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June 14, 2016 News 5 Comments

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American Medical Association EVP/CEO James Madara, MD, speaking at the organization’s annual meeting, lashes out at “digital snake oil” of clinically unproven software and technology products that “impede care, confuse patients, and waste our time,” adding that “interoperability remains a dream.” He says doctors – who mistakenly failed to participate in early digital health projects – need to separate the lame digital tools from the potentially magnificent ones, explaining the present state of “digital dystopia” as:

Direct-to-consumer digital health devices—which only in the fine print say ‘for entertainment purposes only’—to our clunky electronic records, to ICUs that sound like primitive swamps abuzz with a cacophony of  bells, alarms, and whistles.

However, many of the solutions that Madara offers involve products from which AMA benefits – an incubator, an innovation studio, and lobbying efforts.


Meanwhile, John Halamka takes the counterpoint to the “digital snake oil” label, saying that more study rather than politician-like hyperbole is needed to understand that “we’ve achieved exactly the results we designed” in striving to simply replace paper charts with their electronic counterparts and to meet various government mandates. He provides examples in interoperability (e-prescribing, public health reporting, and lab reporting); population health (EHR patient panel queries); and consumer engagement (patient portals), all of which laid the foundation for the next generation of tools that will support team-based workflow, lifetime encounter records, care management workflow support, and family engagement tools. Halamka repeats the same advice he offered for Meaningful Use: focus on a small number of achievable outcomes.

Reader Comments

From Pomp and Circumstance: “Re: vendor press releases. Healthcare institutions are increasingly forbidding them to distribute press releases announcing new sales or contracts. This may distort the perception of success of companies that are compliant with the wishes of their customers.” It’s tough for a vendor to tout their successes when the client asks them not to, going beyond just not naming the client specifically, but prohibiting the sale from being mentioned at all. That practice prevents some much-need visibility into who’s buying what, but I agree that there’s no value to the new customer unless the sale can be crafted into a more self-serving announcement.

From Sticky Wicket: “Re: innovation award winners. You didn’t list those from the attached announcement.” I don’t consider press releases of these types worth mentioning since the average health system CIO would have minimal interest in companies whose enterprise readiness is years away at best even if they manage to avoid being among the 95 percent that will never be successful. Thus I’ve stopped running announcements of the following types, preferring to wait for actual customer success:

  • Company funding under $1 million.
  • New accelerators forming or companies joining an accelerator.
  • Tiny companies winning an app contest or submitting an innovative idea.
  • Startups offering a new consumer-facing health app whose outcomes have not been studied.

From Duluth: “Re: Navicure. Sold to Bain.” Unverified. I’ve reached out to the company for a response but haven’t heard back. UPDATE: Navicure confirms that it will receive an undisclosed strategic investment from Bain Capital Private Equity. Founder and CEO Jim Denny and the executive team will remain with the company.

From Gray Sky: “Re: [vendor name omitted]. Has had outages for the past two weeks for all hosted applications. Inside information points to a storage information where customer data has been erased. The company continues to investigate options to restore the data to a reasonable point in time.” Unverified. A company spokesperson responded quickly after hours and is trying to reach one of its executives for a response, so I offered to withhold the company’s name until my next post, which will also include any response the company provides.


From DOSsier: “Re: US Department of State. Issued an RFI for an off-the-shelf EHR for diplomatic missions.” The RFI is here, but note that it covers EHR implementation project management services only – it’s not a RFI for an actual EHR. The original plan was for the Department of State to share the Coast Guard’s Epic system, but the Coast Guard has backed away from that project. Before that, the DoS was planning to roll out the DoD’s AHLTA, so perhaps this RFI involves the DoD’s Cerner rollout. I don’t know the source of the DoS’s existing eMED system. The RFI was posted June 3 with a two-week response date.

