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Readers Write: Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option

October 4, 2017 Readers Write No Comments

Centralized or Decentralized Revenue Cycle After an Acquisition? Maybe There’s Another Option
By Jim Denny


Jim Denny is founder and CEO of Navicure of Duluth, GA.

According to a recent AMA survey, for the first time, there are as many hospital-owned providers as there are physician practice owners. As this acquisition trend continues to grow, health systems are evaluating the best way to coordinate and consolidate revenue cycle management (RCM) across the entire organization. Typically, to streamline patient billing, healthcare data analytics, and reporting, organizations take one of the following approaches:

  • A centralized approach. All RCM processes are combined across all entities into a single revenue cycle with a central billing office.
  • A decentralized approach. All billing remains separate across all entities.

The path chosen often varies depending on the organization and its structure.

However, in many cases, neither option may be the perfect approach. Instead, organizations may choose to employ a customized billing approach, leaving a majority of each acquisition’s processes, technologies, and best practices separate and in place, which are evaluated over a defined time frame.

A short-term, slower, methodical approach allows the health system and acquisition time to get to know more about each other and can be much less disruptive. A slower integration, perhaps a year or year-and-a-half, allows both to understand how the other works and to work as a team to come up with a plan as how to grow together.

During this period, it is important to establish a common electronic data interchange (EDI) solution so data and reports can be standardized and summarized across all organizations. Then, the health system can review standardized performance data to better understand each acquisition’s approach to RCM, working to identify each one’s uniqueness, strengths, and challenges. From there, they can determine the best way to proceed for the long term. A customized approach is considered a hybrid because it allows the health system to decide whether centralization or decentralization is the right option, and choose from the best of existing RCM approaches, or determine that it’s time to incorporate new ones.

Here are three reasons why a customized approach can make sense for your organization following an acquisition:

This hybrid approach provides time to assess the acquired practic.e

Customized RCM can give leadership the time needed to evaluate the success of a newly acquired practice, while enabling the practice to maintain productivity and conduct business as usual. Questions to ask can include the following:

  • What’s working and what’s not?
  • Does the practice need guidance to improve their efforts? This includes looking at the statistics – days in accounts receivable (A/R), denial rate, and success in patient collections.
  • What IT systems and vendor relationships are yielding the best results across claims management, patient payments, and reporting?

A customized approach allows a health system to choose from best-in-class vendor partnerships.

It benefits both the practice and the health system by allowing practices to maintain their own systems without having to conform to a billing office’s mandate immediately, while enabling the health system time to evaluate a number of systems and vendors and then making a best practice recommendation that fits the health system’s strategic roadmap. This is the time to assess what’s involved in streamlining and integrating technology from a process, people, and data perspective, regardless of whether the organization ultimately chooses a centralized or decentralized strategy.

This method provides breathing room to evolve over time while establishing a strong foundation for future growth.

Using a hybrid model for the short term can offer an organization the opportunity to mesh with other groups in an optimal way. With this approach, health system leadership does not need to force physician practices within the system to conform to the organization’s existing processes immediately. Instead, practices are given flexibility at a critical time that can ultimately lead to a successful merger. Even more importantly, it allows for necessary breathing room for the health system so it can prepare to adapt to industry shifts – such as building a bridge to move from fee-for-service models to value-based care, or in defining the best ways to evaluate when and where to participate in taking on risk-based contracts.

Choosing a short-term hybrid approach yields the opportunity to create a transition plan based on thorough evaluation to help ensure the health system capitalizes on the right processes, technology, and vendor relationships. And while there’s no easy answer, ultimately, the decision to centralize or decentralize an organization’s revenue cycle can be made together with buy-in from each organization, which is the best way to ensure long-term success.

Readers Write: Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance

October 4, 2017 Readers Write No Comments

Value-Based Healthcare Drives “Left of Bang” Approach for Risk Management and Compliance
By Mark Crockett, MD


Mark Crockett, MD is CEO of Verge Health of Charleston, SC.

In 2007, the Marine Corps deployed to Iraq and Afghanistan had a problem: how to identify an enemy that blended in with the population. They developed a behavioral approach to helping teams sharpen their tactical awareness skills to remain “left of bang,” or to fend off hostile actions before they culminate in the “bang” of conflict. In 2017, healthcare needs to deploy the same approach to managing risk and improving outcomes.

Healthcare is currently focused on right of bang, or the future correction of adverse events. Too much effort is expended to react to problems that have happened, and aren’t directed to preventing failure. The military (and other industries) expect that more than 80 percent of efforts should be spent left of bang to reliably prevent failure. A shift to a balanced approach is beginning to happen in top health systems for the first time, and it’s critically important for healthcare leaders to understand the how and the why.

How we got to the current right of bang problem is pretty clear. As a physician, I see failure all the time. Kidneys fail, hearts fail, and ultimately people fail. Dealing with that compassionately and professionally is part of the territory. Financial models have not helped at all. Under straight fee-for-service medicine in the past, if I gave someone an infection, it was quite possible I could bill them for a follow-up visit and perhaps even the antibiotics. In that kind of model, preventing failure is working against your economic model, making success in prevention just that much harder.

Times are changing fast. In the last few years, an array of accrediting bodies, regulatory entities, and payment model changes have made failure punishing to a health system’s finances and reputation. It’s now possible to see quality and adverse events on a dozen web sites, and more every day. Readmission prevention, Healthcare-Acquired Conditions, MACRA, MIPS, etc. are all ways of demanding reliable and efficient care. Health systems fail to execute on quality and safety at their risk: competitors across town that are doing it well are looking to expand and acquire patients and even facilities.

For one California-based hospital system, their timeline-oriented thinking – and solutions – needed to become left of bang. One of their hospitals had implemented a Six Sigma plan to reduce central line infections. Six Sigma is a popular methodology that takes a data-driven approach to eliminate defects in any process. The approach aims for six (or fewer) standard deviations between the mean and the nearest specification limit.

Using Six Sigma, the hospital system found a catheter that was superior in their opinion and a skin sterilization technique they knew worked. That single hospital then worked through the purchasing process, the stocking of the catheter, the sterilization procedures, and finally, implemented a process that ensures no one touches the catheter until the surgeon is ready to insert it into the patient. These improvements eradicated central sepsis at that hospital for more than five years. It was an amazing feat compared to industry standard. This completely redefines the concept of “expected complication” to “zero complications,” and unequivocally saved lives.

It’s a great thing when you can eliminate sepsis in central lines. But five years later, the multiple-hospital system still had a small number of hospitals using the technique. They had no means of assessing system-wide compliance with the Six Sigma process design, which at best was being implemented inconsistently. They simply have not organized left of bang. They admitted they lacked the ability to bring about system-wide change from what was learned at one hospital.

“We know how to prevent central line infections,” said one team member. “But without strong leadership, and the technology to implement the safety procedures system-wide, we find ourselves fixing the same problem every three years. We get serious about a problem, design a solution, and implement it. Then institutional inertia takes over. Two years later we are seeing adverse events, or worse, and ask ourselves ‘Where is that folder on the way we prevent catheter infections?’ It’s just not good enough.”

Getting hospitals to look for patterns in identifying adverse events, and working to identify them before they occur, keeps clinicians and staff in perpetual left of bang mode. But process improvement through Six Sigma isn’t going to enable this essential shift to a safety-first culture. Neither will the latest software or the best management training. It’s going to take all of these approaches – and more – for healthcare to truly see the results and outcomes that payers demand from providers.

Morning Headlines 10/4/17

October 3, 2017 Headlines No Comments

Argument analysis: An epic day for employers in arbitration case?

Epic’s Supreme Court case is split over whether employers should be able to force employees to sign arbitration clauses as a condition of employment.

Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data

A Health Affairs study of EHR interoperability data from broken down into the sub-domains of finding, sending, receiving, and integrating electronic patient information, concludes that at the end of 2015 only 29.7 percent of acute care hospitals are engaged in all four domains.

2017 HIMSS Congressional Asks

HIMSS asks Congress to elevate the role of HHS CISO to that of the CIO, expand telehealth services, and increase funding needed to implement the 21st Century Cures Act.

Announcing Cityblock: Bringing a new approach to urban health, one block at a time

Alphabet’s Sidewalk Labs unveils Cityblock Health, a neighborhood-level approach to improving care coordination for Medicaid beneficiaries through technology.

News 10/4/17

October 3, 2017 News 4 Comments

Top News

Image result for epic arbitration

The Supreme Court in it its first day of the new 2017 term hears opening arguments over companies that require employees to sign away their right to sue them over employment issues and force them into arbitration instead. Epic was one of three companies whose attorneys argued their positions Monday.

Liberal justices expressed concern that allowing such agreements rolls back employee rights by decades and discourages expensive individual employee lawsuits, while the court’s conservative members opined that mandatory arbitration clauses are legal and that employees can as a group hire the same attorney to reduce litigation cost.

The Obama White House had initially asked the Court to hear the case in support of the NLRA, but the new administration now sides with the employers as represented in the proceedings by its Deputy Solicitor General.

The main issue is whether arbitration agreements are legal under the Nation Labor Relations Act, which gives employees the right to take collection action. The attorney representing the companies argues that the NLRA guarantees the right of employees to have a forum convened, but once that has happened, employers can present defenses that include previously signed arbitration agreements, an argument to which one justice took exception in interpreting NLRA as covering all workplace issues.

A decision in favor of the employees would invalidate the employment agreements of up to 60 million Americans. Two courts have ruled that Epic’s arbitration clauses are illegal, while another ruled that they are legal.

The court will render its decision later in the term.

Reader Comments


From Stella Overdrive: “Re: Allscripts. Black Book’s survey finds that 96 percent of McKesson Paragon customers are optimistic that Allscripts will improve their satisfaction, but it reads like an Allscripts commercial. Similar studies by Reaction and KLAS found high levels of skepticism among Paragon customers, with KLAS reporting that only 29 percent were favorable and Reaction saying that the acquisition would actually be a deterrent to attracting new customers. Do you know if Allscripts underwrote the Black Book study, and if so, was there appropriate disclosure? Seems like it might have been commissioned as damage control given negative market reaction to the acquisition.” A Black Book spokesperson says the company did not break from its strong stance against allowing vendors to participate or influence the survey  process – no company or payment was involved in the Paragon user survey. I read the more detailed survey notes and came up with these points:

  • The survey response rate was 23 percent, with 280 respondents representing 66 facilities. I don’t know how many hospitals are running Paragon to know if that’s a significant percentage of sites.
  • Black Book wisely focused on hospital decision-makers rather than end users.
  • The survey found that none of the respondents have developed new plans to replace Paragon, although that’s not surprising since the acquisition was announced only a few weeks ago.
  • The report says that 96 percent of boards are “confidently optimistic” (I would have expected “cautiously optimistic”) that Allscripts will do a better job than McKesson, which might not be a high bar to clear. There’s also the question of how knowledgeable board members would be on IT topics.
  • Two-thirds of the hospitals say they don’t have the money to replace Paragon in the next two years and will instead focus on revenue cycle management, population health management, and analytics. That’s probably the most important finding of the survey. 
  • Eight-one percent of IT leaders representing 58 facilities say they are receptive to the Allscripts takeover.


From Gideon: “Re: Allscripts. Layoffs in the former McKesson’s professional services area on the day the merger was finalized – PMs, tech, and interface resources. The words used in the termination letter were, ‘’Unfortunately, the new organization structure doesn’t include your position.’” Unverified, but reported by several readers. Layoffs by either company are, unfortunately, hardly newsworthy, and certainly an acquiring company will nearly always – immediately or eventually – start trimming costs involving any assumed redundancy to help pay for the acquisition’s cost.


From Givenchy: “Re: Athenahealth. Hospitals are retreating. Following the failed implementation at Jackson Medical (AL), about 20 hospitals are cancelling scheduled go-lives. At least three have returned to their previous systems after collection and cash flow issues and clinician dissatisfaction. Veterans Memorial Hospital (Waukon, IA), Kimball Health Services (Kimball, NE), and Appleton Municipal Hospital (Appleton, MN) have returned to CPSI owned-products.” Unverified. 


From Publius Tullius: “Re: KLAS at Epic’s UGM. In the ‘photo is worth 1,000 words’ category, KLAS’s VP in wizard garb. I can’t think of worse optics for two organizations that are already intrinsically linked amidst concerns of bias. People in the industry joke that KLAS is Epic’s marketing arm and this doesn’t help.”


