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Morning Headlines 1/28/20

January 27, 2020 News No Comments

Epic Supports Patients’ Access to Their Data, Proposes ONC Rule Solutions to Protect Privacy

Epic posts its concerns about HHS’s proposed interoperability rule on its homepage, concluding that while it rarely comments on national policy issues, “We must speak out to avoid a situation like Cambridge Analytica.”

Electronic Health Records Vendor to Pay Largest Criminal Fine in Vermont History and a Total of $145 Million to Resolve Criminal and Civil Investigations

The Department of Justice wraps up its investigation into Practice Fusion, which will pay $145 million to resolve allegations that it used its EHR software to illegally influence the prescribing practices of its end users for the benefit of opioid manufacturers.

Tidelands Health named in class action lawsuit after December malware attack

A Tidelands Health (SC) patient files a class-action lawsuit against the hospital after a December ransomware attack disrupted services and potentially exposed patient data.

Canadian health tech company to relocate to Reno, create 300 jobs

Medication adherence and disease management technology company DayaMed will relocate its headquarters from Canada to Nevada.

Details of Practice Fusion’s $145 Million DOJ Settlement Include Opioid Prescribing Kickbacks

January 27, 2020 News No Comments

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The Department of Justice today announced details about the previously announced $145 million settlement by Allscripts-owned Practice Fusion. Practice Fusion admits in the settlement that it:

  • Solicited and received a million-dollar kickback from an opioid manufacturer in return for allowing the drug company’s marketing department to design EHR clinical decision support alerts that encouraged opioid prescribing outside of accepted medical standards.
  • Solicited 13 other agreements in which drug companies paid the company to influence CDS alerts to increase their prescription drug sales.
  • Obtained ONC EHR certification fraudulently by falsely claiming to the certification body that its software met 2014 Edition portability requirements, after which it disabled the feature and advised users to contact the company if they needed patient data exported.
  • Allowed providers to falsely claim Medicare and Medicaid EHR incentive payments when its product did not incorporate standardized vocabularies as HHS requires.

A Deferred Prosecution Agreement requires Practice Fusion to make compliance changes, obtain independent oversight, report any evidence of kickback violations by other EHR vendors, and to make details of the company’s unlawful conduct available to the public on a website. The oversight organization must also approve any sponsored CDS rules before they are implemented.

The Northern California US Attorney said in the announcement, “Prescription decisions should be based on accurate data regarding a patient’s medical needs, untainted by corrupt schemes and illegal kickbacks. In deciding what is best for patients, electronic health records software is an important tool for care providers. It is critically important that technology companies do not cheat when certifying that software.”

The $145 million settlement amount was announced by Allscripts as a tentative agreement in August, but specific details were not provided. Allscripts said in its Q2 earnings call that the $145 million settlement was in line with what other EHR vendors have paid to settle DOJ charges, but also added that “we expect to have recoveries from a variety of third parties that will help offset a portion of the amounts we have agreed to pay the government.”

Allscripts acquired Practice Fusion in January 2018 for $100 million after withdrawing a previous offer of $250 million. Practice Fusion had been previously valued at up to $1.5 billion.

Epic Lists Its HHS Interoperability Rule Concerns

January 27, 2020 News No Comments

Epic posts its concerns about HHS’s proposed interoperability rule:

  • The rule would require health systems to send data to any app that a patient requests.
  • 79% of healthcare apps have been found to sell or share patient data.
  • Those app vendors would not be required to ask the patient for approval to use their data for other purposes.
  • The patient’s data might also include family member data, such as family history, that the patient doesn’t realize, and those family members would not necessarily approve of having their information disclosed.
  • The proposed rule does not limit the extent of information that an app can request or how its developer can use it.

The company concludes that while it rarely comments on national policy issues, “We must speak out to avoid a situation like Cambridge Analytica. The solution has a clear precedent in HIPAA protections, and creating similar protections that apply to apps would make a difference in the privacy and well-being of millions of patients and their families.”

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Meanwhile, HHS Secretary Alex Azar said in his keynote speech at ONC’s annual meeting on Monday:

Health records today are stored in a segmented, balkanized system, and it’s not just affecting the patient and provider experience—it’s affecting care. This has to change, which is why, last year, we proposed ONC’s bold interoperability rule, as well as accompanying rules from CMS. I want to briefly lay out the context of the interoperability rule, which is the result of years of thinking about what’s needed to deliver on the potential of health IT.

The rule was authorized and required by the 21st Century Cures Act, a piece of legislation that passed on a nearly unanimous, bipartisan basis, and a law that I know many of you in this room either worked on or advocated. The details of the rule may be complex, but the goal is very simple: It’s about access and choice. Patients should be able to access their electronic medical record at no cost, period. Providers should be able to use the IT tools that allow them to provide the best care for patients, without excessive costs or technical barriers. 

This sounds like a pretty intuitive, appealing standard. Unfortunately, some are defending the balkanized, outdated status quo and fighting our proposals fiercely.I want to be quite clear: Patients need and deserve control over their records; interoperability is the single biggest step we can take toward that goal.

In determining how to implement it, we will take very seriously all input from our stakeholders, including all of you in this room. We extended the comment period for the interoperability rule, and have done extensive in-person outreach as well. We will pursue the goal of patient empowerment while providing robust enforcement of and protection for these same patients’ privacy.

This is not about one software system design or the other. This is about ensuring that patients have access to information about their own health, and that providers have a choice in tools and solutions to provide the best possible care. Our work toward that end will in no way limit patients’ privacy protections.

Look at the status quo: Patients cannot easily access their medical records, providers on different systems cannot effectively communicate, and those holding patient data have prevented new market entrants from participating in this space. Defending a system like this, defending that status quo, is a pretty unpopular place to be … scare tactics are not going to stop the reforms we need.

Curbside Consult with Dr. Jayne 1/27/20

January 27, 2020 Dr. Jayne No Comments

The healthcare IT universe is atwitter (both figuratively and literally) about Epic’s opposition to the proposed HHS rules regarding information blocking. Although the rules are designed to speed sharing of patient data among hospitals, medical practices, and other care delivery entities, there are concerns that they don’t go far enough to protect patient privacy.

Opponents are claiming that relaxed rules will allow sharing of data with third parties that aren’t bound by HIPAA, resulting in patients losing control of their protected health information. HHS counters with the assertion that they “want the public to have computational right of access to health information so they can have control over apps of their choosing.”

Although choice is a lofty goal, the reality is that patients (and consumers in general) aren’t going to read the disclosures of how their data is used or what permissions an app might need to operate, which could open the floodgates of information sharing in ways they might not fully appreciate. On the other hand, data sharing is important for better healthcare – improved coordination of services, reduced duplication of testing, greater understanding of the patient’s whole condition, and more.

I see patients who regularly pull up their patient portal accounts and just hand me their phones, hoping I can make sense of their medication lists or what lab testing has been done recently. They know that the big health systems in town refuse to play nicely with independent providers, but they want us to have the whole picture.

