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Monday Morning Update 1/27/20

January 26, 2020 News 9 Comments

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Epic CEO Judy Faulkner tells Politico that the company may sue HHS over terms in its proposed data-sharing rules that the company doesn’t like.

Faulker says the proposed changes would not protect patient privacy and would allow patients to send their information to apps whose developers could then sell or exploit their information.

Epic walked back the lawsuit talk the day after Politico ran its story, saying it would prefer to instead work with HHS to fix the proposed rule.

NextGen Healthcare President and CEO Rusty Frantz took an opposing view in last week’s earnings call,

I won’t comment on other vendors’ activities. However, what I would say is that wellness and lowering the cost of care are truly enabled by putting a patient’s complete medical record in front of their physicians. Most notably, at the front line of wellness, which is their community physicians. I struggled a little bit to understand why blocking that data under the banner of patient privacy really makes sense, especially given how much patient-identified data is already being shared by some health systems with other companies that aren’t directly involved in the treatment of patients. It seems a little contradictory and emblematic of business and competition being put before care.

Meanwhile, Apple, Microsoft, and Salesforce will participate in a Monday HHS meeting to support the proposed interoperability rules.


Reader Comments

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From Ushuaia Fuego: “Re: Komodo Health. Ever heard of them? They got $50 million in VC funding and claim to have access to data on 300 million patients, but I can’t figure out where that data comes from.” The company said last year that it was getting the de-identified information of 50 million patients from Allscripts ambulatory systems, but the 300 million number must come from insurers since it describes them as “150 payer complete datasets.” The company was recently featured in a Nature article titled “15 ways Silicon Valley is harnessing Big Data for health,” along with:

  • Verily (Project Baseline Health Study involving 10,000 participants).
  • Helix (matching genomic and EHR data for research).
  • Ellipsis Health (analyzing user speech to detect depression).
  • Catalia Health (wellness coaching via chatbot).
  • Human Dx (diagnosis crowdsourcing for clinicians).
  • Flatiron Health (cancer research using de-identified patient data).
  • PyrAmes (non-invasive continuous blood pressure monitoring).
  • LunaDNA (consumer DNA sharing with researchers for a portion of proceeds of any innovations that result).
  • Evidation (analysis of user-contributed sensor-based wellness data).
  • Propeller Health (inhaler usage monitoring).
  • Verana Health (clinical trials recruitment).
  • Tidepool (diabetes data sharing).
  • Bigfoot Medical (closed-loop insulin delivery).
  • Freenome (cancer prediction from EHR-stored molecular data).

HIStalk Announcements and Requests

HIStalk sponsors: get your HIMSS20 information included in our guide by completing this form. We’ve got you covered even if you aren’t exhibiting, but are attending – we’ll include your instructions on how customers or prospects can contact you at the conference.

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A slight majority of poll respondents say their EHR vendor’s choice of cloud partners will influence their own cloud decisions. CincyBet notes that Epic’s push to stay current on releases would make it prudent for Epic clients to stay away from Google Cloud.

New poll to your right or here: What motivates Epic’s opposition to proposed HHS information sharing rules? Regardless of your answer, I bet we can agree that:

  • Epic explained itself poorly in expressing vague concerns about patient privacy and healthcare costs and thus is left looking like a corporate moat-protector.
  • The company’s lack of PR expertise is showing. The only PR contact I’ve ever had there left the company within the last week or two and Epic is letting the health IT media control the story. They’re buying self-congratulatory billboards in DC airports, presumably to get the attention of federal officials and ONC meeting attendees.
  • Tommy Thompson’s Wisconsin op-ed that argued that the changes would hurt Epic’s success, employment, and economic impact makes any objection seem even more self-serving.
  • Industry reaction aside, no amount of criticism will cause Epic customer defections or discourage prospects from signing up. Any threats from customers – and I’ve seen none – would be hollow since they won’t walk away from a painful, expensive Epic implementation and rush to Cerner.

I can tell I’ve taken a few days off by my laptop’s sluggish power-up performance as it catches up on CPU-sapping Bitdefender updates. Thanks to Jenn for covering. Thanks, too to the fellow airline passenger who brought a Great Dane on board as an “emotional support animal” for not sitting in my row, thus taking up someone else’s legroom instead of mine.