From Corny Collins: “Re: NYC H+H. NYC tax dollars hard at work as officials played dress-up with Epic employees at UGM.” I disagree. Their attendance (I’ve blurred their ID since it felt creepy otherwise) is reasonable and taxpayer accountability doesn’t require frostiness with their vendor. I agree, however, that healthcare people attend a lot of questionable conferences and thereby increase patient costs questionably, although a vendor’s user group meeting when you are spending hundreds of million dollars to implement their product doesn’t spring to mind as an obvious excess. Those of us with health system experience struggle with appeasing valuable employees whose self-worth is defined by running around like a big shot at conferences of questionable ROI, but the employer has to set the parameters and assess the value they receive in return for the cost and out-of-office time. A better target is the HIMSS conference, where people who clearly have no good reason to attend dutifully pack the exhibit hall because they like the attention and networking and can convince their employer to foot the bill. Meanwhile, NYC H+C may need some wizardry as it says it’s down to 18 days of cash on hand.

From Journomaniac: “Re: HIStalk. You must have had partnership or acquisition interest that you haven’t mentioned but should in the interest of full disclosure since you criticize other sites.” Three health IT sites (that I recall – maybe there were more over the years that I’ve forgotten — have approached me unsolicited wanting me to partner with them, sell out to them, or go to work for them. All three said they would render HIStalk obsolete because of their superior technology, deeper corporate pockets, or more insightful approach, thus leaving me no choice but to throw in with them. I dismissed their inquiries quickly because I like working alone in a way I can be proud of. All three of those sites have folded up their health IT tents while I’m still here doing what I’ve been doing since 2003. That’s all I have to disclose. I’d rather quit than let someone else tell me what to do.


From Abraxas: “Re: VistA. The Indian Health Service uses the VA’s product at no charge. With the VA’s move to Cerner, they haven’t been told whether they will continue to get free access and they have no budget for a replacement EMR. I wonder what will happen to other VistA users once Cerner replaces it in the VA?” I would expect VistA to become an orphan product now that the VA’s attention has been diverted to the Cerner shiny, no-bid object, leaving VistA’s other users without access to the VA’s expensive development. VistA is used by hospitals all over the world as a free public domain product, although some of those are supported by third-party companies like Medsphere and WorldVistA. I invite those with more knowledge about VistA than I have to weigh in on its future outside the VA. Above is part of a 2015 slide I found from the VistA Software Alliance listing VistA’s users.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor ChartLogic, a division of Medsphere. The Salt Lake City, UT-based company, founded in 1994, offers a complete ambulatory EHR solution (EHR, PM, RCM, ERX, patient portal). Providers can create a complete patient note in less than 90 seconds, supported by intelligent voice commands, specialty-specific content (vocabularies, templates, flowsheets, and macros) and a single-page layout. Its practice management system includes a preference-based appointment scheduler, eligibility checking, an automated Collection Center, and quick claims entry and one-click payment posting that reduces claims rejections to less than 5 percent. The company’s browser-agnostic patient portal offers appointment scheduling, mobile intake forms, SMS patient reminders, and online payments to improve patient engagement and experience. ChartLogic also offers services for billing, revenue cycle management, and managed IT and service desk. The Department of Defense recognized the company a few weeks ago for its support of the National Guard and Reserve, a program led by ChartLogic EVP and former Army Ranger Chris Langehaug. Thanks to ChartLogic for supporting HIStalk. 

I found this ChartLogic EHR overview on YouTube.


October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

October 26 (Thursday) 2:00 ET. “Is your EHR limiting your success in value-based care?” Sponsored by: Philips Wellcentive. Presenters: Lindsey Bates, market director of compliance, Philips Wellcentive; Greg Fulton, industry and public policy lead, Philips Wellcentive. No single technology solution will solve every problem, so ensuring you select the ones most aligned to meet your strategic goals can be the difference between thriving or merely surviving. From quality reporting to analytics to measures building, developing a comprehensive healthcare strategy that will support your journey in population health and value-base care programs is the foundation of success. Join Philips Wellcentive for our upcoming interactive webinar, where we’ll help you evolve ahead of the industry, setting the right strategic goals and getting the most out of your technology solutions.

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


First responder software vendor ESO Solutions acquires the Firehouse emergency management software business of Conduent Government Solutions.


Kiio — whose platform screens for low back pain, joint replacement, and rehabilitation and offers exercise guidance — raises $1 million from Wisconsin-based not-for-profit insurer WEA Trust.



Olmsted Medical Center (MN) chooses Epic to replace the former McKesson (I think they were on Series, but I’m not positive). UPDATE: readers say Olmsted was using Cerner CommunityWorks for inpatient, with which it has reached HIMSS EMRAM Stage 6, and McKesson for ambulatory despite undated information I saw mentioning that it was running McKesson Series and McKesson-acquired MED3OOO.



Robert Barras (The Advisory Board Company) rejoins CTG as VP of healthcare sales.


Seattle Children’s (WA) hires Zafar Chaudry, MD, MSC, MIS, MBA (Cambridge University Hospitals NHS Foundation Trust)  as SVP/CIO.

image image

Senior living community software vendor Caremerge (Merge Healthcare) hires Nancy Koenig as CEO. She replaces founder Asif Khan, who remains as board chair.


Larry Wolf (Strategic Health Network) joins MatrixCare as chief transformation officer.


MedeAnalytics hires Tyler Downs (TriZetto) as CTO.


Julie Mann (Optum Analytics) joins Holon Solutions as SVP of sales.


ViTel Net hires Richard Bakalar, MD (KPMG) as VP/chief strategy officer.

Announcements and Implementations


A new Reaction report on telemedicine finds that physicians overwhelmingly support the use of telemedicine to replace the 20-30 percent of visits that don’t require physical examination. A surprising two-thirds of respondents either contract as a telemedicine provider or have considered such moonlighting. Hospitals are mostly using telemedicine for population management or follow-up care rather than for primary care visits as only 14 percent say such services have boosted their revenue. The biggest telemedicine platform vendor by far is “homegrown.”


Sidewalk Labs, an urban innovation group within Google parent Alphabet, announces Cityblock, which will offer residents of low-income communities who are covered by Medicare or Medicaid a care team that provides doctors, coaches, technology tools, and a health plan. The service will launch next year.


HIMSS Analytics adds the former CapSite vendor contracts database to its Logic platform, renaming it Logic Source.


EClinicalWorks adds a self-service option for customers to connect with CommonWell and Carequality.

A Black Book survey finds that while hospitals and medical practices are increasing their IT outsourcing and like the prospect of increased efficiency at a lower cost, their satisfaction with outsourcing companies is decreasing. Most of that dissatisfaction involved IT managers who are forced to manage an inexperienced health IT outsourcing vendor. The top-scoring EHR vendors were Cerner, Meditech, and Allscripts.

A small Dimensional Insight hospital CIO/CMIO survey concludes that less than half of hospitals have implemented enterprise-wide data governance, causing problems with data integrity and access.

Infor launches Cloverleaf Consolidator for data aggregation and exchange in a multi-EHR environment.

JAMA will launch a broad-topic, open access journal in early 2018. 


Fujitsu announces a new palm vein biometrics sensor for its PalmSecure F-Pro Suite authentication solution.

Government and Politics


HIMSS asks Congress to:

  • Elevate the HHS chief information security officer role to be equivalent to its CIO and make that position responsible for creating a cybersecurity plan.
  • Pass the CONNECT act that would remove geographic restrictions for telemedicine.
  • Increase funding for rural healthcare broadband coverage discounts and adopt CDC electronic information flow for case reporting, lab reporting, disease surveillance, and death reporting.


A home care provider in Australia launches a “holographic doctor” in which physicians can participate in a home nurse consultation via mixed reality technology that uses Microsoft HoloLens. Both doctor and patient wear a virtual reality headset that allows them to see each other in real time along with the patient’s healthcare data.


A Health Affairs article finds that hospital interoperability didn’t improve much from 2014 to 2015 as less than 20 percent of them reporting that they “often” use outside patient information to make clinical decisions.


A hospital in Scotland cancels surgeries after going back to paper following flooding of its basement data center.


Ohio National Guard Captain Michael Barnes develops a veteran suicide prevention program as part of his coursework at The Ohio State University to attain a master’s degree in nursing.

Sponsor Updates


  • Employees of The Chartis Group held a community service event at its annual retreat in New Orleans, supporting Boys Town, Covenant House, Raintree, Salvation Army, and YMCA.
  • A Spok case study describes the use of Care Connect by Union Hospital of Cecil County (MD) to reduce communication breakdown.
  • Casenet will exhibit at the Change Healthcare Inspire Conference in Philadelphia this week.
  • Ability Network is named a finalist in the Tekne Awards that recognizes technology innovation in Minnesota.
  • Nordic posts a podcast titled “How do I plan for a successful EHR go-live?”
  • AdvancedMD will exhibit at the American Society for Dermatologic Surgery October 5-8 in Chicago.
  • Aprima will exhibit at the American Osteopathic Association Conference & Exhibition October 7-9 in Philadelphia.
  • Datica publishes a new report, “Public and Private Cloud Computing within Healthcare.”
  • Besler Consulting will exhibit at AHIMA October 7-11 in Los Angeles.
  • Carevive and Crossings Healthcare Solutions will exhibit at the Cerner Health Conference October 9-12 in Kansas City, MO.
  • CoverMyMeds will exhibit at the American Association of Medical Assistants Annual Conference October 6-9 in Cincinnati.
  • The Nashville Business Journal includes Cumberland Consulting Group on its Fast 50 list for the third consecutive year.

Blog Posts


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Contact us.


Morning Headlines 10/3/17

October 2, 2017 Headlines No Comments

US Emergency Department Visits For Firearm-Related Injuries, 2006–14

Health Affairs publishes findings from an aptly-timed study conducted by researchers from Johns Hopkins University School of Medicine that aimed to quantify the clinical and financial burden of firearm-related injuries. Researchers concluded that in the US, firearm-related injuries claim 36,000 lives and account for a financial burden of approximately $2.8 billion, annually.

Iasis Healthcare’s sale closes, CEO Whitmer departs

Steward Health Care (MA) completes its $2 billion acquisition of 16-hospital Iasis Healthcare, expanding Steward’s network to include 36 hospitals spread across 10 states.

Three US scientists win Nobel Prize for uncovering inner workings of the biological clock

The 2017 Nobel Prize in medicine was awarded to Jeffrey Hall and Michael Rosbash, of Brandeis University, and Michael Young, of Rockefeller University, for their discoveries of the underpinnings of the circadian rhythms that help organisms adapt to our 24-hour days.

Authority of Health Care Providers To Practice Telehealth

The VA proposes a rule that would allow employed VA providers to offer telehealth services to veterans across state lines.

Curbside Consult with Dr. Jayne 10/2/17

October 2, 2017 Dr. Jayne No Comments

I saw patients this weekend and was dismayed to find a mini-release from my EHR vendor that disrupted my muscle memory. Apparently they’ve decided to create a workflow to allow documents to be uploaded to a health information exchange. However, instead of putting that feature in place to automatically send when I sign my charts, they’ve broken the signing process.

Previously, upon hitting the “signature” icon, I received a nice little pop-up where the cursor defaulted into the field where I could enter my PIN, then the pop-up closed after PIN entry. Now I get the pop-up, to which has been added a pre-populated “send to HIE” field with the cursor defaulting nowhere. Since we are not connected with a health information exchange, I have to unclick the HIE field, put my cursor in the PIN field, then key my number to sign the chart. Although technically it’s two clicks, it’s a whole lot of annoyance. I was surprised by how long it took to attempt to correct the muscle memory issues as I continued to try to go directly to PIN entry for signature. Even after 50-plus patients, I still wasn’t handling the transition smoothly all the time.

I’m often the proverbial canary in the coal mine since I work mostly weekends and our vendor likes to roll updates on Saturday nights. I talked to our EHR champion and she wasn’t aware of any way to turn off the auto-populated checkbox or to get the cursor to default to the PIN field.

By way of calculation, we can take my 50 patients, multiply it out to the 750+ patients seen daily in our practice, then times all the practices serviced by our vendor. It’s a significant amount of waste. It’s definitely enough to make one wonder whether the EHR vendor does any focus group work or user acceptance testing at all when they ship these changes to the masses. Since we’re on a Web-based product, the updates are automatic, meaning it’s impossible to pick and choose. If there were any actual improvements in the release, I’m not sure what they were since I wasn’t able to tease them out during 12 hours of patient care.