It’s the digital equivalent of what the military did with charts for years. The patient would pick up their chart and take it with them to their appointments so that everything was at the provider’s fingertips. I used to love seeing those recently discharged military members in practice because it meant continuity in a way that I couldn’t get via fax or mail in the olden days before electronic data sharing.

I think it’s important for patients to understand that if they share their health information with third party apps that their data is no longer protected. This is the current reality for a good chunk of health data. Patients are giving their PHI freely to apps tracking fitness, fertility, calorie intake, sleep patterns, biometric factors, lab data, and more. They’re giving away their genomes to commercial testing providers without a second thought, mostly because they haven’t read the fine print.

I’ve heard the call for protection of health information regardless of whether it’s in the hands of a HIPAA-covered entity or not. That is starting to look like a good idea. Maybe it’s time to broaden the definition of PHI and hold everyone who handles it accountable for keeping it protected.

Maybe it’s also time for HHS and other agencies to fight information blocking in ways that don’t involve vendors. My state’s HIE is one of the most pathetic in the nation, with high costs to hook up to it and other barriers to participation. Although the big health systems are feeding it data, it’s cost prohibitive for small organizations or independent providers to connect. How about some grants to eliminate those barriers? Or how about tax breaks for providers who want to connect for better patient care? How about allowing individual providers to go through a credentialing process to be able to log in to see whatever patient data they need to get the job done, just like they do now for prescription drug monitoring programs? Why all the mystery about having to have a practice or institutional login? It drives me crazy, because when I moonlight at the hospital I can access the HIE, but when I’m out at the little practice on the prairie where the data would be most beneficial, I’m in the dark.

There are more pieces to the puzzle then just requiring vendors to jump through interoperability hoops. We need to require healthcare providers to actually comply with existing laws regarding records release and data sharing. Right now, there is little enforcement and little recourse for patients who are caught without their information.

Let’s also spend some money educating patients about their health and the importance of keeping track of their data, even if they have to do it manually. Sure, it’s cooler to do it on your phone or with an app, but even just keeping a file with copies of important labs is better than nothing. Three-ring binders aren’t sexy, but they’re cheap and you can still access the data when you forget to plug in your phone.

Patients don’t realize how important it is to keep track of their health when they’re healthy. I routinely have to restart people’s hepatitis vaccination series because they’ve lost the records of their immunizations and the pediatrician has long since retired. People become sick and realize they need “the binder” or “the spreadsheet” or whatever mode of data gathering they arrive at, but it’s too late.

Some argue that we shouldn’t put the onus on the patient. I would say that’s the only way to make sure their information is accurate.

I did a little View Download Transmit experiment on my own medical records at several different practices and found upwards of two dozen errors. There were diagnoses I’ve never had, medications I haven’t been on in years, and even a couple of lost pathology specimens. Managing that shouldn’t be entirely the patient’s responsibility, but there could be a better partnership between patients and providers to ensure that everyone had the information they need. There are simple workflows that enable this that very few practices do, such as sending the patient a copy of their health summary prior to the visit and asking them to bring any corrections to the visit. You could even (gasp) give the patient a printout of the information when they check in for their visit, ask for a markup, and then review it together. Seems easy, but there’s too often a lack of resources or lack of will to even make these small changes.

Although this is a hot topic for HIStalk and Politico and others, many people in the trenches have no clue. I had lunch with a CMIO friend today and she wasn’t even aware of the situation with Epic despite her role in an Epic-using organization. She works for the biggest information blocker in town, whose staff often refuses to talk to me after I refer patients to their hospitals. Go figure. I guess she wasn’t in Judy’s contacts list. Similarly, no one is fired up in my forums for women physicians or medical school alumni.

It has been interesting to educate people about this issue. I hope they start following what’s going on in healthcare beyond their daily survival routine.

Let’s put on our patient hats for a minute and reflect on what we think about the proposed HHS rule. Do you give it a thumbs up or down, regardless of how it impacts your working world? Leave a comment or email me.

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Email Dr. Jayne.

Readers Write: Alert and Alarm Fatigue: It’s Not Just For Clinicians Any More

January 27, 2020 Readers Write No Comments

Alert and Alarm Fatigue: It’s Not Just For Clinicians Any More
By Drex DeFord

Drex DeFord, MSHI, MPA is a healthcare strategy consultant and adviser to CI Security of Bremerton, WA. 

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I’d like to say that we are lucky now that we have all adopted EHRs and used them to drive better, faster, cheaper, safer, easier-to-access care for patients and families. But based on my post-Meaningful Use experience, “luck” is one of the last words used by doctors, nurses, and other frontline caregivers.

The EHR came with a lot of noise. Distracting, aggravating, and even dangerous noise. There was some good stuff, too, and we thought we were doing the right thing. We had good intentions. But along with the good, EHRs have generated a bunch of unintended consequences.

One of those is alert fatigue, which contributes to physician burnout. In fact, most providers suffer from some level of alert and alarm fatigue. One of the most referenced articles from the past year was Atul Gawande’s New Yorker piece describing how doctors hate their computers. EHRs are a work in progress, and the challenge is enormous.

Just like the patient-facing folks, the cybersecurity team has its own seriously debilitating case of alert fatigue. It comes from the beeping and buzzing that is emanated by the multitude of security systems that we have purchased and installed.

They get alerts for things big and small. A staff member plugs a new device into the network. Someone logs in from another country. A user types their password incorrectly three times. 

Somewhere in these alerts is an actual intruder and a real problem. Or even worse, it’s an intruder who is already in the network, biding their time in an effort to quietly find the organization’s data crown jewels, snag them, then quietly exit the electronic premises.

If you have a CISO and a dedicated cybersecurity team, then good for you. In many hospitals and most clinics, the responsibility for maintaining and managing cybersecurity tools is distributed across a small group of information technology professionals who have other, full-time day jobs, such as managing the network, storage systems, or applications.

Watching for cybersecurity alarms generated by this plethora of systems and then reacting to them – figuring out which ones are real versus false – has become a major burden. It is another unanticipated consequence of adding more technology, with the best intentions, to solve complicated problems. 

Based on the number of breaches in healthcare, one can imagine that those tasked with watching cybersecurity alerts are feeling overwhelmed, a lot like their patient-facing teammates. What may be just as bad is that cybersecurity alarm distraction increases the likelihood that IT operators will make mistakes or have an accident – miss a patch or misconfigure a server – and cause the organization to suffer a self-inflicted breach.

Cybersecurity work is massively stressful. For the delivery of modern healthcare, these cybersecurity professionals are critical. One missed alert and entire hospitals can shut down. Physician practices have had to close their doors entirely.

Being a first responder (that’s what cyber-security professionals really are) is one of the most difficult jobs in the world. It takes unique skills, courage, and grit. And there aren’t enough cyber professionals to go around. Unfortunately, all the stress also takes a toll on the professionals themselves, especially when they are spread too thin across too many responsibilities.