From Pickle Entry: “Re: ACA insurance. UnitedHealth Group is pulling out of the exchange in my state. I’ve had to change insurance companies every year since Obamacare was rolled out, paying multiples of the premium prices I paid before the ACA.” The administration touts decreasing levels of uninsured citizens. That’s good, but those newly insured people are spending a lot of insurance company money catching up on their deferred health needs while young, healthy citizens are going without insurance because they are unlikely to get a payback. You can’t blame insurance companies who are stuck with a money-losing risk pool of self-selected patients when they stem their financial bleeding by exercising the only option the government gives them – shutting down their exchange plans. You are fine if you have employer-provided insurance, have a low enough income to qualify for endless government insurance subsidies, are old enough for Medicare, have few assets and therefore little financial exposure to expensive uninsured services, or are rich enough to not care. Otherwise, you’re paying more to keep the insurance-funded profits flowing to providers, drug companies, and the endless bureaucracy of middlemen who make up most of the US healthcare non-system and who are happy that ACA gave them newly insured patients to bill without touching the real problems of unjustified prices, fraud, and the financial incentive to create overutilization.

From Dan Blocker: “Re: data blocking. John Halamka says he’s never seen it. I say he needs to look harder.” Lots of people (including ONC) claim  that providers and EHR vendors intentionally block the flow of patient information, but nobody is serving up real-life examples instead of poorly sourced anecdotes. Such proof can only come from patient complaints and those are rare because: (a) patients don’t know that their interoperability expectations should be higher; (b) the moment of need is when they are unwell; and (c) they don’t have the information or incentive to figure out who to complain to. I bet that if you asked 100 people who were in the process of being seen as inpatients or outpatients to ask those providers to retrieve their history from other providers, nearly all of them would be unsuccessful, but turning that into a data blocking complaint against either of the providers or their respective EHR vendors would require a lot of investigatory legwork. Most of what’s wrong with healthcare is due to indifference or ineptitude, not carefully planned evildoing.

HIStalk Announcements and Requests

Listening: reader-recommended Fantastic Negrito, raw Delta blues from the Oakland,CA solo artist who describes his music as “uncut realness and zero concern for pop anything” and whose background is uplifting. Mark my words: all things (especially musical ones) must pass and eventually audiences will tire of shimmery musical junk food crafted by false-prophet celebrity musicians who possess no life experience and whose primary musical instrument is Auto-Tune. 

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Ms. Westover says students in her inaugural high school microbiology course in Georgia are making good use of the lab supplies we provided in funding her DonorsChoose grant request, examining bacteria and analyzing water samples in discovering “a whole new microscopic world.” 


June 28 (Tuesday) 2:00 ET. “Your Call Is Very Important.” Sponsored by West Healthcare Practice. Presenters: Cyndy Orrys, contact center director, Henry Ford Health System; Brian Cooper, SVP, West Interactive. The contact center is a key hub of patient engagement and a strategic lever for driving competitive advantage. Cyndy will share how her organization’s call center is using technologies and approaches that create effortless patient experiences in connecting them to the right information or resource. Brian will describe five key characteristics of a modern call center and suggest how to get started.

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

Acquisitions, Funding, Business, and Stock


Hearst acquires a majority stake in MedHOK, which offers health plan software including case management, utilization management, and medication management. MedHOK will be incorporated into Hearst Health, which includes First Databank, Zynx Health, MCG, and Homecare Homebase.


A federal court dismisses the patent infringement lawsuit brought by telehealth provider American Well against competitor Teladoc, with the court finding that American Well’s patent is too abstract to be enforceable. Teladoc asked the patent office to invalidate American Well’s patients in 2015, after which American Well sued Teladoc just before Teladoc’s IPO. American Well will of course appeal. TDOC shares have dropped 33 percent in the year since its IPO.


Hospital medical device spend management software vendor Procured Health raises $10 million in new funding. The Chicago-based company had raised $5.1 million, with its most recent round being completed in March 2014 with little news since. 


