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News 1/5/18

January 4, 2018 News 3 Comments

Top News

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A Mayo Clinic Jacksonville study finds that only around 20 percent of inpatients who had previously registered for its patient portal actually used it during their stay, concluding that inpatient portal use probably doesn’t improve outcomes.

Mayo’s portal provides a real-time view of lab results, admission notes, consultation reports, and operative notes. It does not, however, give patients access to progress notes or provide electronic messaging with care teams, which might help explain why they didn’t bother to log on (or the fact that they were busy being sick). There’s also the question of whether Mayo’s inpatients are representative of the populations of other health systems.

It may also be that staff communication there was good enough that patients didn’t have to chase down news about themselves on the portal.

What I would want in an inpatient portal, or more specifically, a custom app running on a tablet:

  • An integrated call system that allows me to indicate what I want or need and have my request prioritized and routed appropriately (just more ice at some point or a pain med now?)
  • A schedule of my meds due, a photo of each dose to double-check employees who might screw up, and a link to a standard medical reference so I remember what it’s for.
  • Two-way video would be nice for employees who otherwise have to make their way to my room for something that isn’t critical (maybe I want to ask a pharmacist a question, for example).
  • The ability to create tasks for staff (like fix my TV) and for staff to create tasks for me (like get out of bed and walk down the hall twice a day), with completion times noted and stored for accountability.
  • A Bluetooth-powered hospital badge that would flash the name and title of the person on the screen along with their photo and then record it so I could review it afterward.
  • A list of ordered but not yet performed tests or procedures, ideally with the dates and times they are scheduled.
  • Some idea of my care plan, success metrics, and expected outcomes.
  • A display of every line item being charged for my stay in as near real time as possible.
  • The usual hotel-like options for requests involving food, entertainment, and housekeeping.
  • The ability to record what a caregiver is telling me so I can review it afterward to avoid missing something important.
  • The Bluetooth badge-powered ability to display a giant, flashing red dollar sign when a hospital-sent caregiver enters my room who – despite my explicit instructions — isn’t in-network with my insurance.

Reader Comments

From Glory Basking: “Re: solutions, platforms, systems, applications. What’s the difference?” You would need to ask the marketing folks who love these terms and use them interchangeably. I remember an insistent email from a company’s marketing VP who was appalled that I had described its programmer utility (not the VP) as a “tool” instead of its preferred, overarching “platform.” That made me think of old-school techies would reference “a piece of software” — which was odd indeed since software is neither physical or divisible – or when an IBMer urged me in my short time as a vendor employee to always refer to our software as “solutions”or the even more grandiose “solution set” because it lulls the prospect into overlooking its many faults in picturing it as a reliable problem-solving appliance activated by writing a large check.

From Spinnaker: “Re: health IT podcasts. Which ones do you recommend?” I’ve never listened to any podcast – health IT or otherwise – but readers are welcome to make a recommendation. I would much rather skim the news visually for a minute or two (like on HIStalk) than sit through a real-time audio recording whose pacing I can’t control, but then again my attention span is so short that when I listen to the car radio (which isn’t often), I usually leave it on scan.

From Festivus: “Re: more EHR vendor lawsuits. See link.” Newly filed lawsuits are fun to write about, but I’ve mostly stopped because you’re just hearing one side of the story. Anybody can sue anyone for any reason in the good old United States of Litigious Peoples, so it’s journalistically lazy to write about a newly filed lawsuit as though it contains verified facts. Wait for the outcome – that’s the actual news.

From Thank You: “Re: HIStalk. It’s critical to my job and so valuable. I just wanted to drop a note and say thank you for all the hard work and effort you put into maintaining it and keeping the content fresh!” Thanks. I don’t have any time-suck hobbies other than starting with an empty screen and filling it up the best I can, so this is my golf or Facebooking.

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From Spam in a Can: “Re: EHRs. Epic’s ‘we make you more money’ claims are erroneous, if not disingenuous, according to this journal article.” I’m not sure it says that. A JAMA Ophthalmology article recaps a survey of ophthalmologists about EHR use. My takeaways:

  • The very long survey drew 348 respondents from a random sample of 2,000 AAO members invited, which isn’t a fantastic sample size or response rate (the US has about 18,000 practicing ophthalmologists). Only one respondent was selected within a given ZIP code and the survey was delivered via email. Of those respondents, only 265 reported using an EHR, so hopefully the authors discarded the 83 responses of those who don’t (but thus leaving the sample size even tinier).
  • Epic was the most-used EHR, although only a vendor ranking was provided rather than actual numbers.
  • 77 percent of EHR-using ophthalmologists say their practice is owned by physicians and only 6 percent by hospitals, which raises an interesting question – why the heck are so many of them using Epic instead of a specialty-specific EHR/PM? That seems suspicious.
  • The 72 percent of respondents who use EHRs say their net revenues and productivity have declined while their practice costs have increased.
  • Only 9 percent said net practice revenue increased with EHR use, while 35 percent said it stayed the same and 41 percent said it decreased. That seems odd since most of them also said coding levels and charge capture were unchanged or higher, leaving only reduced productivity as a possibility. Or that changes were associated with EHR implementation but not caused by it since time passed and situations changed either way.
  • 36 percent of ophthalmologists said they would go back to paper if given the chance.
  • A great majority of respondents said practice costs went up after implementing an EHR, but the study demographics also noted that most practices were running their first EHR. Obviously EHRs are more expensive than paper and the study didn’t ask respondents how much they thought costs rose, only whether they did, which again could have been due to unrelated factors over time.
  • Many respondents were pushed into using EHRs because of Meaningful Use incentives, which brought their own burdensome EHR documentation requirements.
  • It’s a perception study, which means that while practicing doctors rendered an opinion about cost, revenue, and profits, their participation was not vetted by role (so they aren’t necessarily involved in practice management) and their actual numbers weren’t reviewed.

HIStalk Announcements and Requests

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The frantic Post-New Year’s, pre-HIMSS housekeeping is underway. Sponsors who want to be featured in my HIMSS guide will be receiving a link to the data collection form (anxious ones can contact Lorre). It’s also time to open the HISsies nominations, recalling that it’s like a political primary – the candidates with the most votes will appear for voting on the final ballot, so don’t complain later if you don’t nominate now.

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Ms. M’s pre-K class in New York City received the science kits that HIStalk readers provided in funding her DonorsChoose teacher grant request. She reports, “We have been talking about volcanoes for the past few weeks. Many of the children didn’t even know what a volcano was. We are excited to start using these items within the next few weeks. You have made a tremendous impact on our class. Happy New Year.”

Listening: Garner, NC-based Sarah Shook & the Disarmers, a rare glimpse at what country music could be if devotees would stop throwing money at (a) throaty, big-city pretty boys inexplicably wearing cowboy hats indoors, and (b) privileged, bespangled warblers hiding their shiny pop ambitions behind a faux front of populism. This band is classic country meets sneering punk, unpolished and and full of hard-life experience, which is what country music used to be before big corporations took it over with harmless mannequins who would flee the studio in confusion if confronted with an actual pedal steel guitar or upright bass. I like that Sarah is an angry activist who chose as her band mates experienced (meaning: kind of old) musicians who really round out the sound.


Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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


Acquisitions, Funding, Business, and Stock

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VC-backed, four-state Medicare Advantage insurer Clover Health is not only losing money, failing to negotiate lower-cost provider contracts, and leaving patients on the hook for bills it won’t pay, it is also struggling with its highly-touted analytics technology. A bug in its algorithm that was supposed to rank members from sickest to healthiest for outreach calls had reversed the order with nobody noticing for several months, wasting the time of reps who called its healthiest customers first in chasing the high-hanging fruit.

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Enterprise telehealth platform vendor InTouch Health will acquire direct-to-home telehealth platform vendor TruClinic.

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AMA-backed Akiri, which offers a secure subscriber data transport network for healthcare, raises $10 million in a Series A funding round.


Sales

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The US Army expands its use of Vocera communications technology, adding a new hospital and expanding the rollout of two others.

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Capital Region Medical Center (MO) chooses CloudWave’s managed, cloud-based disaster recovery services for Meditech.

LA County Department of Health Services renews its revenue cycle management software and services contract with Harris Healthcare’s QuadraMed Affinity Corporation.

Hospital Sisters Health System (IL) chooses Health Catalyst’s Data Operating System analytics system for its ACO and PCIN.


People

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Mike Ruotolo (Inovalon) joins PatientSafe Solutions as regional sales VP.


Announcements and Implementations

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A new KLAS report on population health management identifies six functionality areas (data aggregation, data analysis, care management, administrative and financial reporting, patient engagement, and clinician engagement) and finds that HealthEC and Forward Health Group lead the pack, with feedback coming mostly from ACOs. Health Catalyst, Arcadia, and Philips Wellcentive topped satisfaction for IDNs/CINs. Narrowly-focused PHM solutions offered by EHR vendors scored surprisingly poorly in clinician engagement compared to leaders Forward Health Group and Enli. 


Government and Politics

HIMSS adds VA Secretary David Shulkin to a Friday morning session at HIMSS18 called “It Takes a Community – Delivering 21st Century Coordinated Care for Those In and Out of Uniform” that also features Defense Health Agency Director Vice-Admiral Raquel Bono. I assume the VA will have signed its Cerner contract by then, but you never know. I noticed that HIMSS will also need to change the title of fellow keynoter Eric Schmidt, whose credential as executive chairman of Google parent Alphabet will end at company’s board meeting this month when he assumes the less-keynoterly title of “technical advisor.”


Other

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A fascinating article by oncologist and author Siddhartha Mukherjee, DPhil, MD describes “the dying algorithm,” a 2016 Stanford project that mined EHR data retrospectively to create a deep neural network that could accurately predict whether a given patient would die within the next year. Interestingly, the algorithm works well but remains a black box because it’s not easy to figure out what it learned or how it applies its information to individual cases. It’s also interesting that despite sounding coldly high tech, the algorithm was developed with a nobler, more humane purpose – to identify terminally ill patients within the 3-12 month survival “sweet spot” in which palliative care is most effective in not wasting resources too early, but allowing patients enough time to settle their affairs.

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New versions of the cell-enabled Apple Watch are randomly rebooting in hospitals, apparently affected – as its documentation acknowledges is possible – by pacemakers, defibrillators, and other medical equipment. Users report that switching the watch to airplane mode while in the ICU prevents rebooting.

I enjoyed this video from Brad Nieder, MD, a practicing doctor and comedian whose “The Health Humorist” website invites folks to, “Put on a paper dress. Grab a magazine from 1987. This won’t hurt a bit!”


Sponsor Updates

  • Healthfinch is mentioned in KLAS’s emerging companies report.
  • AssessURhealth joins Greenway Health’s online marketplace.
  • Formativ Health renovates new space with sustainability in mind.
  • Ingenious Med staff volunteer with Open Hand Atlanta to deliver meals to the homebound.
  • KLAS highlights Health Catalyst as a high performer in a new population health management report.
  • Kyruus will exhibit at the JP Morgan Healthcare Conference January 8-11 in San Francisco.
  • ZeOmega adds identification and stratification tools to its Jiva population health management solution.

Blog Posts


Contacts

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

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News 1/3/18

January 2, 2018 News 16 Comments

Top News

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Some systems of Jones Memorial Hospital (NY) – including Meditech — remain down following an unspecified December 27 cyberattack.

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The hospital is asking patients to bring in their insurance card, meds list, and whatever medical history they have.


Reader Comments

From Debtor: “Re: news article calling American Well a start-up. What’s the shelf life? That company was founded in 2012. Or is it just a more-hip way to say ‘small business’ with no implicit time constraint?” I agree. I posit that a “start-up” will possess these characteristics, the absence of any meaning it’s just a less-sexy “business”:

  • Founded within the past five years.
  • Has not been acquired. 
  • Founders are still running the show.
  • Annual revenue is under $50 million and headcount under 100.
  • Implicit valuation is less than $500 million and funding is via bootstrapping, angel investors, and early funding rounds.
  • The business model is uncertain and stability is absent.
  • Growing quickly while remaining unprofitable.

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From Sparsely Populated: “Re: hospital construction. All those publish or perish authors should consider trying to correlate big health system construction expense with patient satisfaction and improved outcomes.” That would be interesting, as is the fact that some are questioning why health systems are building Taj Mahospitals while proclaiming themselves fit for purpose as benevolent overseers of declining public health. It’s a Pandora’s box of trying to tie non-clinical hospital overhead to their effect on the only metric that matters – patient outcomes. Locals, however, don’t understand or don’t care that health system costs sap the national economy even if they boost the local one, so they’re proud to show off fancy buildings to visitors.

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From Deal Watcher: “Re: wondering about EHR decisions. Singapore docs want Epic and the CIOs want Allscripts in a decision that was supposed to be made by December 31. Nova Scotia has been out on RFP and it’s between Allscripts and Cerner, perhaps on hold since the entire Canadian Maritime was considering collaborating on a single integrated EHR. The VA is still delayed despite strong rhetoric from Secretary David Shulkin – if interoperability is their goal, why invest $10+ billion in a new EHR that won’t get them very far instead of waiting a few years for MU3 and mandated APIs that will allow interoperability initiatives like the Carin Alliance go mainstream?” Singapore will announce its decision in the next 2-4 weeks, I hear. I haven’t heard about anything new from Nova Scotia. I’ve also never heard of the CARIN Alliance, an apparently for-profit member organization convened by former government officials as a Leavitt Partners project to facilitate consumer-directed exchange.   

From MD Professor: “Re: prescription drug monitoring programs. In my state, the focus on reducing opiate prescribing has seen skyrocketing rates of IV heroin use and overdoses even as available treatment programs have been reduced in number and insurance covers less of the high cost. Prescribing of even non-opiate controlled substances requires five minutes to deal with the state’s website. It only works with some browsers and enforces rigid password and reset rules that encourage poor security practices. The hospital says EHR interfacing is too expensive. I personally think the state makes the process cumbersome on purpose to dissuade clinicians from prescribing, so I don’t expect improvements to PDMP integration or usability any time soon.” You’ve identified four significant problems: (a) reducing the supply of legally manufactured opiates has raised their street cost and pushed users to less-reliable products that may kill them or steer them to crime to pay for their habit; (b) we are mired in the never-ending “war on drugs” that cannot be won by Darwinism, incarcerating users or dealers, fining drug distributors, or trying to limit access to drugs; (c) addicts trying to quit have few affordable treatment options; and (d) the use of PDMPs is creating unintended consequences even as it sucks up provider time. I don’t know the answer, but I’m pretty sure PDMPs specifically and technology in general aren’t it. A public health expert would tell you that few chronic conditions can be resolved by shaming or punishing those who have them, even if their own choices contributed.

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From Jennifer Coons, RN: “Re: Seiling Municipal Hospital (OK). I know there have been lots of comments and rumors on HIStalk about my hospital and our decision to change vendors and I wanted to take time to address them and put them to a close. I appreciate your consideration in posting this letter to your readers.” Jennifer is administrator of the hospital. Click the graphic above to enlarge her letter explaining why the hospital recently reversed its decision to replace CPSI/Evident Thrive with Athenahealth and is now back on the former.

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From Sick Doc: “Re: urgent care centers. I became ill with a high fever on New Year’s Day. All the urgent care centers were closed for the holiday.” I’ve often said that it’s no wonder that people show up in the ED for non-emergent issues. Private practices are nearly always closed outside of what used to be called bankers’ hours, urgent care centers set their own hours, and health system clinics stick to a university-like schedule, with only the ED offering the certainty that the lights will be on and the desk staffed. You would think a provider business case exists for being available for the other 14 or so hours each weekday plus weekends and holidays. I wonder if telemedicine providers similarly limit their availability?

From Banner Downgrade: “Re: Banner – University Medical Center, Tucson, AZ. A patient writes to the paper to complain about the EHR.” The letter writer says that following Banner’s “downgrade’ from Epic to Cerner:

  • His 30-minute appointment took more than 3.5 hours.
  • Banner’s Cerner system doesn’t receive his information his local doctors are sending.
  • Automated paging is no longer offered, so waiting patient names are called out by nurses.
  • He received a 13-page printout (sounds like a visit summary and/or patient education handout) that previously he could have accessed online.
  • He no longer receives telephone appointment reminders.

HIStalk Announcements and Requests

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Most poll respondents celebrate a winter holiday and most of those observe Christmas. Either way, the days are getting longer; we’re back in the post-holiday, pre-HIMSS frenzy; and it’s just 76 days until spring in the Northern Hemisphere.

New poll to your right or here: was 2017 an overall better year for you than 2016? You can elaborate further in the poll’s comments (click its “comments” link after voting).

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Some reader survey respondents suggesting eliminating some sections of HIStalk. I decided to let democracy rule – vote on which of the listed sections I should keep or drop in a survey I call “HIStalk Hot or Not.” I’ll be making a few more changes in response to feedback from survey respondents, one of whom received a late Christmas present in the form of an Amazon gift card (check your junk mail, folks, since all I had was an email address and the emailed gift card hasn’t been claimed yet).

Anonymous Epic Developer’s DonorsChoose donation funded math games for Ms. M’s first-grade class in Goldsboro, NC and solar energy study materials for Mrs. Z’s elementary school class in Brooklyn, NY. Anonymous made a donation that paid for a STEAM center (resources and furniture) for Ms. M’s elementary school class in Albuquerque, NM and a laptop and case for Mrs. H’s high school class in Fayetteville, NC. The teachers took the time to email me on New Year’s Day to say thanks.

This may be the last DonorsChoose update based on responses to the “keep or drop” survey above. One reader survey respondent dismissed the DonorsChoose updates as undesirable “virtue signaling,” a term (made up by a magazine in 2015) that I had to look up and found to be incorrectly applied since it indicates saying but not actually doing something virtuous (like helping teachers in need). Not to mention that I’m celebrating reader financial support of students, not bragging on my own. I admit that while most of the 570 reader survey responses were constructive and/or supportive, others ranged from dismissive to downright hostile and that always stings for awhile.


Last Week’s Most Interesting News

  • A consultant says Vermont’s HIE is not meeting the needs of its stakeholders and advises it to improve its services and financial sustainability.
  • A physician says missed meds are due to complex psychological issues rather than just patient forgetfulness, raising the question of whether a Big Brother-like pill tracker can improve outcomes.
  • The Indian Health Service issues and RFI for help in planning an IT future that will likely not involve the VA’s VistA, on which its RPMS systems are based.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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


Acquisitions, Funding, Business, and Stock

Cancer informatics vendor Inspirata acquires Toronto-based Artificial Intelligence in Medicine, whose product uses AI/NLP to extract oncology information from clinical documents.


Sales

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Union General Hospital (GA) chooses Cerner to replace McKesson Paragon and Athenahealth, planning a CommunityWorks deployment of Millennium, RCM, and HealtheIntent.


Decisions

  • Slidell Memorial Hospital (LA) will switch from McKesson to Epic in 2018.
  • Lavaca Medical Center (TX) will replace Healthland with Cerner in 2018.
  • Merrick Medical Center (NE) will replace Healthland with Epic.
  • Wayne Medical Center (TN) will switch from Meditech to Cerner in June 2018.

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


Announcements and Implementations

Sweden-based telemedicine and care center operator Doktor.se opens a clinic in a Swedish county where primary care is free, meaning that under Swedish law, everyone in Sweden can now access free virtual visits.

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Black Book launches a mobile survey app.


Government and Politics

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Doctors at the VA hospital in Roseburg, OR say metrics-obsessed administrators ordered them to discharge sick ED patients to make sure the hospital’s VA quality ratings (and administrator bonuses) didn’t suffer even though more than half its beds are always vacant. The hospital is also alleged to have told doctors to avoid listing congestive heart failure as an admitting diagnosis (since the hospital would be penalized for poor preventive care) and to steer chronically veterans to hospices to avoid having them counted as an in-hospital death.


Other

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How cold it is? It’s so cold that exhibitionists are flashing drawings of themselves. It’s so cold that lawyers are putting their hands in their own pockets. It’s so cold that systems at IU Health Ball Memorial Hospital (IN) have gone down due to a shattered fiberoptic line.

Here’s Vince’s 30-year look back at the health IT landscape of January 1988, when long-timers might have been distracted by the latest episode of “The Cosby Show,” the end of the war in Iraq, or the scramble to get Michael Jackson “Bad” concert tickets.


