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March 21, 2017 News 18 Comments

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President Trump appoints former US Rep. John Fleming, MD (R-LA) as deputy assistant secretary for health technology. That’s apparently a newly created HHS position whose connection to ONC has not been stated.

The 65-year-old Fleming says his understanding of the job is as a champion for innovation, describing his goals of improving EHR productivity, spurring EHR vendor competition, paying doctors to use technology, and reducing physician administrative burden.

Fleming tells Politico that he thought he was interviewing for the National Coordinator job, but says of the one he took, “I think it’s the same or a similar position – I really don’t know.”

Fleming lost his Senate bid in 2016 after an eight-year term as Congressman, finishing fifth in the primary after giving up his House seat to run. He has criticized the Affordable Care Act as “the most dangerous piece of legislation ever passed in Congress.” The former Navy doctor also owns 36 Subway sandwich shops and suggests that he plans to eventually return to Louisiana politics.

Reader Comments

From Not from Monterey: “Re: patient self-scheduling as mentioned in the Jim Higgins interview. I want to turn on patient self-scheduling for our site, which will use Cerner’s own patient portal and integrates with Cerner’s Scheduling product, but I’d love to hear about other sites’ experiences with patient self-scheduling. As Jim mentions, this is a patient satisfier that can easily be botched, both internally and externally. Heck, I’d love to hear from Epic sites about this. Who is doing this well?”


From Bandana: “Re: Welltok. Quietly laid off 100 employees last week from the Silverlink acquisition.” A company spokesperson responded to my inquiry: “I can confirm that this information is factually incorrect. In full transparency, we did transition out a handful of individuals from the company last week. At the same time, we also proactively hired a handful as well. This business decision was made to reduce duplicative roles within our organization and maximize resources so that we can stay focused on our collective mission – to empower consumers to achieve their optimal health.” Consumer health rewards vendor Welltok acquired Silverlink, which offered consumer communications technology, in December 2015.


From Grab Them By the Headline: “Re: your favorite HIMSS-owned publication. I’m sending them a thesaurus to help them find words other than ‘grabs’ and ‘nabs’ for their re-worded press releases about company funding.” I don’t read their site, but Googling makes it obvious that they over-use those annoying, child-like verbs in describing equity investments. It’s not like those companies are stealing a cookie from the plate and running away, nor does health IT need to be a Bat-fight full of “Kapow! Blam! Powie!” I can never tell whether their goal is to attract a less-intelligent audience or to diminish the collective IQ of the one they already have.

From Confused: “Re: blockchain. I’m looking for a layman’s primer, preferably with real-world healthcare examples.” I’ll invite readers to suggest resources they have found useful as an introduction.

HIStalk Announcements and Requests

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We funded the DonorsChoose grant request of Mrs. S in South Carolina, who asked for spelling games and an organizer. She reports, “My students were overjoyed to hear that others care about them enough to contribute to their classroom and education without even meeting them. This is such a sweet reminder to them of the good in the world. The rolling cart provides my students with an organized way to access their word work materials and the board games are an excellent addition to that.”


March 29 (Wednesday) 1:00 ET. “Improving patient outcomes with smartphones: UW Medicine Valley Medical Center’s story.” Sponsored by Voalte. Presenters: James Jones, MBA, MSN, VP of patient care services and nursing operations, UW Medicine Valley Medical Center; Wayne Manuel, MBA, SVP of strategic services, UW Medicine Valley Medical Center. UW Medicine Valley Medical Center dramatically improved patient outcomes after moving to a smartphone-based platform for clinical communication and alarm and alert notification. Before-and-after analysis shows a reduction in hospital-acquired pressure ulcers and skin integrity events, fall and slip events, and medication errors. By limiting overhead paging, the medical center also created a calmer, quieter environment and improved engagement among nursing and hospitalists. Hospital executives will describe their experience and vision for the future in addressing quality, cost, and the patient-caregiver experience.

