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Monday Morning Update 10/7/19

October 6, 2019 News 9 Comments

Top News

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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


Decisions

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

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


People

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

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


Announcements and Implementations

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

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


Privacy and Security

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


Other

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

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

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


Sponsor Updates

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

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

October 3, 2019 News 7 Comments

Top News

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

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

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

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


Reader Comments

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

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

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

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

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

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

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

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

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HIStalk Announcements and Requests

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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


Sales

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

People

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

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


Announcements and Implementations

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

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

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

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

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


Other

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


Sponsor Updates

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

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Contacts

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


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News 10/2/19

October 1, 2019 News 10 Comments

Top News

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

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

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

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


HIStalk Announcements and Requests

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


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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

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

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


Sales

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

People

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


Announcements and Implementations

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

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Boulder Community Health (CO) goes live on Epic.

Boston Software Systems announces GA of productivity-focused analytics.


Government and Politics

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

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

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


Privacy and Security

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

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


Other

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

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

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


Sponsor Updates

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

Blog Posts


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Contacts

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


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Pretzel Logic 9/30/19

September 30, 2019 News 6 Comments

It’s a Dog’s Life

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

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

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

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

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

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

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

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

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

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

Scribe: “Five days ago.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Monday Morning Update 9/30/19

September 29, 2019 News 1 Comment

Top News

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

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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


Webinars

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

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

 

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


People

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

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


Government and Politics

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


Privacy and Security

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


Other

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

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

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

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


Sponsor Updates

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

Blog Posts

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

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

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News 9/27/19

September 26, 2019 News 11 Comments

Top News

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

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

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

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

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

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

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

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

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

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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

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


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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


Sales

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

People

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


Announcements and Implementations

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

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

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

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


Government and Politics

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

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


Sponsor Updates

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

Blog Posts


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News 9/25/19

September 24, 2019 News 6 Comments

Top News

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

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

Reader Comments

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

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

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


HIStalk Announcements and Requests

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


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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

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

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


Sales

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

Announcements and Implementations

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

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

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


Government and Politics

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


Other

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

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

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

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

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


Sponsor Updates

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

Blog Posts


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Monday Morning Update 9/23/19

September 22, 2019 News 5 Comments

Top News

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


Reader Comments

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

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

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

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

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

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


HIStalk Announcements and Requests

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

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

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


Webinars

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

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

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


People

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


Other

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

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

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

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


Sponsor Updates

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

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News 9/20/19

September 19, 2019 News No Comments

Top News

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

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

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

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


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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

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


Sales

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

People

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


Announcements and Implementations

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

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

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

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


Government and Politics

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

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


Other

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

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


Sponsor Updates

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

Blog Posts


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Shared Medical Systems 50-Year Reunion

September 18, 2019 News No Comments

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


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

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

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


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Check-in (show your Medicare card).

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

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

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

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

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

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

News 9/18/19

September 17, 2019 News 3 Comments

Top News

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

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

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

Firefly’s founders are from Harvard Medical School.

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


Reader Comments

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

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

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


Webinars

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

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

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

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


Acquisitions, Funding, Business, and Stock

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

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


People

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

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

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

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


Government and Politics

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


Privacy and Security

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


Other

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

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

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


Sponsor Updates

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

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Monday Morning Update 9/16/19

September 15, 2019 News 1 Comment

Top News

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

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

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

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

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

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

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

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


Reader Comments

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

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


HIStalk Announcements and Requests

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

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

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

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


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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

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

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


Sales

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

Announcements and Implementations

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


Government and Politics

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


Privacy and Security

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


Other

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

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

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

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


Sponsor Updates

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

Blog Posts


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Contacts

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News 9/13/19

September 12, 2019 News 4 Comments

Top News

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Surescripts finally severs ties with ReMy Health, which supplied Amazon-owned mail order pharmacy PillPack with patient prescription data collected by Surescripts.

Surescripts CEO Tom Skelton told customers the move was made to ensure the “integrity of its network.” It came after Surescripts allegedly discovered that ReMy had requested patient insurance information and prescription pricing data that it then passed on to drug marketing websites without permission. ReMy has denied any wrongdoing.

The tit-for-tat amongst the trio has been going on for several months, with Surescripts claiming it would take its complaints to the FBI and Amazon retaliating with threats of a lawsuit.

The FTC filed an antitrust lawsuit against Surescripts in April for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.


Reader Comments

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From MIPS Maven: “Re: MIPS. More than a dozen major EHRs have not released full 2019 MIPS functionality. Practice Fusion just released their dashboard yesterday after months of customer complaints. MIPS is a FULL YEAR program that began on January 1, 2019. How are EHR vendors not being fined for failing to offer MIPS functionality when they are ONC certified?”

From Attendance Mandatory: “Re: conferences. Don’t you find it ironic that telemedicine conferences require in-person attendance?” I find it ironic that any technology-related conference requires in-person attendance, but I also know that the cash register rings hardest from vendor booths, hotel room bookings, and endless venue advertising. You could easily live-stream every conference education session or just put the video on YouTube as we do webinars. However, attendees are most interested in socializing, making personal connections, or cruising the show room floor, so just watching podium presentations – which are often not very good or very timely anyway – won’t cut it. Conferences provide the supply of whatever it is that the market demands. I’m interested in how the heavily investor-funded HLTH conference will fare in October, having sat out 18 months after making the disastrously stupid decision to launch its initial conference immediately following HIMSS and in the same city of Las Vegas. I haven’t heard any buzz about the 2019 version of HLTH despite its many “media partners” (although quite a few of those are lame).

From Dr. Doctor Please: “Re: surprise medical bills. This is one of the most depressing stories about my profession that I have ever read. Goes well with your recent remarks about how we doctors brought a lot of the burnout-causing conditions on ourselves and how medicine is just another business.” Kaiser Health New says that physician groups are among the biggest and well-funded opponents of laws that would prohibit balance billing, but the real force behind the media blitz is private equity and venture capital firms that have bought physician staffing companies. That earns them fortunes as they intentionally remain out of insurance networks so they can charge whatever they want and leave the patient owing the difference. A snip:

In some areas, doctors have few options but to contract with a staffing service, which hires them out and helps with the billing and other administrative headaches that occupy much of a doctor’s time. Staffing companies often have profit-sharing agreements with hospitals, so some of the money from billing patients is passed back to the hospitals. The two largest staffing firms, EmCare and TeamHealth, together make up about 30% of the physician-staffing market. That’s where private equity comes in. A private equity firm buys companies and passes on the profits they squeeze out of them to the firm’s investors. Private equity deals in health care have doubled in the past 10 years. TeamHealth is owned by Blackstone, a private equity firm. Envision and EmCare are owned by KKR, another private equity firm.

