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July 5, 2016 News 14 Comments

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ONC will measure MACRA-mandated national interoperability progress using metrics from two existing surveys: the percentage of providers who say they are sending and receiving information (AHA’s Information Technology Supplement Survey) and the percentage who say they actually use the information of other providers to make clinical decisions (CDC’s annual EHR survey).

Reader Comments


From Addison in Madison: “Re: Epic non-competes. Epic’s modus operandi is to demand new agreements with any change in status / business. Your employer has perhaps been steady for a while, so they are operating under an old agreement. It is when something changes that Epic introduces their new demands. What changed for Accenture was the acquisition of Sagacious. Same with Navigant’s Epic-related acquisitions. When that happened, Epic put the agreement back on the table, with the new stipulations. You can expect the same if your firm is ever acquired or does any acquiring.”

From Voice of Reason: “Re: Epic non-competes. The reason Epic might be doing this is because both Sagacious and Vonlay were bought out by Accenture and Huron Consulting Group respectively. Epic might be thinking since Accenture and Huron provide a variety of consulting services, their Epic consulting division might pass on proprietary info to their other divisions that might compete with Epic. I don’t think Nordic has these restrictions since they only deal with Epic consulting.”

From Dr. T: “Re: Epic non-competes. what may happen is when Epic learns of the new facility you are going to, there is a quiet conversation with the old employer. Then they call the new employer and say, ‘We won’t do business with that person.’ Guess what happens? You don’t have a job, you can’t prove who talked to which manager/exec, and you don’t have the deep pockets to fight it. I saw it myself and almost had to get the toes out to keep counting how many times it happened with an old employer.”

From DrM: “Re: Epic non-competes. I predict Epic’s approach to the consultants will be what brings down the whole non-compete house of cards for them. Does anyone else find it strange that, shortly after starting up their own consulting firm, they impose rules on competing consulting firms that will (purely coincidentally, I’m sure) reduce the number of available consultants? Other companies have lost anti-trust suits for doing less. I also hope in the trial they bring up their trade secrets so they can be told the definition of trade secrets, i.e., you actually have to try to keep them a secret.”

From Apt Moniker: “Re: Twitterati. I, too am never sure whether Twitter means anything in real life. However, senior execs often watch their own Twitter accounts, although not the company one.” Twitter, Facebook, and LinkedIn are, at least for individual businesspeople, vanity platforms. Heavy users like feeling followed and it gives them a place to tout their self-perceived wonderfulness in humble-bragging to others who are doing exactly the same thing in a never-ending stream of self-promotion. Twitter in particular is full of updates that are simply links to questionable source material with the apparent goal of being the first to highlight something new or to appear to be better read. My experience is the same as what big web publishers have reported – I can get a ton of tweets and retweets linking to my original HIStalk page and it doesn’t boost site traffic one bit. From that I conclude that the Twitterers are happy just to read that the page exists, but free of the motivation to click the link to see what it actually says.

From See My I/O: “Re: leading CMIOs. Here’s a link to the top 15.” Sorry, that’s just the usual time-wasting magazine crap story, or in this case, a pointless but painful to watch slideshow. There’s no stated methodology behind the list – the magazine apparently just chose some names they recognized and proclaimed those CMIOs as “leading” in trying to amass clicks that advertisers might mistake for influence.

HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. H, whose Arkansas elementary school science class needed activity tubs for their Friday projects and labs. She reports, “The students really enjoyed the force and matter experiment in which they had to attach a balloon with a straw to a string and release it to see who’s balloon traveled the fastest. The conversations we got from students were amazing and after each group went students discussed what they could do better next time to make their balloon travel quicker. These were some fun times — we are so competitive.”

I pledged transparency to a reader who asked me awhile back to list not just new HIStalk sponsors, but also those companies that don’t renew. I don’t like doing that because I take it as a personal failure, but I promised. With that, I’ll say goodbye and thanks to the following companies with whom I parted ways in the past year because they were acquired, went a different direction, tightened their belts, or lost the employee who was my only contact there.

