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Monday Morning Update 5/20/19

May 19, 2019 News 7 Comments

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JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million. It’s the bank’s largest acquisition since the 2008 financial collapse, when it took over the failing Bear Stearns and Washington Mutual.

The bank’s head of wholesale payments says that 90% of providers still bill on paper. He says an acquisition makes more sense than starting from scratch since InstaMed has already created both the platform and its extensive network.

InstaMed, founded in 2004, had raised $134 million in funding. Co-founders Bill Marvin and Chris Seib were previously with Accenture. The 300-employee, Philadelphia-based company processed $94 billion in transactions last year.

Reader Comments

From Malted Milk Ball: “Re: ‘most powerful’ and ‘most influential’ lists. What is their methodology?” You’ve seen those click-baity “Best Hamburger in All 50 States” and “The Best Dog Breeds for Families” lists, compiled by some social media-savvy kid who has zero first-hand experience but who knows how Google and steal data from online sites. As far as I can tell given minimal transparency on the process, this is the same. Either someone is nominated (most likely by themselves) or aforesaid Googler simply heads over to LinkedIn. At least HIMSS is honest in accepting nominees for its “Most Influential Women in Health IT Awards,” although a committee of unstated membership makes the final decisions, gives preference to HIMSS members, and obligates nominees to contribute two HIMSS fluff pieces. It’s also good to remember that HIT fame is fleeting – Modern Healthcare’s 2008 “Most Influential in Healthcare” list was topped by Steve Case (Revolution Health Group) and Eric Schmidt (Google), then rounded out by some folks who have since passed away as well as those who are mostly forgotten, are now viewed less favorably, or who held a powerful role for a short time (former Hackensack CEO John Ferguson, short-term National Coordinator Rob Kolodner, and former FDA Commissioner Andrew von Eschenbach caught my eye among faded politicians and lots of people I’ve never heard of).

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A combined 53% of poll respondents take the federal government at its word in pushing interoperability to give patients more control and to save money, although a significant number believe its motivation is to benefit data brokers or to discredit previous administrations.

New poll to your right or here: If you’ve coordinated post-acute care for someone in the past five years, how hard was it? The bonus question, which you can answer by clicking the poll’s Comments link after voting, is how technology might have made the process easier or better.

Dear people who are writing for public consumption: please don’t start sentences with “there,” “so,” and “and.” It would also be nice if you didn’t mismatch a collective subject with a plural verb, as in, “The group of hospital CEOs are attending a conference.” Don’t misspell the possessive “its” as “it’s,” a mistake so prevalent that it seems more the rule than the exception. You can certainly write however you like when your readers are acquaintances — the folks with whom you would be comfortable wearing a ketchup-stained tee shirt or after having one-too-many glasses of wine —  but everybody else is forced to judge you on your thoughts and how well you express them. Most knowledge workers whose writing style is below average will see significant ROI from applying the slight bit of effort that is required to move to above-average (especially since the average is moving down). I’m preachy about this, but only because I want all readers to do everything they can to be successful.

Happy Victoria Day to readers in Canada.

Listening: Brooklyn-based Afrobeat band Ikebe Shakedown, a 1970s-style groove of big horns and wah-wah guitar funk. The Afrobeat genre was created long ago by the legendary Fela Kuti and is carried on by groups like Newen Afrobeat. I’ve seen an Afrobeat band live at an outdoor event and it gets people moving more than just about any other kind of music. I’m also still playing a lot of surf rock ran across the all-female, Canada-based Surfrajettes, which YouTubers compare to a Tarantino movie, what Austin Powers extras do on break, and “one of the best living room bands I’ve seen.”


May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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

Acquisitions, Funding, Business, and Stock


The Alabama Supreme Court rules that purchasers of all software, regardless of whether it is off-the-shelf or customized, must pay state sales tax. Russell County Community Hospital paid the state $18,000 in sales tax for its Medhost software and equipment (as correctly billed separately by the company to comply with state law), but the hospital then petitioned the Department of Revenue for a refund in arguing that what it had actually purchased was non-taxable “custom software programming.” The Supreme Court disagreed, ruling that “all software, including custom software created for a particular user, is ‘tangible personal property’ for purposes of Alabama sales tax.”


  • University of Rochester Medical Center joins the TriNetX research network to expand access to clinical trials and for cohort discovery.
  • KPMG will offer Waystar’s social determinants of health data to users of its clinical intelligence platform for care continuum optimization. 

Announcements and Implementations

Pivot Point Consulting launches HIM services that it will back with quality guarantees.

Government and Politics


FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels. This follows a report of a patient who received repeated insulin overdoses due to incorrect blood sugar readings issued by their homebrew setup.


A single-hospital review finds that adding internal timer functions to the EHR and monitoring its event log allows the hospital to reliably measure the before-and-after result of software changes. It this determined that streamlining the nurse’s EHR patient history function reduced user clicks and the time required by more than 70%. I like this work for two reasons: (a) it highlights the importance of focusing relentlessly on optimizing clinician EHR time; and (b) it provides an automated way to capture the result that goes beyond (or perhaps hand-in-hand with) user surveys and anecdotal reports from the more IT-friendly clinicians.

