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News 4/19/19

April 18, 2019 News No Comments

Top News

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IBM halts sales of Watson for Drug Discovery due to low demand.

The company says it will intensify its focus on clinical development. 

The Watson for Drug Discovery web page is still active, including testimonials from Barrow Neurological Institute.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Healthcare data integration vendor Redox raises $33 million in a Series C funding round. It has raised $50 million since launching five years ago.

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EMV Capital acquires San Francisco-based Wanda, a clinical decision support company focused on preventing adverse events.

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After merging last year, healthcare consulting firms HealthInsight and Qualis Health rebrand to Comagine Health. HealthInsight CEO Marc Bennett has assumed leadership of the new company.

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The Theranos saga just won’t go away. CB Insights reports the company was awarded five new patents in March and April, all filed between 2015 and 2016. Theranos founder Elizabeth Holmes, meanwhile, is preparing for her day in court. Charged with several counts of wire fraud and conspiracy to commit wire fraud, she has filed a motion in federal court to to force prosecutors to hand over thousands of communication records between the FDA, CMS, and Wall Street Journal reporter John Carreyrou, whose reporting helped bring the company’s fraudulent activities to light. A trial date has not been set, given the 17 million documents federal prosecutors must sift through to build their case.


People

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Tom Niehaus (TJN Advisory) rejoins CTG as EVP of North American operations.

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White River Health System (AR) promotes Jeff Reifsteck to AVP/CIO.

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EarlySense names Matt Johnson (Sowell & Co.) as CEO.

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Robert Fosmire (Kareo) joins Greenway Health as SVP of customer success.


Sales

  • Sentara Healthcare (VA) selects PACS software from Mach7 Technologies.
  • Prisma Health (SC) will implement patient access and provider directory technology from Kyruus.

Announcements and Implementations

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After more than a year of training led by a core team of 20, Carris Health (MN) will go live on Epic at six facilities next month.

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Best Buy begins offering TytoCare’s at-home telemedicine kit online and at select stores in Minnesota. The TytoHome kit retails for $300 plus the cost of a virtual visit with partners that include American Well, LiveHealth Online, and Sanford Health.

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In New York, Northwell Health opens an Emergency Telepsychiatry Hub to serve EDs in New York City, Long Island, and Westchester County. The hub’s 35-member team expects to conduct 5,000 consultations this year.

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A new KLAS report on enterprise resource planning systems  (HR, finance, and supply chain) finds that cloud-based systems are attractive and organizations are willing to consider them even if it means replacing their incumbent vendor. Workday leads the field despite gaps in supply chain functionality. Infor and Oracle offer newer, lower-rated products; earn client criticism for not taking an active lead during implementation; and have a significant percentage of customers who say they wouldn’t buy those products again. 


Government and Politics

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In England, the NHS develops the National Events Management Service, a digital personal health record for children that parents may use in place of the traditional paper version they are expected to bring with them to all pediatric appointments. The new service also features real-time messaging capabilities for birth notifications, address changes, and change-of-practice notifications.

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An ONC data dive into the ways in which hospitals used their EHR data between 2015 and 2017 finds:

  • A hospital’s use of EHR data varied significantly by vendor; Epic, Meditech, and Cerner users had the highest rates of data utilization to inform clinical practice
  • Small, rural, critical access, state and local government, and non-teaching hospitals had the lowest rates of EHR data utilization
  • Hospitals most frequently use EHR data to support quality improvement efforts, monitor patient safety, and analyze organizational performance
  • Utilization of EHR data slowed significantly (in some cases stalling completely) between 2016 and 2017

Privacy and Security

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The communications director at Northern Light’s Acadia Hospital in Maine mistakenly emails a spreadsheet containing the names of 300 patients with Suboxone prescriptions and those of their providers to a reporter at the Bangor Daily News. The spreadsheet was an attachment buried in a chain of emails between the hospital employee and the reporter, who was developing a story on the the availability of Suboxone – a drug given to patients battling opioid addiction – in the Bangor region. The hospital’s privacy lapse has, ironically, made the paper’s pages.


Other

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Columbia University (NY) reminds medical staff of the importance of its upcoming transition to Epic, which will encompass converting aging systems to the new or upgraded Epic software across Columbia, Weill Cornell Medicine, and NewYork-Presbyterian facilities. “We knew staying the course was not an option,” said Jack Cioffi, MD, president of ColumbiaDoctors and an executive sponsor of the EpicTogether project. “The pain points we feel now with CROWN and SCM will fade with Epic. That’s not to say we won’t experience new ones these next nine months, but we will be able to better address and fix them. We will have a more efficient, comprehensive system to support us in delivering the best care possible.” Rolling go-lives will take place between 2020 and 2022.


Sponsor Updates

  • Elsevier’s new Transition to Practice platform helps retain newly licensed nurses and build their confidence and satisfaction.
  • EClinicalWorks and Imat Solutions will exhibit at the NAACOS Spring 2019 Conference April 24-26 in Baltimore.
  • Imprivata and Kyruus will exhibit at NAHAM April 23-26 in Orlando.
  • Solutions Review interviews InterSystems Director of Product Management Jeff Fried.
  • Ivenix publishes a new white paper, “Exploring Real-World Performance of IV Pumps.”
  • Vocera receives an Authority to Operate from the DoD, extending the potential purchase and deployment of its Vocera Badge to facilities in the Air Force and Navy.
  • Phynd Technologies migrates its Provider 360° platform to AWS, has partnered with the American Board of Medical Specialties, and joined the Drupal Association.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Health System IT Professionals vs. Would-Be Disruptors: Unfairly Dismissive or Appropriately Skeptical of Outsiders?

April 17, 2019 News 2 Comments

I asked provider IT professionals to weigh in on this question, whose genesis was an outsider’s assessment via an HIStalk comment: do we health system IT people automatically dismiss potentially disruptive technologies (such as AI) because we are too entrenched or too well rewarded by the status quo?

The edited responses are below. Thanks to those who offered their excellent insights.


Outsiders have trouble with understanding the speed at which physicians want to move. They are one of few occupations still paid by the piece, not by the hour or a salary. Every second they are waiting for information to populate on a screen, the screen to flip, or the log-in sequence is a lot of money to them. Until you have a database faster than MUMPS, don’t waste my time. For that reason alone, blockchain is a non-starter.


I’ve been involved in minimally transformative ideas and projects that are shot down due to the (over) regulatory environment. A lot of industries are heavily regulated (airlines and nuclear power come to mind), but their regulations are generally around safety. In healthcare, the regulations are around both safety and the prevention of entities over-profiting (Stark). Sometimes these regulations contradict each other and the outsider only understands some of them.


I believe any technology that puts information and decision-making into the hands of the patient has the potential to be disruptive. This will not be a get-rich-quick application, Most people requiring our services are older and even less receptive to change than outsiders would perceive us to be.


They are correct. We actually look to see if incentives are aligned, like everyone else. We rapidly adopted pagers, cell phones, MRIs, and stem cell treatment when we were paid for it or it makes our lives easier. We didn’t rapidly adopt EMRs or other IT solutions when they made our lives harder and cost us money. The issue is not doing something new, it’s doing something reasonable. Make sure incentives are aligned with realistic business models before introducing anything new. One of my favorite quotes: “Incentives matter, whether you think they do or not.”


I think we probably are resistant to AI, but not solely because of incentives. There’s too much vaporware out there and it takes a lot of time to weed through the good and bad, with the good often being no better than the best systems already provide at the added cost of an AI system and/or of nominal value. If they want to blame someone, blame IBM, who taught us that you need to spend a year training your commercial software only to have it continue to provide inaccurate info. To be fair, it is providers that control the data that makes AI training work and our reluctance to share is probably an issue. On the other hand, Google did manage to wrestle millions of records away from the NHS and they still have nothing to show for it.


It’s the pot calling the kettle black. Everyone wants into the healthcare cash cow, but no one wants skin in the game when it comes to actual outcomes, and that includes providers.


Take a look at the technology adoption lifecycle. We’re still in the innovator phase and they’re not yet screaming from the rooftops to get on board. Technology adoption takes 10-20 years, even for consumer products (many of which in recent years had the benefit of being “free”). Why should they be expecting instant results?


We’re dragging our feet on AI when it comes to digital imaging so we don’t tick off providers. We provide a lot of exceptions where it may not work, yet we don’t fire the entire medical community when we have a misdiagnosis rate of 10%.


What disruptors don’t understand is that their solutions are typically unaffordable in the long term for health systems that like to spend more money building buildings than they do to support their existing IT infrastructure. The new shiny object may get some attention and might even get an executive to bite, but at the end of the day, it falls on IT to implement, support, and maintain that disruptive solution over time, all while our budgets shrink due to “cost controls.” The disruptors must demonstrate real-world (not hypothetical) ROI and in reality be at minimum a budget-neutral solution in order for us to take them seriously.


Treating people, while doing no harm, is an art in addition to science. Humans are not machines made to exacting specs that benefit solely from repeatable process. The chance of patient harm or malpractice is real with bleeding edge technology.


Everyone I know on the health IT side is very aware of our limitations and looking for any way we can help out the providers. AI/ML, although promising, so far has limited proven use cases. That, coupled with a very high barrier to entry due to the skills required, means that AI/ML often gets lumped into the “maybe, if we have money left over” part of the budget. Not a lot of healthcare organizations ever get to make it to funding that portion of the budget. Trust me, if you proved your ML model could improve clinical care and/or save lots of money, organizations would adopt it in a heartbeat. If you haven’t proven its value, then why would you expect us to adopt it?

Honestly, it sounds like a comment from someone who runs an ML-centric company and can’t find a partner to provide the training for their model. That’s a risk and investment for the healthcare organization, and typically the vendor gets most of the benefit if it works even though they tapped the provider’s knowledge and training to make the product. If you really want us to do that, show up with a fully-funded project, including our expenses, and we’ll consider it if you give us partial ownership of the successful project. At this stage of the game, that’s the only deal that makes sense.


You can kill people with the wrong tech, bad tech, or badly-implemented tech. As a clinician who supported clinical decision support, it is easy to talk it, but harder to prevent the medical misadventures that may happen to said Heath IT Outsider’s child.


Speaking as a provider who works in the vendor space, we prefer to wait and see what works in other industries before taking a risk and sinking big development dollars into expensive new solutions. Exhibit A: cloud computing, which went mainstream with Amazon Web Services in 2006, but only in the last few years have we seen this model take off in our industry with web-hosted EHRs. That’s why we’re always 15 years behind. None of the established players wants to spend $500m to develop a buzzword concept (remember “big data”?) that will fold or go out of fashion next year.


Next time you are sick, open your AI program get a diagnosis, prescription, and any blood tests. There is a place in healthcare for AI, but it is not replacing trained medical professionals


I’m guessing that comment came from a former Elizabeth Holmes devotee. Health IT outsiders have a long history of declaring the US health system stupid, launching a startup, then quietly giving up a year later. If our outsider had any real ideas, they’d have products in the marketplace making money. Optum, Health Catalyst, Arcadia, and many more aren’t waiting around for provider permission. They are innovating, pushing the quality-cost envelope, and growing. I don’t know if AI will truly move the needle positively in healthcare any time soon, but I’d have to hear a great conspiracy theory to believe provider IT people are protecting their EHR vendor from AI, open APIs, or any other technologies that would make the customers happier and their jobs more fulfilling.


As a health system CIO, Individuals who are flabbergasted by the risk-averse nature of the healthcare industry as a whole do not fully understand nor appreciate the current healthcare system business model. It has a customer (patient) market that is shrinking. It is becoming more segmented, with alternative specialized scope limited services. The net revenue opportunity per patient is shrinking as operating costs (especially labor and regulatory related) continue to increase.

Entrepreneurs by their very nature take financial risks if they see an opportunity for a high financial return when no one else does. There is a ton of cash flow within the healthcare industry, but no new opportunities for significant cash infusion The customers (patients) do not have any opportunity to shift their spending from one source to another. The industry players are protecting their revenue stream as best they can. Most healthcare providers and hospitals do not have an entrepreneurial spirit, nor do they have the financial reserves to take on the financial risks.

It is also important to note that the financial industry and venture capitalists do not invest in healthcare providers nor hospitals. The risk is just too high for no foreseeable reward. Thus, it is not surprising at all to me that “health IT outsiders” looking to be disruptors are disappointed when they are not embraced with open arms. I predict that someday there will be disruptors who will change the business model itself with a better SYSTEM of mousetraps rather than just one highly effective mousetrap.


I don’t see provider IT people as being entrenched or particularly well rewarded. Rather, we insiders are pragmatic. Too often we’ve been sucked in by the breathless exuberance of the purveyor of the next big thing that will revolutionize healthcare, only to realize that it’s not nearly what it’s cracked up to be. Or worse, we take the blame for it not turning out to be what it was purported to be.

Technology is evolutionary, not revolutionary. Incremental advances by potentially disruptive technologies – once field tested – make their way into the mainstream. Let’s not forget that a mere 15 years ago, EHRs seemed revolutionary.

Look at FHIR. The bright shiny object du jour which will solve all problems in the delivery of healthcare. Will this technology magically address every issue? Absolutely not. Or will it even address any of the issues better than some long-existing technology? I’m on the fence. Is FHIR really even disruptive? Nope. Interfaces have been around since there was more than one computer. But by being a pragmatist and viewing FHIR as an incremental improvement, I get painted as a curmudgeon.


I think there is an extreme sense of being jaded from a long list of previous failures. People often don’t understand the complexities of healthcare, the countless variations, the messy data, the fickle users mixed with the extreme regulations of privacy and billing. Add all of that to hospital bureaucracy, understaffed IT departments, and low-salaried (and therefore often mediocre) IT staff and you have more sub-optimal systems than you can count.


Healthcare doesn’t operate financially as other industries. I’ve spent the majority of my career in community hospitals and it is difficult for them to sink money into disruptive technologies when you’re payer mix is 40-60% government. We would love to invest in disruptive technologies, but when replacing an EMR originally installed in the mid-90’s causes a financial burden, what’s a girl to do?


What’s the evidence of benefit to (a) patients and their caregivers first; (b) physicians, nurses, and other bedside technical caregivers second; and (c) then everyone else? As a 40+ year emergency physician and 20+ year medical informaticist, let’s see the evidence that AI and other disruptive technologies deal with the chaos of patient variability and sensitivity to initial conditions better than the competent, compassionate physician.


This is healthcare. Ultimately, people’s live are literally on the line. There is no room for alpha or even beta level products in a production environment. If AI can do my job and help save lives, so be it. But that is not now and it is not anytime soon.


The workplace dynamics of provider-based healthcare are different than any other industry. Who is the customer? Is it the patient, doctor, nurse, CFO, payer, government, or someone else? Or all of the above?  Outsiders have not not been able to solve that riddle yet, although things may be changing with consumerism on the rise.

Also, in my long experience as a CIO (25+ years), it is rarely the CIO who calls the shots. Hospital CEOs are notoriously risk averse with a huge herd mentality when it comes to IT. The history of the industry is littered with multiple failures of so-called IT solutions. In addition, CFOs control the purse strings, and if they do not control IT, are out to hamstring it.

I have seen several outside CIOs try to “fix healthcare” and they have all failed to recognize the unique cultural characteristics.


I’m not worried about protecting my paycheck. There are always positions available in my particular medical specialty and my current income isn’t that great anyway. What I am worried about are the costs and potential negative consequences of inadequately designed and tested “disruptive technology.”

Healthcare technology is not like trying a bunch of free or cheap apps on your personal IPhone to see if any generate major or disruptive improvements. Instead, with healthcare technology, there are significant upfront costs (often with no guarantees of benefit or acceptance), significant personnel costs for installation and training, significant changes to workflow, and potential for unintended consequences, including inefficiencies, lost revenue, and actual harm to patients if it doesn’t work correctly. Indeed, I’d be concerned that anyone who jumps on the bandwagon too quickly is impulsive and reckless.

Add to that all of the half-baked snow jobs that we’ve been sold over the years and it’s no wonder that HIT providers (and users) are cautious and skeptical.


I welcome the challenge, but I am more often than not faced with those who do not want to accept that they don’t know the extent of what they DO NOT KNOW about the unique specifications of the industry. If only the industry was established in the status quo. Most who make such proclamations dismiss the history to the why and how we are where we are. Case in point — the Jim Cramer declaration and folks like Chrissy Farr who just pass along without doing the basic journalistic research on Epic. If they came about it with some sort of due diligence, it might be a different story.


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News 4/17/19

April 16, 2019 News 4 Comments

Top News

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The New York Times reviews the use of an IPhone-powered whole-body ultrasound scanner in Uganda and other developing nations. The $2,000, US-made device addresses the issue that two-thirds of the world’s population gets no imaging at all due to cost, geography, and machine availability.

The sign that the device is real – it has earned FDA’s marketing clearance. The sign that it works disruptively for public health – one of the company’s backers is the Bill and Melinda Gates Foundation, which unerringly funds projects that deliver the biggest bang for the global buck.

It’s a beautifully written and photographed article.

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The tap-and-swipe Butterfly IQ device offers 18 presets for images such as cardiac and deep abdomen. It stores data in Butterfly Cloud to offer HIPAA-compliant image sharing with patients and peers.