Sponsor Updates

  • Leidos Health publishes a white paper titled “Ready or Not, It’s MACRA Time.”
  • Meditech announces its support for several STEM-related school initiatives.
  • Audacious Inquiry’s Julie Boughn is recognized as a 2018 FedHealthIT100 awardee for contributions in modernizing enterprise health IT.
  • AssessURhealth announces several 2017 company milestones, including a 170-percent increase in customer growth.
  • Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world?”
  • CoverMyMeds celebrates its 2017 North American Visionary Innovation Leadership Award from Frost & Sullivan.
  • KLAS recognizes CTG as Best in KLAS for Partial IT Outsourcing.

Blog Posts


Contacts

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

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The 20 Most Important Health IT Takeaways of 2017

January 1, 2018 News 3 Comments

1. Hospital Consolidation Ran Amok, Benefiting Cerner and Epic

The big are getting bigger and more profitable among both health systems and their technology vendors. The resulting rip-and-replace projects are offsetting the first wave of post-Meaningful Use demand slack-off. That trend will continue as health systems use their favorable billing rules to acquire not only medical practices, but nursing homes. The industry marches toward a few multi-state, legally non-profit but hugely profitable operators controlling their freshly expanded markets.

The EHR vendor market has consolidated into:

  1. Epic and Cerner for US inpatient, as Epic announced plans to move down-market with a less-expensive basic system and Cerner held its advantage among large health systems that are contemplating merging into mega-systems.
  2. Epic for health system-connected private practices.
  3. Meditech for small health systems and those in Canada.
  4. CPSI for cash-strapped rural and safety net hospitals.
  5. Allscripts for hospitals in Australia and Europe, with newly acquired Paragon remaining an unknown.

2. Ambulatory Vendors Faced Reduced Post-MU Demand

Most practices that want an EHR already have one, and even some of those are being forced to displace their preferred system after being acquired by big health systems using Epic and Cerner. Ambulatory EHR vendors face several negative market pressures: complaints about poor usability and interoperability, technologically outdated products that still have to be maintained and enhanced, and lack of demand. The Department of Justice’s $155 million False Claims Act settlement with EClinicalWorks could portend similar charges against its competitors.

The bright spot for ambulatory EHR vendors is revenue cycle services (which they are well equipped to provide) and population health management technology (which they are not).


3. Value-Based Care Sounded Good, But Had Minimal Impact

Everybody likes the idea of paying for value instead of services performed — until they look at the work required and the potential profit lost. Heads in the beds and butts in the waiting room seats will continue to be the main driver as long as Medicare keeps paying for them.


4. The Press Exposed Questionable Business Practices

Theranos, Outcome Health, and NantHealth had their bubbles burst by dogged investigative reporting. Those exposés will likely continue as the shrinking journalism industry finds that those stories sell.


5. ONC Was Mostly Irrelevant

Much of the work around hot topics such as interoperability, EHR safety, and cybersecurity happened outside of ONC’s sphere of influence as it faced personnel changes and threatened budget cutbacks in a vastly different political environment.


6. The VA Rushed to Judgment

The VA — pushed by the White House to choose Cerner with the general thesis that running the same system as the VA will be good for veterans — announced to Congress that it will quickly sign a VistA-replacing Cerner no-bid contract despite unanswered questions around cost, DoD interoperability, and information exchange with the community-based providers that serve veterans.

The VA’s contract signing deadline of November was missed as Congress failed to move the VA’s money around to fund the deal, with the resulting extended timeline allowing Congress to pressure the VA into developing an actual plan on interoperability outside the federal government’s walls.


7. New Inpatient EHR Entrants Quickly Hit a Wall

The inpatient aspirations of EClinicalWorks and Athenahealth were dampened not only by complexity, the market’s preference for broad and mature product suites, and entrenched competition, but also by a DOJ settlement and activist investor pressure, respectively. ECW remained characteristically quiet, but the cost-cutting and executive-shedding Athenahealth was reduced to publicly sparring with CPSI over the decisions of tiny hospitals instead of with Epic over the large ones.


8. Allscripts and Greenway Announced Plans to Streamline Their Ambulatory EHR Portfolios

Both companies said they will develop a single system to replace their multiple aging ones.


9. Drug Companies Suddenly Became Interested in EHR Data That Technology Allowed Them To Obtain

Pharma needs to justify high drug prices and analyzing individual patient outcomes is one way to do that. They also found value in performing virtual clinical studies, recruiting clinical trials participants, and detecting adverse effects.


10. AI Hype Became Rampant as IBM Watson Health Turned Into a Marketing Term

Already-inflated expectations for artificial intelligence and machine learning expanded further, but the lack of results from IBM Watson Health, the paucity of transparency on exactly what Watson is doing and how, and Watson’s high-profile failure at MD Anderson encouraged moderating expectations even as Google and other technology firms look for healthcare nails to pound with their profitable hammers.


11. FHIR, APIs, and the CommonWell-Carequality Linkage Decreased Interoperability Barriers In Meeting The Minimal Market Demand For It

It predictably turned out that technology wasn’t the biggest barrier in exchanging patient information with competitors – it was that providers are fiercely protective of their business. Interoperability always works when demand exists, such as among multiple hospitals and practices within the same health system.

Providers will make interoperability happen quickly only if their profits depend on it. Perhaps the “data blocking” standard should be applied to health systems that manage to exchange information with disparate systems only within their own organization.


12. Population Health Management Presented Promise Without Many Definitive Results

Population health management and its associated technologies are an inherently good thing to patients, but the business model is marginal and slipping as the federal government steers the reimbursement ship back to fee-for-service. Implementation models vary widely, it’s early to publish definitive results, and providers whose profit comes from traditional services show reluctance to kill their golden goose. The track record of innovation whose only benefit is to patients is unfortunately poor.


13. The Federal Government’s Anti-ACA Efforts Threatened Provider Incomes

The federal government’s efforts to kill the ACA without an alternative in place will increase the number of uninsured patients who will still show up in the ED knowing they won’t be turned away, putting pressure on health system bottom lines that look great now only because their non-operational investments are killing it in a booming stock market.

The disrupted risk pool will continue to hamper insurers and the lack of political will to address exorbitant US healthcare charges guarantees that healthcare will be a mess for a long time except for deep-pockets consumers who can afford boutique care.


14. Big Companies Once Again Showed Their Health IT Short Attention Spans

McKesson sold out and GE mulled its healthcare IT exit as both companies chased the next shiny object in the face of sliding profits. Historical precedents are ample that buying health IT products from a company whose toes are dipped in other industries – especially if, as is nearly always the case, they turn out to be crappy health IT vendors — will nearly always leave customers stuck with a far-worse product turfed off hastily to a new owner at a devalued fire sale price.


15. Potential New Entrants Like CVS and Amazon Worried Health Systems As Hopeful Consumers Cheered

Health systems realized that despite the political clout that allowed them to become the default but questionably well-suited profiteer for everything from oncology practices to population health management, the market is becoming attractive to potential competitions such as CVS and Amazon that are not burdened by inefficiency and consumer indifference. The question of “who owns the patient” is valid, even if insulting to the patient who shouldn’t be “owned” by anyone.


16.  Cyberattacks Mostly Spared Hospitals, But Hit For-Profit Company Bottom Lines Hard

WannaCry and NotPetya malware caused temporary disruption of the operations of a handful of US hospitals, but publicly traded Merck and Nuance took big but temporary financial hits due to crippled operations.


17. The Federal Government Chased the Tip of the Healthcare Fraud Iceberg

Medicare’s pay-and-chase practices have created a ton of fraud and a few ounces of penalties that haven’t deterred the large number of scammers who make fortunes working the system’s many holes. A few high-profile settlements and prosecutions showed the risk to criminals, but the reward remains infinitely larger and the risk of actually serving prison time is minimal.


18. HIMSS Kept Getting Bigger

Cash-flush HIMSS has to spend its vendor-provided money somewhere, with competing publications and conferences topping its acquisition list and increasingly making it the all-controlling industry voice.


19. Technology Did Little to Improve the Opioid Crisis

Doctor-shopper databases have done little to improve the opioid situation, which remains a people rather than a technology problem due to user demand, doctor willingness to supply it due to questionable prescribing practices and sometimes outright fraud, and the ever-growing and ever-cheapening illegal drug supply that is happy to take up the slack if legal prescribing declines. Continuing demand with reduced supply does little except to raise prices and encourage customers to seek out more dangerous alternatives.


20. Digital Health Had a Few Bright Spots Among Unproven Apps

Consumer health apps and platforms continue to seem like good ideas even in the absence of evidence that they positively impact outcomes, they have minimal mainstream uptake outside of the quantified selves, and providers show no interest in looking at piles of self-captured information (especially when they aren’t being paid to do so) that provides little basis for intervention.

Patient engagement technologies offer promise in improving outcomes for a narrow subset of consumers, although definitive proof is mostly lacking. Technology vendors see the market opportunity in under-diagnosis, the extent and societal health value of which is questionable.


As an uplifting New Year’s bonus for “year in review” honors, I look back at the best health IT-related video ever created. The “Hamilton”-inspired production of Mary Washington Healthcare (VA) was appropriate to its location, magnificently written and performed by its employees, and reflective of the aspirations of a hospital implementing a new EHR.

News 12/29/17

December 28, 2017 News 3 Comments

Top News

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A consulting firm’s review of Vermont’s HIE finds that 91 percent of its stakeholders think the state needs such a service, but VHIE is meeting the needs of only 19 percent of them.

VHIE gets 95 percent of its funding from public sources, which raises a sustainability red flag. It has spent $44 million, most of that provided from federal Meaningful Use funds.

The report says data quality is a problem; VHIE’s “cumbersome” opt-in policy has limited enrollment to 20 percent of the state’s population; and most users have view-only access.

The consulting firm recommends that VHIE:

  • Provide search capability for extracted portions of the full record of patients
  • Allow providers to submit public health reports and registry data
  • Implement a master patient index and provider directory that can link patients to providers or ACOs
  • Provide quality reports to support data-driven care
  • Allow providers to submit Meaningful Use reports directly from their EHRs
  • Coordinate with the state’s all-payer claims database to allow analyzing cost at patient and population levels

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The HIE is run by Burlington-based Vermont Information Technology Leaders, which agreed with the consultant’s findings. John Evans, VITL president and CEO, will retire on January 1, 2018.


Reader Comments

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From Mordecai: “Re: Renaissance Weekend. I received an invitation – have you heard of it?” I haven’t heard of it. According to its website, Renaissance Weekend  — not to be confused with those goofy Renaissance Faires where historically accurate / BDSM attired attendees frequently exclaim “huzzah” and “good morrow” while they waveth a smoked turkey leg in one hand and cell phone in the other — is an invitation-only retreat of diversely accomplished folks who get together to talk about public policy, innovation, science, and other heady topics. I’m interested in hearing from anyone who has attended or was invited. The idea of going someplace fun for brainy discussions is pretty cool, although interested folks would probably need a connection to be invited and a good supply of extroversion to make it worth going. Maybe there’s something similar with bar lowered for the rest of us. I knew a guy once who convened his own retreat sort of thing, where he invited interesting and diverse people to join him for a day (or maybe it was a weekend) of freewheeling, friendly discussion, although I can see that devolving into a beer bust.


HIStalk Announcements and Requests

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An anonymous reader’s contribution to DonorsChoose, with matching funds applied from my anonymous vendor executive, fully paid for these teacher projects:

  • Science books for Ms. C’s elementary school class in Provo, UT.
  • Programmable robots for Ms. M’s elementary school class in Clermont, FL.
  • A programmable robot for the Robot Coding Club of Mrs. J’s elementary school class in Cleveland, OH.
  • STEAM kits for Mrs. K’s elementary school class in Winnetka, CA.
  • A document camera for Mrs. W’s elementary school class in Elm City, NC.
  • Six tablets and a printer for Mrs. J’s elementary school class in Forest Park, GA (it tugged at me when she mentioned that three of her students are homeless)
  • Math activity centers for Mrs. S’s pre-kindergarten class in Hillsville, VA.

I was working early and funded the projects at around 4 a.m., but the apparently also early-rising Mrs. W got in touch almost immediately to say, “WOW! What a wonderful surprise! I can not thank you enough for your generosity! I am so excited to be able to give all of my students the ability to watch and interact with my daily lessons. This document camera will allow my students to be in the moment as I model lessons. This will also help students to be more engaged. Thank you!”


Webinars

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


Acquisitions, Funding, Business, and Stock

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I realized this morning that it has been nearly six months since Neal Patterson died on July 9, at which time Cerner said its longstanding succession plan meant that “the process to select a new CEO is nearing a conclusion.” CFO Marc Naughton said in the October 26 earnings call that the board would “take their time and go through the process in a very careful manner.” Co-founder Cliff Illig remains as chairman and interim CEO. I don’t know how long the average publicly traded company takes to name a permanent CEO, but six months with an interim seems like a long time.


Sales

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Shepherd Center (GA) will implement Epic in a Community Connect agreement with Piedmont Healthcare (GA).


People

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Kyruus hires Chris Gervais (Threat Stack) as SVP of engineering.


Government and Politics

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A health law firm says CMS is warning hospitals that they cannot send patient information by text messaging in any form since secure texting systems are unreliable. That seems unlikely other than for using messaging to transmit orders, which Joint Commission has raised as a potential problem because of the inconsistent workflow involved in entering them into EHR. I’ve reached out to CMS for a response. UPDATE: per the response I received from CMS, my suspicions were correct. Texting patient information among healthcare team members remains OK as long as the platform is secure, while texting patient orders is prohibited in all cases.

A ProPublica report finds that CMS has done little to investigate private practice doctors who nearly always bill at the most complex visit rate. One Alabama doctor coded 95 percent of his visits at the highest intensity vs. 5 percent of his peers, for which Medicare paid $450,000. An expert blames EHRs that assign billing codes based on which boxes are checked, saying, “Those programs tend to upcode.”


Privacy and Security

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Systems at Jones Memorial Hospital (NY) go down due to an unspecified cyberattack. Amusing to me is that the hospital is located in Wellsville.

21st Century Oncology will pay a $2.3 million HHS OCR settlement for potential HIPAA violations involving a hacker using remote desktop protocol to penetrate the company’s network SQL database.


Other

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The Peoria, IL newspaper describes the planned February 1 complete IT switchover of two hospitals that OSF HealthCare has acquired, which the IT team hopes to complete in just the seven hours between the 12:01 a.m. agreement effective time and the day shift’s start at 7:00 a.m. The OSF team has staged equipment on rolling carts, practiced assembly and testing, labeled 2,000 cables with their destination, and created training videos for non-technical employees and volunteers who will help with the conversion. CTO James Mormann says OSF is considering using its expertise to spin off a new IT system switching business.

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Apple apologizes for intentionally slowing down older IPhones that have diminished battery capacity in an attempt to avoid unexpected shutdowns, offering as a mea culpa a price reduction on batteries for the IPhone 6 or newer from the usual $79 price to $29. The company will also provide a battery health meter in an IOS update in early 2018.

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The latest Gallup poll of most ethical professions ranks nurses at the top, with doctors and pharmacists coming in at #4 and #5 even as the honesty ranking of pharmacists fell to its lowest score since 1994. Finishing dead last were members of Congress, car salespeople, and lobbyists.

Only a small fraction of Washington doctors are using the state’s prescription drug monitoring program database, leading one legislator to advocate making their participation mandatory. The state medical association blames standalone PDMP software that doesn’t connect to EHRs. Epic integrates with the state’s system, but only one hospital has turned it on. An expert recommends that the state double the PDMP’s technology budget, integrate the system with EHRs, and pay doctors to use it to avoid resistance to yet another unfunded mandate that takes up their time.

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A New York Times article notes the new healthcare possibilities of the latest-generation Apple Watch, which connects directly to cellular networks instead of requiring tethering to an IPhone. It mentions the AliveCor KardiaBand for capturing EKGs, but observes that such devices can flood doctors with questionably useful information that they don’t know where to store. The company has responded by developing a software platform for doctors.

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A NEJM op-ed piece questions the psychology behind patients who don’t take their prescribed medications and the role of the Proteus “digital pill” that monitors their medication adherence. The physician author says the problem is rarely caused by patients forgetting to take their meds – despite what they tell their doctor – but rather the psychology in acknowledging their mortality. Some snips:

Understanding takes time, and it’s often easier to tell people what to do than explore why they don’t do it. Even having studied the psychological factors driving non-adherence among patients with coronary disease, I often lapse into check-the-box mode with my patients … For those of us who struggle, the most effective adherence booster may be giving doctors and patients the time to explore the beliefs and attributions informing medication behaviors. These conversations can’t happen in a 15-minute visit. Given how little our health care system seems to value such interactions, it’s no wonder that skepticism often greets these new, unproven, and costly technologies. But though this skepticism may be warranted, it may also reflect a fear that the technology is intended to replace our efforts, rather than facilitate them.

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A Froedtert Hospital (WI) anesthesiology resident with a history of depression kills himself on Christmas day by barricading himself in the OR, withdrawing fentanyl from the computerized dispensing system under a patient’s name, and administering it to himself.


Contacts

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

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News 12/27/17

December 26, 2017 News 10 Comments

Top News

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The Indian Health Service — which is about to have the VistA rug pulled out from under it as the VA frantically couples with Cerner — issues an RFI looking for help in figuring out how it can “modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure.”

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IHS’s RPMS is based on VistA.


Reader Comments

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From Steve E: “Re: Stanford Children’s Hospital. The $1.2 billion facility is open and it’s impressive, with lots of technology. You should write a piece on it.” The expanded 361-bed building opened December 9. It’s a beautiful facility, as it should be for $3.3 million per bed. We take a different approach in the US in building elaborate campuses for which we all pay with no promises that outcomes will improve. Patient satisfaction scores will rise because of amenities, although those aren’t any better of a predictor of long-term quality of life than impressive lobbies filled with crystal awards. I freely admit my cynicism about our profit-motivated healthcare non-system. 


HIStalk Announcements and Requests

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The 82 percent of meeting attendees who sneak looks at their phones are most likely checking email or their calendar, although a few admit to being drawn to non work-related distractions such as news sites, Twitter, Facebook, Instagram, or Snapchat. THB says shiny object fascination is an addiction that can be cured only by confiscating everybody’s phone at the start of a meeting. Bored Amy observes that everybody at her company is so swamped that multi-tasking to keep up with email is mandatory, while MasterBlaster probes deeper into the “just in case you’re needed” meeting invitations where people are just sitting in the room on standby as the core meeting progresses just fine without their involvement.

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Too many meetings are held just because they are on a recurring schedule, often bloated with an ever-expanding roster of marginally involved attendees who can’t escape after being added to a single agenda and never removed from the list. There’s also the age-old meeting problems that make participation frustrating: nobody takes charge, there’s no agenda or action items, nobody puts a stop to pontificating and factless chatter, and specific to-do assignments are not made even though it’s assumed that the next meeting will be held on the appointed calendar day. In that regard, self-gratification by phone may be a reasonable defense mechanism. It may be that just getting together without a specific purpose adds value in keeping everyone updated, but the odds aren’t good.

New poll to your right or here: which winter holiday do you consider to be your primary celebration? I’m happy to observe any holiday and I admit that I’m pleased rather than annoyed when someone wishes me Happy Holidays, Happy Kwanzaa, or Happy Anything Else instead of the traditional Merry Christmas — I’ll take all-too-rare best wishes from strangers any way I can get them. “Merry Christmas” is kind of weird anyway, grammatically speaking – when do we use the word “merry” otherwise? As a contrarian, I enjoy wishing people a John Lennon-style “Happy Christmas” just to stir them from their holiday coma with socialistic suspicion.

An anonymous reader sent a donation to DonorsChoose, which with matching funds will provide math materials for the kindergarten class of Mrs. A in Black Creek, NC.

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I was binge-watching the engrossing “Halt and Catch Fire” on Netflix when I was struck by this strange but mostly unrelated fact, which I will present as a trivia question that you won’t get right without cheating. In what city was Microsoft founded, the same city in which Amazon’s Jeff Bezos was born?


Last Week’s Most Interesting News

  • A newly submitted House bill would allow clearinghouses to sell patient data.
  • Drug overdose deaths cause US life expectancy to drop for the second year in a row.
  • Greenway Health files plans to lay off 120 of its Georgia-based employees in moving some functions to Tampa.

Webinars

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


Government and Politics

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I was curious about former Rep. John Fleming, MD — appointed early this year to the newly-created ONC position of deputy assistant secretary for health technology reform — since I have heard next to nothing about him. I emailed my ONC contact on Christmas Day and got a quick reply,  which is either admirable or sad that both of us were keeping an eye on work email on the holiday. Fleming is leading workgroups on burden reduction, usability, and quality measures and I see he’s written some “Health IT Buzz” blog posts.


