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News 10/18/19

October 17, 2019 News 1 Comment

Top News

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Nuance and Microsoft will co-develop ambient sensing and conversational AI software to enable physicians to pay more attention to their patients instead of on administrative tasks.

Building upon Nuance’s ambient clinical intelligence software (on display at HIMSS earlier this year) and Microsoft’s intelligent scribe service, the new technologies will be rolled out to select end users early next year.

Initial capabilities will include ambient listening, wake-up word, voice biometrics, signal enhancement, document summarization, natural language understanding, clinical intelligence, and text-to-speech. 


Reader Comments

From Henry W. Jones, III: “Re: Epic’s redacted contract that appeared in the SEC filings of Ardent Health Services. Any assessment that the redaction is moderate and the contents are not worrisome (such as the absence of a gag clause) are overconfident. The redaction leaves holes and many provisions that could be contained but not shown (such as IP claims, liability shifting, unique terms and conditions). We know that Epic demands more redactions and secrecy than other EHR vendors and than vendors in non-medical industries. For example, the contract omits in its litigations listing the Epic vs. Tata saga, which involves over 1,000 court pleadings and an initial Epic jury verdict of $900 million (later reduced to $400 million per state statutes). Latency also yields uncertainty and this was a contract signed eight months ago and posted on the SEC seven months ago, so we don’t know what might have changed. The long-term, non-obvious industry impacts of locking customers into EHR contracts merits serious, granular analysis; the devil is likely to be in the many details that are missing here.” Hank is an IT lawyer and consultant. I interviewed him in 2016.

From Skimmer: “Re: HIStalk. How does anyone find the time to read it all?” Many readers think reading everything here provides positive ROI, and I certainly hope that’s the case. I’ve already surfaced the most important or interesting items among the junk, so it’s up to them to pick the parts of what I run that will be most impactful to their careers as professionals who should be taking the time for continuing (and continuous) education. But if they don’t have the time, the news posts run just three times per week (which is a minimal time investment since it’s broken out into easily skippable sections), the Weekender summarizes the week’s biggest news each Friday morning, and the absolutely most important stories appear in my daily headlines. I hope the 90% of readers who say reading HIStalk helps them do their jobs better are finding it worth their time and thus mine.


Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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


Sales

  • Novant Health (NC) will implement telemedicine services from TytoCare.
  • SwipeSense selects health data integration capabilities from Redox to ensure that its RTLS applications are interoperable with any EHR.

People

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Goliath Technologies names Stacy Leidwinger (Nuance) as chief marketing officer.

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Heather Trafton (Steward Health Care Network) joins Arcadia as COO.


Announcements and Implementations

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Champlain Valley Physician Hospital transitions to Epic as part of a $152 million system-wide deployment within the University of Vermont Health Network.

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Mid-Valley Hospital and Clinic (WA) goes live on Cerner Millennium.

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Lightbeam Health Solutions reports that ACOs that attained a positive savings rate using its population health management technology achieved $602 million in shared savings over the five-year Medicare Shared Savings Program.

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A new KLAS report finds that the HIE technology market is moving to broader use of aggregated data, with advanced users of Allscripts and InterSystems most likely to be using those systems for advanced use cases. KLAS notes, however, that less-advanced users of the Allscripts DBMotion product report dissatisfaction with getting the system up and running, Health Catalyst is consistent in its support but behind in keeping technology promises, Orion Health users say the platform is too rigid to support innovative use cases, and InterSystems customers are strongly satisfied across the board, giving it the highest purchasing energy among the four companies.

WVU Medicine (WV) begins enrolling patients in the National Cancer Institute’s Cancer Moonshot program, one of six organizations funded to use technology to enable patients to report and manage their cancer treatment symptoms.  WVU will use its Epic MyChart to answer patient questions (which can include images or files) and to send out routine surveys, with the patient-entered information flowing back into Epic. 

Philips adds the new Sentry Score predictive algorithm to its ECareManager telehealth software, giving clinicians the ability to prepare for patient ICU interventions in under an hour.


Government and Politics

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The VA launches a multi-site pilot program that will give veterans access to telemedicine services at local VFW or American Legion posts using Internet-connected healthcare pods developed and donated by Philips.

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Former VA Secretary David Shulkin, MD authors “It Shouldn’t be This Hard to Serve Your Country,” a book about his 13 months working in the Trump Administration.


Other

The NFL is rolling out a prescription drug monitoring program as part of its more focused efforts on monitoring pain management and opioids. First announced in May, the league’s PDMP will also be used by unaffiliated physicians.

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A Nor’easter takes down the EHR and other systems Thursday morning at hospitals that are part of Northern Light Health in Maine.

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The Colorado Sun profiles the ways state-based hospitals are using AI and machine learning, with innovations ranging from “digital sitter” remote patient-monitoring efforts, to algorithms that predict and cut treatment time for patients at risk for sepsis, to algorithms that can help radiologists identify areas for concern more quickly and accurately. HealthOne CIO Andy Draper says, “We’re right in the very beginning of it. There are a lot of tools that will pop up and we should embrace and love them all and then over time we’ll see what their real potential is.”


Sponsor Updates

  • EClinicalWorks will exhibit at the TACHC Annual Conference October 21-22 in The Woodlands, TX.
  • Healthfinch will exhibit at the Group Practice Improvement Network Semi-Annual Conference October 23-25 in Portland, OR.
  • The Chartis Group names Aaron Bujnowski (Texas Health Resources) director and leader of the company’s integrated delivery network segment.
  • Healthwise will exhibit at Allscripts ACE HHS October 21-23 in Dallas.
  • Glytec forms a Quality Team to help health systems adopt best practices in glycemic management.
  • InterSystems will exhibit at the Gartner Symposium/ITxpo October 20-24 in Orlando.
  • Yukon Health and Social Services in Canada will upgrade its Meditech system next year.
  • Black Book names Nuance the top vendor for end-to-end healthcare coding, clinical documentation improvement, transcription, and speech-recognition technology.

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News 10/16/19

October 15, 2019 News 6 Comments

Top News

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Northwell Health extends its Allscripts Sunrise contract through December 2027.

Northwell’s 19 hospitals have been live on Sunrise since 2005, making it the largest customer of Allscripts.

Northwell extended its Allscripts TouchWorks agreement in 2018. 

MDRX shares rose 1.4% Tuesday after the announcement, performing slightly better than the Nasdaq Composite index for the day.  


Reader Comments

From Grim Sleeper: “Re: Allscripts and Northwell. What are the odds that their collaboration will result in a commercially viable inpatient product that can compete with Epic or Cerner” Zero, my reasoning being thusly even though all of us should be wishing for new inpatient EHR competitors:

  • Allscripts says the new product will be based on Avenel, which is targeted to ambulatory practices but hasn’t sold well in its 18-month history. The company has admitted to stock analysts that it misjudged market interest in a cloud-based EHR that doesn’t offer a paired practice management product, which is a significant oversight for an EHR/PM company.
  • Northwell said in the Allscripts press release that Avenel is immature and its usability needs help from Northwell’s experts, a comment that I’m surprised Allscripts approved.
  • Allscripts has a low-and-dropping inpatient market share in which Sunrise has been replaced with broader, integrated offerings from Cerner and Epic. Northwell will continue using Sunrise for inpatient.
  • Custom developing a product around a key customer’s specifications is a strategy that usually fails miserably except for that one customer, who gets their quirks and petulant demands baked into code that someone has to try to sell to the next hospital. Coding to spec as a follower than a leader is not the best way to create an innovative product that the broad market wants.
  • My conclusion is that Northwell took advantage of knowing it had Allscripts over a barrel as its largest client. I obviously haven’t seen the contract, but I would bet that Northwell is the big financial winner, Allscripts saves face and slings a Hail Mary about a new product (created by improving a not-new product), and we will see in future Allscripts earnings reports whether the new R&D costs and possibly lower revenue contributions from Northwell can be offset by increased additional revenue.
  • The key metrics to watch are overall EHR market share and Allscripts stock price. MDRX shares are up 10% since Paul Black took over as CEO in late 2012, vs. the Nasdaq’s 167% gain and Cerner’s 75% rise, and have shed 23% in the past year.

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From Market Watcher: “Re: Epic contracts. They’re usually a source of mystery, but a moderately redacted copy of one popped up on SEC’s Edgar. I don’t see anything that looks like a gag clause, although there’s a lot of concern about protecting Epic’s IP.” The contract between Epic and Ardent Health Services doesn’t contain anything shocking:

  • Clients pay higher Epic fees as their usage increases.
  • Clients must be current on all Epic payments before bringing a new module live.
  • Disclosure of Epic confidential information is prohibited, and if required by law (such as Freedom of Information Act requests for contract details), the client must notify Epic beforehand and cooperate with Epic to get the legally required disclosure stopped.
  • No non-disparagement clause is present in the redacted version, but the customer is required to make each user sign an agreement to keep Epic’s confidential information confidential. That information includes functionality descriptions, source code, data structures, and implementation methods. Screen shots, which are the most contentious items in that arise in sharing information about system problems among users, aren’t mentioned specifically but probably fall within functionality descriptions (as does documentation, which Epic protects vigorously). 
  • Use of third parties for implementation, staff augmentation, training, support, and hosting is limited to those companies that have signed an agreement with Epic and that have agreed not to hire employees of clients or of Epic.
  • Use of source code, data structures, and APIs can’t be used to develop a product that competes with anything Epic offers or that is “reasonably anticipated Epic software.”
  • The customer is not allowed to solicit or hire (as either an employee or contractor) anyone who has worked on an Epic implementation within the past 12 months without the previous employer’s permission and Epic won’t “work with or provide training” for those exceptions.

From NH: “Re: Novant Health. Creating an innovative electronic patient and family advisory council.” Novant will survey volunteer council members about patient room decor, food quality, and nicer waiting rooms. I’m all for those things, but what I really want from a hospital is for them to put my interests ahead of their profits, develop and follow sound clinical protocols, give me access to caring and highly skilled providers, and send me home vertically and better than when I entered. I might enjoy having better coffee or softer chairs at the oil change place, but that’s not much consolation if the tech uses the wrong filter, doubles my cost by acquiring competitors, or claims to be concerned about my car’s overall health when what they really want is to sell me more services. Consumers can see only the most superficial aspects of healthcare and they assume that they don’t need to worry about the rest, which is not true at all.

From Billing Boy: “Re: patient estimates. They are often wrong, this study finds.” It’s easy to get worked up about patients being charged more than they were told to expect (which would be shocking in any business except healthcare), but portraying those hospitals as dastardly rather than incompetent misses the point. Healthcare billing is so arbitrary and complex that even the hospital itself has no idea what will be billed until after the fact, when all the revenue-obsessed hospital departments have picked the insurance bones clean. Here’s an easy test – give a hospital an anonymized copy of the clinical records from someone’s inpatient stay at their own facility and ask them what they think the itemized bill would look like (no dollar amounts, just which line items the patient would be billed for). It would have little correlation to the bill they actually sent to the patient. Hospitals are right that they don’t know what a given patient needs until they have already provided it, but it’s a mistake to ensure that the variability between estimates and actual bills is strictly due to clinical uncertainty or insurance surprises.


HIStalk Announcements and Requests

Thanks to Jenn for covering my absence of a few days for vacation. I kept up with what she was writing and sent her items that looked interesting, but otherwise spent close to zero time using any computing form factor. Other than the many “circling back” and “pinging you again” re-sent emails from PR people who can’t grasp that not everyone stays online 24×7 or finds their self-serving announcements to be of top importance, I saw no evidence that anyone even noticed my absence, which is how it should be.

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I rarely think of Forbes as an objective, insightful news publication and this doesn’t change my mind – the company has launched a vanity publishing press and is paid-spamming LinkedIn with boilerplate invitations to “business leaders” who are willing to rent the Forbes nameplate to repackage themselves as quote-worthy experts a la “The Art of the Deal.” Its partner company touts that lazy executives can create an industry-captivating book in under 24 hours. Healthcare clients include former CMS Deputy CIO Henry Chao and about a zillion attention-seeking dentists. 


Webinars

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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


Acquisitions, Funding, Business, and Stock

Cerner will lay off 350 California employees following Adventist Health’s decision to bring its revenue cycle operation back in house from Cerner RevWorks. Cerner says Adventist Health has offered to hire all of the laid-off employees, while another 1,000 Cerner employees will swap their badges for those of Adventist Health.


Sales

  • Bozeman Health (MT) chooses Kyruus ProviderMatch to integrate patient access in its website and access center.

People

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Per-diem clinician hiring app vendor ConnectedRN hires Matthew Levesque (Athenahealth) as CEO.

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Industry long-timer Kim LaFontana, MBA (Medically Home) joins Livongo as VP.

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BHM Healthcare Solutions promotes Jean Neiner to president and CEO.

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Ajay Kapare (Ellkay) is appointed to the CHIME Foundation Board and its board of trustees.


Announcements and Implementations

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A new KLAS report looks at strategic mergers and acquisitions in healthcare IT, observing that about 40% of customers are happier afterward, 40% are less happy, and 20% see no impact. The percentage of customers anxious to bolt to a new vendor doubles after M&A when long-term customers resent the imposition of intentional nickel-and-diming, crappy support, and R&D slowdowns. Customers are better off if the acquirer is privately held and thus not desperate to pander to shareholders in chasing short-term profits at the expense of long-term strategy. KLAS concludes that M&A fails when the acquirer saddles the former company with layers of bureaucracy and sales-focused goals; fails to get its executives interested in the acquired company; makes grand promises that aren’t kept; and cuts back on support so that the resulting financial numbers make the acquirer’s executives look smart.

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Family history vendor Ancestry launches AncestryHealth, which will sell a $149 profile of genetic screening results that are matched to specific medical health conditions, as well as a more expensive, membership-based service that provides deeper screening and quarterly screening updates. The company has contracted with an independent physician group to order the tests. Stat notes that the tests of competitor 23andMe are regulated by the FDA since consumers order them themselves, while AncestryHealth won’t get FDA oversight because the tests are ordered by doctors but instead will be under CMS’s physician-ordered diagnostic testing rules. Experts note that only 2% of patients who don’t have a family history of a disease will learn something new from such tests, while others say that genetics accounts for less than 10% of longevity, but lack of rigorous science doesn’t usually stand in the way of companies making big money from irrational health concerns (see: Goop). 

A Black Book provider survey of vendors of software and services for coding, clinical documentation improvement, and HIM finds Nuance topping most categories, but Optum360, MModal, Dolbey, Adadyne, Qventus, and Fujitsu also finished first in some areas.

Nvidia and King’s College London create a platform that allows organizations to contribute their imaging data for machine learning-powered brain tumor research without copying it offsite or sharing it directly, with the federated learning system keeping patient data confidential.

Canada-based EHR vendor Premier Health Group will add AI from IBM Watson to its telemedicine app to use a chatbot to reduce clinician time on each call.


Other

In Australia, the new head of EHealth Queensland says its struggling Cerner implementation can be turned into a showcase project, but urges all of the state’s health bodies to help in getting new sites live while optimizing existing ones.

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A reader sent this article about Shots Heard Round the World, a “rapid-response digital cavalry” that helps providers whose vaccine-related social media messages – such as “flu vaccine has arrived – get your shot today” — trigger an electronically mobilized torrent of negative comments, scathing Yelp and Google reviews, and threats from anti-vaxxers from around the world. The group was founded by two employees of Kids Plus Pediatrics, a Pittsburgh area practice that was attacked relentlessly after it published a video explaining the value of HPV vaccine in preventing cancer. They offer the highly detailed and excellent Kids Plus Anti-Anti-Vaxx Toolkit to help practices defend themselves online harassment. Fascinating to me is their analysis of who created the 10,000 negative anti-vaxx comments on their site:

  • 95% were female, most of them either of age 18-24 or over 50.
  • The vast majority were uneducated and either unemployed or underemployed.
  • Attackers were mostly extremist in their politics, both to the left and the right.
  • Every single person who visited the practice’s Facebook page during the eight-day siege whose profile photo featured one of those dopey filters was an anti-vaxx attacker.

