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Monday Morning Update 2/18/19

February 17, 2019 News No Comments

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HIMSS gives a preview of the “evolution of the HIMSS Brand” (marketing-speak for “we had a new logo drawn up whose deep meaning requires 10 pages to explain.)” Meanwhile, the HIMSS social media folks are apparently fans of “The Dark Knight” or toffee candy bars.

The explainer video talks a lot about “re-imagining” and “reforming” the ecosystem. It also notes “member-driven impartiality,” which is as interesting as it is vague. It ends with a sinister-sounding call to “join the reformation,” which I think is really just a membership pitch.

I am impressed that the HIMSS marketing VP in charge of this project, Terri Sanders, has a long healthcare background (not all in marketing) and an MPH. Quibbles aside, I expect she will do a good job.

A couple of readers have emailed me to express their frustration that HIMSS ignored my request for their IRS Form 990 financial disclosure (which as a non-profit they are required by law to provide), so I’ve emailed the HIMSS media contact, Karen Groppe, with another request.


Reader Comments

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From Rounding Error: “Re: Cerner’s HIMSS19 slide bashing Epic over CommonWell. Carequality was exchanging 11.5 million records per month when the CommonWell connection went live in July 2018. It hasn’t changed much since even though a dozen CommonWell sites have gone live in the last seven months. I suspect CommonWell doesn’t have many members live or those members aren’t exchanging much data, while Carequality has 1,250 hospitals, 35,000 clinics, and 600,000 care providers. It’s kind of lame of Cerner to say that Epic is the laggard. No wonder the government is stepping in.” I was surprised that Cerner has become either more aggressive or more desperate in calling out competitors by name, which it has never done.

From Over the Shoulder: “Re: this tweet featuring a selfie of one of the Twitterati. Notice anything unusual? Hint: it was taken by a third person as the tweet-prolific subject pretended not to notice!” I thought that was odd, too, as was his inclusion of the twitter ID of a PR firm that seems to specialize in pushing vendor thought leadership. Digging further, he’s apparently shilling for the PR company, creating video commercials for their customers right in the exhibit hall. Hopefully all those folks who were unashamedly cashing in on their questionable fame at HIMSS19 won’t need their credibility back now that they’ve sold it.

From DrJVan: “Re: HIMSS19. Kudos on your coverage. Did Allscripts use this year’s gathering to introduce the industry to their AI product, Avenel? It has been over a year now since they announced this product. Was it displayed or mentioned?” I didn’t visit the Allscripts booth, I didn’t hear anything about Avenel, and Avenel wasn’t mentioned in the Allscripts tweets. I’ll invite readers to comment.  


HIStalk Announcements and Requests

It’s a typically quiet post-HIMSS conference period since everyone (even the federal government) blasted out their big news last week. I expect a refractory period this week as everybody gets back to their real jobs, after which the news will return at a pre-summer level. It’s nice that we have nearly 13 months before doing last week all over in Orlando again at HIMSS20.

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It’s nearly an even poll respondent split on whether the VA made the right choice in ending its Epic patient scheduling pilot and plan a replacement with the Cerner offering. King Solomon provided a wise comment as a former Epic Cadence application analyst, saying Epic’s product is awesome at scheduling and can handle complex rules, but that the single-system argument should prevail.

New poll to your right or here: What is your impression so far of HHS’s newly proposed interoperability policies? Vote and then click the poll’s Comments link to explain.

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I’m still struggling to think of something conclusively profound to say about HIMSS19, but I’m beginning to lock into an overview along these lines:

  • We give HIMSS too much credit in thinking that we should draw meaningful industry insights from its conference. Nobody expects to be inspired and educated about imperiled marine life by attending a boat show.
  • HIMSS is a show about selling, not doing, and while the former drives the exhibit hall (and thus the conference itself), the latter improves outcomes and cost.
  • Exhibitors in the hall did a good job in minimizing the hype and the hyperbolic come-ons. Some good conversations took place there.
  • Health systems do whatever benefits them the most. Technology amplifies the effects of both their best and worst practices.
  • Sharks have been jumped. The HIMSS conference probably isn’t one of them since the lower attendance will probably inspire changes, but the signs were there among certain vendors, technologies, and concepts.
  • Some companies and sectors (and maybe even HIMSS itself) seem to be struggling to figure out their post-Meaningful Use futures.
  • The government can talk about information blocking all it wants, but it’s a paper tiger when it won’t even take action when hospitals refuse to give patients copies of their medical records or charge excessively for doing so.
  • Cybersecurity is an increasingly big deal, which unfortunately means that providers will be diverting a big chunk of money sideways just to maintain the status quo.
  • Most health systems remain lemmings in following others at a safe distance, but more of them are forging their own paths without endless hand-wringing fretting whether they should wait for 10 similar organizations to it first. The rise in health system-run incubators was driven by potential profit, but also by being able to influence product direction.
  • Health system consolidation will be a feast for some vendors, but famine for the others, as the big will get bigger on both sides of the fence.
  • We have plenty of digital innovation, but health system indecisiveness and ridiculously long purchasing cycles keep killing it off as startups can’t hang in there for years waiting for their first sale.
  • The only sure way to make money as a health IT startup is to create something that taps into the massive profit stream of drug companies.
  • Big technology companies could become a limited disruptor in healthcare, but their arrogant lack of knowledge about how the industry works and their focus on technology rather than patients will make it hard for them to succeed in an ethical way.
  • Most conference attendees want to do the right thing for patients, but are hampered by a healthcare system and business environment in which those patients aren’t the actual customer. The status quo makes all of us unhappy as patients, but it also creates our paychecks, and we struggle with that.

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I’m interested in your HIMSS19 experience and takeaways. Please complete my anonymous HIMSS19 Impressions form. I’ll summarize the submissions next week.

Along those lines, I would enjoy hearing an exhibitors narrative on the conference – setup day pains, good and bad visitor behavior, company expectations, and shoe tips for the zillion steps per day you took. I’ll keep you anonymous, so you can be honest. Send something my way and don’t worry about polishing it up since I will do that.

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I’ve worked from a 15-inch laptop all week, so my first impression upon re-docking at home is that my desk monitor was the size of a theater screen. I’m also enjoying playing with the Amazon Echo Dot that I won by scoring 10 of 10 on WellSky’s trivia quiz at HIMSS19 – it’s similar to my Google Home Mini with good sound for a small gadget, but the setup was easier with the Dot, it’s easy to find new skills in the Alexa library, it plays Spotify and Pandora well, and it can connect to a Bluetooth speaker. It costs about the same as the Mini at $50. Either device is worth it just for setting cooking timers and reading the weather forecast.

I enjoyed the HIMSS19 write-up of Garen Sarafian, who is surprisingly astute and patient-focused as a money guy. He concludes that HIMSS is out of touch in choosing its dopey “Champions of Health Unite” theme that has little to do with actual health or its champions (who are likely caring for patients episodically instead of juggling Orlando party schedules). Like me, he is struggling to detect any overall HIMSS19 theme, although he notes that population health management didn’t get much airplay and health systems aren’t all that interested in exchanging information outside their walls (and thus forced the need for the federal government to provide a push). 

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Welcome to new HIStalk Platinum Sponsor Practice Velocity. The Machesney Park, IL-based urgent care solutions vendor offers the VelociDoc EMR, just named a KLAS Category Leader for 2019 for urgent care. Urgent care providers can document a visit in under two minutes using its Chartlet one-page urgent care chart. It integrates with online registration, teleradiology, in-clinic dispensing, national labs, and payments, with full integration to its PVM practice management system. The company offers 365-day, US-based support. The company’s 150 urgent care billing specialists can help code, process, and monitor claims as a complete revenue cycle management solution, while its full-time contracting and credentialing team can reduce administrative burden in tapping its longstanding payer relationships to maintain contracts and perform comparative fee analyses. See the company’s top-rated urgent care EMR here. Thanks to Practice Velocity for supporting HIStalk. 


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


Acquisitions, Funding, Business, and Stock

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Cerner’s investor presentation from HIMSS19 (worth a look in its entirety if you follow Cerner) included Brent Shafer’s “new operating model,” with these comments standing out:

  • The big themes are (a) making it easier for clients to do business with the company; (b) increasing the speed of innovation; and (c) growing profitably over time.
  • Cerner is “structured in a way to not conducive to productivity” in growing to $10 billion, thus the need for change.
  • A key component is the Greenhouse, an incubator where innovative ideas can be nurtured without competing for operational resources.
  • Client relationships will be a strong focus.
  • Process improvement is important – accountability, shared goals, driving increased collaboration and transparency, common metrics and KPIs, a focus on life cycle, and doing a better job of partnering.
  • A consolidating market is creating bigger client footprints.
  • Examples of getting innovation to market faster and making adoption easier: Dynamic Documentation is well liked and reduces clinician burnout, but six years after launch, only half the client base has it. The company offers a network for sharing air quality information for asthmatics, which shows what is possible with network connections.
  • The company offers 30 third-party apps and expects that number to increase.

Decisions

  • University of Maryland Shore Regional Health (MD) replaced Meditech with Epic on December 1, 2018.
  • Haskell Memorial Hospital (TX) replaced Evident (a CPSI Company) with Athenahealth on October 1, 2018.

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


People

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Fisher-Titus Health System (OH) hires Linda Stevenson (Cerner) as CIO.


Announcements and Implementations

CPSI makes its EHR information available to patients via Apple Health Records on the IPhone. 


Government and Politics

FDA warns McKesson over incidents where the company failed to take action after finding that one of its employees replaced opioid tablets with some other product, with McKesson doing nothing to warn other customers to check packages of the same lot number.


Privacy and Security

A hospital in the Netherlands confirms that students who work part-time there were inadvertently given the ability to view the complete electronic medical records of all patients, caused by incorrect software settings. 


Other

Some Twitter fluke kept recommending #HIMMS19 as a hashtag, creating a ton of tweets going out under a misspelled HIMSS.

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Rapidly improving photo and video manipulation tools capable of “deepfaking” (like the AI-generated portrait above) will threaten democracy, justice, and commerce since you can no longer tell if what you are seeing on Facebook or anywhere else is real. Check out this AI-powered site to see how easily technology can create believable images out of thin air. We need some kind of digital certificate that verifies that photos and videos were taken with unaltered cameras and have not been changed by even one pixel (some kind of hashed signature embedded as a watermark, maybe?) 

Non-profit health system Atrium Health – the former Carolinas HealthCare System – paid its CEO $6.1 million last year.

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The busiest webmaster in the industry must work at for-profit, CHS-owned Bayfront Health St. Petersburg, which keeps removing executives from its leadership page. He or she is behind, however, as the CFO just quit, joining other recent departees. I notice that the guy at the lower right moved to an assistant CEO job after two years as a performance improvement intern, his first job other than marina manager and a football skybox attendant (although to his credit he did earn an MHA).

Beverly Hospital (MA) admits to the state’s Department of Public Health that a former pharmacy technician stole 18,000 pills – most of them opioids – by marking them as outdated in Pyxis and then either using them or selling them. The hospital finally caught her a year after the thefts began, blaming the delay on a former pharmacy operations director who it says wasn’t reviewing the Pyxis reports. 

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A sperm bank sends a cease-and-desist letter to a female customer whose daughter was conceived using sperm the woman bought from the sperm bank. The woman had her five-year-old daughter’s DNA tested by 23andMe, which identified another 23andMe customer as the child’s grandmother. The woman thought it “was a cool thing” to contact the grandmother to say she would be open to contact from her son the donor, forgetting that the the sperm bank’s terms prohibit such contact until the child is 18 and only then through the sperm bank rather than directly. The sperm bank threatened her with a $20,000 penalty and said it could withhold the remaining four vials of sperm it was holding for her, also reminding her that she’s not allowed to seek the identity of the donor through DNA testing or online facial recognition tools.

A woman’s cancer treatment is delayed after the copies of her CT scan she had overnighted to her clinical trials team never made it – the mailbox place’s owner was in foreclosure and took off.


Sponsor Updates

  • Oneview Healthcare publishes a case study describing how University of Iowa Hospitals & Clinics uses a combination of technology and empathy to improve the patient experience.

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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Morning Headlines 2/15/19

February 14, 2019 Headlines No Comments

Texas Health System Selects CPSI SaaS Offering, nTrust

Mid Coast Health System selects CPSI’s NTrust program, which combines the vendor’s Thrive EHR, interfaces, and maintenance services with RCM support from TruBridge.