Sunquest acquires patient flow technology from The Royal Liverpool and Broadgreen University Hospitals NHS Trust, which it will market to customers of its Integrated Clinical Environment. 


Patient access and RCM services vendor MedData will acquire RCM services vendor Cardon Outreach for $400 million.

Microsoft inexplicably pays $26.2 billion to buy LinkedIn in its biggest acquisition ever. Microsoft always seems desperate to grab onto whatever is trendy at the moment, wildly overpaying to acquire companies with higher growth potential that it then runs into the ground in repeated and easily predicted examples of failed synergy. MSFT is paying a 50 percent premium to the share price of LinkedIn, whose luster has faded as its revenue stalled and the platform keeps finding new ways to annoy its users in between their rare bursts of job-seeking and self-promotional activities.



Manati Medical Center (PR) and Mayaguez Medical Center (PR) choose Meditech 6.1, raising the company’s Puerto Rico hospital count to 21. 

Tampa General Hospital (FL) selects records aggregation and referrals management tools from EHealth Technologies.

Mainstreet Health will implement the HealthMedx Vision EHR for its transitional care facilities.



Justin Barnes (Justin Barnes Advisors) is named partner and chief growth officer of IHealth.


Extension Healthcare hires Ben Kanter, MD (Sotera Wireless) as CMIO.


Eric Kretzer (Strata Decision Technology) joins SA Ignite as SVP of products.

Announcements and Implementations


Boone Hospital Center (MO) lays off 26 transcriptionists following the decision by parent company BJC HealthCare to outsource transcription services to Madison, WI-based Amphion Medical Solutions, which was acquired by Atlanta-based IMedX in January 2016. 

The American Medical Association adopts ethical standards for telehealth and telemedicine at its annual meeting, noting that technology doesn’t change the ethical requirements for physicians to place the patient’s interests first. The guidelines also urges physicians to be cautious in making treatment decisions based on the limited information available in a telemedicine session and suggests that care coordination is essential.

Government and Politics

The SEIU healthcare employee union tries again to convince California to cap total hospital CEO compensation at $450,000, the same salary earned by the President.


Microsoft’s new XBox console eliminates the dedicated port for its Kinect motion-based controller, leading to speculation that Kinect is being phased out. Kinect is used by several innovative healthcare applications for pain assessment, physical rehabilitation, and patient-provider communication. My speculation would be that Kinect turned out to be less interesting (and less profitable) for consumer use but it will continue with a non-gamer focus.


The former chief nursing officer of Sonoma West Medical Center (CA) sues the hospital and one of its board members, claiming she was fired after raising concerns about problems with the hospital’s new clinical software that was developed by the board member’s company. She says the hospital allowed the board member to use its patients as his EHR guinea pigs because he has donated $9 million to keep the previously closed hospital afloat, with the resulting buggy product mixing up patient records, providing incorrect medication information, and failing to display the code status of patients. The software in question appears to be from E-Health Records International, which claims that its tablet-based HarmoniMD hospital EHR can be brought live in single day. Its only users appear to be Sonoma West and a single hospital in Africa.


A Commonwealth Fund-sponsored study finds that only 30 percent of behavioral health providers use EHRs, recommending that SNOMED and LOINC terminology be enhanced to address behavioral needs, incorporating IT costs in setting bundled payment policies, adding behavioral-specific clinical decision support and interoperability capabilities to existing EHRs, and requiring EHR vendors to beef up their security capabilities.


A Peer60 report on payers finds that BCBS and Medicare are the ambulatory provider favorites by far, with UnitedHealthcare trailing the pack. Providers like payers that get them paid more quickly with minimal staff involvement, while their least-favorite attributes are time-wasting practices, denials, and poor customer service.

