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Monday Morning Update 12/14/15

December 12, 2015 News 9 Comments

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Alphabet’s Verily – the just-renamed Google Life Sciences – launches Verb Surgical, which will develop surgical robots in conjunction with Johnson & Johnson.

Reader Comments


From Dickey Ascot: “Re: CareTech Solutions. COO Pat Milostan resigned last week. He follows the resignations of CFO Rob Johnson and Controller Dan Lincoln. Karl Graham, formerly in charge of its service desk, has been reassigned. Since the company was acquired by HCT Global Services of Chennai, india, six executives have resigned as its operation focus has been cost cutting and relocating customer services offshore.” Unverified. The company’s executive page still lists Milostan, Johnson, and Graham in the same roles, as do their individual LinkedIn profiles.

From Bill Duck: “Re: occupations. What would you have been if not a hospital IT person?” I wish I had the skill and personality to be a band manager like Shep Gordon, but since I don’t (and besides, I don’t tolerate prima donnas well), I would probably fall back on some solo endeavor that involves creativity, working mostly alone, a lack of convention, and not working for people or causes I don’t respect. My early days as a clinical analyst hit all of those except the last one, which was a partial match. Actually I guess I have that with HIStalk, which is maybe why I’ve stuck with it for so long. I would probably be a pretty good book editor, especially for non-fiction books.

From All R. Base: “Re: mHealth News. HIMSS Media is shutting it down in favor of recently acquired MobiHealthNews.” I don’t have a reaction since I don’t read either site. As far as I can tell, none of the folks involved have any healthcare or technology background, which is fine when they’re just rewording press releases to sound like expert reporting, but not so fine when they forget that they’re just watching the actual athletes perform as nacho-eating fans.


From Schmarbitration: “Re: arbitration clauses. There was a great series of articles several weeks ago in the NY Times diving into arbitration agreements. The main reason companies do this is to make class actions go away and that has been upheld in pretty much all courts. Sounds like Cerner did this in response to associates being classified as exempt. Epic did the same a few years ago, but with no carrot and a very large stick. People mock frivolous class action suits, but ultimately, they are one of the only tools to keep companies in line when a small amount of damage is spread over large numbers of people.” The article says big companies are eliminating their lawsuit risk by adding a one-sentence arbitration clause (so-called “get out of jail free” cards for corporations) to their agreements, with examples being cable companies, cell phone providers, and online stores. Their customers are unlikely to have the money to pursue arbitration individually rather than signing up with an existing class, so the company gets its way, just like the Wall Street-led credit card companies and retailers intended when they masterminded their protective loophole. A federal judge concludes, “Ominously, business has a good chance of opting out of the legal system altogether and misbehaving without reproach.” An example is Cerner’s Kansas City neighbor Sprint, which charged $20 roaming fees to customers who never left home, but pocketed the millions because each customer would have been required to hire an expert witness at up to $1 million just to get back their $20. The Supreme Court upheld arbitration clauses starting in 2011, led by Chief Justice John Roberts, who as a private attorney for Discover Bank had been involved in creating them in the first place.

HIStalk Announcements and Requests


It was just about a 70-30 poll respondent split as to whether their job is a significant part of their identity vs. just a way to pay the bills. Two percent said the most important part of their life is their employment. Furydelabongo would love to become a patient advocate but keeps working as a “disruptive innovator” after realizing that his/her employers in care delivery and healthcare IT don’t keep patient interests foremost. Mobile Man says his need to support the most important thing in his life – his family – has overemphasized his work as part of his self identity. Cassie admits that she associates the majority of her personal value with her work, but wishes she could stop and move into the “it just pays the bills” group.


New poll to your right or here: What is your reaction to Cerner employees becoming ineligible for future pay raises if they refuse to sign an arbitration agreement? Answer and then click the poll’s Comments link to explain, especially if your employer already has such an employment clause in effect. Tick, tock.


Ms. Catoire sent photos from her urban Virginia high school earth sciences class, for which we provided a Chromebook and printer supplies via her DonorsChoose grant request. Her school can’t earn accreditation because it lacks supplies for interactive and hands-on learning, with our donation allowing her to improve individual learning by supporting individual learning styles. She adds, “Just a few of the activities that I use in my class include having the students create animated presentations, movies, mock assessments, and virtual labs, all which have been made possible by your donation … it is because of your generosity that both the students and myself find the teaching and learning process to be so exciting and fulfilling.”

I was thinking about the ridiculous situation where a patient’s in-network hospital has all kinds of out-of-network people running around sending them bills their insurance doesn’t cover. Instead of those “not this one” markings surgeons make to ensure that they don’t amputate the wrong leg, patients need to write in Sharpie on their foreheads, “no out-of-network providers.” Or, perhaps bring their own single form (vs. the mountain of them the hospital requires them to sign) in which the hospital agrees to provide no out-of-network services without prior authorization. It’s pathetic that hospitals take no responsibility for using providers who bill separately without accepting the same insurance. It’s like paying for a pricey restaurant meal and later finding your credit hard hit for charges from the chef, florist, and exterminator.