Thanks to long-time sponsor Healthwise for taking the recently vacated Founding Sponsor spot (one of just two, with just two dropouts in 13 years). The non-profit company has helped people make better health decisions since 1975 (45 years!), offering evidence-based health education and technology solutions that are free of drug and device vendor influence. Its solutions embrace these simple concepts: (1) allow people to do as much as they can for themselves; (2) help them ask for the care they need; and (3) help them say no to the care they don’t need. Specific educational technology offerings include point-of-care education that fits into clinician workflow, care coordination, digital experiences, care management and behavior change, and care quality and patient satisfaction. Thanks to new Founding Sponsor Healthwise and CEO Adam C. Husney, MD for supporting HIStalk since 2011.


Webinars

January 29 (Wednesday) 2:00 ET. “State of the Health IT Industry 2020.” Sponsor: Medicomp Systems. Presenters from Medicomp Systems: Dave Lareau, CEO; Jay Anders, MD, MS, chief medical officer; Dan Gainer, CTO; Toni Laracuente, CNO. Despite widespread adoption of EHRs, healthcare professionals struggle with several unresolved systemic challenges, including the lack of EHR usability, limited interoperability between disparate systems, new quality reporting initiatives that create administrative burdens, and escalating levels of physician burnout. Join the webinar to learn how enterprises can address current industry roadblocks with existing market solutions and fix health IT’s biggest challenges.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Benefits engagement technology vendor Evive acquires WiserTogether, which offers a personalized treatment guidance tool to guide people to the most-recommended, most-effective treatments.

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St. Louis-based Insurer Centene completes its acquisition of WellCare Health Plans, creating the country’s largest health insurer with 23.4 million covered people and $100 billion in annual revenue, most of it from Medicaid and Medicare. Still, its market cap is one-tenth that of now-smaller competitor UnitedHealth Group. Former HHS Secretary and Wisconsin Governor Tommy Thompson has been on Centene’s board since 2005, has made dozens of millions of dollars selling CNC shares, and still holds $25 million worth.

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NextGen Healthcare reports Q3 results: revenue up 5.3%, adjusted EPS $0.23 vs. $0.18, beating Wall Street expectations for both.

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I always enjoy the health IT summaries of Healthcare Growth Partners, the latest of which contains these observations:

  • Seven health IT companies completed IPOs in 2019 following a 2.5 year drought, of which Progyny topped 2019 performance with an 111% increase while Smile Direct Club imploded with shares down 62%.
  • Health IT investment leveled off in 2019 after 10 years of steady growth.
  • The definition of health IT continues to get fuzzier with integration across providers, payers, and drug and device companies.
  • Companies with $5-20 million in annual revenue will find optimal valuation via M&A if they earn recurring revenue from subscriptions or transactions, book at least 35% in annual revenue growth, retain 95% of customers, have a broad base of customers instead of a few big ones, and report $20+% in profitability on at least $8 million in revenue.
  • Companies get premium M&A valuation if they operate a single SaaS database, align pricing with ROI, develop a scalable distribution model, possess contractual data rights, and address healthcare reform rather than the status quo.
  • Recent valuation is highest for clinical trials management, telemedicine, and analytics, while the lowest multiple valuation was for revenue cycle management services, utilization management, and outsourced services.

Sales

  • Southern Illinois Healthcare will develop an Epic test automation solution in conjunction with Santa Rosa Consulting.

People

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Susan Protos, MBA (independent consultant) joins Emids as VP and client partner executive.

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Spok appoints Advocate Aurora Health CIO Bobbie Byrne, MD, MBA to its board.

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Harvard professor and disruptive innovation guru Clayton Christensen dies of leukemia at 67.


Announcements and Implementations

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AdventHealth will implement Avhana Health’s platform of three applications – Advance, Advisories, and Advice – to offer patient-specific healthcare team support following a previous collaboration to streamline pre-visit planning and to improve colorectal and breast cancer screening rates via API integration with AdventHeallth’s Cerner system.


Other

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An expert says Ireland’s new, behind-schedule National Children’s Hospital will be one of the world’s most expensive buildings now that its cost has ballooned from $441 million to $2.6 billion including technology, or $5.5 million per bed for the 470-bed project. I’ll stand by my long-held assertion (from experience) that children’s hospitals are nearly always the most wasteful and inefficient because management always drags out heart-tugging baby pictures to loosen the purse strings.

