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Monday Morning Update 4/24/17

April 23, 2017 News 5 Comments

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US Surgeon General Vivek Murthy, MD, MBA resigns as the Trump administration announces its intentions to replace the ACA-supporting, Obama-appointed physician.

Serving as interim is Deputy Surgeon General Rear Admiral Sylvia Trent-Adams, BSN, RN, MSN, PhD.

Trent-Adams is the first non-physician to hold the role (either as interim or permanent) since veterinarian Robert Whitney served as acting Surgeon General for a few months in 1993. Whitney was at that time the first non-physician to hold the role since its creation in 1871.

Reader Comments


From Obi-Wan 2.0: “Re: HIMSS buying Health 2.0’s conferences. What’s your take?” I’m not sure I have a relevant opinion since, as an enterprise health system IT guy, I just can’t get interested in startups that often feature unoriginal or irrational ideas, spotty execution, questionable leadership, and naiveté about how to sell into health systems if indeed that’s their target market at all. That’s not to say that interesting companies never make it to the next level, only that I don’t waste time following the gaggle until they beat the long odds and actually do it (otherwise, it’s like scouting tee ball games to find future MLB stars). It’s a great exit for the Health 2.0 folks, who matched up with the only potential buyer who had the money and unbridled ambition to buy their conferences since HIMSS has to spend its profit on something relevant to its non-profit mission. In that respect, it’s a poetic ending since most of the companies in their universe dream similarly of finding a willing, deep-pockets buyer (for many of those techno-toddlers, it’s a race to cash out before the wheels come off). Matthew Holt and Indu Subaiya presumably get deservedly rich, while their ragtag band of pink socks-wearing, self-proclaimed disruptors who cling together seeking relevance among far bigger players are left to wonder whether they will find a comfortable home within Diamond Member-fawning HIMSS, the odds of which are not favorable. I’m not clear on what happens with the remaining parts of Health 2.0, or in fact what those parts actually are.


From Conga Dipper: “Re: Medhost. I doubt its website visitors are fluent in translating nursing benefits from Lorem Ipsum filler text.” Maybe it’s a sales message for prospects in Latin America.

From TxHIT45: “Re: MedStar. Interesting idea mixing ride-sharing and healthcare in this way.” Inexpert HIT fanboy site writers often misstate a hospital’s “partnership” with Uber for patient rides home as though it were hot technology news (failing to see that it’s no different than giving patients a cab company’s telephone number), but this is a bit more interesting. A Texas ambulance service’s nurses are triaging 911 calls and sending low-acuity callers a Lyft ride instead. It costs $450 to roll an ambulance, while that same amount covered all of the 38 Lyft rides it substituted in February. At least that’s a small step in trying to manage costs incurred by people who visit the ED for non-emergent conditions for a variety of reasons, some of them rational only because our healthcare “system” is anything but.

From Oregonian: “Re: Mid-Columbia Medical Center’s layoffs due to losses. The additional $3 million in unpaid debt appears to be due to legacy AR write downs as a result of the audit, which has nothing to do with what rev cycle product is being installed.”


From Reluctant Epic User: “Re: the MUMPS programming language. Made it to the top of Hacker News a few weeks ago with a lot of talk about Epic and Meditech. The 176 comments make common complaints that we’re mostly already aware of, but some of the defenders raise interesting points as well.” Some of the points made:

  • All variables are global and are named with a maximum of six capital letters.
  • Meditech writes all of its own languages, databases, operating systems, and tools.
  • Meditech’s new programming hires, most of whom aren’t computer science majors, go through a 6-12 month training program that allows them to succeed at Meditech, but they are stuck there because experience in a company’s proprietary language isn’t worth much elsewhere (a similar situation holds true for Epic developers, another commenter says).
  • “I find Epic to be more horrifying than Meditech because Epic has somehow managed to convince many healthcare workers that it is a ‘modern’ product worthy of praise despite all evidence to the contrary. People talk about SmartPhrases like it’s some miracle instead of a damn snippets manager (and a bad one at that). The fact that they’re moving away from VB6 to a web-based front-end in 2017 should be reason enough to assume that whatever they come out with is going to be excruciating.”
  • “The MUMPS codebase I worked on in the 80s was so fragile that deleting a single global string could cause the whole system to break down in ways that required a restore from backups. Don’t ask me how I know that.”
  • “A MUMPS program tends to be an unreadable mess to anybody who hasn’t touched it in the last 30 seconds.”
  • “I’m very, very happy to not be using this language any more. After my first year on the job, I read some JavaScript code and I nearly wept at how comparatively beautiful it was.”
  • “The tech stack was a real resume killer. I still get contacted by recruiters desperate for MUMPS developers and they make me feel like someone trapped inside a house besieged by zombies. I get really quiet and hope they don’t break any windows.”
  • “Companies like Epic are why healthcare costs in the US are huge and growing. Epic never refactors anything that still works well enough to hold together with some expensive human labor. It is a technology company that runs on well-trained people instead of well-designed code and processes.”
  • “I found Epic MUMPS to be remarkably readable. Lots and lots of documentation, quite consistent coding standards, and although I would have preferred to write SQL queries rather than MUMPS routines, I didn’t find it that abhorrent.”