With affiliates in every state, these privately owned, profit-driven companies staff emergency rooms, own dialysis facilities, and operate physician practices. Research from 2017 shows that when EmCare entered a market, out-of-network billing rates went up between 81 and 90 percentage points. When TeamHealth began working with a hospital, its rates increased by 33 percentage points.


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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Healthy.io raises $60 million in a Series C funding round and receives FDA clearance for the use of its smartphone-based ACR test to be used in diagnosing chronic kidney disease. The company released a smartphone-based urinalysis app last year.

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Digital prescription savings company TrialCard will acquire medication management app Mango Health. Co-founder and CEO Jason Oberfest left Mango Health to join Apple’s health team late last year.

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Health IT consulting firm HCTec will invest $500,000 in expanding its workforce by 100 employees over the next five years in Tennessee.

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GE Healthcare receives FDA clearance for its Critical Care Suite, an AI-powered X-ray device that can reduce the time between diagnosis and treatment for a collapsed lung to as few as 15 minutes. The company is working with scientists at the University of California to develop screening capabilities for additional conditions.


Sales

  • Provincial Health Services Authority in British Columbia signs a three-year contract with Vocera for its care team communication technology.
  • WellStar Health System expands its use of Glytec’s EGlycemic Management System two eight additional Atlanta-area facilities.

People

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University of California promotes Tom Andriola to the newly created position of vice chancellor of IT and data at the University of California, Irvine, which includes UCI Health.


Announcements and Implementations

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Christie Clinic (IL) will implement Epic through a Community Connect arrangement with neighboring Carle Health System.

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A new KLAS report on EHR implementations outside the US finds that Epic has the highest satisfaction and its customers implement the widest variety of software modules. Allscripts customers report budget overruns and worry that the company is more focused on sales than implementation; InterSystems overpromises on scope and timelines; and Meditech customers are most likely to report budget overruns due to unexpected third-party and infrastructure costs. However, Meditech finished first on hitting the timelines that are under its control. Epic takes the highest amount by far of EHR project budget at up to $164 million, while Meditech, Philips, and MV had narrower cost ranges that were in the single-digit millions.

Redox posts the agenda for its Healthcare Interoperability Summit, convening in Boston on October 15.


Government and Politics

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In Australia, Queensland Premier Annastacia Palaszczuk promises to investigate the IEMR crash that occurred Tuesday afternoon across 14 hospitals. The $1.2 billion system was down for several hours after a routine Cerner software patch caused a “system degradation.”


Privacy and Security

Healthcare technologist Fred Trotter says Facebook still hasn’t fixed some privacy-compromising features of its Groups function, potentially exposing the medical information of people who sign up for health groups. Facebook did a partial fix: (a) you can no longer download the information of group members unless  you yourself are a member; (b) Facebook users can no longer add other users to a group without their consent; and (c) groups are set to be “private” by default. Fred says Facebook needs to add name privacy, so that members are listed by only their first names and are not linked to their full Facebook account, which means the user can interact with the group but nobody can find out more information about them. This is similar to how Facebook set up its “dating” feature” to facilitate privacy. 


Other

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A cardiologist’s New York Times opinion piece says that doctors are always outraged and surprised at onerous or ineffective regulations that are forced upon them, but have done little to offer their own solutions to problems such as inappropriate imaging. He notes interestingly that Medicare created a physician golden goose in 1965 in virtually guaranteeing that medical services would be paid for, but doctors cashed in while ignoring waste and fraud that was eventually addressed by insurers and lawmakers in the form of managed care. He concludes that doctors can retain their independence only if they become more active in addressing healthcare’s problems, some of they they themselves created.  

Google Cloud Executive Advisor Toby Cosgrove, MD – formerly CEO of Cleveland Clinic – says that health systems have spent so much on Cerner and Epic that Google, IBM, and other companies aren’t interested in trying to launch competing EHR products. He said in a conference this week that IBM and Google both considered developing ad EHR, but it’s probably too late.

University of Oxford researchers have designed an algorithm that can detect potential signs of heart attacks years before traditional methods. The technology can flag indicators like inflammation, scarring, and changes in blood vessels that supply blood to the heart. When combined with traditional scans, researchers hope that the software will assist providers in early intervention and treatment strategies.

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Orig3n CEO Robin Smith pushes back against the accusations of 17 former employees who claim the genetic testing company manipulated results to cover up testing errors that led to radically different results when the same genes were tested separately for fitness and nutrition profiles. They claim to have logged 407 such errors in a sample of 2,000 tests over a three-month period, and say that marketing, rather than science, was the priority. Smith says the claims are inaccurate and that “former employees are former employees for a reason.” This is the same at-home testing company that made news last summer for failing to recognize that one customer’s DNA sample was actually from a dog.


Sponsor Updates

  • EClinicalWorks will exhibit at Health 2.0 September 16-18 in Santa Clara, CA.
  • Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
  • FormFast will exhibit at AHIMA September 14-18 in Chicago.
  • Greenway Health will exhibit at the NIHB Annual Tribal Health Conference September 16-20 in Temecula, CA.
  • Hayes hires Jessica Kender (PrismHR) as senior implementation project manager, and Julie Anne Bonee (Change Healthcare) as client success manager.
  • HealthCrowd will exhibit at the MHPA 2019 Annual Conference September 18-20 in Washington, DC.
  • Hyland will host CommunityLive September 15-19 in Chicago.
  • InterSystems will exhibit at the CIO Summit September 19 in Boston.
  • Intelligent Medical Objects will exhibit at AHIMA September 14-18 in Chicago.
  • Pivot Point Consulting names Jeff Maris (Cerner) head of its Cerner Strategic Implementation and Partnerships team.
  • PatientSafe Solutions adds enhanced security and mobile features to its PatientTouch Clinical Communication platform.
  • Prepared Health will lead a roundtable, “Becoming a Preferred Provider: Home Health’s Role in Hospital and Skilled Nursing Transitions,” at the at the Home Health Care News Summit September 18 in Chicago.
  • Vocera announces that Metro Health – University of Michigan Health has improved its stroke time to treatment from 53 to 29 minutes, in part through Vocera communication technology.