Unrelated but interesting: Uber and Lyft drivers who are waiting to pick up fares at Reagan National Airport are logging out of the company driver apps right before big planes land, with the AI of the apps then triggering surge pricing because of the driver shortage. The drivers then log back in a couple of minutes later and are paid at the higher rate. Maybe this is more relevant than I think in illustrating that software-enabled gaming of the system is likely happening all over healthcare.


This might be the news item needed to convince movie studios to make a Theranos-like movie about microbiome testing company UBiome, which was recently raided by the FBI after complaints of billing fraud. Co-founder and co-CEO Jessica Richman, PhD lied about her age to qualify her for various low-rent “Under 30” awards even though she was 40 at the time. I pulled the photo above with Maria Shriver from her Twitter – the now-45-year-old Richman is on the left. In a Theranos-like poorly kept romantic secret, insiders also say she was in a relationship with her co-founder, Zachary Apte. It’s pretty obvious – online records I checked in the free parts of some people-searching sites show both of them living at the same address in Washington (the article says they have houses in two states) and voter records confirm that Richman is 45 and Apte is 34. Lack of age-checking leads me to ponder how organizations that have separate awards for women verify the nominations – do they go strictly by appearance or name and are slippery slopes inevitable?

Newly filed tax records indicate that UPMC CEO Jeffrey Romoff got a 40% raise in 2018, with $8.5 million in total compensation. Another two dozen of the health system’s executives exceeded $1 million. UPMC reported FY2017 profit of $189 million on revenue of $13.5 billion.


I’m pretty sure this little guy who had just emerged from tonsil surgery at UPMC Susquehanna was happier to be comforted by Annie Hager, RN than one of UPMC’s million-dollar executives. He even brought her flowers for his follow-up visit, making it her turn to cry.

Sponsor Updates

  • Patient engagement and Next Best Action technology vendor SymphonyRM doubles its client base year over year.
  • Ken Congdon, content marketing manager at Hyland, publishes “EMR Optimization is the Hottest Thing Since … EMRs.” 
  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.”
  • Mobile Heartbeat and Voalte will exhibit at NWone May 20 in Stevenson, WA.
  • Waystar will exhibit at the ECW Education Expo May 27-31 in Boston.
  • NextGate will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Netsmart will exhibit at the Leading Age TX Annual Conference May 19-22 in Austin, TX.
  • Flywire Health and The SSI Group will exhibit at HFMA Region 1 May 21-22 in Uncasville, CT.
  • QuadraMed publishes a new case study, “Atlantic Health System Entrusts Patient Identity Leader for MPI Cleanup Before Massive Epic Rollout.”
  • Vocera will exhibit at the Northern Ohio HIMSS Spring Conference May 23 in Cleveland.

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Currently there are "7 comments" on this Article:

  1. I love reading Mr. H’s English usage and grammar reminders. As someone who reads executive resumes all day, I am amazed at how often they use the metallic element “lead” instead of “led” for the past tense of leading. I’ve seen this so often that I’ve doubted myself and looked it up five times over the years.

  2. I agree about the writing, but as someone who was trained as an engineer and married to an English major, I also get the woes of having poor grammar skills. Luckily, there are some nice hacks around this. One I use is the Grammerly plugin for Chrome. It helped me correct 5 of my mistakes here.

  3. The poll for interoperabilty should be taken down, made a secret, and never mentioned again as it’s embarrassing. Anyone who actually read the proposed rule knows there is only one thing specifically denied: patient access to data.

    • Richie, as someone who hasn’t read the proposed rule, do you mind elaborating? Does it really deny patients access to their data? Thanks.

      • Yes Anon, I believe it’s in the referenced in supporting documents.
        Initial: Patients want to know who is grabbing their info. Follow-up: that part of the law got specifically wiped away.
        It’s also noted in the first comment of the proposed rule (long document, but it’s in there).

  4. Re: AL hospitals paying sales tax on software purchases. Why would a not-for-profit pay taxes? Or does this only apply to for-profits? How is it any different than the historical process?

    • The actual operating entity, according to the lawsuit, is Jack Hughston Memorial Hospital in Phenix City, which is physician owned and I assume for profit (although I could find nothing saying anything about it either way). The ruling probably does apply only to for-profit, taxpaying hospitals. The only new issue is the interpretation of whether buying Medhost involved custom programming services or an off the shelf product. Medhost correctly categorized the sale as a product sale and remitted to the state the sales tax due that the hospital paid on its invoice, but the hospital then petitioned the state to give back the $18,000 in arguing that the technical work to install it was not a tangible product but rather a service. They eventually lost.

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  1. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

  2. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

  3. Dr Jayne is noticing one of the more egregious but trivial instance of bad behavior by allegedly non-profit organizations. I…

  4. To expand on this a bit. The Vista data are unique to Vista, there are 16(?) different VISN (grouped systems)…

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