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September 4, 2014 News 4 Comments

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CVS Caremark changes its name to CVS Health as it also stops selling tobacco products in its 7,700 pharmacies. The company will take a $2 billion revenue hit in removing tobacco from its shelves, but the move obviously positions it more convincingly as a player in the general health market as it expands the number of its Minute Clinics from 900 to 1,500 in the next three years. CVS says it doesn’t plan to move Minute Clinic into full primary care as Walmart is doing, but will expand its chronic disease management services, which is not surprising given its recently announced care management relationships with several health systems and its transition to Epic.

Reader Comments


From Heathkit Assembler: “Re: Apple HealthKit. Here are the company’s specific developer requirements.” The “improving health” part might be just as easily skirted as HIPAA’s “treatment, payment, and operations” unless Apple defines it further.

From Just Nutz: “Re: Meaningful Use. Mr. H’s ‘Comatose’ was the perfect descriptor. CMS could have made 2015 more flexible. The 2014 period ends in 26 days, so people had already figured Stage 2 out if they were ever going to, and Stage 3 was pushed back but virtually no one cares about this today. The primary stressor for hospitals, the year-long reporting period that also starts October 1, was ignored despite thousands of comments urging CMS to address it as hospitals desperately try to get ready for 2015.” I’m glad Meaningful Use interest is finally fading. It was a necessary and ultra-expensive evil for getting poorly selling EMRs adopted, but it’s time to let the free market take back over and forget piecemeal provider bribes that often don’t provide the biggest bang for the patient outcomes buck.

From Nasty Parts: “Re: Explorys. I can confirm that they’re on the market. I hear GE, IBM, McKesson, and Medecision are the suitors.” Unverified.

From Beltway Bandido: “Re: DoD EHR. VistA is in the mix, being bid by DSS, PwC, and General Dynamics.” Dim-Sum told me they are pushing VistA, which has zero chance of getting anywhere for reasons that are surprisingly good.

HIStalk Announcements and Requests

This week on HIStalk Connect: Dr. Travis discusses Apple’s move into healthcare ahead of next week’s anticipated iWatch unveil. Qualcomm announces the 10 finalists in its $10 million Tricorder X-Prize competition. Ybrain closes a $3.5 million Series A to further development of a wearable device designed to help treat Alzheimer’s Disease. Three students from the University of Queensland in Australia win iAward’s Young Innovator of the Year award for a gamified mHealth app that helps children with cystic fibrosis. 

This week on HIStalk Practice: Healthpointe announces a new urgent care telemedicine service. Veterans in Rhode Island share their health data with the VA via the state HIE. President Obama holds Estonia in high esteem when it comes to sharing digital health data. University of Toledo Physicians selects athenahealth solutions. The VA announces mobile versions of its most popular HealtheVet portal applications. Fall conference season – from open source to the cloud – gets into full swing. Thanks for reading.

Note to desperately idea-starved writers trying to sound hip and topical by riding pop culture coattails: articles like “What healthcare can learn from the passing of [fill in ‘Robin Williams’ or ‘Joan Rivers’ or any other recently deceased celebrity’s name]” are about as lazy, pointless, and lame as their titles suggest.

Listening: Dutch progressive rockers Knight Area, which sounds a lot like early 1970s Genesis. They will release a new album in October.


September 11 (Thursday) 1:00 p.m. ET. Electronic Health Record Divorce Rates on the Rise — The Four Factors that Predict Long-term Success. Presented by The Breakaway Group, A Xerox Company. Presenters: Heather Haugen, PhD, CEO and managing director, The Breakaway Group, A Xerox Company; Bill Rieger, CIO, Flagler Hospital, St. Augustine, FL. Many users are considering divorcing their EHR as dissatisfaction increases. Many are spending 90 percent of their time and resources on the wedding  (the go-live) instead of the long-term commitment to new workflows, communication, education, and care outcomes (the marriage). Hear more about the findings of research published in “Beyond Implementation: A Prescription for Lasting EMR Adoption” about EHR adoption and success factors.  Registrants get a free electronic or paper copy of the book.

