Weekender 3/23/18

Weekly News Recap

• A comment made by a member of the House Appropriations Committee suggests that the VA’s cost to implement Cerner will be at least $16 billion, of which Cerner as prime contractor will be paid $10 billion.
• RCM outsourcer Constellation Healthcare Technologies files Chapter 11 bankruptcy, accusing former executives of falsifying its financials and blaming the high debt it took on to fund acquisitions.
• Former Vice-President Joe Biden calls for HHS to cite providers for data blocking if they fail to give patients their information electronically within 24 hours of their request.
• A New York Times article says the NIH’s $1.4 billion “All of Us” data collection project that hopes to enroll 1 million people is moving slowly, spending a lot of money, mired in the challenge of harvesting information from disparate EHRs, and facing the reality that the US doesn’t have enough DNA sequencing machines to handle the load.
• The IPO of Siemens Healthineers in Germany raises $5.2 billion.

Best Reader Comments

HIMSS is a necessary evil. From my perspective (i.e. for my role/life) it’s overly focused on “hospitals” and “information technology” (I get that’s a feature, not a bug – this was, after all, the Hospital Management Systems Society). Not every problem in healthcare is going to be solved using software in a hospital. Most of them are probably not. But every year, in rolls HIMSS with big booths from the heavy-iron hospital vendors (Epic, Cerner, Meditech, et al.) looking to meet with CIOs who are focused on incremental improvements to ancient and inadequate systems. All of the “education” sessions at HIMSS are some combination of hopelessly in the weeds and a veiled pitch for a piece of software that I don’t really want to buy. I really don’t need to sit in some nosebleed seats to hear Peyton Manning or Magic Johnson tell me something about healthcare. The best part of HIMSS is the Mos Eisley Cantina that is the basement or adjunct hall where HIStalk usually camps out. In those 10×10 booths are the dreamers and builders who might really be the next big thing. HIMSS has to exist, real work does get done there, but it’s really pretty deep in the machinery of the healthcare system. Will HLTH be different? I don’t know, but I’m willing to give it a shot. (Debtor)

Do we really mean data? Most of what I see in motion, even with interoperability initiatives and FHIR APIs, are records — which is to say, documents and text representing the documentation of care, mostly in a legal medical record sense. As a clinician, I can say that, no doubt, this information has use and value, especially compared with the alternative. Still, it is far from computable. Biden’s interest in data sets shows he is reaching for the latter, and I am beginning to think the lack of distinction is really a problem, expectations-wise. Hopefully, ongoing progress in natural language processing (is the language really that natural?) will save us (by which I mean, me, the clinician) from fixing it, by becoming even more of a data entry worker. (Randy Bak)

Orwellian Aeron chair: If sitting is the new smoking, I’m sure this exercise motivator will have some real health benefits. Perhaps a little electroshock to get us up and about on a regular basis? I’m looking forward to Weird News Andy’s updates covering the exhaust analysis feature: colon cancer screening, dietary recommendations, etc. (Another Dave)

Epic, Athena, Allscripts, NextGen, Cerner, and others are all doing the same thing – they have open APIs, but make it very difficult to get approved to access data. (Annon)

I agree that it’s unfair and irresponsible to lay this [social determinants of health] at the feet of physicians. They certainly aren’t in control of all the economic and social factors that inform the health of this country, but its equally unfair to point the finger at patients themselves as if all the external circumstances that impact them (housing, job, food access, sexism, racism, homophobia, you name it) are 100 percent in their control, as well. (HIT GIrl)

I work in an IT department of a large IDN. The physician salaries and perks are obscene. We talk about all “waste” in health dollars, but I would like to see all these hospital costs out in open and distinguish between the costs borne by the hospital for conducting the tests and costs due to physician salaries / payments. Looking at what goes on in our system, physician compensation is the biggest elephant in the room. (IT Guy)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C in Utah, who asked for science books for her Friday morning STEAM lessons. She reports, “We have been so excited to open our boxes and find high-interest books for our third graders. Our class is excited to start planning our projects to demonstrate their understanding of a major science standard in third grade: interactions between living and non-living things. We have already started looking through our books. The kids can’t put them down!”

