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Monday Morning Update 4/8/19

April 7, 2019 News 13 Comments

Top News

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Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 


Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.


HIStalk Announcements and Requests

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Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). Click a logo for more information.

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None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.

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I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.


People

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Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.


Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.


Privacy and Security

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Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

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Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.


Other

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The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.

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A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 

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A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.


Sponsor Updates

  • MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
  • Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
  • NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
  • The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
  • PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
  • PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
  • Optimum Healthcare IT announces a refreshed brand identity.
  • Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
  • Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
  • TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
  • Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

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Currently there are "13 comments" on this Article:

  1. Cerner rev cycle has been “getting there” for at least 10 years. Don’t know if they’ll get there but they’re clinical installs have been tanking ever since the dod and va acquired the company … or rather acquired their ehr.

    • Cerner has not matured despite attempts. Provider based billing not strong. Lots of go live and post live remediation issues.

      • One of the main drivers for the Siemens acquisition was for their Soarian Financials Rev Cycle solution. It’s a superior product and will likely either supplant Mill rev cycle at some point or just have it’s form and functionality merged (either of which would be a big step forward).

        • Cerner went through yet another re-org and now the head of Revenue Cycle is someone that came from the Siemens side. My understanding is that they will essentially merge the two Financial Systems together into a single platform, finally.

          One of their biggest mistakes with the Siemens purchase was actually selling both Millennium and Soarian Financials as options. Cerner’s vision just doesn’t match their production. Once the ink was dried, they should have committed to and supplied all necessary resources to essentially replicate Soarian Financials on the Millennium architecture. Just a big swing and miss there.

          • A.CIO, the commitment and “all necessary resources” you’re looking for have been claimed by other priorities. Per Cerner’s PR this morning: “Currently, Cerner is focused on reducing operating expense.”

            Other stated goals:
            * maximize free cash flow
            * provide a dividend
            * buy company stock

            Translation: “Suck as much money out of healthcare as possible and put it into Wall Street pockets.” It’s a proud day for Brent, up 13%.

        • My understanding is Cerner is making the Sorian Financial Customers migrate over to the Millennium financials. However if they are trying to meld the two together to make a super system in concert with the Millennium Clinical system (so actually three together) does anybody who has been in the EHR industry for the last 3 or 4 decades think that can really work this time? The EHR minefield is littered with craters of vendors who tried to create a synergy between technologies that were created under separate paradigms and methodologies. The only reason Cerner seems to be getting away with it so far is the sheer inertia and cost of having to fix the problem by moving to another vendor. Inertia and the executives who made the decision to go with Cerner have almost no choice but to make it work and keep throwing money down the hole and praying it fills. Best of breed has been an epic failure and we are seeing that again not just with Cerner but with the Athenahealth Frankenstein. I think the biggest misunderstanding about “soft”ware is that it is pliable and you can just merge a software system with a specific underlying architecture with any other system you want with a little effort. As if you are molding a palm full of silly putty on to a solid object— and it will not just form and fit perfectly, but it will remain in that state indefinitely, serve the initial purpose effectively, AND also remain pliable for future needed adjustments. All evidence is to the contrary.

      • Cerner has been live for 2 years at the DoD and still hasn’t demonstrated that it’s “suitable for purpose.” They need to get that dumpster fire put out before the landfill fire that is revenue cycle for commercial clients. Don’t hold your breath. (but do hold your nose)

        There’s also that thorny issue of interoperability, another piece of DoD vaporware that’ll need to be prioritized at some point. 2 years live and still no CommonWell. but a nice quote from a VP:

        “”Every CIO in the country should be asking or expecting interoperability to be the bloodline to EHRs, population health, long-term and post-acute care or any healthcare software.”
        Kashif Rathore, Cerner

        https://www.healthcareitnews.com/news/epic-cerner-and-others-reveal-just-how-their-ehrs-are-interoperable

  2. Re: AI in Healthcare

    Comments from you, your readers and survey results can be cloaked in respectability of skepticism but they also reek heavily of cynicism and status-quo-ism.

    As the saying goes – “The Greatest Fool May Ask More Than The Wisest Man Can Answer”. And while the readers of your blog are no fools, they definitely have a stake in status quo. After all, that has allowed them to profiteer from an industry that sucks in close to 20% of national GDP with no accountability and no measurable outcomes.

    Whether it is AI, digital health, EHRs, there’s always “skepticism” but never any attempt at providing answers or being part of the solution.

    Your blog, sponsors and readers represent a broad cross-section of the healthcare industry, and for once, it will be good for them to actually be engaged and provide a way forward to change the status quo. But that may be asking for too much. After all, “it is difficult to get a man to understand something, when his salary depends upon his not understanding it.”

    • Seems rather ironic for you to assert that the readers of HIStalk “never [make] any attempt at providing answers or being part of the solution” and “for once, it will be good for them to actually be engaged” in the same post in which you accuse these very readers of cynicism.

      Just because everyone isn’t anointing the latest technology as the Next Big Thing doesn’t mean we’re intent on keeping the status quo – we’ve just seen too many NBTs fail to deliver on their promises to so easily give the next one the benefit of the doubt.

      And thanks for the memorable quotations! “I always have a quotation for everything – it saves original thinking.” – Dorothy L. Sayers

  3. I wonder what that computer is, in the Epic (Human Services Computing) photo?

    The color scheme screams IBM. My guess it is a minicomputer complete with removable hard drives, tape drives, printer and all the rest. Could it be a System/3?

    It has to be something that IBM had available in the late 70’s.

    • Probably not IBM since System/3, like everything else IBM sold until the PC, was proprietary and wouldn’t have run any of the software the became Epic (no MUMPS and I think it supported only RPG II as a programming language). The article suggests Epic started on a Data General Eclipse and it looks like one — look especially at the front panel. DG lost popularity and eventually was bought by Dell, with its swan song being the Aviion that mostly ran Unix.







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