Monday Morning Update 9/24/18

Top News

Memorial Sloan Kettering Cancer Center leadership defends itself to its employees following reports that it gave for-profit AI startup Paige.AI exclusive access to its 25 million pathology slides in return for an equity stake for itself and several MSKCC executives (in essence, profiting from the work of its pathologists and the property of its patients instead of by creating new intellectual property). The health system explains that:

• It is sharing only de-identified patient data and not actual slides (note: the Paige.AI partnership announcement specifically says it gained “exclusive rights to MSK’s library of 25 million pathology slides” that are “accompanied by de-identified pathologic and clinical annotation”)
• The relationship between its executives and the company was vetted for conflict of interest
• Board members and faculty who received equity won’t participate in company decisions
• They’ll kick back some of the proceeds to the pathology department

MSKCC’s recent bad press – including unreported conflicts of interest by a since-resigned key researcher who was raking in drug company money and skepticism about its relationship with IBM Watson Health – add it to the list of health systems whose high-falutin’ patient care proclamations fail to hide the fact that it often acts like any other self-enriching business whose own interests come first. It paid its CEO $6.7 million (plus he gets a company house), its CIO $1 million, and its chief fundraiser $1.4 million, according to its most recent tax forms.

In case you missed it, sick and frightened cancer patients are a highly profitable widget in this country. As is typical in healthcare, nebulous consent forms allow their data to be sold to any willing buyer without their permission or benefit.

ProPublica notes that its report didn’t create the MSKCC Paige.AI controversy – it was MSKCC’s own pathologists who complained that their work had been taken for the benefit of top MSKCC brass. Surprisingly, they didn’t complain that Paige.AI’s business model requires the company to characterize the work of human pathologists as subjective, error-prone, and inefficient compared to allowing a computer to do their work.

MSKCC’s former pathology department chair Marc Rosenblum, MD wrote the most brilliantly sarcastic internal email I’ve ever seen last month (subject: “Department: Fleece(d)”) in offering suggestions to hold a Paige.AI naming contest with stock options as a prize to “fully embrace the entrepreneurial tenor of our times;” to create a department logo to “trumpet where we’re going” that would look good on a Patagonia fleece; and to create a department fight song. 

HIStalk Announcements and Requests

Poll respondents are skeptical about the population health benefits of the Apple Watch’s EKG recording capability.

New poll to your right or here: would you be OK with having your social media activities monitored for health research or to trigger personalized health improvement suggestions? I admit I’m fascinated by the human aspect of expecting an insurer to cover huge financial risk while denying them relevant information, which then goes back to the argument about universal healthcare, under which such lifestyle forensics would be unnecessary since the entire country would make up the risk pool. Life insurers are allowed to require medical exams, getting auto insurance involves having your pre-existing condition (driving record) examined initially to set premium prices and having that price jacked up (or the policy cancelled) following a paid claim, and all forms of business insurance (malpractice, cybersecurity, etc.) come with the expectation of allowing the insurer to assess their risk by inspecting sensitive records. Only with health insurance are we offended at the idea that insurers need to learn more about our health before agreeing to pay to maintain it, an expectation that has risen due to out-of-control hospital and drug costs in the absence of political will to address the issue.

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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

People

Mazars USA promotes Gil Enos to leader of its healthcare consulting group.

Announcements and Implementations

Wolters Kluwer Health launches a new version of its Sentri7 clinical surveillance solution.

Other

Researchers question whether it’s a good idea to apply Cambridge Analytica-type social media “digital phenotyping” to target people for population health interventions. They note that such activities incur the risk of public backlash (when social media users realize they’re being monitored and controlled) and having those users go underground by avoiding using words that all out their health-harming practices.

An oncologist’s Wall Street Journal op-ed piece ponders the dilemma in which drug companies charge whatever high prices the market will bear irrespective of their actual research and manufacturing costs and the extent to which the drug improves an individual’s health, noting that the US is the only country that approves marketing of drugs without negotiating the allowed selling price:

The extraordinary cost of these treatments presents a tragic dilemma: We may soon have a miracle drug for cancer whose cost, when multiplied across the population that needs it, could bankrupt the country. Consider what would happen if the new drugs were used to treat 250,000 cancer patients per year—just 40 percent of the Americans who die annually from cancer. At $373,000 per patient, a Kymriah-type immunotherapy treatment would increase drug spending in the US by approximately $93 billion a year. This would mean an almost 20 percent increase in the country’s total annual drug spending—for just one drug. To put that figure in perspective, it amounts to $300 per American, or $500 if we include associated medical services.

Why we should have been lawyers: a Georgia jury awards the family of a baby whose penis was injured during a midwife’s circumcision $30 million.

A fun Bleacher Report profile of Laurent Duvernay-Tardif, MD – who is also a right guard for the Kansas City Chiefs who signed a five-year, $41 million contract extension with $20 million guaranteed last year – reveals interesting facts:

• He made good money at 12 years old selling pesto that he made himself, explaining that it had to be very good since “I wasn’t cute enough to get any sympathy purchases.”
• His parents took the children on year-long sailing trips carrying only rice and canned vegetables to show them that money isn’t all that important.
• The Quebec born Duvernay-Tardif graduated from McGill University’s medical school even though he spoke only French and all his classes were conducted in English, so he played lecture recordings at half speed while looking words up in a dictionary.
• He was on call on NFL draft day, so he gave his phone to a nurse and asked her to say yes to any team that drafted him while he participated in an emergency C-section.
• He is only the 10th player ever drafted by the NFL from a Canadian college and the first active doctor to be on a team’s roster
• The NFL denied his request to add “MD” after his last name on his jersey, which he says is OK since “my name is Duvernay-Tardif, and it’s plenty long enough like that.”
• He explanations the motivation required to master two difficult professions: “My biggest fear is doing nothing. When you start downsizing your expectations of what you can do with your time, it’s hard to go back. If I spend an offseason doing nothing, I don’t know if that drive will come back. That scares me more than anything.”

Sponsor Updates

• Lightbeam Health Solutions launches the Pop Health Podcast with an initial episode on gaining patient buy-in for chronic care management.
• MedData and Experian Health will exhibit at the HFMA Region 7 Conference September 26-28 in South Bend, IN.
• Kansas State University’s College of Engineering names Netsmart its 2018 Company of the Year.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the CSO HIMSS Leadership Symposium September 28 in Cincinnati.
• PreparedHealth will exhibit at the Regional DV-NJ Chapters HIMSS Conference September 26-28 in Atlantic City.
• The SSI Group will exhibit at the HFMA South Texas and TAHFA Fall Symposium September 23-25 in San Antonio.
• Surescripts and ZappRx will exhibit at the NASP Annual Meeting & Expo 2018 September 24-26 in Washington, DC.
• TriNetX will host TriNetX Summit18 September 25-26 in Boston.
• Vocera will exhibit at the Illinois Health and Hospital Association Leadership Conference September 25 in Lombard, IL.
• Consulting Magazine names Huron a “Best Firm to Work For” for the second consecutive year.
• Wellsoft will exhibit at Emergency Nursing 2018 September 26-29 in Pittsburgh.

Blog Posts

• Nursing Communication Tools: 5 Benefits of Smartphones (LiveProcess)
• 6 resources for National Recovery Month (Meditech)
• Welcoming Connance to the Waystar Family (Waystar)
• Opioid Addiction: What It Is, Isn’t and Our Impact (Netsmart)
• 7 Key Epic Optimizations That Have a Direct Impact on Your Bottom Line (Parallon Technology Solutions)
• Keeping Up With Payer Alerts (Experian Health)
• When it comes to patient billing, who wants to be #1 for all the wrong reasons? (Patientco)
• Fast-Paced and Fun: Inside the Workplace of Sansoro Health (Sansoro Health)
• Steps to a Successful Interface Engine Migration (Summit Healthcare)
• Four simple steps for reducing third-party service costs (PerfectServe)
• Free like a puppy. (Voalte)
• The Dos and Don’ts of Balance Billing (WebPT)

Contacts

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

Weekender 9/21/18

Weekly News Recap

• Pathologists at Memorial Sloan Kettering Cancer Center complain that its executives and board members received equity in pathology decision support company Paige.AI after MSKCC gave the company exclusive access to its archive of patient tissue slides
• Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to settle patient privacy complaints related to the in-hospital taping of the TV show “Boston Med”
• Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share, citing problems it found during due diligence
• Waystar announces its acquisition of Connance
• Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million
• The impending arrival of Hurricane Florence in the Southeast motivates HIEs to connect their systems, hospitals to offer free virtual visits, and HHS to temporarily waive several HIPAA Privacy Rule requirements

Best Reader Comments

It’s not the one with the best algorithm that wins – it’s the one with the best data. (MLtrainedMD)

I expect we’ll see more unfortunate deals like the Paige one over the next few years as clinical organizations with good reputations cut deals with AI/ML companies. The AI/ML companies need someone clinical to provide them their training cases and the executives mistakenly think the data isn’t worth anything since it’s just “sitting there.” Lots of AI/ML companies are getting away with a treasure trove of valuable data very inexpensively. (DrM)

I think a lot of women exclude themselves from some pursuits early on in life (computers, science, leadership roles, etc.). Therefore they don’t develop those aptitudes, and therefore there just aren’t a lot of qualified women out there to be hired into those roles. (And therefore, when there is a qualified woman, they can be subjected to more skepticism and scrutiny than others.) Some say the solution is to hire by quota. But if there is an insufficient number of qualified female applicants, then that just results in hiring unqualified ones into roles that others may be better qualified for. Which is (a) not fair, and (b) also creates a credibility problem for the hapless woman. And it renders awards / promotions to women in these roles essentially meaningless, even if they were given based on merit (because people will assume they were quota-driven). Not an easy problem. (Clustered)

I’ve taught research methods and sampling methods for 45 years. I’ve written books and articles about research methods etc. KLAS is the example I use of the worst possible false “research” presentations. Only a fool would pay attention to a KLAS rating. It is a means of selling KLAS reports and of favoring vendors who pay for KLAS reports. I’m not saying they intend to deceive, but their design does that. Period. Thus, even if they wanted to be truthful, they can’t be with their research approach. It has no statistical validity. It’s an advertising tool. (Ross Koppel)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. E in Michigan, who asked for a handheld carbon dioxide meter and map printing supplies for the Girls Club air quality mapping project. She reports, “The members of my Girls Club love to do science activities, and taking them home with them to report back was even more exciting. The girls went through and took data for their own homes, businesses, and even the school. It was interesting to see the areas of high and low concentration of carbon dioxide at different places. Some were surprised at the results, especially the levels coming form our school! Thank you for bringing a science project to life that allowed my girls to become real scientists.”