April 26 (Wednesday) 1:00 ET. “SSM Integrated Health Technologies Clinical Data Migration: Functional and Technical Considerations.” Sponsored by Galen Healthcare Solutions. Presenters: Sandy Winklemann, MHA, RHIA, project manager, SSM Integration Health Technologies; Tyler Mawyer, MHA, managing consultant, Galen Healthcare Solutions; Kavon Kaboli, MPH, senior consultant, Galen Healthcare Solutions. GE Centricity and Meditech to Epic EHR transition. Join us for a complimentary webinar as present the decisions that are important to consider when performing a clinical data migration from the point of view of  the healthcare organization program manager, the clinical analyst, and the technical implementation team. Our expert panel will survey data migration considerations, best practices, and lessons learned. The webinar will present a unique client perspective, offering insight into considerations surrounding staffing, clinical mapping, legacy application support, and validation and testing.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock


Ivenix closes a $50 million equity financing round that will allow the company to pursue FDA approval to market its Ivenix Infusion System smart IV pump.



Coffeyville Regional Medical Center (KS) will upgrade to Meditech’s Web EHR.



Laboratory-focused analytics vendor Viewics hires Keith Laughman (TRG Healthcare) as CEO. He replaces co-founder Dhiren Bhatia, who will move to chief strategy officer.

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Operations planning platform vendor Hospital IQ hires Paris Lovett, MD, MBA (Thomas Jefferson University) as chief medical officer; Jason Harber (TeleTracking Technologies) as VP of product management; and Cheryle Cushion (OneCloud Software) as VP of marketing.

Announcements and Implementations


IBM announces a public, cloud-based service for creating blockchain networks based on the Linux Foundation’s open source Hyperledger Fabric. The starter plan and beta are free, while the business network subscription costs $10,000 per month for four peers and a certificate authority on IBM LinuxOne. The first customer is Canada-based SecureKey Technologies, which is developing a consumer digital identity network and has as investors Canada’s leading banks.

Mercy goes live on the Visage 7 Enterprise Imaging Platform, replacing nine imaging systems used by over 50 locations in less than six months.

GetWellNetwork launches the Person Engagement Index, an 18-question survey that assigns each patient a score representing their capacity to participate in their care. The score can be used by individual clinicians to decide how to educate and engage patients, by care managers to improve risk stratification, and by marketing people to tailor their communication messages.

AHIMA publishes a good brief on enhancing HIM practices to support LGBT populations that includes:

  • Making sure both partners sign provider HIPAA forms.
  • Suggesting that partners share each other’s patient portal log-ins.
  • Allow patients to submit pre-visit information via the patient portal to alleviate privacy concerns in sharing the information at registration.
  • Allow patients to list their preferred name and gender along with the legal versions.
  • Allow lab reference ranges to be modified by gender, such as in the case of someone undergoing a female-to-male reassignment.
  • Add EHR fields for gender identify, sexual orientation, sex assigned at birth, and organ inventory.

Government and Politics


The government of India responds to complaints about the drug supply chain and illegal Internet sales by proposing to require drug manufacturers to register on a new online portal and enter all of their sales there, including the drug’s batch number, quantity, and expiration date, with the pharmacy receiving the drug shipment also being required create an entry on the site. Pharmacists would also have to record each drug prescription on the site and include prescriber and pharmacist information, and for some drugs, the patient’s information. Hospitals would also have to record all medication dispensing activity, including details of any adverse reactions. 


An opinion piece in The HIll says the American Optometric Association is lobbying hard to support state laws that would prohibit online vision tests, not because they don’t work, but because they don’t provide in-office optometrists a chance to upsell new, high-markup glasses or contacts. AOA spent $1.8 million on lobbying in 2016. The target of much of the optometrists’ wrath is Opternative, which offers a $40, 15-minute online refractive test that includes a prescription for glasses or contacts.


ONC updates its SAFER Guides, best practices driven self-assessment tools and templates that allow medical practices to review their EHRs for patient safety issues.

Privacy and Security


Metropolitan Urology Group (WI) announces that basic, pre-2010 patient information was exposed in a November 2016 ransomware attack.

