Going to ask again about HealWell - they are on an acquisition tear and seem to be very AI-focused. Has…
News 8/7/20
Top News
Blackstone will acquire a 75% stake in Ancestry for $4.7 billion, giving the private equity firm access to the company’s DNA information on 18 million people.
The genealogy company, which launched a consumer DNA testing service last year that it has expanded to include genetic health risks and insights, reports annual revenue of over $1 billion.
Ancestry was valued at $3 billion in 2017 and considered running an IPO twice since then, but faced slumping sales as both it and competitor 23andMe laid off employees. 23andMe has sold the genetic data of its customers to drug companies for clinical studies, an area in which Ancestry lags.
Reader Comments
From Bug Frowner: “Re: Epic’s return to work requirement. Ignores its county’s public health order.” Dane County, Wisconsin’s July 7 emergency order says business “should, to the greatest extent possible” facilitate remote work to minimize in-office presence. Epic is therefore not specifically breaking any law that I can see since the wording is more of a recommendation. I would struggle to return to campus work as an Epic employee if I were high risk and otherwise fastidiously isolating, but we all know that bosses make the rules and our choices are to comply or leave. Media coverage has, as it often does, lapsed into the sensationalistic in portraying the complaints of a tiny percentage of Epic employees as a topic for heated debate into which Internet cheap-seaters feel the need to insert themselves. More interesting to me is that Epic says that only 24 of its employees have tested positive, which seems like a tiny number out of 9,000+ mostly young employees, but I assume they haven’t yet mass tested the folks who will be returning to campus. Judy Faulkner has said the company is working on immunity passport capabilities for its EHR, so maybe they’ll run employee antibody testing even though that has limited value outside of healthcare provider organizations given relatively low overall infection rates.
From Al Lewis: “Re: Livongo’s sale for $18.5 billion. The entire employer community doesn’t even spend $18.7 billion on diabetes-coded admissions. Not even close. Nor have they claimed to reduce that one item, the item that should concern employees the most. And they never explained why they want everyone to test multiple times a day when Choosing Wisely says most Type 2 diabetics are more likely to harm themselves than benefit through overtesting. Meanwhile, as I will be posting in a few hours, the price of insulin is skyrocketing thanks to greedy PBMs and employers aren’t doing a thing about it.” I interviewed Al Lewis, who I titled “workplace wellness skeptic,” a few months ago and asked him for reaction to the acquisition news.
From Donor Here: “Re: matching Donors Choose funds from Tyson Foods and your Anonymous Vendor Executive. Is that still available?” Donors Choose still lists 24 unfunded projects for which Tyson Foods is matching donations 10-to-1 and I still have ample matching funds available from my Anonymous Vendor Executive. Many other projects offer 2x or 3x matching from companies and organizations, which is still a lot of bang for the buck. I just received an email today from middle school science teacher Ms. W in Washington, for which our $32 donation (which was then matched 10 to 1) bought distance learning tools (microphone, graphics tablet, lighting, and a camera mount) as well as a 15% optional donation to fund the work of Donors Choose. She told me this morning that her school just announced 100% distance learning to start and she will immediately use the new technology to retool her her hands-on science classes for home learning. Donation instructions:
- Purchase a gift card in the amount you’d like to donate.
- Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
- I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
- I’ll pool the money, apply all matching funds I can get, and publicly report here which projects I funded, including teacher follow-up messages and photos.
From Live Longo Glen Tullman: “Re: Teladoc acquring Livongo. Paid too much, in a hurry to cash in some of its own overpriced shares.” My thoughts on the deal:
- This is the third-largest acquisition of a US company this year. Teladoc will give $0.592 of its shares plus $11 in cash ($159 per share) to buy Livongo.
- I don’t get the synergy, other than that both companies have to keep employers and insurers subscribing for services their constituents may not use and that may provide minimal benefit.
- The implicit market value of the combined money-losing companies is an eye-popping $37 billion, nearly double that of Cerner.
