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HIStalk Interviews Girish Navani, CEO, EClinicalWorks

August 1, 2017 Interviews 1 Comment

Girish Navani is CEO of EClinicalWorks of Westborough, MA.


Tell me about yourself and the company.

EClinicalworks was founded in 1999. We have had significant success in the ambulatory electronic health records space.

What may not be very easily identifiable is the size at which we have had an impact. For example, last year more than 200 million electronic prescriptions and more than 270 million visits were recorded by a provider using EClinicalWorks EHR. I’d go as far as to add that in last 17 years that other than Epic, no other EHR company has had more physician EHR implementations than EClinicalWorks.

Additionally, over the last five years, we started building products for patient engagement under the Healow brand. We have had remarkable success in terms of acceptance. As an example, last year Healow providers sent 200-plus million reminder messages to patients regarding conditions and visit reminders.

That’s the summary of the company in terms of its footprint and how it gets used everyday in the healthcare space.

The company didn’t admit any guilt in the Department of Justice settlement involving falsified testing results, lack of data portability, and failing to keep customers informed of software defects. Given the limits of what you’re allowed to say based on the settlement terms, what’s the side of the story we haven’t heard?

First of all, let me say this. There are regulatory requirements that electronic health record users have to comply with and there are requirements that electronic health record vendors have to comply with. In 2015 and 2016, there were technical non-conformities identified by the government. Once identified, we addressed them promptly. These non-conformities were not intentional on our part, nor did we know about them and ignore them. Nevertheless, I respect the right of the regulatory authority to enforce the requirements.

We have to move forward. We addressed the non-conformities. We also found a meeting ground on the settlement that allows the company and me to focus on tomorrow. I have resumed my normal work activities, including my personal time with family that got compromised last year. We have developed a stronger compliance program and it has made the company stronger. I am more focused on developing our next EHR version and making a positive impact

Do you think the value of the settlement at $155 million reflected the DOJ’s desire to have a single point of resolution without having to ask your customers to pay back their Meaningful Use payments?

I can’t speculate on all parts of the question. But, yes, the settlement amount certainly represented a portion of the Meaningful Use dollars paid under the program.

How have your customers and prospects reacted since the settlement was announced?

I have received hundreds of positive, reinforcing emails. We’ve done well by our customers. My customers recognize it and I’ve received support from a large number of my customers. I have not seen any attrition attributed to the settlement.

Secondly, in terms of new business, June was our best sales month of 2017. We signed 100 new customers and over 1,000 new providers on the electronic health record side. We did well on the population health side as well, as five new ACOs picked our pop health product. Last Friday, we announced our Q2 2017 numbers. We had a strong June and second quarter in terms of new and existing business.

I would summarize by broadly saying that the customer base likes the product and loves the company. It is my commitment to everyone that uses our product that EClinicalWorks is going to be focused on a much brighter tomorrow and that message is strongly heard by my customers. I am dedicating a lot of my time to making the product and service better. I don’t see why an existing customer won’t be delighted with that information and I think it has been reconfirmed to some extent in June with our continued momentum

What progress has the industry recently made in interoperability and data portability?

I have positive data to share in this particular regard, not just for EClinicalWorks, but for many industry players. I would unequivocally say that Carequality has been successful. We’ve been able to connect many Epic customers on a regular and routine basis.

It’s not just connectivity in terms of data exchange, but the simplicity with which we are able to do it. We’re able to onboard practices within minutes. We built the Carequality Hub in the cloud and we can add new practices quickly. There was a recent article regarding an ECW customer, Eagle MD, a 61-provider group in North Carolina. They have a lot of patients in common with Cone Health, which is an Epic implementation. They talked about how patient care has improved because of Carequality.

CommonWell Health Alliance, which we are also a member of, has had success when it comes to Cerner Hospitals. Some of the other acute EHR vendors have not necessarily put the same energy behind it. I hope that changes and we see more success there.

Broadly, I am excited about the fact that these networks can become equated to Visa or Mastercard networks and interoperability becomes more of a trust model that providers have to activate versus custom software that vendors have to develop. We are there from a technology standpoint. It’s now a question of getting providers to start activating the trust relationships so they can retrieve and send data to any provider as patient care is being delivered.

It is happening. This is not hope for the future. We are seeing data exchange happening every day.

How would you assess the industry’s maturity in managing cloud-based systems based on the latest high-profile, extended outage?

The move to the cloud model is — not just for healthcare, but for the ecosystem of every industry — irreversible. We are seeing business models over the last decade facilitated by the cloud that just cannot be contemplated by on-premises and siloed implementations. Uber doesn’t own any cars and does not own the mapping technology, yet it is now one of the largest transportation companies.

Healthcare is no different. Healthcare has the provider side. Healthcare has the consumer side.

The move to the cloud is an irreversible process. It has to go through its trials and tribulations, but the same can be said for an on-premise system. I would not take this episode to be the barometer of whether the cloud is going to revolutionize the delivery of care. I think it will, and it is as we speak.

What significant changes in the ambulatory EHR market have occurred recently and what developments do you expect going forward?

Let me give you an analogy and then make my point. Microsoft Word, Excel, PowerPoint, and Outlook were mostly on-premise deployments with Microsoft Exchange servers. That has been replaced with Office 365. Not everybody has moved to Office 365, but if you look at both Microsoft and its customer base, Office 365 is the trend. I don’t think that is reversible. You want one cloud service that provides all end user capabilities and IT capabilities — storage, collaboration, and anytime, anywhere access.

You expect the same when it comes to not just ambulatory, but healthcare information technology in general. You need to have a unified cloud service that delivers capability, whether it’s scheduling, EMR, practice management, patient engagement, or population analytics. A customer should expect these to be an unified cloud service.

Will it require significant investment? Yes. It’s not 1, 2, 5, or 10 million dollars. It’s tens of millions in terms of capital, organizational investments, and processes that have to be invested. We’ve gone through this over the last 17 years. We know the effort and capital required. So if it results in any significant market change from a vendor standpoint, it will be based on the ability for those investments to be made.

Alternatively, there is Amazon Web Services and Microsoft Azure. It doesn’t preclude a smaller company from leveraging these platforms and building a cloud offering if they want to. But the product has to be architected first to be cloud-centric. It’s not about taking a client-server product and deploying via Citrix or Windows terminal server in the cloud and merely hosting the system. The true differentiator is a cloud collaboration platform that encompasses all capabilities we just talked about.

Companies that can deliver health information technology via the cloud will succeed over the next decade. The other models won’t survive. You and I don’t get electricity today through generators that we power our individual homes with. We expect the electric grid to deliver power. Users should expect the cloud to deliver data and information powering the devices and not having servers housed locally doing it.

What is the status of the hospital system ECW is developing?

We have two products to talk about. One is for the ambulatory surgery center market. Over the last two years, we developed our ASC offering and have had success with existing customers that have ambulatory surgery centers. This product took us in the OR space with anesthesia documentation, preference cards, surgery scheduling, etc. Our ASC product has been successfully rolled out and we’re able to get many of our customers to now implement it.

We have also, without too much fanfare, been developing our Acute Care EHR offering for many years. Our pathway is different. We don’t want to acquire a company to build the solution. Instead, we partnered with our ambulatory hospital customers as joint development partners, or JDPs. We worked with them to develop the Acute Care EHR solution.

We have a large team of product analysts working on site with our JDP hospitals. We have had good customer acceptance to the whole idea of a unified cloud-centric inpatient-outpatient system that will manage the breadth of the acute care space — from ER on one side to all of the ancillaries that include pharmacy, LIS, RIS, etc. We expect to go live with our JDP customers in the first half of next year.

What challenges do you see as you enter that market, which has had basically no new significant entrants for decades?

First, I see excitement, I am an entrepreneur who has a strong technology background. I thrive on the idea of change. Getting into an established market like inpatient, and to some extent, challenging it with a newer premise — a cloud-based offering — that’s exciting.

What challenges does it offer? It is a wide space. The Acute Care EHR requirements and the number of modules as we count them exceed 25. I would put ER as one module, LIS as another one, for example. There are 25 such modules that we have to develop. The breadth is substantial. It takes significant engineering work, product analysis, and product management.

We communicated to our customers that this was going to be multi-year journey. I am comfortable with the progress we have made. We are getting to the stages of user acceptance testing and integration testing in the second half of this year.

The challenge also is the mindset. Can per-bed, per-month pricing truly change the status quo? If you draw parallels, SAP used to dominate the ERP systems for a very long time. Then came Salesforce, with a different model. Salesforce initially succeeded in smaller footprint enterprises and then it stepped its way up the ladder to enterprise systems that have larger scale.

It’s not uncommon for me to be asked a question, will you be limiting this to a certain size of the hospital? It’s more intuitive for me to answer that we will start with the smaller ones and we’ll step it up. But we are not designing the product to meet the needs of a critical access hospital and ignoring larger hospital systems. The market will accept it on its own terms after we have proven success. I am patient while quite enthusiastic about investing in this space.

What is the population health management opportunity and how are you responding to it?

Population health is primarily being driven by the fact that payer reimbursement for care delivery is changing. EClinicalWorks has developed the analytics platform, the care management platform, and has additionally developed risk models and predictive analytics. From a market share standpoint, when it comes to physician groups that are accountable care organizations, we have one of the largest footprints in this space.

The next evolution is patient engagement. When it comes to home trackers, home monitoring, telehealth etc., we have a sophisticated product offering developed under the Healow brand.

In summary, I don’t see this to be a niche area. I see this to be an evolution of the digitization of healthcare. But then again, that’s how I have always visualized technology. I see this as a vertically integrated supply chain. You start from one end of the spectrum and you go to the other.

The first decade was about digitizing the provider space. The next decade is going to be about digitizing the patient experience and managing panels of patients. Companies that do well in that space will thrive and the ones that build a fully vertically integrated ecosystem will do even better.

You said in our 2008 interview that your goal was to work 15 years and leave behind a legacy of a stable software company that could be turned over to the next generation. We’re more than halfway into that 15 years. Where do you see the company going from here?

I have obtained the first goal that any entrepreneur founder has about a company, which is to have success that can be recognized in its industry. We have attained that.

Along the way, I have developed broader goals. To me, it was always about building a company that outlasts its initial founders. This was the premise that made us not go public or take on private equity.

This area of my thinking has been further enhanced over the years. I expect  in my next 10 years to serve a broader population of patients, I’d like to see digital healthcare result in positive health outcomes, I’d like to see our company participate in clinical trials and research. I would like to see genomic data become a part of electronic health records so that precision medicine can succeed.

I am energized and enthusiastic about the next 10 years. Over the last six weeks, I’ve rediscovered myself to some extent and I’m plowing forward. You should expect more from my company and me.

Do you have any final thoughts?

I love my work and I think the future of digital healthcare is bright. Every industry has to go through a maturation phase, I think we’ve attained that in the US healthcare system in terms of the adoption of the basic foundation of digital care.

What we need to now focus on are the benefits. Anytime, anywhere patient care via the use of telehealth and intelligent messaging, genomic data resulting in personalized medicine. I just don’t see why a patient in some part of the world can’t get a second opinion from a neurosurgeon in the US. Many of these broad goals can be attained with the use of technology. It will take some time, but it will happen in this lifetime.

Morning Headlines 8/1/17

July 31, 2017 Headlines No Comments

White House panel urges Trump to declare state of emergency over opioid crisis

A White House commission addressing the opioid epidemic recommends that President Trump declare a federal state of emergency.

Republicans ignore Trump’s Obamacare taunts

Senate Republicans say they won’t try to repeal the Affordable Care Act despite the President’s tweets declaring that they should address no other pressing issues until they pass a healthcare bill.

Baltimore-based Evergreen Health to be liquidated

Baltimore-based HMO Evergreen Health, launched by a former city health commissioner, will be liquidated after investors withdraw their bids to acquire the company.

Spare America a do-over on health care. Seize the bipartisan moment.

Former CMS Acting Administrator Andy Slavitt says in a USA Today opinion piece that Americans should hold President Trump accountable for his threats to cut off Affordable Care Act insurance subsidy payments to low-income citizens and instead demand bipartisan healthcare support. 

Curbside Consult with Dr. Jayne 7/31/17

July 31, 2017 Dr. Jayne 1 Comment

I wrote a little in the last EPtalk about the interview Atul Gawande recently did with Tyler Cowen. I find Gawande fascinating and appreciate his measured, real-world thoughts around some of the challenges we face in healthcare. There’s a lot of push to try to have technology solve everything and his respect for simple solutions, such as checklists, is refreshing.

