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December 4, 2018 News 11 Comments

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A ProPublica report finds that the so-called “Mar-a-Lago gang” of three wealthy supporters of President Trump reviewed the VA’s proposed $10 billion Cerner contract before it was signed even though none of them had healthcare IT or military experience, naming themselves as an “executive committee.”

The physician member of the group, Bruce Moskowitz, also pressed the VA to use his self-developed ED locating app instead of collaborating with Apple. He named his son as the VA’s point person for the proposed project that was eventually abandoned.

The group reportedly got VA Secretary David Shulkin fired for being inadequately deferential to them.

Member Ike Perlmutter (chairman of comic book publisher Marvel Entertainment) has reportedly turned his guns on current VA Secretary Robert Wilkie, angered that Wilkie stopped taking his calls and that he released emails that contained Perlmutter’s name in relation to the VA’s no-bid Cerner contract.

Reader Comments


From Avenel Can’t Save This Trainwreck: “Re: Allscripts. Confirming that at least 250 were laid off, 40 of them from sales. Paragon and HHS support to be offshored. Closing offices and laying employees off is necessary because the company has a debt problem.” Unverified. I didn’t see a WARN notices, so perhaps the company is closing offices and offering transfer opportunities to those displaced, meaning that the resulting intentional attrition isn’t technically considered to be a layoff. With regard to your debt observation, I looked up the debt-to-equity ratio of these publicly traded health IT vendors (lower numbers are better):

  • Cerner: 9
  • NextGen Healthcare: 12
  • Athenahealth: 24
  • CPSI: 91
  • Allscripts: 116

From Smattering: “Re: consulting. Can all these health IT people really make a living as independent consultants?” It should be obvious from the LinkedIn profiles you sent that “consulting” is a euphemism for “desperately seeking a full-time job.” Offering to consult isn’t the same as actually earning a living as a permanent consultant. I suspect that quite a few formerly high-flying health IT executives have been shocked to find that their consulting services were in low demand once they lost their purchasing influence, especially since it’s obvious that a sudden urge to become a consultant coincided with being unceremoniously shown their employer’s door. Reading LinkedIn profiles can be depressing. 

HIStalk Announcements and Requests


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December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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Acquisitions, Funding, Business, and Stock


Medical device manufacturer ResMed continues its recent string of health IT acquisitions by announcing plans to buy inhaler use monitoring technology vendor Propeller Health for $225 million. Madison-based Propeller Health has raised $70 million.  


Medication safety technology vendor Tabula Rasa HealthCare will acquire Australia-based parenteral medication dosing calculation vendor DoseMe.

Meditech acquires its London-based partner Centennial Computer Corporation as part of its creation of Meditech UK.

I was barely interested in McKesson even before it bailed on health IT, but for those who still care, the company will relocate its global headquarters from San Francisco to Las Colinas, TX. Not shockingly, that’s where the company’s incoming CEO Brian Tyler lives (and where costs are much less). Pretty much every place I’ve ever worked that changed office locations ended up near the CEO’s opulent house since the commute time of that one person outweighs that of hundreds of employees despite HR’s claim that its ZIP code analysis makes that location best for everyone.


Athenahealth files the SEC notice of its shareholder vote on the company’s proposed acquisition by subsidiaries of Veritas Capital and Elliott Management. Interesting points:

  • The acquirers will take on several billion dollars of debt to finance the acquisition.
  • Termination fees of several hundred million dollars are specified for both sides of the transaction.
  • 65 companies expressed interest in acquiring Athenahealth — 32 companies and 33 financial sponsors.
  • Athenahealth’s board worried that the company could not meet financial expectations due to declining market opportunities because of low customer switching rates from competing products, a declining win rate, and the need to spend more money on product development to remain competitive.
  • Athenahealth’s change-in-control plan for its top executives provides each with a one-year severance; a year’s bonus; 9-12 months of medical and dental coverage depending on title; full vesting of unvested shares; and up to $10,000 in outplacement costs. That provides Golden Parachute Compensation ranging from $800,000 (for the former interim CFO) to $5.5 million (for the CFO).
  • Former CEO Jonathan Bush would get $4.8 million under a previously negotiated separation agreement. He also owns 900,000 ATHN shares valued at around $122 million.
  • Jeff Immelt, who served as board chair for nine months, leaves with $420,000 and shares worth $1.8 million.


  • Arizona HIE Health Current chooses Diameter Health for data interchange and clinical data quality.



Harry Greenspun, MD (Korn Ferry) joins consulting firm Guidehouse as chief medical officer.

