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Monday Morning Update 7/1/19

June 30, 2019 News 9 Comments

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Diabetes management technology startup Livongo files for a $100 million IPO.

The company’s SEC filing indicates that the company’s revenue doubled from 2017 to 2018 to $68 million, but losses also doubled to $33 million.

The company’s standard boilerplate warnings note that it would have a real problem if Executive Chairman Glen Tullman were to leave. He and the 7WireVentures firm he manages with Lee Shapiro – they were CEO and president of Allscripts, respectively, until the company fired them in late 2012 — hold 9.4 million shares of the company, or 11.7%.

CEO Zane Burke was given nearly 1 million shares, 1.2% of the total, when he was hired in December 2018, two months after resigning as president of Cerner.

Livongo reports having 413 clients representing 114,000 diabetes members whose contracts are worth $155 million. 

Reader Comments

From Dippity-don’t: “Re: NextGen Healthcare. Laid of 100 employees Wednesday. All business analysts, developers, and QA for practice management’s financial, real-time transaction, and patient portal are now offshore. The Milledgeville office was also closed.” Unverified. I didn’t see anything on Georgia’s WARN site.

From I CIO J: “Re: contract gag clauses. Our Epic contract had no such clause and no one from Epic ever raised this concept.” I remain convinced that “gag clauses” are as mythical as the Loch Ness Monster, the subject of rumors spread by people who have never held a position of significant health system IT authority and have never seen an actual vendor contract. A vendor executive asking you nicely (or not so nicely) to remove the extensively detailed screen shots or product documentation that you posted widely for whatever reason isn’t a gag clause, it’s intellectual property protection, which is always part of an IT contract. You can’t assume that a gag clause exists just because your health system boss blames your vendor for shushing you – health system executives often bend too far in hoping to remain in good vendor graces, but that’s not a gag clause. Neither are general non-disparagement terms. It’s true that, this being America and all, companies are free to threaten and sue anyone they feel threatens them, but that’s outside the scope of enforcing a contract term. 


From Clause or it Didn’t Happen: “Re: contract gag clauses. I wish you could ask Eric Topol directly what evidence he has – he has mentioned gag clauses, specifically calling out Epic, in his book and tweets.” I’ve emailed Eric Topol and will let you know what (if any) response I get.


From HITPurist: “Re: Epic’s power over a health system. Remember how Texas Health Resources issued a press release about Epic not allowing the MD to see the Ebola patient’s travel history? THR retracted the statement, which implied that Epic’s attorneys forced them to. Can anyone share insight?” I talked to a couple of THR insiders right after the October 2014 event. My conclusion from those conversations was that THR was so anxious to shift the unfavorable PR spotlight elsewhere that its executives quickly threw Epic under the bus after performing little due diligence, not even asking its own IT folks to assess the EHR setup before proclaiming that as the problem. I’m sure that Epic complained vigorously upon being called out in a press release, as would any vendor who was publicly blamed for a high-profile error. In fact, THR’s press release in which it blamed Epic even included this wording: “Texas Health Dallas has relocated the travel history documentation to a portion of the EHR that is part of both workflows.” That suggests that THR corrected its own faulty Epic setup without requiring Epic’s help. THR’s handling of the Ebola patient was inept, to the point that one of its ICU nurses who was exposed to the patient sued the health for poor training and for disclosing her name and medical condition without her permission. A good post-mortem research analysis is here. The bottom line is that THR was no different than most US hospitals in being prepared to treat, but not diagnose, Ebola.

HIStalk Announcements and Requests


The top reason that poll respondents don’t work for themselves instead of someone else is their concern about stable income and employment.

New poll to your right or here: What is the #1 factor that would motivate you to take a new job?

I have to work harder in the slow summer months (aka “The Doldrums”) to find new sponsors to replace those that have been acquired, run out of money, or made as our unresponsive contact a clueless marketing newbie who knows nothing about the industry. Contact Lorre to learn about:

  • A special deal on webinars
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Vince Ciotti’s HIS-tory Series


Industry long-timer, iconoclast, and raconteur Vince Ciotti penned (PowerPointed, actually) the remarkable HIS-tory series that I ran on HIStalk over several years starting in 2011. Vince recently closed his firm of 30 years, H.I.S. Professionals and retired. He wanted to make sure that the HIS-tory series remained accessible, so I’ve combined all of the 125+ entries into a single downloadable, searchable PDF document. It works best if you download it, then open it in Acrobat Reader instead of directly in your browser.

