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Weekender 11/9/18

November 9, 2018 Weekender 3 Comments


Weekly News Recap

  • Google hires Geisinger President and CEO David Feinberg, MD, MBA to develop its healthcare strategy across its business units
  • Bedside patient engagement company GetWellNetwork acquires HealthLoop, a Silicon Valley-based developer of automated messaging for follow-up care
  • A study of EHR-related medication events in pediatric hospitals, of which 18 percent appear to have caused harm, finds system usability as the cause 36 percent of the time
  • Premier announces that it will acquire clinical decision support vendor Stanson Health
  • Microsoft tells users of its HealthVault personal health record that it will shut down Direct messaging on December 27, 2018
  • ResMed announces plans to acquire MatrixCare for $750 million
  • Allscripts says in its earnings call that it will launch a formal sales process for its stake in Netsmart
  • Two nationally prominent articles observe how poorly hospital EHRs handle the end of daylight saving time, as information entered between 1:00 and 2:00 a.m. is deleted when the system clock is set back

Best Reader Comments

I feel for providers and their in baskets. I previously worked for a gigantic HMO with a huge amount of virtual care and no support staff and it really was a second job. I am sure it is similar for other community providers. At my current employer, we definitely struggle with Revenge of the Ancillaries (or perhaps just curse of complying with billing). For imaging orders, providers have to enter a coded diagnosis and a separate field for reason for test. It makes me cringe every time I watch them. (Midwest Fan)

No one gives a rip about who was promoted to chief marketing officer or of human resources of a vendor’s firm. (leftcoaster)

[Replying to leftcoaster] As a chief marketing officer who is also a company founder and key member of our executive team determining strategy, providing input for product development, and working with customers during implementation, I politely suggest you broaden your view of what a marketing leader really does. (Not Just Glossy Ads)

Just recently finished applying for life insurance and part of that was an hours-long review of medical history where they wanted every place I’ve had care in the last five years. Had to sign ROIs and personally work with a few providers to get my medical record. Also had to have a few labs done with no existing conditions to call for it. (YoungBuck)

Cleveland Clinic Florida release of records – they do have that option in Epic but choose not to use it at this point. They absolutely should get on board and modernize. No reason not to (other than maybe it’s more profitable doing what they do, which is sad). (FactCheckPlease)

The “dilution” effect on systems is real. A really terrific small system can easily become a meh larger system, which can become a truly hated enterprise system. Chefs will recognize this as the “too many cooks in the kitchen” syndrome. (Brian Too)

Does no one see the issue with having a orthopedic surgeon work as a dictation scribe where the productivity is 30 min visit = 1 hour scribing? Does India have too many doctors and not enough jobs for doctors? I think lot of providers still have the paternalistic view that they know best because they are the smartest and the wisest at all times, and everything in healthcare should be catered to them. That has always resulted in bad outcomes for the patient in the past, and that sort of attitude needs to be checked. (“Ancillary” Person)

Regarding the reported archaic workarounds for daylight saving time. What is truly archaic is that we are still changing our clocks twice a year! I don’t see an easy way to alleviate this problem in the EHR when accurate, timed entries are critical to patient care and also required. (CaveNerd)

Atul’s concerns about the problem list are entirely the fault of using an insurance system that demands specific diagnosis codes before they will pay for procedures. Maybe, if we didn’t have a ridiculous payment system, we wouldn’t have ridiculous software designed to feed a ridiculous payment system. (ItsThePayorsDummy)

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. K in New York, who asked for a document camera (the one they have is shared by four classrooms) and a speaker to replace their broken one so the class can hear the audio portion of videos. She reports, “These supplies went straight from the box to the front of the classroom. Your support transformed our classroom learning environment to where we are now able to hear sound for videos and have students bring work up to have it projected and seen. This has led to more student-led instruction and reflection on their work. By empowering them to use their own work to model through the concepts, give feedback to one another, and be open to how they can be better has been transformational to our classroom culture. Thank you for your continued support!”