A journal essay questions why the NHS signed a deal with Google-owned DeepMind for kidney injury alerting, noting that Google gains access to patient information without sufficient controls being spelled out in the contract. It also notes that UK law requires patient consent for sending their data to a third party, and while kidney patients are covered by a patient care relationship, DeepMind was given the data of every patient admitted to Royal Free London NHS Foundation Trust over five years without the consent of those patients. It concludes,

The 2015–16 deal between a subsidiary of the world’s largest advertising company and a major hospital trust in Britain’s centralized public health service should serve as a cautionary tale and a call to attention. Through the vehicle of a promise both grand and diffuse––of a streaming app that will deliver critical alerts and actionable analytics on kidney disease now, and the health of all citizens in the future––Google DeepMind has entered the healthcare market. It has done so without any health-specific domain expertise, but with a potent combination of prestige, patronage, and the promise of progress. Networks of information now rule our professional and personal lives. These are principally owned and controlled by a handful of US companies … If these born-digital companies are afforded the opportunity to extend these networks into other domains of life, they will limit competition there, too. This is what is at stake with Google DeepMind being given unfettered, unexamined access to population-wide health datasets. It will build, own, and control networks of knowledge about disease.

Innovation and Research


The Miami paper describes the health IT project involvement of Miami Children’s Health System (FL), which includes investment, internal development, and pilot projects with accelerator startups.

The American College of Cardiology reports on the multi-center “Genetic InFormatics Trial (GIFT) of Warfarin Therapy to Prevent DVT,” which concludes that dosing the blood-thinning drug based on patient genotype reduced complications by 27 percent vs. the usual method of starting the patient on 5 mg daily and then titrating to INR results. The computer-based, real-time interface estimates the dose and provides recommendations  for adjustment based on other patient factors. The lead author expresses hope that EHR vendors will add genetic and clinical dosing algorithms to their systems to suggest doses early in the ordering process.



Banner Health says the two Tucson, AZ hospitals it acquired in 2015 in absorbing the former University of Arizona Health Network lost $89 million in 2016, will lose $45 million this year, and will require $30 million to be converted to Banner’s Cerner system. The Tucson hospitals went live on a $115 million Epic project in 2013. The 28-hospital Banner, which is Arizona’s largest private employer, is trying to reduce its corporate service department expense by $65 million this year.  

In New Zealand, the health board blames its since-replaced computer system after discovering that critical radiology results that were viewed but not acknowledged would disappear from the physician’s inbox. A woman died of cancer when her doctor took a quick look at a new X-ray showing a lung mass in 2013, but then left for vacation with plans to contact the patient when she returned. When the doctor came back to work, the alert had disappeared and she forgot to follow up. The woman died of cancer in 2015 without having been contacted about her lung mass.


A study finds that hospital death rates drop during the week of unannounced Joint Commission inspections compared to the three weeks before or after. The authors conclude that hospital employees pay more attention to patient care when inspectors are observing them.


Politico ehealth editor and author Arthur Allen writes a nice piece – which may turn out to be a fond eulogy or celebration of life kind of thing – about the VA’s VistA system that seems sure to be mothballed soon in favor of a commercial replacement. I’m intentionally not calling VistA an EHR as I usually do since it does far more than that and maybe that’s important in this context – I’m pretty sure the VA will need more than just Cerner or Epic to replace VistA since has many non-clinical modules. Allen makes the broader point that perhaps the decisions about VistA over the years illustrate “just how difficult it can be for the government to handle innovation in its midst.”  Most fascinating is that the “Hardhats” who built VistA in a skunkworks project were subjected to open hostility from the centralization-obsessed VA, its IT contractors, and unknown folks who fired or transferred them, sabotaged their computers, and at one point, unwittingly symbolically tried to burn their stacks of programming printouts in a computer room by lighting paper medical records on fire.


Forbes publishes its annual list of billionaires, with Epic’s Judy Faulkner coming in at #867 with $2.4 billion. The “healthcare” section is littered with drug company and medical device billionaires, which might suggest where the excess profits generated by sick people accrue. Snapchat’s Evan Spiegel is the youngest self-made billionaire at 26 years old, joined by his Snap co-billionaires and the 20-something guys who started Ireland-based credit card processing firm Stripe.