September 18 (Thursday) 1:00 p.m. ET.  DHMSM 101: The Hopes, Politics, and Players of the DoD’s $11 Billion EHR Project. Presented by HIStalk. Presenters: Dim-Sum, an anonymous expert in government healthcare IT, military veteran, and unwavering patriot; Mr. HIStalk. The Department of Defense’s selection of a commercially available EHR will drastically change the winning bidders, the health and welfare of service members all over the world, and possibly the entire healthcare IT industry. The presentation will include overview of the military health environment; the military’s history of using contractors to develop its systems vs. its new direction in buying an off-the-shelf system; its population health management challenges in caring for nearly 10 million patients all over the world, some of them on the battlefield; and a review of the big players that are bidding. This presentation will be geared toward a general audience and will be freely sprinkled with humor and wry cynicism developed in years of working in two often illogical industries that hate change.

Acquisitions, Funding, Business, and Stock


Best Doctors acquires Rise Health, which offers a population health management platform.  Rise Health’s CEO is Mark Crockett, MD (formerly of OptumInsight/Picis) and its president/COO is Connie Moser (with McKesson until a few months ago).


Clarity Health, which sells a referral management system, raises $1.89 million, increasing its total to $13 million.  

Pain treatment analytics platform vendor Axial Healthcare raises $1.75 million in a Series A round. Paul McCurry, MD, formerly of MedSolutions, founded the Nashville-based company in 2012.  

Google enters the pharma business with a drug company biotech partnership that will research age-related diseases at a cost of up to $1.5 billion.


Piedmont Healthcare (GA) selects Perceptive Software’s Acuo Vendor Neutral Archive.

Health Plan of San Mateo (CA) chooses Verisk Health’s payment accuracy suite.


Saline Memorial Hospital (AR) chooses Allscripts Sunrise. What a great hospital name – if it were located in Normal, IL it could be called Normal Saline.


Singing River Health System (MS) chooses Strata Decision’s StrataJazz decision support and cost accounting.



Nancy Brown (McKesson) joins Oak HC/FT as a venture partner.

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As expected, the White House names Megan Smith (Google) as CTO, replacing Todd Park. Former Twitter lawyer Alexander Macgillivray is named as deputy CTO.

Announcements and Implementations

Elsevier will market Tonic Health’s patient data collection platform.

Flint Rehabilitation Devices launches MusicGlove, a Guiter Hero-type game that helps stroke and muscular injury patients regain hand function through music-paced repetitive exercise games.

MedAptus launches Provider Enrollment in partnership with Newport Credentialing Services.

Government and Politics

Former Senators Trent Lott and John Breaux sign on as lobbyists trying to convince the federal government to cancel plans to impose sanctions on a state-owned Russian bank in protest of that country’s activities in the Ukraine. As Lenin said, “We will hang the capitalists with the rope they sell to us.” The healthcare connection: the political guns-for-hire formed the Alliance for Connected Care to twist political arms on behalf of telehealth-invested companies such as CVS, Teladoc, and WellPoint.


Oregon and Oracle are suing each other over the Cover Oregon health insurance exchange, but even though the state is moving to Healthcare.gov for Medicare it will still need Oracle’s help to get its Medicaid part running. The snag: Oracle won’t give the state access to its servers or set up a new production environment. A consultant’s report says if Oracle doesn’t come to the table by Friday (September 5), the site won’t be ready for the next open enrollment period that starts in November.


HHS announces that a hacker breached a test server of Healthcare.gov in July and installed malware. Apparently it wasn’t a targeted attack, just the usual hack bot cruising, which HIStalk’s server defenses have blocked exactly 1,000 times today (as broken out by the graphic above) which means nearly every site on the Internet, including Healthcare.gov, is getting pounded even though they contain nothing of value. It’s unbelievable that any site can keep running given the endless creativity and resources hackers are willing to waste to penetrate pointlessly.


