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News 1/30/19

January 29, 2019 News 2 Comments

Top News

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FDA Commissioner Scott Gottlieb, MD says in an address to the Bipartisan Policy Center that “digital technologies are one of the most promising tools we have for making healthcare more efficient and more patient focused.”

He added that streams of real-world data from EHRs, devices, and medical claims can provide important safety and effectiveness information beyond randomized controlled trials.

Gottlieb says that adding real-world data into regulatory quality programs is a “key strategic priority for the FDA.”

FDA will:

  • Convene stakeholders to develop a framework for incorporating digital systems into clinical trials oversight
  • Bring clinical trials to the patient using data from EHRs and wearables
  • Use software-based learning to analyze real-world data to suggest drug labeling changes
  • Work with universities to develop an FDA curriculum on machine learning and artificial intelligence and to offer a post-doctoral fellowship on AI tools

HIStalk Announcements and Requests

Filling in your HIMSS19 dance card? Check out what HIStalk’s sponsors will be doing there in “HIStalk’s Guide to HIMSS19” (online) or downloadable as a PDF file here. Spoiler: they will be doing presentations (with customers in many cases), cocktailing, donating to worthy causes for each booth attendee, and giving stuff away.

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Also for your HIMSS19 list, please drop by our unbelievably tiny and sparsely furnished booth (#4085), perhaps multi-tasking by swinging by on your way to the adjacent restroom. No swag, no BS, just Lorre (who’s stuck solo in there all week) saying hello and the usual cadre of really cool industry people who seek us out. We have nothing to sell and little to give away, although I expect that our friends at Arcadia will again provide the ever-popular conference first aid kits.

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Perhaps you’ve basked in the verdant Wisconsin summer moments between sessions of Epic training or UGM, fantasizing about drowsing away an afternoon in the company treehouse or spending a lazy day baring souls with Judy over Chardonnay (a milkshake in her case) in a swing chair as the Epic herd grazes contentedly below in the fragrantly rolling fields. Visitors this week will instead be dashing dangerously from bus to building, appreciating only the geothermal heating and the countless fireplaces that adjoin training rooms. Many of us aren’t thrilled about going to HIMSS19, but Orlando’s blue sky and green grass with highs in the mid-70s are probably sounding pretty good right now to Epic employees as they watch their exhaled breath shatter.

Speaking of weather, the AP Stylebook reminds me of yet another pet peeve, this one involving immaculately coiffed TV weather celebrities. It’s the weather that gets warmer, not the temperature (temperatures, or “temps” as they sometimes say, merely increase). I watch zero broadcast TV except when I’m stuck somewhere, but I’m always amazed at (a) the near-ubiquity of “scare weather” intended to keep people panicked in tracking the steady march of certain Armageddon in the form of a few minor impending flurries or sprinkles; and (b) milking what should be a 10-second update (temperatures now and for the next couple of days, chance of rain or snow) into a grinning, gesticulating, graphics-heavy spiel that lasts several minutes as advertisers wet themselves from excitement. I’m also puzzled (not quite annoyed since I haven’t figured it out) by the suddenly rampant use of the word “inform” in odd ways , such as “to inform product strategy.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Zebra Technologies will acquire healthcare temperature monitoring solutions vendor Temptime.

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Philips will try to dodge trade war tariffs by swapping production to and from the US and China in the first half of 2019. An analyst likes the company’s recently reported numbers, but says that “Connected Care & Healthcare Informatics was, like previous quarters, well below expectations.”

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Interesting: the merging Catholic Health Initiatives and Dignity Health (set to become CommonSpirit Health this week) operate hospitals in 21 states, but none of them are in Illinois even though the combined organization will have its headquarters in a fancy office building on Chicago’s West Loop. A CHI spokesperson says the Chicago office “will house the office of the CEO” even though the 150,000 widgets of production will stay in their non-Illinois trenches. That’s not the stupidest part of the new organization’s plan – the CEOs of both merged organizations will become co-CEOs of the new one, a democratic mess that always results from mergers that one side won’t approve if the other side gets the big chair or more board seats. Co-CEO Kevin Lofton (paid $6.8 million by CHI in the most recent tax year) sits on the board of a drug company and Rite Aid, while Co-CEO Lloyd Dean (his side of the “ministry” paid him over $10 million last year) serves on the board of McDonald’s, so they can do their business stuff far from paying patients. The non-profit, merged ministry’s 140 hospitals will crank out an unholy annual revenue of $28 billion. While I was poring over tax records, I noticed that former Dignity CIO Deanna Wise outearned some of the hospital presidents at an eye-popping $2.3 million for the most recent tax year, eclipsing her CHI counterpart Michael O’Rourke’s $1.3 million. Deanna’s new employer Banner Health paid her CIO predecessor Ryan Smith around $900K.  

Patient scheduling website Zocdoc will start charging physician subscribers for each new patient who books an appointment, abandoning the flat-priced subscription model that has been in place since 2012. One dermatologist says that a new patient appointment will cost him an unsustainable $35. The CEO of the Jeff Bezos-backed Zocdoc helpfully advised that half of New York subscribers would pay less (meaning that .. well, it’s pretty obvious) and adds this insultingly dumbed-down excuse as to why the fee structure the company itself developed now makes no sense since it leaves money on the table: “Providers who receive a greater volume of bookings from our Marketplace have benefited the most from this flat fee structure. However, it has been a less sensible economic decision for the many providers who received fewer bookings via our Marketplace.” Punishing your best customers isn’t usually the soundest business strategy.

Apple reports Q1 results: revenue down 5 percent, EPS $4.18 vs. $3.89, beating expectations for both. The company has stopped reporting individual product unit sales that would likely be embarrassing in the case of the IPhone, whose sales revenue dropped 15 percent year over year, a situation Apple blames on China’s economic uncertainty instead of offering a premium-priced product in a commoditized market. Services revenue was flat at $10.9 billion, representing  13 percent of total revenue.


Sales

  • Summit Healthcare (AZ), an 89-bed specialty provider, chooses Allscripts 2bPrecise for precision medicine. The hospital is also replacing Allscripts Paragon with Sunrise.
  • West Calcasieu Cameron Hospital (LA) will implement Wellsoft EDIS.
  • Northeastern Health System (OK) selects the IntelliGuide financial advocacy and patient eligibility system from PatientMatters.
  • Orlando Health is implementing Collective Medical’s EDie help its ED clinicians identify and support patients at risk of opioid use disorder and those exhibiting opioid-seeking behavior. 

Announcements and Implementations

A former IBM VP says the company fired her after she warned her bosses that their layoff plans would expose the company to age bias lawsuits. She also says she ordered to ignore the federal government’s request to provide the names of those employees over 50 who were laid off from her Nevada business unit as the company attempted to “correct seniority mix.” Catherine Rodgers offers a simple way to resolve the issue: “IBM is a data company, Release the data.” 

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Health Catalyst releases Rapid Response Analytics Solution, which reduces the time required to develop analytic insights by 90 percent by allowing less-technical people to answer their own questions.

Clinical Architecture releases Symedical 2.1 for clinical content management.


Government and Politics

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The VA’s Office of Electronic Health Modernization is recruiting deputy chief medical officers holding the MD/DO degree and state medical license to share EHR best practices, oversee EHR change management, and coordinate with their DoD counterparts. The four-year term positions pay $145,000 to $245,000 per year and require relocation to Washington, DC, Seattle, or Kansas City.

Walgreens will pay $209 million to settle federal charges that it defrauded Medicare and Medicaid by dispensing more insulin pens to patients than their prescriptions called for, falsified claims information, and programmed its pharmacy computer system to prevent its pharmacists from dispensing less than a five-pen box regardless of the quantity actually ordered.


Privacy and Security

Facebook blocks crowdsourced tools that allowed journalists and the public to see how its advertisers – especially those running political ads — target users. Facebook says the change was necessary to protect user privacy under its terms of service.

Singapore’s Health Ministry says the medical records of 14,200 people with HIV were posted online by a previously jailed and deported American who had lied to officials about his own HIV status. Authorities think the information was obtained by the man’s lover, a doctor who formerly headed up a public health unit until he was fired for submitting his own blood samples so that his partner wouldn’t be fired.


Other

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China’s Ping An Health Medical Technology Company installs one of its unstaffed “One-minute clinics” (they don’t really pay attention to US trademarks like MinuteClinic over there) in a highway rest stop, offering drivers and passengers medical advice and prescription drugs that have been “cryogenically refrigerated to ensure their quality.” It’s basically a drug vending machine attached to a Porta Potty-like telemedicine booth. “Cryogenic” actually means using temperatures lower than –238 degrees Fahrenheit, which if the announcement were true would be great for those who enjoy watching liquids explode.

Stanford researchers, including iconoclast John P. A. Ioannidis, warn that healthcare “unicorns” like Theranos often have not published peer-reviewed studies to prove their claims, reiterating a previous definition of “stealth research” in which seemingly brilliant ideas are packaged within aggressive corporate announcements and mass media hype rather than any forms of transparency, accountability, and credibility that might help identify investment thesis holes that range from irrational exuberance to outright fraud.

In Australia, a newspaper’s investigation finds that Queensland Health’s Cerner ieEMR EHR project continues to struggle with mislabeled specimens, missing data, medication errors, and vanished test results. Clinicians in critical areas such as ICU and anesthesia are struggling most after replacing their best-of-breed products. Cost has risen from the original 2017 estimate of $428 million USD to nearly $1 billion today,. Cerner was given a no-bid contract for the project. EHealth Queensland is under investigation by the Crime and Corruption Commission. 

Also in Australia, SA Health will make immediate changes to its Allscripts-powered EPAS project — including applying an upgrade and “rebranding” the system – after an external report criticizes the project’s lack of accountability, poorly articulated clinical benefits, underuse of expert consultants, and lack of physician involvement. The government advocates starting over at two sites to decide whether keep Allscripts, also indicating that it will scrap the billing module for a system specifically built to meet the needs of hospitals in Australia. The project has consumed $229 million of its budgeted $301 million at the 25 percent completion mark. Politicians are arguing whether the software or the implementation is the problem and whether changing the project’s name is just a way of saving face.

You would think marketing people would know how to craft a message that doesn’t instantly make the rest of us roll our eyes, but Illinois Medical District innovation community decides that “launching a new brand identity” is newsworthy, bragging on its “clear, concise, and arresting new creative assets” and reiterating that it offers “the full suite of new branding assets” (the announcement gratingly uses the word “assets” four times in six paragraphs). Change your brand identity all you want, but expect universally negative reaction for thinking that (a) it’s important news; and (b) an announcement is necessary at all, no different than someone issuing a press release touting how much better they look after finally getting new clothes.

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A new book tells the story of Paul Le Roux, a South African computer programmer who made hundreds of millions of dollars selling opioids and other prescription drugs to US customers without ever setting foot here, dealing with small-town accomplices (doctors and pharmacists) who solved his “last mile” problem for cash as customers found his online pharmacies via paid search engine ads. His cartel was run from a laptop, openly publishing pharmacy websites whose ownership was obscured by the domain registrar and servers that be created himself. He branched out into dealing arms; created a fleet of yachts, planes, and drones to move hard drugs around the world; set up his own militia in Somalia; bought gold and laundered money; and hired mercenaries to collect money and kill opponents. He was caught by the DEA in a sting operation after a 10-year investigation by young Minneapolis DEA diversion investigator named Kimberly Brill. This “Breaking Bad” type story has Netflix written all over it.

A woman sues a hospital, claiming that she gave her permission to turn off life support for her brother, only to find that the patient she had been visiting for days was someone else with the same name and similar appearance. Family members gathered to say goodbye to Fred Williams as he died, only to find out as they were making funeral arrangements that their Fred Williams was actually in jail for assault — they had authorized pulling the plug on someone else’s Fred Williams.


Sponsor Update

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  • Audacious Inquiry employees take part in the MLK Day of Service.
  • AssessURHealth will exhibit at the Greenway Health User Exchange February 5 in Atlanta.
  • CoverMyMeds will exhibit at the NACDS Regional Chain Conference February 3-5 in Palm Beach, FL.
  • Divurgent publishes a new white paper, “Navigating Healthcare Through Today’s Cybersecurity Landscape.”
  • Hospital application performance and availability monitoring technology vendor Goliath Technologies achieves its ninth consecutive year of record growth.

Blog Posts


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Contacts

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

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Monday Morning Update 1/28/19

January 27, 2019 News 6 Comments

Top News

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Sleep apnea equipment and connected health vendor ResMed turns in Q2 results: revenue up 8 percent, adjusted EPS $1.00 vs. $1.00, meeting earnings estimates but falling short on revenue, sending RMD shares down an alarming 19 percent on Friday for a market cap of $13.5 billion. They’re down 8 percent in the past year vs. the Dow’s 6 percent loss, but have more than doubled over the past five years.

The company’s recent health IT acquisitions include Propeller Health, HealthcareFirst, MatrixCare, and Apacheta. It also acquired Brightree in 2016.

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ResMed said in the earnings call that the Propeller Health acquisition gives it a big footprint in the management of high-cost lung disease and also ties in well with ResMed’s at-scale digital health for sleep.

The company will spend $7 million per quarter to fund its joint venture with Verily to identify and enroll sleep apnea patients.


Reader Comments

From Stat of the Onion: “Re: readership. My co-worker and I have a bet on the number of visitors you get on HIStalk.” It runs about 1.8 million unique visits per year, although my vanity requires me to say that I intentionally don’t publish in ways that would boost the numbers in a misleading measure of influence (more frequent posts, individual articles instead of one summary, etc.) I rarely look at the stats and thus am not tempted to use reader-unfriendly gimmicks to increase them.

From Blast Furnace: “Re: Facebook. What happened to your page? Did you change pages or just stop updating it? Can I only see your posts on your website now?” I was using Facebook and LinkedIn only as a cc: for tweets indicating that I’ve published something new, but my third-party tools that made it easy kept breaking because these vendors are always fighting against apps they fear will rob them of user screen time, so I only send updates using Twitter and email updates now. Plus I feel more virtuous not using Facebook and LinkedIn because I kind of hate them both, while I’m only indifferent to Twitter.

From Toxic Waist: “Re: HIMSS19 slogan of ‘Champions of Health Unite.’ What do you think about it?” My kneejerk reaction: (a) they are misunderstanding or misusing the word “champions;” (b) attendees are mostly interested in the profitable business of healthcare rather than the human state of health; and (c) “unite” suggests that HIMSS19 is the convener of every one of these champions when clearly it is not. It’s tough trying to come up with a slogan that attempts to describe the wildly varying healthcare interests of a diverse group, but even more to come up with something that doesn’t sound overwrought or downright stupid like 2011’s “Linking People, Potential, and Progress.” I’ll admit that “Getting You To Buy Stuff With Patient and Taxpayer Money,” “Shouldn’t We Be Disrupted By Now,” and “We Have Booth Swag, Parties, and Vendors Faking Respect So You’ll Feel Important” fall a bit short of lofty.


