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Monday Morning Update 8/22/16

August 21, 2016 News 10 Comments

Top News


OCR announces that it will extend its regional office investigations to breaches that involve the information of fewer than 500 people. It previously reviewed those small breaches only as resources allowed. Regional offices will pay extra attention to even small-scale incidents if they involve data theft, hacking of IT systems, or repeated breaches of a given covered entity or business associate.

Reader Comments

From Pondering CIO: “Re: Epic. We recently selected them and are pursing Epic hosting. I have been quite amazed at the terms they require! (not that I wasn’t surprised at the software terms.) This is a big issue for us. Do you have feedback from other new hosting customers? Thanks for any input you can offer!” Readers with Epic hosting experience are welcome to respond – I will forward your comments to Pondering CIO.

From Fire Jose: “Re: KLAS. Many hospital CIOs (like me) and vendors alike call it the KLAS Tax. Vendors had to pay it or risk being left off of hospital CIO vendor short lists. Then vendors called me and prompted me with incentives to rate them with high KLAS scores, which I usually did for some enhancement. Widely accepted: KLAS was the industry kingmaker of the vendors with the deepest pockets. Also, buying the Best in KLAS vendor product was the equivalent of buying IBM since as the hospital CIO, I wouldn’t get fired for selecting it even when system implementation went bad and over budget. BUT FOR THE BETTER health IT rating transparency has shifted, with clearer methodologies in the last 3-4 years. We witnessed over and over that CIO/CFO peer satisfaction commentaries are not  the best indicators of IT success, especially in complex hospital systems replacing EHRs. Organizational satisfaction among all departments must be considered carefully, not just my peer CIO input on a scale of 1-10 on how I felt that particular day about a vendor. Black Book mostly but also Peer60 and Chilmark are gaining great popularity over KLAS because they offer fresh, broader user perspectives. These competitors all have flaws, don’t get me wrong. But now we see rating firms that are stepping up to the evolving needs of healthcare buyers in 2016 and not the marketing needs of vendors.”

HIStalk Announcements and Requests


An unusually large number of poll respondents weighed in on the question of whether we should all care what vendors like Epic and Cerner spend on their campuses, with nearly two-thirds saying their reaction is negative because it’s mostly non-profit hospitals footing the bill. Some comments from respondents:

  • The glitzy Epic campus really doesn’t do much for employees. After the first six weeks, all I ever saw was the inside of airplanes and conference rooms. I question whether I even needed a dedicated office since I was somewhere else more than I was there. The money spent on buildings (especially single-use auditoriums) could have been spent on development or hiring more staff to serve customers.
  • We’re competing for talent. Firms like Cerner, Epic, and Athena that exclusively serve healthcare need to make the work environment attractive like other innovative tech companies.
  • I have seen some very elegant hospitals with the sole intent to be visually appealing to their patients.
  • Have you guys even seen Cerner’s campuses? They are nowhere near as over-the-top as Epic’s. No-nonsense cubicle farms and data centers surrounded by seas of asphalt. Several look like something that came out of “Office Space,” not a Dr. Seuss book.
  • After a trip to Madison for 1.5 days of training to get "certified" (a four-hour class when it’s all boiled down without breaks and YouTube vids) paid for by my safety-net hospital, all I could think was, I wonder why healthcare costs are rising? As an employed or contracted worker in more than a dozen hospitals, I’ve worked in basements with rodents, dripping water, leaking sewers, fleas, bathrooms from the 1950s, and bad HVAC, but never in palatial quarters like Epic.

New poll to your right or here: should hospitals be required to charge cash-paying patients the lowest prices they accept from any insurer?


Peer60 polled C-level health system IT executives (mostly CIOs and CMIOs) this month to determine the reach, influence, and usefulness of the six major health IT news publications and sites. The five-question poll found that HIStalk is:

  • #1 most read
  • #1 most influential
  • #1 in generating interest about companies
  • #1 in providing information most useful for job performance
  • #1 most recommended by executives to others

I’m most proud of the results from the “personal job performance” question above, of course, since it’s just me vs. those corporate-run sites that have a bunch of employees. Thanks to those who responded and to everybody who reads. You might wonder why the graph above shows only five publications instead of the six surveyed – surprisingly, one fairly visible site didn’t even register with the executive respondents.