Anthelio Healthcare Solutions
Aviance Suite
Burwood Group
CareTech Solutions
Greencastle Group
Greenway Medical Technologies
MBA HealthGroup
McKinnis Consulting
Oneview Healthcare
Porter Research
Provation Medical
Streamline Health
XG Health Solutions


July 13 (Wednesday) 1:00 ET. “Why Risk It? Readmissions Before They Happen.” Sponsored by Medicity. Presenter: Adam Bell, RN, senior clinical consultant, Medicity. Readmissions generate a staggering $41.3 billion in additional hospital costs each year, and many occur for reasons that could have been avoided. Without a clear way to proactively identify admitted patients with the highest risk of readmission, hospitals face major revenue losses and CMS penalties. Join this webinar to discover how to unlock the potential of patient data with intelligence to predict which admitted patients are at high risk for readmission.

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

Acquisitions, Funding, Business, and Stock


Digital pathology startup Proscia raises $1 million. The founder and CEO just earned his BS from Johns Hopkins. I’m amused that the company’s write-up says the team has filed “over eight patents” and been involved with “more than four technology companies,” making me wonder what’s wrong with just saying “nine” and “five.”

UnitedHealth Group sues publicly traded American Renal Associates Holdings for fraud, complaining that the dialysis company convinced its Medicare- and Medicaid-eligible patients to instead sign up for UnitedHealth insurance at no charge, arranging to have their premiums paid by a charity whose funding comes from providers who benefit from having better-insured patients. Government programs pay American Renal Associates about $300 for a dialysis treatment while it can bill UHG $4,000 for the same session, giving the company a profitable loophole in billing more in claims than it costs to pay for the patient’s insurance. The Affordable Care Act requires insurance companies to accept all people regardless of their health, but HHS has been vague on whether it’s OK for charities that receive most of their funding from providers to pay individual premiums directly.


Mayo Clinic will implement Visage Imaging’s Visage 7 enterprise imaging platform throughout its radiology practices.

Announcements and Implementations


Carefluence earns the first API certification issued under ONC’s criteria, with Carefluence Open API 1.0 earning certification for patient selection, data category request, and data request. I note several misspellings on its home page, including a claim that it was designed to “demistify” interoperability, which suggests fog removal. The company’s website has minimal information (such as location and management team), but it appears to be connected to the equally reticent technology vendor ModuleMD.

Among the winners of MD Buyline’s user satisfaction surveys are Aesynt (pharmacy robotics), CareFusion (pharmacy automation), Epic (EHR), GE Healthcare (cardiology PACS, perinatal information systems, RTLS,and time and attendance), Healthcare Insights (financial decision support), McKesson (staff scheduling), Philips (PACS), Premier (ERP), SCC Soft Computer (laboratory information system), Siemens Healthineers (cardiology PACS), and Vital (3D advanced visualization).

Government and Politics


The government of South Australia continues to defend its over-budget and delayed $315 million EPAS patient care system even as the auditor-general warns that the project is underfunded and unlikely to deliver $113 million in savings. The Allscripts Sunrise system is live at some sites and will be phased in when the new flagship Royal Adelaide Hospital opens.

Privacy and Security

Catholic Health Care Services of the Archdiocese of Philadelphia will pay a $650,000 HIPAA settlement related to the 2014 theft of a PHI-containing, company-issued iPhone that was not password protected. The phone contained the information of 412 residents of the six nursing homes it owned and managed. OCR found that CHCS had not published a policy about taking mobile devices off campus and had not developed a risk analysis and risk management plan. Most interesting is that CHCS was charged as a business associate rather than as a covered entity since it was the corporate parent of the nursing homes and provided technology services to them.


Atlantic Health System (NJ) sends 5,000 randomly selected employees an email saying they’re getting raises, telling them to just confirm by clicking a link and entering their employee ID number, data of birth, and ZIP code. One-fourth of them opened the email and two-thirds of those provided their personal information. The email was actually a phishing test that mimicked known hacker practices such as using an originating email address ending in .com instead of .org. Several employees complained that the promised raise wasn’t real, but on the upside, quite a few reported the email as suspicious and warned co-workers not to fall for the trap.

Innovation and Research

Researchers find statistical bugs in the software that interprets functional MRI results, leading them to question the validity of 40,000 studies.Poor archiving and data sharing practices mean the existing studies can’t be re-analyzed with better software.


London’s Moorfields Eye Hospital is sharing de-identified eye scans with Google DeepMind, which is developing artificial intelligence for early detection of diabetic retinopathy and macular degeneration.


An Apple iOS 10 update this month will allow iPhone users to sign up as organ donors with the Donate Life America registry and be flagged as an organ, eye, and tissue donor on the phone’s Medical ID emergency information display.



