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May 12, 2016 News 1 Comment

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Theranos President and COO Sunny Balwani will retire, which Theranos says is part of a broader reorganization that involves creating three new positions – chief medical officer, head of research, and COO. The company has also added three board members, two of whom were already on the board until Theranos replaced them in a hasty October 2015 reaction to media coverage questioning its technology claims and a CMS investigation of its clinical practices.

Balwani was a technology executive with no medical or science experience when he was put in charge of the company’s California lab in 2009, which CMS later cited as posing “immediate jeopardy” to patients.

Reader Comments


From Frank Poggio: “Re: HHS challenge to design a simpler patient bill. This is the height of hypocrisy. Does CMS think providers on their own created the insane billing requirements and processes? It started with Medicare Part A, then B, then D. Co-payments, deductibles, out of network, referral approvals, contractual allowances, UC charges, and on and on. Next, billing systems will have to deal with VBP, P4P, bundled payments, MACRs, and more. Providers never asked or suggested any of these — they just have to figure out how to carve up charges /costs and services and put it all on a one-page bill. A 1995 analysis found that the Federal Register contains 11,000 pages dealing with an IRS 1040 submission, but hospital billing required 55,000 pages to describe. If CMS really wants to simplify the patient bill, they need to go to a single-payer system. Until they do that (not likely), the patient bill will continue to be the mess it has been for the last 50 years. Who do I call to collect my $5k?” I had the same reaction. Not only is billing too complicated for even providers and payers (much less patients) to understand, the bill is constantly amended over months as the parties involved negotiate who will pay what. It’s absurd to think that patients will assume financial responsibility when nobody can tell them what they owe at the time they owe it, not even accounting for the fact that bills are full of errors and questionable practices that patients aren’t equipped to analyze and report no matter how well presented the information might be. In comparison, IRS forms and tax policies are a consumer-friendly delight.

From Wonky Warrior: “Re: George Washington Medical. Appears to be switching back to Allscripts from Epic at six of their sites.” Unverified, although a recruiter’s email sent my way says that six recently acquired sites (four urgent care centers and two OB/GYN practices) were on different EHRs, they moved to Epic, and now they’re going back to Allscripts EMR, which is what the medical faculty plan uses. 


From Jenson: “Re: MD Anderson. Encore did indeed run the selection process. It’s a great business model – Encore runs the procurement, chooses the vendor that requires the most third-party integration support (Epic), and then gets nearly $50 million to support the Epic project. I would pick Epic every time.” The internal document is here. The same regent’s meeting agenda from late 2013 also included a nearly $5 million contract with Cognizant for ICD-10 implementation services.

From Pithy Patti: “Re: MACRA. HHS is out of touch if it expects providers to understand 962 pages of legislation.” Here’s an important point that a lot of self-proclaimed experts are missing: nobody expects providers to individually read and understand those 962 pages. We all follow a lot of laws and rules that are mired in endless pages of legalese somewhere in the government, but that doesn’t mean we’re expected to read and interpret those documents on our own. The government’s job is to pass laws that pass legal muster and convey legislative intent, not to create breezy, easily digested summaries of what they mean so that laypeople can use the Congressional Record as their personal policy manual. That’s a job for non-government experts (consultants and associations, for example) who turn those dense documents into rules their constituencies can follow, just like they do for payment rules that providers follow. The Affordable Care Act had a couple of thousand pages that nobody read (including the politicians who voted for or against it), but it has spawned dozens of thousands of pages of regulations that spell out the specifics.


From Kellan Ashby: “Re: Siemens Healthineers video on YouTube. It’s been pulled. Siemens Embarrassedineers?” Fear not – someone reposted a copy of the corporate atrocity-filled video. Sing and air-guitar with me, “Oho, oho …” Just in case it accidentally gets removed from YouTube again, I’ve downloaded a copy.

HIStalk Announcements and Requests

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Ms. Mills from Texas says the electric circuit kits we provided in funding her DonorsChoose grant request have had a great impact on her fifth graders, who have gained confidence in progressing from the easy projects to those that required all the kit’s parts.