- TDOC’s market cap is $16.5 billion, nearly quadruple that of a year ago, on just $716 million in annual revenue. LVGO’s market cap is $1.5 billion, eight times that of September 30, 2019 on $207 million in revenue (selling price is 90 times revenue).
- Shares of both companies regained some of their losses Thursday after dropping hard after Wednesday’s announcement.
- LVGO’s Q2 earnings report from Wednesday went mostly unnoticed in the acquisition news, but the company had a good quarter, with revenue up 125%, adjusted EPS $0.11, beating expectations for both.
- Livongo’s executives will pocket fortunes from the acquisition just 12 months after its IPO. Lee Shapiro’s shares are worth around $860 million, Glen Tullman’s around $700 million, and Zane Burke (who joined as CEO just 19 months ago) holds shares worth around $160 million.
- I’m skeptical in general about early-stage companies that sell services through employers and insurers with unproven promises about saving them money, so I’ll simply say (a) good job Livongo for convincing Teladoc of predicted synergies, and (b) good job Teladoc for riding the likely temporary share price bump even as virtual visits slack off and health systems launch their own competing offerings to diversify. I don’t see the value for shareholders, patients, or the healthcare system in general, but then again I’m not a centimillionaire stuffing wads of investor cash down my pants.
Webinars
August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.
Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
Nuance announces Q3 results: revenue down 10%, adjusted EPS $0.19 versus $0.20, beating analyst expectations for both. The company said in the earnings call that it has signed pilot agreements for its Dragon Ambient Experience with WellSpan, Boston Children’s, Children’s Atlanta, and Lehigh Valley.
CVS Health beats analyst expectations for Q2, reporting a 3% increase in revenue and adjusted EPS of $2.64 vs. $1.93. Utilization of telemedicine services through its Aetna network and MinuteClinics jumped over 700% during the quarter as patients stayed away from in-person office visits.
Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs.
Digital point-of-care prescription savings vendor OptimizeRx reports Q2 results: revenue up 25%, and adjusted EPS of $0.02 versus $0.09, beating analyst expectations for both.
CPSI announces Q2 results: revenue down 10%, EPS $0.12 versus $0.12, beating analyst expectations for earnings but falling short on revenue.
Signify Research says the crown jewel that Siemens Healthineers gets in its $16.4 billion cash acquisition of Varian Medical is the latter’s oncology software business, which has $600 million in annual revenue with an 18% year-over-year-growth. The report notes that oncology is positioned at the convergence of EHR, lab, radiology, and surgery systems and the need to collaborate for diagnosis and treatment creates complicated workflows. Elekta is Varian’s chief competitor in that area. Siemens Healthineers is focused on three digital areas — imaging AI, advanced imaging hardware, and lab diagnostics. Siemens Healthineers, spun off from Siemens AG (which still owns 85% of its shares), is among a small group of medical technologies that have more than $20 billion in annual revenue, possibly coming in at #3 behind Medtronic and Johnson and Johnson.
Sales
- Michigan Medicine selects Mach7’s enterprise imaging technology.
- CPSI selects cloud services from Google Cloud.
- The Iowa Health Information Network selects PDMP connectivity, analytics, risk assessment, and patient support technology from Appriss Health.
People
LexisNexis Risk Solutions promotes Josh Schoeller to CEO of its healthcare business.
Industry long-timer Andrew Eckert (Acelity) joins medical claims company Zelis as CEO. Eckert has held leadership positions at Eclipsys, TriZetto, and Valence Health.
Justin Manning (Nordic) joins Evergreen Healthcare Partners as principal consultant and VP of medical device and data integration.
Announcements and Implementations
UHIN adopts NextGate’s enterprise master patient index across its HIE network in Utah.
Redox announces GA of Data on Demand, giving developers the ability to query any EHR or health data sources via the company’s API.
AHRQ publishes an electronic patient-reported outcomes toolkit.