In England, a hospital won’t be fined the prescribed $190,000 for 600 incidents in which it placed male and female patients in the same room. The hospital says it has a zero-tolerance approach for mixed-sex rooms, but then stretches the definition of “zero tolerance” by adding that it sometimes does it anyway when all beds are full. NHS England says mixed-sex rooms are detrimental to safety, privacy, and dignity, which it fails to note are already endlessly compromised throughout all aspects of hospital care, but especially when any patient is forced to room with another. Imagine if a hotel did this, even without all employees running in and out, awkward moments involving specimen collection and bedpan usage, receiving visitors, and being separated by just a thin curtain from a dying, moaning, or loudly delusional roommate.

Odd: the elected part-time coroner of an opioid-ravaged Ohio county is charged with illegally prescribing 1.5 million opioid doses over two years and fraudulently billing Medicaid and Medicare in his day job as a pain management doctor. On the other hand, he donated to the county’s Staying Clean Club and its drug task force, so there you go.

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Even odder: Tampa General Hospital opens an OnMed telemedicine consult and drug dispensing booth in its food court so that its employees — who are inside its walls — can seek medical care from clinicians who aren’t. Maybe this is a Halloween-appropriate “the call is coming from inside the house” type situation. It’s not really an admission that employees don’t have time to deal with their own hospital employer’s bureaucracy as patients – the hospital is in business with the vendor and this first booth is a pilot for a broader rollout. The hospital CEO says millennials won’t wait to see a doctor in person, which if you’re a doctor who actually wants to care for patients, is depressingly accurate. The oldest millennials are now in their late 30s, so it would be interesting to see how those who are doctors run their practices and patient encounters.

Georgia lawmakers will require the state’s rural hospital CEOs, CFOs, and board members to complete eight hours of classes in financial management and strategic planning (in an apparent lack of irony).


Sponsor Updates

  • Netsmart processes a record 300 million secure transactions through its CareFabric solution suite in a single month, triple the number of a year ago.
  • AdvancedMD will exhibit at ASDS October 24-27 in Chicago.
  • Apixio will exhibit at the RISE HEDIS & Quality Improvement Summit October 23-25 in Miami.
  • Culbert Healthcare Solutions will exhibit at the Association of Administrators in Academic Pediatrics meeting October 17-18 in Miami.
  • Cumberland partners with Chronicled’s MediLedger Project to advance blockchain supply chain networks for pharma manufacturers.
  • Dimensional Insight will exhibit at the Massachusetts Health & Hospital Association event October 18 in Burlington.
  • ONC names Surescripts as an ONC Program Partner for Electronic Prescribing, proving EHR vendors an alternative test method to ONC-ATL.
  • Netsmart will present and exhibit at the American Health Care Association/National Center for Assisted Living 2019 Convention and Expo through October 16 in Orlando.
  • Prepared Health will exhibit at HLTH, October 27-30 in Las Vegas, as part of the Matter Showcase Pavilion.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 10/14/19

October 13, 2019 News 12 Comments

Top News

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Centra (VA) resumes billing and collections after a three-month hiatus caused by glitchy Cerner software that hospital officials say led to rejected claims, delayed billing, incorrect bills, and prematurely sending patients to collections for lack of payment. The $73.5 million Cerner system was installed in 2018, but Centra’s financial team didn’t notice any problems until a few months later. It estimates that 2,200 incorrect billing statements have been sent out.

To rectify the problem, Centra is rebooting its billing cycle, giving impacted patients a 5% discount, and making sure that its customer service reps have had Cerner-specific training so that they can be more empathetic to patients with billing problems.

Centra will continue with the second phase of its Cerner implementation at remaining ambulatory and post-acute care sites next year.


HIStalk Announcements and Requests

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A majority of respondents would have no problem using employer-approved providers if it resulted in a discount on their employer-sponsored health plan. Nevertheless offers the employer perspective: “We have employees who work in at least 5 states today and that will grow. This approach is not at all manageable for a company like ours. I want to be LESS involved in my employees’ healthcare access, not more. I’m ok with paying for healthcare coverage for my employees – but I don’t want to micromanage how they get those services.”

MerryMe offers the employee’s: “Absolutely not. Employers shouldn’t be involved in healthcare – AT ALL. Not insurance. Not in/out of network. Not hey, save $100 if you stop smoking. If my employer or co-worker wants to send around an email saying ‘had great experience at XYZ’ or ‘hey, I found this website and maybe you can save on your Rx like I did,’ fine. Want to do a benefit dinner for a fellow employee who has cancer? Great. Otherwise, keep your nose and ‘help’ out of my business. I don’t trust that costs for types of procedures are not being shared with the employer – and what I’m seeking care for is none of my employer’s business.”

And Sorry that of the too-young-to-need-it: “As a young person who doesn’t use any healthcare right now and expects not to work at a place longer than five years, I’ll take that deal and then continue never going to the doctor. I would be interested to know how much of the cost of health insurance you could knock off this way though. I get the feeling that I’m subsidizing the old people’s healthcare at my company. Eventually we’ll move off employer-tied health insurance (since businesses are starting to hate it) and to something state-funded, at which point the young will still be subsidizing the old but 1. I’ll be old. 2. At least I’ll be able to see what’s going on rather than trying to interrogate my HR rep.”

New poll to your right or here: Would you avoid treatment at a hospital that has a history of suing patients for unpaid bills? Comments (anonymous or not) are welcome, especially if you’ve found yourself on the receiving end of relentless debt collectors.


Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

October 24 (Thursday) 1:00 ET. “The power of voice: Will AI-drive virtual bedside assistants become mainstream?” Sponsor: Orbita. Presenters: Nick White, co-creator of DeloitteAssist and principal in Deloitte’s Smart Healthcare Solutions practice; Bill Rogers, CEO and co-founder, Orbita. Conversational AI and virtual health assistants are bringing new opportunities to care facilities to improve patient journeys and yield radical workflow efficiencies. Will the hospital rooms of the future continue to provide traditional bedside call buttons? Or will these be replaced with digitally reimagined, AI-driven, voice-powered agents? Learn from the expert who created today’s industry-leading, market-proven, virtual bedside assistant.

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


Announcements and Implementations

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Alameda Health System (CA) goes live on Epic. AHS staff from what looks like every department put together this great video celebrating the install. The $200 million project was first announced at the beginning of 2018.

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Virtua Health (NJ) implements SymphonyRM’s Next Best Action CRM.

In Illinois, Pivot Point Consulting assists in the implementation of Christie Clinic’s Epic system through a Community Connect affiliation with Carle Foundation Hospital.

IBM Watson Health Imaging will discontinue support for its Merge Eye Station digital imaging technology and Merge Eye Care PACS by the end of 2020. Topcon Healthcare Solutions will offer transition assistance to Merge customers who want to transition to its Harmony data management system. IBM acquired Merge Healthcare in 2015 for $1 billion.

Brigham and Women’s Hospital (MA) will use digital lifestyle tracking and telemedicine tools from Fruit Street Health in a six-month brain health improvement study of patients at risk for cognitive decline and dementia.


Privacy and Security

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A look back at WannaCry’s impact on the NHS finds that the 2017 ransomware attack resulted in a $7.6 million loss due to a decrease in admissions and appointments. Over 600 NHS facilities were affected. The health service spent considerably more – some analysts estimate nearly $90 million – on IT to fix the fall-out.

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Men’s online health and wellness company Ro alerts customers to a potential breach that occurred when hackers attempted to access information on the laptop of an affiliate physician. The physician’s computer, which was the property of the MD’s health system employer, was infected with malware. Ro fired the physician for violating its Physician Code of Conduct by downloading unapproved software. CEO and co-founder Zachariah Reitano brings up a point relevant to telemedicine vendors who hire physicians with other employers: “The challenge Ro and others face is that, in addition to securing our own systems, we need to account for systems outside of our direct control. Ro has taken and will take a number of steps to implement additional security measures to help further protect personal information, including enhancing the security on our physicians’ computers.”


Other

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Stanford Medicine (CA) hosted its second annual EHR National Symposium featuring speakers from its health system, Epic, ONC, UnitedHealthcare, Microsoft, Cleveland Clinic, Cerner, and Livongo, among others. Videos from the event should be on the symposium’s website soon.

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Researchers find that opioid dosages decreased 22% per new prescription after the University of Pennsylvania Health System implemented EHR alerts in New Jersey practices notifying prescribers if prescriptions exceeded the legal five-day limit.

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Researchers at UC San Francisco’s new Center for Intelligent Imaging will work with Nvidia’s AI computing technology to develop new solutions for radiology. Ci2’s initial work will focus on an NIH-directed project using AI and data analysis to evaluate chronic back pain.


Sponsor Updates

  • Elsevier rebrands its Via Oncology cancer care management and clinical decision support tool to ClinicalPath.
  • The Women Tech Council honors Health Catalyst Chief People Officer Linda Llewelyn with its award for culture leadership.
  • Mobile Heartbeat will host an event on Enhancing Clinical Communications October 16 in Dallas.
  • Netsmart will exhibit at the NAHC Annual Meeting October 13-15 in Seattle.
  • PMD adds a two-click Instant Capture option to its Charge Capture software.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at AWHONN WA Fall Meeting October 13-15 in Bremerton.
  • Authority Magazine features “’5 Things I Wish Someone Told Me Before I Became CEO of Experity,’ with David Stern.”
  • Redox will host its Interoperability Summit October 15 in Boston.
  • The Touch Point podcast features StayWell President Pearce Fleming.
  • Surescripts will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
  • Vocera will exhibit at the Indiana Organization of Nurse Executives Fall Conference October 16-18 in French Lick.
  • Spok publishes a new e-book, “Why the future of healthcare is in the cloud.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 10/11/19

October 10, 2019 News No Comments

Top News

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Mednax will sell its MedData RCM software and services business to private equity firm Frasier Healthcare Partners for up to $300 million.


Reader Comments

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From RWJBetter Believe It: “Re: RWJBarnabas Health’s rumored conversion to Epic. Looks like the rumblings have been confirmed: “We’ve announced the move to the Epic IT platform, and in 2020 that project will kick off in earnest. We view this move as transformational for our organization; it will allow us to truly connect all of our healthcare assets in a deeper way than they have been connected in the past.”  As Barnabas Rubble first suggested here in June, the New Jersey-based health system – the result of the 2016 merger of Barnabas Health and Robert Wood Johnson Health System – will finally bring all of its facilities onto one platform.

From anon: “Re: PeaceHealth layoffs. PeaceHealth just laid off more IT staff. Unlike their last round of layoffs in July, which was almost only people outside their Vancouver, WA office with the stated intent to centralize services, this round included Epic Analysts in Vancouver. Their upgrade goes live this week, no less.” The local news reports that this round is of 50 centralized support service staffers.

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From Vaporware?: “Re: The Brent Schafer AI story. I totally believe that is real. The head-scratcher is further down in the press release: ‘Stemming from Cerner’s collaborative work in the federal space, the company is soon to roll out “Cerner Seamless Interoperability.’ Questions: Will it be a new contract for Cerner, since they’re just now inventing and releasing it? Will it be based on their current ;federal space’ interoperability model of logging in to side-by-side workstations? How is it different from CommonWell, which has been sold as ‘Seamless Interoperability’ since 2013 (and still is not live in federal space)?

From Insider: “Re: Cantata Health. CEO let go and more layoffs coming. They have moved all support offshore, and clients are not happy. Talk about a sinking ship. The CTO and some finance people are now running the company.” Former CEO Krista Endsley’s LinkedIn profile confirms her departure after 18 months. The company’s sole C-suiter is CTO Rich Zegel.


Webinars

October 15 (Tuesday) 1:00 ET. “Universal Health Services Case Study: How to Improve Network Design and Management with Claims Data.” Sponsor: CareJourney. Presenters: Mallory Cary, regional director of ACO operations, UHS; Abbas Bader, director of product development, CareJourney. Universal Health Services (UHS), one of the nation’s largest hospital management companies, has more than 350 acute care hospitals, behavioral health facilities, and ambulatory centers across the US, Puerto Rico, and the UK. UHS has collaborated closely with CareJourney over the last three years in building high-performing networks in new markets, managing patient populations as they flow through those networks, and targeting areas for performance improvement within the network. Join the expert presenters for deep insights into network design and optimization.

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


Acquisitions, Funding, Business, and Stock

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Patient engagement vendor Relatient acquires patient self-scheduling and waitlist software developer Everseat.

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Care coordination, analytics, and value-based care software company Persivia raises $15 million in a Series C funding round.

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Three months after securing $73 million in funding, Omada Health announces an undisclosed investment from Intermountain Ventures. Intermountain Healthcare (UT) has worked with the digital chronic disease prevention company since 2016. Its diabetes services became a covered benefit for Intermountain employees earlier this year.

Harris Computer’s healthcare group acquires Brookfield, WI-based insurance enrollment technology vendor Connecture.


Sales

  • Greeneville Community Hospital East (TN) selects tele-ICU services from Advanced ICU Care.

People

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Nursing Informatics Boot Camp director Susan Newbold PhD, RN-BC will receive the Virginia K. Saba Nursing Informatics Leadership Award from the Sigma Theta Tau International Honor Society of Nursing at its meeting next month.

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Beth Israel Deaconness Medical Center physician and Society for Participatory Medicine co-founder Danny Sands, MD joins Backpack Health as CMO and VP of medical affairs.


Announcements and Implementations

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The Milford campus of Yale New Haven Health’s Bridgeport Hospital (CT) goes live on Epic. The health system wrapped up its system-wide go live in 2013; it added Milford Hospital several months ago.

The Harvard Pilgrim Health Care Institute will leverage Veradigm Health’s HealthInsights de-identified EHR database in its development of the FDA’s Sentinel drug- and product-safety monitoring system.

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Golden Valley Memorial Healthcare (MO) implements Meditech’s Sepsis Management Toolkit.

NewCrop will integrate OptimizeRx’s digital health messaging with its e-prescribing service.

Arrendale Associates adds NVoq’s speech-recognition capabilities to its Transcript Advantage software.

The Public Hospitals Authority in the Bahamas completes the first phase of its integrated health information management system implementation with help from Santa Rosa Consulting.


Other

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VCU Health (VA) announces it will no longer sue patients for unpaid bills after seeing the uproar caused by revelations that UVA Health filed 36,000 lawsuits over six years in an effort to collect $106 million. VCU’s physician group has filed 56,000 lawsuits to recover $81 million from patients over the last seven. “We don’t want to be a part of that,” says CFO Melinda Hancock. “We feel that taking care of the patient’s financial health is taking care of their holistic health.”


Sponsor Updates

  • Capsa Healthcare adds Imprivata’s identity and access management technologies to its CareLink Nurse Workstations.
  • Elsevier Clinical Solutions will exhibit at the National Association for Home Care & Hospice conference October 13-15 in Seattle.
  • EClinicalWorks, Ellkay, FormFast, and Kyruus will exhibit at MGMA October 13-16 in New Orleans.
  • Ensocare will exhibit at the ACMA Great Lakes Chapter Annual Conference October 11 in Novi, MI.
  • EPSi will host the Visis: 2019 EPSi Summit October 22-24 in Austin, TX.
  • Allscripts names Healthfinch’s prescription renewal delegation solution, Charlie, as its October App of the Month.
  • Healthwise and Intelligent Medical Objects will exhibit at the EClinicalWorks National Conference October 18-20 in Orlando.
  • InterSystems will exhibit at the DoD/VA & Gov Health IT Summit October 16-17 in Alexandria, VA.
  • Nuance expands Clinical Guidance for Dragon Medical Advisor, its AI-powered computer-assisted physician documentation capability available through Dragon Medical One.
  • Imat Solutions integrates Zen Healthcare IT’s Integration-as-a-Service and gateway solutions with its health data management technology.
  • Optimum Healthcare IT publishes a new case study, “Improving Provider Practice Efficiency at Southcoast Health.”
  • Phynd partners with MedTouch to offer health systems one-step appointment search and scheduling capabilities.
  • In a new video series, Wolters Kluwer Health takes a candid look at the nursing profession through the lens of practicing nurses.