It was a rough shift overall, especially since I was working at one of our expansion locations that is still under construction. We purchased an independent urgent care facility whose owner wanted to retire, where they were seeing roughly 8-10 patients per day. Our owners figured that the low volume would allow us to do some renovation and expansion while staying open. The ongoing shortage of primary care physicians in our area has fueled a boom in our business, which we sometimes aren’t staffed to handle. Couple that with an office being in disarray due to construction and you have a recipe for a chaotic workplace.

I arrived today to find two of three bathrooms out of commission for construction, which made it tricky to handle patient needs at times. One exam room was doubling as a staff break room, with a refrigerator crammed in the corner and the microwave propped on the exam table. The dedicated laboratory area had been relocated onto one of the nursing station counters, throwing a wrench into some of the workspace efficiency.

Sometimes you forget how well your practice runs until something pushes it off kilter. Although we’ll benefit from swapping the business office and oversized lab for four new exam rooms and a right-sized lab, growing pains aren’t much fun. I was having flashbacks to the last emergency department I staffed, which completely renovated the department over an 18-month period while we continued to see steady volumes of patients and also deployed a new EHR. It was fairly traumatic for the staff, as we struggled to enter orders when we couldn’t even find supplies and were pressed into smaller quarters during the build-out. The construction chaos was bad enough, but adding in the frustration of the extra clicks in the EHR didn’t help.

The shortage of primary physicians is also causing more patients to come to the urgent care who don’t have urgent care problems. I’m glad that we’re less expensive than the emergency department and fill a vital after-hours need, but we’re not equipped to handle complex medical situations or social issues.

About 15 minutes prior to closing, a patient arrived who was seriously ill. She was in the middle oncology treatment and was afraid she had pneumonia. We made a quick decision that she needed to be transferred to the hospital, but we had the complicating factor of the minor children who were with her. We were reluctant to call for an ambulance transfer without someone to care for the children, knowing they couldn’t ride with her, but her condition was worsening. We also can’t have children in the office without a parent or guardian, especially after closing.

As we worked with her to quickly try to find someone to pick up the children, the rest of the story unfolded, revealing an even more tragic explanation for why she was caring for her grandchildren. At least if we could get her to the hospital, social workers could assist. We finally found a solution when one of our patient care techs called the ambulance district and convinced a dispatch supervisor to head over with the ambulance so he could transport the children to the hospital.

These are the situations that can’t be captured well with discrete data, and when you’re trying to problem-solve well outside the box and get the patient ready for transfer, every click counts. We have to complete our H&P documentation so it is printable for transfer and finally I gave up and just free-texted most of it. By the time our patient was stabilized and loaded, the staff was mentally and physically exhausted.

It’s important for team members who work on the IT or billing side of the house to understand the kind of situations we’re facing in patient care. I’m pretty sure I didn’t code the visit as accurately as I could have or gather as many quality measure data points as I should, which would count against a lot of physicians. I won’t take too much heat for it, but it will definitely skew my treatment cycle time metrics. As I reflected on the day overall, I started to question myself on continuing to practice clinically. Although it’s important to see patients to keep me grounded, it’s significantly more stressful than just being on the IT or consulting side and I completely understand why we can’t keep physicians in primary care practices in my community.

Hopefully my next shift will be more in the box than out, but you never know any more in healthcare.

If you’re a CMIO and don’t see patients, how do you stay grounded? Email me.

Email Dr. Jayne.

HIStalk Interviews Satish Maripuri, EVP/GM, Nuance Healthcare

October 2, 2017 Interviews No Comments

Satish Maripuri, MS is EVP/GM of the healthcare division of Nuance Communications of Burlington, MA.


Tell me about yourself and the company.

I came to the US in 1986 as grad student and stayed. I’ve been a Boston-based executive for quite some time. I’ve dealt with a lot of global businesses. I’ve traveled quite a bit, 7 or 8 million miles around the globe. I’ve been with Nuance for six years. I’ve essentially made my career here leading the healthcare business, of which I’m very passionate about. I’m personally driven from a mission standpoint in healthcare.

What has been the business impact of the malware-caused extended system outage?

The business impact was primarily to the production days that we missed in the transcription business. For the most part, in July and early to mid-August. That was the direct impact to our direct revenue.

From an ongoing impact, we don’t have a predicted run rate tail-off from a go-forward standpoint. From our investors’ perspective,  we have this year, of which our fiscal year ended September 30. We have the fourth quarter — roughly four to six weeks’ worth, depending on which clients — of production impact downtime.

We have a few clients who have transitioned away from us during the downtime, as we had given them counsel to seek other solutions. Most of them have come back. A few have stayed with their existing temporary provider. Those we expect as clients we would lose that part of the business going into next year.

One of the things I’ve seen is that clients have been very gracious in giving us an opportunity to earn their trust back. The one thing we have focused through the entire recovery process is transparency and regaining their trust.

The downtime led me to wonder how the clinician voice dictation business is divided among front-end speech recognition, back-end speech recognition, and manual audio transcription and how that’s changed over the past few years.

We transcribe about five billion lines of transcription a year for US hospitals. That’s typically what we call the back-end transcription capabilities. The front end, which is essentially the Dragon-driven dictation, is being used by about a half a million physicians in the US.

We see usage of front-end speech continue to grow and the back-end dictation continue to erode due to phenomena that the industry is already aware of. I don’t see that trend reversing. In fact, in the last year or year and a half, we’ve seen the front-end speech capabilities accelerate in adoption. We have, in fact, been a big part of that adoption by driving front-end speech into the cloud. Dragon is now, for the most part, in the cloud. With that, our physicians get ubiquitous access no matter which setting — at home, in the car, in the clinic, and in the inpatient setting — with a single profile that is always available in the cloud.

Even through the downtime we had, it’s the transcription part of the business that was down, but the front end-speech Dragon capability was up and secure.

That’s where we see the adoption going. In the last three or four months, we’ve added something like 25,000 to 30,000 physicians moving into the cloud-based capabilities. We only see that accelerating.

Speech recognition has reached consumer appliance status, with the Amazon Echo, Apple Siri, and other products moving conversational user interfaces to the mainstream. How do you see that changing?

If you wouldn’t mind, if you would indulge me a little bit in where we see the vision and the next-generational landscape going in clinical documentation, that might just be a little bit of context that’s going to clarify a bit of your question.

We see a world where a clinician is having a conversation with a patient. The two of them conversing is automatically generating clinical documentation that is also annotated and improved on the inside. Then as it goes into the final resting place of the EMR with the capability of being transcribed, being converted to medication lists and into other lab reports, etc. We truly see an ambient clinical documentation world coming to fruition.

Intersect that today with today’s burden of the clinician. Roughly 43 percent of an average clinician’s time today is being spent in front of a computer, dictating and documenting things. You intersect these two and an ongoing increased demand in knowing multiple things to improve clinical documentation. You only see this leading to one thing, which is the more we can take off their plate and the ability to make their life a little bit easier by dealing with the patients — which is what they took the oath for — the better it is for them.

That’s essentially our mission. That’s what we at Nuance Healthcare are putting all our investments into. Every step we’ve taken in speech NLP and now the capability of conversational AI that we’re bringing to the table is geared toward that next step. We have effectively delivered a highly scalable, secure Dragon Medical speech solution. The next frontier for us in that step is to bring Dragon Medical Virtual Assistant to the table.

Our view is that the next paradigm shift in this Virtual Assistant is the ability to have navigational access and conversational interactions with the EMRs in the multi-modality setting. Then of course the question becomes, how do you actually intersect that with the actual device and the form factor? We believe that the complexity of clinical documentation use cases that are in today’s physician’s setting require a level of capabilities that require a unique device to solve that problem. Hence the prototype of an innovation that we announced around the smart speaker as well that goes along with our Virtual Assistant that addresses these needs.

You may already be aware that Nuance as a company has addressed several Virtual Assistant use cases already. Our Virtual Assistant platform is being used at Audi, American Airlines, BMW and I can keep going in both the automotive and the consumer sector. We’re bringing this capability to the clinical documentation problem, as we just announced, by taking all that Virtual Assistant capability and IP and specializing that for healthcare, just like we did for Dragon Medical in the cloud. We think that is much needed.

We’ve had a prototype out there for about two and a half, three years now. Our providers have given us really solid feedback on that. We’re now going to that next level of actually launching that, integrating with the EMRs, and taking some of the early adopters to market.

Now, your question specifically on consumer entrants. They’re not to be ignored. In healthcare in general, there are a couple of different use cases. There are patient-driven use cases and there are physician-driven use cases. Eventually those might blend, but we think that today, there’s a natural extension of the consumer devices into the patient-centric use cases. They may be in an outpatient setting or an inpatient setting, but there’s a big barrier from that point to cross over to clinical documentation and actually being the Virtual Assistant for a physician. That’s the setting in which we have years of experience and that what we are driving to at this point as well.

How will you get clinicians to try something new with the Virtual Assistant and how will you develop and maintain its EHR integration?

You touched on a couple of things that we believe are critical. In terms of the physician adoption question, we can automate tasks that are repetitive and mundane in a very conversational sense. That would be a huge win, because today they go out of their way to document by doing something unnatural — speaking into certain boxes and into certain dialogue frames to be able to capture documentation. If you can eliminate those and make those navigational style control-and-command — open Tim’s record, dictate all of these labs, all the medications, prescribe this, check that — these are all things that are natural command-and-control navigational style. That’s a huge step for us in getting that addressed for our clinicians.

Initial indications from our pioneering clients who have been at the leading edge of technology over the years is that this would go a long way if you make it natural, navigational command-and-control style. That’s what we’re shooting for.

We have to work closely with our EMR partners. Epic, Cerner, Meditech, and others have expressed varying degrees of interest over the years in trying to solve this problem. We now have the enabling technology and we need to work with them for tighter integration. I think you’ll see that every single one of them is interested in aligning and making the physician’s life better. If this leverages a Virtual Assistant that allows the physicians to make their day a bit better, EMR interests are aligned. We understand how to work with the EMR partners very well and that’s a big benefit for us.

As far as your question on adoption of physicians, they’ve been asking for something like this. Ease of use. Take the burden of click-and-dictate — I have to go through five unnatural steps before I can even dictate something into text. Once we take that out of the way, that becomes natural adoption. That’s not to say we shouldn’t go through the training. This year’s next technology razor blade — am I really ready for that? There is a little bit of that curve that happens with any new technology. But I think once the early adopters start to see this, it will be a natural next step.

The other thing is that most of the physicians have some level of consumer devices at home. The early adopters are starting to say, why can’t I do the same thing at the physician’s desk? They are already asking for this. I believe that barrier will be broken provided we make our navigational access and Virtual Assistant easy to use. That’s what we’re focused on right now.

I was with a client on Monday. They’ve even gone to the extent of looking at the overview video and saying, it would be tremendous if I could take the investment in the thousands of TVs that we’ve already put in our hospitals, and beyond just showing movies to our patients, if a physician could walk in and through a Virtual Assistant that’s connected to the TV, they could see the medical record on screen. It’s a bit of a Star Trek look and feel, but that’s not too far away by leveraging existing investments. They’re very creative about this.

It would seem a natural fit that hospitals could be your partners since they often impose the EHR burden on clinicians who are affiliated with them or employed by them, giving those hospitals a competitive advantage in encouraging adoption of a Virtual Assistant that could improve physician satisfaction and alignment.

You’ve hit the nail on the head. Often you worry about, is there a market there if you build the technology? In this case, it’s the large institutions and the hospitals that for the most part have already gotten to the point of, “How can we make this better?” The adoption of speech itself is a good indication of that. This takes it a whole other level. They’re already asking for something like this.I can probably name a dozen institutions that have actually said, “If only this had existed.”

You’re spot on. This would catch on pretty quickly if it was available with a tight integration and with the accuracy they would demand.

Five years ago, we would have been talking about speech recognition accuracy wondering if it would ever be good enough. What will change over the next five years?

For us, it’s been a continuum. You touched on a couple of aspects of that.