I’d like to say it could never happen here, but lately I’m not so sure. India sees three examples of the family members of patients attacking clinicians. Family members of patient who later died beat a government hospital doctor with chairs, rods, and scissors when he recommends taking the patient to a tertiary care hospital to see a neurosurgeon. The relatives of a man who died of swine flu attack a doctor and nurse. Finally, a first-year resident is beaten up by the family of a 60-year-old woman who died of chronic kidney disease. Doctors say attack mobs are a problem only in state hospitals since private hospitals don’t accept desperately ill patients and also don’t allow more than one visitor at a time, limitations that state hospitals aren’t allowed to impose.

Sponsor Updates

  • Agfa Healthcare releases a video compilation of its time at ECR 2017.
  • Arcadia Healthcare Solutions will exhibit at the annual AMGA Conference March 22-25 in Grapevine, TX.
  • QuadraMed Patient Identity Solutions, a division of Harris Healthcare, announces that the QuadraMed EMPI has earned the top 2016 EMPI ranking from Black Book Research.
  • Besler Consulting’s DeLicia Maynard will speak at the Annual Hospital/Physician Collaborative Meeting March 22 in Lancaster, PA.
  • Bottomline Technologies will exhibit at the Health Care Compliance Association Annual Compliance Institute March 26-29 in National Harbor, MD.
  • Carevive Systems will exhibit at the NCCN Annual Conference March 23-24 in Orlando.
  • CompuGroup Medical will exhibit at CLMA KnowledgeLab 2017 March 26-29 in Nashville.
  • The Connecticut Technology Council names Diameter Health Chief Data Scientist Chun Li a finalist for its 2017 Women of Innovation Award.
  • ECG Management Consultants will exhibit at ACHE’s Congress on Healthcare Leadership March 25-30 in Chicago.
  • EClinicalWorks and Evariant will exhibit at AMGA March 22-25 in Grapevine, TX.
  • The NFL and GE partner to advance understanding and treatment of concussions.
  • Consulting Magazine recognizes The HCI Group’s Stephen Tokarz as one of the “Rising Starts of the Profession” in the healthcare category for 2017.
  • Healthwise exhibits at Ehealth Initiative’s annual conference March 21-22 in Washington, DC.

Blog Posts


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Currently there are "18 comments" on this Article:

  1. RE: President Trump appoints former US Rep. John Fleming, MD (R-LA) as deputy assistant secretary for health technology..…a newly created HHS position whose connection to ONC has not been stated.
    According to Fleming’s understanding of the job description, it includes “spurring EHR vendor competition and paying doctors to use technology. Would LOVE to know how that will all play out!

    Fleming tells Politico that he thought he was interviewing for the National Coordinator job, but says of the one he took, “I think it’s the same or a similar position – I really don’t know.”
    ARE YOU KIDDING ME? Did I really read that?

    I’m not even going to mention the rest of his ‘credits’, but it scares me that people like this are anywhere near politics and affecting our government, not to mention HIT. Pass the Subway sandwiches, please!

    • You read that right. And Tillerson said yesterday he had planned on retiring next month and spending the rest of his years playing with his grandchildren, but he was offered Secretary of State and his wife told him he had to take the job. SECRETARY OF STATE. Nothing important riding on *that* job or anything!

        • I think I’m going to start applying for random C-level positions now. I won’t even bother to read the job description, apparently skill, credentials, or even knowing what the job is don’t matter anymore. Seems to be working out well for these dudes. ¯\_(ツ)_/¯

  2. Re: blockchain

    It’s just a fancy ledger that’s decentralized (meaning no one entity controls it; everyone that participates in it can see it and update it) and that cannot be changed retroactively (you can’t cook the books; once a change is made, everyone knows about it and it can’t be unmade). The details that make it work are complicated, but the idea is simple. It’s used for cryptocurrency. Think what it would be like if every bank used the same common register for all their accounts, every bank kept a record of all the changes, etc.

    In EMR I guess you could use it in a similar way to keep track of every single change to every single record. And you wouldn’t have to worry about the records being lost or corrupted (assuming the algorithm has been properly vetted).