Blog Posts


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Contacts

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News 9/11/19

September 10, 2019 News 10 Comments

Top News

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Bayfront Health St. Petersburg (FL) pays $85,000 to settle Office for Civil Rights charges that it failed to provide a woman with the fetal heart monitor records of her unborn child within HIPAA’s 30-day window. This is HHS OCR’s first case brought under HHS’s Right of Access Initiative that was announced earlier this year.

The mom didn’t get the information until nine months later, and then only after she filed an OCR complaint.

The hospital is part of Bayfront Health, which is owned by for-profit Community Health Systems.

The hospital also agreed to a corrective action plan that includes revising PHI-related policies and procedures if necessary, validating its Designated Record Set Policy, training its employees who manage information requests, and providing HHS with a list of its business associates.

The settlement is important since it signals OCR’s belated interest in going after health systems that have been widely ignoring the requirement that they give patients copies of their records promptly and at a reasonable cost.


Reader Comments

From Banga Gong: “Re: physician burnout. What about other people who are burned out? You don’t read much about them.” Agreed. Many Americans are experiencing the cultural phenomenon of burnout that is caused by excessive workload, too much time wasted in conference rooms and on email, an always-on expectation of answering work messages around the clock, jobs that discourage creativity or individualism, a disconnect between accomplishment and rewards, general executive cluelessness and indifference, and employers whose social mission and human connection are coincidental at best. They make it worse by wasting endless time staring at their phones and anguishing second by second over political nonsense instead of cultivating in-person relationships, breathing fresh air, and stepping out of their consumptive role as never-rest shoppers. Therefore, I’ll take the harsh point of view that doctors who have decided to become employees are belatedly finding out that it’s not so great being an employee in the US these days, no matter how much you’re paid. Thousands of lower-earning people name email or Slack as the corporate villain for every doctor who blames the EHR for their unhappy work life. Forming a union isn’t likely to help, so the choices are to (a) find a more suitable physician job; (b) leave the profession and do something else; or (c) become self-employed. Complaining while remaining isn’t a good look, but I can understand why doctors are especially unhappy because their entire post-high school lives were structured around being gunners who earned rewards by beating others.

From Mensch: “Re: layoffs. How would readers know if a layoff seems to unfairly target more expensive workers?” They can easily go down a self-made list of newly vacant cubicles and tally the dearly departed by age group, position level, known health problems or frequent absences, etc. I’ve been involved in health system layoffs, and while HR ran our proposed IT layoff list through a discrimination testing program to make sure we wouldn’t get sued, the end result was that we just took the first run of the program to see if we had the prescribed mix of ages and males-female, then chose more younger people or females or whatever we needed to get the spreadsheet’s green light. In other words, some people were cut loose purely to balance our desire to get rid of some of their peers. I’m saying “we,” but the decision was made above my level by an executive who was new and therefore naive enough to think that his gung-ho team play would benefit him as a man of decisive action.

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From Alan: “Re: Netflix documentary ‘Diagnosis.’ See attached screen grabs. S1-E6  shows a Johns Hopkins neurologist writing a paper note in front of his Epic screen. Seems like he could have more room to write if it weren’t for that annoying keyboard.” The patient is probably happier to have the doctor at least looking him most of the time since the room arrangement doesn’t readily support showing the patient the screen while entering information. Large monitors and even projectors are super cheap and small these days, so it would be nice to have both participants looking at the same screen image as a teaching point. My tax guy has a large monitor behind his desk that we look at together when he is explaining stuff and it works great, especially since his wireless keyboard keeps him untethered.  


HIStalk Announcements and Requests

A relative of mine is a family doctor who has worked for years (not all that happily) for a multi-specialty clinic whose foreign-trained physician-owner pushes the medical staff hard to increase patient volume and keeps elevating the bonus targets. The relative says working conditions suddenly got worse recently as the clinic “got a new investor” (which I take to mean that it was sold to a big investment group), a new practice manager was installed who chews out the doctors over administrivia, and the whip is being cracked harder to make new number targets. Sometimes you forget that even modest private medical offices can be the storefront for big business.

I was also talking to a doctor friend who gets insurance from his academic medical center employer. He found when his kids went to college that his employer’s family plan offers basically no coverage outside its immediate area. I wonder how many of us know what would happen financially if we’re taken to an ED unexpectedly while on vacation several states away from home?


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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A ProPublica report finds that private health insurance companies, unlike Medicare and Medicaid, don’t pursue widespread and sometimes obvious examples of healthcare fraud because they can simply pass its cost on to consumers in the form of higher premiums.


Sales

  • Mayo Clinic signs a 10-year partnership with Google in which Google Cloud will provide Mayo with data hosting, cloud computing, analytics, and machine learning and AI.
  • Cerner signs three new CommunityWorks clients: Eastland Memorial Hospital (TX), Pawhuska Hospital (OK), and Schoolcraft Memorial Hospital (MI).

People

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BioBright, whose technology extracts medical device information for research, hires industry long-timer Edward Chung, MD (Covenant Health) as chief medical officer.

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Michael Keyes, MBA, PT (3M Health Care) joins Collective Medical as VP of health plan business development.

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Patient engagement technology vendor Conversa hires Cameron Ough, MSc (Cigna) as CTO.

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Healthcare talent management software vendor HealthcareSource names Michael Grossi (Ipswitch) as CEO. He is also a former Air Force captain in Intelligence Command.

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Cerner EVP / Chief of Innovation Jeff Townsend will retire this year after 30 years with the company.


Announcements and Implementations

A Spok survey of hospital employees on mobile strategies finds that poor wi-fi and cellular coverage remain the biggest problems, although improving. More than half of non-clinical staff still use pagers, which respondents say provide better coverage than any other communications device.

Carolina EHealth Alliance reports expanded adoption among state EDs after it switches vendors to Health Catalyst.

Apixio announces Quality Identifier, which uses AI to extract quality data elements from patient notes, scanned charts, and other documents that are then presented to abstractors for review.

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Leidos Partnership for Defense Health announces go-live of the Department of Defense’s MHS Genesis project at Mountain Home Air Force Base (ID), Travis Air Force Base (CA), Naval Health Clinic Lemoore (CA), and the Presidio of Monterey, US Army Health Clinic (CA). The project remains on track for 2023 completion, with 23 go-live waves of around three hospitals each.


Government and Politics

The Census Bureau reports that for the first time since 2014, the percentage of uninsured Americans rose in 2018 even with a strong economy.


