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Monday Morning Update 6/18/18

June 16, 2018 News 26 Comments

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The US Attorney indicts Theranos founder and CEO Elizabeth Holmes and former President and COO Sunny Balwani for fraud, charging that as Theranos executives, they knew that the company’s blood testing technology was unreliable and was not competitive with conventional lab testing.

Holmes resigned as Theranos CEO just before the charges were announced Friday. She will remain on the company’s board, for whatever that’s worth when the company in question is on its last legs.

Holmes and Balwani face up to 20 years in prison plus fines and restitution payments. 


Reader Comments

From Portal in the Storm: “Re: patient portals. My EClinicalWorks patient portal still lists the prep for my year-ago colonoscopy on my current medication list. I asked the doctor’s nurse to fix it, so she changed it to ‘not taking,’ but it was still listed on my portal as a current med. I mentioned it to my doctor, who discontinued it, but it still shows up on my current medication list. ECW’s My PHR shows the status as ‘not taking.’ Also, my poor doctor sees all meds, both taking and not taking, in a single current medication list with no option to sort or filter to show just the active meds. When folks complain about usability, I always assume it’s some advanced review these systems need, when in fact it’s obvious things any new user could point out.” Unverified.


HIStalk Announcements and Requests

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A slight majority of poll respondents think Athenahealth will be a lesser company without Jonathan Bush. Some respondents worry that the finance guys will take over from the visionary and cultural leader and instead of fixating on customers and product delivery, will jack up prices and hack at costs to improve the bottom line. Others say that without his dogged determination in focusing on long-term objectives, the bean counters will stifle innovation by just delivering what short-sighted customers say they want. One respondent said directly, “Steve Jobs was a douche, but I don’t think Apple is better off today.”

New poll to your right or here: has your employer had layoffs or other workforce reductions so far in 2018?

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Thanks to respondents who provided honest, painful thoughts about how suicide has affected them.

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This week’s question involves co-worker relationships.

Welcome to new HIStalk Platinum Sponsor Goliath Technologies. The Philadelphia-based company’s technology improves EHR user experience by helping IT departments anticipate, troubleshoot, and prevent issues related to slow log-in and application performance. It brings application monitoring for Cerner, Epic, Meditech, and other EHRs and business applications into a single console with real-time performance data, covering everything from endpoint to Citrix or VMware Horizon delivery infrastructure. Universal Health Services uses the system to monitor performance of its hosted Cerner system deployed nationally, where it logs into several Cerner applications every 30 minutes using a user’s exact keystrokes and network access to identify failures or slowdowns so they can be fixed quickly. That monitoring allowed UHS to pinpoint WiFi problems in a specific hospital. The company offers a demo and a 30-day free trial. I interviewed CEO Thomas Charlton a couple of weeks ago just because he sounded interesting and the company then decided to become a sponsor as a result. Thanks to Goliath Technologies for supporting HIStalk.

Here’s a video I found on YouTube describing Goliath’s Cerner monitoring system.

I had a good experience this weekend with an independent urgent care center in a tiny, remote town whose physician assistant recently treated my minor injury. The place was well staffed but empty, so I didn’t have to wait. They don’t accept my insurance but they charge just a fixed $75 (which in my case included a lidocaine injection, a bunch of silver nitrate sticks, and the usual odds and ends) and they used the insurance card information to retrieve my meds and problem lists, which they verified with me at the start of the visit. I received an email immediately afterward containing a link to sign up for the practice’s Athenahealth patient portal, and that went painlessly in simply entering the numeric code that was texted to my telephone number on file. I really worried about being forced to some hospital’s ED with the strong likelihood of getting stuck with out-of-network charges, so being quoted $75 made me happy, even more so when they treated and streeted me quickly.


Webinars

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

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


Acquisitions, Funding, Business, and Stock

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IBM Watson Health executives tell employees that the company will scale back its hospital pay-for-performance tools business.