Announcements and Implementations


An excellent new KLAS report finds that most EHR vendors are progressing well toward supporting a national patient record network now that CommonWell is connected to Carequality, which the authors call “the connection heard round the US” as users of Cerner and Epic can now exchange information. Another factor is the connection of Meditech to CommonWell and NextGen Healthcare to Carequality. Click the above graphic to see fascinating adoption numbers by vendor. Interesting facts:

  • Allscripts and Medhost have not enabled connectivity at all.
  • Allscripts says it will connect TouchWorks and Sunrise in 2019, but the company hasn’t committed to enabling Paragon, Professional, or other products.
  • Longstanding CommonWell member Medhost has yet to connect anything.
  • EClinicalWorks customer connections have tripled since March 2018 and CPSI has done a good job in integrating connectivity.
  • Virence Health (the former GE Healthcare IT) and Greenway Health have made little progress.
  • Cerner customers face the most significant technical hurdles in connecting, requiring 3-6 months to install Resonance and to perform mapping, making Cerner is the vendor furthest away from plug-and-play interoperability.
  • Epic and Athenahealth enable connectivity by default and thus nearly all users of Epic and Athenahealth have connected, which has given them the chance to move on to other pressing projects.
  • The CommonWell-Carequality connection has removed the final obstacle to widespread sharing of records as nearly all EHR users can connect quickly and inexpensively.
  • The biggest interoperability barrier is that providers don’t really care about sharing data and thus don’t bother to actually share records even though EHR vendors have stepped up to make it possible for them to do so.


Another new KLAS report reviews clinical surveillance technology, finding that despite the claims of several vendors, Epic and Cerner are the only vendors whose surveillance tools have significant usage. It notes that Epic’s surveillance tools are the hardest to set up due to lack of vendor guidance and best practices, but users who have gone live have created the largest variety of use cases. Cerner, Epic, Stanson Health, and Bernoulli users say the alerts improve patient care and reduce readmissions


UCSF will study and manage weight loss in newborns by using SMART on FHIR to integrate Epic with NEWT, a free, web-based, hospital-developed newborn weight loss tracking tool. UCFS’s study is called Healthy Start.

UK-based EMIS Group announces a new cloud-based version of EMIS Web, the UK’s most widely-used clinical system. New features include federated appointments, a voice assistant, video consultations, and analytics.

Government and Politics

A Tennessee nurse practitioner pleads guilty to scamming the military’s Tricare medical insurance out of $65 million via the usual route – conducting telemedicine sessions that resulted in prescriptions for expensive compounded medications that were provided by pharmacy co-conspirators who were also charged.

Privacy and Security

A Florida hospitalist staffing group will pay $500,000 to settle HHS OCR charges that it violated HIPAA in 2011-12 by sharing patient information with someone posing as a billing company employee who then exposed the information to the Internet, all without having a business associate agreement with the billing company or having performed a risk assessment.



In Australia, Queensland Health’s hospital EHR project will run $188 million over budget if implemented in the 12 remaining hospitals, with an auditor-general’s report noting that Cerner can name its price for contract extensions knowing that its customer has not considered alternative systems. The report also concludes that the project can’t continue without further funding and says the system does not provide value for money.


Bill Gates names “Bad Blood” as one of five of this year’s books he recommends. Gates says it is “insane” that Theranos hard-coded demo blood testing machines to display a stuck status bar so they could blame connectivity for the machine’s not working. He says Theranos stumbled because it didn’t have healthcare experts on its board; it sported a Steve Jobs-inspired take-no-prisoners outlook that isn’t appropriate for healthcare; and it allowed Elizabeth Holmes to make her personal legacy the company’s most important goal.

In Canada, the health minister of Newfoundland and Labrador blames Telus Health’s Med Access lab results distribution software for delays in delivering results to several hundred patients in the past year.


Darn, this was almost a clean sweep – an offshore company’s expensive CPOE market report lists six “global top players,” five which are trivia questions having not sold CPOE systems for a long time.

A Wired article says that unlike Amazon and Google, Facebook has no interest in furthering mankind beyond simply growing its own business and assuming that the world will benefit, leaving it with a platform whose chief attributes are tracking and targeting users. A member of Canada’s parliament said in a hearing involving the governments of nine countries – at which Facebook CEO Mark Zuckerberg was a no-show – that “While we were playing on our phones and apps, our democratic institutions seem to have been upended by frat-boy billionaires from California.”