Government and Politics
Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October. The conversion from VistA to Cerner was halted earlier this year as VA facilities focused on preparing for and treating COVID-19 patients. The VA has switched its go-live plans from facilities in bigger metropolitan areas to those in smaller cities in the Pacific Northwest and Midwest, citing a lack of access during the pandemic to clinical experts who had been expected to help with system customizations for the larger facilities.
Politico also reports that two senators have introduced legislation that would make the post office’s address matching software available to EHRs via API for patient identification and matching.
COVID-19
An Ohio Department of Health contact tracing graphic shows how one infected church service attendee spread the virus to at least 91 people in five counties in less than three weeks. The graphic was tweeted by Ohio Governor Mike DeWine, who announced Thursday that he has tested positive for COVID-19 as part of the screening for his now-cancelled Thursday greeting of President Trump in Cleveland.
Virginia launches the Covidwise app, becoming the first state to launch an exposure notification app using technology from Apple and Google. The app notifies users if they come into contact with other users who’ve tested positive for COVID-19. Some public health experts have questioned the effectiveness of such apps, citing low and thus ineffective adoption rates, privacy concerns, false alarms, and a lack of nearby testing capacity.
University of Miami Health System launches a remote patient monitoring program for discharged COVID-19 patients using TytoCare home health devices.
The Harvard Global Health Institute and Google Cloud develop COVID-19 Public Forecasts, a free planning resource that offers healthcare workers 14-day projections of cases, hospitalizations, and deaths by county and state.
An MRI review of 100 recovered COVID-19 patients who had no pre-existing cardiac conditions — most of them who had experienced only minor COVID-19 symptoms and recovered at home — finds that 78% have cardiac involvement and 60% have ongoing myocardial inflammation. The authors conclude that cardiac involvement is unrelated to COVID-19 severity and warn that undetected inflammatory disease may present a large health burden in people who think they got over COVID-19 without incident.
The National Institutes of Health forms the Medical Imaging and Data Resource Center, which will use AI and machine learning to develop new diagnostic tools clinicians can use to better care for COVID-19 patients.
The New York Times explains how the US uniquely failed to control COVID-19:
- A tradition of prioritizing individualism over government restrictions, which has also saddled the country with a world-lagging and unequal healthcare system.
- Lack of effective travel restrictions in excluding from the ban the family members of American citizens and permanent residents returning from infection-ravaged areas, failing to address the infection’s spread to Europe promptly, exempting the UK from travel limitations, and failing to create a quarantine process.
- Lack of state travel restriction enforcement.
- Testing delays caused by the CDC’s distribution of faulty tests that it insisted be used over tests that were developed in other countries.
- Commercial labs charging patients for COVID-19 testing, which discouraged their use.
- Conflicting public mask advice from WHO and CDC, some of that based on the need to prioritize the limited supply of them for healthcare workers, and allowing masks to be turned into a political symbol with partisanship as its most accurate predictor.
- The push by federal and state governments to reopen the economy with the virus still uncontrolled, which caused outbreaks afterward and provided only a brief recovery as personal fear and unemployment caused people to limit spending anyway.
- Mixed and confusing messages from political leaders and partisan news media, including distributing medical misinformation and expressing unwarranted optimism.
Other
HIMSS hires a second Australian Digital Health Agency executive as CIO Ronan O’Connor joins former CEO Tim Kelsey. O’Connor’s new role was not specified, but Kelsey became SVP of HIMSS Analytics International in January 2020.
HIMSS will continue to publish the mobile health app best-practices guidelines of Xcertia, a now-dissolved project of HIMSS, the American Medical Association, the American Health Association, and DHX Group. The Xcertia standards body was formed in December 2016, last updated its guidelines in February 2019, and then went silent shortly afterward. The organizations haven’t announced why they pulled the plug. The three principals of non-profit app curation organization DHX Group seem to have moved on to other projects.
The local paper says that at least 13 Epic employees claim that the company has demoted team leads who expressed concern about its plan to bring employees back to campus, which Epic denies.