Other

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Industry long-timer Orlando Portale says too many self-appointed AI pundits are expounding on a topic they know nothing about, which is unfortunately not uncommon in the “big hat, no cattle” world of health IT:

There remains a great deal of confusion from self-professed digital health evangelists and conference bloviators who don’t grok how AI/machine learning actually works … I suggest learning how to code or teaming with someone who does. Build something, otherwise your prognostications are without merit. To my physician friends on the digital health speaking circuit: AI/machine learning is a science, no different than the courses you had in med school. Treat the field with the same deference … Consider redirecting time wasted on Twitter cutting and pasting articles about other people’s work toward building something useful.

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A study finds that excessive CT scanning turns up a lot of unrelated kidney tumors (“incidentalomas”) that are over-treated by removing the kidney, exposing the patient to more harm than benefit. This is yet another example of where our excessively fine-tuned diagnostic capabilities (which are getting more sophisticated by the minute as technology such as AI advances) lead clinicians down an expensive and sometimes patient-endangering rabbit hole. We need proven, affordable prevention and treatment strategies for already-detectable and clinically meaningful conditions, not companies that are anxious to profit from the consumer misconception that new diagnostic capabilities will improve societal health. Only outcomes matter. We could also use one where just being exposed to it carries its own significant danger via medical errors, overtreatment, and a frequent disconnect between science and practice.

Tanmay Bakshi, a 14-year-old IBM Watson programmer, is convinced of the value of AI in healthcare. He’s working on a project to help a disabled woman communicate through a neural network that models her brain. He developed his first IOS app at age nine, has published 150 YouTube videos to teach young people about technology, consults with major corporations, and has delivered keynote and TEDx presentations.


Sponsor Updates

Blog Posts


Contacts

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

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News 12/22/17

December 21, 2017 News 11 Comments

Top News

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Despite appearances, Medhost wasn’t hacked this week, the company says. The cyber intruder penetrated Medhost’s domain registrar (not its actual server or site) and then redirected visitors to a new webpage claiming he or she had stolen patient data. The company did a nice job explaining what happened and getting the site restored as quickly as the propagation of the restored DNS allowed.

Lesson learned for anyone running a website: use a complex domain registrar account password and turn on two-factor authentication if they offer it. I changed mine this morning.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Silicon Valley, meet Bubble 2.0 (and possibly the need for SEC Oversight Part Zillion): the juice manufacturer behind Long Island Iced Tea changes its name to Long Blockchain Corp. even though it admits that it is only beginning to look at blockchain with the vague idea that it might be something cool. The news sent micro-cap shares soaring 200 percent.

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A previously dismissed shareholder rights law firm’s securities class action lawsuit against Quality Systems, Inc. is reversed on appeal, with the law firm claiming that Quality Systems/NextGen touted increasing revenue through February 2012, at which time the CEO sold his shares at a high price just before the company lowered guidance and reported lower net income. Above is the QSII share price chart from January 2012 through today, with QSII (dark blue, down 65 percent) vs. the Nasdaq (light blue, up 147 percent).


Sales

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USF Health (FL) chooses Kyruus to help its access center match patients to providers.


People

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Nordic promotes Michelle Lichte to EVP of client partnerships.

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Gary Gartner, MD, MS (Allscripts) joins NextGen Healthcare as VP of clinical solutions.


Announcements and Implementations

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A new KLAS report looks at healthcare management consulting (click the graphic to enlarge).The most-trusted partners of respondents in each consulting firm category (cross-industry, healthcare-specific, focused healthcare-specific) were Deloitte, Premier, and Optum. KLAS hasn’t sent me any report announcements since early 2014, so in checking their site to see how the company has grown, I note that it lists 12 executives and a 24-employee research team.


Government and Politics

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A newly submitted House bill would allow clearinghouses to sell patient data in a reincarnation of previous bills that were suggested by lobbyists for Experian, The SSI Group, and Availity. Clearinghouses would not be considered HIPAA business associates or covered entities, and like providers that can use patient data without individual consent under the nebulous umbrella of treatment, payment, and operations, would not be required to seek authorization from patients and would be allowed to charge patients for providing copies of their own data. Unlike providers, they would also be allowed to sell data. Hat tip to Politico for turning this up.

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The just-passed tax law will affect non-profits that include health systems, hitting them with a 21 percent excise tax on each salary of $1 million or more among their five highest-compensated employees who don’t provide medical services. Also affected will be universities (because of their highly paid presidents and sports coaches) and religious organizations. Given historical health system indifference to high salaries and the enforceability of existing employment contracts, the most likely outcome is that they will just figure out how to bill insurers and patients more to cover their new cost of doing business.


Privacy and Security

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Fortified Health Security’s 2018 cybersecurity report finds that nearly all of its web and network penetration tests allowed access to patient information, while 33 percent of systems could be compromised due to incorrectly configured Citrix, VMware Horizon, and SSL VPNs. A rather shocking 72 percent of networks tested were at risk because of weak passwords. It recommends that organizations:

  • Maintain and enforce security policies and procedures.
  • Keep an updated inventory of devices that store, process, or transmit electronic PHI.
  • Use strong security engineering when rolling out remote access solutions and web applications that store patient information in a SQL database.
  • Enforce creation of strong passwords.
  • Consider implementing systems data loss prevention, security incident event monitoring, and intrusion detection.
  • Encrypt data at rest.
  • Don’t get indifferent about patch management even though it’s a never-ending slog.

Technology

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Wired magazine covers CareCoach, a $200 per month human-powered, tablet-presented simulated pet avatar that monitors high-need and elderly patients by checking in, offering medication reminders, and providing a bonding experience. It’s a good idea, although the avatar’s synthesized voice and inherent processing delays are hard to overlook.

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Apple finally admits what many IPhone users have suspected – iOS intentionally slows down older iPhones. Not to sell users a newer model, but to prevent the old phones from shutting down because of deteriorating battery capacity. The takeaway: consider replacing your battery to speed your phone back up  instead of spending $1,000 on a replacement.

Bloomberg reports that Apple is developing electrocardiogram capability for its Watch in which wearers will touch two fingers from the opposite hand on the watch’s frame, possibly helping detect arrhythmias. Apple is behind since AliveCor’s Kardiaband add-on band for the Apple Watch is already FDA approved to capture EKGs.

Twitter continues to kill off its only virtue — mandatory brevity — by allowing its users to stitch together a string of tweets. I haven’t seen proportionately more user brilliance in the expansion of the 140-character limit to 280, no different when people who just couldn’t bear to edit their magnificent thoughts started attaching pictures of words that would not have fit otherwise.


Other

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Sixty-three thousand drug overdose deaths in 2016 caused US life expectancy to drop for the second year in a row, the first time that has happened since the early 1960s.

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A cafeteria worker at Advocate Trinity Hospital (IL) who says “you don’t have to wait until you get rich to help others” spends $5,000 to buy toys for pediatric patients at Advocate Children’s Hospital. In this tenth year of her project, she will donate half the toys to children in Puerto Rico. 

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Dilbert, like “The Simpsons,” somehow remains relevant and edgy after many years.


Sponsor Updates

  • Protenus publishes its November Breach Barometer.
  • Liaison Technologies rolls out a single user interface for access to its Alloy integration and data management platform.
  • HealthLoop will integrate its automated care plans and check-ins with patient activity and behavior analytics from Sherbit.
  • A new release of Harris Healthcare’s Novus Meds medication reconciliation application offers mobile physician access and embedded drug knowledge, developed with Hunterdon Medical Center (NJ)
  • CloudWave employees collect toys for United Way.
  • Conduent will open a global technology and innovation hub in Raleigh, NC.
  • LogicStream Health publishes a new case study featuring Tampa General Hospital, “Decreasing C.diff Rates Through Appropriate Testing with a Clinical Process Improvement software platform.”
  • Mazars USA will donate $100,000 in 2018 to nine charities that will work to fight hunger.

Blog Posts


Contacts

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

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News 12/20/17

December 19, 2017 News 13 Comments

Top News

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Medhost’s public website medhost.com was hacked Tuesday morning, according to a cyber intruder’s message that replaced the company’s usual home page content.

The hacker demanded 2 bitcoin ($37,000), threatening to otherwise “sell the patient data and do a media release regarding the lack of security in a HIPPA [sic] environment.” Medhost offers hosted financial and clinical systems, an emergency department system, a patient portal, and a health and wellness site.

The site had returned to normal by Tuesday afternoon with no acknowledgement of the previous problem on the site or on social media. A Medhost spokesperson did not return my call in which I asked for verification of the hacker’s claim that patient data was exposed.

UPDATE: shortly after the normal home page was restored late Tuesday afternoon, the site was apparently hit again with the “this website has been hacked” message restored.

UPDATE 2: Medhost CISO William Crank reports that the problem has been resolved and no information was compromised:

MEDHOST has full control of the domain, and the restoration of the domain and associated applications has been completed. Depending upon geographic location, sites may already have full access, but it is possible that the DNS restore process could take up to 24 hours to propagate the changes due to TTL. Intermittent application impact may be experienced by end users during that time. MEDHOST wants to reiterate that there is no indication that sensitive information was comprised and the incident didn’t extend beyond the redirection of the MEDHOST DNS to a static site with the message your article referenced. We strive to provide a robust and secure platform for our clients and continue to investigate this incident and its root cause.


Reader Comments

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From Athenahealth: “Re: APIs. We have integrations with over 200 innovators and a developer community of 7,000, processing 700 million calls per month. Our single-instance, multi-tenant cloud platform allows a global integration model that allows immediate access to all partners for our clients – where innovators connect once and then are activated at clients with the flip of switch. We agree that talking numbers is interesting, but more so, let’s start to talk about API usability and the downstream impact of API calls.” It’s encouraging that Allscripts, Epic, and now Athenahealth have checked in with big API usage numbers. None of these are surprising – Allscripts (in the form of the acquired Eclipsys) pretty much defined the idea of inpatient systems with “hooks” as we called them in the old days, while Epic and Athenahealth stay current in deploying modern technologies and Athenahealth’s system is based on connectivity. I’m guessing Cerner has impressive numbers although I haven’t seen them.

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From Event Attendee: “Re: John Halamka’s installation as Harvard Medical School’s inaugural International Healthcare Innovation Professor of Emergency Medicine. I had the distinct honor of attending and snapped a picture of a few notable CEOs in the room – Jonathan Bush (Athenahealth), Girish Navani (EClinicalWorks), and Hoda Sayed-Friel (Meditech). It’s remarkable that they spent the morning together honoring his lifetime of achievement.”

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From Earth Shatterer: “Re: Epic. What exactly is Sonnet?” Sonnet is a streamlined, cheaper, faster-install subset of Epic’s full software suite being developed that will target small hospitals and physician groups, post-acute care facilities, and some international organizations. It will be released in March 2018. Sonnet was announced at HIMSS17 along with Utility, a fast installation program that gets customers live faster with fewer modifications. Epic says Utility implementations started in Q4 2017 (it’s now Epic’s most popular implementation method) and the first Utility-implemented customers will go live in 2018. Judy Faulkner chooses all Epic product names herself and they always contain a subtle reference, in this case with the word “sonnet” as translated from Italian as “little song.” Epic has tried similar rollouts in the past, twice in a partnership with Philips in the early 2000s and another attempt a few years later using the Sonnet name that may have failed because of newly mandated Meaningful Use requirements, but this one seems like a done deal.

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From Who Else Remembers?: “Re: selection consultants having a conflict of interest. This is reminiscent of the late 1980s and early 1990s when Arthur Andersen was accused of a similar bias. Back then, the cozy relationship resulted in a string of predictable yet questionable wins for Gerber Alley and Statlan. Anderson would do the selection and inevitably be granted a large advisory and implementation role post award. Notably, Jay Toole and Andersen were crisscrossing the country espousing the virtues of a best-of-breed approach that needed lots of consulting help, for which Andersen was all to eager to offer the brave buyers of these footnotes in HIT history.” It’s a longstanding question of whether consulting firms that sell system services should be asked to help customers choose those same systems, at least without first recusing themselves from earning future business related to the selection. On the other hand, health systems can hire whoever they want and are presumably acting in their best interest. You mentioned Jay Toole, and in tracking him down, I learned that Dearborn Advisors filed Chapter 7 bankruptcy and apparently closed earlier this year. For more about Gerber Alley, see Vince’s HIS-tory.

From Fanny Pacque: “Re: vendor underbidding. Epic underbids (probably to their advantage) relative to their competitors. Implementation services, additional software, etc. always come later and require direct third-party engagement. This is the tick-tock on how you get to projects that go 2-3x over budget. Example: San Francisco Department of Public Health, which is a few months out from choosing Epic and they’re already bidding out voice recognition software, revenue cycle implementation, HIM, and patient outreach. You can see why Allscripts, Cerner, and others might suggest increased transparency on this topic since they provide fully loaded proposals.” San Francisco DPH’s several Epic-related RFPs are here (on the right side of the page as part of RFP 47-2017). I would think a prospect would know to compare apples to apples in choosing a vendor, but sometimes they get so mentally locked in to their favored vendor that they don’t dig deep enough and/or their lack of EHR selection experience makes them unsuited to detect contract land mines.


HIStalk Announcements and Requests

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The efficiency of DonorsChoose is always impressive to see – we funded the teacher grant request of Mrs. A in Michigan on December 10 and her students are already using the STEM kits and experiment books we provided just nine days later, as evidenced by the photos above. She reports, “My students and I are so elated that this project was funded. The excitement they showed when we unwrapped the science kits was unprecedented! I wanted to thank you again for your very generous donation. The students are now able to take science out of the science classroom and bring it in to their homes. Not only have you allowed the students to experience science phenomena, you have also allowed their families to as well! Many of my students and their families do not have access to the items that will enable them to perform these experiments and now they do! You have truly helped to create lifelong memories.”

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Welcome to new HIStalk Platinum Sponsor Ellkay, which brilliantly taglines itself as “Healthcare Data Plumbers.” The Elmwood Park, NJ-based company enables interoperability, providing a data pipeline for 45,000 practices and 500 PM/EHRs and connecting hospitals, practices, labs, payers, HIEs, and ACOs using almost any system. Products include connectivity for diagnostic labs; PM/EHR integration and data migration, lab orders and results interfaces; and ACO/HIE connectivity solutions. Its CareEvolve portal and interfaces provide clinical workflow support between laboratories and the point of care, while hundreds of hospitals have used Ellkay’s data extraction, conversion, and archiving services to decommission legacy systems. Black Book included Ellkay on its list of 2017’s most disruptive health IT companies that have top customer satisfaction scores. The company’s “Our Story” page is the most entertaining and fascinating backgrounder I’ve seen and the story about why they installed beehives on the company roof roped me in completely. Thanks to Ellkay for supporting HIStalk and for entertaining and informing me with an unusually cool website.


Webinars

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


Acquisitions, Funding, Business, and Stock

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High-profile Silicon Valley investor Bill Gurley – an early Uber backer whose startup Brighter was just acquired by Cigna – launches Stitch Health, a Slack-like care team coordination and patient engagement platform. The Connect team communication system costs from $6 to $18 per user per month depending on features. Stitch CEO and co-founder Bharat Kilaru is a 2015 Harvard MBA graduate and ran a Nashville clinic for the underserved until 2013.

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Pittsburgh-based specialized outpatient clinical documentation vendor Net Health will be acquired by two private equity firms and the company’s management team.

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Humana and two private equity firms will acquire home health and long-term care operator Kindred Healthcare for $4 billion, continuing the trend of insurers moving into direct patient care.

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A New York Times review of proposed health system mega-mergers contains some interesting quotes:

  • “Hospital executives are realizing that someone else, including an insurance company employing the nurse at a walk-in clinic or the doctor at a surgery center, wants to take over their relationship with patients — and the potential revenue that those patients represent.”
  • “But many point to the promises of past mergers as reason to doubt whether the hospital mergers allow much more than an ability to demand higher prices from insurers. After the last wave of mergers that took place a few years ago, the hospitals didn’t use that opportunity to bring their costs down.”
  • “The challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. You’re taking a zebra and a zebra … what they want to become is a unicorn.”

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Silicon Valley, meet Bubble 2.0: SoftBank will invest up to $300 million in a dog-walking app vendor that has already raised $40 million.


Sales

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Mercy Health chooses PatientPing for real-time patient care coordination.


People

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Recondo Technology hires Craig Niemiec (AxisPoint Health) as CFO.

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Patrick Neil Mescall, PhD (Businessolver) joins VirtualHealth as SVP of channel development.

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Former National Coordinator Karen De Salvo, MD, MPH, MSC joins Dell Medical School at the University of Texas at Austin as a professor, with appointments in internal medicine and population health.


Announcements and Implementations

A survey of a few dozen hospital CIOs finds that the biggest jump in deployed mobile strategy components over the next three years will be in critical test result alerts, clinical decision support alerts, and care team assignments. Respondents also indicated that their investment in communications technologies will be slightly more driven by system integration capabilities than by end user needs.

I’ve never heard of CHIME’s 2014 spinoffs AEHIS, AEHIT, and AEHIA – which seem to have been created primarily to help CHIME to lasso new dues-paying members who don’t meet the job qualifications to join CHIME since they aren’t CIOs (security executives, CTOs, and application leaders, respectively) – but for those CHIME members who are interested, they’re waiving dues for 2018. I don’t quite understand why a prominently posted press release on the site of AEHIS (that’s the security group) is “Fujifilm Captures New Customers for its Synapse Enterprise Imaging Solutions,” but then again I don’t usually like providers and vendors sharing an association-provided membership bed even when a logical connection exists. As readers have observed, CHIME is mimicking HIMSS in seemingly trying to get bigger, more vendor-friendly, and more executive-compensating, but its members are apparently OK with that and that’s all that counts.


Government and Politics

Americans say healthcare is the country’s second-biggest problem behind the government, Gallup finds. Healthcare hasn’t been one of the top two problems since 2007, when it finished a distance second to Iraq.


Privacy and Security

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White House Homeland Security Advisor Tom Bossert says in a Wall Street Journal op-ed piece that North Korea launched the WannaCry malware attack earlier this year that hit hospitals hard, adding, “Pyongyang will be held accountable.”

A Black Book survey finds that 84 percent of healthcare provider organizations don’t have a chief information security officer, 54 percent don’t conduct cybersecurity risk assessments, and 39 percent don’t perform regular firewall penetration testing. The survey also finds that few boards of directors actively discuss cybersecurity.

Yet another exercise proves that de-identifying patient data doesn’t really work, as a university in Australia (as several have done) matches up a publicly released Australia Medicare database and re-identifies patients by linking their information to other publicly available databases. The Australian government is considering laws that would make re-identifying government data illegal, which is an interesting (and not in a good way) approach.


Other

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A reader whose company has nothing to do with healthcare consulting was surprised to have it shortlisted among the “Top 10 Healthcare Consulting Firms 2018,” which comes with a (free) certificate and (not free) interview reprint rights from a magazine called Enterprise Services Outlook. The magazine shares a telephone number and street address with shady magazines (CIO Review and Healthcare Tech Outlook) published by Bangalore-based marketing firm SiliconIndia. I’ve previously noted the hilarious misspelling of HIPAA on the cover of Healthcare Tech Outlook and the fact that its covers always feature males. It has published an article by UC Health CIO Steve Hess (which also appeared word for word in Becker’s Hospital Review under a different UC Health author’s name) and by other health system CIOs like Marc Probst and Dan Waltz who probably don’t even realize who they’re writing for. The magazine invites readers who “skimp” [sic] its questionable vanity content to join its august roster of contributors.

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Jenn ran this fun item on HIStalk Practice: an Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own epinephrine and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

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Moxe Health founder and CEO Dan Wilson reads “’Twas the Night Before Go-Live,” an HIT-focused song parody written by Jay Rath. Jay fascinates me because in addition to having spent time with Epic, he’s a former staffer at “The Onion,” a contributor to “Mad” magazine, and has a broad background in theater and radio comedy.

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Wendy from Bellin Health (WI) sent a photo of the Epic Willow team’s holiday-decorated cubicle area in the IT department that creatively adds a fireplace inside and a welcome mat out front. The coats inside prompted me to check Green Bay’s weather forecast – Tuesday was to be sunny with a relatively balmy high of 40 degrees and a low of 11, but Christmas will be biting as temps struggle to rise to zero (Fahrenheit, just to be clear).


