepare for the upcoming school year. Her school is moving toward a STEM (science, technology, engineering, math) emphasis and she and her colleagues needed to dig deeper into how to prepare students for 21st century careers. She especially liked the units on MakerSpaces, do-it-yourself labs where students are provided with tools, supplies, and space to explore their scientific interests. Vendors who donate $1,000 or more to my DonorsChoose project get a mention here on HIStalk and have their funds matched by an anonymous vendor executive benefactor.

My latest LinkedIn gripe: executives who lack advanced degrees (usually sales and CEO types) who pad their resumes with “executive coursework” from big-name schools that offer expensive weekend programs for status-sensitive executives who couldn’t be bothered to actually attend graduate school.

The update on my Windows 10 experience is as positive as I could hope – I’ve had no problems or seen any puzzling or questionable behavior. I had ongoing memory and disk problems under Windows 8 , not a big deal, but near-lockups that occasionally required bringing up Task Manager to kill piggish, long-running apps like Firefox. I haven’t had to do that under Win10 and my CPU and desk utilization are still low, dropping down to 1 percent or so when I’m not doing anything. I hadn’t thought of using the laptop’s webcam microphone to give verbal requests to Cortana, but that’s working too, although its speech recognition isn’t nearly as good as on my Amazon Echo, so I’ll stick to keyboard entry.


Last Week’s Most Interesting News

  • IBM announces plans to acquire Merge Healthcare for $1 billion to add imaging capability to Watson.
  • The Senate moves along the confirmation of Karen DeSalvo as HHS assistant secretary for health.
  • Cerner’s Q2 results miss analyst revenue expectations, sending shares down 9 percent for the week.
  • Meditech’s quarterly results show a 16 percent revenue drop on a 42 percent decrease in sales.
  • Allscripts announces flat quarterly revenue and reduced losses, with the company adding one Sunrise sale in the quarter.
  • Papworth Hospital in England changes its plans to install Epic and instead will look for a more cost-effective system.
  • Medical Informatics Engineering informs HHS that its May cyberbreach exposed the information of 3.9 million patients of dozens of provider organizations to unknown hackers.
  • CHIME announces Gretchen Tegethoff as VP of its for-profit business that charges vendors for access and sales to its CIO members.

Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Sales

Streamline Health Solutions will implement the abstracting module of its Looking Glass solution at one of its existing, unnamed customers through a channel partner.


People

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Texas Health Resources promotes Joey Sudomir to CIO.

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Citra Health Solutions names Eric Olofson (Olofson Group) as COO/CIO.

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Well-being technology vendor Healthways names board chair Donato Tramuto as CEO. He’s also chairman and CEO of Physicians Interactive, which sells “digital marketing tactics” to drug companies.


Announcements and Implementations

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Physicians’ Desk Reference updates its mobilePDR smartphone app to feature concise drug label information such as indications, dosing, adverse effects, side-by-side drug comparison, interaction checker, and pill identifier. The iOS and Android apps are free for US healthcare professionals.


Technology

Baidu, the Google-like China-based web services company, develops “Ask a Doctor,” a voice translation application that allows users to speak their symptoms to then receive a possible diagnosis and link to a nearby medical specialists. The company says its goal is “to build a medical robot.” The company is building artificial neural networks to allow it to accept voice input in the complex Mandarin language. It also hopes to connect to EHRs, which are in early deployment in China.

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The Privacy Visor, $240 eyeglasses that trick facial recognition systems so they can’t identify the wearer in a form of visual opting out, will go on sale in Japan within a year. They were developed by a government-affiliated institute.


Other

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A Health Affairs Blog post asks a question I’ve raised many times myself: why do veterinary practices, especially those in chain pet stores, have far better patient portals and EHRs than their medical practice and hospital counterparts?

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This tweet makes perfect sense: why are hospitals considered the organizations best equipped to manage overall individual or population health? Not only do most people spend only a tiny fraction of their lives interacting with hospitals, hospitals don’t even make up a significant percentage of the time a given patient spends interaction with the healthcare system since most care is delivered from physician practices, pharmacies, walk-in clinics, etc. Unstated bias puts hospitals in the healthcare driver’s seat when they have always been the poorest performing, most expensive, and most consumer-indifferent healthcare resource, not to mention the one patients would most like to avoid. Hospitals made their fortunes cranking out highly paid and questionably effective procedures while blaming insurance companies and doctors for most of what’s wrong with healthcare, and now that the market is less inclined to pay for those procedures, hospitals have suddenly developed a keen interest in the overall wellbeing of their customers.