Health tech is so old-fashioned that Google had to adapt its cloud service to work with fax machines

At HIMSS, Google offers attendees a preview of the ability to fax medical information from its Google Drive cloud-storage service.

Hospital: Failure to read reports may have allowed pill thefts to go undetected

A pharmacy tech at Beverly Hospital (MA) alters computer records to cover up her theft of 18,000 pills over 13 months.

From HIMSS 2/14/19

February 14, 2019 News 4 Comments

News Items

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Veritas Capital is seeking a buyer for the API Healthcare workforce management software business it bought in its July 2018 acquisition of GE Healthcare’s software business. Veritas separated out API Healthcare with the acquisition and restored its previous operating name.

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Meanwhile Veritas-owned Virence Health, which merged GE Healthcare’s Centricity business with Athenahealth, confirmed on the HIMSS floor with me today that it will stop using the Virence Health name and instead move forward under the Athenahealth banner. Veritas Capital bought the GE Healthcare assets in July 2018, rebranded the business to Virence Health in October 2018, and then struck a deal to acquire Athenahealth five weeks later. It’s not surprising that the newly formed company couldn’t wait to shed its GE Healthcare albatross with a new name and then found itself owning a far more valuable one in Athenahealth, but a lot of money was wasted rolling out the Virence Health brand for its short run, including printing all those HIMSS19 totes. I told the booth rep that they should sell the trademark since it’s mostly a blank slate at this point anyway. 

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Adventist Health has laid off all 1,300 employees of Feather River Hospital (CA) and may not reopen the facility that was damaged in the November 2018 Camp Fire. That isn’t much of a reward for those employees whose dedication and heroics saved patients and provided shelter for local residents who were fleeing the devastating wildfire.


From the Burner Phone

“HIMSS sent this registration count for HIMSS19 – 42,595, with 39 percent representing provider organizations.” That’s down a bit from HIMSS18 and well short of the “45,000+” that HIMSS has been touting. Other leading stats for HIMSS19 that would be relevant are exhibitor count (and square footage), percentage of first-time attendees, and percentage of international registrations. My perception is that it was slower than in previous years, less focused given the absence of government mandates, and perhaps an expense that some exhibitors wouldn’t have committed to a year ago if they could have foreseen their now-obvious decrease in business.

“DoD, VA, and CMS take center stage with enormous agency-made booths and session after session talking about how they’re collaborating and leading. Maybe stay home and get your #!@$#!$@# EHR working?! A reminder that their ‘single instance’ has been ‘live’ for two years now and has yet to sniff a D- grade after two major tests. Not suitable, not operable, and most-certainly not INTERoperable.”


Observations

Today featured a beautiful, sunny morning that got even better as it warmed up. The cold and damp from yesterday were quickly forgotten on this last day of HIMSS19. I say “last day” because hardly anyone will stick around for the Friday afternoon wrap-up. This year’s schedule was a mess since the conference started on Tuesday instead of Monday, meaning that all those folks who could have been headed home for Valentine’s Day after the exhibit hall closed for the week on Wednesday now had to wait until this evening, most of them missing what should have been a special day at home.

You may remember the history of why we’re in Orlando this year and again next before returning to Las Vegas for HIMSS21. HIMSS got into a snit with Chicago Tourism in 2014 after finding out that RSNA was given lower hotel room rates and quickly lined up Orlando as a replacement for Chicago for HIMSS19, presumably with less flexibility on dates due to the relatively short notice. HIMSS17 was last in Orlando February 19–23, 2017, with the opening reception on the usual Sunday and the exhibit hall open Monday through Wednesday, a far better and more familiar schedule (I’ve been behind a day every single day this week, including Tuesday, when I was confidently telling everyone it was Monday). Las Vegas will probably always start later in the week because the casinos aren’t about to lose weekend gambling revenue for a conference. HIMSS20 is March 9-13, nearly a full month later than this round (yay – we have a 13-month break), but apparently still on the Tuesday through Friday schedule as this year. Maybe HIMSS has decided to try to synchronize Orlando and Las Vegas in avoiding the Sunday opening reception.

I was quite wrong about how this last day in the exhibit hall played out. I saw few pieces of luggage in booths, companies stuck it out, and reps were reasonably well focused. It was actually a really good day, where booth traffic was down a little and food lines were non-existent. It was quieter and I suspect the quality of the conversations was better. I think some vendors had already written today off and were happy to see fewer swag-seekers and more folks anxious to talk specifics and see demos. Good job not wasting the last day, everyone.

I continue to be amazed at how many men who are employed in healthcare leave the restroom without washing their hands. By the way, you are shaking those same unwashed hands when you visit a booth.

MedData scone trivia – the company brings their own ovens to conventions to bake and then ice the scones, which are made from frozen dough, and it’s all done with their own employees, not convention center catering people. They can do in-booth baking in every convention city except Boston and Las Vegas, where the trade unions are too strong and won’t allow it even if union members man the ovens.

I sat through a dull HIMSS Analytics presentation today, with the only slightly interesting takeaway being that 347 hospitals in 12 countries have achieved EMRAM Stage 7. And that HIMSS is starting yet another adoption model, this one for clinically integrated supply chain like medical devices and implants (H-SIMM). HIMSS sold off its data business to Definitive Healthcare recently, but is keeping the adoption model business, which includes consulting. I haven’t heard why it wanted out of the data business it so desperately wanted in when it bought a data company years ago.

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Good job, everyone (including me) who filled a bag with toys and supplies for hospitalized children at the Connection booth. Coincidentally I ran across an old friend today and found that she is CIO at an area facility – she had just learned that kids at her place will be getting a bunch of the bags. It felt good giving and I hope it feels good receiving.

I did get a memory blast from the past from the HIMSS Analytics presentation since the presenter referred to it – old school hospital wiring closets that, when you sent your network tech to reset a router, always required moving the mop and bucket the nurses had stashed there.

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Cerner previously never referred to its competitors by name, hoping to diminish them by leaving them anonymous. I was therefore surprised to see two slides from a very long deck playing on a huge monitor at Cerner’s main booth podium, the first of which called out Epic as being late to the interoperability party by not joining CommonWell, the second slamming Meditech with a headline of “Rebranding is not re-engineering” in claiming that Expanse is just a new name for an old product that wasn’t selling. I was surprised that they used the logos of both companies.

I heard from vendors all week that exhibit hall Internet connectivity was too slow to present demos. That’s surprising given what they pay for connectivity.

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I wondered if they made the consultants pedal?

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I don’t know why I find boxed water amusing, but here it is.

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I thought my photo included the name of the vendor that put out this very nice spread at the end of the last exhibit hall day, including some nice chocolate-dipped strawberries. Alas, I did not, but I appreciate whoever it was that sprung for impressive closing-day afternoon treats (the red velvet cookies were great).

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Optum made sure that every bench and table were labeled to discourage anyone from sitting on them without permission. They are owned by an insurance company, so they’re good at denials.

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I’m not sure what IBM was thinking in buying up the biggest floor space in the exhibit hall, then leaving it largely vacant. Either they over-estimated customer interest or Watson lost its mind trying to recommend a booth size.

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I was afraid of this door in the IBM Watson Health booth since I figured it might have been the last thing seen by all those older employees who IBM unceremoniously laid off in its attempt to “correct seniority mix.” Or maybe this is where the “Man Behind the Curtain” is sequestered.

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The line to have a custom t-shirt made by DSS stayed long even as the last afternoon of the conference wound down.

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A fun giveaway in the form of George Clooney’s tequila Casamigos. Life isn’t fair that someone with George Clooney’s looks and acting career then sells his tequila brand for $1 billion. At least I won one of the little bottles of it.

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I wouldn’t want to sit next to a stranger on seats like these.

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I admit that while I feel justified in questioning the credentials and intentions of some of the HIMSS Social Media Ambassadors, I’m casting the net too wide because some of them rise above the rest. Case in point is Dr. Nick van Terheyden (you can easily assess my respect because I follow only 133 Twitter accounts and his is one of them). Dr. Nick read that I was shut out from the cool helicopter socks being issued by Intermountain Ventures, and not only did he score me a pair and leave them with Lorre, he also included a pair of pink socks with a beautiful handwritten note that not only describes how he sees the Pink Socks movement, but also his own philosophy. I’m not ashamed to say that it choked me up a little – he was brimming with the positivity that isn’t my long suit. Thank you, Dr. Nick, for sending me not only a giveaway, but a takeaway.  

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The last view of the convention center from the shuttle bus. Taxis were loading up with people anxious to get to the airport and then home.

I’m too tired to keep working tonight, but this weekend I’ll try to arrive at some kind of conclusions about HIMSS19 and ask you for yours.

Dr. Jayne at HIMSS 2/14/19

February 14, 2019 News No Comments

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There was a shuttle immediately available at my hotel today, so I took it, figuring I’d give my feet a rest before hitting the show floor. It delivered me a bit before the doors opened but when I looked to find a place to sit, all the tables were covered with food and trash that based, on its content, was from yesterday. For as much as this conference costs, the tables could be wiped off overnight.

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People always ask me what is the best thing I saw in the hall on any given day, and this is the one. A good friend clued me in to WEconnect Health Management, which was over in the 888 booths. They’re using smartphones to engage patients along the addiction recovery process, delivering positive reinforcement in the palm of your hand. Families and providers can track compliance with care plans and patients who engage with their treatment plan can earn loyalty rewards. Founder and former professional tennis player Murphy Jensen was in the booth. Their content is evidence-based and they use a risk score algorithm to identify risk of relapse before it happens, so the care team and supporters can intervene. This is one of those solutions that I’m excited enough about to actually go home and try to get some of my colleagues to engage with it. My practice provides medical coverage for a residential treatment center and I think they’re going to be really excited about this company. A lot of people don’t spend any time in the small booth areas, but there are some gems for sure.

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Elsevier prominently displayed their sponsor sign.

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So did Santa Rosa Consulting.

I continued my quest to learn more about telehealth with a stop by InTouch Health. They’ve got a slick platform that’s geared to hospitals and health systems with offerings that span from stroke management to cardiology to ICU monitoring and beyond. The booth reps were friendly and knowledgeable and worked to get me the demo I wanted without making me feel like I was waiting. They have some impressive data on their network and connectivity stats that I hadn’t heard from other vendors I visited with this week.

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Intermountain Healthcare had awesome socks with air ambulances on them and were happy to give me a pair just for the asking.

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I was looking for 3D printing at the Hewlett Packard booth and spent some time talking to their team about Fitstation. It’s a device that performs a volumetric scan of the feet and collects data to enable 3D printing of custom orthotics at a fraction of the cost of traditional devices. The team was engaging and very enthusiastic about their product even though this isn’t a high-traffic show for them. They also happily added to my sock collection, supplying both running socks and fashion socks.

I ran into an old friend at Optum – reconnecting with people is really my favorite part of HIMSS (other than getting the required LLSA Continuing Education hours for my Clinical Informatics board certification). Some of the folks I happened across were people that I’ve walked through fire with (at least as far as EHR implementations go) and even though we hadn’t seen each other in years, it was as if had just seen each other yesterday. Several of them were job hunting, and knowing the caliber of people they are, it’s a loss for the employers they’re trying to leave. People are tired of being at risk for being reorganized, downsized, or streamlined and the good ones jump when they can.

Some of the reps were getting more aggressive today. One vendor’s team was halfway across the main aisle soliciting people to come to their booth. I’m pretty sure that’s some kind of violation of the HIMSS rules of engagement, and this particular rep wouldn’t take no for an answer. Once someone indicates they’re not interested, you’re not likely to convert them. Perhaps some additional sales education is in order.

Orchestrate Healthcare had their “booth babes” in short skirts again today. The putting green is such an overdone booth attraction and frankly I would take the company more seriously if they put the green attendants in funky golf pants or even just khakis. The skirts they were wearing were too short to pass the dress code at the last course I played and at least four inches shorter than the one golf skirt I own.

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I attended a lunch that featured FirstNet, powered by AT&T. Having spent some time in the emergency room trenches as well as volunteering with a rural fire department, I was interested to hear about their efforts to build an ultra-reliable wireless network for first responders. The lead presenter had one of their hardened smartphones and literally threw it across the room for attendees to see how rugged it was. It has an insane amount of battery life and can survive submersion and a drop from a seven-story building. One of the company’s goals is to deploy the network to 99 percent of the US population within five years and they’re running a year ahead of schedule, which is impressive. They’re creating a public safety app store where downloads will be fully vetted and guaranteed to have no back-end data capture. The network is used not only for disasters, but to enable ambulance teams to communicate reliably with emergency department medical control officers. They had a great use case of having a physician look at an EKG from the field and reroute the patient from the emergency department directly to the cardiac cath lab. The Orange County Convention Center butter pats were a nice touch.

