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Monday Morning Update 9/28/15

September 27, 2015 News 14 Comments

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A study in England finds that NHS-endorsed medical apps often implement security and privacy poorly, give users bad advice, and have no track record of improving outcomes. Nine of 10 dose calculators don’t check the information entered by users, 70 percent don’t state their formulas, and half of the developers didn’t respond to questions about how their systems performed their calculations. The authors of a BMC Medicine article recommend educating consumers about how to evaluate apps. They also urge developers to be more transparent by providing documentation covering their design and testing methods, privacy policies, and business model. All of that, they say, is better than government regulation of apps as medical devices. It concludes,

The potential for benefit remains vast and the degree of innovation is inspiring, but it turns out we are much earlier in the maturation phase of medical apps than many of us would like to have believe. To build the future we want, in which patients can trust their medical apps, we need to verify that they function as intended.

Reader Comments

From Huskydoc: “Re: Epic. For many years, I’ve been practicing in Epic-based organizations. I’m now in a system that doesn’t. I was anticipating some minor, primarily aesthetic differences in the functionality between Epic and my new EMR… actually looking forward to the experience. But I must say that I was stunned by the inadequacies of my new EMR – a recognized brand name EMR that’s not Cerner. And I’m talking simple stuff, people. I now understand that Epic’s competitors’ boasts of interoperability are really just cries for help.”

HIStalk Announcements and Requests


Only five percent of poll respondents view a company name change as a positive event, with more than 40 percent assuming that the company replaced its old name to distance it from past failures. Unrequited Marketer offered some great thoughts: (a) companies that have grown by acquisition often want their product lines to seem cohesive via consistent naming; (b) research has shown that there’s not much brand equity in B2B product names anyway; (c) many or most people keep using the old product name even after it’s been changed; and (d) he or she doesn’t know of any cases where a company changed a company or product name because of past failures and asks readers for examples. New poll to your right or here as the first in a series of polls I’ll call “Hero or Villain” – is Blue Cross Blue Shield a hero or villain? You can click the Comments link after voting to explain why you think so.


Dennis Lee donated $100 to my DonorsChoose project, which along with matching funds from my anonymous vendor executive and the NEA foundation bought 15 flash drives and six sets of headphones for Mrs. Winger’s fourth grade class in Seattle, WA and math learning tools (plan sets, Base 10 starter sets, and GeoBoards) for Ms. Fulford’s elementary school class in Santa Ana, CA. Meanwhile, it took only five days for Ms. Thomas’s Georgia elementary school class to receive their iPad and bean bag chair to create their Math Exploration Station, leading her to email to say, “It takes one moment to make an incredible impact on a child and you are responsible for this ‘one’ moment! I am so excited to see how this project will support my students in acquiring the independence needed to be successful! Your dedication to children and providing educational opportunities like this one is unmatched!”


Also checking in was Mrs. Wilson from Wisconsin, who sent photos of her students using the listening center we provided.

I’m just full of grammar and usage peeves being a “you kids get off my lawn” kind of curmudgeon in training, but here’s another one: people who spell “desert” when they mean “dessert.” It’s probably because the words are pronounced the same when “desert” is used as a verb, but that’s not a great excuse. If you ate desert, expect an undesirable consequence like sands through the hourglass. One more: the phrase “the Internet is buzzing” in a news story means two things: (a) they should give numbers to back up that conclusion; and (b) it’s probably not a real news story if its main attribute is that a large number of Facebook and YouTube zombies have mindlessly clicked on it.

A friend is taking care of a relative in hospice care, which involves three kinds of caregivers (nurse, aide, and social worker.) Each of them called to schedule their first visits with the usual over-explaining and chattiness that is well intentioned but a bit grating in a hospice situation. All three had the same conversation with my friend:

  • Caregiver: I’ll need turn-by-turn directions to get to your house. Can you give them to me now?
  • Friend: It’s quite a few miles with several turns. Can’t you use the GPS that came on your phone? I’m standing in line at Walmart buying medical items.
  • Caregiver: (without answering the GPS question) We need printed directions for the folder.
  • Friend: OK, then I’ll get on MapQuest myself, copy and paste the instructions from wherever you’ll be starting, and email them to you when I get back home.
  • Caregiver: Well, if you don’t have time to give me exact directions, I can figure it out.

It’s been years since someone asked me for directions to my house, and to be honest, I might be inclined not to hire them if they can’t figure out how to use free phone GPS apps instead of bugging every customer to spell out streets, distances, and turn directions that the free app would do much better (not to mention preventing them from crashing their car while trying to read and drive at the same time). The folks above make their living going to the homes of patients, so you would think they could fast-forward to the current decade where personal directions, AAA TripTiks, and gas station maps are all enjoying their much-deserved retirement.

