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Monday Morning Update 7/31/17

July 30, 2017 News 11 Comments

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Mark Zuckerberg and Priscilla Chan, MD donate $10 million to launch UCSF’s Institute for Computational Health Sciences, which will perform analytics-powered drug discovery using a combined EHR dataset from all five UC system medical centers.


The institute is headed up by UCSF pediatrics professor Atul Butte, MD, PhD, who says, “This is among the richest and most diverse medical datasets in the world, much more than just a set of billing codes. Because the data come from our patients, the data are an incredible resource for UC hospitals to improve the quality of care we deliver throughout California.”  

The UCSF announcement describes the potential application of Butte’s “data recycling” project that will analyze existing data sets to gain new insights:

The results of his work can be surprising. By combing through databases, members of Butte’s lab have shown that it may be possible to combat liver cancer with a drug originally approved to kill parasitic worms. They recently developed another computational method that rapidly predicts what other drugs might treat cancer, again using readily accessible public databases.

These approaches may offer a more cost-effective way to discover drugs than conventional strategies. To bring these novel, computationally identified drug candidates into early clinical trials might require a few hundred thousand to $1 million, compared to the $10 million to $1 billion or more that a pharmaceutical company typically spends to bring a new drug fully to market.

But drug discovery is just one potential use of data, as both scientists and physicians acquire deeper computational sophistication. At medical centers like UCSF, electronic health records (EHRs) are increasingly being looked to for insights on how to improve the quality of care and to better understand disease. For example, UCSF physicians used the medical record system to institute a virtual glucose monitoring system that, over three years, reduced the proportion of patients who were hyperglycemic by nearly 40 percent.

Reader Comments


From UMMC_Breach: “Re: University of Mississippi Medical Center. Another breach. This time their Epic server was hacked, affecting 7,500 individuals.” HHS’s wall of shame says the breach, categorized as a “hacking/IT incident,” was reported three weeks ago. I haven’t seen details. UMMC paid $2.75 million a year ago to settle HIPAA violations related to theft of an unencrypted laptop and poor implementation of security policies and procedures. UPDATE: a UMMC source says it wasn’t Epic that was breached – it was a retired EHR from a facility UMMC acquired several years ago that was maintained by a third-party vendor who operated it on an isolated network. It was never running on UMMC’s network.

From Richard Head: “Re: must-read HIT blogger list. You are on it.” Thanks. I’m not too impressed by the list, which was put out by a publicity-seeking, vendor-produced magazine. The evaluator is the 24-year-old “senior editor” whose LinkedIn says she was working as a bar cook three years ago before landing a job in aviation publishing and finally meandering into healthcare a few months ago. She actually made a few good choices, but some of the sites appear dormant, don’t have anything interesting to say, or have resorted to running promotional articles written by paying vendors. I only read two of the sites listed — Politico Morning EHealth and John Halamka’s Life as a Healthcare CIO.


From Subdude: “Re: Epic’s hardline stance against hosting third-party systems with their new RHO offering. I’m surprised Epic since has many third-party dependencies, far from a full-service offering comparable to those of other vendors.” Subdude provided a list of systems that Epic won’t host, some of which are:

  • PACS and coding
  • Credit card processing
  • Document management
  • Supply chain systems
  • Faxing
  • Fetal monitoring
  • Interface engine
  • Lab instrument middleware
  • Medical device integration systems
  • Enterprise print management
  • Single sign-on
  • Telemedicine
  • Speech recognition


From Vaporware?: “Re: Cerner’s DoD go-live at Oak Harbor. Zane Burke listed what went live in the conference call. What was missing: CommonWell, Cerner Network, or any kind of record exchange to the outside world. No connections Cerner to Cerner, to Athena, or to Carequality. The facility is literally on an island, but this is taking it a step too far.” I wouldn’t assume that failing to mention interoperability to a bunch of stock analysts means it’s not in place, but maybe someone in the know can elaborate further.