A new California law requires hospitals to make plant-based meals – as recommended by the AMA and the American College of Cardiology – available to patients.

Italy’s anti-establishment movement gets a law passed that allows parents to attest that their kids have been given 10 mandatory vaccines without providing proof, promoting personal choice in claiming scientific arrogance, drug company influence, and supposed connections to cancer and autism. One group of doctors publicly claims that eating nuts is more effective that vaccines for preventing illness (insert your own nut-related pun here).

California’s private surgery center accreditation agencies, which are paid directly by their surgery center customers, often approve facilities that have been decertified by Medicare; that are being run by medical professionals who have lost their licenses or who were caught practicing outside the scope of their training; or that have high complication or death rates. One of those private accreditors is Joint Commission. In a fun overlap of events, an endoscopy center earned its “widely recognized symbol of quality” the same day state health inspectors declared “immediate jeopardy” when they saw a newly hired receptionist disinfecting endoscopes.

FDA’s warning letter to a Addison, IL pharmaceutical testing laboratory cites problems with quality control, staff training, unsuitable equipment, and the owner’s operation of a microbrewery in the same space where yeast counts were measured, with FDA dryly noting that “A brewery employee was also preparing beer kegs in this area. In addition, laboratory test media, open beer bottles, and brewing materials were co-mingled within the same refrigerator.” The website of Seery Athlone Brewing touts that its owner – who also owns the lab – has a degree in microbiology and “more than 30 years of experience in fermentation – perfect for brewing!”

Life insurance company John Hancock will require policyholders to wear activity tracking wearables to earn its discounted premium rate, extending the practice of its Vitality program that offers discounted trackers such as the Apple Watch.  That company found that its policyholders lived 13-21 years longer than average, which instead of implying that using fitness trackers improves health, might instead suggest that those customers were healthier to begin with and agreed to prove it by having Big Brother monitor their exercise levels in return for life insurance discounts.

A  man is admitted to the hospital in critical condition after he and his partner, high on a date rape drug, decide (after what I’m sure was thoughtful deliberation) to boil 15 eggs and insert them into the southern rather than the northern opening of his alimentary tract.

In Case You Missed It

• News 9/21/18
• EPtalk by Dr. Jayne 9/20/18
• News 9/19/18
• Curbside Consult with Dr. Jayne 9/17/18
• Monday Morning Update 9/17/18

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 9/21/18

Sloan Kettering’s Cozy Deal With Start-Up Ignites a New Uproar

Pathologists at Memorial Sloan Kettering Cancer Center object to a deal that gave several MSKCC higher-ups an equity stake in pathology clinical decision support startup Paige.AI after it gave the company exclusive access to its archive of patient tissue slides.

Town Hall Ventures, Investment Firm Focused on Improving Health of Underserved Populations, Brings Together Providers, Payors, and Leaders to Announce Close of First Fund At $115 Million

Andy Slavitt’s Town Hall Ventures closes a $115 million fund and makes unspecified investments in payer Bright Health, home health provider Landmark Health, and chronic kidney disease company Strive Health.

Unauthorized Disclosure of Patients’ Protected Health Information During ABC Television Filming Results in Multiple HIPAA Settlements Totaling $999,000

Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to OCR to settle potential privacy violations related to the taping of TV show “Boston Med” without prior patient approval.

Gawande-led venture taps consulting giant to hone strategy for chronically ill

The Amazon/Berkshire Hathway/JPMorgan healthcare venture led by Atul Gawande, MD hires Deloitte’s Monitor Group to help bring to fruition a strategy for improving care for the chronically ill.

News 9/21/18

Top News

Pathologists at Memorial Sloan Kettering Cancer Center object to a deal under which several MSKCC executives and three of its board members received an equity stake in pathology clinical decision support startup Paige.AI after the health system gave the company exclusive access to its archive of 25 million patient tissue slides.

The pathologists say it’s unfair that equity created by their expertise was handed out.

Paige.AI raised $25 million in a February 2018 Series A funding round.

The pathologists also are expressing concern about sending anonymized patient data to the for-profit company.

Reader Comments

From Former Healthx-er: “Re: Healthx. CEO Sean Downs and CFO Jim Meer were replaced a couple of weeks ago with guys who seem to travel together to fix broken companies. The COO and VP of product were released a few months ago. More than half the account management team was let go last week and cutbacks were made in services, sales, marketing, accounting, product development, and the chief people officer. More layoffs are expected this week.” Unverified, except for the newly announced CEO and CFO. New CEO Gene Cattarino has ridden the CEO circuit for SafeOp Surgical, Capsule, Lynx Medical Systems, Landacorp, Medicode, and TDS. Indianapolis-based Healthx offers a provider-member engagement portal to health plans.

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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

Acquisitions, Funding, Business, and Stock

Mercy Health (OH) becomes a minority investor in cloud-based medical image management vendor NucleusHealth. The 23-hospital system served as a beta site for company’s cloud-based PACS, eventually developing an image-sharing network across 300 facilities.

Ooda Health raises $40.5 million in a funding round that led it to seek out investment partners with strong female leadership (of which there are few). Oak HC/FT and DFJ led the round. The San Francisco-based startup is working with Blue Shield of California to develop real-time claims payment software that will be piloted at Dignity Health and Hill Physicians. Co-founder and CEO Giovanni Colella, MD founded and led Castlight Health and Relay Health.

Telemedicine vendor SnapMD raises $7.1 million in a Series B round.

InstaMed expands its Philadelphia headquarters with the addition of a 3,200 square-foot Collaboration Center.

Town Hall Ventures closes a $115 million fund and makes unspecified investments in payer Bright Health, home health provider Landmark Health, and chronic kidney disease company Strive Health. Town Hall was launched in May by former CMS Acting Administrator Andy Slavitt, Trevor Price (Docent Health), and David Whelan (Rebel Labs) to invest in companies that cater to underserved populations.

Details finally come to light about Nest’s secretive 2017 acquisition of Senosis Health, an app-based health monitoring startup out of the University of Washington. Parent company Google put strict parameters around publicizing the acquisition, so as to keep Nest’s digital health plans a secret. The company, which is now part of Google’s hardware unit, has yet to release a healthcare product, though it did throw its hat (unsuccessfully) in the Withings acquisition ring. Reports now suggest that Nest is working on devices to help seniors age in place.

People

Emids names Tim McMullen (NTT Data Services) president and Dan Critchley (Optimum Healthcare IT) VP of its provider business. Tom Niehaus, who served as president since the company’s acquisition of Encore Health Resources last year, will retire at the end of September.

Sales

• The Nebraska Health Information Initiative selects patient identity matching technology from 4medica.
• St. Luke’s University Health Network expands its CarePort Care Management implementation to additional facilities in Pennsylvania and New Jersey.
• La Clinica de Familia will implement EClinicalWorks across its 19 locations in New Mexico.
• Spectrum Health & Human Services (NY) and Reeves County Hospital District (TX) select Cerner’s EHR and RCM technology.
• Cottage Hospital (NH) will expand its use of Summit Healthcare’s interoperability solutions.

Announcements and Implementations

Allina Health (MN) implements Vocera software to better connect its nurse call, patient monitoring, and communications systems.

Provation develops cloud-based procedure documentation software, including automated coding, for ASCs and hospitals. Wolters Kluwer sold the company to Clearlake Capital Group at the beginning of the year for $180 million.

Whitman Hospital & Medical Clinic (WA) goes live on Meditech’s Web Ambulatory EHR with implementation help from Engage.

KLAS ranks WebPT as the #1 ambulatory therapy/rehab EHR vendor in both market share and overall performance, with Clinicient and Raintree also performing well. Casamba and Net Health customers say (75 percent and 46 percent, respectively) they wouldn’t buy the product again.

As part of its continued effort to pivot from a consumer wearable to a medical device, Fitbit creates an app-based virtual care and health coaching program for health systems, payers, and employers.

Privacy and Security

Lutheran Health Network (IN) brings its IT systems back online after an attempted data breach. Lutheran Hospital diverted ER patients to other facilities during the reboot, which took several hours. Hospital administrators were quick to point out the incident was in no way related to known network stability issues. Lutheran is in the midst of a $30 million IT project that will replace outdated McKesson software with Cerner.

Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital collectively pay $999,000 to OCR to settle potential privacy violations related to the taping of TV show “Boston Med” without prior patient approval. New York-Presbyterian Hospital settled for similar reasons several years ago after allowing filming for “NY Med.”

A Springfield, MA gynecologist is sentenced to one year of probation for violating HIPAA by giving a drug company sales rep access to patient files. Rita Luthra, MD lost her medical license upon her arrest in 2015, forcing her to close her practice that served primarily indigent patients.

Other

Intermountain Healthcare (UT) opens a $20 million Healthcare Transformation Center that will house a Healthcare Delivery Institute, Leadership Institute and Simulation Center, and CHIME innovation center.

Hixny’s decision to expand its HIE services into nine new counties in upstate New York prompts HealthlinkNY to cry foul because of overlapping territories. HealthlinkNY Executive Director Staci Romeo believes cannibalizing on service areas will decrease overall data-sharing effectiveness. Both HIEs are part of the Statewide Health Information Network for New York.

Sponsor Updates

• FormFast will exhibit at DreamForce September 25-28 in San Francisco.
• LogicStream Health will exhibit at the MSHP 2018 Midyear Clinical Meeting September 21 in Brooklyn Park, MN.
• Elsevier Clinical Solutions, InterSystems, and Intelligent Medical Objects will exhibit at AHIMA September 22-26 in Miami.
• Meditech will participate in MGMA18 September 30-October 30.
• EPSi will exhibit at the HFMA Arizona Fall Conference September 26-28 in Chandler.
• Glytec customer Honor Health John C. Lincoln Medical Center’s Cardiovascular ICU achieves a silver-level Beacon Award for Excellence from the American Association of Critical-Care Nurses.
• HCTec publishes a new case study on “Delivering Cutting-Edge Coding Solutions.”
• Allscripts features Healthfinch’s Charlie Refill Management app as its Allscripts Developer Program September 2018 App of the Month.
• Madison Magazine includes Nordic on its list of best places to work for the third straight year.

Blog Posts

• The Crucial Transition from Patient Portal to Holistic Digital Patient Channel (Loyale Healthcare)
• Building for Humans: The role of human-centered design in the hospital setting (part 3 of 3) (GetWellNetwork)
• Hurricane Florence Evacuation Response: Imat Solutions Helps EtHIN to Retrieve Medical Records for North Carolina Residents (Imat Solutions)
• How Much Will You Have to Shut Down After a Cyberattack? (The HCI Group)
• Calm During the Storm: Maintaining Communication in the Midst of a Disaster (Spok)
• How to Ensure Good End-User Experience with Proactive Monitoring and Troubleshooting (Goliath Technologies)
• Living the #HylandLife: HIMSS Europe (Hyland Health)
• HIPAA Risk Analysis vs. Gap Analysis – There Is a Difference! (Impact Advisors)
• 6 resources for National Recovery Month (Meditech)
• 10 most common HIPAA violations and solutions (Imprivata)
• How a Healthcare CRM Helps You Stay Secure and Compliant (Influence Health)
• Bottled Up: How Better Information Flow Can Empower Pharmacies and Patients (InterSystems)

Contacts

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

EPtalk by Dr. Jayne 9/20/18

This week is Prescription Opioid and Heroin Epidemic Awareness Week. There are several ONC resources available to help clinicians lean what technology is available to them, including prescription drug monitoring programs and electronic prescribing of controlled substances. My practice still hasn’t taken the leap to the latter since we dispense the majority of our controlled substances from our in-house pharmacy, although it’s now mandatory in some states.

AMIA has issued a Call for Participation for its 2019 Clinical Informatics Conference in Atlanta. The CIC meeting has a greater focus on applied clinical informatics, clinical decision support, and health policy compared to the annual fall AMIA meeting. Atlanta is a fun town and I’ve heard the clinically-focused meetings are great, but I’ll miss it due to it conflicting with my annual stint teaching in an outdoor classroom program.

I had some great reader feedback on my recent piece about cultural competency. Readers seem to appreciate the articles that aren’t necessarily pure healthcare IT but touch on issues that many of us face in the workplace.

One reader shared their own experiences with cultural competency training that’s likely to be minimally effective. It’s being delivered as a single mandatory three-hour session and we all know how much information people really absorb after the first hour or so. The reader notes, “Everyone I’ve talked to has been longing for the olden days before text pagers, when you could go to a meeting, set off your own beeper by surreptitiously turning it off and back on again and then acting surprised before rushing out to respond to the ‘emergency,’ never to return to the dreaded mandatory activity.”

The training is also being delivered lecture-style to large groups, which is a shame because group discussion could really bring this topic to life. If care teams or groups of workers attended together, discussion could help them learn more about each other and how to work together effectively as a team as well as with their patients. The reader goes on to describe an institutional push to curb profanity, noting the need to start “whipping out thesauruses looking for allowable substitutes – maybe they should just put Ivory Soap dispensers in the hall to allow cleansing of tongues and improved hand washing in one swoop.” I suggested they consider the Elizabethan Curse Generator, which automates insults in Shakespearian English. Take that, thou distempered fat-kidneyed wagtail!

I was glad that Jenn mentioned the annual Physicians Foundation report on the state of physician practice. The decline of independent practice continues, with barely a third of the 9,000 physicians surveyed using that term to describe themselves. Although Jenn covered some of the highlights, including that 80 percent of physicians feel they have experienced burnout, I found some additional statistics that were thought-provoking:

• US physicians handle over 1 billion patient encounters each year across all settings of care
• 12 percent of physicians are planning to find a non-clinical position
• 61 percent favor either a single-payer health system or a single-payer system with a private insurance option; 27 percent favor a market-driven system; and only 4 percent think we should maintain the current system
• 22 percent of physicians either do not see Medicare patients or limit the number they see
• 32 percent of physicians either do not see Medicaid patients or limit the number they see
• 47 percent of physicians are compensated based on quality/value, but only 18 percent believe that these payments will improve care or reduce costs
• On average, each office-based physician supports about 17 jobs and pays a total of $1.4 million in wages and benefits.
• 49 percent of physicians would not recommend medicine as a career to their children or other young people
• 27 percent of physicians would not choose to be a physician if they had their career to do over
• More than 68 percent of physicians do not believe that Maintenance of Certification processes accurately assess their clinical abilities
• Physicians work an average of 51 hours per week

The report includes a listing of questions and responses aggregated by various demographic factors including age, employment status, gender, and specialty. It also includes direct comments from respondents, which start on page 50 if you’re interested.

One of the mechanisms that physicians use to combat burnout and reduce the amount of time spent interacting with the EHR is the medical scribe. JAMA Internal Medicine ran an article  this week titled “Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience.” The question posed was whether using scribes decreases documentation burden, improves productivity, improves patient communication, and enhances job satisfaction among primary care physicians. Not surprisingly, the study (although limited at 18 primary care physicians) showed that using scribes was linked to reductions in documentation time and improvements in productivity and job satisfaction.

I’ve been in a practice that uses scribes for the last three years, although I don’t always have a scribe during every shift. We deploy them based on volume of patients seen at our various locations, so if you are scheduled for a lower-volume location you may be on your own. When it gets busy and five or six patients walk in at the same time, you definitely wish you had a scribe. Although I’m fast with the EHR and have tons of personalized templates, macros, and order sets, it’s still not as fast or as accurate as working with a scribe who can document while you’re doing the exam and speaking with the patient.

Unfortunately, many of our scribes are pre-meds or post-baccalaureate students trying to gain admission to medical school or a physician assistant program. This means that once the admissions letters come out, we have to hire a fresh crop of scribes and attempt to turn them into Olympic athletes before influenza season hits.

The new Medicare cards continue to roll out, with more than 35 million mailed to date. Medicare is processing claims and eligibility requests using the new Medicare Beneficiary Identifier and it seems to be going smoothly for the regions where the new cards have arrived. Cards should be mailed to all Medicare participants by April 2019. I polled a couple of colleagues on the revenue cycle side and haven’t heard of any major hiccups, but would be interested to hear from readers who are knee deep in it (especially any readers who are Medicare beneficiaries themselves.)

Email Dr. Jayne.

Morning Headlines 9/20/18

Hacking attempt troubles Lutheran

Lutheran Health Network (IN) brings IT systems back online after an attempted data breach forces Lutheran Hospital to divert patients to other facilities.

Mercy Health Funds Cloud Medical Image Management Company NucleusHealth™

Mercy Health becomes a minority investor in cloud-based medical image management vendor NucleusHealth.

Nest’s digital health ambitions revealed in records from secretive purchase of Seattle startup Senosis

Newly released documents confirm Nest’s hush-hush acquisition of Senosis Health, an app-based health monitoring startup out of the University of Washington, is likely part of a broader move into digital health.

Morning Headlines 9/19/18

Paul Singer balks at $160-per-share Athenahealth bid

Athenahealth shares drop sharply on the news that activist investor Elliott Management will pass on acquiring the company at its previously offered price of $160 per share.

Local health care technology startup Valify makes acquisition

Hospital purchased services technology vendor Valify acquires Lucro, which offers a hospital-vendor marketplace.

Kleiner Perkins is splitting up

Silicon Valley venture capital firm Kleiner Perkins will spin off its digital health group – which includes some of its most prominent partners, who have invested in Uber and Stripe – into an independent group.