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Former Cleveland Clinic President and CEO Toby Cosgrove, MD joins the board of Denver-based prescription decision support vendor RxRevu. The company’s board chair, Stephen McHale, was founder, CEO, and board chair of Cleveland Clinic spinoff Explorys,  which was acquired by IBM in 2015 and rolled into Watson Health.

Google is hiring for its Brain division, apparently for a research project called Medical Digital Assist that will use AI and speech recognition to create physician documentation. It may be a continuation of its Stanford Medicine digital scribe study from last year.


Announcements and Implementations

The AMA weighs in on augmented intelligence in a policy approved at its annual meeting, insisting in its own involvement to set direction, ensure physician friendliness, and integrate it with medical practice. AMA used the term AI to describe “augmented intelligence,” with the subtle difference being important – “augmented” means that AMA considers AI’s role as offering recommendations to doctors who are free to use them or not.


Sponsor Updates

  • Vocera will exhibit at the Cleveland Clinic Patient Experience Summit June 18 in Cleveland.
  • In the Netherlands, The Princess Maxima Center for Pediatric Oncology implements Wolter Kluwer’s UptoDate and Lexicomp solutions.
  • ZappRx expands its partnership with prior authorization services company PARx Solutions to include all treatment areas on the ZappRx platform.

Blog Posts


HIStalk Sponsors Named to the HCI 100

#4 Change Healthcare
#5 Philips
#9 Leidos
#17 Nuance
#20 Ciox Health
#21 Wolters Kluwer Health
#23 Roper Technologies
#26 InterSystems
#30 EClinicalWorks
#31 Meditech
#41 Experian Health
#43 MModal
#44 Netsmart
#47 Waystar
#52 Hyland
#56 Nordic
#58 Spok
#59 Elsevier
#60 Harris Healhcare
#61 Vocera
#62 CSI Healthcare IT
#65 Optimum Healthcare IT
#66 Imprivata
#67 Medhost
#68 Agfa Healthcare
#72 HCTec
#73 The HCI Group
#82 Cumberland Consulting Group
#87 AdvancedMD
#89 Impact Advisors
#90 Medecision
#93 The SSI Group
#97 WebPT


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Currently there are "26 comments" on this Article:

  1. Re Portal in the Storm, as I explained to my nurse practitioner last week, in general EHRs can be configured in a variety of ways to accommodate various workflows. If your physician is seeing both current and past medications, chances are someone made that decision during implementation. It’s easy to blame the software when in fact the fault lies with rushed or inexperienced implementation choices. It very likely can be fixed if the organization is willing to take the time to do it.

    • Your nurse practitioner probably already understands that EMRs can be configured in many different ways. What he/she probably does not understand (and what many EMR vendors don’t seem to understand either) is why configuration is needed to fix a usability issue like the one explained in the portal issue above. Why should any system require configuration to allow a clinician to accurately and efficiently weed through the list of medications a patient is taking/not taking. The default and only configuration would give the ability to narrow down or sort the list to make it useful.

      • This is the main challenge for vendors. Just about everyone will say that there should only be one way to configure something, and in the same breath they say that it should be their way. It’s impossible to satisfy everyone without either customization options or many hard discussions about why something only supports someone else’s idea of the correct configuration.

        Could it be better? Absolutely, but having no configuration options isn’t the right solution either.

  2. Re: Theranos

    My one question is, what took them so long to come to this end? I had commented here occasionally over the past 2 years that to anyone with eyes, something didn’t add up with this whole thing. Not to mention the spooky quality in videos of Liz speaking.

    How did they manage to get so many “names” both inside and outside of healthcare to be on their board? Seems someone’s “due diligence meter” was broken.

    And how were they able to make the claims of the efficacy of their process, since it didn’t appear that it worked, or at least worked so poorly as to be unusable? Isn’t there someone out there – like the local authorities who shut down the lemonade stands of 9 year olds for not having a permit – who validate items that directly impact patient care? The answer is yes, so where were they in this case?