I had an appointment with a new doctor this week, having taken the first available slot (mid-May) when I made the appointment (early January). I was encouraged when the practice sent me a link to its Practice Fusion portal to provide basic information. I arrived 30 minutes early to complete the inevitable pile of paperwork, which was just as I expected (entering my name and date of birth maybe a dozen times on a clipboard full of forms for medical history, insurance, notice of privacy practices, release of information, and so on). I returned the forms and waited for 15 minutes before I was called to the desk, only to be told that the doctor was out sick for the day (which they didn’t mention when I checked in) and that I should have received a call the previous to reschedule (they had transposed the digits of my phone number). The next available appointment was three more weeks out. I’m not sure which worries me more, the inefficiency of the staff or the fact that they use a free EHR and lots of paper to run the practice. We’ll see how it turns out.

This Week on HIStalk Practice: St. Thomas East End Medical Center goes live on Greenway. ReGroup Therapy raises $1.8 million for virtual mental health consults. Pediatric Medical Associates makes the leap to electronic records. British researchers take the first steps in developing a diagnostic video game. Retailers rate their top challenges when it comes to jumping into healthcare. Healthix President and CEO Tom Check offers insight into the challenges of bringing physician practices into the HIE fold.


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

Acquisitions, Funding, Business, and Stock


Teladoc reports Q1 results: revenue up 63 percent, EPS –$0.40 vs. –$5.87, meeting revenue expectations but falling short on earnings. The company reported big increases in telemedicine visits and membership and touted high satisfaction rates, with President and CEO Jason Gorevic saying in the earnings call that telehealth has a higher barrier to entry than many people believe and that its competitors are stumbling in trying to achieve scale. The company spent an unbudgeted $1 million in legal expenses, including $700,000 in its fight with the Texas Medical Board, and will spend another $4 million in legal fees in the remainder of 2016. Teladoc expects to lose around $42 million in the fiscal year. TDOC shares are down 40 percent since their June 2015 IPO, valuing the company at $440 million.

The 14-year-old CEO of a company that sells first-aid vending machines claims he turned down a $30 million acquisition offer from an unnamed healthcare company. He started the company last year after winning a business plan contest in his high school’s entrepreneurship class. The Six Flags theme park has ordered 100 of the machines, which dispense kits of Band-Aids and other supplies for up to $20. One of the four revenue sources he offers is “selling opt-out data.” The machine also requires the purchaser to acknowledge a form that releases the organization that installs it from liability. I’m not sure I’m really buying the success story since the alleged acquisition offer and product sales are hearsay and since then he has raised his unsubstantiated asking price to $50 million, but I’ll try to suppress my cynicism that the world doesn’t really need a Redbox stuffed with overpriced Band-Aids.



Freeman Health System (MO) chooses the Empower patient portal from Influence Health.

British Columbia’s Interior Health Authority chooses FormFast for enterprise forms standardization and automation in its 22 facilities, integrating with Meditech.


Hospital for Special Surgery (NY) chooses Strata Decision’s StrataJazz for cost accounting and continuous improvement.



The NIH names Patti Brennan, RN, PhD (University of Wisconsin – Madison) as director of the National Library of Medicine.


Lee Horner (CareCloud) is named president of telemedicine at remote interpretation services vendor Stratus Video.

Announcements and Implementations


Health Catalyst eliminates its non-compete agreements, no longer restricting for whom employees can work after leaving the company.

ZocDoc will integrate its appointment-finding and patient self-scheduling marketplace with Epic using APIs.


Sunquest announces GA of Laboratory v8.0.

Government and Politics


CMS, responding to small medical practice concerns about MACRA, publishes a fact sheet and reminds that it will accept comments about the proposed legislation through June 27. I’m not sure that “flexibilities” is an actual word (sort of like “implementations”), but it does seem that CMS is listening and they (along with ONC) have been pretty good about soliciting and using stakeholder feedback.

