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Monday Morning Update 7/24/17

July 23, 2017 News 15 Comments

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A Nuance investor disclosure announcement on Friday says the company has not yet fully restored all of its cloud-based systems that went offline in a June 27 malware attack.

Nuance warns that its financial results for Q3 – of which the malware incident impacted only the final week – will suffer, with expected revenue of $485-489 million instead of the previously estimated $500-$504 million. The company expects to lose $0.11 to $0.09 per share in the quarter instead of its previously estimated loss of $0.07 to $0..05. The Q3 results will be posted on August 8.

Nuance says its Q4 results will also be negatively impacted from the outage, mostly related to its HIM transcription services business.


Nuance added that it hopes to restore services within two weeks to all customers of its EScription LH back-end transcription system for large hospitals.

Shares of Nuance Communications fell briefly in pre-market trading following Friday morning’s announcement, but closed up 2 percent. They’re up 6.5 percent in the past year but down 18 percent in the past five.

One might speculate that it’s going to be a rough Q4 for Nuance if just one week of Q3 downtime whacked $15 million off the company’s quarterly revenue — the outage on some significant systems has extended three weeks into Q4 and won’t be fully resolved for at least two more weeks.

Reader Comments


From Firm Mattress: “Re: your HIT index. I took the liberty of scoring the top 10 of last year’s #HIT100. The low scores seem about right to me.” My scoring method tries to quantify how I assess someone’s healthcare credibility from their LinkedIn profile in looking at healthcare-specific education and accomplishments. I place zero value on social media influence. Twitter is a great way to showcase someone’s deep knowledge and thoughtful opinions (I’m thinking of people like Andy Slavitt and Eric Topol), but it’s also a medium embraced by those with few other accomplishments or possessing light credentials for rendering opinions on complex topics who just retweet stuff other people came up with. My problem with the HIT100 and similar recognition is that some people desperately seek it as validation in the absence of other achievements and brag about winning like it actually means something. To which I would ask in rudely re-introducing the real world into the discussion: how many of Modern Healthcare’s “100 most influential people in healthcare” have followed you, retweeted you, contacted you personally, or offered you a job? You earn cool points, however, for being on the list without ever having mentioned it in pandering for votes or bragging on being named. Feel free to poke holes in my scoring method or the reader’s application of it above. I’m tempted to assign points for military service, particularly in a healthcare or leadership role, since I value that pretty highly in someone’s bio.


My final thought about self-confidence vs. knowledge and experience applies to all of us  — I’m uncomfortably aware of how well this describes me at times.

From Aphasian: “Re: HIMSS conference. We need a good marketing idea that will generate buzz in Las Vegas.” Obtain a picketing permit from the city and hire pamphlet-passing shills to carry protest signs on the public sidewalk  –your “protest” should involve your product or service.

HIStalk Announcements and Requests


Poll respondents say the only industry awards that are significant are KLAS and the Davies, but even then, “none of the above” wins the grand prize. Reader Dewey, Cheatham & Howe looks at methodology: “Most Wired is an online form. Completing the form is labor intensive, but not difficult or vetted. If people can (and do) lie about their MU attestations, then what do you think you are getting with Most Wired? KLAS has skilled interviewers and they try to remove bias, but it is easily gamed. HIMSS EMRAM Stage 6 uses same methodology as Most Wired — little to no validation. HIMSS Stage 7 is different because it requires a site visit by experienced surveyors. HIMSS Davies requires a write-up with validation. As for the rest, I assume they are conducted with little or no pre-survey modeling of measurement criteria or post survey review of bias.”

I’ve overseen several “Most Wired” wins in the health systems I’ve worked for, but a comment from the cynical manager I assigned to complete our entry one year best summed up the form’s self-attesting ambiguity: “It’s not what we actually do, it’s how badly you want us to win.” Nobody in IT thought the Most Wired award meant anything at all since the responses allow wiggle room and our job was to support the health system instead of worrying about pointless awards, but we did feel some responsibility after the first win to keep applying. Nobody wants to be the health system that falls off the list – even voluntarily – from one year to the next. Organizations give awards and recipients proudly accept them for entirely self-serving reasons.