Going back to five years ago, we would have been talking about 95 to 98 percent speech accuracy. Would that be a reality? We’ve proven that it absolutely is possible. Now it’s leveraged in the cloud with ubiquitous access at multiple settings with different form factors at a level of accuracy that we wouldn’t have guessed five to seven years ago. That has come to fruition and we’ll continue to innovate on that. We have speaker-independent models, where training is not needed. The level of innovation and applying artificial intelligence into just the speech innovation has been tremendous and I think we’ll continue to stay ahead of that.

The next thing is, how do you make that available through an easy access Virtual Assistant capability, hardware device or not? We’ve demonstrated that in multiple areas around consumer speech and automotive. Now we are bringing that into healthcare. I see that in not more than three years, let alone five years, I’ll walk in as a patient in a physician’s office and I will see a Virtual Assistant. The physician walks in, has a conversation with me, and uses a good amount of command-and-control navigational access. With the Virtual Assistant in the room, the documentation is taking place in either a semi-automated, or for the most part, an automated clinical documentation fashion. I don’t think that’s too far away.

You’ve seen speech accuracy get to a certain level. You’ll see a level of Virtual Assistant use case become mainstream. Then the question is, what do you do to intersect clinical intelligence into that scenario and setting? By that, I mean a level of clinical decision support, a level of knowledge, a level of improving the clinical documentation that’s being captured for a couple of different purposes.

Today’s accuracy and the improvement of documentation that’s being captured is a big part of what we do for our clients. We often refer to that as clinical documentation improvement, or CDI. We’ll see more technologies that improve the accuracy of what’s being captured to accurately represent severity of illness, risk of mortality, etc. because that directly impacts the quality of documentation that eventually drives downstream reimbursement models.

I see a level of intelligence being built on top of what’s being captured. We refer to that as clinical intelligence that’s being introduced in front of the physician and the other parts of the care team, whether it be radiologists, whether it’s part of the CDS specialists, etc. It’s speech, but it’s in the cloud, it ubiquitous, with a Virtual Assistant capability on top of that, and that’s the starting point. It’s already happening today where a level of clinical intelligence is being brought to the care team, especially the physician. With artificial intelligence and the level of deep learning capabilities that are available today, we know that that’s not out of the realm of reality for us within three years. A good portion of that exists today.

Do you have any final thoughts?

Economics don’t quite scale to the level at which the healthcare spend is going. The space is ripe for disruption. I’m extremely confident that enabling technologies, whatever those might be and a few of which we’ve just covered, are going to enable that massive disruption. It’s coming and it’s actually happening. We are at a point where we, through some of our larger partners, are enabling some of that disruption. We’re very excited about that. The healthcare industry will see the benefit of a lot of that disruption coming.

On a personal note, given what we’ve gone through — both in my own personal life as well as the incident recently — I’m really proud of the teams and the way that the company and the teams handled one singular focus of customer focus and doing right by the customer with a set of core values. The operative word there is resilience. Both personally as well as from a team perspective, we are committed to driving what’s right for the clients and driving that through a level of resilience. We’ve come out stronger as a business through that whole experience while it didn’t seem like that in that six-week period.We’re really proud of that.

Morning Headlines 10/2/17

October 1, 2017 Headlines No Comments

Trump’s breaking point with Price

HHS Secretary Tom Price, MD resigns amid public outrage over his use of taxpayer funded private jets for personal travel.  Don Wright, MD and assistant secretary for HHS, will serve as acting secretary until a permanent replacement is named.

VA close to awarding Cerner contract for new EHR

VA Secretary David Shulkin notifies Congress of his intent to award a no-bid contract to Cerner within 30 days as part of the VA’s modernization roadmap.

US jury cuts damages in TCS-Epic trade secrets lawsuit

A Wisconsin court cuts the damages awarded to Epic in its trade secrets suit against India-based Tata Consultancy Services rom $940 million to $420 million, citing a Wisconsin law limiting punitive damages to twice the compensatory damages.

Temple University Health System: Financial Summary

Temple University Health System (PA) reports a $22 million year-over-year decline in net income, despite recording a $68 million increase in net patient services revenue over the same period. Temple attributes the decline in net income to its Epic implementation at Temple University Hospital.

Monday Morning Update 10/2/17

October 1, 2017 News 3 Comments

Top News


President Trump fires HHS Secretary Tom Price – not for his questionably legal stock trades, for serving as a political lapdog in trying but failing to torpedo the laws he swore to uphold, or even for squandering hundreds of taxpayer dollars on unnecessary charter and military flights — but rather for embarrassing the President in the press coverage about the flights, admitting his wrongdoing, and offering only partial taxpayer reimbursement.

The only regret the former Tea Party member expressed in his resignation letter is that he “created a distraction.”

Price also didn’t mention the $19 million Republicans spent to keep his former seat in the most expensive House race in history. A Republican PAC executive director obviously wasn’t thrilled with Price’s short stay in Washington: “While it was certainly fun destroying [Democratic nominee] Jon Ossoff and attacking Nancy Pelosi for three months, I am hopeful Dr. Price will use his newfound fame and leisure time to jet around the country and help make up for some of the $7 million we spent on the Georgia special election.”


Appointed as interim HHS secretary is Deputy Assistant Secretary for Health Don Wright, MD, MPH, an HHS long-timer who replaced Karen DeSalvo, MD, MPH in the January 2017 administration change. The permanent replacement will almost assuredly, like Price, have credentials that are more political than clinical.

Politico’s list of rumored candidates includes some current and former members of Congress, Dr. Oz, CMS Administrator Seema Verma, Florida Governor Rick Scott, the VA’s David Shulkin, FDA Commissioner Scott Gottlieb, former Louisiana governor Bobby Jindal, HUD Secretary Ben Carson, and Don Wright himself.

Reader Comments

From The Basics: “Re: SSN. Yesterday I visited my local hospital to review a bill. I was shocked to see my whole Social Security number on an employee’s computer screen. She said she didn’t know why it was there since she doesn’t use it. It only takes one dishonest person to steal the identity of patients.”

HIStalk Announcements and Requests


A bunch of us have had our information exposed in Equifax’s breach, although nearly as many of poll respondents have lost interest reading about the breach du jour. Some respondents expressed optimism that “the big one” may force companies to get their security act together, while several others said they’ve placed an indefinite freeze on their credit accounts with the belief that the hassle of unfreezing them as needed is still better than cleaning up the post-breach mess.

New poll to your right or here: should a vendor’s newly announced customer be required to attest that they hold no financial interest in the company?

This Week in Health IT History

One year ago:

  • PeriGen acquires Hill-Rom’s WatchChild fetal monitoring system.
  • The local paper spotlights the refusal of the Texas Department of State Health Services to release pregnancy and maternal death statistics to reporters interested in why death rates doubled in one year.
  • PE firm Warburg Pincus announces plans to acquire Intelligent Medical Objects.
  • Former President Bill Clinton, stumping for his wife’s presidential campaign, calls the Affordable Care Act “the craziest thing in the world” because of risk pool limitations.

Five years ago:

  • The UK’s Department of Health admits that its contract with CSC requires it to turn custom-developed NHS software back to the company after NPfIT was shut down.
  • McKesson announces that it will acquire MED3OOO.
  • HIMSS acquires CapSite.
  • Patrick Soon-Shiong’s NantHealth announces that the company will work on personalized medicine with Blue Shield of California and St. John’s Health Center. 

Ten years ago:

  • A KLAS report on how well clinical systems work for nurses gives all vendors a grade of ‘D’ or below.
  • Quovadx acquires Healthvision.
  • Microsoft announces its HealthVault PHR.
  • MD Anderson redesigns its ClinicStation EMR and CIO Lynn Vogel joins Partners (John Glaser) Vanderbilt (Bill Stead), and Marshfield Clinic (Justin Starren) in an AMIA conference session on homegrown development.
  • CMS awards AHIMA a $10 million contract to evaluate the possible change from ICD-9 to ICD-10.

Last Week’s Most Interesting News

  • Epic opens the first group of App Orchard products to public access.
  • A VA OIG report finds that the DoD is not sharing attempted suicide information with the VA despite a 2014 federal mandate.
  • The American College of Radiology and SIIM hold a session and a conference, respectively, on use of artificial intelligence in medical imaging.
  • Senate Republicans fail to bring the Graham-Cassidy bill to a vote.
  • FDA chooses the digital health software vendors that will participate in its software precertification program.


October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRx. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Clinicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Specialists automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


Medication risk management technology vendor Tabula Rasa HealthCare acquires University of Arizona medication therapy management spinoff SinfoniaRx for $35 million in cash.


A Wisconsin court reduces the $940 million awarded to Epic in its intellectual property lawsuit against Tata Consultancy Services to $420 million. The original judgment violated Wisconsin law, which limits punitive damages to twice the compensatory damages, causing Epic to suggest a lower figure of $720 million. Epic says Tata employees working as Kaiser Permanente consultants stole thousands of company documents to help Tata create a competing system, but Tata says its lawyers believe the award can be set aside completely on appeal since Tata did not benefit from the information.



In Canada, Alberta Health Services signs a $368 million contract to implement Epic. It will replace 1,300 systems that it claims will cover most of the project’s overall $1.2 billion cost, although the province’s auditor is skeptical.


Methodist Le Bonheur Healthcare (TN) will implement the PatientTouch communication and clinical workflow platform from PatientSafe Solutions.


  • Mammoth Hospital (CA) will go live on Cerner Millennium in October 2017.
  • Osceola Medical Center (WI) will switch from Evident to Athenahealth in January 2018.
  • Jersey Shore Hospital (NJ) will replace Meditech with Epic in April 2018.
  • Memorial Hospital (IL) will switch from Evident to Epic in November 2017.
  • St. Francis Memorial (NE) Hospital will replace McKesson with Cerner in 2018.

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



Don Woodlock (GE Healthcare) joins InterSystems as VP of HealthShare.


OurHealth hires Brian Norris, MBA, RN (Aledade) as VP of analytics.

Announcements and Implementations

Black Book names its 50 health IT disrupters and challengers.

UMass Memorial Health Care was scheduled to go live on its $700 million Epic project this past weekend, replacing Siemes/Cerner Soarian. 

Government and Politics

The VA gives Congress the required notice that it plans to sign a no-bid contract with Cerner within the next 30 days. Secretary David Shulkin also announces that the VA will end work on 240 of its 299 open software projects, many of them floundering, to shift resources to the Cerner implementation. Shulkin urged private sector employees to join the VA’s Cerner implementation “because we need the A team on this.”


Meanwhile, the VA’s Shulkin has his own Tom Price-like problems to deal with as the Washington Post discovers that a taxpayer-paid trip to Europe included, in addition to discussions with officials in Denmark and England initiated by the VA, attendance at the Wimbledon championship and a cruise on the Thames that also included his wife, four other travelers, and six-person security detail. He took the trip, about half of which didn’t involve government business, less than two weeks after demanding that VA executives approve only essential travel.

The US Supreme Court will hear arguments Monday in a federal labor case that involves Epic and two other companies, a key issue being Epic’s requirement that employees sign away their rights to sue the company over labor issues and instead submit to arbitration.



Performer Cher sues Patrick Soon-Shiong for stock sale fraud, claiming that a drug company convinced her to sell back her shares cheaply and then sold the company for a higher per-share price to Soon-Shiong’s NantCell. The suit says Soon-Shiong paid $15 million for the company that is now worth $1 billion.


Temple University Health System (PA) attributes its $23 million budget shortfall primarily on the implementation of Epic, mostly due to high-than-expected staffing costs and its impact on operations improvement goals.


The president of Erlanger Health System (TN) says its 67 percent drop in net income from operations in the fiscal year is mostly due to its Epic implementation costs, as the health system paid Epic $33 million this year. However, revenue exceeded budget, also due to Epic.

image image

Dean Sittig, PhD, biomedical informatics and bioengineering professor at The University of Texas Health Science Center at Houston, just published a new book on informatics terms. Not sure if you need it? Take this 10-question multiple choice informatics terminology quiz that Dean created at my suggestion, check your score at the end, and then let Dean help you do better if needed. 

Here’s Vince’s latest 30-year look-back on the health IT industry, which addresses the DoD’s 1987 EHR bid and the birth of HL7.


Weird News Andy calls this DWI – driving while immature. Rady Children’s Hospital rolls out (no pun intended) little cars that peds patients can “drive” (they’re actually controlled remotely) to the OR to help them relax before their procedure. The kids – like their surgeons with their larger equivalents – can choose from among a BMW, Mercedes, or Lamborghini.