Blog Posts


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News 10/9/19

October 8, 2019 News 3 Comments

Top News

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Researchers from the University of Pittsburgh School of Medicine and Humana determine that 25% of healthcare spending – between $760 billion and $935 billion per year – can be characterized as wasteful. They believe that $191 billion to $282 billion could be saved if interventions were put in place.

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The study looked at waste across six categories:

  • Failure of care delivery.
  • Failure of care coordination.
  • Overtreatment or low-value care.
  • Pricing failure.
  • Fraud and abuse.
  • Administrative complexity.

Administrative complexity was found to be the biggest driver. Researchers couldn’t estimate administrative cost-savings through interventions like more seamless interoperability and value-based care due to a lack of previous studies done on the topic – a sadly laughable, highly ironic state of affairs that those working in healthcare will likely not be surprised by.


Reader Comments

From EHRWhisperer: “Re: Advocate’s conversion. Advocate Aurora Health began it’s Cerner to Epic conversion in the first of four waves today at Advocate Condell Medical Center and Advocate Good Shepherd Medical Center. There were no major issues. The project will extend the existing Aurora Epic license to all twelve Advocate Illinois hospitals over the next twelve months. The merged system will be the largest single Epic database in the world.” The merger of Advocate Health Care and Aurora Health Care was approved in March 2018, resulting in an organization that has 27 hospitals, 3,300 employed physicians, 70,000 employees, and annual revenue of $11 billion. AHC was an Allscripts and Cerner site before the merger. Its conversion from Allscripts to Epic took place last December.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Filings with the Wisconsin Department of Natural Resources show that Epic intends to expand its Verona campus to accommodate another 1,200 employees over the next five years.

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WellSky acquires ClearCare, a San Francisco-based developer of cloud-based management software for home care agencies.

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One Medical reportedly hires several banks to help it prepare for an IPO next year. Valued at between $1.5 billion and $2 billion, the tech-heavy chain of membership-based primary care clinics has raised over $500 million since launching in 2007.


Sales

  • Lafayette General Health (LA) selects provider search, scheduling, and data management technology from Kyruus.
  • West Virginia University Health System selects IntelliGuide software and services from PatientMatters to connect uninsured patients with available benefits.
  • Salem Health (OR) will install Omnicell XT Automated Dispensing Cabinets at Salem Hospital.
  • The BCBS-managed Federal Employees Health Benefits Program signs a two-year contract with Livongo for its remote diabetes monitoring and coaching program.
  • Marshfield Clinic Health System will implement Sectra’s PACS at seven hospitals and 50 clinics.
  • Geisinger (PA) expands its adoption of Cerner’s HealtheIntent population health management software with a new 10-year agreement.

People

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Niki Buchanan (Philips Wellcentive) joins Jvion as SVP of customer success.

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Streamline Health Solutions names Wyche “Tee” Green president and CEO. He has been serving in those roles on an interim basis since July.

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Jerry Henderson, MD (MD Anderson) joins healthcare analytics company PotentiaMetrics as CMO.


Announcements and Implementations

Change Healthcare adds AI capabilities to its CareSelect Imaging decision-support software.

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InterSystems develops data cleansing and normalization services for use in machine learning and analytics applications.

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Devoted Health becomes the first Medicare Advantage plan to subsidize the Apple Watch purchases of its 4,000 members in Florida. Launched by health IT veterans Ed and Todd Park in 2017, the company has raised over $350 million and plans to expand to Texas.

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The Harvard Pilgrim Health Care Institute will use TriNetX’s EHR data network in its management of the FDA’s Sentinel System, a national program that uses digital health data to monitor the safety of FDA-approved drugs and medical products.

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Patients accessing Meditech’s Expanse or 6.0 EHR can now do so through the Apple Health app. 


Other

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Roadblocks to digital health market entry include a lack of expertise and rigid business and reimbursement models that make getting to market difficult, according to a recent survey of 284 healthcare professionals. Digital health clinician end users say poor reimbursement, lack of expertise, and privacy/security concerns hinder their decisions to purchase new products.

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Kaiser Health News looks at the small but growing trend of health systems getting into the housing business. Denver Health, for example, is converting a 10-story building near its campus to senior housing and transitional living for homeless patients who otherwise could occupy a hospital bed at a cost of up to $2,700 a night. The hospital estimates it could house a patient at its new facility for $10,000 a year, though transitional patients will be given help in finding more permanent housing within 90 days.

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The Cerner Health Conference gets into full swing today in Kansas City, MO. During his keynote, CEO Brent Shafer touched on interoperability improvements; new cloud-based technology dubbed “Project Apollo” that will leverage the company’s previously announced partnership with AWS; AI and analytics enhancements to its opioid toolkit; and free online training tools.


Sponsor Updates

  • Cambridge University Hospitals NHS Foundation Trust saves $3.15 million in equivalent staff time and reduce turnaround time after implementing medical device integration technology from Capsule Technologies.
  • AdvancedMD will exhibit at the AAO meeting October 12-15 in San Francisco.
  • Clinical Architecture will exhibit at Epic’s App Orchard Conference October 16-18 in Verona, WI.
  • CoverMyMeds and Culbert Healthcare Solutions will exhibit at MGMA October 13-16 in New Orleans.
  • Dimensional Insight will exhibit at the New England HIMSS HIE event October 10 in Worcester, MA.
  • Goliath Technologies exhibits at the Cerner Health Conference with new partner Igel through October 9 in Kansas City, MO.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 10/7/19

October 6, 2019 News 9 Comments

Top News

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DCH Health System in Alabama agrees to pay Russian hackers after an October 1 ransomware attack forced it to divert patients and revert to paper processes. Officials haven’t been able to pinpoint when systems will be back up and running normally: “We have been using our own DCH backup files to rebuild certain system components, and we have obtained a decryption key from the attacker to restore access to locked systems. We have successfully completed a test decryption of multiple servers, and we are now executing a sequential plan to decrypt, test, and bring systems online one-by-one. This will be a deliberate progression that will prioritize primary operating systems and essential functions for emergency care. DCH has thousands of computer devices in its network, so this process will take time.”

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DCH, plus hospitals in Ontario and Australia, attribute their recent ransomware attacks to Ryuk malware, named for a Japanese comic book character who can’t be destroyed by conventional human weapons. A total of 13 facilities were impacted, with all still in various states of recovery.


Reader Comments

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From concerned: “Re: Athenahealth. Athenahealth will be leaving the hospital market in the next few months.” A company marketing exec responded with this statement: “We continue to be active in the hospital market through our support and investment in the experience of our existing athenahealth hospital customers. We are also committed to our customers who use the Centricity Business product, and are actively building that customer base, investing in that product, and are focused on our relationships with hospital and IDN revenue cycle clients.”


HIStalk Announcements and Requests

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Responses are nearly evenly split, which isn’t surprising given the schismatic nature of healthcare these days. A deeper dive might look into insurance status, health savings accounts, employer contributions, and the like. The one thing I’m sure most respondents have in common is feeling an increasing squeeze on their wallets for healthcare services that may be hard to access and are priced so that they’ll never truly understand what they’re paying for until the debt collectors come calling. Mr. T says American patients fear the cost of a diagnosis more than the diagnosis itself, while North American attic laughs at the thought of a Canadian being in such a situation: “Deferred or declined recommended medical care for financial reasons? Canadians would not even comprehend the question.”

Nick van Terheyden paints a bleak but realistic picture for many: “Yes. At one end of my personal extreme I broke my ankle (or at least as best as I could tell clinically) but refused to visit any doctor or facility for an X-ray and treated myself with a boot that I had already been charged a huge sum of money for for a pervious fracture. I have told my family and any friends that I do not want an ambulance called under any circumstances – get me to a hospital if you must but by taxi or car. I don’t want my family lumbered with crushing medical debt from me. I buy my drugs overseas to save money – in bulk and at double strength, and use a pill cutter to save money. Were I to get cancer, I highly doubt I would take treatment given the debilitating nature of medical debt that accompanies this and the thought of leaving my family to lose what little we have to some large healthcare billing corporation. I’ll manage any chronic disease I have the misfortune of getting under any and all circumstances – again rather than be a burden to my family leaving them with debt they will struggle to pay. What a sorry commentary on a system that works precisely as designed.”

New poll to your right or here: For those with employer-sponsored health plans, would you be willing to use employer-approved providers if given a financial incentive to do so? As Walmart pilots a program that will do just that, and Amazon offers virtual employee care, I wonder how many of us would go that route to save a few bucks.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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NextGen Healthcare acquires Topaz Information Solutions, a NextGen reseller that works with behavioral health providers and social services organizations.

Court documents reveal that attorneys defending ex-Theranos CEO Elizabeth Holmes in a civil suit filed by former Theranos patients have asked to withdraw from the case because they haven’t been paid in over a year. The Cooley LLP lawyers believe they’ll never be paid given the “dire financial situation” of Holmes, whose blood-testing startup was once valued at $4.5 billion.


Decisions

  • Fayette County Memorial Hospital (OH) will switch from Medhost to Cerner in February.
  • Butler County Health Care Center (NE) will switch from Meditech to Cerner In November.
  • St. Francis Medical Center (NJ) will switch from Sunquest To an Epic Beaker laboratory information system in 2021.
  • Franciscan Health Rensselaer (IN) will switch from Omnicell to BD Pyxis automated dispensing machines next year.

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


People

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Retail pharmacy tech vendor OmniSys names David Pope chief innovation officer. Pope co-founded Strand Clinical Technologies, which OmniSys acquired in July.

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Peyman Zand (Community Health Systems) joins CereCore as VP of advisory services.


Announcements and Implementations

Banner Health (AZ)  implements online scheduling using Kyruus ProviderMatch for Consumers.

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Health Catalyst announces GA of Closed-Loop Analytics to offer providers deeper clinical insights within workflows at the point of care.


Privacy and Security

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UAB Medicine (AL) notifies nearly 20,000 patients of an August email phishing scheme in which hackers tried without success to divert automatic employee payroll deposits to an account they controlled.


Other

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Iris Kulbatski petitions the government of Ontario to enforce fee regulations related to accessing medical records after University Health Network charged her $1,100 to retrieve her late father’s medical records. She appealed the charges for the 3,000-page file, saying that the health system backdated its policy so that it could charge her – and other patients requesting digital copies – more. UHN eventually honored the newer policy, charging Kulbatski the $40 she originally anticipated.

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Hardware malfunctions in the sub-basement data center of $1.3 billion “superhospital” McGill University Health Centre in Montreal cause its computers and back-up system to crash. MUHC suffered a similar event last year when back-up generators failed during a blackout, and in 2013 when a goose got into the electrical system at an off-site vendor, starting a fire that eventually caused similar downtime.

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The local paper commemorates the centennial of South County Health with a look at how computers have impacted provider workflows (and lab hygiene) at the Wakefield, RI hospital. While SCH physicians acknowledge the game-changing benefits of electronic records, they bemoan the lack of interoperability when logging into five different EHRs every day. Cost is a big barrier to getting all systems on the same page. Hospital officials say it would cost $12 million to integrate its inpatient and outpatient systems. It pays $30,000 to $40,000 per year per physician to keep systems updated.


Sponsor Updates

  • Meditech will host its 2019 Revenue Cycle Summit October 8-9 in Foxborough, MA.
  • Mobile Heartbeat will exhibit at the ANCC Magnet Conference October 10-12 in Orlando.
  • Waystar, Experian Health, and Relatient will exhibit; and SymphonyRM will present at MGMA October 13-16 in New Orleans.
  • Netsmart will exhibit at the NAHC Annual Meeting October 13-15 in Seattle.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN 3rd Annual Fall Conference October 11 in Traverse City, MI.
  • PatientPing congratulates customer Bane Care Management on its silver ribbon in the McKnight’s Excellence in Technology Quality Awards.
  • Pivot Point Consulting, StayWell, Summit Healthcare, Surescripts, TransformativeMed, and Zynx Health will exhibit at the Cerner Health Conference October 7-10 in Kansas City, MO.
  • Redox will host its Interoperability Summit October 15-16 in Boston.
  • Vocera will exhibit at the ANCC National Magnet Conference October 10-12 in Orlando.
  • Wolters Kluwer Health releases an enhanced version of its Lipincott CoursePoint+ digital education solution for nursing education programs.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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News 10/4/19

October 3, 2019 News 7 Comments

Top News

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Not to be outdone by Amazon, Walmart announces it will pilot several programs across the country to connect its employees to healthcare services that it hopes will offer quality care at more affordable prices.

Featured Provider programs in Arkansas, Florida, and Texas will incentivize employees to use physicians in their areas that provide appropriate, high-quality care. Health data aggregator and analysis vendor Embold Health (the brainchild of former Walmart Care Clinics CMO Daniel Stein, MD) will provide Walmart with data it will use to create lists of physicians that the company will share with employees. Those who wind up seeing a provider not on the list will pay more for their benefits.

The company will try out a Personal Healthcare Assistant concierge service that will help employees in the Carolinas find providers, deal with billing, understand diagnoses, and find transportation and childcare.

Walmart has tapped Doctor on Demand, Grand Rounds, and HealthScope Benefits to offer employees in Colorado, Wisconsin, and Maryland expanded telemedicine visits at $4 a pop, as well as the option to access care coordination services.


Reader Comments

From PizzaSlinger: “Re: Adventist’s Cerner contract. Adventist Health West Coast is ending the contract with Cerner RevWorks after only 2 years on 11/4. Work will revert back to Adventist and employees have option to convert to Adventist at same pay rate. If employees do not convert they will lose employment on 12/1. Huron is taking over management functions as well. Around 300 employees are affected.” PizzaSlinger’s numbers line up with those of the Kansas City Business Journal, which reports that 360 Cerner staffers will be impacted by Adventist’s decision. At least half of those probably came over from Adventist when the health system started outsourcing jobs last year.

From SoftwareSavvyShrink: “Re: Appriss Health’s acquisition of OpenBeds. I found it interesting that you highlighted the Appriss Health acquisition of OpenBeds software aimed at helping connect behavioral health patients with inpatient and outpatient care. This is a prime example of a technological workaround to a system defect. No matter how good the software is, it’s unlikely to solve the underlying problems, which are:

  • Insufficient numbers and erratic geographic distributions of beds for inpatient psychiatric and substance use disorder treatment.
  • Insufficient supply (and erratic geographic distribution) of psychiatrists and other mental health professionals to provide outpatient care and even smaller numbers of treatment programs for substance use disorder treatment.
  • Insurance reimbursements and utilization review practices that cause many of the existing mental health professionals to avoid taking insurance altogether (including Medicare and Medicaid, so don’t hold out hope for single payer).
  • Fragmentation of mental health services and no mandated accountability so that no one is interested in treating individuals with the most severe disorders or the most complex comorbidities (and value-based care and other performance measures make challenging patients even more challenging to treat without losing money).

Even the best software won’t solve issues of inaccurate information on bed availability and a lack of ability to predict discharges.

Hospitals tend to keep a bed open for their own services (ED or transfers from medicine) and are more reluctant to accept transfers from other hospitals because you often don’t get the full story on the patient from the referring hospital. (The person who’s ‘totally straightforward, has great insurance and their own house’ has multiple medical issues, doesn’t want to take medications, has been filing false complaints to the police, has already reached the coverage limits of their great insurance, and has a home but it’s in foreclosure.)

We had a software system almost 30 years ago to track available inpatient beds in our county but it was never very helpful because we couldn’t get accurate data on bed availability. And getting data on outpatient appointment availability was even more challenging.

The best system that I’ve ever seen for mental health referrals was the one we used 35+ years ago. Our region was divided into catchment areas and every catchment area had a designated community mental health center, an affiliated primary psychiatric hospital, a backup hospital, and a corresponding state hospital. We didn’t need any complicated processes or insurance authorizations. The psych resident on call carried a 1/4 inch bound volume known as ‘the magic book.’ If a patient needed referral, you looked up their address in ‘the magic book’ and learned their catchment area. You either gave them the number of the outpatient service for that catchment area, which was obligated to provide mental health or substance use treatment. Or you called the hospitals in sequence. It was never more than three calls and if they had a bed, they took the patient. If the other one (or two) hospitals had no beds, the patient was automatically accepted at the state hospital.

