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Monday Morning Update 10/27/14

October 26, 2014 News 8 Comments

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From the Cerner earnings call:

  • Bookings hit an all-time Q3 high at $1.1 billion and backlog increased to $9.34 billion.
  • The company predicts that its margins will drop from around 25 percent to the low 20 percent range due to the Siemens acquisition, but expects them return to normal by 2017.
  • Cerner expects the Siemens acquisition to close on February 2, 2015.
  • Adjusted EPS was $0.42 per share. The company expects a post-Siemens earnings growth of 27 percent. I’m not much of a stock analyst, but that seems to indicate an EPS jump to around $0.53, and with 341 million shares out, that means the acquisition will add $38 million of profit per quarter or around $150 million per year, meaning the acquisition will pay for itself in no more than eight years. I expect it will be perhaps half that time given the opportunity to upsell and convert existing Siemens customers. Cerner would have to make as many mistakes as Siemens did to mess up this deal given the fire-sale price they paid.
  • The company says it is committed to “having the most open EMR.”
  • Cerner says best-of-breed registry suppliers aren’t getting value because they haven’t aggregated clinical and financial information across systems, leading some of them to look to Cerner’s offerings.
  • The company expects the DoD EHR selection to occur in the first half of 2015 and the contract to be signed in the second half.
  • Cerner observes that Siemens offers to the global market “relatively low-end solutions” that “played at a little bit of a lower end in terms of scalability,” giving the company a chance to put Millennium in place outside the US.
  • President Zane Burke suggests that non-Soarian legacy Siemens users (Invision, MedSeries4) have a three- to five-year horizon (“horizon” being related to “sunset.”)
  • CFO Marc Naughton explains the Soarian opportunity: “When you look at a Soarian client, their clinical solutions were not very broad. They were focused on EMR orders and a very core set of solutions. All of those clients are paying a third party — in many places a niche supplier — a fair amount of money for their ancillary solutions. One of the key rationales for this business, obviously, and the reason we want to retain that client base is, like for like, exchanging Millennium for Soarian. We have a lot of additional solutions we can sell onto that base.”
  • Zane Burke stated, “I don’t see Meaningful Use driving any buying behavior today.”
  • Burke says that population health could be bigger market than EHRs.

Reader Comments


From Tony M: “Re: Psychology Today article. Says EHRs are a farce.” A sleep medicine doctor writes a not very convincing anti-EHR piece that still manages to make a few good points. He wanders around in fretting (usually anecdotally) about health vs. healthcare, privacy breaches in healthcare and other industries, wasted physician time inputting EHR information, and lack of interoperability. Where he misfires is in failing to identify the real problem: EHRs drive billing (I assume he’s not against billing for his services) and therefore reflect the requirement of those who write the checks, not those who send the invoices. He takes a turn toward the bizarre in his concluding recommendation: give taxpayer money to public health schools to create non-profit EHR companies that will license EHRs from “civilized countries that have worked cheaply and effectively for decades.” Hopefully he is sincere about the “working cheaply” part since he would be doing just that in running an EHR that works in Denmark or Australia – unless he launches an all-cash practice, he’s not going to see a dime of revenue. It is nearly always the case that those complaining about the clinical intrusion of EHRs are confusing the symptom with the disease and the disease isn’t easily cured – the US healthcare system is a world-class, special-interests disaster and EHRs were designed to support it effectively. Doctors are smart but were unwisely obedient over the past few decades – they turned healthcare over to insurance companies, government, and profitable non-profit healthcare systems without a peep, but now misdirect their ire toward whatever’s sitting right in front of them rather than the far more complex hole they compliantly helped dig themselves into.

From Moderated: “Re: anti-EHR comments. I think we’ve heard enough of the same parroting anti-EHR crowd, both about THR and otherwise.” It’s actually a crowd of one. The same poster users a variety of phony names –  Not Tired of Suzy RN, Jenny Dimento MBA, Gopal Singh MD, Keith McItkin PhD, and several others. Sometimes I approve his or her comment if it adds value or is entertainingly strident, but often I delete it because I agree that the incessant “bring back paper charts” droning gets old.