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There were plenty of good shoes to be seen, although I wasn’t able to capture all of them. Props to the woman in the blue embroidered gaucho boots — they were amazing. There were also some memorable thigh-high boots on the floor today along with these numbers. I feel like a creeper taking the pictures at times, so I apologize if anyone was offended.

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The Colorado HIMSS contingent was ready for action. I spotted them at the Intelligent Medical Objects (IMO) booth where champagne and prosecco were being served in honor of Valentine’s Day.

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As was Dr. Nick van Terhyden. My own Valentine’s Day socks paled in comparison.

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The Allscripts booth had the tagline “Open up your possibilities,” but I found the booth oddly claustrophobic with its lowered illuminated ceiling.

A CIO friend told me about Nuance’s new offering that promises “clinical documentation that writes itself.” I am excited about what they have to offer – it’s Dragon-powered virtual scribe technology that links up with EHR documentation. The demo was slick and well prepared, although it’s hard for me to enjoy demos because my brain always gets sidelined by the super-simplified clinical content. They’re going to begin deploying to a subset of specialties soon, although I suspect it might be a while before they get to primary care. If they’re looking for a physician to continue to kick its tires and see if she can stump the dragon, I know where they can find someone.

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I mentioned this empty booth the other day. HIMSS filled it with tables and chairs, providing a much-needed place for weary travelers to rest their feet.

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The Howard Med Technology Solutions booth featured a diner offering ice cream, sodas, and Moon Pies. The staff was welcoming and happy to give refreshments to anyone who asked.

I’ve heard a lot of negative feedback about other vendors this week who weren’t willing to give out their swag, even when asked nicely. I experienced it myself, when one booth’s staff handed me off to three separate people before someone would finally agree to negotiate with me about some socks. Another vendor was only giving out their socks to people who fit a specific sales profile. If that’s your situation, then don’t put them out on the counter and instead keep them hidden for the right person to stop by.

If you have stuffed animals and someone specifically asks you for one to take home to a child, humor them. If you’re in a booth, you’re likely a road warrior yourself, and someday you might know what it’s like to surprise a kiddo with a cool animal that will be meaningful to them during a week where mom or dad was away. Typically on the last day of HIMSS people are a bit more free with their swag because they don’t want to send it home, but apparently not everyone thinks that way.

That’s a wrap on HIMSS19. I’m hanging out at the airport enjoying the free MCO Wi-Fi. Safe travels to everyone who is still at the show. I’ve never attended a closing keynote, so if you want to share your impressions, leave a comment or email me.

Dr. Jayne at HIMSS 2/13/19

February 14, 2019 News 1 Comment

Today was an absolute whirlwind and I am only going to be able to capture the bare minimum because it’s already after 1 a.m. and it’s been a very long day.

Wednesday morning started as a disaster. Everyone was taking the shuttles because of the rain. Three passed me by without stopping, so I decided to hoof it. Since I’m always prepared, I had an umbrella, and with the traffic still managed to walk to the convention center faster than one of the shuttles that passed me. I took advantage of the plastic umbrella bag provided by the convention team, but wasn’t pleased to find the still-wet and slightly mildewed umbrella at the bottom of my bag.

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Among the things I saw today that I liked: Vocera’s new Smartbadge, which functions like a cross between their flagship communications device and a mini smartphone. Users can save directories of favorites, filter calls and messages, and set up a list of favorite contacts. It’s designed to be nearly impervious to liquids and is easily sanitized, and weighs about 90 grams. My favorite feature is the panic button, which lets staff summon help without being too obvious. With the increasing reports of healthcare workplace violence, it’s a useful feature.

Since I’m trying to absorb as much as I can about telehealth, I stopped by GlobalMed to learn more about their workstations. I liked their HD camera, which helped me see in one of their staff’s ears with a picture clearer than my own otoscope at home. It also had a dermatology camera with polarizing features which helps see deeper into the skin layers. I’m glad they didn’t demo that piece on me! They truly are a global player, in use in more than 50 countries.

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The team at Lyft had pink sneakers for the gents and flats for the ladies. Even their visitor had great shoes.

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Medicomp’s wheel of prizes included chocolates and cash. You can’t beat that combination.

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Surveyor Health showed me their medication management system. It was pretty slick. The presenter’s t-shirt that said “I DO EPIC SH_T” was a nice touch.

Vivify Health showed me their Chronic Care Management solution, complete with a Bluetooth-enabled kit that patients can use to send biometric data back to the office. The kits can be configured with scales, blood pressure cuffs, pulse oximeters, and more. The system uses a tablet to gather data and responses to patient questionnaires, plugging them in to a health score algorithm that helps identify the most at risk patients. I had a relatively new sales rep do my demo and he did a great job.

Among the things I saw today that I wasn’t too fond of:

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Masimo had this creepy mannequin in a room mockup. Novarad also had their model patients laying on the table while attendees used VR goggles to do something with them. They do it every year and it’s still weird.

One of the ladies doing a demo at a startup booth was chugging Red Bull during the demo. Not a good look.

Back to the happy thoughts:

Epic’s carpet was ridiculously thick and comfortable. Just be careful not to break an ankle when you first step onto it, especially if you are moving at speed. 3M also had the mega-thick carpet.

I attended a lunch featuring John Halamka and learned quite a bit from it. I’ll save it for a future write-up as there were lots of good nuggets. He was wearing his trademark black jacket and tee, leading some audience members who had never seen him in person to speculate whether he was channeling Steve Jobs.

In the afternoon I stopped by the launch of Zynx Health’s Lumynz product, which I mentioned yesterday. The team outdid itself and painted the town orange (or at least the booth) in honor of its new release. There were plenty of chocolates and wine on hand as well. That event kicked off the evening social schedule, which was one of the more robust ones I’ve had in a while.

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I started off meeting with some old friends at the Rocks Bar at the Hyatt, where I captured these kicks. You can’t see the detail, but the socks say “Stop Talking” and I think I need a pair. From there it was off to MDLIVE’s get together at Urban Tide, which was full of engaging people who have an interest in telehealth. I heard a lot of different perspectives on where the industry might be headed.

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NextGen Healthcare’s party at The Pub was kiltastic. I chatted with one of their events staff because I’m always appreciative of the work that event planners perform. For those of you who don’t know the details behind how some of these booths, events, and parties are pulled off, there are many hard working people who make it happen. Thanks for a lovely time with a great band.

From there it was off to the Allscripts event at Del Frisco, with good food and nice wine along with their balcony which provided some much-needed cool air. The convention hall has been hot and muggy, at least to my senses, so I enjoyed the cool weather today after the rain stopped. The party really started swinging with the arrival of Matthew Holt and his entourage, and then we were off to the Google Cloud party at the House of Blues.

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These folks arrived from the awards gala. There were many other great shoes, but I couldn’t get good pictures without seeming like a creeper. Kudos to pregnant woman in the red dress who was wearing heels, they were super cute.

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I had a chance to spend some time with industry heavyweights who convinced me to come with them to Howl at the Moon, which was quite an experience. One of the physicians in the group hoped that this multi-straw drink had a high alcohol content to kill any germs that might wind up in the communal bucket. It was one of those memorable late-night experiences, although I had to make my exit early to go home and capture the day’s events before my eyelids snapped shut. One more long day to go!

Morning Headlines 2/14/19

February 13, 2019 Headlines No Comments

Veritas seeks buyer for API Healthcare, former GE workforce management unit

After acquiring Athenahealth, Veritas Capital considers selling API Healthcare, which it bought last year from GE alongside its enterprise financial and ambulatory care management units for $1 billion.

IBM Watson Health Invests in Research Collaborations with Leading Medical Centers to Advance the Application of AI to Health

IBM Watson Health will invest $50 million on research collaborations with Brigham and Women’s Hospital (MA) and Vanderbilt University Medical Center (TN) that will initially focus on how AI can improve the role of EHRs and claims data in patient safety efforts, precision medicine, and health equity.

BayCare Teams Up With Cerner, Lumeris and Salesforce to Improve Health of Senior Population

BayCare Health System (FL) will use Cerner’s HealtheIntent population health software, Salesforce’s CRM, and services from Lumeris to better care for senior patients enrolled in its BayCarePlus Medicare Advantage health plan.

Intermountain Healthcare and Trinity Health Make Growth Investment in AI Leader Jvion

Intermountain Healthcare (UT) and multi-state Trinity Health invest in predictive analytics vendor Jvion, which announced growth equity financing from separate investors last month. 

Casetabs Inc. Raises $2.5 Million From Investors

California-based surgery coordination software vendor Casetabs raises $2.5 million, bringing its total raised to over $13 million.

From HIMSS 2/13/19

February 13, 2019 News 8 Comments

From the Burner Phone

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“HIMSS hasn’t announced attendance because it is down thousands over last year. It would have been even worse except for the 10 percent of the attendees who were international.” I was expecting to see attendance figures released today, along with all the other standard announcements that go out on the same conference day every year. Traffic seemed markedly down in the exhibit hall and elsewhere. I will lose a lot of respect for HIMSS if they can’t put their ego in check and announce the conference stats as usual regardless of whether they are flattering, especially when they’ve been pushing “45,000+” in our faces for weeks. 

“Few CEOs were in the exhibit hall. Lots of dead booths and vendors complaining about reduced traffic.”

“We’re firing KLAS this week. Too little value for way too much money.”

“Quoting an ‘EHR extraction’ expert walking around at HIMSS. CMS is basically saying the Trump administration is wanting to prove that the Obama administration was sloppy with giving out all this MU money without any oversight. They are going after the big vendors to recover it. This is just the first of many.”

“It’s interesting how many executives were sitting in hotel lobbies Tuesday morning with their roller bags, obviously not planning to stick around for anything beyond the pre-conference team meeting and the first day’s booth opening. I bet that left some nice suites vacant from Tuesday night on.“

“Do all those social media ambassadors realize that their phones can be set to take photos toward the front instead of just facing themselves?”


Observations

Today started out surprisingly chilly and rainy, with people who were waiting on the shuttle buses forced to seek shelter or create impromptu head coverings from jackets or plastic grocery store bags. Many of them called Lyft, I noticed, also observing that I didn’t see any Uber riders even though I thought years ago that Uber would swat Lyft like a bug. Traffic was slow and my bus took 45 minutes to travel a couple of miles. My bus arrived at the convention center at nearly 10:00, fidgeting like smokers on a long flight as they contemplated the bleak picture of their exhibit hall booths open without them. They were not only late, but irrecoverably mussed from the rainy, windy start of the day.

The shuttle bus had a QR code on the wall, so of course I had to scan it. It brought up a YouTube safety video, which if you are sinking in a Florida drainage pond or feeling gasoline-fueled flames licking your legs, might not be the most productive use of your time.

I forgot to mention that HIMSS gave exhibit hall vendors orange badge lanyards this week vs. the black ones the rest of us have. That’s a step up for exhibit hall staff, though, since before this year, HIMSS gave nothing except the lowest-rent form of clip-on throwaway plastic badge holder like you would buy in flimsy boxes at Office Deport. The two-lanyard system recalls the old days of HIMSS, when the badges of vendors and providers were dot-matrix printed on different colored paper (yellow and blue, as I recall).

I mentioned yesterday that I decided that it doesn’t make sense for me to to spend a large fortune for a small, remotely located booth that draws few visitors, so I’ll pass on exhibiting at HIMSS20 for the first time in a few years. Our booth was quite busy today as a result, with readers paying their respects to the retiring Smokin’ Doc. It was actually kind of moving, like watching people honoring a retiring colleague.

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It was a big readership day today, with 9,000 page views. Thanks to every HIStalk reader, whether you keep coming back because you love it or because you hate it.

Tomorrow is exhibitor bug-out day, as it is not only the last (and shortened) exhibit hall day, but also Valentine’s Day. I guarantee that checkout luggage will fill booths in the morning and the hall will start emptying out by noon, as several vendor employees told me they’ve booked early flights to get home to their loved one. HIMSS policy has an unenforced requirement to stick around until the bitter end (which we never do) but nobody really cares, especially this year, when exhibitors may already be cranky about attendance and traffic. Walk the hall around lunchtime and all that good swag that vendors were protectively hiding will be freely available because they won’t want to pack it up and take it home.