HIStalk Announcements and Requests

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I worry about making decisions without adequate input, so please take a few minutes to complete my once-yearly reader survey. I will not only be happy, I will align our incentives by dropping your name into the Excel-powered randomization hat for a $50 Amazon gift card.

I sneaked a peek at the reader survey responses in which someone once again suggested that I review big announcements from the past to see how many panned out in historical context. I like the idea, but I don’t really know how to do that effectively (by date? by company?) Your thoughts are welcome. I was just thinking this week about IBM’s giant announcement from a few years ago that it was rolling out a ton of healthcare apps that I suspect either failed or were never actually finished.

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The most common recommendation that poll respondents have for Apple in terms of healthcare is to stay away, followed by continuing its present efforts to develop health sensors and data collection. The only other significantly chosen option was to display and integrate information from multiple systems and providers. Only 6 percent agree with stock picker Jim Cramer that Apple should buy Epic or Cerner, and even then I bet those were pot-stirrers who just want to see what would happen.

New poll to your right or here: what will you be doing during HIMSS19?

The story on hospitals running “wealth screening” reminds me of how confused I was in an early hospital job when I first heard about “the foundation.” Its well-paid SVP had a lot of fingers in the operational pie. He was always out in the community schmoozing movers and shakers using paid-for memberships in the best clubs, coordinating black-tie galas, and cozying up with vendors that we were trying to keep at arm’s length (“I’m not telling you to buy Siemens PACS, only that you tell me why not if you don’t,” he said right before jetting off with some of his hospital cronies to Germany for a junket that Siemens was paying for.) I was naive that hospitals are run pretty much like any big business, work community relationships to their advantage, play community doctors like a chess game, and plan endlessly on how to get bigger. My naiveté was also shattered the first time I saw how differently we delivered care to bigwigs in beds compared to mere mortals.

Listening: new from Long Beach, CA’s Rival Sons. Hard rock will eventually return to popularity and this band will be waiting.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Phynd raises $8 million in a Series B funding round, with three of the four investors representing health systems. The company will invest the proceeds in increasing its its collaboration with Epic and other EHR vendors and to further develop its provider enrollment, management, search, and reporting platform.


Sales

  • MassHealth selects Waystar’s Whole Patient Insight risk scoring of social determinants of health risk.
  • Four agencies of Vermont Care Partners choose Netsmart’s full solution suite to support their work in mental health, substance use, and developmental disability.

Decisions

  • Phelps County Regional Medical Center (MO) will go live with American Well telemedicine in March 2019.
  • Hayes Green Beach Memorial Hospital (MI) switched from Meditech to Epic in December 2018.
  • Eureka Springs Hospital (AR) replaced Healthland (a CPSI Company) with Medhost in January 2019.
  • Bienville Medical Center (LA) switched from Healthland (a CPSI Company) to Medhost in December 2018.

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


Announcements and Implementations

Scotland Health Care System (NC) is implementing Epic.

A federal judge in Madison, WI rules that Epic’s mandatory employee arbitration clause is valid, denying the complaint brought by lawyers of current and former Epic employees that the US Supreme Court’s decision in favor of Epic was unconscionable.


Privacy and Security

An Iowa man is surprised that a hospital’s policy prevents him from viewing his 12-year-old daughter’s medical records without her consent. State law supersedes HIPAA and some leave it up to individual hospitals to decide the age at which the parent can’t view the child’s records without their permission, with the requirements intended to encourage adolescents to be honest in their conversations with providers about substance use and sexually transmitted disease. 


Other

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GeekWire profiles Vyrty’s Sync.MD, which claims to empower patients by letting them take phone photos of their medical records (how they get those is breezily unstated), store them, and then selectively share them with providers to whom they provide a QR code. Doctors can print records to a virtual printer to add them to the patient’s file, which is a good idea. The CEO’s LinkedIn (which shows zero healthcare experience) says the company’s technology involves a smart card, so there’s probably a pivot in there somewhere. Unstated in the brochure-ware is that (a) patients don’t want to screw around collecting and managing their own records, as evidenced by both Google and Microsoft failing to impose their personal health record apps on the world; and (b) clinicians don’t trust patient-managed records because they can’t tell if they are complete and it’s easier to just start firing off orders for a barrage of revenue-enhancing tests and imaging studies. Technologists who have no healthcare experience always fail to understand that hospitals and practices don’t trust the records of their peers, rightly or wrongly, and fear the legal consequence of acting on them inappropriately. My personal experience is that dentists are a lot more interested in the records of new patients than doctors.

Four men sue Texas Children’s Hospital for age discrimination, alleging that the hospital fired them from their senior computer operations analyst IT jobs by requiring them to earn Microsoft or Cisco certifications that were unrelated to their job responsibilities, then replaced them with younger employees who didn’t hold those certifications. 

It’s pretty obvious why plastic surgeons are about the only happy medical specialists, but Daily Beast asked them directly:

  • Their surgeries are scheduled in advance and thus they can control their own schedule
  • They have a high percentage of private pay patients, leaving them mostly free of EHRs, insurance companies, and hospital bureaucrats
  • Their patients provide immediate positive reinforcement
  • Their work varies between cosmetic and reconstructive
  • They work more actively on wellness, including encouraging physical activity at their conferences beyond booth-to-booth hikes (this on seems like a stretch, no pun intended)
  • They make a crapload of cash

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The New York Times notes the odd phenomenon in which Millennials – a generation that is perceived by many to be lazy and entitled — claim they can’t wait for Monday mornings and brag online about how long and hard they work in the “hustle culture” that glorifies ambition as a lifestyle. Experts note that most of the people beating that particular “work is life” drum are shareholding owners and managers, not the workers themselves, and they are insisting on harder, longer workweeks despite data showing that it doesn’t improve productivity or creativity (a la Elon Musk’s push for worker bees to put in a sustained 80-hour workweek peaking at 100 hours) is “grim and exploitative.” Allow me to say from vast experience as a wage slave and overseer of wage slaves – your employer cares only about executives and shareholders, not the breathing, interchangeable widgets that fill cubicles in a modern version of the dehumanizing assembly lines of the early Industrial Revolution. Your life is being wasted if it consists of working for someone else and spending your tiny bit of free time staring at your electronica and cocooning with Netflix. It’s an old but wise adage that nobody’s tombstone says, “I wish I had worked more” and you will see exactly how one-sided the value equation is when your beloved employer marches you out, demotes you, or reorganizes you. If you want to work that hard, make sure it’s your shingle, not a corporate one.

Amazon is using the shopping habits of its customers to target ads, allowing a physical therapy center to aim ads at nearby Amazon customers who had purchased knee braces and a credit card company to push ads at users of competing cards. As a result, experts say Amazon’s ad business is worth $125 billion, with much of the revenue coming from companies willing to pay to have their ads appear next to competing products found in customer searches. An investor calls it “insane scale” when companies can target new parents based on Amazon-stored baby registries or their exact car model entered in its “Garage” section. Amazon can also track user movement among non-Amazon sites to determine, for example, that a diet book customer is now reading CNN and might be profitably invited to buy protein bars. 

Eric Topol, MD critiques the 15 published papers covering the use of AI in medical prediction, saying that their lack of sound methodology means that “we’ve yet to see a validation study in a real-world clinical environment.”

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Microsoft’s top healthcare executive, corporate VP and computer scientist Peter Lee, PhD, acknowledges that his employer along with Google have failed in their healthcare efforts, noting that when Satya Nadella asked him to take the job, he was doubtful: “The tech industry is littered with attempts by shiny CEOs to go after a piece of this massive healthcare pie. I think pretty consistently the tech industry has gone into it with a lot of naïveté, even some arrogance. So my knee-jerk assumption was ‘Here we go again.’’” He seems to be focusing on storing genetic data.

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Federal agents arrest a California nurse for running an online pharmacy that sold 20,000 opioid pills. Carrie Markis, who earned a master’s degree in nursing science and healthcare leadership from UC Davis in 2013 (I found her in the school’s graduation video above), told customers in Dark Web chats that she buys drugs from people who resell their prescription meds for cash, eventually netting herself several hundred thousand dollars. On the bright side, reviews of her online store were nearly all five stars.

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Pay someone to swap seats if you end up next to this guy on a plane. A Pennsylvania man suffering from depression registers his alligator Wally as an emotional support animal. His mood won’t be boosted much when Wally rips his arm off.

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I love this – general practitioner Phil Grimmer, MBChB of Chippenham, Wilthsire, England tweets a photo left by a woman in the room of her mother who has dementia to reassure her about her surroundings. His tweet went viral with over 1 million views, encouraging others to post their own signs and stories for loved ones or patients under their care for cognitive impairment, either to give them comfort or to help caregivers address them in familiar ways and to treat them as people rather than patients.


Sponsor Updates

  • Lightbeam Health Solutions publishes a new e-book, “6 Strategies to Thrive in VBC.”
  • LiveProcess publishes a new e-book, “How Clinical Communication and Collaboration Technology Supports Value-Based Care Objectives.”
  • Mobile Heartbeat will exhibit at the San Diego ANIA Regional Conference 2019 February 1.
  • Netsmart will exhibit at the NY Coalition for Behavioral Health Annual Conference January 31 in New York City.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN South Carolina Section Conference January 30 in Columbia.
  • Experian Health will exhibit at HFMA MidSouth January 30-February 1 in Tunica, MS.
  • Sansoro Health releases a new podcast, “Putting Patient Portals into Practice.”
  • Wellsoft will partner with integration vendor Interface People to offer an ED solution for Meditech customers.

Blog Posts


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Contacts

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

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News 1/25/19

January 24, 2019 News 2 Comments

Top News

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The US uninsured rate rises to four-year high of nearly 14 percent.

The increase was driven by higher premiums, less competition as some insurers pulled out of marketplaces, and the White House’s declaration that “Obamacare is dead” coupled with its elimination of the individual mandate, shortened enrollment periods, and deep cuts in signup promotion.


Reader Comments

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From Will the Real HIMS(S) Please Stand Up?: “Re: Hims. The subscription ‘boner and hair pills’ startup will be what comes to mind to non-health IT folks, although maybe they should book a HIMSS booth considering the demographic. The company uses an HIT-like Silicon Valley formula – find an incredibly complex problem, find a disruptively quick ‘solution,’ and throw a ton of money and marketing at it.” This particular Hims offers web-based doctor consultations that always end up with mailed-out prescriptions for what customers want – generic Propecia and Viagra – without looking a PCP in the eye, all under the highly questionable label of “personal wellness.” They will also sell you overpriced vitamins that any competent doctor would assure you offer no benefit whatsoever. It’s weird how in healthcare people cough up exorbitant amounts just because they saw an ad for something that is worthless at best and potentially harmful at worst, but refuse to pay for actual, sound medical treatment – everybody just wants that pill they’ve heard about (and for someone else to pay for it). Hims targets young, tech-savvy men who, I’m willing to bet, don’t bother to buy health insurance or save money to pay unexpected medical bills. Meanwhile, that reminds of something I’ve mentioned several times from years ago, when HIMSS went on a short-lived tear to suddenly start making its staff say out its name as H-I-M-S-S, which made me want to scream a la Sam Kinison to Rodney Dangerfield in  “Back to School,” “SAY IT … SAY IT.”

From Don’t Touch the Area Under My Curve: “Re: Apple. I know you have a poll going, but what would you do in healthcare if you were Apple?” Probably nothing. Apple’s problem its lack of innovation in a mature market, compounded by the fact that it already rakes in $350 billion in annual revenue — $40 billion of that from services, about the same as the company’s annual profit – and even buying Epic, Cerner, and 10 other health IT vendors wouldn’t kick a dent in its financial universe in the unlikely event that Apple could improve their respective situations. Apple’s services revenue dwarfs everything in healthcare that doesn’t involve pharma or insurers – the App Store, Apple Care, ICloud, ITunes, and Apple Pay rake in the cash, but those are tied directly to use of it hardware (ICloud is one of few offerings that works on other platforms) and don’t require a lot of customer hand-holding or an explanation of why they are useful. Tim Cook’s priorities, other than trying to do a Lazarus on Steve Jobs, should be to make Apple’s upcoming streaming TV a killer app, redo the awful ITunes to better compete with Spotify, and consider making acquisitions in big-scale streaming content, home security, or online photo hosting / filtering (I would have gone for Sonos instead of Beats by Dre with my billion dollars, but that’s just me). If they really want to get into healthcare, how about:

  • Buy AirStrip. It seems to have fizzled out after spending $65 million (no new investment since 2014, no press releases since 2016), earning huge amounts of publicity including a demo on the big Apple stage in 2015 and offering what seemed like a sound product.
  • Buy AliveCor (whose Kardia EKG line is like Apple’s version grew up) or perhaps InPen (insulin delivery).
  • Check out that sweat sensor research work that just came out. We’re not short on phones, just unobtrusive, continuous biomedical sensors that can feed them useful health information.
  • Encourage the development of IOS-only apps that can monitor at-home seniors and connect their caregivers.
  • Buy any one of several companies that offer secure clinical communication and alarm / alert notification, making their product IPhone-only, although selling to enterprises is not Apple’s core (no pun intended) competency.

HIStalk Announcements and Requests

Last chance for HIStalk sponsors — contact Lorre to get your company included in our HIMSS19 guide, which will describe anything cool you’re doing there (giveaways, booth activities, etc.) She’ll even make you a “We Power HIStalk” sign if you really want to impress your booth visitors (well, you’ll impress me, anyway). I’m also still on the lookout for fun celebrities to hang out in our booth for an hour to welcome your followers (if you don’t have followers, you’re probably not really a fun celebrity). We’ve had everybody from former Surgeons General to Super Bowl players to noted authors squeezing into our microscopic exhibit hall space just to press flesh.


Webinars

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


Acquisitions, Funding, Business, and Stock

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NextGen Healthcare reports Q3 results: revenue down 0.6 percent, adjusted EPS $0.20 vs. $0.15, beating earnings expectations but falling short on revenue.

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Optum sues its former VP of Product Strategy David Smith for violating his non-compete after announcing his intention to head up research for the unnamed healthcare venture of Amazon, Berkshire Hathaway, and JP Morgan. The UnitedHealth Group business sees the new company as a threat even though it hasn’t announced how it will reduce healthcare expenses for the three participating companies. Optum alleges that Smith is one of fewer than 50 employees who had access to detailed profit and loss statements, also noting that he printed a confidential company market analysis exactly one minute before printing his resume and then continued printing internal documents until his last day. Smith’s attorneys argue that Optum can’t prove that he is violating his non-compete since neither they nor anyone else knows what he’ll be working on.

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Specialty-specific EHR vendor Nextech acquires competitor SRS Health for an unspecified amount.