From Jade Warrior: “Re: provider. I would prefer that you not use that term – it’s demeaning to physicians.” Physicians tend to forget that they aren’t the only “providers,” which is why a more-inclusive term was needed to collectively refer to physicians, hospitals, nurse practitioners, physician assistants, podiatrists, and other non-MDs/DOs who see patients without over-the-shoulder supervision, prescribe medications, and bill for their services. I don’t even like the title “doctor” since physicians hijacked it from others who are equally entitled to use it, such as pharmacists, dentists, or nurses who have earned a PhD or DNP (in which case your nurse is a doctor). The proper response to someone who announces, “I’m a doctor” is, “In what field?” (or if you have a master’s degree, you could say, “Great, I’m a master.”) Maybe for individual providers (not hospitals) we should use the profession’s name to eliminate all confusion  – Physician Smith, Nurse Jones, Dentist Garcia. That still leaves the issue of someone who has earned the degree but didn’t obtain licensure or isn’t practicing, such as the late Monty Python co-founder Graham Chapman, MD or Argentinean revolutionary Che Guevara, MD.  

HIStalk Announcements and Requests


Cerner shares would be vastly preferred by poll respondents forced at gunpoint to choose one of those listed, with Athenahealth finishing a distance second. New poll to your right or here: how would you grade your largest local non-profit health system in terms of selflessly serving their communities and all patients who need their services? Vote and then click the poll’s Comments link to explain their score.


Welcome new HIStalk Platinum Sponsor InteliSys Health. The Las Vegas-based company offers RxStream, the first real-time prescription transparency platform. RxStream integrates into e-prescribing and EHR workflows to help doctors and patients make cost-effective prescription decisions based on real-time local pharmacy pricing of clinically equivalent drugs. It then offers prescription adherence alerts and reminders that are integrated into EHR workflow. Analytics power a feedback loop between prescriber and pharmacy that can prevent adverse events or avoidable encounters that are caused by non-adherence, also helping insurers understand the experience of their members with drug efficacy and outcomes as part of population health management beyond simple claims data. RxStream inventor and CEO Thomas Borzilleri saw firsthand as CEO of a pharmacy benefits manager that PBMs skim big percentages from prescription cost, driving their profits at the expense of not just patients, but also insurers and employers who lack access to the PBM’s opaque business practices and can’t tell whether a PBM is saving them money or actually increasing their cost. Thanks to InteliSys Health for supporting HIStalk.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.


This Week in Health IT History

One year ago:

  • ONC issues a $250,00 funding opportunity to create a cyber-threat information sharing service.
  • CMS adds star ratings to its Hospital Compare website.
  • A disclosed Apple patent shows that the company is interesting in allowing iPhone users connect with a doctor, send them their HealthKit-collected information, and initiate a telemedicine session.
  • Theranos CEO Elizabeth Holmes does a Q&A address the American Association for Clinical Chemistry, which one pathologist said is like having “Al Capone come and talk about his novel accounting practices.”
  • Advocate Health Care Network (IL) agrees to pay $5.55 million to settle HIPAA charges involving three 2013 breaches of its medical group.

Five years ago:

  • Defense Secretary Leon Panetta advises a House committee that DoD-VA integration won’t be finished until at least 2017.
  • McKesson in its earnings call expresses confidence in its Horizon-to-Paragon strategy and its satisfaction with RelayHealth’s market position.
  • Cerner predicts in its earnings call that Epic will suffer from trying to upgrade from its MUMPS-based platform and calls out Epic’s weaknesses as physician solutions, analytics, population health management, and interoperability.
  • Roper announces that it will acquire Sunquest Information Systems from its private equity owners for $1.42 billion.