News 9/19/18

Top News

Activist investor Elliott Management — whose criticism of Athenahealth caused the company to fire founder and CEO Jonathan Bush, cut costs, and seek a buyer – joins several other would-be suitors that will pass on acquiring the company at Elliott’s previously offered price of $160 per share.

Elliot says its due diligence has turned up significant Athenahealth problems. ATHN shares dropped sharply on the news.

Athenahealth will extend its bid deadline by 10 days through September 27.

Critics of Elliott’s tactics speculate that the firm is hoping that Athenahealth will accept a fire-sale price to avoid the public embarrassment of eliciting no acceptable offers.

Reader Comments

From NXGN Woes: “Re: Nextgen. Employees were told last week that two C-level executives are leaving the company. Operations employees will report to the CFO.” Unverified. NXGN Woes provided names, although I’ll decline to include them since their LinkedIn entries and the company’s executive page remain unchanged. UPDATE: a reader tells me that marketing SVP Tamra Rushing has been replaced and provides this internal email from CEO Rusty Frantz:

Due to personal reasons and effective immediately, Scott Bostick has made the decision to step down from his position as Chief Operating Officer and into an Individual Contributor role reporting directly to me. Please join me in thanking Scott for his leadership as he transitions into this new role. Further, in the coming weeks, the executive team will work with the senior leaders within the client services organization to ensure a successful transition under the leadership of our Chief Financial Officer, Jamie Arnold. The leaders who will now be reporting to Jamie Arnold include: Mitch Waters –  SVP, Sales, Colleen Edwards – SVP, Marketing, Allen Plunk – SVP, Managed Services, and Ben Clark – SVP, Client Services. At this time, we will not be backfilling the Chief Operating Officer role. We will move forward with a flatter organizational structure to ensure continued success of the commercial client facing organization.

From Jellico: “Re: KLAS. We dropped out of the relationship after they failed to contact any of the dozens of our consulting firm’s clients whose names we provided. All of the four KLAS reps we had been assigned over several years have left the company. I’ve kept in touch with two of those and both say they were uncomfortable collecting money from vendors they were rating. It will be interesting to see if Black Book gains traction. They appear to be more straightforward and they don’t accept monies from vendors they rate.” I’ve found KLAS’s market reports to be informative in how they broadly characterize a particular market segment. I have less confidence that they use enough statistically defensible methodology to rate individual vendors reliably. Still, the company’s business model is propped up by (a) the high-ranked vendors who usually keep paying in hoping of remaining on top, and (b) the also-rans who believe – accurately or not – that maintaining or increasing their KLAS payments will improve their chances of earning KLAS bragging rights. No CIO in their right mind would buy something based on KLAS scores and I suspect that few do, but anxious vendors are always looking for a competitive advantage and hope KLAS can provide it, even if indirectly. In KLAS’s defense, consulting firms (of which they are arguably one) often make recommendations to clients based on laughably subjective factors gleaned from casual conversations that they package up into impressive PowerPoints, so it’s hardly a new concept. I enjoy the Black Book survey results, where they survey huge numbers of people and then slice and dice their responses into a mind-boggling set of reports whose statistical underpinning and transparency seems reasonable. A significant deficiency of many of the survey-type reports I see is that they fail to categorize respondents (do they work for a single hospital, a health system in a corporate role, or a medical practice?) and they often fail to distinguish between a vendor and its multiple products (which Allscripts EHR were the respondents talking about?)

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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

Acquisitions, Funding, Business, and Stock

Waystar will acquire workflow and predictive analytics vendor Connance to enhance its revenue cycle management capabilities.

Hospital purchased services technology vendor Valify acquires Lucro, which offers a hospital-vendor marketplace.

Signet Accel, the Ohio State University spinoff that offers the Avec data integration platform, has reportedly downsized and parted ways with CEO John Raden. I also noticed that former EVP of Sales and Marketing Brenda Barry has gone back to her previous employer after one year on the job. Regenstrief President/CEO and AMIA board chair Peter Embi, MD, MS was a Signet Accel co-founder and medical advisor.

Aramark will sell its Charlotte, NC-based hospital medical equipment management and clinical engineering business to Trimedx for $300 million.

Silicon Valley venture capital firm Kleiner Perkins will spin off its digital health group – which includes some of its most prominent partners, who have invested in Uber and Stripe – into an independent group. The early-stage team will continue to operate under the Kleiner Perkins name. The firm’s healthcare technology investments include Collective Medical, Livongo, and Mango Health. It previously invested in Teladoc.

The Justice Department approves the $52 billion merger of insurer Cigna and pharmacy benefits manager Express Scripts.

Sales

• Beacon Health System will implement MyHealthDirect’s patient self-scheduling system.
• Children’s Health (TX) signs a 15-year, $75 million agreement with Philips for patient monitoring and PACS technologies.
• DCH Health System (AL) chooses Santa Rosa Consulting to lead its Meditech Expanse implementation.
• Cigna will expand its diabetes prevention program in collaboration with Omada Health.

People

GetWellNetwork hires Peter Keating (Advisory Board) as chief people officer.

Jeff Sturman (Cumberland Consulting Group) joins Memorial Healthcare System (FL) as SVP/CIO. He was previously SVP of IT there from 2004 to 2012, where he led its selection and implementation of Epic.

PatientPing hires Sagnik Bhattacharya (Epic) as VP of payer and provider initiatives.

Jesus Delgado (Rush University Medical Center) joins Community Healthcare System’s Community Foundation of Northwest Indiana as VP/CIO.

Healthcare investor and innovator Tom Main, managing partner of 7wire Ventures, died Sunday.

Announcements and Implementations

VisualDx launches Aysa, a consumer app that inspects a user’s skin condition photos, asks relevant questions, and then provides possible causes. 

Meditech announces Greenfield, a third-party app development environment that supports FHIR and will offer a store of approved apps. 

Mercy Technology Solutions launches a cloud-hosted, pay-per-study PACS offering.

EPSi adds Ilerasoft’s medical equipment investment and usage capabilities to its capital budgeting system.

Ciox Health announces HealthSource Gym, a learning environment that will help healthcare organizations assess, train, and develop medical coders.

Government and Politics

HHS publishes a report covering the state of its data sharing among its 29 agencies, noting problems that include a lack of standards for inter-agency data requests; variation in technical formats and approaches; the variety of statues that regulate data collection project; and the increased chance of privacy violations as data availability increases.   

Other

California doctors will be required to consult the state’s prescription drug monitoring program database before prescribing opiates under a law that takes effect October 2. The CURES system was developed in 1997 and updated in 2009 and 2016, but a 2012 newspaper investigation found that less than 10 percent of doctors and pharmacists had even bothered to sign up for access.

Amazon Web Services features Angel MedFlight Worldwide Air Ambulance’s self-development of an IPad charting application that uses AWS and Salesforce

In Africa, the governor of Nairobi makes an unannounced visit to a maternity hospital to follow up on complaints of negligence, orders an employee to open several unlabeled boxes and bags in a storage room. and finds the bodies of 12 infants. Reports suggest that the babies died when the hospital’s incubators lost electrical power. The government will follow up with investigations into rumored child trafficking and giving babies to the wrong families. Kenya’s public hospitals are mismanaged, underfunded, and staffed by doctors and nurses who have gone on strike over low pay and poor working conditions.

A Cincinnati neighborhood creates a Christmas celebration for a two-year-old whose aggressive brain cancer is likely to kill him before December. Six neighbors of Brody Allen’s family put up their Christmas lights early, sent cards, and will have a Christmas parade that includes fire trucks and supporters driving their own cars. He is too weak to walk, so his siblings wheel him around the neighborhood in a Red Flyer wagon covered with blankets.

Sponsor Updates

• CenTrak donates $5,000 to the Kerala Flood Relief Charity Fund.
• ACOs using Lightbeam Health Solutions achieved 1.7 times the savings generated by non-Lightbeam ACOs.
• Cumberland Consulting Group will sponsor and present at the Medicaid Drug Rebate Program Summit October 1-3 in Chicago.
• Formativ Health adds several new features to its Patient Engagement Platform including payment functionality powered by Patientco.
• Wolters Kluwer highlights patients as an underutilized resource in the fight against sepsis.
• AdvancedMD will host its EVO18 annual user conference October 3-5 in Salt Lake City.
• Aprima and Direct Consulting Associates will exhibit at the Ohio MGMA Fall Conference September 19-21 in Columbus.
• Jason Spurck (SOS Tech Group) joins Audacious Inquiry as support engineer.
• TechVibe Radio features Arcadia CTO Jon Cook.
• Datica publishes a new book, “Complete Cloud Compliance: How regulated companies de-risk the cloud and kickstart transformation.”
• Burwood Group will host “Cloud Revolution with Burwood, Citrix, & Google” September 27 in Chesterfield, MO.
• CarePort Health will exhibit at ACMA Kentucky/Tennessee September 24 in Nashville.
• CoverMyMeds will exhibit at the PCMA Annual Conference September 23-25 in Scottsdale, AZ.