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Hospitals are running nightly “wealth screening” analytics on inpatients and then hitting them up for donations. Hospitals such as MedStar, Johns Hopkins, Cedars-Sinai, and NYU Langone use software such as that sold by DonorSearch to identify the small percentage of wealthy inpatients by searching public real estate and donation records. They then send those patients extra amenities (like plush bathrobes) or dispatch a hospital executive to their rooms to schmooze. They are also training frontline doctors and nurses to pass along the names of patients who express gratitude so they can be approached. Ethics experts aren’t thrilled with the practice, but it’s legal since a 2013 HIPAA change that allows hospitals to use protected health information for fundraising. The article describes a retired TV engineer and Medicare patient who resented being pressed for a donation from St. Clair Hospital (PA), which last year reported $48 million in profit and CEO compensation of $1 million.


People

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Banner Health, responding to my inquiry, confirms that it has hired Deanna Wise, former EVP/CIO of Dignity Health, for what I assume is CIO (Banner didn’t confirm her exact title). She was announced on December 4 as CIO of CommonSpirit Health, the 140-hospital, $30 billion Chicago system that is being formed by the merger of Dignity Health and Catholic Health Initiatives, but she left immediately afterward.

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Greenway Health names Kali Durgampudi (Nuance) as chief technology and innovation officer.


Sales

  • Boys Town National Research Hospital (NE) will implement Meditech’s Expanse EHR.
  • Novant Health selects Genesis Automation’s inventory management system to track supply receipt and movement at 15 hospitals, integrated with Epic and Lawson ERP.

Announcements and Implementations

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Carilion Clinic (VA), Inova Health System (Washington, DC), Little Company of Mary Hospital (IL), Summa Health (OH), and TeamHealth (TN) sign on for clinical communication software from PerfectServe.

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DirectTrust reports that its users sent 110 million messages in Q4 2018 as user count increased by 35 percent and organizations served increased by 30 percent.

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NewYork-Presbyterian Hospital will use remote patient monitoring technology from Philips at Weill Cornell Medicine and Columbia University Irving Medical Center.


Other

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The Rhode Island Health Department charges four Rhode Island Hospital ED physicians with medical misconduct after they voluntarily report errors that caused wrong scans to be ordered. The hospital’s users believe the charges are unfair and will discourage safety-minded providers to self-report issues. The hospital, part of the Lifespan network, rolled out Epic in 2015.

Healthcare futurist Jeff Goldsmith doesn’t like owners of health assets that are poorly integrated under single brand name calling themselves “health systems,” noting that their poor performance should raise questions about how much value they create. He says a true health system:

  • Operates assets that work together under a common vision rather than simply owning them
  • Has at its core a clinical entity that is government by actual clinicians and that collaborates under clearly stated professional values
  • Gives patients a seamless experience and consistently excellent clinical care regardless of how those patients enter the system
  • Actively manage cost by using accurate data, clinical consensus, and collaboration

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Amazon adds “smart” hospital rooms from EIR Healthcare to its retail offerings. The MedModular units retail for $814 per square foot and include a bed and bathroom. Shipping is free, but even Amazon Prime members won’t get their new room within two days.


Sponsor Updates

  • Elsevier Clinical Solutions President John Danaher and SVP Olaf Lodbrok share predictions for 2019.
  • Redox announces it nearly quadrupled its year-over-year annual growth in 2018 and increased its network by 500 percent.
  • Docola will add Healthwise educational content for patients to its Care Communication platform.
  • Hyland Healthcare provides connected healthcare solutions to all of US News & World Report’s 20 best hospitals.
  • Gartner names InterSystems to its “January 2019 Peer Insights Customers’ Choice for Operational Data Management Systems.”
  • Kyruus and Providence St. Joseph Health will present on health system digital transformations at HIMSS19 on Thursday, Feb. 14.
  • Mobile Heartbeat will integrate Imprivata’s Mobile Device Access authentication software with its MH-Cure mobile collaboration technology for smartphones.
  • Divurgent and Gevity announce a strategic business alliance to expand their services across the US and Canada.
  • EClinicalWorks releases a new podcast, “PCMH: How Analytics Drive Better Care.”
  • Imat Solutions publishes a new case study, “HASA HIE: Liberating Health Data for Enhanced Population Health in Texas, and More.”

Blog Posts


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Contacts

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News 1/23/19

January 22, 2019 News 5 Comments

Top News

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Medicare patient readmissions within 30 days dropped sharply after CMS started penalizing hospitals financially, but the death rate appears to have increased during the same period. That raises questions over whether the lower readmission rate was created by hospitals turning away older patients with a legitimate medical need just to avoid paying penalties.

The 20-percent readmission rate turned sharply down within weeks of the penalty’s implementation (which raises eyebrows of how that happened so quickly), but a Health Affairs study attributes at least half the decline to Medicare’s simultaneous expansion of billing forms to include up to 25 diagnoses instead of the previous nine.

The corrected readmission rate reduction was 1.3 percent, about the same as reported by hospitals that were exempt from the penalties. More patients who had been admitted for heart failure and pneumonia died, however.


Reader Comments

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From Associate CIO: “Re: Cerner’s voluntary separation program. Cerner still has many overpaid (by KC standards, anyway) associates it inherited with the Siemens acquisition, Brent Shafer has questioned why Cerner has over 400 VPs, and the company has a lot of topped-out associates who have become stagnant after 20-plus years and it needs some new blood to reignite investor interest.” Unverified. My only issue with VSPs is that they target older employees and the volunteers they attract are often the better-credentialed employees who know they can find jobs elsewhere – the lower-demand employees aren’t about to sign up. There’s also the nagging feeling that the executives are second-guessing their own decisions of who to hire and how much to pay, as layoffs are a management failure. Brent as the new guy may have more energy about correcting whatever undesirable situation exists, although I wonder if, as a first-time CEO, he’s worrying too much about impressing investors by applying the easily wielded but blunt headcount scalpel to give the share price a quick goose.

From Coach Ella: “Re: HIMSS. I notice quite a few bloggers are hitting the exhibit hall floor, participating in and promoting speaker sessions as paid by vendors. Is that allowed under conference rules?” Sure. I wouldn’t do it because it’s kind of a cheap sellout to take vendor money for participating in a booth-hosted “education” session of questionable quality, but I don’t begrudge those who do, even though their presence would give me as an attendee yet another reason to steer clear.

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From Savoy Special: “Re: Health:Further. Shutting down after its two-year run of putting on a health ‘festival’ in Nashville. They are refocusing on providing advisory services to larger healthcare firms, odd since it was borne out of the Jumpstart Foundry. The format was unique in offering the opportunity to choose any track within a single large meeting room and for offering collaboration space in the middle of the conference room floor. With the growing competition for attendees from well-funded groups like HLTH, CES, and SXSW, which conference will be the next to fold up?” Health:Further (or maybe it’s now Health:NoFurther) announces that it has pulled the plug on its planned August 2019 event, spinning the news with a subhead of “from meeting to acting” in concluding that a once-a-year event can’t keep up with acquisitions and Silicon Valley’s healthcare interest, so it will pivot into an advisory business. It doesn’t make sense to me, especially since I see little evidence of the organization’s street cred for advising bigger and likely better organizations. My advice to attendees – stay home and do the work your employer is paying you to do and quit wasting company time and money screwing around at low-value conferences (which is most of them) looking for easy answers to your organization’s challenges. Imagine how un-innovative Amazon and Google would be if their executives just copied each other based on seeing what everyone else is doing via conference presentations and networking.

From Tip O’Spear: “Re: email newsletters. You should do an HIStalk one.” I’ll pass, for these reasons:

  • The “open rate” of emailed newsletters – even those that manage to bypass the invincible spam filters – is low. I’ve signed up for several of various kinds and rarely open any of them, having either lost interest or felt misled about the value I would receive.
  • Nobody needs to read industry news every single day. CNN baits you into raising your political blood pressure by making every minor story seem like breaking, relevant news that you need to follow, and other newsletters and sites mimic that reader-unfriendly practice.
  • Newsletters are usually just sterile links to online junk (mostly press releases) as “curated” by faceless, questionably credentialed writers who are willing to work cheap.
  • Newsletters suffer from the same misaligned incentives that exist with most sites – their measure of advertiser success is open rates and clicks (which encourages clickbait headlines), sensationalistic story selection, and articles that run  way too long, all intended to make you spend more time on their site than is necessary. Your time is their product.
  • When is the last time you learned something from a health IT newsletter that allowed you to perform your job better, gave you a career advantage, or led you to feel more fulfilled?

From Robert Lafsky, MD: “Re: NEJM piece on urgent care. A good look from the other side would be a piece by Atul Gawande, where he walks us through a typical day in his surgical practice, accounting for every dollar charged and every dollar collected for every action he takes. The big picture is too big and the problem is at the ground level.” RL references a NEJM piece that I’ll recap below, but in the mean time, this idea is brilliant. I would love to have Atul Gawande describe the downstream effects, especially the financial ones, that emanate like a boat’s wake from his part-time surgery practice. What’s the cost and price of the supplies and drugs that he uses without thinking? How much does he bill and what does insurance actually pay? What’s the hourly cost of running that fully staffed OR? What layers of management are involved in stocking it, cleaning it, scheduling it, and staffing it? How many of his patients experience financial hardship? What documentation is the by-product of a surgical case, how much of that does he input directly, and who benefits? What does he think of competing ambulatory surgery centers? Is he appalled that Partners HealthCare is such an aggressive market bully and pays its executives exorbitantly? (something that he might want to look into on behalf of his new employers).

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From DisCerner: “Re: [CIO name omitted], formerly of [a merged health system]. Now the CIO of Banner Health.” Unverified, so I redacted the identifying information and will update if I get confirmation from my media inquiry. UPDATE: Banner Health confirms that Deanna Wise, former EVP/CIO of Dignity Health, has been hired as CIO. She was announced on December 4 as CIO of CommonSpirit Health, the 140-hospital, $30 billion Chicago system being formed by the merger of Dignity Health and Catholic Health Initiatives, but left immediately afterward.


HIStalk Announcements and Requests

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HIStalk readers are smarter and more motivated than industry slackers, so I would be remiss if I failed to take advantage of your expertise by asking you to take three minutes to fill out my once-yearly reader survey. You’ll not only be helping me decide how to spend my HIStalk time over the next year, you’ll be entering yourself into a drawing (which will require me to spend half a day stretching my minimal, rusty Excel skills into writing a randomization formula) for a $50 Amazon gift card.

I erroneously (or at least prematurely) predicted at HIMSS18 that voice assistant add-ons would be all the rage by now, as EHR vendors seemed anxious to trade paint in trying to become the first to voice-power their software Alexa style. I haven’t heard much since from the companies that seemed to be leading the charge – EClinicalWorks, Epic, and Nuance come to mind. I’m curious if anyone is actually using those assistants and what their experience has been. I see that Vanderbilt is presenting at HIMSS19 on its work to voice power Epic.

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I’m annoyed at the overused, lame pun of “XXX will see you now,” in which “XXX” is a substitute for “the doctor.” When is the last time, other than on black-and-white TV shows, that someone actually said, “The doctor will see you now?” It reminds me of my early days in a small, rural hospital, in which the office nurses who rounded with our poorly skilled but arrogant community-based medical staff reverentially referred to their employer as “the doctor” as though no others existed. I even heard the wives of those mostly foreign-trained, exclusively male physicians – many of whom treated our nurses like lower-caste handmaidens — refer to hubby in social situations as “the doctor,” although maybe that’s a cultural thing. This particular for-profit hospital had a written policy that employees had to clear a path for incoming doctors in patient room hallways, specifically to hug the wall Parting-of-the-Red-Sea style so that the Doctor (administration capitalized it incorrectly to suck up hoping for more bonus-boosting admissions) could proceed unmolested to wreak patient harm more efficiently and then get back to the office to practice their specialty of defrauding Medicare. That sounds bitter and probably is, but our employees had to intervene nearly constantly to keep doctors from killing our patients through their obvious incompetence. Don’t serve on a hospital’s death committee if you want to preserve your healthcare innocence.

Listening: The Budos Band, a nine-piece instrumental Afro-Soul outfit from New York City that is horns-forward in a 1960s “Iron Butterfly meets Chicago and the Ventures somewhere in Africa” sort of way. I was despondent that I couldn’t get Shazam going in time to ID the song playing in the restaurant I was in, but luckily they were tracking just this band and I was able to get the artist on the next song. Their music would be edgier and more interesting than the usual tinkly piano solos for dinner music.


Webinars

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


Acquisitions, Funding, Business, and Stock

NantHealth, whose shares have fallen to $0.70, receives a Nasdaq de-listing notice now that the stock has closed at under $1 for 30 consecutive trading days. Companies usually skirt that issue by announcing a reverse stock split, which accomplishes nothing other than to confirm their failure and to allow them to keep investors at the table as they hope for an unlikely miracle. 


Sales

  • Bergen New Bridge Medical Center (NJ) joins Collective Medical’s network to support opioid monitoring, real-time event notification, and care collaboration.

People

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Quality benchmarking organization URAC hires Shawn Griffin, MD (Premier) as president and CEO.


Announcements and Implementations

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Brilliant: a “high-density parking solutions” vendor opens Manhattan’s largest automated parking system for an unnamed hospital. The robotically operated system provides 119 spaces in a 30,000-square-foot, four-floored structure, squeezing in 30 percent more cars than garages that require space for drivers to maneuver. It looks like valet parking to visitors, but the valet just drops their car off at the automated system’s loading bay. The system is integrated with the hospital’s information system so that customers can summon their cars and pay from computer tablets, allowing them to hop in and leave from the valet desk. The company’s other projects allow human-free operation, where drivers retrieve their car by app. I hate navigating through dark, tight parking garages, nearly always getting stuck behind a clueless visitor who will wait forever for someone to vacate a low-level spot when everybody knows that the entire upper level is surely empty. Pro tip: drive up a couple of levels, then go back down on the other side since few will take the risk of not finding a freshly emptied space there. Pro tip 2: it’s better to park higher if that gets you closer to the elevator since you’ll be walking horizontally, not vertically.

Allscripts offers free genetic testing to its employees via its 2bPrecise subsidiary. Free or not, I wouldn’t want my employer – who likely provides my health insurance and makes cost-benefit decisions about each employee – potentially learning my genetic predispositions.

King’s Daughter’s Medical Center (MS) goes live on Meditech’s Expanse Point of Care.


Other

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Brendan Reilly, MD pens a cynical yet insightful NEJM recap of his experience taking his wife to an urgent care center in “The Spy Who Came In with a Cold.” His observations, made while keeping mum that he’s a doctor:

  • Everybody wore the same scrubs, white coat, and stethoscope as a corporate standard, leading him to question whether everyone (or even anyone) really knows how to use the stethoscope.
  • He notes that while the clinic’s website boasts, “We’re on your side,” it fails to identify who the opposing “side” is.
  • He describes the eyes of the young doctor working as, “like she slept last night but not the night before. She looks alert but hurt, eager yet ambivalent, like she’s not sure she wants to be here but here we are, so let’s go.”
  • The doctor didn’t use the stethoscope or otoscope correctly and forgot to listen to his wife’s lungs, then diagnosed pneumonia after incorrectly interpreting an x-ray while waiting for a cross-town radiologist’s report.
  • He questions how doctor quality should be measured, noting the unreliability of direct observation and the difficulty in linking care quality to ever-increasing cost.

