I had an old physician colleague whose favorite hobby was bitching about EHRs, and one day told a story about…
News 5/24/19
Top News
California-based drone-delivery company Zipline announces $190 million in funding and plans to expand its healthcare-focused service to the US, starting in North Carolina.
Founded in 2011, the company initially focused on delivering vaccines, blood products, and medications to remote clinics in Rwanda and Ghana. CEO Keller Rinaudo says Zipline is now ready to provide similar services to remote areas in the US: “People think what we do is solving a developing economies problem. But critical-access hospitals are closing at an alarming rate in the US, too, especially if you live in the rural US.”
Webinars
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
Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from direct-to-consumer DNA testing to a provider-focused population health management business. The company has raised $300 million over the last four years. Its most high-profile contract seems to have been with organizers of the Healthy Nevada Project, which had promised last spring to hand out Helix testing kits to 40,000 of its public health data project participants.
Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business, the most high-profile part of which is its Orbis EHR. Analysts believe potential acquirers could include Cerner, Philips, or CompuGroup Medical, which made a purchase offer in 2016.
People
Diabetes management software vendor Glooko names Mark Clements, MD (Children’s Mercy Kansas City) CMO.
Russell Siebert (ZirMed) joins analytics company VisiQuate as EVP of growth.
MDLive appoints Kristen Lalowski (N-of-One) chief product officer.
MD Anderson Cancer Center (TX) hires David Jaffray (University Health Network/Princess Margaret Cancer Centre) as its first chief technology and digital officer.
Former FDA Commissioner Scott Gottlieb, MD returns to venture capital firm New Enterprise Associates as a special partner on its healthcare investment team.
Mona Hanna-Attisha, MD receives the inaugural Vilcek-Gold Award for Humanism in Healthcare from the Vilcek Foundation and The Arnold P. Gold Foundation. The pediatrician discovered Flint, Michigan’s lead poisoning crisis by analyzing patient data in Hurley Medical Center’s Epic system. She has donated the $10,000 prize to the Flint Kids Fund.
Provation names Rick Jennings (Teammate) CTO and Erin Surprise (Hoonuit) SVP of professional services. Wolters Kluwer Health sold Provation to Clearlake Capital last year for $180 million.
Sales
- Consulate Health Care (FL) will leverage Collective Medical’s network for better insight into senior care transitions.
Announcements and Implementations
Innovaccer announces GA of patient outreach management software.
Reports surface that Amazon is developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.
Government and Politics
Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on MHS Genesis, the DoD’s new Cerner-based system, in September. Other facilities in the initial wave of implementations will include Naval Air Station Lemoore and US Army Health Clinic Presidio of Monterey in California, and Mountain Home Air Force Base in Idaho.
Privacy and Security
Indiana-based Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients. OCR’s investigation determined that the EHR vendor hadn’t performed a thorough risk analysis before hackers broke into the system using a compromised user ID and password. Other sources have said the company ignored the recommendations of a cybersecurity firm hired at the beginning of 2015, which included strengthening weak login credentials created so that end users didn’t need individual user names and passwords. The company was named in a multi-state December 2018 lawsuit brought by 12 attorney generals over its lack of health data protection.
Other
Burnout exists in the IT trenches, too, according to a local Madison, WI news outlet. It dedicates a good chunk of copy to the complaints of former Epic employees who have moved on to greener, less grueling pastures. Rachel Neill, CEO of health IT staffing company Carex Consulting, says Epic experiences a 20-30% churn in employees each year, with the majority of replacements coming straight out of college. “They’re looking for someone who can keep on going, going, going until they can’t any more,” she adds. Epic disputes that claim, saying that its actual voluntary turnover is about 10% per year, which is below average for companies in health IT specifically and in the Midwest in general, and that employees work about the same hours per week as salaried US employees overall. Epic Director of Human Resources Allison Stroud believes that most employees feel “happy and challenged, which ends up being one of the best ways to prevent burnout.”
Sponsor Updates
- Elsevier Clinical Solutions, FormFast, Imprivata, and Intelligent Medical Objects will exhibit at the 2019 MUSE Inspire Conference May 28-29 in Nashville.
- EPSi shares the updated features of its EPSi 19.1 financial decision support and budgeting software.
- Hayes Management Consulting hires Yara Hentz (Monster) as client success manager.
- Goliath Technologies releases an updated version of its Performance Monitor software.
- Kyruus will host the Sixth Annual Thought Leadership on Access Symposium (ATLAS) September 23-24 in Boston featuring a keynote by Toby Cosgrove, MD.
- Matter will feature Intelligent Medical Objects co-founder Frank Naeymi-Rad at a networking event on May 29 in Chicago.
- HBI Solutions joins the Iatric Systems AI Solutions Center.
- NextGate responds to requests for information by CMS and ONC on strategies to improve patient matching, underscoring the importance of standards, proven technology, and data governance.
- Glytec receives patent allowances from regulatory bodies in Australia, Japan, and Israel related to systems and methods for insulin titration and glycemic management.
