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Monday Morning Update 8/1/16

July 31, 2016 News 6 Comments

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A newly published Apple patent suggests that the company is interested in allowing iPhone users to connect with a physician, send the doctor their HealthKit-collected information, and then initiate a telemedicine session from their iPhones.

The inventor is Todd Whitehurst, MD, PhD, a former Apple director of hardware development who now holds the same position at Google Life Sciences. He has previously worked on implantable devices for glucose monitoring, drug infusion, and neurostimulation. Whitehurst holds more than 50 patents involving implanted medical devices and has applied for many dozen more.

Reader Comments


From Frank Poggio: “Re: evidence-based medicine. It’s really evidence-based political medicine, as evidenced by the mammography battle three years ago. Every doctor and patient should read ‘Snowball in a Blizzard’ by Steven Hatch, MD. It says doctors are guessing all the time but have led the public to believe the Marcus Welby / Dr. House version of their role, making patients and families angry when there is a misdiagnosis or treatment failure. It will take a very long time and big attitude change to reverse the misconception.” Hatch wrote the book following 2009’s guidelines by the US Preventive Services Task Force that called for a reduction in mammograms because their diagnostic value is less than previously believed, which cause outrage in women (and in providers who make a lot of money performing mammograms) who felt the recommendation was a form of rationing. Interestingly, Hatch concludes that doctors pay less attention to patients with symptoms that are hard to interpret because the doctors are frustrated by their own limitations.


From Hundred Dollar Baby: “Re: Covenant Health. I looked up attestation data to see which systems their hospitals use.” This is great, thanks. According to the attestation data, seven of Covenant’s hospitals (including the big ones) run McKesson Horizon, one uses Meditech 6.0, and one is a Medhost user. All of the systems will apparently be replaced with Cerner. Hospitals that bought McKesson’s sketchy vision of integrating all of its acquisitions to form a cohesive system are paying big to correct their mistakes, but on the other hand, evidence was ample to predict the current state.

From Specific Gravity: “Re: Preservation Wellness Technologies. Rumor has it that the patent troll, which lost its infringement lawsuit against Epic, is now suing Epic’s customers.” Unverified. The company doesn’t even bother to run a website in pretending that it’s a real business rather than a patent troll. I provided some background a couple of months ago:

The “inventor” apparently runs Carlo Coiffures, a beauty salon in New York. The lawsuit was brought by a Texas corporation with a Texas mail drop address that filed the suit in the rural Eastern District of Texas, which attracts 25 percent of the patent lawsuits filed in the entire US because that district’s troll-friendly practices make it hard for defendants to get a ridiculous lawsuit dismissed. A fascinating episode of “This American Life” describes a building in Marshall, Texas (population 24,000) whose long corridors contain locked offices representing the only physical presence of companies whose entire business is filing frivolous patent infringement lawsuits.

HIStalk Announcements and Requests


Thirty-seven percent of hospitals told AHA surveyors that they allow patients to electronically submit their own information to the hospital, but only 12 percent of my survey respondents reported having that option as patients. New poll to your right or here: as a patient, how much value would you place on CMS’s hospital star rating system? Click the poll’s Comments link after voting to explain why you do or don’t trust CMS’s data as a predictor of hospital quality.


Vince Ciotti is working on his review of healthcare software rating services such as KLAS, Black Book, and others. If you work for a hospital or medical practice and have read a software rating report in the past year from any company, can you take a couple of minutes to complete my survey to give Vince a broader look at that market? You’re also welcome to send me your thoughts. Thanks.

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We funded the DonorsChoose grant request of Mr. F in Florida, who asked for programmable robot for his elementary school technology class. He reports, “Thanks to your donations, my students were able to bring their coding skills to practical use by controlling the Sphero robot. Not only did my students wait desperately for their turn with the Sphero, but they used their time to learn how to code it to do even more. I thank you for your generosity and faith in my class as well as myself to put your donations to good use.”

I had another busy day of unfollowing low signal-to-noise Facebookers who post frequent political rants, relentless mugging selfies, and updates about teams and sports that don’t interest me (which is all of them). I rarely look at Facebook but it felt good to take action, sort of like that dashboard-mounted toy that releases stress by letting you shoot imaginary death rays at bad drivers. 