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The inventor is DNA sequencing pioneer and Yale School of Medicine genetics professor Jonathan Rothberg, PhD, who I hereby elevate to the top of my “most interesting people in health IT” list (and that’s a short list).


Reader Comments

From OOB?: “Re: Epic and Cerner. This article says they’ll be out of business within 10 years because their EHR technology is outdated.” That’s just attention-seeking silliness since surely nobody who has any connection to health IT could be that uninformed. I’ll offer just three of the many dozens of counterpoints that come immediately to mind:

  • Seeing Epic and Cerner as offering just “EHRs” – which is an awful and misleading term in the first place – is marking yourself as a clueless technology fanboy who has never worked a day in hospital IT. Their systems run every hospital department and service, including non-clinical ones, and then roll the vast amount of information up into a single database for operational management, reporting, patient access, etc. With what, exactly, would they replace all those systems, which are integrated with every kind of clinical device made?
  • It would take even a tech giant probably five years and $1 billion to develop a competing system assuming they could recruit the right subject matter experts, and given the maze of governmental, regulatory, financial, and clinical minefields to be navigated, no publicly traded company would devote the resources to get Version 0.1 into testing, much less find buyers among conservative health systems who have little interest in bearing the beta testing pain. Even Microsoft and Google couldn’t give away their crappy consumer-targeted personal health records and ended up shutting them down, so don’t expect them run off and responsibly build a laboratory information system or IV barcode scanning.
  • No tech company is working on anything at this scale. They might try to cherry-pick a few seemingly easy targets, but they aren’t hiring armies of people who know how healthcare works to help them design a system that would actually function beyond offering sexy screens. You cannot build healthcare software with 23-year-olds sitting in a Silicon Valley and slinging rad code in between company-provided foosball and beer pong.

From Dignity Defined: “Re: Cerner. Do you you see them cutting back?” All vendors whose sales were goosed by Meaningful Use (note to self – that would be a fun song title) are already cutting back in various ways and will continue to do so. I asked the question publicly when Meaningful Use first came into play of how vendors who geared up for a competitive battle of a fixed duration would gracefully downsize once the feed trough had been licked dry. Nobody could look past the boom years. Hospitals and practices will continue to buy products that provide ROI (why wouldn’t they?) but now that government’s contribution to the equation has been eliminated, software and services will have to pay their own way, which will likely involve lower prices, more tangible short-term benefits, and recurring costs that align with the benefits delivered. Cerner, Epic, and Meditech have won the hospital core IT system wars and the independent ambulatory market seems to be consolidating pretty quickly, so the ripple effects will be seen every aspect of health IT, especially consulting. Cerner is particularly vulnerable because it is publicly traded and has underperformed despite winning billions in federal government business, so in the absence of a fiery, singularly-focused co-founder at the helm, it must now redirect its attention to Wall Street type (although it’s been doing that for years, just to a lesser degree). Note that Cerner Millennium and maybe Cerner itself would not exist today if Neal Patterson hadn’t told 1990s investors that it would take a lot of years and money to create a new hospital IT architecture and they would just have to suck it up until it was done.

From Pistolero: Re: clinical decision support to detect questionably beneficial orders. Why isn’t it more widely used?” I would say:

  • Some and maybe most doctors don’t necessarily think minimum-necessary when ordering – they think more along the lines of, it can’t hurt to get more information while we’re drawing blood anyway
  • But it can hurt – the descent into the medical misadventure maelstrom often starts with a pointless test whose value must be conformed to normal range by aggressive therapy that is unlikely to improve and may in fact worsen a patient’s outcomes as armies of uncoordinated niche experts ply their trade aggressively
  • Doctors are trained around the paradigm of every patient being unique, and given that they see only their own small number of patients, they don’t always see the big health picture in which their patient is one data point in a see of historical information that, along with the N-of-one experience, will determine likely outcomes
  • Even questionably beneficial orders are profitable as long as insurers continue paying for them

HIStalk Announcements and Requests

I use AP Stylebook standards about 99% of the time when writing HIStalk (big exceptions – I always use an Oxford comma and I use post office state abbreviations, in both cases feeling as though AP is way off base in mandating a less-readable form). You probably didn’t notice that I started writing “99%” this week instead of “99 percent” because they just changed their standard. Today I learned from them that “farther” refers to physical distance, while “further” is an extension of time, so now I can obsess about that. Thank goodness they don’t use “everyday” incorrectly (as “I brush my teeth everyday,” which drives me crazy) or incorrectly capitalize a noun that isn’t used as a title (“I sent my Mom a present,” which is wrong). I admit that I’m sadly out of touch in believing that you show respect to those who listen or read what you have to say by following the grammatical rules of the road as best you can, although I’m offended only by obvious indifference usually encouraged by text messaging and posting Facebook nonsense.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

Interoperability platform vendor Bridge Connector raises $10 million, increasing its total to $20 million.

HM Health Solutions, a 3,200-employee insurance-focused IT vendor owned by Pennsylvania-based insurer Highmark, lays off 239 employees. 

London-based Medbelle raises $7 million to create what it calls a “digital hospital” that sounds more like an online marketplace for cosmetic and weight loss surgery practices that also includes a care coordination platform.


Sales

  • Jefferson Health chooses Prepared Health as its digital technology partner for connecting its 14 hospitals to post-acute, home care, and social determinants of health providers for coordination of hospital-to-home care transitions.
  • Fullerton Health, which owns 500 medical facilities in the Asia Pacific region, hires Health Catalyst to assess its data analytics potential. 

People

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Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.

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Change Healthcare promotes Dan Mowery to VP of channel partner and customer marketing.


Announcements and Implementations

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PMD adds video chat capability to PMD Secure Messaging application, extending support for telehealth charge codes for interprofessional teleconsults and virtual check-ins.

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InterSystems adds HealthShare Provider Directory to the 2019.1 release of HealthShare, providing a single source of truth for provider demographics and relationships. The release also includes a renaming of HealthShare Information Exchange to HealthShare Unified Care Record.

NPR observes that rural areas whose local hospital closes take an economic hit — retirees move out or look elsewhere, heavy industry bails because there’s no ED, and medical practices close because doctors don’t want to drive 30 minutes to see their hospitalized patients.

Meditech announces Expanse Labor and Delivery, which includes status boards, mother-baby recall, flowsheets, and fetal monitoring integration.

A Solutionreach survey of healthcare providers finds that patient relationship software that includes text messaging improves outcomes through reminders, reduces no-shows, and decreases phone time while increasing revenue.


Government and Politics

Vermont politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage. Only in maple syrup-producing areas (Vermont contributes half the US total) would a politician describe the maturation of a policy “as it sugars off.”

The VA issues a $1.5 million, no-bid contract to Minburn Technology Group for HPE Synergy server modules and frames that will be used to convert 131 instances of VistA data to Cerner.


Privacy and Security

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India-based IT outsourcing giant Wipro admits that its systems have been breached in a phishing campaign, with hackers using the company’s own systems to attack its customers. Wipro, which sells cybersecurity services, has hired another firm to investigate. Wipro has 170,000 employees and annual revenue of $8 billion.

Facebook actively planned to provide user data to companies willing to buy it or to advertise with Facebook while denying the data to companies that it saw as competitive, all while putting on a public face of protecting user data, an NBC News investigative report finds. Reporters found few examples where Facebook executives expressed any interest in user privacy except as a PR strategy or in profitably selling data access to app vendors.


Other

The DC business paper confirms Dudevorce’s reader rumor that I ran Monday – Inova Health System will stop offering its MediMap genetic testing for medication response after FDA warns it that the test is being marketing illegally. Inova says it was told it by someone unstated that didn’t need FDA’s approval, but FDA made it clear that patients were potentially being put at risk because the unproven tests could lead to bad medical decisions. 

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Clinicians at Bagram Airfield, Afghanistan are trialing a trauma digital documentation system from T6 Health Systems, which the company says can integrate with Epic, Cerner, Meditech, and Allscripts. USAF trauma surgeon Lt. Col.Valerie Sams, MD  of the 455th Expeditionary Medical Group (on the right above) is leading the trial.

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Zuckerberg San Francisco General Hospital changes its billing policy to eliminate balance billing and to set an income-adjusted maximum on patient payments, courtesy of some fine investigative reporting by Sarah Kliff at Vox. Let’s give her the credit instead of the hospital – until the expose ran, they were perfectly happy picking the pockets of patients by intentionally remaining out of network with EVERY private insurer so they could tap ED patients – many of whom didn’t have a choice because it’s San Francisco’s only a trauma center – with high bills that were quickly sent to collectors. One might reasonably expect that hospital heads should roll for creating and enforcing this policy in the first place, but that won’t happen. The hospital recently toyed with the idea of ditching the Zuckerberg part of its name (bought with a $75 million donation) over Facebook privacy shame, but at this point they’ve soiled their own name worse than Facebook.

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Internist and health polity researcher Dhruv Khullar, MD, MPP writes a brilliant Stat editorial titled “Healthcare needs less #innovation,” making these points:

  • The US healthcare system can’t even provide basic care safely and consistently, performing worse than almost all peer nations.
  • As others have suggested, we need more “chief imitation officers” who bring home best practices from elsewhere rather than chief innovation officers.
  • We have “a dissemination and implementation problem” in failing to consistently use medical developments for an average of 17 years after they have been proven.
  • It’s nice to be in a swanky single hospital room hooked up to monitoring and Alexa-powered nurse call systems, but even nicer to know you won’t die of a catheter infection because someone failed to follow a checklist or use antiseptics improperly.
  • Today’s culture favors using the latest shiny technical object as a solution instead of addressing problems the best way.
  • Today’s tech startups follow the Theranos model of making grand claims while studiously avoiding publishing peer-reviewed studies.

A randomized clinical trial finds no evidence that workplace wellness programs work, as a large US company’s employees who participated said they they exercised more and watched their weight, but data analysis found no measurable improvement in their health, their healthcare expenditures, or their employment outcomes in the following 18 months.

In England, NHS Director of Digital Development Sam Shah says that hot technologies from other industries such as AI, virtual reality, and quantum computing should be placed on healthcare’s back burner in favor of building the less-exciting but vital underpinnings that can give consumers easier access, incorporate technology into care delivery, and to integrate data across IT systems and hospitals.

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An India-based paper says that the number of India-based doctors serving as scribes for US hospitals is growing quickly, noting that US-based, $6 billion IKS Health employs 450 doctors in Mumbai and Hyderabad to support customers such as Massachusetts General Hospital and plans to increase doctor headcount to more than 1,000 this year. One doctor says it’s a good deal for young doctors who not only earn money, but prepare to advance their careers by learning medical best practices and documenting care in sophisticated EHRs.

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InstaMed publishes its ninth annual report on healthcare payment trends, noting:

  • 90% of providers still bill and collect using manual, paper-based processes
  • 77% of providers say they rarely get payments within the first month of billing
  • 91% of providers get paid by paper check by at least one payer even though almost all of them would rather have money sent by EFT

Sponsor Updates

  • Mumms Software adds DrFirst’s e-prescribing and medication management capabilities to its hospice EHR.
  • CarePort will exhibit at the NAACOS Spring Conference April 24-26 in Baltimore.
  • The Texas Hospital Association features Collective Medical in its latest podcast.
  • CoverMyMeds will host a block party instead of a groundbreaking as construction starts on its $240 million headquarters.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Monday Morning Update 4/15/19

April 14, 2019 News 2 Comments

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A private company in China is deploying medical vans to rural areas to perform exams and to test urine and blood, but it’s not a benevolent government project. Private healthcare company WeDoctor (part of technology giant Tencent) offers the service so it can collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Participation isn’t optional since the government requires villagers to submit to examination. They don’t necessarily know that a private company is involved.

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WeDoctor, whose valuation is several billion dollars, operates online hospitals, sells data to drug companies, and offers appointment scheduling and video visits. It is connected to 2,700 hospitals, 220,000 doctors, 15,000 pharmacies, and 27 million active users. The founder saw an opportunity to disrupt a clogged medical system in which patients wait in line for hours just to schedule an appointment or resort to buying timeslots from scalpers.

WeDoctor says it has the healthcare information of 180 million people, and while China has no laws that protect personal information, the company says it uses only de-identified patient data for its AI work.

China is gaining an edge in healthcare AI because government control allows collecting and using patient data in ways that would not be legal in most countries.


Reader Comments

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From Unilateral Disarmament: “Re: Cerner. The financial community is expressing amazement that Cerner paid so much attention to Starboard Value given the hedge fund’s low percentage ownership.” Quite a few experts are shocked that Cerner gave the Starboard Value hedge fund two seats on its board when it holds barely more than 1% of CERN shares. As one analyst said, 1% doesn’t give you much power to force change – just sell your shares if you don’t like the company’s operation, adding that two board seats usually comes only with a 5-10% position. Cerner rationalizes by saying it approved the new board members and they are well qualified (which they are), but the company did indeed capitulate quickly. They may regret that later now that they’ve invited a hedge fund into their house. Cerner also made it clear that they intentionally replaced visionary co-founder Neal Patterson (who, when healthy, would have told Starboard where to stick their ideas) with an “operator” in Brent Shafer, which sounds like a message that resonates better with a hedge fund than customers. He is an untested CEO and the whole “operational model” thing he keeps talking about sounds like something dreamed up by accountants rather than leaders, which if you are pandering to Wall Street, is probably the right thing to do. Maybe I’m just bitter in missing the competitive healthcare passion among pre-operator founders Neal, Judy, and Jonathan Bush.

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From Dudevorce: “Re: Inova Genomics. FDA warned them about illegally marketing their tests and predicting response to medications. Their MediMap web pages went down shortly afterward. Oncologist Donald “Skip” Trump, MD was hired by Inova to develop a cancer genomics program as the Inova Schar Cancer Institute. He recently disappeared from the Inova websites.” FDA issued a warning letter to Inova Genomics Laboratory on April 4, saying that its MediMap genetic tests for predicting medication response has not earned FDA’s marketing approval, also noting that the tests were being ordered by lab doctors with the results sent directly to patients without involving their own doctor. Links to the MediMap web pages now forward to Inova’s main site (I took the screen grab above from a cached copy). That other Donald Trump no longer appears under Inova’s “find a doctor” page.


HIStalk Announcements and Requests

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Most vendor poll respondents have seen business conditions slip in the past couple of years, whether than means reduced sales activity, provider consolidation that leads to bigger but rarer deals, or longer sales cycles.

New poll to your right or here: How much time do you spend each week reading healthcare and health IT news, online or in print, excluding social media but including peer-reviewed journals?

Listening: new from Darlingside, extremely likeable, Boston-based indie folkies who huddle around a single microphone and create amazing harmonies around thoughtful lyrics that sometimes involve a dystopian future of uncertain outcome. Perhaps I was just in the mood for it after spending extra time in bed Sunday morning reading old Rolling Stone interviews with John Lennon. You might picture him as having been bitter, cynical, and slightly wacky with regard to Yoko Ono, but only the last one is true – he was a troubled troubador who lacked confidence about his musicianship and just wanted to play 1950s American rock and roll as a guitarist who was “not technically good;” saw the Beatles through the lens of always being pressured to write songs even as he and Paul McCartney fought for album space and collaborated less and less over time; and worried about where the world was heading. It’s hard to believe how thoughtful, worldly, and searingly honest he came across even in early interviews in his 20s. You can feel his pain in this 1970 interview when he declared that the Beatles were the best rockers in Britain until Brian Epstein put them into matching suits and booked them for 20-minute shows instead of their usual 6-7 hours: “The Beatles music died then, as musicians. That’s why we never improved as musicians. We killed ourselves then to make it and that was the end of it. George and I are more inclined to say that. We always missed the club dates because that’s when we were playing music, and then later on, we became technically efficient recording artists – which was another thing – because we were competent people, and whatever media you put us in, we can produce something worthwhile.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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The Detroit business paper profiles Detroit Medical Informatics, an EHR consulting firm started in 2015 by Hass Saad, MD. He says the company is generating $4-6 million in annual revenue, has four full-time employees, and works with 300 physician consultants in serving 20 clients.

A Stat editorial compares the proposed information-sharing rules of ONC/HHS to the Protestant Reformation, where information previously accessible only to priests was made available to everyone via the newly invented printing press, but notes that the final rule could be diluted through the influence of the AHA and lobbyists who are not fans of losing Medicare money when caught hoarding patient information out of competitive spite.

It’s interesting when member organizations change their names or membership criteria to spur growth outside their original mission, such as CHIME when it weakened its membership criteria to include non-CIOs. The latest is AONE (American Organization of Nursing Executives), which in realizing that the “executives” part of its name limits its membership count, has thus decided to rename itself American Organization for Nursing Leadership. The doors have been flung open to dues-payers who are “not just defined by your title, but above all by your actions.” Someone should do a study on how much hospitals spend on dues and conference attendance whose value is primarily driven by vanity.