The Meaningful Love Program


I hereby propose that the federal government turn over responsibility for managing the IRS’s “married filing jointly” tax break. Couples can expect these changes.

  • Couples who want to file jointly will be required to participate in the Meaningful Love program, in which they will document the quality of their relationship using  government-certified software called Electronic Marital Records (EMRs).
  • Conversations and other intimate encounters must be documented via a series of EMR checkboxes and predefined text strings as entered on ever-present computers positioned between them at all times, with the administrative burden estimated at eight distracted minutes of the average 12-minute encounter.
  • Heartfelt handwritten cards and murmuring phone calls will be eliminated in favor of email templates (CPOE, or Computerized Partner Outlook Entry) composed by choosing from a series of government-approved drop-down phrases to improve legibility and standardization.
  • Marital decision support will be used to provide evidence-based recommendations such as anniversary reminders, suggested behavioral changes based on menstrual cycle tracking, and time-since-last-sex alerts.
  • Each couple must maintain a marital problem list that they reconcile during each encounter.
  • EMR records must be sent electronically upon request to anyone with whom either partner might wish to arrange an outside dalliance or in the case of divorce where the new partner would benefit from having the old partner’s EMR data. This will improve the urgent “unconscious person in my bed – what do I do without a history?” scenario as long as all US couples participate despite a lack of incentive for doing so. Future program enhancements will provide the other partner a real-time alert when the tryst has been scheduled.
  • The amount of the tax break will be pro-rated based on mutual attestation that the relationship is loving, the surveyed satisfaction of both people, and their romantic performance as benchmarked against other couples.
  • The Eligible Pair (EP) must submit their EMR-generated marriage quality data to the appropriate state and federal agencies and for the benefit of unmarried researchers who are trying to understand how relationships work.

These requirements are being protested by the American Marital Association and the EMR vendor-sponsored social media campaign #LetLoversBeLovers, but in the mean time, couples who are unwilling to share their marital bed with Uncle Sam just to avoid a few dollars in penalties can opt out by filing individual tax returns.

Last Week’s Most Interesting News

  • Cerner tells employees to sign away their right to sue the company or else they will never be given pay increases.
  • Ascension Health buys almost half of Accretive Health and signs a 10-year revenue cycle agreement with the company.
  • UL acquires IT accreditor InfoGard, which certifies EHR and EPCS systems.
  • National Coordinator Karen DeSalvo, MD tells a group that public health receives only 3 percent of federal health expenditures vs. 97 percent paid to deliver medical services even though 80 percent of health doesn’t involve doctors and hospitals.


December 15 (Tuesday) 1:00 ET. “CPSI’s Takeover of Healthland.” Sponsored by HIStalk. Presenters: Frank Poggio, CEO, The Kelzon Group; Vince Ciotti, principal, H.I.S. Professionals. Frank and Vince are back with their brutally honest (and often humorous) opinions about the acquisition. They will review industry precedents (such as Cerner-Siemens), the possible fate of each Healthland product, the available alternatives, and steps Healthland customers should take now. Their previous webinar that covered Cerner’s takeover of Siemens has drawn nearly 7,000 views and this one promises to be equally informative and entertaining.

December 16 (Wednesday) 1:00 ET. “Need for Integrated Data Enhancement and Analytics – Unifying Management of Healthcare Business Processes.” Sponsored by CitiusTech. Presenters: Jeffrey Springer, VP of product management, CitiusTech; John Gonsalves, VP of healthcare provider market, CitiusTech. Providers are driving consumer-centric care with guided analytic solutions that answer specific questions, but each new tool adds complexity. It’s also important to tap real-time data from sources such as social platforms, mobile apps, and wearables to support delivery of personalized and proactive care. This webinar will discuss key use cases that drive patient outcomes, the need for consolidated analytics to realize value-based care, scenarios to maximize efficiency, and an overview of CitiusTech’s integrated healthcare data enhancement and analytics platform.

December 16 (Wednesday) 2:00 ET. “A Sepsis Solution: Reducing Mortality by 50 Percent Using Advanced Decision Support.” Sponsored by Wolters Kluwer Health. Presenters: Rick Corn, VP/CIO, Huntsville Hospital; Stephen Claypool, MD, medical director of the innovation lab, Wolters Kluwer Health. Sepsis claims 258,000 lives and costs $20 billion annually in the US, but early identification and treatment remains elusive, emphasizing the need for intelligent, prompt, and patient-specific clinical decision support. Huntsville Hospital reduced sepsis mortality by 53 percent and related readmissions by 30 percent using real-time surveillance of EHR data and evidence-based decision support to generate highly sensitive and specific alerts.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.