One of the topics covered in the interview was medical education, specifically what is missing from the way we train doctors. Many of us recognize that there has been quite a bit added to medical education in the last few decades – genomics, precision medicine, and the concepts of clinical quality and patient engagement. I started my medical education at a time when schools were first realizing that non-science majors could be physicians and that we had other knowledge to bring to the table.

Gawande notes that there isn’t any education “around the fact that we are no longer a craft. It’s no longer an individual craft of being the smartest, most experienced, and capable individual.” He goes on to say that medicine has “exceeded the capabilities of any individual to manage the volume of knowledge and skill required” leading to care delivery via teams. Students need to know how to function as a team, how to manage when the team isn’t being effective, and more.

I’ve found that it’s not just in medicine that people are missing out on functioning as teams. Our culture has become so competitive, even down to the ranks of toddler soccer, and activities that promote teamwork and team development seem to sometimes fall by the wayside. Although sports can be an avenue for teamwork, I see more push towards individual performance and trying to advance to more exclusive teams than I see towards working to make sure the team is the best it can be.

I’m working with a client right now that is a case study for this. They have a small stable of individual contributors working on process improvement projects. They can each recite a long list of their achievements and how they have climbed the ladder, but they are struggling to grasp the concept of themselves as a team. Some of it resolves around trust in the team, and teaching people to trust each other is a lot harder than people think. With this group, I’ve never seen as many eye-rolls as I did when I asked the group to read “The Speed of Trust” by Stephen Covey.

He shares his thoughts on physicians of the future needing to operate more as trusted counselors who have increased dialogue with patients about their goals and needs. During my career, I’ve watched the physician-patient relationship evolve from a more paternalistic model to one of shared decision-making and patient empowerment. Being in a more consultative role makes sense, but unfortunately our current framework for compensating physicians doesn’t support that. Even with the transition to value-based care, physicians are being paid for outcomes, which means following population-based protocols that may or may not be right for a specific patient.

He mentions the mismatch between treatment and patient priorities as being a cause of suffering. Additionally, he notes that the change in how healthcare is financed has altered care: “Just the payment incentives alone dramatically affect whether my tendency is to give you overtreatment in certain situations and undertreatment in others.”

I did find it funny and a little bit ironic that Gawande said, “The most powerful tool that a clinician has is their pen, and has the power to order medications to test, to doing an operation.” I haven’t used a pen in the exam room for years and usually I only use one to sign return-to-work notes or controlled substance prescriptions. It just doesn’t sound as exciting to say the most powerful tool you have is your computer, although I think it’s true. For many of us, it’s not just about ordering tests – it’s about having immediate access to information from around the world and to be able to bring that information to the discussion at the point of care.

Gawande was asked about the FDA and whether the new drug development process should be liberalized. Some of us weren’t around when there was no such thing as the FDA and he has some good reminders in that regard. Although it was a time of innovation, it was also a time with horrendous medical endeavors such as the frontal lobotomy and the Tuskegee experiment.

He notes that the process of regulating medical treatments has been sped up by patient engagement efforts around HIV and has led to more discussion of the balance between risk and speed of innovation. Increased speed has led to more drugs being withdrawn as a result of post-marketing surveillance and he supports balance in the approval process. He also mentions his thoughts on the FDA not only regulating drugs and surgical devices, but in tracking outcomes for surgical procedures. Although procedures can have some variability based on the patient and the circumstances, he feels there is a fair amount of institutional variability that could benefit from tracking and analysis.

The interview was a far-ranging discussion, including Gawande’s thoughts on Stevie Wonder (was overrated, now underrated); Michael Crichton (both over and underrated); and Karl Knausgard (overrated). He tags wearables as underrated, largely because they don’t do terribly much right now.

He also talked about his work as the director of Ariadne, an academic center that is part of Brigham and Women’s Hospital and the Harvard Chan School of Public Health. The center looks to study how science and innovation impact healthcare delivery. They recently did work with the state of South Carolina studying how to encourage surgeons to use a surgery checklist without regulations or mandates. Their program achieved 40 percent adoption, but he noted that it would likely take mandates or another process to bring the other 60 percent of surgeons to use it. I have to admit, the center has been running for five years and I hadn’t heard of it, although it sounds like something I’d be very interested in. I have a good friend starting her MPH at Harvard this fall, so I’ll have to see if she can get me an insider view.

There were some other interesting statistics in the interview. The average American has eight operations in his or her lifetime. He’s particularly interested in that because surgery is “the highest-risk, highest-cost, highest-failure moment in your lifetime.” Personally, I think the idea of having eight surgeries is something to be explored in its own right and would love to dig into those numbers.

I also appreciated Gawande’s thoughts on building his team and hiring the right people. He encourages the hiring manager to come up with a list of accomplishments for the next two years and hire someone who can meet the goal rather than hiring someone that is likable or fun. He notes that people should Intend: “Do what you intend to do, and do it with intention. Over and over, that’s what people fail to do.” I see a lot of that in my own world, people treading water or going with the flow, and moving with intention is significantly less common.

The interview closes with Gawande’s thoughts on indie music. He recommends Scottish band Frightened Rabbit, who he describes as “bards of sorrow and nonetheless sticking it through.” He warns that “they’re Scottish, so there’s a whole lot of cussing going on.” Based on that recommendation alone, I’ll have to check it out.

Email Dr. Jayne.

Digital Health Fragmentation – Is Amazon the Answer?

July 31, 2017 Digital Health 7 Comments

Digital health updates are written by LoneArranger, an anonymous industry insider.


Thousands of startups in the digital health space offer a wide variety of features and functions, generally targeted at specific conditions and diseases or designed to address relatively narrow use cases. Relatively few of these are actually being prescribed by providers, and the most popular consumer apps do not typically ingest data from EMRs or other healthcare information systems.

They may have the capability to export data to these systems, but not necessarily in a way that yields any real value for providers or patients. Further, many are standalone tools or part of limited proprietary collections of loosely related applications that fail to offer the value proposition that would engage a large number of users.

This lack of critical mass has impeded broader adoption and limited the potential of digital health solutions to have a significant impact, at least in the near term. Other than the mobile versions of EMR portals like MyChart, few universally applicable solutions cut across large numbers of health systems and users. Even then, they may function differently depending on the sponsoring organization or local community policies. Just having a large number of mHealth apps in the major app stores does not constitute a critical mass for the purposes of delivering value that customers will actually pay for.

What is needed is a comprehensive, cohesive, and interconnected ecosystem that provides greater value for both providers and patients. The goal would be to create an environment that encourages innovation, but also provides a framework for connecting the myriad of applications into logical clusters and leveraging functionality and data that already exists in legacy health IT systems.

This may be the ultimate goal of the newly announced Amazon 1492 health research initiative. The 1492 group reportedly has been working on ways to streamline medical records management, to make the information more readily available to consumers and doctors. In addition, it reportedly has been considering a plan that could improve US healthcare for those with limited access to a doctor. The group is also exploring health applications for existing Amazon hardware, including Echo and Dash Wand. While there’s no evidence that the team is currently exploring connected health devices, it’s possible it could eventually do so.

Obviously Amazon has already built a comprehensive marketplace for selling and distributing a wide variety of goods and services, and global scale which puts it in a prime position to create a mass market once these new offerings are launched. It has existing relationships with many potential customers and through its portfolio of Cloud and other technology products and services has strong connections to enterprise customers, including many in the healthcare industry.

Amazon could use all of these capabilities to create a national framework for digital health delivery that could also provide local customization, working with leading health systems across the country. This would potentially enable patients to access a broad suite of connected apps and services that shared data across the ecosystem and also integrated with their existing patient records at various institutions where they existed. Data from all sources could be aggregated into a complete longitudinal record that could drive advanced analytics and artificial intelligence to enhance patient care and provide improved patient engagement and interaction with their providers to better manage their health.

This is one (but not necessarily the only) way that the true potential of digital health could be realized.

Morning Headlines 7/31/17

July 30, 2017 Headlines No Comments

Mark Zuckerberg, Priscilla Chan Donate $10M to Advance Health Using Big Data

The donation will fund the launch of UCSF’s Institute for Computational Health Sciences, which will perform analytics-powered drug discovery using a combined EHR dataset from all five UC system medical centers.

Cerner (CERN) Q2 2017 Results – Earnings Call Transcript

Cerner says it will name a new CEO soon and acknowledges that it will serve as prime contractor in the VA project for which the contract is being negotiated.

Doctors use this software during patient visits. Now Big Pharma is tapping it to sell their drugs

Doctors in Canada question whether EHR vendor Telus Health should sell drug companies the chance to have their patient discount coupons pop up in their workflow.

Monday Morning Update 7/31/17

July 30, 2017 News 11 Comments

Top News


Mark Zuckerberg and Priscilla Chan, MD donate $10 million to launch UCSF’s Institute for Computational Health Sciences, which will perform analytics-powered drug discovery using a combined EHR dataset from all five UC system medical centers.


The institute is headed up by UCSF pediatrics professor Atul Butte, MD, PhD, who says, “This is among the richest and most diverse medical datasets in the world, much more than just a set of billing codes. Because the data come from our patients, the data are an incredible resource for UC hospitals to improve the quality of care we deliver throughout California.”  

The UCSF announcement describes the potential application of Butte’s “data recycling” project that will analyze existing data sets to gain new insights:

The results of his work can be surprising. By combing through databases, members of Butte’s lab have shown that it may be possible to combat liver cancer with a drug originally approved to kill parasitic worms. They recently developed another computational method that rapidly predicts what other drugs might treat cancer, again using readily accessible public databases.

These approaches may offer a more cost-effective way to discover drugs than conventional strategies. To bring these novel, computationally identified drug candidates into early clinical trials might require a few hundred thousand to $1 million, compared to the $10 million to $1 billion or more that a pharmaceutical company typically spends to bring a new drug fully to market.

But drug discovery is just one potential use of data, as both scientists and physicians acquire deeper computational sophistication. At medical centers like UCSF, electronic health records (EHRs) are increasingly being looked to for insights on how to improve the quality of care and to better understand disease. For example, UCSF physicians used the medical record system to institute a virtual glucose monitoring system that, over three years, reduced the proportion of patients who were hyperglycemic by nearly 40 percent.

Reader Comments


From UMMC_Breach: “Re: University of Mississippi Medical Center. Another breach. This time their Epic server was hacked, affecting 7,500 individuals.” HHS’s wall of shame says the breach, categorized as a “hacking/IT incident,” was reported three weeks ago. I haven’t seen details. UMMC paid $2.75 million a year ago to settle HIPAA violations related to theft of an unencrypted laptop and poor implementation of security policies and procedures. UPDATE: a UMMC source says it wasn’t Epic that was breached – it was a retired EHR from a facility UMMC acquired several years ago that was maintained by a third-party vendor who operated it on an isolated network. It was never running on UMMC’s network.

From Richard Head: “Re: must-read HIT blogger list. You are on it.” Thanks. I’m not too impressed by the list, which was put out by a publicity-seeking, vendor-produced magazine. The evaluator is the 24-year-old “senior editor” whose LinkedIn says she was working as a bar cook three years ago before landing a job in aviation publishing and finally meandering into healthcare a few months ago. She actually made a few good choices, but some of the sites appear dormant, don’t have anything interesting to say, or have resorted to running promotional articles written by paying vendors. I only read two of the sites listed — Politico Morning EHealth and John Halamka’s Life as a Healthcare CIO.


From Subdude: “Re: Epic’s hardline stance against hosting third-party systems with their new RHO offering. I’m surprised Epic since has many third-party dependencies, far from a full-service offering comparable to those of other vendors.” Subdude provided a list of systems that Epic won’t host, some of which are:

  • PACS and coding
  • Credit card processing
  • Document management
  • Supply chain systems
  • Faxing
  • Fetal monitoring
  • Interface engine
  • Lab instrument middleware
  • Medical device integration systems
  • Enterprise print management
  • Single sign-on
  • Telemedicine
  • Speech recognition


From Vaporware?: “Re: Cerner’s DoD go-live at Oak Harbor. Zane Burke listed what went live in the conference call. What was missing: CommonWell, Cerner Network, or any kind of record exchange to the outside world. No connections Cerner to Cerner, to Athena, or to Carequality. The facility is literally on an island, but this is taking it a step too far.” I wouldn’t assume that failing to mention interoperability to a bunch of stock analysts means it’s not in place, but maybe someone in the know can elaborate further.