Ten years ago:

  • Partners HealthCare signs a contract for Siemens scheduling, decision support, document management, community access, and payer connectivity.
  • Misys Healthcare CEO Vern Davenport hints at acquisitions but agrees with his boss Mike Lawrie that the company’s healthcare performance remains poor.
  • A hospital pricing company CEO argues that ambulatory EHRs don’t make sense unless providers are paid fixed prices for quality, questioning whether, “If the entire country implemented EMRs overnight, would we see significant overall improvement in healthcare productivity, efficiency, quality, and customer service?”
  • An Eclipsys shareholder sues present and past company officers who he claimed defrauded investors.
  • Health Affairs publishes a post-mortem on the failed Santa Barbara Project that was led by David Brailer’s CareScience, which had been replaced by CHCF, Perot, and Medicity.

Weekly Anonymous Reader Question


Responses to last week’s question:

  • Conducts all calls on speaker phone in a small office. His loud voice echoes through the hallway. Yes, he could close his door, but why be considerate of others?
  • Someone who when asked a question always responds by saying they’ve sent you the information you are asking for “a long time ago” BUT they’ve never sent anything. After a few rounds like that at meetings, I just resorted to follow up with, “OK, thank you. Please resend the email.” they always end up sending a NEW email. Another one: when you’re leading a productive, decisive meeting and someone literally wakes up halfway into it and asks a long-winded question regarding a topic discussed wayyy at the beginning of the meeting. I simply smile and ask them to refer to their notes. Last ones: missing signatures in email or no out-of office contact information.
  • Two women in leadership who just talk endlessly in meetings, even though 95 percent of what is discussed is already known. Waste endless time to be sure to get the 5 percent across. They apparently cannot see glazed eyes and blank stares and realize that the important 5 percent was probably missed when attendees only hear the “Peanuts” teacher voice after five minutes of regurgitation.
  • The person who annoys me the most is someone who acts supportive and professional, then puts me down to my boss.
  • My boss, who uses all our one-on-one time talking about herself and her work issues.
  • When on conference calls or even team calls, the constant questions. This is especially annoying when someone has already provided the answer or has asked the question previously. I also dislike anyone that constantly complains. My philosophy is that if you don’t like where you work, then save us all your misery and just go work someplace else.
  • They know enough to be dangerous and as if they are engaged and knowledgeable, but really are not and should defer to their knowledge experts. Ultimately results in more work and effort for all to proceed based on erroneous information by someone trying to fake it until they make it.
  • I am a weirdo who generally likes the open office. However, on a different team across the aisle from me (<15 feet away) sits maybe the most infuriating person I’ve ever worked with, and I give him this highly competitive award without ever having had a single conversation – he sings. He sings and whistles, and he does these things LOUDLY and REALLY BADLY, and it’ll just be snatches of a song: there will be silence, and then MEEEET ME IN ST LOUIE, MEET ME AAAT THE FAIR and then NOTHING, and then just when your brain has stopped anticipating more, it’ll come through again. It’s like water torture. It activates a deep, primal rage in me. And this was happening before I got here, and I have NO EARTHLY IDEA why his teammates allow it.
    As I typed this, he whistled for about five seconds. God help me with patience and a cube rearrangement soon.
  • Interrupting!
  • The fact he has to mansplain everything over and over again. Also doesn’t realize that we’re all different life (and work) doesn’t revolve around spreadsheets. Also, “Does that make sense?” all the time. “No, it doesn’t make sense. Why don’t you mansplain to me again?”
  • I work in an office building for a health plan. We have two small office kitchens on our floor. People seem to be either mess-makers or cleaner-uppers. I fall into the latter category. Why is it that whoever spilled the coffee grounds on the counter or got water all over the place, or slightly missed the trash can with a tea bag wrapper can’t be bothered to clean up? We’re not talking about mopping the floors and waxing the microwave here. It’s just basic. This is a first-world problem, I know. And it’s in the annoying category. The last place I worked had nasty office politics with back-stabbing and lies being told routinely. That’s not annoying. That’s career-threatening. I’ll take the mess on the counter any day over that, but still …
  • I’m a big proponent of “”teach a man to fish” vs. just answering the question du jour. I give someone the URL or email that tells them how-to or where to go for FAQ, etc. But it’s so frustrating when they keep coming back saying, “I know you told me xxxx. Can you send me that email again? I can’t find it?” or just asking the same darn question three months later. it’s so lazy and disrespectful when they clearly think my time is not as valuable as theirs.
  • I was going to answer, but I started getting really irritated listing all the traits. I figured I’ll just read other responses and be glad I don’t have to deal with those.
  • No follow through. Tasks are assigned, sort of completed, and left hanging. Somehow I end up completing whatever it is because it needs to be done, and it drives me insane. I’ve mentioned it several times and there was always some lame excuse.
  • People who complain about how difficult their job is because of the many obstacles they face instead of just doing the work.
  • He chooses to call me to discuss issues that can be detailed in a two-sentence email or a 60-second conversation. Those phone calls last 20 minutes minimum due to his ability to belabor the point or jibber-jabber and fail to get to the point. Waste of my time! I avoid his phone calls at all costs.
  • The thought that everything can just change instantly and therefore little thought is given to major requests which means we are in state of constant chaos resulting in rework and duplication that misdirects valuable resources. Hoping that all talk and little action or deliverables catches up with this person soon.
  • My narcissistic VP, who will say and do anything (except deliver) to look good without ever accepting accountability. It’s always some other person’s fault.
  • Instead of trying to solve/configure solutions or workflows for customers, they whine about the “fact” people don’t know what they want. Then find whatever excuse they can to avoid helping.
  • People who pretend they are doing work, but get nothing done; don’t work efficiently, and hold every one else up.  People who lie about the state of affairs and expect you to take the fall. Lack of integrity. Males who’s egos are way to big for their britches.
  • Slow response time.
  • They want to be, and think they are my good friend. Add to that quite a sense of self-importance.
  • Flatulence.
  • Chatterbox who spends conspicuous time at work socially, distracting by itself. Also complains loudly about difficult and complicated projects, so transferred out of associated roles to keep the peace. Yes, management is the core problem here, not the employee. 🙁
  • She treats most people horribly, yells at those who report to her constantly, is known for her back stabbing, and keeps getting promoted. We share an office wall so I hear too many of her cringe-worthy conversations belittling people, either in her office or on the phone.
  • Late to every. Single. Conference. Call. Always.
  • IT executives who are technically clueless and weigh in on every issue in every meeting whether they know anything about it or not to try and impress the CIO.
  • Not aligning priorities to team project deadlines. Other team members then are assigned additional takes late in the project and are frustrated while working to meet the deadline or work on overdue tasks.
  • The person who puts their phone on speaker while in their cube because they don’t like the ”feel of a headset.”
  • Changing deliverables and approaches the last minute.
  • Anal-retentiveness and risk-avoidance in the extreme.


