News 2/27/19

Top News

Two companies run by founders with health IT histories are joined as employee clinic operator Crossover Health acquires the patient-provider communications technology of Sherpaa Health.

Crossover Health was founded in 2006 by Scott Shreeve, MD. He previously co-founded Medsphere with his brother Steve Shreeve and then left the company following a power struggle with the company’s board.

Virtual primary care provider Sherpaa Health was formed in 2012 by Jay Parkinson, MD, MPH, who had previously opened a New York City-based house call practice and then Hello Health, which offers EHR / PM / patient portal.

Sherpaa Health’s platform – which the company describes as a EHR built around online messaging instead of exam room conversations — supports patient questions, orders, referrals, and treatment protocols and adds components that resemble project management and customer relationship management.

Crossover Health, which provides services to Silicon Valley employers and was rumored to have been a potential Apple acquisition target in 2017, has raised $114 million in funding, while Sherpaa has raised $8 million.

Reader Comments

From Creative Loafer: “Re: BCBS of Massachusetts. Just sent this letter saying it will share information with providers to improve care – doctor visits, conditions, and treatments as required by Chapter 224 of the Acts of 2012. Wondering how this will work on the back end? Will my provider see the information in his Epic system? How will it get there? Will he not get information from self-pay visits?” I’ve inquired to BCBSMA.

HIStalk Announcements and Requests

I published most of the comments I received about HIMSS19 in detail. Thanks to everyone who took the time to respond. The overall themes are:

1. The big draw is the opportunity to network and to efficiently meet with clients, prospects, and partners in a single location.
2. Many attendees aren’t fans of Orlando as a host city due to traffic, the lack of nearby dining options, and the vendor buy-out of many of the nearby restaurants.
3. The exhibit hall is so big that it’s hard to manage. The vendor expense involved to host a booth is off-putting when healthcare is already too expensive and many Americans don’t have the financial means to access it.
4. The emphasis on interoperability was encouraging, but overall the industry may be stuck in a rut because of the domination of government, payers, and pharma that dictate technology decisions as a requirement for getting paid. 
5. Keynotes were not inspiring and opinions were mixed as to whether educational sessions were worth attending and whether vendor involvement in them was excessive.
6. The timing of the publishing of the draft interoperability rule took away some of the focus and energy.
7. Some attendees griped about extra-cost conference events.
8. CHIME’s event was well managed and dovetailed well into HIMSS19, although opinions were mixed about how many CHIME attendees remained for the week.
9. The EHR market will become less of a focus in the absence of Meaningful Use money and health systems that have already made their long-term choices, which if hospital margins remain decent will open up budgets to more innovative technologies. This will likely change the nature of the HIMSS exhibit hall, especially as some vendor respondents said the return investment for exhibiting is becoming questionable.
10. Some attendees said that HIMSS should limit the exhibit hall to purely health IT exhibitors rather than medical device companies, aiming for focus rather than maximizing revenue.

Listening: new from 25-year-old, Tony-winning actor Ben Platt, whose vocal range and emotional delivery of personal stories make his vibrato OK even though I don’t usually like it.

It’s usually pretty quiet in the first couple of weeks after the HIMSS conference, so I was surprised to see that I had over 8,000 page views in 6,300 unique visits on Monday, similar numbers to all but one day during HIMSS19 (Thursday of that week had nearly 11,000 page views).

I was thinking about the patient engagement comments from my HIMSS19 survey. Vendors and providers might be creating solutions that focus on hospital and practice benefits rather than those of patients, giving little incentive for using them. Maybe patients don’t really want to see revenue-maximizing, spam-like reminders that are as impersonal as their actual provider visits. My thoughts:

• We need to understand the degree and form of engagement that patients want – actually, what each individual patient wants.
• We aren’t doing a good job addressing what patients want in their actual visits (like more time to talk to their doctor) and automated messages can’t fix that. I’m likely to ignore a doctor’s attempts to engage me as a patient with technology if that doctor made no effort to engage me when I was paying for my short face-to-face time with them.
• The clinician’s job is to make sure the patient understands the health implications of what we’re messaging about.
• The messaging should be actionable. We can message people using primitive EHR reminders for prescription refills, needed tests, or suggested lifestyle changes, but we don’t yet have enough experience with the psychology behind those messages (I’m sure Facebook could offer insight). Surely we’re far along enough now that patients could be surveyed about which messages spurred them to take a desirable action vs. which ones didn’t; how the frequency and wording of the messages impacted results; or how outcomes were improved because of patient engagement.
• People need to feel accountable to other people, not to computer-generated nudges or provider policies. Computer-generated mass messages and chatbots probably have good cost-effectiveness (they cost next to nothing and scale attractively, so even slight improvements make them worth it) but perhaps studies should compare them to human-powered interventions, such as outreach telephone calls or easier, multi-channel access to clinicians. I don’t think I would trust a medical practice in which they want to blast out electronic demands but won’t allow me to email me the doctor whose name appears at the bottom.

Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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

Acquisitions, Funding, Business, and Stock

Children’s Hospital of Philadelphia Foundation will make a $741 million profit from the gene therapy spinoff it created in 2013, which will be acquired by drug maker Roche for $4.8 billion. The company’s blindness treatment drug costs $425,000 per eye and will generate $76 million in revenue this year, while a hemophilia treatment it developed has not yet reached the market. 

Sales

In Canada, Bluewater Health will replace its 20-year-old Meditech system with Cerner, joining several other hospitals in the region that will implement Cerner. 

People

Jason Owens, MPA (HealthPoint) joins HealthInsight as CIO.

John Douglass is named executive board chair of smart infusion pump and software vendor Ivenix. He was a co-founder of Sentillion and president of Capsule.

Announcements and Implementations

KLAS looks at how well vendors share genuinely usable data — especially in light of the Carequality-CommonWell connection – with particular attention to contextual information such as notes and lab results. Leading the pack is Epic, which brings in problem lists, allergies, medications, and immunization history from any EHR and automatically ingests notes and lab results (automatically from other Epic sites, with configuration required for other sources). Cerner is #2 in allowing users to choose which documents they want to bring in for summarization in the chart. Both Epic and Cerner allow accessing outside data via a search bar to prevent users from manually managing CCDs. KLAS found no Greenway Health customers that are using outside data, while CPSI users must manually reconcile every data element, including manually matching patients. The report notes that Epic sends a separate CCD for each encounter, which makes it easier for non-Epic sites to automate data consumption, but that practice may surprise vendors or users who are expecting a summary CCD only.

Cedars-Sinai will outfit 100 patient rooms with Amazon Echo Dot units running Aiva Health’s Alexa-powered patient care assistant, which routes the verbal requests of patients to the appropriate caregiver. It also allows them to control their TV or to play content such as music. Cedars-Sinai is an investor in the company, which graduated from its accelerator.

A survey of hospital CFOs finds that physicians generate an average of $2.4 million each in net revenue to hospitals with which they are affiliated.

Government and Politics

ONC will offer a webinar on Thursday, February 28 to review HHS’s proposed interoperability rule. it will be recorded and offered for playback afterward. I hope they sprang for the high-capacity GoToWebinar subscription.

Other

I hesitate to mention this just-published research paper since it uses observational data and surveys from Brigham & Women’s that were collected in May 2015 (an explanation should be interesting, especially since it finally ran in an open-access journal) and the hospital had just gone live with Epic back then, but here it is. Clinicians used Epic differently during morning rounds, as follows:

• Epic was used on multiple device types — IPad, computers on wheels, nursing station desktops.
• Most clinicians used the EHR before entering the patient’s room and some afterward, but few in the room itself.
• Non-EHR workarounds such as written notes, emails, and verbal discussions were used.
• Residents wrote down vital signs and lab results only because that process helped them remember the information.
• Some residents printed out the patient summary reports to track patients and to write themselves reminders to be entered later.
• Clinicians rarely used the EHR in the patient’s room, but when they did, their backs were facing the rest of the care team due to bedside computer placement and the clinician’s focus was on the screen instead of on colleagues.
• Some participating clinicians complained about too many clicks in Epic and said the handoff process was so cumbersome that they just called each other with verbal updates.
• One resident said, “in order to get a picture of something, if I need one piece of data that’s a lab value and one thing that’s a flow sheet and one thing that’s a radiology thing and one thing that’s an order and one thing that the nurse enters and one thing that the physical therapist enters and one thing that the physician enters, hard. Very very hard, it doesn’t integrate well.”
• Most participants said the EHR is useful for care team coordination and teaching, but half said it doesn’t make rounding more efficient. 

Google Translate can translate ED discharge instructions into Spanish and Chinese with high accuracy, a study finds, but still isn’t good enough for handing out the result without a warning that the translation isn’t perfect. The authors suggest that clinicians use Translate to provide an on-the-fly translation of verbal instructions and only for instructions that don’t contain complex grammar and medical jargon. The authors did not assess the actual readability of the result or compare the output to that of human translators. They also suggested giving patients the English version anyway so English-speaking family members can compare them to the translated version.

Apple is testing sleep tracking for its Apple Watch, although fitness tracker competitors already offer that feature and its acquired Beddit product already measures sleep via a mattress sensor. Such use would require developing Watch batteries that can run longer between charges, a feature also already offered by fitness trackers.

A CMS investigation of Baylor St. Luke’s Medical Center (TX) finds that employees mislabeled blood 122 times in four months, with the hospital taking no documented action in response to their expressed concerns about blood specimen handling. A patient died after the wrong blood type was transfused.

More than half of home care clinicians say they don’t have access to the EHR information of referring hospitals or clinics, making it hard to sort out the 90+ percent of records that contain medication list discrepancies.

This is depressing (no pun intended). Fifteen thousand low-paid Facebook contractors who review potentially inappropriate content experience panic attacks, PTSD symptoms, and depression from seeing the horrific material users have posted, resorting to on-the-job drug use and indiscriminate sex in hoping to forget on-screen murders, graphic pornography, bizarre conspiracy theories that eventually seem plausible, and hate speech. The whip-cracking, call center-like working conditions are depressing enough, but even more is the fact that Facebook users – some of them likely to be your neighbor, co-worker, or relative — are posting so much vile content that armies of moderators can’t keep up.

Sponsor Updates

• AdvancedMD will exhibit at the American Academy of Dermatology meeting March 1-5 in Washington, DC.
  Impact Advisors expands its ERP offerings with program assurance services.
• Arcadia will host its annual Aggregate conference April 24-26 in Boston.
• The Chartis Group posts a paper describing the key takeaways from HIMSS19.
• Gartner recognizes CenTrak as a Visionary in its January 2019 Magic Quadrant report for Indoor Location Services, Global.
• CoverMyMeds will present at the PBMI 2019 National Conference March 4-6 in Palm Springs, CA.
• Sansoro Health publishes its list of “50Best Health IT Blogs You Should Be Reading.”
• Culbert Healthcare Solutions will exhibit at the AAAP conference March 1-4 in Savannah, GA.

Blog Posts

• 20+ years and 450+ hospitals and facilities later: How Ramsay’s CEO helped turn a small Australian system into an $8.7B global health organization (Advisory Board)
• #ECR2019 – Enterprise Imaging can’t actually replicate radiologists, but it can enable you to close the (geographical) gap (Agfa Healthcare)
• Data Breaches Caused by Misconfigured Servers Within a Healthcare Environment (Atlantic.Net)
• Mobility and Identity as a Service can Transform Customer Experience (Avaya)
• What to watch for with Bluetree Managed Services in 2019 (Bluetree)
• The 9 Hot Topics of HIMSS19 (Pivot Point Consulting)
• The Patient Context War: Healthcare-Only Versus Healthcare-Now (Datica)
• How Analytics Can Help Eating Disorder Treatment (Dimensional Insight)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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