Neuroradiologist Shyam Sabat, MD calls for BMJ to retract the “shoddy science” tabloid-like pseudo-study it published in May that claimed medical errors are the third-leading cause of death in the US. His analysis of the paper finds that four studies were improperly combined into a meta-analysis that really left just one 2004 Healthgrades study of Medicare recipients, which the authors then wildly extrapolated to all inpatient admissions. He concludes,

How a reputed group such as the BMJ could not see through these simple but outrageous statistical blunders is anyone’s guess. Did the overwhelming incentive to get a spice tabloid-type, eye-catching headlined paper prevent the editorial process from taking common sense decisions? The result is that the US medical community is being ridiculed by media and people not only from the US but the whole world who cannot understand how US medical system is so incompetent despite spending the maximum in the world and attracting the best talents from all over the world.

The Boston Globe notes the trend of doctors working night shifts in hospitals, where “nocturnalists” oversee the activities of overworked residents, reduce the number of calls to attendings, and get patients out of the ED and into beds when indicated.


Cleveland stakes its claim as “The Medical Capital” by launching a rebranding initiative, a new website, and a new testimonial video. In other words, you should take their word for it because they blew through a ton of marketing money in proclaiming themselves #1. Maybe it will draw business, but I can recall many weed-infested empty lots bordering desolate highways festooned with signs proclaiming that area to be some town’s “high-tech corridor” that never quite caught on.

Dear naive people who cry foul when drug companies raise the prices of critical drugs for no good reason, saying those companies are “putting profits ahead of patients:” that’s exactly what for-profit companies are supposed to do. It’s unconscionable when health systems and insurance companies hide their huge bottom lines behind non-profit status, but for-profit corporations exist for a singular purpose, to deliver maximal profits to shareholders. The understandable outrage would be better focused on advocating for government-led drug price involvement like the rest of the world uses, which leaves US consumers footing the bill for most drug company profits and research investment.


Powell Valley Hospital (WY), which struggled for years to get its $2 million NextGen hospital EHR working well enough to earn Meaningful Use money, learns that the product’s new owner, Harris Computer Corporation, won’t add MU Stage 3 capabilities to the product. Harris has offered to replace NextGen with QuadraMed for just the installation cost, but the hospital would still need to spend over $1 million. Harris confirmed that it will provide only break-fix support for the NextGen hospital system, saying it acquired the product because NextGen was going to shut it down anyway.

A former naturopath (ND) who left a lucrative practice after observing a colleague administered an unapproved cancer drug says that “naturopathic services are quackery” and scoffs at ND ambitions to be recognized as primary care physicians. She writes,

Essentially, naturopaths want to be allowed to take shortcuts. Instead of attending medical school, naturopaths attend their own, self-accredited programs with low acceptance standards and faculty who are not qualified to teach medicine. Instead of a standardized and peer-reviewed medical licensing exam, naturopaths take their own secretive licensing exam that tests on homeopathy and other dubious treatments. What little medical standards that seem to be tested on the exam have been botched, like the one question in which a child is gasping for air and the correct answer on how to treat is to give a homeopathic remedy.

Sponsor Updates

  • Clockwise.MD will exhibit at the UCAOA Regional Conference in Philadelphia on July 14-15.
  • Audacious Inquiry comments on MACRA NPRM V5.
  • Boston Software Systems launches a podcast series covering EHR migration, system optimization, and the sunsetting of legacy systems.
  • CareSync is featured in a USF Health article on Tampa’s digital health opportunities.
  • ClinicalArchitecture will exhibit at the Military & Government HER & Health IT Symposium July 13-14 in Arlington, VA.
  • Cumberland Consulting Group will attend the 340B Coalition Summer Conference July 11-13 in Washington, DC.
  • Elsevier will develop a free benchmarking report detailing the current landscape of cancer research and collaborations as part of the national Cancer Moonshot initiative.
  • Healthfinch joins the Athenahealth Marketplace.

Blog Posts


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Currently there are "14 comments" on this Article:

  1. Re: Epic’s extreme stance on non-competes and vendor restrictions. Imagine if the person who built your home – the architect/builder , dba ABC Homes – insisted that if anyone else ever wanted to make their living from that house, that person must get the ABC Homes’ permission. That ABC Homes had full control over any type of addition or renovation, they set the terms of the plumber or painter who was to perform maintenance on the home (or you use ABC Homes), and that when it came time to sell it, you could only sell it using ABC Homes or someone who they had approved. You think it would stifle growth in the housing and real estate industry in your town? Of course. And it is exactly what Epic does for healthcare.

