Weekender 8/3/18

Weekly News Recap

• Global Payments will acquire AdvancedMD from Marlin Equity Partners for $700 million
• Bob Wilhelm (Adreima) joins emergency and urgent care IT vendor T-System as CEO
• Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51
• Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39
• Cerner reports Q2 results: revenue up 6 percent, adjusted EPS $0.62 vs. $0.61, beating analyst expectations for both
• HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues
• President Trump nominates Marine Corps veteran James Gfrerer to be the VA’s assistant secretary for IT, commonly referred to as its CIO
• The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs

Best Reader Comments

We must remember that in the paper or analog days, most clinicians took notes while speaking to patients so that they had a medical record of what transpired during the visit. These notes (SOAP, scribbles, whatever) were retrieved when the patient returned and/or when the clinician revisited the patient (e.g., in the hospital) so that the clinician had a handy memory jogger and/or quick analysis of the patient’s progress, test results, etc. Because the earliest EHRs were based on existing clinician workflows, the EHRs merely copied the paper workflow routines. What’s pitiful is that 40+ years later, the usability factors of the most popular EHRs have not changed, with companies blaming external regulations as the reason entire product rewrites have not occurred to make the EHRs more 21st century (e.g., Facebook-like) and less 20th century, while still storing key information. (Woodstock Generation)

We all knew that was going to be the case. I’ve been on client side where Cerner says, “That wasn’t in the RFP, but for $400k, we can add that in. Gee, thanks.” (Ex-Epic)

I recall launching an evidence-based focused program for a large academic facility, just to learn that the #1 reason we lost out to patients or companies was because the large academic facility on the other side of the same city included a free golf swing analysis. (Katie Goss)

Very insightful. Key insight: provider organizations spent a fortune on an OS, and now they have to go buy apps to get any value out of the effort. (Robert D. Lafsky, MD)

Watercooler Talk Tidbits

Reader donations funded the teacher grant request of Ms. C in California, who asked for two Kindles for programming her middle school class’s Dash and Dot robots. She reports, “With the new Kindle Fires, my class had only increased their passion for computer science and coding. We have been using our robots daily and integrating it in our curriculum to help them learn from many different perspectives. The students are really excited when they come to school and always ask if we will be coding today or using robots.”

A CNBC LinkedIn search finds that Apple’s employee health clinic unit called AC Wellness has hired at least 40 people recently, most of them focused on wellness rather than healthcare services delivery. The program is rumored to be led by Sumbul Desai, MD, previously of the Stanford Center for Digital Health.

A study by non-profit “patent detectives” I-Mak finds that manufacturers of the 12 best-selling drugs in the US have tried to stifle generic competition by filing an average of 71 patents per drug. Each of the top drugs has been on the market for at least 15 years and all but one have gone up in price, with an average hike of 68 percent.

Walmart announces that it will not renew its contract with price transparency technology vendor Castlight Health, with the news sending CSLT shares down 26 percent and forcing the company to embark on a restructuring and cost-cutting project.

The White House issues a rule that will allow less-expensive, short-term health plans, aka “junk plans,” to be renewed for up to three years versus the previous three months. The plans, which are not required to meet ACA requirements, typically don’t pay for prescriptions, pre-existing conditions, mental health, substance abuse, or maternity and may include low lifetime maximum payouts or tiny daily payments for hospital stays. Minimal coverage also gives insurers a profit margin of 50 percent or more on premiums versus the 20 percent maximum as ACA plans require. Everybody understands both the problem these plans solve (high premiums) and those they create (people won’t understand the coverage limits or will become expensively ill while covered by a plan that offers them little financial help). They also create profound questions:

• Nobody can afford the cost of major and/or long-term medical care, so is it OK for people to under-buy insurance such that their short-term cost savings require the rest of us to pay their bills – maybe for life — via Medicaid or cost-shifting charity care?
• Should sicker people to be charged more for insurance or to make them pay a higher portion of their medical bills depending on their risk, the same as most other forms of insurance? What if they can’t afford it?
• Is it OK to be forced into bankruptcy over medical bills?
• Americans barely understood health insurance even with the mandated coverage and easy comparisons the ACA introduced, so what small-print secrets will be stuffed into the plan documents they ignore when buying this new “insurance?”
• Aren’t we really just playing the shell game in allowing providers to charge wildly high prices for health services that provide questionable value while we argue over “who pays” versus “what it costs” in pretending that healthcare is like other services in which smart consumers buy only what they need and shop around for the best price?

Pediatrician, vaccine expert, and author Paul Offitt, MD says in a new book that scientists need to be able to explain themselves concisely in interviews and on social media to offset the passionate but wrong medical ideas spread by celebrities, activists, and politicians. He notes widespread misconceptions about genetically modified organisms and glutens, suggesting looking at the shelves of Whole Foods to see social denialism at work.

A 26-year-old woman who swears that her new diet of only beef, salt, and water cured her depression and arthritis solicits online donations and sells Skype consultations to support her “carnivore diet.” She has also given her year-old daughter nothing but breast milk and beef so far.

Maybe Theranos should have worked on this. A group of four tech-powered pharma anarchists develops plans for a homebrew MicroLab powered by a $30 computer that they’ve programmed to create drugs cheaply, so far allowing anyone to make their own naloxone, HIV drugs, and abortion-inducing drugs. The government and drug companies don’t make it easy for the group to obtain the raw ingredients, so they buy OxyContin from street dealers to modify into naloxone. They explain,

The rhetoric that is espoused by people who defend intellectual property law is that this is theft. If you accept that axiomatically, then by the same logic when you withhold access to lifesaving medication, that’s murder. From a moral standpoint, it’s an imperative to enact theft to prevent murder. So yeah, we are encouraging people to break the law. If you’re going to die and you’re being denied the medicine that can save you, would you rather break the law and live or be a good upstanding citizen and a corpse?

Apple becomes the first company to achieve $1 trillion in market value, having gone from near-bankruptcy to become the US’s most valuable publicly traded company. Hopefully we won’t see a Y2K-type effect from financial reporting technology firms that didn’t anticipate the need to express market cap to 13 digits.  

Tech expert and newly appointed New York Times opinion contributor Kara Swisher weighs in on the naivete of inexperienced, closed-culture, California-happy social media technology executives who won’t acknowledge the harm their products cause:

Facebook, as well as Twitter and Google’s YouTube, have become the digital arms dealers of the modern age. All these companies began with a gauzy credo to change the world. But they have done that in ways they did not imagine — by weaponizing pretty much everything that could be weaponized. They have mutated human communication, so that connecting people has too often become about pitting them against one another, and turbocharged that discord to an unprecedented and damaging volume. They have weaponized social media. They have weaponized the First Amendment. They have weaponized civic discourse. And they have weaponized, most of all, politics.

In Case You Missed It

• News 8/3/18
• EPtalk by Dr. Jayne 8/2/18
• News 8/1/18
• Curbside Consult with Dr. Jayne 7/30/18
• HIStalk Interviews Lillian Dittrick, VP of Actuarial and Healthcare Analytics, Health Alliance Plan
• Monday Morning Update 7/30/18

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