From Jade Warrior: “Re: provider. I would prefer that you not use that term – it’s demeaning to physicians.” Physicians tend to forget that they aren’t the only “providers,” which is why a more-inclusive term was needed to collectively refer to physicians, hospitals, nurse practitioners, physician assistants, podiatrists, and other non-MDs/DOs who see patients without over-the-shoulder supervision, prescribe medications, and bill for their services. I don’t even like the title “doctor” since physicians hijacked it from others who are equally entitled to use it, such as pharmacists, dentists, or nurses who have earned a PhD or DNP (in which case your nurse is a doctor). The proper response to someone who announces, “I’m a doctor” is, “In what field?” (or if you have a master’s degree, you could say, “Great, I’m a master.”) Maybe for individual providers (not hospitals) we should use the profession’s name to eliminate all confusion  – Physician Smith, Nurse Jones, Dentist Garcia. That still leaves the issue of someone who has earned the degree but didn’t obtain licensure or isn’t practicing, such as the late Monty Python co-founder Graham Chapman, MD or Argentinean revolutionary Che Guevara, MD.  

HIStalk Announcements and Requests


Cerner shares would be vastly preferred by poll respondents forced at gunpoint to choose one of those listed, with Athenahealth finishing a distance second. New poll to your right or here: how would you grade your largest local non-profit health system in terms of selflessly serving their communities and all patients who need their services? Vote and then click the poll’s Comments link to explain their score.


Welcome new HIStalk Platinum Sponsor InteliSys Health. The Las Vegas-based company offers RxStream, the first real-time prescription transparency platform. RxStream integrates into e-prescribing and EHR workflows to help doctors and patients make cost-effective prescription decisions based on real-time local pharmacy pricing of clinically equivalent drugs. It then offers prescription adherence alerts and reminders that are integrated into EHR workflow. Analytics power a feedback loop between prescriber and pharmacy that can prevent adverse events or avoidable encounters that are caused by non-adherence, also helping insurers understand the experience of their members with drug efficacy and outcomes as part of population health management beyond simple claims data. RxStream inventor and CEO Thomas Borzilleri saw firsthand as CEO of a pharmacy benefits manager that PBMs skim big percentages from prescription cost, driving their profits at the expense of not just patients, but also insurers and employers who lack access to the PBM’s opaque business practices and can’t tell whether a PBM is saving them money or actually increasing their cost. Thanks to InteliSys Health for supporting HIStalk.

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


This Week in Health IT History

One year ago:

  • ONC issues a $250,00 funding opportunity to create a cyber-threat information sharing service.
  • CMS adds star ratings to its Hospital Compare website.
  • A disclosed Apple patent shows that the company is interesting in allowing iPhone users connect with a doctor, send them their HealthKit-collected information, and initiate a telemedicine session.
  • Theranos CEO Elizabeth Holmes does a Q&A address the American Association for Clinical Chemistry, which one pathologist said is like having “Al Capone come and talk about his novel accounting practices.”
  • Advocate Health Care Network (IL) agrees to pay $5.55 million to settle HIPAA charges involving three 2013 breaches of its medical group.

Five years ago:

  • Defense Secretary Leon Panetta advises a House committee that DoD-VA integration won’t be finished until at least 2017.
  • McKesson in its earnings call expresses confidence in its Horizon-to-Paragon strategy and its satisfaction with RelayHealth’s market position.
  • Cerner predicts in its earnings call that Epic will suffer from trying to upgrade from its MUMPS-based platform and calls out Epic’s weaknesses as physician solutions, analytics, population health management, and interoperability.
  • Roper announces that it will acquire Sunquest Information Systems from its private equity owners for $1.42 billion.

Ten years ago:

  • Partners HealthCare signs a contract for Siemens scheduling, decision support, document management, community access, and payer connectivity.
  • Misys Healthcare CEO Vern Davenport hints at acquisitions but agrees with his boss Mike Lawrie that the company’s healthcare performance remains poor.
  • A hospital pricing company CEO argues that ambulatory EHRs don’t make sense unless providers are paid fixed prices for quality, questioning whether, “If the entire country implemented EMRs overnight, would we see significant overall improvement in healthcare productivity, efficiency, quality, and customer service?”
  • An Eclipsys shareholder sues present and past company officers who he claimed defrauded investors.
  • Health Affairs publishes a post-mortem on the failed Santa Barbara Project that was led by David Brailer’s CareScience, which had been replaced by CHCF, Perot, and Medicity.

Weekly Anonymous Reader Question


Responses to last week’s question:

  • Conducts all calls on speaker phone in a small office. His loud voice echoes through the hallway. Yes, he could close his door, but why be considerate of others?
  • Someone who when asked a question always responds by saying they’ve sent you the information you are asking for “a long time ago” BUT they’ve never sent anything. After a few rounds like that at meetings, I just resorted to follow up with, “OK, thank you. Please resend the email.” they always end up sending a NEW email. Another one: when you’re leading a productive, decisive meeting and someone literally wakes up halfway into it and asks a long-winded question regarding a topic discussed wayyy at the beginning of the meeting. I simply smile and ask them to refer to their notes. Last ones: missing signatures in email or no out-of office contact information.
  • Two women in leadership who just talk endlessly in meetings, even though 95 percent of what is discussed is already known. Waste endless time to be sure to get the 5 percent across. They apparently cannot see glazed eyes and blank stares and realize that the important 5 percent was probably missed when attendees only hear the “Peanuts” teacher voice after five minutes of regurgitation.
  • The person who annoys me the most is someone who acts supportive and professional, then puts me down to my boss.
  • My boss, who uses all our one-on-one time talking about herself and her work issues.
  • When on conference calls or even team calls, the constant questions. This is especially annoying when someone has already provided the answer or has asked the question previously. I also dislike anyone that constantly complains. My philosophy is that if you don’t like where you work, then save us all your misery and just go work someplace else.
  • They know enough to be dangerous and as if they are engaged and knowledgeable, but really are not and should defer to their knowledge experts. Ultimately results in more work and effort for all to proceed based on erroneous information by someone trying to fake it until they make it.
  • I am a weirdo who generally likes the open office. However, on a different team across the aisle from me (<15 feet away) sits maybe the most infuriating person I’ve ever worked with, and I give him this highly competitive award without ever having had a single conversation – he sings. He sings and whistles, and he does these things LOUDLY and REALLY BADLY, and it’ll just be snatches of a song: there will be silence, and then MEEEET ME IN ST LOUIE, MEET ME AAAT THE FAIR and then NOTHING, and then just when your brain has stopped anticipating more, it’ll come through again. It’s like water torture. It activates a deep, primal rage in me. And this was happening before I got here, and I have NO EARTHLY IDEA why his teammates allow it.
    As I typed this, he whistled for about five seconds. God help me with patience and a cube rearrangement soon.
  • Interrupting!
  • The fact he has to mansplain everything over and over again. Also doesn’t realize that we’re all different life (and work) doesn’t revolve around spreadsheets. Also, “Does that make sense?” all the time. “No, it doesn’t make sense. Why don’t you mansplain to me again?”
  • I work in an office building for a health plan. We have two small office kitchens on our floor. People seem to be either mess-makers or cleaner-uppers. I fall into the latter category. Why is it that whoever spilled the coffee grounds on the counter or got water all over the place, or slightly missed the trash can with a tea bag wrapper can’t be bothered to clean up? We’re not talking about mopping the floors and waxing the microwave here. It’s just basic. This is a first-world problem, I know. And it’s in the annoying category. The last place I worked had nasty office politics with back-stabbing and lies being told routinely. That’s not annoying. That’s career-threatening. I’ll take the mess on the counter any day over that, but still …
  • I’m a big proponent of “”teach a man to fish” vs. just answering the question du jour. I give someone the URL or email that tells them how-to or where to go for FAQ, etc. But it’s so frustrating when they keep coming back saying, “I know you told me xxxx. Can you send me that email again? I can’t find it?” or just asking the same darn question three months later. it’s so lazy and disrespectful when they clearly think my time is not as valuable as theirs.
  • I was going to answer, but I started getting really irritated listing all the traits. I figured I’ll just read other responses and be glad I don’t have to deal with those.
  • No follow through. Tasks are assigned, sort of completed, and left hanging. Somehow I end up completing whatever it is because it needs to be done, and it drives me insane. I’ve mentioned it several times and there was always some lame excuse.
  • People who complain about how difficult their job is because of the many obstacles they face instead of just doing the work.
  • He chooses to call me to discuss issues that can be detailed in a two-sentence email or a 60-second conversation. Those phone calls last 20 minutes minimum due to his ability to belabor the point or jibber-jabber and fail to get to the point. Waste of my time! I avoid his phone calls at all costs.
  • The thought that everything can just change instantly and therefore little thought is given to major requests which means we are in state of constant chaos resulting in rework and duplication that misdirects valuable resources. Hoping that all talk and little action or deliverables catches up with this person soon.
  • My narcissistic VP, who will say and do anything (except deliver) to look good without ever accepting accountability. It’s always some other person’s fault.
  • Instead of trying to solve/configure solutions or workflows for customers, they whine about the “fact” people don’t know what they want. Then find whatever excuse they can to avoid helping.
  • People who pretend they are doing work, but get nothing done; don’t work efficiently, and hold every one else up.  People who lie about the state of affairs and expect you to take the fall. Lack of integrity. Males who’s egos are way to big for their britches.
  • Slow response time.
  • They want to be, and think they are my good friend. Add to that quite a sense of self-importance.
  • Flatulence.
  • Chatterbox who spends conspicuous time at work socially, distracting by itself. Also complains loudly about difficult and complicated projects, so transferred out of associated roles to keep the peace. Yes, management is the core problem here, not the employee. 🙁
  • She treats most people horribly, yells at those who report to her constantly, is known for her back stabbing, and keeps getting promoted. We share an office wall so I hear too many of her cringe-worthy conversations belittling people, either in her office or on the phone.
  • Late to every. Single. Conference. Call. Always.
  • IT executives who are technically clueless and weigh in on every issue in every meeting whether they know anything about it or not to try and impress the CIO.
  • Not aligning priorities to team project deadlines. Other team members then are assigned additional takes late in the project and are frustrated while working to meet the deadline or work on overdue tasks.
  • The person who puts their phone on speaker while in their cube because they don’t like the ”feel of a headset.”
  • Changing deliverables and approaches the last minute.
  • Anal-retentiveness and risk-avoidance in the extreme.


This week’s question: what life-summarizing phrase would you choose right now for your tombstone? Limit yourself to 15 words regardless of your wonderfulness level.

Last Week’s Most Interesting News

  • The FDA announces a pilot certification program for digital health developers that will allow certified companies to get their products to market faster.
  • HIMSS names Hal Wolf as its next president and CEO.
  • A CNBC report says that Amazon’s 1492 healthcare skunkworks project is working on projects related to EHR data, telemedicine, and health applications for Echo.
  • CHIME takes over the “Most Wired” survey.
  • Nuance announces that its systems have not been fully restored nearly a month after its malware-caused outage, also warning investors of lower revenue and higher losses.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


From the Cerner earnings call:

  • The company is almost finished with its succession planning in which a new CEO will be named to replace the late Neal Patterson.
  • Q2 bookings were the highest in the company’s history at $1.636 billion.
  • The company says it is competing well against Epic because of predictable total cost of ownership, contemporary architecture, return on investment, and its commitment to an open and interoperable platform.
  • Cerner is scoping the work required for its VA project and negotiating a contract. It is also selecting partners, noting that unlike its DoD role, Cerner will be the prime contractor.
  • Intermountain’s revenue cycle is finished in the Salt Lake City area and the company will replicate its experience across its client base.
  • Zane Burke, asked about potential new non-traditional health IT competitors, said the core, transactional EMR is safe and that clients are more interested in getting data from it and Cerner’s open systems make that easy. He said, “I actually don’t think that those that are rumored to be doing things in this space are thinking about how they’re going to create the next EHR. They’re thinking about how can they add value into the whole entire healthcare supply chain and how can they think about making the consumer experience a better one because all of us are about to have a better patient experience at the end of the day.”


  • Banner University Medicine (AZ) will replace Epic with Cerner in October 2017.
  • Kingman Regional Medical Center (AZ) will replace Siemens with Meditech in September 2018.
  • AnMed Health Medical Center (SC) went live on Epic in June 2017.

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

Government and Politics

The US Supreme Court will hear oral arguments on October 2, 2017 in several cases involving mandatory class action waivers, one of them Epic’s. Epic — which was involved in previous class action lawsuits involving unpaid overtime — now requires employees to agree to arbitration instead of class action lawsuits for employment-related issues. The court will try to settle the conflicting decisions of lower courts in determining whether such agreements violate the National Labor Relations Act in preventing employees from acting together as  condition of employment.

