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Monday Morning Update 2/1/16

January 31, 2016 News 9 Comments

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CMS proposes a rule that would allow qualified entities – of which 13 have been approved so far — to provide or sell Medicare and private claims data to providers to support quality improvement. Only two of the qualified entities report provider performance nationally — Health Care Cost Institute and Amino. Physician practices (or employers paying for their services) would be able to review all-payer data for their patients.

Reader Comments


From Eddie T. Head: “Re: CHIME’s patient identifier challenge. A 100 percent match is unrealistic. Even in countries with a national medical identifier the accuracy is about 95 percent. The 100 percent goal will get in the way of creating a real solution nationwide.”


From AthenaAscending: “Re: Florida Hospital. Is replacing Epic’s PM/EHR with Athenahealth.” Unverified.


From Unintended Consequences: “Re: AGH in Pittsburgh. Its Epic acute go-live has created medical care havoc in peripheral LTAC and SNF facilities that had relied on Allscripts Sunrise for order entry and results retrieval. They are not on Epic and have resorted to a 1980s paper requisition and lab retrieval system. Doctors cannot see a list of their patients. AGH’s command team has informed doctors that stat orders must be called in and cases ordered as consultations won’t appear on the consultant’s patient list.” Unverified. 

HIStalk Announcements and Requests


A reader asked me to post a single summary of my unsuccessful quest to obtain an electronic copy of my hospital stay information, which I’ve done here.


A surprising 80 percent of poll respondents aren’t fans of the idea of the ONC-published EHR star rating that Congress is considering. Jacob Reider commented that it’s a terrible idea and is outside of the government’s role. Ross Koppel says summarizing complex systems with a single star rating is simplistic. Barbara Hillock thinks such ratings would be misleading since they would be driven by the expectations of customers who don’t always follow the vendor’s implementation recommendations. Meltoots commented that ONC and CMS need to stop getting in the way of patient care with new programs.

New poll to your right or here: how have recent statements from CMS affected your perception of HHS/CMS/ONC?

Thanks to the following sponsors, new and renewing, that recently support HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.


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Mrs. Johnson from Illinois sent photos of her kindergarten class using the math tools we providing in funding her DonorsChoose grant request. She says, “It was so generous of you to help us succeed in getting some of the tools we need to make learning math engaging and fun! The look in these kids’ eyes when I tell them we have something new that will help us learn is motivation for me. I couldn’t have provided these materials on my own and appreciate the support you have given.”


Epic consulting firm BlueTree Network donated $1,000 to secure a spot at my CIO lunch at the HIMSS conference, which allowed me to fully fund these DonorsChoose teacher grant requests with the help of matching funds:

  • Science activity tubs for Mrs. B’s first grade class in Richfield, NC.
  • Three iPad Minis, cases, and a document camera for the second grade class of Mrs. Mann of West Newton, PA.
  • Electricity and magnetism activity tubs for Ms. Anderson’s fourth grade class in Phoenix, AZ.
  • Two Osmo gaming systems for Mrs. Boyd’s elementary school class in Chocowinity, NC.
  • Three programmable robots and engineering components for the new middle school robotics club started by Mr. Rector in Beebe, AR.
  • STEM challenge kits and for Mrs. May’s special education classes in Edgewater, FL.



I have received over 1,200 requests to attend HIStalkapalooza, so I’m closing signups Monday. Sign up now or never. I’ll be able to invite most of the people who signed up. We’ll be handling invitations, RSVPs, reminders, and electronic check-in through Eventbrite this time and I expect the invitation emails will go out this week. This is where the annoying part of throwing a free party begins as it does every year when I vow that this year’s event will be the last because of the time and energy it requires:

  • People will email me asking if they can bring a guest. If you didn’t sign up your guest like the form clearly states, then they can’t come – it’s like going to an Adele concert or traveling on American Airlines –everybody needs a ticket, with the only difference being that HIStalkapalooza tickets are free.
  • I’ll hear from folks who claim to be the most loyal and careful readers who swear they mysteriously missed the dozens of times I’ve provided signup instructions and wanted to be added after the fact. Sorry, no, it’s only a party and your life won’t be ruined if you miss it because you couldn’t follow the rules everybody else figured out.
  • Vendor administrative assistants who don’t read HIStalk and who signed up bunches of their executives (who rarely actually show up) will start bugging us about why they haven’t received invitations. That’s actually already happened as the admin of one company keeps asking why her 23 executives haven’t been invited yet. This isn’t a company outing and we have more important things to do than swap party-related emails, so I’m hitting “delete” on those.