European Union authorities will investigate Google’s acquisition of Fitbit, worried that Google will target ads based on the user fitness data that Fitbit collects. Google says it has no such plans and has offered to sign a contract that limits its use of the data. A consumer group concludes, “It is hugely important that the E.U. carries out this in-depth examination because wearable devices like Fitbit’s could in future give companies details of essentially everything consumers do 24/7.”
Sponsor Updates
- InterSystems launches T2020, the latest version of its TrakCare EHR, which includes COVID-19 functionality, an enhanced user experience, and a unified workspace for patient records and documentation.
- Cloud Computing Outlook names Goliath Technologies a Top Virtualization Solutions Provider.
- HCI Group Chief Digital Officer Ed Marx publishes a new book, “Healthcare Digital Transformation: How Consumerism, Technology, and Pandemic are Accelerating the Future.”
- Spok announces that all 20 adult hospitals and all 10 children’s hospitals named to US News & World Report’s 2020-21 Best Hospitals Honor Roll use Spok clinical communication solutions.
- Saykara’s voice-enabled mobile AI assistant is named as a healthcare innovation awards finalist.
Blog Posts
- Fear: Circling the Wagon vs. Innovating (Access)
- A Diabetes Educator’s Guide to EGlycemic Management Software (Glytec)
- Halo Health Top Performer in KLAS Clinical Communications Report (Halo Health)
- Steps for Effective Patient and Staff Contact Tracing to Defend Against COVID-19 Spread (Health Catalyst)
- Health Payer Priorities in Face of Ongoing Pandemic (Imat Solutions)
- COVID-19: What we know and where we’re headed (Intelligent Medical Objects)
- No time for guessing games: Three things payers need to consider if they are to survive the impacts of deferred care (Jvion)
- How Hospitals Can Thrive in the Midst of Constant Change (LiveProcess)
- Healthcare’s COVID-19 Response is a Window to the Industry’s Future (Loyale Healthcare)
- 2021 Medicare Proposed Rule Released for Physical Therapy (MWTherapy)
- Patient Matching in the Era of COVID-19: Maintaining Control Over Patient Privacy and Data Governance (NextGate)
Contacts
Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.
As a member of an organization, it helps to conceptualize your options into three categories: exit, voice or loyalty[1]. It is remarkable that someone whose business is based on their voice has such a cynical take on using its power.
It is a low bar to judge decision by whether they break the law or not. It doesn’t matter how many Epic employees are currently sick. It matters how many of them pass the virus on to their parents, grandparents, spouse, seat mate on the bus, etc. Those are the people this decision really hurts.
https://en.wikipedia.org/wiki/Exit,_Voice,_and_Loyalty
The statement made was that Epic is breaking the law. The answer clarified that it isn’t.
The Dane county public health department clarified that they would be breaking the law:
https://www.scribd.com/document/471847496/Epic-Complaint-Letter-8-6-20-docx?secret_password=elD0dk889s5YTHA2zWQJ
I think that your assessment of Epic’s COVID response is focused on the wrong choice. Sure, we employees have the choice you mention when reacting to upper management’s decisions. But what you should be focusing on is upper management’s decisions, not our response to them.
Epic’s decision to bring us all back to campus is not founded in logic. The only defense given is that our culture suffers, which is not an adequate excuse for endangering the lives of thousands. In addition, I can attest that we have been writing software at the same clip from home over the past few months, and I can’t name a time when I felt that my subscription to Epic’s culture waned in a way that impeded me.
You should also consider that the majority of Epic employees are keeping silent out of fear. The rumors of demotions mentioned in some of our local papers are quite true, and many of us are fearful that the only place to demote us is out of the company. Team Leaders internally have been asked to listen thoughtfully to employee concerns but never to voice their own, even though personal Team Lead friends of mine have confided to me that they do indeed share concerns about our return-to-work plan. The fact that only a few hundred employees have been speaking out should be viewed as a small sample, not the total.