Unrelated to OpenBeds but related to substance use treatment, the Google Doodle on October 1 honored Dr. Herb Kleber, a pioneer of evidenced-based treatment of substance use disorders and an all-around-incredible person.”

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HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor StayWell. The Yardley, PA-based health empowerment company enables providers everywhere to improve health outcomes using the science of behavior change. Its patient education and marketing solutions inspire change, improve outcomes, and create loyalty. Providers use its digital, video, and print educational materials for 80 million patients each year, with outcomes that have been proven in 120 peer-reviewed studies. Its Krames On FHIR solution — available in Epic App Orchard and Cerner App Gallery – delivers personalizable patient education directly into the clinician’s EHR workflow for the specific patient’s profile and encounter, allowing users to tag their favorite tools, organize folders, search by keyword, and filter by age and gender. Thanks to StayWell for supporting HIStalk.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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22C Capital joins Advent International and Spectrum Equity as an investor in health data marketing and research firm Definitive Healthcare’s recapitalization, first announced in June.

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Defense lawyers for former Theranos CEO Elizabeth Holmes and former president and COO Sunny Balwani insist the prosecution is refusing to turn over documents that would clear the pair of any wrongdoing. The attorneys contend that documents from the FDA and CMS are vital to refuting allegations that the pair knew Theranos blood tests were inaccurate and that they lied to investors, partners, physicians, and patients. The Theranos saga will continue on November 4, when all parties are expected back in court.


Sales

  • The Texas Health Services Authority selects Audacious Inquiry’s Emergency Department Encounter Notifications and Encounter Notification Service care coordination technology.

People

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Mathew Gaug (Lima Memorial Hospital) joins Memorial Hospital and Health Care Center (IN) as VP and CIO.

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Diameter Health names Terry Boch (Machinify) chief commercial officer.


Announcements and Implementations

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In New Hampshire, GraniteOne Health system will leverage Dartmouth-Hitchcock Health’s Epic software and telemedicine expertise once their merger is approved.

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The George Washington University Hospital in Washington, DC implements new software that combines care coordination and communication software from TransformativeMed with clinical decision support from Crossings Healthcare Solutions.

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Meditech will offer EHR software on Google Public Cloud, starting with its Meditech-as-a-Service subscription model. Google Cloud will also work with the company to develop native cloud products and corresponding APIs.

North Memorial Health (MN) will connect its Epic system to the state’s AWARxE PDMP, developed and managed by Appriss Health, next month.

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Porter Medical Center, part of the University of Vermont Health Network, will go live on Epic November 1.


Other

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ProPublica digs into the steps Newark Beth Israel Medical Center (NJ) took to keep a heart transplant patient alive for one year in order to avoid being penalized by federal regulators who could potentially shut the transplant program down. A leaked recording of a meeting of hospital administrators found that some found the situation unethical given the patient’s vegetative state and a lack of communication about palliative care with his family; but most ended up agreeing that the patient would “take one for the team” to help the transplant program survive.


Sponsor Updates

  • Engage and Gevity Consulting partner to expand their services across Canada.
  • Elsevier Clinical Solutions, Ensocare, Healthwise, and Imprivata will exhibit at CHC 2019 October 7-9 in Kansas City, MO.
  • EClinicalWorks will exhibit at the Georgia Primary Care Association conference October 9-11 in Alpharetta.
  • Glytec congratulates customer Sentara Healthcare for achieving Magnet status at its Virginia Beach General Hospital.
  • Phynd becomes a member of the CHIME Foundation.
  • CoverMyMeds will sponsor and exhibit at the IPatientCare National User Conference October 18-19 in Cincinnati.
  • CB Insights includes Kyruus, Redox, MDLive, PatientPing, and TriNetX on its list of 150 digital health startups redefining the healthcare industry.
  • Experity launches a new website to serve as the one-stop-shop for urgent care businesses.
  • Meditech announces its support for Health Records on iPhone.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 10/2/19

October 1, 2019 News 10 Comments

Top News

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Northwell Health (NY) physicians and IT and operations staff will work with Allscripts to develop a cloud-based EHR incorporating voice recognition and artificial intelligence. Northwell has been an Allscripts customer (Sunrise and TouchWorks) since 2009, when the health system was known as the North Shore-Long Island Jewish Health System. It plans to implement the new software systemwide.

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SVP and CIO John Bosco, who has been with the organization since 2004, will likely have a hand in product development.

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I can’t recall an EHR vendor in recent memory putting boots on the ground at a single client site to design, develop, and implement a product before releasing it to the market. Perhaps that end-user accountability will result in something more tangible than the ambulatory-focused Avenel software Allscripts launched at HIMSS18, only to cease mentioning it almost immediately afterwards.

Allscripts shares seem largely unaffected, dipping slightly from $11.11 to $10.58 during Tuesday’s trading.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Summit Healthcare. The Braintree, MA-based company has helped 1,000 healthcare systems take control of their integration and automation needs over its 20-year history while maintaining a 98% customer retention rate. Product suites include Exchange (interoperability platform), All Access (document distribution and display), EMPI (patient identity and demographics management), Scripting Toolkit (robotic process automation), Scheduler (schedule- and parameter-based task launching), and InSync (synchronization for data management). The company’s integration technology and professional services can help health systems lower costs, increase speed to results, improve care, and enhance compliance and control. Its EMPI Analysis Check can help hospitals that have merged, changed systems, or maintain best-of-breed ancillary systems assess the impact of duplicate records, inaccurately billed claims, and reconciliation costs. Thanks to Summit Healthcare for supporting HIStalk.


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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PDMP-focused technology company Appriss Health acquires OpenBeds, software developed by Johns Hopkins faculty member Nishi Rawat, MD that helps providers and social workers connect behavioral health patients with inpatient and outpatient care.

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Athenahealth puts its Arsenal-on-the-Charles headquarters outside of Boston up for sale. It purchased the historic property from Harvard University in 2013 for $168 million. The company still maintains five offices in the US and two in India, and intends to remain in the area as a long-term tenant.

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Siemens Healthineers subsidiary Siemens Medical USA will acquire Seattle-based ECG Management Consultants from Gryphon Investors.

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Francisco Partners will buy LIS vendor Orchard Software. Billie Whitehurst (Netsmart) will become CEO of the newly acquired company. The Francisco Partners portfolio already includes Capsule Technologies, CoverMyMeds, GoodRx, T-System, QuadraMed, and ZocDoc.


Sales

  • Inspira Health (NJ) will offer telemedicine services from MDLive.

People

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Alphabet names Robert Califf, MD (Duke Health) to head of strategy and policy for its Google Health and Verily Life Sciences Divisions. The former FDA commissioner has been a Verily advisor since 2017.


Announcements and Implementations

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WakeMed Health & Hospitals (NC) implements PeraHealth’s Rothman Index predictive analytics software.

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Boulder Community Health (CO) goes live on Epic.

Boston Software Systems announces GA of productivity-focused analytics.


Government and Politics

Beginning next year, the VA will automatically share health data with community providers using the Veterans Health Information Exchange.

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ONC is looking to hire a Washington, DC-based executive director and economist.

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FDA proactively issues an alert about Urgent/11, a cybersecurity vulnerability found in IPnet third-party software that attackers may exploit to hack into medical devices and hospital networks.


Privacy and Security

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A ransomware attack forces several hospitals in the Australian state of Victoria to take their computer systems offline. Impacted organizations include Allscripts customer Gippsland Health Alliance and the South West Alliance of Rural Health, which seems to be an InterSystems customer. The hack coincided with an upgrade to the nationwide My Health Record PHR connecting diagnostic imaging and pathology providers to the system.

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DCH Health System in Alabama diverts patients from all three of its hospitals after their computer systems were taken down by an early-morning ransomware attack. The system announced it was implementing Meditech Expanse just over a year ago.


Other

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Northern Light Health administrators say they will work harder to get physicians on board with the Maine-based health system’s rebrand, which kicked off last year. Staff have questioned the value of an expensive project that has no direct impact on patient care. The undisclosed cost of the marketing project, which typically runs into the millions of dollars, has eaten into earnings as the system attempts to pay off $391 million in debt and borrow another $34 million for construction.

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Stanford University’s Machine Learning Group works with Intermountain Healthcare (UT) to develop software that can accurately identify the presence of pneumonia from chest X-rays in as little as 10 seconds. Intermountain expects to roll out the CheXpert technology in select emergency departments this fall.

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A small Definitive Healthcare survey of healthcare stakeholders finds that a lack of resources including health IT, gaps in interoperability, and trouble with collecting and reporting patient data are some of the biggest barriers to moving to value-based care models. Those who’ve already made the transition cited reduced medial errors as the biggest benefit.


Sponsor Updates

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  • Dimensional Insight team members sponsor the registration table at the St. Jude run/walk.
  • AdvancedMD publishes a new e-guide, “4 Ways to Tell if Your EHR is an Adult or Teen.”
  • Bluetree names Deb May (Renown Health) and Carmen Wolf (Nuance) executive partners.
  • Burwood Group Cloud Services President Chris Pond joins the board of the Boys & Girls Club of Greater San Diego.
  • CoverMyMeds publishes a new case study, “End-to-End Support Improves Patient Access for Specialty Medications.”
  • The One Million by One Million blog features Diameter Health CEO Eric Rosow.
  • Hyland Healthcare assists in the development of NIST’s new practice guide, “Securing Picture Archiving and Communication System.”
  • Zynx Health’s new Import Manager gives customers the ability to import PowerPlans from their Cerner EHRs to Zynx Health’s Knowledge Analyzer.

Blog Posts


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Contacts

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Pretzel Logic 9/30/19

September 30, 2019 News 6 Comments

It’s a Dog’s Life

As everyone knows by now, on the Internet, no one knows you’re a dog. In US healthcare, it turns out, you might actually be better off being treated like a dog.

I recently had to manage my 12-year-old dog’s journey through the veterinary care continuum. I found a system that is responsive to provider, patient, and caregiver needs in ways that our human healthcare system is all too often lacking.

Charlie was a mixed breed rescue dog, but he presented as a black lab. Last spring, he developed a fatty lump on his chest that was benign but growing fast, so we consulted with our local veterinarian and decided to have it surgically removed.

Our ensuing veterinary saga took us from the local ambulatory vet to an acute care facility, back to the local vet, back again to a specialist employed by the acute care facility, back to the ambulatory vet, and finally to a palliative care vet. So, we had a “care team” of organizationally and geographically disparate clinicians of varying specialties. Not unlike, say, a typical Medicare patient.

Routine pre-surgery tests showed an abnormally high protein level, possibly indicating kidney disease. Our vet ordered another test with cystocentesis — insertion of a needle into the bladder — to get a sterile sample. Standard practice is to use an ultrasound to accurately place the needle. The surgeon who drew the sample noted in the EHR that while guiding the needle, she saw a peripheral “shadow” that seemed abnormal.

A follow-up abdominal ultrasound revealed a large mass on the spleen, either a non-cancerous hematoma or a malignant tumor (hemangiosarcoma), that needed to come out. Our vet referred us to Angell Medical Center in Boston, pretty much the Mass General of veterinary hospitals.

We got an appointment easily with a couple of emails to the surgical scheduler. The day before our visit to Angell, I got an email with an estimate of how much the visit would cost. That was a surprise. Not the estimated cost itself, but the fact that they did it at all.

We arrived, checked in, and were met immediately by a medical assistant who cheerfully greeted Charlie. After a quick medical history, she stayed on to scribe for the surgeon.

Kneeling to greet Charlie, the surgeon said that he had reviewed the chart from our local vet — which was already in the EHR (!) — and asked to hear my version of the story while he did his physical exam. He also actively communicated with the medical assistant.

Surgeon: “Can you please check the date of Charlie’s lab results from the local vet?”

Scribe: “Five days ago.”

Surgeon: “We also have the ultrasound report from the local vet, correct? Please read it aloud.”

Scribe: “Yes, no images, but we have the interpretation.”

He concluded there was no need for any more labs or imaging, and recommended a splenectomy and removal of the mass. We talked through the various scenarios and the likelihood and pros and cons and risks of each one. I asked about the price, and he said that I would receive a price estimate via email once he had signed off on the chart. Walking back to the lobby, he told me that on the day of surgery, his staff would send me text updates. He asked if I had any other questions.

Me: “I’m pleasantly surprised by your use of the EHR and a scribe. Is that common among vets?”

Surgeon: “Well, pets can’t talk, so I need to 100% focus on the pet’s and owner’s body language and emotional state to really know what’s going on.”

Me: “I’m impressed by the high-touch engagement with owners through mobile technology. That must be quite a recent change. Do you like these changes?”

Surgeon: “It’s not really a question of what I like. It’s what the world wants, so we either keep up or we go do something else.”

We scheduled Charlie’s surgery for a few days later. Our local vet, who had received the consult report from the surgeon, called me to see if I had any other questions and to wish us luck.

Dropping Charlie off on surgery day, I was part of a parade of owners who were tearily watching our pets being escorted through the double doors of their medical fate. Some sensed danger and frantically tried to dig their claws into the unforgiving tile floor, others were cautious but resigned with heads and tails cast downward, and the rest remained blissfully ignorant with tails wagging. Charlie cycled through all three stages, but ended up with tail wagging, choosing trust over anxiety.

By the time I got home, texts and pictures started arriving from the surgical staff:

“Charlie is resting comfortably before surgery. Please text us if you have any questions or concerns!”

“Charlie’s hanging out on his bed relaxing after surgery. The surgeon will call you shortly.”

“Charlie is getting ready for bed. He misses you!”

“Charlie is ready to come home whenever you are! Let us know what time you’ll be here, and we’ll have him ready to go!”

The surgeon called with a quick update that all went fine. He said he would call again in the morning after the pathology results came in. He called at 8:00 the next morning and told us that the mass was cancerous, but with no apparent metastases, Charlie should be good to go!

We received a final itemized bill that was 24% lower than the estimate. Our local vet — who received the surgery, discharge, and pathology reports from the hospital — called later that morning to express her relief that all had gone well and to discuss follow up.

I so wish I could report that all was fine after that. But I can’t, because it wasn’t.

A couple of months passed. Charlie still had issues, so back we went to Angell, this time to the internal medicine specialist, who again had all the updated local vet’s records available. Her diagnosis after examination broke my heart: large-cell lymphoma in multiple lymph nodes. Prognosis: grim.

Our local vet received the consult report later that morning and called to express her sadness and to help us sort out options. We ruled out further treatment (e.g., chemotherapy) to err on the side of quality, rather than quantity, of life. She connected us with a palliative care veterinarian, who came to our house to visit Charlie. The home vet had already reviewed Charlie’s records prior to our meeting (with our permission, given over the phone), so we were able to focus our time on next steps rather than on reviewing his medical history.

Our discussion was a best practice out of Atul Gawande’s “Being Mortal.” She guided us through a family discussion of our goals for Charlie, what Charlie’s goals might be for himself and for us if he could express them, and our family’s goals for each other. Then we talked about how these goals would translate into plans and actions that met everyone’s needs.

About a week later, Charlie woke up with respiratory difficulty. Quality-of-life indicators were also gone: he didn’t look up and wag his tail when I walked into the room, and he wouldn’t eat his favorite snack foods. One of our end-stage goals was to protect him from distress or pain or fear, so we consulted with his care team. We then spent the rest of the day talking to him and comforting him and letting him know how much he meant to us.

The home vet came late in the afternoon. I laid down next to him in his favorite bed and said goodbye to Charlie.

[Long pause. Deep breath.] Charlie was a very good boy who gripped my heart and never let go. I really miss him.

Our local vet got the final consult report from the home vet overnight and called me the next morning to console us and assure us that we had given Charlie both a joyful life and a dignified death. The home vet also called the next day to see if we were OK. Hand-written condolence cards arrived in the mail from the home vet and our local vet. The card from the local vet was signed, with short notes, by every member of the veterinary staff.

