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March 12, 2019 News 3 Comments

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Hill-Rom will acquire mobile clinical communications vendor Voalte for up to $195 million. Hill-Rom hopes to enhance its point-of-care delivery of actionable insights and to drive its growth and margin.

Voalte’s annual revenue is $40 million. It has 200 healthcare customers.


Reader Comments

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From Boston Beanboy: “Re: Salesforce. You might enjoy this article – replace ‘Salesforce’ with any EHR vendor’s name and ‘sales rep’ with ‘clinician.’ It’s the same story.” A biased but interesting article written by  the CEO of a sales platform that runs on Salesforce says sales reps hate Salesforce because the system wasn’t designed for them, it doesn’t help them meet their goals, and it turns them into highly-paid data entry clerks where which they enter the bare minimum of information required for them to collect their commissions. As a result, 75 percent of sales managers don’t trust the information in Salesforce users want a system that is personalized, flexible, integrated, and that helps them close deals instead of requiring more work. Comments posted that have EHR counterparts include:

  • Salesforce wasn’t designed for the sales rep – it was designed to get information into a database so that work can be inspected and shared
  • Sales reps are like everyone else in avoiding the use of a system that provides them no personal value
  • Companies sell bots that can do some of the data entry work for users
  • Sales teams that use a defined process love Salesforce because it tells them what to do to close more deals, but reps who pride themselves on using their own methods hate it
  • Lack of Salesforce integration is often a problem with the implementation, not the platform
  • Companies use CRM as a tax on salespeople, a way to capture their information to make replacing them easier

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From Grand Padano: “Re: Athenahealth. Any plans to interview its new CEO? The chatter about what’s happening there post take-private is enormous.” I usually turn down interview requests from companies whose CEO is a new hire (thus giving us little to talk about except his or her optimistic plans) and has no healthcare experience (which Bob Segert does not). But I’ll consider it.

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From Junto: “Re: Epic on EHR-caused physician burnout. Judy is officially out of her depth if she thinks hiding behind loose research from KLAS is an appropriate response to physician burnout. It would be nice to hear from her how Epic can be part of the solution instead of deflected the EHR as a non-issue. It’s also beyond comical that KLAS, which makes an exponential percentage of revenue from EHR vendors, conveniently has research at hand for Judy saying EHRs are all that bad.” Epic CEO Judy Faulkner cites an upcoming KLAS report’s study as evidence that minimal correlation exists between EHR and physician burnout. The surveys came from KLAS’s Arch Collaborative, which benchmarks user experience survey results across its 150 paying members, which includes Epic (price ranges from a one-time $1,250 cost to $60,000 annual membership depending on organization size). As with most of KLAS’s research, the real question is their methodology – who they surveyed, how the questions were worded, who actually responded, and how well the results extend to other organizations. All that aside, my thoughts are:

  • I agree with Judy’s point that while doctors often don’t find their EHRs to be empowering and don’t enjoy the time required to feed the beast with their laboriously typed (or dictated) information, surveys don’t always tease out details about the software vs. the rules it enforces that someone else has saddled users with (the “someone else” being insurers, the federal government, and the frequent worst enemy of doctors – their employers).
  • Site-specific implementation issues are often involved, primarily setup, training, support, and ongoing communication about why the system works as it does.
  • EHRs may well have usability issues, but saying that EHRs specifically cause burnout (rather than being associated with it) is like saying that Word and Outlook burn us out when what we really hate is being overworked and underappreciated, being used short of our potential, being required to provide documentation that does not benefit us, and losing our idealistic view of our profession that turned out to be just another crappy job working for faceless overlords.
  • If Epic or another specific EHR were actually causing burnout, it would be reported by nearly every clinician user of those systems, and I haven’t seen that to be the case.
  • The VA’s VistA, one of the most antiquated and ugly systems ever built, has high user acceptance and minimal reported contribution to burnout because it has the luxury of focusing on what a doctor needs to deliver care rather than for billing, a situation that exists nearly nowhere else. It will be interesting to see how its replacement with Cerner, which was built around billing and administrative requirements, is perceived by those same doctors.
  • The argument that all EHRs cause burnout is also an argument that the software isn’t the problem. Those systems look and work wildly differently, with the only common ground being that they were chosen by organizations who wanted them to work in a certain way. I haven’t seen much evidence that doctors universally love any EHR despite the vendors of those system exploiting every competitive advantage they can find. It’s easy to hate the lawnmower when what you really hate is mowing the lawn.
  • EHR design and implementation decisions reflect what the decision-makers want and those aren’t the same people who actually use the EHR.
  • Burnout is not consistent across specialties even though many of them use the same EHR to varying degrees.
  • Working conditions often require doctors to complete their work after hours at home using the EHR, making it likely they won’t love it.
  • Asking Judy her opinion makes for great click-bait for dopey journalists looking for Twitter fodder, but doesn’t otherwise mean a whole lot. She doesn’t have to defend selling the market-leading product or to speak for the entire industry in explaining why the health systems that buy EHRs are somehow wrong.
  • The bottom line is that EHRs or not, physicians would be burned out because of the demands made by  those who pay them. All bets are off if you treat them like a monkey that gets fed only after dancing to organ music. Epic can’t fix that.