We also funded the request of Ms. A, who asked for an air quality meter for a project her fifth grade class in Pennsylvania is doing. She says, “Students are taking turns taking home the air quality meters every three or four days. They have found enough places in their own home to check air quality from the attic to the bathroom to their stinky brother’s room to the basement. Students are recording their results in science notebooks that they take home with the books, but when they come back to school, they transfer their data to a shared spreadsheet. The kids love looking at the results. I can’t wait until everyone has had a chance to take the meters home. Then we can really explore what the numbers mean, and I can teach the students how to create graphs using Google Sheets.”

Listening: the cover of “Zombie” by otherwise forgettable metal band Bad Wolves, which while missing the seething Irish anger of the original by the Cranberries and its late singer Dolores O’Riordan, offsets it with searing guitars. O’Riordan died the day she was scheduled to perform the vocals with the band on the recording, so they released it her honor instead. Speaking of angry political songs of that era on SNL, there’s the prophetic sneering thrash of 1989’s “Rockin’ in the Free World” by Neil Young. But arguably the most discomforting social protest song ever was Billie Holiday’s 1939 “Strange Fruit.” Switching to something new, there’s a just-released album from hard rock band Dorothy.

Our booth neighbor down in the basement of HIMSS18 was integration platform vendor MuleSoft. Some of their self-absorbed sales guys were kind of rude to Lorre and Brianne, but maybe they knew what was coming —  Salesforce just bought the company for $6.5 billion.

ProPublica reports that IBM – panicked by competition from more nimble and often global competitors and its own failure to execute – has intentionally ditched its older, higher-paid workers to replace them with cheaper newbies and offshore workers while breaking US age discrimination laws or using loopholes to avoid them. Techniques include:

• Laying off older workers in telling them that their skills were outdated, but then hiring them as contractors at a lower rate
• Encouraging laid off employees to apply for other company jobs, but telling managers not to hire them
• Requiring laid off employees to pursue age discrimination complaints via private arbitration rather than lawsuits
• Using employee privacy as an excuse for not publishing legally required layoff lists that would allow those employees to see how many of those laid off were older
• Labeling layoffs as retirement even when the employee refused to acknowledge it as such
• Using what IBM called “lift and shift” to lay off US employees and send their work offshore, causing IBM to now have more employees in India than in the US

Meanwhile, Bloomberg says that GE sent former CEO Jeff Immelt packing with millions of dollars in parting gifts but has reduced benefits to employees and retirees in an attempt to make its financial numbers look better. Example: the company changed its pay schedule to push the final paycheck of 2016 to a week later, improving its year-end cash flow position; it implemented an “unlimited vacation day” policy that also means it doesn’t have to pay out the unused days as severance; and it replaced merit raises with bonuses tied to unstated objectives. The article notes, “GE has lost more than $100 billion in market value since CEO Jeff Immelt announced his retirement in June, and not because anyone misses him.”

A sharp Vox opinion piece observes that Facebook is like casinos, cigarette manufacturers, and companies that sell alcoholic beverages – it makes most of its massive profit from addicts who feel depressed and lonely and are therefore less healthy after using its product. It concludes that Facebook is “optimized for fakeness” in deliberately turning news consumption into a confirmation bias machine even as it kills off the business model of real news sources.

Researchers find that a substantial portion of Americans – even those with health insurance – take a big financial hit after being hospitalized. A significant number of those patients never return to work, are disabled, or require unpaid recovery time. A health economist questions whether health insurance is enough to to protect people from significant income loss, as other countries also offer wage insurance, mandatory paid sick leave, and disability insurance.

Drug companies are merrily jacking up prices even as the White House claims that it will intervene, as 20 drugs had price increases of over 200 percent since January 2017. Leading the pack was skin cream SynerDerm, whose price has increased 1,500 percent. Its main ingredients: water and vegetable oil.

In Case You Missed It

• News 3/23/18
• EPtalk by Dr. Jayne 3/22/18
• Readers Write: I Am More Than My Specialty: Physician Burnout and Individualism
• Readers Write: Continuous Clinical Surveillance: An Idea Whose Time Has Come
• Readers Write: Analytics Optimization: Doing What It Takes
• CIO Unplugged 3/21/18
• News 3/21/18
• Curbside Consult with Dr. Jayne 3/19/18
• Monday Morning Update 3/19/18

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