I’m wondering if death rates rise early in each calendar year among people who buy their health insurance through Healthcare.gov or state exchanges. Open enrollment runs November 1 through January 31 and many folks have to start over because their insurer pulls out or changes the plans it offers. They have to:

  • Try to find a decently qualified PCP who will take a new patient.
  • Get a “new patient” appointment sooner than several months out with that new PCP.
  • Obtain referrals for ongoing conditions if the new plan requires it or if their old specialist doesn’t take their new insurance.
  • Hope for no surprises that their maintenance meds, especially the expensive specialty ones, are covered by their new plan (since insurance companies  can’t tell you cost or coverage until the policy takes effect, they’re buying blind).
  • Avoiding getting medical care because of the multi-thousand dollar deductible that resets January 1, meaning they have to pay every expense out of pocket.

Listening: new from reader-recommended Look Park, mellow, folky-style pop with lots of hooks by Chris Collingwood from the unfortunately defunct Fountains of Wayne. I’m also pondering the definition of “country” music – it seems you just stick a cowboy hat on a random musician’s head (some not even US-born, like Keith Urban), add fiddle and pedal steel to the otherwise pop mix, and dumb down the lyrics to include only mournful warblings or throaty backwoods swagger affecting a fake Southern accent. I’m not entirely sure it’s even a real genre any more except as an easier route to pop stardom, where the faux country trappings are quickly dropped (see: Taylor Swift).

Last Week’s Most Interesting News

  • CMS adds star ratings to its Hospital Compare website, with some highly regarded hospitals performing poorly and criticizing CMS’s methodology as flawed, especially for academic medical centers and hospitals in economically challenged areas.
  • Consumer health site Sharecare acquires the population health business of Healthways.
  • A report finds that 88 percent of known Q2 ransomware infections involve healthcare organizations.
  • ONC announces funding availability for a cyber threat information sharing service as previously called for by the White House.
  • University of Mississippi Medical Center pays $2.75 million to settle HIPAA charges related to the 2013 theft of a laptop.
  • Athenahealth announces poor quarterly results and the planned year-end departure of EVP/COO Ed Park.


August 10 (Wednesday) 1:30 ET. “Taming the Beast: CDS Knowledge Management.” Sponsored by LogicStream Health. Presenters: Luis Saldana, MD, MBA, CMIO, Texas Health Resources (THR); Maxine Ketcham, clinical decision support analyst, THR; Kanan Garg, senior applications analyst, THR; Patrick Yoder, CEO, LogicStream health. This presentation will review THR’s systematic process for managing clinical decision support assets, including identifying broken alerts, addressing technical and clinical issues, modifying order sets, and retiring tools that have outlived their usefulness. Attendees will learn how THR uses a robust knowledge management platform to better understand how clinicians are interacting with their clinical content to maintain their order sets and reduce the number of alerts fired.

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

Recent webinars and their associated YouTube video views are:

Acquisitions, Funding, Business, and Stock


Meditech reports Q2 results: revenue up 3 percent, EPS $0.44 vs. 0.46.  Product revenue was flat while service revenue increased 4 percent.

Cognizant acquires Toronto-based digital design firm Idea Couture.



UNC Health Care (NC) chooses Phynd to manage and share the information of its 20,000 providers across six hospitals.


Beacon Health System (IN) will implement Cerner’s Millennium Revenue Cycle.



Colleen McFarlane (US Preventive Medicine) is named CEO of radiology best practice platform vendor Radiology Protocols.


Arno Laeven, who founded the Philips Blockchain Lab in the Netherlands in January 2016, will leave the company, according to reports.

Stanson Health promotes Jeremy Orr, MD, MPH to chief medical officer.

Announcements and Implementations


In Canada, Interior Health is recognized as the first health authority in British Columbia to provide patients with online access to their records, using Meditech’s MyHealthPortal.


National Decision Support Company will incorporate appropriate imaging criteria from the National Comprehensive Cancer Network in its CareSelect Imaging.

A Navicure survey finds that while most healthcare organizations value data analytics and reporting, 55 percent don’t have such a solution, although half of those are planning to implement one. Nearly three-fourths of respondents say data analytics help them improve cash flow by reducing A/R days.