Sponsor Updates

  • The InstaMed team delivers over 900 presents to the Children’s Hospital of Philadelphia.
  • Definitive Healthcare adds visual dashboards to its hospital and provider databases.
  • Elsevier Clinical Solutions publishes a new white paper, “Build or Buy: Considerations when adding a new Clinical Decision Support System.”
  • FormFast publishes a new case study, “East Alabama Medical Center Saves Time and Cuts Costs with FormFast’s Leading Form Design Technology & Services.”
  • Healthfinch publishes a new case study featuring Valley Medical Group.
  • Data analytics from Arcadia Healthcare Solutions supports a New York Times skin cancer investigation.
  • T-System President and CEO is recognized at D CEO’s “Excellence in Healthcare” awards program.
  • Besler Consulting releases a new podcast, “Perspectives on the Alex Azar nomination for HHS Secretary.”
  • Mphasis Eldorado and Change Healthcare expand their partnership to include integration between Javelina and Change Healthcare’s payment integrity services.

Blog Posts


Contacts

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

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Monday Morning Update 12/18/17

December 17, 2017 News 6 Comments

Top News

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The Atlanta business paper has corrected its story that stated Greenway is closing its Atlanta and Carrollton, GA offices, now indicating that only the Atlanta office will close.

The company is moving some functions from Carrollton to Tampa, but a spokesperson says 500 employees of Greenway Revenue Services and other customer-facing functions will continue their work in Carrollton.

Greenway will also hire another 100 revenue cycle management employees for that location in the next few weeks and is actively hiring for its Tampa office.

The Georgia WARN act site indicates that the Atlanta office will be closed and 24 employees laid off, while the Carrollton layoff involves 96 Greenway employees.


Reader Comments

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From Portland Liquid Sunshine: “Re: Cambia Grove. The director, program director, and others have left in the past few months. The new director has no background in innovation.” I don’t know anything about the Seattle healthcare innovation and investment workspace, but comparable offerings elsewhere have struggled.

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From Associate CIO: “Re: UIC, Epic, and Cerner. The main issue that Cerner has (and I am surprised that Allscripts isn’t protesting as well as they finished third) is that the state of Illinois has a very strict procurement process. Final bids have to be all-inclusive, which Cerner’s was, but Epic’s was not since it included only licensing. The cost of Epic could end up being twice that offered by Cerner.” I extracted and summarized Associate CIO’s comment left on last week’s post since it interests me a lot.

From Slick Willie: “Re: UIC, Epic, and Cerner. The project was baked as soon as UIC hired Impact Advisors because (a) they always choose Epic, and (b) they always help with the implementation of Epic. Cerner has valid points.” Unverified. Statistics would  prove how often an Impact Advisors-led EHR selection results in an Epic decision and a follow-up implementation contract, but I assume that only the company could provide those numbers and I don’t expect that to happen unless the state of Illinois requests them as part of its review of Cerner’s protest.

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From Aaron Iota: “Re: API transaction counts. Does that really matter?” Not to me. Prospects and observers should focus on: (a) whether open APIs are offered and to what outside systems; (b) which third-party vendors are using them; and (c) whether the APIs are meeting customer needs in giving them functionality they would not have otherwise had. A high transaction count simply validates that the APIs are functional and capable of scaling. It’s also true that customers of EHR vendors that offer a broader solution will find less value in APIs to outside systems that they may not require. High API usage means that the market wants interoperability and is getting it, which is the biggest takeaway. It might be interesting also to know whether the EHR vendors are charging for those services since “available” doesn’t necessarily mean “free.” 

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From In the Know: “Re: Athenahealth. This is a little old news (October), but I don’t remember you mentioning it. Another Athena exec is gone as now-former CMO Todd Rothenhaus has been replaced by Kevin Ban. Seems like the only one left from one year ago is JB, and I wonder for how much longer?” It’s mostly a new management crew with the exception of Paul Armbrester (chief product officer since 2015) and Paul Merrild (SVP of sales since 2011).


HIStalk Announcements and Requests

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The most common forms of on-the-job sexual harassment reported by poll respondents are inappropriate public comments, unwelcome touching, and seductive behavior. The comments are enlightening — if not entirely encouraging — with regard to male behavior. Perhaps the “glass half full” takeaway is that few respondents reported outright sexual assault or the insinuation that their hiring or advancement was predicated on their sexual submission. Note: please don’t misinterpret those percentages – the poll targeted only those who have been sexually harassed and multiple choices were allowed, so that 36 percent “degrading comments” figure means that one-third of the votes (not of participants) involved it. In other words, it is not correct to infer that 36 percent of all female readers have experienced degrading comments at work.

New poll to your right or here: which do you surreptitiously check most often on your phone during meetings? I’m always curious what drives people to tune out of meeting participation and instead steal sly glances at their phone held just below table level (as though the other attendees can’t tell that they are either screwing around with their phone or contemplating their crotch). Is it being invited to a meeting that you didn’t really need to attend, tuning out when you have nothing to contribute, or just being helplessly lured to the distraction machine that is so readily available?

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Consider giving some closure to 2017 by completing my one-yearly reader survey. The results help me plan for 2018, and even though I can’t implement every suggestion or idea and I don’t make decisions by committee, there’s never been a year that I didn’t use quite a few suggestions to reapportion my HIStalk time. I’ll also randomly draw some responses from folks who will get a $50 Amazon gift card.

RIP Pat DiNizio, the 62-year-old Smithereens singer / songwriter who died last week at 62. I shall play the fabulous “Behind the Wall of Sleep” and “Blood and Roses” in his memory.

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Reader Vicki made a generous donation to my DonorsChoose classroom project fund, which with matching money from my anonymous vendor executive and other sources fully paid for these teacher grant requests:

  • A robotics construction kit for Ms. C’s second grade class in Asheville, NC.
  • Math and science games for Mrs. T’s elementary school class in Merrill, MI.
  • Science kits for Mrs. C’s elementary school class in Hamilton Twp, NJ.
  • A microscope, safety goggles, and an elementary mixtures science kit for Ms. T’s elementary school class in Washington, DC.
  • A Rube Goldberg Machine engineering kit for Ms. Ms. H’s sixth grade class in Blaine, MN.

Last Week’s Most Interesting News

  • Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health.
  • Greenway Health announces the layoff of 120 employees and the closing of its Atlanta offices as it moves some operations to Tampa.
  • For-profit oncology operator 21st Century Oncology will pay $26 million to settle DOJ charges that it submitted fraudulent Meaningful Use documentation and paid its doctors to refer patients to its lab and radiation businesses.
  • CliniComp sues Cerner for infringing on a 2003 patient right after it loses its challenge to the VA for choosing Cerner in a no-bid contract.
  • The White House leads a half-day introductory meeting on EHR interoperability.

Webinars

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


Acquisitions, Funding, Business, and Stock

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Ability Network raises $545 million in debt financing.

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Cigna acquires health plan digital engagement platform vendor Brighter. The price was not disclosed, but the company had raised $49 million in funding and had apparently pivoted from its original business of offering an online marketplace for discounted dental care.


Sales

The Department of Defense chooses McKesson to provide a $400 million digital imaging network.


Decisions

  • Memorial Hospital (IL) will switch from Meditech to Cerner in January 2018.
  • Mountain View OB-GYN (PA) will replace EClinicalWorks with Epic’s ambulatory EHR in 2018.
  • Medical Specialists of St Luke’s (MO) will replace EClinicalWorks with Cerner’s ambulatory EHR in June 2018.
  • Fillmore County Hospital (NE) will move from NextGen to Cerner’s EHR in 2018.
  • Cass County Memorial Hospital (IA) went live with Epic in November 2017.

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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John Halamka, MD, MS is installed as Harvard Medical School’s first International Healthcare Innovation Professor, where he will focus on emergency medicine.


Announcements and Implementations

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Microsoft announces a private preview of an AI-powered healthcare chatbot project, with partners including Aurora Health Care and UPMC.

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Geneia will integrate its cost and quality analyics solution with Salesforce Health Cloud.


Other

In South Australia, a clinical hematologist from Royal Adelaide Hospital – testifying at a coroner’s inquest into the deaths of several patients who were underdosed on chemotherapy – warns that a problematic Allscripts rollout has caused the planned 2009 implementation of electronic chemotherapy ordering to remain on hold, exposing patients to the risk of error-containing handwritten orders.

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Weird News Andy says there’s a very dark comedy somewhere in this story. Organizations that offer doctors hands-on training sessions involving cadavers sometimes hold them in hotel ballrooms – including those of Disney, Hilton, and other big names — with a few sheets of plastic laid over the carpet to catch the inevitable spills and flying bone fragments. Reuters reporters saw cadavers being delivered via the hotel’s main passenger elevators, gore-covered doctors wandering hallways trying to find someplace to wash their hands, conference organizers setting up snack stations near the cadavers, and vacated ballroom trash cans overflowing with bloody materials and used syringes. Doctors are cutting downstairs and amateur porn auteurs are filming in the rooms, so don’t crawl on the carpet or use the comforter as a blanket.


Sponsor Updates

  • Liaison Technologies leads the market in data regulatory compliance with its award-winning Alloy platform.
  • Huffington Post profiles TriNetX.
  • ZirMed’s Crystal Ewing joins the WEDI 2018 Board of Directors.
  • PM/EHR vendor Chart Talk will offer its users patient engagement and communication capabilities from Solutionreach.

Blog Posts


Contacts

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

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News 12/15/17

December 14, 2017 News 11 Comments

Top News

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Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health, which uses both systems.

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Cerner says its bid was lower and that it was not allowed to demonstrate its product during the selection. It also says that UI Health hired as its IT selection consultant Impact Advisors, which it says could benefit from an Epic selection, a charge Impact Advisors denies in saying it works with clients of all three UI Health bidders (Epic, Cerner, and Allscripts).

UI Health chose Epic in September 2017 with plans to replace systems from Cerner, Allscripts, and McKesson in a late 2019 go-live.

The health system responded to the protest by saying that it has experienced Cerner problems in the past; that Epic beat Cerner on RFP scoring; and Cerner wasn’t invited to do a demo because it failed a technical review.

UI Health says it twice tried to roll out Cerner ambulatory and failed both times due to system performance problems that it claims Cerner has admitted. It also notes that Cerner is ranked well below Epic by KLAS. Cerner pointed out that its academic medical center market share is significant and raises the question of how it failed the technical review, noting also that UI Health hasn’t upgraded its systems per Cerner’s recommendations.


Reader Comments

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From Considerable Girth: “Re: White House EHR meeting. It’s interesting that as it was happening, the VA seemed to be digging deeper into Cerner’s interoperability capability as their planned contract signing data passed. Could it be that Cerner downplayed the idea of interoperability to make the case that the VA’s only hope of connecting to the DoD was to also buy Cerner? Rumor is that politicians and even some White House folks are puzzled at how Epic has connected to dozens of VA and DoD sites and 100 percent of Epic sites that are interested in sharing information.” Unverified. The VA, which planned to have its fast-tracked, no-bid Cerner contract signed by now, seems to be suddenly realizing that theoretical interoperability with the DoD and community-based providers isn’t necessarily a reality. That’s the kind of information that should have been fleshed out in performing due diligence, dictating strong contract terms, and convening stakeholders to define mutually agreeable goals, all of which seemed to have been skipped in the VA’s White House-pressured rush to sign a Cerner contract. Both the VA and DoD have awful track records in choosing, planning, and executing IT contracts and allowing cash-flush vendors and consulting firms to pull wool over their eyes, so somehow I don’t think everybody (especially veterans) lives happily ever after just because Cerner is running in both places. I have heard speculation from a couple of folks that Cerner might have de-emphasized interoperability to the VA to make its product seem like the only logical choice for connecting to the DoD, and while that’s just talk, the VA seems to be parroting that concept.

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From Gert: “Re: MedKeeper. Was recently acquired, but the mystery is who bought them.” Unverified. The IV workflow technology company lists no press contacts or other ways to reach it beyond product sales or support, so I couldn’t ask.

From FormerCIO: “Re: Dirty Dirge’s data on CHI is incorrect – they have only 103 hospitals and the allocation of systems is also incorrect.” I don’t have access to the Definitive Healthcare database to which that reader referenced, so I can’t say, although he or she seemed pretty solid on the details.

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From Bet on Black?: “Re: Allscripts. Paul Black claims 1 billion third-party API calls to Allscripts in 2017. Vendors such as Athenahealth, Epic, Cerner, and Meditech – what is your apples-to-apples comparison?” That’s an interesting question, although the admirable “openness” could be a measure of the business necessity of supporting a narrower product line. It also depends whether common integration – such as simply displaying another company’s external clinical reference information via an Infobutton – should be counted vs. sharing data with actual transaction systems. Or for that matter, if transaction count in general is more a function of client volume than technical capability. Putting out a press release invites competitive comparisons. UPDATE: Epic says they’re handling 900 million transactions per month via public APIs, 415 million per month to power customer-developed services, and 21 billion connections to/from Epic-provided services (such as mobile apps and MyChart). So we have Allscripts at 83 million transactions per month to external systems and Epic at 1.3 billion – Cerner, Meditech, and Athenahealth, you’re up, at least if you believe that interoperability is about competing vendors rather than simply being happy that the market has demanded and received API access to EHRs.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Formativ Health. The company’s technology-agnostic patient access, revenue cycle, and practice operations services help patients feel like people and helps providers streamline operations, reduce leakage, improve insurance verification, and empower physicians to focus on keeping patients healthy. The 10-state, 450-employee company, based in New York City and a spinoff of Northwell Health, serves 3.5 million patients. It was selected a couple of months ago to provide management services to independent physicians via the Pennsylvania Medical Society’s Care-Centered Collaborative. Thanks to Formativ Health for supporting HIStalk.

This week on HIStalk Practice: 21st Century Oncology again finds itself in hot legal waters. HHS announces opioid code-a-thon winners. Clinicient acquires Keet. Infinity Behavioral Health Services acquires Health Assets Management. Greenway announces Georgia closures, layoffs. Alivio Medical Center joinsVillageMD. The FTC warns privacy-conscious consumers about at-home DNA testing kits. PRM Pro Jim Higgins shares five technological advances improving primary care communication.

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I sometimes cringe upon reading negative comments left on my annual Reader Survey, no different than a mother being told by a stranger that her child is ugly. Still, I take some comfort in the many positive observations and the fact that even critics are apparently still reading HIStalk despite the flaws they perceive. I spend many hours each day writing it and ask only that you spend maybe three minutes completing the once-yearly, one-page survey to provide hopefully constructive input. You get the pride of participating in the democratic process, the satisfaction that you didn’t have to wait in a freezing voting line, the freedom from being harassed at the polls, and the hope of winning a $50 Amazon gift certificate. I’m secretly hoping that the Russians try to rig the vote.


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 struggling Lifespan (RI) and the struggling GE (in the form of GE Healthcare) will collaborate in trying to save the health system $182 million over six years by identifying inefficiency using “cutting-edge analytics and tools.” Recently tanking GE shares are trading at their 1997 prices after a couple of bursts of misplaced investor enthusiasm, the Dow’s biggest loser since 2001 when Jeff Immelt took charge.

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One-time high-flyer Greenway Health will close its Atlanta and Carrollton, GA offices in January and lay off 120 employees there as it moves operations to its Tampa, FL location. Greenway announced in October that it would merge functionality from all of its EHR/PM products into a next-generation product, but also said at that time that it would leave customer support intact in Carrollton while moving some functions to Tampa. The company was ironically recently named as Atlanta’s “Top Workplaces 2017” by the Atlanta newspaper. Greenway Health was created in 2013 as a repackaging of three holdings of its new private equity owner – publicly traded Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. Vitera was formerly Sage Software, which had purchased the former Medical Manager PM/EHR from Emdeon. Carrollton, population 25,000, is now stuck with an albatross of a street name since the soon-to-be vacated Greenway headquarters building sits on a street also named Greenway. UPDATE: the local business paper’s report that I cited was incorrect and has been updated. Greenway is moving some jobs from Carrollton to Tampa, but that office will remain open. More information is in the 12/18 Monday Morning Update.


Sales

New York EHealth Collaborative chooses Verato’s Auto-Steward for automating the correction of MPI patient mismatches on the SHIN-NY HIE.

In Canada, six-hospital CHAMP will implement Meditech’s Web EHR.


People

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Peter Pronovost, MD, PhD — Hopkins Medicine SVP for safety and quality and perhaps healthcare’s most influential quality expert — will join insurer UnitedHealthcare as SVP of clinical strategy.


Announcements and Implementations

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The HIMSS-owned Personal Connected Health Alliance releases new Continua Design Guidelines that support patients sharing data with providers.

Meditech will offer the patient electronic signatures solutions of Access in its cloud-based Web EHR subscription offering.


Government and Politics

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Florida-based cancer treatment center operator 21st Century Oncology will pay $26 million to settle federal charges that submitted false Meaningful Use attestations that included falsified EHR usage data and phony utilization reports onto which it Photoshopped EHR vendor logos. The settlement also covers whistleblower-reported alleged Stark Law violations involved with paying doctors based on how many patients they referred to company-owned labs and radiation centers. 21st Century Oncology filed Chapter 11 bankruptcy earlier this year to protect itself from creditors and several fraud lawsuits.

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A Chicago Tribune report finds that medical regulation is so lax in Illinois that “even the most desperate of doctors can find financial reward,” pointing out the fraud-filled home health industry that finds it easy to swindle Medicare and Medicaid. It notes that anyone can start a home health business by just paying a $25 license fee with no criminal background check required, leaving them free to troll public areas to recruit patients which, under Medicare rules, don’t have to be certified for care first.

HHS OIG approves a small pilot project in which medication management pharmacists employed by a Medicare Advantage plan will receive real-time discharge information from the hospital’s EHR to help reduce readmissions, which OIG says won’t run afoul of anti-kickback rules.

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A former Johns Hopkins Health System patient appointments supervisor files a False Claims lawsuit claiming that he was ordered to “fill the plane” with patients from outside Maryland to skirt state limits on revenue paid by residents. The plaintiff says the health system’s medical concierge service prioritizes appointments for out-of-state patients as directed by top brass.

The FCC, as expected, reclassifies broadband providers as information services rather than telecommunications, reversing its 2015 ruling and freeing those companies from FCC oversight and thus allowing them to selectively prioritize or price traffic to any given website as long as they disclose their practices. Several states have already announced lawsuits challenging the decision. The broadband providers have declined to promise that they won’t do exactly what everyone fears, and unlike money-grabbing cable providers that can be easily fired, there’s no much of a cord-cutting option for the Internet unless you count cellular data. The only tiny consolation is that they didn’t abuse their customers too much before 2015, but that was a long time ago in Internet years.


Other

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Eighty percent of the 500 C-level health IT executives surveyed by Healthcare Growth Partners report no impact on their business from the Trump administration’s activities and potential ACA changes, although the report notes that provider IT capital budgets were already in place for 2017 by Election Day. The number of executives who believe health IT is in an investment bubble increased from to 36 percent from 29 percent on 2015.

In Scotland, outpatients at Glasgow hospitals miss 12 percent of scheduled appointments, with 20-something men being the least reliable. NHS Greater Glasgow plans to enhance its automated text and call reminder system to require patients to respond to prevent their appointment from being given to another patient.

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Texas medical resident Rachel Pearson, MD/PhD pens an Onion-worthy letter to the editor of a magazine, complaining that none of her patients have worked a day in their lives, they are ungrateful, they vomit and pee on her, and they have to be bribed to be examined. It’s a tongue-in-cheek reference to the still-unfunded federal CHIP program that insures most of her pediatric patients.

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A hospital in China suspends a radiologist after she is caught on video playing a phone game while performing a CT scan.


Sponsor Updates

  • AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.
  • Spok publishes an explainer video for its Care Connect product.
  • Medhost customer Mt. San Rafael Hospital (CO) becomes one of the country’s first to meet MU Stage 3 objectives.
  • Liaison Technologies awards its second Data-Inspired Future Scholarship to AI-focused high school senior.
  • Leidos Health publishes a white paper titled “From Good to Great: Strategic EHR Optimization Can Get You There.”
  • Clinical research network TriNetX adds Natural Language Processing to extract information from physician notes and clinical reports, link it to other EHR data, and then present the combined information to researchers who can then design studies and identify potential patient participants.
  • Logicworks launches targeted professional services portfolio for AWS.
  • PokitDok becomes the first healthcare technology company to achieve CAQH CORE Phase IV Certification.

Blog Posts


Contacts

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

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News 12/13/17

December 12, 2017 News 5 Comments

Top News

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CliniComp, fresh off its failed legal challenge of the VA’s choice of Cerner in a no-bid contract, sues Cerner for patent violation.

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CliniComp says Cerner violated its 2003 patent for a remote hosted hospital system.