From Country Coder: “Re: EHRs and Ebola. Everybody is glomming on with their uninsightful insights. Anything to get your name in the papers even if it’s not related — I’m calling it the Tori Spelling effect.” Tori Spelling has zero chance of getting Ebola, but that doesn’t stop her from turning a case of bronchitis into possible Ebola infection as she coincidentally shows up at Cedars-Sinai right before her new reality show premieres. The TV rags claimed “quarantine,” but she was really just put with other feverish, coughing patients until they decided to admit her for some reason, just in time for her to tweet out a dramatic message complete with photo. I would bet money she uttered the word “Ebola” enough times to make sure she wasn’t just sent home where the cameras aren’t. She pulled the same stunt a couple of weeks ago in falsely claiming she was pregnant in a teaser for the new show. I can never figure out how celebrities can “check themselves” into a hospital while everybody else who is really sick gets sent home because their insurance won’t pay for an admission.

HIStalk Announcements and Requests


The vast majority of poll respondents don’t think the names of Ebola patients should be publicly announced. New poll to your right or here: what is the weakest link in diagnosing Ebola in the ED based on travel history? (I say “travel history” specifically since unfortunately in the absence of such history, no immediate and accurate diagnostic method exists). Vote and then click the “Comments” link to pontificate further.


Welcome to new HIStalk Platinum Sponsor Healthgrades. The Denver-based company’s online provider database – searchable by disease, condition, or procedure – is used by a million people per day who are making trusted, informed decisions about their care in choosing the right provider, more than half of whom follow up by scheduling a physician appointment. The company just enhanced its free physician search to let consumers choose factors that are important to them, such as experience, the quality of the hospitals in which they practice, and patient satisfaction. It  also offers services to hospitals that include business intelligence, marketing, and clinical communication solutions that increase consumer and physician engagement and improve service quality and utilization. I interviewed President Jeff Surges a few weeks ago, who told me, “We’re going to be releasing a lot of data and analytics about our ratings in the fall and using very expressive ways to show how our methodologies can partner with quality and outcomes within a hospital.” Thanks to Healthgrades for supporting HIStalk.

I always cruise YouTube to research new sponsors and found this recently posted 15-second Healthgrades TV commercial.

Listening: new from Brooklyn-based The Budos Band, instrumental Afro-Soul that sounds like sweet, funky 1960s horns and wah-wah guitar without the vocals — think the opening theme from “Hawaii Five-0” or “The Horse” by the underappreciated Cliff Nobles – although it sometimes moves into psychedelic rock territory with molten guitar and a smoke-filled room backbeat. They’re on Daptone Records along with the equally magnificent and musically similar Sharon Jones and the Dap-Kings. I’ll also be listening to Cream (and possibly West, Bruce & Laing and Manfred Mann) in noting the death of bassist Jack Bruce at 71 on Saturday.

Last Week’s Most Interesting News

  • ONC loses its two highest-ranking officials as HHS transfers National Coordinator Karen DeSalvo, MD to acting assistant secretary for health and Deputy National Coordinator Jacob Reider, MD announces his resignation. COO Lisa Lewis, whose non-medical, non-technical background is federal government administration, is named acting national coordinator.
  • HIMSS moves its 2019 convention from Chicago to Orlando after a squabble triggered by a guarantee given to RSNA that it gets the lowest available Chicago hotel room rates.
  • Details of the treatment given to Ebola patient Thomas Duncan by the ED of Texas Health Presbyterian Hospital Dallas show several inconsistencies with earlier reports, with contributions to the missed diagnosis including that a nurse’s failed to follow policy in telling the ED doctor about the patient’s travel to Africa, the doctor missed the nurse’s travel note in a nearly empty Epic patient record, and the patient provided conflicting history and symptoms.
  • HHS announces the four-year, $840 million “Transforming Clinical Practice Initiative” incentive grant program to move providers to value-based, patient-centered, coordinated health services, with health IT playing a key role.
  • The move away from document-based EHR information exchange to API-driven interoperability starting with Meaningful Use Stage 3 gains momentum as ONC and industry groups announced support for the change.
  • A survey of 14,000 RNs finds widespread dissatisfaction with EHRs and the IT departments that help choose and support those systems.