From Pointed Rejoinder: “Re: doctor empathy via robot. Not possible.” It may be unreasonable to expect skilled doctors, especially those such as surgeons and ED doctors whose services are one-and-done, to also be empathetic in a non-phony way to someone they don’t know. Still, nurses do it well all the time and I’ve seen some of our nastiest surgeons – feared and reviled for their tantrums and intentional hurtfulness toward hospital employees – behaving remarkably tenderly with a deceased patient’s family, which as a hospital employee always made me wonder if we really are incompetent, if the doctor was just using us as a punching bag proxy for our employer, or if they were simply putting on an act for their paying customers. Maybe hospitals should hire “empathists,” otherwise unemployable amateur actors who can pretend to be empathetic, letting them take the doctor’s handoff after delivering bad news in helping patients and families get through those first painful moments of understanding.


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Acquisitions, Funding, Business, and Stock

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Australia-based imaging software vendor Mach7 announces that it will implement a restructuring and cost-cutting program that it hopes will propel its US growth, firing its CEO and eliminating the CTO role in favor of strategic product management. The company has several high-profile US customers including Penn Medicine, UW Medicine, Brigham and Women’s, University of Virginia Health System, Adventist Health, Sentara, and Broward Health.

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Business Insider notes that companies such as Hims and Roman that send lifestyle prescriptions directly to the customer’s door often use TruePill, which aspires to the Amazon Web Services of mail-order pharmacy by offering itself as a B2B API and fulfillment service. The technology-focused company can send 100,000 orders per day and allows companies to control the patient experience in the form of custom packaging and shipping options. Co-founder Sid Viswanathan was also a co-founder of a business card scanning company acquired by LinkedIn, while CEO Imar Afridi was working as a CVS pharmacist two years ago.

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The Philadelphia paper questions whether Medicaid-heavy Temple Health — the closest thing to a public hospital in the country’s poorest large city — can survive competition from well-funded and growing competitors such as Penn and Jefferson. Temple is considering selling the cancer system it bought seven years ago, which is its most profitable business, to keep afloat. Temple has survived only because the state chips in a non-guaranteed $150 million per year, not only because the health system offers healthcare services, but because it employs many people.

Insurers Cambia Health Solutions and BCBS North Carolina sign a long-term management services agreement in which they will share corporate services and operate in five states under the Cambia Health Solutions name.


Sales

  • In Qatar, Alfardan Group and Chicago-based Northwestern Medicine select Allscripts Sunrise Ambulatory, Surgery, Radiology, Clinical Performance Management, Lab, and IPro Anesthesia for their joint project.
  • Chapters Health System (FL) will implement hospice and home health EHRs from WellSky.
  • DrFirst implements an interoperability gateway to provide medication histories to the Missouri Health Connection HIE.

People

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Carol Steltenkemp, MD, MBA, former board chair of HIMSS and the Kentucky EHealth Board, is promoted from CMIO to external chief medical officer of University of Kentucky HealthCare.

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Virta Health, which offers type 2 diabetes treatment via virtual health coaches and a ketogenic diet, hires Derek Newell, MPH, MBA as head of commercial. He was previously CEO of digital health benefits technology vendor Jiff and then president of its acquirer Castlight Health for 17 months.


Announcements and Implementations

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A new KLAS report on quality improvement software finds a near-revolt of users of the worst-performing Conduent and IBM Watson Health (the former Truven). The top-rated vendors for hospitals are Nuance and Quantros, while the ambulatory-focused vendor list is topped by Mingle Health, SPH Analytics, and Healthmonix.