Privacy and Security

In Canada, British Columbia’s privacy watchdog opens an investigation into Vancouver Coastal Health’s use of paging systems to broadcast patient movement data, which it says can be easily intercepted by anyone with enough technical proficiency to run software-defined radio since the information is not encrypted. 


Other

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A Washington Post article decries the lawsuits brought against patients who have unpaid bills by University of Virginia Health System, which over six years filed 36,000 lawsuits in an effort to collect $106 million. The article notes that UVA has sued 100 of its own employees, garnishes paychecks from lower-pay employers such as Walmart, and has seized $22 million in state income tax refunds as Virginia law allows. Perhaps the moral outrage could be redirected from UVA – which has broken no laws and is doing exactly what any business would do – to a national health non-system in which exorbitant provider prices collide with a patchwork insurance program in leaving some patients with medical bills – at full list price that only cash patients are expected to pay — that bankrupt them through no fault of their own. Shaming UVA publicly won’t resolve a whole lot since the problem is far greater than defining just how far that specific hospital should go in its collection practices. There’s also the issue that giving those who can’t or won’t pay a free ride just means the health system will milk the rest of us harder to compensate and help hide the real problem. It’s cute that people are still surprised that it’s not the pre-Medicare 1960s in healthcare, or that they beam at  the massive employment and architectural splendor of their local health system without questioning who’s paying for it.

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Speaking of billing practices, nephrology social worker Teri Browne, PhD describes her experience after Lexington Medical Center (SC) notifies her that it has asked the state to place a lien on her future tax refunds for the $286 she owes, with these details:

  • MyChart showed no balance due and she had received no statement.
  • She was told in her 26-minute phone call with the hospital’s billing department that the hospital’s billing company is “infamous for not sending out statements.”
  • She paid the $286, then spent another 16 minutes on the phone with the billing department, who said they didn’t see bills for the dates of service. They also told her that charge display isn’t supported by MyChart.
  • She made another call to complain formally, noting that unlike some people, she knows healthcare, she could afford to take an hour out of her workday to get the problem resolved, and she had the money to settle up what she finally found that she owed.

A Health Affairs article finds that nearly all of the highest-charging air ambulance companies are owned by private equity firms.

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From the Apple Event 2019:

  • The company announced the IPhone 11, 11 Pro, and 11 Pro Max, which mostly involve a better camera (actually three cameras on the back) and a new design, starting at $699. Unlike its competitors, the new IPhone will not offer 5G support.
  • The sixth-generation IPad was introduced, with a 10.2” display.
  • The Apple Watch Series 5 was announced, offering an always-on display, power-saving features, and a compass. The company highlighted health research projects related to hearing, women’s health, and the heart.

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Apple provides more details about the three studies being launched on the new version of its Research app:

  • Looking at menstrual cycles and gynecological conditions, performed by Harvard’s public health school and the NIH.
  • Seeing if heart rate and mobility signals can be correlated with health events, performed by Brigham and Women’s Hospital and the American Heart Association.
  • Measuring sound exposure and its effect on hearing, performed by University of Michigan.

Sponsor Updates

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  • The CoverMyMeds team helps Gladden Community House prep for its annual fundraising dinner.
  • Arcadia will partner with Cigna to present “Will Physicians Ever Welcome a Health Plan into the Exam Room” at Rise West September 11 in San Diego.
  • Artifact Health will exhibit at AHIMA September 14-18 in Chicago.
  • Clinical Architecture debuts “The Informonster Podcast.”
  • CompuGroup Medical releases version 19.9 of its LABDAQ laboratory information system.
  • Charlyn Slade joins the advisory board of Prepared Health.
  • John Halamka, MD, MS joins the advisory board of PatientPing.

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Monday Morning Update 9/9/19

September 8, 2019 News 15 Comments

Top News

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Hackers breach DDS Safe, a cloud-based records retention and backup solution that is sold to dental practices, and use it to install ransomware on the computers of hundreds of dental practices.

The two companies that created the software elected to pay the ransom and then share the unlock codes with their affected customers.

Some practices complained on Facebook that the decryption either didn’t work or didn’t restore all their data.

DDS Safe, ironically, pitches its product as protecting clients from ransomware.


Reader Comments

From Gaping Wound: “Re: AI snake oil. You’ve heard of his healthcare companies.” The founder, chairman, and CEO of Crown Sterling, which sells AI-powered encryption software, is ripped for his “sponsored presentation” at the Black Hat security conference that attendees quickly called out as incorrect, imitative, and lacking rigor. It was so bad that Black Hat pulled it from its website, admitting that its vetting process for sponsored sessions was basically nonexistent, after which Crown Sterling sued the conference for breach of its $115,000 sponsorship contract in claiming that the organizers colluded with attendees to interrupt him. The presenter was amateur mathematician Robert Grant, former president of Allergan Medical and Bausch and Lomb Surgical. He runs a growth equity firm that focuses on “the lifestyle sector of healthcare technology” such as its Alphaeon credit card for financing plastic surgery.

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From Magma: “Re: new technology. When do we need to assemble a focus group?” Focus group type activity never ends, but its membership, method, and purpose should always be changing. When developing a product, figure out who would need to be your likely internal customer advocate to get a deal signed, then randomly choose 10 people who hold that position, get them to sign an NDA and pay them if necessary, and ask them after a brief overview if they would risk their jobs to recommend spending budget money on your offering. Liking a product (or being polite in falsely claiming to) is not the same as putting your employee reputation on the line to push its purchase, so ask the right question. Early in a product’s existence, listen to the users, but don’t assume that their worldview is representative enough to simply give you a list of design features – it’s your job as a vendor to create a broadly useful product instead of letting notoriously process-challenged users take you down a rabbit hole. The easiest focus group for a mature product is the market, which is either buying it or not, and those who look but take a pass will hopefully offer feedback. The bottom line here is listen to your users when considering minor product tweaking, but show some bold leadership in doing more than just coding their self-serving feature requests.

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From Charlie Covin: “Re: Vince Ciotti interview. It brought a smile to my face since I was one of the installation directors who botched a couple of installs in the 1970s before getting it right. On the other hand, thanks to Vince and the many SMS alums for getting me started in a 40-year healthcare IT career.” Charlie’s work history includes SMS, HBO, IDX, HMA, Superior Consultant, and finally Eastern Connecticut Health Network, where he retired in 2013 after 11 years as VP/CIO. Vince has heard from quite a few industry long-timers and copies me on his replies to them. The lesson for relative industry noobs is that (a) quite a few people illogically find their way into health IT and then stick with it for life; (b) the career turns are circuitous as the industry evolves; and (c) those in the industry should create themselves a health IT network of folks and avoid being a jackass since it’s a small, close-knit community where reputations, both good and bad, travel quickly.