Privacy and Security


A Roanoke, VA accountant’s office complains to the local newspaper about receiving frequent faxes from local hospitals, medical practices, and pharmacies after his fax number – which is similar to that of a physician’s office – was widely circulated. The accountant tries to do the right thing and let each sender know, but he gets PHI-containing faxes without cover sheets or spends up to an hour navigating phone trees and trying to reach the right person. He jokes that maybe he should just let the patients know directly since they have more clout with the provider involved. This is like most forms of healthcare data breaches – a provider that’s using poorly managed technology shoots the messenger for finding their mistake. Regardless of cover sheet legalese, the fax recipient is under no obligation to do favors for the the sender of the errant fax.



Doctors in Canada express concern over Telus Health’s decision to display prescription drug coupons in their EHR workflow, paid for by brand name drug manufacturers to discourage the use of less-expensive generics. The doctors worry that patients will infer that brand name products are better and that patients may perceive a conflict of interesting. Telus Health says the coupons display only after the doctor has already chosen a specific brand name product and offers doctors the option to turn the feature off. The company has enabled the voucher in two of its seven EHRs – PS Suite and Nightingale – and will add it to the rest of them.


Nuance offers these comments from my interview with Charles Corfield, CEO of Nuance competitor NVoq:

  • The NotPetya malware does not spread by email, by email attachments, or by infecting other files.
  • No Nuance customer information has been altered, lost, or removed by the malware.
  • We have no indication that any file contents on affected Nuance systems have been viewed by unauthorized parties.
  • We have seen no evidence that ePHI files were encrypted in this incident since the types of files in which Nuance stores ePHI were not targeted by the malware.
  • Unlike some malware, patching alone would not have stopped the propagation of NotPetya.


A Reaction Data survey of 200 HR and benefits leaders from providers, payers, and employers finds that while the majority of provider clinicians would like to see a single-payer health system, just about every body else hates the idea. Most respondents, however, favor universal healthcare that guarantees coverage but with both public and private participation. In fact, respondents seem to fear the federal government’s involvement most, with one benefits manager saying that “government intervention is the cancer” and that the free market should rule, while another observes that “we are the only developed nation on the planet to fail to recognize access to healthcare as a right – is that what we want as our legacy?” Respondents seem to miss the same significant point as their elected officials – the biggest problem involves high costs and provider-driven overutilization that enrich hospitals, doctors, insurance companies, and drug and device manufacturers at the expense of patients and taxpayers. We all foot that bill in one way or another.


In Indiana, a cancer patient’s pain management doctor declines to write her an opiate prescription after explaining that he doesn’t think narcotics would be a good choice for her chronic pain, after which the woman’s husband returns to the doctor’s office, shoots the doctor dead, and then kills himself.


The president and COO of Women & Infants Hospital (RI) quits due to its pending acquisition by Partners HealthCare and financial losses caused by declining birth rates and reduced NICU usage due to healthier babies.

Here’s Vince Ciotti’s review of Cerner’s history from awhile back.

My weekly “this week in healthcare IT history” items inspired Vince to look even further back with a monthly contribution from his stack of old magazines (he must be an HIT hoarder) that will describe the big news items 30 years ago and the lessons we might learn from them. He is also interested in hearing from his fellow pioneers at I got wrapped up in his complete, 100-plus episode HIS-tory series that he created for HIStalk years ago – the people, products, and companies he covers are fascinating.

Sponsor Updates

  • QuadraMed, a Harris Healthcare company, will exhibit at the GHIMA Annual Convention & Exhibit August 6 in Savannah. GA.
  • The Solutionreach Patient Relationship Management Platform joins the Allscripts Developer Program.
  • Diameter Health publishes an explainer video titled “Healthcare IT Hero.”
  • EClinicalWorks says 1,000 providers selected its EHR in June, its strongest month so far this year.
  • Sunquest Information Systems will exhibit at AACC Annual Scientific Meeting & Clinical Lab Expo August 1-3 in San Diego.
  • ZappRx makes it to the final round of BostInno’s Coolest Companies competition.

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 7/28/17

July 27, 2017 Headlines 2 Comments

FDA Announces New Steps to Empower Consumers and Advance Digital Healthcare

The FDA announces a new digital health certification process for software developers that will focus on certifying the vendor, rather than the software product itself.

Senate Health Care Vote: Disarray Over Narrow Repeal Measure

Four GOP Senators refuse to vote for a “skinny” ACA repeal bill without ironclad assurances that it will be followed with a comprehensive replacement bill. Lindsay Graham (R- SC) explains, “The skinny bill as policy is a disaster. The skinny bill as a replacement for Obamacare is a fraud.” Final votes on the bill are scheduled for Friday.

ECMC spent nearly $10 million recovering from massive cyberattack

Erie County Medical Center refused to pay a $30,000 ransom demanded by hackers earlier this year, but ultimately spent $10 million restoring its network following the attack.

Eye on Oversight – Electronic Health Records

HHS OIG publishes a video addressing the eClinicalWorks fraud settlement.

Amazon has a secret health tech team called 1492 working on medical records, virtual doc visits

Amazon has a sunkworks lab called 1492 that is reportedly focusing on health IT projects.

News 7/28/17

July 27, 2017 News 18 Comments

Top News


FDA announces its “Pre-Cert for Software” program that will certify digital health developers (instead of their individual products) for fast tracking to market.


Up to nine self-nominated companies that are working on software that meets the definition of a medical device will be chosen for the pilot.


FDA Commissioner Scott Gottlieb, MD says in a blog post:

The goal of our new approach is for FDA to, after reviewing systems for software design, validation and maintenance, determine whether the company meets the necessary quality standards and pre-certify the company. Pre-certified companies could submit less information to us than is currently required before marketing a new digital health tool. In some cases, pre-certified companies could not submit a premarket submission at all. In those cases, the pre-certified company could launch a new product and immediately begin post-market data collection. Pre-certified digital health companies could take advantage of this approach for certain lower-risk devices by demonstrating that the underlying software and internal processes are sufficiently reliable. The post-market data could help FDA assure that the new product remains safe and effective as well as supports new uses.

FDA also announces in its Digital Health Innovation Action Plan that it will hire more staff for the digital health unit of its Center for Devices and Radiological Health. It will also launch an Entrepreneurs in Residence program in the next few months.

Reader Comments

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From Vera Gemini: “Re: Mediware. Bill Miller, former CEO of OptumInsight, is taking over from Kelly Mann as CEO.” Verified. Miller left OptumInsight in an April 2017 executive shuffle. Private equity firm Thoma Bravo sold Mediware to another PE firm, TPG Capital, in February 2017. Mann was hired as CEO in September 2007 following his 24-year career as SVP of marketing operations for 3M Health Information Systems.


From MDRX ACE Sponsor: “Re: Allscripts ACE user meeting in Chicago August 8-10. They don’t have the usual big party scheduled for the second evening, which has been a staple for the last dozen years with big acts. I’m curious if anyone knows why this was changed – financials, liability, McCormick Place issues?” The agenda lists ACE Fest for Day 3, although it’s running from 4:30 to 6:30 p.m., timing that sounds more like happy hour. 


From Health IT Watchdog: “Re: Politico’s article showing that big, tax-exempt health systems are profiting wildly post-ACA. That certainly puts Epic’s ‘more margin, more mission’ to bed. If it wasn’t already clear, your EMR is not driving the profitability of your health system. Epic’s largest clients show revenue up, charity care down – that’s one way to drive your margins.”

From The PACS Designer: “Re: Java 9 release. July 27 marks the release of the much-anticipated Java 9 by Oracle. Its many new features are expected to excite the software industry, so it will be interesting to see if healthcare is a field that can gain from deploying Java 9.”

HIStalk Announcements and Requests

A reader who wishes to remain anonymous donated $50 to my DonorsChoose project, which actually fully funded a $200 project thanks to a $50 match from my anonymous vendor executive and then a $100 match from State Farm. Ms. L’s first grade class in Texas will receive math manipulatives as a result.

Listening: new melodic metal from Finland-based Nicumo. I’m also digging deep into musical history in enjoying Crack the Sky, which has been playing commercially unsuccessful progressive rock (kind of Steely Dan-ish at times) since forming in the early 1970s in Weirton, WV and making no splash at all other than developing a small following in the Baltimore area. There’s also the amazing 1981 Buck Dharma guitar solo I ran across in live video from the underappreciated, low-cowbell Blue Öyster Cult’s “Veteran of the Psychic Wars.”

This week on HIStalk Practice: Commonwealth Primary Care ACO taps Sonora Quest Laboratories for testing, analytics. Orthopaedic Associates of Michigan enlists Code Technology for patient-reported outcomes program. Idaho and Utah connect HIEs. Patients place physician experience above all else in satisfaction surveys. Legislators launch the Medicare Red Tape Relief Project. ATI Physical Therapy develops patient-facing, portal-friendly app. McKesson Specialty Health’s Calvin Chock offers guiding principles for designing a useful healthcare mobile app. Privia Health grows like gangbusters in Georgia. Rehab therapists cite documentation as their biggest challenge.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


Cerner reports Q2 results: revenue up 6 percent adjusted EPS $0.61 vs. $0.58, meeting earnings expectations but falling just short on revenue.


McKesson reports Q1 results: revenue up 3 percent, adjusted EPS $2.46 vs. $3.15, missing analyst expectations for both. Shares dropped slightly in after-hours trading and have shed 18 percent in the past year.


Amazon is running a Seattle-based healthcare skunkworks project called 1492 that is working on several projects, according to a CNBC report:

  • Sending and receiving EHR information
  • Developing a telemedicine platform
  • Working on health-related applications for Amazon Echo and Dash Wand.


Heading up the 1492 team are Kristen Helton, PhD (above) — a bioengineer who co-founded body sensing technology vendor Profusa –and Cameron Charles, PhD, an electrical engineer whose background is body-worn consumer electronics. The 1492 group listed several open positions that were apparently removed once the article made the project’s existence widely known.



RCCH HealthCare Partners (TN) chooses Summit Healthcare’s Exchange interface engine and migration services for its 17 regional health systems in 13 states.



HIMSS names Hal Wolf as its new president and CEO, replacing the retiring Steve Lieber. His background is quite different than that of Lieber, who spent his career as an association executive. Wolf comes from a vendor (The Chartis Group),  but has also worked at Kaiser Permanente in IT and operational leadership roles. For those who know him, care to speculate how he will change the HIMSS agenda? Particularly since EVPs John Hoyt and Norris Orms announced their retirement in February 2016 (although both are working elsewhere), leaving Carla Smith as the only long-time senior executive.


Drew Madden (Nordic) joins newly formed consulting firm Evergreen Healthcare Partners as a co-founder and managing partner.


Tom Schultz (HealthStream) joins Evariant as chief growth officer.


Carex Consulting Group hires Casey Liakos (Huron Consulting Group ) as president.


Victor Arnold (Huron Consulting Group) joins University of Missouri-Columbia as executive director of University Physicians and associate dean of the school of medicine.

Announcements and Implementations


Four-bed Southern Inyo Hospital (CA) goes live on Medsphere’s OpenVista Cloud.

Government and Politics

HHS OIG creates a video describing the $155 million Department of Justice settlement with EClinicalWorks, saying that the first settlement with an EHR vendor means “we’re entering an entirely new area of healthcare fraud .. we take the certification process for EHR software very seriously … OIG will investigate any conduct that places patient safety at risk and that causes losses to the federal healthcare programs.”



Adobe will retire its perpetually buggy, security-challenged Flash graphics package at the end of 2020 as open web technologies such as HTML5 have largely replaced it. Steve Jobs basically killed Flash in declining to support it on Apple’s mobile devices because it is: (a) proprietary; (b) unnecessary given the H.264 video format; (c) the number one reason Macs crash; (d) a poor performer on mobile devices; (e) a battery hog; (f) incapable of supporting touch-based interfaces; and (g) pushed on developers by Adobe to write cross-platform apps even though Adobe is slow to adopt OS enhancements.


Microsoft’s Asia research group develops a usable prototype of Path Guide, an Android app that provides low-cost, plug-and-play navigation services for inside buildings without relying on the phone’s GPS satellite connection or requiring building infrastructure. A “guide” starts the app’s recording function and then walks to the destination to create a “trace”  that others can follow in real time as they walk. The guide can add photos, video, or voice recordings to explain further. This could be an amazing benefit to patients and families trying to navigate around illogically laid out hospitals.



Erie County Medical Center (NY) has spent $10 million to recover from its April ransomware attacked, half of the money spent on computer hardware and software and the remainder attributed to overtime pay and lost revenue. The hospital says it was lucky to have beefed up its cyber insurance coverage from $2 million to $10 million a few months before the attack that took 6,000 of its computers down. ECMC says the hacker applied a brute force password attack to gain access to an incorrectly configured web server that was secured by an easy-to-guess password.