Blog Posts
- 3 Ways to Prepare for the Future of ASCs (EClinicalWorks)
- Harnessing the Opportunity to do Better in the Midst of EHR Implementation (The HCI Group)
- Chasing health IT interoperability (Hyland)
- UnitedHealthcare and AMA Advancing Social Determinants of Health Data in Care Delivery (Imat Solutions)
- ImpactPalooza 2019 – Impact Goes to the Movies! (Impact Advisors)
- Setting a course for the ‘next frontier’ of cloud-based patient access (Meditech)
- 25 Hospitals with the Best and Worst HCAHPS Scores (Definitive Healthcare)
- Post-Live Training: Converting Face-to-Face Content to ELearning (Optimum Healthcare IT)
- 7th annual Community Giveback Week supports 12 non-profit organizations nationwide (Nordic)
Get Involved
- Join my Rolodex to provide occasional news reaction or ideas
- Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
- Be interviewed (providers)
- Deliver an educational webinar (providers)
- Sponsor
- Report a news item or rumor (anonymous or not)
- Sign up for email updates
- Connect on LinkedIn
- Contact Mr. H
Epic’s response to burnout is precious. Yes, everyone is happy and challenged, excluding of course the thousands who have and regularly leave having worked themselves into a psychological dumpster fire in accordance with the cultural imperative. I suppose it’s progress that they say “avoid burnout,” as for much of recent history top leaders subscribed to the Marissa Mayer school of denying burnout’s very existence, and shaming those claiming it as weak and flawed. Not to knock Epic too much, one can read the same about most of Big Tech. Most find it hard to be sympathetic as well given the salaries, and that certainly is the core of rationalization of both the architects of and participants in these kinds of cultures.
My personal opinion is that burnout is most directly influenced by the relationship you have with your direct manager, and the implicit and explicit expectations set about work load. Great companies are ones that have a management culture that promotes a healthy work-life balance and actually executes on it. At many companies, the execution is often left to the discretion of the individual mid-level managers and as such, results may vary. I think companies can only really influence burnout in a top down approach by giving managers the leeway to exercise judgment on workload in written policy. CEOs can’t personally make sure that every manager is doing a great job, but they can certainly help by removing barriers and necessary management artifice, for example: requirements to log X amount of hours.
That said, nothing abdicate individual employees from taking ownership of their own mental health. Many people paint themselves into difficult corners because of false choices they’ve created for themselves. According to Harvard Business review, managers can’t reliably distinguish between employees who are working 30 hours a week and those working 80 hours a week. More people need to wake up to the idea that sacrificing your time and mental health to corporate entity is not even a good way to get better performance reviews, raises, or promotions.
Mr. H, you can add this little propaganda gem to your file of Top 10 Euphemisms (emphasis mine). You have one of those files, right?
“(in 2017) Users discovered some OPERATIONAL DISCREPANCIES IN THE SYSTEM, which have been corrected.”
For counterpoint, the only published independent oversight in Dec. 2018 disagrees:
* “Although key MHS GENESIS functions improved and the system worked well in 18 of 70 clinical areas, MHS GENESIS is not yet operationally effective.”
* “MHS GENESIS is not yet operationally suitable – users gave MHS GENESIS usability an average score of 40 out of 100.”
* “MHS GENESIS is not survivable in a cyber-contested environment.”
Never seen a disaster so badly in need of a whistleblower.
Is Epic still growing, not if you read between the lines. Last year they said they hired 400 new employees. Now they say turnover is 10%, others say 20% maybe it’s 15%, either way that’s means replacing at least 900 employees /yr. Looks like they may be cutting back or at best holding position. Makes sense, since Judy said a few months ago in a news article they are done building and with the end of HiTech money that juggernaut is over.
The hospital market is clearly saturated, and a month or so ago an Epic VP stated they want to move into other levels of care, like LTC, rehab, etc. But those markets are also saturated with some very well established vendors and Epic behooves buying other companies. Is the writing on the wall?
I’d be interested to see how many places are using Home Health from Epic. That’s a new market they entered. They have the skill and ability to create a new product. They could easily come up with a LTC product quickly, give a sweetheart deal to the first few clients to test it out and then sell it. Another facet would be if we see more consolidation in the healthcare space. Maybe hospital chains start buying SNF and LTC chains. If that happens, Epic would be foolish to not move into the space.
Yes it would be, but in terms of the growth challenge even if they had a great LTC or Home Care product the revenue price points are at best 10% of a hospital system. They’d have to sell a train load just to get to their multi-million dollar hospital EMR price tag. Also there are several big proprietary chains in the LTC market and they are not part of any large hospital group. What many hospital marketers realize to late is that LTC, Rehab, Mental Health and HC are very different markets than acute care and they are today very mature, replacement markets. Ease of entry would be via hospital based units but the number of hospital based LTCs are not that many.
FYI – Epic’s home health product is one of its oldest – older than inpatient. It did see a massive scale-up of customers in the 2014/2015 time frame (I’m unclear as to why).
And Epic released an LTC module with the 2014 release – though it is mostly focused on the SNF side of the market. A few sites are currently live with it.