This week’s question: what life-summarizing phrase would you choose right now for your tombstone? Limit yourself to 15 words regardless of your wonderfulness level.

Last Week’s Most Interesting News

  • The FDA announces a pilot certification program for digital health developers that will allow certified companies to get their products to market faster.
  • HIMSS names Hal Wolf as its next president and CEO.
  • A CNBC report says that Amazon’s 1492 healthcare skunkworks project is working on projects related to EHR data, telemedicine, and health applications for Echo.
  • CHIME takes over the “Most Wired” survey.
  • Nuance announces that its systems have not been fully restored nearly a month after its malware-caused outage, also warning investors of lower revenue and higher losses.


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

Acquisitions, Funding, Business, and Stock


From the Cerner earnings call:

  • The company is almost finished with its succession planning in which a new CEO will be named to replace the late Neal Patterson.
  • Q2 bookings were the highest in the company’s history at $1.636 billion.
  • The company says it is competing well against Epic because of predictable total cost of ownership, contemporary architecture, return on investment, and its commitment to an open and interoperable platform.
  • Cerner is scoping the work required for its VA project and negotiating a contract. It is also selecting partners, noting that unlike its DoD role, Cerner will be the prime contractor.
  • Intermountain’s revenue cycle is finished in the Salt Lake City area and the company will replicate its experience across its client base.
  • Zane Burke, asked about potential new non-traditional health IT competitors, said the core, transactional EMR is safe and that clients are more interested in getting data from it and Cerner’s open systems make that easy. He said, “I actually don’t think that those that are rumored to be doing things in this space are thinking about how they’re going to create the next EHR. They’re thinking about how can they add value into the whole entire healthcare supply chain and how can they think about making the consumer experience a better one because all of us are about to have a better patient experience at the end of the day.”


