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February 25, 2020 News 8 Comments

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The American Medical Association releases its Patient Records Electronic Access Playbook, which aims to dispel HIPAA myths and help practices understand their patient records request obligations. Some points:

  • Physicians must allow patients to connect their health apps to the practice’s EHR.
  • Deploying a patient portal don’t necessarily make a practice HIPAA compliant.
  • Medical images must be provided if they are stored in the practice’s system, even if they originated elsewhere.
  • Practices are required to provide patient information only in the “readily producible” form; they are not obligated to pay an EHR vendor for new capabilities. However, they cannot give paper or PDF copies just because they don’t know how to use available electronic options.
  • EHRs that are certified under 2015 Edition criteria must provide API access, the ability for patients to view and download their information online, and an option to send information via secure email.
  • Practices cannot refuse to send information to a patient via unsecure email or insist that they choose another delivery method, as long as the patient acknowledges the security risk verbally or in writing.
  • Information should not be copied to the patient’s own USB drive because of malware risk.
  • Patients must be given the ability to view, download, and transmit their information within four business days of their request and to receive copies within 30 calendar days (with an optional 30-day renewal). More stringent state laws are common and override HIPAA defaults.
  • Third-party requests, such as those from life insurance companies, are not subject to the HIPAA right of access requirements.
  • Patients can be charged the lessor of state-specified “reasonable” fees or the practice’s actual copying costs, including employee time, media costs, and postage. Practices should not charge a retrieval or records maintenance fee.
  • The report includes forms to calculate the cost of providing medical records copies, a list of state-allowed medical records copying charges, and sample forms for patient requests and the practice’s response.

Reader Comments

From Concerned Vendor: “Re: HIMSS20. Companies across the globe are pulling out of industry conferences. The vendor and provider community needs to put pressure on the HIMSS organizers to cancel or at least postpone HIMSS20.” I don’t think that cancelling HIMSS20 two weeks out is logical, from either a public health or a business point of view. I’ll defer to epidemiologic experts, but avoiding public gatherings and using US border security as a protective moat probably won’t help much (HIMSS says less than 1% of registrants are from countries that are under a travel ban). It’s late in the game to consider cancelling or rescheduling when it’s a domestic trip for the majority of attendees and the odds of problems are low. The conference is the primary money generator for HIMSS; people have already paid for hotel rooms, flights, and other non-refundable travel items; and conferences stay on schedule during much deadlier epidemics, such as the flu. There’s no way HIMSS20 could simply be rescheduled given the years of planning required. HIMSS should:

  • Offer free respiratory masks and perhaps handkerchiefs (exhibitors, there’s your last-minute giveaway idea, especially if you put fun slogans on the masks to make them less ominous). It’s going to be weird to see the convention center full of people whose faces aren’t visible, at least if you aren’t from Asia where masks have been common for a long time, but we’re medical people after all.
  • Put out plenty of handwashing stations and hand sanitizer squirt stands.
  • Encourage attendees to use Ebola-nostalgic fist bumps instead of handshakes.
  • Suggest that immunocompromised registrants consider the possibility of added risk.
  • Make sure people know that medical teams will be on site and hospitals will be on call.
  • Urge attendees to stay in their hotel rooms if they have flu-like symptoms. The good news is that unlike some other infections, transmission risk seems to run parallel with symptom severity, so COVID-19 being spread by people who don’t know they are sick seems unlikely, and few examples of person-to-person transmission have occurred in this country.
  • Avoid checkpoints and mandatory thermometer gun inspections since they don’t work well.
  • Calm everyone down with a reminder that our only majorly deadly communicable disease outbreaks in the past 100+ years US were AIDS in the 1980s and Spanish flu in 1918 (which wiped out a third of the world’s population). Hysterical media coverage aside, swine flu, bird flu, Ebola, SARS, MERS, Zika, etc. were not big killers and have been mostly forgotten. Worry more about interruption of our drug supply chain, which is more driven by China’s steps than ours.

Meanwhile, feel free to cast unpleasant looks at anyone who sneezes or coughs without covering – droplet exposure is the biggest risk. Skip the theme parks if you have global paranoia. The latest sitreps show that we’ve had only a few dozen COVID-19 cases in the US, nearly all of those being returnees from Diamond Princess or recent trips to China, and nobody has died. Meanwhile, the media-unsexy plain old flu has this season caused 29 million US illness episodes, 280,000 hospitalizations, 16,000 deaths, and zero calls to cancel HIMSS20. Perhaps a measured, long-term approach would be to question whether the cost, effort, and carbon footprint involved in dragging people to a specific building to talk about technology (such as remote visits and online digital services, ironically) are worth it even without outbreak threats.


From Illuminati: “Re: Atrium Health. All of Atrium’s primary enterprise (Carolina Medical Center and most of Atrium-owned facilities) have been using Cerner Millennium EMR for years and added Epic revenue cycle about four years ago. That last piece, allowing Atrium to use revenue cycle without Epic clinicals, is unique. It allowed Atrium to buy licenses to all Epic products, implement the full suite in some managed facilities, and then offer it to Navicent. It was also attractive to the full primary enterprise. It’s a big loss for Cerner, but it took a few years and Epic was already more widely deployed on the acute care side than Cerner.”