Sponsor Updates

  • QuadraMed, a Harris Healthcare company, and T-System will exhibit at AHIMA October 7-11 in Los Angeles.
  • Salesforce announces $50 million donation and 1 million volunteer hours to further computer science education.
  • The SSI Group will exhibit at the NJ HFMA Annual Institute October 4 in Atlantic City.
  • Surescripts will exhibit at the EClinicalWorks 2017 National Conference October 6-9 in Grapevine, TX.
  • Versus Technology will exhibit at MD Expo October 5-7 in Orlando.
  • Boston Magazine includes ZappRx CEO Zoe Barry on its list of Bright Young Things.
  • ZeOmega will exhibit at Change Healthcare’s Inspire Change Healthcare Solutions Conference October 2-5 in Philadelphia.
  • Lightbeam Health Solutions and Experian Health will exhibit at the NAACOS Fall Conference October 4-6 in Washington, DC.
  • Logicworks earns PCI DSS Level 1 Certification for the sixth straight year.
  • Navicure will exhibit at the EClinicalWorks National Conference October 6-9 in Grapevine, TX.
  • Netsmart will exhibit at the CBHC Annual Behavioral Health Conference October 4 in Breckenridge, CO.
  • Clinical Computer Systems, developer of the Obix Perinatal Data system, will exhibit at the University of Iowa Health Care Children’s & Women’s Services Fall Nursing Conference October 2-3 in Coralville.
  • PatientSafe Solutions will exhibit at the 2017 IntegraTe 2017 South Florida HIMSS event October 4 in Davie, FL.
  • The Metro Atlanta Chamber selects Patientco as one of seven companies to join its first cohort of Backed by ATL businesses.
  • PokitDok will present at Health 2.0 October 3 in Santa Clara, CA.

Blog Posts


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Get HIStalk updates. Send news or rumors.
Contact us.


Morning Headlines 9/29/17

September 28, 2017 Headlines No Comments

Epic advances its health-centric app store

Years in the making, Epic launches its App Orchard app store, where customers can shop for third-party apps that integrate with Epic’s EHR.

#BeThere: What More Can Be Done To Prevent Veteran Suicide

A VA OIG report on preventing veteran suicides finds that the DoD is still not sharing attempted suicide information on service members transitioning out of the armed services with the VA from its DOD Suicide Event Report system, despite a 2014 federal mandate that it do so.

Certified Health IT Developers and Editions Reported by Hospitals Participating in the Medicare EHR Incentive Program

CMS releases the latest MU attestation numbers by vendor, showing that Epic has edged ahead of Cerner, with Meditech trailing closely behind the two.

U.S. brings new charges over Tenet Healthcare fraud scheme

Two former Tenet executives are facing conspiracy and wire fraud charges in Georgia. The indictment says that from 2000 to 2013, the executives engaged in a scheme to pay over $12 million in bribes to clinics in Georgia and South Carolina so that providers there would refer pregnant patients to Tenet hospitals to deliver their babies. Tenet billed $400 million to the Georgia and South Carolina Medicaid programs as a result of these referrals.

News 9/29/17

September 28, 2017 News 8 Comments

Top News


Epic announces at UGM go-live of its App Orchard, offering software from:

  • American Joint Committee on Cancer (cancer staging forms)
  • Aunt Bertha (connecting patients to social services)
  • Cedars-Sinai Health System (personal device data flowsheets)
  • DocASAP (patient scheduling)
  • Doctella (patient education)
  • HealthDecision (shared decision-making)
  • Healthfinch (patient visit planning, prescription refill processing)
  • ImageMoverMD (EHR image integration)
  • Impathiq (chest pain protocols)
  • Northwestern University (patient outcomes monitoring)
  • Parachute Health (durable medical equipment ordering)
  • PeraHealth (at-risk patient identification)
  • StayWell (patient education)
  • Tissue Analytics (wound documentation)

Epic actually rolled out the App Orchard site early this year, but this is the first public access to the apps it contains.


Epic’s 1.5-day App Orchard Conference will be held November 9-10 at its Verona, WI campus.

Reader Comments

From Kim Wisconsin: “Re: Epic UGM. Clients watched KLAS VP Taylor Davis and Judy Faulkner prance together in wizard costumes on stage. Needless spending on top of what it cost Epic to attain Best in KLAS?” Unverified. Epic’s UGM involves a lot of voluntary whimsy and I’m OK with that, but I’m always skeptical of KLAS’s objectivity and having one of its executive participate in a vendor’s user group meeting skit does little to allay my concerns. Imagine a Consumer Reports editor cavorting on stage at a Ford PR event, although that’s unfair since KLAS is light-years away from the objectivity and science behind Consumer Reports despite the inevitable industry comparisons. Still, customers of both Epic and KLAS make their own informed decisions, so they know what they’re buying and it’s nobody else’s business.

From George St. Short: “Re: executive attributes. What is your observation about strengths and weaknesses and how it affects companies?” That’s a broad topic, but I will summarize thusly. Most of us know our strengths. We don’t, however, know our weaknesses, and that’s where we stumble. Just ask the people you work with to list what you’re bad at. Try to improve, get someone else to handle that function, or both.


From The PACS Designer: “Re: digital pathology. The era of digital pathology is upon us and can be seen through this digital pathology sample. You will see the digital pathology records in your EHR when vendors begin to add them to their EHR systems in the years to come.”

From OnlyForGiggles: “Re: national EHR procurement in Singapore. It’s been four years in the running and Allscripts and Epic are the finalists. Cerner didn’t even bother showing up at this month’s HIMSS Asia. Accenture is running the procurement with Oracle as a partner and only Allscripts runs Oracle. The Ministry of Health CIO is a former Accenture partner and has now installed himself also as CEO of the IT arm of the Ministry of Health. He is partial to awarding contracts to his former employer, so both companies would do well to sidle up to Accenture. We see this kind of drama in the US and UK and Singapore, alas, is no exception.”


From The Mechanic: “Re: Athenahealth. One of its 35-bed inpatient sites is already leaving them and returning to CPSI.” Jackson Medical Center (AL) says collections dropped 75 percent after they implemented Athenahealth, so they’ve gone back to the Thrive EHR solution offered by CPSI subsidiary Evident in what they call a fairly easy transition. 

From Super Bee: “Re: EClinicalWorks. Cold call emails cite an ‘AmericanEHR’ survey that finds EHR tops at many categories. It would be more impactful if they actually provided the study, but in addition, ECW isn’t on any of that site’s Top 10 lists.” That site doesn’t inspire a lot of confidence with outdated information and no recent news items. It was developed by the American College of Physicians to sell reports and to charge EHR vendors to create profiles on its site or to run ads. Its top five EHRs by user satisfaction are CattailsMD (which I thought was long gone or at least renamed, but maybe not), Praxis, Waiting Room Solutions, ABELMed, and Sevocity.


From Beefy Goodness: “Re: ONC’s inpatient EHR certification stats. Epic has overtaken Cerner for the #1 spot in data updated through July.” The chart is above, although it also list hospitals using Siemens Medical Solutions that might be reasonably added to Cerner’s total to keep it on top. Epic is the only vendor that has customers using 2015 certified technology. Also note that while the data source was updated in July 2017, the graphic depicts only participation through the 2016 program year.


From Spacemen Collection: “Re: Sunquest. President Matt Hawkins is leaving, to be replaced by Mike Epplen, who has been president of fellow Roper acquisitions Data Innovations and Atlas Medical.” Unverified, although the non-anonymous source is solid. UPDATE: Hawkins will become CEO of the combined Navicure-ZirMed when that merger is completed in early November.

From Frank Sumatra: “Re: MyWay. Physicians are telling me that Allscripts will shut off the hosted version within five weeks, but can’t get them their data for 12 weeks. Practices will also have to pay $5,000.” Unverified. I invited the Allscripts media contact to comment but haven’t heard back. MyWay was retired several years ago as I recall to avoid adding ICD-10 support, so practices have had five years to seek an alternative. MyWay is disproportionately represented among the many embarrassing points in the company’s history (search HIStalk for a fond look back).

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Vocera. The San Jose, CA-based company offers the leading platform for clinical communication and workflow, with 1,400 hospital and health system customers around the world using smartphone-based secure texting or making hands-free calls using the Vocera Badge. Vocera interoperates with 120 clinical systems to reduce alarm fatigue, reduces staff response time, and improves patient care, safety, and experience. Vocera ensures that critical information reaches the right person at the right time on the right device, or as Halifax Health VP/CIO Tom Stafford says, “There is no other communication solution I’m aware of that can send a notification as closely and instantly to a nurse than the Vocera system.” Hospitals use the system to increase ED and OR throughput, prioritize clinical alerts, optimize patient placement, improve collaboration, strengthen patient communication, and reduce care team burnout. Halifax Health just implemented a real-time sepsis surveillance program by integrating Wolters Kluwer Health’s POC Advisor with its Vocera technology to quickly alert clinicians of a potential sepsis case, while Dayton Children’s Hospital (OH) connects pediatric patients to nurses by connecting Hill-Rom’s nurse call system with :Star Trek”-like Vocera badges to alert them when the child presses buttons for “pain” or “potty.” Gartner’s Hype Cycle report names Vocera as an example of a technology vendor with offerings in several categories of the real-time health system. Thanks to Vocera for supporting HIStalk.

I found this new YouTube video that describes Halifax Health’s use of Vocera in its ED.

This week on HIStalk Practice: Volunteers in Medicine Clinic Executive Director Raymond Cox, MD discusses the role data access plays in caring for the underserved. PeakMed Direct Primary Care founder and CMO Mark Tomasulo, DO shares his thoughts on the ways attempts at health insurance reform are driving the DPC business model. Deadline extended: HIStalk sponsors, submit your MGMA details for inclusion in our annual must-see vendor’s guide over at HIStalk Practice.


October 17 (Tuesday) noon ET. “Improve Care and Save Clinician Time by Streamlining Specialty Drug Prescribing.” Sponsored by: ZappRX. Presenter: Jeremy Feldman, MD, director, pulmonary hypertension and advanced lung disease program and medical director of research, Arizona Pulmonary Specialists. Physicians who treat pulmonary arterial hypertension can spend an average of 20 minutes to prescribe a single specialty drug and untold extra hours each month completing prior authorization (PA) paperwork to get patients the medications they need. This webinar will describe how Arizona Pulmonary Associates automated the inefficient specialty drug ordering process to improve patient care while saving its clinicians time.

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

November 8 (Wednesday) 1:00 ET. “How Clinically Integrated Networks Can Overcome the Technical Challenges to Data-Sharing.” Sponsored by: Liaison Technologies. Presenters: Dominick Mack, MD, executive medical director, Georgia Health Information Technology Extension Center and Georgia Health Connect, director, National Center for Primary Care, and associate professor, Morehouse School of Medicine;  Gary Palgon, VP of  healthcare and life sciences solutions, Liaison Technologies. This webinar will describe how Georgia Heath Connect connects clinically integrated networks to hospitals and small and rural practices, helping providers in medically underserved communities meet MACRA requirements by providing technology, technology support, and education that accelerates regulatory compliance and improves outcomes.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


Leerink Transformation Partners forms its first healthcare IT growth equity fund with $313 million in assets under management, led by managing partners Todd Cozzens (Marquette Medical, Picis, Optum) and Jared Kesselheim, MD, MBA, both previously with Sequoia Capital and Bain Capital Ventures. The fund’s initial investments are Outcome Health,, Vera Whole Health, PatientPing, Health Catalyst, and Kyruus. 

IBM, which has laid off a significant part of its US workforce, now employs more people in India than in the USA, supporting the theory that low-cost overseas labor moves up the food chain from hardware assemblers to knowledge workers. 



Emory Healthcare (GA) chooses Kyruus’s provider data management and patient access solutions.


South Africa’s Areta Health will implement Medsphere’s subscription-licensed, cloud-hosted healthcare IT solutions in its Specialist Day Hospital system.



UW Medicine (WA) hires Joy Grosser (University Hospitals) as CIO. She had been CIO of University Hospitals for just over a year.


Ed Gaudet (Iboss Cybersecurity) joins Censio as CEO.


CheckedUp hires Jim Decker (AMD Group) as VP.


Seattle Children’s (WA) promotes Eric Tham, MD, MS to VP and associate CIO over research IT, clinical applications, and analytics.