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A Virginia woman is sentenced to 15 years in federal prison for scamming $5 million from 50 investors in her phony telemedicine company, spending the proceeds on luxury world travel. She erred in appearing at her sentencing carrying an $1,800 leather portfolio paid for by one of her investors (a special needs teacher and recent widow), with the angry judge ordering her to surrender it since “you’re not going to be able to take it with you to prison anyway.”

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Who’s signing up for this? It’s an award-winning solution (or will be when I announce the HISsies winners).


Sponsor Updates

  • Provider management platform vendor Phynd earns ISO 27001 certification for its information security standards.
  • Pivot Point Consulting enters into a managed services partnership with PDS.
  • Access publishes a new client spotlight, “Norman Regional Health System Takes Next Step on Paperless Journey.”
  • AdvancedMD publishes a new guide, “What NOT to do When Working with a VBC RCM Outsource Supplier.”
  • Aprima’s PRM, Version 18 earns ONC Health IT Certification from the Drummond Group.
  • CarePort publishes a new case study featuring St. Vincent’s Health, “Using Ad Hoc Reporting to Reduce Excess Days and Associated Operational Expenditures.”
  • Arizona HIMSS names CTG Client Partner Patricia Allvin treasurer and VP of finance.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 1/21/19

January 20, 2019 News 1 Comment

Top News

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Alphabet’s Verily announces that its Study Watch has earned FDA clearance as a medical device for performing on-demand ECGs.

Verily’s offering, unlike the Apple Watch, requires a prescription, perhaps because it was developed to capture health data from clinical trials participants. 


Reader Comments

From Stock Picker: “Re: Jim Cramer. What does he know about healthcare?” First, let’s recognize Cramer’s undeniably impressive credentials – Harvard BA and JD, editor-in-chief of the Harvard Crimson, small-town newspaper reporter, successful hedge fund manager (for a short time during a boom market), and co-founder of a stock website, all before he was a TV host. However, it’s always amusing when cheap-seaters (including elected officials) pontificate based on their superficial knowledge. Everybody these days thinks they are an expert on everything they’ve read about from sketchy Internet sources, holding their ground even while emotionally spouting off to an actual expert for whom the topic represents their life’s work. This is a different form of a volume-to-value challenge where loud people talk over more informed ones.

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From LinkedOut: “Re: sending an immediate boilerplate sales pitch after connecting on LinkedIn. What if I write a message specific to you and your org? Less annoying?” Only slightly, assuming you are still trying to sell me something. I didn’t join LinkedIn to be pitched, especially by people or companies I’ve never heard of. It also depends on whether you’ve paid any attention to what I actually do, which means that the LinkedIn sales messages I get for software engineering services, cybersecurity consulting, or webinars for non-health IT topics are going to bug me because my profile makes it clear those don’t apply to me. Overzealous Indian dudes in particular seem to love to invade my inbox. It’s like signing up for Match.com and having some weirdo immediately start blasting out full-frontal selfies.

From Deadlock Loser: “Re: Cerner. Did indeed announce another ‘voluntary separation plan’ right after Cliff Illig’s retirement and before the long holiday weekend. Unlike the previous two in 2015 and 2016, this one contained a threat that it would be ‘involuntary’ if certain financial goals aren’t met. Combine this with substandard benefits, readjustment in titles that led to up to 15 percent pay cuts, and blunt communications like this one that kill morale. Executives who are treated like royalty prefer to hire young, know-nothings from local Midwest colleges who are cheap and don’t know any better.” Unverified, but DL included what appears to be a copy of Cerner’s internal announcement from the company’s ironically titled chief people officer, which I’ll excerpt as follows:

Today, we are announcing to all US associates a voluntary offering created for a group of US associates who meet specific eligibility criteria … In 2019, we are expecting to meet a financial goal in order to fund important areas of investment to secure our future as a growth company. If we do not meet our corporate financial goal with the voluntary separation program, we may subsequently conduct an involuntary separation program … An associate may be eligible for the VSP if … the associate has at least 10 years of service and the associate’s combined age and years of service equals or exceeds 65.

From Minimal Shrinkage: “Re: healthcare influencers. When the conference circuit gets into high gear, their insulated conversations among themselves, event promotions, meet-ups, chats, etc. grow exponentially. For every smart, successful, succinct, and cogent healthcare person that contributes to the online discourse, there appear to be 30 others who hold almost no bona fides who produce an endless stream of meaningless, pointless, and self-aggrandized commentary. My grandfather used to tell me, ‘Don’t tell me what you’re going to do, show me what you’ve done.’ Those influencers have also reduced my interest in attending the conferences they infest — I’m not interested in seeing their regurgitated ‘takes’ on stage after not being excited to see them on Twitter and LinkedIn.” 


HIStalk Announcements and Requests

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About half of provider IT decision-makers look at either KLAS or Black Book before buying software or services, according to last week’s poll. It’s not really a fair comparison since Black Book covers broad trends with big sample sizes while KLAS digs deep into a specific topic (like population health management technology) while interviewing a small number of actual clients, so they are used somewhat differently. I agree with Former Community CIO on the best way to use KLAS, with this being my experience:

  • KLAS is outstanding in describing a market and differentiating vendors within it in ways that vendors themselves would never do for fear of pigeonholing opportunities.
  • A given report tells you who the players are and how much market share they hold.
  • The overall rankings usually jibe with gut feel.
  • Few people would argue with the top- and bottom-ranked products, but KLAS doesn’t help much to distinguish those slugging it out in the middle.
  • Provider executives feel peer pressure to avoid choosing a product that isn’t #1 in KLAS as those peers fail to recognize that one size doesn’t fit all, KLAS isn’t always right, and even top vendors can stumble or get acquired by a crappy parent that ruins the magic.
  • The user comments provide the most interesting information, although they are few in number, you don’t know the commenter’s background and employer to discern relevance, and unknown factors could make them suspect (the client is behind on releases, their IT shop is in shambles, or they merged with someone and had the system foisted on them).
  • Clients who report to KLAS are like Yelp reviewers – they are self-selected with their own agenda, they may not be representative of the entire client base or similar to the reader’s health system demographic, their vendor may influence their participation or rating, and the individual respondent’s background in a particular product may be superficial.

New poll to your right or here: What would you tell Tim Cook if he asked you how Apple should be involved in healthcare?

I invite you to complete my once-yearly reader survey. I have limited ambition, time, and appetite for change just for change’s sake, but nearly everything I do differently today than I did years ago is because I got a spark from someone’s reader survey response. That reminds me that HIStalk will be 16 years old in June, which seems unreasonable given that the initially low readership and conflicting day-job demands should have been strong motivators for me to find another hobby.

I am, as a glass-half-empty curmudgeon, always annoyed by something. My peeve this week, caused by HIMSS19 spam, is people sending an “invite” rather than an “invitation.”Maybe it’s inevitable that verbing nouns (such as “friending,” seeing an Olympian “medal,” or “incentivizing” EHR purchases) will lead to nouning verbs (which along with sending “invites” includes HIMSS listing its federal government “asks.”) It reminds me of nerdy hospital tech guys who worked for me who described their job as “administrating” a system or people (sometimes me included) who say they are “vacationing” given that “vacation” is the noun form of “vacate, ” I say while explanationing.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Data analytics and population health technology vendor Innovaccer closes a $35 million Series B funding round, raising its total to $51 million.

Baxter International acquires True Process, whose platform performs medical device integration and analytics.


People

The soon-to-be-combined Beth Israel Lahey Health names BIDMC CIO John Halamka, MD, MS as executive director of its recently created health technology exploration center.


Announcements and Implementations

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Researchers at Northwestern University develop a wireless, battery-free soft skin patch that analyzes sweat for PH and levels of chloride, glucose, and lactate. Possible applications include detecting dehydration (Gatorade is already on board), testing for cystic fibrosis, and potentially screening diabetics. Researchers are are working on sensors to monitor kidney function, assess post-stroke rehabilitation, and to monitor depression.

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The latest twice-yearly health IT market review of Healthcare Growth Partners says that the market is full of noise, as private equity investors are anxiously looking for investments, health IT seems attractive, and the PE firms are using CRM and other digital marketing techniques to indiscriminately blast out messages trying to beat the others at finding deals. Venture capital and growth equity players say their health IT investment strategy meets expectations, while buyout companies are less satisfied. Primary deal-killers are poor business models, deal sourcing, competition from strategic investors, and valuation. Interesting respondent observations:

  • Many startups offer gimmicky solutions and are run by inexperienced entrepreneurs.
  • Some startups aren’t ready due to lack of a go-to-market plan, an immature product, or lack of pilot sites or customers.
  • Sellers are sometimes looking for a complete exit instead of a non-controlling equity investment.
  • Funding rounds are getting bigger and occurring earlier, such that even a Series A deal involves a company with no recurring revenue and product still in pilot or even pre-pilot.
  • Seed rounds have reasonable valuations, but those from Series A and beyond are overpriced compared to other sectors.
  • Top sectors are population health management, revenue cycle management, infrastructure, and payer services.
  • The most attractive customer segments are payers / employers and health systems, while the least-attractive is patients and families.

Government and Politics

The VA issues an RFI for a software testing contractor,  with 80 percent of the job focusing on Cerner.


Other

Two patients in Scotland’s Queen Elizabeth University Hospital die from cryptococcal fungal infections that authorities believe originated in the droppings of pigeons that were nesting in a machinery room.

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Bizarre: in Scotland, a 28-year-old female hospital nurse is fired and sent to prison for impersonating a rich, male doctor by using photos of handsome men and a voice-changing machine to harass and stalk 10 women she connected with on dating sites.


Sponsor Updates

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  • The Patientco team works with humanitarian aid organization MedShare to sort and pack medical supplies for hospitals in developing countries.
  • The Chartis Group publishes a new paper, “2019 Healthcare Outlook: Strategic Imperatives for the Year Ahead.”
  • NextGate will exhibit at the 2019 IHE North American Connectathon January 21-25 in Cleveland.
  • OmniSys will exhibit at the ASAP Annual Conference January 23-25 in Kiawah Island, SC.
  • OnPlan Health publishes “The Changing Landscape of Healthcare Payment Plans” report.
  • Experian Health will exhibit at the HFMA MidSouth meeting January 30-February 1 in Tunica, MS.
  • Flagship Medical becomes the first durable medical equipment provider to join Prepared Health’s EnTouch network.
  • Surescripts will exhibit at North Carolina Epic UGM 2019 January 22-23 in Greensboro, NC.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 1/18/19

January 17, 2019 News 6 Comments

Top News

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From Dave N: “Re: CNBC’s ‘Mad Money.’ Jim Cramer said he thinks Epic will be acquired or go public, citing Judy’s age.” The stock-picking record of the highly annoying Jim Cramer is poor, underperforming the S&P 500 index funds while exposing investors to more volatility, and this particular recommendation is especially questionable:

  • Judy Faulkner refuses to sell Epic and has told those whose will control the majority of shares after her — her heirs and the board — not to sell or go public. I highly doubt that drowning in a sea of Apple cash would be her preferred way to go.
  • Cramer thinks Epic needs scale, which they don’t — Epic makes billions with a few hundred boutique customers and doesn’t care about millions of app users paying $2.99, social media platforms counting ad clicks, or illogical fanboys who buy overpriced Apple devices as soon as they’re released.
  • Cramer wants Apple to smooth out its hardware vendor market bumps by buying its away into the software market, a strategy that has failed other desperately growth-seeking companies countless times.
  • Apple’s consumer innovation track record died with Steve Jobs, but acquiring Epic to leap headfirst into healthcare won’t make a dent in the real problem of flagging IPhone sales in the absence of any other compelling offering.
  • Cramer claims that Apple and Cerner practice information blocking (which is a stupid thing to say since it’s their customers that are the problem – providers who want to exchange information do so easily) and proposes that Apple become a universal repository for health data. Apple doesn’t need to buy Epic or anyone else to accomplish that, and it’s a weird thing for Cramer to say since he just got finished saying Epic and Cerner aren’t interoperable.
  • Notice the before-and-after result (above) of the show having to alter Jim’s inane comment that Epic focuses on small hospitals. The top version is the original cached version, while the bottom is a post-surgical shot after Jim’s foot was removed from his enlarged mouth. (I reviewed the show video and he really said that Epic is a small-hospital vendor while Cerner focuses on big ones).
  • “Neither Cerner nor Epic wants to make it easier for their systems to work together because their clients would have an easier time switching to a competitor.” Oh, Jim, how much (and how loudly) you say despite how little you know. And by the way, they actually make shirts whose sleeves don’t have to be rolled up – ask for something called “short-sleeved.”

Reader Comments

From Jelly Doughnut: “Re: population health management. Why isn’t it used more if it really saves money, which it should?” Because it saves money years down the road for someone else when the patient / enrollee has moved on to other insurers and providers. A company spending big dollars today to help a 30-year-old patient get healthy will most likely never see the benefit. We probably need some kind of lifetime patient financial scorecard to fix this, yet another healthcare example in which taking better care of people means making less money. The only real exception is with lifetime insurers such as Medicare and the VA, which get to reap the benefit of whatever savings they create.

From KC1981: “Re: Cerner. Is offering ‘voluntary’ retirement packages and is making it clear that if that doesn’t get to the total numbers needed, the next step is forced retirements and layoffs.” Unverified. I’ll get a call in to Jim Cramer.

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From Nicholas Cage-Free Eggs: “Re: HIMSS ‘news’ publications. Down here in Australia, HIMSS dismissed the award-winning contracted editor of its flagship publication after she ran an insightful, critical overview of the problems with the Australian Digital Health Agency, whose CEO is a friend of HIMSS CEO Hal Wolf. That CEO threatened to withdraw sponsorship of the HIMSS AsiaPac conference. Now HIMSS won’t run stories without the agency’s approval.” Unverified, although I’ve heard that before and the editor’s LinkedIn shows that she did indeed leave a few weeks after her story ran. It’s not exactly ProPublica over there – they should have made it clear they weren’t looking for actual news and hired a marketing person instead of a journalist. 

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From Acute Malcontent: “Re: social media influencers. There’s something to be said for the HIT crowd that seems to exist only on social media, but meanwhile, I thought you’d get a kick out of this story.” Instagram influencer Caroline Calloway – who in her mid-20s took a $500,000 book advance that she couldn’t pay back when she found out that she can’t actually write – suddenly announces after a two-year hiatus that she’s offering a national “tour” in which she will instruct attendees (at $165 per head) how to create an “Instagram brand.” Twitter roasted her for trying to recruit free helpers, arm-twisting Philadelphia and Boston ticket-holders to travel to New York City instead to make it easier for her, giving attendees packets of flower seeds instead of the promised live orchids to wear in their flowing locks, and letting 20-year-old friends with no work experience run the show. She cancelled the rest of the “tour” and claims in Fyre Festival style that it’s not her fault and she’ll give refunds. Jezebel concludes, “No one is an influencer if everyone is an influencer.” I would add a health IT corollary – you aren’t an influencer, even in its most shallow form, unless you change the behavior (especially the buying kind) of people with real influence. 


