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February 28, 2023 News 14 Comments

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Cerebral announces its third round of layoffs in the past few months as the beleaguered direct-to-consumer telemedicine company attempts to reorganize and streamline its services.

Cerebral has struggled since the federal government launched an investigation of its prescribing practices for mental health issues, especially its heavily promoted prescribing of Adderall.

Cerebral’s valuation reached nearly $5 billion just over a year ago.

Reader Comments


From Pete Drucker; “Re: Quil Health. To exit the market, with the last day for employees being February 10 and for executives February 24.” This was sent to me on February 7, but I didn’t mention the company’s name pending verification. Quil’s web page has been taken down and CEO Carina Edwards has updated her LinkedIn with a February 2023 end date and references to the company changed to past tense. Philadelphia-based Quil was formed in 2019 as a joint venture between Independence Health Group and Comcast, offering medical alert and monitoring tools to support care-at-home for seniors. I interviewed Carina Edwards 10 months ago.

From Plural Effusion: “Re: plural words. I see examples daily where someone sticks in an unneeded apostrophe.” Plurals shouldn’t have apostrophes except for one-letter items, such as the Oakland A’s or minding your p’s and q’s.

From You Interviewed Me: “Re: my HIStalk interview. It received lots of attention. You have certainly built an engaged group of readers.” Thanks to this CEO for giving me a rare post-interview report. I’m always up for talking to CIOs, clinician executives, frontline people, or anyone who would be interesting to readers who comes from the non-vendor side of the table. If that’s you and you can spare 30 minutes for a call, let me know.

From Pshaw: “Re: attrition goals. Epic in a nutshell.” Former Amazon managers say that the company meets its attrition goals by rating decent performers as not meeting its expectations. The company refers its “unregretted attrition rate,” where it expects managers to rank 5% of employees in the lowest tier that the company wouldn’t mine losing, voluntarily or otherwise. Amazon replaces a set percentage of less-performing employees annually. UPDATE: I’m changing this since while I was thinking that Epic stack ranks employees and I thought I read long ago that the company’s philosophy was to intentionally replace the bottom tier, I’m not sure that employees in that tier are fired. Perhaps some who works at Epic can elaborate further.

HIStalk Announcements and Requests

HIStalk sponsors benefit from being listed in our guide to major conferences, which provides on-site details for those that are exhibiting or attending so attendees can seek them out. Send me your ViVE 2023 information  by Wednesday, March 15 to be included. The ViVE 2023 exhibit hall floor plan shows 169 exhibiting companies, with separate musical stages for pop, hip hop, bluegrass, classics, and country (the latter being the largest by far, which wouldn’t be a plus for me). Glancing down the exhibitor list, I see a few dozen HIStalk sponsors, so those remaining dozens are welcome to contact Lorre to extend their reach beyond occupying a small patch of carpet for a half week.

Speaking of ViVE, I just got an email saying that the Clearsense-sponsored industry night entertainment is the Black Crowes. Two perpetually feuding brothers are all that’s left of the original lineup that formed 40 years ago, also the only two who played on their monster 1990 album “Shake Your Money Maker” or on their last new album in 2009.


March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock


Automated coding technology vendor CodaMetrix raises $55 million in a Series A funding round. The company was spun out of Mass General Brigham in 2019 and is led by former LifeImage CEO Hamid Tabatabaie.


  • Baptist Memorial Health Care (TN) selects LookDeep Health’s Clinical Action Platform to enhance its inpatient video monitoring capabilities.
  • Augusta University Health (GA) will expand its Virtual Care at Home program using technology from Biofourmis.
  • Southwestern Health Resources (TX) selects referral management software from LeadingReach.
  • Yale New Haven Health (CT) will implement RxLightning’s automated pharmacy workflow software.
  • Sheffield Teaching Hospitals NHS Foundation Trust in England will replace its Dedalus EHR with Oracle Cerner’s Millenium software next year.