From Is Greed Really Good?: “Re: EHR vendors. They are finally getting called out for creating physician burnout.” EHR vendors created the product that the market demanded of them. You’ve missed the point that it’s that market that is greedy, not the software companies who operationalize its physician-unfriendly rules. In fact, I will posit that the most-responsible greed is that of physicians themselves, who happily signed up as the widget of production of insurers, lapped thirstily at the government’s Meaningful Use cash trough, and sold their practices to hospitals and private equity firms to become lackeys, all in their naive pursuit of the almighty dollar (there’s nothing wrong with that, but there’s also no reason to whine afterward). Their gates were stormed with no casualties other than the loss of a few invader dollars spent bribing their way in. Some doctors are incredibly naive despite being enrobed in professional arrogance, allowing themselves to be played like a fiddle by everyone from cute opioid drug company reps to online pharmacies that milk their obedient prescribing authority as a key business concept. They chose their bosses, their bosses chose their tools, and thus we have doctors who think EHRs missed their intended target when in fact they hit a bulls eye, just not the one they want. Hang out a shingle, stop taking insurance, use whatever EHR you want or paper charts if that makes you happy, don’t worry about federal carrots and sticks, get to know your patients even if your potential panel is only those who are willing to pay you out of their pockets, and watch the burnout dissipate.


David Meyers, MD Answers a Reader’s Question About Misdiagnosis

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A reader asked a question of David Meyers, MD following his HIStalk interview, wondering how much misdiagnosis is caused by the provider not having adequate information vs. not following clinical guidelines. Also, whether how much of the needed information could come from the EHR vs. from further tests or surgery. David provides this response:

There are no simple answers to the questions, because there is no single diagnostic approach that describes the entirety of identifying the cause of a patient’s illness. Identifying a lesion on an X-ray or CT scan, or a rash on a patient’s skin or cancerous cells on a pathology slide are different from the process of collecting information from a patient about her symptoms and signs via the history of the illness, the physical exam and diagnostic tests, and synthesizing a diagnosis from that information. But all are forms of diagnosis subject to error.

The diagnostic process can be viewed as having two broad elements – individual / human factors and system factors – which interact to lead a clinician to a name for the patient’s illness. While data on the frequency of misdiagnosis is uncertain and dependent on the setting and source of the information (hospital, clinic, autopsy reports, self reports, malpractice data, etc.) the range of frequency of misdiagnosis is thought to be somewhere between 5 and 30%.

In an attempt to identify the causes of diagnostic errors and their frequency, Schiff and colleagues published an analysis of 583 diagnostic errors (mis-, missed, and delayed diagnosis) self-reported by physicians in response to a questionnaire (Diagnostic Errors in Medicine, ARCH INTERN MED, 169:1881-87 (2009). Using a tool to specify where in the diagnostic process an error occurred, they found that test-related factors (delay in testing, wrong tests and dealing with the results accounted for 44% of the diagnostic errors; ~30% were related to assessment and synthesis of the data obtained. The most common process failure was failure or delay in considering the diagnosis. These are largely on the individual / human factor side, although system factors such as lack of time to spend with the patient, distractions, fatigue, flawed results reporting processes, lack of access to old medical records, etc. also play significant roles.

Most EHRs currently in use are seen as inadequate to the needs of the doctors, nurses, and others who use them. Created primarily to be tools for billing, they are not yet clinician-friendly and usable enough to allow for easy navigation to find information, nor are they sophisticated enough to synthesize the data and help the doctor craft a list of important diagnostic possibilities. There are, however, several apps called differential diagnosis generators which can give a list of possible diagnoses when information on symptoms and physical findings is put in by the physician. There are also versions of these apps available to patients. 

And in terms of powerful forces to reduce diagnostic errors, an engaged and informed patient is thought to be one of the strongest. Asking “what else could this be?” and other questions can be a very useful way for patients to influence the doctor’s thinking. See the “Resources for – Patients” link on the web site of the Society to Improve Diagnosis in Medicine for a toolkit to use at the visit with the doctor.


HIStalk Announcements and Requests

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An encouraging one-fourth of poll respondents credit their mobile device with life-changing health improvements. Folks called out MyFitnessPal and Fitbit for tracking nutrition and heart rate, smart watch integration with continuous glucose monitoring, drug management, patient portal communication, Kardia for monitoring atrial fibrillation, the 7-minute workout, and Pokemon Go and 5K training apps.

New poll to your right or here: Has your employer conducted a layoff in which older or sicker employees seemed disproportionately represented?

I’m amused at hospitals that brag that they chose their new executive after a “nationwide” search, like they sent teams out to scour every backwater town for candidates. Are the locals impressed that they didn’t just run a Craigslist ad or hang a flyer on the town lamppost?

Virtual show of hands – who knew that GroupWise email is still being sold and maybe even being used by some hospitals?


Webinars

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

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

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


Decisions

  • United Health Services (NY) will go live with Epic in 2020.
  • Big Sandy Medical Center (MT) will go live with Evident in October 2019.
  • Crozer-Keystone Health System (PA) will switch from Cerner Invision to Cerner Millennium in 2020.
  • Missouri River Medical Center will replace MedWorxs with Evident EHR in October 2019.
  • Logansport Memorial Hospital will implement Cerner on May 1, 2020, replacing Meditech.

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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Curt Thornton (Quantros) joins Healthx as chief revenue officer.


Announcements and Implementations

Sioux Lookout Meno Ya Win Health Centre goes live on the new Vocera Smartbadge.


Privacy and Security

AMA describes its ideal privacy framework that places the patient first in supporting their fundamental right to obtain their complete medical record, but they believe those same patients aren’t smart enough to “understand what they are consenting to when they grant permission to an app to access their information.” AMA also wants the federal government to require EHR vendors to vet API data access requests and to give requestors only the information they need, such as insurers that request the entire medical record for unrelated data mining and threatening to file a data blocking complaint if they don’t get it. I’m finding myself sort of agreeing with AMA, although they don’t do a good job convincing patients that their motivation is anything but self-serving.


