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Monday Morning Update 12/24/18

December 23, 2018 News 8 Comments

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Rep. Jim Banks (R-IN), chairman of the House’s VA technology subcommittee, questions the VA’s plan to implement Cerner patient scheduling, noting:

  • The VA’s Epic Cadence pilot under the MASS contract worth up to $624 million has been successful even though VA leaders keep stopping and restarting the project, decided at one point that the VA didn’t need resource-based scheduling, and then said that a VistA scheduling enhancement (VSE) would suffice.
  • The Epic implementation would be nearly finished if the VA hadn’t slowed the project down, which made VSE look favorable.
  • The VA hasn’t said what it will cost to move to Cerner scheduling, the timelines required, and the benefit to veterans.
  • The VA should consider using FHIR to connect Cerner to Epic scheduling.

Reader Comments


From Archie Tech: “Re: NYT’s Epic piece. Didn’t really get into the gist of the company’s success.” Epic’s campus is cool, but writers tend to fawn over the architecture and bucolic location to the exclusion of finding out more relevant facts about the company, possibly because Judy doesn’t really want to be interviewed at all, much less about the secrets of Epic’s success. I worry that her PR recalcitrance is depriving the industry of the chance to understand how, against all odds, a nerdy, introverted computer science professor created a mammoth tech company in an unlikely location by breaking every rule in the book. Writers who have earned a rare, brief audience with her invariably ask dopey, fawning questions whose answers don’t provide much insight.

From Amish Avenger: “Re: Centra Health’s first loss in a decade, blamed on unexpected Cerner costs and hiring hundreds of trainers. So they planned to install a new EHR + rev cycle system across an entire health system and didn’t anticipate a need to train people? There must be more of a story here. Did Centra believe that Cerner would train everyone or that a new EHR would be as intuitive as a cell phone?” Centra spent double the $33 million it expected for implementing Cerner this year, then was hit after its September 1 go-live with lower productivity that reduced net revenue by 10 percent. It “unexpectedly” hired 400 consultants for two months to help with the go-live. The health system had other revenue-impacting problems (a nursing shortage, executive turnover, and reduced payments) that might have been conveniently blamed on Cerner, but surprise costs for training suggests that the health system either missed something or got bad advice. I think they were replacing a hodgepodge of systems that included McKesson and Allscripts.

From Silicon Valley Geek: “Re: Health 2.0 API survey. It’s got a lot of great data despite all the Epic bashing. I’m a big fan of your astute and objective survey credibility analysis. I’ve love to know if you see methodology flaws or red flags in this one.” My observations on the survey, which was apparently targeted to unnamed and undefined “small health tech vendors”:

  • Only 64 respondents completed the survey, but it was not stated how those respondents were chosen, whether multiple respondents work for the same vendor employer or what jobs they hold, or what defines a “small health tech vendor.”
  • I’m not sure that all small health tech vendors are created equal in terms of expertise, market success, information they need or provide, or their product’s competitive position with EHR vendors.
  • The responses aren’t too surprising and pass the common sense test, but the premise of asking small vendors if the big ones are holding them back incorporates inherent bias.
  • The poll’s bottom line is that EHR vendors are improving in allowing API and other access to their systems, but pricing (especially app store) remains an issue, Athenahealth and Allscripts are easiest to work with while Epic trails the pack, and small vendors are worried that big ones are trying to steal their intellectual property.
  • The poll also raises the question of whether health system EHR customers contribute to the problem by their lack of interest in working with small vendors.
  • Perhaps more insight could have been gleaned by asking health systems which systems they want to use from small vendors and whether their EHR vendor has said yes or no to integrating with them. It’s easy for a startup to blame EHR vendors for their own lack of market success, but I don’t hear health systems complaining that their EHR vendors won’t support the integration those health systems need. The “one throat to choke” health system business imperative, along with ridiculously long and imitative procurement processes, are perhaps most responsible for small-vendor market challenges rather than their involuntary reliance on other vendors.

From Spikes High: “Re: doctor EHR complaints. We need to catalog them for the public good.” It wouldn’t be all that useful given the variables involved:

  • The doctor’s background and experience with competing products is always going to drive their perceptions. Complaints about a particular EHR may in fact be complaints about all EHRs.
  • Much of what a physician sees and is required to do is defined by their employer, the patient’s insurer, government regulations, or malpractice requirements, not the EHR vendor.
  • Complaints about usability can be caused by poor training or lack of experience rather than the product itself.
  • Doctors sometimes unrealistically expect off-the-shelf EHRs to mimic their own highly individualized workflows or specialty-specific preferences.
  • The all-over-the-place complaints about a particular product mean any problems aren’t black and white, and every vendor has clients who happily use its systems.
  • The benefits of an EHR don’t necessarily accrue to those who are forced to use it and thus dissatisfaction is inevitable. Complaints about EHR productivity loss, mandatory data entry, or unwelcome administrative oversight could easily be made about unwelcome paper processes as well. Doctors struggle with the idea that they’ve willingly given up their autonomy to self-enriching businesspeople armed with EHRs and an indifference to their factory workers, including those who wear white coats.
  • Here’s how to tell what parts of the EHR doctors find useful. Survey solo concierge practitioners who pay for systems out of their own pockets and who use only the functionality they need to achieve good outcomes and productivity. Mine is implementing Elation EHR, he told me last week, and he practically spat on the ground when describing his previous job working for a hospital that mandated Epic (but mostly because he didn’t like working for a hospital whose executives were making millions while reducing his income).

HIStalk Announcements and Requests


A reader who wishes to remain anonymous made a generous donation to my DonorsChoose project, asking that I choose elementary and middle school STEM projects. Those are my favorite as well because we’re losing ground globally in STEM and I think it’s important to generate interest in younger students. This donation, along with matching funds, fully funded these teacher grant requests:

  • Science and weather learning activity sets for Ms. C’s elementary school class in Shepherd, TX
  • Math manipulatives for Ms. A’s pre-kindergarten class in Washington, DC
  • Hands-on science kits for Ms. D’s elementary school class in Kansas City, MO
  • A Chromebook for STEAM studies for Ms. G’s elementary school class in Bronx, NY
  • STEM creative materials for Ms. K’s middle school class in Bridgeport, CT
  • An interactive quiz gaming system for Ms. K’s elementary school class in Milwaukee, WI
  • STEM creative building toys for Ms. B’s pre-kindergarten class in Washington, DC

Ms. B responded quickly in emailing, “My students are truly going to feel like January is gift-opening time all over again!”


Poll respondents communicate with their PCP by sending patient portal messages (which was surprising to me as by far the #1 answer), filling out online forms, and visiting the office to obtain or deliver paper forms. Almost unheard of are texting, using electronic signature such as DocuSign to complete forms electronically, and (thankfully) faxing. Selection Bias correctly notes that my readers may not be representative. Two readers love communicating by portal and one just calls the office.

New poll to your right or here, for provider IT folks – has your EHR vendor refused your request to integrate with a small vendor’s system? Vote and then explain what you asked for and how your EHR vendor responded.


January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


  • Community Regional Medical Center (CA) chooses Phynd for provider enrollment, management, and reporting, to be integrated with Epic.



Tenet Healthcare hires Christopher Walden, RN, MHA (Health First) as VP/east region client services leader.

Announcements and Implementations


BayCare (FL) goes live on indoor patient way-finding powered by Connexient’s MediNav. The hospital’s visitor app includes detailed floor maps, department and clinic locations, real-time location, points of interest, and driving and parking directions.


A New York Times health article says that more than half of older Americans – the population in whom medical care is most complex — can’t understand medical information such as the purpose and interpretation of a particular test, weight graphs, and insurance coverage. It recommends that providers stop using abbreviations with patients, make forms and instructions more easily understood, and communicate more clearly while encouraging patient questions. Commenters also blamed provider reluctance to write things down instead of just reciting them orally, assigning non-clinical employees to respond to emailed patient questions, and the economic reality of short appointments and lack of follow-up that cause patient misunderstandings or questions to be missed. One reader’s insightful comment urged that patients be given the NNT (number needed to treat, which is the number of patients who would have to be treated with a given drug to prevent one bad outcome) and NNH (number needed to harm, the number of patients who take a drug before one of them is harmed). Informaticists, what say you on the NNT/NNH issue?


In England, a medical resident hangs himself in his first week on the job after struggling to use the hospital’s computer system. If that’s not bad enough of a computer testimonial, (a) his body wasn’t found for two days because of a scheduling mix-up; and (b)hospital employees told his frantic parents to call the police instead of them because they couldn’t find him in their computer — it turns out that his name had been entered incorrectly.

Inc. lists 10 words and phrases used in business that really need to go away (I wasn’t convinced until I saw “curate,” which ranks near the top of my list of perfectly good words that have been ruined by idiots trying to make “making a list” seem impressive):

  • Digital transformation
  • Disruption
  • Synergy
  • Crushing it
  • Superstar
  • Curate
  • Girl boss
  • Open the kimono
  • Move the needle
  • Reach out

A reader forwarded a link to Episode 1 of “Chiefs in Carts Getting Coffee,” in which Arkansas Children’s Hospital SVP/CIO Jon Goldberg interviews EVP/COO Chanda Chacon while riding in a golf cart (“I think she’ll appreciate the subtleness of this blue, boxy beast.”) Goldberg also sends a “Fone Free Friday” message to the entire organization every week that has developed a cult following.


