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News 8/3/18

August 2, 2018 News 2 Comments

Top News

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A federal jury convicts self-proclaimed human rights activist and Anonymous member Martin Gottesfeld for masterminding DDoS attacks on Boston Children’s Hospital and Wayside Youth and Family Support Network (MA) in 2014 – both in retaliation for their treatment of a patient who was in the midst of a custody battle between her parents and the state. Gottesfeld triggered the router-borne malicious software during the hospital’s fundraising period, which ended up crippling its network and knocking it and several other area hospitals offline. He was finally arrested in 2016 after a cruise ship rescued him and his wife from a broken down boat off the coast of Cuba.

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Rolling Stone published a compelling read on the entire saga last summer.


Reader Comments

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From Deficiencies Down Under: “Re: Patient safety risks with Queensland’s new Cerner system. Doctors have been complaining about system bugs and failures, and worries over patient safety. The government has admitted to five major IT outages over the last 12 months.” Queensland Health pledged $1.2 billion to the 20-year IT overhaul in 2015, including the deployment of Cerner to 21 hospitals.


Webinars

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


Acquisitions, Funding, Business, and Stock

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MDLive raises $50 million in a funding round led by Health Velocity Capital.

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Mediware acquires BlueStrata EHR, a St. Louis-based vendor focused on the long-term care market.

MedStar Health’s National Center for Human Factors in Healthcare secures a patent for a system designed to analyze data gleaned from eye-tracking technology, which researchers hope to use in the development of safer and more efficient healthcare software.

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Evidation Health raises $30 million and develops new data tools to more efficiently aggregate and analyze large-scale datasets from smartphones, sensors, and traditional sources of health data like medical records, claims, and patient-reported outcomes.

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WebMD acquires the Vitals Consumer Services Division of MDx Medical, which includes the provider comparison websites Vitals.com and UCompareHealthcare.com.

A slew of Q2 results:

  • Allscripts – revenue up 25 percent, adjusted EPS $0.18 vs. $0.15, meeting earnings expectations, but falling short on revenue.
  • Cerner: revenue up 6 percent, adjusted EPS $0.62 vs. $0.61, beating analyst expectations for both.
  • IRhythm Technologies: revenue up 55 percent, adjusted EPS -$0.51 vs. -$0.29, beating revenue expectations but falling short on earnings.
  • Teladoc: revenue up 112 percent, EPS  -$0.40 vs. -$0.28, beating expectations for both.

People

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Howard University Hospital (Washington, DC) names Kevin Dawson, MD (MDx BioAnalytical Laboratory) CIO.

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T-System brings on Bob Wilhelm (Adreima) as CEO.


Sales

  • PMC Regional Hospital (IN) will implement Meditech Expanse later this year with help from Engage.
  • LIS and consulting company Rhodes Group will deploy HealthShare from InterSystems to better manage patient data.
  • Allegheny Health Network (PA) selects digital medical image sharing technology from LifeImage.

Announcements and Implementations

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Montage Health (CA) goes live on the latest version of Epic. Upgrades include new functionality related to social determinants of health.

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DirectTrust says Direct users sent more than 50 million messages in the second quarter of 2018, for a cumulative count of 432 million. The number of DirectTrust addresses jumped 19 percent to 1.7 million. Over 240,000 patients are now using the service.

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NIC gives Appriss Health a run for its money with the launch of RxGov, PDMP technology built of of newly acquired software from Leap Orbit. (Leap Orbit partner David Finney laid out the monopolistic state of the PDMP technology market in this Readers Write.)


Privacy and Security

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Reddit suffers a breach that leaves its anonymous users worried hackers will threaten to expose the online personas they created to post unsavory content and unpopular opinions. One security analyst likens it to the marriage-shattering repercussions of the Ashley Madison hack in 2015.

Australia’s hotly contested effort to provide every citizen with a PHR suffers another blow, as the Australian Digital Health Agency reveals the My Health Record system has already been breached nine times, though none were by outside parties. Australians have until November 12 to opt out of the initiative. The deadline was pushed back a month after privacy groups expressed concern with the system’s safeguards.

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NIST publishes a cybersecurity practice guide to securing electronic records on mobile devices.


Other

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A new KLAS report covering go-live support finds that Medasource, Optimum Healthcare IT, and CSI Healthcare IT are top satisfaction scorers, with their respective high-performing areas being avoiding excessive fees, strong relationship-building, and resource vetting. It notes customer satisfaction drop-off for three 2017 high performers: HCI Group (overpromising on involvement and resource expertise); Nuance (poor communications and focus on expanding engagements); and Santa Rosa Consulting (lack of leadership team relationship-building). Customers say their critical success measures are high user adoption, effective training, and meeting timeline and budget expectations.

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Delaware Health Information Network CEO Jan Lee, MD recounts her struggle to find affordable, in-network medical care after injuring her hand on a table saw. A week-long search for a PCP and surgery referral left Lee frustrated and dumbfounded at the amount of hoops she had to jump through. “By this time it’s been close to a week that I’ve been wandering around with an open fracture,” she said. “My friends within the healthcare community who have heard about this are going nuts, saying ‘This is preposterous.'” Despite being a Tricare health plan member, Lee is stuck with over $10,000 in medical bills, which she has vowed to fight. Incidentally, DHIN is in the midst of creating a claims database so that consumers can compare treatment costs across the state.

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Weird News Andy might ask, “Who moved my cheese?” in covering the $1 million a genetically engineered mouse has brought in for the University of Minnesota. The animal was developed to assist researchers with myeloma cancer treatment. Its antibodies have been sold for the last 15 years per a licensing agreement with Cell Signaling Technology.


Sponsor Updates

  • EPSi will host its Western Regional User Conference August 7-8 in San Diego.
  • HBI Solutions will present at the Supplemental Health, DI & LTC Conference August 6-8 in San Diego.
  • Goliath Technologies achieves record growth in the first half of 2018 with new customers like Genesis Health System.
  • Healthgrades announces the recipients of its 2018 Women’s Care Awards.
  • Impact Advisors releases its first quarterly newsletter, “The Impact Advisor 3Q18.”
  • Intelligent Medical Objects will exhibit at the NextGen Midwest Regional Client User Group Meeting August 9-10 in Dearborn, MI.
  • Vocera adds care team alerts from Qventus to its care coordination and communication platform.
  • Gartner recognizes Spok and its Care Connect Platform in its 2018 Market Guide for Clinical Communication & Collaboration.
  • Securance Consulting gives Parallon Technology Solutions a “Best Practice” rating for its Meditech hosting services.
  • PatientSafe Solutions makes its PatientTouch app available in the Epic App Orchard.

Blog Posts


Contacts

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

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News 8/1/18

July 31, 2018 News 3 Comments

Top News

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HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues as required by the Corporate Integrity Agreement it signed in May 2017 as part of its $155 million False Claims Act settlement. 


Reader Comments

From Low Slider: “Re: Recondo. Just a point of clarification. Payment Navigation Compass is a white label of Recondo products, not Empowered Access being a Recondo name for Payment Navigation Compass. Recondo has purchased that Advisory Board / Optum client base to be managed by the original manufacturer, Recondo.” Thanks.

From Not KLAS-sy: “Re: KLAS. A former executive recently took a job with one of its high-scoring vendors that financial supports KLAS’s work. Sounds fishy.” I don’t see any harm on that and I don’t think it reflects negatively on KLAS or the vendor. I don’t know who you’re referring to specifically, but if that person had a lot of healthcare IT experience, it’s not unreasonable that they would remain in the industry and end up working for a high-achieving vendor when they were ready to move on. I doubt there’s any pay-for-play at work here if that’s what you are suggesting – if that were the case, the vendor would be better off leaving that person as a KLAS insider instead of hiring them. Regardless, check back in a year, and if the vendor has dropped out of frontrunner status, then maybe you were right. 


HIStalk Announcements and Requests

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A reader desperate for all-too-rare good news suggested this question about bosses showing humanity (which might be all-too-rare as well since I’ve received few responses.) I remember when I was fresh out school and running a hospital department and one of my employees died unexpectedly in a biking accident. The associate CEO I reported to insisted that the two of us take the six-hour drive to the employee’s home town to attend his funeral, with the hospital quietly footing the travel bill. The employee’s family members were amazed to see us there and were touched that we had traveled so far.

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Welcome to new HIStalk Gold Sponsor Zen Healthcare IT. The Costa Mesa, CA-based interoperability technology and consulting company offers its Gemini Integration-as-a-Service platform that allows healthcare organizations to outsource their interoperability challenges or just use the company’s enterprise architecture. Gemini is the fastest, most affordable way for healthcare organizations to achieve connectivity between systems and exchange partners, whether it’s one interface or thousands. The company also offers the Stargate IHE on-ramp to Carequality and EHealth Exchange and a FHIR-based clinical data repository.  Its consulting service helps design, deploy, and support use-case driven healthcare integrations. Thanks to Zen Healthcare IT for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51 (both based on a new revenue recognition standard), beating earnings estimates but falling short on revenue. From the earnings call:

  • Hospital business remained “relative small” with bookings down year-over-year, and effort will be focused on small hospitals going forward.
  • Executive Chairman Jeff Immelt says the company is “moving with a purpose” in considering a company sale, a merger, or continuing as an independent business to “unlock value in the company.”
  • R&D was one of few expense categories that increased amidst cost cutting.
  • Immelt says the seismic changes in healthcare are forcing clients to figure out their best business model going forward, but they remain supporters of Athenahealth.
  • Executives on the called prefaced their responses to analyst questions with “look” 11 times in addressing the questioner, which I usually read as being defensive or dismissive.
  • It was a pretty dull call without Jonathan Bush.

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Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39. Product revenue rose 28 percent, while services revenue dropped slightly due to customer consolidation.

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Teladoc will change its name to Teladoc Health.

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Walgreens launches Find Care Now, a marketplace on its website and app that lists alternatives for ED visits — with cash prices  — as provided by Walgreens and its partners, which include several major health systems.

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Newly renamed Verana Health (formerly known as DigiSight Technologies) raises $30 million in a Series C funding round led by Alphabet’s venture capital arm. The company’s technology merges EHR data with registries to support drug and medical device development. The company also announces that Miki Kapoor, former CEO of Welltok-acquired Tea Leaves Health, has signed on as president and CEO in replacing Doug Foster, who was apparently demoted to chief strategy officer.

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Columbiu, OH-based healthcare AI and workflow automation vendor CrossChx renames itself Olive and raises $33 million in Series D funding round, increasing its total to $73 million.

Former GE Chairman and CEO Jeff Immelt bet the farm on GE Digital’s “digital industrial” and Internet of Things services before he was shown the door, but now the company is shopping for a buyer of part of that money-losing business.

Bloomberg notes that little-known people sometimes become fabulously wealthy, even billionaires, after helping relatives and friends with their tech startups. The parents of Amazon’s Jeff Bezos helped him out with $250,000 in 1995, with those shares now worth up to $30 billion, while the $10,000 his brother and sister provided in 1996 gave them shares now worth $640 million each.


Sales

  • Roper St. Francis Healthcare (SC) chooses DocASAP for online appointment scheduling.
  • Mercy selects Visage 7 Open Archive and will convert 25 million diagnostic images from its current archive.
  • Four-hospital UHS (NY) chooses Epic, according to this video forwarded to me by a reader.

People

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Evergreen Healthcare Partners hires Todd Hatton, MHSA (Saint Luke’s Health System) as VP of advisory services.

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Kathy Ross, MBA (Stony Brook Medicine) joins Broward Health (FL) as CIO.


Announcements and Implementations

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Mary Washington Healthcare (VA) went live June 2 on Epic, hopefully inspiring the health system to create a new “Hamilton”-themed video as it did when announcing Epic as its choice and when calling out its planned go-live.

Virginia Governor Ralph Northam announces that all 129 of the state’s hospitals are live on Collective Health’s network, allowing emergency medical services personnel to access patient information and to display integrated information from the state’s PDMP database and advance directive registry.

Galway Clinic goes live on Meditech Expanse, the first hospital in Ireland or the UK to do so.


Government and Politics

Specialty physicians are complaining about a proposed Medicare change that would pay them a flat fee per patient visit, warning that not being paid more for seeing more complex patients will hurt their incomes, steer medical students away from specialties like rheumatology, shorten visits that would then require follow-up care, or give specialists incentive to cherry-pick just the healthier patients or to stop accepting Medicare entirely. Doctors would have the option to tack on a $67 Medicare bill for more complex visits, which you can bet will be a popular option as, once again, trying to cut healthcare costs means reducing someone’s income and they’ll fight it however possible.

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Farzad posts a wise comment about the proposed flat fee rule and the political issues that stand in the way of reducing healthcare costs.


Privacy and Security

Blue Springs Family Care (MO) notifies patients that its EHR was penetrated in a ransomware attack, saying that as a result, it has implemented a new firewall and intrusion detection system and also replaced its EHR with one that encrypts patient data (Jenn contacted the practice, which told her they are moving from E-MDs to EClinicalWorks).

Ancestry.com and 23andMed will provide consumers with a separate consent form to convey their permission for their genetic information to be shared with third parties.


Other

AMA Wire interviews a Regenstrief scientist who lists three reasons that EHRs are hard to use even for digital natives: (a) mobile devices can’t display enough information, so PCs are still the norm; (b) most EHRs were designed in the last century before mobile devices became ubiquitous; and (c) the EHR paradigm is that users look up what they need to know, unlike smart search and voice-powered systems that anticipate user need.

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Forty physicians and employees of Dignity Health (CA) who lost their homes in the Carr wildfire are still showing up to work as scheduled.

A new study by the Nation Association of Insurance Companies finds that insurers that sell short-term policies (aka, exclusion-filled “junk” insurance as touted by the White House) pay out just 44 percent in claims versus the ACA-required 80 percent Medical Loss Ratio, meaning those plans generate far higher profits in sticking patients with more of the bills.

An Indiana teen becomes the latest of several hospitalized victims of the Hot Water Challenge, in which YouTube videos dare kids to pour boiling water on an unsuspecting friend or to drink boiling water through a straw.


Sponsor Updates

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  • Bluetree employees raise $7,000 for local nonprofits RISE and Friends of the State Street Family.
  • Burwood Group will exhibit at the NC Tech Leadership Summit August 9 in Pinehurst.
  • Carevive Systems publishes a new video, “Acute Myelogenous Leukemia: Treatment Updates and Implications for Older Patients.”
  • CoverMyMeds will exhibit at the EMDs User Conference August 5-7 in Grapevine, TX.
  • Cumberland Consulting Group will sponsor the Health Plan Alliance Government Programs Value Visit August 6-10 in San Francisco.
  • Meditech publishes a podcast titled “Social Determinants of Health and Transitional Care.”

Blog Posts


Contacts

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

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Monday Morning Update 7/30/18

July 29, 2018 News 3 Comments

Top News

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The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs that the VA included in its contract that the DoD had to add after the fact.

DoD says it had to extend the work of Leidos to include EHR standardization since the VA hired Cerner as its prime contractor, such that “contracting with anyone else (other than Leidos) to work with Cerner would create significant redundancies, inefficiencies, and other issues.”

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DoD says Cerner declined to provide access to its Clinical Application Services to third parties “to enable competition.”

Allscripts and CACI challenged DoD’s sole-source selection of Leidos for the contract extension, but were rejected with the rationale that the government isn’t interested in bringing another EHR into the mix.