Blog Posts

• Using Agile concepts to improve task management (Bluetree)
• 3 Ways Electronic Mental & Behavioral Health Screening Increases Patient Engagement (AssessURHealth)
• Facilitating and Operationalizing Continuous Surveillance (Bernoulli Health)
• The Clinical Side of Case Management (CarePort Health)
• NCPDP Real-Time Prescription Benefit Task Group: Why Stakeholders Need to Take Notice (CoverMyMeds)
• Deduplication of Clinical Data Without Data Loss: Critical to Meeting User Needs (Diameter Health)
• How Analytics Can Help Improve Falls (Dimensional Insight)
• Urgent Care Best Practices for Anti-Kickback Statute Compliance (DocuTap)

Contacts

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

Morning Headlines 9/18/18

Apple has hired a top exec from a hospital chain to help run its employee health clinics

Apple hires M. Osman Akhtar away from Fairview Health Services in Minnesota to run its AC Wellness employee clinics.

Aramark Announces Agreement for Sale of Healthcare Technologies Business to TRIMEDX

To better focus on its food, facilities and uniforms segments, Aramark sells its Healthcare Technologies business to clinical engineering and asset management company TriMedx for $300 million.

Waystar to Acquire Connance, Expanding Powerful Revenue Cycle and Predictive Analytics Technology for Health Systems and Hospitals

Waystar acquires RCM software competitor Connance for an undisclosed sum.

Congress Doesn’t Know Who’s in Charge of VA’s $10 Billion Health Records Overhaul

Lawmakers are convinced that a lack of accountability among the various government agencies, offices, and committees created to oversee the VA’s transition to Cerner will lead to wasted taxpayer dollars and project delays.

Curbside Consult with Dr. Jayne 9/17/18

To maintain my board certification, I have to do a variety of coursework “modules” on an ongoing basis. Sometimes they’re more academic, such as learning the latest and greatest clinical guidelines, and sometimes they’re more practical, such as a practice improvement project around handwashing by providers and staff. For those of us who aren’t in traditional practice, the choices are sometimes slim since we don’t have continuity patient panels that we can research with or look at trends in quality. One of the offerings that I completed for my upcoming board certification renewal was a module on cultural competency.

In healthcare, cultural competency means caring for patients in a way respects their health beliefs and cultural practices. Sometimes it can directly impact medical treatment, such as not making recommendations for animal-derived products when that would be contrary to a patient’s beliefs or preferences. In other situations, it might be more subtle, such as having an understanding of the communication preferences of different cultures and how decisions are made within extended family structures. It can also be having an understanding of medical treatments performed by different groups, including everything from cupping to intercessory prayer. It might also be respecting a patient’s desire to entirely reject treatment regardless of the potential for success.

Understanding different cultural beliefs of your patients can certainly help build trust and rapport with them, as well as helping to identify treatments that they will accept and complete. Letting patients know that you’re interested in learning about their values and beliefs helps them feel empowered and part of the care team. It’s great that healthcare providers are thinking about cultural competency, but learning more about it got me thinking about cultural competency in that context of the general workplace.

I recently worked with a company that placed a priority on this, creating various forums for employees to interact based on their family situations, ethnic groups, or interests outside of work. It was great to watch people who might not normally interact get together around a common characteristic and get to know each other.

I’ve also worked with companies that don’t have even a basic understanding of cultural sensitivity. In our increasingly polarized society, some people push back against the idea of political correctness, but rather than thinking about it that way, one might want to consider that it’s just a basic human kindness to respect the beliefs of others. I’ve been at a company that was hosting a development team from India (along with the host team’s existing multicultural employees) where the catered lunch that was ordered consisted entirely of barbecued beef and other items that had meat in them, including the baked beans and the potato salad. I cringed when I saw several people with plates of only corn bread and coleslaw.

I’ve been in meetings where the presenters used hunting metaphors such as, “You can’t shoot the moose from the lodge” and other gems, not noticing that it wasn’t playing well to the non-sportsman audience. Of course, the audience can exhibit cultural sensitivity and understand that the presenter is reflecting his own cultural practices as well rather than just acting horrified. Cultural sensitivity is a two-way street.

That’s the challenge in coaching people to develop a workplace demeanor that allows them to respect their own beliefs and traditions without stepping on those of their colleagues and employees. There’s certainly a continuum of behavior, ranging from insensitive to boorish with many different shades in between.

It’s important to understand the potential for difficulty here, because when someone in a leadership position doesn’t understand that balance, it can be perceived as creating a hostile workplace. Even when it’s unintentional or through sheer ignorance, a pattern of disrespectful behavior can become a serious workplace issue. Some companies have responded to this by formally implementing diversity training programs employee education, but it needs to go beyond that. Sometimes those programs are highly focused around specific groups rather than focusing on the more general concept of acting in a way that would make people comfortable regardless of their cultural background or beliefs.

Assuming that people from a specific background don’t eat or not eat specific foods can be an issue. I’ve worked with dozens of people whose practices are very different from their historical roots. Sometimes it’s easier to think about these challenges in a broader way – for example, thinking of dietary needs as not only a cultural issue, but also a medical one. Asking a more open-ended question around whether people have any dietary restrictions or requirements is more inclusive than asking whether people need a specific type of meal. I’ve been to plenty of corporate-type lunches where the question is never asked. That’s an easy pitfall to avoid and keeps the meeting planner from trying to figure out what different parameters they need to accommodate.

From a healthcare provider perspective, it’s great to learn about different traditions and practices so that you’re not surprised by the descriptions of treatments that patients may be doing at home, or that so you can have an understanding of how those therapies might complement or conflict with what you might recommend. However, a larger part of cultural competency is just learning how to talk with people about they prefer to be treated and being considerate of fellow human beings. It’s about not making assumptions and not trying to cast your own beliefs and values on the people with whom you interact.

There is a tremendous amount we can learn from each other and it just takes being open to learning about other people’s beliefs and needs and understanding how they may differ from your own. It’s about going back to the basics of hospitality and helping ensure that people feel comfortable regardless of where they come from or where you are going.

How does your organization approach cultural competency? Leave a message or email me.

Email Dr. Jayne.

Morning Headlines 9/17/18

GRAChIE Using eHealth Exchange to Mobilize Connection Points for Hurricane Florence Evacuees

Georgia’s GRAChIE HIE is working to connect Southeast providers via the EHealth Exchange to meet care needs that are being challenged by Hurricane Florence.

etHIN Establishes Connection to North Carolina HIE to Support Medical Records Exchange for Evacuees

HIEs in Tennessee and North Carolina take just 48 hours to connect their respective systems to allow Tennessee providers to pull up records for North Carolina evacuees who require medical care there.

Hurricane Florence and HIPAA Bulletin: Limited Waiver of HIPAA Sanctions and Penalties During a Declared Emergency

HHS reminds hospitals in North Carolina, South Carolina, and Virginia that it is temporarily waiving several HIPAA Privacy Rule sanctions and penalties.

Monday Morning Update 9/17/18

Top News

Paper EHR woes following Hurricane Katrina created the push for EHRs and interoperability in 2005 (and propelled Karen DeSalvo into the National Coordinator role in early 2014), so it’s fitting that Georgia’s GRAChIE HIE is working to connect Southeast providers via the EHealth Exchange to meet care needs that are being challenged by Hurricane Florence.

In related news, HIEs in Tennessee and North Carolina take just 48 hours to connect their respective systems to allow Tennessee providers to pull up records for North Carolina evacuees who require medical care there.

Also, UNC Health Care waives fees for its MDLive-powered virtual visits during the hurricane.

HHS reminds hospitals in North Carolina, South Carolina, and Virginia that it is temporarily waiving several HIPAA Privacy Rule sanctions and penalties:

• The requirement to obtain patient consent to speak with family members and friends about their care
• The requirement to honor patient requests to opt out of the facility directory
• The requirement to provide a notice of privacy practices
• The right of the patient to restrict uses and disclosures and to request alternative forms of confidential communications

I would be interested in hearing from IT folks hurricane-affected hospitals about how they prepared for the storm or responded to its effects.

Reader Comments

From Silver Surfer: “Re: KLAS. We’re a vendor and cancelled our agreement three years ago after KLAS assigned 18 months of feedback from our clients to the wrong vendor. Three years later, anyone searching KLAS for our consulting firm gets a message that our results don’t meet minimum KLAS Konfidence levels, meaning that we might be losing business from prospects who see that as a negative for our company even though it was KLAS’s error.” Unverified. The strongest complaints I get regarding KLAS’s methodology involve (a) how many of a vendor’s clients they survey; (b) how they select those they speak to; and (c) whether that small subset of clients is representative. People also express concern that paying KLAS to survey more clients than they might otherwise contact gives deeper-pockets vendors a chance to gain ground.

From Vishnu: “Re: [vendor name omitted]. Protecting its managers and team leads against internal sexual harassment accusations. Hopefully in time they will do what’s right.” I’ll omit the company’s name in the absence of legal evidence, such as a filed lawsuit.

From Dr. Ross: “Re: Epic in Denmark. I was in southern Europe for a conference and this article seems to be all the talk, even though I haven’t seen it mentioned in the US.” Three doctors in Denmark’s Capital Region refer to its newly implemented system (in a Google-translated page) as “the killing platform,” saying that it’s cumbersome, illogical, and doesn’t easily share data with quality and research databases (they expressed their concerns in a Danish language video that doesn’t include an English translation). The doctors say the Region’s claim that 30 systems have been replaced by one is “fake news,” as departments that previously used 6-7 systems are still running 3-4, and warns that reduced productivity may bankrupt the Region. They conclude that the system was built for private hospitals in the US and isn’t suitable for those in Denmark despite the claims of “US salesmen and lawyers,” urging the Danish Parliament to take over the project instead of “cling[ing] to a mistake just because you spent a lot of time making it.”