Researchers find that EHR medication lists perfectly match a patient’s claims data only 24 percent of the time, with 60 percent of the discrepancies involving EHR-profiled meds with no claim filed and 40 percent having meds for which a claim was filed that didn’t appear in the EHR.

China’s technology-driven healthcare reform has stalled, with policy changes and innovative technology startups failing to overcome inadequate IT systems, overregulation, and pressure from the dominant state-run hospitals that still deliver 90 percent of visits. Doctors are also pushing back against reform that would reduce hospital reliance on drug sales for income, saying they need the money to stay open.

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Greece’s financial crisis has led to the formation of illegal free clinics, most of which refuse to register with the government because they say the government is legally responsible for providing the care they are delivering. The country’s 25 percent of hospitals that are not government run are struggling with patients who can’t afford their services and who are instead crowding public hospitals, which are 40 percent fuller than before despite an austerity-mandated hiring freeze that has been in effect since 2011.

Healthloop founder Jordan Shlain, MD says public reporting of surgical outcomes (“data scalpels”) is causing surgical teams to review their overall performance since every person on it contributes to outcomes (“your income will be dependent on your outcomes.”) He urges physicians to collect and analyze their own data instead of letting insurance company statisticians boil it down to their own questionable conclusion.


Sponsor Updates

  • The SSI Group and T-System will exhibit at the HFMA Region 10 Healthcare Conference August 12-14 in Colorado Springs, CO.
  • Forward Health Group creates a music video to promote its August 27 open house. It seems to have been created as a single, two-minute roving video that involved everybody in the office lip syncing, which must have been quite a coordination challenge.
  • Streamline Health will attend Medhost’s “The Nashville Experience” event September 16 in Nashville.
  • Surescripts offers “I’ll Take One Refill, Hold the Fax.”
  • SyTrue founder Kyle Silvestro is featured in a NewsReview article on data-driven healthcare.
  • TeleTracking offers “Lean Strategies in Healthcare.”
  • Fujifilm Teramedica offers “VNAs usher in new opportunities for healthcare.”
  • GetWellNetwork publishes a white paper on Carilion Roanoke Memorial Hospital’s implementation of its interactive patient care system.
  • TransUnion postss “For Healthcare Companies, Data Security is a Critical Test.”
  • Verisk Health offers “5 Tips for a Successful HEDIS Season.”
  • Versus Technology publishes “5 Myths and Misunderstandings About RTLS.”
  • The Information Difference names VisionWare a leading technology vendor in the Master Data Management space.
  • Recondo’s EmpoweredPatientAccess suite earns a most-improved score in a KLAS mid-year report.
  • VitalHealth Software will host an Executive Forum on “Healthcare Outcomes – what we measure matters” August 12 in Minneapolis.
  • Voalte offers a guest post, “Changing the Game and Getting it Right.”
  • Huron Consulting will exhibit at CORE Conference 2015 August 12-14 in Salt Lake City.
  • West Corp. offers “How Chronic Care Management is Like Going to the Gym.”
  • Xerox offers “An Overlooked Member of an Effective Healthcare Team.”
  • ZirMed offers “Diagnosing the Increase in Surprise Bills at Urgent Care Centers.”

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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August 9, 2015 News 2 Comments

News 8/7/15

August 6, 2015 News 11 Comments

Top News

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IBM will acquire Merge Healthcare for $1 billion, giving IBM’s Watson product “eyes” that will allow users to compare images within a single patient or across similar patients for diagnosis and treatment. IBM will pay $7.13 per MRGE share, a 32 percent premium to Wednesday’s closing price. Merge shares haven’t hit that price since late 2006, having dropped 58 percent in the past 10 years as the Nasdaq rose 135 percent.


