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June 4, 2019 News 10 Comments

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All six former National Coordinators pledge their support for the proposed ONC/CMS interoperability rules in a Health Affairs article. They say the rules will transform information flow, spur innovation, and empower consumers. They also observe that:

  • Rapid advancement of FHIR and APIs is critical.
  • Expanding interoperability requirements to health plans is “game-changing.”
  • Using Medicare’s Conditions of Participation to advance interoperability is a powerful tool.
  • Strong enforcement of information blocking provisions should be high priority and access to the USCDI data set via APIs should be free since “price has unacceptably been used in the past to ration electronic exchange of information or to block it outright.”
  • The federal government should work in parallel to create a consumer privacy framework, especially around third-party APIs and consent processes.
  • Stakeholder education will be important.

Reader Comments

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From Crown Victoria Secret: “Re: Atrius Health. Has become an allied member of The Permanente Federation.” The forwarded internal email announcement describes a vaguely defined collaboration that began on June 1 between the 715-doctor, Boston-based Atrius Health and the Federation, the leadership and consulting group for the eight Permanente Medical Groups that serve Kaiser Permanente members. The independent, non-profit Atrius has 75% of its nearly $2 billion in annual revenue tied to full-risk contracts. It just announced a $39 million profit for 2018.

From Orion’s Belt: “Re: executive coaching. What do you think of people earning a formal coaching credential and hanging out a shingle to advise executives?” I don’t know how many executives are seeking such assistance, and certainly just waving around a freshly printed certificate without a history of demonstrated personal success won’t be much of a draw (it’s a “those who can” sort of thing). I like the idea, though, and I even toyed with taking one of the (expensive and hard-marketed) certification programs not too long ago just because the courses sounded interesting. Certification requires quite a bit of hands-on training and completing a bunch of actual coaching hours that are critiqued by the person being coached, so it’s not a quick, cheap, or low-effort project, not even counting the fact that it’s all for naught if nobody hires you.


HIStalk Announcements and Requests

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Industry long-timer and friend of HIStalk Vince Ciotti tells me that he and his partners have closed down their consulting business, HIS Pros, after 30 years. His long-running “HIS-tory” PowerPoint series on the history of the health IT industry was housed on the now-shuttered website, but Vince is sending me the files so I can post them permanently on HIStalk. The companies and people he mentions shouldn’t be forgotten and some of them offer lessons that we can learn all over again. Plus they are a heck of a lot of fun to read, especially if you’ve been around awhile.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Denver-based RxRevu, which offers EHR-integrated prescription pricing decision support, raises $15.9 million in a Series A funding round led by Colorado’s UCHealth.

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Cerner challenges developers to build apps on top of its platform that can help consumers access, understand, and use their EHR information in the 2019 version of its Code App Challenge. Winners receive a year of assistance in getting their app ready to be published on Cerner’s app store. Last year’s winner in November 2018 was a smart glasses-powered EHR navigation and documentation tool that isn’t yet listed in Cerner’s store.

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CVS, sweating under retail pressure from Amazon following its acquisition of Aetna, will expand its HealthHub store layout pilot to 1,500 stores that will retool 20% of the available floor space to offer health kiosks, digital health tools, yoga classes, dietitian counseling, expanded MinuteClinics. and SmileDirectClub teeth straightening (big companies really hate putting spaces between words). The space will come from reducing the inventory of slow-selling items such as greeting cards. The company’s #3 stated priority is to seamlessly connect digital and physical experiences, turn data into insights and action, and offer an intelligent engagement platform. CVS also expects big financial returns from chronic disease management.


People

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CoverMyMeds, which was acquired by McKesson for over $1 billion in early 2017, promotes David Holladay to president and Scott Gaines to COO. Co-founder and CEO Matt Scantland will leave the 1,000-employee company by the end of the year, while COO Michelle Brown will move into a different role. 


Announcements and Implementations

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A KLAS report covering recently announced inpatient EHRs for under-200 bed hospitals finds that only Athenahealth and Meditech have brought customers live, with those vendors having signed 115+ hospitals each. Just three hospitals each have contracted for ECW’s inpatient system and Epic Sonnet. Athenahealth customers worry about significant product functionality gaps (mostly clinical) and that the company has paused sales of the inpatient product during its corporate turmoil, with 22 hospitals cancelling their contracts in the past two years. Meditech Expanse earns high marks in both administrative and clinical areas, as does the company’s cost transparency. KLAS notes that Epic Sonnet isn’t really intended for small hospitals, but rather larger ones that are willing to start off with less functionality or lower cost with plans to eventually move up to the full Epic product, with Community Connect as provided by larger hospitals (rather than Epic itself) being the only real small-hospital option. ECW is losing prospects, most of them running CPSI or Allscripts Paragon, to other vendors due to delays in bringing any sites live. The bottom line is: (a) Meditech Expanse is the only successful new product; and (b) it’s not easy for ambulatory EHR companies to develop and implement a successful inpatient product.