The local paper covers the 200-employee virtual hospital of CHI Franciscan Health (WA).

In Ireland, a review finds that 21 infants experienced care delays because their referrals were sent by fax, which is the standard method of 80 percent of hospitals there vs. those 20 percent that have switched to electronic referrals.


Twitter shares dropped sharply Thursday after the company announced that its global user count was unchanged in the most recent quarter as its US user count actually declined. Twitter says it will focus on trying to get people to use its platform every day to increase its attractiveness to advertisers.


NextGen Healthcare clarifies via a LinkedIn post that the HIStalk reader-reported rumor about hard-coded passwords in Medhost’s Connex – which is based on NextGen’s Mirth Connect – is not a problem with the Mirth Connect product itself but rather Medhost’s distribution of a forked version of the open source product.


Baltimore Ravens offensive lineman John Urschel retires – apparently after reading new studies about football-caused brain damage – and will pursue a PhD in mathematics at MIT. He has a Penn State bachelor’s and master’s in math and has published several journal articles, including “A Cascadic Multigrid Algorithm for Computing the Fiedler Vector of Graph Laplacians.”

Sponsor Updates

  • The local paper highlights LogicStream Health in its look at Minnesota venture capital funding in the first half of 2017.
  • LogicWorks CEO Kenneth Ziegler discusses AWS growth on the Cheddar Network.
  • Nordic opens a 6,000 square foot expansion of its Madison, WI office.
  • Meditech is recognized as a healthcare innovator in the latest “Best of Canada” report.
  • Emmem Ekorikoh of Obix Perinatal Data Systems, developed by Clinical Computer Systems, joins the board of Black Diamond Charities.
  • CloudWave joins the Cloud28+ global community of independent cloud service providers.
  • ECG Management Consultants publishes a new white paper, “ASCs at a Tipping Point: The New Reality of Surgical Services for Health Systems.”
  • FormFast publishes a new white paper, “Connecting Patients & Providers Through Document Workflow.”
  • GE Healthcare names Catherine Estrampes president and CEO of GE Healthcare Europe.
  • Healthgrades announces its 2017 Women’s Care Award recipients, and publishes a related report on how hospitals can provide optimal maternal care.
  • InterSystems will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo July 31-August 4 in San Diego.

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.


EPtalk by Dr. Jayne 7/27/17

July 27, 2017 Dr. Jayne No Comments

I stumbled across a story on Amazon’s “secret” team that is supposedly looking at healthcare, including electronic health records and virtual visits. It’s supposedly called 1492 (if they chose that as an homage to Christopher Columbus, they had better rethink some of the cultural baggage around his “discovery” of North America). It sounds like they’re exploring interoperability as well, along with figuring out whether they can use the Amazon home-based devices like Echo in a healthcare capacity.


I’ve been a big fan of Atul Gawande ever since “The Checklist Manifesto” and enjoyed reading a transcript of a recent interview with Tyler Cowen. His opening comments on artificial intelligence were realistic and balanced, which was refreshing given the hype we’re used to seeing with headlines like “Dr. Watson Will See You Now.” He concisely explains how challenging it can be to fully understand what the patient is telling you.

Those of us in the trenches know this, but folks on the technology side underestimate the power of the story vs. data points. Patients often point to problem areas or sources of pain and have trouble explaining whether the problem is more external or internal. Some can’t offer descriptive words at all. Then there is the issue of individual perception of pain or problems. Of course, algorithms could probe into that, but there could be hundreds of questions needed to include or exclude various decision points.

He disagrees with the IBM Watson decision to address this problem and notes that the issue is complicated by the fact that the patient data changes over time. Not only discrete data, but the patient’s perceptions change, as does the patient’s willingness to bring new symptoms to the clinician’s attention and also the understanding of the interviewer. He sees technology as more of an adjunct.

I think most of us caring for patients agree. I’m tremendously fond of clinical decision support and systems that help me ensure I’m not missing anything I should be thinking about with complex patients. I think automated checklists are fantastic, and rather than making me practice “cookbook” medicine, they are helping me deliver the same quality care to every patient every time, regardless of how rushed or distracted I might feel at any given moment. They help level the care we deliver when we are trying to see patients in six-minute increments rather than the 30 minutes many of us wish we had.

He specifically mentions Isabel, which I’ve had available in a couple of EHRs that I’ve used in the hospital setting. Isabel prompts you to think about diagnoses you may be missing in rank order based on the data.

Cowen asks his thoughts on the potential of gene editing with CRISPR, which he finds concerning due to the “unpredictable things that people will discover that you can try to do with gene editing.” When those edited genes are propagated in living organisms, they can spread rapidly, and he doesn’t “think we’ve thought through that in the least.” There’s also the risk that people will want to genetically select against characteristics that they feel are undesirable without fully understanding the implications. On the other hand, he notes that many conditions are the result of the interaction of multiple genes and aren’t something that CRISPR will be able to significantly modify.

Gawande also goes on to talk about safety in the operating room and how the rise of procedures where the patient is awake is changing culture. That patient can now be part of the team and not just a passive participant. These procedures have been common in neurosurgery, where brain mapping is needed to try to protect the speech and movement centers while working on other areas. He notes that he’s seeing them in non-brain surgeries, where the team can interact with the patient about their medical issues and goals for the surgery.

Other patients don’t handle awake surgeries very well, so he does note that sometimes you have to adjust on the fly. I know this firsthand since I once had a procedure under “light sedation” and the surgeon asked the anesthesiologist to put me out a bit more because apparently I would not shut up and was getting sassy with the scrub nurse, who I recognized as having hazed me during medical school.

He notes that while checklists have been effective in reducing errors, there are still barriers to success because people either check the boxes by rote or end up not using the checklists at all. The first problem is something that I’ve seen in many organizations I’ve worked in. It can be as simple as running out of a supply and discovering that someone initialed an inventory form just hours before that the exam room was fully stocked.

As a busy urgent care, that’s a major concern in our practice, but fortunately we don’t have a lot of problems with people falsifying their inventory checks. One of our execs is a former Naval officer and “gundecking,” where someone says they did something that they really didn’t do, is a cause for termination. Leadership makes it clear that when you falsify logs, you undermine our mission of care delivery and it is not tolerated.

The idea of people blindly marking a surgical checklist is frightening. He mentions that organizations can take checklists to extreme, taking one 19-item checklist to an 81-item level that was unusable. Administrators rather than clinicians had bloated the content, which essentially led to people ignoring it.

They go on to explore the disconnect between healthcare and health outcomes. He notes that data from coverage expansions like the Massachusetts healthcare reforms has shown that some interventions are more powerful than others – namely primary care, chronic illness care, and mental health care. He also notes the difference between death reduction and changes in quality of life. Still, we’re not getting the biggest killers under control, like high blood pressure. Organizations like Kaiser have been able to improve outcomes through more assertive management of barriers to care.

I see issues with coordination of care and comprehensiveness of care daily, as patients come to the urgent care for situations that would be better handled by a primary care physician. Some days I struggle with the fact that I’m part of the problem – perhaps if we weren’t as accessible, or convenient, or fast, patients would put more pressure on their primary care physicians to re-engineer how they’re delivering care. I still see plenty of physicians who don’t leverage the technology they have in front of them or who refuse to change their office policies and procedures to better support their patients. I have experienced botched prescription refills, botched appointments, and general chaos when trying to get care myself.

The interview also covered the state of medical education, the FDA, and his thoughts on indie music, but I’ll have to leave you hanging for my summary of those topics. Tune in to next week’s Curbside Consult for the rest of my recap.

Email Dr. Jayne.

Morning Headlines 7/27/17

July 26, 2017 Headlines No Comments

Veterans Affairs secretary: VA health care will not be privatized on our watch

VA Secretary David Shulkin publishes an op-ed explaining that, while the VA will begin expanding access to private care for veterans, there is no intention of fully privatizing the VA health system.

Proposed Interoperability Standards Measurement Framework Public Comments

AMIA responds to ONC’s Interoperability Measurement Framework, calling for a framework that supports automated measures reporting, and that targets high-value interoperability use cases.

At Mid-Year, U.S. Data Breaches Increase at Record Pace

A mid-year report on US data breaches finds a 29 percent cross-industry increase in breaches, with 63 percent of breaches involving hacking, nine percent involving  lost or stolen equipment, and seven percent involving accidental Internet exposure.

Yelp adds C-section rates and other stats for all baby delivery hospitals in California

Yelp is working with state and non-profit organizations in California to begin incorporating maternity care metrics, such as C-section rates, into its platform, noting that C-section rates for low-risk mothers varies from 10 to 70 percent, depending on the hospital.

Morning Headlines 7/26/17

July 25, 2017 Headlines 1 Comment

Hospital stocks pounded on repeal vote, HCA disappointment

CHS shares plunged 10 percent, Tenet shares dropped 7.5 percent, and HCA shares fell 4.5 percent following a Senate vote to begin debate on repealing, but not replacing, the Affordable Care Act.

CHIME to Administer Healthcare’s Most Wired Hospital Survey

CHIME has been tapped by AHA to begin conducting the annual “Healthcare’s Most Wired” hospitals survey.

Meritus to invest $100M in electronic health records

Meritus Health (MD) will implement Epic across its health system at an estimated total project cost of $100 million and an anticipated Summer 2018 go-live.

Helix’s Bold Plan to Be Your One Stop Personal Genomics Shop

Helix, a spinoff company of market-leading genetic sequencing vendor Illumina, launches a platform offering consumers genome sequencing and medical insights delivered through an app store that will securely store a user’s sequenced DNA information and transmit it to third-party app developers through an API.

News 7/26/17

July 25, 2017 News 3 Comments

Top News


Hospital shares dropped sharply Tuesday after the Senate voted to proceed with its debate over the future of the Affordable Care Act. The voting was a 50-50 split, requiring Vice President Pence to cast the tie-breaking vote after all Senate Democrats and two Senate Republicans voted no.

President Trump commented in a news conference, “”I’m very happy to announce that with zero of the Democrats’ votes, the motion to proceed on healthcare has moved past and now we move forward toward truly great healthcare for the American people. We look forward to that. This was a big step … We had two Republicans that went against us, which is very sad, I think. It’s very, very sad — for them. But I’m very, very happy with the result. I believe now we will, over the next week or two, come up with a plan that’s going to be really, really wonderful for the American people.”

Reader Comments


From HealthInfoSecGuy: “Re: Medhost. A new vulnerability was disclosed. Looks bad. Different than surgery solution (PIMS) vulnerability disclosed last year. Looks like they have more hard-coded passwords in their applications. This time it is with their proprietary Mirth-based interface engine Connex. Not a good time for this to come out with the possible private equity sell-out. Vendor wasn’t responsive from the report and no patches available today. When will vendors stop this poor practice? Shows lack of enforcement for Meaningful Use attestation and security requirements. eCW, anyone?” The online report came from someone who appears to be knowledgeable of the problem, but who didn’t provide their credentials.

From Nitpicker: “Re: time zones. Why rant when everyone knows what I mean when I say EST instead of the technically correct EDT?” “Technically correct” is the same as “not wrong.” It annoys me that people are so self-indulgently lazy that they don’t care about making public mistakes, such as misstated time zones, misspelling, poor writing, and sloppy grammar and punctuation. That sends the indignant message that their time is more valuable than ours and we’ll just have to figure it out. I’m also noting an increased number of messages — many of them in Yelp and Tripadvisor reviews — that are full of wild misspellings and incorrectly used words because the author (or speaker, in this case) can’t muster the energy to correct mistakes caused by their phone’s voice-to-text feature.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


Continuous ambulatory monitoring technology vendor PhysIQ raises $8 million in a Series B funding round, increasing its total to $19.9 million. The company, whose founder licensed the industrial monitoring technology he developed and sold to GE in 2011, will launch commercially later this year with patient monitoring contracts with two drug companies and two medical device vendors. 


CHIME and the American Hospital Association will take over the “Most Wired” survey. Hospitals & Health Networks magazine, which has been doing the survey with sponsor AHA, wasn’t mentioned in the announcement. Perhaps an early action item would be to correct the puzzling spelling of “HealthCare.” One might also argue that it’s not what you have but rather how you use it – find out what health systems with better outcomes at a lower cost are doing.


Circulation, whose system gives patients and providers access to Uber and other ride-sharing services for non-emergency transportation, raises $10.5 million in a Series A round.


San Francisco-based Hinge Health — which offers employers a wearable-powered app and remote exercise coaching for their employees with back and shoulder pain — raises $8 million in a Series A round.