HIStalk Announcements and Requests

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It’s that just-before-HIMSS time when I ask you to take three minutes to fill out my annual reader survey. I use the results for several things – to plan for the year, to manage my ego up or down as needed by reading the positive and negative comments, and to get a mental picture of who is out there on the other side of that blank screen that I vanquish every day.

Dear overzealous sales types – if you connect with me on LinkedIn and immediately spam me with a boilerplate sales message, I will instantly remove the connection, overriding my initial impulse to report you for spamming. I know people told you to Always Be Selling, but that means you are Often Being Annoying and LinkedIn already offers plenty of that.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

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Consumer health data sharing company Ciitizen raises $17 million in a Series A funding round led by Andreessen Horowitz. CEO Anil Sethi founded the company in 2017 after selling a similar company to Apple for its health records business.

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GoFundMe reports that a third of the $5 billion raised on its platform since launching in 2010 has been used for healthcare campaigns. CEO Rob Solomon says he never though the platform’s medical category would become its most popular. “We shouldn’t be the solution to a complex set of systemic problems. They should be solved by the government working properly, and by healthcare companies working with their constituents.”

Consumer healthcare website company Everyday Health Group acquires Castle Connolly Medical, owner of the Top Doctors database.

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PerfectServe acquires competitor Telmediq for an undisclosed sum. Telmediq founder and CEO Ben Moore will become PerfectServe’s chief product officer.


People

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Chris McMahon (Turbonomic) joins Kyruus as SVP of people.

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Health insurer Oscar names Angela Calman (IBM Watson Health) as VP of communications.

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ZeOmega promotes Sandra Hewett, RN to CNO.

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Todd Stottlemyer (CNSI) joins the board of Verato.

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Nordic hires Tom Kirst (Afton-Armitage) as managing director and special assistant to the CEO.

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PatientSafe Solutions names Kathleen Harmon, MS, RN (Sphere3) as chief clinical officer.


Sales

  • Partners HealthCare chooses Visage Imaging’s Visage 7 enterprise imaging platform, eliminating multiple legacy PACS and giving the company the largest sale in its history.
  • Williamson Memorial Hospital (WV) will implement Meditech’s Expanse EHR via the company’s subscription service.
  • BridgePoint Healthcare (NJ) will deploy EHR software from HCS at its post-acute facilities in Washington, DC and New Orleans.
  • Arkansas State Hospital selects EHR and RCM technology from Medsphere.
  • Northern California behavioral health services provider Remi Vista selects Cerner Integrated Community Behavioral Health and patient portal.

Announcements and Implementations

Texas Health Resources implements MDsyncNet’s physician on-call scheduling software at eight additional hospitals.

Huggins Hospital and Catholic Medical Center of GraniteOne Health implement Oracle ERP and HCM Cloud.

Managed care company NextLevel Health Partners signs on for PatientPing’s real-time care notifications.

Critical Alert Systems will add real-time patient-generated data from medical devices and EHRs to its critical alarm surveillance solution via Bernoulli Health.


Government and Politics

In Canada, the New Brunswick Department of Health will spend $12.5 million to implement an EHR in three phases over the next several years.


Privacy and Security

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In Ontario, Health Sciences North works to recover from a computer virus discovered Wednesday morning that has affected several IT systems. A “major computer system breakdown” was also reported at Hôpital Notre-Dame Hospital in Ontario, though it’s unclear if the two incidents are related.


Other

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After going live on Epic last month, Memorial Hospital (NH) staff struggle to keep up with prescription refill requests as they transfer prescription data to the new system. The hospital has set up an “urgent refill” hotline and special walk-up window at the hospital for patients. It has also established a hotline for pharmacists having trouble with the system. Interim CEO Lee Myles admits the new system’s “complexity is amazing,” and that employees are working “ridiculous hours” to get refill workflows back to normal.

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CNBC reports that Apple is talking with three Medicare Advantage plans about offering the AppleWatch to members at a subsidized cost. The $400 latest version of the Watch features senior-friendly fall detection. Skeptics have pointed out that more evidence is needed to determine the device’s impact on outcomes, and that seniors may have a hard time manipulating and reading the device’s small controls and display.

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Medtronic develops an app that, for the first time, gives users of its pacemakers the ability to pull data from their own devices.

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Coursera adds 100 healthcare-related courses to its roster of online classes, emphasizing healthcare informatics, management, and public health.

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Atul Gawande, MD cancels his keynote at HIMSS19, which isn’t surprising given his media hiatus since becoming CEO six months ago of the joint venture between Amazon, JPMorgan, and Berkshire Hathaway. Maybe he’ll spend the time he’ll save naming the darned thing. Meanwhile, HIMSS announces that HHS Secretary Alex Azar will join CMS Administrator Seema Verma in a Tuesday evening session on interoperability and patient engagement that, based on their Twitter track records, will turn into a political rally.

A 17-year-old teenager in China who sold a kidney to black marketers for $3,000 in 2012 so he could afford to buy an IPhone 4 and IPad 2 is now a 25-year-old man who will be bedridden and on dialysis for life after his remaining kidney failed due to poor technique in the illegal surgery. Five people, including two moonlighting surgeons, went to jail and Mr. Wang was awarded $300,000 in compensation. It’s probably not this Mr. Wang.


Sponsor Updates

  • Optimum Healthcare IT will host a HIMSS19 lunch and learn session titled “Optimizing Outcomes with Real-Time Data Harmonization” on February 12.
  • Patientco adds financing options from ClearBalance to its SmartFinance patient payment technology for health systems.
  • ZappRx partners with Bayer, giving it insight into the medication access and prescription habits of patients living with Pulmonary Hypertension, and with Relapsing Remitting Multiple Sclerosis.
  • Elsevier Clinical Solutions releases a video summary of its recent Health Dialogue roundtable.
  • Clinical Alert Systems partners with Bernoulli Health for real-time clinical surveillance, advanced analytics, and intelligent alert notification.
  • Healthfinch will exhibit at the Allscripts Global Sales Kickoff January 22-24 in San Antonio.
  • Imat Solutions releases a new podcast, “Advancing Data Confidence at HIMSS 2019.”
  • The InterSystems IRIS Data Platform is now available on the AWS Marketplace.
  • Nordic hires Tom Kirst (Afton-Armitage) as managing director/special assistant to the CEO.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Definitive Healthcare Acquires HIMSS Analytics

January 16, 2019 News No Comments

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Definitive Healthcare announced this morning that it has acquired the data services business and assets of HIMSS Analytics.

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Definitive Healthcare founder and CEO Jason Krantz said in the announcement, “HIMSS Analytics has developed an extraordinarily powerful dataset including technology install data and purchasing contracts among other leading intelligence that, when combined with Definitive Healthcare’s proprietary healthcare provider data, will create a truly best-in-class solution for our client base.”

News 1/16/19

January 15, 2019 News 7 Comments

Top News

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Cerner co-founder Cliff Illig retires from the company’s board “to focus on outside interests.”

You get to do that when you’ve sold dozens of millions of dollars of CERN shares in the past few months and still hold $550 million worth.

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I feel like a kid watching Mom and Dad get divorced as companies start losing their colorful founders, making me reevaluate whether I still find them interesting.

Cerner even lost its president, so now it’s exclusively Brent Shafer’s show and I haven’t seen much Neal Patterson-like brilliance or spark from him after a year in his first CEO job.

CERN share price rose a tiny bit Tuesday,  but are down 23 percent in the past year vs. the Nasdaq’s 3 percent loss.


Reader Comments

From Beezer Gutler: “Re: Cleveland Clinic’s Empathy & Innovation Summit. HIMSS is now a ‘partner,’ whatever that means.” I can’t think of many organizations that are less qualified to than HIMSS to provide empathy advice to frontline providers, so I assume that its contribution will be to jam high-paying tech vendors into a program that should be about person-to-person interaction rather than gizmos. The June conference features odd speakers such as bigwigs from Aetna and the AMA (you have to be a pretty awful provider if you have to ask an insurance company how to be empathetic). The conference drew a couple of thousand people last year, although healthcare is notoriously full of people who love to hang around just about any conferences for which patients are indirectly paying via their inflated bills without much hope of ever seeing ROI. It’s fascinating how much money is made by running healthcare conferences – my favorite ironic example is the American Telemedicine Association’s annual conference, which suggests that they believe video is great for practicing medicine but not for watching talking heads.

From Avoiding Buyer’s Remorse: “Re: HIMSS19. What should we expect as first timers in a small booth?” You’ll get some visitors, but most will be just strollers-by looking for giveaways and taking your handouts just to be nice. You’ll feel energized and vital in being part of the “show,” but that high will go away on the plane ride home when you realize that spending the money won’t pan out in sales, and if you were an unknown before, you still are. Shooting your budgetary wad on a HIMSS exhibit as a full-year strategy makes no more sense than binge-eating for three days and assuming you won’t need food for another year. The problem isn’t HIMSS, it’s that exhibitors don’t set reasonable goals and plan well, so I suggest starting with my only partially cynical (which is quite a stretch for me) “Tips for HIMSS Exhibitors.” As holder of an expensive, questionably cost effective three-day lease on a 10×10 space myself, I wouldn’t get my hopes up – we get a lot of visitors just because readers drop by to say hello and that makes it worth it to me, but financially it doesn’t make a lot of sense to be there and you probably won’t get nearly as many folks stopping by.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

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EHR and technology services vendor Parallon Technology Solutions renames itself CereCore.

Walmart leaves CVS’s pharmacy network after failing to reach a price agreement with CVS’s huge Caremark pharmacy benefits management arm.

UnitedHealth Group beats Q4 earnings estimates as its full-year revenue grows to $226 billion and earnings to $17.3 billion. Its Optum services business brought in $8.2 billion in earnings on $101 billion in revenue. It’s good to be a healthcare middleman.


Sales

  • California largest non-profit health data network, Manifest MedEx, selects predictive analytics from HBI Solutions.
  • Lexington Regional Health Center (NE) chooses Cerner Millennium via CommunityWorks.
  • Premier Orthopaedics chooses Allscripts Professional EHR, PM, FollowMyHealth, and Payerpath for its 72-physician practice.

People

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NHS England’s chief digital officer, Juliet Bauer, will leave the organization for a job with NHS-contracted telemedicine vendor Livi.


Announcements and Implementations

CareCloud successfully deploys Medicomp’s Quippe Clinical Documentation throughout its customer base.

DocuTAP launches an urgent care-focused analytics tool called Insight that provides real-time visibility into clinical, operational, and business data.

Northwestern Medical Center (VT) goes live on CommonWell interoperability, embedded in Meditech.

Walgreens signs a deal for its 380,000 employees to use Microsoft technology that includes Office 365, mobility and security tools, and the Azure public cloud. The companies will also work together on R&D for patient engagement and chronic disease management software.


Government and Politics

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Sen. Jon Tester (D-MT), ranking member of the Senate’s Committee on Veterans Affairs, expresses his IT concerns to newly confirmed VA CIO James Gfrerer:

  • The White House’s proposed VA IT budget contains drastic cuts that don’t reflect new requirements and the VA’s history of “fumbling of IT solutions.”
  • The VA needs strong IT leadership since it “cannot continue to operate in a technology environment in which only the largest and latest crisis drives the agenda.”
  • While much of the Cerner implementation will be run by the Office of Electronic Health Record Management, the VA must go beyond just maintaining VistA and ensure that infrastructure is ready for the new system.
  • The VA must continue to invest resources in projects such as its benefits management system, disability rating system, and financial system.
  • Tester warns that CareT, a system being developed for caregiver assistance, may not support the expanded program and might require buying a commercial system, which would be “unacceptable.”
  • The Senator asked for a list of the VA’s IT projects, their priorities, and how those priorities were established. 

Other

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Baylor St. Luke’s Medical Center fires its president, chief nursing officer, and COO following media reports of patient deaths caused by substandard care.

The National Center for Health Statistics says Americans are even fatter than previously thought, which it discovered after measuring people directly rather than relying on their self-reported numbers in which they often inflate height and under-report weight. As the old saying goes, I’m not fat, I’m just short for my weight.

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Those of us who roll our eyes at “influencers” (which is also HIMSS’s new term for “social medial ambassadors who may or not have actual industry influence) will be comforted by the news that they’re being replaced by “avastars,” as companies invest millions to further developer computer-generated, AI-powered synthetic celebrities who not only can generate loyal friends with merchandise-buying potential, but that live forever. Lil Miquela has 1.5 million Instagram followers, of which I would suspect few are significant contributors to society.


Sponsor Updates

  • KLAS recognizes Arcadia for its outcomes-producing, analytics-driven insights in its “Value Based Care Managed Services 2018 report.”
  • AssessURhealth Co-founder Mallory Taylor will present at the Synapse Summit January 23 in Tampa, FL.
  • Bluetree will exhibit at the NJHIMSS 2019 Winter Event January 22 in Monroe Township.
  • The Chicago Tribune profiles Burwood Group President Jim Hart.
  • CoverMyMeds will exhibit at the ASAP 2019 Annual Conference January 23-25 in Kiawah Island, SC.
  • Dimensional Insight publishes a customer spotlight on EvergreenHealth.

Blog Posts


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Contacts

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

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Monday Morning Update 1/14/19

January 13, 2019 News 4 Comments

Top News

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The average acquired health system had annual revenue of $409 million in 2018, according to a new Kaufman Hall report on health system mega-mergers. Seven billion-plus dollar transactions skewed the average upward. 

Only 20 percent of the sellers were financially distressed, and 75 percent of the buyers were non-profit health systems that are anxious to grow. 

Kaufman Hall lists several reasons that health systems are expanding, all of them involving improving their own business rather than patient care. It notes that the line between for-profit and not-for-profit health systems is blurring, such as HCA’s acquisition of North Carolina-based Mission Health that also involves funding a local non-profit health trust.

The country’s largest health system, HCA, operates 178 hospitals with annual revenue of $43 billion. It is focusing on markets with increasing population and low unemployment.

Kaufman Hall recommends that health systems expand in markets with high growth or strong demographics, seek strong operational or clinical partners, and increase consumer engagement.