Other

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A reader alerted me to a new HFMA podcast (#2 in the newly launched series) in which Epic CEO Judy Faulkner is the interviewed guest. I enjoyed it despite the podcast’s imitative “we’re just chatting over coffee” format that puns the host’s name (HFMA CEO Joe Fifer). Fun items from the fairly short and breezy conversation:

  • Judy says it was hard for her husband to see her change from wearing jeans and tee shirts with no makeup to dressing professionally when she started Epic.
  • She had to figure out how to write contracts, policy manuals, and budgets (“we don’t have any”), and whether to accept outside investment or go public (“nope”).
  • She says a visiting HR VP asked her how to maintain the culture, and she said “nothing,” with Judy claiming to be unaware that Epic’s culture is different from that  of other companies. Judy teaches a six-hour course on company culture and each person’s role in it.
  • Skipping a monthly staff meeting requires the employee to get a signoff from their team lead, President Carl Dvorak, and Judy herself.
  • She asks employees to choose the top reason they are there, and while new hires usually chose “money” because they haven’t seen the big picture yet, they need to eventually understand that everybody’s #1 answer should be the same as Judy’s as “the customer.”
  • It’s always a challenge to stay focused on strategic items despite fires that need to be fought. She says it’s the Yellow Brick Road and you just have to keep walking on it. When she has to make a good decision, she looks ahead 25-50 years, decides “what would be good for those folks,” and then works back.
  • She doesn’t think about employees as young – they are hired from tests in which they prove that they are articulate and competent, and once hired and trained, they are treated like everybody else.
  • Epic does not have budgets, instead advocating, “If you need it, buy it. If you don’t need it, don’t buy it.“ She developed that practice when someone told her they needed to spend $2 million of leftover budget and couldn’t return it because they would then get $2 million less the next year. Or they needed to buy something immediately, but didn’t have the budget. “Let’s not go that path,” she said. If someone makes a mistake in spending judgment, she likes to catch it early so the person can learn from it.
  • Judy laughed when asked how she avoids thinking she’s done everything she can do with Epic, asking, “Is this a joke?” She says there are always new areas and new projects, so now Epic is working harder on claims and adjudication, specialty labs, retail clinics, research via the Cosmos program, and new types of customers.
  • “The thing that bugs me is that I haven’t found a test for [curiosity],” since results come from curiosity paired with aptitude.

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Alex Scarlat, MD – who wrote the HIStalk “Machine Learning Primer for Clinicians” series – suggested that I take a look at UMLS.me, a free website that extracts 5.7 million Unified Medical Language System concepts from free text, all from within a browser window (which then also supports voice input). Above is my result from pasting in a medical school’s sample HPI.

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@Farzad_MD and @EricTopol question a study run by JAMA Dermatology that claims an AI model can predict non-melanoma skin cancer by looking at EHR data such as diagnoses and ordered medications, noting that only 1,829 patients were analyzed, the risk prediction covered only one year even though most cancers grow slowly, the control group was chosen in a scandalously unsound manner, and the model was heavily dependent on the medication list even considering that most meds are not relevant to skin cancer. Note to journal editors and investors – hire an expert in statistical analysis and AI to vet claims instead of assuming that the author or founder knows what they’re talking about and is being honest about it, or at least get peer reviewers who can sort it all out. 

A study published in Lancet Digital Heath finds that clinicians with no experience in medical coding or deep learning can create clinical classification algorithms that perform well at diagnosis.

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England’s Daily Mail cooks up a clickbait headline to describe for a rather benign development – EDs will give patients a four-minute, tablet-based questionnaire to answer questions about their complaint to save nurse time. The paper dragged up a professor to make a generic, mostly irrelevant statement decrying computers replacing clinicians. Here’s where newspapers and news websites are guilty of the “fake news” claim – the headline screams that the practice is “controversial” because it goaded one guy into saying so, then later claiming that “NHS bosses were condemned” for recommending the use of Alexa for obtaining health information without saying exactly who condemned them and to what extent. I’m wary of any publication that makes ridiculously unquantified statements in claiming response from “the XXX community” or claiming some broad support or criticism in trying to push their own conscious or subconscious agenda (whether it’s political or simply to force readers to click by misleading them). My guess in this case is that it’s the same questions a nurse would ask but who would add little value in simply writing down the answers.

A nursing instructor and author declares in her New York Times opinion piece that the American medical system is “one giant workaround,” as executives mandate policies and procedures that don’t work or take too much precious time. She calls out the use of scribes to work around EHR design flaws, mentions medication barcode scanning problems that force nurses to cheat, and claims that the Affordable Care Act is a kludge that works around our reluctance to provide healthcare to all citizens.


Sponsor Updates

  • LiveProcess and Mobile Heartbeat will exhibit at Disaster Planning for California Hospitals 2019 September 10-11 in Pasadena.
  • SailPoint names Matt Mills (Oracle) as chief revenue officer.
  • Meditech will host the 2019 Physician and CIO Forum September 18-19 in Foxborough, MA.
  • Waystar will exhibit at the Universal Software Solutions Users Conference 2019 September 10-11 in Grand Rapids, MI.
  • Netsmart will exhibit at the ACMHCK Annual Conference September 11-13 in Wichita, KS.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Ohio 2019 Section Conference September 12 in Cleveland.
  • PatientKeeper will exhibit at AHIMA19 September 14-18 in Chicago.
  • T-System will exhibit at the2019 TORCH Fall Conference & Trade Show September 10-12 in Cedar Creek, TX.
  • Prepared Health will exhibit at Health Catalyst’s HAS19 Digital Innovation Showcase September 10-11 in Salt Lake City.
  • FDB adds Redox’s API to its Meducation app, giving users the ability to transfer patient data from the app into Epic.
  • Surescripts will exhibit at the 2019 Health Care Executive Group Annual Forum September 9-11 in Boston.
  • National Decision Support Corporation Product Manager Ben Gold will co- present “Buy vs. Build in Establishing a PBM Program” September 19 at the Society for the Advancement of Blood Management conference in Baltimore.

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News 9/6/19

September 5, 2019 News 4 Comments

Top News

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Cerner will lay off 255 workers across roles and offices by November 5 as part of a cost reduction program that is intended to boost the company’s profitability.

Cerner announced a hiring freeze this past April and pledged to achieve operating margin targets of 20% for Q4 2019 and 22.5% for Q4 2020. This came in response to Cerner’s April 2019 “cooperation agreement” with activist investor Starboard Capital, which despite holding just 1.2% of outstanding CERN shares, was given four board seats and promises to improve profits. Starboard has since started selling off some of its CERN shares as their price increased.