Maven raises $10.8 million in a Series A round, increasing its total to $15 million. Its female-specific services include video visits and messaging with doctors, nutritionists, midwives, and other professionals.

Private equity firm KKR will acquire WebMD Health Group for $2.8 billion and will fold it into its Internet Brands media division. The Medscape medical news and education site takes in 60 percent of WebMD’s advertising revenue. 

Deaconess Health System (IN)  will integrate the state’s prescription drug monitoring program database with its EHR using Appriss Health’s PMP Gateway.



Meritus Health (MD) chooses Epic in a $100 million implementation project.


Beth Israel Deaconess Medical Center (MA) will use post-acute care patient placement software from The Right Place.


The Bermudas Hospital Board chooses Spok Care Connect for enterprise healthcare communications that includes on-call scheduling, a Web directory, secure messaging, emergency notification, and paging. 



Sphere3 hires Kathleen Harmon, MS, RN (Burwood Group) as chief nurse executive. 


Wes Champion (Premier) joins Kaufman Hall as managing director/COO.


Parkland Center for Clinical Innovation (TX) hires Vikas Chowdhry (Epic) as VP of data science.


VortexT Analytics hires Dick Hull (Hospital IQ) as president/COO.


Samuel Allen Hamood (TransUnion) joins Change Healthcare as EVP/CFO. He replaces the retiring Randy Giles.


Randy McCleese (St. Claire Regional Medical Center) joins Methodist Hospital (KY) as CIO.


Outcome Health promotes Vivek Kundra to COO.

Announcements and Implementations


Allscripts will offer Conversa’s Conversation Platform as the patient-facing portion of its CareInMotion population health management platform to engage patients between visits. Allscripts will also make an unspecified investment in Conversa.


Konica Minolta integrates document sharing technology from Kno2 into its multi-function printer control panel to help transition healthcare customers from faxing to secure data exchange.


Surescripts adds 14 health systems to its National Record Locator Service, raising the total to 41 health systems that are using NRLS or preparing to go live on it.


Boston Software Systems publishes an explainer video on using in-house rather than outsourced expertise to optimize time-consuming hospital tasks using its Cognauto rules-based workflow automation platform.


Helix, a spinoff of big DNA sequencer Illumina, opens up its sequencing technology to consumers who can gain access to a lifetime of genetic insights from a single saliva sample at a cost of $80. Helix’s marketplace allows buying apps and analysis from third parties whose cost might explain why the initial test runs just $80. It’s also unknown what actionable insight healthy people might gain from the information. Providers such as Geisinger and Mayo Clinic will offer genomics services, while other companies offer less-serious products such as a DNA-powered wine chooser and a scarf featuring the wearer’s genomic pattern. 


Aprima will integrate Patient IP’s clinical trials patient matching platform into its EHR.


Dignity Health will extend its use of Docent Health’s patient experience platform to Dignity Health Bakersfield Memorial Hospital.

Cleveland Clinic and CVS Health expand their eight-year affiliation offer medication counseling, chronic disease monitoring, and wellness programs at CVS Pharmacy and MinuteClinic locations on Northeast Ohio and Florida. CVS Health has also joined Cleveland Clinic’s Quality Alliance clinically integrated network.

Government and Politics


HHS revises its online HIPAA Reporting Breach Tool with improved navigation.

Ohio’s healthcare price transparency law that requires providers to give patients a good-faith cost estimate for non-emergency services didn’t go into effect January 1, 2017 as scheduled after heavy lobbying and legal actions by the Ohio Hospital Association and provider professor organizations. They claim that giving patients estimates would slow down patient care.



A Yale study and New York Times report finds that many surprise ED bills – caused hospitals outsourcing their ED coverage to out-of-network companies — come from ED staffing company EmCare, which is owned by publicly traded Envision Healthcare. It notes that at one small, rural hospital, visits that were billed using the highest-level billing codes jumped from 6 percent to 28 percent after EmCare took over, with the resulting patient complaints forcing the hospital to go back to its own coding and billing. The company also has a pending case from 2011 in which a whistleblower alleges that EmCare and Health Management Associates hospitals pressured ED doctors to do medically unnecessary procedures and tests and fired doctors who pushed back. EmCare is buying anesthesiology and radiology practices, which like EDs, do not allow patients to choose in-network doctors and instead leave them holding the full, more profitable bill that their insurance won’t pay.


High school graduate Gwyneth Paltrow – who via her “modern lifestyle brand” Goop empire out-hucksters Dr. Oz with even less attention to science in confusing her personal beliefs with known medical facts – gets called out by Jen Gunter, MD for suggesting that women place a crystal in their vaginas for pelvic floor strengthening and then suggesting that Dr. Jen is a “third party” who is “strangely confident” in labeling that idea as crazy:

I was blogging about pseudoscience long before Paltrow first squatted over a pot of steaming allergens and leveraged her celebrity to draw attention to her website … I am not strangely confident about vaginal health, I am appropriately confident because I am the expert. I did four years of medical school, a five-year OB/GYN residency, a one-year fellowship in infectious diseases, I am board certified in OB/GYN in two countries, I am board certified by the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation in Pain Medicine and I am appropriately styled Dr. Jen Gunter MD, FRCS(C), FACOG, DABPM, ABPM (pain). A woman with no medical training who tells women to walk around with a jade egg in their vaginas all day, a jade egg that they can recharge with the energy of the moon no less, is the strangely confident one.

An articles describes the 20-year health tech venture capital deals database created by Correlation Ventures, whose predictive analytics algorithm then scores a possible investment using CEO credentials, scientific validity, and the track record of previous investors to give it an invest-or-pass decision in two weeks. The firm says the algorithm rules out 90 percent of potential investments, but doesn’t say how the chosen investments have performed.

An interesting study tweeted out by Eric Topol finds that money really can buy happiness if you spend it on time-saving services. One of the studies it reviewed found that doctors who were give vouchers for such services reported better work-life balance.

A KQED article covers EHR usability issues that frustrate doctors and eat up their face-to-face time with patients. The article quotes doctors who blame the EHR for their inefficiency and burnout, but it also includes a wise quote from Redwood MedNet project manager Will Ross: “Documentation is still there, so blaming the computer for what insurers and the government are requiring you to do is misplacing the blame.”

Sponsor Updates

  • InteliSys Health is named a finalist in a publication’s healthcare innovation award for its RxStream prescription transparency pricing platform.
  • Kyruus will host its Thought Leadership on Access Symposium in Boston September 19-20.
  • Ability Network earns accreditation from EHNAC’s Cloud-Enabled Accreditation Program.
  • Princess Elizabeth Hospital in the UK selects Agfa Healthcare’s direct radiography system.
  • Frost & Sullivan recognizes EClinicalWorks with the 2017 North American Frost & Sullivan Award for customer value leadership.
  • Diameter Health, in partnership with Kammco Health Solutions, receives NCQA certification for 21 electronic clinical quality measures for 2017.
  • Besler Consulting releases a new podcast, “Clinical Documentation in CJR.”
  • CompuGroup Medical will exhibit at AACC July 30-August 3 in San Diego.
  • Glytec’s Robby Booth discusses the importance of data-sharing capabilities on AJMC TV.
  • Liaison Technologies will exhibit at the AHA Leadership Summit July 27-29 in San Diego.
  • Diameter Health President and CTO John D’Amore co-authors a study on the implantation of a clinical decision support risk prediction tool for chronic kidney disease.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Morning Headlines 7/25/17

July 24, 2017 Headlines No Comments

KKR to buy WebMD in $2.8 billion deal

Private equity firm KKR & Co will buy WebMD Health Corp for $66.50 per share, a premium of 20.5 percent to WebMD’s Friday closing, for a total of $2.6 billion.

Atul Gawande on Priorities, Big and Small

In a wide-ranging interview, Atul Gawande, MD discusses the limits of artificial intelligence, CRISPR, and what is missing from medical education, of which notes that the medical profession “has exceeded the capabilities of any individual to manage the volume of knowledge and skill required. So we are now delivering as groups of people. And knowing how to be an effective group, how to solve problems when your group is not being effective, and to enable that capability.”

Molina to lay off 10% of its workforce

Medicaid health plan Molina Healthcare plans to lay off 1,400 employees, representing 10 percent of its workforce, to offset losses incurred by its ACA exchange business.

Curbside Consult with Dr. Jayne 7/24/17

July 24, 2017 Dr. Jayne No Comments

One of the great things about consulting is developing long-term relationships with clients. I have a couple of clients that I’ve assisted for almost a decade, starting with some side engagements when I was a CMIO. When I transitioned to full-time consulting, they began engaging me for larger projects. Although we initially started with EHR optimization and organizational development work, they’ve seen the value of having outside help and we’ve been able to move into change leadership and strategic planning.

One of them is particularly great to work with, and not just because they’re located in a great city for live music and outdoor activities. Some organizations are nervous when working with consultants, afraid to expose parts of their operation that they think are problematic. Over the years we’ve developed a great deal of trust.

It’s one thing to let a consultant work on a process that has obvious problems, but it’s another to proactively bring functional-appearing processes to the table and ask for them to be examined in detail. Being given carte blanche to assess the organization at all levels, including the C-suite, has allowed us to identify many areas for improvement. As we’ve moved from department to department with standardization, increased technology adoption, and active management, we’ve stabilized their core practice areas while helping them through a time of unprecedented growth.

Part of their success can be attributed to the vision of their leaders, who are committed to playing the long game. Although they understand the need to keep up with regulatory requirements and to maximize incentives, they consistently put patient needs at the front of decision making. Effectively, they’ve tripled their size over the last five years, not only from a provider headcount perspective, but also when looking at patient volume.

As a Medicaid provider, they’ve seen an expansion of their patient panels due to increased coverage. Although they initially had to use locum tenens physicians to cover the surge, they’ve worked diligently to hire a good mix of both new and seasoned physicians who are committed to the organization’s mission. They’re not afraid to let a provider go when it turns out he or she is not a good fit and they’re not willing to be held hostage by staff with unreasonable demands.

We recently finished revising their plan for provider compensation. First, we did an analysis to look at how their provider compensation fits into their overall financial situation and their budget for growth. We also looked at provider salaries compared to industry benchmarks and to other healthcare employers in the region. It’s tempting to just use national or state data, but when you’re in the middle of a high-tech corridor that has a significantly different economic profile than the rest of the state, then you need to take a much more focused look at how employees are being paid.

We also had to dig deeply into the true cost of care delivery vs. the payments received, which was a project of its own. My client has historically received a lot of grant money and the employee culture was that they shouldn’t charge for certain services because they were “free.” This led to some financial underperformance, as front-line staff didn’t realize that grant money is sometimes tied to documentation of services provided, which can’t be demonstrated via reporting if it wasn’t documented. Although there were some significant findings from the analysis, we decided to pend a project to address them until we were done with the task at hand.

It’s tempting for organizations to dive headfirst into situations like this when they are discovered. Although I’m sympathetic to the fact that they were losing money, they appreciated my support of their plan to address this after the provider compensation project was finished so that the new project could have appropriate organizational focus and so that they could cultivate buy-in from site managers and clinical team leaders. The reality is that waiting another four to six weeks to get our plan together is likely to achieve a faster correction of the problem than if we tried to do it in a half-baked fashion.

I’m especially glad we waited, because our analysis of the missed charges led to discovery of some other workflow processes. Had we tried to have multiple training sessions and process changes, we would have lost a fair amount of productive time. By waiting and doing deeper discovery, we were able to retrain multiple processes at the same time and only pull people away from their clinical duties one time.

Now they’re getting ready to embark on a couple of facility expansions, which has led to the need to look creatively at how (and where) people in the organization do their work on a daily basis. It’s hard to completely remodel office space when people are working in it, and midsize medical practices don’t have a lot of experience with remote work. I’m spending time shadowing a variety of workers to determine exactly what happens during their work day.

It’s often surprising how much people’s day-to-day work doesn’t actually match up with their job descriptions. Employees are often assigned special projects that become part of their regular duties without them being documented. It turns out that staffers we thought could work remotely with little impact are in reality performing tasks that require more face-to-face interaction than would be possible with a telecommute. My goal is to see if we can identify ways to bundle those tasks and consolidate them among a smaller set of workers who would remain in the office, or arrange them so that people could take turns rotating into the office so they maintain the skill set.

The other challenge is to prepare people who haven’t worked from home for the challenges that are ahead. It always sounds great to be able to work in your pajamas, but the realities of working at home sometimes take people by surprise. I’m putting together some training programs to discuss how to set up a home work space, how to manage being away from your co-workers, and how to address the scheduling temptations that come with being a home-based worker. It’s great being able to throw in a load of laundry while you’re on your break, but I know a lot of people who need good advice on how to manage barking dogs when you’re on calls or how to manage when others are in the house with you when you’re trying to work.