Sponsor Updates


  • Pivot Point Consulting’s Seattle team wraps presents for the Forgotten Children’s Fund.
  • OpenText completes its acquisition of Liaison Technologies.
  • Lightbeam Health Solutions publishes a new case study, “The South Bend Clinic: Using Analytics to Thrive Under Value-Based Contracts.”
  • The local paper covers LogicStream’s app to prep hospitals for drug shortages.
  • More providers sign on for Meditech Expanse in 2018.
  • NextGate announces a milestone year with significant market growth and achievements.
  • NVoq publishes a new Meditech use case featuring Alliance Community Hospital.
  • PatientPing publishes a coordinated care success story featuring Houston Methodist.
  • The “Winning in Health” podcast features Sansoro Health CEO Jeremy Pierotti.
  • ZappRx will work with global biopharma company Genentech on idiopathic pulmonary fibrosis, allergic asthma, and chronic idiopathic urticaria.
  • Zen Healthcare IT welcomes Guardian Health Service to its interoperability community.
  • ZeOmega achieves NCQA PHM Prevalidation for its Jiva PHM platform.

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Currently there are "8 comments" on this Article:

    • Please read the article. Nowhere does it state the EHR caused the suicide, rather the young physician struggled with it his first week. If all providers struggling with EHRs committed suicide there’d be none left!

  1. OK Archie Tech: don’t leave us hanging. What questions should the reporter have asked Judy Faulkner?

    • I can’t answer for Archie, but my questions might be:

      Who are the company’s majority shareholders?

      How is the board involved today and how will that change under new leadership?

      What did we learn from watching how Athenahealth is changing after removing Jonathan Bush?

      Do you worry that the company will be less interesting and less focused without you someday?

      Do you consider Epic to be a technology vendor or a solutions vendor? How does that change how you set the company’s strategy?

      What does Epic’s org chart look like?

      Who are your direct reports and how do you manage them?

      How do you avoid being surrounded by yes-people who tell you what you want to hear?

      Do you monitor what other health IT companies are doing?

      How do you feel about startups that might feel steamrolled by Epic?

      How would you describe your political beliefs? How do they support or contradict how you run the company?

      How has your work with Epic affected your personal and family life?

      How much of the company’s growth was funded by profits from operations vs. taking on debt?

      How much of Epic’s revenue is recurring?

      How did you create or keep the company’s culture as headcount grew so rapidly?

      One of your guiding principles for the company is to be frugal, yet the campus is extravagant and whimsical. Is that a disconnect?

      The founders of Silicon Valley tech firms use the experience of their investors and board members as they create what is sometimes their first business. How did it work in Epic’s case?

      How would you describe your positions on hiring for aptitude rather than experience and weeding out underperformers quickly?

      Smart people who pass Epic’s hiring tests for both the company and its clients have strong verbal and analytical skills. How well does that predict their success? What can go wrong?

      How will Epic’s principles disseminate as former Epic employees make their marks with other companies or in other industries?

      What’s your life like outside of Epic? How did it change when you became a billionaire?

      • All excellent questions. I think a few you would get an answer to , but for most my guess is the answer would be ‘no comment’, or ‘I prefer not to answer that’. But then even asking and getting ‘no comment’ says alot.

      • Great list of question – just a couple more:

        o What do you like to do during your down time? Outside interests?
        o How do you like to spend your wealth?

  2. A few of Judy’s “secrets”:

    1) Incredible instincts and vision, and the gumption to push and push to make them happen.
    2) Customer satisfaction is everything. The customer isn’t always right, but we must do everything possible to make them successful, even if it means contradicting them.
    3) A lieutenant (Carl Dvorak) who takes her vision and makes it real. Without Carl behind the scenes making sure the details are done it would be a very different story.

  3. The NYT article regarding patient understanding made me think of the commercials I see talking about drugs for women with “HR+, HER2- MBC”. Do newly diagnosed woman with breast cancer really understand this? I’ve been working in hospitals for 30 years and don’t. Do they influence the specialists ordering? Even adds referencing “COPD” seem over the head of most of the public. I’m sure they wouldn’t spend al that production money if it didn’t work but I’d like to see their data on how effective they are.

    Tim, I hope you have a great Christmas and wish you all the best in the new year! Gerald

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  1. I share your concerns about a lot of similar projects, but I think this one's an outcomes comparison thing, not…

  2. "Ascension Via Christi sent several ICU nurses home after they raised concerns about inadequate staffing." Nice. That'll show em.

  3. Thank you for sharing the full HIStory file. What a great tribute to Mr. Ciotti. “Those who cannot remember the…

  4. "Epic will roll out a “patients like this one” type tool to its users in Indiana this summer. It will…

  5. I don't see Cerner winning employee satisfaction surveys. I can't see VHA pivoting to Epic. It's going to be some…

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