Decisions

  • Humboldt General Hospital (NV) will replace Medhost with Cerner in November 2019.
  • Kingman Regional Medical Center (AZ) will implement Meditech this spring, replacing Cerner.
  • Van Wert Health (OH) switched from Cerner to Epic in June 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


Other

Imprivata explains further the Windows API flaw it commendably discovered in testing its product against new Windows updates (and which Microsoft not-so-commendably broke with a failing API with no acknowledgment to developers who rely on it). I agree that the QE team deserves acknowledgement – I’ve been loaned out to testing teams over the years and it is thankless, unbelievably complex work where 99% of the tests turn up no problems, but some weird example fails only in a particular series of steps that must be replicated and documented for fixing. Those testing teams I worked on also got no love from developers, who were more exasperated than appreciative that their bugs were caught before code was shipped, so it’s nice that Imprivata gives those folks a shout-out:

Imprivata’s core Epic user switch functionality continues to work as intended with or without the Windows API. Instead, the feature that was affected by the API deprecation was a failsafe mechanism and not core functionality. For this to be seen at a customer site, a series of unfortunate events would need to occur, and we would define it as more of an edge case. However, due to the potential it has on our customer’s clinical workflows, we felt it important enough to notify our base as soon as we discovered it. Kudos to our QE team for finding this during our qualifications!

Researchers find that cancer surgery outcomes are poorer in affiliates of top-ranked cancer hospitals that share their name. The authors conclude that hanging the big-brand cancer center’s name on the affiliate makes patients think they will receive care as good as that delivered by the mother ship, but that doesn’t actually happen. To me, the fact that a cancer hospital is a desirable brand is a troubling in itself – having worked for a hospital that affiliated with one of the big names, we talked a lot about sharing protocols and tapping the Big Cancer Center’s expertise, but I’m not sure it really made a positive difference. The health system eventually dumped the affiliation for that of another Big Cancer Hospital, which should have raised all kinds of questions about the before-and-after advantages, the cost to rent the big name, and whether patient outcomes changed as a result.


Sponsor Updates

  • Netsmart will exhibit at the NHPCO Leadership and Advocacy Conference April 15-17 in Washington, DC.
  • Sansoro Health releases a new podcast, “Tacking Information Blocking with an ONC Expert.”
  • Surescripts will exhibit at the 2019 OCHIN Learning Forum April 16-18 in Portland.
  • Vocera will exhibit at the 2019 Argentum Senior Living Executive Conference & Expo April 15 in San Antonio.
  • Wolters Kluwer Health CEO Diana Nole discusses areas where AI will impact future patient care.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 4/12/19

April 11, 2019 News 3 Comments

Top News

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Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

The New York City-based company was spun out of Alphabet’s Sidewalk Labs in 2017.

The company offers care coordination services and technology that cater to Medicaid patients in underserved areas.


Reader Comments

From Ralestorm: “Re: Windows APIs. Check out this problem, in which a sign-off Epic user’s session is restored when a different user logs in afterward. I’ve seen this with other systems and vendors as a CMIO over the years.” This is a timely reminder that APIs create dependencies that can screw things up. Imprivata found out from internal testing that a Microsoft Windows 10 API is no longer working, so that when users switch within a XenApp session, the new user will be dropped back into the previous user’s session. The interesting aspects are these:

  • Microsoft has never told software developers who use the API that it is no longer working or why it’s broken. It has not been officially deprecated, but reports are widespread that it fails.
  • Imprivata caught the problem in its Windows 10 testing, which a lot of vendors might not have done.
  • The problem is technical, but the result could be clinical – users could sign on and inadvertently start entering orders on the wrong patient.
  • Imprivata has modified its OneSign agent to use a new Windows API and will post a hotfix before qualifying Windows 10 1809, a nifty bit of release coordination.
  • Microsoft is touting its new commitment to healthcare, and while this is not a healthcare-specific issue, it might make you wonder whether it really understands the critical nature of its internal APIs and has the communications channel in place to work with vendors who rely on them.
  • As quaint as it seems today as everybody pins interoperability hopes on APIs, this is the problem that healthcare software vendors avoided years ago by refusing to use third-party software components published by companies whose conduct and business outcomes were outside of their control. 

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From Jiggy Jardust: “Re: Cerner. Will it follow the path of Athenahealth now that an activist investor is embedded?” Maybe. My thoughts:

  • Cerner’s share price has been going in the wrong direction for quite some time, even now down considerably since before it signed huge contracts with the DoD and VA. Clearly the company wasn’t impressing investors.
  • The hedge fund activist investor Starboard Value wasn’t as venomous as the one involved with Athenahealth’s – which used some truly deplorable smear tactics to get Jonathan Bush fired so that the reputation-faded Jeff Immelt could broker a questionable deal to sell out – and Cerner was unusually pliable about agreeing to making changes even before the hedge fund had a chance to go low. Starboard wasn’t even a significant holder of CERN shares.
  • Brent Shafer had already laid out Cerner changes, but whether he will survive in his first CEO job reporting to an activist-heavy company board of nearly all new members is anyone’s guess.
  • Whether you like Cerner’s changes may well depend on whether you are an investor or a customer. The recent announcements seem to shift focus to the former, who like the idea of the latter covering the cost of higher company revenue and profit, and Starboard’s track record of making money from activist investing is outstanding. Customers, however, aren’t necessarily going to be big fans of plans to boost profits by cutting costs and increasing revenue.
  • Today’s Cerner is vastly different from the one that Neal Patterson was running until he died in mid-2017. The contrast between the publicly traded Cerner and its chief rival in privately held Epic was already sharp, but even more so now that Cerner is seeking fresh horizons and has involved hardcore Wall Street types for whom it’s just another investment to milk hard.

From Clinical Trials Curious: “Re: software to manage clinical trials. A researcher from a large academic medical center is surprised that we don’t have a platform for managing our clinical trials. We’re a medium-sized health system using an EHR, but manage trials outside it. Are people using specific software?” I’ll invite readers from similar organizations to respond. If you work for a clinical trials management software vendor that has community health system customers, I’ll waive my rule and allow you to give your company‘s information in your comment.

From CIO a NO GO: “Re: MD Anderson. Reportedly offered a candidate the CIO role after a long search with many fits and starts. The ‘recruit’ insisted on tenure status and that stopped the process. They are in desperate need of direction after the Epic Rollout Blowup but it doesn’t appear that they will budge or that anyone will jump into the deep end without a life jacket.” Unverified. I haven’t followed that position since Chris Belmont left in August 2017. The organization struggled with post-Epic financial problems (since resolved, apparently), a high-profile failure to make IBM Watson Health do anything useful, and the resignation of its president following investigation of institutional upheaval and a heavy-handed management style. The new president comes from Canada, so I don’t know how much relevant IT background he brings, especially regarding Epic.


HIStalk Announcements and Requests

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Provider IT people — here’s a final chance to explain to outsiders who think we drag our feet on implementing disruptive technologies. I’ll recap soon.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap. Healthcare Growth Partners advised ChartSwap on the transaction. Ontellus President Newton Ross will lead the new ChartSwap division, while Dawn Toups (Verisma Systems) will join the company as VP of provider sales.

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Glytec receives another patent allowance for systems and methods related to its Therapy Advisor. When released, the new product will broaden the company’s capabilities beyond insulin optimization to include inhaled, oral, and non-insulin injectable diabetes medications.


People

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Patient transfer software company Central Logic names Matt Dinger (Epic) VP of professional services.

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Government health IT vendor Ventech Solutions promotes Tonia Bleecher to chief growth officer and hires Timothy Moore (Auburn University) as SVP of commercial health IT and Nathan Anthony (IBM Watson Health) as VP of healthcare enterprise solutions.


Sales

  • In Canada, Mackenzie Health will deploy patient engagement software and services co-developed by GetWellNetwork and FlexITy at a new hospital set to open late next year.
  • Summit Health Management will deploy population health management technology from Arcadia across its physician practices and New Jersey-based Summit Medical Group.

Announcements and Implementations

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science. The center collaborated with the American College of Radiology and computing company Nvidia to develop a similar set of software and services that will be offered for free to radiologists around the country.

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Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse with consulting help from Engage.

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals. The hospital opened a telehealth command center several years ago.


Government and Politics

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AHRQ awards Northwell Health (NY) SVP Thomas G. McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.


Sponsor Updates

  • EClinicalWorks will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Ensocare will exhibit at the ACMA 2019 National Conference April 14-17 in Seattle.
  • EPSI extends early-bird pricing for its 2019 summit through April 30.
  • Modern Healthcare ranks Optimum Healthcare IT as #2 among the largest healthcare IT consulting firms.
  • Healthwise will exhibit at ANIA April 11-13 in Las Vegas.
  • Mobile Heartbeat releases a new video featuring its clinical communication and collaboration work with Freeman Health System.
  • PatientPing transforms care for high-risk, high-utilizing patients across North Carolina through its care coordination platform.
  • Vocera will add Julie Iskow (Medidata Solutions) and Bharat Sundaram (Vizient) to its board.
  • SyTrue names former HMS Holdings EVP/Chief Strategy Officer Cynthia Nustad to its advisory board.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Vendor Alternatives to Exhibiting at the HIMSS Conference

April 10, 2019 News 1 Comment

The HIMSS conference exhibitor roster turns over every year as a significant portion of companies either sign up for the first time or previous exhibitors decide not to return. I’ve heard from more of that latter group after HIMSS19 who are questioning the return on investment, which for most of them means generating sales leads.

Most vendors have no plans to stop exhibiting. Some are happy with the value they receive in having a lot of people they need to see who are in a single place at a single time. Others worry that their absence will be exploited by competitors as a sign of weakness or that customers will question their commitment. The exhibit hall is likely safe from mass defection, especially for long-established and large vendor players.

However, small and medium-sized vendors who rack up significant booth, travel, and staffing costs for just three frantic days may wonder if they should be spending the money elsewhere. That’s especially true as the industry has settled down into less of a land-grab mentality now that Meaningful Use money has been spent, major software decisions have been locked in at health system corporate levels, and health systems worry about margins as their core business faces unknown changes.

I asked vendor readers for ideas of how they might reallocate some or all of their HIMSS exhibition costs into efforts that would yield more tangible business results. Thanks to those who took the time to share their thoughts.


We don’t exhibit, but we send more than 10 people to HIMSS and get a meeting room instead. We set up meeting room appointments prior to the conference so we can use our time efficiently. We’ve gotten a lot out of this and plan to keep it up.


We use our budget to attend the shows where we already have a big client presence. We go as attendees, offering a dinner with our strategic client advisory board. We don’t get leads, but the partnerships lend to better product strategies and focus areas for the business. HIMSS isn’t a big lead generator for us, so the rest of the budget I would diversify into PR activities and a solid PR agency. We also do sponsored blog content and attend smaller conferences.


We go every year because we want our name on there and it’s an opportunity to meet with customers and partners. But we absolutely do not recover the cost of attendance in ROI. HIMSS is where vendors show off to each other, not where customers come away having made purchasing decisions.


We exhibited at one HIMSS conference 15 years ago as a startup selling a small departmental system and decided never again. Every year a few of us attend the show (we can always rustle up some guests-of-vendors badges), and we set ~20 meetings with current and potential partners. Every year we’re grateful we don’t exhibit. We’re still spending money attending the shows, so we’re not saving as much as we could be, but our expenses are less and we get good value out of the face-to-face meetings. We’ve never specifically allocated the funds we would have spent at HIMSS to other efforts, but the remainder has gone toward our general marketing budget.


We stopped exhibiting at HIMSS following the 2018 show. Even though we booked a booth for 2019 during the 2018 show, we forfeited our deposit because it was cheaper than following through and burning the hundreds of thousands we’d have to shell out to be present as we originally planned. Instead, we found smaller, more regional shows that offered more engagement with our specific target audience. We carried out some branding campaigns, spent more on content development and distribution, and sponsored some webinars that again allowed us to better target our outreach and drive the right people to our event.

We also invested in some technologies to help us connect with our target audience, including ZoomInfo and Definitive Healthcare. That way we could identify the accounts (health systems and hospitals) we wanted to contact and find out exactly who the people were who should be our target buyers. A quarter of a million to half a million dollars can go a long way when you spread it out to different activities and you identify those that will support your marketing and sales efforts. And we’re just a former 20×20 vendor. Think about the major players and all the floor space and investment they burn.


We will continue to exhibit, but an alternative would be to do a roadshow. We would evaluate which cities would be the best locations for existing and targeted prospects. Select an event marketing team to pick venues. Then use the money for team, rent venues, catering, AV, travel, swag, etc. A key component would be to pay to have featured customers and internal team members travel to and speak at event.


An alternative to paying for a large booth is to simply downsize and pay for a 10×20 or even a 10×10 booth. Your company will save a ton on expenses and will benefit from reduced staffing and reduced equipment, etc. But you still maintain a listing in the HIMSS guide so that customers and partners can find you. This will also force you to choose the most impactful people that need to attend and forces a decision on what products you really need to showcase. Sort of like downsizing when you move — it forces some tough decisions.


We stopped three years ago. We spent about $300,000 on a booth, had 90 leads (most were students) and only 12 actual decision makers. Twelve leads for $300,000 is a bad investment. Now we hold an industry breakfast and it has been a great event – CIOs, CTOs, and CMIOs only. We had 30-40 people for about $20,000, a much better investment. The attendees are the ones driving this and frankly we’ll spend our dollars elsewhere. This convention has become nothing but a money grab for HIMSS and the value is long gone.


I would invest those resources in organic PR, meaning I would take the time and effort to document client success stories, translate them to meaningful, educational information to prospects, and pitch that content to trade press, national media, etc. (not sponsored content). I would also consider investing in good, well-produced, reusable video content.


As a small company, we stopped having a physical booth at HIMSS a few years ago for many of the reasons you described — cost, being lost in caverns and hinterlands of the exhibit hall, very few real leads, etc. We still have what we believe is a strong presence for our size by doing other things — working with partner companies in their booths, leveraging healthcare ecosystem areas like the Intelligent Health Pavilion, and partnering with our customers to have educational sessions on the agenda. We also promote our attendance at HIMSS before the conference with customers and on our website / social media so we can make sure to connect with those who we need to see during the show. A few weeks prior, we do a press release about the various ways we will be participating at HIMSS, and during the show we are posting / tweeting “Live from HIMSS”. I guess you could say we have virtualized our booth for HIMSS!


Register as a participant, attend be at all the social events and relevant educational sessions, keep the elevator speech short (2-3 sentences), arrange for a Wednesday or Thursday evening offsite event that can be promoted over the week. Don’t try to cram so much in up front. Create some mystery and intrigue. Useful or unique bling (or chocolate) may help.


This actually occurred at my last company. We opted to host an event at HIMSS, a one-night, blowout event that was half the cost of the booth for the week. We spent months prospecting and getting folks to the event, while setting up meetings outside of the exhibit area (restaurants, hospitality suite, etc.) for 1:1 meetings. This works much better in Las Vegas than it does Orlando.


Is HIMSS a huge financial commitment? It sure is. And if all you’re going to measure is lead generation, then it won’t be worth it. The cost per qualified lead at HIMSS in my experience is north of $10K or even $15K. And clearly there are cheaper ways to get to leads if that is your only measure of success.

But HIMSS is also a place to get stuff done. Strategic partnerships, briefings with current and potential partners, window shopping for possible M&A, early look at emerging trends and competitor positioning, and … gasp … customer engagement (which shouldn’t be confused with lead generation.) A well-planned and executed HIMSS with proper organizational support yields far more benefits than simple leads.

Having said all that, if HIMSS were to disappear as an expo, I would not be all that disappointed. It’s become more of a place to be seen. The nuclear arms race of HIT marketing, if you will. Unfortunately denuclearization only works if everyone disarms. And we know that won’t happen. So we make the most of it with planning and outreach months in advance.

Finally let’s not forget the HIMSS points system. If you have years spent supporting HIMSS, pulling out for even one year knocks you back to zero. And suddenly you’re at the back of the bus in terms of booth selection, making it an even harder ROI to justify.


Have a party right across the street with free alcohol and food. Has that been done before?


Invest in breakfast briefings and lunch and learns as a way to drive targeted executives interested in your solutions and offerings.


As a provider, I don’t care if vendors exhibit, especially if I’m told in advance the reason for not having an actual booth. Having some company representation at the conference to meet with, even if not at a booth, is generally sufficient for my needs.


Exhibit at AHIMA and select state HIMA conferences.


No customers come to HIMSS,  just other vendors. I would rather invite customers and prospects to a smaller, more intimate event and invest in interesting thought leadership or education for that base. For example, physician roundtables with an industry thought leader.


Work with Becker’s and CHIME more closely.


Drive a subject matter interest thought leadership 1.5 day summit for 50 persons


News 4/10/19

April 9, 2019 News 5 Comments

Top News

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Cerner bows to pressure applied by an activist investor — and perhaps as a result of its own self-examination led by Chairman and CEO Brent Shafer, who was hired in January 2018 — by appointing four new board members. Hedge fund operator Starboard Value owns 1.2% of outstanding CERN shares.

Starboard was less adversarial in this case than with previous targets, steering clear of public criticism of the company and not delving into operating minutiae with a public call for changes.

In a previous example, Starboard took control of Darden Restaurants despite owning just 10% of the company by observing that its Olive Garden restaurants are too generous with breadsticks, use non-standard sized drink straws, and over-salt the pasta. Starboard managed to get every member of Darden’s well-qualified board replaced in October 2014, since which DRI shares have since risen 169% vs. the Dow’s 60%.