Glytec will expand the capabilities of its EGlycemic Management System to create Therapy Advisor, a “Software as a Medical Device” platform that supports dosing and management of all diabetes medications, not just insulin. It will give providers evidence-based recommendations on product selection that also include patient affordability.

Sacramento-based non-profit medical technology startup support group MedStart shuts down, citing a drop-off in funding, plans by UC Davis to develop a similar program in Sacramento, and failed merger talks with other organizations. 


Government and Politics

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President Trump responds to a reporter’s question during a joint session with Prime Minister Theresa May by saying that any post-Brexit trade deal needs to allow US companies to sell to the National Health Service. Response was quick and unflattering from everyone from British politicians to clinicians who don’t like people, especially those from other countries, messing with NHS.

Coffey Health System (KS) will pay $250,000 to settle the federal government’s claim that it falsely attested to Meaningful Use in 2012-2013 by failing to perform a security risk analysis. The whistleblower lawsuit was filed by two people, one of whom I was able to find online as an employee of the 25-bed hospital’s compliance office. 


Privacy and Security

The information of 12 million Quest Diagnostics lab patients is exposed in a breach of the systems of American Medical Collection Agency, which provides billing services to Quest contractor Optum360.


Other

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Apple makes some health-related announcements at its WWDC developer conference, most of them pertaining to Watch:

  • WatchOS6 will add menstruation tracking, which will also work on the IPhone’s Health app
  • WatchOS6 will introduce a Noise app that will measure sound levels
  • Watch’s fitness tracking will be displayed as rings that tabulate daily movement, exercise, and non-sitting time and will roll those into long-term trend displays
  • WatchOS6 will allow using the App Store directly from the Watch
  • The IPhone’s Health app will be redesigned to offer notifications, favorites, and health highlights

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Verizon is hyping the heck out of its 5G service, with some of its questionable claims now including improving cancer treatment. The cell carriers like the opportunity to capturing market share, but 5G doesn’t seem like a silver bullet – it requires a ton of closely-spaced towers; it does nothing to bring broadband to rural areas where the cable company monopolies have stopped installing fiber and upgrading infrastructure; nobody has looked hard at what healthcare bandwidth limitations 5G expects to remove; and cell carriers (like the cable companies) provide notoriously poor user support. Eric Topol called them out for the TV commercial above, inviting them to show data proving that they improve cancer outcomes. I also winced at their use of the tired “fight” analogy.  

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Stanford professor and investor Phyllis Gardner is earning fame for her comments about Theranos and founder Elizabeth Holmes that were included in two documentaries about the company, some of those critical observations made long before a series of investigative reports brought the company down. She says:

  • She tried to tell Holmes early on that the company’s technology could not possibly work, but Holmes brushed her off and has since “been the burr under my saddle.”
  • Many smart venture capitalists sent Holmes packing when she invoked “trade secrets” in refusing to explain how the Theranos technology worked.
  • It was corporate malfeasance to load up the company’s board with people who had no science understanding, which she called “old men [whose] brains go to their groin.”
  • She knew the phony deep voice, black turtlenecks, and “the glammed-up look” of Holmes was fake, but says you could never see her real self.
  • “I didn’t find that many people at Stanford who thought she was amazing.”
  • She rips Silicon Valley’s “fake it until you make it”mantra for healthcare: “In medicine, you do not fake it. Ever. That is verboten, and that is why we have regulatory agencies … you don’t fail 10,000 times and get it right on the 10,000st. That is absolutely evil to say that.”

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Forbes releases its list of “America’s Richest Self-Made Women,” with Epic CEO Judy Faulkner coming in fourth with an estimated net worth of $3.6 billion. Wisconsin women took two of the top four spots, with #1 being Diane Hendricks of construction material vendor ABC Supply at $7 billion. The most bizarre winner – Suzy Batiz, whose toilet spray Poo-Pourri has sold 60 million bottles in giving her a not-so-crappy net worth of $240 million, tying Reese Witherspoon. 


Sponsor Updates

  • Dimensional Insight earns top scores for customer experience and vendor credibility in the annual Wisdom of Crowds business intelligence market study.
  • Avaya leverages Google Cloud to provide a wider range of global organizations with flexible, scalable communications and collaboration solutions.
  • Bluetree will exhibit at the Epic Michigan User Group Meeting June 10 in Ypsilanti.
  • Prepared Health will exhibit at the CMSA 2019 Annual Conference June 10-14 in Las Vegas.
  • KLAS recognizes CenTrak for standout industry performance in its 2019 report on real-time location systems.
  • CompuGroup Medical will exhibit at the New Mexico Primary Care Association Annual Conference June 13-14 in Albuquerque.
  • Collective Medical helps providers support and coordinate care for homeless patients.