Engooden Health, the former Cohort Intelligence, names Tom Frosheiser, MBA (Nvolve)  as CEO.


Dan Michelson, MBA joins 7wire Ventures as entrepreneur-in-residence, rejoining his former Allscripts executive colleagues Glen Tullman and Lee Shapiro. He was CEO of Strata Decision Technology through May 2022.


Leah Ray (Jvion) joins Linus Health as chief customer officer.


Chris Belmont, MBA (Memorial Hospital at Gulfport) joins Ochsner Health as SVP/CIO, a position he held from 2009 to 2013.

Announcements and Implementations

Southern Illinois Healthcare implements PocketHealth’s diagnostic image-sharing software for patients and providers.

NIH-funded researchers from Cleveland Clinic and MetroHealth will use digital twins, created from de-identified EHR data, to understand healthcare disparities based on living location.

A pre-print journal article finds that ChatGPT performs well in suggesting improvements to the logic of clinical decision support alerts.


Practice management software end users give EClinicalWorks, ModMed, NextGen, and Veradigm top customer satisfaction marks in Black Book’s latest annual survey.

Government and Politics


HHS OCR renames its Health Information Privacy Division to the Health Information Privacy, Data, and Cybersecurity Division as part of a reorganization that will better enable the office to more effectively respond to complaints. An OCR report published earlier this month pointed out that the office lacks the financial resources it needs to investigate HIPAA complaints and enforce penalties, both of which increased considerably between 2017 and 2021.

Privacy and Security

Researchers at Duke University’s public policy school find that since technology companies, app  vendors, wearables manufacturers, and social media platforms aren’t covered by HIPAA, they are legally selling the health data of their users to data brokers without their knowledge or consent. The authors looked specifically at at mental health data:

  • Some data brokers are offering user health data on the open market, with minimal vetting of customers and few stated limits on its use.
  • Brokers don’t always make it clear whether their health data is de-identified, and some seem to imply that they are willing to provide identifiable data.
  • The most active brokers offered data of people with depression, ADHD, insomnia, ADHD, and bipolar disorder that also included ethnicity, age, gender, ZIP code, religion, number of children living in the home, marital status, net worth, credit score, and data of birth.


It’s not just doctors who are burned out, a Times article says, citing evidence that patients are being burned out by poor healthcare customer service that includes long appointment lead times, short visits, high prices, surprise bills, insurance aggravation, and too much focus on the EHR. Experts say to watch how patients vote with their feet as they flock to non-traditional settings that offer same-day appointments, walk-in visits, flat-rate memberships, and telehealth.

A Stat review of the boards of 15 top-ranked academic medical centers finds that 44% of board members come from the financial sector, while 13% are physicians and 1% are nurses. The authors conclude that board composition may explain why non-profit health systems focus on revenue instead of community need and employee satisfaction. They cite previous surveys showing that a big percentage of hospital board members are white males.

Sponsor Updates

  • Ascom Americas gives Fairchild Communication Systems the ability to re-sell Ascom clinical workflow solutions in the additional market of Toledo, OH.
  • Azara Healthcare and Bamboo Health will exhibit at Rise National March 6-8 in Colorado Springs.
  • Availity will present and exhibit at State HIT Connect March 6-8 in Baltimore.
  • Baker Tilly names Kat Mako (IMethods) and Cindy Kmiecik (Uniper) business development directors of healthcare IT.
  • Bardavon Health Innovations partners with the Gray Institute to offer discounted CEUs to its BNotes customers.
  • Biofourmis, Care.ai, Clearwater, EVisit, and Optum will exhibit at ATA 2023 March 4-6 in San Antonio.
  • CTG publishes a new case study, “CTG Improves Gundersen’s Patient Portal Support with Amazon Connect.”

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Currently there are "14 comments" on this Article:

  1. Hi Mr H – Epic does not terminate a set number of employees each year based on performance. Not sure where you got the bad info, but that’s not actually a company policy.