Reader Comments

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From Dirty Dirge: “Re: big health system mergers. Who wins, Epic or Cerner?” I would instead ask whether the potential benefits of standardizing systems justify ripping and replacing existing EHRs when their sites cover a big swath of geography without much service area overlap. Maybe it’s OK to limit patient information exchange to the basics, like CCDs, since patients rarely seek care outside their local area. The most compelling argument would be populating a single database that can support analytics, operational analysis, research, and best practices, but that could theoretically be done on the back end with a lot of semantic data translation. The only comparably sized  model is the Kaiser’s use of Epic, but their implementation happened a long time ago; they have more focused corporate control than I would expect of newly merged health systems that can’t even name a single CEO; and Kaiser controls more of the patient experience as an insurer as well as a provider. Perhaps most at risk are Allscripts ambulatory or Meditech in sites included in the merger plans. My guess would be that the highest-priority system projects would involve administrative systems to allow executives to get a handle on their sprawling enterprises. We are really entering uncharted territory since most “huge” health systems have revenue of $2-5 billion vs. the dozens of billions that the proposed mega-mergers would create. Lower-tier vendors should take note – as hard as it already is to sell systems, it’s about to get a lot harder when you have to earn face time with a CIO who controls the IT strategy and budget of more than 100 hospitals (in comparison, Kaiser has only 39 hospitals).

Associate CIO provides these merger-related figures from Definitive Healthcare:

  • Dignity Health’s 48 hospitals run Cerner Millennium.
  • Catholic Health Initiative’s 153 hospitals use Cerner (61), Epic (65), and Meditech (27), also on the ambulatory side running McKesson (4) and Allscripts (21).
  • Ascension Health’s 132 hospitals use Cerner except for Providence and Wheaton Franciscan, which use Epic.
  • Providence St. Joseph’s 58 hospitals use Epic (37), Meditech (19), and Allscripts (3).

In terms of dominant vendor in the two proposed mega-mergers, it’s obviously Cerner over Epic (109 vs. 65 and 130 vs. 39, respectively). Here’s a fun opportunity for Definitive or HIMSS Analytics to list the major systems (beyond just the EHR) used by these health systems that are contemplating merging.

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From Comprn: “Re: Lifepoint Health. RIF including multiple VPs, about 25 FTEs, due to lower-than-expected earnings.” Unverified. The 72-hospital company cut its revenue and profit forecasts in late October due to fewer-than-expected admissions for the fiscal year. LPNT shares are down 15 percent over the past year vs. the Nasdaq’s gain of 27 percent, valuing the company at $2 billion. It’s probably tough competing with systems bigger than yours that don’t pay taxes and that are equally profit-motivated.

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From Trust but Verify: “Re: White House EHR meeting. A news site says [publication name omitted] broke the story but I saw it two days before on HIStalk.” Correct. An anonymous reader sent me the agenda via my Rumor Report online form and I posted the information in Sunday night’s post. Nobody else ran anything that I saw until at least Monday morning, so I’m pretty sure all mentions were triggered by reading it on HIStalk. One site that emailed me late Sunday ran their item (with the agenda that I sent them) Monday morning, but didn’t give credit. I’m also surprised at news organizations that cite one particular health IT website as a source when it’s pretty much like Wikipedia, with no original content.


HIStalk Announcements and Requests

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Cumberland Consulting Group’s employee volunteer and community action group donated $1,000 to my DonorsChoose project, which with matching funds from my anonymous vendor executive and other sources funded the entire cost of these projects for high-need classrooms:

  • Take-home family math activities for Ms. D’s elementary school class in Houston, TX.
  • Hands-on math games for Ms. K’s first-grade class in Indianapolis, IN.
  • Games for science game night for Mrs. S’s elementary school in Gautier, MS.
  • Microscopes, telescopes, and science kits for Mrs. B’s elementary school class in Gulfport, MS.
  • Take-home science activity kits for Mrs. M’s elementary school class in Chattanooga, TN.
  • STEM kits for Mrs. M’s elementary school class in Paterson, NJ.
  • STEM books and activity kits for Mrs. H’s elementary school class in Sugar Creek, MO.
  • Programmable robots for Mrs. G’s elementary school class in Brownsville, TX.
  • After-school science kits and supplies for Mrs. P’s elementary school class in Pocatello, ID.
  • 200 sets of headphones for Ms. C’s elementary school class in Provo, UT.
  • STEM project kits for family game nights for Ms. M’s elementary school class in Fayetteville, NC.
  • Programmable robots and a Chromebook for Mrs. G’s elementary school class in Miami Gardens, FL.
  • STEM kits for Ms. T’s elementary school class in Bronx, NY.
  • STEM project kits for family game nights for Mrs. H’s elementary school class in Canyon, TX.
  • Programmable robots for Mrs. F’s high school class in Glen Dale, WV.
  • STEM activity kits for a student-led STEM gender and ethnic diversity project of Mrs. I’s high school class in Orangeburg, SC.
  • Math and science resources for Ms. S’s first-grade class in Dayton, OH.
  • Headphones for the technology lab of Ms. W’s elementary school class in Memphis, TN.

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Can you please take 3-5 minutes to complete my once-yearly, one-page HIStalk reader survey? I’ll use the results to plan for 2018, but if you need even more motivation, I’ll be randomly drawing respondents to win a $50 Amazon gift card. Thank you.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.

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Physician scheduling system vendor QGenda acquires ED physician scheduling software vendor Tangier.

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Aetna CEO Mark Bertolini tells investors that he envisions that a merger with CVS would allow placing health hubs in pharmacies that would serve as health system navigators, especially for the 60 percent of people who don’t have a regular doctor. He says it could work like the Genius Bar in Apple Stores.

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Nashville-based health IT staffing firm ALKU acquires Holland Square Group, a health IT consulting firm also based in the Nashville area. Holland Square Group is a DoD MHS Genesis subcontractor under Leidos.


Sales

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OhioHealth (OH) chooses Casechek’s implant supply chain automation.


People

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Hans Morefield (Experian) joins substance use disorder technology vendor Chess Health as CEO. The company’s executive chair is industry long-timer John Holton.

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CTG hires Jeff Gerkin (Manpower Group) as EVP of sales.

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Brett Jarvis (LinkedIn) will join Solutionreach as SVP of customer success.


Announcements and Implementations

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Mental and behavioral screening software vendor AssessURhealth offers its app on the Athenahealth Marketplace.

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New Jersey’s state medical society brings its OneHealth New Jersey HIE live.

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Legacy Data Access will offer its 800 hospital customers a hosted, AI-powered clinical data service in partnership with Life2.

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Firelands Regional Medical Center (OH) goes live on Meditech’s Web EHR.

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New York – Presbyterian installs telemedicine kiosks in some of its New York-based Duane Read drugstores, making its ED doctors available to review problems that are not life-threatening.

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Ground was broken this week on what would have been Cerner CEO Neal Patterson’s 68th birthday on the Patterson Health Center, a $41 million critical access hospital on the Kansas-Oklahoma border that is mostly funded by the Patterson Foundation. The facility, which combines two existing hospitals that merged on November 1, will offer a 15-bed hospital, health clinic, rehab services, a wellness center, and public green space. The family was represented by Neal’s nephew Alan Patterson:

Uncle Neal never really left the farm. He came back to Harper County just about any chance he had. Even after he was a big shot on the cover of Forbes Magazine, he came home at harvest to drive a combine, bring meals to the field, and hang out with the guys when the work was done. If you drove by the farm, you would often see him running the company from a laptop while sitting on the front porch of the farmhouse where he grew up. To me, he was a big kid who was 30 years older than me but enjoyed doing the same things I did. He was like another high school buddy would come back to visit his parents and hang out …  Neal traveled the world and he saw something troubling that most of us don’t see. He saw that small towns were in a healthcare crisis and they were being left behind. He saw that people in rural areas had poorer overall health compared to people in bigger communities. Little hospitals were not the most profitable areas of the business, nor the ones that would help ensure his company made quarterly earnings… but he did not care. He knew that good healthcare facilities and technology were important to rural communities


Government and Politics

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A Wisconsin judge dismisses the revenue cycle system lawsuit that Agnesian Healthcare filed against Cerner, noting that Agnesian’s contract requires it to submit to arbitration in Cerner’s home state of Missouri instead of suing. Anesian claimed in the now-dismissed September 2017 lawsuit that a botched RCM conversion from McKesson to Cerner in 2015 cost it $16 million in revenue and $200,000 per month due to coding and billing errors, while Cerner insists that it fixed the problems in 2016.

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CDC Director Brenda Fitzgerald is recusing herself from issues related to health IT and oncology because she is legally required to keep her illiquid investments in LLCs involving Greenway Health (EHRs) and Isommune (cancer detection). Fitzgerald – a former OB-GYN, Air Force major, and commissioner of Georgia’s Department of Public Health – and her ED physician husband reported assets valued at up to $16 million.

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The New Yorker profiles “Estonia, the Digital Republic,” describing how the post-Soviet republic of 1.3 million people transformed itself into a digital society that embraces robots, a personalized chip ID, making nearly all business and personal information available online, giving every person ownership of data recorded about them, and a “once only” policy that pulls in existing information for everything from buying a house to seeing a doctor.  The country is reconsidering the definition of “population” by connecting virtual talent in an “e-residency” program that allows citizens of other countries to become residents of Estonia with access to digital services without ever setting foot in the country. Some snips from the fascinating article:

“I’ll show you a digital health record,” she said, to explain. “A doctor from here”—a file from one clinic—“can see the research that this doctor”—she pointed to another—“does.” She’d locked a third record, from a female-medicine practice, so that no other doctor would be able to see it …  E-ambulance is keyed onto X-Road, and allows paramedics to access patients’ medical records, meaning that the team that arrives for your chest pains will have access to your latest cardiology report and ECG. Since 2011, the hospital has also run a telemedicine system … Rita Beljuskina, a nurse anesthetist, led me through a wide hallway lined with steel doors leading to the eighteen operating theatres. Screens above us showed eighteen columns, each marked out with 24 hours. Surgeons book their patients into the queue, Beljuskina explained, along with urgency levels and any machinery or personnel they might need. An on-call anesthesiologist schedules them in order to optimize the theatres and the equipment … She logged on with her own ID. If she were to glance at any patient’s data, she explained, the access would be tagged to her name, and she would get a call inquiring why it was necessary. The system also scans for drug interactions, so if your otolaryngologist prescribes something that clashes with the pills your cardiologist told you to take, the computer will put up a red flag.


Privacy and Security

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An Accenture-conducted, AMA-sponsored survey of 1,300 physicians survey finds that 83 percent have experienced cyberattacks and want cyber hygiene tips, a guide on conducting a risk assessment, and easy-to-understand HIPAA instructions. The survey’s methodology isn’t the best, however:

  • Respondents were apparently self-selected and only completed an online survey.
  • If only AMA members were polled (the report doesn’t say), that would be only a tiny, non-representative subset of all US doctors.
  • Respondent demographics were not provided, such as the size of their practice site or whether they work for a health system.
  • Half of respondents say they have an in-house security official, although the question wasn’t asked about that person’s time allocation and credentials.
  • More than one-fourth of responding physicians say they have outsourced security management, but the survey didn’t ask what that means.
  • More than half of respondents say someone clicked on a phishing link, which doesn’t really seem like a cyberattack unless it resulted in downtime.
  • Only 37 percent reported that an employee inappropriately accessed PHI, which is surely low.

Technology

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Apple will launch the IMac Pro this week at an entry price of $5,000 for 32 GB of memory and 1 TB of storage and up to $17K for a fully loaded machine, testing the limits of just how much of an Apple tax even professional users are willing to pay. It’s not an Apples-to-apples comparison, but my Acer laptop has 16 GB, 1 TB (along with a 128 GB SSDD for running Windows 10) and cheap available upgrades and I only paid a bit more than $500. Even that capacity is excessive since nearly everything I use is on the Web.


Other

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Two-thirds of the few dozen interviewed patients who got their lab results via a clinic’s patient portal weren’t given further explanation, sending most of them to Google to try to figure out what the results mean. The article concludes that just displaying lab numbers on a portal isn’t enough, especially for patients with abnormal results.

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In Canada, all-digital Humber River Hospital opens a Meditech-powered, 4,500-square-foot Command Centre in which staff monitor real-time incidents such as delayed care and provider workload issues. It also contains a 26-panel GE Wall of Analytics with live video feeds from patient care areas.

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A just-published review of a 2016 Netherlands bake-off of 32 algorithms that analyze tissue slides to detect breast cancer metastasis finds that seven performed better than a panel of 11 pathologists when limited by typical workflow time constraints. The best algorithms performed equal to the pathologist panel when time constraints were removed. 

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A review of 1,300 clinic visits finds that patients asked their doctors for specific lab tests, referrals, pain meds, other medication an average of once per visit; the doctor agreed to write the order for what they wanted 85 percent of the time; and those patients who were turned down gave the doctor lower satisfaction scores.

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Javon Bea, CEO of five-hospital Mercyhealth (WI), was paid $8.38 million in 2016, far more than basically any charity or health system. The newest tax form I found was from 2014 and even then the CIO made over $750,000. Maybe nobody wants to live in Janesville, WI or work for Mercyhealth if they have to pay that much. Axios notes that even under his previously slightly lower pay, Bea earned $72 per patient day, although he told the local paper that his then-$3 million paycheck had no impact on healthcare costs even as he increased the system’s revenue from $33 million to $1 billion. 


Sponsor Updates

  • Spok launches a library of stories illustrating the ROI of clinical communication technology.
  • Optimum Healthcare IT completes its work as primary partner for UCI Health in its Epic Connect strategic partnership with UC San Diego Health.
  • Change Healthcare SVP of Product Development and Technology Michael Wood joins the 2018 Class of the Nashville Health Care Council Fellows.
  • AssesURHealth raises $2,700 for the American Foundation for Suicide Prevention as part of the Out of the Darkness Tampa Bay Walk.
  • Change Healthcare will integrate Tibco’s Connected Intelligence product line with its products.
  • Besler Consulting releases a new podcast, “S10 changes you should know about.”
  • Glassdoor includes CoverMyMeds in its list of Best Places to Work in 2018.
  • Diameter Health achieves NCQA Certification for all 2017 e-measures.
  • Vyne’s Trace and FastAttach solutions earn HITRUST CSF certification.
  • EClinicalWorks will exhibit at the New York Society for Gastrointestinal Endoscopy 41st Annual New York Course December 14-15 in New York City.
  • The “I Love Madison Podcast” features Healthfinch VP of Finance and Operations Leah Roe.
  • Technology Headlines Magazine names Intelligent Medical Objects CEO Frank Naeymi-Rad one of the 50 Most Admired CEOs of 2017.
  • ConnectiveRx publishes a new white paper, “Boost prescriber knowledge and confidence using in-EHR formulary-status messaging.”

Blog Posts


Contacts

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

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Monday Morning Update 12/11/17

December 10, 2017 News 16 Comments

Top News

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The White House’s Office of American Innovation will host a half-day meeting Tuesday on EHR interoperability, led by Jared Kushner and CMS Administrator Seema Verma. Thanks to the reader who forwarded the agenda, which did not include a list of invitees. Working groups will address four topics:

  • How CMS, ONC, and HHS can encourage interoperability and accelerate its timeframe.
  • The methods of authentication that could be used and how can the industry can be aligned to support them.
  • How patients and physicians can be engaged in interoperability and how and any HIPAA issues can be addressed.
  • How can the private sector can become engaged and their participation jump-started by the government’s release of claims or other data.

HIStalk Announcements and Requests

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Fairly few male readers are worried that incidents in their past could result in new claims of sexual harassment. HarassedMan was pursued by a male superior and urges employers to provide clear training, policies, and enforcement procedures. HISJunkie wonders whatever happened to innocent until proven guilty and also suggests that a man who is terminating a female employee for cause think carefully about the situation.

New poll to your right or here, continuing last week’s poll: women, what kind of sexual harassment have you experienced? I found my inquiry limited by the format of a poll, so perhaps I’ll follow up with a survey to answer questions such as:

  • Did you rebuff the advances, and if so, did it hurt your career?
  • Did you report it to HR, and if so, was the issue resolved to your satisfaction?
  • If you didn’t rebuff or report, why not?
  • Have you ever provided sexual favors or accepted sexual situations — or worked with someone who did — to get hired or to improve job prospects? This is hard to ask, but it happens and encourages bad situations for others. I feel sorry for a man or woman who successfully stops an uncomfortable situation but sees their job suffer because co-workers accept it as quid pro quo.
  • Are you considering taking any legal action or going public with incidents from your past?

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Three dozen clinician respondents are mixed on whether hospital VIP patients have better clinical outcomes. Nearly half say yes, while around one-fourth each say the outcomes are the same or worse as in the cheap seats. I was appalled at my first hospital job in learning that my for-profit employer – whose outcomes were universally terrible, as you would expect when bean counters oversee all the clinical decisions of a badly educated medical staff recruited for obedience and volume rather than quality –cleared an entire hallway to house the hypochondriac mother of our very profitable eye surgeon. Our profit-obsessed executives convened emergency department head meetings to make sure everybody figuratively genuflected to meet her every need (I got stuck running out to get the kind of wine she preferred since our nutritional services people could barely open cans and heat up food service frozen entrees) and made rare appearances in patient care areas only because she was propped up back there like a queen. At least working for a for-profit hospital shortened the path to my disillusionment with hospitals and maybe humanity in general.

Listening: new from Bully, Nashville-based grunge rockers who sound like Hole mixed with the Breeders. The tiny female singer, who has a rather chirpy conversational voice but can really belt it out cathartically when singing, looks quite a bit like Lucy in the original “Twin Peaks.” 

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Friend at Impact generously donated $1,000 to my DonorsChoose project, asking that I focus on elementary school STEM materials (which I’m quite happy to do since I usually seek those out). I applied a dollar-for-dollar match from my anonymous vendor executive plus other matching (the $1,000 donation ended up fully funding a stunning $8,200 worth of grants) for these projects in schools whose students are almost all from low-income households:

  • Lab coats, goggles, science journals, and activity kits for Ms. G’s fourth-grade class in Los Angeles, CA.
  • An IPad for running programmable robot kits for Ms. S’s elementary school technology club in Los Angeles, CA.
  • Three video cameras for home science experiments for Mrs. S’s third-grade class in Philadelphia, PA.
  • STEAM activity kits for the after-school elementary school program of Mrs. M in Springdale, AR.
  • Math activity kits and games for Mrs. H’s elementary school class for the deaf and blind in Mobile, AL.
  • Programmable robots for Mrs. W’s elementary school class in Cartersville, GA.
  • Programmable robots for Mrs. O’s elementary school class in Garland, TX.
  • STEM kits and experiment books for Mrs. A’s elementary school class in Detroit, MI.
  • Six electronic note pads for Mrs. N’s elementary school class in Farmville, MI.
  • Take-home math and STEM games for Mrs. F’s elementary school class in Mescalero, NM.
  • A STEM bundle for Mrs. T’s kindergarten class in Dallas, TX.
  • Take-home math game bags for Ms. M’s elementary school class in Bronx, NY.
  • STEM games for Mr. M’s elementary school class in Milwaukee, WI.
  • Weekly take-home science projects for Ms. I’s elementary school class in Oxnard, CA.

This Week in Health IT History

One year ago:

  • President Obama signs the 21st Century Cures Act into law.
  • The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.
  • CommonWell Health Alliance and Sequoia Project’s Carequality announce plans to connect their respective systems.
  • The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia to establish best practices for mobile health apps.
  • SocialWellth brings back the Happtique app certification program.
  • MD Anderson considers layoffs and research cutbacks after losing $102 million in the first two months of its fiscal year, with the cost of its Epic implementation being one of four factors hurting its bottom line.

Five years ago:

  • Mediware acquires inpatient rehabilitation and respiratory services documentation systems vendor MediServe.
  • Allscripts sues NYC Health + Hospitals for choosing Epic at what the company says is a $535 million premium to its own bid, to which the health system responds that Allscripts lacks an integrated EHR and that the company is suing to try to prop up its sagging share price.
  • McKesson Paragon beats out Cerner as the #2 product suite behind Epic in Best in KLAS, while Agfa, McKesson, and Allscripts were ranked as the worst vendors overall.

Ten years ago:

  • MedAssets conducts its IPO.
  • Dairyland Healthcare brings in a new executive team following its acquisition by Francisco Partners.
  • NextGen creates a revenue cycle management division for physician practices.
  • Philips acquires ICU monitoring technology vendor Visicu for $430 million, paying 12 times Visicu’s annual revenue.

