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Monday Morning Update 6/17/19

June 16, 2019 News 4 Comments

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The local paper’s review of the June 2 ransomware attack on Estes Park Health (CO), which includes a 23-bed critical access hospital, contains interesting nuggets:

  • The ransomware took down the health system’s network, phones, and email.
  • The health system’s cyberinsurance company negotiated and paid the unspecified ransom.
  • Further ransom payments were required as the health system found additional encrypted files.
  • The health system defends paying the ransom because other businesses that have refused remained offline for weeks and “we rely heavily on this summer business to maintain our financial stability.”
  • The health system had to pay a $10,000 deductible of the total ransom paid,  which it says was money well spent because it generates more revenue than that in a single hour.

Reader Comments


From Just a Gigolo: “Re: Allscripts acquiring ZappRx. Good move, do you think?” Yes, assuming that ZappRx’s underlying fundamentals are anywhere near sound after several years in business. The end of HITECH has given EHR vendors a breather that they both appreciate (in allowing them to get back to product development) and hate (they need something else to sell to avoid a drop in revenue). Allscripts is the best EHR vendor at running itself, as one HIStalk reader observed, like a health IT mutual fund of minimally related software products bought at a discount, and this acquisition seems to be well aligned with that strategy. Allscripts also likes working with pharma, which is another plus since that’s who pays for ZappRx’s services. You don’t really want to be a publicly traded EHR vendor (or a consulting firm dependent on their implementation business) as demand for your primary product drops, even if external factors such as HITECH expiration are to blame. Cerner is in the same boat, but seems to be pinning its diversification hopes to healthcare projects that don’t necessarily involve just software.

From Cutting Rejoinder: “Re: EHR bloat. How can technology fix that?” I always give the same answer, but nobody seems to agree with me – allow each clinician to tag the information (highlighted text or discrete fields) that they feel is important in the patient’s care, adding or removing those tags at any time and for any reason. That provides two benefits: (a) the provider could click a single button to display only the information they themselves have previously tagged, with date sorting / filtering that makes getting a quick refresher nearly instantaneous; and (b) someone plowing through the chart for the first time could look at what everybody else found useful, or perhaps that a particular clinician saw as useful (like a cardiologist). The underlying EHR data collection and storage would not require changes since it could keep collecting the junk as usual. It would be like highlighting a textbook or contract with the added ability of seeing what one or more others have highlighted. One more benefit is that the patient could then see the highlighted information in their electronic copy of their record to help them make sense of the 90% of the record that nobody will ever care about.

HIStalk Announcements and Requests


More than half of poll respondents say their job description requires an applicant to have earned a bachelor’s degree, while 24% say it takes a master’s. Only 5% say that no degree is needed, although a maddening 17% observe that their employer ignores their own job descriptions if they really want to hire someone (meaning that the requirement isn’t really required, which is the kind of wishy-washiness that you often see in hospitals).

New poll to your right or here: For those treated by a hospital (inpatient or ED) within three years: did your PCP have your hospital records at your next visit? I don’t worry too much about practice-to-practice interoperability since that usually involves minimal urgency, but surely my PCP would be curious about what was done to me in the hospital during a recent inpatient stay or ED visit.


Welcome to new HIStalk Platinum Sponsor HealthCrowd. The San Mateo, CA-based company offers a unified, cloud-based, end-to-end communications solution that allows organizations to deliver member-centric engagement at scale, moving communications from tactical to strategic. Its Unified Communications Platform (text, voice, email, and nanosites) drive members to action, backed by Clairvoyance campaign analytics. Case studies: (a) Aetna developed a sustainable digital outreach program for its Medicaid project; (b) a health plan used intelligent mobile messaging as part of its disease management program, nearly doubling screening; (c) a managed care organization used the company’s platform to communicate with Medicaid beneficiaries. Founder and CEO Bing Doh founded the company with the behavioral change and consumer analytics knowledge she gained in the online advertising technology world. Thanks to HealthCrowd for supporting HIStalk.