Our story ended sadly, but Charlie’s care journey was much better than similar human episodes that I’ve been through. How so?

  • Customer service. We didn’t get valet parking or gleaming lobby atriums, but we did get attention not only whenever we needed it, but whenever we asked for it. From convenient communications via email and texting and promptly returned calls, to on-time appointments and regular updates, we always felt like the system was working for us instead of the other way around.
  • Accountability. There is no Accountable Care in veterinary medicine, but we got plenty of accountability nevertheless. We never had to step in to fill obvious gaps. Medical records were shared electronically in the background among the various provider organizations without any intervention or “sneaker-net” transport from us. Doctors called us promptly with new information and called repeatedly when they couldn’t get hold of us. We were given price estimates prior to major visits, and the actual prices were almost always below what was estimated (obviously they’re gaming this a little, but it gave us confidence that we wouldn’t get any surprise bills).
  • Care coordination. Transitions of care were well oiled by the exchange of records and consult notes and by phone calls between primary care and specialist and hospital. Referral loops got closed every time with timely consult reports back to the local vet. The hospital proactively pushed information back to the referring vet for local follow-up. The incidental finding of a tumor – a common gap in human health care – was picked up and followed through on expeditiously.
  • Embracing of modern technology. There was no Meaningful Use for veterinarians, but all of the providers involved in Charlie’s care had invested in EHRs regardless. They were also active users of convenient communication technologies like email and texting. Finally, they integrated technology into the patient experience with well-orchestrated division of labor between physicians and support staff.

Before you deluge me with all the institutional reasons that impede human health care from being this responsive, I’ll beat you to the punch.

  • Privacy and security. There is no animal equivalent of HIPAA or 42 CFR Part 2, which impose rules on information sharing.
  • Payment. There are no claims, prior authorization, coding, documentation, quality measures, or Meaningful Use requirements imposed by health insurers, which occupy too much provider time.
  • Technology. There are no EHR Certification or HIPAA Security Rule requirements, which load EHRs with a lot of administrative overhead and prevent the use of widely adopted off-the-shelf technologies (e.g., non-secure email and SMS) for communication with other providers and patients.

These constraints, and many more, certainly make veterinary care “easier” in some ways than human healthcare. And yet I’m not convinced that this accounts for the whole difference, or even most of the difference.

While it’s routine to complain about the burdens of HIPAA, the reality is that a large fraction of that burden is self-imposed, either for ulterior motives or out of sheer confusion or incompetence. See the recently released Patient Record Scorecard from ciitizen if you don’t believe me.

With respect to payment and technology, I sympathize with providers who understandably lament the hijacking of EHRs for ever-higher claims support documentation and quality reporting requirements. But one need only look at the circular firing squad debate on surprise billing to see that both institutional providers and insurers are complicit in putting their own needs ahead of patients’ needs.

Veterinary care isn’t perfect and has some of the same issues as human care, such as extra-inflationary price growth. But we didn’t have to goad Charlie’s providers to work as a team as if it were some unnatural act. We weren’t left anxiously waiting for important diagnostic results. And the condolence cards and calls we got from Charlie’s doctors after he died had me trying to remember whether that happened after my father and father-in-law passed away. Oh, I remember now – it didn’t.

Our human healthcare system has somehow become way less than the sum of its parts. Our world is divided into those who have already made that discovery and those who are just about to. It comprises brilliant, dedicated, and caring individuals whose efforts somehow often aren’t accretive or synergistic, giving us a “system” that is often indifferent, and all too often, aggressively callous toward patients. The veterinary “system,” by contrast, seems imbued with a certain humanity that is missing from human healthcare. Maybe what we need is an incentive payment tied to a “humanity” quality measure – pretty sure that’ll take care of it.

My profound thanks go to Dr. Alleman and the staff at VCA Rotherwood Animal Hospital in Newton MA, Dr. Schoenberg at Autumn Care & Crossings in Medford MA, and Drs. Trout, Kearns, and Magestro and the staff at Angell Animal Medical Center in Boston. Please please please keep doing what you do.

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Micky Tripathi, PhD, MPP is president and CEO of the Massachusetts eHealth Collaborative. The views expressed are his own.

Monday Morning Update 9/30/19

September 29, 2019 News 1 Comment

Top News

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Canada’s New Brunswick Medical Society will close Velante, the for-profit company it created in 2012 as the sole EHR provider for the province’s doctors.

Few doctors signed up for the system, which was provided via New Zealand-based Intrahealth, despite government subsidies.

The province has since decided to allow doctors to use whatever EHR they want.


Reader Comments

From Jules Verne and Shirley: “Re: must-follow health tech influencers. What do you think of this list?“ Most of the winners have good career accomplishments and job stability that give them credibility to be called an “influencer,” while others have done little beyond promoting themselves loudly. The winners were plucked out of the Twitterverse by the vendor-sponsor’s recently-graduated Twitter manager, whose has zero healthcare and IT experience. I feel that I can critique the list since I’ve appeared on it before, though I wasn’t desperate enough for attention or validation to brag about it. But I do admire any business model that is fueled by ego and insecurity since we adults remain high schoolers in many ways, so perhaps I’ll start my own certification program or “Best Doctors” type list. 


HIStalk Announcements and Requests

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Last week’s poll results are informative even though I regretfully neglected to provide a “no regrets” option. Takeaways from respondent comments: (a) choose wisely in giving up your preferred lifestyle to grind away at a job / career that could go up in smoke because of some unforeseen corporate event; (b) take risks that force you out of your comfort zone; (c) stand up to corporate bullies and bad bosses when patient safety is at risk; (d) spend more time with your kids when they are young since you only get that chance once; (e) build a community outside of work, such as volunteering; and (f) spend time every day learning something new.

New poll to your right or here: have you deferred important medical care for financial reasons?

Listening: new from Temples, which lives somewhere between riffy, chorussy progressive music and 1960s reverb-loaded psychedelia. I’m not sure it’s deep enough to hold my attention, but it was snappy enough to get it in the first place (see: Muse). 


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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

 

Here’s the video of last week’s well-attended webinar, “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.”


People

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Regional Medical Center hires Michelle Edwards (Palmetto Health) as CIO.

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Rohit Madhavarapu, MS (Salesforce) joins SymphonyRM as VP of product.


Government and Politics

The Department of Justice charges 35 defendants, including nine doctors, for fraudulently billing Medicare $2 billion by running phony telemedicine companies whose doctors ordered unnecessary cancer genetic screening tests that were processed by private labs that were in on the scheme. The owner of Atlanta-based molecular testing firm LabSolutions – 40-year-old Minal Patel, who was charged with soliciting Medicare beneficiaries through telemarketing and health fairs and then bribing doctors to order unnecessary tests to the tune of $494 million – had $30 million and his luxury cars seized.


Privacy and Security

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In Canada, the systems of two-hospital Listowel Wingham Hospital Alliance go offline due to a ransomware attack.


Other

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In Canada, the document scanning service of a closed medical practice refuses to give an elderly couple copies of their medical records unless they pay $309. RSRS (Record Storage and Retrieval Services) had a change of heart once they were named in a TV station’s report and says it has a program to help patients who are unable to pay. RSRS offers free services to closing medical practices that include notifying patients, creating a customized web page for inquiries, providing boxes and packing help, extracting data from EMRs, shredding paper, and selling or donating used medical equipment. Nova Scotia’s Personal Health Information Act allows providers to charge $0.20 per page and $12 per hour for copying a patient’s paper records. Only 300 of the province’s 2,400 doctors use EHRs.

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The Detroit paper profiles David Farbman, an entrepreneur who was lured into healthcare revenue cycle management years ago by Meaningful Use-fueled EHR proliferation. He began his career running his dad’s huge commercial real estate firm, developed and sold a hunting and outdoor life media company, and formed a failed competitive hunting tournament in which participants stalked animals to shoot with tranquilizer darts (the concept reminded me of the bizarre movie “The Lobster” that I watched on Netflix recently). His HealthRise has 20 hospital clients and $20 million in annual revenue.

In India, a newspaper claims that “corporate hospitals” are intentionally adding clauses to their patient consent forms in the English language only, hoping that non-English speakers won’t notice that they are giving their permission for the hospital to use their data for research.

In England, hospital volunteers help patients who have motor neuron disease “bank” their voices so that if they lose the ability to speak, they can communicate through a synthetic computer voice that sounds like their own. I Googled and turned up Nemours-created ModelTalker, in which a user records themselves reading 1,600 sentences via a web tool or Windows app, after which  the result is turned into a synthetic voice for $100.


Sponsor Updates

  • MDLive Chief Medical Officer Lyle Berkowitz, MD will present at the Telehealth Secrets Conference October 2-4 in Silicon Valley.
  • Meditech will exhibit at the First Databank User Group Conference October 1-2 in Indianapolis.
  • NextGate responds to CMS on the CY 2020 Physician Fee Schedule Proposed Rule.
  • Netsmart names Dennis Jakubowicz (MatrixCare) VP and GM of its senior living business unit.

Blog Posts

Sponsors named to Modern Healthcare’s “Best Places to Work in Healthcare” for suppliers in 2019 are:

  • Nordic (#4)
  • Burwood Group (#6)
  • Divurgent (#10)
  • PMD (#11)
  • The Chartis Group (#20)
  • Impact Advisors (#25)
  • Santa Rosa Consulting (#41)
  • ROI Healthcare Solutions (#46)
  • Health Catalyst (#53)
  • Imprivata (#56)
  • Redox (#72)

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Mr. H, Lorre, Jenn, Dr. Jayne.
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News 9/27/19

September 26, 2019 News 11 Comments

Top News

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The FDA releases new draft guidance documents that cover the safe and effective use of digital health technologies, using a risk-based framework under its Digital Health Innovation Action Plan that addresses provisions of the 21st Century Cures Act. 

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FDA will focus its enforcement on software that hasn’t been approved as a medical device but that offers clinical recommendations to providers without transparency about how it derives those recommendations. Examples are flu detection functions that use EHR data and location; software that identifies patients with potential opioid addiction; and machine learning algorithms that predict postoperative cardiovascular events in diabetic inpatients. These software functions do not allow providers to see the underlying logic that is being used and are therefore considered to be medical devices.

FDA will also review software that analyzes or manipulates medical images; designs custom orthopedic or dental implants; monitors physiological signs to predict heart attack or narcolepsy; measures lesions to predict malignancy; and that analyzes images to differentiate between stroke types.

FDA is also interested in software that issues caregiver alerts when detecting life-threatening situations that require immediate action, such as stroke.

Also on FDA’s list of clinical decision support as a medical device is software that analyzes sleep apnea monitor data; calculates insulin doses; and that analyzes genetic variants to issue patient-specific treatment recommendations.

FDA considers consumer technologies to be medical devices if they recommend lifestyle changes for insulin-dependent type 2 diabetics; recommend treatment options based on questionnaire answers; and advise parents whether to take a child to the ED.

Software will not be considered a medical device it if meets these four conditions:

  • It doesn’t process medical images or signals.
  • It doesn’t display or analyze patient information.
  • It makes recommendations to providers to help them make patient care decisions.
  • It enables a provider to see how and why it made a particular recommendation for a patient’s diagnosis or treatment.

FDA makes it clear that software that matches patient information to reference information is not a medical device, such as displaying practice treatment guidelines; issuing warnings for drug-drug interactions and drug-allergy contraindications; checking drug or device orders to see if they follow FDA labeling; recommending additional tests or interventions; and calculating nutritional needs.

Comments on the proposed clinical decision support-related rules are due by December 26, 2019.


Reader Comments

From Going Epic: “Re: RWJ Barnabas. Has 90+ jobs listed that require Epic experience.” Reader Barnabas Rubble said back in a June rumor that they would be replacing Allscripts and Cerner with Epic, although CIO Robert Irwin ignored my resulting inquiry. You have to wonder what Northwell Health is thinking since they are one of few big US Sunrise sites left and they are supposedly making a keep-or-dump decision in the next few weeks. UPDATE: an equities analyst noted that while Allscripts said in its most recent earnings call in talking about new Sunrise sales that “extending and expanding” at Northwell is being decided soon, he thinks that its Sunrise and TouchWorks agreements were extended last year and run for several more. He’s thinking that it’s the IT outsourcing agreement that is expiring and thus being discussed. I think he is correct as I re-read the Q3 2018 earnings call transcript, in which Rick Poulton says that Northwell extended its TouchWorks agreement for five more years, the managed services  agreement is up for renewal but isn’t a high-margin business anyway, and Sunrise wasn’t specifically mentioned. Readers who know more are welcome to chime in. Thanks for the correction.

From Insider: “Re: Cantata Health. Continues to purge employees who have been around since the Keane days. They have abandoned the acute market, with NetSolutions as their only viable product under new leadership.” Unverified. A private equity firm acquired the health IT assets of NTT Data to form Cantata Health in 2017. The company’s website continues to list Optimum.

From Exec Checking In: “Re: your site. My onboarding with a very large global firm required me to sign up for HIStalk updates. It’s the only email I always click on. I have to be up to date on industry news at all times and your site is my best source.” That comment made my day, thanks. I like being required reading, although having people following me voluntarily is even better.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor OpenText. The Waterloo, ON-based company’s cloud and on-premise Enterprise Information Management products for healthcare drive interoperability, improve information access, eliminate paper documents, and enable data-driven decisions. Among its solutions are RightFax (paperless, secure faxing that creates an organization’s most-connected device with minimal disruption); MedNX (lab report distribution); EMR-Link (lab and imaging orders and results integration and outreach); Intelligent Forms Automation (transition to digital processing); Documentum (information asset management); TeleForm (document-driven workflows); Covisint MIPS reporting; and Magellan (analytics and AI). Banner Health uses the company’s EnCase EDiscovery and EnCase Endpoint Investigator to assess potential cybersecurity issues and to respond accordingly, while Lahey Health uses Documentum to present outside unstructured clinical data within Epic with a single click. Thanks to OpenText for supporting HIStalk.

I noticed that a distant relative is working for a small-town behavioral and substance abuse facility whose website talks about “empowering people” and “putting clinical excellence above all else.” Corporate sleuthing reveals that, like much of healthcare these days, the organization is part of a chain owned by a private equity firm.


Webinars

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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Veteran health IT communications executive John Hallock shares insight into the PR run-up to the Athenahealth and Livongo IPOs, stressing that hard data helped craft a narrative that attracted the attention of investors, media, and influencers. Hallock’s comms resume also includes stints at Imprivata, CareCloud, and Change Healthcare.

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Best Buy expects to take in $50 billion in revenue by 2025, a move that will be driven in large part by a more aggressive push into senior-focused home healthcare services. The next five years will see the company scale its remote monitoring devices and services through its Geek Squad unit and partner with additional payers to add care coordination services.

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Digital stethoscope and ECG technology company Eko raises $20 million.

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New Mountain Capital acquires Nashville-based healthcare technology, services, and consulting company Emids for an undisclosed sum. Analysts have speculated that the purchase price is between $200 million and $225 million.

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GoodRx adds virtual visits to its prescription drug discount website and app after acquiring telemedicine company HeyDoctor.

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Sam’s Club partners with Humana to offer Care Accelerator, health-related discount bundles that include free prescriptions for popular generics, unlimited $1 telehealth visits, dental discounts, free lab tests, and prepaid health debit cards.


Sales

  • Tenet Healthcare signs a new multi-year agreement with NTT Data Services for application, infrastructure and security support and development services

People

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Greenway Health names David Cohen (Cerner) SVP of product management, David Millen (R1 RCM) SVP of product development, Sri Rajagopalan VP of architecture (SAP America), and Sagy Mintz (Allscripts) VP of quality assurance.


Announcements and Implementations

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A KLAS report finds that Cerner customers are more satisfied with advisory and implementation consulting services obtained from third-party firms than those provided by Cerner itself. Firms such as PwC, Atos, and Emids — which sometimes are engaged to fix a struggling Cerner implementation — had zero dissatisfied respondents. Customers complained that Cerner sends inexperienced fresh graduates while third-party firms not only decline to hire inexperienced employees, they often bring on former Cerner people. Customers also report that Cerner lacks a prescriptive implementation methodology, its consultants don’t talk to each other, and high costs and estimate overruns leave customers feeling that they aren’t getting their money’s worth.