Reader Comments

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From GuyFromMadna: “Re: Apple. More power to Tim Cook if he can somehow use Apple Watch to solve the crisis of $300 insulin vials or $3,000 out-of-network ED visits. It took me back to Joe Biden’s precision medicine initiative – whatever happened to it?” No technology company or technology itself can solve our mess of a healthcare system and globally underperforming public health. Cook is one of these: (a) naive, which is probable given that companies that have delved much deeper into healthcare than Apple have met their Vietnam after confidently proclaiming themselves disruptors; (b) confusing a narrowly defined view of health that pertains only to a few undiagnosed and often harmless maladies of IPhone-only users; or the most likely answer, (c) desperately trying to feint away from Apple’s rapidly slipping relevance as investors get wary. Claiming that Apple’s best is yet to come and that it involves an industry largely unexplored by Apple is, to me anyway, just silly. Meanwhile, former VP Biden just delivered the keynote address once again at StartUp Health Festival in San Francisco, railing against data silos and most likely thinking about his inevitable presidential run. I haven’t seen any news from his Biden Cancer Initiative, just like I’m still waiting for MD Anderson to justify that “making cancer history” business (no pun intended). At least you know there’s no good treatment for cancer if even rich people are still dying of it.

From AnonymousPlease: “Re: Mid Coast Hospital (ME). Had an extended computer or network outage recently, accordingly to a family member who was told by their lab tech that the computers were down. Sounds like there was an HVAC alarm in the data center that was ignored (reset). By the second time, many servers had overheated.” The hospital’s Twitter account is frozen in mid-2017 and their Facebook doesn’t mention an outage. It seems odd that someone would ignore a data center cooling warning, so I speculate that maybe they shut the alarm off while trying to mobilize an HVAC expert to investigate and then had the temperature get away from them. It would be a tough call to proactively start turning off servers in that situation and they may not have had enough time to activate whatever failover plan they have. Modern servers should be good to at least 110 degrees F, but their individual thermal safeguards can be programmed to take them down at a user-defined temperature. It is, of course, a nightmare trying to recover individual software systems that went down hard even after the server they run on has been brought back online, requiring the enlistment of individual system experts to look at potentially corrupted databases, run disk recovery, free up phantom user sessions, and assess what information was lost.

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From Sticky Wicket: “Re: [publication name omitted.] How did they get ‘Bret’ Shafer in rewording another site’s story?” Misspelling Brent Shafer’s name and omitting his Chairman title is sloppy, but I won’t call the writer out since just a year ago she was finishing up college and working as an office assistant. That particular clickbait-heavy news aggregation site seems to hire from a single demographic of freshly-graduated, female journalism majors. It has an audience, so there’s not much else to say.

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From Visual Acuity: “Re: National Federal of the Blind lawsuit against Epic. One of our residents is legally blind and can use Cerner using ZoomText, which we installed after trying the Cerner option that allows increasing some (but not all) font sizes. The resident has less flexibility since Zoomtext must be installed on individual machines and not through Citrix. I do think Cerner (and it sounds like Epic as well) could do a better job supporting accessibility even for physicians who aren’t legally blind, but who have reduced visual acuity.” Thanks for the tip on ZoomText. It offers a Windows-only screen magnifier, another version that includes reading screen contents and keypresses, and a super-product that provides those capabilities plus keyboard navigation, customization, and more expressive screen reading. It also sells a large-print keyboard with hotkeys that control its software. I agree that clinicians, especially those over 40 when presbyopia kicks in nearly universally, might find that their fatigue level, eye strain, and headaches from frequent computer use could benefit from a screen magnifier. I should also mention that Windows 10 has a screen magnifier built in – just press the Windows logo key plus the plus sign (or navigate through the Settings/Ease of Access menu options) – but I tried it and it seems laggy, although I haven’t tried ZoomText to compare. It’s hard to envision (no pun intended) how well a screen reader would work, however, so I don’t envy someone trying to navigate an EHR as the computer reads its screen contents aloud.

From Informed Consent: “Re: partnering with IBM. I have experience with a healthcare software vendor that entered a joint project with a large client of IBM. ‘Joint project’ means that IBM took full control with their leverage and contacts even though we were providing the core of the solution for which they had no alternative. IBM insisted on ‘handling the paper,’ which means they beat us down to a sub-share of the client revenue, then took 20 percent off the top of our portion for ‘taking the risk.’ They didn’t allow us to talk to the client (‘we have the relationship’). We got sucked into providing a reasonable quote for the work, then midway through, IBM said the client’s budget had changed and, ‘You need to cut your portion to $X for this deal to work.’ This happened three times in this one deal even though they wouldn’t tell us how much they were billing our customer. We were down to 40 percent of the original quote when the client cancelled. IBM’s motto is, ‘Our clients are our clients, and YOUR clients are our clients.’ Their salespeople kept wanting intros into our client base but wouldn’t provide the same. Our CEO was excited to get a call from the IBM sales team wanting a price call for a client with similar need. I warned that even though it was their lead and their paper, by the end of the call, they will demand that we give them a minimum revenue commitment, for which we will be on the hook for THEIR unvetted client. The CEO scoffed, but sure enough, my prediction came true in our first call.” I considered HAL – err, IBM — somewhat evil even before their current financial desperation and Watson missteps. I admire some of the technology developments, especially their inadvertent creation of the modern PC industry and Microsoft by botching the original IBM PC rollout by snapping together off-the-shelf components (the failed, proprietary MicroChannel architecture came after the horse had long departed from the barn). IBM eventually walked away from the now-commoditized business by selling the PC business to China-based Lenovo, which turned out to be a much better vendor.


HIStalk Announcements and Requests

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A convincing 88 percent of poll respondents who self-identify as longstanding HIMSS members say their feelings about the organization are less positive now than five years ago.

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Gerald says that at least HIMSS now acknowledges that the annual conference is a “trade show” (or a “boat show,” as Jonathan Bush always said, although at least boat show attendees are spending their own money instead of someone else’s) instead of claiming that its primary purpose is education. He says he hasn’t attended a provider’s educational session there in the past five conferences, which is about the same as my own record.

A reader asked via a poll question what’s wrong with HIMSS. My answer as a longstanding member, off the top of my head:

  1. They run their operation like a dues-funded vendor, maximizing revenue at every opportunity.
  2. In fact, they really are a vendor, having acquired for-profit companies, conferences, and publications while somehow remaining a non-profit.
  3. They wildly overpay their executives compared to similarly-sized, non-profit member organizations (I researched this thoroughly years ago when Steve Lieber first hit the million-dollar annual compensation milestone).
  4. They sell access to their provider members to their vendor members in the “ladies drink free” model.
  5. Its “vendor points” system rewards the big vendors that are most willing to send HIMSS huge checks, giving those vendors the dominant voice over those that can’t or won’t pay more.
  6. Like most other member organizations, they get involved in government programs that have profit potential for their vendor members.
  7. They pay lip service at best to patients since there’s no money to be made in supporting better public health, outcomes, or access (much like their provider members, in fairness).
  8. Their media operation studiously avoids running anything that looks like real news unless it cheerleads the industry, filling the remaining empty space with inexpertly written filler pitching products and services that are always predicted to improve healthcare but somehow never do.
  9. They aggressively demand to be the voice of the industry even though, as in the case of the American Medical Association, many of the people in that industry aren’t members and those who are may not agree with the positions HIMSS takes on behalf of its vendor members and itself.

New poll to your right or here, as suggested by a reader: for provider IT decision-makers: which service do you consult before buying software or services?


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

More JP Morgan Healthcare Conference nonsense: the entire hotel area is so packed that the moneyed minions are meeting in public parks, restrooms, and the furniture department of a nearby Macy’s, with one hotel charging $300 per hour for a table and four chairs with no service. I didn’t really need more depressing examples of what America has turned into, but this one’s at least kind of funny as long as you don’t think about who’s paying.


Sales

  • University Hospitals Cleveland Medical Center joins the global health research network of TriNetX.

Other

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The conservative-learning National Affairs ponders “The Cost of Hospital Protectionism,” with the obviously brilliant Chris Pope (kudos, seriously – it’s a tough industry to understand and explain) making these points as he looks back on recent hospital industry history:

  • The government has done little to reduce healthcare costs other than to shift the responsibility for paying them while protecting hospitals and encouraging them to inflate costs.
  • Healthcare insurance is becoming increasingly unaffordable, with premiums tripling since 1999 and entitlements expect to consume 40 percent of the federal budget by 2047.
  • Hospital overcapacity encourages hospitals to offer tests and procedures whose per-unit cost is high due to small volumes, often with poorer outcomes.
  • The American Hospital Association promoted cost-based Blue Cross insurance during the Great Depression purely to fund the growth of the expenses of its members.
  • When Medicare Part A was rolled out in 1965, the instant 75 percent payment increase encouraged hospitals to spend more on buildings, staffing, and technology. Within five years, total hospital spending rose 37 percent even though only 7.5 percent of the population gained insurance.
  • Cost-based payment created a “medical arms race” in which hospitals built expensive facilities for expensive procedures, shifting themselves from “institutions of last resort” to all-purpose providers whose costs rose 345 percent in 10 years vs. the Consumer Price Index’s 89 percent rise. As one hospital CEO said, “You could be an idiot and make a fortune on Medicare reimbursement. Any mistake you made got reimbursed.” 
  • Hospitals didn’t worry about the introduction of Medicare DRGs in 1983 because those had a 14.5 percent profit margin built in and excluded capital expenditures, physician fees, and post-acute care services, all of which then started to rise.
  • Patients with good insurance don’t care about cost because they aren’t paying, choosing instead based on convenience and amenities.
  • Commercial insurers have cut into Blue Cross’s dominance by reducing costs, choosing providers based on quality, and introducing managed care that can exclude expensive providers from their network, require prior authorization for expensive procedures, and give doctors financial incentive to reduce the use of unnecessary services. That, along with the rise of ambulatory surgery centers, has slowed the arms race.
  • Hospitals use local political influence, community pride, and vast employment to protect their interests and to have favorable legislation enacted that restricts referral of lucrative patients to lower-cost specialty hospitals that often deliver better outcomes.
  • HMOs and heavy-handed employer cost-control efforts in the 1990s caused a consumer backlash that was fueled by lobbyists for hospitals and doctors, which triggered states to limit cost control practices.
  • Mergers have left 67 percent of hospitals as members of larger systems and often the owners of many more physician practices, but instead of reducing excess capacity, the now-larger health systems are using their clout to increase prices further.

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A doctor who received the above “notice” calls out the phony American Board of Cardiovascular Disease, which is hoping that inattentive medical office workers will send a renewal check to the Falls Church, VA edifice in which it conducts its scientific deliberations (photo above – it’s in the UPS Store, not the adjacent UBreak- IFix). It doesn’t even have a website. This would be hilarious if not for Googling, which reveals many cardiologist “diplomates” who actually advertise their fake credential. The Board’s executives apparently live communally in their tiny mailbox along with those of the equally bogus American Academy of Peripheral Vascular Disease, the American Council of Christian Physicians and Surgeons, the American Academy of Surgery, the American Board of Dental Surgery, the American Association of Ethical Physicians, the American Board of Oncology,  National Diabetes Institute, and the American Board of Urogenital Gynecologic Surgery. Being a Diplomate in Internet-Primary Sleuthing in Heath IT myself (no acronym, please), I tracked down the apparent owner of all these organizations – Keith Lasko, MD, DDiv, who had his own medical license yanked by three states in 1990, after which he started all these organizations and several more like them as retribution (or perhaps correctly identifying an underserved market in fake credentials by those entrusted with the public’s health). The reverend-doctor lives on the spectacularly porn-worthy named Vivid Violet Avenue in Las Vegas, although a lawsuit I ran across suggests that his house is being foreclosed upon by “allied infidels” who want to “throw him and his children into the street as unclean dogs,” referring to his “Mosque of the Golden Rule” religious organization, where he has commendably attained the rank of Imram. He also wrote a poorly-received 1980 book titled “The Great Billion-Dollar Medical Swindle.” My conclusion – the “diplomates” are the bad guys here since there’s no way they believe their bogus credentials are real, so their only intention in buying them must be to mislead patients. The Imran is simply meeting the demand.

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The Hustle interviews the original voice of Siri, voice-over actress Susan Bennett, paid an hourly rate in the summer of 2005 to read seemingly meaningless sentences such as “Militia Oy Hallucinate Buckram Okra Ooze ”for ScanSoft (later acquired by Nuance). She found out only after hearing Siri for the first time that those meaningless syllables – which she had to read precisely as measured by an audio analyzer strapped to her throat – were then chopped up into fragments that could be reassembled to make new words and sentences. Here’s a health IT connection – some of my favorite interviews are with NVoq CEO and speech recognition pioneer Charles Corfield (April 2014, July 2017), who was an early investor in Nuance acquisition BeVocal, widely rumored to have contributed the basics of mobile device speech recognition that became Siri. He’s always amused when I amateurishly try to pin him down on his Siri contribution, chuckling and intoning in his mellifluous British accent, “I think I shall refer you to Nuance to comment on matters of Siri or otherwise.” Corfield also created the precursor to Adobe FrameMaker, the first desktop publishing program, while working on his astrophysics PhD at Columbia after graduating from Cambridge. He’s one of the most interesting people I’ve ever talked to, a lock for my HISsies vote for “industry figure with whom you’d most  like to have a few beers.” 


Sponsor Updates

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  • The Nordic team continues its partnership with The River Food Pantry in Madison, WI.
  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.)
  • MDlive publishes a case study featuring Cone Health (NC).
  • EClinicalWorks publishes a podcast titled “How Interoperability Fine-tunes a Neurology Network.”
  • Netsmart will exhibit at the North Carolina Providers Council Annual Conference January 14 in Greensboro, NC.
  • OnPlan Health and Patientco will exhibit at the HFMA Western Region Symposium January 13-16 in Las Vegas.
  • Experian Health and Change Healthcare partner to deliver identity management solutions.
  • PatientKeeper will exhibit at the HFMA MA-RI Annual Revenue Cycle Conference January 17-18 in Foxborough, MA.
  • TheFutureofThings.com includes PatientKeeper in its list of top healthcare apps.
  • Huron announces 20 senior-level positions.
  • ZeOmega publishes a new case study highlighting how Alliance Behavioral Health is using Jiva to manage care for North Carolinians experiencing mental health challenges, addiction issues, and intellectual disabilities.

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Weekender 1/11/19

January 11, 2019 News No Comments

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Weekly News Recap

  • Apple CEO Tim Cook tells CNBC that the company’s greatest contribution to mankind will be related to health.
  • CMS Administrator Seema Verma says its requirement that hospitals post raw CDM lists will encourage developers to create tools that consumers will find more useful.
  • IBM CEO Ginni Rometty says Watson Health is still a viable part of the company’s business and that Watson for Oncology is doing well.
  • England’s NHS issues a long-term plan that calls for technology to improve the ability of patients to manage their own health and to give clinicians access to patient records from any location.
  • Healthgrades acquires Influence Health.
  • Vatica Health acquires CareSync’s care coordination and chronic care management technology following a $1 million bid made last October.
  • The Senate confirms James Gfrerer as the VA’s assistant secretary of information and technology, its first permanent CIO in two years.
  • SVB Financial Group completes its acquisition of healthcare and life sciences investor Leerink Partners for $280 million in cash.