HIStalk Announcements and Requests

A reader who is a physician, researcher, and professor got last-minute approval to attend the upcoming HIMSS conference as a first-timer. She messaged me for any tips I might have. Your assignment is twofold: (a) send me useful, lesser-known tips — we all know to wear comfortable shoes – of the type that clickbait sites might refer to as “hacks,” especially anything that is pertinent to her specific background; and (b) let me know if you want to extend an invitation to her for whatever velvet ropes you control, be they social or educational, that would enrich her experience. I’ll write up the tips I receive plus my own in the next day or two. I admit that my ego soared in an impostor syndrome kind of way when I saw her wealth of clinical credentials on LinkedIn along with her being in the HIStalk Fan Club group that reader Dann set up forever ago (and noticing that the group has 3,700 members).

Give me some advice here. A reader alerted me to a potential conflict of interest with large, state-funded RFP in which Epic consultants are to be engaged. The health system hired Vendor A in an advisory role to manage the selection, and quite a few of Vendor A’s people were involved in various committees and oversight groups. Some of Vendor A’s employees are actually 1099 contractors who work for other companies that are bidding for the Epic work. Neither Vendor A nor the health system’s compliance department have responded to my inquiries, but my question is this – what line would you draw in describing a situation like this as either unethical or illegal versus just how business works when taxpayer money is involved? I assume (maybe incorrectly) that Vendor A doesn’t have people on the selection team and won’t be allowed to bid on the services work, but is sending the employees of bidding companies on site while wearing Vendor A badges unusual? I’ve seen the bidder list and quite a few companies have a vested interest in the outcome.


March 4 (Wednesday) 1 ET: “Tools for Success: How to Increase Clinician Satisfaction with HIT Solutions.” Sponsor: Intelligent Medical Objects. Presenter: Andrew Kanter, MD, MPH, FACMI, FAMIA, chief medical officer, IMO. Dr. Kanter will explore how striving to achieve the Quadruple Aim (by focusing on the provider experience) can improve clinician satisfaction and population health needs while also reducing per capita healthcare costs. Attendees will learn how to set providers up for success with new technology, the potential unforeseen consequences of purchasing without the clinician in mind, and the factors that are critically important to clinicians who are using new health information systems.

March 4 (Wednesday) 1 ET: “Healthcare Digital Marketing: Jump-Start Patient Discovery and Conversion.” Sponsor: Orbita. Presenters: Victoria Petrock, MBA, MLIS, principal analyst, EMarketer; Kristi Ebong, MBA, MPH, SVP of corporate strategy, Orbita. Does your digital front door capture consumers who search for health-related information one billion times each day? Do you have actionable steps to convert them into patients? Do you understand voice and chat virtual assistants? The presenters will explore the consumer challenges involved with finding, navigating, and receiving care, discuss why healthcare marketers need to embrace conversational voice and chatbot technologies, and describe how new technologies such as conversational micro-robots can improve engagement.

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

Acquisitions, Funding, Business, and Stock

Bloomberg Businessweek visits a Walmart Health center in Georgia, which offers a $30 medical checkup, $25 teeth cleaning, and $1 per minute psychological counseling, with prices clearly displayed in the 12-room, 6,500 square foot facility that has its own entrance. Walmart changed direction after opening just 19 Care Clinic urgent care centers because they provide little value, especially for chronic conditions. It accepts insurance, but patients often save money by paying cash given high deductibles and co-pays. Beyond medical, dental, and eye care, the center also performs X-rays, hearing checks, and lab tests. Walmart says patient volume is running above expectations and that it has lowered costs by 40% by reducing “all that administrative baloney,” with one of its doctors saying that paperwork takes her 25% less time than in hospitals.


  • Arizona’s Health Current statewide HIE chooses NextGen Healthcare’s Health Data Hub for sharing and aggregating patient information. It includes clinical content management, an API-first design, a user portal, consent and data protection, and AWS cloud hosting.



Continuous monitoring solutions vendor EarlySense hires John Dragovits (Allscripts) as SVP of strategic partnerships.


Price transparency and provider rating vendor Healthcare Bluebook hires Scott Paddock (GuideWell Connect) as CEO. He replaces founder Jeff Rice, who will become executive chairman.

Announcements and Implementations

Nuance announces GA of Dragon Ambient Experience (DAX), its “exam room of the future” where “clinical documentation writes itself.” Dig deeper by reading my interview with Nuance CTO Joe Petro a few weeks back, including the interesting tidbit – the company got the idea 5-6 years ago from Epic President Carl Dvorak, who “floated the notion of a room being able to listen.”


Prepared Health renames itself to Dina, the name it previously used for its digital assistant that analyzes patient assessments from home and makes evidence-based recommendations. The company is a first-time exhibitor at HIMSS20 and will co-present with Jefferson Health. I interviewed CEO Ashish Shah — who worked a long time at Medicity before co-founding what is now Dina in 2015 —  last year about the concept of “healthcare with no address.”