    When is the last time you called the person who designed your house in order to ask permission to have someone update the bathroom cabinets? And that Joe the Cabinet Maker had to be in good standing with the person who built your home 30 years ago in order for you to hire him? That is what Epic basically wants its customers to do.

  2. To: MidWest CIO – I agree that the restrictions are a bit extreme but your analogy is dead wrong. I have never bought a house with unlimited lifelong updates and a maintenance contract in place. If I were to have that kind of arrangement with a builder and if I were to call the builder when the first thing goes wrong, I expect the builders to put in some other clauses. Joe Cabinet Maker must be in good standing with your builder if you want the cabinets from next upgrade work with all the changes Joe has made to your house.

  3. It’s unclear why the whole non-compete issue is coming up now. It has been this way for years. And it’s not just in consultant agreements. It’s in customer agreements too. Same thing for no-hire provisions. If I remember correctly, if you wanted to be eligible for Epic’s Good Maintenance refunds, you had to not hire people from another customer’s project team. It was crazy: essentially it created a situation where we could violate the laws (prohibition on no-hires) or take the refund.

    So, to get its way, Epic creates a massive market distortion in favor of consultants and long-term employers. It further makes it really expensive to get training and certifications. It’s platform and expertise aren’t really all that portable (unlike many other technology skills). All this does is increase everyone’s costs. Epic can’t cost effectively staff its implementation project, doesn’t provide customers a good way to get this staff, and then forces everyone to do arguably illegal things.

    Epic should worry first about its software, not the employment situation of people who had some access to it in support of a customer.

  4. The reason this is coming up again now is that Epic is forcing consulting firms to have each of their employees sign a noncompete (with Epic) in order to have continued access to their clients’ systems. This non-compete then extends 1-year beyond the end of employment with that consutling firm.

    Keep in mind that many of these people left Epic 5+ years ago, and some never worked there in the first place.

    I understand that this is nothing new for Epic, but people need to keeping making noise, and those that can need to start taking a stand.

  5. More of the same old stuff form Epic. For a company that supposedly cares about “doing good”, Epic sure loves to be unethical (and illegal).

    Consultants should be very upset about this. Everyone should be very upset about this.

  6. When someone holds a gun to your head (or career) and tells you to sign a contract, one can just ignore the contract signed afterwords and encourage them sue you if they dare. Generally speaking the law recognizes coerced contracts as being unenforceable and the last thing that Epic would actually want is to see their non competes tested in court.

  7. “Dear naive people…” – if the government were more involved in drug pricing, we would still be looking for a cure for polio. The open market works.

  8. Re: Polio – While I generally support a nice free market economy as much or more than the next guy, Polio isn’t really a good example of that working. Massive non-profit funding supported the research and development of a Polio vaccine (March of Dimes). No patent was filed and the vaccine was distributed pretty cheaply all things considered. Some good reads on the topic: http://www.slate.com/articles/technology/history_of_innovation/2014/04/the_real_reasons_jonas_salk_didn_t_patent_the_polio_vaccine.html

  9. I was taught in law class, many years ago. Non-compete agreements are viewed in law as needing to be “reasonable”. They must be with people who could actually take intellectual property to a competitor (meaning critical, keystone employees, not average joe positions). They must also be for a reasonable timeframe, with one year being the typical maximum. On this latter point the law takes the position that the employee’s own needs must be taken into account. Being unemployable for more than a year isn’t viable and the law recognizes that.

    Lots of non-compete agreements are signed but are not enforceable because they violate the boundaries of reasonableness.

    Hate to say it but it certainly sounds like Epic is throwing it’s weight around and attempting to intimidate people.

  10. Not surprising…Epic is renowned for brow beating their clients into structured support and maintenance contracts – often at significant penalty to Epic customers – why is anyone surprised that Judy’s micromanaging non-competes?

  11. I cringe at the thought of hospital with a “NextGen” hospital EHR, struggling so. One has to think that Powell Valley Hospital is more than a little bent that it’s NextGen EHR doesn’t act so NextGen. And that includes whatever responsibility Powell Valley themselves may have for the problems.

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