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CoverMyMeds announces GA of AMP: Access for More Patients, an automated specialty prescription access and adherence support tool for patients developed with parent company McKesson.

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Relatient adds secure two-way messaging between patients and providers to its patient engagement software.

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Wolters Kluwer Health adds clinical natural language processing capabilities to its Health Language data extraction and integration software.


Government and Politics

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The VA’s OIG finds that its providers aren’t checking PDMPs regularly, placing patients who take opioids at risk because they don’t see their non-VA prescriptions.

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The Chalmers P. Wylie Ambulatory Care Center in Columbus, OH will become the first VA facility to replace Epic scheduling with Cerner next April, coinciding with the VA’s rollout of Cerner at facilities in the Pacific Northwest.


Sponsor Updates

  • AdvancedMD will host its global user conference, Evo19, October 2-5 in Orlando.
  • Elsevier Clinical Solutions will exhibit at the Emergency Nursing Association event September 29-October 2 in Austin, TX.
  • EClinicalWorks will exhibit at the APHCA Annual Conference October 1-3 in Gulf Shores, AL.
  • Ellkay and Healthwise will exhibit at AdvancedMD Evo19 October 2-5 in Orlando.
  • Goliath Technologies publishes a new solutions brief, “Goliath Technologies + IGEL: Improving patient care through proactive, fast and secure delivery of clinicians’ digital workspaces and EHR applications.”
  • Redox will host its third annual Healthcare Interoperability Summit October 15 in Boston.
  • Meditech maintains its momentum in the Canadian EHR market with 47% market share and a number of new customers and product expansions.
  • ITether adds access to Healthwise’s evidence-based curriculum to its outpatient care coordination and patient engagement software.
  • GetWellNetwork collaborates with Cerner to improve care coordination and patient engagement before and after hospital admission.
  • The Chartis Group publishes a new paper, “How Does Your Physician Enterprise Measure Up?”
  • StayWell’s My StayWell Platform and Krames on FHIR and Krames On-Demand products achieve ISO 27001:2013 certification for its information security management system.
  • Mobile Heartbeat collaborates with Eisenhower Health (CA) to improve emergency response communication.

Blog Posts


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Contacts

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News 9/25/19

September 24, 2019 News 6 Comments

Top News

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CHIME, AMIA, MGMA, AHIMA, AMA and two other groups ask Congress to modify ONC’s proposed implementation of the information blocking provisions of the 21st Century Cures Act, providing these recommendations:

  • Add more rules to address concerns.
  • Enhance privacy and security details, particularly those related to the use of APIs and potential disclosure of patient information to third parties, by requiring privacy notices and transparency statements.
  • Extend the timeline.
  • Encourage HHS to prioritize education and corrective action plans over monetary penalties.

Reader Comments

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From It’s Going To Be Epic: “Re: VCU Health. Announced last week that an RFP will be created to replaced the hybrid IDX/Cerner implementation with either full Cerner (PowerChart + Rev Cycle) or Epic. I’m in the camp that believes that Cerner can’t possibly win.” The forwarded internal email says VCU’s system selection will take three months, with demos in October. I have to think they have already made up their minds if the selection will be finished so quickly, especially since site visits aren’t mentioned. I’ll side with you that Epic is the favorite because: (a) VCU already uses Cerner and yet is going to market; (b) Cerner is weak in revenue cycle; (c) any selection process that is demo-centric favors Epic since it is really good at wowing clinicians; and (d) Bon Secours runs Epic.

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From Yusta Knowhim: “Re: Dave Cernio, formerly of Zynx Health. He’s now CEO of Envera Health.” Dave’s been in health IT for years, including stints at Microsoft’s Health Solutions Group, Zynx Health, Providence Health & Services, and WiserCare. He took the Envera CEO job last week. Richmond-based Envera offers health systems a centralized scheduling service, a consumer engagement line, and patient activation and follow-up campaigns. The company has raised $16 million in two venture rounds. Envera formed Careto a couple of years ago to operate the MedVirginia HIE and to connect life insurers with patient underwriting data.

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From Heart of Hearts: “Re: cardiac rehabilitation. An AHRQ program advocates setting the hospital EHR to automatically refer certain patients to cardiac rehab, which increases referrals up to 86%.” Sometimes I’m puzzled by the failure of doctors to do the right thing. AHRQ says that cardiac rehab is a class 1 recommendation for patients after heart surgery, MI, coronary intervention, stable angina, and heart failure, yet only 20% of doctors refer those patients, costing the country 25,000 lives and 180,000 hospital admissions. I’m all for technology helping doctors do the right thing, but what were all those docs thinking if this is really an evidence-based intervention? Do their patients know that they nearly always drop the ball unless software tells them what to do? If it’s a black-and-white issue as AHRQ suggests, let’s see the names of the biggest offenders so patients can look elsewhere. t’s like penalizing drug manufacturers and wholesalers for the ridiculous doctor overprescribing of opioids. Maybe doctors, like pilots, really do need AI’s help in applying science correctly and consistently.


HIStalk Announcements and Requests

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Dear ONC, HIMSS, and many of the PR people who email me stuff – EST does not exist until November 3, when EDT ends and EST pops up like a fake vampire on a Halloween hayride. Pro tip: just say “ET” if you can’t figure it out and you will always be correct. It’s a minor mistake, but to me, it’s like grammar and spelling errors that raise questions of intelligence and  attentiveness to detail (leading me to conclude that about 75% of Facebook users aren’t just inarticulate, but downright dim). The band Chicago called it on their “Chicago Transit Authority” album 50 years ago – ”Does anybody really know what time it is? Does anybody really care?”


Webinars

September 26 (Thursday) 2:00 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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Meditech sells a Framingham, MA office building to discount retailer TJX (TJ Maxx, Marshalls, HomeGoods) for $120 million. The 450,000 square foot building at 550 Cochituate Road also houses the headquarters of Definitive Healthcare.

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Amazon launches a Seattle-area pilot of Amazon Care, a virtual primary care clinic for its employees that includes a nurse house call option.

Leidos Australia chooses as its partners for the Australian Defence Force bid MediRecords (EHR/PM), Coviu (telehealth), and Nous (consulting), all of which are Australia-based companies. 


Sales

  • Lake Health District (OR) chooses Cerner Millennium under the CommunityWorks model.
  • Connecticut Orthopaedic Specialists will implement Updox for collaboration.

Announcements and Implementations

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China’s Ping An Good Doctor – which offers online consultations, hospital referrals, appointments, second opinions, and prescription delivery – reaches 300 million registered users, which represents one in three internet users in China.

New York EHealth Collaborative issues an RFI for patient-facing software that can access and aggregate patient medical records and support patient-provider messaging.

Cerner will add Simplee’s patient cost estimates and payment options to its revenue cycle system.


Government and Politics

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Former VA Secretary David Shulkin, MD has a book coming out on October 22. I’ll suck up the cost and review it if anyone cares, although I tend to discount the value of books written by (and words spoken by) politicians or pseudo-politicians.


Other

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University of Kentucky HealthCare ends ED diversion after fixing a registration system problem that was caused by a routine software update. I believe UK is running Allscripts Sunrise, but it signed with Epic two weeks ago and plans a mid-2021 go-live.

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An informatics physician lists the many national problems with health IT – clunky EHRs, questionable value, unclear paths to interoperability, poor clinical decision support, privacy issues, lack of patient engagement, and a shortage of visionary government leadership. On the plus side is the greatly beneficial unique patient identifier. Just in case that last item was as startling as the previous items were not, note that the author, David G. More, MB, PhD, is reviewing the state of health IT in Australia.

Guido Germano, PhD, the fired former director of artificial intelligence medicine at Cedars-Sinai Medical Center and UCLA medical school professor, is sentenced to five years of probation for possession of child pornography.

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A Bain & Company report says that medical technology suppliers need to market themselves to ambulatory surgery centers that now perform more than half of all outpatient surgeries at a cost lower than that of hospitals. The report observes that surgeons have greater control over product selection in ASCs, but the pressure to hold costs down means those centers are willing to switch to more cost-effective products. Health systems are doing exactly what you would expect  in serving themselves rather than patients – buying up ASCs to tap into their profits and acquiring physician practices to steer referrals to the more expensive, self-enriching option. 

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Movie director Richard Linklater will make a film starring Robert Downey, Jr. about Kansas physician (via a diploma mill) John Brinkley, who in the pre-FDA days of the 1920s claimed to have cured male virility problems and many other ailments with grafts of goat gonads, killing quite a few patients along the way. He built his own radio station, where he would talk endlessly about whatever interested him while hawking his goat gland treatments. He would have become governor of the state in a write-in campaign if the state attorney general hadn’t changed the ballot rules three days before the election. Brinkley became one of the country’s richest people, but died penniless after the IRS, FCC, and US Post Office cracked down. Fun fact: during the short transition from silent movies to “talkies” in the late 1920s, Hollywood added talking sequences to completed silent films to make them marketable, a term they called “goat-glanding.”


Sponsor Updates

  • Arcadia and CarePort Health will exhibit at the NAACOS 2019 Fall Conference September 25-27 in Washington, DC.
  • Avaya implements hybrid cloud solutions from IBM to expand its ReadyNow private cloud unified communications and contact center offerings.
  • The Chartis Group names Paul Murphy (ECG Management Consultants) a principal within its Informatics and Technology Practice.
  • CoverMyMeds will exhibit at the PDX Pharmacy Forum October 1 in Fort Worth, TX.
  • Diameter Health will host its annual customer forum October 2-4 in Dedham, MA.

Blog Posts


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Contacts

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Monday Morning Update 9/23/19

September 22, 2019 News 5 Comments

Top News

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Campbell County Health (WY) goes on diversion and transfers some patients out after a Friday ransomware attack.


Reader Comments

From XModem: “Re: patients downloading their health data. The government is puzzled why it isn’t happening.” Several recent reports indicate that people aren’t interested in downloading their medical records even though the industry is working frantically to allow them to do so. I’m not a bit surprised since I don’t do it myself and I suspect most HIStalk readers don’t either, so imagine the vast majority of people with high-cost chronic diseases who lack technical knowledge, don’t have consistent insurance and thus aren’t spinning out webs of claims data, or who just don’t worry about their health until they need to. My personal reasons:

  • While the general concept of health is ongoing and far-reaching, healthcare is episodic and specific. I don’t really think about my data until I need it for some specific purpose. I don’t think of my health as being limited to what providers have done to me.
  • I’m not so sure that those providers have cracked the health code any better than I have, or if so, how much of it is relevant to me. Ample numbers of clinicians fail the “do as I do” test.
  • My information is scattered all over the place, much of it within individual provider portals that have their own logins, web addresses, etc.
  • I use software when it solves a problem, which is rarely the case with health data.
  • Providers aren’t going to look at my self-collected data from other providers anyway in my allotted 15 minutes, so it won’t save me money, prevent unneeded tests, or improve my outcomes.
  • Most of what’s important about my health is not available or easy to find in my health records, so the health picture that a provider would get from it would be no more accurate than looking at my car’s oil change history to figure out whether I’m leading a swell life.

From Banner Health Phoenix Nurse: “Re: downtime last week. Cerner went down first, then all the phones. I had noticed Pyxis acting up, monitor displays not connecting with heart monitors, the web-paging tool went down. It was brief, but phones going out all across Banner is crazy!” Unverified. IT people are regularly reminded that ubiquitous connectivity, application integration, and middleware means that downtimes are usually no longer limited to a specific department or physical location. We used to worry mostly about a backhoe cutting a fiber link, an overheated data center, or server failure, but now the potential problem areas are everywhere. You’re not a health IT expert if you haven’t had to explain to the C-suite why a IT-managed phone system, which is just another software application, has gone down and left the hospital disconnected from the entire world.

From Usurious Interest: “Re: readers. Are they Net Promoters of HIStalk?” I barely know what that means, but I’ve learned that regular readers go two ways: (a) they feel HIStalk is useful or enjoyable and want to share it with others; or (b) they are sort of embarrassed that they read amateur-produced news and opinion or they don’t want to share the competitive advantage with peers. The independent Reaction Data of CIOS and CMIOs found HIStalk to be #1 among major health IT sites in readership, influence, generating company interest, providing job-enhancing information, and being recommended most, but even then I’m sure quite a few of those folks don’t broadcast that they’re big fans of Weird News Andy or my musical meanderings. I write for myself, though with the knowledge that others may be reading over my shoulder, occasionally attracting curious passersby.

From Krill Cracker: “Re: hospitals. Business or charity?” Yes. I know of few legally created charities that run such huge and sometimes ruthless bureaucracies, unless it would be behemoths like Goodwill or American Red Cross or perhaps universities. It seems odd that our country in the mid-1960s decided that hospitals need to operate like any other business except with huge government payments, tax advantages, and a carefully crafted image of being selfless while ringing the cash registers.

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From Branding Is Life: “Re: new HIMSS conference name. Is it really global? Is it really health?” HIMSS is attempting to bolster its declining attendance by renaming the conference “The HIMSS Global Health Conference.” It is “health” in hawking technology for profit-maximizing providers and it is “global” because it is marketing itself around the world. Otherwise, it’s the same old exhibitor-powered boat show and, seems to me, should be portrayed as such. They say 80% of health has nothing to do with providers, so how is that represented on the show floor?


HIStalk Announcements and Requests

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Most poll respondents got their current jobs because of their work history or connections, so I take the career to-do’s as: (a) spend more time creating and maintaining your network; and (b) practice your interview skills.

New poll to your right or here: for those over 50, what do you regret most in life so far? Click the Comments link after voting to provide advice to the younger folks who might change their life’s course as a result of your wise counsel.

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The pundits from Pune gave me my best laugh of the weekend in their offer to share their deep health IT knowledge in a $3,500 report.


Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


People

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David Jones –- the Louisville lawyer who with partner Wendell Cherry created the country’s largest nursing home chain as a side business, then its biggest hospital chain in Humana, and then top health insurer Humana — died last week at 88.


Other

A small observational study finds that ED residents often create EHR documentation of their physical exam and review of systems that doesn’t match what they actually did. Cynics might note that documentation, rather than action or outcomes, drives payment and thus rewards creative writing.

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CNBC’s Chrissy Farr sits in on an Amazon PillPack new hire training session for empathy, in which the employees simulate the experience of the company’s senior citizen target audience by wearing mobility-limiting gloves and vision-blurring glasses while working against the clock to redistribute complicated prescription meds into individual day-and-time compartments (which is what PillPack does for them).

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A former hospital pharmacy technician is charged with stealing 13,000 doses of controlled substances after she found a bug in its automated dispensing cabinet that allowed her withdraw doses for inactivated nursing unit names.

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Weird News Andy titles this story “Left-Handed Compliment.” Surgeons in England create a new tongue for an oral cancer patient by using skin and an artery from her arm. The woman credits cancer psychology counseling sessions for her recovery.


Sponsor Updates

  • Lightbeam Health Solutions will exhibit at the AMGA IQL 2019 Conference September 26-27 in Las Vegas.
  • Health Catalyst will exhibit at the 2019 Patient Safety, Quality & Sepsis Symposium September 23-24 in Harrisburg, PA.
  • Waystar will exhibit at the MedInformatix MISummit 2019 September 24-27 in Pittsburgh.
  • NextGate will exhibit at the HIMSS Washington Chapter Innovation Summit September 26 in Seattle.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
  • OmniSys will exhibit at the PDX Chain Link event September 28-October 1 in Fort Worth, TX.
  • CereCore congratulates partner Cuero Regional Hospital on its Leadership Culture Award from the Texas Organization of Rural Community Hospitals.
  • Phynd joins Epic’s App Orchard, allowing Epic users to search the company’s network of 4.6 million providers and enroll them directly in Hyperspace.
  • Experian Health will exhibit at the NAACOS Fall Conference September 25-27 in Washington, DC.
  • MadStartups features “Redox Cofounder Niko Skievaski’s journey through Madison’s startup ecosystem.”
  • ROI Healthcare Solutions celebrates its 20th anniversary.
  • Surescripts will exhibit at FMX 2019 September 24-28 in Philadelphia
  • TriNetX will host its annual Summit September 24-25 in Boston.
  • Visage Imaging will exhibit at the SIIM Conference on Machine Intelligence in Medical Imaging September 22-23 in Austin, TX.
  • Vocera will exhibit at the 2019 Illinois Health and Hospital Association Leadership Summit September 26-27 in Lombard.
  • Wellsoft will exhibit at Emergency Nursing 2019 September 28-October 2 in Austin, TX.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 9/20/19

September 19, 2019 News No Comments

Top News

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Alphabet brings AI innovation unit DeepMind underneath the Google Health umbrella as announced last year.