Anyway, I’m writing this in the hope that, in the future, you will use this soapbox in a more thoughtful way. You have the opportunity to speak truth to power in a way that many even within our company can’t. Please don’t waste that power punching down unless you truly believe it’s the right thing to do.
The culture of fear is real at Epic. There have been multiple instances during staff meetings (sometimes lovingly called internally as “The Two Hour Hate”) where they have done alarming things such as asking the person who leaked the average age chart to volunteer to be reprimanded (fired), call people out for taking too much food after hours from the kitchen where they have food for people working after hours, and display submitted receipts from onsite trips to reprimand us on spending too much.
They’ve also created a company where people literally inform on other employees Fascism style via “feedback”. If you get on the wrong side of literally anyone in the company you are reprimanded by your team lead, and that feedback sticks with you forever in their internal pogi system. I’ve had multiple colleagues get absolutely destroyed by feedback from people who were supposed to be helping and nurturing them, but instead are informing on them to their boss. Even worse is how they determine employee rankings, where all the team leads sit in a huge auditorium and look thru slideshow of all employees, and everyone can air their grievances about a given employee . You better hope you haven’t accidentally rubbed anyone wrong ever. I wonder why everyone works so hard and is so nice.
And of course the amount of times I’ve seen instances where employees are thrown under the bus (fired) by customers as a result of their mistakes or political machinations. I’m sure its the customer support person’s fault that the organization is struggling with the system, regardless of the fact that this person was still in college going to senior parties when you made those decisions during install. Everyone is expected to eat sh*t with a smile on their face and say thank you sir.
I left many years ago at this point, but I doubt much this has changed.
Mr. H, I would like to second Epic Dev’s sentiments towards your expressed opinion on this matter, and I only hope I can do so with a fraction of their eloquence. I would likely be in agreement with your assessment of bosses setting the rules, and we just comply or leave, if this was a question of whether we need to put a new cover sheet on our TPS reports. Whether we risk our lives for no apparent benefit is an entirely different matter, and this is highlighting some really dangerous attitudes on the part of management at a number of companies right now when they’re pushing prematurely for a return to the office when the work can be done remotely.
The proposition of “Leave if you don’t like it” isn’t really great in good times, anyway. Sometimes managers and executives get things horribly wrong. In a time with a healthy job market, and ample health coverage, it can still be the kind of behavior at companies where they punish good employees who are trying to save them from themselves. In today’s market, it’s unconscionable that a highly successful company is taking a step like this. And it’s beyond the pale to just say, “Well, you can leave if you don’t like it” and send people off to unemployment without health insurance.
The last time I checked your bio, you said you live in the Madison area. You need to care more about this. This return to campus is an unnecessary risk to the whole community. Back before we locked down, weeks after other leading tech companies, many of us knew colleagues who were dealing with a severe flu. I knew two people just down the hall from me. What do you think will happen when the same number of people are back on campus? How do you think that goes when people start traveling in large numbers again, flying on planes to and from Florida, Texas, Arizona, Georgia, California, and other places? Don’t get taken in by the news reports citing internal assurances that our individual offices and air filters are going to magically contain the virus. Those offices share an extensive ventilation system after air comes through the filters, and into individual offices where masks aren’t required. People share elevators. People find themselves in large groups daily, sometimes spontaneously, when going places. And people who get sick will bring this to their families, who will bring it to their schools and workplaces. This isn’t Vegas. What happens on campus will not stay on campus. Make no mistake about it: Managers ARE responsible for their employees, and this whole exercise is testing in production with their lives.
If you’re still sympathetic to management, think about the business end of this: We develop and support critical infrastructure for US healthcare, and I’m sure you’ve noticed that things aren’t going so well in that industry right now. How does that go if large numbers of people developing and supporting that infrastructure are sidelined for weeks with illness? How about if some of them die? What if their families sue? How about if many of them leave because they are so disgusted by the disregard being shown for their safety? How do important clients feel if a critical vendor is taking these risks? And what of local clients (which you’ve said you worked at) that may see their case counts rise when the confluence of UW opening, flu season, and a return to campus converge? I can’t imagine that physicians being overworked by a large number of patients are going to keep using the product without it occurring to them that the product is responsible for the overwork they are risking their lives to do.