Privacy and Security

I’m giving public credit to DataBreaches.net, which has become my go-to source for breach reports and from which most of the items below originated. It’s brilliantly run by an anonymous mental health professional.


Crozer-Keystone Health System (PA) notifies 900 bariatric surgery patients that their information was exposed when an employee emailed all of them using CC: instead of BCC:. I’m beginning to think that the average hospital employee isn’t sharp enough to trust with a fully capable email client. Maybe they should either have to pass a competency exam or be forced to use a dumbed-down email client that protects the organization from their inattentiveness since the “we trust everybody to do the right thing with Outlook” isn’t working too well. The reduced functionality front end could restrict the ability of users to:

  • CC more than a handful of recipients.
  • Click embedded links to sites that have not been previously whitelisted.
  • Open attachments from external senders that have not been previously whitelisted.
  • “Reply to all” to more than a handful of recipients (that’s not a privacy risk, just an annoying practice, especially when they start emailing everyone to angrily tell them to stop emailing everyone).

Prosthetic & Orthotic Care (MO) notifies patients that hacker The Dark Overlord hacked its systems on July 9. DataBreaches.net brings up an interesting point – should OCR require the covered entity to tell patients that their information is for sale on the Dark Web as it is in this case? The Dark Overlord used his signature method to gain access, a zero-day exploit in Microsoft’s Remote Desktop Protocol.

Also experiencing a breach via remote access is Jefferson Medical Associates (MS).


The FTC reverses overrules a previous decision to drop data security charges brought against lab testing firm LabMD, now saying that LabMD’s security practices failed to address even basic security to protect the information of 750,000 patients, resulting in undetected installation of file-sharing software that left the information of 9,300 patients freely available for 11 months. Note that this action plus ONC’s observation that only FTC has jurisdiction over non-covered entities and you might infer increased FTC involvement going forward. Above is Friday’s response by LabMD President and CEO Michael J. Daugherty. My November 2015 summary of the original ruling was:

The first incident was reported by Tiversa, a security vendor who was trying to sell its services to LabMD. A former Tiversa sales manager said its warning to LabMD was “the usual sales pitch” and said no breach actually occurred. The second involved documents recovered in an identity theft investigation. The judge ruled that any consumer risk was theoretical and scolded the FTC for relying on Tiversa’s “unreliable” claims. It appears that Tiversa is still in business selling peer-to-peer cyberintelligence services, while LabMD shut down after being buried in court costs and customer defection due to the now-dismissed charges. LabMD was never charged with a HIPAA violation, only with deceptive trade practices, which seems to make little sense in this case (as the judge validated).



Another medical transport aircraft goes down as a Cal-Ore Life Flight plan crashes in Northern California, killing the pilot, flight nurse, medic, and patient. The flight’s operator was Air Medical Group Holdings, which was acquired by a private equity firm last year for $2 billion.


A bravely brilliant JAMA editorial questions whether it makes sense for NIH to be spending so much money on precision medicine research, which in 2016 earned $15 billion of NIH’s $26 billion in grant funding. It notes the general failure in trying to apply complex genetic information to clinical practice even in relatively simple forms, such in sickle cell anemia where detection of the causative gene 60 years ago still hasn’t provided any treatment options. It questions whether NIH should instead refocus on blue sky research that has obvious public health benefits instead of projects that are “constrained by current narratives” (in other words, chasing the latest shiny scientific object). Other points made in the article:

  • The financial and clinical benefits of EHRs haven’t materialized due to lack of interoperability, the poor quality of information they collect, and their high cost.
  • Most of the improvements in mortality, morbidity, and life expectancy have come from public health efforts, not medical research or interventions.
  • Genetic research will probably not create big-picture improvements in care and outcomes since it will at best create high-cost, highly targeted interventions for small numbers of people, not even counting the inevitable overdiagnosis and overtreatment that intensive monitoring encourages.
  • The authors recommend that NIH engage independent assessors to review the value received for research that promised specific deliverables, such as personalized medicine.
  • The article questions whether NIH should be spending federal taxpayer money in funding projects to discover new drugs, tests, and technologies or instead leave that work to private industry.


