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November 19, 2019 News 9 Comments

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The American Medical Association adopts a policy that calls for EHRs to be able to collect the preferred name and clinically relevant, sex-specific anatomy of transgender patients.

AMA’s policy aligns with recommendations that medical documentation contain the patient’s preferred name, gender identity, pronoun preference, and history of medical transition history as well as current anatomy.

Reader Comments


From Creative Juice: “Re: being laid off. I’m thinking about suing. Advice?” Don’t bother. Allow me to list the steps you’ll go through after being laid off, ending with the distant speck of light at the end of the unemployment tunnel:

  1. You will experience the ultimate humiliation in coming home early to notify your family that you are no longer employed, threatening your identity in ways you could not have imagined. 
  2. For a couple of days after being marched out, you’ll embrace false hope that your former employer will call to explain it was all a big mistake or that they want you to come back in a different role.
  3. You will expect an uprising from customers that will never happen, or expect those customers with whom you worked closely to call you cold with job offers, which will also never happen.
  4. You will commiserate with former co-workers who also got the axe, convening depressing lunches and not-so-happy hours where the conversation gets louder and faster as you try to convince each other that the company or your former boss will fail without you, which they won’t. 
  5. Most of your “work friends” will disappear from your life permanently because (a) they weren’t really your friends, they just shared employer space with you, and (b) nobody wants to hang around former colleagues who were marched out and who are now seeking comforting scuttlebutt about how bad things are at work.
  6. You will consider legal action, which is pointless. Even if you are legally right (and you aren’t), it would take years to arrive at a resolution that will not include hiring you back. Not to mention that employment lawyers want their money upfront (they know you won’t win) and it doesn’t really matter anyway because you signed away your right to sue as a condition of receiving severance.
  7. You will belatedly update your resume and think about overdue networking as the reality sets in that your income stream is ending. The grim reality of signing up for unemployment will cause endless anguish because you don’t see yourself as one of those pathetic people.
  8. Initially you will apply for no positions because of the indignity of the hiring process, then later you will apply for every job in sight because of the indignity of being unemployed.
  9. You will struggle with the idea that many of the seemingly good jobs are located in far-away areas where you don’t want to live, requiring uprooting the family with new schools for the kids and a new job for your working spouse (if you have either). You will also rage at the Catch-22 fact that you might get more money later if you move, but you need money now to move.
  10. You will eventually find some kind of job, either (a) a short-term one or even a contracting gig that will help pay some bills while you keep looking, or (b) one that is better than your previous one. Then you will rejoice that your incompetent former employer kicked you out of their sorry nest. I’m not one to offer unjustified cheerleading – if you are competent and willing to work, your lot will improve, and if not, then I don’t blame your previous employer for booting you.

From Oingo Bongo: “Re: Allscripts. Heard from a contact that there’s been another round of Paragon staff. Got any info on that?” The company laid people off last week, and while I haven’t heard anything specifically regarding Paragon, I can’t imagine that’s a growth area. Also relevantly not growing is MDRX share price, down 12% in the past year vs. the Nasdaq’s 22% gain.

HIStalk Announcements and Requests


Reader AC made a great suggestion to turn on two-factor authentication for Gmail and other important services that don’t enable it by default, following my story about a hospital employee stealing co-worker logins using a keylogger program. I did it and it was painless. Gmail prompted me to enter a one-time verification code that it sent via SMS message, which it does each time I log in from a new device. Once I did that, it’s business as usual with no further verification unless I (or someone else) logs in from a different device. That means a hacker who has obtained my login credentials still can’t hijack my email account. An extra feature – you can ask Gmail to generate a bank of one-time codes to use when you won’t have your phone. Thanks for that advice. I can’t even imagine the headache and security exposure that would be involved with someone gaining full access to my email account, including all the personal and confidential information it contains.

Listening: the first, eponymous album by The Doors from 1967’s Summer of Love. “The Crystal Ship” alone is worth the ride. Mr. Mojo Risin’ had just turned 23 when the album came out, the beginning of his four-year term as the country’s most dangerous and reckless poet, musician, and performance artist until the unfortunate intersection of drugs and bathwater sent him to “The End” (as it did Whitney Houston and Dolores O’Riordan of the Cranberries). I’m also enjoying new from singer-songwriter JP Saxe, who I think is probably going to be pretty big.