    In a related matter, I STILL have that bridge for sale . . .

    • More specifically, what diligence process did Walgreens use? They were actually marketing this stuff to their customers. I have personally been at VC retreats where Walgreens was proudly preening themselves about their Theranos partnership, and the VCs were fawning all over them.

  3. A reply to Portal in the Storm from a Gastroenterologist, RE your colonoscopy prep: the question I have here is how did the prep work and was the taste acceptable? Because although you didn’t say how old you are or what the findings of the colonoscopy were, in most cases there’s going to be another colonoscopy some years in the future, and the longer away it is the less likely you are to remember which prep you liked or didn’t like the last time you took one. So at some point that information may be useful.

    Your case raises wonderful issues about detail in electronic medical records. Do I have permission to use it as an example in a future article here?

  4. “I asked the doctor’s nurse to fix it, so she changed it to ‘not taking,’ but it was still listed on my portal as a current med. ”

    Epic does this too. Very annoying as on every visit I have to answer whether I’m still taking multivitamins. I wish I’d never told them I take multivitamins at this point.

    • To AC: The scenario described is how the software works. Nurses do not make decisions to start or stop medications generally. The nurse marks “not taking” meaning the patient either ran out and didn’t refill because of cost or just forgetting, had a side effect and stopped or finished the course of meds. The provider is tasked with reviewing these medications marked “not taking” and determines does the patient need a pep talk about taking their BP med, a generic for their expensive cholesterol med, an alternative medication for a side effect, or just discontinuing the medication. Unfortunately the medication review is not always completed by the provider and we have the result described. Many EHR software users do not yet think of their keystrokes and clicks as data input to a system. They are just “doing the note and filing the charges” to move on to the next patient. I used to try to show users that their inputs early in the visit resulted in an excellent or mediocre after visit summary medication list in the hopes that a light would go on and they would see the system as working to improve care.

      • Is there no ill in contemporary medical care that’s not blamed on the EHR? It’s considered the standard of care today to document all of your medications, including vitamins and supplements. It’s not the EHR designers that force the nurse to ask you. In fact, it’s been part of the Meaningful Use program for years that you are expected to confirm all meds as part of doing full “medication reconciliation”.

        • I often wonder the same thing, I hear so many complaints about how EHRs are ruining the practice of medicine by requiring doctors click this and that to document that they’ve reviewed medications, acknowledged allergies, etc. and I have to ask: what were you doing *before*?

          • “Before” we got the list of meds and allergies from the patient and/or family, asked them to clarify if it seemed different from what the nursing history said, and wrote the finalized list in our note without then having to confirm that we reviewed them. “Before” we could write out a list of 10 meds on a new patient in 5 min instead of 45. “Before” we could write meds in a way that was concise. (E.g., depakote 250 mg qAM & 500 mg qhs rather than two separate orders for the two doses and then dealing with a duplicate alert.). “Before” we could document exactly what adjustments had been made in outpt med doses between scripts and have it reflect accurately in the chart. “Before” we were spending more time talking to patients and hearing their histories and concerns. “Before” we were excited about the prospects that HIT would make our lives easier and make clinical care better. If the EHR would do those two things, then you’d hear many fewer complaints.

      • The issue is not them documenting “Not taking”, the issue is that the “not taking” doesn’t take, and every time I have to say I’m not taking it. Can you imagine if you’d been on an EHR for 70+ years, and have to now rattle off 100 different medications that you’re not taking since you were born? How long will that take? Do you think people will still remember what those medications are? Still think it’s a good design decision and patient to blame?

        • Is “not taking” the same as “discontinued”? I’m not being a facile jerk here, are they legitimately two concepts? I could be prescribed an active med that I should be taking just stopped taking for one reason or another, which is different from a med that I was prescribed but the prescription was discontinued because I didn’t need it anymore, or a better therapy came along.