    • I thought that the Epic comment was odd also. Either way, I don’t think it would be that unusual for a company to have a 5% involuntary turnover rate from new hires that don’t work out and disciplinary action. It wouldn’t be a good overall turnover rate, but not absurd either.

      A mandatory 5% employee termination is just bad HR strategy. It imposes the cost of turnover and the only way it would make sense is if you believed that 5% of people hired per year were bad hires, which is a recruiting and management shortcoming.

    • Thanks. I’ve added a correction. I thought I remembered hearing that years ago in some kind of 20-60-20 tiering, but it must have been used as a performance management tool rather than for firing people.

      • GE 10% Rule. Also known as forced distribution and, derisively, as “rank and yank,” the practice was championed by former General Electric CEO Jack Welch, who insisted that GE identify and remove the bottom 10 percent of the workforce every year. In practice, it takes several forms. Popular years ago, never heard it related to EPIC at all.

        • Re: GE 10% Rule

          This was a lionized practice by many during the sugar high of Jack Welch’s tenure. To those on the ground, it was more clear that it incentivized backstabbing, hollow self-promotion, and distrust of your coworkers that you were competing with to not be at the bottom. It had the knock-on effect of pushing out a lot of experienced workers, keeping salaries low. Sugar sweet.

          Fast forward a few years: How’s GE doing these days? How’s Neutron Jack’s reputation after flooding the GE Alumni population with disgruntled former staff?

          Companies that take this path are playing with fire, in my humble opinion.

  2. Plural effusion- one of your best.

    Re: employee attrition and burnout- making employee’s lives miserable seems to be another way of getting to employee attrition. Rather than have layoffs, make people so unhappy that they leave. Some big tech companies seem to be taking this approach as well.

    • Thesis: a small company can selectively target the lesser performers to make them unhappy enough to leave voluntarily, while a large company resorts to impersonal spreadsheets and staffing by service line to conduct formal layoffs. If that’s true, then big companies are more likely to part ways with people they should have retained because managers aren’t always involved.

      Thesis 2: remote work impacts employers who may gain or lose workers given the removal of employee relocation barriers, especially the mid-career and older ones who have homes, kids in school, and working spouses. Most people are happy, or at least comfortable, where they live and work and dread the upheaval of taking a job that requires relocation.

  3. Regarding Epic attrition: I was an Epic Team Leader (manager) in Implementation for three years, from 2015 to 2018. Every six months, Epic managers stack-rank employees on a forced bell curve, on a scale from A to D. The ranks are A (the highest), AB, B, BC (the intended median), C, CD, and D, and each team was given a number of employees who had to fit into each category – if you were allotted two As for your team, you could only have two highest-ranking people, regardless of the relative strength against other teams (e.g. the Lab implementation team vs the Professional Billing team). In my experience, the CDs were put on mandatory PIPs, and the Ds were required to be “coached out.” Epic didn’t really fire people (other than for cause in HR-related situations), but Team Leaders were instructed to have “a fit conversation” and get their team members to recognize it wasn’t a good fit. Those conversations didn’t always go as planned, so Team Leaders would then be coached to “work them out” – give the underperforming team member more and more responsibility and accountability until they burned out and quit. Happy to elaborate further – rankings were a fascinating experience where every manager got into the same room, looked at a spreadsheet, and then yelled for three hours.

    Quite the employee-focused, health-minded organization, really.

    • Thanks for the background on Epic force ranking. I think many of us are familiar with this practice and there are credible HR leaders with differing opinions on whether it’s a good idea. It’s certainly different than the GE practice, but I can see how it’s related if people at Epic are force ranked into the lower curve and then coached. If this is true, you could have solid performers who are made to feel unwelcome through coaching conversations when I’m sure other organizations would be happy to hire them.