Reader Comments

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From Helen Waters: “Re: MEDITECH’s financial report. To reference a famous quote: ‘The reports of my death have been greatly exaggerated.’ (Mark Twain, 1897). MEDITECH is ushering in a long overdue level of energy and meaningful innovation to the EHR market. Our customers, and the EHR industry, should expect more. We are delivering disruptive innovation with fiscal responsibility, which we believe the industry very much needs. No other company is better positioned to deliver an advanced and contemporary EHR solution that addresses the needs of the market at an affordable price point. We are doing that. Let’s stop assuming that if you pay more, you get more. To what degree has that premise really been vetted? The EHR vendor community needs to work harder for your health care IT dollar. As healthcare leaders, you owe it to your organization, and as vendors, we owe it in partnership with the national agenda. We are all being called upon to drive down the cost of delivering efficient and effective quality healthcare, as well as to spend the healthcare dollar more wisely, and this includes information technology. We are fortunate to have a big seat at the EHR table, and we intend to preserve and grow it. While you note a change in our revenue and earnings, given these transformative efforts, this was not unexpected. Please know we are responsibly at the table, and we are committed to our existing customer base, providing them with an affordable option to migrate to our latest platform. We celebrate the success of our customer base and the impact they’ve had advancing the delivery of high quality healthcare for the communities they serve. At times, the EHR market feels a bit irrational relative to IT decisions and the promise of utopia often being trumpeted with selecting one system over another. We are proud of our past, executing in the present, and delivering for the future of healthcare technology.” Helen is VP of sales and marketing for Meditech and references my mention of the numbers above from its Q2 report.

From DoD: “Re: DoD contract. The actual amount Cerner got is very small and will need to be shared with Intermountain. I suspect we’ll see a tremendous amount of infighting in this group as they begin the work of delivering while not being paid until the users come online as the contract requires. That stretches payments over seven years, but the investment needs to be done up front. There are several off ramps built in and some strict deliveries. The prime will have to beat the subs into submission in order to deliver on the commitments while withholding payments for years.” Unverified. I’m not sure what Intermountain contributed to the bid or what they’ll get in return.

From Doogie: “Re: Epic. In light of news of Epic’s failures in the UK, coupled with DoD decision, Epic should probably start worrying about its public image. Judy’s silence may have worked for her in the past, but now that Epic is finally being held accountable for its shortcomings, people are going to start wondering if there’s nothing to hide why not comment? One thing is certain, Epic’s stubborn refusal to join CommonWell, among many other things, may finally be backfiring.”

From Concerned Reader: “Re: HIStalk. You’re a Cerner hater and an Epic lover. I have decided to stop reading HIStalk because your bias affects your reporting to the extent of being unethical journalism. On Monday the morning update headlined Cerner missing financial projections in the first line and Epic’s loss of the UK hospital as the very last line.” One thing I’ve learned in writing HIStalk for 12 years is that I can’t mention Epic, religion, or George Bush in any capacity without having a few hysterical, anonymous readers react like a bull instinctively charging a red cape. It doesn’t matter what I actually say — just seeing the words on the page sends a few grudge-bearing readers off screaming with fingers in ears. Lt. Dan writes the headlines and wisely chose Cerner’s earnings report (along with those of Allscripts and Meditech) as the top headline  – Cerner’s report and comments were more important given their DoD win and continued integration of Siemens Health Services. If you’re truly going to stop reading HIStalk (those who threaten almost never do), consider first Googling to see which of the cookie cutter, opinion-free alternatives covered Epic’s reported loss at Papworth – I don’t see even one, which means your only source of that negative Epic news was right here on good old unethical and Epic-loving HIStalk.

From Out of Touch: “Re: KLAS. Using ‘fighting words’ and posturing as they holding vendors hostage on a topic KLAS clearly doesn’t understand. Irrelevant. For a price, I bet.” KLAS says many large vendors “challenged KLAS to step up and be the Switzerland of interoperability,” an assignment it accepted “with trepidation” in offering to convene a meeting along with CHIME. It adds that, “Congress and federal agencies are likely to cheer when they know such action is voluntarily taken” and lists as participants CEOs of Allscripts, Cerner, Epic, Athenahealth, Meditech, and others. I’m not sure I would expect KLAS to be the Switzerland of anything or to lead the interoperability charge while selling non-interoperable vendors reports as its main focus, but we’ll see what the participants come up with.