When it comes to cybersecurity, there are better ways to manage both organizational and individual risk. For example, managed detection and response services can shift the burden of answering and investigating all those alarms to cybersecurity professionals who do this for a living, all day, every day. They are experts at figuring out what’s real and what’s not. Some can even integrate products that specifically target the Internet of Medical Things, doing both discovery and security analysis. They can do it all incredibly quickly using a combination of well-tuned technology and human review.

By pushing more of this responsibility to managed service organizations, a health system’s IT team can reclaim control of their time. They can shift attention back to the major IT initiatives that can help their organization grow and succeed. Maybe they will even have more time to work on projects to reduce healthcare burnout and alarm fatigue for everyone else in the organization.

Readers Write: ONC Regulations: Why Epic is Wrong and Judy is Right

January 27, 2020 Readers Write No Comments

ONC Regulations: Why Epic is Wrong and Judy is Right
By Chinmay Singh

Chinmay Singh, MSE, MBA is co-founder and president of Asparia of Saratoga, CA.

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In August 2018, a highly satisfied medical practice customer of a company I co-founded decided to join a large, multi-state group. As part of this deal, they were required to switch to Athenahealth’s EHR, which was used by the large group. My company was an Athenahealth More Disruption Please partner, so I thought we would get an opportunity to go live across thousands of practices.

My jaw dropped when I got the email below from the medical group’s vice-president of clinical informatics, indicating that the group had decided not to integrate our solution:

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This is not the only case where my startup suffered due to information blocking. As any other health IT startup founder can attest, my mailbox is Exhibit A for proving that information blocking is rampant. Thousands of patients can also attest that such blocking impacts their wellbeing.

Despite of all of this, I ended up siding with Epic CEO Judy Faulkner last week.

As many of you know, Judy (my mom in India would be aghast if she knew I was addressing a 75-year-old woman by her first name) asked customers to oppose ONC’s proposed interoperability regulations, which are expected to be announced as soon as next month. CNBC published a series of articles that singled out Judy and hijacked the issue. The tone of the articles and associated tweets was similar to the partisan rhetoric that we regularly see on some national TV channels.

The article ignored Judy’s concerns about patient privacy. The Twitter world competed to paint the most successful health IT entrepreneur — a woman who has not taken a penny from VCs or from the stock market — as the villain.

Epic has done the right things by opening up App Orchard and enabling over 600 APIs. But is that enough? The answer is no.

App Orchard requires a company to pay a hefty membership fee and then a per-API call fee. There is no justification for the fee model. As an entrepreneur, I think the fee is arbitrary and excessive. The hefty membership fee does not make any meaningful contribution to Epic’s revenue (did someone at CNBC say $3 billion?) The only thing it does is to give ammunition to Epic’s opponents.

Similarly, Epic wants hospitals to use its software as the single source of truth. Unfortunately, by charging for each API call, Epic is encouraging the developer community (defined as “API Users” by ONC) to minimize use of such APIs, leading to the creation of new data silos. Why in the world you would develop 600+ APIs and not want them to be used is beyond my comprehension.

Epic’s flat-footed response does not end here. A few months back, the company decided to revoke developer access to all the APIs. Epic wants developers to contact Epic TS with their use case, who in turn will expose APIs on a case-by-case basis. You guessed it right — Epic will charge for this consultation.

Information blocking has hurt me and my company financially. Despite media portrayal of entrepreneurship, it is not fun to drive a rear-ended, 11-year-old Kia in Silicon Valley.

So why do I side with Judy? (sorry mom!) Because she is right to express privacy concerns.

I think everyone agrees that health information data is valuable. Mined at scale, it has the potential to help discover new treatments and reduce costs. At an individual level, interoperability can provide significant relief to patients as they seek treatment from a team of clinicians for conditions such as cancer. I have no doubt that the proposed ONC regulations will allow this. But patient privacy will suffer, and in the end, we will get overpriced and lower quality care.

The proposed regulations mention “API user” 40 times. As far as I can see, the regulations do not ask the API user to sign a business associate agreement or anything equivalent. Not once.

Not only this, the regulation requires “health IT developers” (aka Epic or Athenahealth) to approve the API user rather than their use case. Moreover, the regulation requires that such approval should not take more than five business days.

Who else, other than entrepreneurs like me, will get access to your health data?

Let’s start with law firms. Would malpractice premium jump because law firms will be mining such data at scale to find that one instance where a physician slipped? If that happens, will we continue to attract the best possible talent for medical schools?

Now imagine a cancer survivor who exchanges their health information for a free ride after chemo. Will they be discriminated against in job interviews because of publicly available information? Will politicians pit them against ALS patients in seeking votes?

What if this free ride was given to a teenaged incest victim from an underserved community who went for an abortion? Would the shaming ever end for her?

That is why Judy is right. But I do understand that she may not have said this as eloquently as a fellow Blue Devil from The Fuqua School of Business – “privacy is not an afterthought.”

Morning Headlines 1/27/20

January 26, 2020 Headlines No Comments

Epic ramps up campaign against HHS interop rules

Epic downplays potential plans to sue HHS over terms in its proposed data-sharing rules, instead saying it would prefer to work with HHS to fix the proposed regulations.

Evive Acquires Treatment-Guidance Tool WiserTogether

Benefits engagement technology vendor Evive acquires WiserTogether, which offers a personalized treatment guidance tool to guide people to the most-recommended, most-effective treatments.

Nextgen Healthcare (NXGN) Beats Q3 Earnings and Revenue Estimates

NextGen Healthcare reports Q3 results: revenue up 5.3%, adjusted EPS $0.23 vs. $0.18, beating Wall Street expectations for both.

Centene and WellCare complete giant health insurance merger

St. Louis-based insurer Centene completes its acquisition of WellCare Health Plans, creating the country’s largest health insurer with 23.4 million covered people and $100 billion in annual revenue

Monday Morning Update 1/27/20

January 26, 2020 News 7 Comments

Top News

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Epic CEO Judy Faulkner tells Politico that the company may sue HHS over terms in its proposed data-sharing rules that the company doesn’t like.

Faulker says the proposed changes would not protect patient privacy and would allow patients to send their information to apps whose developers could then sell or exploit their information.

Epic walked back the lawsuit talk the day after Politico ran its story, saying it would prefer to instead work with HHS to fix the proposed rule.

NextGen Healthcare President and CEO Rusty Frantz took an opposing view in last week’s earnings call,

I won’t comment on other vendors’ activities. However, what I would say is that wellness and lowering the cost of care are truly enabled by putting a patient’s complete medical record in front of their physicians. Most notably, at the front line of wellness, which is their community physicians. I struggled a little bit to understand why blocking that data under the banner of patient privacy really makes sense, especially given how much patient-identified data is already being shared by some health systems with other companies that aren’t directly involved in the treatment of patients. It seems a little contradictory and emblematic of business and competition being put before care.

Meanwhile, Apple, Microsoft, and Salesforce will participate in a Monday HHS meeting to support the proposed interoperability rules.