AMA clarifies that the bar I saw set up outside their booth Tuesday afternoon wasn’t a happy hour, but rather the setup for an invitation-only event reception for women leaders in business. I wasn’t judging, but that’s good to know.

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This is definitely some odd wording, especially from an industry magazine’s email blast, although the whole thing had a lot of awkward prose and punctuation like maybe the author learned English later in life. A couple of readers sent this my way.

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I decided to wear my new socks from Fortified Health Security today, then the CoverMyMeds ones tomorrow.

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Nathan Grunewald, MD gave Epic’s Judy Faulkner a pair of pink socks and got her to pose for a photo besides. Note also that unlike most company CEOs who aren’t billionaires, Judy was working the Epic booth. I admit that despite trying to figure it out, I have no idea why pink socks have anything to do with healthcare or why people wearing them think they are leading some kind of movement, but having Judy among the socked will surely help. I assume she got a full pair without having to share it with the other person in the photo.

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The American Hospital Association is already blasting attempts to make its members share patient data, declaring that “CMS already has better levers to ensure the exchange of appropriate health information for patients.” Hospitals will do anything to prevent attempts to make them share information — that is both infuriating and embarrassing.

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Lyle Berkowitz, MD (MDLive) and Justin Graham, MD, MS (Hearst Health) dropped by to pay their respects to their retiring colleague.

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Epic’s booth was so big that they created their own aisle and demarcated it as a green, winding path. Epic booked 13,500 total square feet (behind only IBM) at a cost of around $200,000 per exhibit hall day not counting freight, furnishings, services, signage, the salary and expenses of booth staffers, and a bunch more stuff like electronics rental. Someone on the shuttle bus this morning said Epic had a large, impressive booth that must have cost a fortune, when another guy chimed in, “We’ve paid them $250 million, so we don’t care what they spend.”

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I dunno … that tall wall seems like a “bounds” to me.

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I really enjoyed talking to the super-nice and fun guys at the Philippines outsourcing booth. Vendors, they have a lot of clinicians (nurses, doctors, and even specialists and surgeons) ready to help with everything from utilization review to life sciences work, not to mention an army of well-trained folks who can supplement all kinds of projects remotely, such as revenue cycle management.

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I’ve observed in past years that BestCare has a cool-looking EHR, but the obvious cultural differences between its South Korea home and the US will make it a tough sell unless it hires US salespeople. Example: I counted 15 employees and zero visitors in its large booth. A guy comes up to scarf some free BestCare popcorn, and just to be nice, asks the company’s point person, “Do you have an EHR, or is it a dashboard that sits on top of the EHR?” The BestCare rep says, “We have both” and then just looks at the guy without saying anything more for several uncomfortable seconds, after which the guy took his popcorn and ran. An American salesperson would have been projectile vomiting out a stream of product superlatives in making the visitor earn his popcorn.

I stopped by Guardian Eagle upon seeing their first-time exhibitor sign. The St. Petersburg, FL-based company offers security systems and around-the-clock monitoring.

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I like coffee, but I’m simple – the cheap stuff is just fine as long as there’s plenty of flavored non-dairy creamer to make it more like a milkshake (hazelnut and Almond Joy are my favorites). I know nothing about the fake Italian descriptions Starbucks assigns to its sizes and Mrs. HIStalk has to order for me since I can never remember which is Americano, espresso, cappuccino, and all those other options. I’m happy, therefore, that PatientKeeper did what every coffee shop should – skip the showy vernacular and just tell us what it means, even if Starbucks coyly makes you say something other than “large” to get them to pour your cup. 

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Hearst Health not only had our sign out, but the First Databank subset of the company wrote a poem for the always-popular Health Policy Valentine’s Day in honor of the last HIMSS conference for The Smokin’ Doc: “Roses are red. Violets are blue. We’ll miss you Smokin’ Doc, but we know where to find you .” I’m not saying he won’t return next year, just not in an HIStalk-paid booth. Now that I’ve killed off HIStalkapalooza and exhibiting, I’ll be asking readers next week what, if anything, we should do at HIMSS.

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ESD is offering a new product called ARI (Virtual PM), a real-time automation tool for managing go-live activities, especially those involving contractors and consultants. The demo looked cool – consultants clock in by facial recognition, real-time updates show problem areas and workload, and trending shows which fires have been put out vs. those that need more resources. The real-time information stream helps health systems keep projects on time and budget by raising the visibility of problem areas and making sure consultants are being used optimally and billing correctly.

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I would consider this booth to be a contender for best design and theme in a modest space.

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This vendor (I forget who it was) is one of few offering those little heart-shaped candies and having a drawing for this guy.

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I had a creative idea for taking a picture with this cut-out, but it would have required a ladder and some privacy.

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This hero didn’t explain how he earned that honor, but he must have been granted the right to assign the exalted status to others since he had a lot of giveaway capes.

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I failed to notice previously how neon-like the AWS sign is, rather like that of Seattle’s Pike Place Market.

At least eight companies were offering to take professional headshots and had the equipment and photographer to do it. Pretty cool.

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Only in healthcare would you find “enterprise-class,” “API,” and “cloud” in the same tagline as “fax.”

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Capsule must have assumed that its freedom from Qualcomm Life shackles was inevitable since its booth looked pretty polished. The name change back to Capsule happened just a few days ago, although I don’t think it ever really went away. Although I do have one slight correction – the Francisco Partners acquisition announcement said the old name of “Capsule Technologies” would be restored, but the actual original name was the odd-looking “Capsule Technologie” because it was started in France, as I seem to recall.

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Big Nerd Ranch is my new favorite company name and logo. It offers developer training, noting that 21 of the world’s top 25 applications involve developers it trained.

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I find statements like these to be compelling. 

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I loved talking to Brent from PatientBond. I’ve somehow lost my notes, but he told me that the company uses psychographic analysis – obtained by having patients complete a 12-question quiz — to assign them a profile and to then engage them in ways that are likely to be most effective (it’s a nudge theory kind of thing). He said that “Willful Endurers” live for the moment and will ignore messages involving long-term management of their health, but will respond to a single “do this now” message that can then queue up the next one. Most astounding is that those Willful Endurers make up two-thirds of urgent care visits (not to mention a bunch of ED visits), and private equity firms that own those centers are using the information for marketing purposes. Brent used to work for Proctor & Gamble before leaving the dark side, so he knows how products are pushed and applying that knowledge to health is cool. It’s fascinating and it works – urgent care centers are snapping it up with an average sales cycle of just 30 days (since the product is incredibly inexpensive and has a 40x ROI) but hospitals are of course dragging their feet in the usual 12-24 month decision cycles. It’s like Cambridge Analytica except for good instead of evil.

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I dropped by WellSky, the new name for the former Mediware, which has assembled an impressive package of applications for home, hospital, practices, and community with 10,000 customer sites. The new CEO is Bill Miller, former CEO of OptumInsight, which became a juggernaut through well-managed acquisitions, a strong brand identity, and a relentless pursuit of growth. Not only that, I scored 10 of 10 on its trivia quiz, earning me an Amazon Echo Dot. Mediware was always kind of cool but niche-y, with no clear “what do you do exactly” identity and 30 individual brands. TPG Capital bought Mediware in December 2016 from Thoma Bravo. Annual revenue is nearly $300 million.

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I think I just heard a collective sigh of “awwww” from some of the ladies of health IT. I can say for sure that I heard it at the Stericycle booth, where the llama tee shirts were snapped up quickly.

I sat through an interesting presentation by Verizon on location services. Scenario: a patient enters a hospital campus, at which time a welcome message and parking instructions (based on their specific campus destination) pops up on their cell phone. A virtual beacon alerts the hospital that they have arrived. They are guided to their service area with turn-by-turn, inside-the-building instructions. They have their procedure and their family is notified when they can visit. That’s amazing on its own, but even more so when you remember that just a few years ago, hospitals were adamant that cell phones had to be turned off despite a complete lack of evidence explaining why, leaving patients, visitors, and staff offline permanently while at work. The hospital cell phone ban is even more embarrassingly dark ages to me than faxing.

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I think this is my first Wall O’ Doughnuts.

I talked to the folks at Goliath Technologies about their EHR performance monitor for Citrix and other infrastructure. It goes way beyond simple application monitoring. Here’s a real-life scenario from a hospital client. The hospital sees a massive EHR slowdown in certain areas. The app is running fine in the data center, but not on the desktop. The various IT teams – server, app, network – say everything is fine on their end (they always say that), yet the users are dying by hourglass. Some network guy takes a shot in the dark in recalling that a new driver was rolled out to every hospital scanner and suggests that each of those drivers be manually rolled back, which will take forever with the system still unavailable to users. Someone remembers that Goliath is running and checks its micro-detailed log – say, look at this, the slowdown happened early Sunday morning and seems to be network-related. Oh, Mr. Network Guy who wanted the drivers rolled back, did you make any system changes at that time? Why yes, as a matter of fact, but all we did was replace a switch that serves those specific units, although I can’t see how that would … OK, I’ll get a team on it. Goliath measures and logs everything that might degrade the Epic, Cerner, or Meditech user experience, giving IT a heads-up even before the users complain.

I checked out NextGate for an overview of the challenges and opportunities of patient matching. The state of the art is comparing current data from third-party sources to potentially stale EHR data that has outdated addresses or telephone numbers. The company offers location intelligence, where every EMPI patient address is geocoded for market research or locating the nearest doctor. 

NantHealth surely has the tiniest booth ever for a publicly traded company that is also a HIMSS Diamond Member – it occupied the same 10×10 space we did.

Note to presenters: the correct answer to “do I need to use this microphone?” is always yes. Despite your self-consciousness, it’s a little bit more work for you and lot more for your audience when you insist on giving a long talk without it (even if you do preface it with a chuckling reference to how loud your voice is).

I was drawn to Indigo Vision, which offers video security cameras that can be integrated with other applications. They showed a high-resolution camera streaming real-time crowd video that could track the movement of individuals by their attributes – male, red shirt, backpack, glasses, etc. That way it’s easier to look for someone suspected after the fact of doing something by querying the metadata to find video in which a guy with a red shirt and backpack was recorded. The company’s basic video system can be programmed with rules, such as triggering an alarm if anyone enters a garage after hours.

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That’s a wrap on what will be the next-to-last day of HIMSS19 for most attendees who, like me, will be departing Orlando either Thursday evening or Friday morning. I’ll be back with a final day’s report tomorrow night, but if you are leaving, safe travels and Happy Valentine’s Day to you and those who are waiting patiently at home for you.

Dr. Jayne at HIMSS 2/12/19

February 13, 2019 News No Comments

I started the day at the HIStalk booth seeing what Lorre’s plans were for the day. She’s riding solo at HIMSS this year and had a few take-home items on her list, including various stuffed critters from vendor booths. I was happy to help score her a Charlie from Healthfinch (#2790), but she’s still seeking a zebra and a giraffe for her menagerie. If you can help her score one, she can be found at #4085. You can also come by and have your picture taken with our iconic Smokin’ Doc and pick up a HIMSS survival kit from our friends at Arcadia (#2915).

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The folks at WatchGuard (#633) drew me in with their friendly smiles and bright shoes, which were accompanied by equally fun socks. I always love booth reps who reach out to greet you in a friendly way. Apparently, socks are a hot item again this year at HIMSS. I was also impressed by the reps at Kronos, who not only asked nicely if they could scan my badge, but looked at where I was from and asked some questions about my travel and whether I had a hard time making it to HIMSS. Those are the kind of people you want working your booth, those who can strike up a conversation without making it feel forced.

I dropped by First Databank (#1921) and saw some of their new solutions for targeted medication alerts. They are really helping to work to make alerts more meaningful for clinicians by using lab values to filter out alerts where they’re not appropriate because labs are being monitored and checked. They’re also doing some interesting work building out a database for veterinary medications. We love our pets, and especially with the entry of payers into the pet market, there is a need for better tools for those caring for our furry friends.

Just next door (also in #1921) was sister company Zynx Health, which was showing their new Lumynz solution. It’s really slick for those of us trying to lead the charge for value-based care, allowing clinical and financial leaders to easily see whether patients are receiving the evidence-based interventions they should be receiving, or whether factors of underuse or overuse are in play. The tool also measures compliance with order set use on a per-provider basis and helps clinical leaders educate their physicians on the evidence behind caring for a variety of clinical conditions. On the financial side, they’re helping CFOs understand how much they might be losing by under-delivering care. It will be great to see how it takes off and is well worth seeing.