I was thrilled to discover Fakespot, an AI-powered analyzer of reviews on Yelp, Tripadvisor, and Amazon that spots reviews that are likely phony and then recalculates the star rating accordingly. Those sites could do this themselves, of course, but then they wouldn’t have nearly as many reviews to brag about and their advertising revenue might be threatened. Amazon should allow reviews only from people who have actually purchased the item via Amazon, Yelp should ignore reviewers who have posted few reviews or who are posting about businesses all over the world (likely for cash unless they travel extensively), and Tripadvisor really can’t do much about the flood of fake reviews since neither of these methods would work for a global travel site.


In Japan, National Center for Child Health and Development will work with Sony to see if that company’s AI-powered robotic dog Aibo can measurably reduce stress and provide emotional support to children facing long hospital stays. Sony is selling Aibo’s “First Litter Edition” for the US market for $2,900, although there’s a wait list and they won’t ship to Illinois for some reason. Reviews have been OK, although some testers didn’t expect that having a robotic pet that learns that, like a real puppy, you have to train them (although presumably not in the peeing or chewing kind of way).  

Speaking of robots, Weird News Andy volunteers to spearhead an ICD-10 revamp to include the trendy electric scooters that are sending 1,000 people a month to EDs. WNA notes the billing challenge when available codes consider only scooters of the mobility and non-motorized varieties. I swear we’re regressing to children in fawning over scooters, wasting most of our free time playing with toys (of the Internet-enabled variety), and reducing discourse about global events and politics to a spirited game of Rock ‘Em Sock ‘Em Robots.

Sponsor Updates


  • Burwood Group helps patients connect with Santa at Advocate Children’s Hospital.
  • AdvancedMD publishes a new guide, “In or Out-source Your Value-Based Care Revenue Cycle Management.”
  • Aprima announces EHR integration with SE Healthcare’s Physician Empowerment Suite software.
  • Bernoulli Health will exhibit at the AARC Congress through December 7 in Las Vegas.
  • KLAS recognizes Bernoulli Health in its 2018 clinical surveillance report.
  • Clinical Architecture will exhibit at the AHIMA Data Institute December 6-7 in Las Vegas.
  • Dimensional Insight will exhibit at the MDM-Forum through December 6 in Denver.
  • DocuTap’s Eric McDonald will present at 1 Million Cups in Sioux Falls, SD December 5.
  • Meditech adds diabetes management capability to Expanse Ambulatory.
  • Access releases EFR Mobile, which supports electronic forms and signatures capability on mobile devices.
  • EClinicalWorks publishes a podcast titled “Strengthening Patient Engagement in Illinois.”

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Currently there are "11 comments" on this Article:

  1. KLAS interoperability report is unsurprising. Who would have thought Cerner puts up the most obstacles to plug & play interoperability? (other than literally anyone who has done business with them)

    My question is, if it takes 3-6 months to get CommonWell up and running, why isn’t the DoD on CommonWell after nearly 2 years live?

    • Vaporware asks this question nearly every time CommonWell is mentioned in HIStalk. Can someone from Cerner person-up and answer the question thoughtfully?

    • Re: KLAS report. Cerner is THE founder of CommonWell and they make it hardest for their customers to implement. What a sh*t-show. What disrespect for Neal Patterson’s vision, let alone their customers.

      Further mucks up DoD and VA plans for interoperability, though they seem to be all talk little action on interoperability anyway.

      Thank you Athena, Eclinical, and Epic for leading the way!

      • Charlie & ‘Answer’ … No answer is coming. Cerner’s “vision” was invented to make the sale. CommonWell was invented to make the sale. The sale is made, so what’s to talk about? (other than “fine tuning”)

        Plenty of room here on this axe-handle if you want to have a seat and grind it with me 😉

  2. Am I missing something, or is “clinical surveillance” just an ominous and sensational renaming of “predictive analytics”?

    I suppose I would be the first to accuse bigger companies who use analytics of committing true surveillance (Google, Facebook), but the difference between those companies and EHR vendors seems pretty vast.

  3. Gonna keep this super-anonymous…but I take issue with your commentary on Consultants all being folks that are ‘desperately seeking full time jobs’. I am sure there are plenty of those people, and I am sure it also hard to tell some of us are not them based on LinkedIN (which is still a terrible, awful, miserable place). But there are a group of people who worked in Health IT, some for a short while, some for decades, that love consulting and can make a decent living on projects and smaller-term engagements. It fits our life, it fits our skillsets, and it can be of greater value to the client than a full-time hire. And for many (definitely not all, probably not most), they do a great job for their clients, and then leave when they have completed the assigned work.