November 5 (Wednesday) 1:00 ET. Keeping it Clean: How Data Profiling Leads to Trusted Data. Sponsored by Encore, A Quintiles Company. Presenters: Lori Yackanicz, administrator of clinical informatics, Lehigh Valley Health Network; Randy L. Thomas, associate partner of performance analytics, Encore, A Quintiles Company; Joy Ales, MHA, BSN, RN, senior consultant, Encore, A Quintiles Company. Data dictionaries, organizational standards, and pick lists for data entry fields may describe the intent of a particular data field, but don’t guarantee that the data captured in the source system actually reflects that intent. Data profiling is the statistical analysis and assessment of the data values in source systems for consistency, uniqueness, and logic to ensure that the data landing in a data warehouse or analytic application is as expected. Attendees will learn which projects benefit from data profiling and the resources needed to accomplish it.

Imprivata put on an excellent webinar last week on electronic prescribing of controlled substances. We had a lot of engaged attendees, but if you weren’t able to participate, the  YouTube video contains the complete 49-minute webinar, including the Q&A. The presenters cover the DEA rule, which requires EMRs to be certified and providers to use two-factor authentication (along with other technical requirements). New Yorkers should be especially interested since the I-STOP act requires EPCS starting in March 2015. HIStalk webinar questions can be directed to Lorre.

Acquisitions, Funding, Business, and Stock


Small practice software vendor Kareo lands $15 million in funding, raising its total to $47 million.


Cambia Health Solutions, which has held a few health IT investments in its portfolio of companies, is creating a collaboration space that it hopes will draw healthcare startups and providers to Seattle to launch pilot projects. It won’t be an incubator or accelerator – which the company says are hard to implement in healthcare – but will “raise all the boats in the Puget Sound market around healthcare.”


A Reuters article says that Salesforce will make a big push into healthcare, hoping to create a $1 billion annual business despite the lack of success it and other technology companies have in similar attempts. The company’s healthcare head, whose background is as a drug company CIO, says they see a growth opportunity in care coordination, patient engagement, and analytics.

Government and Politics


The states of New Jersey and New York impose an involuntary 21-day quarantine on healthcare workers returning from West Africa via Kennedy and Newark Liberty International Airports, even those who are free of Ebola symptoms. The “just to be safe” actions in which spacesuit-wearing workers quarantine and burn everything touched by people guilty only of a history of travel aren’t exactly calming a media-frenzied populace that is much better at being illogically scared than at understanding science. “We are no longer relying on the CDC standards,” said New Jersey Governor Chris Christie, who along with New York Governor Andrew Cuomo made their decision without consulting New York City’s health department. The first person detained, a nurse returning from work for Doctors Without Borders, says Newark airport officials treated her rudely, barked questions at her, reacted happily in claiming she had a fever that she was later found not to have, and forced her into an unheated tent wearing paper scrubs (rudeness, incompetence, and lazy union indifference were my strongest memory of my one international arrival at that airport, so I’m not exactly shocked.) She’s tested negative twice for Ebola but New Jersey is still locking her up for the full 21 days. She says healthcare workers are being treated like “criminals and prisoners.”