None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


  • Mary Free Bed Rehabilitation Hospital (MI) will implement Epic in an $8 million, 10-year Community Connect agreement with Covenant HealthCare.
  • Cooper University Health Care chooses Phynd for provider management.
  • Novant Health will implement KenSci’s AI platform to match workforce demand to capacity and to identify patients who are at risk for longer stays or readmission.
  • Visiting Nurse Service of New York selects Netsmart CareManager for care coordination, data reporting, and analytics support for its population health management programs.



Ryan Miller (Anthem) joins Change Healthcare as SVP of corporate development.


Medical practice software and services vendor IKS Health hires Kelly Reed, DO (The Iowa Clinic) as SVP of clinical services and outcomes.

Announcements and Implementations

Collective Medical will add HIE CCD data to its care team platform, connected by Kno2.


Virtusa will add EHR data to its VLife life sciences platform from the InterSystems IRIS for Health interoperability solution .

Privacy and Security


National Veterinary Associates, which owns 700 veterinary hospitals and boarding facilities, is struggling to recover from an October 27 ransomware attack that affected 400 of its locations. The company declined to answer questions about the malware or whether it paid a ransom.



American healthcare in a nutshell: the manufacturers of heart stents assure their investors that a widely praised study that proved the less-than-expected value of such procedures won’t hurt their business much. Translation: hospitals, doctors, and device manufacturers aren’t about to let medical evidence get in the way of their profits, meaning your odds of being stented won’t change just because we now know that it doesn’t work any better than a prescription. Meanwhile, a cardiologist whose research helped develop a new drug for a rare type of heart failure criticizes the manufacturer for setting the price of the capsule at $225,000 per year versus the estimated cost-effective price of $17,000.


A Bahamas senator says he “makes no apologies” for his involvement with the 2016 signing of an $18 million contract with Allscripts and Infor that was supposed to transform healthcare there, even through the Public Hospital Authority warned Allscripts in late 2018 that it wasn’t happy that the company hadn’t installed any software anywhere despite having been paid $7 million. The local newspaper speculates that the government will give Allscripts a 60-day cure notice, then terminate the contract with expectation of a full refund. The government blames Allscripts in “a glaring lack of oversight” for “a staggering increase in implementation costs” beyond agreed-on amounts, with consulting firm Avaap billing the government $1.5 million. The paper also notes that the Allscripts proposal was stamped as received 11 days after the tender’s closing, which had already been extended by 14 days. The country’s minister of health declares the project “a bust.”


A free clinic in Syracuse, NY closes after 12 years when the part-time founding doctor found that she was spending more time maintaining its EHR than seeing patients.


Johns Hopkins Bloomberg School of Public Health profiles Assistant Professor Smisha Agarwal, MPH, MBA, PhD in its magazine, which describes her as “the school’s first faculty for digital health” in a sharp contrast between investor-crazed US digital health and public-focused health projects overseas. Snips:

  • She says we don’t know how to integrate digital tools with health system, we don’t know if they are cost effective, and we need to be careful not to amplify existing healthcare inequities, such as improving health only in urban areas or for those people who own a mobile phone.
  • She hopes mobile clinical decision support tools can help shift caregivers away from triaging low-severity illnesses and providing preventive services, data from which could then be used to apply machine learning algorithms to predict poor outcomes for intervention.
  • She says that a downside of digital health is opportunity cost, where resources are moved from established programs to experimental digital programs.
  • She worries about gender inequity in countries where the men are the primary phone owners and the effect on needed pregnancy and newborn care.
  • She sees the biggest transformational opportunities for digital health being putting real-time data in front of caregivers, using analytics to target high-risk patients, assisting providers who have limited training with education or remote assistance, and counting births and newborn deaths.