Last Week’s Most Interesting News

  • The GAO says CMS seems to have prepared well for the ICD-10 switch, but cautions that all software projects carry risks that can’t be identified until after go-live.
  • Accenture acquires Epic-focused Sagacious Consultants.
  • Blue Cross Blue Shield announces its Axis claims and quality database, to which all 36 BCBS companies will submit data.
  • An IOM report on diagnosis recommends that ONC require health IT systems to support information flow across care settings.
  • The medical information of millions of people is found to be publicly available on Amazon Web Services, apparently from unsecured SQL backups stored there by claims management vendor Systema Software.
  • An updated report from Robert Wood Johnson Foundation finds that ONC made mistakes in managing its siloed grant programs and that EHR adoption digitized information only within “corporate islands” that were created by ever-expanding health systems as a way to improve their competitive position.


October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services.

Acquisitions, Funding, Business, and Stock


Medical image exchange platform vendor LifeImage receives a $5 million investment from the investment arm of BCBS Massachusetts, raising its total to $62 million.

Announcements and Implementations


WEDI (Workgroup for Electronic Data Interchange) and NATE (National Association for Trusted Exchange) will work together on the next phase of Virtual Clipboard, a mobile app that would speed up patient check-in by transferring their demographic, insurance, and clinical summary information to the provider’s system.

Government and Politics

Three Alaska healthcare providers sue a Xerox subsidiary for causing delayed payments from the state’s new Medicaid system, claiming that Xerox lied about the system’s readiness for its October 1, 2013 go-live.



We should all be grateful to hedge fund manager turned pharma bro Martin Shkreli of Turing Pharmaceuticals for exhibiting an astounding amount of greed, arrogance, and patient indifference by buying an old but vital single-source drug and jacking up its price by 5,000 percent. He’s a cartoonish bad boy who helped everybody finally realize how drug companies have been given capitalistic free rein in charging whatever they want while hiding the research costs they blame for their high prices, all while the pharma lobby successfully deleted planned price controls from the Affordable Care Act and US citizens pay dozens or hundreds of times the price the rest of the world enjoys as a result of our drug development subsidy. The soothing suits from the big drug companies have been coached to feign patient concern and a willingness to participate constructively in healthcare system dialog while Shkreli just told everyone unapologetically that he fully intends to make a lot of money and too bad if they didn’t like it. He’s exactly what we needed to bring the drug pricing issue to light in a way that even dim-witted citizens can get mad about. Healthcare is full of companies and people who try to make everybody forget that they’re in it for the cash and it’s refreshing for someone to finally say so, leaving the rest of us to decide what if anything we do about the system we built that allows it.

Eastern Iowa hospitals say a state-run database for locating available mental health beds isn’t useful because the psychiatric hospitals aren’t updating it with their available bed count.

Informatics and health policy expert Hardeep Singh, MD, MPH says common medical conditions such as UTI and CHF that are most often misdiagnosed, with the most common cause being the provider’s lack of time to conduct a thorough patient interview and then perform critical thinking. Doctors with a poor diagnostic track record are overconfident in failing to consult external resources. He shows modest hope for electronic diagnosis tools, saying they require complete patient data and doctors don’t use them for situations they think are routine. He says that nobody follows up on eight percent of abnormal lab tests, suggesting that electronic escalation could help and patients could take more responsibility in checking their own results on patient portals.

Sponsor Updates

  • Divurgent will host a cybersecurity dinner discussion during the AEHiX conference in Orlando on October 8, with guest speaker Sensato CEO John Gomez.
  • The SSI Group will exhibit at the 2015 SurgCenter Development Annual Conference September 27-28 in Clearwater Beach, FL.
  • Sunquest Information Systems is featured in a JAMA article on connecting healthcare data.
  • Nordic posts video highlights from its open house during Epic’s user group meeting. It was brilliant – they worked with a local brewery to create a custom beer, distributed it to 14 bars and restaurants, and donated $1 for every pint poured to The Road Home Program for veterans. I was trying to figure out ways to shamelessly steal their idea for the HIMSS conference. 
  • Surescripts will exhibit at the AAFP Family Medicine Experience October 1-3 in Denver.
  • TeleTracking’s annual users conference will feature a record number of health system presenters and innovative new products.
  • Valence Health will exhibit at the NASHCO Annual Conference 2015 September 27-29 in Denver.
  • Verisk Health will host the VHC2015 client conference September 30-October 2 in Orlando.
  • VitalHealth Software will exhibit at Transform, hosted by the Mayo Clinic Center for Innovation, September 30-October 2 in Rochester, MN.
  • Huron Consulting will exhibit at the Rural Health Clinic and Critical Access Hospital Conferences September 29-30 in Kansas City, MO.
  • Wellsoft Corp. will exhibit at Emergency Nursing 2015 September 28-October 3 in Orlando.
  • Zynx Health will exhibit at the Meditech on the Road Event September 30 in Toronto.
  • XG Health Solutions Chairman Glenn D. Steele Jr. takes part in the opening of Geisinger’s new laboratory medicine building.

Blog Posts


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

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Currently there are "14 comments" on this Article:

  1. One clarifying point about the context of my comment highlighted above…. It was in response to a post that was lamenting the fact that Epic was frequently chosen despite not winning the demo portion of an enterprise selection process. My point was that I actually couldn’t imagine a scenario where my new EMR would win a demo bake-off against Epic. Whether the superior usability justifies a premium price tag is a separate question.