New poll to your right or here: which company’s stock would you buy if forced to choose one?


Welcome to new HIStalk Platinum Sponsor Redox. The Madison, WI-based company was founded in 2014 with the belief that EHR vendors can’t solve healthcare interoperability. The company’s API allows innovators the ability to code once, connect to all. It uses cutting edge methods such as HTTPS, JSON, and OAuth to create a modern Web experience without digging into HL7, FHIR, CCD, or DICOM. The company’s integration experts know how to get data into and out of EHRs using scalable integration strategies, enabling both software vendors and providers to integrate their apps, exchange information with affiliates, and commercialize innovation. Redox has already connected hundreds of enterprise applications. It monitors and maintains interfaces 24/7; expedites pilot testing; streamlines referral management, population health, and analytics; and creates a build-once environment that fuels innovation and scalability. The company also integrates wearables and home medical devices with EHRs and data warehouses; connects payors to providers; and integrates remote patient monitoring and telehealth services with medical groups and EHRs. Thanks to Redox for supporting HIStalk.

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We funded the DonorsChoose teacher grant request of Mr. S in California, who asked for a Chromebook for his second grade class. He reports that the students are using it for online math practice, graphing, virtual field trips, and geography look-ups using Google Maps.


I noted that Nuance’s status updates contain the same infuriating error that I see in endless emails in claiming that a stated time is “EST.” There’s no such thing until November 5, when our clocks are turned back from “EDT,” or if you can’t be bothered to understand what the rest of us get, then just write “ET” and we’ll figure it out for you. The same folks are often confused by time zones and have to confirm for scheduled calls, “What time is it where you are?” to which I’ll provide this invaluable advice: just type “time in Phoenix” or “time in London“ in a Google search box and it will tell you in engaging zero of your brain cells. Daylight Saving Time is illogical, but that doesn’t mean you can just ignore how it works.

This Week in Health IT History

One year ago:

  • University of Mississippi Medical Center agrees to pay $2.75 million to settle HIPAA charges related to the theft of an unencrypted laptop and discovery of an unsecured PHI-containing database.
  • Athenahealth announces that EVP/COO Ed Park will leave his position.
  • CTG CEO Cliff Bleustein, MD resigns.
  • Kate Granger MBChB, MBE, the NHS geriatrician who created the “Hello, my name is” campaign that urge clinicians to introduce themselves to patients before treating them, dies of cancer at 34.

Five years ago:

  • IRobot announces its first healthcare robot.
  • Shares of Quality Systems (NextGen) drop 33 percent after a poor quarterly report and the loss of long-term customer HMA.
  • The Commonwealth Fund announces former National Coordinator David Blumenthal, MD as its next president.

Ten years ago:

  • Several companies bid for struggling NPfIT contractor iSoft.
  • Mediware shuts down its OR product line to focus on “closed-loop systems.”
  • Misys exits the healthcare business by selling its lab, pharmacy, and radiology software business to Vista Equity Partners and its Misys CPR product to QuadraMed, with both acquiring companies agreeing to support the Misys Connect strategy.
  • Picis announces its intention to acquire ED revenue cycle software vendor Lynx Medical Systems.

Weekly Anonymous Reader Question

Responses to last week’s question:


  • My boss knows me at a professional level and we do some small talk. He lives across the country, so we do not have any off-work interaction.
  • None. I try to have as little interaction as possible with her at work, let alone socially.
  • Zippo. They have no interest to ask, and I have zero interest to share. Best that way.
  • He knows of my family , no names. No social interaction besides Christmas party, and there is no family allowed in the building.
  • Not at all, and that’s the way I like it. I learned some hard lessons about being too familiar with management, and now I draw a hard line between my personal and professional relationships.
  • None.
  • I have found that my bosses have never really known much about me and my family socially, and we have had minimal interactions outside of work, and never outside of work events. For me, this led to some burnout because they were unaware of everything I was juggling. Because of that, as a boss myself, I’ve made an effort to know my team members and their family’s because it helps everyone perform better. If I know that you’re stressed because you have a particular family issue going on, it let’s me step in to help out at work to relieve some of the work stressors. When people feel like you care about them for more than just doing the work you need done, morale is higher and performance improves. And bottom line, part of being a leader is hopping into the trenches with folks and working side by side with them, which you can’t do unless you know what’s going on outside of the four walls of your office.
  • We have zero off-work interaction. Frankly, we barely have on-work interaction. He is chronically late to our scheduled 1:1 calls and sometimes doesn’t show up at all. Something “more important” always seems to be coming up. I know I’m one of the top ranked members of his team and I’m generally self-sufficient, but there’s no way he’s ever going to do any professional development work with me if he can’t even show up on calls. BTW, it’s not just me he does this with. Upper management should be appalled but no one seems to care.
  • He doesn’t. None. We spend so much time together during the week that we need to NOT see each other on the weekends. Same is true for our entire executive team. It is healthier that way. We get along just fine. Seeing more of each other would not be healthy then work would not creep but barge it’s way into the weekend.
  • Working with my boss for the past 18 months, he has never met any of my family members. As a remote worker, off-work social interaction with my peers and boss does not occur. My company does not value this interaction with its remote workers; however, it does value this interaction with on-site office staff. Perhaps my company cannot justify the cost associated with social interaction with the families of its remote workers.
  • I’m a remote employee, so “not at all” and “none”.
  • Learned the hard way during my time at McKesson, MPT, that letting work and family mix is not always the best idea. When times got tough, I would hear things like, “You better work harder and sell more or you won’t be able to provide for your children.” And then refer to them by name and even what activities that they might not be able to do because we wouldn’t be able to afford it.
  • All previous bosses took time to know me and my family within the first month of starting the position. We have a small team of six, so it is not hard to remember kids’ names and estimated ages. My current boss is in her third year and still has no idea what my kids’ names are. She avoids off-work interactions like the plague. Happy hour? No. Team building exercises during off hours? Absolutely not. On going team member conversation in the break room? No eye contact. To say the least, it is tough to work at a level of 110 percent to make someone look good who doesn’t know your kids’ names. I have always believed interpersonal skills are imperative in leadership and my current boss reinforces it that belief.
  • No off-work interaction. We share normal chit-chat in the office, names of spouses/kids, school activities, etc., but that’s it.
  • We don’t do anything socially or have any off-work interaction, nor is this encouraged or discouraged by the organization. I started my career with a consultancy who did an excellent job of pulling family into social activities throughout the year. In the 30 years since then, not really something my employers (hospitals, health plans) cared about.
  • We had lunch the day I started. Otherwise, boss refuses to engage socially. No interaction.
  • We don’t discuss family. Dogs, occasionally. There is minimal interaction outside of work and only incidental to work. Considering the question in terms of bosses I’ve had in the past, there have been some that really did care about everybody and everyone’s family. Would see them routinely out of work and even at their homes on holidays. Made work-life at the time enjoyable, sometimes a little too personal, and I can’t say the team was any more effective then ones I have participated on where this is not the case.
  • Zero interaction with family or personal life. I live on the east coast, she lives on the west. I’m a telecommuter.
  • Somewhat, but I would say 80% business.
  • Well enough to think he knows a lot, which makes him happy, but he really doesn’t and it’s going to stay that way. He uses what he knows in weird and uncomfortable ways so additional sharing is off the table. It creates some awkward situations if he’s prying for more, but handling that is a better trade off than the alternative.
  • My boss knows very little about me outside of work and that is the way I want it to be. Work life is work life and personal life is personal – separate from each other. Consequently, I spend zero time outside of work with my boss.
  • No social interaction at all, and that is fine with me ~ like the boundaries!


This week’s question: What drives you crazy about the person at work who annoys you the most?

