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EPtalk by Dr. Jayne 4/6/17

April 6, 2017 Dr. Jayne 2 Comments

For people breathing easy after completing their 2016 Medicare-related attestations, it’s time to start gearing up for next year. Organizations need to register or update their information via the CMS Web Interface  prior to June 30 if they plan to participate as a group. Organizations that plan to use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey also need to register. There are many other details on who does or does not need to register, so consulting the website and making sure you know whether an ACO or registry will be reporting on your behalf is recommended. For those not breathing easy because they’re still completing 2016 Medicaid-related attestations, good luck! Some states have extended their attestation windows into May.

CMS has also been busy promoting the value of Chronic Care Management, launching a new Connected Care program to raise awareness through the Office of Minority Health and the Federal Office of Rural Health Policy. Connected Care will focus on racial and ethnic minorities along with rural populations who statistically have higher rates of chronic diseases. The new website includes toolkits with detailed information about CCM, resources for implementation, and patient education resources. CCM requires a patient copay, and that has posed a barrier to adoption in my area. Patients already think physicians should be providing these services for free and don’t always understand the value of why CMS is making a push to specifically address the need for services. Although the copay is small, patients living from Social Security check to check and who may be choosing between medication and food are often reluctant to consent to enrollment. Sadly, those can be the patients who most need the services.

CMS has also been busy with its Social Security Number removal initiative. I’m working with my first consulting client on a project to look at how it uses the SSN within the organization and to assess vendor plans to remove the SSN from software systems. There is a new provider webpage, in addition to the main page, for the initiative. Although this program impacts Medicare beneficiaries and the use of the SSN as the de-facto Medicare ID, organizations use the SSN in a variety of different ways. Not everyone is excited about the removal program, as the SSN has also become a proxy for an individual identifier to a large degree. Kind of makes you think about our lack of a national healthcare identifier, doesn’t it?


ONC has updated the SAFER Guides, which are designed to help organizations assess EHR safety and best practices. Topics include organizational responsibilities, contingency (downtime) planning, interfaces, patient identification, clinician communication, and test results reporting/follow-up. I really wanted to review the latter topic, but received an error. There are plenty of practices that need this information. I can’t believe the number of groups I run across that either don’t track their laboratory and diagnostic orders from ordering through completion and patient notification, or track but don’t notify. The era of “no news is good news” should be long gone by now. Patients should never be expected to assume results are normal unless they hear otherwise.

Medicomp Systems announces its Medicomp University event, to be held starting April 24 in Reston, VA. Attendees will gain in-depth knowledge of the Quippe products and how to integrate them into EHRs. I’ve enjoyed watching the Quippe offerings evolve since I first saw it at HIMSS11. If you haven’t seen them, they’re definitely worth a look.


I’m way behind on email again, but it’s been fun to go back and weed through all the premature commentary about the repeal of the ACA. What had us hanging on tenterhooks now seems like a long time ago. For those of you who have never seen them, this is what tenterhooks look like. I’m also catching up on some educational webinars. My new pet peeve is people who use PowerPoint for presentations, but fail to put it in presentation mode, forcing the audience to review shrunken versions of the slides while being distracted by the thumbnail navigation.

I came across this article about what hospitals waste and it’s startling to think about. When patients are discharged, many supplies are thrown out due to concerns about infection control or potential contamination after they’ve been left accessible to patients or visitors. Policies vary dramatically from facility to facility across the country. I’ve worked at places that toss everything and at those where supplies are restocked, and seen all kinds of variations. There’s also the issue of hospitals getting new equipment and needing to get rid of old devices. I once assisted with an effort to send a “gently used” MRI machine to South America – now that was a project.

Scholarly research has been done looking at the problem, with findings that when hospital staff are appropriately incented, waste can be reduced. Many surgeons in one study were unaware of their operating room costs; when they were asked to reduce costs, they met goals where the control group’s costs actually increased. Getting people to be conscious of the true costs of the care provided is central to the concept of value-based care, especially when those costs are obscured, such as costs that are included in a hospital room charge.

During my recent hospitalization, most supplies were kept in a secured cabinet inaccessible to patients and family members, which not only controls costs but reduces contamination and the risk that something would have to be tossed for fear that someone had opened it or otherwise ruined it. Other items that are placed out for every patient (shower products, toothpaste, etc.) are discarded after each patient whether they were used or not, since it’s too difficult to determine if they’ve been opened or used. I specifically asked the staff about this prior to discharge – I hadn’t used anything, since I brought my travel kit with me. But they were going to toss everything, so I grabbed it for a community drive that gathers non-food items to be distributed to food pantries for their clients. You’d think hospital leadership would have considered that when crafting their policies and reached out to a local organization. Maybe they did, maybe they didn’t, but I’m trying to connect the two for some potential community benefit.

What does your hospital do with discarded or excess supplies? Email me.

Email Dr. Jayne.

News 4/7/17

April 6, 2017 News 1 Comment

Top News


23andMe receives approval from the FDA to market its genetic health risk tests for 10 diseases, including celiac, Parkinson’s, and late-onset Alzheimer’s. The approval – the first for a home DNA test – is no doubt being celebrated by the Google-backed startup, which stopped giving consumers health analysis information in 2013 after an FDA slap on the wrist. The company received approval two years later to disclose a person’s carrier status, and has since been largely providing results to consumers seeking answers about their ancestry.

HIStalk Announcements and Requests

This week on HIStalk Practice: The AAFP creates the Center for Diversity and Health Equity to study social determinants of health. The National Governors Association selects seven states to participate in rural health collaborative. MTBC debuts analytics for ACOs. Arizona Connected Care selects referral management tech from Fibroblast. CVS Health awards $1 million to 33 health centers. New report sheds light on physician compensation. American Society of Sleep Medicine studies patient receptiveness to virtual consults. Nancy Gagliano, MD helps readers strategize for MACRA.


April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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

Acquisitions, Funding, Business, and Stock


PHI protector CloudVault Health closes a $2.6 million Series A funding round led by investors that include Rudish Health Solutions. President Richard Nelli came to CloudVault in 2015 after a two-year stint at Streamline Health.


Data analytics company Intermedix acquires Nashville, TN-based WPC Healthcare, bolstering the predictive analytics division it created in 2015. WPC CEO Ray Guzman will join Intermedix, also based on Nashville, as SVP of strategy.

Predictive analytics investments continue … Boston-based OM1 secures $15 million in a Series A round led by venture capital firm General Catalyst.


TeleTech Holdings – a global company that specializes in the vague (but presumably profitable) business of customer experience and growth – acquires Connextions from OptumHealth for $80 million. Connextions, which offers tech-enabled member acquisition and retention services, will be folded into TeleTech’s Customer Management Services division.

Drchrono raises $12 million in a Series A funding round led by Runa Capital.

Efforts to eschew becoming a healthcare company don’t stop Alphabet from hiring healthcare tech talent. Job listings for subsidiaries including Sidewalk Labs, Calico, and Verily indicate strong interest (and compensation packages) in computational biologists, robotics experts, and researchers. The Google parent company has already pulled Tom Insel, MD away from heading up the National Institutes of Mental Health, and Jessica Mega, MD from Harvard Medical School.


Redox receives an additional $1 million from the Healthbox-managed Intermountain Healthcare Innovation Fund, bringing its total Series B round to $10 million. The healthcare API vendor took part in the Healthbox Studio Program several years ago, and will now help Intermountain integrate digital health apps with its Cerner system. (Thanks to the reader who reminded me they were on Cerner, not Epic.)



Sinai Hospital (MD) will roll out predictive analytics from PeraHealth this summer.


Appalachian Regional Healthcare (KY) will begin implementing Meditech’s Web EHR later this year.



Stuart Long (Monarch Medical Technologies) joins InfoBionic as CEO.

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I2I Population Health names Dawn Berg (Assist Consulting Group), Scot McCray (CamCare) (not pictured), and Jay Wilkes (RyMir Consulting) to its sales team. Adam Ackerman (Relatient) joins the company as director of client development.

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Medecision hires Donald Casey, Jr. MD (Alvarez & Marsal) as chief clinical affairs officer, and Ian Chuang, MD (Netsmart) as SVP and chief analytics officer.


Erik Phelps (Epic) joins genetic testing and data analysis startup Tempus as EVP and general counsel.

Announcements and Implementations


Sylvester Comprehensive Cancer Center (FL) selects oncology data-sharing technology from Syapse as part of a new precision medicine initiative.

The NJSHINE HIE connects to the Camden Coalition HIE, launched in 2010 by the New Jersey-based Camden Coalition of Healthcare Providers.


Adirondack Health (NY) will equip local public health agencies and their patients with remote monitoring and videoconferencing services with help from Health Recovery Solutions and the Hixny HIE.

Iowa-based Mercy ACO selects Innovaccer’s Datashop data warehouse to aggregate health data from 65 participating facilities including ambulatory sites, hospitals, and payers.

Government and Politics


FDA Commissioner nominee Scott Gottlieb, MD pledges to uphold the agency’s “gold standard of safety and efficacy” during his confirmation hearing before the Senate HELP Committee. He also stressed that there are ways of modernizing and expediting clinical trials without compromising safety, adding that addressing the opioid crisis and speeding generic drugs to market will be two of his top priorities if confirmed.


Efforts in Missouri to implement an opioid prescription drug monitoring database take one step forward then two steps back when vocal PDMP senatorial holdout Rob Schaaf announces he will finally support a bill authored by proponent Rep. Holly Rehder on the condition that physicians must register on it. The Missouri State Medical Association, however, was quick to tweet its opposition.

Privacy and Security



  • Behavioral Health Center (ME) discovers that 4,500 records from between 3,000 and 3,500 patients have been stolen and sold on the dark Web.

Research and Innovation


The Washington Post sensationalizes a Mayo Clinic study published in the Journal of Evaluation in Clinical Practice that found 20 percent of patients who asked for a second opinion had been misdiagnosed by PCPs – a result the WaPo author admits is “generally similar to other research on diagnostic error.” The retrospective study of 286 patients found the second diagnosis to be “distinctly different” from the first in 62 cases, the same in 36 cases, and partly correct in the remaining 188.



Medable develops Cerebrum, machine-learning technology that aggregates health data from a variety of sources to better power smartphone apps like Apple’s HealthKit and CareKit with disease predictions and treatment.



After a recent hospital stay filled with slamming doors and beeping medical equipment, ambient electronic musician Yoko Sen proposes using sound design to reduce alarm fatigue and make hospitals calmer places for patients. She has created a “tranquility area” at Sibley Memorial Hospital (Washington, DC) that offers staff green tea, reclining chairs, soothing music, lavender scents, and projected images. A similar area for patients is under consideration.




@HuffPostComedy urges tweeters to share #AHCASequelTagLines. Legislators seem unlikely to reach any sort of compromise on the rumored resurrection of repeal and replace efforts before they adjourn for a two-week recess.

Sponsor Updates

  • Intelligent Medical Objects will exhibit at the Allscripts Northeast Pro ARUG April 7 in Hartford, CT.
  • MedData introduces an app to help providers keep better tabs on patients suffering from binge-watching illness.
  • The American College of Radiology features National Decision Support Co.’s latest case study, “Homing in on Quality.”
  • The Atlanta Journal-Constitution recognizes Navicure with its Atlanta Metro Area 2017 Top WorkPlaces Award.
  • Netsmart is the first and only behavioral health EHR vendor to achieve ONC 2015 Edition Health IT Module Certification.
  • Nordic Consulting presents what employees love most about the company.
  • CloudWave will exhibit at the HIMSS New England Conference April 11 in West Lebanon, NH.
  • Experian Health will exhibit at the HFMA NorCal Spring event April 12-14 in Sacramento, CA.
  • Sutherland Healthcare Solutions publishes “Digital Reinvention in Healthcare: How Lawrence General Re-Engineers Their Patient Experience.”
  • GE Healthcare adds the CareFinity business continuity and archiving solution from EMedApps to its Centricity Partner Program.