Last Week’s Most Interesting News

  • CMS warns Theranos that its California lab practices are dangerous to patients and that it has 10 days to fix the problems or face suspension from Medicare.
  • Leidos announces that it will acquire the IT business of Lockheed Martin for $5 billion.
  • Cerner Chairman and CEO Neal Patterson notifies shareholders that he is being treated for soft tissue cancer.
  • A Texas hospital regains access to its EHR after being locked out for more than a week by ransomware.
  • Flint, MI-based Hurley Medical Center says it was hit by a cyberattack by hacker group Anonymous, which is protesting the city’s water crisis.
  • Big Bucks Equals Big Interest in CHIME’s National Patient ID Challenge.
  • McKesson’s Paragon Dilemma.


None scheduled soon. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


Capital BlueCross orders Theranos to stop performing blood draws in Capital’s storefront in Hampden Township, PA following a CMS investigation that found deficiencies in the California lab of Theranos that “pose immediate jeopardy to patient health and safety.”


Xerox will split itself into two companies, responding to pressure from activist investor Carl Icahn to separate its $11 billion document imaging business from its $7 billion business process outsourcing. Xerox, which acquired Affiliated Computer Services for $5.6 billion in 2010 and will now basically spin it back off, has 104,000 employees who will be part of the new BPO company. Xerox announced Q4 results with the announcement: revenue down 8 percent (its 15th consecutive quarter of declining sales), adjusted EPS $0.32 vs. $0.31, beating earnings expectations.


WeiserMazars acquires Lion & Company CPAs, which includes healthcare consulting among its offerings.


Quality Systems (NextGen) announces Q3 results: revenue down 1.7 percent, EPS $0.16 vs. $0.16, missing on revenue but beating on earnings. Shares dropped nearly 20 percent Friday on the news. Above is the one-year share price of QSII (blue, down 20.7 percent) vs. the Nasdaq (red, down 1.34 percent). Five-year performance looks a lot worse, as Quality Systems shares dropped 67 percent as the Nasdaq gained 67 percent.


The HCI Group acquires Houston-based Expert Technical Advisors.


Philadelphia-based orthopedic practice The Rothman Institute and the University of Virginia Health System participate in a $4 million funding round for Locus Health, a remote care management company of which both organizations are customers.


Meditech publishes its FY2015 annual report. Revenue was down 8 percent for the year (“primarily due to lower product bookings”) and net income dropped from $124 million to $70 million. Neil Pappalardo owns about $450 million worth of shares.  

Announcements and Implementations

Recondo Technology launches MySurePayHealth, which allows patients to estimate their out-of-pocket cost for a given procedure.


An emerging technology site profiles Valdic co-founder and CTO Drew Schiller as part of its “Today’s Entrepreneur” series, in which he lists his top three lessons learned:  (a) if someone isn’t interested in paying for your product, ask them what they would pay for; (b) reputations follow you, so treat everyone well; and (c) we are so fortunate to be living in an era where it is this easy to start a new company and iterate on ideas.

Government and Politics


Ashkan Soltani, senior advisor to White House CTO Megan Smith on loan from the Federal Trade Commission, announces that he has effectively been fired after just six weeks on the job when the Office of Personnel Security denies his security clearance. Soltani, whose White House assignment involved privacy, data ethics, and recruiting technologists for government service, previously won a Pulitzer prize as part of the Washington Post investigative team that revealed the extent to which the National Security Agency spies on American citizens.


This might be the highest-profile bungling of the HIMSS acronym. Pedantic grammarians such as myself smugly note that HIMSS and HIPAA are “acronyms” as opposed to “initialisms” (acronyms are sounded out as words, while initialisms are pronounced as their individual letters, as in “CIA” or “IBM”).

Privacy and Security


Scientific American’s “How Data Brokers Make Money Off Your Medical Records” contains no new information, but gives the public a glimpse at how companies are buying and selling their de-identified medical information. It mentions IMS Health, which takes in $2.6 billion per year by combining and repackaging information on 500 million people worldwide and then selling insights to drug companies and other to help them target sales. It repeats the now-obvious concept that it’s not hard to re-identify people by linking multiple databases. Drug company Pfizer spends $12 million per year to buy health data, but even its own analytics director says patients own their data, should be told how it’s being used, and should be given the ability to opt out of data that’s being collected for purely commercial purposes.


A Fast Company article describes the use of robots in long-term care, giving as an example Luvozo’s SAM “robotic concierge” that uses remote care staff. 



A good interview with WebMD’s dethroned founder Jeff Arnold, now CEO of Atlanta-based Sharecare, describes how the company uses individual results from its acquired RealAge health questionnaire to push content to users. Sharecare also offers personal health consultations via its AskMD app and publishes a voice-analyzing app to detect stress. On the downside, the company’s co-founder is the pseudo-medical huckster Dr. Oz.