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Meanwhile, Leidos says in its earnings call that it will serve as Cerner’s subcontractor in the VA’s implementation, providing services for program management, implementation, help desk, and security.


Reader Comments

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From Magic Kingdom: “Re: Orlando Health. Going Cerner.” Unverified. The job description of the CIO who was hired earlier this year said that the health system will be choosing a new EHR after running Allscripts Sunrise for around 15 years. Adventist, the other big system in town, is a Cerner shop, and Orlando Health uses Cerner lab. But nothing’s been announced and I haven’t seen any relevant open position listings. If the rumor is true and the process is far enough along (and I have no knowledge of either), the announcement would probably come Thursday when Cerner post Q2 earnings.

From Health System Exec: “Re: consultants. Is it possible for you to ask where your readers would go to find a list of consulting firms that can handle a large health system’s full ERP implementation? (human capital, materials management, finance and accounting). Gartner? KLAS? Other?” I’ll open it up to readers to post a comment about their sources (not specific consulting firms since that’s not the question).

From RxPriceResearcher: “Re: drug prices. Is there a public or federal database that maintains historical medication prices? For example, I would like to compare the price of Tylenol 500mg from 1990-2017.” Medicaid publishes a database that goes back to 2013. The only source I know otherwise is from Wolters Kluwer and it’s not free. It’s hard to even understand the effect of “price” since the US healthcare non-system involves a hidden web of contractual discounts and rebates that make it less meaningful.

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From Vague Gravity: “Re: Optum and Recondo. Confirming Eligible Bachelor’s rumor from Friday with the attached email.” The customer email from both companies says that, as the reader’s rumor said, Recondo has taken over Advisory Board’s Payment Navigation Compass reimbursement product, which Recondo has been reselling under the Empowered Patient Access name. The email notes that both Optum and Advisory Board are owned by UnitedHealth Group, which is a “key shareholder” in Recondo (I don’t think I knew that).

From James: “Re: hospital sleep. Not really news, just confirmation of what we know.” A JAMA Internal Medicine-published survey of 2,000 inpatients in the Netherlands asked a simple question – how did you sleep last night compared to at home? Patients reported sleeping 83 percent less and 70 percent said they were awakened due to external causes, half of those due to hospital staff. Rest was most commonly interrupted by the noise of other patients, medical devices, pain, and toilet visits. I’ve spent just one night in a hospital and it was anything but restful and recuperative, hitting every anecdotal cliche in been awakened by vital sign checks, IV tinkering, hallway staff exuberance, and the racket of beeping and wheezing machines from my own bedside and that of my roommate in what was supposed to have been a private room. I will posit that length of stay would be longer if hospitals had better accommodations, food, and hospitality instead being barely better than a prison, which is probably a good thing since it’s not supposed to be a vacation (not to mention that every hour in a hospital bed increases your chances of being harmed by the never-ending screw-ups).


HIStalk Announcements and Requests

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The vast majority of poll respondents don’t want health insurers making coverage or premium decisions based on their harvested, non-medical data, which of course will return to legality once again following the White House’s scuttling of the ACA, which set minimum standards for coverage and policy terms that benefitted even those who buy insurance from their employers. The business of health insurance is interesting since pricing every other kind of insurance — auto, homeowner’s, life, and malpractice — requires the applicant to disclose everything that might affect the insurer’s risk even though those insurers don’t pay out until the subscriber experiences a catastrophic, measurable event, with premiums set by that person’s risk. Health insurance pays routine costs for accumulated health conditions starting almost immediately, yet we don’t want those insurers knowing too much about us. It’s like a reverse Las Vegas, where the house’s lack of information and forced participation gives gamblers the edge, with the solution being that insurers either overcharge and bank handsome profits or pull out of a market entirely, all based on the risk pool they’re stuck with.

This week’s question, based on the Montefiore resident who may be fired over unproven accusations that he posted white supremacist writings under another name – Is it OK to fire an employee over unsavory but legal off-the-job activities? Internet lynch mobs who were raised on TV judge shows love playing armchair jury and going personally after someone who has done or said something they don’t like — even when that person hasn’t been charged with a crime or the information source is unvetted — and companies that are worried about taking a bottom-line hit find it easier to just fire them in publicly shared indignation. Any resemblance to actual legal process is coincidental – it’s short attention span, “I know it’s true because I read it on Facebook and someone is trying to hide it even though I haven’t read a newspaper in years” outrage, because everybody is required to be outraged by everything these days.

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I gave the “wish I’d known” series a short vacation since summertime responses were sparse, but I’ll revive it this week with a reader-requested question in a slightly different format.The reader says we need more positive stories and I agree.

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Welcome to new HIStalk Platinum Sponsor Apixio. The San Mateo, CA-based company offers an AI-powered data insights platform that creates a comprehensive picture of a patient’s medical history, then applies data classifiers and predictive models that give insights to their health to support delivery of personalized and affordable care. It also offers an efficient, accurate, and complete risk management solution that turns unstructured data into meaningful data to maximize coding efforts while remaining compliant, with an average ROI increase of 400 percent and productivity gains of 4-7x over manual, low-tech methods. Quality measurement expert Darren Schulte, MD, MPP has worked in healthcare analytics and technology for a long time and has been with the company since 2011. Thanks to Apixio for supporting HIStalk.

I always head over to YouTube to scope out a new sponsor, so here’s the intro video I found for Apixio.

I’m losing a handful of sponsors that (a) have hired empowered but industry-clueless marketing people who don’t know what HIStalk is; or (b) are too broke to continue their sponsorship. Contact Lorre to replace them. I don’t lose many sponsors except by acquisition, so it boosts my self-esteem to replace the others.


Webinars

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Vocera announces Q2 results: revenue up 8 percent, adjusted EPS $0.09 vs. $0.02.


Sales

  • Carilion Clinic (VA) joins TriNetX’s global health research network to assess its patient population for suitability for clinical trials.

Decisions

  • Nemaha Valley Community Hospital (KS) has switched from Medhost to Cerner.
  • Essentia Health (MN) is replacing Caduceus Systems with Tecsys supply chain management software, to be completed by June 2019.
  • Stonewall Memorial Hospital (TX) will replace Evident (CPSI) with Athenahealth in October 2018.

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


Other

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A literature review finds that consumer-facing diagnostic websites and apps – excluding those that are approved or being reviewed by FDA, that perform physical tests, or that offer only literature searches – are poorly supported by clinical studies and sometimes offer low accuracy rates. The categories included symptom checkers, smartphone photo analysis for skin or eyes, and crowdsourced problem solving. The authors recommend that studies name the apps they are reviewing (as they would in medical device studies), consider how the apps work (algorithms versus attached devices), and follow a standardized evaluation methodology.

A data-crunching research project tries to associate EHR adoption with 30-day mortality, predictably failing to conclude much of anything useful for obvious reasons: (a) EHR adoption isn’t binary since use may vary widely; (b) the study used old data from 2008-2013; (c) the authors obviously had no way to prove causation of EHRs to deaths, only to find a faint correlation that is likely to be dependent on a zillion more relevant factors that changed over those years or that differ among hospitals. I want to perform studies that correlate hospital quality to CEO salary, the average Kelly Blue Book value of cars parked in the doctors’ lot, and the number of self-congratulatory awards and signs posted in public areas.

This is dope: A study finds that 25 percent of people who show up in the ED with a sprained ankle were given a prescription for opioids.

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CNBC’s Chrissy Farr writes about her sneak peek at Mount Sinai Hospital’s (NY) Lab100, a reinvented, technology-focused annual physical. Patients complete an online assessment in advance, then pass through a series of stations that includes a body composition scanner, a virtual reality-powered strength assessment, and cognition tests, with the results displayed on a screen for discussion with the physician. I’m cynical:

  • Are all these tests meaningful, exhaustive, and supported by evidence?
  • Do we really need more vague diagnostic measurements that rope people into a medical system they would do well to avoid?
  • Is this just another form of the “executive physical” that allows health systems to sell high-margin, medically questionable services that the rest of us can’t afford and probably don’t need?
  • Do you go to Mount Sinai because you don’t trust your own doctor who knows you well and who offers — instead of buzzword-heavy gadgetry — medical expertise, empathy, and chronic care?
  • Is Mount Sinai doing this to improve population health, the health of wealthy folks who can afford this test, or just its own bottom line, patient funnel, and marketing reputation?
  • Do we really need more diagnostic tools when much of our population can’t afford treatments for their known chronic conditions?

Sponsor Updates

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  • Lightbeam Health Solutions employees donate toiletries and snacks to charities serving the homeless in Dallas.
  • MDLive joins Walgreen’s new digital healthcare provider marketplace.
  • Waystar will exhibit at the NextGen Texas Regional Client UM August 2 in Irving.
  • Netsmart will exhibit at the HCAF Annual Conference July 30 in Orlando.
  • Voalte CEO Trey Lauderdale will speak at the Sarasota Young Professionals Group on August 10.
  • Mission Health President and CEO Ronald Paulus joins Vocera’s board.

Blog Posts


Contacts

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

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News 7/27/18

July 26, 2018 News 11 Comments

Top News

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IBM Watson Health’s supercomputing abilities in the area of cancer treatment once again come under fire as Stat uncovers internal IBM documents showing employee and customer concerns with the software.

“Unsafe and incorrect treatment recommendations” for cancer have been blamed on Watson’s training — by IBM engineers and a team of physicians at Memorial Sloan Kettering Cancer Center (NY) – that used hypothetical instead of real-life cancer cases.

A Jupiter Hospital (FL) doctor complained to IBM, “This product is a piece of s***. We bought it for marketing and with hopes that you would achieve the vision. We can’t use it for most cases.” (the irony being that a hospital that admits buying Watson for its marketing value complains about the company’s overzealous marketing).

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A previous Stat report found that IBM started marketing the oncology product before it was ready and without subjecting it to clinical studies, also noting that Watson doesn’t meet the definition of AI since it doesn’t actually learn, it only relays the treatment preferences of MSKCC in what is little more than a virtual consultation. Oncologists also reported that while Watson provides them with background information such as journal articles, it doesn’t directly help them make a decision or tell them anything they don’t already know in regurgitating the hospital’s own training data. It also suffers from lack of clear-cut medical evidence that makes many oncology decisions difficult to turn into algorithms.

MD Anderson Cancer Center (TX) cancelled its Watson partnership in February 2017 also spending three years and $60 million trying to create an oncology advisor similar to the one MSKCC is developing.

IBM Watson Health confirmed in early June that it had laid off an unspecified number of employees, mostly from its expensive acquisitions Truven, Merge Healthcare, and Phytel.


Reader Comments

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From A Good Walk Ruined: “Re: Sutter Health. Heard that the Sutter board met Wednesday morning and let CIO Jon Manis go because of its $25 million recent downtime. I’ve also heard that the CFO and COO were let go.” I reached out to Sutter, who confirms that SVP/CIO Jon Manis (photo above), IS Chief Operations Officer Stuart James, and Director of IS Finance Randy Davis have left the organization for unstated reasons. Serving as interim CIO will be Chris Van Pelt, who I believe still works for PricewaterhouseCoopers. Sutter’s Epic and telecommunications systems went down for more than a day in mid-May at its 24 hospitals, which the health system said was due to activation of a data center fire suppression system.

From Careening Corvette: “Re: Medhost. Lists an open position for chief information security officer after having their share of security problems in the past 24 months.” The job sounds like the one William Crank has held, but he still lists it on his LinkedIn.

From Eligible Bachelor: “Re: Recondo. Appears to be buying the former Advisory Board PayNav client base from Optum 360. PayNav was a white label for Recondo products. Terms not disclosed, transition of 57-58 clients beginning immediately.” Unverified.

From Joel Martin: “Re: physicians and EHRs. I spent many years working on Epic optimization, especially for inpatient and ambulatory physicians, and most of the complaints about time and user friendliness are actually about regulatory, financial, and other compliance requirements. Very few of the issues they disliked were actually attributable to the software other than poor defaults for orders. Even note documentation, by far the biggest time spent, is really about a financial decision of the organization to shift cost away from transcription that all EHRs can accept. Individual healthcare organizations and the system as a whole have shifted enormous amounts of work onto physicians over the past 20 years. The EHR enabled a lot of that shift, but is not the cause, and the best EHR possible cannot undo this reality.” I agree with Joel, who’s now with HealthX Ventures– it’s like blaming TurboTax instead of Uncle Sam for the unpleasantness of paying taxes. The worst aspect of the EHR is that it gives non-clinicians a sly way to impose their will on doctors anonymously via software requirements, turning medical documentation into a Pavlov’s Dog experiment in which dollars pop out as a reward for doctors clicking boxes someone wants clicked that don’t necessarily benefit patients and instead steal a big chunk of their allotted encounter time. Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work, keyboarded into submission by executives who wouldn’t be caught dead using a computer while speaking to someone (ever see a CEO’s sumptuous desk hogged by a computer monitor?) I’ve mentioned my $60-per-month all-inclusive concierge PCP, who doesn’t use an EHR and who instead conducts an unhurried, richly nuanced conversation with me, free of the pressure to click, stare at a screen, or wonder if he’ll have his payment denied by a bored insurance company clerk ready to pounce on a mistyped field. The biggest mystery to me is why doctors allowed insurance companies and then hospitals to elbow them out of their own profession and turn them into regularly whipped slaves, or more accurately, why they don’t bolt en masse right now, skim the cash-paying patients, and let the rest of the system crash and burn so we can start over.


Webinars

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Home DNA testing company 23andMe will sell the data of its 5 million customers to pharma giant and just-announced $300 million company investor GlaxoSmithKline for developing new drugs, raising the question of why consumers shouldn’t be paid – even in the form of a rebate — when a for-profit company they’ve paid for services sells their health data to another. 23andMe, which says its consent allows such sharing and requires consumers to opt out otherwise, also acknowledges that it’s doing its own drug development. Meanwhile, Canada’s border patrol is reportedly accessing ancestry websites to determine the nationality of those being considered for deportation.

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Atlanta-based billing company Patientco raises $28 million in a Series B round led by investment firm Accel-KKR.

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Medical information sharing startup Ciitizen prepares for a private beta program with $3 million from Andreessen Horowitz. Founder and former Apple health technologies director Anil Sethi sold a similar company, Gliimpse, to Apple in 2016.

Up to 1,500 Epic employees begin filing individual overtime claims — some dating back to 2012 – after a Supreme Court ruling that prohibits them from filing as a group. The company settled a similar overtime case with employees in 2014 for $5.4 million.

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Google patents headphone technology designed to capture a user’s body temperature and alert them to changes that may indicate the onset of illness.

Financial technology vendor Flywire raises $100 million in a Series D funding round. The company – which offers universities, healthcare organizations, and business the ability to accept online payments in the customer’s own currency – operates OnPlan Health, a full-service patient billing and payment solution for hospitals. 

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A Facebook warning about slowing revenue growth sends shares down 20 percent Wednesday, wiping out $120 billion in market capitalization. It’s the largest one-day valuation slide in history for a US-listed company, with the lost market value exceeding the entire valuation of 90 percent of companies in the S&P 500.


People

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Lloyd Mangnall (Imaging Advantage) joins AbleTo as SVP of technology.

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Healthcare-focused investment banking firm Edgemont Capital Partners hires Kojo Appenteng, MBA (Credit Suisse) as managing director, where he will create the firm’s healthcare information technology investment banking platform.


Announcements and Implementations

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Healthcare data science company Apixio launches HCC Auditor, an AI-powered solution that helps health plans and providers perform internal audits of their risk adjustment payment data.