Kaleida Health (NY) chooses Ascend Software for accounts payable document imaging.



Baptist Memorial Healthcare (TN) adds CIO to responsibilities of Beverly Jordan, RN, its VP/chief clinical transformation officer.

Announcements and Implementations

Versus Technology announces a new Wi-Fi locating platform and asset tags.

Government and Politics


National Coordinator Karen DeSalvo, MD, MPH calls for health IT stakeholders to commit to providing consumer access, avoiding information blocking, and following standards to support her vision of a connected health system that includes an app store of FHIR-based consumer tools.

An essay in the Wall Street Journal says the Affordable Care Act is “neither the triumph trumpeted by its proponents nor the disaster suggested by its critics.” ACA’s positives include reducing the number of uninsured patients, its possible effect on slowing healthcare spending growth, the upcoming Cadillac tax that encourages employers to control low-value spending, and the creation of a more cost-conscious market than existed with employer-provided insurance. Its negatives are rising numbers of insured thanks to Medicaid expansion that is “more like welfare for the medical-industrial complex than support for the needy” and being promoted as budget-neutral when it isn’t. The article concludes, “Both sides also need to recognize that the changes in incentives necessary to bend the cost curve will be highly unwelcome to many Americans. Markets for health care are the perfect example of the old saying that ‘every dollar of waste is someone’s income.’”



Several high-profile Silicon Valley technology entrepreneurs, including Tesla’s Elon Musk, donate $1 billion to launch non-profit OpenAI, which will develop artificial intelligence technologies that benefit humanity without worrying about profit. They might be surprised to find that healthcare’s use of AI and other technologies always has profit first and foremost, with benefit to patients coincidental.

The Chicago Tribune observes EHR-caused doctor burnout, focusing on doctors turned into data entry clerks and patient visits that emphasize clicks and drop-downs rather than paying attention to what patients tell them.



Turing Pharmaceuticals CEO Martin Shkreli is getting the publicity exposure of his life and not just for raising Daraprim prices 5,000 percent and buying $2 million rap albums. Shares in the failing biotech company he bought a few weeks ago for $1.50 are now trading at $28 as investors express confidence that newly named CEO Shkreli will figure out a way to rape the system. Apparently he has – the company has exclusively licensed a drug not available in the US that is used to treat an uncommon parasitic disease. The drug sells for $50 per course of therapy and Shkreli says he’ll raise the price to the $60,000 to $100,000 range. About 300,000 people in the US have the disease, almost all of them Latin American immigrants who entered the country with it, and Shkreli estimates that 3,000 to 7,000 of them will need treatment each year. Even if the market doesn’t pan out, Shkreli has another path to quick profits – he is petitioning the FDA to grant him a fast-track research voucher that he can resell to another drug company for up to $350 million, which benefitted Shkreli’s previous drug company that sold one of the free FDA vouchers for $245 million. I admit that I would invest in his companies since his entire focus is on enriching himself and his investors without letting altruistic emotions interfere with his lust for profit.

A new Missouri law addresses the physician shortage by eliminating residency requirements, allowing newly graduated medical students to start practicing immediately. Medical associations don’t like the law, saying medical schools aren’t set up to prepare their graduates to start practice immediately, perhaps forgetting that residencies were neither mandatory or common for non-specialists outside of urban areas in the early 1980s. So far no new graduates have taken advantage of the change, however, probably realizing that it’s a career gamble that won’t pay off if other states don’t follow suit.

A former part-time employee of New York cardiologist Hussain Khawaja, MD sues him, claiming he fired her looking up her computerized hospital records to determine that she was pregnant. She says the doctor told her while recruiting for other positions that he doesn’t hire applicants with children.


New York’s tax department notifies 1,900 taxpayers who worked for Erie County Medical Center in 2012 that they owe the state money because miscoded hospital W2 forms gave them a pension deduction to which they weren’t entitled. The hospital found a bug in its payroll system and says it will pay the interest, fees, and penalties for those affected and will even provide up to $200 to those who hire a tax preparer to amend their 2012 tax forms.


Medical helicopters seem to crash a lot given their small numbers, with 78 deaths in the past decade. In a new example, a patient and three rescue personnel die when a SkyLife air ambulance goes down in fog and rain in California. I’ve known folks on hospital helicopter teams and it’s a funny business, with such high cost for so few deployments that ROI (other than for dramatic hospital photos) is tough to justify. I would guess in the vast majority of countries where healthcare is a service rather than a private industry the number of such helicopters is low. As was eloquently stated in “The Right Stuff” even though it wasn’t talking about insurance companies or taxpayer subsidies, “no bucks, no Buck Rogers.”


