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January 2, 2018 News 16 Comments

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Some systems of Jones Memorial Hospital (NY) – including Meditech — remain down following an unspecified December 27 cyberattack.


The hospital is asking patients to bring in their insurance card, meds list, and whatever medical history they have.

Reader Comments

From Debtor: “Re: news article calling American Well a start-up. What’s the shelf life? That company was founded in 2012. Or is it just a more-hip way to say ‘small business’ with no implicit time constraint?” I agree. I posit that a “start-up” will possess these characteristics, the absence of any meaning it’s just a less-sexy “business”:

  • Founded within the past five years.
  • Has not been acquired. 
  • Founders are still running the show.
  • Annual revenue is under $50 million and headcount under 100.
  • Implicit valuation is less than $500 million and funding is via bootstrapping, angel investors, and early funding rounds.
  • The business model is uncertain and stability is absent.
  • Growing quickly while remaining unprofitable.


From Sparsely Populated: “Re: hospital construction. All those publish or perish authors should consider trying to correlate big health system construction expense with patient satisfaction and improved outcomes.” That would be interesting, as is the fact that some are questioning why health systems are building Taj Mahospitals while proclaiming themselves fit for purpose as benevolent overseers of declining public health. It’s a Pandora’s box of trying to tie non-clinical hospital overhead to their effect on the only metric that matters – patient outcomes. Locals, however, don’t understand or don’t care that health system costs sap the national economy even if they boost the local one, so they’re proud to show off fancy buildings to visitors.


From Deal Watcher: “Re: wondering about EHR decisions. Singapore docs want Epic and the CIOs want Allscripts in a decision that was supposed to be made by December 31. Nova Scotia has been out on RFP and it’s between Allscripts and Cerner, perhaps on hold since the entire Canadian Maritime was considering collaborating on a single integrated EHR. The VA is still delayed despite strong rhetoric from Secretary David Shulkin – if interoperability is their goal, why invest $10+ billion in a new EHR that won’t get them very far instead of waiting a few years for MU3 and mandated APIs that will allow interoperability initiatives like the Carin Alliance go mainstream?” Singapore will announce its decision in the next 2-4 weeks, I hear. I haven’t heard about anything new from Nova Scotia. I’ve also never heard of the CARIN Alliance, an apparently for-profit member organization convened by former government officials as a Leavitt Partners project to facilitate consumer-directed exchange.   

From MD Professor: “Re: prescription drug monitoring programs. In my state, the focus on reducing opiate prescribing has seen skyrocketing rates of IV heroin use and overdoses even as available treatment programs have been reduced in number and insurance covers less of the high cost. Prescribing of even non-opiate controlled substances requires five minutes to deal with the state’s website. It only works with some browsers and enforces rigid password and reset rules that encourage poor security practices. The hospital says EHR interfacing is too expensive. I personally think the state makes the process cumbersome on purpose to dissuade clinicians from prescribing, so I don’t expect improvements to PDMP integration or usability any time soon.” You’ve identified four significant problems: (a) reducing the supply of legally manufactured opiates has raised their street cost and pushed users to less-reliable products that may kill them or steer them to crime to pay for their habit; (b) we are mired in the never-ending “war on drugs” that cannot be won by Darwinism, incarcerating users or dealers, fining drug distributors, or trying to limit access to drugs; (c) addicts trying to quit have few affordable treatment options; and (d) the use of PDMPs is creating unintended consequences even as it sucks up provider time. I don’t know the answer, but I’m pretty sure PDMPs specifically and technology in general aren’t it. A public health expert would tell you that few chronic conditions can be resolved by shaming or punishing those who have them, even if their own choices contributed.


From Jennifer Coons, RN: “Re: Seiling Municipal Hospital (OK). I know there have been lots of comments and rumors on HIStalk about my hospital and our decision to change vendors and I wanted to take time to address them and put them to a close. I appreciate your consideration in posting this letter to your readers.” Jennifer is administrator of the hospital. Click the graphic above to enlarge her letter explaining why the hospital recently reversed its decision to replace CPSI/Evident Thrive with Athenahealth and is now back on the former.


From Sick Doc: “Re: urgent care centers. I became ill with a high fever on New Year’s Day. All the urgent care centers were closed for the holiday.” I’ve often said that it’s no wonder that people show up in the ED for non-emergent issues. Private practices are nearly always closed outside of what used to be called bankers’ hours, urgent care centers set their own hours, and health system clinics stick to a university-like schedule, with only the ED offering the certainty that the lights will be on and the desk staffed. You would think a provider business case exists for being available for the other 14 or so hours each weekday plus weekends and holidays. I wonder if telemedicine providers similarly limit their availability?