Fred’s right on the money here.
I vividly recall one of Epic’s TLMMs (Team Lead Management Meeting – a meeting where upper management tries to teach the middle management the “Epic way” of managing foot-soldiers) where one of the presenters tried to convince everyone that burnout is just a fake concept, that people don’t get burnt out as much as they get bored. And knowing how Epic operates, that messaging likely came right from the top.
The message was that if someone in the team is complaining about burnout, that really means that their immediate manager is not doing a good job of keeping them engaged. Come to think of it, it is really a masterstroke – by making the middle management responsible for this, you are not only shirking responsibility, but are actually incentivizing middle managers to suppress any cases of burnout (because it will be deemed to be their fault). No wonder Epic didn’t take physician burnout seriously for a long time until it became really hard to ignore.
Of course, this conveniently ignores the research and the evidence behind burnout. In fact, go and ask some of the primary care docs and mental health specialists at GHC Madison, Dean Clinic and University of Wisconsin regarding how many cases related to mental health they see from Epic employees and whether that’s disproportionate to their head count and you will get your answer.
The “Epic voluntary” turnover rate really isn’t the story- the slow hire, quick fire mantra means most of the terminations are involuntary. I’m told in shareholder meetings where management can’t lie without repercussions that the turnover rate has been identified as a major corporate issue.
I spent about four-ish years at Epic. Almost everyone left voluntarily and had a job lined up immediately. A significant percentage of people I talked to left in the first couple years because of unrealistic work expectations. I dont think Epic hires particularly slow – theyll take pretty much any smart driven college grad to be a TS or IS which are the majority of positions filled and where they actually see their high turnover. I cant really comment on how fast they fire other than to say that Epic has notoriously poor middle management and its one of the reasons that they have to pay comparably high salaries for inexperienced but high quality entry level workers. A firing is often as much a problem caused by management as it is by the employee.
If you think people are all leaving Epic voluntarily, you’re most likely oblivious. I was myself oblivious about it for a long while. Because Epic commonly gives time to find a new job, it may seem like people are quitting because they found greener pastures when in reality they’ve been given 6 weeks to quit or be fired. Having now been on the other side of the process, I can think of at least 2 employees on our Epic install who were not very good and ended up suddenly transitioned off our project; I assume they were counseled out. There is not a Life after being fired from Epic blog for nothing.
I can’t tell if you’re implying this is a bad thing? I think every organization will have some amount of involuntary turnover. The person you replied to said there was involuntary turnover. I don’t see the problem with an organization that works out weaker employees, but does so in a way that is fairly generous and allows people to explore other employment opportunities while collecting still collecting a paycheck for a few weeks.
You probably can’t tell because I didn’t really mean to imply good or bad, just that the voluntary turnover is not “almost everyone”. I myself waffle on the issue and can make arguments both ways.
Epic is very sink or swim with their employees. I think most of the “you dont have what it takes“ weeding out happens in the first year. I know Epic management sometimes tells people to look for a new job because they are getting fired in a month. I have a few friends who were fired before they hit the year mark – I dont think the other people who left lied to me about the reason for their departure. Regardless, I dont think management is doing this sort of weeding out to people past the second year. After you have been there a couple years, I think Epic has arrived at the conclusion that you are capable of doing the work. People still don’t stick around when they hit the two year mark. Epic requires a large amount of work relative to the pay they offer and the work environment that they foster. Im going to take people at their word and believe them when they say that they left voluntarily due to the working conditions. I think that you should too.
When “Guy M Fay” wrote: “I’m told in shareholder meetings where management can’t lie without repercussions that the turnover rate has been identified as a major corporate issue.” – he made it clear that he has never been to an Epic shareholder meeting…and that he lied.
I’m still trying to get my head around why people insist that privately held companies that are still very profitable are “struggling” because revenues are down. The key being the slight decline in overall revenues was clearly predicted in advance. Maybe the major share holders have a little heartburn because of unreasonable expectations borne out of the MU honey pot days but the companies still are very healthy.
Not sure if you were referring to my post, but if you are I never said they were ‘struggling’. On the other hand now that you mention it the old adage in the world of high tech businesses is that if you are not growing, then you are dying. There is no in between.
This may sound trite but the reality for high tech companies is you need to keep making significant investments as technology changes (and as government rules change) and in order to do that you need to grow and keep increasing profits. That’s true for both private and public companies. They may not be struggling now, but without growth they will be in the not too distant future.
This story is soooo familiar. We were told years ago that Meditech hired young analysts, worked them hard and burned them out. The emphasis on education seems good unless it becomes just another expectation piled on a mountain of expectations.
There was another aspect of Meditech’s hiring culture, which is that they frequently hired people with neither a Healthcare nor an IT background. The in-house education programs were expected to fill those gaps.
The impact on customers was, and continues to be, uneven and unpredictable service levels. A lot of the support analysts are inexperienced and lack appropriate knowledge. Around the time they start getting good, they are quitting due to burnout or lack of opportunities to advance.