Blog Posts


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


Morning Headlines 4/6/17

April 5, 2017 Headlines No Comments

FDA Nominee Scott Gottlieb Commits to ‘Gold Standard’

Scott Gottlieb, President Trump’s nominee to run the FDA, had his confirmation hearing before the Senate HELP Committee today, during which he committed to upholding the “gold standard of safety and efficacy,” but noted that he believed there were ways of modernizing and expediting clinical trials without compromising safety.

Missouri senator says he’ll end years of opposition to prescription drug database

In Missouri, efforts to implement an opioid prescription drug monitoring database faces renewed opposition from the Missouri Medical Association, which opposes any legislation requiring doctors to check the database before writing opioid prescriptions.

Thousands of brokers exit as plan commissions go unpaid

Insurance resellers are exiting the exchange markets as payers stop paying commissions on a variety of plans. Utah-based insurance broker Craig Paulson explains, “they’re not paying commissions on platinum plans, and they are not paying them for special enrollment plans which cover some of the sickest patients.”

How Redesigning The Abrasive Alarms Of Hospital Soundscapes Can Save Lives

After a recent hospital stay filled with slamming doors and beeping medical equipment, ambient electronic musician Yoko K. Sen proposes using sound design to reduce alarm fatigue and make hospitals calmer places for patients.

Morning Headlines 4/5/17

April 4, 2017 Headlines No Comments

VA’s most important 2017 decision

Speaking at a conference Monday, VA CIO Rob Thomas confirms the agency is on track to make a decision by July 1 on whether to replace Vista with a commercial EHR vendor.

Q1 2017: Business as usual for digital health

Rock Health publishes its Q1 report on VC investments in the digital health startup space, noting that 2017 investment activity is keeping pace with 2015 and 2016 levels despite the uncertainty around ACA repeal.

Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

A Health Affairs study that analyzed the EHR activity logs of physicians found that they appear to split their day between computer work and patient care.

Why the Orion Health Group Ltd share price was slammed today

New Zealand-based Orion Health Group fall seven percent after announcing stalled growth and a full-year net loss between $22 million and $26 million.

News 4/5/17

April 4, 2017 News 9 Comments

Top News


The VA confirms that it remains on track to make a decision about the future of VistA by July 1. It also raises the possibility of continuing to use VistA, but as a vendor-hosted service.


VA Secretary David Shulkin committed to the July 1 date last month. He has also said that the VA made a mistake in not working with the Department of Defense — which chose Cerner for its MHS Genesis project – to buy a single, integrated system.


Acting VA CIO Rob Thomas says a commercial solution remains an option, specifically mentioning Cerner.

The VA has hired consulting firm Grant Thornton to create a business case for four possible actions, one of which is to turn VistA over to a vendor that would then provide it as a service.

Reader Comments


From CIO Uptime Monitor: “Re: BIDMC/Harvard Medical School job posting. Says the CIO is retiring this spring. Is that John Halamka?” No. That job posting is for the Harvard Medical School CIO position held by Rainer Fuchs, PhD, who has been at HMS since 2012 and who is indeed retiring.

HIStalk Announcements and Requests


Welcome to new HIStalk Platinum Sponsor Docent Health. The Boston-based company provides health systems with the people, technology, and insights they need to improve and personalize the patient experience, giving each person a set of customized touch points to cover their journey. Its consumer-centric approach drives higher satisfaction scores by satisfying the human need of patients to understand and to be understood. The company provides on- and off-site liaisons – or docents – who coordinate with patients before, during, and after their clinical experience and who participate in nursing huddles and rounds to make sure the non-clinical needs and preferences of patients are met and to empower clinical staff to deliver empathetic care. Health systems get operational patient data dashboards and executive reporting to spot service gaps and identify community health needs. Doing the right thing also drives measurable return on investment via more loyal customers, better satisfaction compensation, and long-term savings. I interviewed CEO and industry long-timer Paul Roscoe a few days ago, obviously catching him off guard with my spur-of-the-moment question wondering whether “data-driven empathy” is an oxymoron. Thanks to Docent Health for supporting HIStalk.

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We funded the DonorsChoose grant request of Mrs. S in Missouri, who says her high school pre-calculus students are learning from the Breakout EDU problem-solving kit we provided. She says, “This donation to my classroom has completely engaged students. They are thinking critically and creatively while also practicing the content. I am so proud of my students during these challenges and their willingness to persevere and solve the problem. It is truly a learning environment any teacher would be thrilled to witness and it is all thanks to your generosity!”


April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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

Acquisitions, Funding, Business, and Stock


Healthcare payments system vendor Ability Network acquires ShiftHound, which offers staff scheduling and credentialing systems.



Attorneys for Chicago-based Tronc (the former Tribune Publishing) file a letter with the SEC in response to a complaint by NantHealth’s Patrick Soon-Shiong, who made a $70 million investment in the company last year to help thwart a hostile takeover attempt by Gannett. The company says that before investing in Tronc, Soon-Shiong first suggested that Tronc invest in NantHealth’s IPO, and after being rebuffed, then insisted that Tronc Chairman Michael Ferro make a personal investment in NantHealth is an “implicit threat” to pulling out of the deal. Tronc says Ferro took a $10 million stake in NantHealth to pacify Soon-Shiong. Tronc has removed Soon-Shiong for board member re-election and has capped his ownership stake, leading to accuse the company of intentionally squeezing him out. Tronc also claims that Soon-Shiong is demanding payments for Nant-provided technology he made available to Tronc to monetize its online content even though the technology turned out to be unsuitable.


Doctor search website Amino raises $25 million in a Series C funding round, increasing its total to $45 million. The company makes money selling customized versions of its search function to employers and health plans and by offering access to its insurance claims database.


Orion Health Group shares drop sharply after the New Zealand company’s trading update predicts lower revenue. They’re down 61 percent in the past year with a market cap of $226 million. The company says it still hopes to swing to profitability in 2018.


McKesson completes its $1.1 billion acquisition of CoverMyMeds.



Pomona Valley Hospital Medical Center (CA) chooses Cerner Millenium to replace Cerner Soarian Clinicals and NextGen ambulatory. It will continue to use Cerner Soarian Financials.

Bon Secours Virginia Health System will implement Tonic Health to automate its intake and payments processes.


Skagit Regional Health (WA) and San Joaquin General Hospital (CA) choose MPI clean-up services from Harris Healthcare’s QuadraMed Patient Identity Solutions as they move to Epic and Cerner, respectively.  



Nadine Hays (Verscend) joins OmniClaim as chief growth officer.


Texas Health Resources promotes Debbie Jowers to VP of ambulatory ITS services.

Announcements and Implementations


Baystate Health’s Techspring innovation center launches a software development and testing environment for its partners, built on the InterSystems HealthShare interoperability platform.

Rock Health releases its Q1 2017 digital health report, indicating that providers and health plans are delaying expenditures based on regulatory uncertainty but key players remain cautiously optimistic and feel well positioned to navigate any regulatory changes. In Q1, they counted 71 digital health deals totaling over $1 billion. The top six categories by deal volume were Analytics/Big Data, Care Coordination, Telemedicine, Hospital Administration tools, Consumer Engagement, and Wearables/Biosensing.

A small Spok survey finds that health systems rarely apply strategic hospital initiatives to their mobile strategy and don’t often include clinicians in their planning teams.

Change Healthcare releases InterQual 2017.  

Government and Politics

The revised ACA replacement apparently being pushed for quick approval would allow individual states to permit insurers to offer less than the current “essential health benefits” and to charge higher premiums for people with pre-existing conditions. Both were the pre-ACA norm, when less-expensive insurance bought directly from insurers (rather than via an employer) often didn’t cover pregnancy or drug addiction treatment and denied policies to those with relatively minor medical conditions.

Privacy and Security


A review of significant hospital data breaches finds that major teaching hospitals were more commonly involved than smaller or non-teaching hospitals from 2009 to 2016, possibly because they allow more employees to view patient data.


Hackers breach the systems of the International Association of Athletics Federations, exposing the information of athletes who have applied for exemptions that would allow them to use drugs contained on anti-doping lists. The Fancy Bears hacker group, which claims responsibility, previously published the medical records of mostly American and British Olympic athletes after the IAAF accused Russia of state-sponsored doping and banned their teams from competition. 

ABCD Pediatrics (TX) is hit with ransomware, and though it was able to restore from backups without paying the hacker, it found evidence that its systems had been compromised for some time.


HHS OCR warns healthcare organizations that use HTTPS security that malware-detecting HTTPS interception products may not pass along any warnings or errors, allowing the organization to validate only the connection between themselves and the interception product’s certificate rather than all the way to the server.



Ambulatory practice physicians in a community-based health system spend about as much time practicing “desktop medicine” as they do in face-to-face office visits, an analysis of time-stamped EHR records finds. Physicians are spending an increasing amount of time communicating with patients via the  patient portal, managing prescription refills, ordering tests, communicating electronically with staff, and reviewing test results, none of which are billable activities. Work that isn’t logged in the EHR made up the remaining 20 percent of the average doctor’s day. The authors suggest using scribes to manage progress notes, which they estimate would free up one-third of the physician’s time.


World Wide Web creator Sir Tim Berners-Lee wins the Turing Award (computing’s Nobel Prize) for that 1989 accomplishment, but his concern for net neutrality and an overly centralized, commercialized Web storage model that threatens individual privacy has led him to create Solid. Users would be able to decide where their data is stored and how it is shared. He’s also concerned that the web has been turned into a “purveyor of untruth” by an ad revenue model that rewards click-baiting rather than accuracy.

A study finds that ABIM’s Choosing Wisely campaign that encourages both clinicians and patients to skip low-value services had a small but statistically significant reduction in back pain imaging, for which patients often must pay out of pocket. It concludes that the 4-5 percent reduction indicates that consumer incentives may be ineffective for reducing low-value medical care.


A study finds that chargemaster prices not only vary widely among hospitals, they correlate to the price actually paid by insurers and patients. Not surprisingly, list price was not correlated with hospital quality. The authors conclude that hospital list prices are neither irrelevant nor indicative of price gouging, but are rather a subtle method hospital use to get favorable deals from insurers, leaving uninsured patients stuck with paying the made-up high prices in cash while everybody else gets negotiated discounts.


Doctors at Lancaster General Health publish a medical staff newsletter retrospective on its 10 years of using Epic. It refreshingly includes negatives as well as the expected positives – its larger-than-expected $100 million cost, the extra time some doctors spend documenting after hours, and its contribution to physician burnout. One surgeon says Epic is struggling to fulfill its potential because he has to look in other systems to review images, operative reports, and pathology reports, while also noting that EHRs are designed to optimize billing and therefore relevant clinical information is “buried in giant pile of clinically unimportant information.”


Cambridge Mobile Telematics, which offers brilliant smartphone driving apps to educate drivers and allow auto insurance companies to set rates based on driving habits, analyzes its user records to determine that drivers were distracted by their phones in 52 percent of trips that ended in crash, with an alarming one driver in four using their phone within 60 seconds of their crash. The company also found that distraction was just as bad in states with laws against using phones while driving. Users of the company’s DriveWell program reduce their phone distraction by 40 percent within two months.


In England, a newspaper’s undercover investigation of the NHS 111 non-emergency hotline call center finds that workers sleep at their desks, send text messages while pretending to listen to callers, and put suicidal callers on hold until they hang up because “after a while you can’t talk to them no more – it just gets awkward.”


In England, an Iran-born doctor referred to by co-workers as “Little Hitler” loses his medical license after being found guilty of several bizarre outbursts in which he used vulgar terms to describe patients who didn’t bring him gifts, called his receptionist a “fat blob,” referred to a colleague as a cockroach that he hoped would die, and described to female co-workers his vacation adventure in which he “inserted his private parts into a hole in the wall at a nightclub.”