I’m impressed that John P.A. Ioannidis, MD, DSc of Stanford Prevention Research Center had the courage to challenge the precision medicine-driven funding frenzy that has taken federal money away from public health programs that could have provided an immediate and far greater ROI on public health. As I’ve said many times, the US is great at heroic, expensive (meaning: profitable) medical interventions that suck up ever-increasing chunks of our federal and state budgets, but we lag much of the world in public health, exporting most of our public health expertise. Check out his interview earlier this year with “Retraction Watch” and his “Evidence-based medicine has been hijacked” article from March 2016, in which he fearlessly criticizes the trend:

As EBM became more influential, it was also hijacked to serve agendas different from what it originally aimed for. Influential randomized trials are largely done by and for the benefit of the industry. Meta-analyses and guidelines have become a factory, mostly also serving vested interests. National and federal research funds are funneled almost exclusively to research with little relevance to health outcomes. We have supported the growth of principal investigators who excel primarily as managers absorbing more money. Diagnosis and prognosis research and efforts to individualize treatment have fueled recurrent spurious promises. Risk factor epidemiology has excelled in salami-sliced data-dredged articles with gift authorship and has become adept to dictating policy from spurious evidence.


A NEJM article advocates expanding the five rights of medication ordering (right patient, drug, dose, time, route) to six, requiring prescribers to provide an indication (what the medication is for). The authors say it would reduce errors (where pharmacists might see “hydroxyzine” with an indication of “hypertension,” allowing them to call to see if they really meant “hydralazine”) and to educate patients on what each medication is for. Another strong point for me would be to allow researchers to determine from electronic data sets why a particular drug was chosen, or for payers to be able to detect prescribing without a valid diagnosis or vice versa. Challenges include extra prescriber effort, privacy concerns, how to code (if at all) the indication and how to handle multiple indications, and the system redesign required to handle the extra data element. I’ve been a fan of this idea for many years going back to when it was included on paper standardized order forms and it makes perfect sense. In fact, just as physicians are supposed to be planning discharge upon admission, maybe they should indicate and reaffirm the desired endpoint of the drug prescription, i.e. when might it be stopped based on patient response instead of just putting people on drugs for life with nobody really remembering why, which should be a big help to continuity of care since nobody likes taking responsibility for blindly discontinuing someone else’s order.


I bet attendees of the American Association for Clinical Chemistry could scalp tickets to Monday’s 45-minute talk and the following Q&A by Theranos CEO Elizabeth Holmes. My prediction is that she’ll be so scared and over-coached to avoid referencing information that is proprietary or related to the company’s criminal probe that she will either cancel with a medical or other emergency excuse or will deliver a glossy performance to an audience expecting facts and humility who will rebel at the absence of both. Maybe a black turtleneck is the opposite of a white lab coat. The damage is already done to AACC for inviting her in the first place, as pathologist Geoff Baird, MD, PhD says, “Would you have Al Capone come and talk about his novel accounting practices? Is it acceptable to allow someone to talk about science if they’ve used that science so horribly inappropriately?”


A Florida pediatrics practice mails letters to eight mothers who had criticized it on Facebook, telling them to find a new pediatrician. The mothers were appalled that they were no longer welcome at the business they had flamed, running to the local TV station to complain, with one dramatically telling the reporter in milking her moment in the limelight, “I just started stressing, and I got dizzy, and I fainted” (obviously she’s challenged by the concept of replacing a doctor she didn’t like anyway). Lots of people have courage only of the Internet kind, confidently bold in their online commentary but meekly shamed by its real-life result. The practice – like an accountant, lawyer, or plumber – can choose whoever they want as customers (if only teachers had that same right). This is like writing a Yelp restaurant review complaining that all the food was inedible, and not only that, the portions were too small.

Maybe these folks are goofing on healthcare with all those lame apps out there. Media people swoon, hundreds of people sign up for the email list, and would-be Silicon Valley investors fill the inbox of Pooper, “the Uber for dog poop,” in which app users snap a photo of the dog’s excrement to summon a Prius-driving scooper to clean it up. People keep emailing the company looking for scooper jobs. The app is an elaborate prank from a couple of guys who plan to do more of them, who explain, “We’re going to continue to put content out there that makes people question what they’re reading in the news, what they’re looking at online, and on a deeper level, what their relationship is to technology … people should be thinking about it and questioning what roles apps and the gig economy play in their lives.”