Magician Penn Jillette turns into a pitchman for Withings after using the company’s smart scale and blood pressure monitor to lose 120 pounds in switching to a plant-based diet.  He explains, “It’s just making it automatic and instant. It doesn’t allow a guy like me to spin information — something I’m normally very good at. A little tool, a little bit of a nudge, can make a huge difference.” Penn will be all set if Withings invents a scale to monitor his still-overweight obnoxiousness.

Sponsor Updates

  • TransUnion Healthcare identifies more than $1 billion in insurance payments for hospitals.
  • Versus joins the Cisco solution partner program.
  • Freakonomics author Stephen Dubner will keynote Zynx Health’s Care Guidance 2016 event May 23-26, 2016 in New Orleans.

Blog Posts


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

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Currently there are "9 comments" on this Article:

  1. If in fact COO Pat Milostan resigned last week and his resignations follows those of CFO Rob Johnson and Controller Dan Lincoln. and Karl Graham and at the same time their bio’s are still listed on the company’s website more than likely they received some form of severance package. If that is the case then they are technically still employed by the company until the severance package term expires. As part of the company’s purchase it might have been required that executives are required not to update public bio’s such as Linkedin of their status change for a period of time. This is done so customers and prospects do not become concerned.

  2. So just for the benefit of being employed you have to sign away any rights to possible future legal recourse if you are wronged/harmed by your employer?

    Ridiculous but part of for the course as the upper hand continues to shift to employers with no end in sight. All this will do is to further embolden companies to treat their employees lousy if necessary and let managers who are bad actors potentially run amok.

  3. Re: mHealth News

    This is an absolutely perfect analogy and an accurate appraisal of this “news” source (and most other HIMSS Media “news” sources as far as I can tell). From the quality of the articles that get churned out, I’ve always assumed they’re running a clickbait mill over there.

  4. Re: Arbitration clauses and other employment issues.

    IT employees seem too caught up in their individual plights to realize that they aren’t powerless in these types of negotiations. Just starting the process toward a union vote would be enough to start a dialog. Basic collective bargaining laws are in place to level the playing field so that employers can’t just arbitrarily alter terms of employment to their advantage – but the individualist nature of most tech shops means that these options are never used.

    Management at Epic, Cerner, and most of these established IT conglomerates are used to treating their employees as cogs in their profit wheels. With the egos involved at most of these companies, their first reactions would probably attempt to stomp on legally protected organization rights, with subsequent missteps only adding to their self-inflicted liability.

    You can sit back and complain about your lack of power in this employment relationship – or you can do something about it. Your choice.

  5. Re: Hospitals contracting with out-of-network providers. A few years back, I was employed in IT by a large well-known academic medical center. My husband (self-employed and covered under my health plan) took ill and was hospitalized for 4 days for a serious infection, requiring IV antibiotics. I was comforted by the fact that our CMIO, a faculty hospitalist, was the attending physician overseeing his care. Imagine our shock when the bills came and it turned out that the faculty hospitalist was considered “out of network” by our health plan! When I asked the physician about this, he was just as much in shock, as he delegated his administrative billing functions to the faculty practice manager, and she confirmed that although he was faculty, their group was not “in-network” for the employee health plan covering the full-time staff employed by the medical center. Go figure.

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Reader Comments

  • jp: I'm with you on the icebreakers and other "interacting for the sake of interacting" types of things....
  • AynRandWasDumb: Re: VA/Jackson - WOW http://apps.washingtonpost.com/g/documents/politics/ronny-jackson-summary-of-allegations/2922/...
  • Drivin' and Cryin': I witnessed a noted health IT leader do the same "tears after telling a story about how he didn't treat his wife well en...
  • Mr. HIStalk: I agree for a class, where an ongoing relationship is important -- you'll be spending time with the instructor and fello...
  • jp: On the whole conference thing and engaging the audience. If the purpose of a conference (or one of the main purposes) is...
  • MerryMe: Anyone besides me disturbed by the title of the Healthwise webinar listed? "Converting Consumers into Patients" -- Shoul...
  • Justa CIO: Wholeheartedly agree with System CIO's comment. I like him/her do not have time for HIMSS, CHIME, etc., as I am heads d...
  • shh bby is ok: I was taken by the tongue-in-cheek wit of your cartoon above Stealthily Healthily's comment. Then I clicked on it an...
  • Fourth Hansen Brother: My God, 60 is too old? Hint- rapidly aging population. He's not anywhere near retirement age, and CEO tenures are pretty...
  • Lisa Hahn, RN, Org Management/Clinical Strategist: I have seen a mixed bag of tricks for these situations. There is no specific singular “path” for for every organiza...

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