Reader Comments

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From Ushuaia Fuego: “Re: Komodo Health. Ever heard of them? They got $50 million in VC funding and claim to have access to data on 300 million patients, but I can’t figure out where that data comes from.” The company said last year that it was getting the de-identified information of 50 million patients from Allscripts ambulatory systems, but the 300 million number must come from insurers since it describes them as “150 payer complete datasets.” The company was recently featured in a Nature article titled “15 ways Silicon Valley is harnessing Big Data for health,” along with:

  • Verily (Project Baseline Health Study involving 10,000 participants).
  • Helix (matching genomic and EHR data for research).
  • Ellipsis Health (analyzing user speech to detect depression).
  • Catalia Health (wellness coaching via chatbot).
  • Human Dx (diagnosis crowdsourcing for clinicians).
  • Flatiron Health (cancer research using de-identified patient data).
  • PyrAmes (non-invasive continuous blood pressure monitoring).
  • LunaDNA (consumer DNA sharing with researchers for a portion of proceeds of any innovations that result).
  • Evidation (analysis of user-contributed sensor-based wellness data).
  • Propeller Health (inhaler usage monitoring).
  • Verana Health (clinical trials recruitment).
  • Tidepool (diabetes data sharing).
  • Bigfoot Medical (closed-loop insulin delivery).
  • Freenome (cancer prediction from EHR-stored molecular data).

HIStalk Announcements and Requests

HIStalk sponsors: get your HIMSS20 information included in our guide by completing this form. We’ve got you covered even if you aren’t exhibiting, but are attending – we’ll include your instructions on how customers or prospects can contact you at the conference.

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A slight majority of poll respondents say their EHR vendor’s choice of cloud partners will influence their own cloud decisions. CincyBet notes that Epic’s push to stay current on releases would make it prudent for Epic clients to stay away from Google Cloud.

New poll to your right or here: What motivates Epic’s opposition to proposed HHS information sharing rules? Regardless of your answer, I bet we can agree that:

  • Epic explained itself poorly in expressing vague concerns about patient privacy and healthcare costs and thus is left looking like a corporate moat-protector.
  • The company’s lack of PR expertise is showing. The only PR contact I’ve ever had there left the company within the last week or two and Epic is letting the health IT media control the story. They’re buying self-congratulatory billboards in DC airports, presumably to get the attention of federal officials and ONC meeting attendees.
  • Tommy Thompson’s Wisconsin op-ed that argued that the changes would hurt Epic’s success, employment, and economic impact makes any objection seem even more self-serving.
  • Industry reaction aside, no amount of criticism will cause Epic customer defections or discourage prospects from signing up. Any threats from customers – and I’ve seen none – would be hollow since they won’t walk away from a painful, expensive Epic implementation and rush to Cerner.

I can tell I’ve taken a few days off by my laptop’s sluggish power-up performance as it catches up on CPU-sapping Bitdefender updates. Thanks to Jenn for covering. Thanks, too to the fellow airline passenger who brought a Great Dane on board as an “emotional support animal” for not sitting in my row, thus taking up someone else’s legroom instead of mine.

Thanks to long-time sponsor Healthwise for taking the recently vacated Founding Sponsor spot (one of just two, with just two dropouts in 13 years). The non-profit company has helped people make better health decisions since 1975 (45 years!), offering evidence-based health education and technology solutions that are free of drug and device vendor influence. Its solutions embrace these simple concepts: (1) allow people to do as much as they can for themselves; (2) help them ask for the care they need; and (3) help them say no to the care they don’t need. Specific educational technology offerings include point-of-care education that fits into clinician workflow, care coordination, digital experiences, care management and behavior change, and care quality and patient satisfaction. Thanks to new Founding Sponsor Healthwise and CEO Adam C. Husney, MD for supporting HIStalk since 2011.


Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, CNO. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Benefits engagement technology vendor Evive acquires WiserTogether, which offers a personalized treatment guidance tool to guide people to the most-recommended, most-effective treatments.

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St. Louis-based Insurer Centene completes its acquisition of WellCare Health Plans, creating the country’s largest health insurer with 23.4 million covered people and $100 billion in annual revenue, most of it from Medicaid and Medicare. Still, its market cap is one-tenth that of now-smaller competitor UnitedHealth Group. Former HHS Secretary and Wisconsin Governor Tommy Thompson has been on Centene’s board since 2005, has made dozens of millions of dollars selling CNC shares, and still holds $25 million worth.

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NextGen Healthcare reports Q3 results: revenue up 5.3%, adjusted EPS $0.23 vs. $0.18, beating Wall Street expectations for both.

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I always enjoy the health IT summaries of Healthcare Growth Partners, the latest of which contains these observations:

  • Seven health IT companies completed IPOs in 2019 following a 2.5 year drought, of which Progyny topped 2019 performance with an 111% increase while Smile Direct Club imploded with shares down 62%.
  • Health IT investment leveled off in 2019 after 10 years of steady growth.
  • The definition of health IT continues to get fuzzier with integration across providers, payers, and drug and device companies.
  • Companies with $5-20 million in annual revenue will find optimal valuation via M&A if they earn recurring revenue from subscriptions or transactions, book at least 35% in annual revenue growth, retain 95% of customers, have a broad base of customers instead of a few big ones, and report $20+% in profitability on at least $8 million in revenue.
  • Companies get premium M&A valuation if they operate a single SaaS database, align pricing with ROI, develop a scalable distribution model, possess contractual data rights, and address healthcare reform rather than the status quo.
  • Recent valuation is highest for clinical trials management, telemedicine, and analytics, while the lowest multiple valuation was for revenue cycle management services, utilization management, and outsourced services.

Sales

  • Southern Illinois Healthcare will develop an Epic test automation solution in conjunction with Santa Rosa Consulting.

People

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Susan Protos, MBA (independent consultant) joins Emids as VP and client partner executive.

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Spok appoints Advocate Aurora Health CIO Bobbie Byrne, MD, MBA to its board.

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Harvard professor and disruptive innovation guru Clayton Christensen dies of leukemia at 67.


Announcements and Implementations

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AdventHealth will implement Avhana Health’s platform of three applications – Advance, Advisories, and Advice – to offer patient-specific healthcare team support following a previous collaboration to streamline pre-visit planning and to improve colorectal and breast cancer screening rates via API integration with AdventHeallth’s Cerner system.


Other

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An expert says Ireland’s new, behind-schedule National Children’s Hospital will be one of the world’s most expensive buildings now that its cost has ballooned from $441 million to $2.6 billion including technology, or $5.5 million per bed for the 470-bed project. I’ll stand by my long-held assertion (from experience) that children’s hospitals are nearly always the most wasteful and inefficient because management always drags out heart-tugging baby pictures to loosen the purse strings.

A JAMA Network op-ed piece says that hospitals that are considering the use of AI-powered ambient intelligence in exam rooms need to consider (a) patient and healthcare worker privacy given the ease of re-identifying de-identified data; (b) whether workers and patients need to consent before being monitored; and (c) the liability exposure involved in recording medical mistakes or uncorrected employee practices. 

Four former Cerner employees claim via a class action lawsuit that the company cost them money by choosing high-fee Fidelity investment options for its retirement plans.