Last Week’s Most Interesting News

  • Athenahealth’s quarterly results beat expectations even as the company is dogged by an activitist investor and its CFO leaves the company for another healthcare IT company.
  • Google Glass is revived as X Glass Enterprise Edition, with healthcare one of the targeted industries.
  • Epic’s first full-suite implementation in Canada goes live.
  • The DoD’s second MHS Genesis pilot site goes live on Cerner.
  • Emids acquires Encore Health Resources.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Acquisitions, Funding, Business, and Stock

From the Athenahealth earnings call, following results that sent shares up 8 percent on Friday:

  • The company says enterprise software competitors can’t duplicate its recently launched work reduction guarantee for independent medical groups that differentiates its cloud-based services model.
  • CMS has approved the company to received adjudicated Medicare claims data as a Qualified Entity, which it says will allow it to build up a scalable hospital service that can pre-populate information without requiring redundant data entry. Jonathan Bush says, “Athena will be the only company with an EMR that actually has medical records in it before you type them in.” He also describes the claims information containing 98 million patient records as a “data asset.”
  • The replacement CFO search will focus on a “demonstrated record of operating discipline and value-creating capital allocation” who can analyze the potential return on investment of every company project as more of a COO and portfolio manager instead of just handling financial controls and accounting management.
  • The company says it is winning 80 percent of the deals it goes after, the highest in its history.
  • Bush says the company has a very high win rate in community hospitals, #1 in net hospital wins according to KLAS, mostly because they need systems quickly without using capital budget to improve cash flow. Still, he admits that the hospital business isn’t yet profitable and it represents the company’s shallowest product offering.
  • Bush says the company’s recent $63 million acquisition of Praxify gives it modern technology that can containerize future app development as the aging AthenaNet platform is re-architected in “an intense crisis level of reconstruction.”
  • Bush says electronic data interchange makes implementations tougher, especially in hospitals. “Hospitals will show up at the door with lab systems written before my children were born. Someday we’ll get the courage to say, here’s the app store. Buy any of these lab systems. We’ll pay, but we’re not connecting to that MUMPS-based museum piece.”
  • Bush says the CMS-certified Qualified Entity application required completing a 700-page application and was completed only because the Trump administration changed the data sampling requirements. He adds that CMS is not technically ready to meet the requirements: “The government is on some very tired systems. So are the contractors. We understand that the way we will receive this data is they will send us a drive in a padded envelop by certified mail. We have people on eBay now looking for machines that can receive this drive.”
  • Bush says of population health management, “Population health is population surveillance outreach, population engagement, and population love. Every health system needs to find out what population thinks of them as a prospective provider of choice and love on them in a digital continuous way rather than waiting for them to be the path to the hospital parking garage. As we get our population health clients to agree to that approach, we get a much bigger bite of their patient population and get much more traction.”



  • Boca Raton Regional Hospital (FL) will go live on Cerner in August 2017.
  • Monroe Community Hospital (NY) will go live on Healthmedx Vision in August 2017.
  • Gerald Champion Regional Medical Center (NM) will go live on Cerner CommunityWorks in August 2017.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Part 3 of Vince’s HIS-tory of Cerner from a few years back covers how the company’s name was chosen (and by whom), stock performance, and how its lab system became #1 by the late 1980s.

Sponsor Updates

  • Over 500 Mazars employees volunteer at community organizations in six states for its third annual “Days of Service.”
  • ZappRx releases a new podcast, “It’s Hard to Prescribe Specialty Drugs.”
  • Audacious Inquiry founder and managing partner Chris Brandt is named an Aspen Institute health innovator fellow.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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Currently there are "15 comments" on this Article:

  1. For a publication, audience and author that apparently doesn’t care about awards, a shit load of attention has been paid to the totally irrelevant HIT100 here

      • Where’s the methodology that @HeDothProtestTooMuch references and the ‘scoring tool’ that @HIT Realist notes? I’m not seeing one. @FirmMattress asked people to poke holes in the scoring method – I assume that is referring to the table in last week’s HITTalk post?

        Also, as far as Modern Healthcare’s “100 most influential people in healthcare” as some point of comparison: it’s ludicrous – and quite an example of the writer’s lack of health it social media awareness – to think that most of those on the MH Top 100 list list would have any significant activity on health IT social media (although a handful of them do.)