Kaiser Health News describes the enthusiasm patients of Newport Orthopedic Institute are expressing for the empathetic, automated post-surgery daily emails they receive from the practice’s HealthLoop system. The article provides an example of a knee surgery patient who responded to a system-generated, emailed question about calf pain, which triggered his doctor to see him immediately and diagnosis his dangerous blood clot.



The Hurley Medical Center pediatrician who uncovered the human effects of the Flint, MI water crisis credits the hospital’s Epic system and EHRs in general for allowing her to quickly discover the increasing number of children with high levels of lead in their bloodstream. “If we did not have Epic, if we did not have (electronic medical records), if we were still on paper, it would have taken forever to get these results,” says Mona Hanna-Attisha, MD, MPH. She cross-referenced the abnormal blood levels to home addresses using geographic information system software to prove what was happening despite the denials of state officials. She is also adding an Epic flag to allow doctors to track those children for lead poisoning symptoms that can take years to emerge. Note once again the key involvement of a doctor trained in public health when discovering and responding to a regional crisis.


Chester County, PA commissioners proclaim January 29 as R. James Macaleer Day, honoring the recently deceased local charitable benefactor and founder of Shared Medical Systems on his birthday.


The US Army Reserve highlights the actions of three members of the 345th Combat Support Hospital of Jacksonville, FL who are deployed to Kosovo and who saved the life of a motorcycle accident victim while on leave in Greece. Those involved were Major David Whaley, who is a doctor of pharmacy; Colonel Edward Perez-Conde, brigade surgeon; and Major Kirk Shimamoto, a doctor of dental surgery. Perez-Conde says he considered using a pocketknife and ball point pen to relieve the victim’s pneumothorax, but, “we didn’t know how the police would react to a medical procedure using a pocketknife and we certainly didn’t want to go to jail.”


Flint-based McLaren Health Care (MI) will centralize its 13 billing and collections offices, saying it lags in standardizing its revenue cycle processes but hopes it can increase revenue by $30 million by reducing denials and increasing collections. The health system also says it is working on integrating Cerner’s EHR and patient billing systems.


An article describing how ad-supported publishers are “freaking out” over their readers using ad-blocking software provides an example in Modern Healthcare. The Interactive Advertising Bureau calls AdBlock Plus, which has been downloaded 500 million times, “unethical” and “immoral,” declining to note that publishers are producing content that few people are willing to pay for in any form, including by the viewing of ads.

A New Hampshire jury awards $32 million to a former Walmart pharmacist who claims she suffered gender discrimination in being wrongfully terminated for notifying the state’s board of pharmacy about the large number of errors the pharmacy was making, some of which the store manager inappropriately blamed on her. Mauren McPadden, who had worked for the company for 18 years, also says Walmart violated her HIPAA rights by accessing her PHI and telling co-workers that she had suffered a nervous breakdown. Walmart claims it fired her because she lost her pharmacy keys.

Sponsor Updates

  • T-System offers free tool to providers for documentation and diagnosis of influenza patients.
  • Valence Health will exhibit at the HFMA First Illinois Managed Care Meeting February 4 in Chicago.
  • Huron Consulting Group releases a new clinical research management briefing.
  • ZirMed will exhibit at the AAPAN Annual Forum February 1-2 in Laguna Niguel, CA.
  • Aprima launches its redesigned website. 
  • Caradigm completes the ConCert by HIMSS interoperability testing and certification program.
  • Sandlot Solutions will exhibit at the Louisiana Hospital Association’s Winter Leadership Symposium February 2-3 in Baton Rouge.
  • Surescripts will exhibit at the EHealth Initiative 2016 Annual Conference February 3-4 in Washington, DC.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there are "9 comments" on this Article:

  1. Well, in my opinion and I tend to be pretty bottom line being a one time programmer, I see CMS Slavitt right now as not much more than a “mad quant” on the loose with this latest effort. Granted, we know he wanted that job and Burwell having been Bob Rubin’s right hand assistant with getting Glass Steagall nullified during the Clinton administration, probably understands more of this than she may want to disclose. Maybe at HIMSS this year, a keynote departure from the usual could be like this “what it was like being chief of staff for Bob Rubin”:)

    Back on topic though we have already seen Otpum Labs which has been around for a while, a couple years I think, offer not much more than a rerun of the joint hips and knees study that Kaiser did even before that, so what’s the value of all this data, just to have it just in case? Optum just bought another PBM as well in the workman’s comp area too, so there’s money in distributing drugs to patients, no matter what perception folks come up with of pharmacy benefit managers.

    Companies “score” patients and actually don’t sell their data and get around HIPAA a lot as well. Sometimes you think you are getting a diagnosis and what you are really getting is a “risk assessment” and Silicon Valley ranks king at confusing public perception there as well. I don’t this Quant Slavitt at CMS holds a lot of water at this point as those United mentored models have been working their way around CMS for years, long before he ever got the job. Former CMS analysts could tell you the same thing they told me, called Untied if you are having problems with your model.

