Weekender 3/16/18

Weekly News Recap

• Theranos CEO Elizabeth Holmes settles SEC fraud allegations by agreeing to pay a penalty, give up her company shares, and not serve as an officer or director of a publicly traded company for 10 years.
• A blog post from UCSF’s Center for Digital Health Innovation says EHRS can never be a “comprehensive health record” since important patient health information is created elsewhere.
• Epic CEO Judy Faulkner says the company won’t challenge the VA’s no-bid Cerner selection, but estimates the government could have saved at least $3 billion by choosing Epic.
• Inovalon announces that it will acquire Ability Network for $1.2 billion.
• Epic confirms that it will integrate Nuance’s AI-powered virtual assistants into its software.
• Cerner says the VA’s planned go-live will begin in Q4 2019 with pilot sites and will then involve 48 waves that will be completed in 2027.

Best Reader Comments

With respect to Holmes, she DOES still face jail time. The settlement with the SEC covers only civil – not criminal – charges. The SEC has no criminal enforcement capability. The DoJ can pursue criminal charges if they deem it worthwhile. (Debtor)

My opinion / observation is that CommonWell is vaporware and it’s largely due to Cerner’s leadership or lack thereof. Athena went elsewhere to do real exchange. McKesson and Allscripts stopped talking about it. Cerner used it to land the ultimate whale in the DoD and has delivered LESS THAN the Joint Legacy Viewer for interoperability. With the DoD and VA combined, my family of five is in for about $250 to Cerner. For that price, I think I’m entitled to my equivalent of a Yelp review. (Vaporware?)

It’s very much en vogue to simply say API over and over again, but the fact remains – at some magical moment in time, you need as much data as relevant to the situation in order to make the best decision possible. APIs don’t actually accomplish that in general, and in the contrived example where one might try, you’d have the slowest computer system known to man. (UCSF only semi correct)

Agree with the interoperability problems in non-medical systems. It is only because we users demand a high level of accuracy that we complain so bitterly about the difficulties and errors. There are less complex data systems out there that perform much worse than the top tier of EHRs, but lives are not on the line, so we let it ride and only complain under our breath. (Graduated When?)

Thanks for highlighting Dan Linskey’s session. I was huddled out in the Boston suburbs with my kids on those awful days, but last Thursday evening, I felt as if I was standing next to Linskey – heart racing – listening to “Channel 1” in the middle of Boylston street. I cannot recall a more emotionally immersive experience. I will wonder all year how it is that I stumbled upon that talk at 5:30 – bleary-eyed as I left the exhibit floor. (Neil)

KLAS for validation. CIOs I work with generally find KLAS credible because the comments they read reflect the experiences they’ve had. They also conduct their interviews in person, which helps. Maybe not statistically bullet proof, but still credible, IMO. (Ex Epic)

Thank you for including this comment: “I’ve been the recipient of a couple of sexist comments this week – things that people would never, ever say to a male CMIO – so we definitely have a long way to go.” So many of my male colleagues just frankly don’t believe or seem skeptical that this behavior is as widespread as it is, suggesting that it’s only the creeps who make comments like that and that the comments are rare. Nope. (Kallie)

Love or hate KLAS, they have made both the provider buyer community and the vendor seller community pay them for telling them what to do. First, you have to understand the founders of KLAS are all prior leaders of HIS vendors and topnotch salesmen from days gone by. They were very successful in that world and they simply used those skills and tools they honed selling hospitals IT systems to sell them on needing someone to measure the vendor community and the vendor seller community on needing someone to tell them what they clients wanted and what their competitors where doing. It’s the perfect storm of a sales job and all of you bought it. They knew no vendor could pass up the notion of competing against its competitor, as healthcare is such a lead/follow vertical that once any provider stated they used KLAS, then others just followed because no one wants left out. (Real KLAS)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. C in New Jersey, who asked for take-home science kits for her elementary school class (note that the photos were taken in the homes of students). She reports, “As soon as I received the materials and displayed them in the room, the students went wild! They could not wait to pick a kit and take it home to do some extracurricular learning! What is so great about the kits is that the students will be able to use them year after year. I already have students in the upcoming grade looking forward to science because of the wonderful materials we now have in our room. Thank you so much for keeping our students engaged in learning in and out of the classroom! Your donation will reach many young minds this year and in years to come!”

Also checking in was Mr. M from Wisconsin, whose describes his school’s area as “hardest hit by poverty, lack of jobs, mental illness, childhood trauma, and civil unrest.” We provided STEM games, which he acknowledged with, “Our students are lacking critical math skills, but they find our math book to be too confusing. We are incorporating games like Farkle into our curriculum. It is really effective because the games are fun. There is a huge push away from procedural knowledge to conceptual knowledge. What this means is they want kids to understand why the math works, but they are moving away from actually being able to do the math. I find this to be foolish. So we are working on ways to memorize numbers and how to manipulate them.”

HIStalk traffic always spikes during the HIMSS conference, this year peaking at nearly 12,000 page views and 8,400 unique visits on Wednesday, March 7. That’s not quite a record – July 30, 2015 (DoD announcement day) saw 17,000 views on 12,000 visits, sporadically making my overloaded server (since upgraded) unavailable for some of that afternoon.

