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Monday Morning Update 11/7/16

November 6, 2016 News 2 Comments

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The Gordon and Betty Moore Foundation awards the non-profit ECRI Institute and its Partnership for Health IT Patient Safety a $3 million, three-year grant to study ways to optimize EHRs while avoiding patient harm.

The foundation said in the announcement, “With the increasing presence of health IT in all aspects of health care, we need to remain mindful of safety issues that are unintended consequences of this new technology. We are happy to see the Partnership advising health IT developers, users, and policymakers on how to optimize technology and avoid patient harm.”

The Partnership previously analyzed patient safety incidents that were reported to ECRI’s patient safety organization and issued recommendations for using copy-and-paste in EHRs. Its advisory panel includes experts such as David Bates, MD, MSc; Peter Pronovost, MD, PhD; Hardeep Singh, MD, PhD; Dean Sittig, PhD; and Paul Tang, MD, MS.

HIStalk Announcements and Requests


Only 20 percent of poll respondents think FHIR will have a lot of impact on interoperability. Cosmos, who works for an EHR vendor, says APIs are like wall sockets in that you can plug in anything and it just works even if you don’t know anything about electricity, with the potential that FHIR can power a new generation of plug-and-play connected health tools. Mobile Man says interoperability has never been a technology problem and ManAboutTown agrees that interoperability will occur only as healthcare’s business models change. Furydelobongo suspects he or she won’t live long enough to see true interoperability where information flows to the point an entry in System A shows up in System B as though it were natively entered there, opining that a unified view isn’t enough. HIT Geek provided a thoughtful response:

FHIR is an API specification. It does not specify how data gets to the API, nor what happens after a corresponding API receives it. Being stateless, it does not support a workflow with state transitions, nor coordination of multiple related actors. The data vocabularies referenced in FHIR, such as clinical code sets, are not controlled within the FHIR standard. The underlying RESTful transport specifications for FHIR are also not controlled within FHIR. The corresponding EMRs, IHRs, and PHRs are outside of the standard, And it says nothing about the end-user interfaces needed to create, read, and update data. The policies and regulations envelope for FHIR is a political and organizational crazy quilt, inhibiting interoperability even if FHIR supports it. Similar things could be said about HL7 v2 and v3, including CDA. While FHIR promises to resolve some technical issues, and that’s certainly a necessary piece of the puzzle, we still have a lot else to do. The referenced and supporting standards for FHIR are relatively easy to coordinate, but will require ongoing effort. FHIR itself will need to evolve to incorporate changes in health care data, also with ongoing effort. Permanent sources of funding for the work, and willing participants, are needed. Volunteerism needs to be obtained from a wider set of sources and disciplines, including patients. Dealing the crazy quilt is the most difficult problem. It’s a whack-a-mole with more moles than whackers.

New poll to your right or here: how well managed did the medical practice where you most recently seen appear to be? Dr. Jayne loves hearing first-person stories, so click Comments after voting and describe what you experienced. 

Jenn is working on a story about telemedicine and would like to hear from doctors who have provided those services. Let me know if you have time for a quick chat (anonymously if you’d rather). We know what a video or telephone visit is like for a patient, but what’s involved on the other side?


Thanks to Optimum Healthcare IT, Validic, and Healthwise for signing up as sponsors of HIStalkapalooza on Monday of HIMSS week. Contact Lorre to join them – I appreciate the help in covering the cost and we can accommodate most any budget.

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Mrs. W says her South Carolina fifth graders used the math games we providing in funding her DonorsChoose grant request to prepare for state testing, adding, “This was by far the most fun and pumped up math review that I have ever been able to lead thanks to your generous donation … Every day they would ask as they walked into class if we were going to get to play the math games that we received thanks to our donor on DonorsChoose.”

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.


Listening: new from Deap Vally, all-female grunge that sounds sort of like Janis Joplin covering Black Sabbath in Courtney Love’s basement. Also: new from Nick Cave & The Bad Seeds.  

Last Week’s Most Interesting News

  • McKesson, Allscripts, and Cerner post disappointing quarterly results.
  • NTT Data completes its acquisition of Dell Services.
  • CMS publishes changes to the EHR Incentive Program that will allow returning participants to use a 90-day reporting period.
  • Athenahealth lays off nearly 150 employees.
  • A hospital in Canada pays doctors extra to keep using its Cerner system after they voice patient safety and productivity concerns.
  • CompuGroup Medical announces its interest in acquiring Agfa.