    This new CMS thing about “selling” data is just one more item to add to the data selling epidemic for profit in the US. Even outside of healthcare, you have Bloomberg who bought NetBox blue for behavioral analytics and the ability to sell the scored data. I still think Citi is using their install of IBMWatson to find those clients who won’t notice a few extra fees, as when they were caught by CFPB, there were no consumer complaints. Bloomberg has to replace revenue quickly as JPM and B of A are removing thousands of Bloomberg terminals that rent for $21k a year.


    I started calling CMS “Andy’s Algo Shop of Horrors” for a fun twist:) Selling patient data is all about making money and zero about better care.

  2. To be fair to Andy Slavitt

    a) Twitter doesnt allow do-overs and hasn’t got an inbuilt stupid acronym checker, and many of us suffer from making the odd typo on it (about 50% of my tweets have one!)
    b) HIMSS is a stupid acronym. No decent branding agency would let a new organization use a pointless double S
    c) HIMSS means “Healthcare Information and Management Systems Society” while AHIMA means “American Health Information Management Association”. Yes insiders know one is health tech and the other is coding and billing but just read those two and tell me that 98$ of educated non-specialists wouldn’t think they were exactly the same thing
    d) Andy Slavitt’s version “HIMMS” might be referring to the “Healthcare Information Management Marketing System” which while the name doesn’t exist is a much more accurate description of what HIMSS actually is!

  3. Hopefully in the process of making money, some good does occur. Steve Jobs created the smart phone and made a lot of money as did countless others, and we all benefitted as a result. There’s a lot to be learned from the data. So long as its de-identified, I think it’s great if smart people have a chance to uncover or create something of value.

  4. Re: Meditech annual report. Bottom was in Q12015. Quarterly product revenue has risen every quarter since then.

  5. Sadly, the doc in Flint MI had to reference Epic, probably because of behind the scenes pressure after such a hefty investment.

    But the bottom line is that any enterprise EHR would have been able to expose the rising lead levels as once data is in digital form, it is far easier, as the doc pointed out, to uncover these types of trends than we could ever do with paper.

    Which simply points to where the value is with digital health. Many gripe about where is the ROI from the massive investment in EHRs via HITECH. Well, this example in Flint is a poster child. There have been many more examples as well and countless more in the future. As an industry, we are very early into this journey but I remain optimistic.

    On a side note Tim, sad to see this massive proliferation of selling medical data to the highest bidder when folks like you and I are challenged by the system itself to give up these data to their rightful owner, the patient. And without true enforcement, with hefty penalties, nothing will change.

  6. RE: Kermit

    Below are MEDITECH’s revenue by quarter in 2015 to back up Kermit’s point that MEDITECH’s revenue bottomed out in Q1 2015, and has increased each quarter since.

    Q1 – $113,045,487
    Q2 – $117,135,917
    Q3 – $119,107,098
    Q4 – $126,237,079

  7. Interesting that in this same thread there are articles on both data selling to unlock value and the inability of a patient to get access to his own data to unlock its value. Not personally a big fan of data brokering, but what better solution is there right now to unearth the supposedly immense value locked away in the “walled gardens” we hear so much about?

  8. Defending Andy Slavitt under the guise of “fairness” is a bit of a stretch, IMO.

    Here’s why:
    1) As acting CMS Administrator, he has made the unfortunate decision to use a social media platform that, by design, trades the “message” for the “masses.” Simply using the platform to capture the attention of stakeholders is unprofessional and in bad taste.

    2) Those who need to know what changes are coming subscribe to CMS updates and don’t need Andy to tell us what to to expect in 140 characters. Especially while using hyperbolic language which ultimately weakens any point he might have otherwise have had (it also makes him look like a narcissist).

    3) There are most certainly do-overs in Twitter. While they can be retweeted, deleting a tweet after an impulsive gaffe is more likely to be forgiven, then say, making a false statement via Twitter and later clarifying it all on the CMS blog (recalll the now-infamous “MU as we know it” tweet).

    If none of his staff was quick enough to catch the error you mention–if indeed one was made–then he simply should have deleted it for lack of content anyway and reposted it corrected.

    4) To be fair to us, Andy Slavitt just needs to move on. Those of us saving lives for a living, or supporting those that do, can live without the grief of explaining away his misinformation, however well meaning it might be.

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  2. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

  3. Dr Jayne is noticing one of the more egregious but trivial instance of bad behavior by allegedly non-profit organizations. I…

  4. To expand on this a bit. The Vista data are unique to Vista, there are 16(?) different VISN (grouped systems)…

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