Last Week’s Most Interesting News

  • FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).
  • Dignity Health and Catholic Health Initiatives announce plans to merge in creating the country’s largest health system in terms of revenue.
  • Advocate Health Care announces plans to merge with Aurora Health Care.
  • The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.
  • CVS announces an agreement to buy Aetna for $69 billion.
  • Former GE CEO Jeff Immelt says the company tried to buy Epic but was immediately rebuffed and also considered acquiring Cerner but thought the $2 billion price was too high.

Webinars

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


Acquisitions, Funding, Business, and Stock

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Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.

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Patient payments technology vendor Cedar raises $13 million in a Series A funding round. Co-founder Florian Otto, DDS, MD, PhD was sales VP for ZocDoc before starting Cedar in April 2016.

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The urge to merge reaches manic levels as Ascension and Providence St. Joseph Health are reportedly talking about combining to create a 191-hospital system with $45 billion in annual revenue, eclipsing last week’s signed agreement between Dignity Health and Catholic Health Initiatives that set the short-lived annual revenue record of $28 billion. Ascension is a Cerner shop, while Providence St. Joseph Health – formed in a July 2016 merger — uses Epic, Meditech, and Allscripts.


Decisions

  • Albion Family Practice (PA) will switch from Allscripts to Epic ambulatory EHR in 2018.
  • Saratoga Hospital Medical Group (NY) went live with Athenahealth ambulatory EHR in Q4 of 2017.
  • Munroe Regional Medical Center (FL) switched from Medhost to Cerner in 2017.

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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Atlantic Health System promotes Ben Bordonaro to chief administrative information officer.


Government and Politics

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A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA – HealtheVet, iEHR, VistA Evolution, and EHRM. GAO also notes that the VA has requested $4.1 billion for IT in 2018. Among the 15 key VA contractors on the failed projects was Cerner, who will sell the VA its VistA replacement system. An interesting tidbit from the report is that two of the VA’s systems are over 50 years old, both of them COBOL-based mainframe systems.


Privacy and Security

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UNC Health Care (NC) notifies 24,000 patients that their PHI was contained on an unencrypted laptop stolen from a dermatology practice it had acquired in 2015. The health system pledges in the announcement to do a better job of reviewing the security of practices it acquires.


Other

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In England, Royal Surrey County Hospital goes back to paper scheduling after an upgrade to its Allscripts system fails. I think they are using the Oasis Medical Solutions PAS, acquired by Allscripts in mid-2014.

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I ran across Medsender, a company I hadn’t heard of that promises to end 100 percent of medical record faxing or else there’s no cost to the customer. The company claims the product can be installed in 60 seconds and works with any EHR. Founder/CEO Zain Qayyum developed the product in 2014 while attending Marist College full time. 

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The operating income of UMass Memorial Health Care (MA) declined 74 percent in the fiscal year that ended September 30, with executives noting a modest increase in insurer payments, its $200 million in capital projects, and a $700 million Epic implementation that has taken doctors away from their revenue-generating clinic work as they build the system.


Sponsor Updates

  • Sunquest Information Systems hosts its 19th annual holiday toy drive for Aviva Children’s Services.
  • Surescripts will exhibit at the Health Care Law Institute 2017 December 14 in New York City.
  • A national IDN upgrades to ZeOmega’s Jiva 6.1 population health management platform.
  • LogicStream Health will exhibit at the IHI National Forum December 10-13 in Orlando, and will host a poolside party December 11 from 6:30-8:30pm ET.

Blog Posts


Contacts

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

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News 12/8/17

December 7, 2017 News No Comments

Top News

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FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

FDA will focus its attention and medical device status on software that analyzes medical images, physiological monitoring data, sound waves, sleep apnea monitor data, spectroscopy data, and slide pathology, as well as software that uses undisclosed algorithms.

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FDA says software isn’t a medical device just because it:

  • Uses patient information to present treatment guidelines and drug interaction / allergy alerts.
  • Offers prioritized alternatives to orders and drugs using generally accepted practices.
  • Suggests an intervention or a test consistent with clinical guidelines or drug labeling.
  • Makes suggestions for chemotherapy.
  • Uses rule-based tools to compare patient data to practice guidelines.
  • Provides tools, calculators, or protocols for TPN or enteral nutrition. 
  • Provides patients with prescription reminders and instructions that are consistent with FDA labeling.
  • Helps patients choose a non-prescription drug based on their symptoms.
  • Is intended only for healthcare facility use.
  • Allows patients to document or illustrate their conditions with their providers.

FDA also says it will not enforce its own requirement that electronic patient software be classified as a medical device if it isn’t certified by ONC.

Software that stores, converts, or displays medical images will also be moved to non-device status, but software that analyzes the images will be treated as a medical device.

Software that flags patient results based on specific parameters (such as out-of-range results or opportunities for complementary tests) will not be regulated as a medical device as long as it only performs the same interpretation that the practitioner could do themselves.


HIStalk Announcements and Requests

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CompuGroup Medical and its US CEO Benedikt Brueckle donated $500 to my DonorsChoose project, which when matched with funds from my anonymous vendor executive and other sources (I found some GREAT matching, as you’ll see, $5 for each $1 in some cases) fully paid for these classroom projects:

  • STEM games for Mrs. S’s fourth-grade class in Columbus, OH.
  • A mobile science lab for Mrs. N’s middle school class in Bay Shore, NY.
  • Ten sets of headphones for Ms. M’s elementary school class in Philadelphia, PA.
  • A library of 30 fiction and non-fiction books for Ms. E’s elementary school class in Bronx, NY.
  • A carbon dioxide meter and air quality mapping supplies for Mrs. E’s elementary school class in Detroit, MI.
  • A STEM activity table for Mrs. S’s elementary school class in Malden, MA.
  • STEM activity centers for Ms. Z’s pre-kindergarten class in Fort Worth, TX.
  • Air quality meters for Mrs. A’s fifth-grade class in Greenville, PA.
  • A three-day environmental science mountain camping trip for Mrs. V’s fifth-grade class in Los Angeles, CA.

Several teachers, including Ms. E, responded almost immediately: “We want to thank you for your warm heart and generosity. I can’t begin to tell you what it means to these kids to have information at their fingertips! They are kind-hearted, sweet, intelligent kids who sometimes just need a little boost and you are a part of them. Again, thank you, and we will send pictures after we get the books. Our classroom is a better place because of your awesome contribution.”

This week on HIStalk Practice: Burke Pediatrics (VA) partners with Food for Others as part of a new food prescription program aimed at ensuring patients can put healthy food on their tables. The Y builds out health IT infrastructure with HIPAA compliance, cybersecurity services. Teladoc drops lawsuit against Texas Medical Board. AJC investigation highlights physician contributions to opioid epidemic. CyberKnife Center of Miami selects Identillect. Aprima integrates DocBuddy voice recognition. HealthiPass raises $7.2 million. UnitedHealth buys DaVita Medical Group in multi-billion dollar deal.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Dignity Health and Catholic Health Initiatives sign a merger agreement that will create the country’s largest health system as measured by operating revenue. The new Catholic health system will have $28 billion in revenue, 139 hospitals, and 159,000 employees, operating in 28 states. The CEOs of each organization will become co-CEOs of the new system. Dignity uses Cerner, while I believe CHI runs a mix of Meditech, Allscripts, Cerner, and Epic.

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I’m interested that the asset management company co-owned by Nobel-winning economist Richard Thaler – which focuses on shares that are mispriced due to irrational investor psychology – holds 2.8 percent of the outstanding shares of Allscripts, worth around $72 million. MDRX shares are up around 12 percent over the past 12 months (vs. the Nasdaq’s 48 percent) and 30 percent over the past five years (vs. the Nasdaq’s 129 percent). It’s Thaler’s theories rather than his investing acumen that earned him a Nobel — the Fuller & Thaler Behavioral Small-Cap Equity fund has performed consistently worse over several years than the Dow, Nasdaq, and S&P 500.

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A Huffington Post article profiles ReHAP, an algorithm-driven system for hospitals to help hospital rehab therapists identify and prioritize patients who need their services. The co-founder is Krishnaj Gourab, MBBS, who is chair and medical director of rehab informatics and analytics at Johns Hopkins Bayview Medical Center (MD).

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An Axios financial analysis of 84 large health systems finds that while their patient care margins are slim, they’re making a fortune with their Wall Street investments and M&A activity in raising their overall average profit margin to 6.7 percent on their huge revenue volumes, with the article concluding, “Large not-for-profit hospital systems now resemble and act like Fortune 500 companies instead of the charities they were often built as. They consequently hold immense financial and political power.” The analysis unfortunately and rather obviously mixes up “millions” with “billions” in the pop-up graph legends, but commendably provides the raw data as Google Docs spreadsheet. The most profitable health system is Kaiser Permanente at $3.1 billion in FY2016-27 profit, of which 38 percent was generated by its investments. To take the counterpoint, one contributing factor in the success of any charity is to accumulate enough assets to iron out the operational cash flow challenges, although people often get suspicious when those war chests swell and executives take home multi-million dollar salaries. Not to mention that the stock market won’t always perform as well as it has lately.

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Anil Sethi, MS – who became director of Apple Health in 2016 after the company acquired his personal health record company Gliimpse — will leave Apple to focus on his new startup Ciitizen. Former ONC Chief Privacy Officer Deven McGraw, JD, MPH also works for Ciitizen, which helps people obtain and share information and health-related legal documents.  


Sales

Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.


Announcements and Implementations

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Solutionreach announces SR Schedule, which allows physician practices to offer the patients easy self-scheduling. 

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Aprima integrates its EHR with DocBuddy voice-powered physician workflow for mobile devices. A hand surgeon early adopter says it saves him 45 minutes per day.

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EBroselow will integrate ASHP’s AHFS DI Essentials database into its SafeDose bedside dosing application.


Government and Politics

The rate of growth of US healthcare spending slowed in 2016, but still increased by $354 per capita to $10,348 in consuming 17.9 percent of the gross domestic product.


Other

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A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.

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A TransUnion report on Millennials finds that 60 percent don’t understand their health insurance benefits. They also also pay their medical bills more slowly than other generations, mostly because they entered the workforce as lower-income employees just as employers shifted more healthcare payments onto consumers and thus they don’t have the money. The report suggests that providers educate Millennial patients at the point of service, give them an upfront cost estimate when possible, and encourage them to pay at the time of service.

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The Indianapolis paper profiles Chuck Dietzen, MD, medical director for pediatric rehabilitation at Riley Children’s Health (IN); founder of the non-profit Timmy Global Health; and co-founder and chief medical officer of EHR/PM vendor ISalus Healthcare.

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St. Joseph Healthcare (ME) will eliminate 24 jobs as parent organization Covenant Health centralizes billing after completing its Cerner implementation.

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Fun from The Onion.


Sponsor Updates

  • LogicStream Health launches clinical process modules for sepsis, CAUTI, and VTE.
  • Nordic releases a new podcast, “Consolidating your EHR after a merger or acquisition.”

Blog Posts


Contacts

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

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News 12/6/17

December 5, 2017 News 16 Comments

Top News

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Advocate Health Care will merge with Aurora Health Care pending regulatory approval, creating the country’s tenth-largest non-profit health system.

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The CEOs would serve as co-CEOs of the new organization (Advocate Aurora Health) as a result of a “50-50 merger,” with naming two equal leaders appearing either indecisive or ego-stroking but unlikely to prove successful regardless.

There’s also the EHR challenge. Aurora uses Epic, while Advocate runs Cerner and Allscripts.


Reader Comments

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From Not From Monterey: “Re: hospital luxury floors. I’m reading a book by written a doctor (Jacob Appel) in which the suicidal psychiatrist main character says that in his hospital, the posh floor where the wealthy people stay is unsafe compared to the rest of the hospital since it lacks residents and med students asking questions. Would you find this character’s statement to be plausible, or better yet, backed up by data?” I’ve written before that, amenities aside, I wouldn’t want to be housed in a hospital’s VIP unit. Personalized medicine is overrated in this regard – the nurses assigned are the most deferential rather than the most skilled; they are under the thumb of hospital executives whose suck-up meddling may negatively impact care; those annoying middle-of-the-night room rounds and always-beeping monitors sometimes detect real problems; and wandering off the cookie cutter center line of care is always dangerous (like asking the kid at McDonald’s to make you a steak dinner). Hospitals are well-intentioned but dangerous places where the last thing you want is extra attention. I created a poll for clinicians with firsthand experience to weigh in and hopefully offer comments. My only first-hand experience is when my colleague, the health system’s chief medical officer, mobilized the Big House’s trauma team to address a family member’s ruptured appendix, which I declined and instead chose one of our community hospitals with no VIP attention expected or desired. 

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From Ty Dolla Cosine: “Re: Aetna’s CEO. Will get $500 million if the CVS deal goes through. It’s good for at least one consumer, anyway.” CEO and HIMSS14 keynoter Mark Bertolini will leave with a $500 million parting gift, consisting of the inevitable executive golden parachute plus his appreciated stock. His net worth already approached $200 million, so the only thing standing between him and near-billionaire status is the Trump Administration’s anti-trust people in the DOJ and/or FTC, which probably means he’s fine to book the truck to haul away his loot.

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Had you wisely (given 20-20 hindsight) invested your money in Aetna shares (dark blue) five years ago, you would have realized a 292 percent gain vs. the Dow’s (light blue) 84 percent. You would also be singing the praises of Mark Bertolini for making you rich as he did the same for himself.


HIStalk Announcements and Requests

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I finished my initial playing around with my Black Friday-priced Google Chromecast and Home Mini. They featured Apple-like slick packaging and no-instructions setup that had me running in minutes. Chromecast can display anything from your phone that can be cast onto your TV (photo albums, browser pages, YouTube videos, Netflix, etc.)  with just a WiFi connection and the provided HDMI cable into your TV. The Home Mini has an Alexa-like conversational interface that can provide weather, news, your daily schedule,  flight departure time, time to drive to a location given current traffic, and the usual smorgasbord of jokes, games, list-making, song-singing, and music-playing with pretty good audio quality. Both gadgets offer a lot of smooth technology at a price low enough to be impulse-purchased as a toy or stocking-stuffer. I’m happy with both.

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Ben and Michelle from ST Advisors supported my DonorsChoose project with a $500 donation, to which I applied matching funds from my anonymous vendor executive as well as other sources to fully fund these teacher-requested projects:

  • 30 sets of headphones for Ms. B’s second-grade class in Chicago, IL.
  • 35 calculators for Ms. T’s all-girls elementary academy in Houston, TX.
  • STEAM supplies for Ms. C’s middle school class in Provo, UT.
  • A programmable robot kit for Ms. G’s elementary school class in W. Valley City, UT.
  • Science experiment kits for Ms. M’s pre-kindergarten class in New York City.
  • Hats and gloves for Ms. H’s elementary school class in Omaha, NE.
  • STEM activities for Ms. D’s elementary school class in Hialeah, FL.
  • An interactive whiteboard for Mr. T’s elementary school class in Houston, TX.
  • A document camera and speakers for Ms. K’s middle school class in New York City.

I’ve already received thank you notes from most of the teachers, including from Ms. D, who says, “As a first-year teacher, I am absolutely ecstatic! My students are going to be so excited to learn about all these new tools. I am extremely thankful for your donation towards my little learners and I’m positive that they will be too. Thank you for our early Christmas gift! HAPPY HOLIDAYS!”

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Mike also sent a $500 donation, saying that he’s been out of the industry for 10 years but still reads HIStalk every day. Merry Christmas to (and from) Mike, whose donation with matching funds has made these classroom projects a reality:

  • Programming books, posters, and whiteboards for Mr. C’s middle school class in New York City.
  • Lap desks to replace those lost in Hurricane Harvey for Mrs. A’s fifth grade class in La Marque, TX.
  • STEM activity kits for Mrs. C’s elementary school class in Havelock, NC.
  • Programmable robots for Mr. V’s elementary school student-driven programming class in Cherryfield, ME.
  • Five virtual reality headsets for Mrs. B’s high school class in Norfolk, VA.
  • A math and science library for Ms. G’s elementary school class in Houston, TX.
  • Two Bee-Bot programmable robots for Mrs. F’s kindergarten class in Los Angeles, CA.
  • Puzzles, books, and glue for the after-school clubs of Ms. B’s elementary school in Camden, NJ.

Want to donate, especially if your company is willing to pony up $500 in return for a mention of their largesse? Instructions:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded, with an emphasis on STEM-related projects as the matching funds donor prefers.

Webinars

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


Acquisitions, Funding, Business, and Stock

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Philips acquires Netherlands-based interoperability software vendor Forcare.

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Population health management software vendor VirtualHealth raises $7 million in a Series B funding round.

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Genetic sequencing vendor Human Longevity dismisses its CEO after 11 months on the job, along with the COO, chief medical officer, and head of oncology. Co-founder and executive chairman Craig Venter returns to the CEO role. HIStalk reader Informatician tipped me off in a mid-November rumor report that the company had laid off its chief medical officer and his team of 15, at which time I noted that eight of 18 executives listed on a cached copy of its executive page from June 2017 had been removed (the number now stands at 11 of 18).

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Patient education software vendor Mytonomy raises $7 million in a Series A funding round in which Philips and MedStar Health participated. The company previously pivoted from its original business of offering college preparation videos for high school students. The founders are CEO Anjali Kataria (who co-founded a drug company software vendor and then worked for HHS and FDA) and her husband Vinay Bhargava (Google).


Sales

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Chesapeake Regional Healthcare (VA) will implement Glytec’s EGlycemic Management System.

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Memorial Hermann Health System (TX) signs an enterprise agreement for PerfectServe’s communication and collaboration platform.

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Steward Health Care will convert eight more of its hospitals to Meditech’s Web EHR.

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Singing River Health System (MS) chooses FormFast Capture and ESignature, while Medical University of South Carolina (SC) will implement FormFast Capture and Mobile App. 


People

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Brookfield, WI-based Insurance enrollment technology vendor Connecture hires Brian Lindstrom (Datica) as CFO. Industry long-timer Jeff Surges is the company’s CEO.

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Tom Zajac (Philips) joins the executive-in-residence programs of Summit Partners and Noro-Moseley Partners.

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The Chartis Group hires Tonya Edwards, MD, MMM (Impact Advisors) as principal.

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Marc Andiel (Iatric Systems) joins HealthGrid as EVP of corporate business development.

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Regenstrief Institute hires Jeremy Harper (The Ohio State University Wexner Medical Center) as chief research information officer.

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SCL Health (CO) hires Louis Capponi, MD (Cleveland Clinic) as VP/CMIO.


Announcements and Implementations

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Ability Network streamlines the Triple Check process — for skilled nursing facilities to review Medicare Part A claims prior to submission —  via new functionality in its UBwatch platform.

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The Children’s Center Rehabilitation Hospital (OK) goes live on Harris Healthcare’s Novus ClinDoc linked to its QCPR EHR.

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ISpecimen releases data connectors that allow organizations to integrate their LIS and EHR systems to the company’s marketplace, where those organizations can offer their biospecimens to researchers.

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The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.


Government and Politics

Hector Ramos, the former $200,000 per year IT director of North County Health Services (CA), pleads not guilty to stealing $800,000 from the organization. Prosecutors say he submitted and approved phony invoices from two fraudulent companies he created, telling employees the invoices needed to be paid quickly to avoid a computer system shutdown. They probably should have paid more attention to his resume, which boasts of advanced degrees “earned” from known diploma mills.  

Honduran officials arrest Eric Conn, the on-the-run Kentucky lawyer who conspired with doctors and judges to earn $550 million in fraudulent Social Security disability benefits for his clients. 


Technology

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Google announces the open source release of its DeepVariant genomic analysis tool.


Other

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A Vox reports looks at ED facility fees, as hospitals are increasingly using higher-intensity codes to bill higher rates. The prices charged for those fees jumped 89 percent from 2009 to 2015 in raising ED costs by billions even as the number of ED visits dropped. The article profiles a man whose lifting-induced back spasms were treated by a hospital ED – the only place open — in 20 minutes at a cost of $3.50 for a muscle relaxant and over $2,400 in facility fees.

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The owner of a New Jersey lab that was paid $150 million by Medicare and private insurers over eight years says he couldn’t compete against the national lab companies without bribing doctors to send him patients. His lab offered fake consulting agreements, prostitutes, sports cars, vacations taken on private jets, and Super Bowl tickets. The owner says the lab’s biggest expense was a New York strip club, where he spent $10,000 in one night to entertain a pediatrician who bragged about how many tests he was ordering on young patients. The owner spent $800,000 – less than one month’s profit from the lab — to build a pool shaped like Mickey Mouse’s ears. 