I’ll acknowledge the poll results by starting my annual “new sponsor special” early. It’s like a once-per-year Pledge Week for healthcare IT vendors who want to support what I do and who don’t put it off until right before HIMSS when I’m super busy. Contact Lorre, who will also have HIStalkapalooza information soon.

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We funded the DonorsChoose grant request of Ms. B in Maryland, whose kindergartners needed an iPad Mini for literacy work (her low-income area school has a large number of refugees and English as a Second Language students). She reports that they have only two pieces of technology in the classroom and they’re using the iPad for letter identification, rhyming, and math exercises, even pairing up during playtime so they can keep working. She concludes, “Thank you so much for helping move our classroom forward by providing this engaging learning tool. It not only teaches them academic concepts and skills, but allows them to become more comfortable with the technology that the whole world now relies on. We thank you for adding this piece to our routine and our day.”

Last Week’s Most Interesting News

  • The FTC resolves its patient privacy complaint against Practice Fusion by imposing oversight and requirements for its posting of patient doctor reviews to its Patient Fusion review site.
  • A security firm notes a rapid rise in infections by more sophisticated versions of the Locky ransomware, with US healthcare organizations being the hardest hit.
  • An op-ed piece in JAMA says EHRs haven’t kept up with the technologies used in other industries, offering specific recommendations of how they could improve.
  • Leidos closes its merger with Lockheed Martin’s Information Systems & Global Solutions business.
  • Bon Secours Health System (VA) notifies 665,000 patients that a revenue cycle contractor’s mistake exposed their information to anyone performing an Internet search.
  • Patient advocate and Aetna director of innovation labs Jess Jacobs dies.


August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

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

Acquisitions, Funding, Business, and Stock


Cisco will lay off 5,500 employees.


The federal government awards Agfa HealthCare a 10-year, $768 million contract for diagnostic imaging, extending its DINS-PACS win streak to four. 


Harris acquires Nashville-based DigiChart, which offers EHR/PM for OB/GYN practices. It’s a bit confusing since DigiChart changed its name to Artemis in 2013 after years of news that mostly involved layoffs and refocusing, but the former Artemis website now brings up a Windows IIS welcome page that suggests that the rebranding was meekly acknowledged as another strategic misstep (although the DigiChart page is still titled “Artemis | DigiChart”). Canada-based Harris’s stable of faded US health IT stars includes Picis, QuadraMed, NextGen’s hospital EHR business, and OptumInsight’s CareTracker.



SAP names Thomas Laur (Sutherland Healthcare Solutions) as president of its recently created Connected Health group.


D. A. Henderson, MD, MPH, an epidemiologist who led the 10-year effort to eradicate smallpox and afterward served as dean of what is now the Johns Hopkins Bloomberg School of Public Health, died Friday. He was 87.

Announcements and Implementations


A Peer60 report on the impact of the Brexit vote finds that a strong majority of hospital leaders believe it will be negative for healthcare, especially in terms of staffing. They don’t buy the pitch that Brexit will free up government funds that will be redirected to NHS as “leave” proponents claimed. Nearly half of respondents expect IT spending to be cut, with more than half of respondents expecting to upgrade their Allscripts, Meditech, SystemC, Orion, and Graphnet CareCentrix EPR systems less frequently, while only CSC and CaMIS were the only PAS systems named by more than 50 percent of respondents as being less likely to be upgraded.

Privacy and Security


From DataBreaches.net:

  • The Outer Banks Hospital (NC) announces that two unencrypted thumb drives containing the information of an unspecified number patients treated over 12 years at a recently acquired cardiopulmonary rebab practice are missing.

I’ve read several theories about the recent proliferation of ransomware and here’s mine. Bitcoin became more popular and easier to buy, giving hackers a way to collect their extortion funds anonymously and quickly (you can’t charge extortion to a credit card). I’ve heard unverified reports that hospitals are proactively opening bitcoin accounts or identifying local bitcoin-dispensing ATMs just in case they get hit with ransomware.



A Dallas paper visits for-profit Texas General Hospital — which charges more than 10 times the Medicare payment rate and accepts no commercial insurance — and finds it nearly empty, with no patients and almost no staff. The four-year-old hospital accepts Medicare and Medicaid, but makes most of its profit billing out-of-network insurance companies for patient services and hoping they pay. The article describes a patient whose doctor said his foot surgery would cost $5,200 but who didn’t warn him that Texas General Hospital is out of network for his insurance, leaving him with a “please pay this amount” bill of $332,000. Pakistan-born surgeon Hasan Hashmi, MD opened the hospital with his son, spending $85 million in claiming that his goal is to provide care to the underserved.