A federal judge rules that the US government can’t subsidize the cost of health insurance for lower-income Americans by reimbursing insurance companies for income-based premium reduction, saying that the administration overstepped its bounds since Congress did not approve that expense. Insurers were reimbursed for more than half of the exchange-issued policies, and if appeals fail and the payments are stopped, insurance companies will be stuck with paying several billion dollars per year themselves, giving them strong incentive to stop selling policies on the exchanges. It’s a complex issue that is beyond my understanding, but Tim Jost at Health Affairs provides expert opinion.

Privacy and Security

Allen Hospital (IA) notifies 1,600 patients that their information was accessed by a former employee whose EHR login credentials had not been deactivated despite having apparently left the organization seven years ago.


Ponemon Institutes’s annual healthcare privacy and security study, sponsored by ID Experts, finds that 90 percent of the 91 covered entities have had a breach in the past two years, although most involved fewer than 500 records. It calculates the cost of a provider breach as $2.2 million. Half of the reported breaches involved criminal activity, with an additional 13 percent caused by a malicious insider. Providers continue to worry most about careless employees, but a significant number also worry about cyberattacks and the use of unsecured mobile devices. One-third of providers say they’ve bought cybersecurity insurance.



@drnic1 tweeted about Luxe, an Uber-like service that will meet you wherever you are, park your car securely, and return it to wherever you want for $5 per hour or a flat rate of around $15 per day (the price varies by city, but that includes both the parking car and the service). They’ll even wash your car or fill it up with gas for a bit extra. It’s available now in San Francisco, LA, Chicago, Seattle, Austin, and New York. That would be cool when you’re driving into the city for meeting, heading off to the airport, or attending an event that might charge $20 or more to park in an uncovered and unsecured lot. I would enjoy not only the cost savings, but the lack of stress and time required to find a spot and then hunt down the car afterward.



Doctors in England are told to review patients for whom they had prescribed statins after experts find a seven-year-old error in the QRISK calculator provided in the SystmOne EHR sold by UK-based TPP. QRISK is a short questionnaire that determines the disk of cardiovascular disease.

ProPublica notices from Web traffic to its 2013 Prescriber Checkup — a database that shows heavy opioid prescribers based on Medicare Part D data – that drug seekers are apparently using it to find doctors who are most likely to write them narcotics prescriptions.

Minnesota’s health department cites a nursing home operator for two deaths involving mistakes in transcribing medication orders, one involving a blood thinner transcribed to the wrong resident’s chart and the second due to a 10-fold morphine dose transcription error.


US Army Sgt. Elizabeth Marks, the combat medic who won four swimming events this week at the Invictus Games — for injured military personnel and veterans — and received her medals from the competition’s organizer Prince Harry asks him to instead take her medal to the medical team at England’s Papworth Hospital that saved her life from respiratory distress in 2014. The 25-year-old Arizona swimmer joined the Army at 17 and suffered a serious hip injury while deployed to Iraq in 2010 that left her with no sensation in her left leg.

The ratings agency of Gulfport, MS downgrades the city’s bonds issued on behalf of Memorial Hospital at Gulfport, noting a sharp decline in liquidity that the agency partially attributes to an increase in AR days following the hospital’s Cerner implementation.


This is a great graphic making the social media rounds, although like most graphics, it’s nearly impossible to determine the source.

A Washington Post reporter touring a hospital in North Korea with government handlers is ushered out for asking too many questions in the staged situations that tried to put the country in a positive light. She apparently insulted her hosts in noting ancient diagnostic equipment, staff who aren’t allowed to access the Internet, supposedly frequently used PCs for which nobody knew the password, and a photo op with a perfectly made up patient who strangely had no personal effects or chart in her room. I assume “The Interview” wasn’t available on the patient entertainment system.


Weird News Andy has Hollywood gold in mind with his script for “Snakes in the Ceiling,” inspired by the story of a live python falling from the ceiling at Tacoma General Hospital (WA). WNA wonders if the reptile subsisted on hospital food during its stay. A visitor brought the snake into the hospital a month ago in a cat carrier filled with stuffed animals (any one of those elements might suggest a need for mandatory psychiatric observation), then called the hospital to report that he had lost his slithery friend. The hospital, to its credit, called him back so he could take his wayward pet back home to do whatever it is that people do with pet reptiles in the privacy of their homes. I’ll stand by my long-held assertion that hospitals are the one place where you see a random and often disturbing cross-section of the citizenry that you would ordinarily avoid.