CMS Acting Administrator Andy Slavitt commits at the AMA conference that CMS will simplify its processes, involve physicians in decisions that affect them, focus on patients, support small physician practices, and make “healthcare technology a tool, not an industry.” Some snippets:

Off-the-shelf tools like Certified EHRs and clinical data registries can provide complete capabilities [for quality reporting], but other options exist as well, including most types of reporting that a physician is doing today. If CMS can get data automatically or through another source, we will do so … [CMS will focus on] putting more pressure on technology vendors and less burden on physicians, so physicians can do simple things like track referrals when a patient sees another specialist or visits a hospital … It’s also time to ask a lot more of the technology and technology vendors. This is particularly true in the area of what many call interoperability … the burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs so data can move in and out of an application safely and securely. This will also serve to help eliminate the ‘desktop lock’ that occurred based on early EHR decisions by allowing technology to more easily plug and play. Today’s data silos are more a function of business practices than technology capability and we cannot tolerate it any longer.


Here’s a textbook example of how to write a bad press release. The boring headline contains glaring spelling and capitalization errors, oddly uses the past tense, and reeks of company self-importance in providing a “news item” that would interest no one except the unfortunate author who was charged with getting some company buzz out there despite a lack of buzzworthy events. It randomly capitalizes job titles and other words that are not proper nouns (“EHR Systems”) and uses awkward phrasing that suggests it was crafted by someone whose mother tongue is not English. My mom’s advice remains valid: if you don’t have anything good to say, don’t say anything.

A Virginia hospital blames a misplaced EHR click for sending a sympathy card to the family of a patient who was in fact still alive. Sentara Martha Jefferson Hospital says someone clicked “deceased” instead of “discharged to home” in Epic, triggering the obviously automated condolences. At least the errant checkbox entry didn’t create a medical error that actually killed the patient.

Athenahealth’s Jonathan Bush provides an impassioned video reaction to news that TV host John Oliver formed a fake debt collection company, bought $15 million in overdue medical accounts receivable for $60,000 cash, and then told those patients that he was forgiving their debt. I assume that buying debt at less than a penny on the dollar means it was uncollectible anyway, so it wasn’t really much of a gift.

The Minneapolis newspaper covers the problem in which patient advance directives are not easily located in EHRs. It cites a study in which less than one-third of ED doctors were confident that they could find patient preferences for resuscitation, feeding tubes, or ventilators.


Eastern Maine Healthcare System (ME) offers voluntary early retirement to 43 of the 300 employees in its IT department, which is running $3 million over budget.


The American Diabetes Association is embarrassed when it allows a drug company to present new, sensitive research data to thousands of doctors attending one of its conferences, warning them to hold the information for one hour until the public announcement and the inevitable stock market reaction. The itchy Twitter finger doctors were already blasting out photos of the presentation’s title slide even before the presentation began, after which they tweeted out the presentation’s data slides and charts despite pleas from the ADA to remove them. Novo Nordisk shares dropped 5.6 percent on the modestly positive news.

Here’s the final physician practice vendor overview from Vince and Elise, which includes tips for product selection.


Weird News Andy loves good customer support even if it comes from sophisticated ransomware hackers who now provide live-chat operators to walk victims through the payment process in an effort to differentiate themselves professionally by improving usability. WNA suggests the hacker’s customer support agent be prepared to answer questions such as:

  • How do I buy bitcoins?
  • How do I know you will actually unlock all our data?
  • Do you provide training on how not to click suspicious links?
  • How’s the weather in Romania?

Sponsor Updates

  • Impact Advisors is named as  one of the 500 largest technology integrators in North America.
  • AirWatch announces updates to AirWatch 8.4.
  • Bernoulli CNO Jeanne Venella is featured on RN FM Radio.
  • Carevive Systems will host a tweet chat on the oncology care model on June 21.
  • Cumberland Consulting Group will exhibit at AHIP June 15-17 in Las Vegas.
  • Fast Company features CTG Technical Recruiter Kate Orngard in an article on recruiters.
  • Extension Healthcare will exhibit at the ONL Annual Conference June 16-17 in Newport, RI.
  • FormFast publishes an infographic on the real cost of paper-based informed consent processes.
  • Healthfinch will exhibit at the AMDIS Annual Physician Symposium June 21 in Ojai, CA.