Best Reader Comments

Maj. Gen. Payne says “I want to give you a transparent review of where we are with MHS GENESIS” and then doesn’t. Unless maybe the author of the article left out parts like “it doesn’t work yet,” or “it failed its only assessment so far” or “it has zero interoperability with community providers.” It’s one thing to not see a train wreck coming, but another to have it wreck at your feet and disavow it. (Vaporware?)

Did everyone forget about the Tata case? I understand Epic (or any other vendor) wanting to protect their intellectual property. (UGM Attendee)

But this [health system selling Epic Community Connect that refuses to participate in an HIE] would not be the vendor. It’s the hospital itself that’s trying to absorb / acquire / whatever the neighboring clinicians. Epic has nothing to do with it other than being the hospital’s EHR. It’d be the same situation if it was Cerner I assume. My guess is the ONC will put out a proposal that tackles something that isn’t actually an issue. (Epic Complainer)

My patience and sympathy for gripes concerning no-shows is sharply limited. OK, yeah, it’s socially poor form and it has economic and medical consequences. Yet when those same providers are asked to explain, justify, or even quantify wait times, they cannot. Or will not. Or we receive a long list of excuses as to why the poor on-time performance of clinicians exists. With no solutions offered, not ever. Can anyone say they have not waited in a reception room, for an appointment that didn’t start on time? Often by an hour or more? (Brian Too)

Coach, is your HIE on any national plug & play network? I believe Carequality’s terms are share one, share all. (Ex-EDI)

The Allscripts 2bprecise product was built on NantHealth’s Geonomics product, which they obtained after investing $200 million into NantHealth, only to lose nearly all of it when that division failed and was the focal point of possible legal issues. Any word on how many sites implement and use this 2bprecise product / service? (Dr. JVan)

The screenshot issue is ironic. As I recall, around 2000, Epic settled (for millions $$) a lawsuit that IDX had filed against them which stated Epic had stolen screenshots and documents from the UW Medical foundation.(HISJunkie)

As for Epic moving into tangent markets for LTC, mental health, etc. it will be very interesting to see how they go about this. Develop or buy? Considering that there are many successful vendors that own these markets, they sure do not have the time to develop, so will they break down and buy? Secondly I think that the sales argument that the organization will want to buy from a single vendor will not carry as much weight as it did selling within the hospital. (HISJunkie)

Epic doesn’t have an IP leg to stand on for the screenshot restriction, but I believe they started putting this into their contracts a while back that the organization wouldn’t allow it from their employees, and it probably hits their “good install” metrics if they do. (DrM)


Watercooler Talk Tidbits

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Reader donations funded the DonorsChoose teacher grant request of Ms. B, who asked for 30 sets of headphones for her second grade class. She reports, “When my class received our box of goodies, we opened it together and they were so happy to have new headphones. Our old headphones were taped or broken from the usage due to the prior years of teaching. We also had to borrow from other classrooms in order to have a class set. Through your donation, my students have an opportunity to build their educational skills in all areas of learning. Working during technology time as a whole has enhanced reading comprehension, math, and vocabulary development by providing them comfort as they work in their own personal space. Receiving their personal headsets has opened up a whole new world.”

Facebook employees liken their work environment to a cult, in which they are forced to pretend to love their jobs, keep quiet about the company’s many scandals, and to form fake friendships with co-workers to game the company’s peer review system that encourages employees to submit anonymous, unchallenged feedback to the employee or their manager.

A jury awards $14 million to parents in a lawsuit brought against a hospital and a radiologist in a “wrongful birth” case in which they were not warned that an ultrasound image of their 22-week fetus showed possible abnormalities that might have convinced them to terminate the pregnancy.

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Cell phone providers are selling the real-time location data of their customers, creating a gray market for “bounty hunters” who can locate any cell phone to within a few hundred yards. Companies are selling the data that is intended to be used for fraud detection and roadside assistance firms  – in violation of the privacy policies of the cell phone providers — to developers of apps for car salespeople and bail bondsmen.

A urologist removes a patient’s healthy kidney at UMass Memorial Medical Center after pulling up the wrong CT scan by looking up his patient by name alone, which displayed the images of a different patient with the same name who had the same kidney scan performed on the same day. 

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The mother of a five-year-old boy whose diabetes is continuously monitored complains that she called Johns Hopkins All Children’s Hospital (FL) to report a high reading, but doctors didn’t call her back for three days. The hospital’s endocrinology department says they will start returning the calls of diabetic patients within 24 hours.

A Qualcomm executive’s keynote at the Consumer Electronics Show is interrupted by his unmuted Alexa device, which demonstrated an uncanny use of AI (during his pitch for using AI in cars) by loudly proclaiming, “No, that’s not true.”


In Case You Missed It


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News 1/11/19

January 10, 2019 News 2 Comments

Top News

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Apple CEO Tim Cook tells CNBC’s Jim Cramer that the company will soon roll out new healthcare services that have been years in the making. He says those offerings will ultimately revolutionize the way patients manage their health data.

Cook added, “I believe, if you zoom out into the future and you look back, and you ask the question, ‘What was Apple’s greatest contribution to mankind?’ it will be about health.”

Cook’s enthusiasm for healthcare, while not new, comes at a time when the company has seen the health of its own share price suffer as consumers are finally rebelling against the Apple tax of paying premium prices for increasingly commoditized products. Those few days of AAPL’s $1 trillion valuation are receding in the rearview mirror.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

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Change Healthcare makes a strategic investment in MDsave, a healthcare price comparison startup that offers consumers discounted services when booked through its website. The timing seems opportune, given the practically useless price lists hospitals are now federally mandated to post. Perhaps sites like these will give consumers a better, easier-to-understand way to compare costs at different facilities. The Brentwood, TN-based company boasts former senator Bill Frist, MD as a founding investor.

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Seattle-based Providence St. Joseph Health’s venture arm announces a second $150 million VC and growth equity fund. Since launching in 2014, it has invested in Collective Medical, Kyruus, Omada Health, Trilliant Health, Xealth, and Wildflower Health.

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Northwestern Medicine (IL) requires patients to agree not to pursue class-action lawsuits or jury trials over the mishandling of digital services like Epic’s MyChart. That product was ironically developed by Epic employees who are forced to accept a similar class action waiver, which the US Supreme Court upheld as a valid requirement to prevent employment-related class action lawsuits.

Despite a plethora of recent bad press about IBM Watson’s healthcare capabilities and disingenuous marketing practices, IBM CEO Ginni Rometty says it is still a viable part of the company’s business, and that Watson for Oncology is doing well. The company’s website offers no insight into how many organizations are using Watson for Oncology; its only case study material comes from two hospitals in India.

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Boston-based PatientPing will hire 100 employees over the next 12 months in doubling its staff.

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Federal health IT vendor Planned Systems International acquires competitor QuarterLine for an unspecified amount.


Sales

  • Val Verde Regional Medical Center (TX) will add patient engagement content and software from Allen Technologies to its in-room smart TVs.
  • VA hospitals in the Pacific Northwest will implement Carestream’s enterprise imaging technology.

Announcements and Implementations

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In Texas, 25-bed Liberty Dayton Regional Medical Center (OH) spends $1 million on transitioning from paper record-keeping to Cerner.

Federal health IT vendor DSS adds newly acquired EDIS software from VeEDIS Clinical Systems to its new Juno EHR.

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Stanford Children’s Health (CA) expects to double its telemedicine visits to 2,500 this year. The hospital uses virtual visit technology for clinic-to-clinic, home-to-clinic, and school-to-clinic visits. It introduced a second-opinion service with Stanford physicians last November, though I imagine the $700 presumably out-of-pocket fee might not make it Stanford’s most popular telemedicine service. The hospital is no stranger to high healthcare costs, having taken heat last year for charging a family $23,000 for a single MRI scan.

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Solutionreach releases SR Spotlight, a phone-based patient triage system that integrates with practice management software.


Government and Politics

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MHS EHR Functional Champion and Air Force Maj. Gen. Lee E. Payne, MD reassures federal health employees that the MHS Genesis project is on track now that the initial testing phases are over, and that the next wave of implementations will benefit from improved training processes. He stressed, however, that end users will have to adjust their workflows to fit the new Cerner-powered system. “If you try to take your existing business processes,” he says, “whether that’s in AHLTA or Essentris, and you try to jam that into the new electronic health record, you will fail.” The DoD rollout, scheduled to be organization-wide by 2024, will continue with wave-one implementations at three clinics in California and one in Idaho.

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CMS Administrator Seema Verma reacts to consumer frustration and negative press over the agency’s efforts to make hospital price lists public, noting that, “While the information hospitals are posting now isn’t patient-specific, we still believe it is an important first step & sets the stage for private third parties to develop tools & resources that are more meaningful & actionable.” She added that University of Utah Health, UCHealth (CO), and Mayo Clinic (MN) have gone above and beyond in making their pricing user-friendly and transparent.


Other

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Lease requirements force several physicians to keep their practices open at Physicians Regional Medical Center (TN), which began shutting down last November as part of its parent company’s effort to consolidate services in the area. OB/GYN Lowell McCauley, MD is waiting out his six-month notice of termination in a facility that is now “a desolate institution.” His patients have been cancelling their appointments once they reach the parking lot. “It’s not that they’re not comfortable with me and my staff,” he says, “they’re just not comfortable driving in and seeing what looks like a prison.”

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University of Washington Medicine researchers seek FDA approval for Second Chance, a phone-based overdose prevention app that will automatically dial 911 if a user’s breathing and movement slows down or stops.


Sponsor Updates

  • EPSi will exhibit at the HFMA Western Region Symposium January 13-15 in Las Vegas.
  • Loyale Healthcare talks with TransUnion Healthcare Services Principal of Healthcare Strategy Jonathan Wiik about his new book, “Healthcare Revolution: The Patient is the New Payer.”
  • HASA leverages Imat Solutions to deliver value to the healthcare community through data.
  • The local news highlights the Texas Hospital Association’s efforts to help providers fight the opioid epidemic using Collective Medical technology.
  • Cumberland Consulting Group Principal Lori Nobles joins AHIMA’s Commission on Certification for Health Informatics and Information Management.
  • Optimum Healthcare IT publishes an infographic titled “5 Phased Approach to an Epic Upgrade.”

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Contacts

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Morning Headlines 1/9/19

January 8, 2019 Headlines, News 2 Comments

The NHS Long Term Plan

In England, NHS issues a long-term plan that calls for technology to, among other goals, improve patient access and the ability to self-manage health, and give clinicians access to patient records from any location.

Healthgrades Acquires Influence Health

Physician and hospital information publisher Healthgrades acquires Influence Health, which offers web services, listings, reputation management, and CRM.

Amazon’s next big thing? Prime, but for healthcare

Analysts predict that Amazon will create Prime for healthcare, which could focus on offering lower drug prices via its acquired PillPack mail order pharmacy, Alexa services, and using its recently announced medical records analytical service to scribe clinical encounters.

AT&T and Rush System for Health Ink Agreement to Use 5G in Hospital Setting

AT&T and Rush University Medical Center (IL) will create the country’s first 5G-enabled hospital and will explore ways that a faster cellular network can improve operations and patient experience.

News 1/9/19

January 8, 2019 News 2 Comments

Top News

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In England, NHS issues a long-term plan that calls for technology to:

  • Improve patient access and the ability to self-manage health
  • Give clinicians access to patient records from any location
  • Apply best practices using clinical decision support and AI
  • Apply population health prediction techniques to assign resources accordingly
  • Capture data automatically to reduce administrative burden
  • Protect privacy and give patients control over their medical record
  • Link clinical, genomic, and other data to improve treatments

Reader Comments

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From Jaye P. Morgan Gong Show: “Re: JP Morgan Healthcare Conference. I really like your post about the moneyed investors dodging the homeless on San Francisco’s sidewalks, but let’s remember Jonathan Bush stopping to administer CPR while he was walking down the street. Of course, we know what happened to him.” That unscripted drama from 2016’s conference said a lot about the character of the former Army medic and EMT, who didn’t hesitate to hit the dirt in his expensive suit to perform CPR. He explained at the time, “It was a lot like the healthcare industry: a lot of people were standing around tweeting about it, but no one was trying to do anything about this guy lying in the street. So I was like, turn him the f*** over! It was really dramatic. It was intense. The crowd was rooting for us.” Among the beauty queen sashes I ordered for that year’s HIStalkapalooza was one for JB that said, “I CPR’ed some random guy.” Meanwhile, Elliott Management’s Paul Singer had best hope that JB isn’t the only bystander if he goes to ground.

From Info Blocker: “Re: health system not sharing information with an HIE. That’s not like Epic.” Epic isn’t the problem here, it’s that one of their customers that doesn’t want to share patient information. Suggesting that EHR vendors are the bad guys distracts from reality. You only need to find one user of any EHR system that is sharing data by any means (HIE, Carequality, CommonWell, API, internal app, etc.) to disprove the idea that it’s not possible for that system to share information. The only way the vendor is the villain is if they charge unreasonable fees to make it happen. 

From See Me, Feel Me: “Re: National Federation of the Blind. Is suing Epic for discrimination, saying that Epic’s failure to support screen readers prevents blind people from working in Massachusetts hospitals.” That’s actually old news from July of last year. The organization does of lot of suing for inaccessible websites, self checkouts that don’t work well for the blind, universities that don’t make every function and benefit accessible, and hospitals that don’t offer all materials in Braille or electronic form. Section 508 of the Rehabilitation Act of 1973 requires the federal government to make its own technologies usable by the disabled, but I don’t think the requirement extends further and I’ve only heard of it in the context of public web pages. I can’t imagine that Cerner – the federal government’s most expensive IT system in history – is natively accessible, so if it supports use by the blind, it’s probably through a third-party screen reader. Good intentions aside, I don’t know how someone who is blind could navigate information-packed displays that require clicking, choosing drop-downs, and displaying dynamic patient information. The lawsuit notes that Epic’s patient-facing applications have been made accessible and concludes that “Epic thinks that blind people are only fit to be patients, not healthcare workers.” I’m not sure the sarcastic tone and claims of discrimination will win friends and influence people.


HIStalk Announcements and Requests

We’re putting together our HIMSS19 guide that features HIStalk sponsors, so if your company is exhibiting or attending, contact Lorre to get our information collection form about your booth, giveaways, or activities. You’re probably spending a fortune to be there, so you might as well get some free exposure. She also convinced me to offer some sweeteners to cash-strapped startups who sign up as new sponsors, especially those who realize that their exhibit hall time leaves them out of the spotlight for the 362 days of the year afterward.

HIMSS will have some holes in its agenda if the federal government shutdown continues for 33 more days, which I assume would leave some attendees and presenters unable to attend.

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Ellkay sent some fun stuff my way (via Lorre) for the holidays – a beautifully packaged sampler box of their honey (from their rooftop bee hives) and a really cool drawing of their Christmas party guests with a find-the-object game included. I’m generally indifferent to unimaginative corporate giveaways, but Ellkay does it perfectly in not only providing something novel and useful, but that also expresses who they are.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

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Physician and hospital information publisher Healthgrades acquires Influence Health, which offers web services, listings, reputation management, and CRM.