Medhost adds COVID-19 screening tools to its systems, including travel-related screening questions in its Enterprise EHR and EDIS.

Allscripts announces GA of TouchWorks EHR 20.0.

Waystar launches Hubble, an AI and robotic process automation platform that will reduce the labor required for revenue cycle management. It is being used in 10 of its RCM solutions so far.


Apple and drug company Johnson & Johnson launch a study to see if people on Medicare who use the Apple Watch have a lower risk of stroke via early detection of atrial fibrillation. It’s a two-year study, so expect the same lack of conclusive results that have plagued similar studies because their study group wasn’t representative and dropout rates were high, not to mention that Android phone users are excluded even though they outnumber the IPhone crowd.

Government and Politics


ONC publishes its health IT priorities for research (full report).


CBS runs a flattering, consumer-oriented review of “Epic, the software company that’s changed the sharing of medical records (including, probably, yours.” They got nice shots from a campus visit, interviews and demos from staff, and a rare on-camera extended interview with the “76-year-old genius behind Epic” Judy Faulkner, who “built this curious place in her own curious image.” It’s a decent overview, Judy came across well, and the look back at the era of paper records flying around a hospital via pneumatic tube is fun. Judy also mentioned the “Hey, Epic” voice assistant that the company is developing.


A Twitter war erupts between UK healthcare chatbot and doctor referral vendor Babylon Health and user @DrMurphy11 (oncologist David Watkins, MBBS), who called out problems with its symptom checker that offers advice for chest pain and other conditions. Babylon Health, which was founded by an investment banker, says its “anonymous detractor” (who has since revealed himself) found just 20 serious errors in 2,400 tests in “trying to trick our AI.” Interestingly, the company footnoted its document with its standard warning that “Our AI tools provide information only and do not provide a medical diagnosis, nor are they a substitute for a doctor.” The company has apparently expanded to the US.


Healthcare in America. A Miami guy fresh off a China work trip develops flu-like symptoms and heads to the hospital ED. He asks them to run a flu test first since he had purchased non-ACA (aka “junk”) insurance as allowed by White House policy changes and didn’t want to run up extra charges. The blood draw and nasal swab proved that he had the plain old flu. He then received a bill for $1,400 from his insurance company, which discounted the hospital’s charge of $3,270 on the condition that he provide three years’ worth of medical records to prove that his flu wasn’t a pre-existing condition. Meanwhile, the hospital says more bills are headed his way but couldn’t explain when or for what (like $3,270 wasn’t enough for a couple of low-cost items). The big finish is this – he works for a medical device company that doesn’t offer its health insurance to its employees.

Sponsor Updates


  • Kyruus team members help out at Cradles to Crayons Massachusetts.
  • Avaya wins the 2020 Channel Influencer Award from Channel Partners and Channel Futures.
  • CoverMyMeds will exhibit at the 2020 American Glaucoma Society Annual Meeting February 27-March 1 in Washington, DC.

Blog Posts

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Currently there are "8 comments" on this Article:

  1. Re HIMSS and COVID-19.

    It’s sound judgement to cancel the dang thing.

    To suggest that it’s too late … tell that to family members of those that died from it.

    Re masks. Really? From a HCIT forum this is a recommendation? If masks were effective nobody in China would have this virus.

    Oy vey!

    • When you read the original response, it seems logical and has practical advice, and is actually educational. Here’s another piece of advice: If you are worried about getting sick at a major gathering of people…don’t go. I am sure your organization would understand and the potential cost of cancelled airfare, hotel, other non refundable fees ( would HIMSS refund?) would be far far less than the cost of you coming back sick and potentially infecting others. Everyone going to HIMSS should recognize they have a choice.

  2. If being stuck on a luxury boat or fancy hotel is bad, can you imagine the nightmare of being stuck in a HIMSS conference ?

    Cancel it and move to a virtual conference.
    It’s 2020…

  3. Holding HIMSS during what is normal flu season seems like a bad idea generally. Last year all but I think three of the people at our booth wound up with the flu (despite having gotten the vaccine, there was at least one strain going around that it didn’t touch), my symptoms settled in about halfway into my flight home on Thursday and I was flat out for about five days following. Being in an enclosed space with 40,000 of your closest friends and their dirty germs with uncertain handwashing habits takes its toll.

    If they moved it to April I think we’d all be better off anyway, maybe something to think about for next year.

  4. Re: Give me some advice

    Absolutely this is a conflict of interest! Shame on the state health system hiring Vendor A without a thorough background check of their employees and shame on Vendor A for hiring 1099 contractors who work for other companies that are bidding for the Epic work. I’m not an attorney; therefore, I don’t know if this is illegal vis-a-vis taxpayer’s or anyone’s money. However, it sure smacks of unethical practices. Independent HIT advisory consultants should have NO ties to any HIT companies, period. In the past, “business as usual” did not include sending employees of bidding companies on-site while wearing Vendor A badges. Then again, in these days of money-money-money, sadly, no one seems to give a damn.

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