Sponsor Updates

  • Healthcare Growth Partners advised Russell Phillips & Associates on its sale to Jensen Hughes.
  • CenTrak donates RTLS equipment to students at Drexel University in Philadelphia.
  • Dental practice management company Dentisoft selects patient relationship management technology and services from Solutionreach.
  • Access partner The Last Well advances its clean water initiative in Liberia with matching grants through December 31.
  • Audacious Inquiry’s CALiPR earns ONC Health IT Certification.
  • Change Healthcare’s Stuart Hanson speaks at the AHIP Health Forum in Nashville.
  • Elsevier Clinical Solutions will exhibit at the North Carolina Council of Community Programs Conference December 6 in Pinehurst.
  • FormFast will exhibit at the 2017 IHI National Forum December 10-13 in Orlando.
  • Definitive Healthcare hires its 200th employee.
  • Impact Advisors publishes a new report, “Constructing an Analytics Strategy.”
  • Kyruus will exhibit at the Diabetes Innovation Summit December 7 in Boston.

Blog Posts


Contacts

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

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Monday Morning Update 12/4/17

December 3, 2017 News 3 Comments

Top News

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CVS will buy Aetna for $69 billion.

Unanswered questions:

  • Will the federal government approve the deal given its reluctance to allow big insurers to buy each other, especially since CVS has a strong pharmacy benefits management business in CVS Caremark and both companies have specialty pharmacy operations?
  • How will CVS structure the combined companies to use its newfound vertically integrated clout?
  • How will CVS’s pharmacy relationships with competing insurers be affected?
  • What actions will diehard competitor Walgreens take or what acquisitions might it consider?
  • Was the proposed acquisition driven by Amazon’s interest in the prescription drug and/or durable medical equipment business or will this transaction increase that interest?

HIStalk Announcements and Requests

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Black Friday shoppers hit Amazon hard for electronics, with Best Buy landing an anemic second and the other online retailers sucking wind.

New poll to your right or here, for male readers: do you fear that past incidents could result in a new sexual harassment claim being made against you? The poll is anonymous, as always, and your comments are welcome. Recent headlines triggered me to review my past to make sure I wasn’t forgetting something that could have been misconstrued, leading me to think that others are similarly hoping they surface no repressed memories of previous impropriety.

Next week’s poll will ask women if they’ve experienced work-related sexual harassment or assault. Note: I considered making both of these polls gender-nonspecific, but my assumption is that most of the examples are male-on-female and I didn’t want to dilute the denominator.

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

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This Week in Health IT History

One year ago:

  • The House passes the 21st Century Cures Act.
  • A CDC study finds that the number of families struggling to pay their medical bills dropped 22 percent in five years due to an improving economy and those newly insured via the Affordable Care Act.
  • Allscripts acquires Australia-based Core Medical Solutions.
  • China-based investors finalize their acquisition of Lexmark and announce plans to quickly sell off its software business, including the former Perceptive Software.

Five years ago:

  • “Tricorder” company Scanadu announces plans to release consumer tools for vital signs, urinalysis, and saliva testing by the end of 2013.
  • Reuters reports that several private equity firms have submitted revised takeover offers for Merge Healthcare.
  • Constellation Software acquires Salar from Transcend Services, which had itself been acquired by Nuance.
  • Vitera closes its hardware support business.
  • Athenahealth announces plans to acquire Harvard’s Arsenal on the Charles complex in Watertown, MA for $169 million.
  • CDC reports that 40 percent of office-based physicians use an EHR with at least basic functionality.

Ten years ago:

  • Philips announces plans to acquire medical alarm and notification vendor Emergin.
  • Dennis Quaid and his wife sue Baxter Healthcare for the Cedars-Sinai heparin overdose of their newborn twins.
  • Siemens announces Invision 27.
  • An entrepreneur offers a $10 million prize for developing software that can map the genetic codes of 100 people in 10 days for $10,000 or less per genome.

Last Week’s Most Interesting News

  • Caring Voice Coalition, a drug co-pay charity, says it will likely shut down after HHS OIG finds that it sent patient data to its drug company supporters.
  • Nuance turns in better than expected quarterly results as the actual financial impact of its June malware attack was less than it projected.
  • Siemens Healthineers announces plans to go public on the German market in the country’s largest IPO in 20 years.
  • Athenahealh names its third CFO of 2017.
  • A newly unsealed lawsuit claims that Indiana hospitals falsely attested for $300 million in Meaningful Use money by failing to promptly provide patients with copies of their medical records.

Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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

 

Here’s the recording of last week’s webinar titled “Making Clinical Communications Work in Your Complex Environment,” sponsored by PatientSafe Solutions.


Acquisitions, Funding, Business, and Stock

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Nashville-based data management vendor Trinisys acquires Mica Health, which offers ambulatory EHR decommissioning services. Former Mica President Mike Justice will apparently stay on as Trinisys VP of business development.

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Former GE CEO Jeff Immelt made some interesting comments on a conference stage last week:

  • Companies offering healthcare point solutions are in for a rough ride since door-to-door sales in healthcare take 10-15 years.
  • Immelt thinks AI will influence radiology practice, but says no great companies will focus exclusively on that.
  • His shortest meeting ever (at five minutes) was driving to Epic and pitching the idea of GE buying part of Epic to Judy Faulkner, who simply replied, “No. No interest.” I can’t imagine a CEO in any industry who would have the brass to tell the CEO of GE to hit the bricks.
  • GE considered acquiring Cerner, but didn’t think it was worth the $2 billion figure being bandied about (the company’s market cap has since risen to $23 billion). CERN’s market cap hasn’t been that low since early 2005, so GE’s acquisition interest must have been before then but after Immelt took the CEO job upon Jack Welch’s retirement in 2000.
  • Hospital CEOs are still clueless about health IT and aren’t generating ROI, with the original goal being connectivity rather than value creation. He thinks they’ll gain interest in improving patient outcomes and value.
  • Immelt said companies that started venture funds “have stunk at it,” admitting that they have been “company killers.” In healthcare, of course, GE’s direct acquisitions – which weren’t usually top-rated companies in the first place – gave it the “elephants’ graveyard” moniker as the place where previously good companies go to die.

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The average healthcare CEO who lost their job due to a merger or acquisition received a golden parachute of $25 million, much less than the $37 million average from a 2015 version of the same report. Dismissed trench warriors presumably were paid basically nothing for being cut loose through no fault of their own even though their need for income was probably much more acute than that of the aristocracy. 


Decisions

  • WellStar West Georgia Medical Center (GA) will switch from Meditech to Epic in 2018.
  • St. Luke’s Hospital Cardiothoracic Surgery (MO) will switch from EClinicalWorks to Cerner Ambulatory EHR in July 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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New York Health + Hospitals hires Kevin Lynch (LA County Department of Health Services) as SVP/CIO.


Other

Here’s Vince’s look back 30 years at what was going on in health IT in December 1987, when George Michael’s “Faith” topped the charts and “Three Men and a Baby” foretold an epidemic of poor taste.

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Weird News Andy titles this article “DNR, R, DNR, EXP.” A 70-year-old diabetic man with “Do Not Resuscitate” (emphasis his) tattooed on his chest shows up at a hospital ED with an elevated blood alcohol level. Doctors considered his tattooed instructions invalid and started an IV, but covered themselves by also conferring with an ethics consultant, who told them they should honor the man’s request. The doctors wrote a DNR order and eventually also located a copy he had filed with the state’s health department. Meanwhile, the man died without further intervention.


Sponsor Updates

  • Deloitte names Definitive Healthcare to its Technology Fast 500 list of fastest-growing companies.
  • Logicworks announces support for AWS Guard Duty, a new machine learning-based security service.
  • Reaction Data publishes “Ideal Medical Imaging Trends 2017.”
  • Surescripts will exhibit at the AHIP Consumer Experience & Digital Health Forum December 5-7 in Nashville.
  • T-System President and CEO Roger Davis receives Dallas Magazine’s Excellence in Healthcare Award for achievement in medical technology.
  • Huron releases a new video, “Transparency Empowers Healthcare Consumers.”
  • Mazars USA expands its New York office with the addition of Elliot Horowitz & Company.

Blog Posts


Contacts

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

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News 12/1/17

November 30, 2017 News 2 Comments

Top News

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HHS OIG cracks down on drug co-pay charity Caring Voice Coalition, removing its seal of approval after finding that the charity shares data with the drug companies that provide its support.

CVC, which has received hundreds of millions of dollars from drug companies earmarked for paying patient prescription co-pays, had been exposed by several former employees as fast-tracking assistance for patients that use a donor company’s drug while wait-listing those who are prescribed drugs sold by non-donors.

OIG says the information sent to the drug companies could help them raise Medicare prices by accumulating anecdotal patient-reported successes.

CVC told OIG that it will probably shut down following the ruling.

I found CVC’s 2015 federal tax forms, in which it reported $132 million in 2014 revenue (vs. $83 million in 2013), giving it a $30 million surplus for the year.

The Justice Department had previously sent subpoenas to a handful of drug companies in its investigation of patient assistance programs, after which United Therapeutics set aside $210 million in case it gets caught up in a False Claims Act lawsuit over its donations.

The Internal Revenue Service is reviewing the tax-exempt status of another patient assistance program, Chronic Disease Fund (now known as Good Days), which took in more than $1 billion of drug company money over six years, of which the charity used $35 million to pay for data processing services provided by a company owned by the charity’s founder. Good Days has filed eight lawsuits so far this year to fight IRS subpoenas.


Reader Comments

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From Dollar Bill: “Re: [site name omitted.] Who finds actionable information there?” I can’t say, but the above is from Reaction Data’s independent C-level survey that asked about which sites influenced their decisions. I’ve blurred the names, but the one you’re asking about finished poorly in this and the other four categories (most-read, most-influential, most interest-generating, most positively affecting job performance, and most recommended). I immodestly note that the winner in all categories was a spare-bedroom, one-author one.


HIStalk Announcements and Requests

This week on HIStalk Practice: DaVita preps to sell its $4 billion medical group. South Carolina’s PDMP helps slash opioid prescriptions. Elderly New Hampshire MD faces non-license renewal over lack of computer skills. Google researchers develop gaze-detection software to deter snooping smartphone bystanders. Senate HELP Committee questions HHS Secretary nominee Alex Azar on drug prices. VillageMD New Hampshire selects Geneia predictive analytics for PHM efforts. CareCloud’s Polly Friend offers three key things practices should do to prep for MIPS.


Webinars

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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


Acquisitions, Funding, Business, and Stock

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Nuance announces Q4 results: revenue down 8 percent, adjusted EPS $0.20 vs. $0.31, beating analyst estimates for both and sending shares up to extend a run that started in mid-November. The company says its June malware attack cost it $53 million in revenue for the quarter. NUAN shares have risen 4 percent in the past year vs. the Nasdaq’s 30 percent. From the earnings call:

  • The total impact of the malware incident was just over $60 million vs. the originally expected $85 million.
  • The healthcare business delivered its best net new bookings quarter in history in Q4 despite the malware attack.
  • Nuance’s strategic focus will be conversational AI and analytics-based solutions.
  • The company expects Dragon Medical to replace transcription as its largest healthcare revenue contributor as its HIM business continues to decline.

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Siemens will take its Siemens Healthineers healthcare business public in Germany at a valuation of $47 billion, the country’s largest IPO in 20 years. The company chose the German exchange after ruling out London due to Brexit and the US markets because it wants to appeal to investors from Asia.

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AI-supported diagnostic software vendor Prognos closes a $21 million Series C funding round, increasing its total to $43 million. Its target audience is drug companies, insurers, and labs. Co-founder Jason Bhan, MD used to work for Clinovations, while Sundeep Bhan co-founded Medsite.

Bizarre: three-employee medical translation training vendor MiTio files for a $10 million IPO despite having only ever enrolled 1,000 students, naming as its CFO/CIO/CTO the founder’s 16-year-old son who is “a rising star in the coding community.” The company says it won’t sell shares publicly,  but had to file for an IPO because it will give investors cryptocurrency tokens. That’s the second company I’ve seen today offering that form of investment (see the Health Wizz item below). I admit that I don’t understand that concept.


Sales

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Artesia General Hospital (NM) chooses FormFast’s FastPrint, Capture, FastFlow, Content Manager, and Connect.

The Ministry of Health of the Republic of Kazakhstan will implement Elsevier’s ClinicalKey reference solution in 200 locations.


People

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Nuance hires Tom Beaudoin (SimpliVity) as EVP of business transformation. He was EVP/CFO for Nuance from 2008 to 2015.

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Laure Kreofsky, MHA, MBA (MedSys Group) joins Pivot Point Consulting, A Vaco Company as VP of advisory services.

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Hurley Medical Center (MI) promotes Casey Bryson to CIO from the interim role.


Government and Politics

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The VA misses its target date to sign with Cerner, which it originally vowed to get done in November in responding to a lawsuit protesting its no-bid selection. A VA source says the contract is ready to sign as soon as Congress approves moving the money to the correct accounts.


Announcements and Implementations

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Elsevier will offer WiserCare’s Shared Decision Making solution as part of its patient engagement suite.

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Glytec’s Glucommander Outpatient will be integrated with the virtual diabetes clinic of Onduo, whose parent companies are drug manufacturer Sanofi and Alphabet’s Verily.

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MemorialCare (CA) opens a technology testing and training center in conjunction with systems integrator Sirius Computer Solutions. It includes the technologies need to run a 2,000-bed hospital, an isolated data center, and a simulation lab.

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Health Wizz launches a blockchain-powered consumer tool for managing and sharing their medical data with research organizations and drug companies that can offer to pay them. The company is recruiting investors who will receive digital tokens.

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GE launches blood collection firm Drawbridge Health, which will allow physician offices and clinics that don’t have a blood draw technician to easily draw small-volume blood samples and send them to third-party labs. I like the idea of going back to the good old days when you could get your blood drawn during your office visit instead of starting over with the DMV-level indifferent employees of Quest or LabCorp and then listening to your NPO stomach grumble while watching the Unemployment TV Network of fake judges, on-cue fistfights over infidelity, and ambulance-chaser commercials.

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Tahoe Forest Health System (CA) goes live on Epic, implemented and hosted by Mercy Technology Services. 

GetWellNetwork adds Elsevier’s patient education videos to its content library.

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QuadraMed and Harris Healthcare launch individual websites that cover their respective products, with QuadraMed offering its EMPI solutions and Harris Healthcare covering Affinity Patient Self-Service, Affinity ERP, AcuityPlus staffing, Team Notes, the QCPR EHR, and Affinity RCM. The Harris Health Group brands are listed above, although it should be noted that it acquired only the hospital division of NextGen and not the entire NextGen Healthcare product line or its parent company Quality Systems, whose logos appear on the page.

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Deborah Heart and Lung Center (NJ) will go live on Meditech 6.1.5 today (Friday). I believe they’re upgrading from Meditech Magic.


Privacy and Security

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A cybersecurity publication asks three healthcare security experts to assess the recent hospital ransomware episode of “Grey’s Anatomy,” who conclude:

  • It didn’t make sense for the hacker to take down patient monitors since the hacker’s objective is to make money and the on-screen ransom note would accomplish that less dramatically.
  • The attack took down phones, computers, and medical devices, which the experts say could actually happen since hospital networks are often “one big, flat, happy family” instead of being segmented or protected by internal firewalls. Still, the variety of operating systems and versions used in a typical hospital make it unlikely that everything could be taken offline by the same malware.
  • Medical uncertainty due to lack of a paper backup may be realistic, although more hospitals are keeping electronic snapshots of important clinical information.
  • The demanded ransom – $20 million in bitcoin at the time of the airing and $50 million today – is not realistic because nobody would pay that much.
  • It’s not likely that a cyberattack could take down access control systems, as shown on the show when nobody could open the door to the blood bank.
  • It’s unrealistic that the FBI would arrive in minutes and take charge as the show depicted.
  • It’s not necessarily advisable to just shut all systems down, but rather to control the malware’s spread while forensically trying to learn more about the hacker.
  • The TV chief of surgery made the decision to pay the ransom, which is unrealistic not only because that’s a CEO-level decision, but also because hospitals usually follow the FBI’s advice and refuse to pay.

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Security researchers find that the installation script of free, web-based OpenEMR does not automatically remove itself upon completion and that the instructions don’t tell users to delete it, allowing hackers to gain administrative access and to execute PHP scripts of their own. Kudos to the developers, who released a patch within four days, made a community announcement about the vulnerability, and updated its instructions to include removing unnecessary files after installation. The system is used by thousands of healthcare facilities and users in supporting an estimated 90 million patients.

In England, a financial administrator who was worried that she was being out-earned by co-workers hacks into the hospital’s systems, looks up salaries, collects data on celebrity mental health patients, and deletes key files. The judge let her off with a suspended sentence since she argued that her deeds were to “ease her mind” rather than for financial gain.

A federal court drops child pornography charges against a California oncologist after his attorney argues that the warrant used to search his home – in which child pornography was apparently found – was invalid because the FBI’s tip from a Best Buy technician was triggered by a photo of a naked girl that was not pornography but rather “child erotica,” which is not illegal but may not be the kind of image you hope your oncologist is studying intently.


Other

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Family medicine doctors from the University of Missouri School of Medicine design a prototype of collapsible accordion physician notes, comparing four models that also emphasize abnormal items.

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FDA approves AliveCor’s EKG watchband replacement for the Apple Watch to warn users of possible atrial fibrillation. The KardiaBand use what it claims is AI on the smart watch to determine a specific user’s normal heart rate based on activity, then issue a warning to run the EKG function if the rate goes outside the normal range. The band costs $199 plus a $100 per year subscription. Like other “advances” that find previously undetected conditions that require expensive treatment, we’re all going to be paying for it. Going problem fishing by using data for bait isn’t usually as good for patients as it seems.

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IHI/NPSF publishes “Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era.” Recommendations include developing better interoperability among EHRs used by PCPs and specialists; conducting a risk assessment of the electronic referral process using the SAFER guidelines; creating collaborative care agreements for PCPs and specialists that include how patients will be managed and communications etiquette; and developing easy ways to track referral status by patient. The impressively credentialed expert panel notes that 24 percent of malpractice claims are caused by missed or delayed diagnosis; the volume of referrals has skyrocketed and more frequently involves multiple specialists; and that patients don’t follow through on up to half of referrals. The study also observes that while EHRs have potential to improve the referral situation, they generate a lot of ignored noise and a lack of evidence-based guidelines makes it tougher.

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Australia’s My Health Record – rollout of which cost up to $1.5 billion with annual costs of up to $300 million — is being roundly ignored by both providers and consumers, according to the government’s dashboard that shows few new voluntary registrations and that only 200 doctor-entered patient summaries were viewed by hospitals in August.

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This is a fun tweet.

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Here’s another great tweet I found via @healthblawg.

Big health systems keep moaning about how financially strapped they are and brag about how they’re moving away from the lucrative “heads in the beds” financial model, but Ohio State University joins a bunch of other health systems that have recently announcing huge construction projects. The cost of their much-anticipated erection – which includes an impressive 840-bed tower – has not been determined.

A study estimates that healthcare illiteracy – which includes half of Americans, according to the CDC – costs the country up to $175 billion per year.

Snapchat CEO Evan Spiegel says the factors that have driven social media – more friends, more likes, and more free content – will undermine it. He says that automated, personalized newsfeeds based on what friends are consuming — like Facebook’s — “came at a huge cost to facts, our minds, and the entire media industry.”

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Weird News Andy will love this. A startup that raised millions to develop its $40-a-bottle “cognitive enhancement” concentration pill (aka “nootropics”) tries to bury the results of its own study, which conclude that the expensive product is less effective than just drinking a cup of coffee.


Sponsor Updates

  • ZeOmega achieves Oracle Validated Integration of Jiva 6.1 with Oracle Healthcare Foundation 7.1.1.
  • The HCI Group partners with the Dubai Health Authority as part of its Transformation Forum.
  • The local paper features Healthlink Advisors consultant Claude Younger’s health-prompted feat of running marathons in all 50 states.
  • Optimum Healthcare IT publishes an infographic titled “The ROI of Interface Error Management.”
  • Meditech posts a video featuring ancillary department directors of Colquitt Regional Medical Center (GA) discussing their time savings from using its Web EHR.
  • Bill  Spooner, founding advisor at Next Wave Health Advisors – a Huntzinger Management Company, leads sessions at the Millenium Alliance’s Assembly on healthcare provider transformation.

Blog Posts


Contacts

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Contact us.