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HBI Solutions develops predictive algorithms to help providers identify patients at risk for opioid abuse.

Centura Health (CO) implements health data exchange software from ESO Health to give its 17 emergency departments real-time access to EMS data.

HealthSparq adds timelines and insurance-specific cost estimates for patients who use its HealthSparq One transparency and guidance platform.

Agilon Health will use HMS Essette care management software for its PCP customers.


Sales

  • Indiana HIE will deploy Diamater Health’s data interchange, clinical data quality, and e-clinical quality measures products.
  • Columbus Regional Healthcare System (NC) selects Avaap to implement its new Cerner CommunityWorks software.
  • Hartford HealthCare (CT) will implement data integration and analytics and reporting software from Innovaccer across its 70 ambulatory facilities.
  • Flagler Hospital (FL) selects clinical variation management software from Ayasdi.

Government and Politics

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CMS’s proposed outpatient reimbursement takes aim at hospitals that have bought physician practices to take advantage of a billing loophole that allows them to immediately raise prices by declaring the practice a hospital outpatient department (a practice closed to new conversions since 2015, but with existing sites grandfathered). The proposed change would mandate site-neutral payments to eliminate that advantage. The American Hospital Association responds quickly in saying that CMS doesn’t understand how hospitals operate.

CMS reverses its decision to suspend the Affordable Care Act’s risk adjustment payments, citing the need to keep payers from becoming insolvent or withdrawing from the market.


Other

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An investigation by USA Today into maternal deaths during or just after childbirth reveals a chilling lack of attention to patient safety protocols, resulting in the preventable deaths of 700 women each year. A review of hospital quality records from facilities in New York, Pennsylvania, and North and South Carolina found that less than half of maternity patients were treated for dangerous blood pressure levels; of those that were treated, less than 15 percent received recommended care.


Sponsor Updates

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  • EPSi employees donate to local food pantries in honor of Global Impact Day for Hunger Relief.
  • Medicomp Systems releases a new video, “Enhanced Patient Outcomes with Quippe: Phoenix Children’s CDI Story.”
  • Elsevier will offer its STATdx online radiology diagnostic decision support tool through MModal’s Fluency for Imaging speech recognition and workflow management system.
  • EClinicalWorks will exhibit at the 2018 FACHC Annual Conference July 29-August 1 in Fort Lauderdale, FL.
  • FormFast will exhibit at the FHIMA Annual Convention July 29-August 1 in Orlando.
  • The InterSystems IRIS Data Platform is now available in the Google Cloud Platform Marketplace.
  • Kyruus will exhibit at the Virtual Health Care Summit July 30-August 1 in Boston.
  • AdvancedMD updates its AdvancedInsight financial reporting solution to include enhanced data visualization and cross-browser capabilities.
  • Indiana Health Information Exchange continues its collaboration with Diameter Health after successfully piloting the company’s Fusion, Analyze, and Quality applications.
  • Optimum Healthcare IT publishes an infographic titled “2018 Health Data Breaches Fast Facts.”
  • Meditech Senior Government Affairs Manager Barbara Hobbs joins the HIMSS EHRA Executive Committee.
  • Healthfinch makes its Refills Lite e-prescribing solution available to AthenaClinicals end users.
  • Audacious Inquiry hires Danny Krifcher (Aledade) as CFO, Marnie Basom (Health Management Systems) as senior director, and Kate Ricker-Kiefert (Amelia Mayme Consulting) as director.
  • Parallon Technology Solutions receives the HDI Team Certified Pinnacle of Excellence award for its commitment to customer service.

Blog Posts


Contacts

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

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News 7/25/18

July 24, 2018 News 7 Comments

Top News

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The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard. The extra cost will also cover items included in the VA’s contract that were not present in the DoD’s agreement, according to Defense Healthcare Management Systems Program Executive Officer Stacy Cummings.

Cummings added, “A standard electronic health record baseline for the Department of Defense, Department of Veterans Affairs, and US Coast Guard will enable more efficient, highly reliable, safe, and quality care.”

The DoD’s original contract ceiling with lead contractor Leidos was valued at $4.3 billion and a total of $9 billion if all options were exercised.

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The Coast Guard gave up on its attempt to implement Epic in 2015 after running $46 million over budget with no sites live. A GAO investigation blamed poor project management, insufficient governance, inadequate project documentation, lack of testing, and internal staff turnover. The Coast Guard began searching for an alternative to Epic in February 2016, reverting to paper and, according to the GAO, endangering members with convoluted processes.

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Cummings said the Pentagon will publish a second evaluation report by the end of the year, following a scathing internal review from May that concluded that MHS Genesis “is neither operationally effective or operationally suitable” and not capable of managing care delivery.

The DoD also announced that the next four MHS Genesis rollout locations will be Naval Air Station Lemoore, Travis Air Force Base, US Army Health Clinic Presidio of Monterey, and Mountain Home Air Force Base.


Reader Comments

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From FlyOnTheWall: “Re: Allscripts. The company’s investor page proudly boasts in a press release from last year that Rothman Ortho selected Allscripts PM to replace its ‘legacy system.’ Was not that system Allscripts Vision? Nice to see Allscripts getting into the rip-and-replace frenzy of Allscripts solutions, even though they did an RnR of one of their own products.” Unverified, but I believe Rothman was using the old Vision product of Medic / Misys, acquired by Allscripts in 2008. If that’s indeed the case, then I would categorize the announcement as misleading since it’s just swapping one Allscripts product for another, not a brag-worthy displacement of a competitor’s system.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

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Former employees of the shuttered CareSync describe the company’s final days to the Hardee County (FL) Board of County Commissioners, saying they were pressured to keep patients of its chronic care management business on the telephone line for at least 20 minutes to qualify them for their monthly Medicare billing. CareSync co-founder and State Rep. Jamie Grant — who served as senior solutions architect and was cleared of ethics violations after charges that he funded the company’s startup by misusing Hardee County development grants – says he hasn’t ruled out suing unnamed parties. Co-founder Travis Bond, who employees said was removed by the board because of poor financial management, says he does not plan to pursue litigation.

Cerner has added half of the 600 Kansas City-based employees it needs for an expansion of its RevWorks and ITWorks outsourcing businesses.

University of Minnesota hopes to license an algorithm created by its medical school researchers that predicts a patient’s one-year mortality risk using EHR data.


People

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DirectTrust hires Scott Stuewe (DataFile Technologies) as president and CEO. He worked for Cerner for 20 years through December 2016.

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Methodist Health System (NE) promotes Kent Sona to VP/CIO.


Announcements and Implementations

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A Reaction Data survey of 250 physicians finds that EHRs, regulatory compliance, and internal bureaucracy contribute most to their burnout, with patients named as the problem only 2 percent of the time. The top wished-for EHR improvements are improved user friendliness, additional dictation or scribe capabilities, and reduced time required.

A Black Book survey finds that two-thirds of hospitals are reconsidering whether the ED information system supplied by their EHR vendor can handle efficient ED workflows and meet consumer expectations, with outsourced ED doctors being the least satisfied due to EHR training gaps, excessive clicking, and difficulty in obtaining outside patient data. ED doctors who were forced to move from a best-of-breed EDIS to an EHR’s ED module say their new system hurts their productivity (90 percent), impedes patient workflows (75 percent), and contributes to medical staff burnout (90 percent). CIOs are mostly at odds with those beliefs, favoring a single source EHR solution. The top-rated best-of-breed EDIS vendor is T-System, followed by Optum Picis and Wellsoft. Cerner, Meditech, and Allscripts were also highly rated by users. The most-desired features of both types of EDIS in order are better mobile deployment, interoperability, and patient satisfaction tools.


Government and Politics

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The Senate confirms Robert Wilkie as VA secretary in a 86-9 vote.

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The National Institutes of Health launches its Google Cloud-powered STRIDES Initiative to allow researchers to analyze large biomedical data sets. Meanwhile, a Google Cloud blog post says that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor.


Privacy and Security

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A Kaiser Health News report recommends that consumers pay cash for alcohol and cigarettes while bragging about gym memberships on social media since insurers and other groups are using personal information from credit cards and other sources to create individual profiles that are then sold to companies. Buyers include drug manufacturers – which might want to buy a list of men over 50 who are experiencing erectile dysfunction – and insurers that may use the profile to predict lifespan or medication adherence. Even employers can use the information to check for a job candidate’s potential work-affecting and expensive chronic illnesses before hiring them. The article quotes Harvard fellow Adam Tanner, who wrote “Our Bodies, Our Date: How Companies Make Billions Selling Our Medical Records.”


Other

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A small JAMA-published study finds that back-end speech recognition (specifically Nuance’s former EScription product) has a 7 percent error rate when creating dictated notes (operative notes, office notes, and discharge summaries), with some of those errors such as “grown mass” instead of “groin mass” remaining on the chart for weeks or sometimes indefinitely as clinicians either don’t review them promptly or sign them without double checking. The authors recommend that speech recognition errors be submitted for calculating error rates and for creating automated error detection systems.

Banner Health posts a job for CEO of its Tucson campuses just after its corporate VP/CIO announced plans to leave and the local paper published documents from a state investigation into problems with patient care, provider satisfaction, and billing from its Epic-to-Cerner conversion at the former University of Arizona Health Network hospitals in Tucson.

Google’s Nest home automation division is approaching eldercare facilities to use its products for monitoring the wellbeing of residents.

A Stanford University scientist invents a patch that measures cortisol in sweat to detect disease, measure stress, and evaluate sports performance.

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Columbia University’s new Center for Precision Dental Medicine offers RFID tracking of patients and equipment, biofeedback-measured stress levels for quantifying pain, video recording of procedures, and all-digital dental chairs whose six instruments are RFID-enabled for tracking usage and sterilization. They hope to use the resulting data not only to make patients more comfortable, but to analyze provider technique to identify best practices. They also hope to to integrate their systems with EHRs to remove the silos between professions.


Sponsor Updates

  • Ellkay will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo next week in Chicago.
  • Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22.
  • In Ohio, the MetroHealth System and Medical Mutual become the first provider and payer organizations to digitally exchange data and documents with Hyland’s OnBase Mackinac solution.
  • AdvancedMD publishes a new eGuide, “Best Practices to Improve Patient Payments.”
  • Nordic posts a podcast titled “Developing a strategy for your Epic Community Connect program.”
  • Audacious Inquiry names Roxanne Johanning health IT product manager.
  • Arcadia will host a career open house at its Pittsburgh office July 25.
  • CompuGroup Medical will exhibit at AACC July 29-August 2 in Chicago.
  • Divurgent publishes a new white paper, “Medjacking: A Life or Death Issue for Leaders in Connected Healthcare.”

Blog Posts


Contacts

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

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Monday Morning Update 7/23/18

July 22, 2018 News 5 Comments

Top News

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In England, new Health Secretary Matt Hancock pledges his support for NHS modernization and announces $640 million in new technology funding. He touted virtual visits, barcode tracking, and electronic medication ordering.  


HIStalk Announcements and Requests

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Poll respondents say Epic has the best CEO. HISJunkie says Meditech hasn’t grown, Brent Shafer is too new to judge, and Allscripts is a mess. Tripp Tart voted for Judy Faulkner in admiring her for keeping the company free of shareholder influence. Former Community CIO votes for Howard Messing since he also kept Wall Street out of the picture and is creating company growth again, while Epic’s growth is mostly due to its hospital customers acquiring more facilities.

New poll to your right or here: would you be OK with insurance companies using your harvested social, financial, and lifestyle data to approve and price your medical coverage?


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Decisions

  • Schoolcraft Memorial Hospital (MI) switched from Evident to iSolved HR and payroll software in June.
  • Divine Savior Healthcare (WI) will replace Evident with Athenahealth in fall 2018.
  • Crisp Regional Hospital (GA) will replace Meditech HR with Kronos in 2018.
  • North Country Hospital & Health Center (VT) replaced Allscripts Paragon with Athenahealth in April 2018.

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


People

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Chronic Care Management, Inc. hires two former executives of its defunct competitor CareSync, Gurpreet Singh (CIO) and Marc Gauthier (head of enterprise business development).


Announcements and Implementations

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Publicly traded rural hospital operator LifePoint Health is considering selling itself to a private equity firm for up to $6 billion, with the report sending LifePoint’s shares up 40 percent. LifePoint Health also operates 15 hospitals in partnership with Duke University Health System under the Duke LifePoint Healthcare brand.


Privacy and Security

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LabCorp is close to fully restoring its systems after they went offline in a July 13 ransomware attack. The company’s security team detected the Remote Desktop Protocol attack and stopped it within 50 minutes, but by then, the SamSam ransomware had impacted 7,000 Windows-based systems and 1,900 servers. SamSam took Allscripts down earlier this year, reportedly also using RDP as its vector.

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Members of a private Facebook group for sexual assault survivors find themselves trolled by new users who threaten to post the intimate details they had shared under their real names. The group was apparently created by an anonymous administrator who either had duped the members or whose account was hacked. The report by “Wired” notes a Facebook flaw that allowed this to happen – groups can be created by “pages” that aren’t tied to an individual’s profile, the same way Russian propagandists used the platform before the 2016 elections to keep themselves anonymous. I was going to play around with some Facebook group stuff but decided instead to try Microsoft Teams now that the company is offering a free tier and no longer requires members to use Office 365.

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Singapore says hackers stole the information of one-fourth of its population, 1.5 million people, in an attack involving its SingHealth clinics. The hackers specifically targeted the information of the prime minister in the cyberattack that lasted from June 27, 2018 until it was discovered on July 4. They breached a specific PC and then elevated its account privileges to access the database.


Other

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Epic’s campus is free of cranes for the first time in two decades as the company’s frenetic construction projects wind down, having expanded the campus to handle employee headcount that tripled to 10,000. Epic says that it may another set of buildings next year.

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The local paper reports that Banner Health’s $45 million, October 2017 conversion to Cerner at its acquired Tucson academic medicine locations caused medical errors and staff frustration, although hospital officials said delays in patient registration, lab ordering, and medication ordering and delivery didn’t harm patients. The paper just received heavily redacted records of an Arizona Department of Health Services investigation. Banner says it made 100 improvements to Cerner this year, naming specifically changes in pharmacy processing, oncology administrative activities, and patient records access. The paper notes these items uncovered from various state investigation documents and meetings:

  • The Tucson locations had a smooth transition when they originally implemented Epic, but moving to Cerner “provided fraught for some patients and staff,” with significant problems due to poor implementation planning and training.
  • This was Banner’s first implementation in an academic medical center (the former University of Arizona Health Network) and its Cerner system couldn’t distinguish between a medical resident and an attending doctor.
  • A near-miss infant overdose happened because Cerner was set up to order per-kg weight-based doses, while Epic had been set up as per-gram ordering.
  • Banner’s CFO admitted to state officials last month that it underestimated Cerner’s data center and bandwidth requirements.
  • Banner’s CFO says both revenue and clinical productivity have yet to recover from the Epic-to-Cerner switch nine months ago. He replied to a Regents member who expressed concerns about Banner’s Tucson reputation, “You and me both.”
  • The article notes that Phoenix-based Mayo Clinic Arizona will replace Cerner with Epic on October 6.
  • In other Banner news from Tucson, the health system cancels its nurse Magnet status, where under University of Arizona Medical Center’s ownership in 2003, it became the first Magnet-designated hospital in Arizona. Banner will continue Magnet participation at its Phoenix campus.