Good luck containing the outbreak to Africa if US-based aid workers face detention in return for helping there. If possible exposure is reason enough to lock people away, are all the Bellevue doctors and nurses going to be be quarantined for three weeks? Farzad Mostashari says it best: “Politicians suck at making public health decisions, especially when the public has lost their mind.” I’ll say it again: fast identification of potential Ebola carriers will be impossible if and when it starts spreading within US borders and the travel history becomes worthless, so someone better come up with a fast, early diagnostic tool since we can’t lock up everybody up for three weeks just because they have a fever.


Update: in timely news, FDA just approved fast-tracked tests that can detect Ebola in one hour, which is a huge development with all of this hysterical Dark Ages quarantine nonsense. Salt Lake City-based BioFire Defense, a University of Utah spinoff, already won a $240 million defense department contract to turn its FilmArray product into a biological warfare detection system. It analyzes saliva or blood for genetic markers. The test has already earned FDA approval for respiratory and GI conditions. The instrument costs $39,500 and the tests are $129 each. Government comments suggest that the Ebola test may already be in use in Africa. I’m not clear from the product information if there’s a lag time between exposure and detection, which would be important in using it to detect pre-symptomatic infections.

Meanwhile, in New Jersey, New York, and everywhere else, use of the vaccine that protects against a far greater virulent killer – influenza – is optional (Governor Christie effectively vetoed a New Jersey bill earlier this year that would have required healthcare workers to get a flu shot, although he does urge everyone to get one). Contagious outbreaks can be contained only through herd immunity, meaning you need a critical mass of the overall population to be vaccinated to stop the spread and protect the unvaccinated. I got my flu shot yesterday – you’re welcome. Not making the headlines among the Ebola hype is that the first child of the 2014-2015 US flu season died the week of October 4; over 100 babies and up to 50,000 people overall died of influenza in the 2013-2014 season, although public health reporting tools have overlap between influenza and pneumonia that probably throws the count off.


HHS posts Karen DeSalvo’s bio page for her new job. I thought of another reason HHS might have moved her into the position. Her predecessor, Wanda Jones (who was also in the “acting” role) holds a public health doctorate but isn’t an MD — the Assistant Secretary for Health has always been a medical doctor, at least was in recent years. Another HHS problem: the US has had only an “acting” Surgeon General since mid-2013, when the NRA stalled the appointment of the President’s nominee, Vivek Murthy, MD, MBA because he has labeled guns as a public health problem. Acting Surgeon General Boris Lushniak, MD, MPH has kept a low profile during the Ebola scare, so perhaps HHS wanted to have an MD who is credible, visible, experienced in actually practicing medicine, and free of political baggage. Whether the selection reflects HHS’s placement of ONC in its food chain is up for speculation.


The family of a 12-year-old New Mexico student accused of shooting two of his classmates sues University of New Mexico Hospital after it told them that at least eight people inappropriately accessed his medical or mental health records.

Uber runs a one-day promotion called UberHEALTH in which customers in Boston, New York, and Washington DC could tap an app button to have a flu shot administered in their homes at no charge. The idea was suggested by a Harvard epidemiologist, who adds that “the model of delivering healthcare by car service could work to provide basic preventive care.”

A fascinating New York Times article profiles the decades-long work of psychologist Ellen Langer, whose experiments suggest that aging and the course of life-threatening diseases are influenced by how old the individual feels as triggered by their surroundings and the perceptions of others. In other words, to some extent you really are as old as you feel.

Partners HealthCare CEO Gary Gottlieb announces that he will resign with five years left on his contract to run the Partners in Health non-profit, just as his current employer faces unprecedented scrutiny of its expansion plans and its high pricing. He says he will take a pay cut from $2.6 million to $200,000 and will leave without a golden parachute.

Weird News Andy finds this story infectious, as scientists in China find a virus-killing penicillin in honeysuckle plants. WNA admits that he rarely sees bees and hummingbirds with the flu (although they possibly flew up the flue, he quips) but questions whether his employer will allow proof of honeysuckle tea consumption instead of a flu shot.


