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April 5, 2016 News 8 Comments

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A study of scripted standardized patient encounters performed by physicians of six virtual visit companies finds significant clinical variation. Remote physicians didn’t ask the right questions or didn’t perform the correct examination steps in 30 percent of visits and gave the wrong diagnosis or no diagnosis at all 23 percent of the time. They ordered urine cultures for only 34 percent of recurring urinary tract infection patients and failed to order the recommended X-rays for ankle pain 84 percent of the time. The authors conclude that while virtual visits may involve lower rates of inappropriate testing, remote physicians often don’t order even medically indicated tests, possibly because of the complexity involved in following up on test results from the patient’s home location or concerns about insurance coverage.

The authors also note that some of the companies performed better than others and suggested they share best practices. The virtual visit companies tested were Ameridoc, Amwell, Consult a Doctor, Doctor on Demand, MDAligne, MDLIVE, MeMD, and NowClinic.

While the virtual visits weren’t perfect, they were not compared to face-to-face visits. Those probably have a similar lack of conformance to best practices, but there’s no good way to send standardized (i.e., fake) patients into an exam room to serve as mystery shoppers.

Reader Comments



From PHE: “Re: Sandlot Solutions. Has ceased operations. They were down to a skeleton crew as of last week, looking for last-minute funding to maintain core operations, but I was told that the board had already voted to close down if nothing came through as of Friday. No evidence of ongoing operations this morning.” Unverified. However, the logo of Sandlot Solutions was recently removed from the banner of parent company Santa Rosa Holdings – it was there in a March 13, 2016 cached copy but is gone now.


From Luxardo: “Re: NYC Health + Hospitals going live on Epic. Reports say it went OK, but 900 Epic installers were on site at the two facilities whose combined census was 700. No wonder these installs cost a small fortune – that has to be at least $2 million per day to have a tech person standing next to each clinical person all day. The real test will be 30 days from now when all those installers have gone back to Wisconsin.”



From Concerned Customer: “Re: Vocera. Do you put in any stock into this?” SkyTides, which sells “deep due diligence” to hedge funds in “targeting over-hyped stocks and outright frauds,” calls Vocera and Chairman Robert Zollars “purveyors of fraud and obsolete, defective products.” It says Zollars previously ran two companies that paid $591 million to settle fraud charges (Neoforma alone paid $586 million, it says) and claims Vocera strong-armed customers into accepting early product shipments so that the resulting revenue could help the company hit forecasts. It says insiders have been aggressively selling their shares and that Vocera’s one product hasn’t had a major upgrade since 2011 and “appears to be inferior” even though it’s the most expensive. SkyTides accuses Vocera of committing accounting fraud in the three of 16 quarters it reported a profit, says the company has lost $110 million, and predicts that Vocera will have to cut prices to compete. Vocera shares had little reaction to the announcement and have risen 29 percent in the past year vs. the Dow’s decrease of nearly 2 percent. A federal judge gave initial approval a month ago for Vocera to pay $9 million to settle securities class action litigation that accused it of telling investors during its March 2012 IPO that the Affordable Care Act would boost its business, then admitting in May 2013 that ACA was actually hurting sales, sending shares down 37 percent. I’ll be interested to see if Vocera responds, although since it’s an analysis firm making the claims rather than a regulatory agency or litigant, they wouldn’t have much to gain and would instead call attention to the unflattering charges.

HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mr. Cho in providing 15 scientific calculators for his Bureau of Indian Affairs high school math classes in South Dakota, replacing the 99-cent models he was using. He reports, “These calculators have made it easier for us to do more in the 47 minutes I’m allotted each day per class. The students are now able to move into higher level math. We just started 4th quarter on Monday and your calculators have, over the past three months, allowed us to go into pre-calculus in my Algebra 2 class. My Algebra 1 students were able to use the calculators and fly through it and are now starting Algebra 2! We will continue to use these calculators weekly for many years.”

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Also checking in is M. Feeley from New York, whose pre-schoolers are experimenting with the light kits and games we provided.


April 8 (Friday) 1:00 ET. “Ransomware in Healthcare: Tactics, Techniques, and Response.” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Ransomware continues to be an effective attack against healthcare infrastructure, with the clear ability to disrupt operations and impact patient care. This webinar will provide an inside look at how attackers use ransomware; why it so effective; and recommendations for mitigation.

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

Acquisitions, Funding, Business, and Stock


Sunquest acquires GeneInsight, a genetic testing software firm created by Partners HealthCare (MA). Sunquest had previously invested in the company. which will operate as a wholly-owned subsidiary from its Boston office.


Cumberland Consulting Group acquires 50-consultant  Oleen Pinnacle Healthcare Consulting, expanding the company’s payer market capabilities.


Credentialing software vendors Symplr and Cactus Software merge.


Healthcare software vendor Ability Network acquires EHealth Data Solutions, which offers software for senior living providers. Minneapolis-based Ability, whose chairman and CEO is former McKesson President and CEO Mark Pulido, has made four other acquisitions in the past two years following a $550 million investment by Summit Partners.

Announcements and Implementations


St. Luke’s University Health Network (PA) goes live on Bernoulli’s medical device integration and connectivity in six of its hospitals as part of its Epic implementation.


NYC  Health + Hospitals goes live on Epic at its Elmhurst and Queens hospitals, reporting no major problems.

Massachusetts General Hospital and two other Partners HealthCare (MA) facilities go live on Epic, with 1,000 Epic employees participating in Boston.

ESD celebrates its 26th year in the consulting business, noting that its implementation team members worked 30,000 hours in March.


McKesson signs up 2,111 of its employees to the Gift of Live Bone Marrow Foundation’s donor registry.