AP Stylebook neatly summarizes how publications should use the results of political polls, offering rules that also apply to healthcare IT:

  • The existence of a poll isn’t in itself newsworthy.
  • The poll results should disclose who paid for it, and if the poll was commissioned by an organization that benefits from its results, it is not newsworthy.
  • Polls should include a description of their methodology and a list of the questions asked.
  • The polled group should be randomly selected to make sure that every member of that population has an equal chance of being selected. Online polls are valid only if participants are randomly recruited, while polls of website visitors, a company email list, or Twitter should be avoided.
  • The poll should state its margin of sampling error.
  • Reporting on results from a poll’s subgroup – such as people of a certain age or location – may be meaningless if the sample size is small.

An interesting study finds that telling students to “find your passion” for a career is bad advice since most passions are grown from experience, not discovered. The danger of the “do what you love” argument is that it encourages people to give up too easily and move on to something else if they don’t receive immediate gratification.

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This is where science and public health meet the reality of people who don’t value them or who think they are driven by conspiracies. The parents of 57,000 Texas public school students decline to have them vaccinated in the 2017-2018 school year for non-medical reasons. In a significant jump, some counties saw a 9 percent opt-out rate and nearly half of the parents of students at one Austin private school opted out of giving them vaccinations under the repeatedly scientifically disproven belief that vaccines cause autism and other diseases, with “vaccine choice” being viewed by some as resistance against overly intrusive government. Supporters of Texans for Vaccine Choice are mobilizing political activities, protesting with signs that say “The State Does Not Own My Children” and promoting “informed consent” in publishing anecdotal stories in which parents claim that the medical problems of their children were caused by vaccinations. Obviously their choice affects everyone as vaccines work for entire populations only when enough people receive them to create “herd immunity.”

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A CNBC report notes that a roadblock to digital health company success is that apps always end up recommending that users see their doctors, which people don’t like doing and often can’t afford. That leaves apps as “a funnel or a stopgap rather than a revolution.” A cardiology fellow and digital health founder says, “All the things done well by digital health — they’re simple, fun, visual, with great user experience — are still missing from most clinical visits, so it remains pretty unpleasant to be a patient. To me, this gap gets closed by bringing the clinical experience up to the same standards as our digital health solutions.” That is pretty brilliant insight – imagine frictionlessly summoning a ride on Uber and then having a 2004 Pontiac Aztek show up an hour late with the meter already at $40 and the lost driver refusing to use the GPS.

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Google, Facebook, Microsoft, and Twitter launch an open source Data Transfer Project that allows people to transfer their data from one online service to another (the technical overview is here). Healthcare wasn’t mentioned specifically, but it would be pretty cool if EHR vendors provided a similar capability in allowing patients who are seeing a new doctor to initiate their own transfer of data to the new doctor’s EHR, although questions would then arise about the lack of synchronization capability afterward.


Sponsor Updates

  • Elsevier will offer its StatDX radiology diagnostic decision support tool through MModal’s Fluency for Imaging.
  • Liaison Technologies partners with One Laptop Per Child.
  • Pivot Point Consulting names Matthew Curtain director of business development.
  • Sunquest will host its annual user group conference July 29-August 3 in Scottsdale, AZ.
  • Vocera will exhibit at LeadingAge Florida July 29 in Kissimmee, FL.
  • Mazars USA names Steven Herbst principal, health care consulting group.

Blog Posts


Contacts

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

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News 7/20/18

July 19, 2018 News 1 Comment

Top News

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A Deloitte physician survey finds that while both consumers and doctors recognize the benefits of virtual care, most consumers haven’t experienced a virtual visit and only 14 percent of doctors offer them.

The most commonly implemented virtual care technologies are email / patient portal consultations, physician-to-physician consultations, and virtual visits. Adoption was in the single digits for remote care management and coaching, remote patient monitoring at home or in other facilities, and integration of wearables.

The factors listed above do not include the big ones that doctors can’t control — reimbursement and licensing. You can bet that they would be quick to offer those services if adequately paid to do so or if per-visit fees were eliminated under value-based care payments and an in-person visit actually cost the practice money.


Reader Comments

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From DisCerner: “Re: Banner Health. CIO Ryan Smith has tendered his resignation and a posting is up for SVP/CIO on Banner’s site.” The job is posted here, although Ryan is still listed as CIO on the company’s executive page. His career was with Intermountain until he joined Banner in October 2013. He was paid $900K in the most recent year. The tax filings also indicate that Cerner was Banner’s third-highest paid independent contractor at $47 million. 

From Email Privilege: “Re: HIPAA. I was emailed a receipt after paying online that included my name, account number, date of birth, and telephone number. Should they not just have the account number and amount paid because of HIPAA?” All of those fields, as well as your email address itself, are elements of PHI. However, your use of the provider’s portal probably could be taken to indicate your consent for communicating by email (I bet that was listed in its terms of service). It’s also not illegal to send PHI by email – HHS’s only requirement is that the provider “apply reasonable safeguards,” of which encryption would be one even though the rule doesn’t specifically require it as far as I know.

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From Avuncular Robert: “Re: McKesson’s outpatient pharmacy point-of-sale system. It’s been down for over 24 hours and their service desk is blaming Amazon Web Services. It is a huge headache – we’ve had to go back to the old cash box process.” I reached out to McKesson, which provided this response:

We are aware of the situation that affected a subset of our customers and impacted their operations for the past 24 hours. Though point-of-sale services were impacted, the dispensing of medication was not affected. We have resolved the issue and have informed customers of next steps. As always, we appreciate our customers’ support and thank them for their patience and cooperation.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor EPSi. The Allscripts-owned, Chesterfield, MO-based company is the industry leader in health system integrated financial decision support, budgeting, and planning. More than 900 US hospitals — including nine of the top 10-rated hospitals, 128 IDNs, and 40 global academic facilities — rely on EPSi for data-driven insight into managing costs and improving their long-range financial performance, as well as addressing requirements created by value-based care, bundled payments, accountable care, and continuum of care. The company’s just-launched, cloud-based RealCost financial decision support and analytics system allows health systems to quickly gain deeper cost insights and empower informed decision-making. Check out case studies from Texas Children’s Hospital, University of Kentucky Healthcare, and UMC Health System. Thanks to EPSi for supporting HIStalk.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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Stat reports that Atul Gawande, MD — head of the still-unnamed healthcare joint venture of Amazon, Berkshire Hathaway, and JPMorgan Chase — will embark on a cross-country listening tour to gauge the healthcare concerns of employees at the three companies. Those conversations will likely fuel the nonprofit’s business plan, which could include a digital primary care solution, according to Mount Sinai Health System Chief Population Health Officer Niyum Gandhi. “I wouldn’t put it past them to … test it on all their employees first before they go broadly to market. I mean, if anybody could do it, it would be them. But they’re going to have to do things that are at national scale, which there just aren’t quick wins on.”

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Tenet Healthcare considers selling its Conifer Health Solutions business to UnitedHealth Group in a deal that could be worth $2 billion. Tenet hired Goldman Sachs last December to help it divest Conifer as part of a $250 million cost-reduction initiative that it aims to wrap up by year’s end.

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Vyera Pharmaceuticals, known as Turing Pharmaceuticals under the infamous leadership of now-incarcerated pharma bro Martin Shkreli, reports Q1 losses of over $1 million thanks to declining sales of Daraprim, the drug Shkreli infamously raised the price of by over 5,000 percent when he acquired it in 2015. Vyera is considering changing its name to Phoenixus, no doubt in an effort to shed its former association with Shkreli and revitalize slumping sales.


Announcements and Implementations

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NYU Langone Health (NY) implements Omnicell’s automated medication management software and dispensing cabinets at its new inpatient hospital.

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Northwestern Memorial Healthcare (IL) selects HealthSource release-of-information technology from Ciox.

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AdvancedMD releases a redesigned version of its AdvancedInsight financial reporting suite for private medical practices.


People

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Adam Boehler, director of the Center for Medicare & Medicaid Innovation, takes on the additional HHS role of senior advisor for value-based transformation and innovation.


Sales

  • Methodist Hospital (KY) selects cloud-based backup and recovery software and services from CloudWave.

Other

A Health Catalyst survey on patient safety efforts across care settings finds that ineffective IT combined with a lack of real-time alerts is the biggest impediment to reducing medical errors. A lack of adequate staffing and budget is a close second.


Sponsor Updates

  • Formativ Health is recognized as the Gold Winner in the startup categories of both the CEO World Awards and the Globee Awards
  • RxBenefit Clarity, a prescribing decision support solution developed by CoverMyMeds and RelayHealth Pharmacy Solutions, will be adopted by a dozen health systems that use Epic, Allscripts, and other EHRs.
  • EClinicalWorks Director of Interoperability Strategy and Business Development Tushar Malhotra joins the CommonWell Health Alliance Board of Directors.
  • FormFast and Kyruus will exhibit at the AHA Leadership Summit July 26-28 in San Diego.
  • The Jacksonville Business Journal recognizes The HCI Group as one of the city’s fastest growing companies for the sixth year in a row.
  • Optimum Healthcare IT publishes an infographic ttitled “3 Keys to Change Success.”
  • Impact Advisors promotes April Smith to principal.
  • InterSystems will exhibit at the Defense HIT Symposium July 24-26 in Orlando.
  • CoverMyMeds announces that its RxBenefit Clarity prescribing decision support tool, developed with RelayHealth Pharmacy Solutions, will soon be used by 250,000 providers via new integrations with a dozen EHRs and Epic health systems.

Blog Posts


Contacts

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

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News 7/18/18

July 17, 2018 News 6 Comments

Top News

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LabCorp shuts down its entire computer network when it detects that a hacker has penetrated its systems and is trying to access patient records.

The company says via an SEC filing that test processing and customer access was limited over the weekend. It will take several days to bring all systems back online, the company says, causing delays in results reporting.

LabCorp hasn’t yet said whether PHI was compromised.

The company does not use Twitter or Facebook, but its LinkedIn profile and its website don’t mention the outage.


Reader Comments

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From Another Allscripts Casualty: “Re: Friday the 13th Allscripts layoff. Our VP used a lot of corporate jargon words like ‘synergy’ and ‘socialize the discussion’ to describe the streamlining process in which basically each manager had to remove one employee slot, even those with teams of just a handful of people. Team managers were notified only 30 minutes before the heads rolled. The cuts were not performance based, so producer worker bees were let go instead of middle layer fat. The McKesson EIS acquisition brought in a lot of overlapping people and I expect another round late this year or early next as more people are trained to be cross-functional. Allscripts is like the mythical Hydra – every time they lop off a head, another acquisition causes 10 more to pop up, and management is never lopping the right heads. I think some of the people at the top have a good idea of where they want to take the company, but the inertia of herding cats keeps them in the same rut.” Unverified. I’m not as confident that the company has a solid, rational strategy other than making undisciplined acquisitions that sometimes work out great (Netsmart, DbMotion) and sometimes just fizzle out quietly. That’s been the strategy all along, but other than a burst of investor enthusiasm that sent shares on a tear in 2000 (peaking then at more than six times today’s share price), it’s been a market-lagging stock that made headlines for mostly the wrong kind of reasons as it also came late to the post-MU EHR consolidation party by finally announcing that it would develop a new product, which is new territory for a company known for buying instead of building. Even with all that acquisition activity, Allscripts has a market cap of $2.2 billion, around 1/10 that of Cerner and one-third of Athenahealth’s market value. It has made some good deals, though – it paid just $185 million to buy the health IT business of a desperate and perpetually HIT-clueless McKesson, then sold off just the content management part to Hyland for up to $235 million.

From Fact Checquer: “Re: Allscripts. You mentioned the new EHR product Avenel. I find no mention of it on the company’s site.” It’s not listed on the physician EHR page with TouchWorks or Professional, but I found by Googling that it has its own site that says “machine learning” a lot and offers only a “contact us for more information” form. 

From Bjorn To Be Wild: “Re: HIStalk theme music. I don’t know when you added it, but I love it. It improved an already wonderful daily morning reading and coffee experience.” I put up the prog rock “HIStalk Theme” a few weeks ago. That musical style isn’t to everyone’s taste, so I’m considering commissioning a light jazz sort of tune for a more mellow experience. It’s surprisingly inexpensive (in the $100 range) to have custom music created to spec.

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From RN Data Maven: “Re: National Guidelines clearinghouse shutdown. A tragic loss of a resource for practitioners to access evidence-based clinical practice guidelines. Fear of evidence-based scientific research or short-sighted funding decisions?” AHRQ says it can’t come up with the $1.2 million to keep the site running and thus took it down this week, but the non-profit ECRI – who managed the site for AHRQ — will bring it back in the fall with enhancements as a fee-based service. Some speculate that the site was doomed once then-Congressman Tom Price, MD (who later became HHS Secretary for a few months) demanded that AHRQ remove a study that was critical of a drug sold by one of his campaign donors.


HIStalk Announcements and Requests

Lorre has a backlog of inquiries for my annual “summer doldrums special” on new sponsorships and webinars, but she would still be happy to chat.

I was thinking today that Karl Marx’s “opiate of the masses” is no longer religion – now it’s actually opiates.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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


Acquisitions, Funding, Business, and Stock

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UnitedHealth Group reports Q2 results: revenue up 12 percent, EPS $2.98 vs. $2.32. The company’s UnitedHealthcare insurance business took in $46 billion as membership increased to 49 million people. Its Optum segment, which provides pharmacy benefits management and technology services, booked $1.8 billion in profit on $25 billion in revenue for the quarter. 

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Nashville-based post-acute care CRM software vendor PlayMaker CRM acquires post-acute market intelligence and analytics vendor ViaDirect Solutions and renames itself PlayMaker Health.


Sales

  • CoxHealth (MS) chooses Kyruus to provide a digital provider directory and patient-provider matching technology for its website and call center.
  • Southwest Mississippi Regional Medical Center selects Phoenix Health Systems for outsourced IT management and support.
  • Australia’s Canberra Hospital and University of Canberra Hospital will implement Alcidion’s Electric Patient Journey Board to reduce length of stay and improve patient flow from the ED.

Announcements and Implementations

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Health Catalyst launches a patient safety surveillance system and applies to become an AHRQ-certified Patient Safety Organization (PSO) that can offer clients a litigation-free environment for data analysis. The trigger-based system cost $50 million to develop. The company says EHRs offer limited surveillance capabilities and, unlike a PSO framework, are legally discoverable.

CompuGroup Medical launches its ELVI telehealth product.

Behavioral Health Network of Massachusetts goes live on ZeOmega’s Jiva population health management.


Government and Politics

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NIH Director Francis Collins, MD, PhD pitches IRhythm’s Zio arrhythmia monitoring patch for detecting unknown atrial fibrillation, although noting that while the results may get patients to visit their doctor and begin anticoagulant therapy, its long-term benefit in reducing strokes, ER visits, and hospitalizations remain unproven. Collins concludes that the clinical trial was interesting because high-risk patients were recruited by email, had the patches mailed to them, then mailed them back at the end without having met a researcher face to face. Less exciting is the fact that we have yet another high-powered diagnostic tool to detect diseases that we as a country can’t afford to treat because we refuse to control healthcare costs — those newly ordered anticoagulants cost $15 per tablet, meaning someone will be paying $5,000 per year for the rest of each new patient’s life, although maybe that’s cheaper than treating the subset of them that would have otherwise had strokes.