This has been a horrible week after months of a slow burn for Epic. What is happening right now has reached the point that it can truly be called an employee revolt. All the news coverage and the negative attention it’s bringing has to have weighed heavily on Judy. I hope that she also realizes that this week’s coverage, while a terrible thing to experience, is going to feel like the best sex of her life compared to what’s coming when there’s an outbreak on campus.
Mr. H, I know you care about businesses. I know you care about health. I know you care about the community you live in. For those reasons, and as a longtime fan of yours, I hope you can find it in yourself to engage with the important questions that are coming out of this whole mess. This is too important to be swept under the rug of “bosses gonna boss”.
re: “Politico also reports that two senators have introduced legislation that would make the post office’s address matching software available to EHRs via API for patient identification and matching.”
I love that we need new legislation for one government agency to share IP that will improve patient matching, and overall population health.
Great take. It’s amazing how many errors there are in address information in EHRs , which makes geocoding quite a challenge. The Post Office API is already available- is this just going to make it less expensive?
Yes, the legislation says that these APIs should be made available to healthcare facilities and vendors for no charge and they will be required to use it within a stipulated timeframe.
So you “would struggle to return to campus work as an Epic employee if I were high risk and otherwise fastidiously isolating”? Hi, I’m a tenured enough employee to have my hand prints up on the wall. I’m not high risk, but my spouse is. And I’m currently faced with the choice of going back to the office starting in September and potentially bringing home a virus that will likely kill them or taking a leave of absence and likely not getting my job back when it’s over. If I was the high risk person, I would be able to stay home another 6 weeks until November 2, but nope! Thank you for seeing my struggle and then immediately taking the stance that the bosses make the rules and I should just shut up and go along with them.
My TL is happy with the work I’m doing at home, my customer is happy with the work I’m doing at home, but because 1 person doesn’t believe WFH can be effective, my years of experience are probably going to be leaving the company soon. Judy’s insistence on our return to the office is based on the fact we are losing our culture of having conversations in the hallways. I’m not sure how many people are going to be eager to just hang out in the halls these days though. She and other upper management have provided no concrete evidence that productivity has suffered significantly and it’s essential for us to come back to the office on the current timeline.
Also, Epic has no plans for any sort of testing effort, either before or after anyone returns to campus. Employees are supposed to self assess before coming to the office each day. If cold and flu seasons are any indication, this will definitely result in cases of COVID on campus. Epic does not offer overly generous sick leave and the mentality is often “come to work unless you’re physically unable to”. And while the reported case number is currently 24, I know of multiple coworkers who were extremely sick in March but unable to get tested because they weren’t quite sick enough to be hospitalized. If you’re basing your stance on the company having a low incidence rate so far, 1) that case count is an under count and 2) at one point places like Florida had low case counts, and then they didn’t take sensible precautions and look at where they are now.
There is no reason that Epic is unique and is the one software/tech company that can’t work from home. Most of us who are asking for this are not asking to be able to do WFH forever. We are asking for recognition that these are extraordinary times and that increased flexibility is needed. Right now, my concrete ask is that anyone who wants to can WFH until the end of the year. Because that’s not even on the table for consideration, the company is going to lose me and others like me.
It’s been awhile since I left Epic in 2012, but reading these stories has brought a rush of memory around the company culture. I recall vividly how as team leads we were encouraged to support the company policy, even if we disagreed with it. I have a lot of sympathy for anyone working there right now. Especially those with families. I agree with the comments of others – if your culture can’t manage through another 6-12 months of remote work, your culture may be too fragile to begin with.
Epic’s unfailing belief in its own judgment has often been a strength, but it’s completely irresponsible now.