Government and Politics

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HHS’s Office of Inspector General opens a position for Health Information Technology Attorney, looking for someone with expertise in EHR incentive payments, EHR interoperability, and breach notification to represent OIG in civil fraud enforcement and compliance with corporate integrity agreements. Do something wrong in health IT land and maybe you’ll get to meet the successful candidate.


Other

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ECRI Institute lists its top patient safety recommendations for 2019:

  1. Don’t rely solely on EHR information for diagnostic stewardship and test result management
  2. Manage patient expectations around antibiotics
  3. Review burnout and listen to provider concerns
  4. Deploy mobile health technology wisely by identifying patients who are good candidates, give them training, and monitor the systems for user error and inactivity
  5. Provide training and communication to ensure that all providers treat people who have behavioral health needs with dignity and respect
  6. Detect changes in a patient’s condition, including using alarms and other technology appropriately
  7. Use simulation training to maintain device and procedure skills
  8. Recognize the early signs of sepsis in all setting and develop protocols supported by tools for rapid response
  9. Increase awareness, surveillance, and reporting around peripheral intravenous catheter infections
  10. Standardize patient safety efforts across large systems and leverage the privilege and confidentiality benefits from forming a patient safety organization

An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month, claiming that practices that provide services under risk-bearing contracts would be happy to give Apple a cut. I seriously doubt all of this, but mostly the idea that the Watch is collecting information that will allow doctors to deliver better, more cost-effective care to entire populations. 

America’s homeless population is fueling a resurgence of “medieval” diseases such as typhus, shigellosis, hepatitis A, and trench fever caused by living in unsanitary conditions.

A Health Affairs blog post questions whether CMS’s push to give people easier access to their medical provider-managed information will improve outcomes or improve smart shopping, when instead what is known to work is (a) making easily understood information available when they are making a decision; and (b) allowing them to share in any cost savings. The authors are encouraged by apps such as Apple HealthKit that help consumers understand their data and take action on it, but nobody really knows how they will be used.

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A man who threatened to sue MIT Technology Review for using his picture to accompany an article explaining why hipsters all look alike – he called it “click-bait” and “a tired cultural trope” — inadvertently proves the article’s conclusion when the editor-in-chief sends him a screen shot of the stock photo (which wasn’t of him) and concludes on Twitter, “All of which just proves the story we ran: Hipsters look so much alike that they can’t even tell themselves apart from each other.”


Sponsor Updates

  • Optimum Healthcare IT adds ERP to its service lines.
  • AdvancedMD and Aprima will exhibit at the AAOS conference March 12-16 in Las Vegas.
  • Arcadia will host Aggregate 2019 April 24-26 in Boston.
  • Artifact Health will exhibit at OHIMA 2019 Annual Meeting & Trade Show March 18-20 in Columbus, OH.
  • Avaya expands its line of video collaboration solutions with new offerings designed for smaller meeting spaces.
  • CompuGroup Medical will exhibit at the Arizona Medical Association Spring Conference March 16 in Phoenix.
  • Collective Medical releases a video featuring New Mexico Hospital Association Director of Policy Beth Landon.
  • Cumberland Consulting Group will exhibit at the Health Plan Alliance Spring Leadership Meeting March 19-22.
  • Diameter Health will exhibit at the Rise Nashville Summit March 17-19.

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Currently there are "3 comments" on this Article:

  1. Re: Epic-Usability and Mr. HIStalk’s comment re: VistA – you nailed it. It will be fascinating to monitor Cerner’s encounter based EHR’s acceptance as well as how they will decide to address functional nuances in the VA (and DoD). Cerner’s EHR is designed for a “clinically driven revenue cycle” – a help or hindrance to the VA and DoD?

  2. After 35+ years on the hospital front lines, I don’t think it’s possible to make any generalizations about people’s skill or empathy based on their roles. I’ve worked with surgeons who have a wonderful bedside manner and pediatricians who are rude and gruff. I’ve also worked with amazingly compassionate nurses and with nurses who are sadistic and humiliating to patients.

    I’ve also seen physicians who ordinarily have the patience of a saint, lose it entirely when confronted by some organizational inanity that compromises patient care. Some of the Joint Commission requirements also rank highly on the “you’ve got to be kidding me” list of annoyances.

    I’m sure there are plenty of physicians, regardless of specialty, who could speak to a patient via a telemedicine “robot” and convey empathy. So please blame any outrage on the individual purveyor of bad news and not on all physicians or all robots.

  3. So Epic pays KLAS, then conveniently cites KLAS research when their product comes under scrutiny. In what world is this allowed to pass as objective, transparent research?







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