Rumors suggest that separated employees will received eight weeks’ salary plus and additional two weeks of pay for each year of service. They will also be paid for unused paid time off.

The company says it will hire hundreds more employees by the end of the year.

Meanwhile, the Kansas City Business Journal reports that the company continues to pay former president Zane Burke $112,000 a month as part of a $2.7 million severance package.


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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Digital prescription savings and patient engagement company OptimizeRx will acquire cloud-based digital therapeutics vendor RMDY Health for $16 million.

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PCare, a Lake Success, NY-based interactive patient experience software vendor, acquires digital rounding and real-time patient feedback technology company TruthPoint.

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Health Recovery Solutions raises $10 million in a Series B funding round led by Edison Partners. The Hoboken, NJ-based remote patient monitoring company has grown to 80 employees and raised $16 million since launching seven years ago.

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Lab-testing startup UBiome files for bankruptcy, inspiring a plethora of excrement-inspired jokes and Theranos comparisons on Twitter. The San Francisco-based business — which placed its co-CEOs on administrative leave and  laid off staff earlier this summer amidst an FBI investigation into its billing practices, among other purportedly bad business dealings — will use an $8 million bankruptcy loan to stay afloat until it can find a buyer. CVS has reportedly put a halt to sales of the company’s at-home gut health testing kits.


Sales

  • The AsOne Healthcare Independent Practice Association in New York City selects Netsmart’s CareManager population health management technology and services.
  • Guthrie will implement POC Advisor from Wolters Kluwer Health to better enable the detection and treatment of sepsis at its four hospitals in New York and Pennsylvania.
  • In North Carolina, Cone Health and the Triad Health Network of community physicians will implement advance care planning technology from Vynca.

People

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Former PatientKeeper CEO Paul Brient joins Athenahealth as chief product officer.

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In Australia, EHealth Queensland names hospital executive Damian Green CEO and CIO. Green takes over from Richard Ashby, who resigned eight months ago amidst continued provider pushback against the statewide IEMR rollout and accusations of improper conduct with a staff member. Green will oversee the continued rollout of the Cerner software, a project that has been put on hold until 2021 as the agency sorts out patient safety and budgeting issues.

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Life sciences compliance software vendor MediSpend hires Craig Hauben (Ciox Health) as CEO.


Announcements and Implementations

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WellSky develops predictive analytics for home healthcare providers that combines population health with patient-specific data.

CNBC reports that Verily is working with wearable heart monitoring company IRhythm to develop a wearable for people at risk of atrial fibrillation. Verily Head of Clinical Science and Neurology William Marks, MD has said the device will be developed with physicians – and their aversion to unnecessary data – in mind

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Elsevier will use a rare disease database created by NIH’s National Center for Advancing Translational Sciences in its development of a Web-based diagnostic tool.that will take into account patient symptoms, medical histories, and predilection to certain rare diseases.

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Datica announces GA of Integrate, new API integration software that ensures secure compliance with interoperability standards.

Urgent care clinics within St. Mary’s Health Network (NV) implement Carbon Health’s patient engagement and virtual care software.

Politico reports that the Florida HIE has turned on the state’s Emergency Census Service, developed by Audacious Inquiry, to help public health officials locate people displaced by Hurricane Dorian.

AMA releases 2020 CPT, which includes 248 new codes, 71 deletions, and 75 revisions. Several of the new codes cover digital communications, such as patient portals.


Government and Politics

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Montana Governor Steve Bullock signs an executive order allocating $19 million towards the funding and development of the Big Sky Care Connect HIE. The nonprofit will hire a vendor to manage its data network later this month. While Big Sky is now the state’s official HIE, it’s not its first. HealthShare Montana was established with HITECH funding, but later shut down over governance and technology issues.


Privacy and Security

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European advocacy group Privacy International discovers that Web-based mental health services in the UK, France, and Germany have been selling user data to third parties for ad targeting without permission. Google, Facebook, and, to some extent Amazon Web Services were top purveyors of data.


Other

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The Commons Project, UCSF Health, Open MHealth, and other groups will develop CommonHealth, an Android alternative of IOS-only Apple Health Records. It will be the first project of non-profit Commons Project Foundation, which will build public-benefitting digital projects that are free of third-party financial interests. The organization’s leaders have healthcare experience in companies such as Wellpass, Sapiens Data Science, and Surescripts.

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Healthcare investor Garen Sarafian isn’t impressed with an American Hospital Association-commissioned article that claims hospital mergers decrease costs and increase quality. He notes that the piece was not peer-reviewed, the authors chose which hospitals to study, and data used consisted entirely of responses to interview questions posed to executives of those same hospitals. He summarizes, “Look at the appendix survey questions starting from the title in the full report and you’ll be appalled.” (see above sample).


Sponsor Updates

  • EClinicalWorks and Greenway Health will exhibit at ASCENT 2019 September 8-11 in Austin, TX.
  • Ensocare will exhibit at the ACMA Illinois Chapter Conference September 17 in Rosemont.
  • HealthCrowd will exhibit at the NASP 2019 September 9-11 in Washington, DC.
  • Healthcare Growth Partners publishes its “Health IT August Insights.”
  • Healthfinch publishes a new case study featuring The Guthrie Clinic, “Improving Efficiencies and Reducing Provider Burnout with Refill Technology.”
  • Healthwise will exhibit at the Medicaid Managed Care Summit September 9-10 in Scottsdale, AZ.
  • Kyruus will exhibit at SHSMD Connections September 8-11 in Nashville.
  • Prepared Health will exhibit at Health Catalyst’s Healthcare Analytics Summit September 10-11 in Salt Lake City.
  • Spok publishes a new infographic, “Cloud Computing in Healthcare.”
  • Intermountain Healthcare (UT) expands its use of SymphonyRM’s AI-powered HealthOS Platform to its new kidney services program and clinic.
  • DrChrono adds Relatient’s patient engagement technology to its tablet-based EHR and practice management software.

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News 9/4/19

September 3, 2019 News 3 Comments

Top News

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ONC chooses The Sequoia Project as Recognized Coordinating Entity for TEFCA, where it will manage the Common Agreement component of the Trusted Exchange Framework and Common Agreement. It will also work with ONC to manage Qualified Health Information Networks. 