Coming soon to an already economy-devastating US healthcare system: cancer drugs that cost $150,000 or more per patient per year and are required for the rest of a patient’s life.

The city council of Berkeley, CA approves a “charity cannabis mandate” that requires medical marijuana dispensaries donate at least 2 percent of their product to low-income residents, with the mayor arguing that marijuana is a medicine and everybody should have access to it. The response from the California Narcotic Officers’ Association: “Instead of taking steps to help the most economically vulnerable residents get out of that state, the city has said, ‘Let’s just get everybody high.’”

Someone tweeted that “assumptions are imperfect substitutes for data.” I might agree, but with several caveats:

  • Data are never perfect, complete, and free from bias, so there’s always a leap of faith even when data (including the “big” kind) are available.
  • You can lose your advantage (competitive or clinical) while waiting on the perfect set of data.
  • It’s hard to distinguish causation from correlation, subjecting any given data set to imperfection. As our hospital pathologist helpfully told me early in my career when I reviewed a patient’s chart for a committee, “He died with it, not of it.”
  • Sometimes intuition, experience, and people knowledge works better than data. The challenge is to determine which side of the fence a given situation falls on. Ideally, someone with that intuition, experience, and people knowledge is the one evaluating the data so you get the best of both worlds.
  • Healthcare straddles the fence above. Data analysis can provide new insight and help make treatment decisions, but only if wielded by expert clinician hands. You as a patient are just like other patients in not wanting to be managed by faceless payer or government algorithms cranked out from population health number-crunching that don’t take your own feelings, impressions, and beliefs into account. When it comes to the practice of medicine, art and science aren’t conveniently demarcated by a sharp line.
  • Bad decisions can (and often do) come from good data.


Weird News Andy calls this story from England “Meals on Wheels.” A new hospital uses a fleet of 12 robots to deliver patient meals, linens, instruments, and pharmacy items to the floors. Unrelated but interesting is the hospital’s response to patient complaints about small portion sizes, some of which found their way (with pictures) online: “We don’t know if it is a frail old man we are serving or a large rugby player so it’s up to each ward to know their patients and serve food accordingly.” WNA finds this a good story pairing: a company’s restaurant robot grinds beef and cooks it to order to create 360 burgers per hour, even slicing tomatoes and pickles simultaneously and placing the finished product in paper bags. The company’s co-founder says the machine isn’t intended to make fast food employees more efficient, but instead to eliminate them.

Sponsor Updates

  • NVoq announces the 2014 SayIt Healthcare Productivity ShowcaseFest, where 12 chosen healthcare professionals will work with the company’s SayIt speech recognition product to build and record a voice-optimized EMR Showcase. Nominations are due September 26.
  • GetWellNetwork Inpatient earns 2014 Edition Modular Inpatient EHR certification.
  • EDCO Health Information Solutions will host a session titled “An Unexpected Necessity – Indexing Software” at the AHIMA conference in San Diego on September 28.
  • Impact Advisors publishes a blog post, “Meaningful Use Final Rule.”

EPtalk by Dr. Jayne


The Greenway Engage14 user group meeting kicked off today in Dallas. I’ve got a reporter embedded. Here are some of his preliminary thoughts.

“We are making our final descent into Dallas, where the temperature is 99 degrees and the local time is 8:04 p.m.” Maybe it is just me, but it felt like 324 degrees Kelvin when departing the airport. Greenway has chosen yet another Gaylord hotel, this time a short ($25 cab) jaunt from DFW. It is the official hotel of the Dallas Cowboys and there are some players milling around and mixing with the OB/GYNs. It is a huge complex. So far, no riots over MU2 have broken out. That being said, the gent next to me at the bar was here to cancel his contract — he was hoping to get to do so directly to Tee Green. He was upset about product performance and issues upgrading, describing 2014 as, “The year I will never recover from financially.”