This document of nearly 1,300 pages covers the history of our industry from the mid-1960s through 2000 or so. Vince captured information that might have been otherwise forgotten as health IT’s pioneers have changed industries, retired, or passed away.

I asked Vince if he might be up for adding new reader-contributed material, clarifications, corrections, etc. Vince jumped at the chance because, in his words, “I’m so bored with retirement that you wouldn’t believe it.”

Vince and I would be interested in your pre-2000 contributions as follows:

  • A “where are they now” update on the folks Vince mentioned who he has lost track of.
  • Scans of your interesting old magazine articles, ads, etc. like those he included.
  • Your anecdotes about the companies, products, and people that he mentioned.
  • Anything else that you think is fascinating or important about that health IT era through 2000. This might be the last chance to archive what you have or know for future readers.

I won’t update the original slides, but instead will invite Vince to create new ones that update the series with the new information you send. I’ll probably run those on HIStalk as he finishes them, hopefully generate additional reminisces, and then roll those into the PDF file above.

Thanks for your contributions. Email Vince at vciotti@hispros.com or me.


July 18 (Thursday) 2:00 ET. “Healthcare’s Digital Front Door: Modernizing Medicine’s Mobile-First Strategies That Are Winning Patient Engagement.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Michael Rivers, MD, director of EMA Ophthalmology, Modernizing Medicine. Providers are understandably focused on how to make the most of the 5-8 minutes they have on average with a patient during an exam, but what happens between appointments also plays a significant role in the overall health of patients. Modernizing Medicine is driving high patient engagement with best practice, mobile-first strategies. This webinar will describe patient engagement and the challenges in delivering it, how consumerism is changing healthcare, and how to get started and navigate the patient engagement marketplace.

July 25 (Thursday) 2:00 ET. “Meeting patient needs across the continuum of care.” Sponsor: Philips Population Health Management. Presenters: Cindy Gaines, chief nursing officer, Philips Population Health Management; Cynthia Burghard, research director of value-based healthcare IT transformation strategies, IDC. Traditional care management approaches are not sufficient to deliver value-based healthcare. Supplementing EHRs with advanced PHM technology and a scalable care management approach gives health systems proactive and longitudinal insights that optimize scarce resources in meeting the needs of multiple types of patients. This webinar will address the key characteristics of a digital platform for value-based care management, cover the planning and deployment of a scalable care management strategy, and review patient experience scenarios for CHF and diabetes.

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

Acquisitions, Funding, Business, and Stock

Shares of Scotland-based Craneware drop 35% after the company reports disappointing second-half sales.


  • Ascension Seton Smithville Regional Hospital (TX) will go live with Cerner in 2019.
  • Abbeville Area Medical Center (SC) replaced Evident (A CPSI Company) with Athenahealth in September 2018.
  • Kennedy Krieger Institute (MD) will go live on Epic on July 1, 2019.
  • Dupont Hospital (IN) went live on Cerner on March 1, 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.



Andy Crowder (Scripps Health) joins Atrium Health as SVP/CIO and chief analytics officer.


CI Security hires Drex DeFord (Drexio Digital Health) as healthcare executive strategist.

Government and Politics


ONC posts the 100+ comments it received about TEFCA Draft 2.


England’s NHS will develop an app that allows patients to anonymously register any concerns they have about their treatment.

Lawyers for former Theranos CEO Elizabeth Holmes blame Wall Street Journal reporter John Carreyrou for unduly influencing FDA and CMS to shut the company down, claiming that he was “eager to break a story, and portray the story as a work of investigative journalism.” Holmes says the reporter prodded his sources to file government complaints about Theranos, then pressed those agencies to investigate them.