HIStalk Announcements and Requests

I’ve enjoyed doing some recent interviews whose subjects were iconoclasts, rogue thinkers, or just all-around troublemakers. I need more of those to supplement my usual roster of vendor executives, so if you are one or can recommend one, let me know.

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

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Webinars

September 5 (Thursday) 2:00 ET. “Driving 90% Patient Adoption Across Your Network: How US Dermatology Partners is Showing Us The Way.” Sponsor: Relatient. Presenters: Michele Perry, CEO, Relatient; Sara Nguyen, VP of applications and integrations, US Dermatology Partners. US Dermatology Partners is helping its physicians reclaim time they can spend with patients and is turning patient engagement strategies into business results across its 90 locations in eight states. Attendees will learn how US Dermatology Partners defined its patient engagement objectives and physician-optimized strategies. They presenters will provide advice on starting or accelerating  patient engagement goals.

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

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

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


Acquisitions, Funding, Business, and Stock

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“Teledentistry” vendor SmileDirectClub, which sells $1,900 clear teeth aligners that cost a fraction of traditional braces – prescribed remotely by contracted dentists who review photos and self-made bite impressions — files for an IPO that values the company at $8 billion. Shares owned by the co-founders, who are aged 29 and 30 and who met at summer camp, will be worth $1.5 billion and $1.4 billion, respectively.

A Black Book review of global EHR usage finds that Allscripts outperforms other vendors in the UK, Australia, and Canada in getting implementations finished on time and budget, while Epic is first in Southeast Asia and the Middle East. Cerner’s only #1 finish was in Africa.


Announcements and Implementations

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Mayo Clinic prepares to open its first UK clinic in collaboration with Oxford University Clinic, first announced in late 2017. The London clinic will use Oxford’s Cerner Millennium EHR rather than Mayo’s Epic.

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Vocera announces Vina, a smartphone app that prioritizes patient-centric calls in an inbox that also includes secure messages and alerts.

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Ellis Medicine (NY) goes live on Cerner Millennium, assisted by Optimum Healthcare IT.


Privacy and Security

Temple University Health System restores its systems following a cyberattack last week.


Other

The American Medical Association, American Hospital Association, and other healthcare groups request changes to proposed HHS rules that would require hospitals to share medical records with patients via their smartphone apps such as Apple Health Records. The groups think patients won’t understand that their downloaded information could be accessed by other apps, insurers, or employers since privacy protections would no longer apply. Taking the opposing viewpoint is National Coordinator Don Rucker, MD, who says it is self-serving for hospitals and practices who might benefit from holding patients and their data hostage to play up privacy concerns.

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The New York Times runs an obituary of Donald A.B. Lindberg, MD, who died of fall-related complications on August 17 at 85. It notes that his medical informatics career included heading the National Library of Medicine, where he gave users access to research and genomic information and launched its website, one of the federal government’s first, in 1993. He helped create the National Center for Biotechnology Information; launched the “Visible Human Male” and “Visible Human Female” series of cadaver images; opened up NLM resources to online and API access through services such as PubMed and ClinicalTrials.gov; and served as AMIA’s first president.   

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Carlsbad Medical Center (NM) has sued 3,000 patients over unpaid medical bills, earning the 115-bed hospital an unflattering profile in The New York Times. The hospital, which is owned by for-profit Community Health Systems, is the only hospital in town, with one big local employer running numbers proving that it would be cheaper for them to send a gall bladder patient and their guest to Hawaii for surgery — including airfare and a seven-day cruise for two — than to send them to CMC. Private insurers pay the hospital five times the Medicare price, double the state average.

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I receive an email pitch today for discounted HIMSS20 hotels from Conventioneers US, apparently one of several companies that obtain conference registration lists without authorization to offer prices lower than the conference’s own housing bureau. I found a bunch of conference sites claiming that such organizations are “housing poachers and data scammers,” but all of those came from the conference organizers (who lock up all the rooms to sell themselves) instead of from individuals who were defrauded. Still, the HIMSS site has the Westgate Palace at $186 vs. the email’s claimed $175 rate, so I’m not seeing the reward to be sufficient for the risk of showing up in Orlando with no room at the inn. Years ago you could beat HIMSS prices pretty easily, at least for those hotels that HIMSS didn’t buy out completely, but I don’t think that has been the case for a long time.

A physician’s editorial says that high hospital bills are the biggest driver of out-of-control US healthcare spending, but hospitals are politically untouchable because: (a) they donate a lot of money to politicians; (b) they have become the biggest employers in some cities, especially in the rust belt; and (c) voters don’t see them as villains as they do drug companies and insurers. She notes big medical centers make high profits that they use to build more cancer clinics, boost CEO pay, buy unneeded medical gadgets, and “install spas and Zen gardens,” but they don’t deliver any better outcomes than their less-expensive counterparts in other countries.

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The only-in-Texas phenomenon of high schools building football stadiums that cost dozens of millions of dollars and then selling expensive naming rights includes one whose new $53 million stadium bears the name of Children’s Health in a $2.5 million, 10-year deal, as another high school charged Mansfield Methodist Hospital $575,000 for 10-year naming rights. Another district’s $60 million, 18,000-seat high school stadium includes among its sponsors an unnamed hospital system in a Nascar-like (or HIMSS-like) branding program in which sponsors can plaster their names just about anywhere for the right price. 


Sponsor Updates

  • Boston Software Systems announces intelligent automation for hospital laboratories and their externally linked facilities.
  • Datica will exhibit and present at Health 2.0 September 16-18 in Santa Clara, CA.
  • CoverMyMeds will exhibit at Future Pharma September 9-10 in Boston.

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Reader Comments

  • Vaporware?: Or this from Donald Trigg, Cerner EVP of Strategic Growth: "Our global market share, our clinical research practice and...
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  • Data Business: I agree it is patient's data but that is not the business model in other industries. What about credit information? Isn'...
  • X-Tream Geek: @My Data - I agree with you that it is solely the patient's data. What bothers me is that many hospitals willingly give...
  • GoodFirstImpression: If you bought Athena inpatient, you are probably a 25 bed hospital in the rural midwest or Texas. Those places are pilla...
  • Roberto Duran: re Segert's inpatient hospital systems response: "We are not actively selling that in the marketplace today. We are red...
  • Math: Per news articles, Epic's data warehouse, Cosmos, uses deidentified data. So not exactly the same as Google here....
  • HIT Observer: Im sorry, but EPIC and CERNER are THIRD PARTIES!!!!!!!!! Their clients deployment of their software is their clie...

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