November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates “stickiness,” and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock


From the Allscripts earnings call:

  • Sales dropped off unexpectedly as clients held off purchases and upgrades in waiting for CMS to publish its final MACRA rule, although the company does not expect MACRA itself to drive incremental software sales.
  • Netsmart’s bookings were down from the previous quarter, which the company attributes to seasonality and deal delays.
  • RCM services bookings were up 90 percent quarter over quarter.
  • The company sees big opportunity in selling RCM services to its ambulatory EHR customers.


Meal planning app vendor Zipongo raises $18 million in a Series B funding round, increasing its total to $28 million. The founder and CEO is Jason Langheier, MD, MPH.


Leidos posts Q3 results: revenue up 44 percent, adjusted EPS $1.25 vs. $0.74, beating earnings expectations but falling short on revenue. Chairman and CEO Roger Krone mentioned the DoD’s MHS Genesis project in explaining that it will contribute lower revenue next year:

I want to make sure that you understand what we said is that relative to revenue, we don’t see the program being delayed. What we’re doing is we’re actually maturing some of the software, we’re conducting some more tests, we’re doing some cyber scans. And so the installation at the first facility will be a few months later than we had anticipated, but the level of activity is essentially the same. And the entire program if you think about deployment to all of the facilities within the Department of Defense will essentially remain on track. So we’ll be a little bit later on the first couple facilities, but we expect to pick that back up as we go into the implementation phase.



The Joint Commission chooses Clinical Architecture’s Symedical terminology management platform for semantic normalization, mapping, and value set creation.


Get Real Health will use technology from Validic to add patient-generated health data to its patient engagement offerings.


  • Missouri Delta Medical Center (MO() will replace Infor with Premier for supply chain management in March 2017.
  • UMass Memorial Medical Center (MA) is underway with a PACS change from Philips to Agfa.
  • Throckmorton County Hospital (TX) changed EHR and revenue cycle systems from CSS Health Technologies to CPSI Evident in January 2016.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.



Lisa Stump is promoted to SVP/CIO of Yale New Haven Health System after holding the interim role since November 2015.

Government and Politics


CMS Acting Administrator Andy Slavitt in a Friday speech to a pharma group expresses his candid opinion about drug prices:

You know, last year when I spoke here, the price increases at Turing were making news, and I told you I didn’t want this industry to be defined by its worst actors. I defended the industry then, but the more data that’s revealed, the more bad actors you find, and I’m telling you now: it’s too many … Drug costs have become the health policy issue Americans are most anxious to see us act on, and we have a responsibility to them to explore all the options available us to make their medications more affordable. I hear occasionally from some that life sciences needs to tell its “value story” better. Perhaps. But it also needs to do the math. If something is growing by 11 percent, unless it’s causing something else to decrease by 12 percent, it’s not going to last forever. The reality is that in the next few years these costs will put unsustainable pressure on the Medicare program and action is going to be necessary to address them.


China-based laboratories are feeding America’s drug addiction by creating new designer opioids faster than the Drug Enforcement Administration can declare them illegal, allowing addicts to buy them semi-legally and inexpensively over the Internet without seeking out street dealers. Several hundred people have died from known popular drugs like U-47700 and various forms of fentanyl. The labs get their recipes from old drug company research papers that describe painkillers that were never marketed. Ironically, U-47700 was studied by drug company Upjohn as a less-addictive painkiller but was never developed because it had the same addictive properties and side effects as other opioids, exactly what the copycat chemists want.

Privacy and Security


In England, Papworth Hospital describes its near-miss with ransomware infection after an employee clicks on a malicious email link, allowing the malware to spread via file shares. The ransomware started encrypting the hospital’s files just after its midnight backup had completed, allowing it to quickly restore its systems from its fresh copy. The hospital changed to hourly incremental backups using tape since ransomware often encrypts backups digital backups along with everything else.



I’m not sure I need to replace my old iPhone 5, but Wired magazine says the Google Pixel is the best smartphone on the market, giving the company perfect timing as Samsung goes up in smoke and Apple putters around with yawn-inducing iPhone tweaks. The Pixel comes with a “Quick Switch Adapter” for moving everything over, includes deep Google integration, charges for seven hours of use in just 15 minutes, offers Google Assistant that sounds smarter than Siri, and provides a best-in-class camera. I may have to check it out at Best Buy since AT&T isn’t selling it yet.



Medical device manufacturer Medtronic donates $5 million to the Patient Safety Movement Foundation to help the organization pool de-identified patient data collected from the devices sold by several companies to improve patient safety via predictive analytics.

MD Anderson Cancer Center will lose $450 million in FY2017 following a $267 million loss in FY2016, according to an internal report obtained by The Cancer Letter. The report blames four factors, starting with the cost of its Epic implementation.