FCC will propose in its August meeting to fund a $100 million “Connected Care Pilot Program” that would promote using telehealth among low-income families and veterans by providing affordable broadband service. Up to 20 providers that serve low-income populations would receive up to $5 million in funding in partnership with a broadband services provider.


Privacy and Security

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In Canada, home care provider CarePartners is hit by ransomware, with the hackers contacting CBC News with samples of the patient information they have stolen (the samples alone involve 80,000 patients).The cyberintruders, who say they found unpatched software that allowed them to penetrate the systems, are demanding unstated “compensation in exchange for telling them how to fix their security issues and for us to not leak data online.”

Change Healthcare introduces a kill switch for its HealthQX value-based care analytics suite that allows customers to instantly revoke access to their data as long as two of its authorized operators issue the command from separate locations as part of a “bring your own key” capability.


Other

A Quest Diagnostics survey finds that healthcare has made little progress toward value-based care since last year. More than half of health plan executives think physicians don’t have the tools they need to succeed under VBC arrangements, while 61 percent of doctors say their EHR doesn’t contain all the information they need to deliver patient care.

In Australia, 20,000 people opt out of sharing data with its My Health Record online system on the first day of the three-month opt-out period.

Western State Hospital (VA, rebranded from the more memorable Western State Lunatic Asylum) realizes that it hasn’t followed state laws allowing it to destroy the records of patients 10 years after their last date of service, forcing a three-year records review in which a single HIM employee examined 6,000 reels of microfilm dating back to the 1800s. And you thought your job was dull.

A New York Times report notes that rural hospitals are not only closing at alarming rates, they are eliminating OB services to the point that fewer than half of US rural counties still have hospitals that deliver babies. It notes that loss of OB services means that fewer women receive prenatal care due to the time and cost of traveling further, more of them deliver prematurely, infant mortality increases, and EDs deliver babies the best they can.

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This is important as the White House dismantles ACA protections that prohibit insurers (including those who sell through employers) from denying coverage for pre-existing conditions or charging sicker people higher premiums. A ProPublica report finds that insurers are buying the lifestyle information of hundreds of millions of Americans from data brokers that includes race, educational level, TV habits, clothing size, net worth, credit, and social media activity, all of which are run through algorithms that predict how much that person’s healthcare will cost. The article notes that while the information is ostensibly used to manage population health, it could also be applied to premium pricing formulas. Experts say that while insurers can’t blatantly discriminate (at least for now), they have cherry-picked the healthiest people by choosing their geographic coverage based on population data, or as one data salesperson said, “God forbid you live on the wrong street these days.” An excerpt:

[LexisNexis] said it uses 442 non-medical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cell phone numbers, criminal records, bankruptcies, property records, neighborhood safety, and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy, and their stress levels. People who downsize their homes tend to have higher healthcare costs, the company says. As do those whose parents didn’t finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won’t share its methods and hasn’t published the work in peer-reviewed journals.

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In New Zealand, an internal health board report finds that hospital generators failed to kick on after a power line was cut, with battery back-ups having just four minutes of power left when the power came back on. My experience with generators is not reassuring – even with regular testing and fuel monitoring, the switchover always seem to fail. What’s your experience?

In England, a nurse assistant is charged with fraud after submitting timesheets indicating that she had worked 242 shifts in 20 months instead of her actual 10, for which she was overpaid $66,000. She claimed that she thought she was entering the times she was available for work instead of logging her actual time. She had asked her manager to help her, which might have provided yet another clue to the manager that her entries were incorrect. The judge noted that the hospital makes such fraud easy.

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Bizarre: a hospitalized prisoner who eats metal objects such as catheter clamp, thumbtacks, and screws racks up $1 million in medical bills, then is admitted under 24-hour watch to Loyola Medical Center in a stay that has added $500,000 to his tab as taxpayer-funded hospitals try to keep him from being admitted to their facilities and the hospital presses the prison for payment. The prisoner is a 6-foot, seven-inch former basketball player who has previously threatened hospital employees. The sheriff bluntly but accurately explains:

We have a guy right now that has cost us — has cost all the people in this room — close to a million dollars in health bills because he constantly eats the jail. Across the country, the easy thing to do was cut mental health services, and they’ve done it. So people don’t get better. They don’t get treatment. They go to jails and prisons and emergency rooms.

Welcome to a country run by lawyers. In Las Vegas, Mandalay Bay Hotel’s corporate parent MGM Resorts International sues 1,000 concert-goers injured in the Route 91 Harvest festival shooting last year, hoping to force a decision that it can’t be held liable because it hired a security firm that was certified by the Department of Homeland Security for protecting against mass injury. A lawyer representing some of the victims says the company – which also owns the concert venue — is “judge shopping” in trying to push any case into federal instead of state court.


Sponsor Updates

  • PatientKeeper publishes an e-book titled “Attending to Physicians: Why Healthcare Must Focus on Improving Physician Experience” and a video titled “PatientKeeper Charge Rescue Service.”
  • Buffalo Business First profiles Hamish Stewart-Smith, CTG’s managing director of sales for its North American healthcare business unit.
  • Huntzinger Management Consulting Group earns high rankings in the KLAS HIT Assessment & Strategic Planning 2018 report.
  • FDB releases a new video to help people understand how its Opioid Risk Management Module supports safer opioid risk management and prescribing.
  • Divurgent publishes its “Windows 10 Upgrade Benchmark Report.”
  • Optimum Healthcare IT publishes a white paper titled “Change How You Approach Change in Healthcare.”
  • Dimensional Insight VP George Dealy earns CHIME’s CFCHE credential.

Blog Posts


Contacts

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

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Monday Morning Update 7/16/18

July 15, 2018 News 5 Comments

Top News

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CMS issues a massive draft set of rule changes that it says will reduce provider administrative burdens, encourage price transparency, revamp the longstanding E/M codes to a single code in which physician payment is driven by time spent or medical decision-making required, and paying for virtual visits (although at a very low rate).

CMS Administrator Seema Verma said in an announcement, “Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients. Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This Administration has listened and is taking action. The proposed changes to the Physician Fee Schedule and Quality Payment Program address those problems head-on, by streamlining documentation requirements to focus on patient care and by modernizing payment policies so seniors and others covered by Medicare can take advantage of the latest technologies to get the quality care they need.”


Reader Comments

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From Another Allscripts Casualty: “Re: Allscripts layoffs Friday the 13th. Follows the voluntary early retirement program. I don’t know the numbers, but it definitely involved US-based support for ProEHR, ProAPM, and interfaces. Knowledgeable staff were released and offshore customer support will become even more prevalent.” Unverified, and I didn’t even bother asking because Allscripts always declines to comment on personnel issues. Another reader says he heard 70 folks were let go. I was thinking that as I write this, I don’t even have a good mental picture of what Allscripts has become – a distant fourth-place inpatient EHR vendor; seller of badly aging EHR/PM systems but with a newly developed product in the wings; acquirer of fire-saled unrelated products like Paragon, Practice Fusion, and NantHealth; or a pseudo HIT mutual fund trying to tap-dance investors into a buy-and-hold stupor by promising a better future involving genomics and population health? Even that master-of-none pandering to financial markets hasn’t worked out great – since Paul Black hired on in December 2012, MDRX shares are up just 13 percent vs. the Nasdaq’s 149 percent gain and Cerner’s 49 percent jump. Let’s hear from you, however – what has Allscripts done well and not so well and what would you do first thing if installed as King or Queen of Allscripts for a day?

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Speaking of Allscripts, I just noticed a subtle change in the company’s logo to make the L’s look like they’re rising and to darken the font. The change was made sometime in April or early May, according to cached copies of the page. Hopefully the rationale for the change made it worth what must have been a significant cost to swap it out everywhere. While I was looking over their site, I also noticed that seven of eight executives are male, as are nine of nine board members, which is high even in man-centric health IT.

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From Banty Rooster: “Re: KLAS’s EHR global market share report. Cerner signed the most contracts and more beds than InterSystems, yet KLAS positions ‘rapid growth’ for InterSystems while Cerner ‘lagged.’ The chart doesn’t seem to match the narrative.” I think KLAS struggled to characterize Cerner since it’s the only one of the top vendors that sells multiple systems that it targets to specific geographic regions, and half of its 2017 global contracts and a pretty big chunk of its new international bed count came from sales of its I.S.H. Med system instead of Millennium. I know basically nothing about I.S.H. Med other than Cerner inherited it with its acquisition of Siemens Health Services, which had bought the SAP-based system from Austria’s T-Systems (no relation to the US-based T-System as far as I know). KLAS’s summary from the full report: “Over the past five years, Millennium has not grown as quickly as its primary competitors. Cerner has slowed Millennium’s growth by limiting it to targeted markets, offering I.S.H Med in additional markets around the globe, and marketing their non-EMR platforms (like HealtheIntent). Those who do choose Millennium like its broad functionality and flexibility.”

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From Measly Metric: “Re: population health. The tools are promising, but where’s the process?” My take on population health is simple – one of the biggest threats to your health is getting pulled into the bosom of the US healthcare “system” and having your insurance milked and your body tinkered with, most often to your detriment even with good intention as uncoordinated experts blast their diagnostic and therapeutic guns in ready-fire-aim fashion. PHM sounds like a good idea as long as doctors get paid only if you stay well, but otherwise, many people would remain healthier by steering a wide path around financially motivated doctors and hospitals whose “health” expertise (versus “healthcare services sales”) is minimal. Whatever you do, try not to be admitted to a hospital, because the dangers there – both clinical and financial — are staggering. I’ve seen them firsthand as a member of various hospital committees that review the plethora of errors, lack of coordination, and outright bad decisions — the reality of regular medical mayhem versus the proudly displayed crystal awards in the tasteful lobby is jarring. Executives fresh off an admission to their own hospital – even in luxury suites with piles of extra attention – invariably marvel among peers at how lucky they were to escape without permanent harm.


HIStalk Announcements and Requests

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Virtual visits haven’t kicked much of a dent in the health IT universe, with 83 percent of us never having participated in one (and I generously included “telephone” in the category). Judy says Doctor On Demand costs her just $5 on her employer’s plan and she has avoided at least three ED/urgent care visits as a result. Carla loved a Sunday afternoon session for an infection. Allen says his insurance covers only office visits, making me wonder why employers wouldn’t embrace them to keep employees productive instead of wasting half a day driving and waiting. Jim loves MD-Live for routine issues and care in rural areas, noting that he was able to choose a highly qualified doctor from a list instead of paying retail clinic prices that now cost about as much as a PCP visit but that mostly use NPs/PAs instead of doctors.

New poll to your right or here, which popped into my head while I was thinking about Allscripts: who is the best CEO among the largest inpatient EHR vendors? Vote and then click the poll’s “comments” link to explain what “best” means to you and why your choice qualifies.

Listening: Australian singer-songwriter Courtney Barnett, an interesting combination of blandly delivered but smart, observational lyrics paired with her stripped-down guitar. Sample lyrics: “Tell me I’m exceptional and I promise to exploit you” and “I think you’re a joke, but I don’t find you very funny.” She’s one of those musicians whose modest singing and instrumental skills transform into something great just because it’s her words and her unpretentious, non-computer enhanced knack for saying what everybody feels. Music goes through predictable cycles where audiences finally rebel against corporately backed, wildly overproduced mindless mainstream pop, and when it happens again, Courtney will be ready.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

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


People

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New Ascension-owned process automation vendor Agilify hires Doug Thompson (NextStep Solutions) as president.


Government and Politics

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The VA creates an Office of Electronic Health Record Modernization to oversee its Cerner implementation, to be headed by Genevieve Morris, who is on loan from ONC as principal deputy national coordinator.


Privacy and Security

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The email account of an employee of Billings Clinic (MT) is hacked while he or she is traveling overseas, exposing the information of 8,400 people who were mentioned in the employee’s emails and attachments.


Other

JAMIA President Doug Fridsma, MD, PhD says in a BMJ editorial that medical students should be taught health informatics. 

The New York Times looks at a town in Mexico whose ongoing water shortages encourage residents to drink cheap, readily available Coca-Cola, of which the locals consume an average of a half-gallon per day. Public health has suffered, with the diabetes mortality rate jumping 30 percent in three years. Residents complain that the local bottler pays little for the water it uses and that money goes directly to the federal government in a sweetheart deal. A local activist neatly summarizes Coke’s business model as, “Coca-Cola is abusive, manipulative. They take our pure water, they dye it, and they trick you on TV saying that it’s the spark of life. Then they take the money and go.”

As a regular Waze user, I’m happy to see that the Google-owned GPS app will give cities access to its massive amount of traffic and driving data to support real-time emergency notifications and long-term infrastructure planning.


Sponsor Updates

  • LogicStream Health releases a new podcast, “How data analytics, data democratization and clinical process improvement are helping to increase innovation and control costs in healthcare.”
  • Mobile Heartbeat adds Amplion’s Alert nurse call system to its MH-CURE clinical communications and collaboration smartphone app.
  • Santa Rosa Chief Strategy Officer William Leander shares his presentation from HFMA titled, “Seven Critical Aspects of a Successful BI & Analytics Program.”
  • Summit Healthcare raises $3,900 for A Gift for Teaching, this year’s Heart of MUSE Foundation recipient.
  • Surescripts releases a new video, “Technology: A Prescription for a 21st Century Health Crisis.”
  • Optimum Healthcare IT is named as one of Jacksonville, FL’s list of fastest-growing companies for the third consecutive year.
  • Mazars employees volunteer at local communication organizations across six states for the company’s fourth annual “Days of Service.”
  • ZappRx will exhibit at Integrate 2018 July 23-25 in Philadelphia.
  • ZeOmega releases a Jiva customer success video featuring MCG Health.

Blog Posts


Contacts

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

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News 7/13/18

July 12, 2018 News 3 Comments

Top News

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Facebook eliminates a privacy setting that allowed third parties to glean the names of users who participate in private, closed Facebook groups.

The company also shuts down the Grouply.io Chrome extension that was designed to allow marketers to harvest such information on a large scale.

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The latter problem was discovered by the moderator of a group for BRCA-positive women who worried that their potential breast cancer information could be shared with insurance companies, with the extension’s behavior documented and reported to Facebook by healthcare technologist Fred Trotter.


Reader Comments

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From Dockside: “Re: BJC HealthCare Information Services. Laid off 68 employees and 45 contractors Wednesday following the Epic rollout on June 2 at the remaining facilities. Health Information Partners (HIP), the internal group responsible for the Epic implementation (a joint venture with BJC and Washington University) did not seem to suffer any layoffs. We knew this would be coming at some point, but in our opinion it was handled very poorly. People were told individually and were given an hour to remove their personal items prior to being walked out. Those on PTO were given the news by telephone and told not to return to the office – their personal items were shipped to them. Those of us who were left finally received an email saying what was going on just after 4:00 pm Wednesday. Any semblance of the ‘family’ culture that originally came from the hospitals pre-merger has pretty much been wiped out and replaced with the typical cold corporate culture.” I reached out to June Fowler, BJC SVP of communications, marketing, and public affairs, who confirmed Wednesday’s elimination of about 10 percent of the health system’s IT workforce. She provides this statement:

Market forces are driving all healthcare organizations to deliver patient care services in new, more efficient, and more cost-effective ways. BJC’s positioning for sustained long-term success in response to these pressures will rely increasingly on information technology and IT expertise for innovative solutions. As a business enabler, IT must increase focus on strategic priorities and align work and resources in support of these priorities. Reprioritizing the work towards improved system stability, strengthening of information protection, and disciplined execution requires changes in the IT staffing structure. This realignment includes an adjustment of skills and capabilities required in IT and will eliminate some current positions. In some cases, new job roles and responsibilities will be created to enable improved capabilities and assure accountability for execution as well.