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I managed to pick these up from VMware for the sock-lover in my life, who was very disappointed that I spent his birthday at HIMSS instead of being curled up under a quilt in the frozen north.

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Thanks to the following sponsors who were proudly displaying their signs: Visage Imaging (#1391); PatientBond (#4591); and Nordic (#2579). Thanks also to Lorre who ran around the sweltering convention hall this morning delivering them before the doors opened. I spent much of the day wishing I was wearing cooler clothes, so hopefully tomorrow will be a bit cooler.

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MySphera (#985) had this awesome Playmobil hospital setup, complete with operating room and IV bags. It brought a smile to my face during a long slog through the hall.

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CPSI featured Dave Maskin, The Amazing Wire Man, who is able to make anyone’s name out of wire. He got his inspiration for the craft after rewiring a lamp and is available for parties and special events. People were in quite a line waiting to have their names crafted. It seems like there are overall fewer catchy entertainers today, although I only made it through half of the hall.

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Cognosante had some great orange shoes.

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Sponsor Lightbeam Health Solutions (#4370) truly brought their A game, featuring this trio of dapper gents.

I attended a lunch sponsored by Cognizant, who had a lot to say about digital revenue cycle management. They’re advocating a sensible approach to automation, where people are used to handle exceptions and difficult situations but where routine tasks are automated. They’ve done some interesting work with claims and denials that is worth taking a look at. They also talked about using Blockchain for “smart contracts” between payers and providers along with real-time adjudication to create frictionless payments. They also offered wisdom on tackling small projects first and earning trust and demonstrating wins, rather than trying to proverbially boil the ocean as some organizations do.

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Healthjump brought their color coordination.

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These folks didn’t bring anything, since their 20×10 booth was empty.

Tonight’s social schedule included the New Media Meetup and a dinner with some potential clients, although bad traffic and inability to use Uber due to a cell connectivity issue conspired against me and kept me from making it to the Salesforce party. I’m disappointed but there wasn’t anything I could do, so hopefully they won’t blacklist me for next year.

I did manage to catch up with some former colleagues, which was time well spent. I always enjoy hanging out with people who are truly motivated to make life easier for their clients (and by translation the patients they serve) and who can see through all the bluster and noise that HIMSS brings.

Time to rest up!

From HIMSS 2/12/19

February 12, 2019 News 6 Comments

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News Items

CMS Administrator Seema Verma said in today’s opening session that previously announced hospital penalties and lower incentives for practices were supposed to encourage the industry to move forward on its own with interoperability, but the industry’s failure to do so resulted in this week’s proposed rules that are more prescriptive. She said the changes are aimed at insurers that refuse to share their claims data, although I’m not sure that comment was intended to be comprehensive.

Former White House CTO Aneesh Chopra agreed that the industry failed to self-organize to add more content, adding that the federal government’s initial data set was supposed to be a minimum, but the private sector didn’t take it further and the government had to create a new rule to get the entire medical record. Chopra said that CEHRT 2015 is a Roku and now we can add channels.

Verma added that this administration wants to deregulate, but the industry’s lagging behind the government required new regulations to get value for the $36 billion it spent on Meaningful Use. She also said that the next task is to bring in post-acute care providers.

University of Toledo issues an RFP for an EHR, apparently giving up its questionable project to help then-Athenahealth (now Virence Health) develop a new inpatient system. I expected that project to flounder once Elliott Management started pressuring the company, but there’s not much doubt that it will never see the light of day under new leadership.


From the Burner Phone

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“Hope you’re enjoying Orlando, and washing your hands regularly. This little tidbit just crossed my Twitter stream. I look forward to seeing it mentioned in the News section.” “Fox & Friends” TV host Pete Segseth says on TV that he hasn’t washed his hands in 10 years, adding in placing a second foot in mouth, “Germs are not a real thing. I can’t see them, therefore they’re not real.” He claimed later via Twitter (of course) that he was only joking and then returned to his real job of bashing Democrats, but here’s the punch line: he was President Trump’s frontrunner to replace soon-to-be-fired VA secretary David Shulkin. Imagine a guy who is running a sprawling medical enterprise like the VA who throws out comments like that, even if he is kidding.

“A company won a KLAS Best in Category and attended the KLAS event this week, but its attendees weren’t allowed to go on stage to receive their award because they weren’t wearing sport coats.” That might be the most bizarre thing I’ve heard this week.

“I was talking to someone fro the since-acquired HIMSS Analytics about their physician clinical data. Turns out they only have information for hospital and employed doctors – they don’t know anything about independent practices.”

“Is it just me or are some of these HIMSS Social Media Ambassadors losing all semblance of self-control? What is wrong with these people?” Some of them are like kids turned loose on Disneyworld after chugging a two-liter Mountain Dew, but HIMSS chose unwisely in anointing one highly questionable guy who doesn’t even seem be at the conference – his entire HIMSS-related output since the conference started is one retweet. Therefore, he’s my favorite one.


Observations

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I haven’t been to a HIMSS conference opening session for a couple of years (because they promised to be dull or vendor-led). My observations:

  • The slick media show that played before the session began was all about HIMSS, its influence, its acquisitions, and its grand plans to stick its nose into every aspect of health and healthcare. Gone are the days when a series of quaint PowerPoints were running that listed its committee members, Life member and Fellows, local chapters, and volunteers. It was a celebration of being large and influential rather than giving credit to the members who pay dues, attend events, and serve on committees.
  • HIMSS should be renamed HIS (Health Information Society) since Management Systems (the MS part of its name) has disappeared from the agenda and maybe as a career discipline since its 1980s heyday. Instead, HIMSS has decided that the “information technology” part of its mission statement will be split as “information and technology.”
  • HIMSS sees itself as an advisor, enabler, and media powerhouse, all of which sound like for-profit activities even though HIMSS is a non-profit.
  • The musical act was harmless enough, with a gospel choir of probably Disney day-jobbers singing dad rock (granddad rock, actually) in the form of Queen’s “We Will Rock You” and “We are the Champions” as the HIMSS logo throbbed obscenely in time with the music.
  • HIMSS pointlessly paraded its caped poster children Champions on the stage – where they danced awkwardly for a few seconds before thankfully getting off – and just seeing one of them who has been relentless with self-promoting tweets and selfies made me recoil physically. Probably nice in person, but unaware or unconcerned about an obvious need for constant attention.
  • The opening keynote celebrated the accomplishment of moving the industry from paper to electronic records, failing to look at the flip side of billions in taxpayer-funded incentive payments and the failure of that expensive technology to improve cost and quality.
  • Karen DeSalvo is a gem, whether she’s working in health IT or public health, and Aneesh Chopra seems fun and enthusiastic.
  • I really disliked having talking points popping up on the screen beside the speaker’s image. Reason: the practice reminds me that they’re just reading their presentation.

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Mayo Clinic CIO and HIMSS board Cris Ross, MBA (he’s not a doctor, despite what some Twitterers seem to think) was an outstanding speaker in describing his transition from helping get Epic implemented to seeing it used by his caregivers for treating his newly diagnosed cancer. He seemed genuine, empathetic to others who are facing a cancer journey, and optimistic about technology’s potential role in improving care.

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Our booth traffic was nearly non-existent today, the day in which we had to choose booths for HIMSS20 (for which we’ll always get the dregs given our lack of HIMSS spending). I’ve long questioned whether the high cost of exhibiting is worth it for little guys like us with no HIMSS vendor points, low budgets, and non-existent ROI, so I pulled the plug on exhibiting at future HIMSS conferences. The Smokin’ Doc will be no more, at least in standing guard in his own space. A reader said I would get far more value from having someone drop by vendor booths to explain the benefit of supporting HIStalk, so maybe that’s an alternative.

Speaking of dead exhibits, I can only imagine what it was like in the beyond-7000 sections past the food court. I doubt many attendees are noticing the signs begging them to keep going beyond the fake ethnic food booths.

It takes me at least five hours to recap my day here, so I’ve learned to hightail it out of the exhibit hall when it closes (or earlier) and get to work. Last night it was cheap Chinese and a burger the day before that, so who knows what culinary delights await tonight? The lunch madhouse at the convention center was as crazy as usual – long lines to buy overpriced and over-processed food, then the pleasure of eating it standing up next to a restroom door because the demand for seats exceeds the supply by fivefold.

Thanks to the reader who dropped me off a great backpack. It has been invaluable.

Show floor notes:

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Connection put out games and supplies for attendees to bag up for patients in the local children’s hospitals. I did it and it was quite satisfying. Good job.

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This nice lady whose name I forgot to write down insisted that I try the smoothie she had made. It was delicious, something with strawberries (and I don’t usually enjoy smoothies).

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I still can’t grasp pairing Centricity with Athenahealth, but the deal has been consummated.

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Meanwhile, I guess Athenahealth had already paid for its large space before it was led away on a leash, so it was turned into a basement rec room with basically nobody stopping by. Although to be fair, its bad booth location at HIMSS18 and installing Jeff Immelt as Jonathan Bush’s bumbling chaperone had already killed off the massive crowds that Athenahealth had drawn every year before the mess started.

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Here’s the MedData scone schedule. It includes the great pumpkin and cranberry orange that I’ve had before, but omits the best flavor of them all – their passion fruit.

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Epic always has calculatedly weird stuff in its booth, but this guy is creepy.

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Epic marketing posters. I didn’t get a shot of the one that said 80 percent of medical students or something like that are trained on Epic.

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This Epic poster includes a footnoted credit to healthcare equities guy Constantine Davides for his laborious plotting of the acquisitions over time of Allscripts, Cerner, and Epic (also crediting HIStalk since I ran it a few years ago and it was a big hit). Epic is picking up the torch in keeping the graphic updated, for obvious marketing reasons. Constantine is now at Westwicke, which was itself recently acquired. 

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Here’s what Cerner had to say on the matter.

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I remember years ago when Voalte’s tiny band of mostly industry newbies blew into the HIMSS conference bedecked in shockingly Pepto-Bismol colored pants. Voalte’s booth has grown along with its business and its people are now experienced, but the company has admirably continued to use pink as its trademark – you can spot someone from Voalte from way down the hall.

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Ellkay keeps honeybees on its roof, co-founder Lior Hod is the proud head beekeeper, and there’s always beekeeper’s gear around the office so visitors and the children of employees can visit the hives (they almost brought a live hive to HIMSS19). They have honey in their booth along with cool graphics and really nice people (thank goodness their “data plumbers” tagline didn’t steer them toward carrying plungers while wearing low-rider pants). 

AxiaMed has the nicest people I’ve ever met in a HIMSS booth. They offer a patient payments solution, and in my case anyway, some cool argyle socks.

AT&T was doing a demo of using Magic Leap virtual reality during surgery.

What I didn’t see today:

  • The usual magicians from Hyland and Cantata Health. The former used a different guy and I assume that the amazing Bob wasn’t at the Cantata booth that I couldn’t find. Update: a reader says Cantata, like quite a few other vendors, took a meeting room rather than a booth, so no more Bob.
  • Booth babes, at least not any obvious ones.
  • Demos involving hospital beds and non-clinicians wearing scrubs or white lab coats.
  • Food offered in booths during happy hour.

What I did see: people filming and recording everywhere, getting in the way of everybody else to record material that nobody cares about. And the same handful of “pay us and we’ll show up in your booth and promote it” folks.

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People of mobile device sterilizer vendor Seal Shield let me down in having non-clinicians running around in scrubs. I know it seems innocent enough, but clinicians earn those scrubs every day and resent having them worn by laypeople as conference costumes. They may actually be so turned off that they’ll seek out your competitor. You have been warned.

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This was over the top but kind of cool, although I don’t remember the vendor (which may say a lot). Update: a reader says its Intermountain Healthcare, something to do with launching an incubator / investment arm like every big health system seems to be doing (although Intermountain missed the unicorn in their back yard, Health Catalyst).

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Thanks, Phynd, for featuring our sign so prominently.

Identity Automation had a photographer and studio-type setup for taking professional headshots, for which demand should be high given the awful profile pictures I’ve seen on LinkedIn.

Google Cloud, Microsoft, and Amazon Web Services all had big crowds in their booths.

NextGen Healthcare gave me a quick look at its mobile EHR app, which despite some questionably motivated and questionably insightful recent praise, looked just fine, but not anything a knowledgeable observer would consider game-changing. In fact, NextGen didn’t even develop the app – they got it when they bought the money-losing Entrada for $34 million a couple of years ago.