Australia’s health insurance risk pool “death spiral” is like ours, as young people who struggle with college debt and poor job prospects are dropping coverage after questioning the value they receive for the high premiums, leaving older and sicker people to absorb higher costs. They are also like us in not having a good solution. 

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Weird News Andy offers a public service for his Florida fans in offering the ICD-10 code (W59.02: “Struck by nonvenomous lizards”) for patients who are injured by falling iguanas as cautioned by the National Weather Service.


Sponsor Updates

  • Meditech releases a new video, “How King’s Daughters Medical Center is improving the patient experience.”
  • Business Intelligence Group honors OpenText CEO Mark Barrenechea and Vocera’s Smartbadge with 2020 Big Innovation Awards.
  • CereCore welcomes Christopher Wickersham (CareTech Solutions) as director, level 1 support.
  • Experity publishes its latest Urgent Care Quarterly, “An Analysis of the Impact of Radiology in the Urgent Care Industry.”
  • Healthpac adds Relatient’s patient engagement software to its medical billing services.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 1/24/20

January 24, 2020 Weekender 1 Comment

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Weekly News Recap

  • Epic updates its software to include travel screening prompts for patients who may have traveled from China or who are experiencing symptoms of the coronavirus.
  • Columbus, OH-based analytics company Aver raises $27 million in a Series C round led by Cox Enterprises.
  • Judy Faulkner urges CEOs at some of Epic’s largest hospital customers to sign a letter to HHS Secretary Alex Azar protesting the proposed interoperability rule published last year.
  • Consumer DNA testing company 23andMe lays off 100 employees as it struggles with declining sales.
  • Epic decides to stop pursuing integrations with Google Cloud based on a lack of customer interest.

Best Reader Comments

Android permissions are a good example of one software provider using imprecise permission definitions to screw over consumers and other software makers. For example, I’m trying to copy a person’s name into an app on my phone. The app wants access to my contacts to do so; it might even request that access when I install the app. Many Android app vendors use this permission to vacuum up your whole contact list and sell it to others. You and the software developer that makes your contact list application can’t do anything about this without denying access to application data.

We need to prevent a similar situation with regards to health care data. Imagine you are trying to copy a lab to a telehealth app so that you can get a second opinion. The app requests access to your Mychart; you click Accept. It pulls all of your health information, labs, provider notes, tests, genetic information, etc. The telehealth company then sells this data to IMS. IMS has a breach and your health data floats around the internet.

HHS does not have the skills necessary to define this type of access or permission system. Certainly the proposed rules do not mitigate the dangers of the above scenario. If HHS can’t get a healthcare data security policy properly defined and enforced, what are they doing trying to force providers to share their application data with others? (Burgers)

Yeah, can’t wait till the architecture is opened up and I can place orders with my ordering app. Then scans with my imaging app. Then diet orders in my patients’ favorite diet tracking app. Maybe I can review them all in a new Review app! The future! (App for that)

Think about it – the big 2-3 EHR vendors are going to use the ‘security’ (fear/doubt) angle for ever to try and keep the oligopoly and ‘money printer’ they have today. This is a very expected play. They also know the architecture of what they’ve built is archaic and if the market opens up, apps/innovation will take over the provider and even patient user experience pretty rapidly. Just do a google search and look at the 1990s user interfaces that the big 2-3 still use today! Btw, the gigabytes of data we voluntarily expose each day is significantly more than the amount of healthcare data we obsessively try and protect. (Tom Jackson)

Government and Politics are forever part of health technology, however, I am constantly irritated with the government mandated monopoly granted to the AMA. I will go out on a limb to state that at some point the defense for Surescripts will raise the AMA situation and draw comparisons. It would be delightful to see that play out. (Bill O’Toole)


Watercooler Talk Tidbits

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Citing health, safety, and security issues, the Department of Transportation proposes a ban on emotional support animals and restrictions on the types of service animals passengers can bring on board planes, limiting them to trained dogs. Association of Flight Attendants President Sara Nelson has echoed the frustrations of many a road warrior with her reaction: “The days of Noah’s Ark in the air are hopefully coming to an end.”

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Simulation in Motion Montana brings hard-to-access training to remote clinics that would otherwise likely go without. The nonprofit’s three mobile training labs cover over 100,000 miles annually to offer rural healthcare providers training for scenarios like childbirth, trauma, pediatric overdoses, and sepsis infection.

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Madison, WI landmark Ella’s Deli and Ice Cream Parlor closes after 41 years in business. Epic purchased the diner’s famous carousel along with other decorations and installed them in its lobby last year.

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The Atlantic looks at the role military hospitals and the federal government play as medical debt collectors, recounting the story of an uninsured trauma patient who was taken to Brooke Army Medical Center in Houston because there was no better place to receive care. Described as “one of the most unforgiving debt collectors around,” the federal government can mete out punitive action to patients who need the biggest breaks, withholding wages, tax refunds, or 15% of a person’s Social Security income without a court order. Data from the Defense Health Agency puts civilian medical debt to military hospitals at $198 million.

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Pediatric surgeon Robert Parry, MD has gained quite the following as a post-op bandage artist at Akron Children’s Hospital in Ohio. He explains his technique: “I use Telfa dressings (not an ideal art medium) and cut out the outline of the image freehand. Then I color it in using Sharpies. It doesn’t go directly on the wound — it’s protected by a Tegaderm (plastic) dressing. I’ve operated on more than 10,000 children, and all of them that needed a dressing got a drawing. From tiny newborns that weigh less than a pound to fully grown young adults. And I can’t recall anyone not enjoying it — no matter how old they are.”

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@Farzad_MD clarifies an earlier tweet about Epic’s billboard placement in Washington, DC. Meanwhile, Politico reports that Epic CEO Judy Faulkner has said she might sue HHS if they move forward with publishing the interop rules she has so publicly objected to.


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Morning Headlines 1/24/20

January 23, 2020 Headlines 2 Comments

23andMe lays off 100 people as DNA test sales decline, CEO says she was ‘surprised’ to see market turn

Consumer DNA testing company 23andMe lays off 100 employees as it struggles with declining sales.

Babylon Health is building an integrated, AI-based health app to serve a city of 300K in England

Babylon Health signs a 10-year agreement with the Royal Wolverhampton NHS Trust to develop an app that will offer the city’s residents diagnoses, virtual care, and monitoring of chronic conditions; plus appointment booking, prescription refills, and other care management capabilities.

Wuhan Coronavirus: Epic Sends Automatic Travel Screening Update to Spot New Cases

Epic updates its software to include travel screening prompts for patients who may have traveled from China or who are experiencing symptoms of the coronavirus.

Cybersecurity Vulnerabilities in Certain GE Healthcare Clinical Information Central Stations and Telemetry Servers: Safety Communication

The FDA alerts hospitals to cybersecurity flaws found in some GE Healthcare Clinical Information Central Stations and Telemetry Servers that could enable hackers to effectively take over devices and gain access to PHI.