The new, well-credentialed Cerner directors — former top executives of Hill-Rom Holdings, MedAssets, Jawbone, and Cloudmark, two of them nominated by Cerner and two by Starboard – now represent 40 percent of the board. Another board member will be retiring.

Chairman and CEO Brent Shafer stated previously and reiterated today that the company has identified opportunities to “unlock the company’s significant potential” in creating a new operating model and will focus on improving profits and efficiency along with ramping up innovation. He says Cerner has:

  • Replaced the president position with chief client officer
  • Eliminated the strategic business unit structure
  • Reviewed its product portfolio to maximize development resources
  • Centralized operational functions that were previously spread across multiple executives who reported to the COO
  • Announced plans to pay share dividends, repurchase more shares, and add free cash flow generation as an executive bonus metric
  • Expanded margins

Starboard Value was a significant shareholder and an activist investor in MedAssets a few years back. It also triggered the sale of physician services vendor Envision Healthcare to a private equity firm last year.

CERN shares were up 10% at Tuesday’s market close. They’re up 17% over the past five years vs. the Nasdaq’s 93% rise.

Perhaps I missed it, but I wasn’t aware that Cerner was being pressured by Starboard, although in this case the relationship seems more collaborative than Starboard’s history would suggest and Shafer had already implemented changes to reposition the company in ways that Starboard would likely have found aligned with its own areas of focus.


Reader Comments

From Mark: “Re: HealthVault. Why can’t a company that’s worth $700 billion leave something running for probably $10,000 per year? They probably spend that on fancy coffee for management alone.” This is probably good news for Apple and other Microsoft technical competitors since MSFT tends to turn tail and run at spectacularly mistimed points after burning through a ton of cash and partner / customer goodwill with little to show for it as competitors find a way to sell their own versions of the same technology. This is the company that couldn’t figure out how to find success in offering a smartphone (Lumia and Windows Phone), a music player (Zune), a streaming service (Groove), a fitness tracker (Band), a browser (IE/Edge), a search engine (Bing), a smart speaker (Cortana), a tablet (Surface RT), a sophisticated movement tracker (Kinect), and now a personal health record even as Apple gets accolades for its own product and the government begins a hard push on giving patients their data. I’m being nice in not mentioning Microsoft’s healthcare-specific fumbling with Sentilion single sign-on and Azyxxi / Amalga / Caradigm. Keep that history in mind as the company starts playing the soothe-the-cobra music in trying to convince healthcare that this time, in the face of entrenched cloud competition from Google and Amazon, it’s serious about healthcare interoperability and AI.

From Spinal Screw: “Re: HIStalk. I find it hard to believe that anyone has time to read it all.” Not everyone does, but somehow quite a few folks – many of them running big provider and vendor organizations and some of them likely outcompeting you – invest the time in their success. I’m editorially selective and good at summarizing, but even I can’t tell you everything you need to know in a 30-second phone read in the coffee line or on the toilet and you may or may not be good at skipping stuff that you don’t think applies to you. I have no incentive to pad it out with fluff or verbosity. You might be in the wrong business or need a productivity makeover if you don’t have 5-10 minutes per day to follow your field.


HIStalk Announcements and Requests

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A reader commented that opinions expressed on HIStalk – both mine and those of readers – “reek heavily of cynicism of status-quo-ism” in always being skeptical of potentially disruptive developments (such as AI, EHRs, digital health, etc.) without offering alternative solutions, all because we’re protecting our hospital paychecks. This tension between would-be disruptors and those who keep the IT lights on today is important – we’re always going to be defending ourselves to impatient, often naive disruptors whose technology hammer is desperately seeking a healthcare nail to pound as we try to maintain a responsible, enterprise-driven approach. Here’s your chance to respond, perhaps considering these issues in your comments on the survey form I created. I’ll recap our collective thoughts in a few days.

  • Are provider health IT people really averse to investigating and using disruptive technologies or are we just jaded by a long list of previous failures?
  • What are the outsiders missing about what makes healthcare different?
  • What is the potential of technology-powered disruption in a mostly non-profit healthcare system that is heavily regulated and full of entrenched stakeholders ranging from hospitals to insurers to drug and device companies?

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Welcome to new HIStalk Platinum Sponsor Relatient. The Franklin, TN-based company offers a patient-centered approach to patient engagement that recognizes that “it’s not just a phone, it’s healthcare’s digital front door.” Solutions include appointment reminders and rescheduling, on-demand outreach for events such as weather delays, patient self-scheduling and waitlisting, satisfaction surveys, AR balance messaging, MDpay balance collection, and health campaign management (recalls, education, portal promotion). The service requires no app, no portal, and no password (since the service validates directly to the phone) and communicates with patients via their preferred channel (phone, email, or text messaging, the latter preferred by a startling 98% of patients vs. the basically zero who like patient portals). Patients are engaged as comfortably as they would be with friends and families, using behavioral science to meet their wants and needs without having a clumsy app inserting itself. An Epic-using pediatric hospital dropped its clinic no-show rate by 27 percent within six weeks, while a FQHC uses it to help meet the needs of diabetic patients with transportation problems. It’s integrated with a long list of systems that include those of Epic, Cerner, Allscripts, Meditech, EClinicalWorks, and Athenahealth. Thanks to Relatient for supporting HIStalk.

Listening: King Crimson, purely because the reclusive and formerly retired Robert Fripp — the only consistent band member as its 72-year-old guitar player — just did an amazing press conference for the band’s 50th birthday as reported by Rolling Stone. It’s a delightful, wry look at the challenges and rewards of playing in a band whose membership is constantly evolving (Fripp loves blowing it up and starting over to stir his creative juices) and whose epic progressive music plays great live even though each musician must count different time signatures in their heads in front of thousands of audience members in playing songs recorded decades ago by someone else. Their tour goes out in June and has some US dates. Certainly many (including me) enjoy the take-no-prisoners “21st Century Schizoid Man” (original vocals by ELP’s Greg Lake) or the mostly improvised “Asbury Park,” but my favorite will always be “Starless.” How cool it must be to bemusedly explain to your grandchildren that time in 1969 when, as an impossibly young man of 23, Grandpa was rocking half a million people at England’s Hyde Park weeks before Woodstock and the moon landing, and now he’s about to hit the road again.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

Morgan Stanley predicts that Apple’s healthcare opportunity is $15 to $313 billion in annual revenue within the next eight years, with analysts speculating (with little evidence to back it up) that the company could roll out medical-grade wearables within AirPods, integrate sensor-powered apps into the Watch, get insurers to pay for the Watch, or buy healthcare companies. The prediction seems laughable given its assumption that the company’s 2027 healthcare revenue could exceed today’s total revenue even as Apple scrambles to defend its mature market position. People keep trying to make excuses for Apple’s unpleasant slide into middle-aged corporate mediocrity and often predict healthcare as its savior based on one-off ideas like Apple Health Records and the Watch EKG that are interesting to consumers but don’t have any kind of monetization path (Rule #1 in healthcare – patients do not pay. Rule #2 – neither do doctors.)

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Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

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DocuTAP and Practice Velocity announce that their merged companies will be branded as Experity.


Sales

  • Acuity Healthcare, which owns three long-term acute-care hospitals, chooses HCS Interactant as its enterprise health IT platform. 
  • AdventHealth will implement Par80’s referral management system.
  • McKesson chooses Google Cloud as its preferred cloud provider for infrastructure, platforms, applications, and analytics.
  • Australia’s NSW Health signs a 13-year contract with Sectra for enterprise radiology imaging for its 11 Local Health Districts.
  • Signature Healthcare will implement Meditech Expanse.

People

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OptimizeRx hires Denys Ashby (CaptureRx) as VP of hospital and health systems.

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Jeff Fallon (Oneview Healthcare) joins patient experience technology vendor EVideon as CEO.


Announcements and Implementations

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Google Cloud opens its healthcare API for beta testing, offering an interoperability engine that supports FHIR,  HL7v2, DICOM, patient de-identification, and machine learning.

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Microsoft will shut down its HealthVault service on November 20, 2019. The notice – sent via email to registered users — expands the company’s January 2018 warning that it would retire HealthVault Insights and its December 27, 2018 announcement that Direct messaging would no longer be supported. Now the whole thing has been scrapped.

Fortified Health Security publishes its 2019 Horizon Report on the cybersecurity risks of connected medical devices.

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Montefiore St. Luke’s Cornwall Hospital goes live on Artifact Health’s physician query solution to expedite accurate coding just four weeks after the project began.

Saratoga Hospital goes live on integration of B. Braun Medical’s smart IV pumps with Meditech Magic as delivered by Iatric Systems.

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DirectTrust earns ANSI accreditation to develop interoperability and identity standards and invites industry stakeholders to participate.

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Recondo Technology announces record bookings and growth in Q1.


Government and Politics

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A jury finds a South Florida nursing home operator guilty of defrauding Medicare and Medicaid of nearly $1 billion via fraudulent billing. The best part of the story is this – he used part of the $37 million he pocketed to bribe a Penn basketball coach to get his son admitted into the Ivy League university. Former Penn basketball coach Jerome Allen, who has pleaded guilty to money laundering in connection with the incident, admits that he accepted $300,000 in bribes to get the son — Morris Esformes — admitted to the Wharton School, after which he never played a single second of Penn hoops. The son’s LinkedIn says he last worked as a summer analyst for merchant bank The Raine Group. Somehow I expected that – state-school guys like me who spent our summers sweating doing dirty, low-paid work outdoors (in my case, coal mines) always knew people with better-connected parents who got them clean, connection-creating jobs working as caddies or perhaps merchant banking. One guy I knew donated his daughter’s way into dental hygiene school (“I’ll buy the damned place if I have to,” he told everyone who would listen, which apparently included the admissions folks) and got his underachieving son into medical school despite the kid’s having been caught breaking into his undergrad college’s administration office to manually improve his grades.


Other

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In Australia, newly opened, 488-bed Northern Beaches Hospital delays its HIE project after it finds “unacceptable errors and omissions.” A sign that the grand opening wasn’t going well – the CEO quit the day after the ribbon-cutting ceremony.

Massachusetts Governor Charlie Baker, speaking at a Partners HealthCare innovation event, says he is skeptical of the promises of AI. He adds that healthcare is rightfully held to a higher standard than other industries and that patient privacy must not be compromised. Baker was the final decision-maker for AI projects in his previous roles in government and provider organizations and says AI was often less useful than its developers thought, it takes longer than expected to make it work, and the choice and formatting of input data complicates the issue.

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Ireland’s state data agency rules that people don’t have an absolute right to have their names spelled correctly, reviewing a TV producer’s complain that the fada (an accent or diacritic mark) in his name was omitted by University Hospital Galway because its software doesn’t support the special character.

Cigna’s PR people shrink from the glare of public spotlight as the insurer suddenly agrees to pay the out-of-network hospital ED bills of a woman’s two daughters who had attempted suicide – one by slashing, one by pills – by reversing its initial decision that neither event was life-threatening. The mother was relieved about the bill, but the story doesn’t provide any insight on what it’s like to have two daughters of unstated age who tried to kill themselves simultaneously.

Weird News Andy codes it as W61.42XA. A Detroit motorcyclist dies when one of several turkeys that were crossing the road take flight and hit him in the chest, causing him to lose control. WNA cautions, however, that we must escalate our coding work to keep up with the stupidity of people, providing as evidence this story in which a 10-year-old boy is critically injured after falling off the car driven by one of his parents as he “surfs” on the roof.


Sponsor Updates

  • Audacious Inquiry joins HL7 and IHE.
  • Spok announces its upcoming conference participation at AONE, the Healthcare IT Institute, and AMDIS PCC Symposium.
  • Impact Advisors is named as one of Modern Healthcare’s largest healthcare IT consulting firms.
  • Digital prescription savings company OptimizeRx announces integration with Cerner and Epic.
  • Aprima will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Audacious Inquiry joins Health Level Seven International and Integrating the Healthcare Enterprise as an organizational member.
  • CompuGroup Medical will exhibit at the Henry Schein National Sales Meeting April 11-13 in Denver.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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Monday Morning Update 4/8/19

April 7, 2019 News 13 Comments

Top News

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Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 


Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.


HIStalk Announcements and Requests

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Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). Click a logo for more information.

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Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.

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I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.


People

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Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.


Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.


Privacy and Security

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Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

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Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.


Other

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The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.

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A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 

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A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.


Sponsor Updates

  • MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
  • Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
  • NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
  • The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
  • PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
  • PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
  • Optimum Healthcare IT announces a refreshed brand identity.
  • Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
  • Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
  • TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
  • Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 4/5/19

April 4, 2019 News 5 Comments

Top News

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PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company. The personalized health network has raised $127 million in several venture rounds.

The Trump administration expanded the committee’s oversight last year as concerns heightened around national security and trade secrets, a move that caused Chinese investments in US companies to plunge from $46 billion to just under $5 billion over the last two years.


Reader Comments

From Sagebrush Sister: “Re: CIO vendor entertainment violations. Looking for examples, as my organization is hosting a Pebble Beach outing for key clients. They didn’t consider the healthcare folks and I’m trying to get them to add CEs, even if just for damage control.”

From John R. Public: “Re: America’s Health Insurance Plans whining. It’s funny that they are crying wolf after they’ve harassed providers forever for information while providing them with dated stacks of papers or confusing web pages that are not actionable.” AHIP says 2020 implementation of mandatory data sharing under CMS’s proposed interoperability rules is unrealistic given the effort required to comply with standards that aren’t yet defined.

From HIT OG: “Re: CareCloud. Laid off 40 employees yesterday via a conference call.” Unverified.


HIStalk Announcements and Requests

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Readers have sent some great alternatives to buying a big swath of HIMSS conference exhibit hall space, which I’ll run shortly, Meanwhile, your suggestions are welcome.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


People

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Spok names Timothy Tindle (Harris Health System) as CIO.

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Quil, the joint digital health venture of Comcast and Independence Health Group, names former Imprivata executive Carina Edwards as CEO.

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Ascend Innovations hires Marty Larson (Greater Dayton Area Hospital Association) as president and CEO.

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Michelle Blackmer (CareEvolution) joins Verato as VP of marketing.

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Jim Costanzo (Ernst & Young) will succeed Bruce Cerullo as Nordic’s CEO on July 1. Cerullo will become chairman of the board.

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Sonifi Health hires Cheryl Cruver (Aetna) as chief revenue officer.


Sales

  • The Heights Hospital will implement RCM and health IT software and services from MTBC when it opens in Houston later this year.

Announcements and Implementations

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UMass Memorial Health System will roll out video-based substance use disorder evaluation software at three of its EDs over the next three months. The technology, developed by four physicians from within its Memorial Medical Group, was the winning submission in the annual UMass Prize for Academic Collaboration and Excellence.

Innovaccer launches social determinants of health surveys that feed into its community resources referral program.

The Consumer Technology Association, organizer of CES, forms a working group with nearly 30 healthcare and tech companies to develop standards and best practices for AI in healthcare.

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Healthgrades develops a customer data platform to help providers better aggregate and manage health data and power CRM systems.

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ProMedica’s Coldwater Regional Hospital (MI) will go live on Epic next month. The Toledo, OH-based provider began a system-wide implementation in 2015.

InstaMed launches a blockchain-powered platform for payments.


Government and Politics

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The FTC wins a $50 million court judgment against Omics International, an India-based scientific research publishing company that has for years been accused of deceptive business practices. A judge in Nevada, where the company has a mailing address, has also ordered the company to stop misleading authors about the legitimacy of its publications, marketing conferences with unconfirmed speakers, and failing to disclose fees.

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Departing FDA Commissioner Scott Gottlieb, MD will return to the American Enterprise Institute to work on drug pricing. He joined the think tank as a resident fellow in 2002.


Privacy and Security

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Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills. Organizations participating in the invite-only, HIPAA-eligible program include Express Scripts, Cigna, Livongo, Boston Children’s Hospital, multi-state Providence St. Joseph Health, and Atrium Health (NC).


Other

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The New York Times highlights the popular trend of “restaurant-style” medicine offered by prescription-on-demand companies like Roman, Kick Health, and Nurx. Medical experts point out these startups give consumers the power to choose their drugs and then have their choices validated by a remote physician, a service that typically omits any type of counseling about potential side effects. Detractors warn that despite their buzzy marketing, convenience, and multimillion-dollar fundraising rounds, consumers should approach these services with caution. The big question I always have – why would a doctor agree to practice in this type of arrangement that violates just about everything in the Hippocratic Oath? (answer: easy work for $$$). It’s too bad that our culture sees prescribing as just a minor speedbump to getting what we think we should have, regardless whether it’s likely to be beneficial or safe.

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Bloomberg looks at the lengths hospital chain Narayana Health will need to go to in order to care for India’s poorest patients under the country’s new national health insurance plan. The company, which already offers assembly-style procedures at rock-bottom prices, was launched by cardiac surgeon Devi Shetty in 2000 with a $20 million loan from his father-in-law. Shetty has tapped his son to lead a software startup dedicated to analyzing and trimming costs from Narayana’s operations, which are already operating on razor-thin margins that, when all is said and done, result in outcomes equal to or better than those of US hospitals. Shetty says, “I would like in my lifetime for every citizen of this planet to get health care at a price they can afford to pay without having to beg or sell something.”