From Banner Downgrade: “Re: Banner – University Medical Center, Tucson, AZ. A patient writes to the paper to complain about the EHR.” The letter writer says that following Banner’s “downgrade’ from Epic to Cerner:

  • His 30-minute appointment took more than 3.5 hours.
  • Banner’s Cerner system doesn’t receive his information his local doctors are sending.
  • Automated paging is no longer offered, so waiting patient names are called out by nurses.
  • He received a 13-page printout (sounds like a visit summary and/or patient education handout) that previously he could have accessed online.
  • He no longer receives telephone appointment reminders.

HIStalk Announcements and Requests


Most poll respondents celebrate a winter holiday and most of those observe Christmas. Either way, the days are getting longer; we’re back in the post-holiday, pre-HIMSS frenzy; and it’s just 76 days until spring in the Northern Hemisphere.

New poll to your right or here: was 2017 an overall better year for you than 2016? You can elaborate further in the poll’s comments (click its “comments” link after voting).


Some reader survey respondents suggesting eliminating some sections of HIStalk. I decided to let democracy rule – vote on which of the listed sections I should keep or drop in a survey I call “HIStalk Hot or Not.” I’ll be making a few more changes in response to feedback from survey respondents, one of whom received a late Christmas present in the form of an Amazon gift card (check your junk mail, folks, since all I had was an email address and the emailed gift card hasn’t been claimed yet).

Anonymous Epic Developer’s DonorsChoose donation funded math games for Ms. M’s first-grade class in Goldsboro, NC and solar energy study materials for Mrs. Z’s elementary school class in Brooklyn, NY. Anonymous made a donation that paid for a STEAM center (resources and furniture) for Ms. M’s elementary school class in Albuquerque, NM and a laptop and case for Mrs. H’s high school class in Fayetteville, NC. The teachers took the time to email me on New Year’s Day to say thanks.

This may be the last DonorsChoose update based on responses to the “keep or drop” survey above. One reader survey respondent dismissed the DonorsChoose updates as undesirable “virtue signaling,” a term (made up by a magazine in 2015) that I had to look up and found to be incorrectly applied since it indicates saying but not actually doing something virtuous (like helping teachers in need). Not to mention that I’m celebrating reader financial support of students, not bragging on my own. I admit that while most of the 570 reader survey responses were constructive and/or supportive, others ranged from dismissive to downright hostile and that always stings for awhile.

Last Week’s Most Interesting News

  • A consultant says Vermont’s HIE is not meeting the needs of its stakeholders and advises it to improve its services and financial sustainability.
  • A physician says missed meds are due to complex psychological issues rather than just patient forgetfulness, raising the question of whether a Big Brother-like pill tracker can improve outcomes.
  • The Indian Health Service issues and RFI for help in planning an IT future that will likely not involve the VA’s VistA, on which its RPMS systems are based.


January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Cancer informatics vendor Inspirata acquires Toronto-based Artificial Intelligence in Medicine, whose product uses AI/NLP to extract oncology information from clinical documents.



Union General Hospital (GA) chooses Cerner to replace McKesson Paragon and Athenahealth, planning a CommunityWorks deployment of Millennium, RCM, and HealtheIntent.


  • Slidell Memorial Hospital (LA) will switch from McKesson to Epic in 2018.
  • Lavaca Medical Center (TX) will replace Healthland with Cerner in 2018.
  • Merrick Medical Center (NE) will replace Healthland with Epic.
  • Wayne Medical Center (TN) will switch from Meditech to Cerner in June 2018.

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

Announcements and Implementations

Sweden-based telemedicine and care center operator Doktor.se opens a clinic in a Swedish county where primary care is free, meaning that under Swedish law, everyone in Sweden can now access free virtual visits.


Black Book launches a mobile survey app.

Government and Politics


Doctors at the VA hospital in Roseburg, OR say metrics-obsessed administrators ordered them to discharge sick ED patients to make sure the hospital’s VA quality ratings (and administrator bonuses) didn’t suffer even though more than half its beds are always vacant. The hospital is also alleged to have told doctors to avoid listing congestive heart failure as an admitting diagnosis (since the hospital would be penalized for poor preventive care) and to steer chronically veterans to hospices to avoid having them counted as an in-hospital death.



How cold it is? It’s so cold that exhibitionists are flashing drawings of themselves. It’s so cold that lawyers are putting their hands in their own pockets. It’s so cold that systems at IU Health Ball Memorial Hospital (IN) have gone down due to a shattered fiberoptic line.

Here’s Vince’s 30-year look back at the health IT landscape of January 1988, when long-timers might have been distracted by the latest episode of “The Cosby Show,” the end of the war in Iraq, or the scramble to get Michael Jackson “Bad” concert tickets.