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From Mute Pointer: “Re: BJC. Says their downtime wasn’t due to a hack.” MP forwarded an internal email describing the results of BJC’s investigation, which concluded that “inadvertent actions within our own IS department” flooded the network and caused its protection systems to restrict application access. They’ve hired an external consulting firm to review their IT infrastructure, having not done one since 2013.

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From Isadore Nobb: “Re: AHA Solutions. I don’t think any product has failed to earn their ‘vetting’ approval as long as the company paid. With one contract at least, they added a huge group of solutions from a business unit without any process other than to require another million dollars and a percentage of sales. Turns your ethical stomach.” Unverified.


HIStalk Announcements and Requests

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I took a deep breath of hesitation before clicking the button to upgrade my primary PC to Windows 10. It was painless and has been perfect so far, with zero learning curve, no unexpected gotchas, and no incompatible programs. The only extra step for me was to install a new Win10-compatible version of Bitdefender Total Security 2015 and the upgrade even prompted me to do that automatically. Win10 has a good user interface and just feels right all around. Here’s what I’ve discovered so far with a small amount of use:

  • The Cortana “ask me anything” digital assistant box is useful, even if only to avoid navigating trying to find commonly used functions like Device Manager.
  • The Start Menu is not only back, it has been enhanced to display some of the Metro live tiles by default (but that can be turned off, too).
  • The Edge browser replacement for Internet Explorer feels really fast and lightweight – it brings up the HIStalk page faster than Firefox by my timing.
  • Task View does something with virtual desktops that would seem to be useful, although I haven’t done anything with it.
  • The Action Center icon rides in the system tray and offers one-click access to some settings and a log of recent system activity. The much-hated “hover to see the charms” option is gone.
  • I haven’t studied it in depth, but looking at Task Manager’s CPU and disk utilization, Win10 seems to be much more efficient. My CPU usage always seemed to be high under Win8, but it’s at 1 percent right now and so is disk utilization. I don’t know what actually changed, but everything feels snappier.

So far, I would say this is the best and easiest Windows upgrade ever. That only negative I’ve read is that some basic and not universally used features (being able to play DVDs, for example, or play ad-free Solitaire) have been removed from the basic free upgrade and are now paid options in the previously little-used Microsoft Store, raising the possibility that Microsoft plans to give away the basic OS (to previous consumer-only licensees, of course – businesses and new users still pay) and charge more for optional individual apps and services in a cafeteria-style promotion. In that regard, Microsoft may have moved Windows into the ultimate machine for generating recurring revenue instead of a one-and-done upgrade.

My server took a temporary break when I sent out the email blast about the IBM-Merge deal Thursday, just like it did last week on DoD news, which I thought was a one-time overload of readers. The result was a “you’re going to need a bigger boat” maxing out of server memory to the point it couldn’t even swap out storage even though I’m running a dedicated server with a Xeon E3 four-core processor, 16GB of memory, and solid-state disk. I’ve placed an order to upgrade the server yet again, a problem I’ll happily accept every time since it means someone is reading other than me.

My present grammar gripe, which isn’t really a gripe since it’s cutely old school: referring to a “piece of software” as though the user gets just one slice of the larger software pie.

This week on HIStalk Practice: Dr. Gregg composes a moving requiem for the patient portal. AncestryHealth Chief Health Officer Cathy Petti discusses company plans to move member health histories into EHRs. Practice Fusion ramps up executive team in preparation for IPO. WEDI survey confirms what other ICD-10 research has already shown: Physician practices aren’t ready for October 1. AMA lobbying dollars come under scrutiny. Azalea Health secures a new round of financing. Premier Physician Network goes live on Centricity. The newly formed Ohio Independent Collaborative looks to extend the livelihoods of independent physicians.

This week on HIStalk Connect: Yelp expands its consumer review platform to include Medicare performance data for hospitals, dialysis clinics, and nursing homes. The FDA issues a safety alert over cybersecurity vulnerabilities found within Hospira infusion pumps. Developers in South Korea introduce a new Braille-based smartwatch for the visually impaired. A new startup focused on women’s health unveils an earbud that tracks basal body temperature during sleep, plotting it on a paired smartphone app.