I’ll be curious to see and hear some other opinions as the conference begins in earnest tomorrow. I remain skeptical of the premise that the annual way to educate and inform your best customers is to price gouge them at a hotel that is inconvenient at a time when most kids are just going back to school and many practices are becoming quite busy. For now, everyone is getting settled in for what should be a long weekend of wondering what happened to MU and where they go from here. Also, what happened to Vitera in all of this, their product wasn’t so bad …”

He plans to attend the opening night gala and snap some photos and get feedback from the trenches as the liquor flows. I perused the agenda to suggest some sessions for him. It seems they have ambitiously scheduled fitness classes on Friday and Saturday at 5:30 a.m. I noticed they left them off the schedule for Sunday morning, which is probably a good thing since their client event runs from 7 p.m. to 1 a.m. the night before. The agenda says the “Greenway team is famous for its dance moves,” so I’ll definitely be on the lookout for photographic evidence.

I don’t envy them with the updated Meaningful Use timeline being released the weekend prior. Attendees will expect Greenway staffers to be knowledgeable and ready to provide advice on their particular situations. I have to admit this is the first rule I’m not going to read in its entirety. Like Mr. H, I am kind of “over” MU and will wait for the CliffsNotes versions that I anticipate my vendors will send within a week or so.

I laughed as I went through my inbox. Right after the notification from CMS was this article from JAMA touting the benefits of “cognitively stimulating activities such as reading” as preventive against cognitive impairment. I think I’ll go for some 2048 instead.

As for my roving reporter’s comments about user group meetings in general, I’m sympathetic. Our primary vendor’s meeting continues to increase in cost, not only for the meeting itself, but for hotel and travel. We’ve had to cut back on the number of people we send and rotate attendees to make sure that everyone has the chance to go every few years. A couple of our staffers who really enjoy attending have gotten smart and submit a presentation every year in the hopes that they’ll be selected to speak and will get one of the coveted spots.


Thanks to Dr. Travis for turning me on to NomadList, which appeared in a tweet about 25 promising startups. NomadList quantifies the best cities to live in when you can work remotely, providing info on cost of living, Internet speed, and weather. I know a couple of consultants who have a minimal home base and travel all the time whether they’re client-facing or not. I once had an EHR conversion done by a guy who admitted he was processing my data from the beach in Thailand. Top US cities include San Juan, Las Vegas, Austin, Dallas, and Park City.

If you’re a digital nomad, what do you think? Email me.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

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Currently there are "4 comments" on this Article:

  1. Just Nutz is correct. The big miss in the Final Rule was not allowing a quarterly submission for 2015. However, Mr. HIStalk, I encourage you to separate Meaningful Use certified EHR technology (CEHRT) and Meaningful Use Clinical Quality Measures (CQM). No one’s interest is fading related to CQM. The inpatient quality reporting (IQR) system has been around for a long time and up to 2% of Medicare reimbursement is at risk related to reporting quality measures (Core Measures) through manual chart abstraction. CQM is slowly but surely replacing manually abstracted Core Measures. This trend will continue and eventually the dollars at risk associated with quality measures will move from Core Measure reporting to CQM reporting. I am confident that Director’s and VP’s of Quality are and will continue to be very focused on Meaningful Use CQMs.

  2. CQM’s are a complete disaster and responsible for some of the most horrific workflows being forced into EHRs to support measures that are still based on chart abstraction methodologies.

    Keith – it’s awful.

  3. Reluctant eCW User, I didn’t say CQMs were great, I just said they are here to stay and, because of changes to reimbursement, will be more important as time goes on.

    That said, look at the IQR alternative used today. I’ve sat with abstractors and their workflow is truly horrific and has been for years. While they have “electronic” medical records, they nonetheless have to dig through patient files that are in different systems, read scanned documents, and sometimes look at paper charts to find the information they are looking for. Then they have to enter that data manually into yet another system to submit it electronically to CMS and TJC. If nothing else, CQMs have exposed to others in the hospital the back office nightmare that abstractors live with every day.

  4. Dear Elsevier: it’s common practice to use a space between words in order to make it easier for your readers to understand what marketing-babble you are trying to sell. Thatisall.

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