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Monday Morning Update 1/8/18

January 6, 2018 News 14 Comments

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ONC publishes a draft of its Trusted Exchange Framework as directed by Congress in the 21st Century Cures Act.


ONC hopes to create “a single on-ramp to interoperability for all.” Click the graphic to enlarge.

The public comment period is open through February 18. ONC expects to publish the final version late this year.

Reader Comments


From Chip McFlaude: “Re: Meltdown and Spectre CPU bug. The software patch will likely degrade performance on all IT systems. We’re waiting for benchmarks from Epic.” The near-certain performance hit that the patch will cause – and the possible need to add computing horsepower to offset it – is something providers and vendors should be paying attention to. Application of the patch isn’t optional even if hardware upgrades can’t be done first. Needless to say (hopefully, anyway), health systems need to apply the patch to every computing device – smartphones, desktops, servers, etc. — now that the flaw’s existence has been globally publicized and malware authors are rushing their new releases to market. 

From Just Another Healthtech Insider: “Re: KLAS. I founded a very successful health IT consulting firm that was always highly ranked in KLAS, but we never made the official list because we refused to pay KLAS for consulting services to be moved up from ‘not statistically relevant.’ Healthcare organizations rely on this information not realizing that moving up on the list may involve paying KLAS for their advice on how to rank higher. It may well be that KLAS helps vendors improve in general to also improve their scores specifically and that’s OK, although mixing vendor consulting with vendor ranking will always create suspicion, justified or otherwise. But has been observed many times, KLAS isn’t exactly either Consumer Reports or Black Book in transparently selling statistically validated customer reports that were collected on a large scale via transparent methods. Whether KLAS has a high impact on purchasing decisions or not, the possibility that it might has created an ever-expanding , KLAS-enriching vendor demand and relationships that are far from arm’s length. I don’t expect KLAS to ever publicly list how much it is paid annually by each vendor it ranks, but they fact that they’re paid at all serves as a reminder that it’s a consulting firm, not an influence-free industry watchdog. Unfortunately, the steps KLAS would need to take to achieve the latter would destroy its lucrative business model, so you either accept them as-is or not.

From Press Hangry: “Re: public relations firms. Our company needs PR services and would be interested in your recommendations, from boutique firms to larger ones.” I don’t have a good company-facing view of who does what, but PR folks are welcome to complete this form about their firms and I’ll forward the information to those companies that occasionally ask for help.

HIStalk Announcements and Requests


Most poll respondents say their 2017 was better than 2016, although commenters reported that they experienced personal illness, loss of family members, and concerns about the country’s direction.

New poll to your right or here: what makes a newly filed lawsuit newsworthy? My opinion is that accusations mean zero until a jury weighs the evidence and renders a verdict, but that’s just me not wanting to waste time on the vast majority of lawsuits that don’t result in a decisive victory either way.

HISsies nominations are still open.

HIMSS18 is just eight weeks away. Like every year, I’m getting a lot of post-New Year’s Day sponsorship information requests and new sponsors who are anxious to get started. I greatly appreciate the interest and the support. Lorre will be thrilled to get on a call to make it happen before March when we’re all hearing slot machines 24×7.

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We provided three video cameras for Mrs. S’s third grade class in Pennsylvania in fully funding her DonorsChoose grant request to enrich her scientific methods unit. She reports, “My students are already planning out the science experiments that they want to conduct at home and record. There are so many possibilities of things to record and fun lessons to do with these video cameras!”

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


Last Week’s Most Interesting News

  • A study finds minimal use and outcomes improvement of patients using a hospital’s patient portal while admitted as an inpatient.
  • A report finds that one of many problems at VC-backed, four-state Medicare Advantage insurer Clover Health is that an analytics bug caused its outreach employees to call its healthiest members instead of its sickest to offer health advice.
  • Doctors at the VA hospital in Roseburg, OR say administrators anxious to fudge their quality data ordered them to discharge sick ED patients and steer chronically ill patients to hospice care to avoid having them die in-house.


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

The price of the world’s best-selling drug, Humira, has doubled in the past five years to $38,000 per year and accounts for two-thirds of its manufacturer’s $26 billion in annual revenue. It costs multiples more in the US than in the rest of the world and so far the company has done a good job squelching competing biosimilars.



Adventist Health outsources management of its revenue cycle and clinical applications employees to Cerner.


  • Cherokee Medical Center (AL) will switch from Medhost to CPSI Evident in February 2018.
  • Merit Health-Batesville (MS) will go live with Medhost inpatient EHR in March 2018.
  • Siloam Springs Regional Hospital (AR) replaced Medhost with McKesson’s inpatient EHR in September 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.

Announcements and Implementations


Glytec’s software-as-a-medical-device for outpatient insulin titration earns a US patent.