          • Those are two different things, at least in the EHR at my doctor’s office (Epic, I think). Not taking means you might start up again, and discontinued (or whatever word they use) means it’s over and done with. I had to take some blood pressure medicine post partum, but once I stopped, no one asked me about it again.

          • So if Epic offers options for “not taking” which presumes active, and “discontinued” which is inactive, this sounds like user error.

          • “Not taking” and “discontinued” are distinct concepts if you’re fluent in CernerSpeak or EpicElocution. However, if you’re the patient and the clinician says “I see Proscar here in the computer. What about that?” And the patient says “Oh, I’m not taking that anymore ever since my prostate was removed.” Then “not taking” means “discontinued”….

          • If they’re clinically distinct, which it sounds like they are, then it makes sense to keep them as distinct indicators. If the UX is making people confused, change the label to make it clear what each of them means.

  5. Kudos for asking such a difficult question and to the Histalk community for being willing to share- those responses to the question about suicide are a must read.

  6. The comment you printed that “Steve Jobs was a douche” was completely inappropriate! Some people think he changed an industry and judging his personality, if that’s what that was, is only one person’s opinion. Your printing it, just validates that opinion, quotes or no quotes.

    From a very satisfied (with this blog) reader.

    • The commenter’s point was that being a douche doesn’t preclude also being a visionary that a company is better off with than without, whether its Jobs or Bush who’s getting fired for obnoxious behavior that hadn’t change from the day they were hired. By every account I’ve read, Jobs was a complete douche — pouting, crying, scheming, firing people during temper tantrums, and gloating over successes. I will agree with your point that no objective checklist exists for being correctly labeled as a douche (or correctly labeled as not being one), or for that matter characterizing any personality attribute (hero, leader, etc.) but I’m pretty sure most everyone — including those who know him personally, worked for him, or competed against him — would label him as such. Googling “Steve Jobs douche” returns a million hits and substituting a more anal term returns more than four million, so the commenter wasn’t the first person to suggest such a possibility.

      • seriously, you guys think it’s appropriate to use the word “douche”? It’s a vulgar term and sexist at the same time. Check your biz lexicon.

      • I don’t care what you label him, the only thing I’ll remember about Jobs is that his own hubris allowed him to think he was smarter than oncologists. He ignored treatment options for a very treatable form of pancreatic cancer until it was far too late.

        I wonder if they have Healthkit on the iPhones in heaven.

        • As a 20 year survivor of the same form of pancreatic cancer as Steve Jobs had (neuroendocrine), I agree that he might have had a better outcome if he’d taken the oncologists’ advice to undergo Whipple surgery immediately upon diagnosis. Nowadays, the criteria for performing Whipple procedures on pancreatic cancer patients takes into account multiple factors, such as degree of metastasis and “operability” of the tumor itself. Eventually Jobs underwent a Whipple procedure, but by that time he had metastasis to the liver and possibly to other organs. A subsequent liver transplant was not able to save him. Regarding his interpersonal and relationship style, it is well documented in the comprehensive Walter Isaacson biography.

        • Gastrinoma, which Jobs had, is not all that treatable. It is rare, clinical pathways are nascent etc. and folks die from it all the time, some very rapidly if their disaease presents as aggressive and that is simple a function of the cards they are dealt.

          Jobs did wait too long to get on to traditional therapies for this drug but he may have ended up in same place just the same.

          This is a cancer that is incurable, one simply takes the therapies to keep progression at bay.

  7. T

    “Top executives of IBM’s Watson Health division told employees at a meeting on Wednesday that they are scaling back the part of their business that sells tools to help hospitals manage their pay-for-performance contracts, citing softening demand in the market,”

    Yet another example of IBM performing excellent due diligence before offering a product that seemingly no one wants or needs…Sigh,,,,

    • Competitors in the market are doing fine. IBM knew little (if anything) about the market and brought in their own management team to teach everyone how Big Blue operates. The sound of the original Explorys employees leaving the building has been deafening.







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