News 1/24/20

January 23, 2020 News 14 Comments

Top News

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Citing patient privacy concerns, Epic CEO Judy Faulkner urges leaders at some of the company’s largest hospital customers to sign a letter to HHS Secretary Alex Azar protesting the proposed interoperability rule published last year. Faulkner emphasizes the urgency with which the letter must be signed, saying there’s “[v]ery little time” and that the final rule may be published the first week of February.

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The timing of the letter is odd, given that the proposed rule, which seeks to prevent information-blocking and give patients easier access to their data, was published early last year. Perhaps the company is trying to take advantage of decision-makers and media convening at ONC’s annual meeting in Washington, DC, which kicks off in a few days.


Reader Comments

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From Tom Jackson: “Re: Epic’s info-blocking. Think about it – the big 2-3 EHR vendors are going to use the ‘security’ (fear/doubt) angle for ever to try and keep the oligopoly and ‘money printer’ they have today. This is a very expected play. They also know the architecture of what they’ve built is archaic and if the market opens up, apps/innovation will take over the provider and even patient user experience pretty rapidly. Just do a google search and look at the 1990s user interfaces that the big 2-3 still use today! Btw, the gigabytes of data we voluntarily expose each day is significantly more than the amount of healthcare data we obsessively try and protect.”


Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, CNO. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Consumer DNA testing company 23andMe lays off 100 employees as it struggles with declining sales. CEO Anne Wojcicki has attributed the decline to recessionary fears and data privacy concerns. She hired 23andMe’s first chief security officer earlier this week.


Sales

  • Partners HealthCare in Boston selects Clinical Architecture’s data quality and content management software.
  • In England, Babylon Health signs a 10-year agreement with the Royal Wolverhampton NHS Trust to develop an app that will offer the city’s 300,000 residents diagnoses, virtual care, and monitoring of chronic conditions; plus appointment booking, prescription refills, and other care management capabilities.
  • Roundtrip selects health data exchange capabilities from Redox to better integrate its patient ride-sharing software with EHRs. 

People

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Care communication software vendor TigerConnect names Tim Goodwin (Vacasa) CTO.

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Cerner VP of Strategic Growth Amanda Adkins steps down to focus on her campaign for the 3rd congressional district in Kansas.


Announcements and Implementations

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Huntington Hospital (CA) deploys AI-enabled, stroke-detection software from Viz.ai.

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UI Health (IL) goes live with managed services from HCTec.


Privacy and Security

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Senator Mark Warner (D-VA) calls on the Defense Health Agency to look into lax data practices at three Army facilities that have left the medical images of over 9,000 military patients exposed online. German cybersecurity experts discovered the unsecured PACS last year. DHA CIO Patrick Flanders believes the images were stored on servers belonging to private companies doing business with the DoD: “What’s happened is DoD has either shared its data with a commercial entity that failed to follow security procedures or individual patients have gone to hospitals and gotten their record … when you are referred to private practice … you go get it, and it’s uploaded into the commercial world and it’s susceptible.”


Other

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China suspends transportation in and out of three cities in an effort to contain the coronavirus, which has infected more than 500 people and killed 17. One US citizen in Washington has been diagnosed with the virus so far, prompting his caregivers at Providence Health & Services to add travel and screening alerts to their Epic system. NYC Health + Hospitals is making similar adjustments to its Epic EHR in anticipation of travelers arriving for Chinese New Year celebrations.

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Bloomin’ Babies Birth Center in Colorado pilots the Mayo Clinic’s Nest West virtual care program, which offers expectant mothers the option of having four to seven of the typical 12 to 14 prenatal appointments virtually. Patients take readings at home using borrowed tools like digital blood pressure cuffs and bathroom scales, and then share those readings with nurses via telemedicine software provided by Doxy.Me. Birth Center staff have high hopes for the virtual visits, given that 14% of their patients drive over an hour – sometimes in harsh winter conditions – to make their appointments.


Sponsor Updates

  • Elsevier will organize a new conference, AI and Big Data in Cancer: From Innovation to Impact, March 29-31 in Boston.
  • Ensocare will exhibit at the 2020 Patient Flow Management Summit January 30-31 in Las Vegas.
  • Healthcare Growth Partners publishes its “Semi-Annual Health IT Market Review.”
  • InterSystems releases a new podcast, “Jim Collins: An Authentic Approach to Artificial Intelligence in Healthcare.”
  • Health Catalyst becomes the first healthcare member of the Partnership on AI.

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EPtalk by Dr. Jayne 1/23/20

January 23, 2020 Dr. Jayne 2 Comments

IBM has proposed measures to reduce concerns of bias in the use of artificial intelligence solutions. Critics have noted that AI technologies use data that can reflect past discrimination and may not accurately reflect health factors for women, minorities, the elderly, and disabled persons. IBM is urging industry and governmental agencies to work together to create standards to measure bias and prevent potential discrimination. It also calls on companies in the AI space to appoint ethics officials and to assess whether AI systems can cause harm.

I’m eagerly awaiting the arrival of useful AI systems in my clinical practice, since we perform primary readings on all of our so-called “plain film” radiology studies. (It’s been decades since I’ve seen any film, or smelled the delightful chemicals, and I certainly don’t miss it.) It feels like we sometimes over-call findings on chest X-rays, but without truly crunching the data it’s hard to tell, since we have an inherent bias because everyone who has a film is already pretty sick. It would be great to have AI backup or pre/post screening to make our lives a little easier and a little more evidence-based, while we wait the 30-45 minutes for a radiology overread.

I enjoyed reading this op ed piece about renewed efforts to combat medical errors. I’ve worked with a handful of systems recently that still struggle with the basics, including ongoing use of so-called “do not use” abbreviations. Some vendors seem to think that just because their product isn’t certified EHR technology that they don’t have to respect the standard conventions for safety and usability. The piece does treat a couple of issues too simplistically, blaming EHRs for physician burnout (I’d argue it’s not only EHRs but the mounds of regulations and data collection requirements that EHRs were designed to satisfy). There is also a lack of citations for key data points, such as the allegation that radiologists at one organization are viewing images at a rate of one every four seconds. I wonder if that state’s Board of Healing Arts has anything to say about that.

Applications for the CMS Primary Care First program closed this week, and I’ll be interested to see how many organizations signed up and ultimately what payers end up participating in the program. The initiative didn’t excite any of my clients, despite their detailed evaluation of the program’s different tracks and comparison of it to existing programs. The application process ran so far behind that they had to shift the program by a year, so I’m not sure anyone has too high of hopes for it.

I missed this newsy tidbit last week: The US International Trade Commission will be investigating Fitbit, Garmin, and other wearable devices following a patent infringement complaint by competitor Koninklijke Philips. At least in my community, interest in fitness trackers seems to have waned – no one talks much anymore about their steps or jumps up based on a prompt to MOVE! like they used to. I still use my Garmin watch to track my runs in addition to telling me the time, but I turned off the activity prompts and the display of texts from my phone, as I found them too disruptive.