To adjust staffing levels to meet current priorities, we made the difficult decision to reduce the IT workforce effective July 11. The workforce reduction affects 68 employees and 45 IT contractors.

We recognize any action that results in job loss has a significant impact on employees and their families. There is a comprehensive compensation and outplacement support package in place to assist those who are directly affected by this necessary action. The BJC human resources team is working closely with these affected colleagues to support them through this transition. The reduction initiates action towards a major transformation of our delivery capabilities where IT will realign resources to deliver against BJC’s most strategic intents.

From Plebe: “Re: health IT influencer blogs. What do you think of this site’s list?” It’s not up to me to decide who influences whom, but I checked out the 32 sites and found that: (a) 13 are no longer online; (b) nine rarely post anything; and (c) the remaining 10 write something at least occasionally. I’m not getting into a quality debate on the content of those 10, but for most, their rather simplistic articles wouldn’t seem likely to influence anyone who themselves have actual influence.


Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president Emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

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


Acquisitions, Funding, Business, and Stock

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On-demand birth control delivery startup Nurx raises $36 million in a funding round led by Kleiner Perkins. The San Francisco-based company, which has raisd $41 million since launching four years ago, also offers access to anti-HIV medication and plans to offer at-home HIV testing lab kits.

Alphabet’s Verily health business will partner with medical device company ResMed to apply sleep data to study the health and financial impacts of undiagnosed and untreated sleep apnea. I’m not sure how that will work since ResMed mostly sells CPAP equipment that would be prescribed only after a positive diagnosis for sleep apnea.

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Analysts predict that health IT company Henry Schein will downsize after a regulatory filing hints at plans to increase efficiencies. The Melville, NY-based company spun off its animal health business in April and announced a joint dental software venture with Internet Brands last week.

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Epic Systems founder and CEO Judy Faulkner climbs three spots on the latest Forbes list of richest self-made women, proving that the “extreme fame leverage” of list cover girl Kylie Jenner (#27) isn’t necessary to achieve a net worth of $3.5 billion and the #3 ranking behind women involved in ABC Supply and Little Caesars (does anyone actually still buy awful Little Caesars pizza except as evening-out sustenance to be left for the kids and babysitter?)


People

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Eric Pupo (Accenture) joins Columbia University Irving Medical Center as CIO.

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Divurgent hires Sarah Sample-Reif (Modis) as VP of client services.


Sales

  • Hospital management company Candor Healthcare will implement MedSphere’s CareVue Cloud EHR at Rock Regional Hospital (KS) early next year as part of a facility-wide roll out that will include ChartLogic’s EHR and RCM software and services.
  • Benefis Health System (MT) selects patient self-scheduling and EHR integration software from MyHealthDirect.
  • Eagle Physicians & Associates (NC) opts for real-time patient care alerts from PatientPing.
  • MemorialCare Health System (CA) chooses RTLS-based patient workflow technology from Vizzia Technologies.

Announcements and Implementations

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Virginia Hospital Center goes live on Bernoulli Health’s clinical surveillance, analytics, and medical device integration software.

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CompuGroup Medical announces GA of Electronic Videoconsulting.

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PatientSafe Solutions develops an app for rounding and clinical communications.

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Allscripts, Athenahealth,  CareCloud, and DrChrono users can offer patients appointment scheduling through Alexa using Nimblr’s virtual assistant, Holly. Integration with Epic is scheduled for Q3.

CipherHealth introduces patient engagement technology for ACOs, including targeted outreach and care coordination tools.

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Healthcare Growth Partners publishes its always-brilliant midyear health IT market review. It notes:

  • Despite $29 billion in health IT investment since 2014, broad impact on care delivery, cost, and outcomes has been muted, but value is accruing.
  • Healthcare’s IT spending as a percentage of revenue is close to the average across all industries at 3.5 percent, but still runs about half of what banking and securities companies spend.
  • That healthcare IT spending, however, has been spent on infrastructure and by providers switching from one EHR or billing system to another, gaining little improvement in cost and quality.
  • M&A activity for smaller companies have three points at which value is assigned – proof-of-concept (the product can be sold and deployed commercially, with annual revenue less than $1 million); growth scalability (the company shows signs of profitability and growth scaling, with revenue $5-10 million), and mature scalability (the company takes on real infrastructure and begins to show strong profitability, with revenue $20 million and up).
  • HGP’s HIT Index gained 25.7 percent in 2017 and added another 21.6 percent in the first quarter of 2018.
  • Leading the Q1 HIT performance in share price change are Tabula Rasa Healthcare (up 128 percent), Connecture (up 116 percent), Evolent Health (up 71 percent), and Teladoc (up 67 percent). 
  • Bottom-performing in the Q1 HIT index are Inovalon Holdings (down 34 percent), Invitae (down 19 percent), Oneview Healthcare (down 19 percent), and Allscripts (down 18 percent).
  • Health IT IPOs have dried up completely, with zero in 2017 and so far in 2018.

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A new KLAS report on non-US EHR activity finds that Epic gained 16,000 beds in signing six contracts in 2017, more than doubling its small, non-domestic market share as concerns about high-profile problems at Cambridge’s implementation in the UK faded. InterSystems continued its rapid growth, especially in smaller, multi-hospital organizations, while Cerner’s growth was moderate and lagged its primary competitors. The early days of the UK’s Global Digital Exemplar program has seen only four new contracts signed, of which Epic earned two, System C one, and Allscripts one.

Virginia Hospital Center (VA) goes live on Bernoulli One for clinical surveillance, medical device integration, and real-time analytics.

Advisory Board’s annual survey of health system CEOs finds that their top concern is preparing for sustainable cost control and creatively reducing expenses, followed by finding diversified revenue streams. A fast-growing #5 was meeting rising consumer demands for service.


Government and Politics

The House Committee on Veterans’ Affairs names to the subcommittee that will oversee the VA’s Cerner implementation Rep. Jim Banks (R-IN, chairman); Rep. Conor Lamb (D-PA, ranking member); Rep. Jack Bergman (R-MI);  Rep. Mike Coffman (R-CO); and Rep. Scott Peters (D-CA).

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HHS awards Cue Health a $14 million contract to develop app-based flu-testing kits for the home and office that will include virtual consult and prescribing capabilities. The company announced a $45 million Series B funding round earlier this week. Diassess has been awarded a $10 million contract to develop a similar kit, though its focus will be on creating a disposable, battery-powered device for use during public health emergencies.


Privacy and Security

Public health officials in Nashville, TN discover that the PHI of thousands of HIV patients was accessible to all employees on a Metro Public Health server for almost nine months. The database, typically accessed by a small group of physicians, is used to track and help patients living with HIV.

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Children’s Mercy Hospital (MO) faces its fourth data breach-related lawsuit, this time pertaining to an email phishing scam discovered in January that potentially exposed the data of 63,000 individuals. Children’s Mercy faced another suit from the same firm over a 2017 breach involving the PHI exposure of 5,500 patients. Two additional lawsuits involved the theft of paper records from employee vehicles.

Fortified Health Security releases its mid-year cybersecurity report, noting that 28 percent of breaches so far this year involved an email attack.


Other

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The FDA issues recalls on 39,000 Medtronic implantable heart devices after the company alerts providers that the devices need software updates to avoid potentially adverse events.

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In England, the Royal College of Surgeons calls out the NHS after discovering the health service is still using 9,000 fax machines despite a nationwide push to convert to digital technologies. “NHS hospital trusts remain stubbornly attached to using archaic fax machines for a significant proportion of their communications,” says RCS chair Richard Kerr. “This is ludicrous. The NHS cannot continue to rely on a technology most other organisations scrapped in the early 2000s.”

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UC Health describes its central data repository for all six UC Health systems at its Data Day in San Diego, noting these points:

  • The scientific method of asking questions and then making observations is becoming obsolete as ample data already exists, with the bottleneck not being the gathering of information, but rather “asking the killer questions.”
  • UC Health’s tools include UC-Rex, a search engine for anonymized patient information, and Epic’s SlicerDicer, which creates patient cohorts from EHR data.
  • Studies now start with looking at what has happened to patients clinically, then getting IRB approval to dig deeper.
  • Information that is being added to the data warehouse includes patient satisfaction and survey results, hospital operations data, claims data, and eventually genomics data.
  • Data analysis includes looking at how physicians spend their time and looking for potential burnout risk factors.

CNBC reports that Amazon and Xealth, a digital prescribing and analytics startup, are in talks with several health systems to develop bundled medical product recommendation and delivery services for patients just before discharge.

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Weird News Andy is proud as a peacock that New Zealand scientists have performed the first 3-D, color X-ray on a human.


Sponsor Updates

  • CarePort Health extends its discharge planning and referral management software agreement with Jackson Health System (FL), and helps JHS integrate its software with the hospital’s Cerner EHR.
  • Elsevier Clinical Solutions will exhibit at the APC 2018 Annual Meeting July 15 in San Diego.
  • EClinicalWorks will exhibit at the 2018 FSASC Annual Conference July 18-20 in Orlando.
  • Optimum Healthcare IT publishes a video describing SkillMarket, software to manage EHR go-live resource evaluation, compliance, and scheduling.
  • Meditech publishes a case study titled “The Clatterbridge Cancer Centre NHS Foundation Trust Transforms Cancer Care.”
  • IMAT Solutions will exhibit at HealthImpact East July 18-20 in Washington, DC.
  • Butler Health System (PA) achieves 97-percent patient-matching accuracy using solutions from LexisNexis Risk Solutions and Occam Technologies.

Blog Posts


Contacts

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

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News 7/11/18

July 10, 2018 News 4 Comments

Top News

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Cerner will partner with value-based care services operator Lumeris to create a combined VBC technology product to be called Maestro Advantage. Lumeris will also adopt Cerner’s HealtheIntent platform.

Cerner will make a $266 million investment Lumeris, acquiring a minority share.


Reader Comments

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From You Dubbed: “Re: UW Medicine’s EHR project. You shouldn’t have included the link from your reader since other sites used it without listing HIStalk as a source.” That happens quite a bit when I run insider-reported news that competing sites have to pretend they discovered on their own even though the source is obvious due to timing and the link (or lack of a link). I don’t mind that they do it, but I do mind that they intentionally don’t give credit, which I would unfailingly do. The most head-scratching commentary was added by the 2017 journalism graduate of Becker’s, who ill-advisedly went off script in pondering to a stated CIO audience, “UW Medicine has not revealed whether it will build its own system or select an EHR vendor for the $180 million effort,” missing the obvious points that (a) no health system has built an EHR in many years; (b) the project budget clearly indicates the line item involved with buying the unnamed vendor’s product; and (c) the rollout will start in a few months.

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From Blank Cheque: “Re: HIT family tree. Looking for the graphic depiction you ran.” The most recent version I have of the thoroughly researched and incredibly complex document that was created by Constantine Davides (now a managing director at investor relations firm Westwicke Partners) is from 2015. From which I shall extract this trivia question: what was the former high-flying point-of-care patient safety technology vendor that Cerner acquired for just $11 million in 2005? You might also want to consult Vince Ciotti’s HIS-tory, which I believe had similar depictions.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Medical practice technology vendor AdvancedMD acquires competitor NueMD, which offers practice management and billing applications that include clearinghouse capabilities.

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Verity Health System (CA) is looking for a buyer of some or all of its six hospitals, hoping to “address challenges our hospitals face after a decade of deferred maintenance, poor payor contracts, and increasing costs.” Patrick Soon-Shiong’s NantWorks bought a majority interest in the health system last July from its hedge fund owner, which retained a minority share and provided additional funding. That announcement touted the health system’s access to new technologies such as the ones NantWorks sells. Shortly after the announcement, Verity moved to implement Sunrise from Allscripts, of which Soon-Shiong was also an investor, a move so embarrassingly self-serving that the Allscripts sales announcement declined to refer to Verity by name. 

Population health management technology vendor Arcadia opens a Pittsburgh office, where it will add 30 software engineering jobs by the end of the year.


Sales

  • Catholic Health Initiatives chooses CTG to implement Epic in its Chattanooga, TN region.
  • Non-profit Manifest MedEx adds two large California medical groups and Stanford Health Care to its network that provides real-time patient encounter notification and a display of aggregated patient data. CEO Claudia Williams and Chief of Staff Erica Galvez previously worked for ONC on interoperability.
  • Avera Health (SD) will implement PeriGen’s PeriWatch labor analysis software in its birthing units and will add the full PeriGen suite that includes its fetal monitoring solution. 
  • Nova Scotia Health Authority chooses Corepoint’s integration engine for province-wide interoperability for its One Person One Record initiative.

People

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Ingenious Med hires Nimesh Shah (McKesson) as CEO. He replaces Joe Marabito, who was hired for the CEO job in September 2016.


Announcements and Implementations

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State of Alaska hospitals can view view prescription drug monitoring program information at the point of care via Collective Medical’s network and platform, which also allows providers to identify their highest-need patients in real time and collaborate to meet their needs. Collective’s system is endorsed as a best practice for emergency medicine by ACEP, whose state chapter was involved in the rollout.

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KLAS introduces high-mindshare precision medicine vendors in a new report that will be followed in Q4 by a more detailed version that will include customer opinions.

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InstaMed makes its External Payment Page Integration available in Epic’s App Orchard, allowing sites to create a seamless, secure online payment experience without requiring them to store credit card and bank payment information.


Government and Politics

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In England, Secretary of State for Health and Social Care Jeremy Hunt replaces the resigned Boris Johnson as foreign secretary. Taking over Hunt’s job in a flurry of Brexit-related resignations is culture secretary Matt Hancock, a 39-year-old former economist and technologist. 

The White House eliminates most of the remaining CMS funding for navigators who help people sign up for Affordable Care Act policies, also requiring groups who apply for navigator grants to pitch short-term and association health plans that offer cheaper but less comprehensive coverage, charge sicker people higher premiums, and exclude pre-existing conditions.


Other

Drug users are monitoring their post-ingestion heart rates on their fitness trackers and posting screen shots on Reddit and other sites to show the effects of what they took. A quantified selfer reports, “Drugs are the only reason I wear a Fitbit. I want an early warning system for when my heart’s going to explode.” Experts warn that this is a really bad idea given the inaccuracy of the devices and maybe for taking potentially deadly drugs in the first place.

More interesting claims from Tennessee’s lawsuit against OxyContin maker Purdue Pharma:

  • The company’s sales reps, none of whom were medical professionals, were told to claim medical expertise and to focus their sales efforts on overworked, lesser-trained doctors
  • The company paid to create noble-sounding advocacy groups that called the opioid epidemic as a “psuedoaddiction” that could be prevented by prescribing higher doses to eliminate addiction symptoms
  • Reps were ordered to keep selling to doctors known to be running cash-for-pills operation and whose patients were dying of overdoses
  • Purdue Pharma specifically targeted military veterans as opioid patients with a campaign called “Exit Wounds”
  • The company’s tagline was to “sell hope in a bottle” and it urged reps to “always be closing”

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A woman with a family history of cancer celebrates her 23andMe BRCA1/2 breast cancer genetic test results that showed no variants, only to receive hospital results four weeks later indicating that the company’s less-than-thorough testing missed the fact that she’s genetically at risk. 23andMe’s fine print indicates that it tests only the most common genetic variants. The woman will have her breasts and ovaries removed this month to reduce her 70 percent chance of getting cancer.  