Sponsor Updates

  • Crossings Healthcare Solutions posts its most recent newsletter.
  • Daw Systems will integrate CoverMyMeds electronic prior authorization into its ScriptSure e-prescribing system.
  • Bernoulli’s John Zaleski and Jeanne Venella, RN co-author an article in the Spring 2017 issue of AAMI Horizons.
  • Besler Consulting releases a new podcast, “How much revenue is your chargemaster costing you?”
  • Black Book honors top cybersecurity firms at InfoSecWorld Conference and Expo.
  • Dimensional Insight will exhibit at the Cannabis Business Expo April 12-14 in Phoenix.
  • Healthgrades announces Outstanding Patient Experience and Patient Safety Excellence Award recipients.

Blog Posts


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


Morning Headlines 4/4/17

April 3, 2017 Headlines No Comments

CMS readies insurance market stabilization rule as insurers wait nervously

CMS sends rules designed to stabilize the individual insurance markets to the Office of Management and Budget for final review as insurers wait decide whether to offer plans on the exchanges in 2018.

Soon-Shiong made ‘implicit threat’ to spur investment in NantHealth, media company says

A media company that Patrick Soon-Shiong recently rescued from a hostile takeover attempt with a $70 million investment is claiming that its CEO was forced to personally invest $10 million in NantHealth’s initial round in exchange for the help.

Clinic venture arm hopes to assist innovation work

Cleveland Clinic is launching an investment business, called Cleveland Clinic Ventures, that will work with its innovation department to turn new medical breakthroughs into funded spin off companies.

Wellness Apps Evade the FDA, Only to Land In Court

Wired Magazine covers the legal accountability of health apps that make misleading claims and the effect those court decisions might have on a market that has largely escaped FDA oversight.

Political battles are a ‘distraction’ for health-care business, CEO says

Athenahealth CEO Jonathan Bush discusses the ACA and AHCA, and comments on how healthcare-related political battles affect providers.

Curbside Consult with Dr. Jayne 4/3/17

April 3, 2017 Dr. Jayne 1 Comment


I’ve been doing a lot of thinking about my work lately. I’ve been doing consulting for a while now, starting with side work even when I was a CMIO. I left that ersatz glamour to do consulting full time and it’s been an adventure.

My clients are generally good to work with, and that is a side effect of being your own boss and having the ability to terminate clients who are difficult or want to play mind games. Still, they get stressed out like anyone does, and often the consultant is expected to try to fix issues whether they’re in scope or not. That creates some tension around whether I should allow them to change the scope of work or whether I need to send them in another direction, especially when they try to game the system to get their new problem included for free.

Everyone is under significant economic pressures and I understand where they are coming from. Just because you’re in healthcare, though, doesn’t mean that we can give you services for free. Especially as a small consulting firm, even small discounts can make a big dent in our bottom line. We’re in the purest of “eat what you kill” models and even though we have low overhead, we still have bills to pay like everyone else. Fortunately, my partner and I are both fairly frugal and we’re not in this business for the money (although it is nice at times). But with increasing financial pressures due to the shift from volume to value, many more of our client-facing conversations are about money rather than vision, mission, or strategy.

Our clients feel increasingly like they’re in the crosshairs with payer audits, federal and state regulations, anti-kickback worries, medico-legal issues, and legislative uncertainty. Not to mention there are also decreasing contract rates, more bundled payment initiatives, and the ever-present worry about the inefficiencies of EHR. For the most part, we can help clients tackle many of their stressors, but the fact that healthcare delivery continues to be in a state of rapid change is something that we can’t do a lot about. Of course, we can help the clients with strategic planning and trying to future-proof their businesses, but that’s a big change for clients who thought they would be independent practitioners forever.

I work for myself, which has a lot of perks. I can generally control my travel schedule and have no problem saying no, although clients have been less flexible the more they are stressed. We have a solid plan to divide and conquer when our clients have needs for specific expertise, although we can cross cover each other enough that we don’t ever feel we are working without a net. Still, I thought we’d be at a different place by now in the evolution of healthcare. Unfortunately, we’re still grappling with some of the same concepts that we grappled with decades ago. They were challenging then, but throw the technology piece at them as well and they can be even more messy.

I’ve been in the healthcare technology leadership space for more than a decade and I’m still fighting the fact that my clients (and their patients) don’t have full access to their medical records. In a lot of ways, they can’t even cobble together a medical record because of the barriers to sharing that are all around them. I’m personally enrolled in four patient portals. One has two of my physicians on it, but they don’t share any data. It might be better that we’re not sharing data, though — my new primary care physician sent me a summary of care record, but unfortunately it has multiple family history errors and even gave me some new diagnoses that I never knew I had, including a pulmonary embolus and clear cell carcinoma.

Because of the crazy way our payment system works, many providers game the system to gain the maximum reimbursement possible. Anyone who has experienced provider-based billing knows what I’m talking about, as do those who have pushed the boundaries on time-based services to achieve higher codes. This creates a lot of stress in the ambulatory space as everyone struggles to figure out how they’re going to add headcount for care management and preventive services while fee-for-service payments are decreasing. Although there are some programs seeking to provide those payments up front, such as the Comprehensive Primary Care Plus program, providers are constantly under the threat of missing some kind of documentation, reporting deadline, or other hurdle that might mean they have to pay back those monies even though they were trying to do the right thing by their patients and communities.

We’ve thrown a lot of precious time and billions of dollars at a healthcare system that isn’t generating the return on investment that we need it to. Divorced from the payment scheme by insurance and other third parties, the majority of patients have no idea whether their providers are gaming the system or not. Is the price they’re charging fair? Is the patient receiving value? It’s hard to tell. In many parts of the country, the only entity that has even close to a full picture of the patient is the payer, and that’s a shame. I’m watching my friends who are only 20-25 years into their careers plan for early retirement when they realize selling out to a big health system wasn’t the answer to their struggles with independent practice.

When physicians are together, we talk about the predicaments we’re in and whether the primary care physicians can hold on long enough for the balance to tip in their favor, helping them come off the hamster wheel and be able to truly connect with their patients again. I know of many physicians who have gone into politics – talk about going from the frying pan into the fire. Although most of them are altruistic, one in my state makes spectacularly poor decisions about a variety of issues. For those in the trenches, especially after the last election cycle, there is plenty uncertainty around tomorrow even if they make it through today.

Some days it’s harder than others to grind through the muck. Whether you’re seeing patients or whether you’re trying to help practices and organizations survive an obstacle course that would make an American Ninja Warrior take cover, it’s tough. I miss the days when we were adding technology to our lives because it solved problems, not because we were forced to and certainly not if it added hardship. Although I see the bigger picture and try to translate it to our clients, it’s getting harder to convince people to hang in there and keep moving forward.

I relish my office days, when I put on my hourly employee hat and just see patients to the best of my ability. For the most part, I make patients’ bad days better and they’re grateful. It reminds me of why I wanted to be a doctor in the first place. But I know that behind the scenes there is still a seedy underbelly of coding, billing, modifiers, and more. I’m spoiled by how well my partners run our practice and spend a lot of time thinking about how much I’d like to bottle their leadership skills and atomize their fortitude around my clients.

Although it feels like healthcare is behind where it should be, it also feels like we’re on the verge of something big. We do things every day that no one had heard of when I was in medical school, and that’s a good feeling. It makes me want to stay in this game another month, another year, another five just to see what happens.

If you could bottle one thing and spread it all around healthcare, what would it be? Email me.

Email Dr. Jayne.

The Blockchain Interview with Jason Goldwater

April 3, 2017 Interviews 3 Comments

Jason Goldwater, MA, MPA is senior director at National Quality Forum of Washington, DC.


What healthcare problems can blockchain solve?

There are three, initially, that it has the potential to solve.

First is access to data. The way that systems have been set up in hospitals or large integrated physician networks is that the data will either reside in a centralized server or now the trend is to reside it in a cloud. That’s fine and that certainly has been effective, but you’re talking about a large consolidation of data in a centralized location. 

Blockchain is very different because it is what is known as distributed ledger technology. Essentially translated, that means the data is not all residing in one place. The data is residing in various different locations. Every time a change to the data is made, that change is reflected across all the locations of which the data is stored. If there are going to be threats or hacks to data, it’s easier, to some extent, to hack into a centralized location to find a large amount of patient-generated data, whereas it’s more difficult to be able to get a large amount of patient data when it’s distributed across a large number of networks.

The second thing it potentially has the possibility of helping is in the area of interoperability. That’s where most of the attention has come from with respect to blockchain. A lot of individuals are looking at this as possibly a solution to the problems of interoperability over the years, Some have even gone so far as to label it as panacea of sorts. I don’t think it’s that, but I do think it has far-reaching potential to help with interoperability because it allows data to flow in whatever syntax and whatever structure to be stored across locations.

If a provider, care team member, patient, or a patient’s family needs access to that data, the data can be delivered through the blockchain to whoever is requesting it as long as authorization has been given by the individual of where that data came from. If I’m the patient and you’re a doctor and you need to see my complete patient record to help aid in decision-making for a particular diagnosis, and I grant you access to the blockchain, then you’re able to get all of the data that has been stored. Regardless of how it is structured, you will be able to access all of that data and potentially use it.

It does not solve the problem of interpretability, which is if your system cannot read the data, it’s not computable to the system that you have. If it’s in a standard or a structure that your system cannot interpret, you’re still not going to be able to access the data, but it does allow for more free-flowing exchange of data as long as I’m authorizing you to view it.

The third biggest potential for blockchain, and what I wrote about and have been speaking about, is that it can help move forward the idea of patient engagement and patient empowerment. The emphasis now is that with the amount of technology that’s around us, we’re generating more data than we ever have before, through wearable technologies and through portals. Even through genomics, with organizations like 23andMe, where you can get an entire genetic profile that you then have and can then send off to whomever you so choose.

If I’m a patient and I have data that I’m able to view, and you’re a provider and you want to view that data, or you want to examine that data and then work with me on how to improve particular aspects of my health based upon what you’re reading, we can engage in a conversation where we both have access to the very same information. You could help me interpret what that information means. I would be able to look at that data on a regular basis to be able to see if I’m making improvements. As long as I’m authorizing you to be able to examine the data, then you’re able to look at that and then work with me on aspects of health that need to be improved.

Even if we get out of the provider relationship and we get more into the performance measurement aspect of it, if I’m a patient and I have a wearable technology that measures the amount of exercise and steps that I take, if I’m on an online nutrition diary, I’m also on another website where I’m measuring my stress level and other aspects of my mental health, and I’m sending all of that information to a blockchain. If I authorize you as an administrator, provider, or a quality measurement professional to look at that data and put that into a measure, you’re able to measure the performance of the care that I’m getting. Not just at a particular episode, but over a significant period of time.

Every time that that data changes, the blockchain changes. Since I’ve authorized you to have access to that blockchain, you’re viewing that data as it’s changing. You can then view and see exactly what changes are being made in my health as a result of activities that I’m doing that may have been prescribed by you, if you’re a provider, or may have been prescribed by another entity.

Profit and legislative mandate drive much of what happens in healthcare. Who would benefit financially to move forward with blockchain, and is it implicit that the patient must control their own data?

There are two incentives. You’re right, nothing really is going to change in healthcare, particularly in IT, without there being some sort of legislative intent or incentive to do so. But MACRA is upon us, so we are moving from a fee-for-service into a value-based delivery system. That has been a change that’s been evolving over a number of years. That’s not something that has just suddenly come about. That’s something that has been evolving and has been directed towards the medical associations for a long period time.

Understandably, there’s concern about that. How are you adequately going to be able to measure value-based care? You have a number of quality standards and performance metrics and you measure those during the course of an encounter to see if you have met what evidence is dictating should be done for a patient off a basis of a process — whether the structure’s in place to fit the patient, or whether the outcome is exactly what’s intended, if you have followed the correct actions. As long as that’s done, then you’re getting value for your care and the physician is reimbursed.