A reader asked me to report on Nuance’s  “AI-Powered Exam Room of the Future” demo room. It was about what I expected since I saw something similar from them last year and liked it – a doctor conducts an entire patient encounter using only voice, in which speech recognition converts lay terminology to medical (and vice versa) to create a progress note, structured documentation, and orders, all ready to be signed. Voice biometric authentication is part of the package as well, as is a wall-mounted bank of 16 microphones that can sense location (such as which leg the doctor is examining). My recommendation – the instructions the “doctor” was rattling off to the patient were full of timelines, activities, and drug names – the doctor could send the voice recording or the layperson transcription to the patient to reinforce what they were told but likely forgot. Patient advocates should pick up that charge, although doctors probably fear malpractice exposure.

Speaking of which, I haven’t heard anything about the “voice assistants” that were all the rage at HIMSS18. Maybe they’ve graduate to actual use in the field already.

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Here’s your mysteriously unsung hero of the conference and of the last several years of health IT. Grahame Grieve is the always-modest guy who is basically the father of FHIR (at least as I understand it, but I’m sure one could argue the point). Think about that – one guy from Down Under makes it happen that Apple can develop health apps, that vendors can offer third-party APIs and apps, and that systems can exchange information to the point that the federal government becomes FHIR’s cheerleader. You can’t tell me this guy hasn’t done more than many of the self-important suits running around, yet he never demands credit or recognition and hasn’t earned a dime from his work. Did you hear when I said Apple? Do you get what we wouldn’t have without FHIR? Nearly everything you need to know about today’s interoperability opportunities and challenges are made clear in my 2015 interview with him. I asked him a final question of what he would wish for if he could wave an interoperability wand and he brilliantly said (or perhaps predicted), “I wish the clinicians would believe in clinical interoperability the way that the IT people believe in IT interoperability. We’ve had doubters in the past, but pretty much everybody believes in it now if only we can get there. I wish the clinical people thought that that was a clinical problem.” To which I might add, “I wish health system executives would see interoperability as a responsibility to their patients, not as a threat to their bottom line.”

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At least it was your apostrophe rather than your heart that was misplaced, HIMSS.

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This is kind of a fun look and appropriate, too.

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Brilliant, not to mention self-designed. I believe we may have struck a distribution deal.

I had a quick theater demo of an Alexa-powered patient scheduling app from EMedApps. It was OK, although the generic wording of “provider” as recited to the home user is awkward, even though we as industry people haven’t figured out the best term to refer to the alphabet soup of licensed people who could see a given patient.

I had never hood of Hook, a three-year-old company that connects to Epic and Cerner (via FHIR API and Sandbox, respectively) to present a single view of a patient’s information that can be filtered, sorted, and searched. NYU Langone is piloting and the company is looking for more sites.

CITI Healthcare offers data migration and has an app on Epic’s App Orchard. Steve was a good guy there.

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The younger crowd represent with skin-tight suits, wild shoes, and diligently differentiating accessories like bow ties. Those of use whose youth is behind us can attest that when we, too were trying convey confident rebelliousness by ironically dressing and acting the same way, that practice itself was obvious form of confidence-lacking conformity. I like that HIMSS is targeting the early-career folks with their own social events – let’s make them feel welcome. We’re at that interesting point where the people who created health IT from punch card readers and 80-character terminals are retiring and throwing the flag to those behind them.

My goal of the day was to get vendor-offered socks, especially the loud and unusual kinds. Sometimes they handed them over generously, sometimes they stiffed me in saying that the front-and-center displayed socks are for prospects only (hey, if it’s on the podium, it should be fair game), and in Intermountain Healthcare’s case, I couldn’t score a pair of the cool Life-Flight socks because the lady working there was deep into some kind of technical struggle from which her gaze did not avert.

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I was surprised that the AMA had a happy hour bar going. But then again, just about every booth had a happy hour bar going.

Someone asked me at the end of the feet-ruining day what I saw as the big themes. I’m not sure I saw any so far, but I’ll say:

  • I saw few claims of old systems being suddenly AI-powered, and in fact not many companies were pitching AI at all and most of those that did were obviously using the term in a marketing rather than technical definition (they don’t actually have it, in other words).
  • The term “big data” was spoken by no one, having been yesterday’s tired fad (again, a marketing term than a technical one).
  • Certainly the new proposed CMS rule has diverted a lot of industry attention right as the conference started – it’s a huge document to digest and it has big implications to both providers and vendors.
  • Vendors didn’t seem all that excessive in their booths, although maybe I’ve just become immune to it.
  • I didn’t see all that many booth staffers screwing around with their phones or huddling for inter-employee chats instead of paying attention to visitors. In fact, I saw vendors having pre-opening scrums, going through orientation checklists, and describing the goals of the company to everyone involved.
  • It felt like maybe people are starting to see the HIMSS conference as more of a boat show distraction with the ever-present government action discussion thrown in and little of substance in between. Maybe system selection has been rationalized, health systems have locked in with their preferred vendors as those health systems expand, and the huge unknowns of genomic science and artificial intelligence fighting for air time with lack of interoperability (or lack of a market for it), questionable usability, and uncertain ROI. We’ll see if the HIMSS attendance – announced tomorrow, probably – is trending up or down (they predicted more than 45,000).
  • The US health non-system is not sustainable and expensive technology hasn’t improved cost or outcomes despite those neon gulches of previous HIMSS conferences in which vendors claimed to have the solution for every problem du jour. As Mike Leavitt said in today’s opening session, you can’t be on the world’s leaderboard if you’re spending 25 percent of your GDP on healthcare.

Tell me – what should I see or do Wednesday that would rise above my trite observations about booth snacks or lack of magicians?

Morning Headlines 2/13/19

February 12, 2019 Headlines No Comments

Partners Healthcare system back up following IT issue

Partners Healthcare (MA) rectifies Citrix connectivity issues that affected clinical and administrative systems at its 12 hospitals.

RTI International Launches Center for Health Care Advancement to Provide Evidence-Based Solutions to Problems in Health Care

Nonprofit research institute RTI International will develop the Center for Health Care Advancement to offer providers and payers insight into health IT, data analytics, population health, policy, delivery, and financing as they transition to value-based care.

MediQuant acquires DataEmerge, HeF Solutions

Medical records archiving vendor MediQuant acquires data extraction company DataEmerge and health data conversion business HeF Solutions.

Dr. Jayne at HIMSS 2/11/19

February 12, 2019 News No Comments

I was thrilled to finally make it to Orlando in one piece, and to not have to engage my backup plans of flying to Tampa and renting a car or having to come a day later. My HIMSS schedule this year is crazier than it’s ever been, with only a few scattered hours of free time. Missing all of Monday would have been a mess since I had several meetings with people I only see face-to-face at HIMSS. Fortunately, I connected with a colleague in Chicago that I hadn’t expected to see and we were able to spend a couple of minutes together doing some quality shoe-watching.

ONC jumped on the “let’s release things at HIMSS” bandwagon by posting the Notice of Proposed Rule Making for Interoperability since we’ll all have time to read it this week. Those of us who are at HIMSS are running around crazy, and the ones we left on the home front are running around crazy covering the work we left them. Proposed requirements include the ability to export electronic information in a computable format for not only single patients, but for all patients in the event of a provider switching EHRs. They missed the mark, however, since they’re allowing vendors to determine the export standards they will use rather than making a proscribed standard. They also clarified seven exceptions to the information blocking provision. If anyone has the time to read it and finds other interesting nuggets, leave a comment or email me.

I was glad to get out and pick up my registration materials in the morning before the sun began to beat down mercilessly. For those of us in frozen climates, being exposed to anything warmer than 50 degrees is likely to cause heat prostration. I met up with a good friend and planned our booth crawl strategy for tomorrow, so I hope all of you manning the booths have your game faces on. We’ll be watching for the best, worst, and most memorable booth teams. Despite the sun, I made the walk back to my hotel without melting, but opted to take the shuttle bus when I returned to the convention center for the opening reception.

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The reception was full of attendees donning superhero capes, some of them over their backpacks, which made for an interesting look. There were Spandex-clad entertainers dressed like Spiderman, Batman, and their masked colleagues. The room was pretty dark so it was difficult to take pictures without being totally obvious – I missed some great shoe pics for sure. The lobby outside the Valencia Ballroom had some faux food trucks serving as bars that looked like they had long lines – fortunately the lines inside were much shorter. HIMSS continues to not understand “cocktail reception food,” offering several items that required forks, making it difficult to figure out what to do with your drink. I also thought I saw someone eating something with chopsticks but was never able to find the buffet from which it came.

The reception is a great time to connect with friends old and new before everyone splits up to various vendor events and company dinners. I try not to sign up for more events than I can actually attend. My usual wing-woman was off to the KLAS dinner, so I opted for one of the regional HIMSS chapter events, which ended up being a good choice as I met several new folks who had some great stories to share. My dinner partner was a vendor rep who covers several states including two served by the chapter, and I learned a fair amount about a certain niche in the medical equipment market.

Key themes continue to include EHR optimization and workflow improvement. In talking to a few people at big health systems, I learned that there are quite a few organizations that aren’t anywhere near down the path to value based care as it might be assumed that they would be. In many areas there is still a lack of alignment between value-based contracting and physician incentives. It’s hard to get people to coordinate care and reduce utilization when they’re still being paid on a model that is largely based on production. I think those of us in the healthcare trenches assume everyone is trying to be on the cutting edge when in reality many groups are just trying to hang on. Since Mr. H doesn’t do the party circuit and Jenn isn’t here this year, I had to do my part for the team and whirl off to the next event.

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Nordic Consulting outdid itself as usual with its classy event at the Oceanaire Seafood Room. Just about every type of seafood was represented, along with a nice wine selection and a dessert bar that made a nice addition to the night. The room layout was conducive to conversation and I was able to recover from the loud volume yell-fest at my previous event. I’m always impressed by their staff, who print out badges and place them in reusable magnetic holders so you don’t wind up with sticky film on your clothes or holes from the pins given at some events. No wristbands, either.

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Upon returning your badge holder on the way out, you were presented with a Cards Against Health IT game, which I can’t wait to play. They assured me it is workplace appropriate, unlike the game that inspired it. I regularly attend a Halloween party with a number of local healthcare IT folks, so I know what I’ll be bringing this year along with my standard casserole full of hot artichoke dip.

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Lots of cool shoes at Nordic, reminding me of my wilder shoe days. I’ve needed cortisone shots after my last couple of trips to HIMSS, so I’ve dialed my footwear down quite a bit. I do have some sparkly numbers planned for tomorrow night and they’re comfy to boot.

There were several other parties tonight. I heard the one hosted by sponsor Redox was hopping, but I was pretty worn out after battling travel last night and surviving the relative heat wave today. As I headed for my low-rent but walkable hotel, I met up with an attendee who was trying to figure out how to walk to a hotel adjacent to mine, so we had a nice chat on the way. It was nice to get to know a woman in the startup space and learn more about what she is trying to accomplish with using technology to fuel smoking cessation and positive behavior change.

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Also on tomorrow’s dance card is an opportunity to crash the new HIMSS member ice cream social. If that doesn’t work out, there are plenty of in-booth happy hours to offer distraction. I’ve got a long list of must-see booths and will be waiting with the crowds for the doors to open. Until then, I need some beauty sleep!

From HIMSS 2/11/19

February 11, 2019 News 4 Comments

News Items

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HHS / CMS / ONC seem to have developed a knack for publishing important documents late on a Friday or immediately before the first day of the HIMSS conference. HHS released its long-awaited Notice of Proposed Rulemaking for interoperability, as required by the 21st Century Cures Act, on Monday morning, although legal experts note that the NPRM was posted online but not in the Federal Register. A few items I noted from a quick skim of the 724-page document:

  • Actors who spend money to support information exchange would be allowed to recover those costs by charging fees.
  • EHR vendors would not be allowed to charge for using their APIs, except in charging providers who use them or vendors who offer value-added services. Fees would be cost-based, objective, and consistently applied.
  • All EHR vendors would be required to support USCDI Version 1 as a standard.
  • APIs would be certified and vendors would be required to use the SMART Application Launch Framework Implementation Guide. They would be required to post API specifications publicly.
  • EHR certification would be expanded to include the product’s ability to export data to allow users to convert to another product.
  • EHR certification would be expanded to include pediatric care criteria.
  • Charging patients excessively to obtain their own information when they paid to have it created in the first place is information blocking. That’s going to be a big one that the American Hospital Association is sure to vigorously protest.

From the Burner Phone

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Text me news, rumors, photos, and booths I should visit this week, then watch for your items to appear anonymously in my daily recaps if I find them interesting.