Meanwhile in the US, a West Health-Gallup survey finds that one in eight Americans borrowed a total of $88 billion last year to pay for healthcare services. Sixty-five million people deferred care altogether because of cost.

An outside review of Memorial Sloan Kettering Cancer Center finds that the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care. MSKCC’s relationship with AI startup Paige.AI was one of the issues that triggered the review, as reports noted that it shared pathology slides with the startup as some of MSKCC’s top executives were given lucrative participation arrangements.

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This is bizarre: People claiming to work for Passport Health Plan are showing up in an unmarked van around poor neighborhoods in Louisville, KY offering members $20 for DNA samples. Those who underwent a cheek swab were told they were being tested for cancer.

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This is how obituaries should be written, as the family of 63-year-old Iowan Tim “Lynyrd” Schrandt describes him in a way that makes you wonder how he interacted with his doctors and nurses. The big finish is this:

Tim led a good life and had a peaceful death, but the transition was a bitch. And for the record, he did not lose his battle with cancer. When he died, the cancer died, so technically it was a tie! He was ready to meet his Maker, we’re just not sure the Maker is ready to meet Tim. Good luck, God! We are considering establishing a GoFundMe account for G. Heileman Brewing Co., the brewers of Old Style beer, as we anticipate they are about to experience significant hardship as a result of the loss of Tim’s business. Keep them in your thoughts.


Sponsor Updates

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
Contact us.

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News 4/3/19

April 2, 2019 News 1 Comment

Top News

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Walgreens announces executive changes, store layout redesign, and cost-cutting measures following its announcement of disappointing quarterly results Tuesday.

WBA shares closed down 13 percent Tuesday after the company released results that fell short of expectations for both earnings and revenue. They’re down 12 percent on the year and up just 14 percent over the past five years vs. the Nasdaq’s 96 percent gain.

In yet another example of the “healthcare is big business that takes money from the ill” paradigm, the company’s US pharmacy operations delivered disappointing results because of a mild flu season and a de-emphasis of tobacco.

The company says it has created a new digital leadership team and embedded Microsoft within it.


Reader Comments

From Clarence Oveur: “Re: exhibiting at HIMSS. We’re questioning the value. Wondering if you are hearing that from other companies?” I’ve heard from a couple of folks who asked me what I thought about moving their multi-hundred thousands of dollars of exhibit hall expense into something that might generate actual leads (which for them, HIMSS19 did not, and I’ve heard that quite a bit). Most of those who have toyed with that idea in past years got scared into paying up over fears (likely justified) that competitors would create innuendo around their absence. Consider these points:

  • Make sure customers and prospects don’t see an exhibit hall pullout as a sign of financial challenges. Tell them well beforehand why you’ve changed strategies and where you’ll spend the money instead.
  • You’ll still probably want a convenient way to connect with people during the conference, which might be an exhibit hall meeting room, a staffed HIMSS Bistro table (if they offer that service again), or either a single event or a series of dinners with an executive. HIMSS locks down basically everything in sight of the convention center and then some, so solve the real estate issue early (a la the JP Morgan Healthcare Conference, which to many attendees is held in unofficial hotels, coffee shops, and park benches because the main venue is sold out).
  • Don’t fail to work the hall even if not exhibiting in it. You might find a prospect, partner, employee, acquirer, or acquiree just from wandering around in the right places as a plain old registrant.
  • Figure out the kinds of activities that offer better ROI than a glitzy booth. Maybe it’s a series of webinars, regional events, testimonial videos, or sponsorships (OK, that was self-serving) that work all year instead of for just three days.
  • Take that tiny part of exhibiting that represents education and make that the focus instead of just watching unengaged passersby offloading swag from your podium.

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I’m interested in what readers think about companies who decide to stop exhibiting at the HIMSS conference, so tell me here. Do you care? What other ways can they connect with prospects? I’m especially interest in hearing from companies that have moved their exhibit hall expense into other forms of marketing that turned out to be more effective.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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NTT Data Services acquires Cognosante Consulting, which provides services to state Medicaid programs. It will operate as NTT Data State Health Consulting.

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The Knoxville paper covers PerfectServe’s three 2018 acquisitions, its 220 local employees, and the use of its secure provider communications solution by UT Medical Center.


Sales

  • In England, Great North Care Record chooses Cerner for information exchange.
  • San Francisco medical group Brown & Toland will implement Epic for ambulatory for its 2,500 independent physicians. The network manages insurance functions for its members and says Epic is the only system that can support both patient care and insurance administration.

Announcements and Implementations

UnitedHealthcare and the American Medical Association will work together to create 20+ ICD-10 codes related to social determinants of health that can be used to trigger referral to social and government services.

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KLAS looks a patient privacy monitoring solutions, with Protenus, FairWarning MPS, and Maize Analytics topping the list. Purchasing decisions are often driven by reducing false positive warnings, at which FairWarning MPS was found to excel.

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MIT Technology Review notes that DeepMind demonstrated a prototype of its AI-powered retina scanning device in London last week. The 30-second scan can detect retinopathy, glaucoma, and macular degeneration. It’s still years away from availability, however, since the company hasn’t yet submitted it for UK regulatory review.

Meditech expands its Meditech as a Service offering, which was initially offered only to critical access hospitals, to all community health systems.


Government and Politics

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The VA joins DirectTrust’s anchor bundle, which will allow its employees to use Direct messaging and information exchange to communicate with 1.8 million providers.


Privacy and Security

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“60 Minutes” visits Hancock Regional Hospital (IN) to talk about its January 2018 ransomware attack in which it paid a hacker $55,000 to regain access to its files. The hospital notes that not only was it back in business on the Monday following the Thursday attack, it has since learned that antivirus software that can only recognize a particular technical signature would not have helped (since the strain was new) and it has since added a system that instead looks for patterns of malicious behavior. The hospital also contracted with cybersecurity vendor Pondurance because “if we’re attacked by humans and the only thing we have to defend ourselves is software, then the humans will win.”

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An Indian state’s health agency exposes the information of 12.5 million women who had undergone pregnancy-related testing by leaving the Internet-connected database unsecured. The agency didn’t respond to warnings that its information was exposed and the problem was fixed only when India’s Computer Emergency Response Team removed the health information three weeks later. The MongoDB server is still online and exposed, with other agency information still accessible by anyone. The medical data was especially sensitive since it involves data collected to support India’s ban on prenatal sex determination tests, which it implemented to prevent widespread selective abortion of unborn females.


Other

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Epic’s April Fools’ Day home page makeover contained some Onion-worthy gems:

  • Epic hires CNBC host Jim Cramer as a financial advisor after he urged Apple to buy Epic on “Mad Money.” The funniest part about that bit is Judy Faulkner’s actual response at the time, when she asked a reporter with puzzlement, “Who’s Jim Cramer?” which apparently annoyed him based on his tweets about it afterward.
  • The rollout of MyMom, which encourages a health lifestyle with “a dose of love, a firm hand, and perhaps a little guilt.” It will include “genetic test processing filters that predict the likelihood that one day, you’ll have one just like you, and see how you like that.”
  • Epic adds a 200-member support team for Fortnite by Epic Games after its reception employees take 400 calls per hour that were intended for the gaming company (that’s apparently a real statistic).

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Dear PR people: “discreet” means watching what you say or being modest, which isn’t really an adjective you want to use when referring to data points (that would be “discrete.”)

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Kaiser Health News calls out respected hospitals such as Swedish Medical Center, Mayo Clinic, Cleveland Clinic, and University of Miami for offering profitable but medically unproven stem cell-related therapies even as FDA tries to shut down clinics that do the same thing. Some hospitals are even employing informercial-like sales pitches and enthusiastic but anecdotal patient stories to lure cash-paying patients in. One area in which evidence is ample – hospitals and medical practices will do whatever people pay them to, regardless of scientific merit. Just because hospitals are non-profit, unlike medical practices, doesn’t mean they don’t relish bringing in the cash through any legal (and sometimes illegal) means.

Researchers find that Ontario’s experimental payment of bonuses of up to $36,000 for PCPs to keep their patients out of the ED created unintended consequences, with most of the money going to small-town doctors whose patients had fewer PCP visits, less after-hours care, more ED visits, and higher ambulatory costs. The bonus-earning doctors also had lower-acuity patients. The authors identify a problem in creating rewards for those who are already exhibiting the desired behaviors instead of changing those who aren’t, also noting that the payment rules encouraged doctors to send patients to the ED or to specialists instead of to a walk-in clinic.  

Pharma bro Martin Shkreli is sent to solitary confinement for using a contraband cell phone to continue running his renamed, price-jacking Turing Pharmaceuticals from his federal prison cell. I’m pretty sure we haven’t heard the last of him since people who are willing to do most anything for money somehow keep finding new ways to take it away from someone else.


Sponsor Updates

  • Imprivata will offer its PatientSecure biometric patient ID solution with Verato’s cloud-based MPI as a comprehensive solution to address patient identification and record matching.
  • PatientBond will exhibit at the 2019 UCA Urgent Care Convention & Expo April 7-10 in West Palm Beach, FL.
  • Meditech publishes a case study on the use of its CAUTI prevention and surveillance tool by RCCH Healthcare Partners.
  • AdvancedMD will exhibit at the American Society of Addiction Medicine meeting April 4-7 in Orlando.
  • Aprima will exhibit at the CORHIO Forum April 4-5 in Denver.
  • PatientPing and Lightbeam Health Solutions will exhibit at the National Association of ACOs spring conference April 24-26 in Baltimore.
  • Avaya works with Nuance to develop new self-service automation capabilities with easy-to-navigate conversational interfaces integrated in its Avaya IX Contact Center solutions.
  • CompuGroup Medical will exhibit at the AZ HIMSS Annual IT Summit April 11 in Phoenix.
  • DocuTap will present and exhibit at the Urgent Care Association Convention & Expo April 7-10 in West Palm Beach, FL.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 4/1/19

March 31, 2019 News 5 Comments

Top News

A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems.

Some of their patients worry about starting over at new practices that can’t get their previous records.

The partners decided not to pay because they had no guarantee that the hackers would restore their data or that they wouldn’t extort them further afterward. They also didn’t want to rebuild their practice from scratch.

The doctors apparently practiced within Swedish American’s Brookside Specialty Center. They declined a TV interview, saying the FBI is now involved.


Reader Comments

From Cyrus of Persia: “Re: [vendor name omitted]. Rumor is they’re for sale after raising $80 million but failing to keep up with their valuation. The co-founder left in December for VC-land, a high-profile client ripped and replaced because the product didn’t work, and none of the company’s sales have gone live.” Unverified, so I’ve omitted their name for now, but I welcome readers to comment.

From Mawkish: “Re: [vendor name omitted]. I heard they have abandoned their development efforts to create an enterprise behavioral health EHR/PM system for the community mental health center and larger mental health / substance abuse agency marketplace after three years of signing up customers who paid deposits with promises that they would be involved in product design, with the remainder not due until go-live. This removed those customers from the marketplace for legitimate solutions. At least the company is refunding the deposits after laying off 40 developers and returning  to their roots of selling EHR/PM to the small practice marketplace.” Unverified, so again I’ve left the name out until I can ask for a company response. I’m not a big fan of pre-announcing software since the only possible reason is to convince prospects to hold off buying an immediately available competing product, but then again, customers who fall for that rather obvious ploy probably would have found a way to screw up their selection and implementation anyway. Still, it’s good news that the company is providing refunds, which isn’t a given in the rough-and-tumble world of health IT.

From Irritable Cereal Bowl: “Re: opioid lawsuits. Good for the states that are suing McKesson and other drug distributors who shipped enormous quantities of opiates that they had to know were being misused.” I disagree – every dose that was sent to those states was dispensed by a state-licensed pharmacy, on the order of a state-licensed prescriber, and under the jurisdiction of the DEA, which tracks every dose of opiates that is shipped to a pharmacy. Clearly those states were asleep at the wheel in expecting the deep-pockets drug wholesalers to provide oversight of legal but inappropriate drug use. If I were McKesson, I would sue the boards of pharmacy and medicine in those states, and perhaps their attorneys general and law enforcement agencies, for failing to do their jobs in protecting the public. Maybe individual prescribers and pharmacies as well since every single transaction is readily available. Drug distributors are required to report unusual usage patterns to the DEA and they failed to do that (not that the DEA isn’t already inspecting pharmacies and prescribers), but blaming them for the immoral and probably illegal behavior of prescribers and dispensers is clearly deflecting blame long after the fact. You can’t tell me that a tiny town from which flowed millions of doses of opiates that were being dispensed to patients who lined up around the pharmacy’s block every single day was too subtle of a problem for their police departments to detect.


HIStalk Announcements and Requests

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Most poll respondents say EHR design is not a major cause of physician burnout.

New poll to your right or here: How much impact will AI have on patient satisfaction, outcomes, and cost in the next five years? Click  the poll’s “comments” link after voting to explain, especially if you punt with the safe “some” option.

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About 20 percent of poll respondents call their PCP by their first names instead of “Doctor  XXX.” Some agree with me that the PCP is working for them and therefore there’s no need for academic formality, at least once the relationship has been established, while others prefer that both patient and doctor use formal titles (Mr. Ms., etc.) One respondent says they call anyone who has earned a doctorate as “Doc,” but that’s a slippery slope when you separate a medical practice degree (MD/DO) from other medically related doctorates (PhD, DNP for nurses, PharmD for pharmacists, etc.). That doesn’t even consider saying “No fries, thanks, Dr. Jones” in answering the drive-through query of your philosophy PhD. Or, what to do when both patient and doctor have earned doctorates in any academic discipline — do they call each other “Doctor” in the exam room? Or if the poetry PhD patient is called “Mr.” or “Ms.” by their PCP, do they correct them with academic haughtiness? We’ve polluted the etymologic waters quite a bit by assuming holders of doctorates of medicine, dentistry, chiropractic, podiatry, and veterinary medicine should get an extra dose of respect beyond those who hold every other doctorate. My experience is those who are most insecure about their doctorates (usually DO’s and DC’s) are the most likely to insist on being called “doctor.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


People

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Medical imaging software vendor Novarad names Paul Jensen (Microsoft) as president.

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Julie Flaschenreim (Fairview Health Services) joins Hennepin Healthcare as CIO.


Other

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I really dislike the headline of this article from HIMSS, and not just because they misspelled “ZIP” as “Zip,” used unrelated stock photography, and pitched their recent acquisition Healthbox. ZIP codes do not “define” health outcomes, although situations that are common in the economic demographics of those who reside in a given location certainly do. As the headline fails to indicate, people who live in South St. Louis would not get instantly healthier by moving to Palo Alto since there’s no guarantee their social determinants of health would change along with the relocation to an area with a closer Whole Foods, or that their healthcare journey isn’t already set in stone to some degree. There’s also the meme-bursting phenomenon of a single ZIP code covering wildly disparate income ranges, such as parts of San Francisco and Atlanta in which multi-million dollar apartments are flanked by the homeless and working poor (if you like digging deeper, check out census department’s Gini Index measure of income concentration.)  I agree with the remainder of the article, just not the simplistic concept that knowing someone’s address is all you need to understand their health.

Former Microsoft CEO Steve Ballmer gauges return on investment in healthcare by looking at the average age of death, which he says has increased only 0.6 years in the past 20 even as healthcare spending rose dramatically. He says employers should look at their prices and costs, such as whether end-of-life spending really increases overall value, but adds that a non-transparent system of healthcare management and delivery makes such analysis nearly impossible.


Sponsor Updates

  • Meditech produces a new podcast, “Clinical efficiency and the journey to Expanse.”
  • Mobile Heartbeat and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at the BGHIMSS & INHIMSS Annual Spring Conference April 4-5 in Florence, IN.
  • NextGate will exhibit at the CCI Symposium April 4-6 in Greenville, SC.
  • Netsmart will exhibit at the LeadingAge IL Annual Meeting April 2-4 in Schaumburg, IL.
  • Nordic will present at the Quality of Care Outcomes Research Scientific Sessions April 5-6 in Arlington, VA.
  • Medhost congratulates its 19 hospital customers that earned CMS’s five-star quality rating.
  • Practice Velocity, T-System, Wellsoft will exhibit at the 2019 UCA Urgent Care Convention & Expo April 7-10 in West Palm Beach, FL.
  • Cooper University Health Care (NJ) expands its use of Access Passport’s electronic forms solution to oncology and surgical services.
  • The Oliver Wyman Health Podcast features Qventus CEO Mudit Garg.
  • SymphonyRM will sponsor the Women in Data Science Pittsburgh @CMU event April 4.
  • Visage Imaging will exhibit at the 2019 SBI/ACR Breast Imaging Symposium April 4-6 in Hollywood, FL.
  • Vocera will exhibit at the Beryl Institute Patient Experience Conference April 3 in Dallas.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 3/29/19

March 28, 2019 News No Comments

Top News

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Medicare Advantage payer Clover Health lays off 140 employees as part of a restructuring that will eventually add more staffers with health insurance and clinical backgrounds. The company, which has touted its predictive analytics capabilities since launching in 2012, has raised nearly $1 billion. It operates in seven states including Tennessee, where it plans to open an office in Nashville.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Healthcare CRM vendor SymphonyRM expands to Pennsylvania with the opening of its Health AI Center of Excellence in Pittsburgh.