From Big Data Hard Times: “Re: Atigeo. The analytics software firm seems to have been hit by hard times, listing 95 employees in April 2016 and now listing only 49. That seems to be the wrong direction for a company that received $18.5 million in VC investment in late 2015. I’m looking to including them as part of the vendor pool our hospital is looking at, but won’t if they are headed for the big data crunch in the sky.” Unverified. The company was founded in 2005, has received funding only through a Series B round, and lists no customers or recent sales on its site. The company’s “About” page grandly describes it as, “Atigeo is a compassionate technology company for a wiser planet,” which makes me think that maybe too much of that Series B money went toward hokey marketing. The company’s excessive tweeting dried up to nothing in October 2016, suggesting that something happened then (I like to think that the corporate tweeter was the “wiser planet” hack and the company wised up to their prior lack of supervision).

HIStalk Announcements and Requests


About half of poll respondents have volunteered to give up their seats on flights. Me being one, which worked great the two times my offer was accepted (most recently, I got a $400 voucher for giving up a seat to take a flight just three hours later). One reader recommended going for cash, not a voucher, and trying to wangle a first-class upgrade. Nick longs for the good old days when airlines sometimes offered a voucher good for a ticket to any domestic destination served by the airline. Everyone seems to agree that if you can get a seat on another flight that leaves shortly, or if you can choose a nearby airport and drive to your destination, it’s a pretty good deal.

New poll to your right or here: what will be the VA’s biggest challenge if it decides to implement Cerner or Epic?

Grammar peeve: the innumerable folks who write sentences such as, “The building houses 10 different companies,” apparently believing readers require the redundant clarification of “different” to comprehend that it’s not 10 of the same company.

Vocational dissonance: the puzzlement that results from trying to reconcile the lofty accomplishments and skills claimed by someone on their inflated, largely fictional LinkedIn profile with first-person knowledge that suggests far more modest capabilities.

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We funded the DonorsChoose grant request of Mrs. O in Texas, who asked for programmable robots and electronics kits for her library maker space. She reports, “The technology that was donated is really helping my students become independent problem solvers. My students are learning to work with one another and most importantly communicate effectively with one another in order to learn how the new technologies work. Students come to the library in the mornings for about 50 minutes of maker space time and I give them the opportunity to use all the different technology. I provide a risk-free learning environment and give them this time to engage in creative play, but they don’t realize that they are really learning because they are having so much fun! Surprisingly, more girls than boys are attending the maker space technology days. I am really impressed that the girls are really drawn to creating things with the Little Bits.”

Listening: new from Chris Cornell, who in addition to his solo career is also lead singer and songwriter for both Soundgarden and Audioslave. He has an amazing voice and his compositions are strong.

This Week in Health IT History


One year ago:

  • Federal prosecutors launch a criminal investigation to determine whether Theranos misled investors about the state of its technology and operations.
  • UnitedHealth Group pulls its plans from ACA exchanges, citing $1 billion in losses.
  • CMS announces that it will hold off on publishing quality ratings for hospitals for several weeks amid questions from healthcare providers and Congress over its methodology.
  • Five-hospital health system Centra (VA) contracts with Cerner to replace EHRs in use at each of its hospitals and 50 ambulatory and long-term care facilities.
  • New York insurer EmblemHealth lays off 250 IT and operations employees after contracting with Cognizant to modernize its IT systems.

4-19-2012 4-20-06 PM

Five years ago:

  • Cerner CEO Neal Patterson makes the cover of Forbes in a piece called Obamacare Billionaires.
  • Mediware closes its $2.2 million acquisition of Cyto Management System, an oncology management system.
  • Thomson Reuters announces it will sell its healthcare unit to Veritas Capital for $1.25 billion in cash.
  • Liverpool Heart and Chest Hospital chooses Allscripts Sunrise, the company’s first sale to a UK trust.