My inbox has been overstuffed for the last couple of months, so I also missed this item: Hims & Hers telehealth is partnering with Ochsner Health System for coverage of conditions not usually treated through the Hims & Hers platform. They’re fairly small as a telehealth vendor with only 200 physicians, so I’m sure broadening their network will be a benefit. I’m not a fan of their sale of nonmedical consumer products such as beauty and skincare formulas, nor their sale of various supplements and alleged sex drive boosters. I’m not a fan of those in face-to-face practice either, as I think it’s hard to remain objective about pushing products if you profit from them, and I think the evidence on some of their products is thin at best. Apparently Ochsner isn’t worried about being on the slippery slope and they plan to launch the service first in Florida.

A good friend of mine has done significant work for tobacco quit-line services, so I was glad to see this article looking at EHR-based versus fax-based referrals to the quit lines. Long study short, the availability of EHR-based referrals produced referral rates at three to four times that of the current fax-based standard of care. EHR-based referrals were also more numerous for underserved populations. The key takeaway is that the easier the process, the more likely that clinical teams will do it – and if launching referrals from screens where the staff is already working does the trick, that’s a win for patients.

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HIMSS is hosting a webinar on Monday, February 3 that caught my eye: “Monitoring Grandma: Adoption of Connected Health Tech by Seniors.” The objectives are to explore current tech trends in the older population, along with real-world experiences from clinicians using technology with geriatric patients. They also plan to discuss attitudes toward health technology at the community level along with how it should impact design and adoption. I’ve struggled occasionally with getting my Amazon Echo to do what I want it to do – maybe it’s my accent or maybe I’m just not using the right words. Or perhaps as I head farther away from the tender age of 29, I need to embrace the mythical Amazon Echo Silver.

Informaticists are discussing the recent surge in China of a novel coronavirus that has killed 17 people with more than 540 cases confirmed. Health systems in the US, especially those in major points of entry, are debating the addition of EHR screening questions similar to past outbreaks of Severe Acute Respiratory Syndrome (SARS) and Ebola virus. The city of Wuhan, with a population of nearly 12 million people, has shuttered local transportation systems, suspended outbound flights, and is asking residents to stay home. The new flu-like virus is suspected to have jumped to the human population from illegally traded wildlife at a Wuhan market. The World Health Organization will decide this week if this outbreak qualifies as a global health emergency, although airports are already screening travelers. Meanwhile, the United States has already seen over 9.7 million cases of influenza with 87,000 flu-related hospitalizations and 4,800 deaths (including more than 30 children) this season. Just something to think about.

Has your hospital added coronavirus screening questions to the EHR yet? Leave a comment or email me.

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Morning Headlines 1/23/20

January 22, 2020 Headlines 6 Comments

Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info

Judy Faulkner urges CEOs at some of Epic’s largest hospital customers to sign a letter to HHS Secretary Alex Azar protesting the proposed interoperability rule published last year.

Gentem raises $3.7 million to fund future growth

San Francisco-based Gentem raises $3.7 million in a seed funding round that will help the company scale its RCM technology for physician practices.

DoctorLogic Secures $7 Million Series A Financing From Unbundled Capital

Medical marketing software and services vendor DoctorLogic raises $7 million in a Series A round.

Morning Headlines 1/22/20

January 21, 2020 Headlines No Comments

Snohomish County man is first US case of new coronavirus

Providence Health & Services in Washington is working to install screening for the Novel Coronavirus in its Epic EHR after caring for the first US citizen to contract the infection.

Amazon just filed a bunch of international trademarks for ‘Amazon Pharmacy’

Amazon files trademarks for “Amazon Pharmacy” in the UK, Canada, and Australia.

Operations back to normal at Great Plains Health after cyberattack

Great Plains Health (NE) nears full recovery from the November 25 ransomware attack that forced it to pen and paper for several days, and to cancel some services and appointments.

News 1/22/20

January 21, 2020 News No Comments

Top News

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Amazon files trademarks for “Amazon Pharmacy” in the UK, Canada, and Australia. It’s a move some see as indicative of the company’s global plans for PillPack, the online prescription drug delivery company Amazon acquired for $753 million in 2018 and rebranded to an Amazon company late last year.


HIStalk Announcements and Requests

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I had a technical hiccup when publishing this week’s poll, so I’d like to give readers another chance to respond. Comments (anonymous or not) are appreciated.


Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, CNO. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Health Scholars raises $17M in a Series B round. The Westminster, CO-based company has developed virtual reality-based medial training and simulation software and programs for hospital and public safety personnel. Co-founder, President, and CMO Brian Gillett, MD is still a practicing emergency physician with US Acute Care Solutions.

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Socially Determined, a social determinants of health analytics startup based in Washington, DC, raises $11 million in a Series A round. 


Sales

  • Banner Health (AZ) signs a five-year contract with EVisit and VeeMed for integrated ambulatory and acute care telemedicine services.
  • Steward Health Care expands its Meditech deployment with the addition of 18 facilities across Arizona, Arkansas, Louisiana, Texas, and Utah.

People

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Kernie Brashier (Payspan) joins urgent care health IT vendor Experity as CTO.

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Tenet Healthcare names former Oracle EVP Joe Eazor president and CEO of Conifer Health Solutions.


Announcements and Implementations

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Fulton County Medical Center (PA) will move from Greenway to Meditech Ambulatory in early February.

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Experity announces GA of Experity 2021, software that combines EHR, practice management, RCM, and updated coding capabilities from Practice Velocity and DocuTap, which merged to form the company last year.


Privacy and Security

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In Nebraska, Great Plains Health CIO Brandon Kelliher says the hospital has nearly fully recovered from the November 25 ransomware attack that forced it to pen and paper for several days, and to cancel some services and appointments. Primary clinical systems including Epic were back up and running in less than two weeks. The hospital ended up having to rebuild 290 of its 360 servers.


Other

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Researchers at UC San Francisco determine that physicians prescribe fewer opioids when default settings related to the preset number of opioids are adjusted downwards in the EHR.

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Mayo Clinic Platform President John Halamka, MD shares a high-level overview of Nference, a new project that will turn patient data into de-identified data that analytics partners can then use to generate new insights. Halamka stresses that “this is the perfect balance of agility, innovation, and privacy protection. I’ve worked in many organizations and not experienced a design that has so many safeguards against data leakage.”

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Cape Fear Valley Health (NC) apologizes to 17 rape victims after billing them for their forensic medical exams, an action prohibited by state law. The health system blamed the patient classification and billing error on its conversion from Cerner to Epic last May.


Sponsor Updates

  • Avaya names William Madison (Masergy Communications) VP, North America cloud sales.
  • Bluetree adds Emily Tempels, Brian Redig, and Paul Haney as executive partners.
  • Burwood Group will sponsor the HIMSS 2020 Cybersecurity Forum January 24 in Irvine, CA.
  • Nuance makes Dragon Medical One available in France, Belgium, and the Netherlands.
  • Spok adds Advocate Aurora Health CIO Bobbie Byrne, MD to its Board of Directors.