  3. Now you’ve done it. The Batman reference has that trumpet thing, used to segue from place to place, earworming through my head.

    “To the Batcave!”


  4. The topic on self scheduling is something that we have been hearing about in the field with clients a lot with great interest in making this happen. However, from what we have been able to discern, it does not appear to be on any vendor’s agenda nor do their tools and portals seem truly capable of being capable of doing anything but “messenger model” requests for scheduling rather than actual scheduling. Getting more feedback from those out there working on this would be really interesting – especially given MACRA’s ACI and API access requirements (just one small item that is related) to see if we really are ready to support real open access for patients to their physicians and related services (why shouldn’t you be able to schedule a referred imaging service or complex lab?).

    • We discussed self-scheduling & self-registration when we opened our breast care center. The problems surround data integrity & data quality. I still have to have a registrar validate the information provided by the patient, so I don’t see any productivity gain. If I trust the patient to enter information correctly and bill without validation, I risk not getting paid and having to correct the account to re-bill, which negates my savings on not having the registrar.

      I’d love to be able to let patients do some of their own data management, but if trained people can’t reliably get a high level of data integrity on the first try (the reason we implemented a registration accuracy monitoring system), I can’t trust the general public to do so.

    • Self-scheduling is definitly out there. I personally schedule all my primary care visits through MyChart either on the web or via the iPhone app. My HMO also allows me to schedule things like routine eye exams this way. I can’t schedule my own specialty visits, though. Basically anything that doesn’t require a referral can be scheduled directly. And I don’t think my provider organization is a unique Epic customer. My understanding is that most Epic organizations are allowing their patients to schedule some appointments directly (not via scheduling requests).

  5. RE: New Zealand error. Does anyone know which EHR? My guess is Orion, but what a scary situation. I think like “safe harbor” for nurses. Doctors and nurses should be able to call a national “safe EHR harbor” for malfunctioning EHRs.

  6. My cynical view of blockchain is that it’s an interesting technology that tech companies are shopping around to different industries to see if it fits anywhere. Could it fit into healthcare? Probably, although the touted benefits could have been solved a dozen different ways already and the industry chose not to do so. I don’t think it’s very likely that the EHR vendors will rework their core systems to incorporate this, nor do I think it likely that providers will choose to spend their thin margins on something that solves a problem only tech people and compliance complains about. Can you imagine being that CIO making the pitch for blockchain to your board? Good luck even describing it…

    • Continuing the blockchain conversation that @DrM and @dysF(n) started on this comments page…

      I understand how blockchain works as a technology, but I don’t understand how it is going to fit into the current healthcare infrastructure workflow. It seems like a completely new infrastructure system to me. Is it something that will talk to my current systems or something that my current systems must implement internally? Or is it yet another centralized 3rd party thing that I have to pay for? Will the IBM version be compatible with the PokitDok version? Or will I need to run both? How will the patients interact with this? Who manages them?

      I am not sure what I am missing. To me – and I could be wrong – it seems like yet another marketing fad like FHIR, Health Exchanges and CCDs. Something that really could possibly change healthcare information exchange, but in reality very few are actually going to implement with their existing technology infrastructure.

    • Referencing blockchain, I just don’t get it. Not at all! And not just healthcare either, blockchain itself seems to have become the latest buzzword designed to stir up excitement.

      I’ve been around a long time and I’ve been interested in many technologies that either fizzled completely or achieved only modest success: RFID, SOA, Grid, CASE, Objects, XML, KM, …

      Blockchain is the one idea that doesn’t connect with me at all. It all just sounds like so much hype.

      • I think it’s kind of like thinking about quantum computing. What impact will it have? Potentially a huge one. Is it going to change anything about what we’re documenting with the tools we currently have? Not in any way I can imagine.

  7. re:GIFT trial and Coumadin dosing. Medicare wouldn’t pay for warfarin-based genotyping and this trial doesnt really seem to make the case any stronger. Basically fewer people ended up having INR>4; the rates of major bleeding and DVT/PE were the same in both groups, and (thankfully) nobody died in either group. I dont think this makes the case for personalized medicine in warfarin dosing.

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