My mention of hospitals still requiring faxes resonated with a reader who works in a large radiology practice. They have HL7 integration and many options for sending results electronically, but they still send 100,000 pages each day by fax. Most interesting is that clients ask them to fax, on average, THREE copies of the same result, which as he concludes,” Yes, we are their copy machine!” I joked that someone should develop a healthcare-only fax integration engine that can parse information from fixed form locations and convert it to HL7-compatible data and he said that’s already been attempted, but was thwarted by low fax image quality and trying to convert handwritten data. The fact that it was even attempted says a lot.

I looked at the records request page of several hospitals and found these consistencies:

  • The patient is expected to know which of several listed health system departments delivered care to them (hospital, clinic, private practice, imaging, etc.) and to complete a form for each. So much for the benefit of being treated by a health “system.”
  • The request forms are often lengthy (several pages) and confusing because they try to cover all situations, such as patients requesting their own records, authorizing someone else to receive their data, or requests by providers rather than patients.
  • Most hospitals require the completed form to be delivered to the HIM department in person, mailed, or faxed. You will immediately understand the consumer challenge in the majority of hospitals where HIM is buried in the basement of the hospital’s busiest building where parking is hard to find and not free (although commendably, some hospitals offer patient drop-off parking spots or free valet parking). Why can’t hospitals offer a service desk in a less-congested area where all patient requests can be handled? Kudos to those hospitals that provide an email address for submitting the form, which works if patients have a scanner at home (none of the hospitals I checked provide a form that can be completed online).
  • The forms often refer to “PHI” as though patients should understand what that means (even when the form indicates what the letters stand for).
  • Requests for billing records are not covered by requests for medical records and are not mentioned on the HIM page.
  • On the plus side, some hospitals gave specific instructions for downloading information from the patient portal, offered the option to receive information via secure email, listed their prices for providing copies of records, listed the legal rights patients have with regard to their records, and gave estimates of how long it would take to receive records (although that ranged from days to many weeks).

California voters reject a proposition that would have capped dialysis profits, a measure opposed by hospitals, doctors, and the two highly profitable national dialysis companies that spent $111 million to squash it.

NIH seeks a contractor to manufacture “marijuana cigarettes” for THC-related studies, also requiring the small business it chooses to provide a placebo for control groups (“nicotine research cigarettes.”)

The SEC files insider trading charges against the airplane mechanic husband of a UnitedHealth Group HR VP who spied on her to obtain confidential merger information. James Hengen is alleged to have made $63,000 in profits by taking positions in two companies that were later acquired by UHG and also tipped off his brother and some co-workers to load up on shares.


Someone steals a 10-foot-long inflatable colon used by University of Kansas Cancer Center in its “Get Your Rear in Gear” colorectal cancer public education program. In a happy ending, KC police recovered the stolen colon, moved to action by TV colonoscopy queen Katie Couric, who wittily tweeted, “Does anyone know the scope of the crime?” Hopefully, there’s no obstruction of justice. We need to flush out what happened here and get to the BOTTOM of it.” It was returned intact (no semicolon here) although conspiracy theorists question whether the theft was a PR stunt.

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Currently there are "3 comments" on this Article:

  1. Re: Daylight Savings Time. Technically, this is trivial to implement. You merely keep track of an internal “base time” and then for display purposes, you tag an offset for DST purposes.

    Amazingly, a legislative declaration that time moves forward or backward does not change reality – just our interpretation of reality. Systems that can’t distinguish between reality and an artificial display of that reality are architecturally suspect and it makes you wonder what other idiocy is designed into the core product by designers who can’t resolve basic logic problems.

    • Right, so when a doctor orders a medication at 1:30 AM, to be administered in 60 minutes, you just display 2:30 AM and trust the nurse knows that it means the first time 2:30 AM comes around and not the second. That’s safe! Such a basic logic problem, easily solved.

      • There are elegant solutions to daylight savings time. Coming up with one is not an issue. The issue is that EHRs contain many inelegant solutions for things that people do every day so it makes much more sense to prioritize fixing those over something that maybe causes problems twice a year.

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