Government and Politics


VA Secretary David Shulkin says in an interview that the VA has held off signing a contract with Cerner because the company’s definition of interoperability includes only the exchange of CCDAs, adding that, “To say it wasn’t a good meeting would be an understatement.” I doubt it was a intended as a shrewd VA contracting strategy to announce Cerner as its no-bid EHR vendor and then drag the publicly traded company along until it agrees to the VA’s terms under the threat of killing the golden goose, but at least the VA didn’t sign first and ask questions later as they seemed desperate to do just a few weeks ago. Having VA and DoD both using Cerner is not a guarantee of interoperability, but the bigger challenge might be connecting the VA to its many community-based providers, who use every EHR on the market. Going live without that capability when spending $10 billion or more is ludicrous. This is the first evidence I’ve seen that the VA might be listening to skeptical members of Congress instead of its White House selection committee who displayed questionable expertise in declaring Cerner the only viable choice. You have to wonder if Cerner could wangle out of the scrutiny more easily if they were working with a big government contractor used to making problems go away.



An 18-year-old who pretended to be a doctor – running his own clinical and urgent care and strolling hospital halls in a white coat – is sentenced to 3 1/2 years in prison after pleading guilty to charges that also include stealing $35,000 from an 86-year-old “patient.” The fantastically named Malachi Love seems indignant that he was caught: “I’m just a young black guy who opened up a practice who is trying to do some good in the community. If that is a negative thing, we have a lot more work to do in the community than to single out me … Just because someone has the title doctor in front of their name does not necessarily imply MD.”

Sponsor Updates

  • Optimum Healthcare IT creates an infographic titled “Formulary Management: Effects of Standardized Vs. Non-Standardized.”
  • The American Heart Association names Sphere3 CEO Kourtney Govro a co-chair of the Kansas City Go Red for Women Luncheon on April 18.
  • Surescripts will exhibit at the ASAP Annual Conference January 10-12 in Naples, FL.
  • Visage Imaging will exhibit at the ACR-RBMA Practice Leaders Forum January 12-14 in Chandler, AZ.
  • ZeOmega’s Jiva tackles major challenges surrounding population identification and stratification.

Blog Posts


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Currently there are "14 comments" on this Article:

  1. I disagree with Just Another Healthtech Insider: KLAS is not pay to play. If you pay the fees to work with them, they provide guidance and advice on how to improve based on the information they receive from providers. I have previously worked for a vendor that Did Not pay and was best in KLAS in their heyday. You do
    Not have to pay to be ranked. You gain a Konfidence level based on the number of clients you provide. If he/she had the ranking they said, it was below konfidence because they did not submit more than 6 clients.

  2. You say….”the bigger challenge might be connecting the VA to its many community-based providers, who use every EHR on the market. Going live without that capability when spending $10 billion or more is ludicrous.” Since that capability is the Holy Grail in the HIS industry I’d say they may spend more than $10B to get it. Surely they didn’t miss that little detail what have been a huge RFP/I. Wow!!!

  3. Can you please start publishing your summary of the news in the email that you send to your subscribers, like you used to? Consuming your website on a mobile device is a horrible experience, there’s no table of contents or links to sections at the top, there’s no summary of what is or isn’t in this update, and there’s no way I’m going to read an entire update or post on my phone. I know you’re aiming to up the number of views on the site to justify sponsorship money, but this is a bummer way to do it as it removes all value from me as the consumer (and means I’ll skip over the ads that the sponsors are paying for). I’d be fine if you published your summary on the site and not in the email to subscribers, but this current state is just unusable.

  4. Having installed and clinically used both Cerner and Epic interoperability as a clinician and IT staff, Dr. Shulkin and the VA should hold firm and push for the ability to import and add problems, meds, immunizations from outside systems (Like DOD and civilian Cerner installs) in one click the way Epic has made so practical and easy. Epic Care Everywhere also makes it easy to read notes and imaging reports from outside hospitals.

    Cerner has a gap to close and it would help everyone if the VA pushed them to increase the clinical value of their interoperability to rival Epic’s. Perhaps this push is coming in part because, unlike a government contractor, as a still practicing physician, Dr. Shulkin is eventually going to have to use the system himself.

  5. ONC is clueless.

    MDs are still struggling with just day to day burdens of the certEHR disaster piled on us.
    Frameworks for on ramping etc are a complete joke when coming out of DC.
    Its like asking for us to fly from NY to California is record time when we don’t even have a working plane. HIT was hijacked by CertEHR HITECH MU and set back real progress and HIT improvements at least a decade. We all are working with complex, interfering, burdening IT systems and are being asked to send our patient information everywhere in an instant, without ever losing a byte. Its an impossible task. We really need a dose of complete deregulation and rolling back of all the MACRA MIPS ACI IA certEHR regulatory activity and allow MDs to work DIRECTLY with IT to tell them what we need and how we want it to work, not how ONC CMS and WashDC wants it to work.