A JAMA Network op-ed piece says that hospitals that are considering the use of AI-powered ambient intelligence in exam rooms need to consider (a) patient and healthcare worker privacy given the ease of re-identifying de-identified data; (b) whether workers and patients need to consent before being monitored; and (c) the liability exposure involved in recording medical mistakes or uncorrected employee practices. 

Four former Cerner employees claim via a class action lawsuit that the company cost them money by choosing high-fee Fidelity investment options for its retirement plans.

Australia’s health insurance risk pool “death spiral” is like ours, as young people who struggle with college debt and poor job prospects are dropping coverage after questioning the value they receive for the high premiums, leaving older and sicker people to absorb higher costs. They are also like us in not having a good solution. 

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Weird News Andy offers a public service for his Florida fans in offering the ICD-10 code (W59.02: “Struck by nonvenomous lizards”) for patients who are injured by falling iguanas as cautioned by the National Weather Service.


Sponsor Updates

  • Meditech releases a new video, “How King’s Daughters Medical Center is improving the patient experience.”
  • Business Intelligence Group honors OpenText CEO Mark Barrenechea and Vocera’s Smartbadge with 2020 Big Innovation Awards.
  • CereCore welcomes Christopher Wickersham (CareTech Solutions) as director, level 1 support.
  • Experity publishes its latest Urgent Care Quarterly, “An Analysis of the Impact of Radiology in the Urgent Care Industry.”
  • Healthpac adds Relatient’s patient engagement software to its medical billing services.

Blog Posts


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Contacts

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Currently there are "9 comments" on this Article:

  1. Epic and the executives of their leading hospital customers should be up for some special shared Nobel Prize… Their selfless willingness to use their own corporate legal resources to fight the US government in court – all the interest of protecting us from putting information in the hands of unscrupulous applications that will exploit us – is so noble and magnificent.

    I am sure they could use these resources to advance their business objectives (or healthcare), but nothing is more important than protecting us from ourselves! Just so wonderful and heart warming. Why can’t every company be this selfless and focused on the public good?

    Will they be limiting this noble activity only to healthcare? There is so much data we have that could benefit from Epic’s protection to make sure we don’t share it with unscrupulous applications. Can Epic lawyers sue the government to prevent us from doing financial transactions online? If only Epic would have acted sooner all this identity theft stuff would never have happened.

    Or maybe we can just store ALL our personal information in Epic databases at hospitals? That way our data will never be victims of ransomware or HIPAA breaches. Wouldn’t it be great if all our personal data were in Epic and whenever we wanted a copy of something we could go to the efficient hospital records department and spend just a few hours and usually only one or two trips (and pay the hospital and Epic a reasonable per-page/per-transaction charge) to get some of what we need in an unusable format that meets MU2 minimum requirements within 30 days or so? Too bad only our health records can benefit from this kind of great protection and service!

    I understand that maybe Epic can’t save every industry – but at least in healthcare, can Epic at least help make sure we never get paper health records either? What if we leave them on a table in the hospital lobby or throw them in a trash can without shredding them? Or scan them and give them to unscrupulous app vendors masquerading as health and wellness companies?

    Mr. H – is their a GoFundMe where we can contribute to the Epic public protection legal defense fund? Will you provide matching funds? It’s the least we can do…

  2. The issue being raised, albeit clumsily, is that these patient facing APP vendors are in no way restricted by federal privacy and security regulations under HIPAA, since they are neither covered entities nor business associates of covered entities. Once a patient decides to release their data to an APP, that data is no longer protected in any way. As an Epic organization, we already expose our FHIR interface to hundreds of APPS, but we warn patients that they are doing so at their own risk, and we should not be held responsible for what the APP vendor does with their data after it leaves our control. Which begs the question of why Epic and its customers should be held responsible under HIPAA for any breach, as an example to Mychart, but if an APP developer who has access to that same data experiences a breach, they are not held to the same standards, and fined? The federal government needs to update the HIPAA regulations to ensure that anyone who has access to PHI is held equally accountable for maintaining the privacy and security of that data. Judy is not the only one who is trying to raise awareness about this issue. I heard Micky Tripathi speak about this in a NE HIMSS event last year.