Webinars

None scheduled in the next two weeks. Previous webinars are on the YouTube channel. Contact Lorre for webinar services including discounts for signing up by Labor Day.


Acquisitions, Funding, Business, and Stock

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Computer cart maker Capsa Solutions acquires Rubbermaid Healthcare., which offers basically the same product line.

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Marlin Equity Partners will acquire ambulatory EHR/PM vendor AdvancedMD. ADP bought the company in early 2011. Marlin also owns e-MDs and MDeverywhere.

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Health Catalyst acquires Health Care DataWorks, the early but lagging data warehouse vendor that was spun off from Ohio State with former CIO Herb Smaltz in 2008.

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India-based Cognizant reports a 39 percent increase in its healthcare business is it continues to boost revenue and profits following its September 2014 acquisition of TriZetto for $2.7 billion.Health makes up 29 percent of the company’s business. Share price rose 50 percent in the past year, valuing the company at $41 billion.

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Leidos Holdings reports Q2 results: revenue up 4 percent, adjusted EPS $0.73 $0.61, with its health and engineering segment losing $7 million vs. a loss of $482 million in the previous year. Chairman and CEO Roger Krone said of the company’s Department of Defense EHR bid, “We’re in that weird period between the award and the expiration of the protest period, so we’re not going to give a lot of guidance on what’s going on. We probably have another five days or so until we think we’re safely on the other side of the protest period.”

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McDonald’s tries to stem its dramatic business downturn by naming Dignity Health CEO Lloyd Dean to its board. Perhaps it missed Dignity’s web page declaration that “in today’s fast-paced, fast-food society, it can be tough to make healthy decisions for kids.” McDonald’s is getting endless pressure from franchisees unhappy with out-of-touch management and lack of buyers for their underperforming locations; competition from fresher offerings at Burger King, Wendy’s, Shake Shack, and Chipotle; and strongly slumping sales.

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India-based provider search website Practo raises $90 million in funding from investors that include Google.


Sales

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WellStar Health System (GA) chooses Legacy Data Access to retire its McKesson Horizon applications.

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The FDA awards genome informatics vendor DNAnexus a contract to build precisionFDA, an open source platform for sharing genetic information as part of the White House’s precision medicine initiative.


Announcements and Implementations

Extension Healthcare publishes a guide for hospitals working to comply with the Joint Commission’s January 1, 2016  alarm safety goal.

Long-term care software vendor PointClickCare adds the ability for customers to receive radiology tests results into their EHR using technology from Liaison Healthcare. 

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Yelp will add ProPublica-produced data to its provider business listings, including ED wait times, fines paid, and readmission information. It’s a bit of an odd relationship given that ProPublica is a non-profit, public-spirited news reporting organization now turned data vendor to a commercial customer via an undisclosed business arrangement. I took the screen shot above Wednesday afternoon. Hospitals will learn that Yelpers tend to get dramatic given one bad experience even after many good ones, so it’s common for an otherwise quiet or even complimentary Yelper to suddenly go off on a one-star tirade over something only marginally related to the business’s main focus, as they often do when they can’t get a table at their favorite restaurant or find an error in their credit card charge after the fact (you really are only as good as your latest review).

HIMSS offers so many conferences that it is now co-locating them in confusing attendees about what they’re signing up for. The latest: the Connected Health Conference in chilly National Harbor, MD in November, which includes the mHealth Summit, Cyber Security Summit, and Population Health Summit. Each requires $695 registration, but signing up for one allows attending the others.

Apple’s ResearchKit gets its first international use as Stanford’s MyHeart Counts app is made available to people living in Hong Kong and UK.


Government and Politics

The Senate’s HELP committee unanimously approves the promotion of Karen DeSalvo, MD, MPH to HHS assistant secretary for health without a hearing Thursday, clearing the way for a full Senate vote following its recess through September 8. DeSalvo has been holding the assistant secretary position since October 2014 while remaining National Coordinator. In that role, she oversees the Surgeon General, communications, regional health administrators, and a number of public health related offices.

The SEC approves a new rule that will require most public companies to publish the ratio of CEO pay to its average overall employee salary.