  • Banner University Medicine (AZ) will replace Epic with Cerner in October 2017.
  • Kingman Regional Medical Center (AZ) will replace Siemens with Meditech in September 2018.
  • AnMed Health Medical Center (SC) went live on Epic in June 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.

Government and Politics

The US Supreme Court will hear oral arguments on October 2, 2017 in several cases involving mandatory class action waivers, one of them Epic’s. Epic — which was involved in previous class action lawsuits involving unpaid overtime — now requires employees to agree to arbitration instead of class action lawsuits for employment-related issues. The court will try to settle the conflicting decisions of lower courts in determining whether such agreements violate the National Labor Relations Act in preventing employees from acting together as  condition of employment.

Privacy and Security


A Roanoke, VA accountant’s office complains to the local newspaper about receiving frequent faxes from local hospitals, medical practices, and pharmacies after his fax number – which is similar to that of a physician’s office – was widely circulated. The accountant tries to do the right thing and let each sender know, but he gets PHI-containing faxes without cover sheets or spends up to an hour navigating phone trees and trying to reach the right person. He jokes that maybe he should just let the patients know directly since they have more clout with the provider involved. This is like most forms of healthcare data breaches – a provider that’s using poorly managed technology shoots the messenger for finding their mistake. Regardless of cover sheet legalese, the fax recipient is under no obligation to do favors for the the sender of the errant fax.



Doctors in Canada express concern over Telus Health’s decision to display prescription drug coupons in their EHR workflow, paid for by brand name drug manufacturers to discourage the use of less-expensive generics. The doctors worry that patients will infer that brand name products are better and that patients may perceive a conflict of interesting. Telus Health says the coupons display only after the doctor has already chosen a specific brand name product and offers doctors the option to turn the feature off. The company has enabled the voucher in two of its seven EHRs – PS Suite and Nightingale – and will add it to the rest of them.


Nuance offers these comments from my interview with Charles Corfield, CEO of Nuance competitor NVoq:

  • The NotPetya malware does not spread by email, by email attachments, or by infecting other files.
  • No Nuance customer information has been altered, lost, or removed by the malware.
  • We have no indication that any file contents on affected Nuance systems have been viewed by unauthorized parties.
  • We have seen no evidence that ePHI files were encrypted in this incident since the types of files in which Nuance stores ePHI were not targeted by the malware.
  • Unlike some malware, patching alone would not have stopped the propagation of NotPetya.


A Reaction Data survey of 200 HR and benefits leaders from providers, payers, and employers finds that while the majority of provider clinicians would like to see a single-payer health system, just about every body else hates the idea. Most respondents, however, favor universal healthcare that guarantees coverage but with both public and private participation. In fact, respondents seem to fear the federal government’s involvement most, with one benefits manager saying that “government intervention is the cancer” and that the free market should rule, while another observes that “we are the only developed nation on the planet to fail to recognize access to healthcare as a right – is that what we want as our legacy?” Respondents seem to miss the same significant point as their elected officials – the biggest problem involves high costs and provider-driven overutilization that enrich hospitals, doctors, insurance companies, and drug and device manufacturers at the expense of patients and taxpayers. We all foot that bill in one way or another.


In Indiana, a cancer patient’s pain management doctor declines to write her an opiate prescription after explaining that he doesn’t think narcotics would be a good choice for her chronic pain, after which the woman’s husband returns to the doctor’s office, shoots the doctor dead, and then kills himself.


The president and COO of Women & Infants Hospital (RI) quits due to its pending acquisition by Partners HealthCare and financial losses caused by declining birth rates and reduced NICU usage due to healthier babies.