    I am sure the big-wigs and muckity-mucks that come into consulting after losing their comfy jobs make the rest of us look pretty bad and desperate to outsiders, but from my experience (7 years of consulting, running my own little shop, loving it each and every day) there are plenty of opportunities to work, great clients to help, unbelievable experiences to have, and we have a bit more freedom to live a life that supports having a family, raising children, and balancing a life that isn’t just an identity of “I work for [blank company name].”

    It’s not for everyone, there is inherent risk all the time. But, if you are good, you are honest, you have a dogged work ethic, and some reasonable communication skills, there is a real market for healthcare IT folks to move out from under the corporate umbrella and make a decent living and a difference.

    For me, on a very personal note, I deal with some chronic diseases that usually mean I need more than corporate vacation policies allow through the year to stay alive and healthy. My batteries run out differently than healthier people. I am lucky to have insurance from my spouse, but I am unwilling to entertain disability or leaving the workforce all together. So consulting is a perfect blend of being able to do a good job (and I do), be around to care for my family (I try), keep my physical and emotional health in line (always a challenge, but the alternative isn’t pleasant), and I even get to expand my skills and experience. I love that I can also be honest with a potential client and let them know they are barking up the wrong tree. I feel like even when I don’t get the project I am helping. Sometimes they are looking for consultants when they need full-time help, or they are looking for skills that won’t matter to the project, or sometimes the project has been wrongly prioritized over other things that I know (from my experience) they should focus on, even if that means the work they need is not work I am comfortable doing. It’s a good feeling. You make an honest living, a few honest friendships, and when you land a new client, you outperform expectations for a reasonable investment.

    So yeah, there are some well-dressed, well-travelled has-beens of Health IT that are consultants in name only, biding their time before their next big job, but be a bit nicer to those of us who drive used cars, where off-the-rack suits, and no watch at all, but are also here trying to make a difference in healthcare. Not all consultants are bad, or desperate. Some of us are wonderful people that actually found a perfect balance and niche in our careers, will ya?

    Maybe we just need a union or a big lobbying effort to protect ourselves and our interests?!?!?

    • I wasn’t clear in my rant — I was referring only to those folks whose LinkedIn shows an unbroken string of health system executive jobs going back decades who, after a few months of involuntary downtime, suddenly hang out a consulting shingle under an unimaginative LLC name. Maybe that’s their lifelong dream job, but I suspect not. Those “jobs” appear suddenly on a former executive’s LinkedIn profile, then are either superseded or replaced by the C-level job that was the goal all along (I’ve noticed that some folks delete their “consulting firm CEO” credential that lasted only a few months once they get hired on elsewhere).

      The short-timers are competing against people who consult by choice, who have a track record in it. who are good at it, and who will be doing it years from now. That’s who I was defending in pointing out that consulting (like teaching a college course) isn’t just something everybody is good at.

      I commend you for what you do and why you do it. I don’t think you need a union — your client references and word-of-mouth advertising are all you need and those distinguish you from the new consultants who are probably disappointed that their phone doesn’t start ringing immediately and each day’s mail brings bills that need to be paid.

      Really, despite by cynical outlook, I feel sorry for those former executives most of all. I’ve felt the panic and shame of disappointing my family due to being on the wrong end of impending health system org chart tinkering. You do what you have to do to survive and remain productive, and consulting is the only option that is under your sole control. It seems like it would be hard to figure out the process, get gigs, and always keep an ear to the ground for the next engagement, all while trying to achieve work-life balance and a predictable income. I would be looking for that full-time job too.

  4. Re: McKesson
    Technically, Brian lives in Pheonix and has lived there a while. They sent him to the UK but once he got the promotion, he moved back to Phoenix. Twenty years ago, McKesson bought their way into the hospital business by buying a business based in Carrolton. That office has been growing ever since, under John H’s leadership. I assume that since Brian has owned the house in Pheonix for over 20 years, he would probably prefer to move everyone there. At least that would be my preference.

    • Interesting. The San Francisco business paper and his McKesson bio says he lives in Los Colinas. I see by Google stalking that he bought his $2.4 million Phoenix home in 2015

  5. Hey! Been out here doing the independent consulting thing for almost four years. Military, DoD, NFP IDN, Specialty Hospital, Research Institute, For-Profit IDN, and Start-Up CEO experience; former CHIME Chair and HIMSS National Board experience. I’m helping others (health systems, vendors, start-ups, investors) create better, faster, cheaper, safer, easier-to-access healthcare for patients and families. And I’m the luckiest guy on the planet! And I’m not alone!

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