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Teladoc Health shares rise on the news it will launch its services in Canada.

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Digital prescription startup Xealth raises $11 million in a funding round led by McKesson Ventures, Novartis, Philips, and ResMed. The company has developed software that enables providers to prescribe apps, devices, and services from their EHRs. It has raised nearly $20 million since launching out of Providence St. Joseph Health (WA) in 2017.


People

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Max Hanner (HCTec) joins Pivot Point Consulting as VP of business development.

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Clarify Health names Imran Qureshi (Health Catalyst) chief data science officer.

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Medication tracking company Kit Check promotes Doug Zurawski to SVP of clinical strategy and MaryAnn Jensen to VP of strategic marketing; and names Amy Langan (Fresenius Kabi) CMO and Eric Bolling (Cardinal Health) EVP. I interviewed Kit Check co-founder and CEO Kevin MacDonald last December.


Sales

  • OSF HealthCare (IL) will use Redox’s interface capabilities to connect its clinical systems with third-party applications.

Announcements and Implementations

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Sutter Health (CA) will pilot an AI-enabled digital voice assistant developed by Suki in primary care, dermatology, and orthopedics.

The multi-state Lewis and Clark Information Exchange adds PatientPing’s real-time care alerts and patient utilization details to its HIE services.

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Inspira Health (NJ) implements Intraprise Health’s wayfinding technology at its three hospitals.

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United Regional Health Care (TX) will go live on Epic next week.

Thirty-five bed Lackey Memorial Hospital (MS) rolls out Evident’s Thrive EHR.


Government and Politics

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Departing FDA Commissioner Scott Gottlieb, MD tweets that the agency will make good on its promise to release thousands of patient safety reports after Kaiser Health News found manufacturers have for years been taking advantage of a secretive, alternate summary reporting program that kept patient safety impacts hidden from public view.

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The Australian Digital Health Agency will offer qualifying vendors $30,000 to integrate interoperability standards into their clinical software so that providers using different systems can share health information. The incentive is part of the country’s larger effort to do away with paper-based communication and faxes by 2022.


Privacy and Security

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Officials at Northampton General Hospital in England say they are fending off at least 240 data-breach attempts a day, and worry that the problem will only escalate as NHS facilities become paperless. They list phishing email campaigns, unpatched software, and a lack of cybersecurity expertise as their biggest concerns.

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CynergisTek adds around-the-clock monitoring to its line of cybersecurity, privacy, and compliance services for healthcare.


Other

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Prosecutors say the former Vanderbilt University Medical Center nurse on trial in Tennessee for a medical injection error made at least 10 mistakes that led to the death of a patient, many in line with findings from a CMS investigation. The nurse has pled not guilty despite admitting she made a mistake. Errors included:

  • Being distracted by an unrelated conversation with another staff member when she grabbed the wrong drug from the dispensing cabinet.
  • Overriding a cabinet safeguard even though it wasn’t an emergency situation and she hadn’t checked with the hospital pharmacy.
  • Ignoring four warnings or pop-ups about the medication being withdrawn.
  • Not noticing the drug in hand was a powder instead of a liquid.
  • Overlooking a boldfaced warning immediately before injecting the drug.

Sponsor Updates

  • Elsevier Clinical Solutions will exhibit at the Beryl Institute Patient Experience Conference April 3-5 in Dallas.
  • EClinicalWorks and Imprivata will exhibit at the AMGA 2019 Annual Conference March 28-30 in National Harbor, MD.
  • Ensocare will exhibit at the American Case Management Association Conference April 13-17 in Seattle.
  • FormFast and Iatric Systems will exhibit at the Health Connect Partners Spring 2019 conference April 1-3 in Anaheim, CA.
  • Hayes Management Consulting welcomes Nancy-Linn Swain as director of training and engagement, and Bo Zhang as senior financial analyst.
  • HGP advises Clearwave in its significant growth investment from Frontier Capital.
  • Healthwise will exhibit at the EClinicalWorks Enterprise and Urgent Care Summit April 1-3 in Fort Lauderdale, FL.
  • InterSystems releases the latest update of its IRIS data platform featuring enhanced performance and scalability, cloud support, integration capabilities; and enhanced support for Java, Python, and C# development.
  • Intelligent Medical Objects will exhibit at the AORN Global Surgical Conference & Expo April 6-10 in Nashville.
  • Spok publishes “The Non-CIO’s Guide to Interoperability.”
  • The local paper covers Nordic’s move to new, expanded office space.
  • With help from Pivot Point Consulting, Acumen Physician Solutions adds legacy data archiving technology powered by SMART on FHIR from Trinisys to its Acumen 2.0 powered by Epic software for nephrology practices.
  • Glytec announces that its Glucommander Outpatient insulin dosing management software is now capable of receiving data from DarioHealth’s smart glucose meter.
  • Lightbeam Health Solutions and AMGA have developed a collaborative to help providers maximize the effectiveness of Medicare Advantage and other value-based contracts.
  • Health Catalyst receives top marks for healthcare analytics in Chilmark Research’s latest report.
  • Cooper University Health Care (NJ) expands its use of Access Passport e-forms to oncology and surgical services.
  • Vail Health (CO) improves care team communication with Spok’s Care Connect solution, and continues to expand its use of the software.
  • The Chartis Group hires Beth Price (North Highland) as director of its oncology solutions practice.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 3/27/19

March 26, 2019 News No Comments

Top News

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The Justice Department won’t dispute a federal court’s decision that the Affordable Care Act is unconstitutional and should therefore be eliminated in its entirety.

This two-sentence announcement represents a position shift from earlier arguments in which the Trump administration advocated striking down only certain of ACA’s consumer protections, such as the requirement that insurers cover pre-existing conditions. 

A group of Republican governors sued the federal government after Congress eliminated the penalty for not buying health insurance, arguing that the decision renders the entire ACA unconstitutional, a position with which the federal government now agrees.


HIStalk Announcements and Requests

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Lorre found and fixed a bunch of new HIStalk email signups (over 1,000, actually) that went automatically and silently into an “unconfirmed” status in the bulk email service I use, requiring manual approval. Welcome if you got your first email today. Sign up here if you aren’t sure since you won’t get duplicate emails even if you’re already on the list.

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Welcome to new HIStalk Platinum Sponsor Ensocare. The Omaha-based company’s care coordination solution includes software; a national network of post-acute care providers, services, and community-based organizations backed by 24-hour support; and solutions that help hospitals and payers succeed under value-based care. Transition of care solutions include Transition (hospital discharge software); NEMT (links hospitals to non-emergency medical transport providers); and SDoH (connects patients with community services that can help with social determinants of health). Patient engagement solutions include Wellplan (digital care plans) and Aftercare (RN-led scheduled phone calls). The company’s care coordination platform is integrated with Cerner, Meditech, Epic, and VistA to automate discharges and post-acute referrals. Its Patient Choice app allows patients and families to explore post-acute care options at the bedside. Thanks to Ensocare for supporting HIStalk.  


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

Previous webinars are on our YouTube channel. Contact Lorre for information.


Sales

  • Atlantic General Hospital chooses Welltok-owned Tea Leaves Health for analyzing referral patterns and expanding its physician network.


    People

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    Collective Medical names Jim Lacy (Waystar) as president / COO.


    Announcements and Implementations

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    Philips acquires Idaho-based teleradiology practice Direct Radiology, whose 70 radiologists provide services to 300 hospitals, imaging centers, and medical practices.

    UC Davis offers a three-month online educational program titled “Health Information Literacy for Data Analytics Specialization,” which targets technologists with no healthcare experience. Courses include Healthcare Data Literacy, Healthcare Data Models, Healthcare Data Quality and Governance, and Analytical Solutions to Common Healthcare Problems. UC Davis also offers a five-course analytics certificate program for which healthcare experience is recommended, with completion in 15 months or less at at cost of $6,125.

    Netsmart will implement the 360X interoperability standards for managing referrals and sharing information between PCPs and community-based healthcare providers.

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    A KLAS review of 2018 health IT purchasing decisions finds that the most active areas were PACS, population health management, ERP, and secure communications. Markets are mature for EHR/PM, automated dispensing cabinets, cardiology systems, ERP, home health, PACS, patient accounting, and smart pumps. Newer and more disruptive areas are behavioral health, patient privacy monitoring, population health management, secure communications, virtual care platforms, and vendor-neutral archive. Vendors ranked at the top of KLAS’s assessment of customer satisfaction and retention are American Well (leads by far), FairWarning, Varian, BD, Protenus, Omnicell, Grifols, Workday, Nuance, and Baxter. Top reasons for replacing systems are integration, consolidation, and functionality, with price falling outside the top five.


    Government and Politics

     

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    Outgoing FDA Commissioner Scott Gottlieb clarifies interview comments that some sites interpreted as his call for more EHR regulation.

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    Duke University will pay $112.5 million to settle federal False Claims Act charges that one of its researchers falsified pulmonary research data to win $200 million in federal research grants. Duke fired heavily grant-funded biologist Erin Potts-Kant in 2013 for embezzlement, after which she pleaded guilty to forgery and Duke retracted several of her papers. The former Duke lab analyst turned whistleblower, 34-year-old Joseph Thomas (above), will be paid $33.75 million of the settlement, while the remainder is set aside to repay the grant money involved.

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    HELP committee chairman Lamar Alexander (R-TN) says HHS’s proposed interoperability rules will provide a definition of information blocking, require insurers to give patients copies of their data, mandate that EHRs support API access, and require hospitals to send ADT notifications to a patient’s doctors. He quotes a Tennessee family doctor who sends printed copies of an admitted patient’s record from his EHR to the hospital for re-keying because it would cost his practice $317,000 per year to send information electronically (he didn’t say who would get that money).


    Other

    Fast Company looks at healthcare’s “giant patient-matching mess,” which it mostly blames on (a) EHR vendors not using a standard format for entering patient information; (b) provider consolidation that dumps the patient records of other facilities into a single database; and (c) lack of an easy way to de-duplicate records of common names that sometimes also share a birthdate. It notes CHIME’s 2015 $1 million National Patient ID Challenge that it eventually abandoned because the problem is too complex, a conclusion reached by Pew, which could only recommend that EHR vendors force standardization of addresses using US Postal Service records. It notes that other countries think the US is fighting an impossible battle to figure out which is the right Maria Garcia or John Smith given Congress’s ban on a national health ID.

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    In Australia, investigative reports show that Queensland Health was so desperate to prove the financial viability of its Cerner-powered IEMR that it planned to go live at Princess Alexandra Hospital in mid-2015 even though the project was in “cannot meet objectives” status. The plan was halted only when a Cerner VP and the project’s delivery director said a six-month, big-bang implementation was not possible, especially in radiology and pathology.

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    Bloomberg notes the increasing number of doctors who choose a telemedicine practice now that reimbursement has been sorted out and startups such as Hims and Roman need doctors to generate their lifestyle prescriptions. A startup that was founded strictly to place doctors in telehealth jobs says about 25 percent practice full time, with most of the remainder being those fresh out of school or easing into retirement. Doctors still need to be licensed individually by each state — the doctor who is the subject of the Bloomberg article spent $10,000 to gain licenses in 26 states.

    Stat reports that digital health startups are struggling with how to respond to users who express suicidal thoughts using their mostly unattended platforms. Patients are threatening self-harm during video visits and people are posting suicidal comments to the Facebook pages of hospitals and practices or even to their patient portals.

    Researchers retest the DNA of 49 people whose consumer genetics tests told them they are at risk, with commercial labs failing to reach the same conclusion in 40 percent of them. Some of the “increased risk” classifications were also incorrect, as the observed variants are common and benign. The authors conclude that consumer DNA testing results should be confirmed by clinical labs that understand the variants better.


    Sponsor Updates

    • First Databank’s Meducation patient instructions creation system is added to Epic’s App Orchard.
    • Aprima, an EMDs company, announces integration with RavePoint.
    • Avaya introduces a cloud transformation program, making it easier for companies to adopt the cloud communications infrastructure that best meets their needs.
    • The Digital Healthcare Podcast features Collective Medical CMO Benjamin Zaniello, MD.
    • CoverMyMeds will exhibit at the Technology Health Experience Conference March 28-30 in St. Louis.
    • Culbert Healthcare Solutions will exhibit at AMGA March 27-30 in National Harbor, MD.
    • DocuTap will exhibit at the Pediatric Urgent Care Conference April 3-5 in Dallas.

    Blog Posts


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    Contacts

    Mr. H, Lorre, Jenn, Dr. Jayne.
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    Monday Morning Update 3/25/19

    March 24, 2019 News 1 Comment

    Top News

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    Departing FDA Commissioner Scott Gottlieb — reacting to the “Death By 1,000 Clicks” article — says FDA oversight of EHRs would be appropriate “when they’re doing things that could create risk for patients” in turning into a medical device.

    Gottlieb added, however, that Congress would need to define those conditions. He doesn’t expect any changes in the next several years.  


    Reader Comments

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    From Captive Cursor: “Re: Beth Israel Lahey Health. Named former Dartmouth-Hitchcock CIO Peter Johnson as interim CEO of the new entity. He would be an interesting interview.” Johnson’s LinkedIn says he’s been an independent consultant since leaving Dartmouth-Hitchcock in 2011 after 26 years and I know he has covered CIO roles since. I agree that it might be fun to interview him.

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    From From Athena With Love: “Re: Athenahealth. Post-acquisition layoffs are about to happen (April) according to rumors.” I’m pretty sure you can count on layoffs, especially when combining two companies that must have quite a bit of corporate overlap. The real question is how they handle the product portfolio, especially the GE Healthcare part. That’s compounded by the fact that healthcare experience, especially that obtained from somewhere other than Athenahealth, is hard to find among the executive team members.The corporate raider script, especially with hedge funds like Elliott Management, seldom wavers from: (a) create distress by criticizing the targeted company publicly and maybe applying some dirty tricks; (b) use the resulting share price drop to bully the board into selling the company at a discount; (c) cut costs mercilessly to shore up the financials while the company is sequestered away from investor oversight as a private entity; and (d) either find another willing buyer, or as is more likely with Athenahealth, expand into sexy-sounding areas with big potential, take it public again, and transport wheelbarrows of cash to the bank before the company’s long-term prospects turn out to be less impressive than the juiced numbers and creative story suggested. Vertitas Capital’s big healthcare IT score was selling the healthcare database business of Thomson Reuters, renaming it Truven Health Analytics, and then selling it to IBM for more than double the $1.25 billion it had paid just four years earlier. Athenahealth’s prospects are probably less rosy in the absence of a likely buyer (especially one as desperate as IBM), the overall sagging of the EHR market, having product that were run into the ground by GE Healthcare in its mix, and the significantly inflated company value that was purely due to Jonathan Bush’s involvement.

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    From Randall N’Jobu: “Re: doctors. I saw an article wondering how many people call their doctor by first name. Survey your readers?” Take a few seconds to answer and I’ll share the results. I’ve noticed than I’ve changed my practice of always calling my PCP “Dr. XXX” changed when I moved to a concierge doctor, where it’s more personal, less formal, and in my mind more appropriate to use first names since he’s working directly for me. Oddly enough, however, both concierge docs I’ve seen call me “Mr. XXX” even as I called them by their first names, so maybe I’m either faux-pas’ing or something about the situation has turned the tables (they are also younger than I, so that may play a part, as I included in the poll). Physician readers, are you put off when patients call you by your first name, do you invite it, or what do you really prefer? I remember cringing in my early hospital days with a 20-something nurse would address an 80-year-old patient as “Mildred,” but that perhaps was a signal that informality was moving from society in general to medicine in particular.

    From Dollar Cost Averaging: “Re: healthcare IPOs. Are they suddenly a thing again?” I’m no expert, but it seems to me that companies see the recessionary writing on the wall and figure they need to either move now or wait years for the cycle to turn back around.


    HIStalk Announcements and Requests

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    A third of not very many poll respondents say they saw something at HIMSS19 worth following up on. They left us to guess what that was.

    New poll to your right or here: How much doctor burnout is caused by EHR design (workflows, screens, clicks, etc.)?


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

    Previous webinars are on our YouTube channel. Contact Lorre for information.


    Sales

    • Iowa Health Information Network will provide real-time patient notifications to its provider members using PatientPing, replacing Iowa’s Statewide Alert Notification system. 
    • University of Vermont Medical Center will use solutions from Loopback Analytics to identify at-risk patients and improve outcomes related to specialty medications.

    People

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    Two ROI Healthcare Solutions executives – Founding Partner / CFO Kathy London and Managing Partner / President Jim Jancik – announce their retirement.


    Other

    The VA struggles with documenting care for veterans who have undergone gender reassignment surgery, as one advocate wants all EHR mentions of surgery and previous gender removed to protect them from violence, while others say providers need to know the patient’s full history.