      I can also see how this maintains a high bar of excellence and ensures quality support for Epic customers as long as it doesn’t create a serious morale issue. It wouldn’t be my policy, but I at least understand the reasoning.

      As a leader, I hated having to use force-rank systems because when I had a very strong team I wanted to rate them as such and give them the corresponding raise for their performance. However, if you have a set budget for raises and every leader takes this approach, then you end up going over budget for raises.

      • One of my biggest challenges with it was that it was almost entirely subjective – we didn’t have a set of the actions and behaviors that made an “A”, we just had people’s individual rank of their teams and their manager’s normalized rank. It created a system that rewarded some of the most visible firefighters, rather than the people who took on really tough work and didn’t have delivery problems. The guy who worked consistent 80-hour weeks was always an “A” or an “AB”, even if that was inefficient or led to worse outcomes than the person who worked 55. Notably, the average hourly workweek for someone in my division when I was at Epic was 56 hours per week (based on logged time in the internal tool).

        • Every subjective employee evaluation system? It raises the spectre of favouritism. A manager who personally likes their employee is inevitably going to up-rank that individual. Those they don’t like will get down-ranked.

          It’s a problem everywhere, to be honest. It’s worst though with subjective systems. Sometimes the favouritism is conscious, sometimes it’s unconscious.

          You’d have to be inhuman to avoid this trap.

    • I was a TL (manager) in TS for a few years until last year. I want to clarify some things about the ranking system being described.

      The A – D system described is correct but an employee’s “base rank” is completely up to the manager’s discretion, only reflects performance, and does not need to be curved. If I had a team of all As, I could rank them all As. That “base rank” is used for understanding performance and eligibility for promotion etc.

      The rankings meetings where employees’ so-called “group ranks” are put on a curve is only used for compensation. So if we only had room on the curve for two A-level raises but three employees had an A “base rank”, one would be curved down to an AB for their “group rank” and get a slighly smaller raise. They would still have a A base rank and be considered just as high a performer as the As that didn’t get curved down. Getting curved down to a CD in a rankings meeting would not have an effect on whether that employee was on a PIP or whatever. Only if their base rank matters for that.

      So to recap,
      – base rank = manager’s discretion, performance and promotions, not curved
      – group rank = rankings meeting, compensation, curved

      The rankings meetings had a secondary purpose of some accountability for each individual manager’s assessment of their team member’s performance. By getting us all in a room to look at the ranks we’d given our team members, it was more obvious if someone was a “soft” or “hard” ranker, and if they couldn’t justify a base rank they’d given based on the team member’s outcomes, it was often changed (either up or down).

      Last addition to this essay I am writing here in the comments of HIStalk… there is more curving at higher levels that can undo some of the curving at lower levels. So perhaps when my team of three As with one curved down to an AB is combined with other teams in my division that don’t have so many rockstars and didn’t use all their A slots, the AB can get curved back up to A.

      At least on my team, we kept our meetings to two hours and there was no yelling :p

      PS – Epic folks reading this, this is why you need to impress not only your TL but other TLs on your team. They are in the rankings meetings and, also, they are much more likely to submit PMGIs than other employees. Make sure TLs know, or better yet, see the cool things you do.

    • The other problem with this system? Ranking on a curve only works when you have groups of employees large enough to be statistically significant. For very small groups there is no “curve”, and educated people are supposed to know that.

      I’ve never been entirely comfortable putting an actual number on the smallest permissible group to treat statistically, but it’s something like 100 or so. Now, how many managers do you know that manage 100 people?

      No cheating allowed! This means direct reports. Once a manager has other managers reporting to them, it’s those sub-managers who will be doing the curve rankings.

      I still remember the statistical abuse I witnessed in University. An allegedly smart professor excitedly told us how he had curve ranked his students. The student body consisted of a whole 3 students.

      • In my undergraduate Statistics course–taught by a graduate student–half the class got D’s and F’s. Was the problem students who couldn’t learn, or an instructor who couldn’t teach?

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