Alphabet acquired the British company in 2016 for $500 million. It has since embarked on several high-profile projects with the NHS and VA.

The transition comes several weeks after DeepMind co-founder Mustafa Suleyman confirmed an unexplained leave of absence. He headed up the organization’s division that looked for ways to use AI in healthcare and energy, with rumors suggesting that Google plans to take more direct control of that aspect of the business, leaving DeepMind to function mostly as an AI university.

The company, which will maintain its London headquarters, will now report to Google Health VP David Feinberg, MD, MBA, who joined after leaving Geisinger Health as CEO in January.


Webinars

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish. By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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Robin Healthcare raises $11.5 million in a Series A round. The company’s digital Robin Assistant captures clinical notes through audio and optional video during an appointment and transmits them to the provider’s EHR.

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PE Hub reports that Warburg Pincus has acquired behavioral health and human services EHR company Qualifacts for over $300 million.


Sales

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  • In Kenya, Aga Khan University chooses Meditech Expanse, which it will implement in Kenya, Pakisan, Afghanistan, and Uganda.
  • Rush Health Systems (MS) will implement Epic as provided by Ochsner Health System (LA).

People

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Collective Medical names Vatsala Pathy (Rootstock Solutions) VP of policy.


Announcements and Implementations

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Covenant Health (TN) implements Wolters Kluwer Health’s UpToDate Advanced and Lexicomp interactive clinical decision support and drug information tools.

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3M Health Information Systems announces GA of AI-enhanced CDI software that incorporates natural language processing technology from MModal, which it acquired in February.

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Health First (FL) implements Privia Health’s proprietary practice management technology, including EHR, patient portal and app, and online scheduling.

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A new KLAS report on the use of Epic Community Connect in practices of 1-10 physicians finds that Epic performs better than most small-practice EHR vendors in the areas of value and system performance; the practices are happy with integration with local ACOs and IDNs; and nearly all would choose Epic again. However, Epic’s usability scores lagged due to deep but not necessarily relevant functionality and cumbersome workflows. Unrelated to Epic itself, most users aren’t happy with the support they receive from their host organization, with some striking deals with Epic itself or seeking a different host. 


Government and Politics

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In Australia, Queensland Health Health Minister Steven Miles assures the press that a full review of the recent five-hour Cerner EHR outage at 14 hospitals is underway. He’s also taking heat for the state’s $92 million supply ordering system, which crashed hours after launch on August 1. One frustrated politician says it’s become almost impossible for nurses to order basic items. “Nurses having to put Band-Aids on the corporate bank card is absolutely appalling. Last week I heard nurses were actually buying food for patients from Woolworths. This is just absolutely ridiculous.”

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The Justice Department charges 58 people in Texas for participating in Medicare fraud schemes and operating pill mill clinics that doled out 6.2 million pills at a cost of $66 million. Three of those charged broke into a provider’s EHR to steal patient data that they then sold to durable medical equipment providers and contractors for $1.4 million.


Other

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In Arizona, Summit Healthcare Regional Medical Center’s August 1 switch from eight separate systems to Allscripts Sunrise has left many patients frustrated by long waits, chaos in the ER, and difficulty obtaining prescriptions. Numerous down times have occurred, creating backlogs in several departments. An executive admits, “We did have issues and we know we had things that didn’t work at first. Going from eight systems to one, you practically have to reinvent the wheel.”

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A Colorado man whose bachelor party hangover led him to seek rehydration in a freestanding ED generates a bill for $12,600, double the cost of the wedding itself. For that, he received two IV bags of saline and a dose of the anti-nausea drug Zofran, which the facility says justified a severity of four on a five-point scale and thus a facility fee of $7,644. The insurer’s negotiated price and payment left him with a balance of $2,600, which he says he can’t pay. Rural Colorado has only eight freestanding EDs and all of them in affluent ski resort towns. This one is owned by publicly traded hospital operator HCA. It says it has to overcharge patients with insurance because it can’t turn away those who can’t pay. The article notes that a local, spa-like hangover treatment center offers basically everything the groom received for $168.  


Sponsor Updates

  • Elsevier Clinical Solutions will exhibit at CAP19 September 21 in Orlando, FL.
  • EClinicalWorks will exhibit at the AMA’s 2019 FMX September 25-27 in Philadelphia.
  • Ellkay will exhibit at the Mayo Leveraging the Laboratory event September 24-25 in Nashville.
  • Ensocare will exhibit at the ACMA Maryland Chapter Annual Conference September 21 in Hunt Valley, MD.
  • Greenway Health will exhibit at the Virginia MGMA Fall Conference September 22-24 in Williamsburg.
  • InterSystems will host Global Summit 2019 September 22-25 in Boston.
  • Kyruus publishes a new case study, “How Providence St. Joseph Health Increased Visibility into a Growing Provider Network to Boost Demand Conversion and Improve the Patient Experience.”
  • AlayaCare adds Waystar’s RCM capabilities to its home care software.
  • Madison Magazine names Nordic as the best place to work in Madison, WI. 
  • Nuance develops pediatric-specific versions of its clinical communication, documentation, and analytics software.
  • Kyruus adds Uber ride-sharing capabilities to its ProviderMatch appointment-booking software for hospital access centers.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Shared Medical Systems 50-Year Reunion

September 18, 2019 News No Comments

Vince Ciotti attended the recent reunion of former employees of SMS. He sent some photos, augmented by those of SMS veteran Bob Haist (his photos label those employees whose names he jotted down).


We held the 50th reunion of early employees of Shared Medical Systems (SMS) this past Saturday, September 14 in King of Prussia, PA, the location of its early HQ. An amazing count of 140 ancient “King of Prussians” showed up, about 100 former employees and 40 (bored) spouses. It was quite a treat to see so many old friends, recognize their faces, and actually remember many of their names.

The highlight of the evening was an introductory speech by Harvey Wilson, co-founder of SMS in 1969. Harvey founded SMS along with Jim Macaleer, who sadly passed away quite recently, and Clyde Hyde, who passed away far too many years ago.

You may recognize Harvey’s name as the founder of Eclipsys in the mid-1980s, an early EMR vendors that he later sold to Allscripts. It is incredible that one man could be the founder of two of the leading vendors in the HIS industry!


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Check-in (show your Medicare card).

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Amazing how good SMS co-founder Harvey Wilson looks after all these years!

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Harvey’s introductory speech gave most of the credit for the company’s success to its hard-working employees.

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On the left is Keith Phillips, an early marketing superstar, trying to stop me on the right from guzzling too much Chianti.

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Another leading SMS executive from those days was Karl Witonsky, VP of development, in center in the back in the blue sweater. He gave a moving speech about life in the early days of IBM mainframe computing.

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Another leading SMS veteran was Ken Shumaker, with a beard in the center, drawing a diagram of how he programmed Unifile.

See also a PDF of Bob Haist’s photos with names.

News 9/18/19

September 17, 2019 News 3 Comments

Top News

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Jonathan Bush (Athenahealth) joins video and office visit provider Firefly Health as executive chair.

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Bush’s appointment was announced in the same press release as the company’s $10.2 million Series A funding round.

The two investment groups taking part in the funding round – F-Prime Capital and Oak HC/FT — are represented by former Athenahealth executives Carl Byers and Nancy Brown, respectively. 

Firefly’s founders are from Harvard Medical School.

Firefly bills a patient’s insurance for co-pay and video visits, with no charge for messaging. In-office visits are conducted only in Wellesley, MA, and the company does business only in that state. Firefly says it will “enter several new markets” in 2020.


Reader Comments

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From Wall Flyer: “Re: Leidos Health. Sold to private equity firm A&M Capital last week. I’m interested in your perspective of what this might mean. Leidos Health was the commercial healthcare business unit of Leidos, which essentially consisted of MaxIT and Vitaliz that were purchased by SAIC before spinning off into Leidos and Leidos Health.” Verified that the commercial EHR implementation business has been acquired, although I don’t have deal details yet since the announcement isn’t scheduled to come out until next week. The DoD’s Cerner project isn’t included — Leidos runs that project through its federal business unit. The portfolio of A&M Capital Partners includes government health IT contractor CNSI, which it acquired in April 2018. I’ll probably have more to say once I see the announcement. UPDATE: The Leidos PR contact graciously offered to answer my questions ahead of the announcement:

  • The affected business unit is Leidos Health, LLC, which does healthcare staff augmentation and EHR implementation and optimization work, basically the former MaxIT Healthcare and Vitalize Consulting Solutions.
  • About 850 Leidos employees will transfer to A&M Capital.
  • The reason for the sale is, “This transaction emphasizes Leidos’ focus on what it does best – creating and delivering solutions and services that drive improvements in patient care and make managing and delivering healthcare less costly and more effective. Additionally, the sale aligns the commercial EHR staff augmentation services business with a parent company that has a robust growth strategy that provides increased opportunities for employees focused on commercial EHR implementation services.”
  • The DoD’s MHS Genesis is not affected. It is operated the federal business unit of Leidos.
  • Terms of the sale will not be announced.

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From Who Dis: “Re: HIMSS20 keynote speakers. They just announced Chris Christie (former Governor of NJ) and Terry McAuliffe (former Governor of VA) for the Friday morning session. Does that change your mind about attending?” It confirms the wisdom of my decision to skip the last day, as I always do. I doubt that even the few folks who stick around all week will be anxious to hear more political yammering. I’ll spend that time waking up at home or at the beach (maybe Chris Christie will join me). I’m more interested in who gets the primetime agenda slots, which usually ends up being some minor celebrity (Dana Carvey comes to mind as one of the worst, with Dennis Quaid a distant second) or big-company executives. My wild guesses for the good spots: someone from “Shark Tank” (Robert and Mr. Wonderful spoke at HIMSS17), Barack Obama, Malcolm Gladwell, Nicholas Webb, David Feinberg or Toby Cosgrove from Google, Amy Abernethy from the FDA, Sean Parker, Jay Leno, Bill Gates, or someone from Walmart or Amazon. My off-the-wall suggestions, who you can Google if you don’t know them: Jen Gunter, MD; Ken Jeong, MD; Jonathan Bush; Devi Shetty, MBBS; Elizabeth Holmes (or John Carreyrou in her probable absence); Atul Gawande, MD (since he bailed out this year); Stephen Bergman, MD, PhD (aka Samuel Shem); and Neil Pappalardo. I would have said Martin Shkreli, but he’s still in prison, although maybe he can tele-keynote.


Webinars

September 19 (Thursday) 1:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2:00 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

October 2 (Wednesday) 1:00 ET. “Conversational AI in Healthcare: What About ROI?” Sponsors: Orbita, Cognizant. Presenters: Kristi Ebong, SVP of strategy and GM of healthcare providers, Orbita; Matthew Smith, AVP and conversational AI practice leader, Cognizant. Conversational AI holds great promise to drive new opportunities for engaging consumers and customers across all industries. In healthcare, the stakes are high, especially as organizations explore opportunities to leverage this new digital channel to improve care while also reducing costs. The presenter experts offer a thought-provoking discussion around conversational AI’s timeline in healthcare, the factors that organizations should consider when thinking about virtual assistants through chatbots or voice, and the blind spots to avoid in investing in those technologies.

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


Acquisitions, Funding, Business, and Stock

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The New York Times confirms that two big financial backers of Doctor Patient Unity – which has spent $28 million to squash proposed legislation that would eliminate surprise medical billing – are the private equity-owned physician staffing and practice operators TeamHealth and Envision Healthcare, which make fortunes sending out-of-network bills. Just in case you’ve forgotten that healthcare is a big business, Blackstone Group bought Team Health for $6.1 billion in 2016 and KKR took over Envision Healthcare in 2018 for $9.9 billion. DPU warns that hospital will close and doctor shortages will arise if the government requires companies to accept the median in-network payment instead of whatever inflated amounts they dream up. They advocate for independent dispute resolution instead, which is already the standard in New York. 

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Toronto-based specialty practice EHR, PM, PACS, and AI chat bot vendor OrbCare is reportedly nearing insolvency just six months after announcing a $2 million seed round. The company’s problems came to light when one of the investment firm’s partners, who had been announced as OrbCare’s new COO, found that its monthly revenue was half of what it had reported. The founder and CEO gave a variety of excuses – he was dealing with family matters, the company’s debt was incurred after the funding round, revenue was reported for clients who ultimately never signed up, he intentionally did not share a re-filed financial report with investors, and he never intended to be CEO in the first place. The investment firm provided a $1.2 million loan and has offered another $1.2 million to buy the company in a stalking horse bid. I don’t know how good its products are, but it sure has a bunch of them, so perhaps there’s intellectual property in play.


People

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Cerner hires Darrell Johnson (Medtronic) to the newly created position of chief marketing officer.

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Pivot Point Consulting promotes Keith Olenik to VP of revenue cycle services.

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Vince Vitali (Vitali & Associates) joins NextGate as VP of strategy and business development.

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Ricci Mulligan (Leidos Health) joins Grant Thornton’s healthcare practice as director. She previously held leadership roles the VA’s OIT department and retired from US Army Intelligence after 21 years.


Government and Politics

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A woman who bought her family short-term health insurance (aka a “junk plan”) gets a $244,000 hospital bill after her husband’s emergency bypass surgery. Her plan didn’t cover pre-existing conditions and limits hospital payments, so it covered only $4,000. She says “negative stories” had kept her from buying real insurance through Healthcare.gov, which she found afterward would have cost her less than the junk plan’s $400 per month premium. The real beneficiary was publicly traded insurance broker Health Insurance Innovations (HIIQ), whose share price tripled from 2016 to 2018 as its annual revenue grew to $350 million, valuing the founder’s stake at $150 million at its peak and earning its CEO $14 million since 2016. A White House executive order expanded the scope of short-term plans, resulting in a six-fold increase in policies since the end of 2018 to  600,000. Big insurers have jumped on board since they aren’t required to spend 80% of premiums on claims like they are for ACA-compliant plans, and in fact are averaging just 39%, making the plans highly profitable with minimal regulation. Meanwhile, HIIQ just paid $70 million to acquire a company that sells insurance via TV ads to senior citizens, so it sees promise in the “low-hanging fruit in the over-65 space.”


Privacy and Security

A ProPublica investigation identifies 187 Internet-accessible, unsecured servers that hold the medical information of 5 million Americans. Many of those records belong to mobile X-ray provider MobilexUSA – whose parent company Trident USA is operating under Chapter 11 bankruptcy – but the company says it has beefed up security after being notified of the exposure by ProPublica. DICOM overseer Medical Imaging & Technology Alliance says that secure connection capability was added to the standard in 1999 and any lack of security is the responsibility of the operator, but adds that some of the insecure systems don’t contain live patient information and instead are being used for product development and testing.