Coulee Medical Center (WA) cancels its Meditech upgrade when the project’s cost swells from the budgeted $1.3 million to at least $4 million. The 25-bed hospital says it didn’t understand the extra costs required for third-party software, with the CEO likening the project to buying “a car without an engine, brakes, or exhaust.” The hospital will keep its existing Meditech system even though it’s on the hook to pay licensing fees for the new system it won’t use.


The local paper says the switch from Hitachi to EMC storage at Fairview Health Services (MN) has caused three crashes of Epic in the past year, the most recent lasting 10 hours.


A new Peer60 reports finds that 90 percent of hospitals have an analytics strategy, but it ranges from a piecemeal approach with multiple vendors to homegrown systems to a single enterprise approach. The short-term replacement market for data visualization and enterprise analytics is significant, but consulting services and data warehouses have less short-term demand. Health Catalyst and Cerner are the strongest healthcare-specific vendors.


A researcher develops a tool to identify which drug companies and universities aren’t publishing the results of their clinical trials, which it determined by matching the studies registered on ClinicalTrials.gov with results published there or in PubMed-covered journals.


The US Marine Corps profiles use of its TMIP-MC battlefield EHR, recently testing during the DoD’s Global Medic joint patient movement and medical field training exercise at Fort McCoy, WI. Information from the training exercise will be used in designing its MHS Genesis replacement.


Sutter Health notifies San Francisco area employers that it won’t offer in-network prices to their employees unless the companies sign an arbitration clause that waives their right to sue Sutter over pricing issues. Healthcare software vendor Castlight Health received one of the letters from its plan administrator Anthem (above) even through it is self-insured and has no direct relationship with Sutter. Castlight’s general counsel says Sutter is flexing its market dominance with prices that are 25 percent higher than those of other hospitals. Castlight hasn’t decided if it will sign the letter, but says declining to do so would allow it to “maintain our flexibility in fighting against what we consider to be difficult, anti-consumer provisions in provider networks.”


Southampton Hospital (NY) bans political conversations in its cardiac rehab gym following an incident in which a treadmill-using patient was stuck between two people arguing over Trump versus Clinton for 15 minutes.

Sponsor Updates

  • Smart Business Magazine includes TeleTracking COO Diane Watson in its “Smart 50” list of executives.
  • TierPoint gains traction in new Gartner DRaaS report.
  • Valence Health will exhibit at the Children’s Hospital Association Annual Leadership Conference November 7-9 in Phoenix.
  • KLAS rates Voalte a top platform vendor for improved care team communication.
  • Huron Consulting Group representatives will present at the Children’s Hospital Association Annual Leadership Conference November 7-9 in Phoenix.

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Currently there are "2 comments" on this Article:

  1. RE: Andy Slavitt’s comment: “life sciences needs to tell its “value story” better. Perhaps. But it also needs to do the math. If something is growing by 11 percent, unless it’s causing something else to decrease by 12 percent, it’s not going to last forever. The reality is that in the next few years these costs will put unsustainable pressure on the Medicare program and action is going to be necessary to address them.”

    I appreciate his thinking and addressing this issue. It will affect ALL of us.

  2. The latest version of Microsoft Word (which I have nicknamed “CDA”) is a little better than the previous one (some might debate that), a lot better than the one I used 10 years ago, even better than WordPerfect on DOS which I used before that, not to mention my IBM Selectric Typewriter.

    Now, suppose you were given a limited budget and resources and tasked with designing and implementing a program to teach basic reading and writing skills on a remote island where people don’t currently do either. Part of your challenge is that their economy is tied to illiteracy, so that the wealthiest and most powerful people on the island have a vested interest in ensuring that nobody learns how to read and write – even though it is clearly in the interest of the vast majority of island inhabitants and would enable them to live longer and healthier lives.

    So… would your first priority be designing and implementing a new word processor version that would require upgrades to super-computers that the government paid for over the past ten years (at an exorbitant cost with terrible ROI) and bribed everyone to deploy all over the island, which are currently being used to do all kinds of stuff that is in the interest of the rich and powerful (who somehow managed to make them actually help block literacy)?

    If so, you are probably reading this in an airport on your way to a convention somewhere in the world where HIMMSSS/Health 9.0/HL7v99/DirectBlocking/Argonot or whoever will be sponsoring a “birds of a feather session” featuring the industry and political celebrities we all know and love – so don’t forget to tweet a picture of the dinner celebration of the 10th anniversary of FHIR (http://wiki.hl7.org/index.php?title=FHIR_Connectathon_10).

    I do believe that any day now there will be a real world implementation of FHIR that could actually help a patient get an electronic copy of their health data that HIPAA says they have a right to get from everywhere, from somewhere…

    Which will, with a little luck, bring us back to where we started…. weezall notta beknowin howabout to reednright sogoodly…

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