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Morning Headlines 1/21/20

January 20, 2020 Headlines No Comments

Two Former Outcome Health Employees Plead Guilty

Former Outcome Health analysts Kathryn Choi and Oliver Han change their pleas to guilty of charges related to felony conspiracy to commit wire fraud.

Health Scholars, the Virtual Reality Healthcare Training Platform, Raises $17M in Series B funding.

VR medical training and simulation company Health Scholars raises $17M in a Series B round.

Apple working on preventative healthcare technology, CEO Cook reveals

Apple CEO Tim Cook says he is hopeful the yet-to-be-revealed work the company is doing to further incorporate preventative healthcare technologies into products like the Apple Watch will improve lives and cut healthcare costs.

Curbside Consult with Dr. Jayne 1/20/20

January 20, 2020 Dr. Jayne 2 Comments

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On occasion, I’ve done consulting for groups who are trying to drive clinical outcomes through better patient engagement. Both vendors and healthcare delivery organizations have an interest in this, as they try to help providers capture incentives with value-based payment models or try to prevent unnecessary care. I’ve seen some unique and compelling apps that they expect patients to use, some of which try to gamify the healthcare experience. Other organizations are betting their money on patient portal functionality, and some are leveraging text-based solutions.

There’s a fine line, though, between trying to converse (whether electronically, face-to-face, or virtually) with patients versus using social medial platforms to try to reach specific clinical goals. I was interested to see this article in the Journal of the American Medical Association that looks at the potential role of social media in preventive health care. The authors start by noting Centers for Disease Control and Prevention data that indicates that more than 100,000 lives could be saved annually if patients in the US received clinical preventive services. These include basic elements such as vaccinations, tobacco use counseling, cancer screening, and blood pressure screening. They note key barriers such as access, cost, and awareness as factors that lead to inadequate delivery of services.

The authors note that “social media and other digital platforms that enable connectivity have unprecedented influence,” which to me is an understatement. The rise of social media “influencers” in many facets of life is somewhat surreal to those of us who have dedicated our lives to being expert in a field and trying to use evidence to guide what we say and do. In the world of social media, you can know fairly little about something, but if you present yourself well and have something catchy to offer, you can get thousands of people to begin following your every word. Sometimes notoriety is more important than knowledge or experience, and often consumers fail to understand the difference. With that in mind, I was skeptical about how social media could positively impact healthcare delivery. Not to mention, there are obvious privacy concerns where social media and personal health information intersect.

The authors specifically discuss the Facebook Preventive Health tool, which is available only in the mobile app. The app consumes sex and age data and matches it with guideline-driven preventive health services, also offering locations where users might want to receive them. The app uses a variety of guidelines from the American Cancer Society, American College of Cardiology, American Heart Association, and the Centers for Disease Control and Prevention. In looking at the app myself, they seem to pick and choose some of their recommendations, particularly where there are discrepancies between bodies such as the CDC and ACS. It’s also not very clear who is behind choosing the recommendations, and how they decided which set of guidelines to follow for any given condition. It’s also not clear how they decided what conditions to include or exclude in the tool. The app isn’t totally benign, as Facebook gathers user data about how individuals interact with the tool. Although the company claims they’re not sharing it with third parties, I’m skeptical.

The authors note that the Facebook Preventive Health tool suggests that users can share it with their networks. Although this can theoretically raise awareness of screening measures, it’s not clear whether such sharing actually drives health behavior change. They do cite a study on voting that showed that among 15 million Facebook users, direct messages encouraging voting influenced the behavior of individuals and their networks. However, they note that “a better understanding is needed in regard to whether information about preventive health propagates across users and how new users and influencers affect dissemination.” They also note some previous research that shows that “fact checking declines when information is presented on social media compared within an individual setting.” They cite the number of anti-vaccine “influencers” online and how misinformation can impact vaccine delivery. They go on to note that “for any health intervention on a social media platform, it will be important to determine how to assess the success of an intervention that includes vetted health recommendations on the same platform as misinformation.”

The authors note that privacy is an issue. While patients easily offer their personal data to apps, fitness trackers, and other platforms, they may not be aware how that data is used or that it can be combined with other data sources to personal data profiles that are beyond what they might normally share. I had a “wow this is scary” moment with one of my clients recently when they did just this – combining publicly available data that used only a name and email address to bring in demographic data, address information, and more, and ultimately created psychosocial profiles with specific predictions of income, educational status, political leanings, and other potentially sensitive data.

They go on to discuss the challenge of engaging populations that struggle to access health services – uninsured patients and those without primary care providers. Just making these patients aware that they need screening isn’t going to make family physicians create more openings for Medicaid or uninsured patients. The retail clinics mentioned in the app don’t offer a wide variety of services and the federally qualified health centers that are recommended might not have capacity to care for these patients either.

In the end, the authors leave us with more questions than answers. They note that it has always been a struggle when technology crosses paths with healthcare and there is typically skepticism of things that are new. Miasmas versus germ theory, anyone? They note the need for careful evaluation of the use of social medial platforms in driving public health needs, and the opportunity for partnership among healthcare delivery organizations, researchers, and the social media industry. These groups need to work together to enable studies of the interventions and definitions of a successful result.

This leaves me wondering, though – what would happen if specific social media influencers teamed up with reputable healthcare organizations to promote healthy behaviors? What if the Kardashians were hawking the concept of “eat less, move more” rather than “waist trainers,” which are essentially corsets? What if Goop sold “wellness” products that were actually based in science? What if famous rappers talked about taking their lady friend to get her pap test versus taking their daughter to get a “virginity test?” (Google it if you missed it in real life.) It has to go beyond getting former Surgeon General Vivek Murthy and HHS Secretary Kathleen Sebelius on Sesame Street.

What do you think about the role of social media in health promotion? Leave a message or email me.

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Reader Comments

  • No Idea: Thanks! Good luck to you getting a complete electronic copy of your health records via your patient portal download or a...
  • Elizabeth H. H. Holmes: Yeah now I'm just entirely convinced you have no idea what you're talking about. Good look on your app development....
  • Disingenuous knob: Serious answer - No need for any lengthy Terms of Service agreement. Just like I can download my (woefully incomplete su...
  • BlazerHipGlassesHandMotion: Eric Topol is a thought leader. His writing makes readers feel good about themselves so that they keep reading. It also ...
  • Elizabeth H. H. Holmes: Eric Topol is incredibly frustrating. He is uniquely arrogant in his hubris, even when he's provably wrong half the time...
  • Made me smile: Not just a knob, but a disingenuous knob. I like that one....
  • Elizabeth H. H. Holmes: Serious question - do you really think a lengthy Terms of Service document is a good way for consumers to inform themsel...
  • Nael Hafez: The issue being raised, albeit clumsily, is that these patient facing APP vendors are in no way restricted by federal pr...
  • Awe and admiration: Epic and the executives of their leading hospital customers should be up for some special shared Nobel Prize... Their se...
  • Stinky: Re: Epic's Information Blocking: No one passionate about patients and their care opposes interoperability. The only care...

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