Government and Politics


The Federal Trade Commission creates an online tool for developers of health-related software that asks questions about how their software works and then suggests specific federal laws and regulations (such as HIPAA and the FDA) that might apply to them.

Privacy and Security


The Associated Press reports that MedStar Health’s ransomware attack exploited known flaws in the Red Hat’s JBoss Application Server that date back to at least 2007. Red Hat and the federal government have for years urged JBoss users to apply patches that correct a common configuration error that allows external users to take control of the server. The article notes that MedStar may be fully exposed to lawsuits or sanctions if it (or its vendors) failed to apply the patch and therefore could be construed as not having exercised reasonable diligence in protecting its systems and data. MedStar criticized media coverage of its attack, saying the publicity will encourage copycat hackers.


Epic’s trade secrets lawsuit against India-based Tata Consultancy Services goes to trial in federal court.

A Wall Street Journal op-ed piece called “How Not to End Cancer in Our Lifetimes” says the White House’s proposed changes to patient consent policies may impede research. The author, dean of Weill Cornell Medicine, says proposed HHS regulations will limit the number of patients who consent to having their leftover medical samples de-identified and stored for future research. It would also require providers to obtain new specimens from each patient every 10 years and to manage their consent documents.

Hospital executives surveyed by The Advisory Board Company state their top concerns as minimizing clinical variation, retooling for population health management, meeting rising consumer expectations, developing patient engagement strategies, and controlling avoidable utilization.

Sponsor Updates

  • AirStrip will exhibit at the Health Evolution Summit April 13-15 in Dana Point, CA.
  • Besler Consulting will exhibit at the HFMA Hudson Valley Annual Institute 2016 April 7 in Tarrytown, NY.
  • Crossings Healthcare Solutions will attend the Cerner Southeast RUG April 20-22 in Charlotte, NC and the Great Lakes RUG May 31-June 2 in Chicago.
  • Crain’s Chicago Business names Burwood Group as one of the Best Places to Work for Women Under 35.
  • Caradigm will exhibit at the Care Coordination Institute April 7-9 in Greenville, SC.
  • Clockwise.MD will present at the 2016 Spring Healthcare Tour and Conference April 5-6 in Nashville, TN.
  • CompuGroup Medical will exhibit at G2 Lab Revolution April 7-8 in Phoenix, AZ. 
  • Direct Consulting Associates will exhibit at Health Connect Partners – Hospital & Healthcare IT Conference April 13-15 in Atlanta.
  • Divurgent will exhibit at the Health Information Technology Summit April 10-13 in Washington, DC.
  • EClinicalWorks will exhibit at the NCCHC Spring Conference on Correctional Health Care April 10-12 in Nashville, TN.
  • HCI Group CEO Ricky Caplin earns recognition from Consulting Magazine, KPMG, and the University of Florida Entrepreneurship & Innovation Center.
  • Healthgrades releases its 2016 Outstanding Patient Experience Award and 2016 Patient Safety Excellence Award recipients.
  • HealthMEDX will host its annual user group meeting April 12-14 in St. Louis.
  • Healthwise will exhibit at the Allscripts Central Region User Group April 13-15 in Minneapolis.

Blog Posts


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Currently there are "8 comments" on this Article:

  1. Hard to believe the numbers in today’s news – 1000 Epic people at Partners and 900 at HHC . That is more than 20% of the total company strength. Are these two hospitals exaggerating numbers or did they really bring those many people to East coast?

  2. I assume 900 + 1000 are not actual Epic employees but maybe they are contractors that the hospitals brought in for at the elbow support?

  3. More than likely they are outside contractors from a variety of consulting firms that were brought in for Go-Live Support. Epic Implementations for large scale systems, like Leigh Valley, will bring in 100’s of Go-Live Support specialists. This is very common and given the press and cost of these two particular Implementations, I am sure they over staffed them so that they could be “successful”.

  4. With 300 new inpatients during go-live, it is only three non-clinical staff per patient. One can be writing everything on paper (just in case), and the other two can be a back up for the first one. Amazing.

  5. Agree with the above comments about contract staffing. Additionally, the article on Partners specifically says that the ~1000 figure is “over the next few weeks,” so it’s not as if there are 1000 there at a single time. I suspect the same is true of HHC, but I could certainly be wrong.

  6. re: NY Health + Hospitals Go-Live

    Of course the real test will begin when the go-live support marches off home, but I have believe that having a 1:1 Go-Live Specialist to Clinician ratio is going to help these facilities once that support does evaporate. Better that than an aborted go live at 90 days – or worse, a platform that no one knows how to use.

  7. As a former epic implementer for several years who has friends currently installing for both of these projects, I promise you there are not 900 Epic implementers at NYC & 1000 Epic implementers at Partners. That would be an unsustainable approach that would severely shake up customer service for everyone else. The vast majority of people supporting are consultants, with some supplemental Epic help from technical service, implementation, and other roles. Most people get confused when they see consultants at go lives and think they are Epic staff. Absolutely not the case. Agreed with Cerner/Epic that these locations overstaffed to be “successful” but having more warm bodies around definitely doesn’t guarantee that things will be done well. Quality over quantity!

  8. Epic! Epic! Epic! Is Everybody Epic? I imagine it is difficult to publish each blog update without some reference to you know who…..

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  1. I share your concerns about a lot of similar projects, but I think this one's an outcomes comparison thing, not…

  2. "Ascension Via Christi sent several ICU nurses home after they raised concerns about inadequate staffing." Nice. That'll show em.

  3. Thank you for sharing the full HIStory file. What a great tribute to Mr. Ciotti. “Those who cannot remember the…

  4. "Epic will roll out a “patients like this one” type tool to its users in Indiana this summer. It will…

  5. I don't see Cerner winning employee satisfaction surveys. I can't see VHA pivoting to Epic. It's going to be some…

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