Sponsor Updates

  • Solutionreach adds the voice of three patient advocates to its company blog.
  • Datica joins the Cloud Native Computing Foundation.
  • CRN recognizes Burwood Group’s Joanna Robinson as one of its 2018 Women of the Channel.
  • CenTrak expands IoT location and sensing services to Awarepoint customers.
  • Change Healthcare introduces Member Healthcare Payments, a consumer payment tool that helps payers display patient financial information in one place

Blog Posts


Contacts

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

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Monday Morning Update 7/9/18

July 8, 2018 News 5 Comments

Top News

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A reader-forwarded committee meeting agenda from University of Washington Medicine dated July 12 indicates that the health system will move to a single EHR in a 30-month, $180 million project.

The health system is using Cerner inpatient at University of Washington Medical Center and Harborview Medical Center, Cerner Soarian at Northwest Hospital, and Epic for ambulatory.

The document doesn’t say which system UW Medicine has chosen, but all of the peer group hospitals mentioned in another document I found online use Epic.


Reader Comments

From Ricardo Researcher: “Re: my journal article. I was hoping you might mention this one on HIStalk.” I’m increasingly frustrated by articles that exist only behind a paywall, which of course is the ridiculous default for peer-reviewed journals that make a fortune by selling access to articles they didn’t themselves write, describing important research work that they didn’t themselves perform, and funded in many cases by taxpayers who aren’t allowed to look at it. It does no good to proudly tweet out links when non-subscribers don’t have access. I usually won’t mention those articles unless the author emails me a copy since I don’t trust someone else’s summary, especially if they don’t have relevant medical or technical background. 


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor MDLive. The Sunrise, FL-based virtual care provider has since 2009 offered high-quality, convenient, and cost-efficient virtual care to meet the medical, dermatological, and behavioral health needs of its 25 million members. Consumers, health plans, health systems, and self-insured employers enjoy 24/7/365, anyplace access to its network of board-certified doctors and therapists via mobile app, online, or phone. Health systems can get a free virtual care assessment to learn how the company’s end-to-end virtual care solution reduces readmissions, removes barriers to ongoing care, increases brand loyalty, drives utilization, and optimizes provider schedules. Informatics luminary Lyle Berkowitz, MD (DrLyle) recently joined the company as chief medical officer, EVP of product strategy, and president of its medical group. Thanks to MDLive for supporting HIStalk.

I found this MDLive intro video on YouTube.

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Provider poll respondents mostly spend 1-2 work weeks each year attending conferences.

New poll to your right or here, repeating one I did two years ago to see what’s changed since: have you participated in a virtual visit in the past year? Click the poll’s “comments” link after voting to explain why or why not.

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Every year I offer a “Summer Doldrums” deal on newly signed sponsorships and webinars to overcome the seasonally-induced vendor siesta that makes me question whether I have slipped into irrelevance. Contact Lorre. Extra points for naming the summer movie depicted above.

The week of July 4 is traditionally one of the slowest for real news and having the holiday fall on a Wednesday encouraged a week-long work slowdown. You will likely not resent the idea of having less to read knowing that while I wrote less, I still covered everything important.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

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


Sales

  • Claxton-Hepburn Medical Center (NY) chooses Masimo’s Patient Safety Net remote monitoring solution that will automatically record vital signs in its Meditech system.

Government and Politics

A Politico article notes that never-ending government healthcare changes and resulting uncertainty, especially those driven by the Affordable Care Act, have been a boon for consultants, observing that, “American healthcare has no shortage of saviors. Some have brilliant insights that save lives and trim costs; others mainly generate invoices … Half of Twitter seems to consist of consultants. (The other half is developing health apps, which themselves spawn niche consultants.) They offer marketing, communication and wellness strategies; practice transformation; team-based-care building, revenue maximizing, behavioral health integration, pharmaceutical price-calibrating, and YouTube channels.”

The White House suspends the Affordable Care Act’s risk adjustment payments, which without further action will drive more insurers from the market and increase premiums. The payments to insurance companies, worth billions of dollars per year, discourage them from cherry-picking the healthiest and thus lowest-risk people as customers. CMS cites a recent New Mexico ruling in which a court found that the payment methodology is flawed in favor of large insurers, with the founder of a small, non-profit New Mexico insurer saying the decision will increase competition and reduce prices despite the commonly held perception that it’s just one more way for the Trump administration to sabotage the ACA.


Other

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Informatics nurse and analytics guy Brian Norris is looking for responses to this poll. My choice would probably be email since (a) I don’t like getting voice calls, and (b) text messages are harder to manage, although I would also worry that the email would end up in my spam folder as is often the case these days.

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Companies trying to attract investors by claiming their systems use artificial intelligence sometimes instead are sometimes using a “pseudo-AI, fake it until you make it” approach where humans are actually doing the work behind the scenes, or as an expert calls it, “prototyping the AI with human beings.” Examples:

  • A company whose app converts voicemails into text message ran its service from an offshore call center instead of with technology
  • A scheduling app vendor hired people to pretend to be a chatbot
  • An expense receipt company admitted that receipts were sometimes entered by humans instead of its “smartscan technology,” sending work to Amazon’s Mechanical Turk crowdsourced labor tool that allowed low-paid workers to read the full information from user-scanned receipts
  • Google admits that some third-party apps allow their developers to read user emails to collect advertising information or to refine the logic of their apps

In Australia, a hospital’s handwashing compliance rate drops from 94 percent to 30 percent after it replaces human auditors with an expensive, sink-installed automated surveillance system.

The parents of two unrelated 11-year-old Florida boys struggle to straighten out an insurance company identity mix-up, caused by the boys having the same full name, date of birth, and birth county. Their Social Security numbers are also one digit apart. The insurance company paid claims without questioning why an unrelated child would be covered on a family insurance plan. The parents worry about which child’s medical record would be displayed in an emergency, but are at least happy that both families are reasonable since “we have the most sensitive information about each other’s children.” 


Sponsor Updates

Blog Posts


Contacts

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

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Events and Updates

July 7, 2018 News No Comments

Upcoming Webinars


Recorded Webinars

Sponsor Announcements

Events

Jobs

News 7/6/18

July 5, 2018 News No Comments

Top News

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England’s NHS announces December 2018 availability of a new app that will allow all citizens to book doctor appointments, order prescription refills, manage chronic conditions, and make calls to its 111 non-emergency medical helpline.

The app will also allow users to record their data-sharing, organ donor, and end-of-life care preferences.

Health and Social Care Secretary Jeremy Hunt said of the app, “I want this innovation to mark the death-knell of the 8 a.m. scramble for GP appointments that infuriates so many patients.”

Thursday was the 70th birthday of NHS, formed on July 5, 1948 to bring together all health services under a single organization.


Webinars

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


Acquisitions, Funding, Business, and Stock

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The investment fund of David Einhorn – a long-time, vocal critic and stock-shorter of Athenahealth that he dismissed as “a business process outsourcer with a very promotional CEO” that stood no chance against Epic – is losing investors as the value of its investments dropped 11 percent from 2014 to 2017 as the S&P 500 rose 38 percent. Einhorn is also shorting Amazon and Netflix, which have gained value, and is long on Brighthouse Financial, whose shares have dropped 31 percent so far this year.


Sales

  • In England, NHS Digital awards IBM a three-year contract for cybersecurity services that include vulnerability scanning, threat detection, and threat intelligence.
  • Atrium Health (the former Carolinas HealthCare System) chooses Golden Hour’s EMSHIE solution for exchanging patient information with emergency responders.

People

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Our Lady of the Lake Regional Medical Center (LA) hires Stephanie Manson, MBA, MS (Franciscan Missionaries of Our Lady Health System) as COO.


Announcements and Implementations

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Holzer Health System (OH) goes live on Athenahealth.

Cleveland Clinic joins the list of hospitals that give patients access to their medical records on Apple Health Records. Apple lists more than 60 health systems that are participating in the Health Records beta.


Government and Politics

Politico reports that Cerner hired two former Congressmen as lobbyists for its VA project the day the contract was signed – Jeff Miller (R-FL) and James Moran (D-VA), both employed by McDermott Will & Emery.


Privacy and Security

A former patient information coordinator at UPMC and Allegheny Health Network (PA) is indicted on federal charges involving her retrieval of the information of 111 patients and her disclosure of the information of three of them “with the intent to cause malicious harm” if an unspecified nature. She faces an 11-year prison sentence and a fine of $350,000.

Facebook can continue tracking the browsing habits of people who have deleted their Facebook account, the company confirms, where it obtains information from any site that uses its Like or Share buttons or that runs Facebook ads to nag the former user into returning to Facebook and to serve them ads.


Other

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A small study finds that adding a second exam room monitor that mirrors the clinician’s EHR screen can be helpful in engaging patients. Patients liked the transparency, not having to look over the clinician’s shoulder in feeling engaged, and having the clinician’s conversation reinforced by seeing their information on the EHR screen. However, they found the EHR user interface, screen-flipping, and on-screen jargon confusing. Clinicians liked the ease of sharing information with patients, but noted that not all patients are interested. They also worry that raising more patient questions would extend visit time. Both groups noted that exam rooms were not well laid out for adding a second monitor.

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Epic adds to its quirky campus art collection by buying the old-fashioned carousel and decorations of the recently closed Ella’s Deli of Madison, saying that it was an easy decision to preserve part of the iconic landmark.

In Wales, Assembly member Lee Waters says the country is struggling with NHS’s IT systems, claiming that the unreliability of its Cancer Network Information System Cymru (Canisc) is causing daily problems. BBC says the system is over 20 years old, is not supported by Microsoft, and went down 11 times in a recent four-week period, delaying some chemotherapy and radiation therapy treatments.

A Fortune opinion piece by a venture partner observes that companies are claiming their systems are AI-powered when they are really capable of doing only basic data analysis via pre-programmed logic or plain old algorithms. His investment evaluation checklist for AI-claiming companies is:

  • Do their systems get constantly smarter?
  • Do they leave a large trail of proprietary data collected from interesting sources?
  • Does their technology reduce the need for humans to be involved?
  • Do the founders have deep technical understanding of machine learning models and how they can be applied to a large data set?
  • Is their AI expertise so deep that they have an extreme advantage over competitors and can they attract the right talent to go after their market?

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Independence Day always generates some fireworks-related cautionary tales. A Dayton, OH man who had just purchased fireworks couldn’t wait to light one and throw it out his car window, with his unsuccessful toss igniting his in-car stash and causing an explosion that severely injured him and several people nearby, set off car airbags down the street, and damaged a nearby house. A 21-year-old Maryland man sustains severe hand injuries when he tries to launch an illegal firework from a mortar over his head during a party, not realizing that he was holding the mortar upside down.  A Florida man holding an M80 blows off all his fingers. Another Florida man loses his fingers and eyebrows when a mortar he had modified went off in his hand. Kudos to NFL’er Jason Pierre-Paul, who, as he does annually, posted gruesome photos of his July 4, 2015 fireworks-caused hand injury in warning people to be careful with fireworks (ESPN’s tweeting of a hospital OR schedule to scoop the world on his finger amputation kicked off a privacy firestorm, you may recall). 


Contacts

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

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News 7/4/18

July 3, 2018 News 2 Comments

Top News

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UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business for $138 million and will pay another $14 million to acquire a 25 percent share of its population health unit.

In a complicated transaction, Orion will then reinvest some of the proceeds to buy back equity from the same acquirer, leaving it with 25 percent of Rhapsody and 75 percent of population health. It will use the rest of the money to buy back shares and fund its hospital division.

Orion shares, traded on the New Zealand exchange, rose sharply on the news but are still down 81 percent since the company’s December 2014 IPO.  


Reader Comments

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From Gaunt Survivor: “Re: HIStalk ‘like’ buttons. Which items have earned the most votes?” That’s an interesting question since I’ve never looked at the statistics from those little thumbs up/down icons I added to each post and comment, and in fact I didn’t know I could look up historical results. The all-time top three items by net score (likes minus dislikes over the past 18 months since I first turned on voting) are a diverse group:

From Sprachen: “Re: telemedicine. Some harsh tweets say it was overhyped.” The virtual visit companies have certainly hyped themselves (which is what companies do, especially when they are trying to create a new consumer market) and uptake has been slower than you might expect because of state-specific laws, reimbursement issues, and natural market consolidation. However, there’s no way telemedicine can fail to attract a significant share of some market elements — specifically non-urgent acute issues, mental health, and chronic disease management – because it eliminates the geographical challenges that are caused by irregular provider distribution and challenging physical access. The biggest challenges to telemedicine vendors are (a) they have to market directly to consumers, which is expensive and difficult; and (b) they have to maintain a supply of competent providers who are wiling to conduct video visits at reasonable compensation levels. They have an advantage that both insurers and consumers should find appealing in that they can operate as a de facto national medical practice that is professionally managed to follow sound medical standards defined by policy and procedures and measured by analytics across a broad scale, which could be a lot better than a rogue independent doctor whose practice patterns stray from the accepted. There’s actually a third challenge that sounds worse than it is – it’s not as good as having access to your regular doctor via email or telephone, but most medical practices are eliminating that threat by hiding themselves behind the four walls of their insurance billing factory.


HIStalk Announcements and Requests

Listening: new from The Wild Feathers, which breaks my lifetime-long streak of never recommending a country-rock band. It’s like the Eagles with the annoying parts excised, with remarkable harmonies and enough minor chords to keep me from quickly flipping on. I only wish they would ditch the cliché cowboy hat affectation that is emblematic of Nashville-based artists even though I’ve never seen anyone the South (except for Texas) wear a cowboy hat in public since they have no actual cowboys, especially the kind that work indoors at night miles away from the nearest horse that they couldn’t ride anyway.

It’s the beginning of the July Syndrome, when fresh batches of frightened, newly minted medical residents begin working in US hospitals in scarily defining why we call it the “practice” of medicine. You will be well advised to steer clear for non-emergent needs for the next month or so.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Laid-off IBM Watson Health engineers describe the challenges faced by the company following its expensive acquisition of Phytel, Truven, and Explorys in 2015-2016 in trying (and failing so far) to turn its $15 billion investment into profits:

  • Phytel employees thought they would accomplish great things under IBM, but has seen the company lose half its clients and 80 percent of its employees
  • IBM halted everything Phytel was doing for the first post-acquisition year as it “bluewashed” the company by making it do things IBM’s way
  • Non-technologist IBM leaders tried to create new Watson products from the capabilities of its acquisitions, but didn’t have clear ideas, kept changing their mind, and sketched out products that were impossible to create
  • IBM is losing the war to attract AI talent
  • Former engineers say IBM is “not anywhere close to injecting AI into the provider space” as the planned new products don’t use AI
  • Asking Phytel’s customers what they wanted resulted in their demand to bring back the pre-IBM product

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Rock Health’s Midyear Funding Review says:

  • Digital health investments continue to grow at a record pace
  • Startups are increasingly having their products validated even in a post-Theranos shadow
  • Two-thirds of digital health investors have made previous deals in the sector
  • M&A activity is down from its 2015 high as companies are staying private longer even when they have raised more than the $136 million average of previous IPOs, instead choosing to be acquired pre-IPO
  • Half of the digital health companies acquired so far in 2018 were bought by other digital health companies, although the number overweighted by virtual visit providers that aren’t really technology companies

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CNBC notes that e-cigarette maker Juul – whose USB-recharged vaporizer is easily concealable before and during use — is enjoying an 800 percent sales jump and a valuation of $15 billion, even as public health experts warn that while the company claims its products are intended to help adults quit smoking tobacco, many of its users are teens and adults who have never smoked. The company and its knock-off competitors offer nicotine-containing pods in such flavors as apple honeydew, donut cream, and Gummy Bear.