It’s been rejuvenating to deal with problems that are a little outside the realm of healthcare IT and to help the organization realize that these issues are no less important to their overall success than interoperability or reporting their clinical quality measures. Figuring out how to best leverage your workforce and motivate your providers might even be more important at times. Too many organizations forget the people part of the equation. I’m excited that this group has been willing to be a laboratory for setting up the practice of the future.

How are you positioning your practice for the next decade? Email me.

Email Dr. Jayne.

HIStalk Interviews Charles Corfield, CEO, NVoq

July 24, 2017 Interviews 1 Comment

Charles Corfield is president and CEO of nVoq of Boulder, CO.


Tell me about yourself and about the company.

I grew up in England. I came over to America as a graduate student, and like many immigrants, I stayed. I have been in the high tech world for the last few decades, doing a mixture of early-stage companies and then later-stage buyouts and spinouts. My current day job is CEO of a company called nVoq in Boulder, Colorado.

I forgot to ask you last time we talked – did you ever finish your PhD in astrophysics?

No, I did not. I was starting to write the dissertation and then I got distracted by startup land. The irony is that some years ago, on a visit to Cambridge University in England, the then-department chairman said that if I ever get bored with the commercial sector, he would have no problem finding a slot for me as a post-doc there in spite of the missing dissertation. Maybe we could find it behind a hot water pipe or something like that. [laughs]

I’ve tried and failed previously to get you to admit that you are the father of Siri, so I’ll ask you this question instead. Are you surprised at the level to which speech recognition has reached the consumer appliance level?

Not really. Although speech recognition per se has been around for a few decades, it is nice to see that has matured to a point where companies are willing to take the risk and put it into a consumer environment, where of course you have no idea what’s going to come at you. It’s nice to see that.

By and large, it works. It also affords the consumers of it a certain amount of humorous surprises at some of the results they get, which are no secret to people who’ve been messing with speech recognition. But it’s great to see how far it’s come.

It is also interesting to see how the mental leadership in speech recognition has very much been picked up by the major platform vendors such as Microsoft, Google, Apple, Baidu, and others. Even Facebook, which we have seen publishing papers on speech recognition. It has definitely come a long way.

Which consumer speech recognition technologies do you personally use?

Actually, very few. For most of my life as a consumer, I’m extremely old-fashioned. I try and avoid talking to these systems because I’m usually very transactionally-based. Sorry to disappoint you with not taking sides. [laughs]

That just added to your legend. Where do you see speech recognition going next, especially as new human interface technologies such as virtual reality ramp up?

I think the ability to do some command and control is still largely an unworked area in the enterprise sector. If we take your example of virtual reality, you can imagine that surgeons and other healthcare professionals will find themselves in this sort of virtual reality zone. It may turn out to be an interesting hands-free zone. The ability to speak to the environment around you may be a more natural interface. This will be one where we’ll see a lot of experimentation.

We’ve also seen some speculation out there about whether, say in a hospital environment, you might find something like an Alexa device able to come into the point of care and physicians able to interact with it in some fashion. We might see somebody like IBM, who has been working hard on Watson, may be able to come up with something like that.

What action items or analysis did NVoq undertake following Nuance’s malware-caused extended cloud services outage?

If I can step back a bit to before that incident, malware has been around quite a long time. As a company, in terms of our info security practices, we’ve liked the discipline that PCI data security standards … PCI stands for payment card industry. Before healthcare was worried about HIPAA, HITECH and so forth, the payment card industry was very worried about fraud. They evolved a set of 12 practices and you can get yourself audited for your adherence to these practices. As a company, we’ve been having PCI audits performed on us for years.

As to the more current outage at Nuance, in terms of lessons people might want to take from that, it is important to stay up to date with patches that are released by the system vendor, such as Microsoft and others. It is quite possible that they were behind on that and somebody clicked on the wrong thing in an email and then, what do you know, you’re having a very bad day at the office.

From our perspective, you do want to stay up to date on whatever the latest patches are being released by people. You also want to have what you might call defense in depth. You should always operate from the presumption that somebody, somewhere is going to click on something in an email and you’re going to be infected by something. What are the obstacles that you’re putting in the way of that malware so that it can’t propagate and wreak the havoc that we’ve seen in that incident?

We do things like having, if you will, air gaps between systems, segregating networks, systems primed to shut down immediately on or cut off access immediately if they detect something fishy, and various other what you might call low-tech methods. All designed to make it much harder for malware to spread and wreak havoc.

Defense against malware is not necessarily having to become an expert in the rocket science or the black arts of whatever these hackers get up to. A lot of it is just a discipline around daily housekeeping. For readers of your column, start with the simple things. Don’t over-engineer. Consider the social engineering ways by which things come in. The best way of getting malware into an organization is through an email which looks like it comes from a highly-trusted individual about an extremely plausible subject. The email that just seems totally innocuous — that’s the one that you’re going click on. Then you’re going to have a really bad day.

The other challenge for Nuance is trying to keep millions of customers updated about their downtime. Any lessons learned there?

Goodness, that’s a large question there in terms of the impact on the users. [laughs] I was a little surprised that they didn’t seem to have fail-over systems. In other words, if you have a major outage in one data center, you should be able to continue providing service for the entire customer base from isolated, separate data centers. That was a little surprising.

In terms of communication, an additional problem they faced was that their own email system was infected. There was a risk there that their customers were actually being sent emails with malware in them as well, which is a difficult problem for them to have.

But the take-home point for everyone else is that you need redundancy in systems so that, even if you have a primary production site, you can shut it down and continue without loss of service to service your customers from backup centers.

Are clinicians more interesting in going beyond dictation to use their voices to navigate systems?

Oh, yes. If you take users of a laboratory information system like pathologists, there’s a great case there for when they are dealing with sample specimens and what have you, they really want to operate hands-free. What their hands have been on, they don’t want to get that anywhere near their keyboards. [laughs] There’s a reason it’s called the grossing station. That’s a great example of voice-powered command and control.

We also find that there’s a lot of usage in things which are not necessarily voice-based,. You can use your voice to drive. But we’ve just found that, with EHRs and other similarly very complicated systems, the very lightweight automations we bring – sometimes people call them robotic process automations — are a real life-saver to them. In a recent customer survey we did, it was something like two-thirds of the respondents said we were saving them an hour or two a day. That’s not just speech – that’s around the automations.

Everybody’s talking about artificial intelligence and now we’ve got this idea of chatbots having some application in healthcare. Where do you think that part of human-computer interaction is going?

I think in general, we’re at something like the top of the Gartner hype curve on artificial intelligence. It’s a very attractive narrative. The rise of the GPU — graphical processor unit, prime case would be in video — they’re having an enormous success at the moment on that. There’s a lot there for artificial intelligence to tackle.

But if I might so put a pin in the bubble here, these neural networks are essentially nothing other than brute force programming. You just have a computer carry out the zillion steps, throwing everything you can at a problem. It’s a very tedious, iterative process. It’s not quite as rocket science and glamorous as you might think.

That being said, there are clearly problems which lend themselves to just throwing a lot of computing power at it. You can get some pretty good results. You’ve seen a lot of progress in things like image recognition and classification. We ourselves are using neural nets as the basis of speech recognition. But I think some of the more exotic applications people have talked about will be a while coming because there’s still a long way for these neural nets to go before they can really cover the gamut of human behavior cultural assumptions.

Remember, the human brain has typically been on the planet for a few decades, busy acquiring experience, whereas the neural net is something we’re trying to train up in a matter of days or weeks. It has nothing like the range of experience that a human being has. A child by the age of three or four has already heard tens of millions of words in all sorts of different contexts. That child, in some sense, is light years ahead of the best speech recognition neural net.

It’s a very promising area and we’ll see a lot of good things come out of it, but I would urge people not to get too carried away by the hype. Because after the hype comes the trough of reality.

When we spoke three years ago, you predicted that the most attractive health IT investment would be workflow tools running on top of EHRs. Did that pan out and what do you see happening next?

Yes, I think that is very much panning out. The big iron has gone in, and now the next question is, how are you going to get your return on it? We saw this with enterprise resource planning software and CRM software. There is a lot of opportunity for innovation here, to really hone particular work cycles or delivery methodology. We’ve really just scratched the surface there in healthcare.

You’re a pretty fascinating guy. You’re a centi-millionaire, you’ve climbed Mount Everest, you run 100-mile races, and you’ve started tech companies that developed technology that is used all over the world. You also bake your own bread and study Yiddish. What are your lessons learned on living a full life?

[laughs] Always be curious about things. Never lose that sense of curiosity. When I look at new areas to try my hand at, the most important thing is to get stuck. It’s when you get stuck that you make progress.

Morning Headlines 7/24/17

July 23, 2017 Headlines 1 Comment

Nuance Provides Update on Malware Incident and Business Impact

Nuance lowers its forecasted Q3 revenue by $15 million, citing its ongoing cyberattack related network outages.

athenahealth’s (ATHN) CEO Jonathan Bush on Q2 2017 Results – Earnings Call Transcript

In its earnings call, Athenahealth CEO Jon Bush provides an update on its CFO search, saying, "we’ve initiated a search to identify a permanent CFO and are focused on individuals who can serve as a strong partner to the senior team and to me. And who will bring demonstrated record of operating discipline and value creating capital allocation."

Expanding his medical empire is good for Patrick Soon-Shiong. But is it good for patients?

STAT continues its ongoing investigative reporting of Patrick Soon-Shoing’s business dealings, this time questioning the ethics of his acquisition of six California hospitals.

Monday Morning Update 7/24/17

July 23, 2017 News 15 Comments

Top News


A Nuance investor disclosure announcement on Friday says the company has not yet fully restored all of its cloud-based systems that went offline in a June 27 malware attack.

Nuance warns that its financial results for Q3 – of which the malware incident impacted only the final week – will suffer, with expected revenue of $485-489 million instead of the previously estimated $500-$504 million. The company expects to lose $0.11 to $0.09 per share in the quarter instead of its previously estimated loss of $0.07 to $0..05. The Q3 results will be posted on August 8.

Nuance says its Q4 results will also be negatively impacted from the outage, mostly related to its HIM transcription services business.


Nuance added that it hopes to restore services within two weeks to all customers of its EScription LH back-end transcription system for large hospitals.

Shares of Nuance Communications fell briefly in pre-market trading following Friday morning’s announcement, but closed up 2 percent. They’re up 6.5 percent in the past year but down 18 percent in the past five.

One might speculate that it’s going to be a rough Q4 for Nuance if just one week of Q3 downtime whacked $15 million off the company’s quarterly revenue — the outage on some significant systems has extended three weeks into Q4 and won’t be fully resolved for at least two more weeks.

Reader Comments


From Firm Mattress: “Re: your HIT index. I took the liberty of scoring the top 10 of last year’s #HIT100. The low scores seem about right to me.” My scoring method tries to quantify how I assess someone’s healthcare credibility from their LinkedIn profile in looking at healthcare-specific education and accomplishments. I place zero value on social media influence. Twitter is a great way to showcase someone’s deep knowledge and thoughtful opinions (I’m thinking of people like Andy Slavitt and Eric Topol), but it’s also a medium embraced by those with few other accomplishments or possessing light credentials for rendering opinions on complex topics who just retweet stuff other people came up with. My problem with the HIT100 and similar recognition is that some people desperately seek it as validation in the absence of other achievements and brag about winning like it actually means something. To which I would ask in rudely re-introducing the real world into the discussion: how many of Modern Healthcare’s “100 most influential people in healthcare” have followed you, retweeted you, contacted you personally, or offered you a job? You earn cool points, however, for being on the list without ever having mentioned it in pandering for votes or bragging on being named. Feel free to poke holes in my scoring method or the reader’s application of it above. I’m tempted to assign points for military service, particularly in a healthcare or leadership role, since I value that pretty highly in someone’s bio.


My final thought about self-confidence vs. knowledge and experience applies to all of us  — I’m uncomfortably aware of how well this describes me at times.

From Aphasian: “Re: HIMSS conference. We need a good marketing idea that will generate buzz in Las Vegas.” Obtain a picketing permit from the city and hire pamphlet-passing shills to carry protest signs on the public sidewalk  –your “protest” should involve your product or service.