Weekly Anonymous Question

I asked respondents to describe the most patient-endangering IT issue they’ve seen personally, with these responses:

  • Medication reconciliation that isn’t a priority, done well, or enforced.
  • The usability of patient identity functions being so bad in a new EHR that the front desk just defaulted to making a new patient record and let HIM sort it out. Who then … didn’t. We found it later in trying to do analytics in support of an ACO.
  • The way that our major commercial EMR vendor handles medications. When you make an adjustment in the med dose without issuing a new script, there is absolutely no way to show that as part of the formal medication history.
  • At a previous hospital, we had a EHR from a vendor whose name starts with Mc. It was mixing up sigs on medications, literally assigning them to the wrong patient and med in the database. Issue was quickly discovered and software was declared unfit for use and was yanked.
  • On an old system no longer in use, there was not any logic not to prevent a new line in the middle of a medication dose. It happened leaving ‘0.’ on the line above and 10 beginning the next line. It was not until a patient was injured and a very competent nurse was devastated during root cause analysis that this issue came to light. At the time there was a comment about the "stupid nurse," which made my blood boil.
  • Wrong med given due to system having order on wrong patient.
  • Lab labels generating on the wrong patients.
  • Oh, my God, this one still causes me panic. Zero-day architectural decision in erx by people with no concern for safety or even basic understanding of the practice of medicine caused the wrong prescription to be created, depending on how a medication was ordered. The mistake was invisible to physicians in the UX, due to yet *another* terrible design decision. Two patients received scripts that would have killed them, one was caught by the doctor who thankfully double-checked the printed rx, the other by the pharmacist.
  • Lack of a singular and accurate person identifier across all systems.
  • Letting unqualified people do patient merges.
  • Malfunctioning IV pump used (on me), supposedly to deliver much-needed pain medication after emergency orthopedic surgery.
  • Upper EMR managers: "If it saves the physician one click, nobody cares about the downstream effects to <insert department>.” Do the customization.
  • CPOE architecture that required only selection of a single generic name as the drug product despite the directions (it’s too hard for physicians to select a specific product or dosage form). The product would be automatically selected by the CPOE system. The first item alphabetically would always be selected, so for instance, all fentanyl orders would be sent as Fentanyl 100 mcg/hr patch whether instructions were 50 mcg IV q1h prn, patch, PCA.
  • Allowing entry of orders prior to allergy entry.
  • Suppressing all physician alerts. Everyone ELSE needs to deal with allergies, duplicates, and order requirements.
  • Endless customization and lack of standardization. It might seem like a great idea to have a zillion versions of the same thing and have unseen programming operating in the background, but it is not.
  • Implementation of an inpatient EHR that included a pharmacy and MAR application, where the MAR had incorrect doses listed.


This week’s question: If you are a former or current individual HIMSS member who either considered quitting or actually did so, what led to your decision?

Last Week’s Most Interesting News

  • Alphabet’s life sciences business Verily launches its Project Baseline initiative, a four-year project to create a database that will be used to look for early warning indicators for a variety of illnesses.
  • AMA introduces a web-based EHR training tool developed by Regenstrief Institute that uses the de-identified records of 11,000 patients with built-in medical histories going back as far as 40 years.
  • Theranos settles its ongoing legal battles with CMS over unsafe practices at its Newark and California labs and settles its legal battles with the Arizona Attorney General, agreeing to issue a full refund to all 175,000 Arizona residents who received Theranos blood tests.
  • The Phoenix VA Medical Center announces plans to partner with CVS to expand coverage locations, including local MinuteClinics.
  • HHS Secretary Tom Price, MD announces the availability of $485 million in state grants for combatting the opioid epidemic.


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.

April 28 (Friday) 1:00 ET. “3 Secrets to Leadership Success for Women in Health IT.” Sponsored by HIStalk. Presenters: Nancy Ham, CEO, WebPT; Liz Johnson, MS, FAAN, FCHIME, FHIMSS, CHCIO, RN-BC CIO, Acute Care Hospitals & Applied Clinical Informatics – Tenet Healthcare. Join long-time C-level executives Liz Johnson and Nancy Ham as they share insights from nearly three decades of navigating successful healthcare careers, share strategies for empowering colleagues to pursue leadership opportunities, and discuss building diverse executive teams. This webinar is geared toward female managers and leaders in healthcare IT seeking to further develop their professional careers. It’s also intended for colleagues, executives, and HR personnel who are looking to employ supportive techniques that ensure diversity in the workplace.