From Udon: “Re: ERISA. Would love to see an expose on that statute, which renders most state-level legislative and regulatory actions meaningless because it governs employer-funded health plans. If you are denied a scan or behavioral stay, you have to sue the health plan – which will fight it tooth and nail – and the most you can get is the cost of the denied benefit.” ERISA, which sets standards for private health and pension plans, got a recent spotlight when an HCA hospital assured a heart attack patient that his out-of-network stay would be covered by his insurance, then went after him for the $109,000 balance beyond what Aetna paid because his employer-provided insurance was self-funded (as is true of 60 percent of people), meaning he’s not protected by state-mandated prohibition of balance billing. On the other hand, those state protections are not common anyway and are often not comprehensive. ACA prohibits balance billing for out-of-network ED visits, but still allows out-of-network doctors, hospitals, and ambulance services to demand payment from the patient beyond the negotiated amount their insurance pays. So, Mr. Life-Threatening Emergency Patient, your job before breaching a hospital’s financially (and sometimes clinically)dangerous wall is:

• Study your employer’s insurance ahead of time to see if it’s self-funded.
• Keep a list of which hospitals are in your policy’s ever-narrowing provider network.
• Never travel beyond the immediate vicinity of those in-network hospitals.
• Stay conscious at all times during your medical crisis (or better yet, bring a medical bodyguard) so you can ask every person you see whether they’re in your network since hospitals are notorious for letting people work out of their building who are anxious to bill you separately and who don’t need your approval to do so.
• Remember that you don’t have a choice of ED doctor, surgeon, anesthesiologist, hospitalist, etc. and your condition makes elective transfer unlikely, so wear ear plugs to mute the sound of the ever-ringing cash register.
• Assume that despite paying for what looks like decent insurance, an unplanned medical event could progress quickly into an unplanned medical bankruptcy courtesy of healthcare profiteers and their political lap dogs who like things just the way they are.

HIStalk Announcements and Requests

Poll respondents express little interest in paying for expanded consumer genetics testing at a higher price, with the most significant concern being that long-term care insurers could use your personal data against you — the testing companies aren’t covered by HIPAA’s minimal protections and therefore your data can be sold to anyone.

New poll to your right or here: How much impact will Apple Watch’s announced EKG recording capabilities have on overall population health? I admit I’m skeptical about all consumer diagnostic tools for these reasons:

• Our system is already burdened by excessive use and cost, so further clogging up EDs and PCP offices with Apple Watch wearers demanding to have providers interpret their likely meaningless readings isn’t necessarily a good thing
• Many millions of Americans have already been accurately diagnosed with life-affecting conditions they can’t afford to have treated and this further aligns people into have/have not categories
• It reinforces Silicon Valley’s misperception that our poor public health is caused by underdiagnosis or misdiagnosis rather than a screwy system of misaligned incentives and the siphoning off of most of our healthcare spending to episodic care providers rather than toward population and public health
• Such tools also reinforce the inaccurate idea that funneling symptom-free people into a healthcare system that can do more harm than good is in their best interest, especially the largely elderly population likely to experience atrial fibrillation

Thanks to Jenn for covering for me for a few vacation days. I’m happy to have rendered myself at least temporarily redundant so I can take occasional worry-free time off without being chained to a computer all day. You may notice the difference since my writing is grumpier and more wearily skeptical than Jenn, whose forte is admirable journalistic excellence rather than pent-up, post-vacation ranting.

Spam protection has made sending bulk email – such as my HIStalk “we’ve published something new” notices – a crapshoot. People tell me every day they aren’t getting the updates, yet the problem always involves their email server’s settings that I can’t fix. I can only suggest that you enter your email again if you aren’t getting my updates, which is risk-free since you won’t get multiple email copies no matter what.

Welcome to new HIStalk Gold Sponsor LightSpeed Technology Group. The Chapel Hill, NC-based company’s VeriDOCs revenue cycle solutions offer a secret sauce for professional fee coding and billing in emergency, anesthesia, and hospitalist management services in supporting technical disparity and diverse coding volume across many locations. It offers interfacing (EHR integration, demographics, billing); the VeriCODE quality-driven medical coding application; a web-based coder QA pre-billing audit application; a physician peer review tool; and VeriNET workflow oversight and reporting. The end result is that coders and auditors work from a streamlined, secure platform that drives faster onboarding, more efficient coding, and faster bill turnaround. Thanks to LightSpeed Technology Group for supporting HIStalk.

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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

Acquisitions, Funding, Business, and Stock

Outgoing Cerner President Zane Burke has sold $52 million worth of CERN shares in the past couple of weeks. I notice. CERN shares are down 6 percent in the past year versus the Nasdaq’s 24 percent gain.

Netflix co-founder Marc Randolph, speaking at Health Catalyst’s Health Analytics Summit, urges attendees to develop optimism, confidence, and a tolerance for risk in describing how the tiny, struggling, two-year-old Netflix practically begged Blockbuster to buy it for $50 million and was quickly shown the door. He advocates “testing it without doing it,” explaining that Netflix “was not about having good ideas. It was about a system and a culture of trying lots of bad ones. What we realized is that the key to this is not the good idea. It was how quickly and easily and cheaply you could try as many ideas as you could think of.”

Sales

• Wyckoff Heights Medical Center (NY) chooses Allscripts Sunrise Abstracting.
• Chicago area home care provider Bowes In Home Care joins PreparedHealth’s EnTouch network that connects hospitals with post-acute providers to improve outcomes.

Decisions

• Stevens Community Medical Center (MN) will replace Cerner and EClinicalWorks with Epic in November 2018.
• Summit Healthcare Regional Medical Center (AZ) will go live with Allscripts Sunrise in 2019, replacing Allscripts Paragon.
• IU Health Jay Hospital (IN) replaced Meditech with Cerner on March 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

Industry long-timer Jonathan Niloff, MD, MBA died Saturday of cancer at 64. He was chief medical officer of Diameter Health, a board member of HIMSS North America, and founder of MedVentive (acquired by McKesson in 2012) as well as a former cancer surgeon and ovarian cancer researcher.

Announcements and Implementations

A new Reaction Data survey of 300 providers finds that 62 percent are using speech recognition in their EHRs, with another 15 percent working on it and a stubborn 23 percent saying they’ll never use EHR speech recognition. Not surprisingly, Nuance is the big dog and is gaining ground, while MModal’s much smaller market presence still makes them Nuance’s only real competitor and its user satisfaction is higher. Epic is by far the most commonly used speech-integrated EHR. Only 3 percent of speech recognition users say they might switch vendors.

A new KLAS report on clinical documentation improvement says that Nuance and ChartWise provide the strongest financial ROI, Iodine’s high-satisfaction tools are disruptive in prioritization functionality, and 3M’s offerings are overhyped. Claro Healthcare leads a small pack of services firms that offer CDI optimization and outsourcing.

Other

AMA’s newswire highlights a JAMIA-published comparison of order entry clicks between Cerner and Epic under the title of “62 clicks to order Tylenol? What happens when EHR tweaks go bad.”

An investor in online pharmacy Pillpack — whose value went from zero to more than $1 billion in five years when it was recently acquired by Amazon from its early 30s founders above — lists the company’s lessons learned:

• Relentlessly focus on the end user
• Build a full technology stack that allows the company to control its own destiny (Pillpack spent $10 million building its systems)
• Stand your ground against larger competitors
• Realize that you can’t grow and optimize a business simultaneously – design for scale, don’t code before understanding processes, and don’t industrialize without understanding the problem you’re trying to solve
• Hire executives and board members who have a founder mentality
• Invest in culture, which will be harder to manage as the company grows
• Don’t aim for a people-free business – human touch is essential
• Hire strong operations leaders who have a bias for action
• Hire a strong CFO/COO

In India, the state of Uttarakhand orders the government to provide printers so that every doctor’s prescription can be printed out before signing, addressing a problem in which patients and pharmacists often can’t read the doctor’s writing.

NYU Langone Health’s magazine notes that for the first time, all eight of its surgery chief residents are female.

A jury awards $4.6 million to a cruise ship passenger whose flu symptoms were mismanaged by the ship’s doctor, claiming:

• The Colombia-trained physician (which the lawsuit misstates as “Columbia-trained”) was inexperienced and gave a 25 mg dose of promethazine IV instead of safer, better drugs
• The doctor missed the patient’s cubital vein and instead injected the drug quickly into his ulnar artery
• Staff ignored the patient’s report of a burning sensation, declining to evacuate him by helicopter and instead waiting until the ship’s next port
• The patient developed compartment syndrome, requiring his arm to be amputated at the elbow

Weird News Andy says that despite early examples of scientific hype that turned out to be wrong (“nuclear power will be so cheap it won’t be worth metering usage”) he still likes that we’re getting closer to a Tricorder-like device. University of British Columbia engineers develop a Band-Aid sized ultrasound transducer that could turn a smartphone into an ultrasound machine for $100.

Odd: a Pennsylvania court upholds the prison sentence given to a man who in 2015 dialed 911 while choking. First responders found the 47-year-old passed out on his living room floor, clad only in underwear and socks in front of his computer monitor that was displaying a child pornography chat room. He unsuccessfully claimed that unnamed enemies framed him, with his daughter providing a heartwarming family moment in testifying that her dad isn’t smart enough to know how to download porn.

Internal medicine resident Mike Natter, MD notes that the relationship between the number of things carried and level of medical training is inverse.