That data has generally either come from manual extraction of clinical records, which is starting to fade, or it’s coming from electronic health records, That has posed problems as well, because not every EHR is the same. Not every one is conforming to the same standards. Not every one is conforming to the same syntax. There’s movement in that area. There are ways of examining how that can be measured to see how we go forward, but we’re still in the beginning phases of that.

Where blockchain can assist in value-based care is that if you have a distributed ledger where data is going to be shared across a number of areas, you are authorizing the blockchain to receive the data, and you’re working with your provider to be able to look at that data on a regular and continual basis, the provider can understand what needs to be done in order to improve the outcomes of your health and what processes need to be taking place. That, in turn, then meets the value threshold for reimbursement. As such, by doing that, they’re able to continually examine and understand a patient’s health in a way that they may not have been able to before. Because it usually relied upon a patient coming in, or in some cases having a virtual visit, and they would diagnose and look at the patient then and be able to prescribe the appropriate treatment protocols.

With blockchain, you’re taking a large amount of data, personally available data that patients are generating, and being able to look at that on a regular and continual basis to drive better outcomes of care, which then in turn drives value. That’s the first thing.

The second thing is the market dynamics are changing. Twenty-some odd years ago, it was a pretty basic concept. A patient would come in, they would say, "This is wrong with me," or they would come in for a regular checkup. They would be diagnosed and the provider then would recommend the appropriate medications, labs, treatment protocols, whatever it may be. The only data that was generated at that point was the data that was generated during the encounter.

That is not the case any more. The data is being generated everywhere. There is more data available for a patient than there has ever been. It’s not just the data that would come from wearables, portals, and smartphones, it’s also the data that’s available on social media sites, where patients write very eloquently about their health. It’s available through validated instruments that they have filled out over the course of their care. It’s available through sites like PatientsLikeMe that store an abundance of patient-generated data. There’s more data available. Patients have more control and more access to data than they have.

How, then, do we take that bolus of data and turn it into something where we can use it for improvement of care? You could store it all in one location and access it when it’s needed. That’s what people are doing, and there’s nothing wrong with that. Having cloud-based storage allows you to access that data and those applications as a service, so when you need it, you get it.

Blockchain allows the data to be distributed across a variety of locations, but the benefit of that is that the patient and the provider both have access to it. I have to authorize you to look at that, and every time that data changes, every time on a daily basis, if things begin to change — my heart rate changes, my blood pressure changes, my mood changes, I’m not exercising as much, I’m not taking the medications I need to be — that data is updated and sent to the provider on a regular basis.

If the provider understands that they’re going to get that data on a regular basis and that it will aid in the decision-making, that they can put that data into an EHR and send that data around to provide access to that patient’s care, and understand that that data is then available to not only aid in decision-making, but to provide the impetus for better decisions — because the value based market is demanding that — then certainly that’s going to be an impetus to push towards better interoperability and better use of the data.

Three things come to mind as barriers. The terminology and syntax issues among EHRs, the need to convince EHR vendors to modify their systems to interact with the blockchain, and the lack of a unique patient identifier.

I’ll start with the second one. There’s no need to rip and replace. Blockchains are peer-to-peer networks. It’s a distributed ledger technology, but it’s peer-to-peer, It’s shared through numerous different systems that generate data. If you have a public blockchain – there’s plenty of them, like Hyperledger, which is written about and spoken about as an open source blockchain – EHRs serve as the access control point for what information is going to be sent to the blockchain. That would have to be done with the consent with the patient, obviously. There’s no need to be ripping and replacing. It’s a matter of, are you going to grant access to the blockchain through your system? Are you going to then engage the patient? There’s going to be continual contributions of data, That data is stored in a blockchain in a  chronological, linear order, and then as it’s updated, it’s changed. There’s no real need to be replacing systems.

The syntax, the semantic structure of data, and how that data is presented is not something the blockchain universally can solve. It’s not something that you can force the issue from. But the dynamics of the market are changing to the point where value-based purchasing is going to become the norm. It’s not something that’s just going to be an option. There’s going to be a bigger demand and a better drive towards improved outcomes of care and better processes of care, but the emphasis is really going to be on outcomes. If you’re looking at the potential of blockchain to assist that, then you’re talking about being able to store significant amounts of data on this peer-to-peer network where that data is being generated from patient devices, but also being generated from an EHR, and that patient is able to work with a provider to control that access and flow of information.

Does it solve the problem of standardization? No. Does it lend itself to creating a better environment for improving outcomes for value-based care that in and of may change it? Possibly, yes.

To your third point, there’s no unique identifier. You’re correct — there’s not. Blockchain  doesn’t solve the problem, but when data is uploaded to the blockchain, a patient has to authorize that access and they authorize the provider to view that. A digital fingerprint is created between the provider and the patient. That fingerprint contains all of the data attributable to that patient that’s being uploaded from the variety of devices or technologies in which the provider and the patient will use to improve care.

So, it can be attributable to a patient because a fingerprint is created in which only that block of data on the chain can be viewed by the provider of the patient, but it does not create a unique identifier. It does create a unique fingerprint. When you talk about financial transactions of bitcoins, which is where blockchain really came from, there hasn’t been any issue to date with respect of bitcoins being attributable to the wrong individual. They’ve been attributable to the individual that has the fingerprint that’s associated with it. The theory is that the same thing would work in healthcare. Has that been tested? It’s been tested in a laboratory environment. Has that been tested in a actual market? No, not yet. At least not to my knowledge it hasn’t.

What should health system CIOs and technology vendor executives be doing now with regard to blockchain?

They definitely need to be interested in it. I would not say at this point they need to immediately start implementing a blockchain and sending data there. But what they need to understand, first and foremost, is the scalability. They have a system now that stores records and stores information about patients. Whether they can send that information to other providers or members of a care team that are responsible for that patient, I don’t know.

Does blockchain provide enough scalability for them to be able to increase the amount of data they can have for a patient? Does it provide the ability to exchange data across partners that could access that where they could either add to the blockchain or they could use the blockchain to help provide care for the patient? Because if it’s going to come down to value-based services and greater outcomes of care, how can blockchain, from the scalability standpoint, be able to improve those outcomes for your environment, be able to improve outcomes for that patient, and be able to meet the dynamics of this new value based marketplace?

The second is to start to look at the access security issues with respect to blockchain. That’s always going to be a paramount issue. The real thrust right now is for patients to have access to data. It’s the patients’ data. They should have access to it and they should be able to engage in a shared conversation with their provider using the data to understand their care better and for the provider to work with them on what needs to be improved. Understand how blockchain can improve access security between the provider getting data and the patient getting data and how that dynamic would change. How that dynamic would improve outcomes, enhance patient care, and enhance patient engagement, which is another part of this value-based dynamic.

They really should also look at their data and their data privacy. How is their data stored? How is their data encrypted? How is their data protected? Is it vulnerable? Does it have the potential to be accessed and hacked? Is there a potential for a breach? No technology will solve that completely, but blockchain provides a greater ability to be able to protect data because it’s not stored in a centralized location. It’s stored in a peer-to-peer network.

The EHR on the blockchain can be access control manager. Who gets access to the data? What data flows into it? Does that significantly improve what they already have? If it does, then it’s a solution worth considering, because it can scale upwards in the ability of for them to not only gather more data, provide more data to the patient, and be able to exchange more data. It not only addresses better access security between the provider and the patient, but it may also improve privacy overall. Rather than the data being in a centralized location — whether it’s a cloud storage system or whether it’s in a centralized server — a distributed ledger provides a better mechanism by which data privacy can be maintained.

HIStalk Interviews Denise Basow, MD, CEO, Wolters Kluwer

April 3, 2017 Interviews No Comments

Denise Basow, MD is president and CEO of the Clinical Effectiveness business unit of Wolters Kluwer, which includes UpToDate, Lexicomp, Medi-Span, and Facts & Comparisons.


Tell me about yourself and the company.

I’m a primary care physician by training. I practiced internal medicine for about four years. In 1996, I had the good fortune of meeting the founder of UpToDate and decided to join at a fairly early stage of the business as an editor. I then held a variety of roles in the business on the editorial side for many years.

In 2008, when UpToDate was acquired by Wolters Kluwer, I became the general manager. I led the business operations of the business until around 2015, when we did some reorganization of the Health division at Wolters Kluwer and decided to form this Clinical Effectiveness business unit. Since 2015, I’ve been the CEO of Clinical Effectiveness, which includes UpToDate; our clinical drug information solutions Lexicomp, Medi-Span, and Facts & Comparisons; and our newest acquisition on the patient engagement side, which is called Emmi.

What’s the process of reviewing ever-changing medical literature in huge quantity, assessing those new findings, and then figuring out how to present the new information to clinicians?

It’s interesting that you asked the question in that way, because in the early days of UpToDate, we used to say that we wanted to be the first place that doctors would go to when they needed an answer to a clinical question. Then when we realized that was happening, we said, wow, we need to really put a lot of thought into how we put together an editorial process so that we get things right. We felt like we had this tremendous responsibility to do this in a very high quality way, because not only were people looking at the content, they were acting according to what we said.

I put all of that into the editorial process that we’ve developed over many, many years. It involves a number of in-house experts who edit the content, but then also the 5,000-plus contributors that we have around the world and multiple layers of review. Having the right people looking at the content with the right expertise. Always having a focus on the patient, having a focus on the provider who needs an answer to a clinical question, and making sure that we’re giving them the best answer that we can provide.

The style of medical journal articles makes it hard to extract what’s important and actionable. What’s involved once you’ve decided that an article is clinically useful to present it in context to a busy physician at the point of care?

As physicians, we are all trained to read the medical literature. We can take any individual study and understand what it says, understand at a reasonable level whether it’s a good study or whether it has some limitations. The real challenge is not in reading any single study. It’s how you take that particular study and put it in the context of everything else that’s been written and decide how that applies to the patient sitting in front of you.

A simple example would be a new drug for hypertension that’s studied in literature. Study X comes out and says that it’s effective for patients with hypertension. That raises a whole series of questions. Should it replace other medications that my patient is on? Do I need to call in every patient that I have who’s on another drug and change them to this one? What are the side effects of this drug? So many questions come up.

That’s what we focused on early on. What are those questions? How do we train our editorial team to think about those questions, but also to write the information in a way that is accessible to people at the point of care? Even if people have the expertise to put of that together, nobody has the time.

Physicians are often resistant to having someone else summarize literature for them, but they are accepting that by using a trusted reference. How does that change the way they practice?

One of the things that attracted me to this business early on was that I understood how hard it was to get this information, because I was out there practicing. It’s a very uncomfortable feeling to be sitting in front of a patient and wanting to do the best job that you can, but feeling that it’s difficult to get that information. And, knowing that even if you have the expertise to understand the medical literature, you don’t have the time to do it.

I don’t feel like there’s a lot of resistance, in that sense, for clinicians to look at a resource that they trust and to look to it to give them help. All physicians want to do the right thing. I haven’t seen that there’s been much resistance at all. We’re not trying to tell people what to do. We’re trying to help them make the best decisions that they can. I think some of the resistance that you’re speaking of is more along the lines of being told what to do versus our approach of, let’s help you do your job.

Is there a place to incorporate evidence that’s accumulated from actual physician experience rather than being generated by a study?

I’ll give you a little anecdote, which may be a piece of trivia. The original name of UpToDate was Consultant, but the name couldn’t be trademarked, so it was changed. But the original concept was almost as you’re saying — to be a consultant for the clinicians along the concept of what you described.

The editorial process has been built around that. What we’re saying is that we’ve been able to work with the best experts in the world to deal with all of the clinical issues that we address. We’re giving every physician, every healthcare provider, access to the best consultants.