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News 11/29/17

November 28, 2017 News 11 Comments

Top News

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A newly unsealed state court lawsuit claims that 62 Indiana hospitals fraudulently attested for $300 million in Meaningful Use money because they don’t give patients copies of their medical records within three business days 50 percent of the time as required.

Two lawyers filed the suit after testing four Indiana Hospitals with a records request. They say that none of the hospitals delivered their records promptly even though all the hospitals reported that they had done so.

Their statistics were extrapolated to other state hospitals to assume that they, too are not following through on patient records requests in a timely manner.

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Also named in the lawsuit is records release vendor Ciox Health, which the plaintiffs say illegally profited from overcharging patients for their records in violation of anti-kickback laws.  


Reader Comments

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From Uncle Douger: “Re: HIStalk reporting bias. Have you looked at who is making those claims as article comments? I would be suspicious.” I will only say that those commenters claiming that I’m biased against any given company often use IP addresses owned by that same company. Today’s anti-journalism environment encourages anyone who doesn’t like particular facts to accuse those who present them of bias. There’s nothing I like more, however, than having my own opinion — when I actually state one — challenged and occasionally changed by rational and well-considered facts.

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From Apple Alar: “Re: billion-dollar lawsuit against ECW. It’s interesting that it was filed as a class action suit rather than wrongful death / malpractice. The implications for setting a legal liability precedent for a vendor involving the content of the electronic health record would be game-changing. What about systems that send information to the EHR that is improperly presented there?” I don’t really know what to make of the lawsuit since the plaintiff made vague claims that her husband’s cancer wasn’t diagnosed because of EHR issues, but she wasn’t specific and didn’t name any doctors or hospitals as defendants. It also copied and pasted a lot of information from the DOJ’s settlement with ECW, which I took as an indication that it was a me-too claim hoping for a quick settlement from a company trying to distance itself from its $155 million payout. Attorney readers, what do you think?

From ExEpic: “Re: HIMSS compensation survey. They don’t even list Washington, DC as an option for the state or territory of residence.” I checked the survey and it asks, “In which state do you work?” in omitting DC but including an “Other US Territory” option.


HIStalk Announcements and Requests

I was reviewing the rehearsal of Thursday’s excellent webinar by PatientSafe Solutions and took note of the “wireless wellness” problem mentioned by both CIO presenters. It was a key lesson learned – every new application that would use the wireless network must be tested because some of them are poorly designed and could mess up other apps.

I like this brilliant quote as tweeted from a conference: “Palliative care is what all care would be like if we started over with healthcare.”


Webinars

November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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


Acquisitions, Funding, Business, and Stock

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The Boston business paper reports that while Athenahealth is selling its Bombardier Challenger 300 jet in a cost-cutting move, it will keep its second aircraft, a propeller-driven Pilatus PC-12. I was curious about the cost of the Challenger – $24 million new with an operating cost of $7,250 per hour.

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UnitedHealth Group’s Optum launches a $250 million fund to invest in early-stage healthcare startups, including digital health. If you’ve started a crappy company that everybody else’s digital health fund has passed on, here’s your chance.

Bloomberg predicts a wave of bankruptcies involving hospitals and healthcare vendors in 2018, especially for disproportionate share hospitals whose funding has been cut.


Sales

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The Clinical Radiologists radiology group chooses MModal for radiologist documentation, real-time physician documentation, business intelligence, critical test results management, and peer review and learning.


People

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Athenahealth names Marc Levine (JDA Software Group) as CFO.

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University Hospitals (OH) rehires Robert Eardley (Houston Methodist Hospitals) as CIO.

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Vice-Admiral Raquel Bono, MD, MBA, director of the Defense Health Agency, accepts the HIMSS Federal Health IT Award.

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John Halamka, MD will serve as editor-in-chief of the new open access, online journal Blockchain in Healthcare Today. Another site run by the same company runs ads, so I assume this one will, too.

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Health coaching app vendor Farewell names former US Surgeon General Richard Carmona, MD, MPH to its board. He’s also a combat-decorated Vietnam veteran and a Special Forces medic who also earned an AA degree in nursing and accumulated many awards as a deputy sheriff and SWAT leader.

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Patient engagement software vendor Relatient hires board director and venture capital operating partner Michele Perry as CEO.


Announcements and Implementations

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TigerText announces TigerFlow Enterprise, a clinical communication and collaboration platform.

Unified clinical communications platform vendor Telmediq integrates the IPhone X’s Face ID authentication.


Privacy and Security

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The University of Chicago student newspaper reviews the network log scans of its hospital, finding unsecured network printers that are being used to print PHI-containing forms that any hacker could theoretically access. They found Epic-issued print jobs containing organ donor information, diagnostic procedure reports, and prescription forms. The reporters also found Internet of Things devices such as cameras and sensors were accessible and sometimes controllable. In the all-too-common shoot the messenger scenario, the person who initially tipped off the reporters was identified during the university’s ensuing investigation and was “formally summoned to the Office of the Dean of Students.”

Precision medicine platform vendor LifeOmic offers customers a $1 million ransomware guarantee that covers “any financial extortion payment or service reimbursement.”


Other

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A Medscape survey of 4,000 physicians finds that half have been sued for malpractice, noting that New York OB/GYNs pay nearly $200,000 per year in malpractice premiums. Sixty percent of doctors said they were either encouraged or required by their insurer to settle their case, with two-thirds of those resulting in payouts of less than $500,000. A surprising 62 percent of doctors said the outcome of the lawsuit against them was fair, but one-third of those sued said they no longer trust patients, treat them differently, or left the practice setting after the lawsuit. Three-fourths of doctors in general say the threat of malpractice influences their actions. Doctors say the best ways to discourage lawsuits include communicating more effectively with patients, screening cases for merit by a medical panel, capping non-economic damages, making the plaintiff responsible for paying the legal fees of both sides if they lose, and banning lawyers from taking cases on contingency. 

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An interesting graphic (click to enlarge) shows that Walmart is the largest private employer in 22 states, but also unintentionally illustrates that 12 states have a health system as their largest employer. Unlike Walmart, those systems are tax-exempt and create profits that often involve less-direct societal costs in the form of Medicare and Medicaid.

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Facebook upgrades its AI tools to identify users who are expressing suicidal thoughts so they can be connected to first responders.

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A Google Research Blog post says the company will work with Stanford researchers to understand how automatic speech recognition models can be used to transcribe physician notes, with a patient-consented pilot study looking at ways to reduce EHR interaction in capturing clinical information from conversations. It will use voice recognition technology from Google Assistant, Home, and Translate. A Google team just published “Speech Recognition for Medical Conversations.”

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CNBC profiles Cedars-Sinai testing of AbStats, a stomach-attached wearable that analyzes bowel sounds to alert doctors that their post-op patients are capable of eating. The hospital is also testing the device to alert users that their stomach is empty so they eat only when it’s time. The inventor of AbStats is Brennan Spiegel, MD, MSHS, director of health services research at Cedars-Sinai.

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A JAMIA-reported study finds that hospital Meaningful Use performance is associated with the EHR they use, with Epic users scoring higher in five of six criteria. The article – which is of the “let’s merge some government databases and see if we can find something to publish” type — duly notes that correlation does not necessarily indicate causation, as hospitals that use Epic, for example, might well have different resources and motivations than those that don’t. It also correctly notes that MU criteria have little to do with patient outcomes. In that regard, I don’t see one iota of usefulness in the study, especially since the information is hardly actionable even if valid. It also fails to note that presence of EHR functionality (as measured by certification) doesn’t do anything to meet hospital MU requirements — the hospital creates and actively enforces policies on EHR use (maybe Epic-using shops just press their doctors harder to chase MU targets). I’ve seen sites pushing sensationalistic headlines around this article and interpreting it wildly incorrectly, making it even worse and more like an Epic commercial.

A JAMA op-ed piece proposes – not very convincingly – the creation of a “medical virtualist” specialty, with the proposed required training including “webside manner,” competency in conducting virtual examinations, and including families in virtual visit. It’s not clear why those specific competencies should not be included in regular medical education or as a certificate (no different than learning to use a particular EHR) rather than carving out yet another self-serving, expensively maintained medical specialty.

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The local paper notes that the CEO of Novant Health (NC) has had a 93 percent salary increase since 2012, with total 2016 compensation of $3.4 million. SVP/CIO Dave Garrett was paid $990,000.

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Microsoft CEO Satya Nadella says in his new book that he learned empathy after the 1996 birth of his son, who has cerebral palsy:

On one of his son’s hospital ICU stays shortly after Satya Nadella became CEO, the Microsoft executive noticed how many devices in the room were running Windows and were connected to the cloud: “It was a stark reminder that our work at Microsoft transcended business, that it made life possible for a fragile young boy. It also brought a new level of gravity to the looming decisions back at the office on our cloud and Windows 10 upgrades. We’d better get this right, I remember thinking to myself.”

The surgeon treating the minor tongue condition of a five-year-old asks the mother if she wants her daughter’s ears pierced while she’s under anesthesia, so she says OK. The daughter leaves with a repaired tongue, a pair of earrings installed, and an extra $1,900 bill for “operating room services” that her insurer refused to pay. Children’s Hospital Colorado demanded that she either write a check or deal with its collections agency, but eventually waived the charge. Meanwhile, one of the piercings was off center and had to be redone at a mall kiosk, which set her back another $30. 


Sponsor Updates

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  • Netsmart recognizes its employees in honor of Giving Tuesday.
  • Ivenix will demonstrate its infusion system at the ASHP meeting in Orlando December 3-7.
  • The Washington Stat Health Care Authority certifies consumer decision aids from Healthwise for knee osteoarthritis and hip arthritis.
  • Nuance launches its AI Marketplace for Diagnostic Imaging.
  • Change Healthcare will work with healthcare AI vendor Zebra Medical Vision to apply AI to radiology solutions
  • Endpoint management software vendor Igel will integrate its product with Imprivata’s OneSign SSO after joint work at Parkview Medical Center (CO). 
  • AdvancedMD Cares makes 600 quilts for three Nashville charities during its Evo17 conference.
  • The Boston Globe includes Definitive Healthcare in its list of Top Places to Work in Massachusetts for 2017.
  • MModal extends its Speech Understanding technology to the PACS desktop in a unified workflow.
  • Conduent Health publishes a new e-book, “Patients’ Attitudes Regarding Healthcare.”
  • Forbes features Kyruus co-founder and CEO Graham Gardner, MD in its look at how AI and digital will shape the future.
  • Arcadia Healthcare Solutions sponsors the Millenium Alliance Healthcare Payers Transformation December 7-8 in Nashville.
  • Besler Consulting publishes an analysis of the 2018 OPPS Final Rule.
  • Change Healthcare announces a strategic relationship with Google Cloud.
  • ChartLogic publishes a new white paper, “Evaluating Your Next EHR’s Support.”
  • CoverMyMeds will exhibit at the American Society of Health System Pharmacists Midyear Conference December 3-7 in Orlando.

Blog Posts


Contacts

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

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Monday Morning Update 11/27/17

November 26, 2017 News 12 Comments

Top News

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CNBC reports that Amazon Web Services and Cerner will announce an agreement this week involving Cerner’s HealtheIntent population health management system, which is already hosted on AWS.

The new deal may involve allowing researchers to analyze HealtheIntent data using AI technology.

CERN shares led the S&P 500 in gaining 5 percent Wednesday afternoon after the article ran.


Reader Comments

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From Dr. Scripps: “Re: Eric Topol, MD. Has been pushed out of his position as chief academic officer at the Scripps Healthcare System, where he reported to CEO Chris Van Gorder. He still practices cardiology at Scripps Clinic one day a week, but is no longer a member of the executive leadership team. He has joined The Scripps Research Institute (TSRI), which shares the Scripps moniker, but is not part of the health system, which never adopted the ideas Eric has been evangelizing for years.” Eric’s LinkedIn shows that he left the CAO position in August 2017, moving into the role of EVP and professor of molecular medicine at the Research Institute.

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From A Little BIrdie Told Me: “Re: Iraan General Hospital. They were implementing Athenahealth because of the cost model in the clinics and decided to put it into the acute side. I’m working on what the specific drivers were to go back to CPSI.” Unverified. The trend of CPSI customers going to Athenahealth and then returning quickly to the fold is close to astonishing, although it would be interesting to see what if any inducements CPSI gave them.


HIStalk Announcements and Requests

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Just over half of poll respondents think the VA’s Cerner system will allow it to exchange information with providers outside the VA. Commenters note, however, that being able to exchange information doesn’t necessarily mean that the VA will actually make it happen.

New poll to your right or here: where did you do your online electronics shopping last week, if anywhere?

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I limited my Black Friday shopping to getting a Google Home Mini and Chromecast to play around with, unable to resist the great deal Google was offering. I was tempted by an $800 Mac Air, but that device is so long in the tooth (especially the display) that it seemed like an unwise investment, especially since I recently paid less for a much better equipped Windows 10 laptop and my only interest was learning Mac stuff and running a couple of Mac-only apps. Actually, I went back Saturday for one more Black Friday weekend special – Amazon-owned Woot! has fantastic deals on Diamondback bicycles (inexpensive, but plenty good for someone like me who hasn’t ridden in years) that beat every price available plus $5 shipping, so the his-and-hers models are on their way.

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A minimally Spanish-speaking friend is traveling in South America, so I checked out the much-improved, still-free Google Translate app. It can now be used with the mobile device’s microphone both ways – you set the to/from language (like English to Spanish), speak into it (“Where is the nearest bar?”) and it puts the translated text on the screen with an option to play it aloud with a natural-sounding voice for the other person to hear in their language. Then, you flip the languages and let the other person speak in Spanish, which you then see on-screen or hear in English. Google has improve the translation engine a lot, apparently, so it’s more conversational than before. A cool new option (via a Google acquisition) is the ability to translate written words on the screen by pointing the device’s camera at road signs, menus, etc. that then displays the English translation as an image overlay in real time. You can also download the language package so it can be used while offline.


This Week in Health IT History

One year ago:

  • President-elect Trump nominates Tom Price, MD as HHS secretary and Seema Verma as CMS administrator.
  • Constellation Software subsidiary Harris acquires IMDsoft.
  • Orion Health shares drop to a post-IPO low following poor quarterly results and its announced post-election US sales concerns.

Five years ago:

  • KLAS lists its top radiology PACS innovators as Infinitt, Intelerad, DR Systems, McKesson, Novarad, and Sectra.
  • Cleveland Medical Mart signs Cleveland Clinic and GE Healthcare as tenants.
  • OIG warns that CMS is not adequately auditing Meaningful Use attestation submissions, recommending that CMS conduct random audits, issue guidance of the types of documentation it expects providers to have available, and require certified EHRs to issue verification reports.

Ten years ago:

  • UPMC CIO Mark Hopkins dies of cancer at 47.
  • A nursing professor creates simulation training on Second Life.
  • Experts at Penn’s Wharton School predict that personal health records such as Microsoft HealthVault could serve as the bridge between incompatible hospital EHRs.
  • Athenahealth buys a 130,000 square foot office facility in Belfast, ME as its second site.
  • Carestream Health announces plans to integrate its radiology solutions with IBM’s Lotus Sametime messaging.

Last Week’s Most Interesting News

  • The AMA severs its relationship with Outcome Health following fraud allegations that also caused the company to offer buyouts that were accepted by one-third of its staff.
  • The VA announces that it is considering merging its Choice program with the DoD’s Tricare following discussions about their planned joint EHR.
  • Banner Health confirms that its Tucson-based hospitals are experiencing patient delays following its October 1 Cerner go-live.
  • Advisory Board closes the sale of its healthcare business to Optum.

Webinars

November 30 (Thursday) 1:00 ET. “Making Clinical Communications Work in Your Complex Environment.” Sponsored by: PatientSafe Solutions. Presenters: Steve Shirley, VP/CIO, Parkview Medical Center; Richard Cruthirds, CIO, Peterson Health. Selecting, implementing, and managing a mobile clinical communications platform is a complex and sometimes painful undertaking. With multiple technologies, stakeholders, and disciplines involved, a comprehensive approach is required to ensure success. Hear two hospital CIOs share their first-hand experience, lessons learned, and demonstrated results from deploying an enterprise-wide mobile clinical communications solution.

December 5 (Tuesday) 2:00 ET. “Cornerstones of Order Set Optimization: Trusted Evidence.” Sponsored by: Wolters Kluwer. Updating order sets with new medical evidence is crucial to improving outcomes, but coordinating maintenance for hundreds of order sets with dozens of stakeholders is a huge logistical challenge. For most hospitals, managing order set content is labor intensive and the internal processes supporting it are far too inefficient. Evidence-based order sets are only as good as their content, which is why regular review and updates are essential. This webinar explores the relationship between clinical content and patient care with an eye toward building trust among the clinical staff. Plus, we will demonstrate a new evidence alignment tool that can easily incorporate the most current medical content into your order sets, regardless of format, including Cerner Power Plans and Epic SmartSets.

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


Acquisitions, Funding, Business, and Stock

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Behavioral app vendor Ginger.io pivots its business to become a technology-focused national medical practice that will provide therapists. The company, which had raised $28 million with its most recent funding round in late 2014, had struggled to get hospital customers in its previous model.

Philips acquires Analytical Informatics to enhance its PerformanceBridge Practice imaging department management system. The company offers applications for quality analysis, productivity, dictated report search, scanner utilization, peer review, undictated studies lists, image quality problem reporting, and real-time alerts.


Announcements and Implementations

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Children’s Healthcare of Atlanta (GA) will spend $1 billion to build a replacement 446-bed hospital on a new campus on North Druid Hills.

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University of Pennsylvania Health System (PA) will spend $3.9 billion on construction in the next five years, including $1.5 billion for a 17-story patient tower, updating other buildings, and adding a new Center for Health Care Technology that will house IT and other corporate functions.

UMass Memorial Medical Center (MA) goes live on Agfa HealthCare’s enterprise imaging platform.

Memorial Hospital (IL) goes live on Epic.


Privacy and Security

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Cottage Hospital (CA) pays $2 million to settle state charges regarding two incidents between 2011 and 2013 in which patient information was freely discoverable in Internet searches. The hospital, which faced up to $275 million in penalties, has agreed to upgrade its security infrastructure and to hire a chief privacy officer.


Other

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Researchers find that only 21 percent of Florida physicians have registered for the state’s prescription drug monitoring program database, with lack of EHR integration being found as one significant factor. Use of the database to check patient opiate histories is voluntary, but submission of opiate prescription and dispensing data is mandatory.

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A designer creates a virtual reality system to reduce death anxiety in terminally ill hospital patients by creating a sensation of leaving the body. He says,

The fear and experience of death is a neglected topic. If we began treating our anxieties surrounding death, it might mean the process of dying could become more comfortable. In the developed world, the majority of people die in hospital or a care home, turning deaths into medical experiences. But doctors are trained to save and prolong lives, not tend to our demise. They simply lack the tools.

China, following through on its ambition to lead the world in AI by 2030, announces plans to build an unmanned, AI-powered police station that can handle DMV-type issues such as administering driver exams and vehicle registration.

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I wrote last week about the dedication of a new e-health center in India that admitted afterward that it had no actual doctors or staff, with outside workers brought in for the ceremony as pretend employees to impress the locals and the governor of Punjab. The center has closed four days after it opened after the lone doctor at the dispensary where it was housed “was found missing” (is that an oxymoron?) and even the dispensary itself has closed until a replacement is found.


Sponsor Updates

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Reader Comments

  • Ramon bonilla: Does a current problem list mean that everything on the list is what u have?...
  • Woodstock Generation: When my college peers and I decided to major in one of the many healthcare professions, including the nascent HIT, the r...
  • AC: "American Airlines apologizes to Tisha Rowe, MD, MBA and promises to hire a chief inclusion and diversity officer after ...
  • DoesNotSoundFun: Is Providence's thing really a tech company though? They have an interest in saying that it is since they could bill mor...
  • Joe Gellatly: We are one of those white-glove service, reasonably-priced Security Risk Assessment vendors out there. I must say that t...
  • richie: Hope a Dx patient doesn't read how attrition is fun fodder for heartfelt sentiment. I think there are people who care a...
  • Demo Chic: Kudos to Dr. Belden and the MU team for their EMR Happy Hours. We did something similar back in 2007 but our sessions w...
  • David N: "The kidney has a very special place in the heart" - President Trump 07/10/19...
  • richie: Taking people out of a system of people is a basic design flaw....
  • Jim Beall: FWIW, Columbus Regional Health will go-live on Epic at their inpatient hospital later this month. I think the date is J...

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