Sponsor Updates

  • KLAS names HealthCast as the top-rated single sign-on vendor in its 2016 midterm report, with the company earning a score of 92.
  • T-System will exhibit at Symposium by the Sea August 4-7 in Naples, FL.
  • Talksoft is rated highest in the KLAS Patient Outreach 2016 Performance Report.
  • TeleTracking will celebrate its 25th anniversary and record-breaking registrations at its annual client conference October 9-12 in Naples, FL.
  • Valence Health Vice President of Market Solutions Ryan Smith contributes an article on hospital employee health plans to Trustee magazine.
  • Huron Consulting Group will exhibit at the Studer Group’s What’s Right in Healthcare Conference August 2-4 in Chicago.
  • ZeOmega publishes a case study on how SignalHealth uses its Jiva HIE to deliver patient information to its provider network.
  • Xerox is a Health 2.0 Ten Year Global Retrospective nominee.
  • Experian Healthcare will host a West Regional User Conference August 4 in San Diego.
  • The local paper features PatientPay in its look at fintech startups in the Research Triangle area of NC.
  • The local business paper cites Peer60 in its profile of Agfa HealthCare.
  • The SSI Group will exhibit at the FHCA Annual Conference & Trade Show August 7-11 in Orlando.
  • Sunquest Information Systems will exhibit at the AACC 2016 Annual Meeting & Clinical Lab Expo July 31-August 4 in Philadelphia.
  • Surescripts will exhibit at the Aprima 2016 User Conference & VAR Summit August 4-6 in Dallas.
  • InterSystems will exhibit at the AACC Annual Scientific Meeting and Clinical Lab Expo July 31-August 4 in Philadelphia.
  • Intelligent Medical Objects will exhibit at Aprima’s 2016 User Conference + VAR Summit August 4-6 in Dallas.
  • Pittsburgh Magazine interviews MedCPU President and Co-Founder Sonia Ben-Yehuda.
  • NEA Powered by Vyne announces the release of version 4.1 of its FastAttach electronic claims attachment health information exchange solution.

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Currently there are "6 comments" on this Article:

  1. Re: Apple patent. Comprehensive data like what’s in the screenshot could only come from an EMR. It would be nice to see additional, significant partnership between Apple and Epic.

  2. Regarding Crozer-Keystone Health System and your question about some employees sharpness, It’s been said ‘You can’t fix stupid’

    These types of mistakes by employees happen with faxes as well. As a result we sell software to scan and filter PHI from faxes.

    Matt Rose

  3. @Publius if you go through the whole patent it seems they have a lot that encompasses the data that would go into that view. Upon first glance over patent it seems that a lot of this info may be patient generated through various other wearble/3rd party sources. The other thing is it seems that a telemed service may be part of this as well, which would have physician input into this system to generate data.

    But to your point, patient portal health data at the very least should be able to feed into an app/program like this for patients from their docs EMR.

  4. I’m frankly surprised Mr HIStalk approved Matt Rose’s comment but can appreciate that he had his reasons.

    While not an expert about e-faxing, I’ve used it in a process analyst role for hospitals going on 6 years. Accordingly, I find his post to be short sighted and somewhat tragic. But, let me start by repeating that I don’t know the market and there may be a big market in this niche – protecting a non-covered entity from the FTC.

    Assuming that healthcare is the market for which Mr. Rose attempts to sell his wares:

    Healthcare organizations and providers need HPI to be on faxes. I won’t buy the argument that because not all faxes have PHI, his software is useful or even marketable. I don’t have all the “fax,” to be sure. But even the best case for his software – origination encryption and destination decryption – fails to find a use case, because that would require all of a customer’s fax recipients use proprietary software or worse.

    Let’s be clear: Stupidity aside, covered entities work very hard to ensure employees are trained. Employees will beech. Hospitals will settle. Mr H will report. The circle of life goes on. I’m not sure Mr Rose’s clever idea will.

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