As we grade our recommendations, we have some very strong recommendations and some weaker ones. Usually that’s because we have very good evidence for the stronger ones and much weaker evidence for the others. The strong recommendations are in the minority, unfortunately. That’s just the state of the medical literature.

We very much consider that not only what’s in the published literature, but the experts that we have involved in the content are a part of the evidence. Our responsibility to the provider, or to the person looking at our content, is to be transparent about how strong that recommendation is. Is it based on solid medical literature, or is this based more on the expertise that we have because that’s the best evidence that’s available? We have always considered all of that to be evidence — it’s just a matter of how strong or weak that is.

Do you collect user feedback to harness their collective opinion on how useful a particular recommendation is in their actual practice?

We get a lot of feedback from our subscribers. Sometimes it helps us understand gaps, where maybe there’s a particular clinical question that we haven’t answered. That’s very useful for us because we try to intuit the questions, but we can’t get all of them. That’s kind of one category of feedback.

We also get feedback from some subscribers who may not agree with our recommendations. All of that feedback goes to our editorial team and is answered by our editorial team. We consider the whole world to be our peer review, in a sense, and we encourage getting that feedback. It makes a big difference in our content.

What makes physicians practice in ways that don’t reflect best practice or best available evidence?

That’s the billion-dollar question. More of a trillion-dollar question, actually, if you think about how much we spend on healthcare.

What you’re describing is what has been talked about for 40-plus years –unwanted variability in care. There are a lot of things that contribute to that. Some of it is certainly access to the right information, and we have lots of examples of that. Some of it is that we come out of training and we practice in a certain way and we tend to stick with that level of practice. Some of it is that our clinicians are making very good decisions, but things break down somewhere else in the process.

That’s why we have tried to broaden things from saying that, as UpToDate, we’ve been able to make an impact on clinical decision-making. We’ve been able to demonstrate that that impact on decision-making influences outcomes, but that’s only a piece of the puzzle. The whole thought behind broadening this to a clinical effectiveness mission was to say, how can we begin to attack some of the other areas where this breaks down?

Office physicians used to excuse themselves from the patient to look something up in a paper reference. How has that changed with EHR workflow and clinical decision support?

That still happens. “Excuse me, I’ll be right back” and go look something up. What we’ve seen over the years is more and more providers trying to involve patients directly in the decision-making. More and more we’re seeing physicians looking those things up while sitting with the patient and being comfortable saying, we’re going to look this up together and make sure that we’re doing the right things here.

I think that’s a very good thing. Patients are the most underutilized resource in our healthcare system. We need to continue to involve them more in their care. Educating them directly and giving them access to what our providers are looking at is a way to do that. That’s the biggest change that I’ve seen. Certainly when I was practicing, I would excuse myself and go look at a textbook, which is what we had available at the time. Now a lot more of that is happening with the patient in the room.

Doctors spend a lot of time debunking irrelevant or inaccurate mass media information patients ask about. Is there value in presenting objective information that’s more patient-focused?

Part of it is that. Early on when we were thinking about how we would address the patient education side of things, I would occasionally hear people say, doctors don’t really want to educate patients. That’s absolutely false. What providers want is for patients to have good information. Not to spend time debunking, but let’s spend time making sure you have the best information because you’re an important part of the healthcare continuum. To achieve our vision for clinical effectiveness, that has to happen.

What we’ve tried to do is say, how do we provide information that clinicians feel comfortable sharing with patients? How do we build information that doesn’t just provide information to patients, but engages them in their care? There’s a big difference between handing patients a leaflet or a monograph of information and understanding how to speak with them in a way that allows them to take action.

We’ve focused on the behavioral science behind that. How do we truly engage patients in their care, and do it in a way that physicians don’t feel like they have to debunk things, but where the patients become an active participant in their care?

As to the behavioral aspect, physicians are the target of multi-million dollar drug company and medical device campaigns intended to sway their opinion. Is it difficult for practicing physicians to go back to the literature and double check what the sales rep is telling them?

There’s been a lot of studies that have looked at the influence that third parties, like pharmaceutical companies, have on providers. Most of it has shown that providers don’t think that they have any influence, but the studies show that they do.

There’s always that little bit of disconnect, but we don’t spend a lot of time thinking about that. What we’re trying to do — whether you’re a doctor, nurse, pharmacist, physical therapist, or anybody touching a patient – is that if you’re the patient, making sure that we provide the best information that we can to help that provider make a good decision to help that patient be as informed as they can be to participate in their care. In that respect, try to begin to solve this problem of variability in care and improve clinical effectiveness.

Do you have any final thoughts?

When I think about the challenges that we have, I always keep a vision of a patient sitting in an exam room and the responsibility we have to to provide the best care that we can and to make good decisions for that patient. Whether it’s in providing information, whether it’s in educating that patient, for those of us involved in helping provide good healthcare, if we always keep those patients in mind and the ultimate mission and vision of what we’re trying to do, it’s very helpful in the decisions that we make in staying true to what we’re trying to achieve.

Morning Headlines 4/3/17

April 2, 2017 Headlines No Comments

NantHealth (NH) Tops Q4 EPS by 1c

NantHealth reports Q4 results: revenue climbed 18 percent to $24 million, falling short of analyst estimates, EPS –$0.19 vs. -$0.10.

Former Siemens exec to head ONC

Former CMO of Siemens Healthcare, Donald Rucker, MD, MBA, MS is named as the next National Coordinator for Health IT.

Kaiser campaign slashes opioid prescriptions

Kaiser Permanente’s home-grown opiod prescription drug monitoring program is the subject of a local public radio article.

GPB Capital acquires healthcare software assets from NTT DATA – New company to be named Cantata Health, LLC

PE firm GPB Capital acquires the hospital and long term care software assets of NTT Data, creating a new company called Cantada Health in the process.

Monday Morning Update 4/3/17

April 2, 2017 News 9 Comments

Top News


HHS quietly hires Don Rucker, MD, MBA, MS as National Coordinator, as evidenced by his new entry on the HHS employee list.


Rucker holds a Penn MD and Stanford master’s degrees in business and informatics. He is an adjunct professor in biomedical informatics at Ohio State, but is best known as being chief medical officer for Siemens Healthcare from 2000 to 2013.


Apparently reporting to Rucker is former Rep. John Fleming, MD (R-LA), who said previously that he thought his newly created position of HHS deputy assistant secretary for health technology reform was equivalent to National Coordinator.


Reader Comments


From Lisa Buller:”Re: Skagit Regional Health’s Epic project. As the project director of this implementation, I can tell you the post regarding our EHR project is not only unverified – it is untrue. We are very happy with our selection of Epic and look forward to our on-time go live of October 1, 2017 and the improvement in quality, safety, and efficiency that it will bring to the care we provide our communities.” Lisa referenced the original Epic announcement that indicated a mid-2017 go-live date. Publicly available information suggests that the IT department added 53 positions with 20 more planned to implement Epic (although those employees are often rolled back to their previous jobs after go-live) and CIO John Dwight moved to EvergreenHealth in February. Both items were mentioned by the rumor reporter whose main point was that budget overruns of the $72 million project, if they exist, have not been publicly acknowledged. UPDATE: Lisa provides additional information: “Our project is on time for go live on October 1, 2017 across our organization, including two hospitals and 18 clinics. The project cost is $72 million. We moved our go live from July to October 1, 2017 to ensure adequate time for project build, test, and training. We currently have 23 consultant-employed FTEs – not 60 as was reported in the unverified post. The pay rate referenced in the post is also false.”


From Steve: “Re: NTT Data’s divestiture of its healthcare software division. The acute EHR/RCM products are so far behind any of the competitors, have next to no market share, don’t show up in any industry reports, and NTT Data lost so many clients. I will be curious to see if they recover under the new company. It’s the same leadership that ran that division at NTT Data, so chances are probably pretty slim.” I’m thinking the prize there is the NetSolutions long term care software product line, which runs in 1,700 facilities.

HIStalk Announcements and Requests


Nearly three-fourths of poll respondents have a negative reaction to the White House’s recent HHS appointees.

New poll to your right or here: When will blockchain have a significant healthcare impact?

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We bought three Chromebooks for Mrs. J’s first grade class in South Carolina. She reports, “Our class LOVES our Chromebooks. They are a fundamental part of the reading process in our classroom. Students use them almost daily for taking AR quizzes, reading online information, playing learning games, and practicing math facts. They are really enjoying being able to access the tools they need. I’m so thankful that donors like you continue to make a difference through DonorsChoose. It makes teachers like me and students like mine extremely grateful.”


This infuriatingly common mistake bugs me. Is it really so hard to match a singular subject to a singular verb? As the headline writer might say, the grammatical sloppiness of Americans are driving me crazy.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.


This Week in Health IT History


One year ago:

  • The Department of Defense names its Cerner-centered EHR project MHS Genesis.
  • A study finds wide clinical variation in how patient visits are conducted by six virtual visit companies.
  • Southcoast Health lays off 95 employees after running over budget on its $100 million Epic implementation.
  • Massachusetts General Hospital and other Partners HealthCare sites go live on Epic.


Five years ago:

  • CSC announces plans to launch iSoft in the US after poor performance in England’s NPfIT.
  • 3M acquires CodeRyte.
  • HHS awards $50,000 to the designers of THUMPr, a web-based heart health consumer profile tool.
  • HIMSS lists the HIT-related affects that would arise from a Supreme Court finding that some or all of the ACA is unconstitutional.
  • Seven-month-old hospice management software vendor Hospicelink predicts that it will hit $50 million in sales by the end of the year.
  • TriZetto announces plans to build a $40 million headquarters building in Denver.

Weekly Anonymous Reader Question

Last week I asked readers to describe their proudest moment in health IT, with these responses:

  • Getting the result interfacing going from our lab to the local cancer treatment facility. It had been a months-long project with many fits and starts, but seeing it actually happen was amazing. They went from needing up to a week to get results to make changes to chemotherapy regimens to being able to make changes in a few hours. They can actually correlate some improved survival rates to being able to respond faster to changes in their patients’ health.
  • Being the first (and maybe only?) IT person to receive the Employee Recognition Award at the health care organization I worked for.
  • When I first started out in health IT, I was part of a SWAT team who would swoop into troubled sites. I was disheartened about six months into the job. I then went to my fifth or sixth site and sat with a doctor who was visibly frustrated. A few tweaks, 30 minutes of coaching and training, and customizing the program and all was better. I went back about three months later and the doctor gave me the biggest hug and looked at me with tears in his eyes and said "I’m no longer stuck in the dictation room until 7, 8, 9:00 at night. I leave the hospital at 6:00 at the latest every day since you came. I’ve made it to all of my son’s tee-ball games this season, my wife and I eat dinner together, I sleep better, and my nurses have all noticed a change in my patient care. Thank you so much. You have made me want to stay in medicine and keep doing what I was put on this Earth to do." Cue me totally getting all teary right ahead of a big executive meeting 🙂 But I remember that doc, and all the other docs on days where it’s kinda crappy. End of quarter, forecast calls, dealing with code issues, trying to keep customers… It’s all kinda crappy, but if I can do one thing each day where I help one person be able to go out there and do better at keeping people healthy and alive, that’s good enough for me.
  • Around 10 years ago, I was a sales executive working with small independent medical groups trying to help them move to our network-enabled rev cycle service. There was a wonderful physician I was working with who provided great family practice services to an undeserved population, but struggled to run her practice. I was fortunate enough to help her make the leap of faith to join our network. A year later, I called to check in. The physician started tearing up over the phone. (full disclosure: I went into panic mode once I heard her voice crack). I asked what was wrong and she said, "Wrong? Nothing’s wrong. Yesterday I was able to pay my daughter’s tuition in full for the first time and I owe that to your company.” Thinking about that moment still makes the hair on the back of my neck stand up.
  • When the first customer I helped acquire their eICU program verified the clinical, operating, and financial results we had promised. The icing on the cake is when one of the practicing intensivists also reported that for the first time in years he was sleeping through the night uninterrupted, and he felt more alive and happy than he had in years.
  • I designed and helped build a bedside critical care CIS that at one site operated nonstop for four-plus years without a server reboot. It was the only system in the data center that kept operating when all the others went down during a hurricane.
  • In a meeting, a frustrated physician, who felt burdened and attacked, retorted, "What’s the point? Nothing ever changes here anyway." After the meeting, I compiled a list of the changes that we had made in the past year. Some were IT, some were process, some were new initiatives. In all, I listed 24 accomplishments that we had completed in the previous 12 months. I leaned back in my chair, kicked my feet up on my desk, and raised my hands behind my head. In the silence, I swore I could hear a faint echo of applause.
  • In the late 1970s, I wrote a master’s thesis on clinical decision systems, which I defined (simplistically for research) as a physician, nurse, and patient. Key to the triad is the patient as an equal member of the decision team. IT wasn’t until a decade or so into the 21st century that the patient was recognized as a key decision-maker in his/her care. I was proud in retrospect that I had identified the key role a patient plays in their care, based on the different kinds of information which they hold and on which only they can act. Similarly with the differences among physicians and nurses and their unique and special knowledge and decision characteristics.
  • One thank you note from a former customer: “The richness of your experience and knowledge is a true asset to the HIT community and it’s always a pleasure to shine the spotlight on you. You never disappoint!”
  • Leading an EMR conversion and receiving Joint Commission accreditation 16 days post-EMR conversion with zero nursing citations at a hospital that had never passed Joint Commission without citations previously.
  • I was at the Magnet nursing conference doing a demo in our booth and a random attendee walked up and interrupted the demo and said, "I use your product every day and I love it" and then she just walked away.
  • Seeing a presentation about better care of patients by a customer using a tool I was integral in designing and testing. It’s pretty awesome to see someone talking about things that were were not possible prior to the existence of something I helped create.
  • Oddly, a proud time was spending New Year’s Eve 1999 on call and having almost nothing to do because the years of Y2K preparations were done right. Management invested appropriately and early enough to the work done, people worked hard to address all the issues, and the results were there. We were also prepared for what didn’t happen. I can’t recall another go-live that went as well.
  • Hearing a doctor exclaim, "Look, it’s right here!" as she pulled up a hospital discharge report in real time while the patient was in her office for a follow-up. No calls to the hospital chasing paperwork, no checking billing office inboxes or wire baskets — everything ready to go while the patient was in front of her.
  • Chair of an AMC department walking through exhibits at a conference, taking a few steps backward, turning to me at the booth and saying, "I may not have said this before, but your system has changed the way (our specialty) is practiced in America. Thank you."
  • Teaming with Kaiser Permanente in Southern California in a partnership to build and deploy an application integrated with Epic that used NLP to automatically calculate the E&M code at the point of care. This was an early (2005) commercial use of AI. The end result was an a operational success for Kaiser and a commercial success for our small company. The technology is now owned by Nuance.
  • Being the first hospital to activate the first commercially available EMR 19 years ago and it’s still running fine. And it only cost $16 million for an 800-bed hospital.
  • I don’t really have one other than doing a great job every day before the Big Vendor came along and there needed to be 8-10 of me.
  • My first invitation to Histalkapalooza.


The question this week: What is your favorite moment from any past HIMSS conferences?

Last Week’s Most Interesting News

  • An IBM report finds that the number of healthcare records exposed via breach dropped 88 percent for 2016 vs. 2015, with just 29 percent of incidents involving outsiders.
  • The FBI warns healthcare organizations that hackers are targeting FTP servers configured to allow anonymous access.
  • The White House appoints Roger Severino as director of HHS’s Office for Civil Rights.
  • A review of UCSF’s virtual glucose management service finds significant improvement in glucose control.


April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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

Acquisitions, Funding, Business, and Stock


NTT Data sells its hospital and long term care software suites to newly created and PE-backed Cantata Health. Those products involve Optimum (hospital clinical and RCM) and NetSolutions (for skilled nursing, assisted living, and independent living). The PE backer is GPB Capital Holdings. NTT Data acquired the software with its acquisition of Keane in October 2010 at a rumored $1.2 billion. Cantata Health will be led by former NTT Data healthcare technologies division executives Mike Jones (CEO) and Rich Zegel (CTO).


NantHealth reports Q4 results: revenue up 18 percent, EPS –$0.19 vs. -$0.10, beating earnings estimates but falling short on revenue, sending shares down 3 percent Friday. The company lost $184 million in the fiscal year, doubling its 2015 losses.


  • Community Health Systems (TN) chooses Infor for enterprise financial management and will begin rollout this year.
  • University of California Irvine Health System (CA) will go live with Oracle PeopleSoft ERP in 2018.
  • Charlton Memorial Hospital (MA) will go live with Oracle PeopleSoft HR this year.

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


Public radio profiles Kaiser Permanente’s opioid prescribing program, implemented in 2009 after clinical leaders noted that OxyContin was among its most-prescribed drugs, patients were on the medication for long periods with ever-increasing doses, some of the prescriptions were for 1,000 or more pills, and doctors were specifying brand name drugs that weren’t covered by insurance but that command a higher street value. KP studied its opioid use from its Epic data, sent reps to counter pharma sales pushes to use more, programmed Epic to help guide physician decisions, and implemented “The Difficult Pain Conversation” to encourage patients to stop demanding opioid prescriptions.

The VA complains about employee-friendly laws that force it to keep paying workers it’s trying to fire, with the latest example being an employee who was caught watching pornography while with a patient who the VA has to keep paying for at least 30 days while the bureaucracy-laden termination process is followed.

A heart surgeon who sued former employer Memorial Hermann (TX) for using peer review and quality data to discredit him after he complained about quality problems wins $6.4 million in a jury award.


Epic’s April Fool’s web page makeover included these stories:

  • Introduction of TinDR, an Epic app that allows doctors and patients to choose each other via a right or left swipe, quoting a doctor user as saying, “I didn’t do great in med school, but I hit the gym six days a week, and that’s finally paying off.”
  • The meeting of AI systems IBM Watson and Epic Bruce, in which Bruce sent Watson a 2 a.m. messaging questioning, “You up?”
  • The release of Chirp, a clinical notification app for the Apple iRing that displays college insignia or birthstones in the absence of pending notifications.


A hacker defeats the facial recognition security of the just-released Samsung Galaxy S8 smartphone by copying the registered user’s Facebook photo and then just sticking it in front of the phone’s camera.

A med student’s interesting article says that the broken medical residency electronic match program is leaving half of new graduates without a residency slot. The author says the electronic application process encourages blasting out applications en masse, overwhelming the ability of the residency programs to evaluate their candidates wisely. He concludes that pen and paper applications might force applicants to be more selective in expressing their true interests, adding that the number of electronic applications per student could also be limited but that’s not likely because the AAMC-owned system makes a lot of money per application.


California-based surgery collaboration app vendor Casetabs (which describes itself pointlessly as “the Uber of surgeries”) runs a Craigslist ad (where apparently all the health IT experts look for work) for a sales development rep with some fun requirements:

  • “Sales sniper with a proven track record of crushing sales quotas.”
  • “Extreme comfort in cold-calling (70-100 calls/day).”
  • “Water Garden office complex in Santa Monica (sofas, fire pit, B-ball, football, corn hole, Foosball, etc.)”
  • “High performance, high pay environment (eat what you kill).”

Here’s Part 2 of the top 10 HIS vendors report from Vince and Elise.


Dr. Weird News Andy would like to order a vodka drip, stat. Veterinarians save a cat that poisoned herself by licking spilled brake fluid off her fur by administering IV vodka to counter the effects of ethylene glycol. Princess the cat is recovering at home, which by WNA’s calculation leaves her with eight remaining lives.  

Sponsor Updates

  • Clinical Computer Systems, Inc., developer of the Obix Perinatal Data System, celebrates its 20 years in healthcare.
  • ZeOmega will exhibit at NAACOS Spring 2017 Conference April 5-7 in Baltimore.

Blog Posts


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


Morning Headlines 3/31/17

March 30, 2017 Headlines No Comments

IBM X-Force Finds Historic Number Of Records Leaked And Vulnerabilities Disclosed In 2016

An IBM cybersecurity report finds that the healthcare industry fared better in 2016 than it did in 2015, with only 12 million records exposed to cyberattacks throughout the year, compared to more than 100 million in 2015, representing an 88 percent decrease.

WHO Launches Global Effort to Halve Medication-Related Errors in 5 Years

The World Health Organization announces the Global Patient Safety Challenge, an initiative to aimed at reducing avoidable medication errors in all countries by 50 percent over the next five years.

Ontario Hospitals Join Partnership to Deliver Seamless Patient Care with MEDITECH’s Web EHR

In Ontario, Markham Stouffville Hospital, Southlake Regional Health Centre, and Stevenson Memorial Hospital will partner to implement Meditech’s 6.1 Web EHR.

Alexander, Corker Introduce Bill To Rescue Americans With No Options For Insurance

Senators Lamar Alexander (R-TN) and Bob Corker (R-TN) introduce legislation that will allow consumers living in counties where no ACA insurance plans are offered to use the federal subsidies they qualify for to buy insurance from any company willing to sell it to them.

News 3/31/17

March 30, 2017 News 5 Comments

Top News


An IBM security report finds that healthcare is the #5 most-hacked industry sector, with just 29 percent of the incidents involving outsiders.

“Inadvertent actors” — such as employees who fall for phishing or malware scams — made up nearly half the total number of incidents, while malicious insiders were behind just about as many attacks as external hackers.

Many successful healthcare attacks involved smaller organizations, resulting in an 88 percent drop in exposed records in 2016 vs. 2015.

The report estimates that criminals made $1 billion from ransomware in 2016 and that 44 percent of spam email contains malicious attachments, most of it ransomware.

IBM warns that the success of hackers has driven down the black market value of structured data, adding that “unstructured data is big-game hunting for hackers and we expect to see them monetize it this year in new ways.”

Reader Comments

From Jake Serpent: “Re: ransomware. The FBI is investigating a case where PCP’s clearinghouse account was hacked and $86,000 in insurance payments were routed to other bank accounts. Interestingly, the FBI advised them not to disclose to their EHR/PM vendor’s IT support that they had been hacked until they had learned more. This is a new hole in the cash flow for thieves to exploit.” Unverified.

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From Jigger: “Re: NantHealth. Allscripts invested $200 million in the company in mid-2015 before the NH IPO, while NantHealth’s Patrick Soon-Shiong personally invested $100 million in Allscripts. How have they fared?” The best I can tell, Allscripts spent $200 million to acquire shares that are now worth $74 million, so they are down $126 million. Soon-Shiong’s $100 million investment in Allscripts shares is now worth around $92 million. In the past year, MDRX shares are down 7 percent, while those of NH have shed 73 percent since they began trading in June 2016.

From Oleander: “Re: Aventura. Has ceased operations and closes Friday.” Unverified, but folks in the know say they’re winding it down. It’s highly unusual for a company that sells a product (rather than a service) to just walk away instead of selling out for whatever price the market will bear. I expect to have more details soon.


From Lugubrious Lad: “Re: Missouri’s lack of a prescription drug monitoring program. From reports I’ve read, it’s a small group led by a powerful state legislator that has blocked a statewide program. State Senator Rob Schaaf once said people who die of overdoses remove themselves from the gene pool.” Senator Schaaf is a doctor, with his obvious lack of empathy perhaps validating that he’s better suited for power-brokering than attending to patients. Schaff’s PDMP objections involve patient privacy – he proposes his own bizarre system in which doctors would send the state the names of patients for whom they are considering issuing prescriptions for narcotics and then the state would let the doctor know of any concerns (given that they have no medical information to review and that such a system wouldn’t work with that of any other state, including those that border Missouri). Schaaf says he will filibuster any attempts to implement a PDMP other than his own: “I’d just as soon not have a PDMP. Would they rather have a database that protects privacy or no database at all?” On the other hand, his skimpy legislative body of work includes designating Jumping Jacks as the official state exercise.