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    A “Madison Magazine” columnist says the local airport should be renamed from Dane County Airport to Judith Faulkner Airport as Epic has remade the area’s economy from its Oscar Mayer heritage of making “wieners and pimento luncheon meats” (the company bailed to Chicago in 2015) and Epic saved the area from “one of the most forlorn demographics in all the world.” He notes that Epic makes it possible to take direct flights to Phoenix, San Francisco, and Los Angeles and has fueled the growth of hip venues that cater to its campus full of young adults with significant incomes.

    Wolters Kluwer is providing International Space Station astronauts with access to its UpToDate medical information resource. I admit that I don’t follow low-orbit type projects, especially now that they sell seats to space tourists, but this announcement made me wonder what will happen if an occupant has a stroke, heart attack, or even appendicitis. I assume it would be like in the remote parts of the world, where doctors on the ground instruct crew members who have undergone the most basic of medical training to perform diagnostic tests or minor treatments in sort of a celestial MinuteClinic, but without the option to call an ambulance to take them to a better equipped hospital.

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    Warner Music Group signs a startup’s AI-powered algorithm to release 20 albums in the next year. Endel creates custom soundscapes such as “Sunny Afternoon” and “Rainy Night” that embed custom frequencies that are tailored to a particular listener’s mood, location, and heart rate. Endel’s engineers said their songs are intended to serve as tailored background music rather than album tracks, but agreed since all 20 albums can be “made just by pressing one button.” They had to hire an entertainment lawyer to figure out who to list as artists for collecting royalties, finally settling to just listing all the engineers as songwriters.

    A woman sues Olive Garden for up to $1 million for failing to warn her that her “defective” stuffed mushrooms were “extremely hot,” claiming that after the first bite she staggered through the restaurant with it stuck in her throat, vomited in the restaurant’s kitchen, headed off to the ED, then called 911 on the way because she thought “death was imminent.” She was taken to the hospital, then airlifted to Parkland Hospital’s burn unit. Personally, I would be more tempted to snoop in her medical records than those of Jussie Smollet.


    Sponsor Updates

    • Lightbeam Health Solutions, Experian Health, and PerfectServe will exhibit at the AMGA 2019 Annual Conference March 27-30 in National Harbor, MD.
    • MDLive and Redox will exhibit at ATA19 April 14-16 in New Orleans.
    • Meditech will host the 2019 Home Care Optimization Symposium March 26-27 in Atlanta.
    • NextGate achieves advanced technology partner status in the AWS Partner Network.
    • OmniSys will exhibit at the Computer-Rx T.H.E Conference March 28-30 in St. Louis.
    • QuadraMed’s EMPI partners with LexisNexis Risk Solutions Partners to prevent patient identification errors.
    • Surescripts will exhibit and present at the 2019 AMCP Managed Care & Specialty Pharmacy Annual Meeting March 25-28 in San Diego.

    Blog Posts


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    Contacts

    Mr. H, Lorre, Jenn, Dr. Jayne.
    Get HIStalk updates. Send news or rumors.
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    Reader Survey Results: How I Would Change EHRs

    March 24, 2019 News 3 Comments

    I asked readers how they would change EHRs to improve outcomes and reduce costs while still meeting the requirements imposed by the US healthcare system. That’s the basic question EHR vendors face every day. Some of the excerpted answers I received are as follows. Non-clinician responses are indicated with an asterisk.


    * Keep them headed in the direction they’re on: platforms supporting standardized open APIs. The Fortune article was hysteria-feeding bias by writers who don’t understand economics, technology, or healthcare. Chopra had the best take in the article: MU was a messy process but it was a necessary down payment that will yield benefits to patients for years to come.


    Create true app store-type environment being opened up by the recent mandate for FHIR APIs,  a way to totally separate the data entry issue from the clutches of current vendors. The most practical complementary situation in the interoperability realm would be a timeline approach to presenting links to patient specific information for the caregiving team. There are many candidates whose product offerings could be customized to fulfill this.


    * Allow doctors to create/buy their own EHRs with no regulatory restrictions on interoperability other than summary reports, lab interfaces, and pharmacy interfaces. This puts agency back into the hands of the frontline clinicians themselves and allows us to cut the complexity out of entrenched vendor products and brings e-health back to the basics, where it belongs.


    * I would move EHR interoperability to something more similar to the SWIFT financial network. A cooperative would operate a set of datacenters and network. Transactions on this network would be defined by a set of standards (HL7+X12 but with a strong opinion on what that actually means.) Messages would be routed from the providers to the cooperative then onward to other providers or insurers or wherever. Failure to reply to requests with the appropriate clinical information would result in an increase in the transaction fee that the networks charge for submitted claims.

    Say you don’t return a request for patient data promptly or fail to submit an HL7 ADT message when a trigger happens — some percentage of your claims for the next year will be put into a general fund that supports the network. Awards are given from the general funds to whistleblowers who point out failure and non-compliance. Additional failures or non-compliance will result in a steadily increasing withholding from each payment your org receives. Failure to join the network or repeated non compliance with the requirements will lead to loss of Medicare and other government payments. US digital service and some CMS lawyers form the initial public committee that organizations go before to submit complaints against each other, appeal decisions, etc.


    * All big systems were designed around billing, and the visit is the hub. That should be tossed out and redesigned so patient is the hub.


    * Phase out Meaningful Use. Halt any usability mandate initiatives (let free market decide). Pass legislation that makes it much more difficult to sue for patent infringement. For EHR software that is released and used in production at publicly funded health systems, screenshots, videos, and specific descriptions of functionality / workflow should be shareable with open public (excluding PHI stuff) i.e. greatly limit an EHR vendor’s ability to nix content from web with IP protection claims


    * I would allow malpractice carriers to drive the market need for effective electronic clinical documentation through how they price premiums rather than CMS reporting requirements. That should shift the market dynamic away from a great billing product to one built around patient safety.


    *Interoperability: generate rich patient records with specific variability and define a set of assertions that are associated with those cases. Send them via CCDA and FHIR and ensure that each EHR can receive, reconcile, and directly incorporate all data into their EHR.

    Usability: generate a standard set of the top 10 nursing and physician workflows — give the workflow 100 points. Then for every time the user has to switch contexts from the patient to the computer, deduct seven points. Every time the user has to switch from the keyboard to the mouse, deduct five points. Every keystroke the user has to enter to do a search – deduct one point. Grade it based on standard: 90 percent A, 80 percent B, 70 percent C, 65 percent D.

    Error reporting: Put the EHRs under FDA CFR and require they publish all harms with their customer notice to a Federal EHR Adverse Event Reporting System (FEHRAER?). All potential patient safety or safe use issues reported to the same system, but perhaps we would mine those for trends and allow them to remain non-public.

    When someone cheats on their MU reporting or MU certification, a change in suit color is in order. Not just fines. but hard time.


    * Centrally managed (decentralized storage) common health record structure that all EHR technology vendors and providers of all types are forced to contribute to. This would break up monolithic EHR vendors, stimulate creativity, and allow each provider to select the tools used to contribute to a commonly defined health record. This would solve the interoperability issues and allow the market evolve quickly. Basically we follow the ubiquitous app store approach. We could use a distributed ledger approach to record management.


    * We need to focus on the paradigm that exists around our transition from paper-based, trust-based, fee-for-service charting to an electronic health archive and medical billing support infrastructure. There is no direct correlation between the two worlds. And I am not talking about the change felt by payers and providers. We have not changed the patients’ encounter as dramatically as we need to in order to support new world order in healthcare.

    Patients are typically scheduled in much the same way as before. The Doctor’s office visit is mostly the same. And what is scary is the huge push and hyper focus for MORE office visits. A vastly different office visit is required. And since everyone is a consumer, we all share the same responsibility to adapt.

    One very tangible change would be patients acknowledging that their visit with the physician is being recorded. Recorded sessions will be saved for 24 hours until the medical record has been appropriately updated and accurate labs and meds are ordered and prescribed. This one process change has many downstream benefits to both accuracy and integrity. There are ways to incorporate many levers to assist, however, it starts with changing the patient’s point of view of a doctor’s visit.


    * Systems that you can easily dictate into via headset, for example, as you are performing assessments, “breath sounds diminished in left lower lobe, slight wheeze in left upper lobe, strong, loose, productive cough. Resp Rate 14, pulse 84”, etc.
    having discussions with patients, “Mr. Gonzales indicates shortness of breath walking up one flight of stairs”. System would be smart enough to catalog information discretely in the right places in the right way to make it interoperable.
    Alexa-like recall of important information or tasks “Alexa, please reconcile Mr. Jones medication list and show me any discrepancies” “Alexa, what is Mrs. Smith risk of 30 day readmission and what should we do to mitigate it?” “Alexa, what routine care items / screenings is Ms. D’Meanor due for?”


    * At the health system level at a minimum, standardization of content based on evidence should be required. Utilizing 4,000 different order sets, customized care plans with zero evidence, lack of consistent clinical decision support should be disallowed. EHRs only get better when the information available at the point of care is better.


    Implement National Patient Identifier, and mandate that it cannot be SSN. Get rid of the old school “funny Money” mentality of charges that all the stakeholders can get an accurate view of value in health care, and not monopoly money gross revenue nonsense that is currently what is floated out there.


    * I think we need some UPS-style time and motion studies to understand how to make the EHR more natural and complementary to physician and clinician practice. Some future improvements should be possible based on this understanding, for example:

    • Narrowing what is on a screen based on context in the patient encounter
    • Narrowing what is on a pick list based on context
    • Improving adoption and usability of no-touch UI’s

    There is a lot to be learned for the major EHR vendors from the computer gaming industry on having commands and data elements be contextual. I think we need to shatter the “project mentality” in EHR rollouts and just assume optimization never is finished. If any investment deserves the the continuous improvement process, it’s this one.


    * Get rid of the need to document every single minutiae. Let the doctors decide and be responsible for what they enter in (if they start making mistakes or not entering important information, it’s on them and their insurance). Have a simpler interface for physicians, and another a complex one for “scribers” (could be the same as what’s currently offered). What’s required for simpler interface should be arrived at by a mix of EHR vendors and physicians (AMA), make this required for certified software. This you could be standardized across the US. If the doctors don’t like it, they can switch to the scribers interface and go nuts but no complaining anymore about the interface. Only the simple interface should be required for the software to be certified.

    If the bean counters want something tracked and entered in, let them pay for it in the term of scribes, etc. This will easily track the true cost of of all this data entry which is currently being paid through physician time. Since they love tracking costs, they should love this, right?

    Have a tool to download record from patient portal, in an open and readable format. Even better two formats, one human readable, and one machine readable. Make this required and always available if you want to be certified.

    Have tool in patient portal and in EHR to submit feedback on the software. A copy goes to the vendor, one to the health system, and a copy goes to regulators, available through FOIA to anyone (once personal details are scrubbed).

    Not really something that can be done on EHR side but:

    Make health systems pay for failing to share patient’s records (if the above functionality fails). Make this an increasing cost based on delay and also based on the amount of money the health system generates (not profit, as they’re all not-for-profit).

    Make the health system generate a single, detailed bill. If the health system is not-for-profit,” it should have both the cost of the material and how much they charge for it in the bill. If the bill goes out past a certain date, the patient doesn’t have to pay it. Let them deal with paying outside the network, etc.


    * I worked in financial services technology in 90s and early 00s. If you free the data, innovation will come. We’re in generation 1. There are whole entities just forming that normalize, curate data. Better user centered design will come when SME for particular problems are able to enter at a price point commensurate with value. Add-on and systems next to the EHR will become primary home for tasks for specialized workflows. EHRs that can build and partner for these models will succeed. The ones that stay data locked will be the last system stand alone docs have before getting eaten by local mother ship. That could take decades. Ones that unlock data and become integration partners have a chance at survival.

    The larger orgs that command a premium $ in their practice and have a handle on ROI and total cost of practicing will bring support for doctors into exam room. MGH in Boston has been doing this for almost a decade.

    There is no perfect technology. Our ability to acknowledge data integration is key is tantamount.

    Although politically undesirable, move to a unique patient identifier/set of unique keys per patient would help immensely.


    Since early 2013, the Texas Medical Association has recommended to ONC that they should require all EMR data elements to be XML tagged using a single national standard, much like the accounting profession successfully uses XBRL. With a universally-understood tagged data structure, physicians and hospitals would ideally be able to pick up their databases and move them quickly and cheaply between vendors. Vendors then would be forced to compete on their user interface, including usability.

    XML is just one approach for tagging. FHIR is analogous to this approach, but it’s not being used in a “pick up your database and change” way, as far as I know.

    If, in 2013, the ONC had started us on the XML tag journey (or its equivalent), we would be far, far closer to true interoperability and data sharing.


    * Leverage the massive amount of data that has already been collected over the past 10 years. Utilize machine learning to automate the largely repetitive tasks done by clinicians. A run-of-the mill CAP admission already gets the same order set anyway, with the same billing codes. There is no need for things like this to be done manually every single time. Machine learning should be able to take care of 80 percent of the tasks currently done by clinician end users. The other 20 percent are the unique clinical situations where we need clinicians to use their experience and critical thinking skills to solve complex medical problems beyond the capabilities of machine learning.


    Mandate interoperability and provide real teeth to enforcing this with real consequences for facilities, systems, and technology that does not share all the data. This includes providing all to the patient. Don’t let perfection stand in the way of progress when it comes to interoperability – start with something and expand on it.

    Relegate the EHR to a database and allow for customized solutions as an overlay for specialties and individual workflow.

    Stop punishing doctors with data entry and find an alternative to capture of information and allow them to return to the art and joy of medicine.

    Require justification form variation from standards of practice established and proven holding clinicians accountable for that variation when they find alternative paths and treatment protocols.

    Make the technology a part of medical education and allow those individuals to contribute to rethinking the solutions, workflow, and layout. They are unencumbered by the baggage of paper notes and as digital natives would have new and innovative ideas that we could use. They are also deeply invested in fixing this unholy mess since they are forced to use this archaic solution and are often the data entry clerks of choice as the most junior clinical employee, wasting all their training time on updating the system  — residents spend 70+ percent of their time in their basement room updating the EMR not seeing patients.


    My notes would be minimal, perhaps even written primarily by the patient. Diagnoses would be common language and not all the absurd detail ICD-10 brings. Real-time costs would be part of ordering and someone other than me could figure out the charging in the end. Make the screens as simple as an iPad, intuitive so that they just work as expected.


    News 3/22/19

    March 21, 2019 News 5 Comments

    Top News

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    Providence St. Joseph Health EVP / Chief Digital Officer and venture fund manager Aaron Martin participates in a Reddit AMA (Ask Me Anything) that quickly turns ugly as participants – including claimed former employees of his Digital Innovation Group — press him about layoffs and a reported sexist, bullying, and stressful culture. I’ll paraphrase a few comments, although I’m obviously unable to verify their accuracy:

    • Is spending hundreds of millions of dollars on what is essentially a tech start-up consistent with the Sisters of Providence mission?
    • Bragging that two-thirds of the leadership team is women doesn’t reflect a culture that favors “young brogrammers.”
    • More than 80 employees left last year.
    • “People joined DIG because they were inspired by the mission and often took a step back in pay to make a difference. Then, it takes about three weeks at DIG to realize you’ve been tricked. It’s not mission-driven, it’s driven by bullies who care for no one but themselves. I think the leadership team would even turn on each other if needed.”
    • Participants questioned whether Martin profits personally from deals on top of his reported $1.6 million in compensation, also claiming that the sale of Circle Women’s Health Platform to Wildflower Health “involved Providence paying Wildflower $4M to take it, kind of like a dowry.”
    • A participant said that PSJH’s acquisition of blockchain vendor Lumedic (although not part of Martin’s group) “appears to be the hiring of a group of five executive-level ($$$) friends who used to work together at previous companies with a pointless blockchain vaporware company and no actual intellectual property (patents) or software engineers or working product. Why is PSJH throwing money at scammy, buzzword-slinging suits?”

    Reader Comments

    From BurbianEHR: “Re: Lahey / Beth Israel post-merger administration layoffs. Starting today.” Unverified, but not surprising.


    HIStalk Announcements and Requests

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    I’ve received some good responses to my “how would you change EHRs” question, although respondents face the same challenges as vendors – you don’t get the pie-in-the-sky satisfaction of submitting a “world peace” type answer because the US health system defines EHR requirements, not vice versa. Your assignment, then, is to describe how you would make EHRs better while still allowing them to function in the unreal realities of our healthcare system.

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    The Forbes “Death by 1,000 Clicks” article stirred some nostalgia about those heady Meaningful Use days, when EHR vendors turned into shameless used car salespeople in hawking their previously unwanted wares. HIMSS, too – my favorite insanity moment was when HIMSS launched a road show series called “Takin’ HIT To the Streets” (subtitled “The ARRA Era”) in late 2009 as a self-appointed convener of sellers and potential buyers.

    My comment from November 2009:

    The HIMSS Takin’ HIT to the Streets campaign (gag, even for Doobie Brothers fans) leaps that last boundary of member organization common sense —  they’re paying people to attend the sales presentations of their vendor members. I’ve been watching the remake of the old miniseries “V” and I think maybe vendor visitors have taken over Steve Lieber’s body since the previously furtive and tentative vendor-HIMSS gropefest has advanced to a full-on public consummation.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

    Previous webinars are on our YouTube channel. Contact Lorre for information.