Ireland will roll out a national patient identifier, with the automatically assigned record including a signature and photograph. According to the health minister, “It will allow us to follow patients and staff as they move through the service in a way we currently can’t. This will improve patient safety, reduce duplication and errors, and give us a huge amount of new data that we can use to make services more efficient and improve planning.”

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The American Hospital Associates asks the Department of Justice to review possible increase in healthcare costs that the proposed merger of Anthem and Cigna could cause. Perhaps the insurance companies should ask DOJ to look at hospital mergers since those seem to be increasing opportunistic pricing as well.

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Arizona Governor Doug Ducey announces a plan to improve the state’s Medicaid program that includes offering personal savings accounts for paying for non-covered services and an app- and portal-based member system that includes appointment reminders, disease management tools, and a provider locator. 


Innovation and Research

Johns Hopkins University researchers develop an algorithm that uses 27 factors to predict septic shock in 85 percent of cases.


Other

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A Commonwealth Fund survey finds that 50 percent of primary care physicians see technology as improving care quality, with 28 percent feeling that HIT makes it worse. Their feelings about ACO impact are all over the place, with only 30 percent of those actually participating in an ACO saying they have a positive impact on patient care. Nearly half of PCP physicians say healthcare trends are causing them to consider early retirement.

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Phoebe Putney Memorial Hospital (GA) will go live on Meditech on October 1 at a total project price of $50 million. It chose Meditech 6.1 in April 2014.

The family of a 14-year-old girl who died at a “Foam Wonderland” rave concert at the New Mexico State Fair sues the state, three promoters, two security firms, an ambulance company, a hospital, and two paramedics, claiming that all of them contributed to her death by their recklessness and negligence in failing to save her from her MDMA overdose.


Sponsor Updates

  • Medicity CEO Nancy Ham co-authors the HFMA article “The Financial Impact of Population Health Analytics in the Shift to Value-Based Models.”
  • Billian’s HealthData and Porter Research invite responses from professional marketers in a survey on marketing practices.
  • Hayes Management Consulting posts “Prepping Your Staff for a Successful EHR implementation, what you need to know.”
  • MBA Health Group and Netsmart will exhibit at the Allscripts Client Experience 2015 through August 7 in Boston.
  • MedAptus offers “A Glimpse into the Facility Billing World from a Split-Billing Expert.”
  • MedData offers “The Wait is Over: Welcome to ‘The Impatient Patient.’”
  • Navicure offers “Increasing Patient Payments with Clarity.”
  • Nordic offers the latest video in its “Making the Cut” series on Epic conversion planning.
  • NTT Data offers “Six Reasons You’re Not Yet on the Cloud.”
  • NVoq offers “Your iPhone has Good Dictation. Why Doesn’t Your Enterprise Application?”
  • Oneview Healthcare will host Health Facilities Design and Development Victoria August 17-19 in Melbourne, Australia.
  • Experian Health/Passport Director of Strategy and Innovation Karly Rowe is featured in Washington Business Journal’s “4 things to know about data security after the Children’s hack.”
  • PatientSafe Solutions offers “Alarm hazards as patient safety concern.”
  • UlteraDigital interviews Patientco Director of Marketing Josh Byrd about redesigning PatientWallet and the need for innovation in healthcare.
  • PatientKeeper offers “The Physics of EHR Advocacy.”
  • PerfectServe offers “Put down the phone, and other communication lessons from healthcare professionals.”
  • PeriGen piblishes “How research resulted in a checklist solution.”
  • Phynd Technologies offers “Is There a Solution to Provider Abuse of the Medicare System?”
  • PMD posts “Client-Server Architecture and Finding the Right Balance.”
  • Qpid Health offers “Getting meaning from patient records stuffed full of results and statistics.”
  • Sagacious Consultants launches a charity ad campaign for Tri 4 Schools at the Dane County Regional Airport in Madison, WI.
  • Salar Inc. offers “ICD-10 is still on track to launch October 1, 2015, will you be ready?”
  • Sandlot Solutions will exhibit at the EHealth Initiative’s IThrive Innovation Challenge August 12-13 in Washington, DC.
  • Elsevier Clinical Solutions, Impact Advisors, and Intelligent Medical Objects will exhibit at the Allscripts Client Experience through August 7 in Boston.
  • EClinicalWorks offers “1.5 Million Referrals Exchanged via P2POpen.”
  • Galen Healthcare Solutions publishes “Clinical Data: Hey, You Are Migrating Your EHR, Take Me with You!!”
  • Greenway Health offers “CMS Expands ICD-10 Grace Period Guidance.”
  • The HCI Group offers “Epic Consultant Corner: Robert Kight Interview.”
  • HDS offers “Thoughts on Meaningful Use by the Brookings Institution.”
  • Healthcare Growth Partners advises GMed on its sale to Modernizing Medicine.
  • Healthfinch offers “It’s Not Just a Formality: Formal Refill Protocols are a Must.”
  • Healthgrades recaps its second HG Challenge hackathon.
  • HealthMedx will exhibit at the Arizona Health Care Association Annual Conference & Trade Show August 18-20 in Scottsdale.
  • Holon Solutions offers “Next Up For Enabling Data Exchange: Transitions of Care Between Hospitals and Nursing Homes.”
  • Influence Health posts “Engaging Patients for Impactful Changes.”
  • Ingenious Med offers “IM1: Solving ZDoggMD’s Readmission Problem.”
  • InterSystems publishes “From Opposition to Cooperation: Payers Join the Care Team.”
  • LifeImage offers “The Top 5 Reasons to Integrate Image Exchange with Your EMR.”