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

Acquisitions, Funding, Business, and Stock


A hedge fund that is suing Theranos deposes 22 former company employees or directors who told it:

  • Theranos formed a shell corporation to buy commercial lab equipment from companies like Siemens, then modified the machines to run its proprietary finger-stick blood samples.
  • The company ran fake investor demonstrations of what it claimed was its innovative technology that was actually equipment sold by other companies.
  • The company’s financial projections for investors that called for $1 billion of annual profit in 2015 were vastly different from similar estimates provided to the IRS just two months later, which estimated $100 million in 2015 annual profit.



Stephens County Hospital (GA) will deploy Wellsoft’s EDIS including clinical documentation, CPOE, patient tracking, results reporting, and charge capture.



Voalte founder Trey Lauderdale returns to the CEO role. Former CEO Adam McMullin has left the company after a year “to pursue other opportunities.”

Announcements and Implementations


Video visit provider PlushCare launches Lemur, the telehealth EHR used by its 50 doctors. The announcement (and the fact that the company felt compelled to make one) suggests that PlushCare is commercializing its EHR, but I think it’s actually just pointless PR puffery in describing its internal-only product.

TransUnion Healthcare adds a prior authorization solution to its patient access offerings and enhances its existing eligibility product.


In Saudi Arabia, King Faisal Specialist Hospital and Research Center goes live on GetWellNetwork’s in-room interactive patient services.

RadmediX launches its urgent care digital radiology solutions.

Privacy and Security


Computer systems of Erie County Medical Center (NY) remain down following an April 9 ransomware attack. 


A patient seeks class action status for her lawsuit against virtual visit vendor MDLive, which claims that the company’s app sends an average of 60 screenshots per visit to an Israel-based app performance testing company.

A proposed class action lawsuit claims that Bose’s wireless headphone app collects the music listening habits of users and that the company then then sells that information to other companies.

Government and Politics

Some AMIA members participated in Saturday’s March for Science in Washington, DC and other locations, which depending on your point of view was created to: (a) protest the Trump administration’s policies; (b) highlight scientific acccomplishment; or (c) influence the government keep taxpayer dollars flowing into the pockets of scientists via federal research grants.

Innovation and Research

Atlanta NPR reviews blockchain in healthcare, with the CEO of one personal health record startup unconvincingly explaining why she’s trying to duplicate the health record storage practices of Estonia, 95 percent of which involves blockchain. A blockchain-related vendor disagrees in saying that blockchain isn’t good at storing large amounts of data, instead suggesting that its healthcare use focus on storing digital signatures of patient records to maintain an access log of who has viewed them.

Apple hires Steven Keating, the MIT mechanical engineering PhD who is best known for creating a 3-D printed image of his own since-excised brain tumor (he’s still on chemo). He described in a conference presentation last week that he learned from his experience in collecting 75 gigabytes of his own health information (his “medical selfie”) that it’s hard for patients to obtain their own data:

My doctors are incredible for sharing my data and encouraging me to learn more from it. However, the process raised some questions for me, as I received my data on 30 CDs, without easy tools to understand, learn, or share, and there was no genetic data included. Why CDs? Why limited access for patients to their own data? Can we have a simple, standardized share button at the hospital? Where is the Google Maps, Facebook, or Dropbox for health? It needs to be simple, understandable, and easy, as small barriers add up quickly. Imagine having your whole medical record that you could not only share with doctors and scientists but also with friends and family, too. Patients could get second opinions very easily, and doctors can follow what leaders in the field are doing.



The dean of Stanford’s medical school says that “innovation is at the algorithmic level,” predicting that significant medical and health advancements will be driven primarily by the ability to interpret huge datasets.


Kaiser Permanente Chairman and CEO Bernard Tyson tells the Nashville Health Care Council that the future isn’t in “heads in the beds,” but rather in virtual visits. He asked the 300-plus attendees how many of them can do as he can in pulling up their medical record on their phones, which resulted in fewer than a dozen raised hands. Tyson also says KP is mimicking the Starbucks concept of community and coffee in creating buildings that provide walking paths, healthy foods, and areas where people can study and share health information. 


A Reaction survey finds that nearly half of McKesson customers didn’t know that the company was spinning off its IT business with Change Healthcare, although both customers and non-customers were neutral about the potential effects and nearly no respondents say they’re more likely to buy products from the new company.