Announcements and Implementations


The American College of Radiology’s newly formed Data Science Institute hosts its first meeting in its Reston, VA headquarters, convening an international group of artificial intelligence experts, device vendors, and physicians to discuss the use of algorithms in clinical workflows. ACR DSI is building consensus around a vendor-neutral framework to apply AI to patient care that will include developing imaging use cases, setting interoperability standards, testing algorithms, and addressing regulatory issues. 


Society for Imaging Informatics in Medicine holds its second conference on using machine intelligence in medical imaging (SIIM C-MIMI) at Johns Hopkins Medicine, with keynotes offered by presenters from Google Cloud and the FDA.


Allscripts will integrate medical reference and patient education information from Merck Manuals into its EHRs via an HL7-compliant Infobutton.


Nuance releases Dragon Medical Virtual Assistant, which applies voice biometrics and text-to-speech via a smart speaker conversational user interface to automate high-value EHR clinical workflows.


Lightbeam Health Solutions will integrate AI technology from DocSynk into its population health management platform to improve identification and targeting of patient groups.


Ability Network announces the Ability Insight Medicare revenue cycle analytics and benchmarking application for SNFs, home health agencies, and other LTPAC organizations.


Talent management solutions vendor HealthcareSource launches a healthcare job search site that is integrated with its Position Manager applicant tracking system. The company’s CEO is industry long-timer J.P. Fingado (API Healthcare, Cerner, Dynamic Healthcare Technologies). HealthcareSource says it has 3,000 healthcare customers of its Quality Talent Suite.

Healthcare Growth Partners posts the first in a six-part series on due diligence in health IT transactions, this installment covering accounting and tax considerations.

Government and Politics


The Department of Justice charges several executives of for-profit hospital operator Tenet Healthcare with Medicaid fraud, claiming that some of its Atlanta-based facilities paid $12 million in kickbacks to a medical clinic that serves pregnant women who are in the US illegally, steering them to Tenet hospitals for their deliveries that were then billed to Medicaid for $400 million.


A report on veteran suicide by the VA OIG finds that despite federal mandates going back to 2014, the Department of Defense still does not share attempted suicide information from its DOD Suicide Event Report system with the VA. The report also notes that 11 percent of the patients identified by the VA as being high risk for suicide did not have a suicide prevention safety plan in their EHR record and that the VA’s use of EHR suicide risk flags could be improved. A previous report found that veterans have a 21 percent higher suicide risk compared to civilians, with 20 of them killing themselves each day, 30 percent of those after recent VA visits.


Former HHS CIO Frank Baitman says he doesn’t understand why needs to go offline for 12 hours every Sunday (including the first day of open enrollment period) as announced by HHS. The system was down less than 1 percent in previous years vs. a scheduled 6.6 percent this year, triggering several letters from senators to CMS Administrator Seema Verma questioning whether the impetus is political rather than technical. The open enrollment period has already been reduced from 12 weeks to six and outreach programs for signups have been cut almost entirely.


HHS Secretary Tom Price apologizes for the $400,000 worth of chartered plane flights he has taken – some for questionable purposes and five in a single week —  in the past few months in potential violations of federal travel laws, declaring that he won’t take any more charters and that “taxpayers won’t pay a dime for my seat on those planes.” He will repay the $52,000 portion represented by his own seat, but taxpayers remain on the hook for the additional $350,000 Price spent to bring HHS employees along for the ride. Meanwhile, a Politico investigation finds that fiscal hawk Price and his wife also took global trips on military aircraft that raises his total since May to more than $1 million, but HHS says Price reimbursed the government for his wife’s travel. Price, his wife, and eight HHS employees took a private jet from Berlin to Geneva at a cost of $16,000 for the flight offered by several commercial airlines for between $60 and $260. Price railed about Democrats flying charters when he was a Congressman, citing “fiscal irresponsibility run amok in Congress.”



Fujitsu develops a wearable, hands-free speech translation device that can identify the voices of two speakers and translate their speech into the other’s language. The company claims 95 percent accuracy in a typical hospital setting. It was developed to help hospitals in Japan converse with their patients who don’t speak Japanese.



From Epic’s user group meeting:

  • CEO Judy Faulkner talks up Epic’s new Share Everywhere, which allows any provider (even those who don’t use an EHR) to view a patient’s records via C-CDA.
  • Faulkner advocates eliminated the term “electronic medical record” in favor of the “comprehensive medical record,” which of course why the term “electronic health record” was created to describe systems that manage information extending beyond the four walls (at least for that term’s first five minutes of life, after which overzealous and often crappy EHR vendors misappropriated the term to describe their unchanged systems to sound sexier).
  • Epic demonstrated the use of consumer technology such as Google Home and Amazon Echo that can allow patients to connect to MyChart to request prescription refills.
  • The company announced Payment Guardian for reimbursement.
  • Epic is working on using artificial intelligence to assist clinician users, with Epic being noted this week in Microsoft’s Ignite Vision keynote speech by CEO Satya Nadella as an AI-first healthcare leader.


CVS joins the opioid abuse fight in a puzzling manner, limiting new opiate patients who are covered by insurance to a seven-day prescription supply, limiting the number of doses its pharmacists will dispense based on product strength, and declining to dispense extended-release opiates until immediate-release products have been tried. It’s interesting that a drugstore chain – which has limited access to a patient’s medical history – feels it needs to override physician prescriptions, although certainly state medical boards, pharmacy boards, and other overseers haven’t made much of a dent in questionable opiate prescribing.


This might be a good early warning. Doctors performing a bronchoscopy on a long-term smoker find that his lung mass isn’t cancer, but instead is an easily removed plastic play set traffic cone he swallowed as a child, which caused no symptoms until 40 years later.

Sponsor Updates

  • Boston Software System publishes “Simplifying Legacy System Decommissioning.”
  • Parallon Technology Solutions publishes a white paper for CIOs and chief medical officers titled “Upgrading to Integrated Meditech 6.16.”
  • Robert Lord, co-founder and president of Protenus, is chosen as a New America Cybersecurity Policy Fellow, where he will focus on defining the program’s next-generation healthcare cybersecurity efforts.
  • Datica CEO Travis Good, MD will moderate a panel event at the Health 2.0 conference next week titled “What does the success of digital health look like?”
  • Lightbeam Health Solutions publishes a case study describing Princeton HealthCare System’s 15 percent reduction in inpatient admissions after implementing the company’s population health management platform.
  • The Chartis Group publishes a white paper titled “The Shift to Value: Understanding Market Dynamics to Inform Your Strategic Course.”
  • Meditech AVP Cathy Turner, MBA, RN will serve on a panel at Northeastern University’s Nurse Innovation and Entrepreneurship Summit this week.
  • EClinicalWorks will exhibit at Health 2.0 October 1-4 in Santa Clara, CA.
  • Iatric Systems will exhibit at the HCCA Regional Conference September 29 in Indianapolis.
  • Boston Voyager profiles Image Stream Medical CEO Eddie Mitchell.
  • InterSystems will exhibit at the CompuGroup Medical User Conference October 3-5 in Las Vegas.
  • Intelligent Medical Objects Senior Software Engineer Yunwei Wang becomes the first to successfully complete the Health Level Seven International inaugural HL7 Proficiency Exam.
  • Kyruus will exhibit at the Boston Bar Association’s Life Sciences Conference October 3 in Cambridge, MA.

Blog Posts


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EPtalk by Dr. Jayne 9/28/17

September 28, 2017 Dr. Jayne No Comments

Hot on the heels of Anthem and Express Scripts as they work to curb the opioid epidemic, CVS Health announces restrictions on coverage for certain opioid doses and durations. The Caremark unit of CVS is one of the largest pharmacy benefit managers, covering nearly 90 million patients. Starting in February, patients requiring short-term opioid therapy will be limited to seven days of medication.

I was surprised to learn that some patients with short-term pain needs were receiving 20-30 day supplies of medication since I don’t see a lot of that prescribing behavior in my community. Patients requiring long-term treatment will be limited to a dose of 90 morphine milligram equivalents. Patients must also demonstrate that they’ve been treated with immediate-release medications before they will be allowed to fill prescriptions for extended-release medications. Physicians will be able to appeal the restrictions through a prior authorization process, and employers and insurers can opt out of the restrictions. They’re basing the restrictions on recommendations from the CDC, issued last year. CVS is also adding medication disposal units in 750 of its pharmacies.

The healthcare IT season is starting to heat up, with the Epic user group underway and the Cerner conference approaching. From a vendor standpoint, the buzz ebbs and flows until it reaches its apex at HIMSS, but I’m starting to see some activity among health systems and larger medical practices. Maybe it’s the potential relaxation of some of the regulatory burdens that people were anticipating, or perhaps there are other forces at play, but groups seem to be talking about making technology and systems investments when they had previously been keeping their purses closed.

I’ve been asked to give input on a couple of RFP documents, which could result in some large purchases that I didn’t see happening in the next couple of years. It could also be that organizations want to use the relative regulatory lull to get ready for any future crushes. I’ve worked with a couple of groups that have done rip-and-replace system transitions across reporting periods and shifting regulatory requirements, so I agree it’s smart to move things forward now if you think you’re ready to make a change.


I’m not mourning the demise of the 2014 NCQA Patient Centered Medical Home Standards, which are nearing their end. Practices who had already purchased the 2014 survey tool can use it through September 30, but after that, organizations have to transition to the 2017 standards. This has been a confusing time for many of my clients and I’m certainly looking forward to being able to support groups on a single set of standards. Patient-Centered Medical Home efforts continue to get quite a bit of attention, even for practices that aren’t trying to maximize their payments under MIPS.


I’ve been trying in vain to contact a colleague in Puerto Rico, not only so I can know that he’s OK, but also to ask if there is anything I can do to help other than sending money. The reports I’ve seen are personally heartbreaking and professionally unfathomable. A week after Hurricane Maria’s landfall, most of the island is still without power, including more than 50 of the island’s hospitals. A little more than half of the residents have access to drinkable water.

The hospitals that are still open are running on generators and attempts to connect them to the power grid have resulted in a few hours of success followed by a return to the generators. Patients are seeking emergency care in larger numbers than facilities are prepared to handle — partly due to water, power, and supply shortages — but also due to the fact that many facilities are also damaged and unable to operate at all. Those facilities that are able to run are not at full staffing levels and surgical case volumes are limited.

Some descriptions liken it to a war zone, with healthcare providers making due with whatever then can find. It sounds like pharmacy stocks are holding out, although there are glitches with electronic payment systems and technology infrastructure. Patients are being evacuated to Louisiana and South Carolina, with the Navy’s hospital ship USNS Comfort expected to arrive next week.

The Comfort is no stranger to natural disasters, having been on station in Haiti following the 2010 earthquake and in the Gulf of Mexico following Hurricane Katrina in 2005. It can staff up to 1,000 hospital beds and has 12 operating rooms. Still, patients with critical needs, such as open heart surgery, are being encouraged to travel to the continental US for surgery, although travel off the island remains an issue.

The Department of Health and Human Services has relaxed rules on physician licensure, allowing physicians to practice in the emergency area under an unrestricted license from another state rather than requiring them to be licensed where services are rendered. HIPAA penalties are also being waived with regard to distribution of privacy practices documents and sharing medical information with family members. It could be six months before power is fully restored and the needs will be great to combat public health crises related to the storms and flooding.

The One America Appeal, originally launched by the five living former US Presidents to support recovery from Hurricane Harvey, has been expanded to include areas devastated by Irma and Maria. Donations will go to a fund managed by the George H. W. Bush Presidential Library foundation, which will distribute them to existing disaster relief funds supporting affected areas. The Foundation will ensure that 100 percent of donations will go to hurricane recovery, and donors can specify which recovery effort they want to support, if desired. I’m hoping I hear from my friend soon and that he and his family are safe.

Email Dr. Jayne.

Morning Headlines 9/28/17

September 27, 2017 Headlines No Comments

Senate Republicans Say They Will Not Vote on Health Bill

Senate Republicans will not bring the Graham-Cassidy bill to vote, ending what might be the GOP’s final opportunity to repeal ACA.

VA running out of money for Choice program

Despite receiving $2.1 billion in emergency funding, the Trump administration says the Veterans Choice healthcare program may run out of money as early as December.