This graph is making the social media rounds, showing just how much the US spends on health vs. the fact that we trail other developed nations in life expectancy. My thoughts:

  • We are the only country in which healthcare is a free-wheeling, mostly for-profit business that costs more here than anywhere. We pay more for drugs than any other country and use more of them besides.
  • Lobbyists don’t stroke politicians to earn support for public health. There’s no money in prevention.
  • I would bet that a lot of our reduced lifespan comes from economic disparity, lack of access to prenatal care, violence, and an economy and generous government assistance that support life-shortening behaviors such as smoking, overeating, lack of exercise, and drug use.
  • The cost figure is probably increased by heroic, expensive interventions that extend life at poor quality and require a lifetime of special care. It’s expensive to add years of life spent on a ventilator or with around-the-clock medical care provided by for-profit business.
  • We’ve entrusted much of our health outcomes to hospitals, which have performed poorly yet expensively in prolonging life other than for emergency care and surgical intervention.
  • We have developed a culture in which our medical expenses are someone else’s problem, our care is delivered mostly by businesses rather than family, and we pay piecework for endless tests, prescriptions, and surgeries in hopes of a quick fix that is easier than a lifestyle change.
  • Like all graphs that fail to show the zero value of the Y-axis in order to exaggerate their message, the difference isn’t as dramatic as it appears. US life expectancy is 79 years vs. the top value of just over 83.
  • The graph begs the question of whether we should spend less or expect more, and if it’s the latter, who should be held responsible?

Here’s Part 3 of “Rating the Ratings” from Vince and Elise, this time covering Black Book and Peer60. 

Weird News Andy is nuts about a story he titles “Entertaining Mammal Salvation.” A Connecticut EMS crew extracts a squirrel whose head had become stuck in a plastic cup, freeing up their new bro-dent pal for other endeavors.

Sponsor Updates


  • GetWellNetwork sponsors the Day at the Beach for Special Surfers that benefits challenged athletes in San Diego County, CA.
  • AdvancedMD opens registration for its annual conference EVO16, to be held October 11-12 in Salt Lake City, UT.
  • Vital Images will exhibit at HIMSS Asia-Pac August 23-26 in Bangkok.

Blog Posts


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Currently there are "10 comments" on this Article:

  1. Re: Healthcare spending
    I get agitated when I see the articles stating that the US spends more and gets less from their healthcare dollar than other nations. I agree with your points illustrating why our spend per outcome is so high. No other country has the access we do, nowhere can a patient direct as much of their care as in the US, I know of nowhere else a patient can stroll into an ER with a sore throat and get seen, we as a society take pills for every ill and as you point out those pills cost more in the US than nearly anywhere else in the world. Regardless of what everyone has to say about cost, this is where they come when they need advanced care. Other than to save money I have not observed a large quantity of people going to any other nation for complex cases. Also, as you point out we go to extreme measures to preserve life spending the bulk of our healthcare dollars in the last part of life. The articles and comments on the high spend in the US should focus less on quality (we have good quality) and more on why we have created a system that allows such waste.

  2. Considering what Epic pulls with their contracts, I would be very skeptical about Epic hosting data. They already search your employees for “black listed” people (aka people who have not waited out their non-competes or left Epic on not-so-good terms). Do you really want them hosting your data when they pull the stuff they do?

  3. We’re going through an Epic Hosting consideration. They seem to be building the tracks with the engine on it. No one from the Epic side seems to have figured out the business and they’re being really defensive. Now, they probably get away with things in their software contract because they’ve been successful. They don’t have that on the hosting side. Frankly, it’s kind of scary, but my leadership seems to think we’ll come out a head.

    Their hosting team really needs to make a decision: are they going offer hosting as a business or are they just dabbling. If they’re dabbling, they shouldn’t be setting their customers expectations up like this. If they’re not dabbling, they need to bring in people with hosting experience.

  4. Texas General is a Trubridge client (aka CPSI). Several people there refuse to bill for them because they don’t want to be liable when the Feds shut down that whole sketchy operation.

  5. Re: Hosting

    Our experience has been that Epic’s in over its head with hosting. I have several pieces of advice, and can share the most critical. Really, though, this is advice you should follow for any vendor.