HIStalk Announcements and Requests


Poll respondents say the only industry awards that are significant are KLAS and the Davies, but even then, “none of the above” wins the grand prize. Reader Dewey, Cheatham & Howe looks at methodology: “Most Wired is an online form. Completing the form is labor intensive, but not difficult or vetted. If people can (and do) lie about their MU attestations, then what do you think you are getting with Most Wired? KLAS has skilled interviewers and they try to remove bias, but it is easily gamed. HIMSS EMRAM Stage 6 uses same methodology as Most Wired — little to no validation. HIMSS Stage 7 is different because it requires a site visit by experienced surveyors. HIMSS Davies requires a write-up with validation. As for the rest, I assume they are conducted with little or no pre-survey modeling of measurement criteria or post survey review of bias.”

I’ve overseen several “Most Wired” wins in the health systems I’ve worked for, but a comment from the cynical manager I assigned to complete our entry one year best summed up the form’s self-attesting ambiguity: “It’s not what we actually do, it’s how badly you want us to win.” Nobody in IT thought the Most Wired award meant anything at all since the responses allow wiggle room and our job was to support the health system instead of worrying about pointless awards, but we did feel some responsibility after the first win to keep applying. Nobody wants to be the health system that falls off the list – even voluntarily – from one year to the next. Organizations give awards and recipients proudly accept them for entirely self-serving reasons.

New poll to your right or here: which company’s stock would you buy if forced to choose one?


Welcome to new HIStalk Platinum Sponsor Redox. The Madison, WI-based company was founded in 2014 with the belief that EHR vendors can’t solve healthcare interoperability. The company’s API allows innovators the ability to code once, connect to all. It uses cutting edge methods such as HTTPS, JSON, and OAuth to create a modern Web experience without digging into HL7, FHIR, CCD, or DICOM. The company’s integration experts know how to get data into and out of EHRs using scalable integration strategies, enabling both software vendors and providers to integrate their apps, exchange information with affiliates, and commercialize innovation. Redox has already connected hundreds of enterprise applications. It monitors and maintains interfaces 24/7; expedites pilot testing; streamlines referral management, population health, and analytics; and creates a build-once environment that fuels innovation and scalability. The company also integrates wearables and home medical devices with EHRs and data warehouses; connects payors to providers; and integrates remote patient monitoring and telehealth services with medical groups and EHRs. Thanks to Redox for supporting HIStalk.

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We funded the DonorsChoose teacher grant request of Mr. S in California, who asked for a Chromebook for his second grade class. He reports that the students are using it for online math practice, graphing, virtual field trips, and geography look-ups using Google Maps.


I noted that Nuance’s status updates contain the same infuriating error that I see in endless emails in claiming that a stated time is “EST.” There’s no such thing until November 5, when our clocks are turned back from “EDT,” or if you can’t be bothered to understand what the rest of us get, then just write “ET” and we’ll figure it out for you. The same folks are often confused by time zones and have to confirm for scheduled calls, “What time is it where you are?” to which I’ll provide this invaluable advice: just type “time in Phoenix” or “time in London“ in a Google search box and it will tell you in engaging zero of your brain cells. Daylight Saving Time is illogical, but that doesn’t mean you can just ignore how it works.

This Week in Health IT History

One year ago:

  • University of Mississippi Medical Center agrees to pay $2.75 million to settle HIPAA charges related to the theft of an unencrypted laptop and discovery of an unsecured PHI-containing database.
  • Athenahealth announces that EVP/COO Ed Park will leave his position.
  • CTG CEO Cliff Bleustein, MD resigns.
  • Kate Granger MBChB, MBE, the NHS geriatrician who created the “Hello, my name is” campaign that urge clinicians to introduce themselves to patients before treating them, dies of cancer at 34.

Five years ago:

  • IRobot announces its first healthcare robot.
  • Shares of Quality Systems (NextGen) drop 33 percent after a poor quarterly report and the loss of long-term customer HMA.
  • The Commonwealth Fund announces former National Coordinator David Blumenthal, MD as its next president.

Ten years ago:

  • Several companies bid for struggling NPfIT contractor iSoft.
  • Mediware shuts down its OR product line to focus on “closed-loop systems.”
  • Misys exits the healthcare business by selling its lab, pharmacy, and radiology software business to Vista Equity Partners and its Misys CPR product to QuadraMed, with both acquiring companies agreeing to support the Misys Connect strategy.
  • Picis announces its intention to acquire ED revenue cycle software vendor Lynx Medical Systems.

Weekly Anonymous Reader Question

Responses to last week’s question:


  • My boss knows me at a professional level and we do some small talk. He lives across the country, so we do not have any off-work interaction.
  • None. I try to have as little interaction as possible with her at work, let alone socially.
  • Zippo. They have no interest to ask, and I have zero interest to share. Best that way.
  • He knows of my family , no names. No social interaction besides Christmas party, and there is no family allowed in the building.
  • Not at all, and that’s the way I like it. I learned some hard lessons about being too familiar with management, and now I draw a hard line between my personal and professional relationships.
  • None.
  • I have found that my bosses have never really known much about me and my family socially, and we have had minimal interactions outside of work, and never outside of work events. For me, this led to some burnout because they were unaware of everything I was juggling. Because of that, as a boss myself, I’ve made an effort to know my team members and their family’s because it helps everyone perform better. If I know that you’re stressed because you have a particular family issue going on, it let’s me step in to help out at work to relieve some of the work stressors. When people feel like you care about them for more than just doing the work you need done, morale is higher and performance improves. And bottom line, part of being a leader is hopping into the trenches with folks and working side by side with them, which you can’t do unless you know what’s going on outside of the four walls of your office.
  • We have zero off-work interaction. Frankly, we barely have on-work interaction. He is chronically late to our scheduled 1:1 calls and sometimes doesn’t show up at all. Something “more important” always seems to be coming up. I know I’m one of the top ranked members of his team and I’m generally self-sufficient, but there’s no way he’s ever going to do any professional development work with me if he can’t even show up on calls. BTW, it’s not just me he does this with. Upper management should be appalled but no one seems to care.
  • He doesn’t. None. We spend so much time together during the week that we need to NOT see each other on the weekends. Same is true for our entire executive team. It is healthier that way. We get along just fine. Seeing more of each other would not be healthy then work would not creep but barge it’s way into the weekend.
  • Working with my boss for the past 18 months, he has never met any of my family members. As a remote worker, off-work social interaction with my peers and boss does not occur. My company does not value this interaction with its remote workers; however, it does value this interaction with on-site office staff. Perhaps my company cannot justify the cost associated with social interaction with the families of its remote workers.
  • I’m a remote employee, so “not at all” and “none”.
  • Learned the hard way during my time at McKesson, MPT, that letting work and family mix is not always the best idea. When times got tough, I would hear things like, “You better work harder and sell more or you won’t be able to provide for your children.” And then refer to them by name and even what activities that they might not be able to do because we wouldn’t be able to afford it.
  • All previous bosses took time to know me and my family within the first month of starting the position. We have a small team of six, so it is not hard to remember kids’ names and estimated ages. My current boss is in her third year and still has no idea what my kids’ names are. She avoids off-work interactions like the plague. Happy hour? No. Team building exercises during off hours? Absolutely not. On going team member conversation in the break room? No eye contact. To say the least, it is tough to work at a level of 110 percent to make someone look good who doesn’t know your kids’ names. I have always believed interpersonal skills are imperative in leadership and my current boss reinforces it that belief.
  • No off-work interaction. We share normal chit-chat in the office, names of spouses/kids, school activities, etc., but that’s it.
  • We don’t do anything socially or have any off-work interaction, nor is this encouraged or discouraged by the organization. I started my career with a consultancy who did an excellent job of pulling family into social activities throughout the year. In the 30 years since then, not really something my employers (hospitals, health plans) cared about.
  • We had lunch the day I started. Otherwise, boss refuses to engage socially. No interaction.
  • We don’t discuss family. Dogs, occasionally. There is minimal interaction outside of work and only incidental to work. Considering the question in terms of bosses I’ve had in the past, there have been some that really did care about everybody and everyone’s family. Would see them routinely out of work and even at their homes on holidays. Made work-life at the time enjoyable, sometimes a little too personal, and I can’t say the team was any more effective then ones I have participated on where this is not the case.
  • Zero interaction with family or personal life. I live on the east coast, she lives on the west. I’m a telecommuter.
  • Somewhat, but I would say 80% business.
  • Well enough to think he knows a lot, which makes him happy, but he really doesn’t and it’s going to stay that way. He uses what he knows in weird and uncomfortable ways so additional sharing is off the table. It creates some awkward situations if he’s prying for more, but handling that is a better trade off than the alternative.
  • My boss knows very little about me outside of work and that is the way I want it to be. Work life is work life and personal life is personal – separate from each other. Consequently, I spend zero time outside of work with my boss.
  • No social interaction at all, and that is fine with me ~ like the boundaries!


This week’s question: What drives you crazy about the person at work who annoys you the most?

Last Week’s Most Interesting News

  • Athenahealth’s quarterly results beat expectations even as the company is dogged by an activitist investor and its CFO leaves the company for another healthcare IT company.
  • Google Glass is revived as X Glass Enterprise Edition, with healthcare one of the targeted industries.
  • Epic’s first full-suite implementation in Canada goes live.
  • The DoD’s second MHS Genesis pilot site goes live on Cerner.
  • Emids acquires Encore Health Resources.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call, following results that sent shares up 8 percent on Friday:

  • The company says enterprise software competitors can’t duplicate its recently launched work reduction guarantee for independent medical groups that differentiates its cloud-based services model.
  • CMS has approved the company to received adjudicated Medicare claims data as a Qualified Entity, which it says will allow it to build up a scalable hospital service that can pre-populate information without requiring redundant data entry. Jonathan Bush says, “Athena will be the only company with an EMR that actually has medical records in it before you type them in.” He also describes the claims information containing 98 million patient records as a “data asset.”
  • The replacement CFO search will focus on a “demonstrated record of operating discipline and value-creating capital allocation” who can analyze the potential return on investment of every company project as more of a COO and portfolio manager instead of just handling financial controls and accounting management.
  • The company says it is winning 80 percent of the deals it goes after, the highest in its history.
  • Bush says the company has a very high win rate in community hospitals, #1 in net hospital wins according to KLAS, mostly because they need systems quickly without using capital budget to improve cash flow. Still, he admits that the hospital business isn’t yet profitable and it represents the company’s shallowest product offering.
  • Bush says the company’s recent $63 million acquisition of Praxify gives it modern technology that can containerize future app development as the aging AthenaNet platform is re-architected in “an intense crisis level of reconstruction.”
  • Bush says electronic data interchange makes implementations tougher, especially in hospitals. “Hospitals will show up at the door with lab systems written before my children were born. Someday we’ll get the courage to say, here’s the app store. Buy any of these lab systems. We’ll pay, but we’re not connecting to that MUMPS-based museum piece.”
  • Bush says the CMS-certified Qualified Entity application required completing a 700-page application and was completed only because the Trump administration changed the data sampling requirements. He adds that CMS is not technically ready to meet the requirements: “The government is on some very tired systems. So are the contractors. We understand that the way we will receive this data is they will send us a drive in a padded envelop by certified mail. We have people on eBay now looking for machines that can receive this drive.”
  • Bush says of population health management, “Population health is population surveillance outreach, population engagement, and population love. Every health system needs to find out what population thinks of them as a prospective provider of choice and love on them in a digital continuous way rather than waiting for them to be the path to the hospital parking garage. As we get our population health clients to agree to that approach, we get a much bigger bite of their patient population and get much more traction.”



  • Boca Raton Regional Hospital (FL) will go live on Cerner in August 2017.
  • Monroe Community Hospital (NY) will go live on Healthmedx Vision in August 2017.
  • Gerald Champion Regional Medical Center (NM) will go live on Cerner CommunityWorks in August 2017.

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


Part 3 of Vince’s HIS-tory of Cerner from a few years back covers how the company’s name was chosen (and by whom), stock performance, and how its lab system became #1 by the late 1980s.

Sponsor Updates

  • Over 500 Mazars employees volunteer at community organizations in six states for its third annual “Days of Service.”
  • ZappRx releases a new podcast, “It’s Hard to Prescribe Specialty Drugs.”
  • Audacious Inquiry founder and managing partner Chris Brandt is named an Aspen Institute health innovator fellow.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Reader Comments

  • Where's Kyle: Nevermind. Obviously, Kyle's been busy....
  • HIT Girl: \m/ (>-<) \m/...
  • Dysf(n): I would say the speaker meant "epic" (vs "epoch"), using the concept from Agile development. I don't have hard data, but...
  • Agile Ninja: I agree the tenant/tenet one is maddening, but I'm not sure epics is wrong. Agile project management works in "user sto...
  • Mr. HIStalk: I hate typos and I'm happy to have fixed this one. Thanks....

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