    • I wish Trump would just disband EHR
      certification, MU etc. of course the big player
      don’t want this, because it would threaten their hold on the industry.

    • Seems to me that allowing Doctors to get ‘what they want and how they want it to work’ is and has been problematic. This isn’t Burger King, it’s healthcare that we continue to deliver at an alarming cost with often questionable results. Frankly, after watching this industry for the past 30 years, we need a watchdog pushing an agenda because it sure as heck isn’t going to come from within.

      • I’ve noticed that most users, in any industry, are terrible at defining “what we want” or “how do we work”. Of those few who can, they tend to view those answers as proprietary information they use for competitive advantage. Or they view those answers as “someone else’s problem to solve, preferably IT.”

        Allowing Physicians to run the whole show sounds good. Except it led to healthcare being a lagging adopter of technology, unsustainable cost growth, and a 17 year delay (on average) in clinical best practices receiving universal adoption. Healthcare was run like a medieval guild. That’s what Physicians running everything led to and leads to.

        Now Physicians have a specific problem. The EMR/EHR doesn’t match their workflow. That problem can be corrected and the Physicians have the motivation to do it. Maybe that’s what was needed all along?

        • Spot on, Brian Too! Yet…..we’re still allowing Providers to ‘count clicks’ as a means of evaluating a workflow and determining the ‘success’ of an implementation…….Welcome to 1996.

        • Brian Too is spot on. The amount of times I have sat in a room to have two physicians in the same organization get into a shouting match as to how something should work is uncountable. If you cannot figure out your ideal workflow, how is a vendor supposed to create software to support it?

          Vendors/developers still need to be in charge of creating software, there simply needs to be more input from qualified clinicians, and less regulation on the specifics regarding clicks and metrics from the government.

          As someone who has grown up with a laptop in hand, the state of Health IT is atrocious, and the fact that far greater strides have not been made is an absolute travesty.

        • A couple of follow-up thoughts.

          My users are GREAT at telling me when I haven’t provided what they wanted. Note the parallels to current Physician satisfaction with their EMRs. Seems like the negative example is needed, if only to break the deadlock between the missing user specifications and IT reluctance to produce an EMR in the absence of those specifications.

          Also, where was the AMA? Where was COACH, CHIME, CCHIT, IMIA, WHO, CDC, JAMA, The Lancet, the endless stew of acronyms and organizations, where were they 30 or more years ago?

          My point is, Physicians could have been leaders in design and development of the EMR as a very concept. We all know the reasons why and we can argue about who did what and when. Some even did, but certainly not enough. Mostly what we got was the founding of various healthcare companies. That led to the EMR offerings we see today, and those unsatisfactory EMR workflow designs. It wasn’t enough.

          Know what I see? I see that healthcare is similar, in more ways than clinicians know or admit, to software development in every other industrial sector. Real software solutions are built on a foundation of failure and inadequacy, slowly rising to competence. Fortunes are spent on this process. A few winners emerge over time.

          Sectors like Finance had the advantage of (far) fewer data elements and strong theory, widely taught (this includes GAAP and goes all the way back to Luca Pacioli). Biology is more complicated but healthcare will get there.

          The real question should be, why did Physicians expect highly competent EMRs to exist when so few Physicians bought them, used them, or participated in designing them? A market economy will build what the market supports. Low investment results in sub-par results. Except, sub-par EMRs also discourage Physician adoption and chokes off investment.

          This is why the ACA was necessary. It forced the market to get bigger and healthcare to modernize. Finally, for you frustrated clinicians, I hope you do more than vent on the internet. You need to engage with your vendor. Bug reports, enhancement requests, all that stuff. Nothing gets better without it. And if the vendor doesn’t respond, you need to consider pulling the plug and getting a better vendor.

  6. Re: Cerner/VA: “Going live without that capability when spending $10 billion or more is ludicrous.” Yes, ludicrous… and exactly what the DoD did, only for $5 billion.

    You have to give Shulkin credit for this glimmer of reason, but all the hard-nosed contracting in the world isn’t going to magically do the years of work that Cerner hasn’t done.

  7. I wonder if Malachi will be singing to the old Kiss standard… “They call me…they call me Dr. Love…” in prison?

  8. Mr Histalk –

    With regards to Cerner and the VA, I would agree with you. I, too, am surprised that they didn’t leverage the Leidos relationship and have them act as the primary, similar to what occurred with the DOD. To my knowledge, Cerner, on their largest government contracts, hasn’t been the direct supplier. They won the DOD with Leidos playing lead and in the United Kingdom, they first were with Fujitsu as the primary, before BT took over for Fujitsu.

    Perhaps it is best for any of the EHR firms, when working with Federal Governments, to be secondary and have a known Contractor take the lead. Like it or not, those contractors (Leidos, Fujitsu, General Dynamics, etc) know how to play that game..

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