From Tip Toe Through the Tulips: “Re: Skagit Regional Health (WA). The 185-bed system’s consultant and another consulting firm that was being paid $500 per hour contracted for Epic for $72 million to replace Meditech and NextGen, more than larger sites have paid. The cost is now over $100 million and the IT department has gone from 53 FTEs to 113 plus 60 consultants. They are missing deadlines, dates have been pushed back, the consultant-turned-CIO has gone, and they are continuing without a CIO. This coupled with a money-sucking HIE they own with Island Health that is in disarray, for which they have hired another expensive consulting group to review. Time will tell whether this system survives a $1 million per bed Epic project.” Unverified.

HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. V in Texas, who asked for a 8×10 carpet for her first grade class’s reading area. What won me over was her eloquent description of its importance to her classroom in replacing the worn out one they had been using for years: “We start from only knowing mostly sounds and basic words to reading chapter books. We will basically summit a knowledge mountain this year to be prepared for our future. I do my job so that someday these students will have the opportunity to have a career of their own. The carpet is the heartbeat of our classroom. We share all of our lessons there. We share joy, excitement, heartbreak, breakthroughs, and growth on that piece of cloth. The battle of education is fought and won in one spot in the classroom and that is on that carpet.”


The government’s Internet privacy protections rollback revived my interest in using a private VPN service for web browsing (though to be fair, those protections hadn’t taken effect yet anyway, so nothing has changed.) My requirement of a free trial led me to VyprVPN at $45 per year. Speedtest shows no slowdown and it’s painless to install and use. A VPN also protects you when using public WiFi, but even more intriguingly, it apparently can save money on Internet purchases, where price is often set by the user’s location — VyprVPN priced the same SYD-LAX flight on Kayak by connecting through servers in several countries and it ranged from $2,900 to $5,400. VyprVPN runs great on the laptop and iPad, although it didn’t work on my Chromebook because of router settings that I didn’t bother changing because it wasn’t really important.

This week on HIStalk Practice: Congratulatory AHCA ads fly fast, furiously, and prematurely. Facial recognition software helps physicians diagnose rare pediatric disease. Wisconsin MDs prepare for mandatory PDMP reporting. Eastern Shore Psychological Services implements MediWare EHR. EPatientFinder’s Lance Hayden offers inexpensive steps to better practice cybersecurity. IHealth acquires AllDocuments. Mecklenberg County health officials accidentally release PHI. Navicure’s Jim Denny eases providers into care cost transparency practices.


April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

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

Acquisitions, Funding, Business, and Stock


San Francisco-based primary care practice Carbon Health raises $6.5 million in a seed funding round to expand use of its patient app that offers appointment scheduling, payments, and prescription refills.


Health kiosk vendor Higi receives an unspecified Series B investment from BlueCross BlueShield Venture Partners and acquires EveryMove, which offers a health rewards system to health plans.



Three Ontario hospitals will implement Meditech 6.1 Web EHR, hosted by Markham Stouffville Hospital.



Evariant names Clay Ritchey (Imprivata) as CEO.


Leidos Health hires Bill Kloes (Nuance) as VP of operations integration of its health group.


Terri Ripley, MIT (Inova Health System) joins OrthoVirginia as CIO.


The Strategic Health Information Exchange Collaborative hires Pam Mathews, RN, MBA (Pam Mathews & Associates) as interim executive director.

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Solutionreach promotes Paul Kocherans to SVP of sales; Justin Everette to VP of marketing; and Lance Rodela to VP of product management.

Announcements and Implementations

IBM will incorporate SNOMED CT terminology in its Watson Health offerings.

CMS approves Forward Health Group’s PopulationManager as a qualified registry for the 2017 performance year.


The World Health Organization launches a global initiative to reduce severe, avoidable medication error harm by 50 percent over the next five years. It will offer guidance, strategies, plans, and tools.


Healthwise provides a $2 million grant to fund the Informed Medical Decisions Program at Massachusetts General Hospital’s Decision Sciences Center. Michael J. Barry, MD, Healthwise chief science officer, will return full time to MGH to direct the center, which will study how to incorporate the patient’s voice in making healthcare decisions.

The Connecticut Hospital Association and Bayer will create a statewide database to track patient exposure to radiation from CT scans.

Government and Politics


Senators Lamar Alexander (R-TN) and Bob Corker (R-TN) introduce legislation that would allow Americans who live in a county where no insurers offer ACA plans in 2018 to apply any federal subsidy they receive to plans they buy directly from insurers. The challenge, which they didn’t mention, is that those same counties may well have no insurers willing to sell individual policies either, meaning that those who can’t get insurance through an employer can’t obtain it at any price.


Meanwhile, Sen. Corker responds to the comments of fellow Republican and House Speaker Paul Ryan (R-WI), who expressed concern in a TV interview that President Trump will reach out to Democrats to get healthcare legislation passed instead of twisting the arms of party loyalists to repeal ACA in purely partisan fashion. A new poll finds that 62 percent of Americans think President Trump has mishandled healthcare reform, sending his record-low approval rating even lower to 35 percent following last week’s AHCA drama.

The Texas Senate appears to have ended the state’s relentless efforts to stifle the use of telemedicine.

Privacy and Security

Thieves hoping to steal petty cash from a clinic of CoxHealth (MO) also grab patient fee slips from the state, triggering the requirement that the incident be reported as a breach to HHS.



A New York Times Magazine article describes the expensive industry created around “coder vs. coder” billing code jockeying that occurs among hospitals, insurers, and auditors that often leave patients holding an indecipherable bills from multiple providers involved in a single episode of their care that may bankrupt them despite their best intentions. Some excerpts:

Individual doctors have complained bitterly about the increasing complexity of coding and the expensive necessity of hiring their own professional coders and billers … But they have received little support from the medical establishment, which has largely ignored the protests. And perhaps for good reason: The American Medical Association owns the copyright to CPT, the code used by doctors …  when Medicare announced that it would pay only a set fee for the first hour and a half of a chemotherapy infusion — and a bonus for time thereafter — a raft of infusions clocked in at 91 minutes … Today many medical centers have coders specializing in particular disciplines … The Business of Spine, a Texas-based consulting firm with a partner office in Long Island, advises spine surgeons’ billers about what coding Medicare and commercial insurers will tolerate, what’s legal and not, to maximize revenue. The evolution of this mammoth growth enterprise means bigger bills for everyone.

Colorado’s new Medicaid payment system for developmental disability services is rejecting provider claims due to coding errors that the state blames on users who didn’t pay attention to its communication about the changes over the past 18 months. Speech therapy clinic operator Jill Tullman says she bills up to $12,000 per week to Medicaid, but has been paid only $288 in the past month. She also spent 2,500 minutes trying to get help from the state’s call center, run by Hewlett Packard Enterprise, which still has 90-minute wait times even after fixing software and connectivity problems. The state has paid 48 percent of submitted claims in the first month. 

A Florida State University psychology researcher studies the EHR data of 2 million patients to create a machine learning method that can predict whether someone will attempt suicide within the next two years with 80-90 percent accuracy.


The University of Texas system regents will pay Ron DePinho, MD — the just-resigned president of MD Anderson Cancer Center — over $1 million per year to serve as a professor of cancer biology, placing his compensation at nearly triple that of his boss, the cancer biology chair. He will also receive $1 million per year to fund his research projects. Cynics might presume that his resignation was neither voluntary nor unchallenged.

Sponsor Updates

  • Consulting Magazine profiles Peter Smith of Impact Advisors.
  • Imprivata will exhibit at the VHHA Spring Conference April 5-7 in Williamsburg, VA.
  • profiles InstaMed.
  • InterSystems will exhibit at the HIMSS Population Health Forum April 3-4 in Boston.
  • Intelligent Medical Objects will exhibit at AORN International Surgical Conference & Expo April 1-5 in Boston.
  • Kyruus hosts NewCoBos April 5-6 in Boston.
  • NTT Data’s Lisa Woodley presents at the LOMA 2017 Customer Experience Conference March 30 in Las Vegas.
  • Point-of-Care Partners will exhibit at the HL7 Mini-Connectathon April 10-12 in Chicago.
  • Protenus hosted its inaugural Privacy and Analytics Conference last week at its headquarters in Baltimore.
  • SK&A publishes “Physician Office Usage of EHR Software.”
  • PatientSafe Solutions will demonstrate new Rounding and Early Warning System worfklows of its PatientTouch platform at AONE/ANIA.

Blog Posts


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


EPtalk by Dr. Jayne 3/30/17

March 30, 2017 Dr. Jayne No Comments


I spent some time this week coaching a physician informaticist on some of the less-exciting aspects of running a team. At first, he was very excited to be the leader of a team of optimization specialists to work with clients across the south. He didn’t understand what he’d have to deal with as far as the actual logistics of managing people though – vacation approvals, travel authorizations, and the dreaded expense reports.

We talked through the idea of creating some team policies and procedures beyond the standard corporate policies in an attempt to manage the chaos. He has more than 20 people on his team, which is a lot to handle when you’ve never managed people.

Some of the problems were simple solutions. For example, processing the vacation requests 1-2 times a week based on a published timeline for the team, and then ad-hoc for last-minute issues. For travel authorizations, processing daily at mid-day so that his team could complete booking tickets before the travel agency closed. That way he felt less fragmented and less like he was in and out of different software applications all day long.

Creating a strategy to manage his team’s expense reports became the highlight of my day. I have to admit that in reviewing some of the problems he is dealing with, I developed an appreciation for the level of shenanigans his employees were putting forward. Several were pushing the limits of the daily meal allowance, logging the wait staff gratuity as a separate line item under “cash expenses” so they could expense an extra cocktail on their dinner checks without hitting the cap.

Another’s expense reports can only be described as stream of consciousness. Despite traveling to the same client every week, he files reports in a random way that doesn’t seem to line up with any of the scheduled trips. A third consultant included airport hotel bills for the night prior to his travel, “just in case the weather was bad” even though he only lives 20 miles from the airport.

The winner, though, was the consultant who repeatedly stops to purchase a single beer at the gas station next door to the rental car pickup. The timing seemed a little odd, especially since he stays at a hotel where you can purchase single beers in the lobby. It makes me wonder if he is drinking it in the car as he heads to the hotel. All things considered, and especially working for a healthcare company, I’d probably just pay for that out of pocket and not try to expense that $2.85 worth of my day. Not to mention that my client may want to encourage his employee to purchase his beverages at the local package store and pass the cost savings onto their customers.

We had to do some back and forth with the corporate expense people to find out whether some of the outlier expenses were prohibited or acceptable but just tacky. Not all of his employees were gaming the system, though. Several use coupons for their airport parking to save the clients’ money, and at least five of his team members were spot on with their expenses. We’re using those good corporate citizens as an example to the rest of the team and plan to leverage a couple of them to teach the others how to file an expense report that doesn’t drive the reviewer mad.

Another challenge was coaching him on what to do with some of his new employees who are having challenges with professional behavior. That’s always rough when you inherit a team from someone else, or when candidates are hired without your input.

One is struggling with professional dress. My client mentioned that he never thought he would have to tell a field trainer that wearing a fishing hat to the client site isn’t appropriate. That was mild compared to the employee that he described as a “predator” based on reports from multiple clients. Apparently, this trainer would meet members of his training classes at bars after class, with all the imaginable bad decisions taking place. Whether you go to medical school, business school, or any other school, nothing prepares you for having to deal with employees on the prowl, especially when they’re propositioning your clients. The employee is currently on a performance improvement plan, but it’s surprising that people are having to deal with that type of behavior after all the stories we hear about sexual harassment and inappropriate behavior.