Former IBM Watson Health employee on AI: The truth needs to come out

A former IBM Watson employee remembers his time working on Watson, saying, “There’s a lot of money in marketing and there are a lot of ads on TV but I don’t actually see the products. Anytime anyone would want to see a product roadmap or wanted to see what the future is or when it was coming out, we never really got that timeline.”

Increasing Telehealth Access in Medicare Act

A CBO estimate on costs associated with expanding Medicare telehealth coverage concludes that “enactment of this provision would reduce direct spending by $80 million over the 2018-2027 period.”

Readers Write: Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 2 of 4)

September 27, 2017 Readers Write 4 Comments

Why Healthcare Organizations Take So Long to Make Buying Decisions and How We Can Fix It (Part 2 of 4)
By Bruce Brandes


Bruce Brandes is founder and CEO of Lucro of Nashville, TN.

As any industry observer knows, health systems continue to consolidate in an attempt to ensure their viability given unprecedented financial and operational pressures.  Many organizations struggle to fully leverage their scale post-merger. Most often the difficulty is to align focus, priorities, internal knowledge. and industry experience across the expanded team as they integrate.  

Misalignment is usually the main contributor to the length of the sales and purchasing process. Too often people fall in love with a PRODUCT without first clearly defining the PROBLEM they seek to solve. This challenge is exacerbated by complex purchasing decisions that require collaboration across multiple stakeholders to make the right choices.

My 16 year-old daughter, Lily, recently got her driver’s license and immediately spent lots of time and energy looking to buy a car (product). Much to her chagrin, the head of home operations (my wife) and the economic buyer (me) defined the problem as our daughter needing transportation, and buying a new car was only one of several options for us to address this issue. As we considered how to best solve her transportation problem weighed against other family priorities, we decided to simply get Lily an Uber account and an extra key to use our cars when available.

The same disconnect happens every day in healthcare. So much sales activity and investment are squandered on potential buyers who are only empowered to say no — not yes — to an actual buying decision. With the best of intentions, they may not be aware they are wasting time pursuing deals that will never come to fruition. Just like the sales guy at the car lot with my daughter.

By first defining the problem and enabling appropriate enterprise visibility, we can avoid projects that are misaligned with organizational priorities.  Further, we may also discover that due to poor or fragmented communication, we are pursuing a project where:

  • An organizational decision on how to address this problem has already been made.
  • Others within the same organization are already pursuing a similar project in parallel.
  • The organization already owns existing products, best practices, or internal resources that should be compared as an alternative to buying something new

In working with many health systems to design a solution to this common inefficiency, we borrowed concepts from established solutions we all now use to make buying decisions in our personal lives (Amazon, Airbnb, Yelp, Angie’s List, Pinterest, TrueCar, Zillow, etc.) Healthcare organizations need a better, digital way to define and share the ideas or projects they are considering, to detail objectives, success measures, categories, budgets, timelines, etc. to promote transparency and alignment. 

Additionally, while vendors use a CRM like Salesforce to track their sales activity with prospective and current clients, health systems do not have a similar system to capture and coordinate buying activity with the vendor community (and Salesforce is too complex to serve that purpose for buyers). Gaining visibility into past and current interactions and assessments of vendors and their products is essential to unify knowledge across diverse stakeholders.

As we focus as an industry on important topics like care coordination, healthcare organizations must also apply coordination to implement modern tools and processes that achieve the efficiency and alignment needed to make better decisions faster regarding vendor partners.

Readers Write: The Treatment for BCD (Big Company Disease): How to Streamline EHR Decision-Making

September 27, 2017 Readers Write No Comments

The Treatment for BCD (Big Company Disease): How to Streamline EHR Decision-Making
By David Butler, MD


David Butler, MD is associate CMIO of the Epic/GO project of NYC Health + Hospitals of New York, NY.

I’ll never forget it. I was presenting to a large group of physicians about how we need to implement, adopt, and standardize the EHR to meet quality metrics and decrease total cost of ownership. Before I could finish stating the “S-word” (standardization), a more senior physician looked over his glasses and declared, “Son, I’ve been in healthcare for over 30 years and I can tell you for a fact that this is simply not going to work.”

I had to agree with a portion of his statement. I also had a degree of skepticism about whether this would work or not. However, the former part of his statement caused me to pause and ask, “With all due respect, Doctor, have you been in THIS healthcare for 30 years?”

While I’m not sure he appreciated my Gen X retort, what I said was true. No one has been in today’s healthcare environment for 30 years. A senior executive mentor from McKinsey once told me, “If someone tells you that they understand healthcare today, they’re either lying or just have not been paying close enough attention.”

How We Got into This Mess

The US has wrapped technological advancements in healthcare around an antiquated legal and compliance system that was designed for the long-gone days of paper-based record keeping. We have essentially paved the cow path. Years after these technical infrastructures in healthcare have been hardwired and codified, we are now asking the question, “How can we unwind this and do it the right way?”

Unfortunately, much of the capital dollars and funding that attained the EHR are no longer available to optimize the EHR (understatement of the year). Very few practicing physicians have the time or legal prowess to navigate a fleet of internal compliance, risk, legal, and information technology “experts” who have all agreed that “x should not be turned on.”

All is not lost, though. We have figured out ways to map and execute the transition to digital healthcare, but we must do it together. EHR optimization starts with governance. In this article, I will share three guiding questions that physicians and physician executives can use to assure that their voices are heard and prioritized when EHR decisions are being made. Just as we do not triage a patient with a cough prior to one with chest pain, we must use this same approach when we collectively request changes to the EHR software.

BCD: Big Company Disease

Rule of thumb: The bigger the healthcare system, the slower it is to change.

At one large multi-hospital facility that shared a single instance of the EHR, a physician stated that it took three months for their EHR team to fix a misspelling on the after-visit clinical summary that we give to the patient. The road to EHR optimization is not a straight one, and you need a team to decide what you’re going to do every time you encounter a fork or a bend. Who makes decisions about EHRs in health systems? If you’re like most, this is a staggeringly complex and confusing process (and calling it a process at all might be generous). You’re likely suffering from BCD, or big company disease.

BCD is an epidemic. Hospitals and health systems must implement technology that helps them meet the goals of 2017 healthcare, Value-based purchasing, consumerism, MIPS/MACRA, ACOs … the list goes on. These goals require change in clinical and technology operations and this change must occur rapidly — or at least much more rapidly than the current pace at most organizations — to meet them.

BCD is fraught with complex requirements, departmental silos, poor stakeholder representation, and highly-educated and well-intentioned leaders whose decision-making authority has been stretched much further than their own comfort zones (and pay grades). As we’re working on the cure for BCD, these treatment options will alleviate many of its symptoms.

Three Questions to Establish Governance for EHR Optimization

1. Who makes the decisions about the EHR?

The first step of governance for EHR optimization is determining who the decision-makers are. If you employ a democratic philosophy of governance, then you must first decide what is your constitution (some call it a mission statement). This constitution drives every decision that you make, including who needs to be at the table from the key stakeholder groups: operations, clinical, and IT. These three functional branches of government compose the three-legged stool governance model. If you’re a large system, you’re also going to need three levels of stakeholders: site/local leadership, regional leadership, and corporate/system leadership. No matter how you answer this question, your governance model must be clearly defined and communicated throughout the organization.

2. What are your priorities?

Everything can’t be a priority. All optimization efforts, requests, and enhancements are certainly NOT created equal. After asking the two most critical questions—“can we?” and “should we?”—I often use and recommend adapting an impact effort matrix to determine the clinical impact and resource requirements for EHR project request prioritization:

  • Quadrant 1: The “Just do it” quadrant. High clinical impact, minimal resources.
  • Quadrant 2: The “Get the geeks, the execs, and the checkbook” quadrant. High clinical impact, high resources.
  • Quadrant 3: The “That’s cool” quadrant. Low clinical impact, low resources.
  • Quadrant 4: The “Diva” quadrant. Low clinical impact, high resources.


Before you do anything, make sure you know what quadrant you’re working in! Many organizations have found success building upon this simple framework with Lean or other process improvement methodologies.

3. How are we going to make this happen?

You have your governance model established with balanced representation or your three-legged stool. Now, how do you get these people together to actually use the framework to make critical EHR optimization decisions? This is one that plagues virtually every organization I work with. “I didn’t know WE decided that” or “when are the meetings even held?” are common stakeholder grievances.

When the governance group can’t all come together, you end up making decisions based on time constraints instead of thoughtful ones with the right people around the table. Keys to recovering from BCD include:

  • Clear roles and responsibilities. What is each committee responsible for accomplishing at the end of the day? (Oh, this is called a charter.) These obligations should be fully defined and every committee member should know this for their committee, as well as the others in their organization.
  • Effective meeting management and tools. Before each governance meeting, tackle these items. Determine which decisions, if any, can be made without meeting. Pre-plan the meeting – set the agenda for this meeting by highlighting what was discussed at the last meeting and the action items/decisions to be made at the meeting. Meeting polls — If your governance committee is large, this is a great way to determine consensus quickly. Virtual meeting tools exist that make interaction and measurement much easier.
  • Transparent decision-making and prioritization. You have to share information and you have to share it often. Send out a post-meeting debrief to the committee and the other committees within your organization. Make sure everyone knows how the decision was made and how they can escalate an issue. IT should not be the first place to go to get an EHR solution fixed—physician leadership should determine this. Remember: EHR optimization is a clinical project, not a technical project.

Large-scale EHR optimization starts with an effective, mission-aligned, and accountable governance process. Nagging symptoms of BCD may linger longer than you care for, but with the treatment plan I’ve prescribed above, you’ll be in a much better state to move your organization forward.

Readers Write: The Problem List is the Problem

September 27, 2017 Readers Write 6 Comments

The Problem List is the Problem
By Sam Bierstock, MD


Sam Bierstock, MD is president and founder of Champions in Healthcare, LLC. He developed and trademarked the concept of Thoughtflow.

For years we have heard that the goal is for complete interoperability of electronic health record systems (EHRs). While this must certainly be achieved in the ultimate attainment of confluent data availability, it is important to be sure that exchanged data from differing systems is consistent. In this regard, we have a huge problem – problem lists.

As an interesting exercise, ask any physician the difference between a diagnosis and a problem. It will readily be seen that very few know the difference, and those that offer an explanation of the difference will provide a wide variety of definitions. As a result, problem lists are loaded with a combination of current and inactive complaints, symptoms, and diagnoses, and generally are a mess. They are inconsistent, unmaintained, confusing. and vary between systems for the same patient. A patient who has been admitted to different hospitals using different EHRs will have a different problem list at each hospital, not to mention any problem lists that may exist in EHRs of physicians that they have seen as outpatients.

While I am unaware of any actual studies to assess the cost of inconsistent problem lists to the healthcare system, these costs must be enormous. Medical record departments and coders spend hours sorting out diagnoses since problem lists frequently populate discharge summaries from which billing data is extracted. Active and inactive problems must be identified and separated out. For instance, “Status Post Myocardial Infarction 1999” may be on the list but is not billable. Symptoms frequently appear and may confuse or diminish reimbursement or be entirely non-reimbursable. Productive cough for three days for instance is a symptom, not a diagnosis, and yet is typical of the types of problems currently listed.

In 1970, I was a medical student at the University of Vermont when a dynamic, energetic, brilliant, and visionary physician who had recently joined the university staff brought his radical ideas about computerizing patient histories and findings to the attention of the industry. His name was Larry Weed, MD, and his system, “The Problem-Oriented Medical Record”, was rapidly changing clinical documentation across the country. A level of logic and thinking that had been missing in the assessment, planning, and treatment of patients’ conditions was being recognized for its enormous value. Problems included medical diagnoses as well as social issues and all matters that need to be considered to treat patients in their entirety.

But Dr. Weed’s system got sidetracked in the ensuing years by the introduction of independent electronic record systems designed by corporate vendors. In general, these system designers had a very poor understanding of the Problem-Oriented Medical Record, and as a result, all tended to handle diagnoses and problem lists differently (if they had them at all). As a result, decades later, few physicians can differentiate between “problems” and “diagnoses” and problem lists have degenerated into a morass of confusion.

For more than a decade, I had been advocating an approach to EHR design that differed from the standard approach of existing systems which were based upon reproduction of text-book clinician “workflows.” Although they frequently followed the textbook workflows, these designs were inefficient and had nothing to do with the way physicians think and work and have historically been abysmally received. Most physicians use EHRs today primarily because of legislative mandates and Meaningful Use requirements, but there is almost universal agreement that they are cumbersome and reduce efficiencies.