Sponsor Updates

• Voalte announces that its VUE user conference, to be held October 3-5 in Sarasota, FL, has sold out for the first time in its history.
• LogicStream Health publishes a new report, “The New Healthcare Imperative.”
• MedData will exhibit at the Ohio American Academy of Pediatrics 2018 Annual Meeting September 21-22 in Dublin.
• Waystar will exhibit at Ohio MGMA September 21 in Dublin.
• The American Heart Association/American Stroke Association names Nordic a “Get with the Guidelines”-compatible vendor.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the annual Georgia Perinatal Conference September 19-21 in St. Simon’s Island, GA.
• Experian Health and PatientKeeper will exhibit at AHIMA September 22-27 in Miami.
• PerfectServe will co-host the Hospital for Special Surgery Educational and Networking Open House September 21 in New York City.
• Redox will present at Health 2.0 September 16-19 in Grapevine, TX.
• T-System offers disaster relief T Sheets free of charge to hospitals in the path of Hurricane Florence.
• Mazars USA welcomes Chief Human Resource Officer Julie Venkat.

Blog Posts

• A Person-Centered Approach for Success in Intellectual and Developmental Disability Services – Part II (Netsmart)
• Optimize Your Billing Office – Improve Workflows through Consolidation and Automation (Parallon Technology Solutions)
• Wasteful Ordering? Meet Order Manager (Experian Health)
• Four simple steps for reducing third-party service costs (PerfectServe)
• Healthcare communication is catching up. (Voalte)
• Designing Safe and Effective Digital Health Applications (Sansoro Health)
• Four Keys to EHR Go-Live Success (Santa Rosa Consulting)
• The 8-Minute Rule: What it is and How it Works in WebPT (WebPT)

Contacts

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

Weekender 9/14/18

Weekly News Recap

• Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.
• Memorial Sloan Kettering Cancer Center (NY) CMO José Baselga, MD comes under fire (ultimately resigning) after media outlets report he failed to disclose his financial ties to research journals in which he was published.
• Cerner President Zane Burke announces he will leave the company November 2. John Peterzalek, EVP of worldwide client relationships, will assume Burke’s responsibilities and the title of chief client officer.
• Former VA Secretary David Shulkin, MD joins Sanford Health (SD) as chief innovation officer.
• Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.
• General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Best Reader Comments

Re: 340b comments. Sounds awfully familiar. Regulatory bodies ask for public comment, then that process is abused via copy/paste comments and identity theft to support corporate positions. At what point do we start prosecuting people for this? (340b)

With Zane out the door as a scapegoat for the first three years of DoD vaporware delivery, who does Cerner send up next to stammer empty assurances to Congress? John Peterzalek? Or does the world finally get to meet Brent Shafer? (Vaporware)

Mediware /Wellsky…marketing runs rampant again! Their PR states: “We stand at the forefront of innovation that will eliminate the fragmentation that exists in health and community care… By integrating its offerings under one brand, WellSky is better positioned to partner with providers and organizations to create and sustain communities that thrive.

Please explain how re-branding under one new name really accomplices product integration for customers when their 30 diverse products hardly talk to one another?? They probably spent big bucks to come up with this new name. Would be better spent on developing code that really integrates their 30 disparate product lines. Whatever you brand it doesn’t matter, Wellsky is still a tornado of flotsam. (HISjunkie)

Watercooler Talk Tidbits

Researchers uncover a 2016  Amazon patent for a transport system in which a human worker would sit in a metal cage atop a robotic trolley, an engineering design they call “an extraordinary illustration of worker alienation, a stark moment in the relationship between humans and machines.” Amazon reps contend the company has never and will never develop such a system, adding that sometimes even bad ideas get submitted for patents. Given the company’s intensified focus on lowering employee healthcare costs, I can’t help but wonder what sort of ICD-10 codes might be warranted at its future employee clinics by injuries sustained within the hypothetical people-movers.

Perhaps Amazon should consider installing these on its warehouse floors: EIR Healthcare in Philadelphia starts a “tiny hospital” movement with the development of a prefabricated modular hospital room that comes pre-wired with fall-detecting sensors and a smart TV. CEO Grant Geiger boasts that “it should be the only option worth considering when building new hospital construction from this point forward.”

The Washington Post looks at the increase in electric scooter-related trips to the ER, interviewing emergency docs in seven cities – all of whom have seen a spike in injuries since shared scooter services became available in their areas. Start-ups like Bird, Lime, and Skip are riding on the coattails of ride-hailing and bike-sharing companies thanks to investments from Uber, Alphabet, and Sequoia Capital. Yet their business practices are being called into question by riders who end up in the ER with severe injuries due to mechanical malfunctions. “Injuries are coming in fast and furious,” says  Scripps Mercy Hospital (CA) Chief of Medical Staff Michael Sise. “It’s just a matter of time before someone is killed. I’m absolutely certain of it.”

In Case You Missed It

• News 9/14/18
• EPtalk by Dr. Jayne 9/13/18
• News 9/12/18
• Curbside Consult with Dr. Jayne 9/10/18
• Monday Morning Update 9/10/18

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Morning Headlines 9/14/18

Introducing WellSky — A New Approach to Health and Community Care

MediWare Information Systems rebrands to WellSky in an effort to better unify 30 brands across multiple companies in the US and abroad.

Babylon Healthcare targets chronic disease in $100 million expansion

Babylon Health will spend $100 million to double its workforce, aiming to hire 500 additional staff within the next nine months.

Alameda Health System Names Mark Amey as Chief Information Officer

Mark Amey (UC San Diego Health) joins Alameda Health System as CIO ahead of its $200 million Epic implementation.

News 9/14/18

Top News

Apple’s latest product announcement regarding the new Watch’s ability to record ECGs and monitor heart rhythm for abnormalities leaves healthcare reporters salivating and clinical experts torn between guarded optimism and healthy skepticism. The device, which can also detect when a user has fallen and alert emergency services, will start at $400 when it debuts later this year.

Industry folks were quick to point out that the device could lead to over treatment, and that its FDA clearance states the new apps are “not intended to replace traditional methods of diagnosis or treatment.” FDA Commissioner Scott Gottlieb, MD also tweeted out amidst his Hurricane Florence PSAs that app clearance is “a significant step forward in FDA policy because we decoupled review of the app from review of the watch itself. The watch isn’t a medical device, just the apps that help consumers detect serious medical conditions.”

Webinars

September 26 (Wednesday) 12:30 ET. “How to Ensure Patient Records are Always Available.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. This webinar will discuss how an early warning system can help your organization ensure your EHR systems and patient records are always available. You’ll also learn how to proactively anticipate, troubleshoot, prevent, and resolve end user experience issues before users or patients are impacted.

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

Acquisitions, Funding, Business, and Stock

Cigna allocates $250 million for a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics. Cigna’s previous health IT investments include MDLive, Omada Health, and Cricket Health.

OneOncology launches with a $200 million investment from General Atlantic and health IT support from Flatiron Health. Created by a partnership between Tennessee Oncology, New York Cancer & Blood Specialists, and West Cancer Center (TN), the company aims to offer oncology patients access to providers, treatments, and clinical trials typically unavailable in smaller, community-based settings. Former CVS Health EVP Tracy Bahl will serve as president and CEO.

MediWare Information Systems rebrands to WellSky in an effort to better unify 30 brands across multiple companies in the US and abroad.

In the UK, Babylon Health will spend $100 million to double its workforce, aiming to hire 500 additional staff within the next nine months. The plan is part of the virtual consult company’s efforts to expand its chat bot symptom assessment technology to include chronic disease management for diabetes and depression. The company is perhaps best known for powering the NHS telemedicine app GP at Hand.

Nuance and ChartWise top the list of CDI vendors driving the most tangible financial outcomes, according to a new KLAS report, while Iodine Software surpasses both when it comes to enabling efficient workflows. Third-party CDI firms like Claro Healthcare, Navigant, PwC, and Huron all score similarly on value and satisfaction. 

People

Mark Amey (UC San Diego Health) joins Alameda Health System as CIO ahead of its $200 million Epic implementation.

Akiri, a health data network spun out of AMA’s Health2047 business development and commercialization arm, names David Watson (The SSI Group) CEO.

Caradigm co-founder Warren Ratliff joins Seattle Children’s Hospital analytics spin-off MDMetrix as CEO.

Kermit Randa (Waystar) joins Kaufman Hall as CEO of its Software Division.

Access appoints Davin Marceau (Success Group) COO and promotes Cody Strate to the new role of VP of strategy and innovation.

Sales

• Bristol Hospital (CT) selects ESO’s Health Data Exchange software for improved data-sharing between its ED and EMS agencies.
• San Luis Valley Health Regional Medical Center (CO) will implement FormFast’s FastPrint Enterprise and ESignature bundle.

Announcements and Implementations

The North Carolina Health Information Exchange Authority rolls out subscription-based clinical event alerts to members of the NC HealthConnex HIE.

Marin General Hospital (CA) will install University of California San Francisco Health’s Epic software as part of a strategic alliance that includes co-branding and designating UCSF as its academic and teaching partner.

Regional West Health Services (NE) prepares to go live on Cerner Millenium this weekend.

Mercy Technology Services develops a cloud-based imaging solution that comprises Visage’s imaging software, workflow technology from Medicalis, and speech recognition and reporting capabilities from Nuance.