Listening: new from Midland, which if I’m ever going to like country music (which isn’t likely), this would be why. It’s not the usual Nashville city slicker pretty boys warbling with fake Southern accents over a few token pedal steel pop licks while wearing cowboy hats in places like midtown Manhattan or on stage at night where their only value is as a poser cowboy affectation. This recently formed Dripping Springs, TX trio sounds to me like the California country-rock of the 1970s Eagles with the occasional surf guitar, Spanish guitar, and moody minor chords skillfully blended in. Fun fact: they formed the band when one member was getting married and the other two were his groomsmen, jamming on the porch after showing up a few days before the ceremony and deciding that they could form a band. I’m not entirely sure this is really country music, so I’ll admit that I actually like it a lot. Audio of the excellent new single is here.


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

Acquisitions, Funding, Business, and Stock


Change Healthcare raises the amount of its IPO again, this time to $1.2 billion. The original value from March filings was for $100 million. The company hopes to use the proceeds to pay down some of its $5.8 billion in debt.


  • Lincoln Medical Center (TN) will replace CPSI Evident radiology PACS with Intelerad in June 2019.
  • Jefferson Memorial Hospital Radiology (TN) replaced GE radiology PACS with Change Healthcare on June 1, 2019.
  • The Orthopedic Hospital (IN) went live on Cerner in March 2019.
  • Ascension Seton Smithville Regional Hospital (TX) will go live on Cerner in 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.



Health First (FL) hires William Walders, MHA (VMware) as CIO. He is a US Navy veteran and served in a number of military IT roles, including CIO of the USNS Comfort and Walter Reed National Military Medical Center.

Announcements and Implementations


CPSI offers users of Microsoft HealthVault – which will be shut down in November – migration of their data to the Lydia platform sold by its subsidiary Get Real Health.

Clinical Computer Systems, Inc. will distribute amniotic fluid lactate level monitoring technology developed by Sweden-based ObsteCare pending FDA clearance for its use in prolonged labor. 


Patients complain that the Cerner system of Abrazo Community Health Network (AZ) has been down for several days, which the hospital says was caused by a Cerner upgrade.

Researchers are mining EHR data to determine when expensive medical helicopter transfer services make sense, especially those involving moving a patient from one hospital to another. They hope to create a checklist to help clinicians decide whether air transport is worth it, especially since patients often get stuck with exorbitant air flight bills after their insurance declines to pay.


LifePod Solutions will offer its caregiver-managed voice service for home care on IHome’s consumer electronics equipment. It will provide monitoring, fall detection, real-time alerts, and reports that are driven by the senior’s voice alone.


A New York Times investigation finds that GE, Siemens, Philips, and Toshiba are bribing poorly paid Chinese hospital officials to buy their medical equipment. GE salespeople offered one hospital administrator a $1 million bribe to buy a $4 million CT scanner. The companies inflate equipment price to cover the cost of bribes and kickbacks, refuse to underbid each other, and use shady third-party importing companies to cover their tracks.

An Atlantic article says that the US healthcare system is an expensive flop globally because Americans are the worst patients – we are hypochondriacs; we demand drugs that we don’t need but refuse to take those we do; our “cost is no object” beliefs trigger outrage when insurers decline to pay for expensive treatments that have been proven to offer little value; we sue providers so often that they order unnecessary tests and initiate treatment based on the results purely as malpractice defense; and we believe that heroic interventions are justified in delaying death. The author concludes,

It makes sense that a wealthy nation with unhealthy lifestyles, little interest in preventive medicine, and expectations of limitless, topnotch specialist care would empower its healthcare system to accommodate these preferences. It also makes sense that a healthcare system that has thrived by throwing over-the-top care at patients has little incentive to push those same patients to embrace care that’s less flashy but may do more good. Medicare for All could provide that incentive by refusing to pay for unnecessarily expensive care, as Medicare does now—but can it prepare patients to start hearing “no” from their physicians? 