One of the most egregious examples of unprofessional behavior was the team member who asked a client physician (the CMO no less) whether he could write her a script for some Ambien because she left hers at home. Her previous manager left the incident hanging out there for my client to deal with when he inherited the team, an act which is unprofessional in its own right. Clearly the employee didn’t find asking a client to write a controlled substance script to be a problem, so it’s likely to be an interesting conversation when the inevitable counseling occurs.

I could never work in human resources because I don’t have the poker face to deal with some of the things that come through the door. One of the funniest books I’ve read in the last few years is Let’s Pretend this Never Happened by Jenny Lawson. There’s a chapter about her past life as a human resources staffer that will make your head spin. (Warning: language may be inappropriate for the workplace, although common.)

I sincerely enjoyed working with this new client this week and look forward to several more sessions in the coming months. It’s always fun to see someone who is idealistic and enthusiastic who hasn’t been beaten down like so many of the rest of us. I’ve enjoyed teaching him my favorite Jedi tricks around email management and getting through days with high volumes of meetings and little productivity. I hadn’t imagined myself as an elder statesperson in the realm of corporate survival, but it seems that I may have arrived there. It’s definitely a new adventure.

What’s your best story about bogus expense reports? Email me.

Email Dr. Jayne.

Morning Headlines 3/30/17

March 29, 2017 Headlines No Comments

AI versus MD  

Pulitzer prize-winning oncologist Siddhartha Mukherjee, MD describes recent advances in AI-based image recognition algorithms and their potential use as a diagnostic tool for future radiologists.

This Is How Bipartisan Health Care Reform Could Actually Happen

In a Time Magazine op-ed, Former National Coordinator for Health IT Farzad Mostashari, MD discusses various health reform options that could win bipartisan support.

Rupert Murdoch reportedly sold $125 million in Theranos stock for just $1

Rupert Murdoch walks away from his $125 million stake in Theranos, selling his shares for $1. Meanwhile, Theranos CEO Elizabeth Holmes has agreed to give existing investors more shares from her personal stock if they agree not to sue the company.

The Patent Battle Over Revolutionary CRISPR Gene-Editing Tech Just Went Global

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Trump taps Chris Christie to lead fight against nation’s opioid addiction crisis

New Jersey Governor Chris Christie is selected by President Trump to lead a commission combating drug addition and the nation’s growing opioid addition.

HIStalk Interviews Paul Roscoe, CEO, Docent Health

March 29, 2017 Interviews No Comments

Paul Roscoe is co-founder and CEO of Docent Health of Boston, MA.


Tell me about yourself and the company.

I’ve been in healthcare my whole career. I’ve had the privilege of working with some amazing teams over the past 25 years at Sentillion, the Advisory Board, and Crimson.

I’ve been very privileged now to work with an equally amazing team of folks here at Docent Health solving a problem that is a top priority for most, if not all, health system CEOs. Which is, how do you think about the patient experience in dramatically different ways and more compelling ways than we’ve seen to date? 

If you think about other industries that have done an amazing job of redefining the experience their customers have when they’re engaging them, healthcare has a lot to gain and learn. That’s why we created Docent Health — to be able to think about a completely new approach to experience for patients as they go through their healthcare journeys.

What do your patient liaison folks — your docents — actually do? How do they integrate with the traditional healthcare team?

There are two parts to the story. One is the use of technology to fill a gap that exists today between the electronic medical record — which has a very good, rich, clinical representation of the patient — and maybe the CRM, which has a more sales and marketing orientation of the patient. There’s this gap between the two, which is providing a rich profile on the patient as a human being.

What are their concerns? What are their anxieties? What are their preferences? Building out a rich profile so we can understand previous experiences and then personalize an experience to them.

It feels like health systems are treating patients as a stranger every time they interact with them. There’s a lot of opportunity to capture this information and make sure we’re personalizing the experience.

There’s a large role for technology, but we felt that there was also a bit of a service gap in terms of how you then engage with a patient. Clinicians are extremely busy, focused on top of license. There’s an opportunity to partner with those caregivers to deliver a new service approach. In our business, that is through a service function that we call the docent program.

Docents are empathetic, hospitality-trained, customer service-oriented people coming out of healthcare. They may have been nurses who don’t want to nurse, or they’ve come from hospitality or other customer service industries. They provide a bridge in many ways between the patient and the caregiver. They act as a guide. They set expectations.

They are providing service touches throughout the journey. Not just in an inpatient setting. That’s obviously the logical one, but we’re now engaging with patients throughout they’re journey.

One of our health systems is focused on maternity. If you think about the journey for a mother, her inpatient stay is only two or three days, but there’s all this time before and sometime afterwards where we can be engaging with them to understand what they want from their experience. That’s the role of the docent.

When hospitals get docents involved, is there resentment or conflict with staff who are accustomed to being the only connection to the patient?

I’m not sure I would frame it as resentment, but certainly there are logical and understandable concerns that one must initially overcome. Clinicians feel they have a sense of responsibility for the patient and they’re bringing on a new resource. You almost have to earn your stripes.

One of the things we do at Docent Health is to very much focus initially on that relationship between the docent and the caregiver. What we’re already starting to see from the work that we’ve done with our customers is that there’s a lift in staff engagement. Clinicians have joined healthcare, on the whole, to deliver great care. Many of them have become somewhat disenfranchised because they’re not able to provide the amount of time on an individual patient basis.

The docents now are building relationships with patients in more meaningful ways. Perhaps earlier on in their journey, starting to capture this picture of what’s important to patients. Then sharing it with the caregiver, so that when the caregiver does interact with that patient, it’s not generic — it’s personalized to things that are relevant for that patient.

Our belief is that for experience to be successful, it must meet two tests. It’s got to be a better experience for patients — make them feel like they want to come back, make them feel loyal. It also absolutely has to be a great experience and have lift for the staff, because at the end of the day, it’s a complete, total experience.

One view would be that we don’t have ways to capture the necessary non-clinical information, while the other would be that clinicians don’t have the time or maybe even the ability to do something with it even if we did. Does the docent make the process less laborious than reading a lengthy, free-text narrative at the right time in the process?

It’s a good observation. The logical technology solve to this might have been to say, "We’re capturing all this information about what’s important to a patient. Why don’t we just push that up into the electronic medical record?" The reality is that clinicians are already at their breaking point sometimes on the use of EMR, so putting more data in there and flagging it wouldn’t necessary be the solve.

We’re engineering processes where the docents — on a daily, maybe even more frequent basis than that — are huddling with clinicians, and at the right, appropriate time, delivering information that might be relevant for that particular patient. We operate in the nursing huddles. We participate in the rounding meetings.

Rounding is an interesting concept in a hospital. It’s like the general manager of a hotel randomly knocking on four or five doors saying, "How are we doing?" What we’re able to do with the docent program integrated with the caregivers is have rounding that is more personalized and adaptive to the issues the patients are facing rather than generic. That’s an example of a process where we’ve integrated the docents into that rounding so that we can provide a lot more lift and a lot more information that’s relevant to the patient.

What incentive do health systems have to get to know their patients better?

It comes back at the end of the day to whether you are in a fee-for-service world or a risk-sharing world. Health systems are waking up to the realization that they haven’t done a lot of work in terms of building a relationship with a patient, a relationship that takes their brand and makes it much more personal to that patient. Consumers are paying more for their healthcare then they’ve ever done before, having more choice, and going to different venues to make that choice. They don’t go to the common channels that health systems might like around cost and quality. They’re going to Yelp. They’re going to other social media resources.

The final frontier for a health system to build a relationship is not just about clinical outcomes. That’s a much more of a level playing field these days. It’s about experience. If you look at outside of healthcare, great brands have created an experience around their products and services. Product and service, in many ways, is somewhat incidental to the experience they can wrap around. Their belief — and there’s proof — is that that experience creates a relationship, and the relationship equates to retention, loyalty, and maybe in a more advanced state, advocacy.

Health systems are realizing that consumers have choice and are paying more for their healthcare. There are new entrants to healthcare coming up — urgent care clinics and retail medicine — that don’t have the same baggage as the health system. They’ve figured out how to get an appointment quickly. They’ve figured out what customer service is. 

Health systems are increasingly concerned about those.They are realizing that experience is almost an untapped asset. If they do it well, it creates this relationship with a patient that’s great for both the mission and the business.

Is data-driven empathy an oxymoron?

Data-driven empathy? [laughs] When you think about the tech-enabled service model that we’ve deployed at Docent Health, they go hand in hand. You can’t have one without the other.

Just data for data’s sake but not empathetically driving an interaction comes across as clinical and vanilla in many cases. Empathy itself — just being touchy-feely without knowing what the right actions are and using the data to direct those actions — also doesn’t necessarily solve the problem and doesn’t scale. Our view is that you need both.

I go to health system CEOs and say, "If you had $20 million to improve your experience, where would you start?" There’s a lack of data to figure out what things make a difference to a patient that you should be focused on. We’re hoping to provide much more data inside our platform to help guide those.

The empathetic service model is as important as the data. I would point out that our way of doing it through our docents may not be the right answer for everyone. There are some health systems out there that have already invested in this, both culturally and in terms of resources. For that customer, the technology that we provide might be the most important for them as opposed to the technology and the service.

What kinds of patient information that you collect are most often relevant yet missed by hospitals?

Let’s take the journey of a middle-aged knee replacement patient who has been to that hospital in the past. We can craft an experience for that patient that combines things we know about him individually and preferences of perhaps other patients who have been through similar processes and similar procedures before. There’s a segmentation set of activities that will allow us to tailor this experience. We can look at past experiences and what worked, what didn’t. Whether there were previous service recovery moments in a past experience that we can learn from.

Did he have a good experience with anesthesia in the past? Has he expressed any specific concerns or fears that we want to be able to capture? Do we know of any specific sport that he participates in and he’s anxious to get back to, so we can anticipate his questions and perhaps his needs around physical therapy?

Based on all this data, the journey we could prescribe could include interactions. Pre-surgery discussion of how he’s going to get his knee ready to go back and play his tennis championship in three months because that’s what he’s so focused on. Suggestions for physical therapy near his house that are focused on that.

For us, it’s about taking a personalized approach, but combining that with data we’re capturing on like patients in similar cohorts. Then combining that with data science that says, "We’ve done 10,000 of these journeys for this type of patient before. What we’ve noticed is that if we deliver an experience in this way with these steps — some of them digital, some of them human — the likelihood of a great experience is Y."

Do you have any final thoughts?

For me, after being in healthcare for so many years, it’s invigorating and a thrilling time to be in the patient experience space. The beauty of it, in many ways, is that there’s already a playbook in front of us. Restaurants, hotels, airlines, and other industries have been rethinking customer journeys over the last 20 years or so. There’s been a term for that — the experience economy. It’s been a well-known economic industry that’s been created through these experiences. In many ways, they had no choice but to innovate and to evolve. 

Now healthcare has this same opportunity. It’s an extremely exciting time to be able to use my experience in healthcare and that of my team to fuse that with these learnings, best practices, and approaches that have worked in other industries.

Morning Headlines 3/29/17

March 28, 2017 Headlines No Comments

Cyber Criminals Targeting FTP Servers to Compromise Protected Health Information

The FBI’s cyber division issues an alert warning healthcare organizations that hackers are targeting FTP servers operating in anonymous mode to access PHI and launch ransomware attacks.

Virtual System Works in Managing Diabetes for Hospital Patients

UCSF researchers piloting a centralized dashboard designed to help diabetes specialists monitor the glucose levels of hospitalized diabetes patients find that the new system led to a 39 percent decrease in hyperglycemic patients and decreased the number of hypoglycemic events from 40 to 15 over a 12 month period.

Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians

The American College of Physicians, written by ACP’s Medical Practice and Quality Committee discusses the need to reduce administrative burden being placed on physicians.

Leading Wisely: Better Executive Decision Support

Health Catalyst launches Leading Wisely, a near real-time executive decision support dashboard for healthcare leaders.

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