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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August 6, 2015 News 11 Comments

EPtalk by Dr. Jayne 8/6/15

August 6, 2015 Dr. Jayne 2 Comments

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I’ve always been an early adopter of technology. When personal computers first came out, my parents made sure we had one. Sure, it was an Apple II+ and it TYPED IN ALL CAPS ALL THE TIME, but it put us on the cutting edge. It also put me on track to disassemble and modify devices after the Apple IIe came out (with its functional shift key) and I figured out you could run a jumper wire to make the II+ stop YELLING. My brother procured a used modem from his football coach and there we were, dialing up all kinds of trouble.

I learned the virtues of the “pretzel” key with a Macintosh Classic, then finally joined the world of color monitors with Windows Millennium Edition. After surviving a medical school that made us use Lotus Notes, I headed off to residency at a hospital with a half-baked Cerner system and finally found myself in practice with Medical Manager. I felt like I was really on the cutting edge, especially since some of my private practice colleagues still billed using ledger cards and made their appointments in the same kind of schedule book used by my hair stylist.

Through my continued interest in technology and a willingness to serve as a guinea pig on multiple occasions, I worked my way up in the world of “big” hospital IT. Having spent a good chunk of the last decade convincing physicians to add technology to their practices, I never thought I’d find myself feeling such a backlash against technology. According to USA Today this week, “46% of physicians report burnout: cynicism, less enthusiasm, low sense of accomplishment, too much bureaucracy.” Physicians feel overworked and are unable to cope with the stressors they currently face. They report being less empathetic toward their patients. Many cite EHR use as a key part of the problem, but I think there’s a lot more to it than that.

I’m wondering whether we as a society are becoming increasingly burned out and think that technology is a significant part of the problem. Instead of freeing us, smart phones are increasingly tethering us to the workplace. One of my friends recently reported working nearly 10 hours during her week-long vacation, citing the need to “protect” her boss from covering while she was out. I was certainly guilty of checking email on vacation when I was an employee, but I always felt supported in taking time off and knew I could forward critical emails to the person covering me so that she could address them. In turn I covered others while they were away. Eventually I learned to not even open Outlook.

Through social media, we’re under constant pressure to document every moment of our lives and share it so the world can see how interesting our lives are. There are plenty of studies citing Facebook and other social media services as actually making people feel like their lives are less meaningful or less satisfying than others because of what they see posted. Luckily most of the people I follow on my personal Facebook account are pretty mature – there are rarely photos of what they’re eating (unless there’s a great story attached) and don’t post their every move throughout the day. Although they post some spectacular vacation photos, when I see them I’m more likely to tease them about the risk of having their houses burglarized since they just advertised they were away than I am to be jealous.