Sponsor Updates

  • Lightbeam Health Solutions publishes a new case study, “Kootenai Care Network: ACO Automates GRPO Reporting.”
  • Mobile Heartbeat and Voalte will exhibit at the Organization of Nurse Leaders event June 20-21 in Newport, RI.
  • Waystar, Experian Health, Patientco, and ZeOmega will exhibit at HFMA June 23-26 in Orlando.
  • Netsmart will exhibit at the LeadingAge Collaborative Care and Health IT Innovations Summit June 23-25 in Baltimore.
  • Nordic will exhibit at HIUG Interact 2019 June 16-19 in Orlando.
  • ROI Healthcare Solutions will exhibit at the Midwest Infor User Group meeting June 19-20.
  • SailPoint will exhibit at Gartner Security & Risk Management Summit June 17-20 in National Harbor, MD.
  • Sansoro Health releases a new 4×4 Health podcast, “CMS & ONC Propose Big Changes for Payers.”
  • Surescripts and Wolters Kluwer Health will exhibit at AHIP June 19-21 in Nashville.
  • T-System will exhibit at the 2019 Western Region Flex Conference June 19-21 in Marana, AZ.
  • TriNetX applauds the House Appropriations Committee for supporting use of real-world evidence in the House Agriculture-FDA Spending Bill.
  • Visage Imaging will exhibit at the SIIM19 Annual Meeting June 26-28 in Denver.
  • Vocera will exhibit at HITEC 2019 June 17 in Minneapolis.

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Mr. H, Lorre, Jenn, Dr. Jayne.
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Currently there are "4 comments" on this Article:

  1. I actually love your idea about people being able to tag what they want. It would be nice to be able to jot a note as well as tag/highlight information. I’d like to have “notes to self” that are distinct from notes that could be viewed by patients or other clinicians.

    Jotting a note for one’s own recall would be especially helpful in relation to the problem list where you’d like to be able to note some additional key details about timing, clinical features, etc that just don’t fit within the structured data fields.

    A note that’s later retrievable would also be great for medication history. Often we make changes in medications and on later review, we can’t figure out why the med dose was changed (too many side effects, starting to taper one drug, inadequate efficacy) or stopped (too many side effects, not effective, no longer on formulary, too expensive).

    A condensed display of the longitudinal medication history (with filtering for meds of particular interest) would be a big benefit especially if you could see med doses/changes in parallel with key information (symptoms, labs, side effects).

    Another way to eliminate the untoward effects of note bloat, at least for reviewing the chart, is to let users pick specific notes or info that they want to see for a defined time frame and have the system do an on-the-fly save to a single scrolling document with just that info included. There are multiple events that happen, especially for inpatients, that generate a “note” yet the bulk of information can be summarized in one line. Unlike paper records though, you have to click on each “note” to get that small amount of info (e.g., was a PRN effective, did the patient refuse their respiratory treatment, did they attend patient education group). Such a custom display could include info that you or others tagged (with comments) and you could choose to include things like conclusions of radiology reports, PRNs given (with response), major lab findings (abnormalities plus ones you specify), etc. Being able to scroll quickly through a single document would be so much nicer than clicking on multiple tabs and multiple notes.

    Of course the best way to get rid of note bloat is to get rid of E/M codes but that’s less controllable.

    • Note bloat could be combatted a couple of different ways.

      – long form notes are always going to be a problem. Lengthy text descriptions, by their very nature, require the investment to read them. Short descriptions with the ability to drill down are the way to go here;
      – sometimes, a better organizing principle can be a revelation. I’m thinking of a time-based layout for example.

      For an example of the latter, I’m thinking of a little-used feature of Windows, called the Reliability Monitor. It charts issues over time and shows a view of the health of your computer. All the information is summarized initially and you have to click on the various items to find out what they are. However by using the ideas of “What Changed” and “When”, you get a higher-level, more coherent view of what is going on.

  2. Listening to Midland – seen them live twice and they are a lot of fun. I would venture to say they are more country than just about anything new on the radio these days.

    Not a fan of the current HickPop scene…

  3. So very happy to see talent and leadership such as William Walders join commerical provider care. He is and will continue to be an ego-less change agent who balances future thinking respectfully alongside practical realities. He joined one of the most respected vendors post his military career, and is clearly returning to provider care because he is dedicated to the mission. It’s a good day for HIT and patient care. William will set a new standard, respectfully and without the need for attention. Thank you for sharing the local news report.

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