Other

FHIR architect and interoperability consultant Grahame Grieve tells the Australian Senate an IT overhaul is needed to assure the success of the My Health Record initiative. The national digital records database, which he has been an advisor on, has come under fire over the last several months thanks to a questionable opt-out policy, and privacy and governance concerns. Grieve, an Australian native, told the Senate ahead of a September 17 inquiry into the program that, “The design of the system and the standards it is based on were state of the art in 2007. Although a more distributed design was initially planned, it is now, unfortunately, a centralised national database of static summary documents. This was an inevitable consequence of the technical standards used at the time, but now constrains the use, extensibility and therefore the value of the system.”

A survey of 109 providers finds that 68 percent have not yet developed a disaster preparedness plan, despite having experienced two such events within the last five years. All bets are off when it comes to securely communicating with hospitals during and after weather events: 25 percent of specialty providers have used unsecured text messaging to reach hospital staff, and 22 percent have used the same method to reach patients and their family members. Hospital-based respondents take secure messaging more seriously, perhaps because they already have resources in place: 44 percent believe secure messaging to be a key component of preparedness plans, surpassed only by the need for backup generators and extra supplies and medication.

Sponsor Updates

• EClinicalWorks will exhibit at Health 2.0 September 16-19 in Santa Clara, CA.
• Formativ Health partners with Lyft to help get patients to medical appointments.
• Broadlawns Medical Center adds FormFast’s Go electronic document solution to its existing Capture software.
• The HCI Group publishes a new white paper, “You’ve Signed a New EHR Contract: Now What?”
• Loyale Healthcare explores healthcare CEOs and innovation in a new video, “Who Thrives? Who Survives?”
• Politico features PatientPing in “Connecting your medical data could be the next big payoff.”
• Consulting Magazine ranks Impact Advisors third on its list of best small firms to work for.
• Hyland Healthcare collaborates with Change Healthcare to speed and simplify claim attachments for providers and payers.
• InterSystems adds a mobile, touchscreen-enabled user interface to its TrakCare health information system.
• Intelligent Medical Objects will exhibit at the 2018 OR Manager Conference September 17-19 in Nashville.
• Kyruus will present at the 2018 Tri-State Conference September 19-21 in Wisconsin Dells, WI.
• Join Meditech in signing the World Sepsis Declaration.
• TransUnion Healthcare announces its support of nonprofit RIP Medical Debt.
• Dimensional Insight publishes a new case study featuring Doctors Hospital in Puerto Rico.
• Voalte’s annual Vue user conference, set to take place October 3-5 in in Sarasota, FL, sells out for the first time.
• PatientKeeper and Medhost enter into a reseller agreement.
• Hayes Management Consulting hires Mark Rivero (Athenahealth) as director of client experience.
• EPSi partners with MPA Healthcare Solutions to offer customers risk-adjustment and clinical analytics.

Blog Posts

• Finding the best long-term home for Aries Systems (Elsevier Clinical Solutions)
• Implementing a Plan to Unite Clinicians, Compliance and Revenue Cycle Teams (Hayes Management Consulting)
• Are EHR Companies Difficult to Work With? (Goliath Technologies)
• Digital Disruption in Healthcare: How to Accelerate Innovation and Progress (Healthgrades)
• Ciox Believes Mandate is Necessary to Achieve a Fax-free Future (Ciox Health)
• Four Keys to Frustration-Free Health Education Care Managers Love (Healthwise)
• Kudos to Texas Scottish Rite Hospital for Children – Named One of the Top-Performing Children’s Hospitals (Huntzinger Management Group)
• Top HIEs Advancing Interoperability, Data Quality and More (Imat Solutions)
• The Broad Impact of Unique Patient Identifiers (Imprivata)
• Getting Buy-In for Healthcare Technology: Winning Over Physicians (Influence Health)
• Sowing the Seeds for EMR Satisfaction (InterSystems)
• Understanding Patients and Providing Personalized Experiences in Healthcare (Kyruus)
• Combating Sepsis: How University of Utah Health Saved Lives and Cut Costs (Spok)
• The Anatomy of a Successful Community Connect Install (Optimum Healthcare IT)
• Staying connected: 5 blogs about interoperability (Meditech)
• Keep Patient Satisfaction High at Bedside and Discharge (Access)

Contacts

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

EPtalk by Dr. Jayne 9/13/18

As we move into hurricane season, the American Academy of Family Physicians has released disaster preparedness resources for both practice and personal needs. I’m always amazed by the practices I visit that don’t have an EHR downtime strategy or business continuity plan. Even if they have plans, it’s rare that they have done drills or really discussed what would happen in a serious emergency. I’m not a serious doomsday prepper, but I do have some survival basics in my car including water, food, a first aid kit, and a survival blanket. There are plenty of organizations that end up having staff sleep at the hospital or medical office buildings in the event of major disasters, so it’s not a bad idea to keep some extra clothing and essentials like a toothbrush in your “go bag” because you never know where an emergency is going to happen.

Backup solution vendor Webair is offering complimentary offsite backups and disaster recovery services for business affected by Hurricane Florence. Clients can select backup replication sites on the West Coast or outside the continental US. I took a look at their offerings and was happy to see that they include up to 72 hours per month for disaster recovery testing. Far too few sites test their backups or disaster recovery strategy, so this is a plus.

HHS has declared a public health emergency in the Carolinas in preparation for Hurricane Florence. The public health emergency eases some restrictions for Medicare and Medicaid providers, and likely will lead to accommodations for various reporting requirements for 2018. I know all of us hope that the storm will not be as bad as predicted and are sending our prayers to the East Coast.

CMS is convening a Technical Expert Panel to look at the Merit-based Incentive Payment System, specifically the Improvement Activities (IA). This panel will give feedback and provide “direction and thoughtful input on the improvement activities during development and maintenance.” They’re looking for a dozen clinicians with expertise in the Improvement Areas, consumer/patient/family caregiving, healthcare disparities, performance measurement, and quality improvement. Nominations close at 5pm PT on September 22.

A wise man once told me to always spend a little time looking for my next career move, so I keep my eye out for interesting postings or opportunities. On Tuesday, I received a notice from ONC that they were looking for a medical professional in the Clinical Division. I have no desire to relocate to Washington, DC but was curious about the posting. Clicking the link embedded in the email took me to Indeed.com, where the header said the posting was no longer available on Indeed. It’s going to be difficult to recruit someone if you don’t keep the posting live, and the email from ONC made it sound like it would be open through September 19. It did cross-link me to a Medical Officer posting, which was interesting in that it was targeted to someone who is already employed by a governmental or academic institution that is willing to contract them out for a period of two years. Despite the requirement that the candidates be MD or DO physicians, the salary range is $114k to $164k, and there is no eligibility for federal benefits. I wonder if they will have candidates beating down the doors for this one given the cost of living in the DC area and the earnings potential for physicians in clinical practice.

It’s that time of year to start talking about flu season preparedness. This week brought a blip in reported flu cases, and I hope it’s not a predictor of an early or more severe flu season. Vaccinations arrived at my clinical office on Tuesday, and everyone rolled up their sleeves and got it done. After seeing the number of seriously ill patients we saw last season, no one wants to experience that personally. Please consider a flu vaccination to protect patients, your family, and the community.

LOINC is holding its annual Fall Conference next month in Salt Lake City. Workshop topics include Document Ontology, the use of the RELMA mapping assistant, Clinician Perspective, and FHIR. I’ve been doing LOINC mapping for clients for nearly a decade and appreciate the logic and deliberate construction of the framework. Sometimes the specificity of some of the tests seems complicated to those who haven’t worked in the depths, but when you’re looking for granularity with lab data it’s important to be as accurate as possible.

The Pew Charitable Trusts, the AMA, and MedStar Health have released a new report detailing recommendations for improving EHR usability and safety throughout the software life cycle. It also identifies what can be considered rigorous strategy testing and how to create testing scenarios based on currently-understood EHR safety issues. The report also addresses the culture of safety along with EHR user training as ways to improve patient safety. Other topics covered include EHR design and development, EHR implementation, configuration and customization by end users, and EHR upgrades.

This is National Suicide Prevention Week and gives us the opportunity to reflect on the lives lost each year due to suicide. I think often of my medical school classmate, the high-school student I taught, and a family member we lost to suicide. Our local high school’s Harvard-bound valedictorian went missing after graduation and committed suicide. It really is everywhere, and it can be prevented. TMF Quality Innovation Network is hosting a webinar titled “Suicide Prevention Tips for Physicians, Clinical Staff and Their Patients,” to be held September 18 at noon CT. It features Christine Moutier, MD, CMO of the American Foundation for Suicide Prevention, along with Leah Patterson, a survivor. They will offer practical tips for clinicians to address suicide risk for patients, peers, and themselves.

Email Dr. Jayne.

Morning Headlines 9/13/18

With OneOncology, Flatiron and Cancer Docs Aim to Boost Community Care

General Atlantic invests $200 million in new cancer care company OneOncology, which aims to bring the latest in oncology care to patients in community settings using technology from Flatiron Health.

Cigna Announces Cigna Ventures with $250 Million to Fund Transformative Innovation and Growth for Health Care

Cigna invests $250 million in a new corporate venture fund that will target companies working in the areas of care delivery and management, digital health and retail, and insights and analytics.

Apple Watch Series 4 can detect falls, take ECGs, and lead you through breathing exercises

Apple introduces the fourth iteration of the Apple Watch, featuring fall detection and heart monitoring features that include the ability to record ECGs.