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Currently there are "10 comments" on this Article:

  1. Poor Judy got cheated. $3.6 billion? No way. The company grosses 2.9 bill/year and the typical successful high tech company sells for over 5 times gross. She owns at least 80% per other stories I read, so 5 X 2.9b X .8 = 11.6billion. I think she should sue Forbes for publishing fake news. Judy is numero UNO!

  2. So did Meditech get any new customers or did they just sell Expanse to existing customers with older versions of their software (like MAGIC?) It is always so unclear to me. It seems strange to group that scenario in with Athenahealth selling to new clients. From what I can remember Athena bought their inpatient EHR off Beth Israel, so they must have sold into about a 100 hospitals, though who knows how many organizations that actually is. In my opinion, grabbing 100 hospitals in a tough market is nothing to sneeze at. I hope they decide to fill out the gaps in the software and dont shelve it.

    • Athenahealth is actually selling the former RazorInsights EHR into these small hospitals. The WebOMR from Beth Israel has not been “productized” as far as I know.

      What struck me though as odd is where is CPSI in all these numbers as the small hospital market is their sweet spot?

      • Athena is selling their own, self-developed HIS, integrated on their own ambulatory platform – not simply a re-skinned WebOMR or Razor Insights (which was shut down after the last client upgraded to the Athena platform).

        Keep in mind there were 25 or so Razor Insights clients when Athena bought them, but the rest of those 117 clients were acquired the old fashioned way – through sales.

      • The big attraction for small hospitals, and some larger sites who couldn’t afford to go to the board asking for a new system, was the fact that Athenahealth had zero up front cost… well zero upfront capital cost. No huge deposits. No large upfront hardware cost. Very attractive. Plus the practice software was working very well so why wouldn’t the succeed building an inpatient system? It can’t be THAT much more complicated can it? However the cost to actually implement and use was all too real for almost a dozen hospitals that we know of so far who pulled the plug. Costs so high the vendor had to “pause.”

        The cost of implementing a slicker front end essentially best of breed system that presents great but functions horribly in the real world was too much. Hospital executives who were enamored by the presentation and sales pitch were not aware of the fact that best of breed was fully vetted and wholly rejected by the industry. They just got a front row seat and the results have not been surprising. It’s hard enough for a hospital who can afford the required staff to implement a complete proven system with proven implementation methodology. Imagine trying to do that with a IT staff usually 1/5th the size of most community hospitals who could afford a traditional cost structure install – – – as your vendor tries to piece together a system using interfaced stop gap third party modules that are the absolute core elements for safe workflows within an acute care setting.

        It is crystal clear that the need to show expand revenues for investors forced Athenahealth to run before they could even walk.

      • CPSI and Medhost are waiting for someone to buy them out. They see the writing on the wall and arent going to spend money on development or marketing. They would rather keep costs down and earnings stable or up so that they have a stronger negotiating position when they sell.

        • Many people are misreading the KLAS report. This was a report “covering recently announced inpatient EHRs” and did not include or consider offerings from Allscripts, Cerner, CPSI, Medhost, etc…It had a very narrow focus of 4 vendors – athenahealth, eClinicalworks, Epic, and MEDITECH.

          My question is did KLAS actually conduct a study and research the new emerging Acute EMR’s or did they just regurgitate already gathered information and spit out this report?

    • I’m not sure the President fully understood the question that the reporter repeated three times in referencing NHS — President Trump told Teresa May that he couldn’t hear the question, she explained that it involved the National Health Service, and then he answered quickly but generically in saying that “everything has to be on the table.” He corrected his own comment several hours later after hearing the backlash, explaining in a TV interview, “I don’t see [the NHS] being on the table. Somebody asked me a question today and I say everything is up for negotiation, because everything is. But that’s something I would not see as part of trade. That’s not trade.”

      I question the original backlash since his comment, while ill advised, was not specific or threatening. The interpretation that he was calling for the US-led privatization of NHS was a stretch. I’m not even sure why the reporter asked an NHS-specific trade question in the first place.

      • The reporter probably asked because they knew Trump has no idea what the NHS is, or how it works, and that it would likely generate an interesting response. The outrage over the comment is overblown, but it just goes to show that Trump likes to negotiate without actually understanding the chips on the table, what they are, or what they’re worth. See: the gaffe with the Chinese about MOUs.







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