I didn’t get many responses to my question about the best and worst parts of the HIMSS conference, so I’ll just list them here:

• Best: the companies that exhibit are reaching out in more meaningful ways, with panel discussions, lunch and learning events. The worst: getting hit in the head or back by the ubiquitous overloaded backpacks. The carriers don’t seem to be aware that they have heavy luggage on their back.
• It’s always fun seeing old friends, but my favorite part of this year was having a virtual HealthTap doc stroll up to me while I was Facetiming my kids. We had a nice conversation with the doctor, who was very friendly, and although my kids are still confused about it, we’ve had some fun conversations around the type of work I’m in. Way to stick out, HealthTap!
• Best: networking opportunities and having a large number of products and vendors all in one place. Worst: not seeing any major new items or topics. I finished the conference thinking either I have reached some type of plateau in my knowledge and exposure to the industry and/or that the industry in general has plateaued. Considering focusing my time outside of HIMSS in the coming years.
• Was very disappointed in the Women in HIT networking event. I was really looking forward to it and encouraged many women to pay the $45 each to go. But I can’t figure out what the money paid for. Very crowded, cold, and barely food — had to pay for dinner afterward. I truly hope there was money left over for a nice donation somewhere. A speaker or sit-down event where you can hear people talk to each other would have been nice.
• The smoke was the worst. I enjoyed meeting folks and learning about their different technologies. As a fellow vendor, I think the other vendors were more engaging and just happy to chat. Seems attendees are truly afraid to make eye contact and get roped into conversation. I approached it truly wanting to learn about others’ ideas, needs, and experiences. Wish I had learned more from attendees.
• Worst part: Las Vegas. Disgusting place. Why have a healthcare conference in one of the unhealthiest cities in the US?
• While my sentiment likely won’t be popular, I was pleased to see the rise of non-native healthcare companies at the conference. High time for outside influence in what might otherwise be a generally stagnant field. The worst was hearing the perspective of first-time attendees who were disappointed to discover the lack of a patient presence. If anyone out there is ready to host a conference dedicated to patient panels, I’m all in!

I had to re-read this article carefully because it sounds like satire from “The Onion.” Elon Musk considered buying “The Onion” several years ago and has since hired its top two former executives and four other staffers to work on a secret comedy project. Musk’s reply to inquiries was, “It’s pretty obvious that comedy is the next frontier after electric vehicles, space exploration, and brain-computer interfaces. Don’t know how anyone’s not seeing this.”

Another “Onion”-worthy story involves startup Nectome, whose tagline is, “What if we told you we could back up your mind?” The company proposes to inject preservatives into the brains of dying people while they’re on life support, in essence killing them in the hopes that the stored memories in their brains can somehow be recreated later despite lack of proof that dead tissue actually stores memories. A neuroscientist critic says, “Burdening future generations with our brain banks is just comically arrogant. Aren’t we leaving them with enough problems?”

University of Michigan stirs up controversy by offering its donors concierge medicine services in a program it calls Victors Care that costs $2,700 per year. It promises that customers get “enhanced access and time with their primary care physician.” Its website lists just one participating doctor. Concierge medicine has become increasingly common, but is always offered by private practice doctors rather than public university hospitals.

A NEJM article ponders the ethical challenges of using machine learning in healthcare, saying:

• Machine learning may unintentionally offer recommendations biased against race or genetics because of the data it was trained with
• Private companies might develop algorithms that will recommend activities that are designed to artificially inflate quality scores or increase the use of profitable products without actually improving outcomes
• Diagnostic methods and treatment best practices may not be well enough defined to support a machine-generated conclusion
• Physicians need to understand how the algorithms work rather than treating them as a black box since ethical challenges may result otherwise
• Physicians are ethically bound to withhold information from the EHR to protect patient confidentiality, but that practice would skew the performance of machine learning that expects to find a complete data set

The physician reader who sent me the article notes that while the authors worry about the perceived authority of AI-powered systems, that’s what medical records technology pioneer Larry Weed, MD proposed 50 years ago – a system in which lower-level providers interview the patient and enter their findings into the EHR, after which the doctor is offered a computer-generated list of possible diagnoses before seeing the patient. Weed wasn’t thinking about AI, though – his idea was “problem-knowledge couplers” in which technology would analyze the available patient data to provide an objective assessment, avoiding the problem in which doctors who are faced with too much data make decisions using instinct instead of relevant facts. The illustration above came from Dr. Weed’s 1983 presentation at the SCAMC conference – he was running self-developed software on a Northstar Advantage computer with 64K of memory.

Researchers develop an open source template for a 3D-printed stethoscope, clinically validating that the $3 result works just as well as expensive models while being affordable to clinicians in developing countries. They got the idea after playing with a toy stethoscope and realizing that it actually worked pretty well.

In Case You Missed It

• News 3/16/18
• EPtalk by Dr. Jayne 3/15/18
• News 3/14/18
• Curbside Consult with Dr. Jayne 3/12/18
• The Smokin’ Doc Celebrates a Successful HIMSS
• Monday Morning Update 3/12/18
• What I Wish I’d Known Before … Taking My First Hospital IT Executive Job

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