Blog Posts


Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Currently there are "5 comments" on this Article:

  1. The insurance business has indeed turned into a “House of Cards” if you will. There’s a lot going on that I think we are not hearing about. With Anthem and Cigna trying to merge, it’s getting interesting as United has a lot to loose if that occurs, all the pharmacy benefit management dollars, as OptumRX is their pharmacy benefit manager. Also of note, OptumRX just secured contracts for Calpers for 5 years as well as GE, which they took from CVS. United started in the last 70s as a pharmacy benefit management company and then sold the PBM to Glaxo, who then a year later sold it to Express Scripts. That money allowed United to buy a few health insurance companies and then they were in the health insurance business. Meanwhile all seem to be using a flavor of the same software. If you look at the 1st quarter report for United, OptumRX made more money than their other 3 revenue streams, which are insurance groups.


    Interesting too that Cigna is now sanctioned by CMS so is Slavitt looking after his former employer? Cigna announced a new subsidiary this week, a mini Optum type of company if you will. If Cigna merges with Anthem, they could re-underwrite all the Cigna polices and get out from underneath having United Healthcare with OptumRX managing their PBM business. Also it’s interesting to hear that there’s a former White House and Cigna executive, Dr. Julian Harris is named to run that company. Kevin Coulihan, CEO of Healthcare.gov is also touting Cigna as one who will come in to play for ACA policies as United leaves exchanges, so what’s next, co-op marketing? One has to wonder. Coulihan is also a former Cigna executive.


    Meantime the Governor of Connecticut singed a “secrecy bill” to keep everyone in the dark as to what’s going on with Anthem/Cigna. In addition the CT insurance regulator is a former Cigna executive, married to another Cigna executive…something stinks? Aetna too is located in CT. Excerpt below.

    “Despite those reassurances, the Connecticut State Medical Society — which represents physicians — has echoed the concerns of the healthcare advocate’s office, saying the law will give the Malloy administration “carte blanche authority to deem nearly any data collected in the process of a market conduct exam or inquiry exempt from FOIA disclosure.” The group has a merger-related open records request now pending with the Insurance Department.”


    Something stinks….again I don’t think United would want to lose all that pharmacy benefit business from Cigna, as you do get a “two fer” now with Cigna, as they do the insurance and United does the pharmacy benefit management, and maybe going back more to their roots and cuddling closer with pharma, where the money is.

  2. I was trying to pay attention to what Bush was saying but my eyes got distracted by his shock of hair and my ears got irritated by his shouting. If I were him, I’d fire my entire marketing team for coming up with a terrible hashtag (#UnbreakHealthcare) and marketing videos that look like they were produced by a couple of 14 year olds having fun in their parents basement.

  3. Regarding the Minneapolis StarTribune report on advance directives in EHRs: Minnesota residents have the option of having “Living Will/Healthcare Directive” displayed on their state-issued ID. I’m guessing a driver’s license might be easier to locate by the first responders and hospital staff than this info in the EHR.

  4. Re: Bush’s video rant
    JB’s video rant about the administrative mess at providers shows his PR department works overtime but clearly does not understand why the mess is there in the first place. It is evident he nor his PR staff ever worked in a provider setting. If he had he would know that the administrative processes are yes a mess but it is because of balkanized payment systems that have evolved over fifty years. Starting with Medicare /Medicaid, they are a Pandora’s box. If you really want to ‘fix’ this mess JB start talking to your relatives who took part in creating the zoo called reimbursement systems. Or you can continue to blame the providers – who you want as customers but you so quickly condemn. Condemn customers – now that’s a smart marketing strategy!

    Re: Sentara’s almost deceased patient
    Poor system design in action! Epic needs to put in a few more clicks: Are you sure this patient is dead? Then: Are you REALLY sure? Then: What is the patients current BP?
    That should do it.

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