  2. HuskyDoc’s sentiments echo what I’ve heard from my physician friends who worked with a variety of EMRs through the course of their residencies, fellowships and eventual placements. All of them found Epic to be superior, which is not to say they loved it or even liked it much, only that they preferred it over the other options out there.

  3. Why doesn’t government find five good ways to improve government in this country and leave EHRs alone!

    Also, Huskydoc and ThatGuy – thank you for speaking some basic truths. This notion that Epic is the worst EHR and only sustains because it holds over half the nations healthcare and almost all the nations Academic Medical Centers hostage is just silly. Epic lives its life under an intense microscope with some of the nations best and smartest doctors able to speak their mind at a moments notice. That’s got to be hard work!

  4. Martin Shkreli embodies short-term thinking. He will make a ton of money, but his pathetic character and lacking integrity are what we will all remember when it is said and done. I hope he enjoys his exotic car, because sadly driving it is the only fulfillment he will find in life.

  5. HuskyDoc’s comments are interesting, but would be more so with some clear statement of the specific issues encountered.

  6. I’ve heard good and bad experiences with Epic and chalk it up to the relatively poor state of virtually all EHRs in the market. Also important to note that sometimes it is not just an issue with the software itself but more the way it was configured and deployed at a specific site.

  7. In response to Huskydoc, I agree about true interoperability however I have been a Meditech user or IT person for about 20 years and finally got to work on Epic. My 2nd job/clinical job installed it earlier in the year, coming off a disparate-feeling Siemens & MedHost. I was very excited for the install after hearing about Epic forever. Totally underwhelmed. Does not seem worth the price at all from the standpoint of ER & imaging. I cannot rule out whether the hospital made poor choices & decisions. The consultants were definitely a waste of money also as far as user training went. As an IT person, I have many outstanding questions.

  8. Husky Doc – The question becomes then when was that system you are using now installed, what version is it, and how active has your hospital been in terms of adjusting and maximizing functionality. EHR systems do not show up fully ready to use like business office software. For example the difference between the difference between Cerner Community works and Cerner Millennium installed by a hospital with a large IT/Informatic staff dedicated to full optimization relative to that hospital’s work flow is night and day.

  9. He’s a cartoonish bad boy who helped everybody finally realize how drug companies have been given capitalistic free rein in charging whatever they want

    From what I’ve read, the real issue is a lack of competition for these drug manufacturers. The drugs themselves are generic, so there should be at least a chance for robust competition. But the FDA has to approve all new manufacturers of generic drugs. They currently have a backlog of 4,000 applications and it takes about 27 months for each new generic to be approved. Given that people are always motivated by greed, I think the real issue is that we have a scelerotic regulating agency that can’t move fast enough to enable competition to hold the greed in check.

    Maybe we should allow patients to buy an generic that’s already approved for sale in Europe. That would apparently give us access to much, much cheaper sources of Daraprim, leaving Martin Shkreli high and dry.

  10. “Healthcare is full of companies and people who try to make everybody forget that they’re in it for the cash and it’s refreshing for someone to finally say so, leaving the rest of us to decide what if anything we do about the system we built that allows it.” AMEN BROTHER!

  11. I would like to wholeheartedly endorse View from the trenches view… I firmly believe that an organization’s success with its EMR has more to do with the quality of their clinical IT team and informaticists than it does with the software itself.

    Regarding the specific pain points I was referring to: My point was not to start a debate about the flaws of specific EMRs… they all have them. I did specify that I’m not on Cerner only because I have a particular distaste for C vs. E debates, and didn’t want to start one.

    CeliaFate – can’t comment on ED or RIS. That’s not my area; I’m an outpatient user.

  12. Re Martin Shkreli.

    Anyone saying they’re not in any role they play in healthcare for the money can donate their pay checks.

    Of course it’s all for the money. What? You thought this was about patient safety and outcomes? It’s about the mula baby. The Feds, the payers, the providers , the vendors … wake up ya’ll

  13. Re Martin Shkreli

    Always amazes me that we (collectively) deride those that are telling the truth – dude wants to make serious bank and is doing it legally. We can act all offended if we want, but EVERY SINGLE ONE OF US is complicit in giving him the opportunity. And he’s just telling the truth. What do we want him to do, lie? Oh, we want him to be more like us.

    Same thing I always said about Tiger Woods – I’d like to think that given nearly limitless money, power, and fame, that I would be a better man than he was, but I can’t guarantee it. How could I? Never been in his shoes. Would I make different decisions than Mr. Shkreli in the same position? Dunno – would like to think so, but I can’t guarantee it.

    I would like to try the clothes on for size though.

    Let’s hear from all these folks that have walked away from a giant pile of money.


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Reader Comments

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  • My Two Cents: Re: I wish we could all just get along and put the patient at the center of what we do. Yep, I get more and more disc...
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