    First, be very upfront about your interests with regards to any 3rd party interoperability you anticipate needing, particularly if it’s with an Epic competitor where there might be sensitivities about hosting the 3rd party’s software on Epic-hosted hardware. Epic’s gotten their pants pulled down in a big way over this, and I still don’t feel like they know what they don’t know. There may be workarounds that avoid the problem by not requiring those components to be installed on Epic hardware, but there might not. Don’t get into any agreement with them where you aren’t protected if they can’t do something that would be no problem for you to do if you ran Epic on your own hardware.

    Second, be skeptical of who you talk to. My feeling is that the leaders we’ve talked to when there have been hosting issues have never done the day to day work of administering Epic before. It’s a problem I’ve been seeing about Epic more generally that escalated issues are delegated to people that have been selected more for skill in telling you no, and how you’re wrong for wanting something, than in any skill with the application you’re inquiring about. This is more problematic on the hosting side, since they haven’t developed anywhere near the maturity that they have on the software side.

    Lastly, if you’re at the point where you’re committed, have some faith in Epic. Just have even more in yourself. They reached a point of maturity with the software. My impression from colleagues that have worked with Epic over the years is that they’re struggling mightily with growing pains, and that the quickness their reputation was built on isn’t really there anymore. This doesn’t necessarily mean doom, though. It does mean that you have to work much, much harder to achieve the same results. You should be attuned to the power structure there, how to get things done, and to be relentless in calling Judy and Carl (since that is the power structure in a nutshell).

  6. KLAS was the 800 lb gorilla 5 years ago. Now we get competitive intelligence for our IDN vendors from Blackbook research firm and benchmarks from HIMSS.

  7. Just wanted to reply to GE, in particular the point that patients come to the US for complex care. There’s been a recurring meme that patients from Canada routinely flood across the border for more immediate and higher quality care in US hospitals. When a large IDN that I worked for which has several hospitals along the border tried to prove this out with admissions data, they found the number of Canadian inpatients to be negligible. Same for outpatient cardiac and ortho. Could be that they were going somewhere else, maybe our exorbitant self-pay prices driving the unicorns elsewhere, couldn’t tell from the data. Also see how many self-insured large employers are happily sending employees offshore for hearts, hips and and knees, and take a look at the hospitals that are now in production in the middle east – their reported quality metrics and costs blow away most US provider systems. Second point: countries with universal coverage have far greater access than the US population as a whole – to think that the vast majority of uninsured have access to the full force of the for-profit US system is at best naïve.

  8. Re: Healthcare spending
    I usually note that the United States has a healthcare industry, not a government run healthcare system, but are the costs in the places where we DO have a system (Medicare, VA) significantly different from the costs for private health?

  9. Re: Fire Jose

    So let’s review for a minute, you’re saying that you took bribes as CIO to falsely present your ratings of products to KLAS. [pause] *sigh [*** shaking head profusely ***]. Regardless of your lack of integrity, let’s look at some of your other comments. You recommend 3 other peer review research companies for their “fresh” perspective while already pointing out that CIO’s lie in those evaluations. Now, I’ve heard of good experiences with peer60, but all I’ve ever heard about black book is that due to their background in outsourcing they tend to be heavily weighted to vendors that do a lot of outsourcing. If you want to spend lots of hours on a foreign tech support line, be over budget on your large implementation, and end up with a less than stellar implementation than by all means seek out Black Book’s advice. The fatal flaw in their methodology is that clinicians, hospital executives, IT specialists, and front line implementation veterans are all polled. On the surface this sounds good, but they don’t seem to CONTROL for mix with in these results. For example, for one vendor all of the front line implementation veterans could respond and those veterans have a a strong incentive to push for their vendor as in many cases that’s their job on the line. In other cases, that vendor’s implementation specialists either don’t respond or are too busy doing real work to respond.

  10. Re: Pondering CIO

    With a mission to bring quality health care to patients everywhere, Mercy, a non-profit health system headquartered near St. Louis, hosts Epic for several external partner healthcare organizations. We run Epic for our nearly 50 hospitals, 300+ clinics and have invested heavily in a sophisticated data center complete with healthcare-level security and have the capacity, expertise, and processes in place to help other healthcare organizations. We’d love to talk with you about your needs: https://www.mercy.net/form/contact-mercy-technology-services.

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

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  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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