I didn’t think too much about how technology is changing us as a society until I had the recent pleasure of taking my nephew on a trip to the East Coast. We visited several historical cities and quite a few monuments and landmarks. I was surprised to see that the atmosphere was very different than when I was in the same places just a few years ago. Rather than taking photos of the sights, everyone seemed to either be trying to take a selfie with the monument in the background or to take pictures of each other at the monument, blocking others from even seeing it in some cases.

Some of them were so obsessed with getting the perfect picture that they completely missed out on what they were supposed to be seeing. At one museum, I watched a mother force her children to wait in line to have their picture taken with an artifact and then she immediately bustled them off to do the same thing with another artifact. None of them spent any time looking at the phenomenally interesting collateral around it. (Moon landing note: Did you know the Apollo command module had to detach from the module with the lunar lander, turn 180 degrees, and re-dock with it? What could possibly go wrong? Learned it reading the sign.)

My brother is a photographer and once made a comment about his children’s generation being the most photographed but least seen. With the advent of digital technology, people don’t have to ration their shots any more. I tried to explain to my nephew about film coming in cartridges of 10 or rolls of 24 to 26 pictures back in the day. You had to choose your subjects carefully and you certainly didn’t take a picture of every single thing you found interesting. Although you might entertain your family and friends by showing them 35mm slides projected on a bed sheet (carousel if you were fancy, stacker if you weren’t) you definitely didn’t take hundreds of photos at a museum and make a nuisance of yourself. At one location, there were so many people taking pictures with tablets (including full-size iPads) you could hardly see the exhibit because of the air clutter. I hadn’t intended on seeing the world through someone else’s screen held aloft.

It turned into a teachable moment. My nephew and I had a good discussion about the psychology of all this and how technology makes people feel. We also talked about how it can physically affect people as well. He mentioned hearing that Disney had banned selfie sticks, and after this week, I think it’s a fantastic idea since I was almost hit a couple of times. I’ll be interested to see 10 or 20 or 30 years from now how immediate access to information has impacted our ability to leverage human memory. Personally I think we’re losing the ability to make good memories – rather than being in the moment and experiencing something, we’re either multitasking on our phones, listening to music, or trying to take a picture of ourselves doing it.

What’s worse is seeing people allow their children to be cheated by the lure of technology. At one famous site, I watched a family of four sit next to each other, completely absorbed in their devices. The pre-teen daughters were playing games, the dad was checking sports scores, and mom was just surfing. None of them were talking about the history of the property or why it was significant to our country’s history. Technology could have been a tool for them to talk about the site or the Civil War (which I also heard referred to as the War of Northern Aggression, which was slightly amusing in 2015) but instead it was a distraction. They certainly weren’t giving it the reverence it deserved as a burial site.

We also watched people on the subway interacting with children in strollers with some clearly generational behaviors. Older individuals (who appeared to be grandparents or hired caregivers based on some of the conversations) turned the strollers to face them so they could keep an eye on the children, which also meant they were interacting. Younger individuals tended to leave the strollers facing out and often had earphones in while using a smart phone, so there was very little interaction. If this is a common pattern, will it cause attachment problems, anxiety, or other disorders? And what about the toddlers using electronic media for hours a day? We know that’s an issue. While kids need to learn patience and how to deal with situations they may find boring, it’s helpful for parents to engage with games of “I Spy” or “Twenty Questions.” (Some of the answers this week: Robert E. Lee, Thomas Edison’s light bulb, and a bald eagle.)

As technology professionals and leaders in our field, I think that some re-examination of how technology impacts our lives may be warranted. We may not be able to change the technology demands of our organizations, but we can certainly advocate for wise use in our workplaces. Let’s start with rational email policies. My favorite boss had a three-day policy – if you needed a response within three business days, you weren’t allowed to send an email but had to actually talk to another human being. It was one of the most cohesive teams I’ve ever experienced. We also need to support our employees and colleagues in taking real vacations that don’t involve the expectation of checking email or voice mail. If something doesn’t change, we’re going to need a bunch of new ICD codes to address it.

What do you think about the pervasiveness of technology in today’s society? Did you know that you can turn your toast into a selfie? Email me.

Email Dr. Jayne.

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August 6, 2015 Dr. Jayne 2 Comments

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