    Acquisitions, Funding, Business, and Stock

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    Unite Us, whose platform connects providers with community resources to address social determinants of health, raises $35 million in a Series B funding round, increasing its total to $45 million. Two of the three co-founders are military veterans – CEO Dan Brillman served in Iraq and Afghanistan and still flies as an Air Force Reserves major, while Taylor Justice graduated from West Point and spent time as an Army infantry officer. The company was founded in 2013 to connect veterans to resources that could help them adjust to civilian life.

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    France-based medical appointment app vendor Doctolib raises $171 million in a funding round, valuing the company at more than $1 billion. It recently added video visits and digital prescriptions.


    Sales

    • LifeBridge Health will implement Artifact Health’s physician query solution to expedite accurate coding of patient records.
    • Hospital de la Concepcion (PR) chooses FormFast’s electronic signature system, integrated with Meditech.
    • Humana selects Inovalon’s analytics solution.
    • First Health of the Carolinas chooses HealthMyne’s imaging decision support for screening and following lung cancer patients.

    People

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    Outgoing CVS Health EVP Meg McCarthy, who has a long background in health IT, is appointed to the board of Marriott International. She served early in her career as a Navy Medical Services Corps lieutenant at Bethesda Naval Hospital and earned an MPH focusing on hospital administration.


    Announcements and Implementations

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    Medhost responds to a whistleblower lawsuit in which two former IT employees of Community Health Systems claim that CHS fraudulently attested for Meaningful Use and that Medhost made false statements to earn Meaningful Use Stage 2 certification for its EHR. Medhost denies the allegations, notes that the federal government has declined to get involved in the lawsuit, and says that its software is successfully used by hundreds of facilities and continues to be chosen by sophisticated clients who have analyzed and compared it extensively.

    The American Academy of Family Physicians offers a Primary Care Innovation Fellowship to study EHR usability and support for primary care.


    Privacy and Security

    A study finds that 79 percent of medication-related Android apps share user data, most commonly their device information, browsing history, and email address. Four apps were found to share medical conditions and six sent the user’s drug list. Recipients include social media companies and two private equity firms. The study notes that HealthEngine, Australia’s most popular medical appointment scheduling app, shares user information with personal injury law firms without providing an opt-out option.


    Other

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    NHS’s new technology group surveys clinicians on what one technology change they would make, with the #1 answer by far being integration of patient records.

    A GAO report finds that two-thirds of air ambulance transports, which cost an average of around $40,000, are out-of-network for insured patients. That means they are billed for huge balances even though they didn’t make the decision to call in an aircraft instead of using ground ambulance. Air ambulance providers are prohibiting from balance-billing Medicare and Medicaid patients, but privately insured passengers are fair game.

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    The Kansas City lakefront estate of former Cerner CEO Neal Patterson is put up for online auction. The 13,000-square-foot house on four acres was built in 1993 by the development company owned by Patterson and Cerner co-founder Cliff Illig, which created the gated Loch Lloyd community in which the house is located. It is appraised at $3.26 million. Patterson died in July 2017.

    Several board members of University of Maryland Medical System resign or take leaves of absence following investigative reports indicating that one-third of the board members have business dealings with the health system, one of them being Baltimore Mayor Catherine Pugh, who says she’s a victim of a “witch hunt” in failing to disclose her deal. She sold the health system $500,000 worth of her self-published children’s books, of which not a single copy has ever been bought by anyone else.

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    I missed this earlier: Rochester Institute of Technology researchers begin commercialization of a cardiovascular monitoring system embedded in a toilet seat, which they expect to sell (via their Heart Health Intelligence startup) to hospitals hoping to reduce readmissions of congestive heart failure patients. I assume it works better for women.


    Sponsor Updates

    • EClinicalWorks will exhibit at Endo Expo 2019 March 23-25 in New Orleans.
    • Hayes Management Consulting will host a networking event at the 2019 HCCA Compliance Institute April 8 in Boston.
    • Imprivata will exhibit at Texas HIMSS March 25-26 in Austin.
    • InterSystems will exhibit at the AMIA Informatics Summit March 25-28 in San Francisco.

    Blog Posts


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    Contacts

    Mr. H, Lorre, Jenn, Dr. Jayne.
    Get HIStalk updates. Send news or rumors.
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    News 3/20/19

    March 19, 2019 News 6 Comments

    Top News

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    A Kaiser Health News – Fortune article titled “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong” says the federal government’s Meaningful Use program cost $36 billion, yet 10 years later, the system is an “unholy mess.” It makes these points:

    • Malpractice and whistleblower lawsuits have exposed an underreported number of cases in which patients were potentially harmed by EHR problems.
    • EHRs remain a “sprawling, disconnected patchwork” of systems that now-unhappy users bought quickly to collect incentive payments.
    • Doctors aren’t allowed to publicly talk about observed safety issues because of “gag clause” requirements of either their employer or their EHR vendor.
    • A survey found that 20 percent of consumers found mistakes in their EHR records, most often involving medical history.
    • User customization makes it hard to compare safety records across health systems and sometimes the site’s own configuration creates the problem.
    • Experts note that while the EHR solved several problems, it created a big one lacking visual cues to assure clinicians that they are working in the intended patient’s record.
    • A MedStar usability study found that an ED doctor ordering Tylenol is faced with a drop-down that lists 86 options, many of them inappropriate for a given patient.
    • The article includes a brilliant comment from WellSpan SVP/CIO Hal Baker, MD: “Physicians have to cognitively switch between focusing on the record and focusing on the patient … I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to [entering a computer] record, and it’s a pretty complicated interface.” 
    • The urgency to dump money into the Meaningful Use program in 2009 – it was part of an economic stimulus program that targeted  “shovel-ready” projects – left too little time to consider interoperability or broader improvements an instead rewarded only widespread adoption.
    • EHR vendors rushed out aggressive sales tactics to get their place in the EHR Meaningful Use land grab, figuring they could fine-tune implementations afterward, leading to customer complaints and lawsuits over shoddy software and patient harm.
    • An unknown number of doctors and hospitals falsely attested to EHR use to earn incentive payments.
    • Patients still can’t get copies of their own medical records easily and inexpensively from hospitals.
    • Some patients who are suing for malpractice claim that hospital employees changed EHR entries after the incident and refused to turn over audit logs that would prove it.

    Thoughts on the “Death By 1,000 Clicks” Article (And Your Chance to Weigh In)

    This article was a good rehash of how we went from the first glimmers of Meaningful Use to today’s “unholy mess.” It doesn’t contain much of anything new for industry followers, but it will reach a mass audience as the Fortune cover story.

    The Past, Which By The Way, Can’t Be Changed

    • Healthcare was slower than most industries to adopt technology.
    • Meaningful Use was an ill-conceived, rushed stimulus project that paid EHR-resistant doctors to use (not necessarily buy) EHRs in government-mandated ways with the vague hope that patient care and cost would improve once they were in place.
    • The short payment timelines discouraged innovation as providers were forced to buy the same outdated systems they didn’t want before the government offered bribes.
    • EHR vendors fought for their share of the resulting taxpayer-funded windfall with aggressive sales tactics and over-the-top marketing that were a lot more sophisticated than the old EHRs that were gathering dust on their shelves.

    Provider Greed Made Today’s Undesirable EHR Situation Possible

    • Hospitals and practices bought whatever inexpensive, quickly implemented system would get their faces into the government trough as quickly as possible.
    • They did the bare minimum required to earn incentives.
    • The government used the honor system of unverified attestation to trigger checks, leading some providers to lie.
    • In the case of larger practices and most hospitals, they didn’t ask (and didn’t really care) what physician users thought of the systems they considered before buying.
    • They customized new EHRs to work like paper charts and their old systems.
    • They under-invested in training, physician support, and optimization, opting instead to push the decisions of committees – often with minimal user involvement – to the front lines.
    • Freshly armed with the technical means to allow easy sharing of patient data, they have refused to do so.
    • They didn’t allow doctors to publicly share EHR-related patient safety information because of malpractice concerns, competitive worries, and the lack of incentive to help someone else’s patients.

    The Challenges to Making It Better

    • Doctors and hospitals don’t believe in standardizing processes, either within their own organizations or across competing ones. They all believe they have a self-developed secret sauce that is better than everyone else’s. The same patient will receive different care depending on where they go in the absence of “one best way.” You don’t want to be the developer that has to code around that.
    • Doctors and other clinicians are the only professionals who are expected to perform their own clerical work and to perform data entry during professional encounters. Hospitals are willing to force their doctors to perform tasks that other professional employers (law firms, accounting practices, and even dental practices and veterinary practices) would find not only insulting, but a waste of highly-paid resources when lower-skilled employees could do the work.
    • The executives who require doctors to use computers generally don’t use them themselves.
    • Only a tiny part of what is entered into an EHR directly contributes to patient care and the user of that information is often not the person who enters it.
    • Doctors don’t like to have bosses or to have their decisions questioned, yet ancillary departments and EHRs catch and prevent their mistakes regularly, creating tension between doctors and almost everyone else, especially when the doctor is not a hospital employee. Everybody thinks they understand patient care – or at least their particular pet aspect of it — better than everyone else.

    The Big Question: What Would An EHR Look Like If Clinicians Designed It For Themselves?

    We will never know because clinicians don’t drive our healthcare system. It’s mostly overseen by hospital and practice executives, insurers, regulators, and the government. I would also wager that getting consensus would be impossible since nearly every doctor mistakes their opinion for irrefutable fact.

    There’s also the question of whether clinicians have enough of a broad view to design software that will be used by thousands of users. EHR design is the de facto consensus of a broad swath of users in the most heavily represented specialties and user configuration options are the safety valve for practice deviations (which is why EHRs are so deeply configurable).

    It’s also a pie-in-the-sky fantasy that a clinical system should be as easy to use as Facebook, Amazon, or an IPhone. It’s true that those systems empower their users with smart design, but their functionality is comparatively simple and users are motivated because their purpose is largely recreational.

    The Bottom Line

    EHR vendors are incented to create the systems that customers will buy. Companies selling well in a contracting EHR market Cerner, Epic, EClinicalWorks, etc. – are delivering what customers want (“customers” not necessarily being synonymous with “users.”) They have no incentive to build products that everybody hates, and given the competitive environment, they would do whatever they can to gain market share.

    The underlying business model drives EHR design, and that’s what a lot of clinicians don’t like (and especially their place in it). That resentment gets pushed both down and up.

    There’s still an immediate need for not only allowing, but encouraging system users to publicly and anonymously report patient-endangering software bugs. Vendors have not done a good job in pushing these notices out, and even in cases where they do, word doesn’t always filter down from the hospital’s IT department to end users.

    Now Comes Your Part

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    Enough griping about EHRs or leaving laypeople to draw their own conclusions about them. What would you change? Tell me here,  be specific, and assume (as EHR vendors are expected to do) that our screwy US healthcare system is off the table.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

    Previous webinars are on our YouTube channel. Contact Lorre for information.


    Acquisitions, Funding, Business, and Stock

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    Health Catalyst hires bankers to initiate its IPO.


    Announcements and Implementations

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    Apple quietly rolls out new models of the IPad Air and IPad Mini. The former has a larger display, a processor that’s three times faster, and support for the Apple Pencil, while the latter hasn’t changed much except to add Pencil support (and thus supports high-margin Pencil sales). Apple seems more focused on the impending announcement of its video streaming service and other high-margin, non-commoditized services.

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    Sopris Health claims that its chat-powered digital assistant app allows clinicians to create a visit note in 45 seconds, or the time required to walk from one exam room to the next. Co-founder and CEO Patrick Leonard previously worked for Aetna’s consumer technology group and was CTO of the symptom-checking app ITriage that Aetna acquired in 2011 along with its developer, Healthagen.  

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    A new KLAS report on the medical oncology technology needs of community cancer canters finds that Flatiron Health leads the pack, as Cerner, Epic, and McKesson Specialty Health lag in supporting workflows. Cerner and Epic also score poorly in connecting with EHRs of other vendors.


    Government and Politics

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    A whistleblower lawsuit brought by two former IT employees of Community Health Systems accuses the for-profit hospital chain of submitting fraudulent attestations for Meaningful Use, reaping $544 million in incentive payments in 2012-2015. It adds that CHS acquired 60 hospitals of Health Management Associates that attested to Meaningful Use payments even though their Pulse EHR was poorly integrated and require printing paper at multiple stages during a patient’s stay. The lawsuit also claims that Medhost made false statements to get its EHR certified under Meaningful Use Stage 2. The former employees also say that CHS used Medhost partially because of illegal kickbacks in the form of providing free Medhost Financials with the purchase of its clinical applications.

    The White House’s US Digital Service says the VA’s newly developed online eligibility tool for veterans who seek private care under 2018’s MISSION Act is so flawed that it should be scrapped. warning that it will be slow, will cause errors, and will require an extra 5-10 minutes for each appointment booked. The report says VA contractor AbleVets isn’t the problem – it’s the VA’s poor oversight and a rush to bring the system live in June without adequate testing or integration with six existing VA systems. VA doctors are already pushing back, with one saying, “These people are out of their minds. We aren’t housekeepers, doorkeepers, or garbage men.” The VA says it needs $5.6 million to finish work on the system, which it says will cost $96 million in this fiscal year. An inefficient approval and scheduling process caused major delays in the VA’s 2014 rollout of a similar program, creating the need for this new project.


    Other

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    Samuel Shem, MD – who in 1978 wrote what might be medicine’s most enduring novel in “The House of God,” which is a lot like MASH except more clinical and more cynical– calls EHRs “the new bullying to all of us in medicine.” He calls EHRs “an epic intrusion and frustration in our doctors’ lives” that require more time than actually delivering care, He also notes that EHRs are billing machines that have not been proven to improve safety or quality of care. I’ve read “House of God” many times and hereby give you some teasers to encourage you to do the same:

    • “The delivery of good medical care is to do as much nothing as possible.”
    • “It’s an incredible paradox that being a doctor is so degrading and yet is so valued by society.”
    • “Gomers (Get Out Of My Emergency Room) are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We’re cruel to the gomers, by saving them, and they’re cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them.”
    • “To do nothing for the gomers was to do something, and the more conscientiously I did nothing, the better they got.”
    • “It ain’t easy to do nothing, now that society is telling everyone that their body is fundamentally flawed and about to self-destruct. People are afraid they’re on the verge of death all the time.”

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    For more insightful medical wit, check out retired ED doc and author Rada Jones, MD, who describes herself as, “I speak like a vampire since I lived most of my life in Transylvania” and who just relocated to Thailand with her husband. She offers “47 Tips to Keep You Away From My ER” (which actually contains 49), one of which is, “NEVER EVER stand around minding your own business. It’s the most dangerous thing known to man. 90 percent of my assault victims were doing just that.”

    Glen Falls Hospital (NY) reaches a confidential settlement with Cerner over the $38 million of revenue it lost due to billing problems after go-live.

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    A study finds that implementing EHR-generated severe sepsis alerts didn’t improve treatment performance measures or patient outcomes. Two-thirds of the alerts were true positive, but only eight percent of those doctors used the EHR sepsis order set, with two-thirds saying they would rather enter their own orders and 58 percent expressing skepticism about whether the alert captured a meaningful change in clinical status.

    Stat notes that despite the hype associated with Stanford’s widely reported study of the Apple Watch’s ability to detect atrial fibrillation, it’s hard to look at the overall effects since the study was not a randomized controlled trial and instead just observed what users experienced. It did not look at false positives, how many doctor visits resulted, the conclusions from those visits, and whether wearing the Watch can actually improve the health of a large population.

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    Doctors in England express concern about fast-growing online visit provider Babylon, which NHS has embraced under its GP at Hand program. Local NHS cost have skyrocketed as 40,000 Londoners have joined Babylon’s program, which as a medical group requires people to leave their local practice (which patients often don’t understand), creating economic upheaval under NHS’s per-patient payment model that looks at where the practice – not the patient – is located. Doctors also complain that Babylon attracts the most easily managed patients, sticking them with the more complex ones under the fixed payment. Insiders also raise questions about the company’s AI-powered chatbot, which sometimes delivers flawed results and has not  been peer-reviewed.

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    At least 48 adult strangers find that they are half-siblings after taking home genetic tests and sharing their results, their newly discovered father being an Indiana fertility doctor who admits that he used his own sperm instead of that of donors in the 1970s and 1980s. Meanwhile, some former writers for “The Onion” launch a home DNA testing parody site called “DNA Friend.”


    Sponsor Updates

    • AdvancedMD will exhibit at NATCON March 25-27 in Nashville.
    • Aprima will exhibit at the AIMSVAR Annual Conference March 21-22 in San Antonio.
    • EClinicalWorks publishes a case study of the implementation of ECW’s population health management tools at Adult Medicine of Lake County (FL).
    • Avaya announces further integration with Google Cloud Contact Center AI.
    • Bernoulli Health becomes an Affiliate member of the Intel IoT Alliance; its Bernoulli One solution has been named an Intel IoT Market Ready Solution.
    • Culbert Healthcare Solutions will exhibit at AMGA March 27-30 in National Harbor, MD.
    • Divurgent launches a data and analytics approach to address physician burnout.

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