Sponsor Updates

  • Leidos Health publishes a white paper titled “Ready or Not, It’s MACRA Time.”
  • Meditech announces its support for several STEM-related school initiatives.
  • Audacious Inquiry’s Julie Boughn is recognized as a 2018 FedHealthIT100 awardee for contributions in modernizing enterprise health IT.
  • AssessURhealth announces several 2017 company milestones, including a 170-percent increase in customer growth.
  • Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world?”
  • CoverMyMeds celebrates its 2017 North American Visionary Innovation Leadership Award from Frost & Sullivan.
  • KLAS recognizes CTG as Best in KLAS for Partial IT Outsourcing.

Blog Posts


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Currently there are "16 comments" on this Article:

  1. Regarding Vince’s look back, he listed NewCo but actually, before it was Eclipsys, the name was Integrated Healthcare Solutions (IHS). The year was 1996 and the main office was located above the Harvard Garden restaurant at 316 Cambridge St. in Boston. You can actually see the office space through the windows on their website picture, https://harvardgardens.com/. I know because I worked for Harvey at that time and in that office.

    • Oh my, the Harvard Gardens, spent more than a few late nights there ’77-’82 while employed across the street, and NOT at the Fruit St. clinic.

  2. Re free primary care in Sweden.

    The Personal Income Tax Rate in Sweden stands at 57.10 percent. Personal Income Tax Rate in Sweden averaged 56.31 percent from 1995 until 2016, reaching an all time high of 61.40 percent in 1996 and a record low of 51.50 percent in 2000.

    I doubt anything is “free” in Sweden.

    • @Iknowaguy Regarding Swedish tax rates: Employment income for residents and business income for both residents and non-residents are subject to both municipal income tax and national income tax. Municipal income tax is levied at a flat rate, which varies from one municipality to another. The present average rate is 32.12 percent. National tax is levied at a rate of 20 percent on the portion of earned income between SEK 439,000 and SEK 638,500. The rate is 25 percent on the portion of earned income exceeding SEK 638,600.

      Average income is SEK 360,000. So most average folks pay ~35% tax rate.

        • Re: Fact Checker and Machete:

          Fact Checker is correct as Sweden has a progressive Tax System, similar to that of the US. However, they only have essentially 4 Tax Brackets and that 57% is the Top Tax Bracket. Interesting, if you do the currency conversion, their Top Tax Bracket, in US$, is only $78,000 in USD. Very interesting when you look at the discrepancy in pay and Tax Brackets.

    • Many of these countries offer free college and healthcare, so if you add what we as Americans pay for those services to OUR tax rate how would we equate?

      For myself I know I am paying 18k out of pocket to cover my family’s health each year.

      I also know that I am in debt nearly 140k for education.

      Factor that!

      • I agree Greg. I think too many people look at higher taxes as bad but don’t realize that they wouldn’t be paying for other items they pay for today like Healthcare and education.

        For example if someone was making say $50,000 a year and to have universal Healthcare, their taxes were raised 3%, then they are looking at about a $1500 increase in Taxes. Now that is where most people stop, without diving deeper into the whole picture, and say “I am not paying anymore in taxes!!)

        However, what they fail to see is that now, with universal healthcare, they no longer have to pay their premiums. So, lets say the average single person premium is about $350 a month..Well for the year, that is $4200 out of pocket on just premiums. They will no longer be paying that so actually, they are now saving $2700 a year.

        Now, I don’t know if Universal Healthcare would only cost us 3% or not, but the point is, if taxes are raised to cover things like Healthcare or Education, then Healthcare Premiums and Student Loans are either reduced or eliminated, so its like a sliding scale.

  3. Regarding “… waiting a few years for MU3 and mandated APIs that will allow interoperability initiatives like the Carin Alliance…”

    I have no connection to the VA system, but the above seems like particularly bad advice. It has no timeline to speak of (how many years, exactly, is a few?), Meaningful Use is running out of steam everywhere, and promised initiatives are more common than leaves on the ground in the Fall. In healthcare probably 90% of announced “grand plans” either fail outright or turn into tactical advances at best.

    If you don’t want the VA to implement a new EMR, just say that and provide a reason why. That’s what the above advice amounts to except lacking clarity and justification.

  4. Re: Donors choose. It’s one of my favorite parts of the website and always pleasant to see some unadulterated good news once in a while. Don’t fall prey to trolls!

  5. Please keep the DonorsChoose updates. It’s heartening to read about these donations and the positive impact on students throughout the country.

  6. RE: Selling Hosp…from CPSI to athena, back to CPSI
    OK, so this hospital makes significant operational and financial progress installing a new system. The implication being CPSI could not support these advances as the hospital sat on the brink of bankruptcy. But a corporate mgt group comes in and says…to make our job easier consolidating inter hospital data and cross institutional analyses…go back to the vendor that had a weaker system, ’cause that’s what all our other clients use.

    What kind of management insanity is this??? Does this mgt company have any idea how to run a facility?? Or are they just experts in building fancy spreadsheets??

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