        “HIT” stands for “Health Information Technology” – The HIT is about Health and INFORMATION TECHNOLOGY on social media!! The Modern Healthcare list acknowledges “healthcare only” and ranks mostly “President & CEO-types” (75 % are CEO/Chairmen/Presidents). Anyone who’s been in healthcare IT for any length of time knows there are very few CEO’s active on Twitter and social media. And while I’m sure the MH List honorees are smart, important and ‘worthy’ people, would they be sharing the type of information and engagement many who do participate and lurk on social media expect and value?

        And as I’ve said before, I am no raving fan of the HIT100. And at the same time, I’m not a fan of those who present faulty and irrelevant counterpoints.

        • Thanks for confirming that the HIT mutual masturbation choir is really just preaching to other since “there are very few CEO’s active on Twitter and social media.” But also note that the scoring method applies to all self-proclaimed experts, not just the easy target of the HIT100.

        • You didn’t need to use so many words to try and explain HIT. And then you also didn’t need to conflate HIT with social media. “Social media awareness” doesn’t do as much to improve health or HIT as you seem to imply.

  2. Thank you for your scoring tool. It is truly the way most need to begin thinking. And frankly, it should encourage folks to both A) Respect the credentials of others and take pride in being a supporter or ancillary vendor (as opposed to feeling miffed about how it exposes their own lack of industry credentials); and B) Learn. Observe. Participate. Aspire. And all practically, not through social media and ego. Sadly, I do suspect it may inspire a few to go grab a few quick hit internet certificates and degrees, but at least it somewhat stalls the social media metric of success.

    In addition to a potential military addition, how about federal health policy?

    While I applaud your consistent focus on facts and integrity, the likelihood is that any one who has the credentials for the high rankings doesn’t have the time, nor the concern about the metric They likely would not want to waste any industry resources on such scoring. We are all focused on our job/mission at hand.

    Well done.

    • There’s nothing wrong with the HIT100 as a marketing-style measure of twitter reach and nothing more. We have plenty of other self nominated experts who delve into interoperability, system usability, security and clinical technology without knowing WTF they’re talking about except for what they have read about somewhere else. The Twitter curation function is useful, just not an indication of deep knowledge or influence when all it is is linking to the work of others.

      • Canula — That is a lot of Monday Morning Quarterbacking…..all the language tied to HIT100 was not about Twitter networking. Twitter Networking was the side effect of it all. The language was about “Change Makers”, :”Disrupters” and gave the impression that these were the most influential people in healthcare delivery. Mr. HISTalk’s has valid points as the HIT100 enthusiasts took many liberties, and as a result, they were professionally, and fact-supported called out, as a matter of speaking. Now that this has been exposed, there is a lot of back-peddling.

        For those who claim they are about supporting and helping the healthcare industry, you seem to be far off from the evidence-based practice that is medicine. Do you think a physician can keep practicing if they decided to follow non-evidence backed protocols and then gets exposed? I wish the over-self-marketers would finally eat a piece of humble pie. This is a level-setting moment that helps maintain the integrity of this industry. Take note and learn. Stop battling to prove that you are not posers.

  3. Regarding “Most Wired” — I look at this “award” as one of those participation trophy awards. If you take the time to complete the information then most likely you will receive the award. I assume there is valid information gathered and submitted to qualify for the award, however it is self-policing, yes?

  4. I guess I will take some smug self satisfaction that in a week of semi-actual news I get the entire comments section talking about bullshit awards.

    I now expect Mr H to create a a HISTalk100 award for most influential commenter on any given post that gets tracked every 5 minutes with results posted to Twitter! Which then of course will boost my standing on Twitter (assuming I win it ever again!)

    • Matthew Holt — I think you overlook that Mr. H doesn’t waste his time on such trivial acts. He is about keeping it real. Which is why you, myself and his 13k email subscribers plus additional readers still visit, engage and comment as we do. He is not limited to 140 characters.

  5. Matthew Holt, I award you the 2017 “Outstanding Achievement in the Field of Excellence” award. Congrats!

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