Sales

  • University of Mississippi Medical Center chooses Kyruus’s ProviderMatch for Access Centers to allow call center agents to identify the right provider based on a patient’s needs.

Announcements and Implementations

Japan’s first telemedicine intensive program goes live, developed in conjunction with Philips.


Government and Politics

Politico reports that the VA will not continue its Epic-powered MASS scheduling project beyond the pilot stage and will instead use Cerner’s capabilities. The VA ended up spending $28 million of the $624 million contract. However, the publication has since issued a “clarification” that its original report was incorrect, and the VA in fact hasn’t yet decided whether to continue the MASS project.


Privacy and Security

A former peer review coordinator of Memorial Hermann Healthcare System sues the health system, saying it fired her for her refusal to reveal confidential surgery-related information at open meetings.

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A developer whose company’s mission-critical monitoring application runs on Google Cloud is dismayed to find his entire site down, shut down hard by Google’s automated systems after “potential suspicious activity” with warnings that the entire site would be deleted within three business days. He reports that Google’s customer chat was offline and no support telephone number was provided – Google requires completing an online form and attaching a scan of the credit card use for payment as well as the holder’s picture ID, requiring him to wake up the company’s CFO in whose name the card was issued. He advises using Amazon Web Services instead, having experienced this problem twice with Google Cloud.

In England, NHS Digital blames one of its technology vendors (TPP) for failing to send it patient opt-out requests, a just-uncovered problem going back to 2015 that has caused the information of 150,000 patients to be shared against their wishes.


Other

Stat profiles Biobot Analytics, whose technology analyzes a city’s wastewater as a “public health observatory” that uses “wastewater epidemiology” to perform population-level, toilet-based studies. The company’s challenge is that cities don’t really want to know (and to have publicized) their incidence of opioid use and it would merely confirm the extent of a problem already known to be extensive.

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The New York Times says people are being unnecessarily frightened by false positives after they send information from their consumer genetic tests to third-party analysis companies like Promethease, which looks for health-related mutations in the raw data of companies like 23andMe even though they aren’t certified clinical laboratories. The other (unstated) issue is that like much of today’s sophisticated diagnostic testing, we can recognize and name it without being able to fix it.

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This medical versus financial decision repeats itself endlessly every day in the only country where an urgent medical need can leave you broke for the rest of your life.

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Cordova Community Medical Center (AK) won’t close after all, despite having warned the community that it would shut its doors on July 1 when it expected to run out of money to pay for the Internet access that its computer systems require. The hospital CEO says the FCC’s cuts to the Rural Healthcare Fund left the hospital to pay for its Internet access in full, leaving it with an accumulated $1 million bill. The hospital didn’t say how it resolved the issue, although the FCC boosted the program’s funding on June 1 to account for inflation, possibly restoring the subsidy that allowed the hospital to receive $80,000 per month worth of broadband services for $1,000.

A Detroit jury awards a 17-year-old girl a $135 million judgment in her malpractice lawsuit against Detroit Medical Center, which she claims botched her spinal surgery when she was 10 and left her with permanent weakness that the hospital says was due to a blood clot.

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Reno, NV police arrest a 31-year-old man who was running around a hospital’s public areas wearing scrubs and a doctor’s nametag, although he wasn’t booked for that charge specifically since he didn’t identify himself as a doctor and there’s no law against “just throwing a stethoscope around your neck and walking around.” The charge involved a similar incident at a different hospital in which he came in as a patient and then decided to video himself wearing someone’s scrubs. He has led an interesting life – he had two airplane crash landings in two days after convincing aircraft owners that he was a pilot and potential buyer and needed to take their planes up for test drives, then crashing them. His scrubs in the video carry the name of “Denver Prinz, MD,” suggesting that he might be this guy (Prince Denver of Prussia) who claims to be a prince, a charity CEO, a friend to countless celebrities (“my friend Jeff Bezos, owner of Amazon”), a talented keyboard player (whose fingers aren’t shown and whose body movements clearly don’t match the music), and a pilot of everything from helicopters to stunt planes.


Sponsor Updates

  • Waystar (the former Navicure and ZirMed) rolls out its “The All-New Rev Cycle” branding campaign at the HFMA annual conference.

Blog Posts


Contacts

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

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Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem

July 2, 2018 News No Comments

The Opioid Crisis: Fix the Process, Fix the Problem
By Brita Hansen, MD

Brita Hansen, MD is chief medical officer of LogicStream Health of Minneapolis, MN.

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As the nation continues to grapple with the overprescribing and misuse of opioids, reaching a solution often feels far out of reach. According to the US Department of Health and Human Services, more than 11 million individuals have been documented as having misused prescription opioids, resulting in an alarming 116 opioid-related deaths daily.

Despite this growing epidemic, provider organizations are uniquely positioned to address a key issue contributing to improper prescribing practices – inefficient clinical processes. Outdated and obsolete clinical processes built into electronic health records (EHRs) can be significant factors driving inappropriate drug utilization and impaired patient safety and quality care.

While the opioid crisis has no single origin point, one contributing factor can be traced back to the early-2000s when the Joint Commission implemented its revised pain management standards in response to the under-treatment of pain that was reported throughout the industry. In turn, many healthcare organizations interpreted these standards as a mandate and began to adopt clinical processes that aggressively treated patients’ acute and chronic pain. This also contributed to the then-growing trend of patients and caregivers equating pain management with medication use, which led to a demand that helped drive the increase in opioid prescriptions, and subsequently, opioid-related abuse and overdoses.

Despite evolving patient expectations and the emergence of new best practices for opioid prescribing, EHRs still lack the ability to appropriately guide clinicians and provide effective decision support during the prescribing process. Further, healthcare organizations also face the challenge of ensuring that clinicians understand and adhere to both general opioid ordering practices and best-practice guidelines. Gaining insight into these clinician’s ordering habits has been a continuous issue, and while clinicians express interest in reviewing and improving their ordering practices, this information is difficult and time-consuming to gather.

In addition to fixing and controlling processes and improving clinician adherence, provider organizations must ensure content in EHRs are continuously and reliably aligned with evidence-based guidelines to enable sustainable opioid therapy. For instance, recently developed treatments limit patients’ exposure to opioids, and instead, provide them with powerful yet non-addictive drugs such as corticosteroid injections for rapid pain relief and local anesthetics used during surgery or physical therapy sessions.

Facing the pressures to curb the country’s misuse of prescription opioids and adhere with rapidly changing prescribing guidelines, many healthcare organizations are increasingly leveraging health IT to encourage and improve the use of evidence-based best practices at the point of care. However, these tools are only as effective as the upstream clinical processes governing them, processes that are too often overlooked in the overall improvement strategy.

The data and trends contained within EHRs provide the key insights needed to optimize, measure, and manage the clinical processes related to opioid prescribing. With this critical information, frontline care teams can target and eliminate obsolete opioid protocols and order sets, thereby helping to improve, standardize, and better control processes and decrease the variability in how opioids are prescribed.

By identifying inefficiencies in workflows and the EHR build that often drive inappropriate prescribing practices, care teams can eliminate these issues. With the right tools, they can also continuously monitor the clinical processes guiding opioid prescribing and ensure they are aligned with current clinical evidence, regulatory requirements, and internal workflow needs. It’s equally imperative to continuously monitor clinician interaction with and adoption of the clinical processes that have been implemented, as various barriers inevitably lead to low compliance with set prescribing standards and protocols among some clinicians. Regular monitoring of opioid ordering enables clinical leaders to identify outliers, address barriers, and deploy appropriate interventions as needed.

To truly address the current opioid epidemic, provider organizations must fix the process to fix the problem, which begins with maintaining upstream improvements to clinical processes guiding opioid prescribing. While these steps may be one part of the nation’s opioid strategy, they remain key to providing healthcare organizations with the proactive support needed to combat the crisis.

Monday Morning Update 7/2/18

July 1, 2018 News 8 Comments

Top News

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CNBC’s talented and prolific reporter Chrissy Farr (she’s smart because she listens instead of talks, unlike most vain, vacuous TV talking heads whose raison d’etre is a buffoonishly gleaming smile rather than journalism) ponders why telemedicine “has been such a bust so far,” as 82 percent of Americans don’t use it.” Reasons:

  • People don’t know about it
  • Companies use the word “telemedicine,” which consumers don’t understand
  • Patients worry about the cost since most video visits require cash payments that aren’t affordable to a lot of people
  • They worry that doctors who are willing to offer video visits may be inexperienced or questionably skilled
  • Sick people want personal reassurance that an app can’t deliver
  • The common $75 charge is more than the co-pay of a doctor visit and not much less than a Minute Clinic cash visit

Still, I’m not sure I’d call telemedicine a bust. It only recently overcame technical and legal challenges to enter mainstream healthcare and its potential to more geographically evenly distribute medical expertise is promising. We have plenty of doctors, just not enough of them in primary care and an overabundance in big cities like Boston and New York where doctors prefer to live.

I’ve never had a video visit myself, but I would be more inclined to use it for a conversation with a skilled specialist in obtaining a second opinion since I have my $60-per-month concierge doctor available at all times anyway. 


Reader Comments

From Ms. Security: “Re: Quest Diagnostics. Their online bill password protection is a joke — MM-DD-YYYYZIPCODE.” Unverified. I registered on MyQuest to see how it works – the site requires creating a case-sensitive password that’s at least eight characters long that contains at least one alpha and one numeric or special character. Maybe it varies by the way the site is accessed.


HIStalk Announcements and Requests

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Two-thirds of poll respondents admire and respect their employer’s big boss.

New poll to your right or here: provider employees, how many work days do you spend attending conferences each year? I admit that I’m skeptical that conference attendance delivers employer value beyond giving providing an ego stroke for employees who enjoy feeling important among external peers (for which patients are paying, of course). However, I acknowledge those who say their attendance is important for building relationships with vendors and staying current (OK, I’m still skeptical).

Happy birthday, Canada (July 1) and United States of America (July 4).

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I was in Trader Joe’s early on a recent morning and was surprised to hear the immediately recognizable opening and then the growling Hammond organ of “Fire” by the bizarre 1960s psychedelic band The Crazy World of Arthur Brown, which made my day as I felt a secret, shared rebelliousness with a grocery store that is too cool to play “Daydream Believer.” In fact, I’m picturing a dramatic opening for presentations by FHIR expert Grahame Grieve, in which he takes the podium wearing a giant flaming helmet as an overdubbed version of “Fire” blares with these modified lyrics: “I am the god of health FHIR and I bring you FHIR. I’ll take you to learn.”


Webinars

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


Acquisitions, Funding, Business, and Stock

I’m fascinated with the comments of investor and technology executive Dave Kellogg, who ponders the “does the emperor have clothes?” question in reviewing the S-1 filing of BI tech vendor Domo, about which he observes (think of Theranos as you read this):

  • The Silicon Valley goal is now to raise more capital, generate more hype, and buy the most customers.
  • The ratio of venture capital to annual recurring revenue is the “hype factor,” for which Domo’s is 6.4, meaning “you give them $1 and you get $0.15 of heat and $0.85 of light.”
  • The founder controls nearly all the voting shares.
  • The company’s growth is leveling, but its burn rate is $150 million per year and it carries an $803 million accumulated deficit.
  • Market penetration is less than 4 percent.
  • The company leases a private jet from the founder for $1 million per year and spends $300,000 per year on catering by a company owned by the founder and his brother.
  • Kellogg says Domo is “the Kardashians of business intelligence” in being famous for being famous as its product description is nearly indecipherable other than it uses a lot of VC buzzwords in concluding that its product “enables CEOs to manage their entire company from their phone.”

Sales

  • Duke Regional Hospital (NC) chooses Glytec’s EGlycemic Management System for insulin therapy.

Decisions

  • Community Hospital of Staunton (IL) will switch from Evident to Meditech in November 2019.
  • Beatrice Community Hospital & Health Center (NE) will replace Allscripts with Epic on December 1, 2018.
  • Neshoba County General Hospital (MS) will go live with Cerner in February 2019.

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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T-System President and CEO Roger Davis has resigned, verified by the company in response to my query from a reader-reported rumor.


Government and Politics

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Los Angeles prosecutors name nine new defendants, including a former hospital CFO and three orthopedic surgeons, for their alleged participation in a kickback scheme involving surgeries, compounded drugs, home health services, and hospice care as orchestrated by the former owner of Pacific Hospital on Long Beach, CA. He is charged with paying $40 million in kickbacks to generate $950 million in fraudulent bills over 15 years. Orthopedic surgeon Daniel Capen, MD (above) will plead guilty for his part in creating $142 million in fraudulent bills, for which Pacific Hospital was paid $56 million. Michael Drobot, the former hospital owner, was sentenced to 63 months in prison earlier this year for billing worker’s compensation hundreds of millions of dollars for spinal surgeries for which he paid kickbacks of up to $15,000 per case, which he funded by billing the hospital at inflated prices for spinal surgery implants used in the cases. He also bribed a state senator to keep the spinal device law in effect, for which the former senator went to prison. The federal government rather wittily refers to its investigation as “Operation Spinal Cap.”


Other

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Don’t read this if you’re of the “healthcare is a calling, not a business” frame of mind. Atrium Health (the former Carolinas HealthCare System) replaces its anesthesiology group for refusing to lower their prices, choosing instead a local group based in Charlotte. The displaced group, which is owned by a publicly traded company valued at $4 billion, launches a media campaign that warns the public that the decision will jeopardize patient safety and says the health system’s previous cost-cutting efforts simply padded its bottom line to pay for huge executive salaries and its aggressive expansion. The company also notes that its anesthesiologists signed non-compete agreements that prevent them from accepting the job offers that the new company made.

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More US healthcare system madness as uncovered by Medicare claims analysis that would make Martin Shkreli beam with pride from his prison cell:

  • An old drug whose only approved use is for a rare condition in babies was being sold by Drug Company A for $40 in 2000.
  • Drug Company B bought the drug’s rights for $100,000 in 2001 and immediately raised its price to $750.
  • Drug Company B kept raising the prices, including a 2007 jump overnight from $1,600 to $23,000.
  • Drug Company C bought Drug Company B in 2014 and raised the price another $7,000.
  • Drug Company C immediately began aggressive promotion of the drug for questionable uses that included paying speaking fees (“peer-to-peer speaking engagements”) to doctors, writing checks to 80 percent of the drug’s prescribers.
  • Medicare spent $2 billion on the drug from 2011 to 2016 even though far cheaper drugs, such as prednisone, work just as well.
  • Overall, the drug’s price has been increased from $40 to $39,000 per vial and the company boasts that “current regulatory guidelines … make a generic unlikely.”

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Don’t show up here with a medical emergency. Despite its appearance and name, CHI Health Center isn’t a hospital – the Omaha arena that hosts concerts and wrestling matches sells its naming rights to CHI Health (part of Catholic Health Initiatives) for $24 million over 20 years. 


Sponsor Updates

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Contacts

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Get HIStalk updates. Send news or rumors.
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