Bizarre: men are signing up for telemedicine visits using false IDs just to flash their video-connected doctors. Sherpaa says people have sent its doctors more than 30 unrequested penis photos, while American Well explains that as with face-to-face medical visits, the solution is to ban problematic patients and to verify all IDs by credit card. A guy must really be desperate to showcase his package to unwitting viewers if he’s willing to pay telemedicine fees to do so. Armed with this newfound knowledge, I’m sensing a business opportunity in creating an app that matches pervs to people willing to look at their private parts for cash (my working name is Glory Telehole).


A doctor in England faces suspension for looking up a patient’s personal details in her medical record; using her information to contact her to suggest having sex with him to help restore sensation in her genitals that had been reduced by multiple sclerosis; and then discouraging her from researching her condition in assuring her, “Trust me, I’m a doctor.” The married urologist’s version of the story is that the woman asked him for sex.

Vince and Elise review physician practice EHR vendors. I would, however, be cautious about assuming that each vendor’s client base can be inferred by the number of MU user attestations, especially given vendors like Epic that have relatively few (but also relatively large) health system customers that have lots of doctors as employees and affiliates.

Sponsor Updates

  • TierPoint completes its most recent round of HIPAA, PCI-DSS, GLBA, and SOC 2 Type II annual compliance audits.
  • ZeOmega introduces the Jiva Consultant Certification Program.
  • Employees of Clinical Computer Systems, Inc. raise $10,500 for the March of Dimes annual fundraising walk.
  • Visage Imaging will exhibit at ConHIT April 25-27 in Berlin.
  • First Databank Senior Director of Clinical Knowledge Charles Lee, MD will present the company’s recently acquired Meducation solution at Health Datapalooza this week.
  • ZeOmega will exhibit at Health Integrated Empower April 26-28 in St. Petersburg, FL.
  • ZirMed publishes a new infographic, “Riding the Sea of Change.”
  • Spok posts a case study of Hospital for Special Surgery’s use of Care Connect for medical, gas, and fire alarm alerting.

Blog Posts


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Currently there are "5 comments" on this Article:

  1. I think I just got whiplash from the cognitive dissonance in this comment: “The tech stack was a real resume killer. I still get contacted by recruiters desperate for MUMPS developers….”

  2. A nurse in a surgeon’s gown! Simply another depreciation of physicians by a White House making up the real truth.

  3. Re: Atigeo. I looked into the website copy given your comment “that maybe too much of that Series B money went toward hokey marketing.” Clearly this is a case of not enough money went into marketing. The copy is what I frequently see written by founders or product managers in love with their product, writing for investors not buyers, with excessive use of jargon, over-promises and assertions that would make any corporate lawyer cringe on internal review (but they probably didn’t review the pages with one). The use of the word “scale” and “impact” on the home page are the first clues that they did not “leverage” an experiened B2B marketer to assist with messaging. So many phrases are delete-worthy and would be off-putting to most buyers, but my favorites are: “Our premier software platform…makes all data in organizations and ecosystems accessible and secure for discovery, insight, and innovation.” (All, really?). The statement that their platform “is the fastest, highest performing, and lowest risk way to build intelligent big data applications” is an overpromise that would make potential buyers doubt. In addition to using “game-changing” several times, there also was a promise to “assure optimal outcomes.”

    This sentence was just stuck in mid-paragraph, clearly after the fact as it didn’t fit the context: “Most importantly though, we want to make a positive difference in people’s lives.” I loved the resounding yet unnecessary quote from HR: ” The people here at Atigeo are among the very best! I love being surrounded by such intelligent and hardworking people.”

    I think some simpler, honest-sounding (aka clear) copy that addresses their buyers’ problems would help them get more inbound inquiries to learn more – which should be their website’s first goal. Save the company-centric bragging for the investor roadshow presentation. Unfortunately this site probably prevents potential relationships with wary healthcare execs who have dealt with early stage analytics companies and their exuberant promises before.

  4. I don’t know if this is getting traction back home, but Epic’s having a mess of a time with its program in Denmark. This is about the 5th story in local papers since February. There have been massive access and registration issues, the Epic system has deleted prescriptions and as described has also over/under dosed scripts that were filled by patients. The oncologists and some physician heads have been very vocal re: patient safety and usefulness of the system. Lots of eyes on this rollout with national tenders planned or in process in Sweden, Norway and Finland.


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Recent Comments

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  2. The thing I'm focusing on are the department(s) these have hit: Marketing & Customer Experience. The database community has believed…

  3. How Cerner fumbles VA and rolls out at DHA without issue, and Congress to my knowledge doesn't as why, so…

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  5. That BH ER experience matches mine even years before the pandemic - went in with a suicidal friend, and they…


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