Here’s Vince Ciotti’s review of Cerner’s history from awhile back.

My weekly “this week in healthcare IT history” items inspired Vince to look even further back with a monthly contribution from his stack of old magazines (he must be an HIT hoarder) that will describe the big news items 30 years ago and the lessons we might learn from them. He is also interested in hearing from his fellow pioneers at vciotti@hispros.com. I got wrapped up in his complete, 100-plus episode HIS-tory series that he created for HIStalk years ago – the people, products, and companies he covers are fascinating.

Sponsor Updates

  • QuadraMed, a Harris Healthcare company, will exhibit at the GHIMA Annual Convention & Exhibit August 6 in Savannah. GA.
  • The Solutionreach Patient Relationship Management Platform joins the Allscripts Developer Program.
  • Diameter Health publishes an explainer video titled “Healthcare IT Hero.”
  • EClinicalWorks says 1,000 providers selected its EHR in June, its strongest month so far this year.
  • Sunquest Information Systems will exhibit at AACC Annual Scientific Meeting & Clinical Lab Expo August 1-3 in San Diego.
  • ZappRx makes it to the final round of BostInno’s Coolest Companies competition.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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Currently there are "11 comments" on this Article:

  1. Who gives a f what they say. Can you really take any statement out of them with 100% certainty?! No.

    Just like attorneys say to a jury: once you identify an untruthful witness, everything else they say must be questioned.

  2. RE: “predictable total cost of ownership.” Give me a break. I would say that any Cerner customer could tell you that TCO was anything BUT predictable, but their gag clauses prevent them from doing so. Another earnings call, another round of Cerner untruths.

    • Well Cerner Earnings Call if they meant “It is predictable that your cost of ownership will go up because everything we demonstrated wasn’t in the contract” technically they aren’t lying.

  3. Fake news:

    This isn’t news – Banner University Medicine (AZ) will replace Epic with Cerner in October 2017.

    Banner bought U of AZ 2 years ago and immediately announced they’d be replacing Epic with their corporate standard, Cerner.

    Why does this show up as a “decision”? It isn’t. It’s a sale and replacement with a corporate standard.

    One might wonder why it’s taken so darn long? Wonder how much Epic functionality Cerner is having to add to its product line to keep users satisfied.

  4. RE: Vaporware’s post about Cerner/DoD and the Oak Harbor go-live. The poster conveniently forgot to send you the following from CERN’s earnings transcript that was no more than 2-3 lines removed from what he/she originally provided to HIStalk.

    “The ability to integrate and share interoperable patient information with the U.S. Department of Veterans Affairs and civilian health systems is critical and is inherently built into the system.”

    • Tully, I can’t tell if you’re being sarcastic or just naive. Words are picked very carefully in prepared statements from a publicly traded company. Zane very clearly listed what is live in his paragraph that starts “Capabilities deployed include…”.

      Having something “inherently built in” is not the same as having something live. If you think otherwise, you should report it to the SEC as misleading.

      Will a Cerner exec put their name on something that says CommonWell is live at the DoD? They will not, because it is not. It’s vaporware that was used to get the sale. (Maybe it will exist by the time Cerner’s “free through 2017” promotion runs out?)

  5. RE: hit blogger list

    Mr. H: “I reject your superficial, worthless honors soundly and make no apologies.”

  6. Also- Re: Telus Health’s Rx Coupons

    If the system doesn’t even display the coupons until after a decision has been made by the prescriber I fail to see how this is a conflict of interest – unless the prescribers are clicking back and forth in the system trying to find name-brands with discount coupons. Strikes me as a solid feature that could save patients money. Good on Telus.

    • @SpeakSoftlyAnd I disagree about advertising laden prescribing systems. Rats don’t get the pellet until they “learn” to press the bar. Physicians (including myself here) are at least as intelligent as rats and learn what works. There is no way a system like this is ethical.

  7. Hey now! I resemble that remark (got my “start” bartending…) Of course I can’t even remember what it was like to be 24, but…

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