Sponsor Updates

  • Avaya announces the availability of Google Cloud contact center AI integration with its IX Contact Center solutions.
  • Netsmart takes the top spot for the fifth year in a row for customer satisfaction in Black Book Market Research’s annual look at the post-acute health technology market.
  • Dimensional Insight will exhibit at the New England HIMSS Maine Conference November 21 in Portland.
  • EClinicalWorks posts a podcast titled “Telluride Medical Center: On the Primary Care Frontier.”
  • Collective Medical partners with Kno2 to add enhanced clinical data capabilities including continuity of care documents to its clinical insights and analytics software for HIEs.
  • Virtusa enhances the health data integration capabilities of its VLife life sciences platform with the integration of the InterSystems IRIS for Health Data technology.
  • Woman’s Hospital (LA) will expand its use of Spok solutions.
  • Vocera will resell Spectralink Versity smartphones, which has been certified for use with its clinical communication and workflow system.
  • Optimum Healthcare IT completes Epic go-lives at several hospitals under Deaconess Health System’s CareConnect program.
  • A five-year study finds that a health literacy incentive program using health education content from Healthwise lowered healthcare costs.

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Currently there are "9 comments" on this Article:

  1. You should feel good about filing for unemployment as it is the only way for you to get back at the soulless corporation that laid you off. As far as I know, the states sums up the total unemployment they paid out for a particular company last year and then uses that to calculate the amount they will charge the company the next year.

  2. I agree with many of your observations about lay-offs. It’s happened a few times to me and, while it sounds cliché, each lead me to far, far better opportunities and were some of the best things to happen to drive my career. Best of luck to any who have this happens. As an aside, on timing – there’s never a good time, but I’d think before holidays (and the spending that they entail) might be better than after. OTOH, job search in December can’t be easy – so take some time (if you can afford it) to decompress, detox, and decide where you want your next phase to take you. Best of luck and take good care. (and absolutely take unemployment, you’re entitled to it and should not feel a modicum of shame)

  3. Regarding the layoff advice…as others have commented, it is on the money. I have learned and I hope some of your readers will learn that you are only as good as the last day you have completed on the job and this can happen at any moment. Tomorrow’s employment is not a promise, unless you have a contract. Layoff, RIF, firing, termination… whatever you call it, the outcome is the same. I would add that career management requires constant networking, having your resume and Linked In account up to date, trusting your intuition – meaning that if if feels or looks like it is going to hit the fan, it probably is and what are YOU doing about that. So yes, lots to consider and yes, like other readers, I have been through it a few times and I have ALWAYS landed right side up with a better opportunity. Don’t feel sorry for yourself for too long – but do take a little time to mourn. Then dust yourself off and get to it. One last item – don’t hide that fact that you are unemployed. Broadcast it. You never know where you will get a lead for the next chapter. Good Luck!

  4. RE: the AMA calling for inclusive EHR.
    I am not arguing against this, but from my experience it can be quite a lot of work for a very small patient cohort.

    I run a product team at a small company that does a variant of claims processing and we just did a pretty small enhancement to allow for an `O` in our gender field (now I’m wondering if the field should be renamed as well). The project turned very surprisingly complex and and ended going way over budget. After the fact, I did a review of how many patients we had with `O` gender and it was less than 1% of a sample size of 2.5 million patients. We did the enhancement b/c it was important to our clients.

    If it was hard for us, it’s going to be really hard for the much older and complex EHR products out there.

    • I don’t think anyone would disagree with you on this. Changing the behavior of core demographic information (like name and sex) is going to be a big task. It’s not a quick and easy update, but being treated with respect (by being called by your real name) from your doctor can help an already at risk population better engage with their healthcare providers.

      There are additional benefits to having this be a thing the entire industry focuses on. If your EHR can handles this gracefully, but your EKG system doesn’t, then you end up with unnecessary added complexity both on the IT side and on the clinician side.

      The AMA of course has no teeth on this, but it emphatically is something the industry should be working towards.

      • Epic did a big enhancement a year or two ago to replace their single “sex” field with an entirely new series of fields to capture sexual orientation, gender identity, sex assigned at birth, legal sex, preferred name, preferred pronoun, etc. It was a big change for healthcare organizations to start using the functionality, but it was the right thing to do.

  5. Lay-off observations.

    Perhaps a Step 9A:

    You will struggle with the idea that many of the seemingly good jobs require a skill or language you have not obtained and would need to go back to school, and then compete with new graduates, for. You will also rage at the Catch-22 fact that you might get more money later if you get the training, but you need money now to pay for training.

  6. Re: Layoff Observations

    Lyrics: Won’t Get Fooled Again
    1971, The Who (Pete Townshend)

    Meet the new boss
    Same as the old boss

    Then I’ll get on my knees and pray
    We don’t get fooled again
    Don’t get fooled again, no no

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