Since 2003, I have advocated a different approach which I call (and have trademarked) Thoughtflow and which I first described in the literature in 2004 – supporting the way physicians access, assess, prioritize, and act upon data. In other words, how they think and act.

One of the areas that can be addressed using this approach is the Problem List. As a first step, I had to decide what made it to the list in the first place, what constitutes a “problem.” I picked up the phone and I called Larry Weed. Now well into his 90s, Dr. Weed was as brilliant as ever, and I quickly learned the answer to my question about the difference between a problem and a diagnosis.

A problem, Dr. Weed explained, is the highest level of the current diagnosis. Understanding this basic principal provides a path to cleaning up problem lists, keeping them consistent and updated and maintaining active and inactive problems. EHR system designers do not understand this any better than most physicians do, and as a result, each has a different approach to the construction of problem lists in their systems.


Consider the following scenario:

A patient is seen in the emergency room with a five-day history of abdominal pain and constipation of unknown origin, and subsequently admitted for evaluation. The diagnosis is constipation and abdominal pain, which may appear as a combined problem or two separate problems on the admitting history and physical.

Problem #1: Abdominal pain x 5 days
Problem #2: Constipation

The admitting doctor orders a GI consultation and some baseline studies including a flat plate x-ray of the abdomen. On the first day of admission, the x-ray shows an abdominal mass. The Problem List may now look like this:

Problem #1: Abdominal pain x 5 days
Problem #2: Constipation
Problem #3: Abdominal mass

On day 2, the patient has an exploratory laparotomy and is found to have carcinoma of the colon.

Problem #1: Abdominal pain x 5 days
Problem #2: Constipation
Problem #3: Abdominal mass
Problem #4: Carcinoma of the colon

At this point, and at the sole discretion of the attending physician, Problems 1, 2 and 3 may be removed entirely from the Problem List, may be moved to inactive problems, or may stay on the list. They may stay there for some time or be moved by a future physician providing care for a different problem. There are no fixed rules.

However, if Dr. Weed’s dictum is applied, consistency is attained.

On day 1, when the x-ray shows an abdominal mass, “Abdominal mass” becomes the highest level of the current diagnosis, and therefore replaces both “Constipation” and “Abdominal pain X 5 days,” becoming Problem # 1. In my system design, clicking on the updated Problem #1 “Abdominal mass” resulted in a drop-down menu showing, in chronological order, the previous problems leading to the most current and the dates. So clicking on “Problem # 1 Abdominal mass” produced a drop-down that looked like this:


On day 2, after a diagnosis of Carcinoma of the colon, Problem #1 is further updated:

Clicking on each drop-down menu reveals configurable granular data dependent on user preferences.

Consistent with the concept of Thoughtflow as opposed to workflow, the design minimized any requirement for the user to update the problem list. Using vocabulary standards, clinical decision support software, language processing, and automated ICD-10 coding, the Problem Lists can be automatically updated. They can also automatically exported to an evolving discharge summary from which the automated coding provided billing and reimbursement data. The potential savings in time spend scouring charts by coders can be appreciated, as well as the accuracy of coding and assurance of reimbursement.

In addition, updated and current Problem Lists can also populate any medical summary screens which may have displayed overall summary data such as medications, allergies, past surgeries, etc. This assures an accurate, consistent summary of past maximally updated problems, or in other words, the highest level of current diagnoses. Symptom and other extraneous data will then not appear to congest the list and add to assessment and billing confusion.

Rapid maintenance of the list can be attained by simply dragging a problem that was inactive or resolved to the corresponding list. A problem “Myocardial Infarction 1990” could be moved at a physician or coder’s discretion to an Inactive or Resolved Problem list, while “Atherosclerotic Coronary Vascular Disease” remains as an active problem. Problems could be prioritized in order by simply dragging them to the desired position, and numbers changed automatically as the new position was attained or as
problems were added or removed.

The inconsistency of Problem Lists is an inadequately discussed, but universally recognized issue with enormous costs to the healthcare system, both financial and with respect to quality of care. The issue also generates an enormous challenge to EHR design and to the assurance of interoperable, consistent patient information across the spectrum of healthcare systems, physician offices, disparate hospitals, and payers.

HIStalk Interviews Scott Booker, CEO, Healthgrades

September 27, 2017 Interviews No Comments

Scott Booker is CEO of Healthgrades of Denver, CO.


Tell me about yourself and the company.

I have a common thread in my background, a combination of product technology driving marketing solutions. I spent a lot of time in the hospitality space early on in my career with hotels and casinos developing CRM solutions. Most recently, I spent almost 10 years with Expedia, running the brand as president of about a $6.5 billion dollar revenue business worldwide. I’ve got a good mix of CRM and B-to-C Internet from my background.

The main focus of Healthgrades is to provide access to more appointments for health systems and physicians. Our strategy is basically a pithy strategy around choose, connect, and manage.

“Choose” is about providing the very best place on the Internet for consumers to do their research and choose a doctor. The logical next step, “Connect,” is making an appointment. Primarily that’s done by phone today, but we’re big believers in the efficiency and simplicity of online appointment scheduling. We have our own capabilities in that regard. “Manage” is the CRM components that wrap around that interaction with the consumer to acquire, engage, and retain them.

People complain almost universally that the provider directories of their insurers are outdated. What are the challenges in keeping that information current?

You’ve hit on a big one. The stat I’ve heard is that about 25 percent of physician information churns every month because of doctors moving, switching practices, ceasing to practice, or changing the insurances they accept. That’s a real challenge.

We put a lot of effort into validating that our information is accurate. It can come in many forms. One is working directly with the hospitals and what we do from the sponsoring of those listings on our site. We do primary source verification, which  means calling out, faxing out, and emailing out. All kinds of work there to make sure that we have the accurate information. It’s a big part of what we do to make sure that the consumer gets what they need from that standpoint. It is a real problem, but we work hard to try to stay on top of it.

The CRM component and the ability to merge its information with publicly available data gives you a lot of data to work with. What insights can you derive?

That’s one of our core competencies that goes back many, many years. We started off as a quality ratings business for hospitals, where we would take in claims information from every source we could get our hands on and use that information to assess quality for specialties of a hospital. It’s a small piece of what we do today. More of the strategy is what I talked about earlier.

But the information, the data that underlies that, is still very, very valuable. It helps us inform the kind of information that we put on profiles and so forth. It gives us insight as to what’s going on in the region around that hospital that can inform and help management make decisions, and in particular, acquire patients.

An example would be a particular hospital that is saying, “We want to focus on this segment of orthopedics. We think that’s a big play for us. We’re good at it. People have known us for that. How do we go and make sure that everybody in our region knows that?” We can look at the claims information around that region of the hospital. We can overlay that with retail data and demographic data. We build fairly sophisticated data science predictive modeling to go out and reach and target those consumers, whether it be by digital campaigns, email campaigns, print campaigns, and so forth. There’s a lot of insight that goes into that information that we can provide about those patients or customers that are in a particular region.

There’s a lot of insight there that we pride ourselves on. We think that’s a core competency and a differentiator for us. We’ve had data science in our organization as a core competency for many, many years. For the clients we work with, that’s probably one of the things that they most like about the insights they can get from us.

Can consumers use search filters for provider location, availability, and cost?

I’ll hit on the cost one for a second. We believe that cost is an area that we need more transparency on. It’s on our radar. It’s a challenging one to go after, but it is something that we’re continuing to look at.

With regards to setting appointments, you’re absolutely right. We provide a bunch of filtering capabilities to help consumers narrow down to a selection they want from an online appointment scheduling capability. You can look at today, the next day, next three days, and so on and so forth. You can look by insurance or by the gender of the physician. There’s many filtering capabilities.

What providers like in working with us is that is in many cases, the rock star physicians, if you will, don’t have a lot of slots available over the next couple of weeks. We know from our research that the next two weeks is really important as consumers are on our site looking to make an appointment. If the physician they look at is not available, we provide a feature where you can look at other doctors in the practice that can also provide that same kind of service and that do have availability within the two weeks. Cross-promote is what we call it, so that consumers don’t have to wait if they don’t want to.

There’s a lot of the same functions and features that you might find in online travel that we’re bringing to the table in making an appointment.

What homework should a consumer do in choosing a hospital for elective care given that the several available hospital ratings systems don’t necessarily agree?

There’s a lot to unpack in that one. We believe that it is difficult to pin quality on a particular doctor, because the quality of care that you get is really related to the team of the hospital you’re associated with or going to go see. That’s where the ratings actually come into play.

We’ve been doing this for almost 20 years on the quality ratings side of things. There’s a lot of sophisticated data science that goes into this. We have a medical advisory board that’s involved with our team, to try to make sure that we are doing everything we can to present the right kind of information from that standpoint.

All of the many quality ratings have a similar intent. The core of it is, what kind of data are they using? What are they risk-adjusting for? Are they using reputation versus not? Some of the publications will use the reputation of an organization, but that’s really just branding. We don’t do that. We don’t feel like that is a representation of the actual quality you’re getting at a hospital.

When you choose a physician, or you’ve got a surgery or something that needs to happen from that standpoint, it’s really about the care team that you’re going be involved with. As a consumer, that’s what I would be interested in. If I choose a doctor, what hospital are they associated with? Then, from that perspective, what kind of ratings do they get overall?

What are the benefits and the challenges of allowing people to rate their doctors online?

I would make an analogy to other industries where there’s typically a trusted third-party site, maybe more than one, where consumers can go to get more unbiased opinion about a particular product or service that they’re offering. You could talk about Zillow and real estate; or Tripadvisor and and travel; or and autos. That’s a function that consumers have been taught in other industries. They expect it in all industries from that perspective. When you think about it from a healthcare perspective, it’s very similar. A lot of consumers come to our site just to look and validate based on the patient engagement survey score and comments.

When consumers come to a site to do a review – and I’ve seen this in the travel space — as a company, you’ve got to do what you can to make sure fraud’s not happening. If there’s stuff that shouldn’t be happening,  you take care of that through various validation processes that you put in place. We certainly have that, and probably more so in this case because it’s healthcare. But I think that trusted third-party review process is important for consumers to get some validation that is from a third party.

What we see is that for the most part, people review at a relatively high level. When there is a poor review, we have the capability for the doctor’s office or the physician to respond to a review. The same thing happened in hotels. When we provided that capability for hotels to respond to a review, it put a human from behind the curtain and brought them out in front. The consumers really like that. 

When that happens in the hotel space, you get higher conversion. When those hotels embrace the reviews and realize that this is like primary research — where I’m getting direct feedback that I can respond to, improve on, and make things better — their conversion continues to rocket. That’s the same thing you see in the healthcare side of things. When docs and offices are responding, that helps consumers have a better understanding.

We’re using pretty much the Press Ganey survey when we do reviews on the site. A lot of it has to do with the experience at the office. If somebody says they waited an hour before they got in to see the doctor,  the doctor can say, “Yes, that was an issue that day. We were overbooked. Something happened and we’ll make sure it doesn’t happen again.” That is something that consumers can understand.

Putting a human behind that review process is really important. Certainly consumers value that feedback on reviews to make a decision about a doctor.

Do you have any final thoughts?

Healthcare is obviously a bit behind other industries in terms of adopting consumerism. But all the executives that I talk to now — and I speak at board meetings and various conferences and interact with CEOs — view consumerism and wanting to be where the consumer is online as a top priority. Now it’s a matter of marshaling their resources and putting the full effort behind it. The systems that do that — that go all-in on online appointment scheduling, embrace reviews, and respond to those reviews to make their experiences better for the consumer — are going to be well ahead of their competitors.

We’ve always been in the CRM business, but we have a new solution coming to the market that is around CRM. We call it the Healthgrades Consumer Intelligence Platform. Other industries have already adopted a similar component. They utilize CRM to aggregate the information about consumers, acquire consumers, then engage and retain them. That whole equation of acquisition, engagement, and retention is something that hospitals haven’t quite figured out yet, but it’s very, very important. Those that do are going to have a leg up.

My belief is that although healthcare has moved slowly, it is moving faster than it ever has, partly because of consumerism. As consumers have to make their own decisions and pay more of their own costs for healthcare, there’s a real opportunity to improve the service and the experience of consumers going forward.

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