Sponsor Updates

  • Medicity CEO Nancy Ham is named one of the most powerful women in healthcare IT. Also named is Vyne President and CEO Lindy Benton.
  • Bernoulli will present a poster on alarm reduction during the 18th Annual NPSF Patient Safety Congress, May 23-26 in Scottsdale, AZ.
  • ID Experts sponsors the Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data.
  • Influence Health announces the 2016 eHealth Excellence Award Winners.
  • Orion Health announces that its software manages 102 million patient health records globally.
  • AdvancedMD launches patient-centric solutions for independent OB/GYN practices with a limited-time promotion at the ACOG conference.
  • GetWellNetwork will host its user conference May 23-25 in Philadelphia.
  • InterSystems will exhibit at VA Healthcare 2016 May 16-18 in Arlington, VA.
  • Early bird registration for Health Catalyst’s September 6-8 HAS16 ends May 27. 
  • Nordic releases a white paper titled “Value-based care: How’d we get here and how do we go forward?”
  • LifeImage and National Decision Support Co. will exhibit at ACR 2016 May 16-17 in Washington, DC.
  • LiveProcess will exhibit at the 2016 Virginia Public Health & Healthcare Preparedness Academy May 17-18 in Portsmouth, VA.
  • Bernoulli will exhibit at the at the Association for the Advancement of Medical Instrumentation (AAMI) 2016 Conference & Expo, June 3-6 in Tampa, FL.
  • MedData will exhibit at the ASCA Annual Meeting May 19-21 in Grapevine, TX.
  • Obix Perinatal Data System will exhibit at the CSO HIMSS Spring Conference May 20 in Dublin, OH.
  • Direct Consulting Associates will exhibit at the Central & Southern Ohio Spring HIMSS Conference May 20 in Dublin.
  • Divurgent will exhibit at the 2016 Texas Regional HIMSS Conference May 12-13 in Houston.
  • ECG Management Consultants will co-host the first annual Behavioral Health Business Summit May 12-13 in Chicago.
  • EClinicalWorks will exhibit at the American Telemedicine Annual Meeting and Trade Show May 14-17 in Minneapolis.
  • Hayes Management Consulting will exhibit at CHUG and GE Centricity Live 2016 May 17-20 in Phoenix.
  • HCS will exhibit at the HealthTech Conference 2016 May 19 in Newark, NJ.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there is "1 comment" on this Article:

  1. Folks, let’s not forget the Siemens Healthineers rebranding debacle when it comes time for HISsies nominations – “Stupidest Vendor Action Taken” or “Industry Figure in Whose Face You’d Most Like to Throw a Pie” (for Joe Kaeser?)

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Reader Comments

  • MiroslavB: Great insights - Thanks Ed !...
  • SteveS: I’d like to hear more from Ed about his perspective on the current state of “Professional Organizations” – in te...
  • Brian Too: Nice to hear from a small hospital for a change. We hear lots from the large players and consolidation has meant that b...
  • Sam Lawrence: Except in this case, coding = medical billing, not development. Though the same warning may be true...
  • BeenThere: Partners will find the savings from their cuts of coders as fools gold. There are a lot of hidden costs running an outs...
  • JC: If there is not there can be. VistA has a reference lab interface that can create the manifests/labeling and such as we...
  • Tom Cornwell: Great stuff from Dr. Jayne as usual. One small typo, last sentence of second-to-last paragraph: should be 'who's' not 'w...
  • HIT Observer: What I find most interesting here, is people defending their common practices rather than truly taking this as invaluabl...
  • Bob: There's no incentive for the provider to spend time doing a price comparison for the patient. Nor is it a good use of th...
  • Peppermint Patty: Veteran - can you clarify what was "fake "? Was something made up (definition of fake) or did you disagree with Vapo...

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