Other

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Cardiac surgeon and India hospital operator CEO Devi Shetty, MBBS makes some fascinating points in an interview:

  • Doctors will continue to be the most important people in a hospital, but they will need to be backed by skilled executives who know how to run the business.
  • The MBBS (MD) degree has lost its relevance because specialists make the broadest impact. He says lack of safe surgery kills 70 million people in India each year and 90% of India’s healthcare problems could be solved with emergency C-sections, laparotomy for burst appendix, and compound fracture repair.
  • Analytics holds great promise in healthcare, but 95% of hospitals in India don’t use EHRs, which is why his Narayana Health built its own after finding commercial products lacking.
  • Shetty’s hospitals perform 15% of all heart surgeries that are done in India and the company is using the huge volume of data that results to predict outcomes.
  • He does ICU rounds using Microsoft Kaizala encrypted mobile messaging and will soon have access to cardiac monitor live streaming.   
  • Shetty says that the keyboard is the biggest roadblock in capturing and using information. He predicts that voice-powered phone apps will overcome loneliness in elderly people by providing alarms, reminders, physiologic monitoring, and wellness checks.
  • He scoffs at the idea that AI will replace radiologists, saying that as with airline pilots, radiologists who use AI will replace those who don’t.
  • Shetty predicts that India will “become the first country in the world to disassociate healthcare from affluence,” unlike every other country where the cost of healthcare rose with incomes.

A husband and wife are charged in federal court with stealing trade secrets from Nationwide Children’s Hospital (OH), where they worked as exosome researchers. They are charged with selling the results of their research through companies they formed in the US and China. They also filed four patents in China. The indictment calls for the couple to forfeit $876,000 in cash, $450,000 in stock payments, and their shares in two biotech companies. The FBI is also investigating possible ties to the Chinese Communist Party and the Chinese government-sponsored “Thousand Talents Program” that encourages its citizens who work abroad to return to China with their newfound knowledge. The couple’s attorney scoffed at most reporter questions with the response, “Research while Asian.”


Sponsor Updates

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  • Audacious Inquiry prepares blessing bags for the Manna House in Baltimore.
  • AdvancedMD will exhibit at WebPT’s Ascend Conference September 19-21 in Minneapolis.
  • Arcadia Healthcare Solutions will exhibit and present at the NAACOS 2019 Fall Conference September 25-27 in Washington, DC.
  • Bluetree and Dimensional Insight will present at IntegraTe HIMSS South Florida September 24 in Davie, FL.
  • CarePort Health will exhibit at ACMA Maryland September 21 in Hunt Valley, MD.
  • Clinical Architecture will exhibit at the InterSystems Global Summit September 22-25 in Boston.
  • Redox joins the Allscripts Developer Program and earns its first global integration engine certification.
  • CompuGroup Medical will exhibit at the AZ MGMA Conference September 24-25 in Chandler.
  • Rob Gallo joins The Chartis Group’s informatics and technology practice as a principal.
  • CoverMyMeds will exhibit at the PCMA Annual Meeting September 23-25 in Scottsdale, AZ.
  • Cumberland Consulting Group will lead sessions at the Medicaid Drug Rebate Program Summit September 23-25 in Chicago.
  • Diameter Health will host its 2019 Customer Forum October 2-4 in Dedham, MA.

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Monday Morning Update 9/16/19

September 15, 2019 News 1 Comment

Top News

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A report from the American Hospital Association and consulting firm EY says that participatory health, or “healthcare with no address,” is coming. It predicts that health systems will respond to consumers who want on-demand, connected, and data-driven services.

The report says a participatory health framework will require health systems to offer:

  • Health and wellbeing support.
  • A personal health cloud containing the patient’s own data, including biometrics.
  • AI analysis of the data to create new insights and solutions.
  • A demand-driven global marketplace.

The report predicts that physicians will become “data-driven conductors” who will take responsibility for managing the lifestyle and wellness of patients.

The authors observe that while the future is more patient-centric and participative, health systems must move toward value while continuing to earn most of their revenue for volume. They will also have deliver anywhere, anytime care even though they have spent a lot of money on brick-and-mortar locations.

Nontraditional players such as entrepreneurs, retailers, and technology companies are ahead of health systems in offering consumer-oriented health services. Value-based payments favor non-hospital locations such as retail clinics and consumers prefer those anyway, with the next step for those retail locations being to offer chronic care management via telehealth.

Time zone differences also encourage global approaches, such as ICU monitoring virtual second opinions.

The article also calls out successes in which health systems have applied their quality improvement and relationship-building expertise to partner with their communities to address social determinants of health. 


Reader Comments

From Set in Code: “Re: CPT codes. I work in a large Medicaid health plan. CMS requires use of AMA-copyrighted CPT codes. We are now being charged per member for each instance of the CPT code set that is used in any of our systems, meaning that we’re paying AMA multiple times for the same member. It also seems that organizations pay radically different per-member rates. AMA has created a monopoly and I believe that CPT licensing revenue is its largest revenue source, but I would like to see leverage applied to keep the cost reasonable as AMA seems to be offsetting shrinking membership by forcing health plans and providers to make up the gap.” AMA’s most recent tax filings show a profit of $26.4 million (up from $9.4 million last year) on revenue of $317 million, of which only $38 million came from membership dues. Royalties generated $148 million of the “other revenue” total of $191 million. AMA paid its EVP/CEO $2.2 million, its COO $1.2 million, and the former Allscripts executive who heads up the CPT group $900,000. About 80% of US doctors are not AMA members. AMA made $1.5 million in political contributions last year and spent $20 million on lobbying, just in case you want to launch a grassroots effort to get politicians to rein in its CPT fees. Like a lot of member organizations (including HIMSS), the organization’s most significant revenue comes from selling access to members and running businesses that actually compete with the work of some of those members (as I always say, that’s the “ladies drink free” business model). 

From Jonas Sister: “Re: Epic’s employee testing. Some of your readers have spoken, but you haven’t.” My position is that: (a) Epic can use whatever methods it wants to hire employees and it’s nobody else’s business; (b) you can argue theoretically why Epic’s tests shouldn’t be good predictors of job performance, but you can’t argue with the success Epic has had for decades in using those tests virtually unchanged to hire thousands of employees; (c) people who complain about Epic’s tests as being irrelevant or unfair are usually folks who weren’t hired, either by Epic itself or its health system customers who administer the same tests to their own prospective Epic team members; and (d) while we might personally believe that our experience should be valued over test scores, that’s not the case with Epic, who sees greater long-term promise in a blank canvas. Also note that Epic has an endless supply of applicants, the company is an efficient machine in onboarding new hires and either moving them up the ladder or out the door, and its processes are apparently so well laid out that it doesn’t need people who have learned bad habits from crappy health IT companies. I will give more credence to passionate arguments about how Epic’s hiring and retention practices are wrong once I see the company struggling because of them. It hurts to be passed over purely based on the results of a “lions, tigers, and cages” type question or a MUMPS-like programming logic quiz, but the most important logic question is why anyone would expect Epic to ditch practices that made it the industry leader.


HIStalk Announcements and Requests

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Two-thirds of the employers of poll respondents have laid people off recently, and of those, about half say that older or sicker employees seemed to have been targeted. Not Exactly says his EHR vendor laid off to hit a payroll dollar target, so that raised the risk for experienced, higher-paid employees. Cosmos says their vendor employer reduces headcount by running long hiring freezes instead of layoffs, but the folks who leave are often younger ones with better options and who don’t need the health insurance instead of those who might be laid off otherwise.

New poll to your right or here: Which factor do you think was most important in being hired by your current employer?

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Welcome to new HIStalk Platinum Sponsor Zynx Health. The Los Angeles-based company, which is part of the Hearst Health Network, offers ZynxOrder (evidence-based order sets and clinical decision support rules); ZynxCare (evidence-based plans of care); specialty content packages (home health, pediatrics, skilled nursing, chronic conditions); Knowledge Analyzer (evaluation and optimization of clinical content and processes); and the recently introduced Lumynz (analytics that looks at orders vs. evidence, including the financial impact). Its Vital Interventions has identified high-impact interventions (mortality, cost, length of stay, admissions and readmissions, and hospital-acquired conditions) that align with performance measures and quality and cost objectives. The company just announced new Knowledge Analyzer reporting capability that allows hospitals to map clinical decision support to best outcomes and to prioritize the potentially most impactful interventions. Thanks to Zynx Health for supporting HIStalk. 

I was playing some country music on the Sonos for a visitor who, unlike me, enjoys it. Just about every song featured cartoonishly cowboy-hatted, testosterone-swaggering male singers with questionable Southern accents. I looked up how many of the 20 or so songs that we heard were actually written by the throaty twangers themselves. Answer: zero, although a couple of them shared a songwriting credit with an actual songwriter in what I imagine was a pay-to-play deal to get the tune recorded in the first place. Country and pop were about the same on Billboard’s current top 10 charts – lots of co-writing credits, but no singer actually wrote their hit solo. Conclusion: as in acting, comedy, politics, and maybe most other areas, music stars are usually just reading someone else’s thoughts since they are entirely separate forms of craftsmanship, although (a) those with star power in TV and music can command inflated billing as executive producers or co-writers, respectively; and (b) in music, at least the less-recognizable people who actually create the songs are earning publishing royalties in perpetuity instead of swigging vodka from an onstage water bottle while unenthusiastically shouting “How you doing tonight, Omaha?” from their gig in Kansas City.


Webinars

September 19 (Thursday) 2:00 ET. “ICD-10-CM 2020 Code Updates.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, director of terminology mapping, IMO; Theresa Rihanek, MHA, RHIA, classification and intervention mapping lead, IMO; and Julie Glasgow, MD, senior clinical terminologist, IMO. The 2020 regulatory release is right around the corner. Join IMO’s top coding professionals and thought leaders as they discuss new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines; share potential impacts of the code set update; and review ICD-10-CM modifier changes.

September 26 (Thursday) 2 ET. “Patient Education Data: A Key Ingredient for Improving Quality and Patient Experience.” Sponsor: Healthwise. Presenters: Victoria L. Maisonneuve, MSN, RN, director of the Nursing Center for Excellence and Magnet program, Parkview Health; Marta Sylvia, MPH, senior manager of quality improvement and outcomes research, Healthwise. Healthcare data is everywhere! It’s scattered across various systems and in countless formats, making it difficult to collect and glean actionable information. Knowing where to start depends on what your organization wants to accomplish.  By focusing on your patient education data, you can drive quality improvement across your organization. Vicki Maisonneuve will share how her team analyzes data around the use of patient education. By combining different data sets, she can easily identify trends, gaps, and opportunities to improve quality and patient experience across Parkview Health.

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


Acquisitions, Funding, Business, and Stock

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I missed this last week. Livongo reports Q2 results: revenue up 156%, adjusted EPS –$0.46 vs. -$0.31. The company says it will lose $40 million on the year. Shares dropped 17% on news of widening losses, with LVGO shares now trading at under $25 versus their first-day offering price of $28 and first-day close of $38.10 on July 25, meaning that someone who spent $10,000 jumping on the IPO now has less than $6,500 worth of shares. The company is valued at $2.4 billion. From the earnings call:

  • The company says it met all of its financial and operational objectives in the quarter, with increased enrollment and 720 clients signed.
  • Livongo touted its increasing total contract value, which it calculates using percentage enrollment assumptions that are applied to company headcount. Contracts runs 1-3 years.
  • The company didn’t directly answer an analyst’s question about how many users drop out, but later said it lost about 2% of users during the year and three-fourths of that was due to employees leaving their companies that provided the platform.
  • Livongo is cross-selling among its products – hypertension, weight management, diabetes management, and behavioral health – but its diabetes offering is generating almost all its revenue so far.

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Cancer powerhouse Varian will invest an unspecified amount in Philadelphia-based Oncora Medical, which offers precision radiation oncology software.


Sales

  • Thomas Health (WV) outsources its Level 1 help desk to CereCore.
  • England’s East Lancashire Hospitals NHS Trust joins the global health research network of TriNetX for searching patient cohorts, querying study-related data, and adding study visibility to pharmacy and contract research organizations.

Announcements and Implementations

Nordic creates Registry Direct, which offers automated, FHIR-powered abstraction for sending EHR data to the American Heart Association’s Get With The Guidelines online registry.


Government and Politics

An article in Foreign Affairs says that China is following the economic growth script of Germany, France, and Japan in moving up the food chain from manufacturing cheap global goods to creating an innovation powerhouse that is being driven by a world-leading economy and government-led investment in research. It predicts that China will soon end the US’s 70-year run as the world’s leader in science and technology. The authors cite JAMA, which predicts that China will become the world’s leader in drug development in the next five years. The well-credentialed authors recommend that the US government spend more on scientific research, push efforts to translate the results into marketable products and services, and create jobs outside of the usual hub cities like Seattle, San Francisco, and Boston and instead focus on cities where land is cheaper and people can be more productive.  


Privacy and Security

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Facebook warns users that new privacy protections are enabled by default in IOS13 and Android 10 that prevent the app from tracking its users in real time, which Facebook insists (without irony) is a problem because users will thus be deprived of valuable services such as location-targeted ads. The new features mimic privacy options that are already available in Facebook, but Facebook knows that few users modify its defaults and in any case will struggle to find the option within its complex privacy settings menu.


Other

The Chicago business paper looks at the highest-paid executives of Lurie Children’s Hospital, including the CEO ($2.2 million) and the CIO ($460,000).

Britain’s health secretary Matt Hancock declares that he won’t let his country’s drug usage “escalate to the level seen in the United States,” following release of a new government report that says 25% of people in Britain are taking meds for pain, anxiety, depression, and insomnia, with half of those being long-term users of at least a year. More than 10% of Britain’s population take antidepressants and nearly that many are taking opioids, with women and people in poorer parts of the country having higher rates. England and Wales have a long way to go to hit US-class opioid death rates, as just 2,200 people there died of opioid overdoses last year vs. 47,600 in the US.

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The 33-year-old investor co-founder of Hims – which peddles erection and baldness treatment drugs following an “online assessment” that is reviewed by “our network of doctors” – publicly announces his expectation of being a billionaire “by my mid to late 30s” in a Quora post he later deleted in a late-onset attack of faux humility. If you want to upend US healthcare and save billions of dollars, make all drugs available without a prescription since consumers who want them will get them at any cost regardless.

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@DrJenGunter explains why she became a patient advocate in answering the call of Bernie Sanders to describe “the most absurd medical bill you have ever received.”


Sponsor Updates

  • Health Catalyst will exhibit at the 2019 MHA Fall Convention & Trade Show September 18-20 in Billings, MT.
  • Mobile Heartbeat will exhibit at the Chief Nursing Officer Summit September 16-17 in Scottsdale, AZ.
  • Waystar will exhibit at CareVoyant UGM September 18-20 in Schaumburg, IL.
  • Netsmart will exhibit at the Ohio Council for Home Care and Hospice Annual Conference and Tradeshow September 17-18 in Columbus.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal Partnership Conference September 22 in Concord, NC.
  • OmniSys will exhibit at the Pennsylvania Pharmacists Association’s Annual Conference September 19-22 in Seven Springs.
  • PatientKeeper will exhibit at AHIMA through September 18 in Chicago.
  • Health Catalyst shares insights from its annual Healthcare Analytics Summit.
  • Wolters Kluwer Health announces efforts to promote Sepsis Awareness Month, including a new blog series and its Sepsis Resource Center.

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Reader Comments

  • Scot Silverstein MD: I can say, unfortunately, with an exceptional degree of confidence that patients are harmed by events such as we describ...
  • Clinton Phillips: Thank you Dr. Jayne for the Veterans Operation 11/11 shout out. Medici is excited to see how many veterans we can help a...
  • @henryjones: Again what evidence do you have here that you "know that Epic demands more redactions and secrecy than other EHR vendor"...
  • Mr. HIStalk: Vikas Chowdhry gets all the credit for interviewing Dr. Bhavan. He volunteered to conduct interviews, of which this is h...
  • Expressyourself: I think the sensor part is referring to sending when you open or are in a patient's chart. Then they probably use that t...
  • Matt Ethington: This is inspiring and has so much more potential for healthcare. So many new reimbursements focus on patient engagement...
  • Eddy T. Head: "Patented sensor-based software technology in use at health systems and practices delivers actionable patient data to pr...
  • Code Jockey: Mr. HIS - you, once again, do this world a great service. For me personally I'll say thanks for posting to a document th...
  • Vaporware?: re: Queensland's Cerner project * Delayed ... check * Over budget ... check * "Not fit for purpose" ... check * Buye...
  • E!: Agreed. Epic is just generally anti-worker with their regular labor violations, over aggressive non-compete, etc....

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