South Australia’s SA Health creates a new chief digital health officer position to lead the overhaul of its Allscripts-powered EPAS system that has struggled with project delays, cost overruns, and usability problems. The EPAS concept has been retired in favor of a change in direction as evidenced by the new position’s job description as described by SA Health’s CEO: “We’re looking for somebody to take us from that centrally controlled, large monolithic systems across SA Health to protecting our core data, protecting our single patient view, but capitalizing on an interoperability, best of breed, switch-in switch-out wave of innovation from small new technologies.” The new hire will serve as the government’s top executive for e-health and will develop its digital health strategy.


Medtronic recalls an older model insulin pump because of theoretical cybersecurity issues that it says can’t be fixed with an update, although skeptics question whether the company is using the flaw as a way to force users to buy newer models such as the 670G, with was found in a small study to have been abandoned by 40% of users because of usability issues.

Sponsor Updates

  • Loyale Healthcare will offer the CareCredit credit card as part of its Affordability Workbench patient financial solutions.
  • MHK integrates the prior authorization functionality of Surescripts into its member care platform.
  • The South Florida Business Journal profiles MDlive.
  • NextGate’s identity-matching solutions are now available in the Microsoft Azure Marketplace.
  • Thrive Global profiles PatientKeeper CMO Christopher Maiona, MD.
  • Relatient publishes a new case study, “How US Dermatology Partners Solved the Patient Intake Bottleneck with Mobile Registration.”
  • The American Academy of Nursing inducts Vocera CNO Rhonda Collins, DNP, RN into its 2019 Class of Fellows.

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Currently there are "9 comments" on this Article:

  1. Theranos lawyers: our client may have done all those things, but the real bad guy is this reporter who reported on the things our client did.

  2. Hammergren’s salary as Change Healthcare COB at $900+K after the $141M McKesson gave him to retire is truly baffling. Seriously. I’d like to know how to get THAT job. Or even half of that job.

    Elizabeth Holmes is fascinating. I can only guess at the level of pathology involved but her machinations are very interesting.

  3. The legal scholars tasked by JAMA to document non-disclosure clauses in vendor EHR contracts had no difficulty finding them. The “joint and several” clause in the contracts means that one needs an experienced healthcare lawyer to identify them. IT vendor salesmen and CIOs are rarely trained in healthcare law. . See my JAMA article on the hold harmless and non-disclosure clause. (BTW, I never called them “gag clauses” with refer to a different sort of clauses).

    Ross Koppel; David Kreda
    Health Care Information Technology Vendors’ “Hold
    Harmless” Clause: Implications for Patients and Clinicians

    JAMA. 2009;301(12):1276-1278 (doi:10.1001/jama.2009.398)

    • I remember in the ICD10 days everyone was going crazy with those indemnity agreements. I think they are pretty common in healthcare. I have one on my apartment lease.

      I also think that we have established non-disclosure agreements for intellectual property. Are there non intellectual property non disclosure agreements? If so, what do these entail?

      This situation reminds me of HIPAA, where everybody misconstrued the law to suit their own purposes.

      Your article is paywalled. Maybe you can leak it on scihub or something

      • Funny Ross… You’re JAMA friends seem to like to protect their intellectual property.

        IP protection, indemnification and liability agreements ARE NOT GAG CLAUSES.

        Eric T. needs to show his evidence or stop asserting Epic has one if he can’t find one.

        • Another issue is that health system employees aren’t the parties signing vendor contracts, so they are not bound by contract terms. I’m free as an employee to say whatever I want within the bounds of my own employment agreement, although I also know I can be fired for any reason. I think that threat silences many more people than an explicit but questionably enforceable legal clause that they have likely never seen.

          My definition of gag clause is that I discover a patient-endangering software problem and I warn others (whether by email, a blog post, a conference presentation, a journal article, or a Facebook post). I don’t include screenshots or wording from product documentation. Did I violate a legally binding contract, and if so, is the vendor’s only contractual remedy to convince my employer to discipline me?

          • Talk to your union rep if you can be fired for whistleblowing. If you don’t have a union rep, get one.

  4. Thank you Vince Ciotti and Mr. HIStalk, for the history of healthcare vendors! I’ve always wondered about certain aspects of our history and this has been quite the resource for answering those questions.

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