“The Athenahealth – Elliott deal closed. Some ELT turnover was announced, including Paul Merrild. You should do some asking around about the hospital product, keeping an eye on the LinkedIn profiles of the company’s hospital-oriented employees.”

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“A Greenway client told me today that Intergy – not only Prime Suite – has 30 broken certification elements. I don’t pretend to understand what’s involved in fixing this list on ONC’s site (scroll down to ‘surveillance activities,’) so maybe it’s being overblown. I am following up with a solid inside source.” 

“As the US healthcare continues to struggle with protecting and securing our data, I suggest readers attend HIMSS19 Session 171 to learn real world experience of implement GDPR from two real professionals who have walked the talk, and have the callouses and boot blisters of the journey. I have no conflict of interest, do work for, or have financial interest – I’m just aware of their excellent work.”

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A couple of folks asked me about my burner phone, which actually is an app called Burner rather than a physical phone. It’s easy to set up, slick, and cheap ($4.99 per month, no commitment, unlimited texts and calls). You get a new phone number that you can give out freely since it’s not traceable (no caller ID) and is disposable (apparently it’s good for Craigslist, online dating, signing up for online services that require phone verification, and probably stalking). The texts and calls flow to your phone normally, but through Burner inbound and outbound, so your actual cell number is never exposed and your cell bill shows only your Burner number. Folks who are doing something far more sensitive than I can delete their Burner and all associated records by literally just pressing one on-screen button, which I suppose is a benefit if you anticipate an “FBI, open up” knock at your door. I’m just using it because I ran across it and was intrigued.


Observations

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I checked the online HIMSS shuttle schedule while waiting at the designated spot. It suggested using the real-time shuttle location app, which was actually a web page and not an app. Perfect – it said a shuttle would be arriving in one minute. Then the one minute changed to 23 minutes, then to seven, then to six, then to 16 … and by then I had waited quite awhile and gave up and called for a Lyft ride. Unlike the HIMSS bus “app,” Lyft’s was deadly accurate.

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I was anxious to pick up my conference backpack so I could transfer all the junk in my hands and pockets. That didn’t happen – for the first time that I can recall in my long HIMSS conference history, the official HIMSS bag is a actual tote instead of a backpack. It holds a lot less, but more importantly, it can’t be slung over my shoulder, meaning I’ll be spending all week with one hand dedicated to lugging it around. I nearly brought along my travel backpack from home since I didn’t want to be without it for even the few hours of travel (much less for a week), but alas, I made an incorrect assumption that its presence would be, as it has been every year, redundant. Vendors in the exhibit hall, this could be your moment in the sun if you brought giveaway backpacks – let me know and I’ll let everyone know (after first grabbing one for myself, of course).

Tote bag (literally) pick-up didn’t go so well for me today because I couldn’t understand a word of what the person at the desk was saying because of her strong accent. However, I celebrated whatever culture she is or was part of since it’s good reminder that the industry isn’t just white-bread tech geeks and frat boys salespeople any longer (having a clear memory of when it was, and when male nurses and female executives were unheard of). 

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The exhibit hall was like a summer day in Vietnam – swelteringly hot, loud, and dangerous with vehicles (fork lifts and tractors) careening in all directions following no apparent rules and with little regard for pedestrians. The heat levels, caused by having the massive load-in doors opened wide on an 82-degree afternoon, sent me fleeing for the comfort of the air conditioned main halls after just a few minutes watching the pre-game show of geeky IT guys and swaggering equipment operators who were slowly turning the unsightly mess of packing boxes and rolled-up carpet into what you will see tomorrow.

Tomorrow morning will be like Christmas. Vendors will be downing Starbucks in the hall after spending a tiring late night decorating the tree, stacking the presents, and turning on the twinkly lights. We kids will be pacing outside the doors, pressing our noses to the glass and fidgeting impatiently until the doors are flung wide so we can rush in to ooh and aah at the marvel of the tableau that was created just for us. It won’t be long afterward, however (Thursday, to be exact) before everybody will be sick of their new and often broken toys, the pre-holiday euphoria will have transformed into disillusionment, and various family members will have drunk too much spiked Kool-Aid and will have stormed off to their rooms in anger and then scheduled earlier flights home.

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Arcadia has once again put together these invaluable conference first aid kits that you can get from their booth (#2915) or ours (#4085).

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This vendor’s packing crates luckily arrived at the right place despite the spelling error, which I expect to see a few more times this week in locations that are, unlike this one, public-facing.

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Our magnificent edifice is fully constructed, requiring one Lorre and zero Teamsters to pack it all in from the Lyft drop-off area since it weighs in at maybe 20 pounds total. I’m sure some overnight HIMSS inspector will correct the beneficial mistake in which we have two power outlets (having paid for none), three chairs (having paid for two), and a backdrop that is larger than the carpet (having paid for a 10×10 carpet to cover the same-sized space). I’m not sure that paying $6,000 for a mostly-empty square of concrete that will hold maybe $300 worth of homebrew furnishings makes good fiscal sense, so I will reevaluate in our post-show briefing call, which basically means I’ll ask Lorre if she thinks it was worth it. Her outlook will be more positive if fun people keep stopping by or new sponsors keep signing up.

Special guests in our micro-booth this week (covering Lorre’s necessary intake and output since she’s working solo) will be:

  • Tuesday 2:00 – 3:00: Nancy Ham, WebPT CEO, will offer advice to women in health IT on negotiating with confidence.
  • Wednesday 10:00 – 11:00: Susan Newbold, PhD, RN, owner, Nursing Informatics Boot Camp.
  • Wednesday 1:30 – 2:30: Stuart Miller, CEO, MindMapUSA.
  • Thursday 11:00 – noon: Ben Rooks, founder and principal, ST Advisors.

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This video posted on Twitter shows KLAS celebrating its winners during HIMSS19. It’s nearly as cringey as that Siemens Healthineers forced merriment video from a couple of years ago, as the suit-wearing stiffs are cajoled by prancing funsters to sing along with the words on the screen (painfully woven to include the names of the winners in the lyrics) and to bang their sticks in appreciation as the script requires. Seriously, KLAS, shouldn’t you keep arm’s length from the vendors you purport to objectively review? Do you suppose Consumer Reports throws sing-a-long parties with car-makers after the April issue comes out? Would CR have lauded Volkswagen as a winner after the feds caught them falsifying their test results? Does everything in healthcare have to involve a party or self-promotional opportunity that might raise the question of WWPT—What Would Patients Think?

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Several folks sent me this odd feature of the opening reception, in which gloved hands protruded from topiary to offer drinks. I would have enjoyed hearing the HIMSS staffer pitching the idea of an alcoholic glory hole, or perhaps hearing the even zanier ideas that didn’t make the cut.

Morning Headlines 2/12/19

February 11, 2019 Headlines No Comments

Francisco Partners Acquires Qualcomm Life

Francisco Partners acquires Qualcomm Life from Qualcomm and will restore the name of Capsule Technologies, the medical device connectivity business that Qualcomm acquired in 2015.

HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information

HHS proposes a new rule that would give patients instant electronic access to their health data from federally-funded providers at no cost, and that would require providers and payers to adopt technology to make this real-time data-sharing possible.

Critical Alert Systems to Acquire Sphere3® Consulting

Patient communications and nurse call vendor Critical Alert Systems will acquire nurse call analytics vendor Sphere3 Consulting.

Apple announces Health Records feature coming to veterans

Apple solidifies plans with the VA to give veterans access to their medical records via the Health Records app.

ImageMoverMD Raises $4 Million to Automatically Connect Medical Images with Electronic Patient Records

Medical image management startup ImageMoverMD raises $4 million in a financing round led by Bain Capital Ventures, Cultivation Capital, and Health X Ventures.

Dr. Jayne at HIMSS 2/10/19

February 11, 2019 News 2 Comments

I was eagerly awaiting my flight to the Sunshine State this morning, but the travel gods decided to conspire against me with an inch of ice that closed the airport and a good number of Interstate segments. I thought I was getting ahead by traveling in on Sunday instead of Monday, but no such luck. I’m sitting here with my re-ticketed flight, plus three others in hand, so that I can cover my bases and get there one way or another even if I wind up going through Tampa. Thank you, Southwest Airlines, for the beauty that is the fully-refundable ticket.

I’ll start reporting on HIMSS once I actually get there. In the meantime, I received a thought-provoking contribution from an anonymous CEO and I thought it was worth sharing.


Thirteen times in the past 14 years, I have ventured to HIMSS. Each year, at an earlier moment in the week, I regretted the decision to attend. It is mainly because I am missing work that doesn’t go away (because I have), but more and more it is because the show serves no actual purpose. In the following rant, I am going to lay out an argument for how to make the best of HIMSS now that you are on your way, as well as why many that are excited to be in sunny, humid, putrid Orlando are doing the fool’s errand in thinking this will be a worthwhile week.

Full disclosure: I have held (too) many jobs in healthcare IT over the past 12 years and have been on all sides of the HIMSS conference. I have worked a booth, represented companies that didn’t have a booth, paid my own way to join in the educational experience, paid for booths, been on stage, been on panels, and have even just gone to spy on competitors under a fake name and fake company. I’ve had all the badges.

For all parties involved, the juice is most definitely not worth the squeeze.

From a participant / attendee standpoint, I can learn the same from the sessions that I can from a simple Google search (Google Scholar, that is) or a dogged follow of specific influencers in healthcare IT. The sessions fall into distinct categories: (a) a health system employee getting that CV bump by reporting some of the details of something they did successfully; or (b) a vendor-driven presentation that solves no need I am aware of, with limited data and an obvious conclusion.

In the end, most people are nursing a hangover, catching up on real work, or looking to network their way through the presentation. Very, very little actual discourse is driving these educational sessions. It is not like novelty is a strong suit here.

Seeing all the vendors under one roof is both staggering and depressing. We’ll spend the same amount of money on “eradicating AIDS in the US” this year than HIMSS collects for booths with VR headsets, cushy lounge chairs, video demonstrations, DeLoreans, Vespa scooters, and random art and marketing collateral. Think about that. Is this conference on par with eradicating a horrible disease (or at least attempting to? I can’t say for certain if the Trump Administration’s promise is actual doable) What does the money actually go toward?

From a vendor perspective, it is highly unlikely you’ll get a return on your investment from HIMSS (and highly unlikely that your company actually provides an ROI to your customers, but that rant is saved for another day, cool?) The booths are mainly visited by the lookie-loos, the spies, the executives who are just getting their steps in before they go drinking, the swag shoppers, and the investors looking to defend their previous capitalization. Very few decisions are made at HIMSS that are business related, and many of the non-business decisions made at HIMSS are not good ones either (no one looks smart and successful at a business event that looks more like a 1990s wedding party, no one).

You’ll end up running out of your good swag and people will mill around just long enough to earn the larger gift you are hiding for the good prospects. The big award you give out — be it an Alexa, Apple Watch, Caribbean cruise, or gift card — will go to the best prospect you met that week, and we all know that. And if you don’t do that, take my advice, you should. If you are giving things out to everyone, splashing cash and gifts on anyone that comes by, we’re thinking of all the reasons you are able to do that … and let’s be honest, there is no good reason in healthcare to be that flush with money. But sending out those enticing emails for $50 to take a demo — are you sure that is the most enticing way to get your solution known? It’s trick-or-treating for professionals. Scan my badge and give me my prize. Boo!

If you are looking for a job, I actually give you a pass. It is an expensive way to get a new job, but I understand that for many in geographically inconvenient locations, this is the hiring fair that you yearn for. I just know that if you are convinced to get that 100 percent online master’s degree from the “Academics” arena, well, you are too easily parting with your hard-earned money. I have yet to encounter someone who went through those programs successfully. And I have been around a long time. I know people have been successful finding a new job at HIMSS, I am personally unsure how best to go about it, and quite certain that the readers of this blog would be incredibly excited to learn your story and tricks. (Tim, can we pay someone $25 for sharing their tale of recruiting at HIMSS?)

So, what is left? Who is really at HIMSS? Well, if you work for a big vendor in a sales role, you are there. If you are looking to invest in healthcare IT, you are probably there, too. If you are actually shopping for a new solution for your hospital, state, government agency, health system, or clinic, you are fooling yourself into thinking that you are buying what you are seeing — as vaporware is really the only commodity on the HIMSS market — but most likely your institution had a HIMSS budget and you won the lottery this year (and that was me one year and it was cool, except when it wasn’t). Beyond that, there are some media folks, some freelance marketers, consultants, and 14 licensed care providers. Even though you are at the largest healthcare IT conference in the country, if you fall ill or hurt, there will most likely not be a doctor available to help (excusing the ones that have the license but don’t practice because they are too busy “disrupting.”)