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

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Currently there are "8 comments" on this Article:

  1. I find Burke’s comments about population health being a bigger market than EHRs interesting. If reimbursements change, I’d like to agree with him, but I believe that’s several years if not decades off.

    The tricky part of population health is the reimbursement model and I don’t see ACOs being adopted fast enough or with the right financial model to really be viable.

  2. Farzad Mostashari…the public has “lost their mind” because the government and the CDC (health officials) have no idea on how to deal with Ebola. Furthermore, we’ve had a Dr. riding the subway, bowling and god knows what else…AND HE HAS EBOLA! So if a nurse is upset that she is quarantined, to bad.
    We know where the virus is coming from. Why we refuse to ban those traveling from a country that is a hot-bed for Ebola is mind-boggling. If we won’t ban them, why can’t we at least quarantine them until we know they’re are clear?
    I have talked to dozens about this and everyone thinks this is reasonable.
    Again those in Washington are out of touch with us ignorant subjects.

  3. RE: What is the weakest link in diagnosing Ebola in the ED based on travel history?

    Apparently healthcare providers have forgotten the days of the “GOMER” shuffle. The scenario for “patient zero” embarrassingly brings back an old practice in many places that used to be called “Emergency Rooms” where a highly non-contagious and asymptomatic malingerer was patted on the head and sent home. I believe this is as polite as I can be.

  4. Doctors seem to deserve as much blame for undesired industry developments as American software developers are to blame for H1-Bs; or maybe as much as banking tellers are to blame for the ATM.

  5. I wasn’t sure about how to react about Ebola, but. Mr Drummond has talked to dozens, and all of those dozens think it’s reasonable to quarantine people. Hard to argue with that.

    GO READ The Stand everyone!. 99.4% of us are screwed! I

    ‘m moving to Boulder!

  6. So “To Bad”, what would you do? Someone being quarantined for 21 days seems a small price to pay to keep people safe. The US doesn’t have the stones to do what is needed.

    And to be more specific, I’ve talked to co-workers family members, friends and strangers (white, black, Hispanic, rich, not so rich, democrat and republican)…all of us agreed. What am I missing here? This is so simple.

  7. What would I do?

    Well, I wouldn’t force people into a tent that looks like it was borrowed from the set of E.T., without allowing them to shower or wear their normal clothes, despite their complete lack of symptoms.

    I would bet a large sum that no one from the bowling alley or NYC subway will get Ebola from the doctor, nor anyone in the great state of Maine will get it from the nurse.

    Then, I would dedicate my winnings to support the aid effort in West Africa, and I would publicly recognize the people making contributions to resolving the actual problem. If this virus is really that infectious, then thousands of people would have been infected by now, and we should be doubtful about whether we can truly identify all of the people that we would need to quarantine in the first place.

    But that’s beside the point: People are not contagious with Ebola if they don’t have symptoms, nor if you don’t come into contact with their bodily fluids. If an isolation is really deemed medically necessary (by, perhaps, an infectious disease specialist), I would isolate them to home and assign someone at the CDC or a qualified nearby hospital to check in periodically to ensure no symptoms have come up. I wouldn’t treat everyone who has been in contact with Ebola patients like they belong in a 19th Century leper colony, and I wouldn’t disregard the mounds of scientific knowledge about how this kind of virus is transmitted.

    Meanwhile, I would investigate why there are nearly 2 million hospital acquired infections per year in the United States alone, leading to an estimated 100,000 deaths, and pay a little attention to these. I would ensure that we develop a long term plan for hospitals to have better identification, triage, and isolation methods – whether through technology or education and human protocols – so that potentially infectious patients can be cared for safely, and their caregivers are safe, and so that their infection is not spread to others. I would use Ebola as the fuel to feed the solution to this more serious long-term problem, and would continue to make advancements in this area long after this Ebola hysteria has ended.

  8. Does that mean everyone in Texas should have been quarantined; should still be quarantinued until the whole state proves there is no Ebola in Texas? The panic and ignorance is what will spread this disease.

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