  3. Serious question – do you really think a lengthy Terms of Service document is a good way for consumers to inform themselves about what happens to their data when they give apps access to it?

    Serious questions – do you know what FHIR is? All of the major vendors support it. Why aren’t you using any apps that use FHIR to query EHR data that exists today? What data elements are missing that the public is demanding so much? Do you think vendors should expose their own unique APIs, or would it be better for app compatibility to adhere to a common API standard?

    Serious question – do you know what patient portals are? All of the major vendors have them, and support download functions. If you knew that, why would you go to a records department and ask for a printed document?

    Serious question – why are you acting like such a disingenuous knob, and creating an absurd strawman instead of addressing the actual points being made?

      • Serious answer – No need for any lengthy Terms of Service agreement. Just like I can download my (woefully incomplete subset of) my EHR record via a patient portal and do what I want with it (and no, I didn;t read the terms of service), I should be able to do the same with an app of my choosing. And it should be my entire record not some MU2 core requirements subset. That also is completely out of Epic and the hospitals control. And I could trade that for a taxi ride after chemo (talk about strawmen!)

        Serious answer – I really hope your life or the life of someone you love never depends on getting care based only on what is downloadable from your patient portal (typically 30 copies of the same C-CDA summary with minimal data and boilerplate discharge instructions that are identical to everyone else’s). Which portals do you use? I am familiar with several hundred across EHR vendors. So, yes, you will need to go to the records department to get your full record. If you’re lucky you’ll get in on CD without per-paper printing charges. Or you can use a $3,000/year service that will do the legwork for you (as part of a “Second opinion service” or otherwise). Or, if you are being referred to a high-end hospital that can bill your insurance company a fortune for your care (or you can afford it yourself), they will use a service from a company like eHealth Technologies to do it for you. Working around information blocking is a big industry. Google “medical record retrieval services”. Vendors that help hospitals turn their record disclosure department into profit centers are also doing very well.

        Serious answer – Yes, I know what FHIR is. I wrote my first FHIR server 5 years ago. FHIR is actually a step backwards relative to accessing portal documents via APIs like those from Human API that have been around for years. As an app developer, I can get help a patient get access to their portal data but i can’t do anything with FHIR unless I join Epic’s insane App Orchard program via a hospital partner – and convince Epic they should let me. I’d love to see a consumer FHIR app you are using that gets patients their complete record – can you send me a link? FHIR is only as useful as providers (and the EHR vendors) let it be. Which right now is near-zero for consumer access to and control of their data. Actually easier to information-block with FHIR than it was before without any regulatory requirements or bribes. At least our $20B got us some minimal data on portals… will probably take much more than that to get FHIR to do what it could…

        Serious answer – The actual points being made are, in my view, shamefully pathetic and paternalistic – and, yes, very disingenuous. I will continue to get “disliked” by most readers of HISTalk who I think really believe the nonsense spewed at them about how providers and Epic are really a force for good and looking after their interests and apparently think you know what you’re talking about in the either disingenuous or ignorant stuff you wrote above about FHIR, portals, etc.

        • Yeah now I’m just entirely convinced you have no idea what you’re talking about. Good look on your app development.

          • Thanks! Good luck to you getting a complete electronic copy of your health records via your patient portal download or an Epic-blessed FHIR application when you need them or want them.

            I suspect you don’t want the unsolicited advice of a disingenuous knob – but do hang on to that 3-ring binder. Epic can skip the billboard spend in the DC airports. Nothing will come of these rather toothless/ambiguous regulations and we can all debate this again at the party for the 50th anniversary of HIPAA Right to Access.

            Until then… be well!

  4. I think we can all agree that health providers should provide your complete medical record in a consumable format at no or little cost. That isn’t the status quo and this is easily correctable through regulations. See regulations for written estimation of cost from health insurers for a model of how that could work. This is low hanging fruit for government.

    Providing medical data to a patient dorectly is very different from providing programmatic access to an app on a patients phone.

    Look at practice fusion to see the ethics of these advertising companies that HHS is forcing providers and vendors to share your medical data with. These companies are opioid pill pushers willing to do whatever to make a buck. Why does HHS want Epic and Cerner to act more like Facebook? Who wants that?







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