If you are presenting on a side stage, you have been conned. You’ve been convinced that being a vaudevillian sideshow act on the floor amidst 40,000 wanderers is somehow going to attract interest in your small company or solution. You are just noise. If you are in the hall where booths turn into small lockers with a monitor, you are lost beyond help and your best chance is to meet your neighbors and see if you can partner together. People floating into those dead-end sections are mainly there to steal a good idea for their idea-bereft big company. And you’re lucky if you get a chance to partner with them, otherwise consider your “innovative, breakthrough disruption and killer app” officially stolen. The deepest depths of the floor are always very interesting, but also reek of desperation and fear. If this doesn’t go well for so many of them, the prospects for their continued operation through next year is staggeringly limited.

For those that go to meet up with friends and old colleagues, I am sure your employer would wish you’d find a less expensive reunion in the future. But I get it, I have many HIMSS-friends from over the years that I only see there, and it is nice to bump into them and quickly swap stories and hugs before sauntering off.

Quick help on your attire: suits=rank-and-file employees; jeans=investors; ties=people who have been doing this longer than you want to know; cool shoes=posturing innovators and lemmings. Socks are clearly the new tattoo, so if you aren’t in a hip color, you may not be invited to the meet-up, party, or club, so choose appropriately. If you get blisters and complain about it, you should be banished. It is a big show, big floor, lots of standing. No one will besmirch the genius who desires to wear a comfortable, but unfashionable shoe. Medical personnel have been wearing Dansko clogs for millennia without any concern. (They are damned comfortable if you are ever in the market. It makes sense to me if you are on your feet for 18 hours to wear them, regardless of price).

I hate to rain on your parade down to Orlando (I actually don’t, but I know I should care about it), but the sideshow act that HIMSS has become is worth pointing out. They are in it for their own gain, not yours. HIMSS is not there to cultivate a better healthcare system for the world, it is there to separate you (and/or your employer) from money. They’ll put you on their television show, let you be retweeted or favorited on their social media, they’ll incent you to buy a bigger thing next year, all so long as you keep sending them money. They will bend over backwards to sell you whatever they think you will buy. They have become shameless.

We’ve oft joked that Vegas is best for getting people to part with their money. Paying unnecessarily for food, drink, events, and hotels. But Orlando has mastered this art. They do it for the entire family, the grift of the entire community is astounding, and they don’t even take a gamble on losing. Even for the most seasoned, there is always a regretful purchase or expense that is only possible when you are stuck in Mouseville with a million tourists. International Drive does not do discounts, sales, or market-based pricing.

So, given this, what should one do with HIMSS? My simple answer is to profit from it. And I mean that in the dirtiest way possible. “If it is free, it is for me.” If there is a contest, enter it. If there is a meeting that comes with a gift card, schedule it. If there is a party with an open bar and dinner, feed and imbibe to your heart’s content. If there is someone in an elevator, say hello. If there is a group of people that look interesting, introduce yourself. If you see someone in military regalia, thank them, offer to buy them a snack, and ask them questions since they are usually the most interesting people there.

If you are stuck behind a booth in a job you’d rather not have, walk a row over and chat up your contemporaries. They know the drill, they know where the snacks are, the free beer and wine at 3:30, and the evening parties that are so big a formal invite isn’t necessary. They’ll get you through, show you the ropes, and maybe even become a friend. But eliminate the notion that you are going to learn about the future, become a better version of yourself, or grow your business, because that’s not what HIMSS is there for (unless they can profit from it).

Have fun, be safe, enjoy the show, and avoid the biggest mistakes you can. I’ve decided to cancel my reservations this year, as it appears I have finally graduated to recognizing my folly before I even leave for the show.

Acquisition Announcements 2/11/19

February 11, 2019 News No Comments

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Francisco Partners acquires Qualcomm Life from Qualcomm and will restore the name of Capsule Technologies, the medical device connectivity business that Qualcomm acquired in 2015. The business also includes the 2Net medical grade mobile connectivity platform. Qualcomm announced in June 2018 that it was seeking a buyer for the Life division.

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Patient communications and nurse call vendor Critical Alert Systems will acquire nurse call analytics vendor Sphere3 Consulting. 

Morning Headlines 2/11/19

February 10, 2019 Headlines No Comments

Catholic Health plows $100M into electronic records

Catholic Health (NY) will spend $100 million to implement Epic over the next 18 months – its most expensive health IT project to date.

OCR Concludes All-Time Record Year for HIPAA Enforcement with $3 Million Cottage Health Settlement

OCR wraps up its record-setting  $29 million year for HIPAA fines with a settlement from Cottage Health, a California-based hospital operator that experienced breaches in 2013 and 2015.

R1 Develops Technology and Innovation Center in Collaboration with Intermountain Healthcare

After taking on hundreds of Intermountain employees last year, RCM vendor R1 will again partner with the health system to build a technology and innovation center in Salt Lake City.

VA announces mortality data collaboration with Centers for Disease Control and Prevention

The VA will use FHIR-based standards to share mortality data from its VistA EHR with the CDC’s Modernizing Death Reporting project.

From HIMSS 2/10/19

February 10, 2019 News 4 Comments

From Degree Checker: “Re: Hal Wolf. WTF on his undergrad degrees and no advanced ones?” I’m not quite sure how Hal’s undergrad-only degrees in business and textile management became the perfect qualification for running the sprawling HIMSS (although I bet he wears really nice suits), but quite a few people in the industry show little evidence of academic achievement or curiosity. However, my dichotomy is this: while I sometimes share the urge to belittle those whose educational accomplishments seem inferior to my own, I appreciate those who lacked the resources or connections to attend big-name schools (or to graduate college at all) yet made their mark purely on their ability and/or ambition. My classroom knowledge has often proved laughably simplistic as I mounted a feeble argument with someone who toils in the trenches every day. I remember that despite my freshly minted MBA, I struggled with the practical impact of depreciation and PTO balances on our health system IT budget until someone who didn’t have a degree provided stories that helped me keep it straight. Therefore, I will save my wrath for those who lack both education and work achievement, holding firm that Twitter-professed enthusiasm offsets neither.

From Overhead Opener: “Re: this article pitching a specific EHR vendor’s app. Looks like pure shill work.” I agree. I won’t mention specifics since what I’m about to say is unkind. The author is a notoriously self-promoting gasbag (I edited out the other kind of bag that I originally wrote) and the site isn’t exactly known for the purity of its journalistic endeavors. The author’s LinkedIn lists no degrees and no work experience outside of marketing, which is exactly what this crap piece smacks of despite being labeled as some sort of thought leadership. All of the author’s recent articles for that site pitch the products of specific companies under the guise of identifying big-picture trends.

From Green Around the Gills: “Re: Greenway’s DoJ settlement. There are a lot of extremely vindicated former (and current) Greenway / Vitera employees out there this week. Too bad Tee Green just got himself named chairman by Streamline Health. There really isn’t a lot of justice in the world.” I’ve learned from experience that those people at the top tend to stay there. My takeaway: when the captain of the ship sprints for the lifeboats, the rowers had best be considering their escape route, which probably doesn’t include the typical C-level exits of moving to another executive role, taking an investment firm job, or sitting profitably on company boards. Those aren’t rower benefits, but perhaps provide incentive to seek situations that are less dependent on the whimsy of those who are, like everybody else, mostly interested in their own outcomes.

Since I’m complaining about misleading clickbait posing as journalism, here’s my full disclosure: despite my headline, I am “from HIMSS” only mentally, not yet physically (that happens Monday at the last possible minute). This is just my pre-HIMSS19 warm-up stretch before the real exercise begins.

I criticize HIMSS a lot (because they give me ample reason), but let me be clear – they are unbelievably good at running conferences. Their slips won’t be showing this week. Everything will seem to unfold effortlessly, every microscopic detail will form one pixel of the big picture, and you will leave at the end of the week having seen a polished show in which the props, backstage workers, and a year of planning stayed out of the spotlight. Groups are often lured into starting their own conferences because HIMSS and others make it look deceptively easy to draw a satisfied crowd in the absence of a large staff or budget, but it doesn’t work like that.

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This week’s Orlando weather is looking good, other than prediction of a slightly bleaker Wednesday that exhibitors will love because it will keep attendees inside.

Many attendees – including Dr. Jayne – aren’t so lucky with their weather at home, as folks are having their flights to Orlando delayed or cancelled. 

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Text me interesting news, rumors, and photos during the conference. It’s a burner, so I’ll likely ignore voice calls and block the inevitable PR spammers. I’ll just be cruising the exhibit hall and convention center hallways looking for examples to share of both good and bad behavior.

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Thanks to Dimensional Insight, which celebrated its “Best in KLAS 2019” for business intelligence and analytics by increasing its level of HIStalk sponsorship.

Speaking of that, Lorre is offering a deal to companies that want to sign up as sponsors or upgrade their sponsorship, a reward you get only for having the perseverance and ingenuity to find our tiny, poorly positioned booth buried in the exhibit hall alleys (hint: it’s near the place where guys come out checking their zippers – no outside jokes allowed, please).

Buffalo-based Catholic Health will implement Epic. I think they’ve been on Cerner Soarian for many years.

Also choosing Epic – Saudi Arabia’s King Fahad Medical City. Cerner is usually stronger in that part of the world, but Epic’s go-live at Johns Hopkins Aramco Healthcare a year ago may have established a figurative beachhead.

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I’m not too bothered by non-experts running underfoot throughout the exhibit hall snapping selfies and acting important, but charging vendors for in-booth appearances while riding the HIMSS social media ambassador coattails seems inappropriate. However, HIMSS itself rakes in a lot of vendor cash for providing exposure and access in blurring the ethical line, so at least it isn’t being hypocritical in insisting that pay-for-play be ended or even clearly noted. I should run a poll of how many readers have been “influenced” by each “influencer,” although I expect they would implore their Twitter followers to stuff the ballot box to validate their self-imagined importance.

Buzz suggests that ONC may announce its long-delayed information blocking rules this week.

Decisions, brought to you by Definitive Healthcare:

  • Kenosha Medical Center (WI) will replace teleradiology from REAL Radiology To Envision Physician Services in 2019.
  • Central Peninsula General Hospital (AK) moved from NightShift Radiology to REAL Radiology on February 1.
  • Island Hospital (WA) replaced Nightshift Radiology with REAL Radiology on February 1.

Business Insider ponders the $1.8 billion paper valuation of Medicare Advantage insurer Devoted Health, started up by Ed and Todd Park (formerly of Athenahealth) even with zero customers or revenue so far. That must be one fantastic slide deck.

More birth tourism news: a couple from China who paid a company to get them into the US for their baby’s delivery hightails afterward back to China, leaving their hospital bill unpaid and leaving their baby still in NICU because it was born with birth defects. China’s one-baby policy was recently expanded to two and may be eliminated entirely as the country faces economic stagnation, which should reduce some of the barbaric health practices that the law caused.

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Reader Comments

  • Lazlo Hollyfeld: It is just a form of self-promotion and attention grabbing that is legion at HIMSS. If you can name one objective an...
  • Lazlo Hollyfeld: This is the cool, angsty ‘insider’ take but it ignores that large gatherings like this present several opportunities...
  • Mr. HIStalk: It's tough when the hospital won't reopen for a year or more (if ever -- Adventist Health didn't seem to want to commit ...
  • Brian Too: I am a little disappointed Ellkay didn't bring the bees to HIMSS 2019. Can you imagine the pictures, the headlines, t...
  • NoGoodDeedGoes...: RE: Adventist Health & Paradise - your coverage is warranted, but your commentary would have been better off omitted...
  • Vaporware?: I almost feel a little bad and embarrassed for Cerner. It's notable that MEDITECH's "re-branded" and "old" EMR has score...
  • Dave N: I also am continually amazed at how many men don't wash their hands after using the restroom. Society still struggles to...
  • RE: Pink Socks: Please check the facts. Not everything revolves around Epic. Here's the original website https://pinksocks.life/...
  • Brian Too: "We’ll need a new ICD-10 code for [...] Gwyneth Paltrow’s Goop..." Might I suggest 2 ICD-10 codes? F6101 - Lif...
  • Brian Too: "...the VA’s EHR project could balloon beyond its estimated $16 billion budget..." Sorry to be cynical, but wasn't ...

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