Change Healthcare and Experian Health will combine their healthcare network and identity management capabilities, respectively, to create an identity management solution.

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Patient engagement technology vendor Vatica Health acquires the technology of the defunct CareSync, for which it made a $1 million stalking horse bid to the bankruptcy court in October 2018. CareSync, founded in 2011, burned through nearly $50 million in funding before abruptly shutting down in June 2018.

Analysts predict that Amazon will create Prime for healthcare, which could focus on offering lower drug prices via its acquired PillPack mail order pharmacy, Alexa services, using its recently announced medical records analytical service to scribe clinical encounters, and providing services such as telehealth and medical devices.

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Patient matching technology vendor Verato raises $10 million in a Series C funding round, increasing its total to $35 million.


Sales

  • St. Luke’s University Health Network (PA) signs a three-year Epic managed services agreement with HCTec.
  • Boston Medical Center Health System chooses ZeOmega Jiva for advanced care management in its Medicaid ACO. 

People

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CHIME names Stanford Children’s Health CIO Ed Kopetsky, MS as 2018’s John E. Gall Jr. CIO of the Year.

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Isaac “Zak” Kohane, MD, PhD (Harvard Medical School) joins the board of Inovalon.


Announcements and Implementations

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Vocera launches a new hands-free, voice-powered Smartbadge that offers a larger color screen, improved audio, a dedicated panic button, and extended battery life.

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Another 12 health systems representing 250 hospitals join Civica Rx, which will manufacture its own generic drugs – many of them in IV form — to save money and reduce shortages.

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Withings will offer consumers a less-expensive EKG device than the Apple Watch with its $129 Move ECG, which hasn’t yet earned FDA’s marketing clearance. AliveCor’s $99 KardiaMobile came out two years ago as the first and arguably best of the lot.

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Omrom launches a $499 blood pressure watch that uses an inflatable cuff built into the band rather than the usual questionably accurate optical sensors. It also announces Complete, which adds EKG capability to the blood pressure monitor.

AT&T and Rush University Medical Center will create the country’s first 5G-enabled hospital and will explore ways that a faster cellular network can improve operations and patient experience. 

California health data network Manifest MedEx goes live on NextGate’s EMPI.


Other

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Wired magazine notes that China’s healthcare AI efforts, such as imaging analysis, benefit from that country’s less-rigorous privacy regulations that allow vendors to train their systems using millions of readily available patient images. An example is InferVision, which is being tested at Wake Radiology (NC) and Stanford Children’s Hospital.

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Vox finds that the ED of taxpayer-funded Zuckerberg San Francisco General Hospital intentionally remains out of network for all private insurers, which the hospital explains is necessary to generate the money it needs to offset charity and Medicaid care. The hospital billed a 24-year-old woman whose broken arm was treated in its ED $24,000 (12 times the Medicare price), of which Blue Cross paid $3,800, leaving her on the hook for over $20,000.

A study published in Health Affairs finds that the 20 top-funded digital health companies have had minimal documented impact on disease burden or cost, with few published studies and an avoidance of measuring outcomes in sicker patients.

A large-scale consumer survey by NRC Health finds that 80 percent would change providers based on convenience alone; long waits and lack of respect are big dissatisfiers; people want to provide feedback quickly after their encounter and preferably by email; and patients don’t care much about provider brand identity and instead focus on their experience with individual clinicians.

Observer polls a panel of experts to name its 20 best “flyover tech” digital health companies that aren’t on either coast:

  • Bind (MN) – insurance management for consumers
  • Solera Health (AZ) – connecting patients to community organizations and apps
  • NightWare (MN) – intervention for PTSD-caused nightmares
  • ClearData (TAX) – cloud computing and information security
  • Healthe (MN) – eye protection from computer device blue light
  • MyMeds (MN) – medication adherence
  • Visibly (IL) – online vision testing
  • Higi (IL) – health kiosks
  • HistoSonics (MI) – non-invasive treatment robotics
  • Lumea (UT) – digital pathology
  • Springbuk (IN) – actionable health insights
  • Sansoro Health (MN) – healthcare data exchange
  • LearnToLive (MN) – online mental health treatment
  • Smile Direct Club (TN) – teeth straightening aligners
  • SteadyMD (MO) – remote primary care that matches the lifestyles of patients and doctors
  • Collective Medical (UT) – ED patient data sharing
  • Limb Lab (MN) – prosthetics
  • Upfront Health (IL) – care journey “next best action”
  • AbiliTech Medical (MN) – robotic assistance for those upper-limb with neuromuscular conditions
  • Vivify Health (TX) – remote care mobile devices

Tennessee pays contracted doctors a piecework rate for reviewing disability applications, with one of them finishing cases – of which 80 percent were denied — in an average of 12 minutes, allowing him to make $420,000 in the past year and $2.2 million since 2013. At least two of the contracted 50 physicians are felons, while others have had their medical licenses revoked.

In England, experts take a hard-eyed view of sloppily handwritten prescriptions after female patient irritates her eyes with what was supposed to be a soothing ophthalmic lubricant, which the pharmacist mistook as an order for a cream for erectile dysfunction. One might assume that the pharmacist ignored a series of computer warnings for issuing a drug for an inappropriate route of administration and patient sex.


Sponsor Updates

  • Divurgent and Gevity will offer their combined healthcare information systems consulting expertise.
  • Access and Dimensional Insight will exhibit at the MUSE Executive Institute January 13-15 in Newport Beach, CA.
  • AdvancedMD announces the winners of its annual Healthcare Innovator of the Year Awards.
  • Tampa Bay Tech awards AssessURHealth with its Emerging Tech Company of the Year award.
  • The Best and Brightest names Burwood Group a Wellness Winner.
  • The Chartis Group publishes a new report, “Why Your Provider Workforce Plan Isn’t Working.”
  • The local news highlights UCSF Medical Center’s use of Collective Medical technology to help “frequent flier” ER patients.
  • Divurgent and Gevity announce a strategic business alliance to expand their services across the US and Canada.
  • DocuTap announces its 2018 student scholarship essay winners.

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Monday Morning Update 1/7/19

January 6, 2019 News 7 Comments

Top News

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The VA finally has its first permanent CIO in two years after the Senate confirms James Gfrerer as assistant secretary of information and technology.

The 20-year Marine Corps veteran and US Naval Academy computer science graduate most recently worked for Ernst & Young. He has spent most of his career working on IT business risk and cybersecurity.

Gfrerer replaces interim CIO Camilo Sandoval, a military veteran and former Trump campaign executive.


Reader Comments

From Casual Commitment: “Re: sharing Epic screen shots. Some customers would release shots of every single screen. It’s hard to create a competitive advantage with software and harder to maintain it over time. Customers could release every screen shot of a new release to the world even before going live and competitors could simply copy it, taking away the incentive to create innovation and usability. Some would argue that it’s in the best interest of science and/or safety, but I think most vendors are OK with using images for those purposes and would not ask a client to take them down. Vendor contracts nearly always require clients to get permission before sharing confidential information and academic medical centers often require the same assurances that their confidential information not be shared.” Sometimes I question whether just getting a look at the user interface exposes the intellectual property underneath, but I admit that I’ve written some programs that were inspired by seeing a screenshot or demo, then figuring out how to make it work under the covers, so I can buy that.

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From Epic Customer: “Re: sharing Epic screen shots. Epic publishes its straightforward approach, but it isn’t well publicized at customer organizations and folks don’t check with the IT department when preparing their publications. Then they are notified that they have used a screenshot inappropriately and are upset that their publication needs to be take down or changed. Blaming Epic doesn’t seem appropriate, but clients are challenged to make it clear to staff the restrictions that ALL vendors impose on to prevent inappropriate use of proprietary information. Most health systems have committees, which would seem to be needed to guide compliance.” Epic Customer provided Epic’s predictably thorough and clear screenshot guidelines, which say:

  • Any public sharing of Epic content (to websites, other vendors, presentations other than to Epic clients, research papers, publications, and books) requires Epic’s review via its Content Approval process, which takes about two weeks.
  • The submission requires stating why using the screen shots is necessary, who will see it, how it will be distributed, and the goal or conclusion of any research (that last aspect troubles me a tiny bit, such as the case where the argument is that Epic’s design endangers patients or burdens clinicians – would that impact the likelihood of approval?)
  • Any vendor that will receive Epic screen shots or functionality description must ask Epic before using it.
  • An Epic copyright notice must be included on every screen shot.
  • Screen shots should crop or blur information not needed for the specific purpose, such as removing menus and toolbars.
  • Content can’t be posted on private video or quiz sites (including YouTube) because the terms and conditions of those sites say that anything posted there becomes the property of that site. 

From Merger Frenzy: “Re: CommonSpirit Health (the soon-to-be merged Dignity Health and Catholic Health Initiatives). Deanna Wise was announced as the consolidated CIO a few weeks ago, then was gone a few days later with two interims in place. The organizations have very different cultures and IT systems (Cerner at Dignity and Epic, Cerner, Allscripts, Meditech, and others at CHI, I think) but they’ve been working on this for over two years. In addition, the merger has been pushed back again to February 1.” I’ll first say that I detest that embarrassing married name, as I do any time the marketing geniuses decide it will be amazing to simply remove the space between two words while leaving them capitalized (“common spirit” sounds like a bar’s cheap well drink). Deanna Wise was named CIO of the 140-hospital, $30 billion, Chicago-based mega-system in a December 4 announcement. Her LinkedIn hasn’t changed and she’s still listed as EVP/CIO on Dignity’s executive page. That’s all I know, other than that big-ego organizations that are used to calling their own shots often can’t stop arm-wrestling for control before, during, and after a superficially friendly merger.

From Telebicycle Coach: “Re: information blocking. My HIE employer has ONE large non-profit hospital in the entire state that refuses to contribute lab result data, which I suspect is because it wants to sell Epic to small practices that don’t need it and can’t afford it, so it tells them it’s the only way they can get lab data. I would love to hear thoughts.” Intentional health system blocking is rampant, as you might expect when trying to convince competitors in any industry to share internal information. I don’t really have any new thoughts except to say that it should either be made a strictly enforced law (driven by complaints like yours) or a condition of being paid taxpayer money in the form of Medicare. No amount of shaming or dangling the patient benefit carrot has worked, just like it hasn’t for getting hospitals to give patients copies of their own records quickly and inexpensively. Shame is an effective weapon only to the extent that an organization fears being shamed.

From Barnard Rubble: “Re: big data. Is it still a contender for the HISsies ‘most overhyped’ category?” The perpetual frontrunner is actually not on this year’s ballot due to a plethora of fizzy competitors, such as blockchain and IBM Watson Health. Maybe big data has finally summited Gartner’s Peak of Inflated Expectations, although I expect the Trough of Disillusionment to be in the form of the lawyer’s warning to “don’t ask a question for which you don’t want to know the answer.” Big data will tell us what we already know and can’t solve – that our system healthcare system is unfair, unaffordable, inefficient, reflective of primitive social policies, incapable of delivering consistently high outcomes, and rife with profiteers and political influence. It’s nice for society’s financial winners to foresee a world in which their every malady is machine-diagnosed and optimally treated with the best, most personalized therapies available, but people are suffering and dying due to problems that have nothing to do with analytics. We should just declare ourselves a third-world country and then take the Bill Gates public health funding approach – use analytics to identify the most health-impacting problems that can be fixed creatively and inexpensively at scale to benefit the most people in hoping to move up from the dregs of developed nation health rankings.


HIStalk Announcements and Requests

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Poll respondents aren’t interested in reading executive interviews that focus on the company’s products or the individual’s personal history – they would rather learn more about the executive’s views on healthcare trends and what they think about life in general. Me, too – I’ve interviewed executives who couldn’t stop blabbing about the amazing potential of their companies under their skilled watch, only to have the company or their careers take a startling stumble soon after. Show us your character and let the rest of us decide whether that piques our interest enough to want to learn more about your business. I’m proudest of my interviews that led readers to feel that they got to know a CEO.

New poll to your right or here: For longstanding HIMSS members: how do you feel about the organization now vs. five years ago? Vote and then click the poll’s comments link to describe what has changed for the better or worse.

Thanks to these companies for recently supporting HIStalk. Click a link for more information.

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Two warnings as HIMSS19 approaches (anybody have other Orlando scam alerts?):

  • Don’t book your hotels through email solicitations, even when they list seemingly legit hotel names and prices. HIMSS blocks all the hotel rooms, so you can only reserve through them for hotels on their official list.
  • Don’t call pizza places whose flyers are shoved under your hotel room door. Those are scams, too, as criminals make up restaurant names, create flyers with phone numbers, and then steal your credit card information when you order that pizza that never arrives (they could get even smarter using a national brand name like Domino’s but with a phony phone number).

Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

SVB Financial Group completes its acquisition of healthcare and life sciences investor Leerink Partners for $280 million in cash and $60 million as a five-year retention pool for Leerink employees (of which D&B Hoovers says there are just 42).

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For those who might otherwise forget that US healthcare revolves around business rather than patients, a gallon of meeting room coffee at this week’s JP Morgan Healthcare Conference costs $170 ($21 per cup), hotel rooms for the besuited moneychangers run thousands of dollars, and borrowing 14 power strips in a hotel conference room costs $1,000. Meanwhile, attendees complain about having to dodge San Francisco’s unwashed to get to their all-important meetings about profiting from healthcare services delivery, as hotel security guards and side job police officers shoo away people who are homeless, addicted to drugs, or suffering from mental illness and are thus offensive to the dealmakers whose influence over healthcare policy and delivery keeps increasing. Someone should snap a photo of a money mover in a $5,000 suit (“come on!”) who invests in tech companies pitching population health management or social determinants of health who snootily sidesteps the people the company claims to serve.

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Patrick Soon-Shiong is once again a leading candidate in the “pie in the face” HISsies category, so I took a look at NantHealth share price – it’s at $0.62, valuing the once-touted enterprise at a paltry $68 million. NH shares rose to as high as $21 on IPO day in June 2016, having since lost a startling 97 percent of their value. I’m pretty sure I can predict the HISsies pie vote of  those early shareholders. The logo reminds me of an old, possibly appropriate, not-safe-for-work joke involving a feather and the distal colon.


People

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Echo Health Ventures hires Jessica Zeaske, MHS, PhD, MBA (GE Ventures) as partner.


Government and Politics

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Livongo hires its board member and investor Lee Shapiro as CFO. Shapiro was president of Allscripts when Livongo board chair Glen Tullman was CEO of that company.


Other

I finally got around to looking over last month’s telehealth-focused Health Affairs, with these snips from various articles catching my eye:

  • Not many doctors or patients are using telehealth, although the numbers are increasing and the available information is dated.
  • Lessons learned by four large health systems that have implemented a telehealth program include making sure executives agree on its goals and strategic contribution; coordinating telehealth efforts among multiple departments to set priorities and ensure the availability of support resources; identify champions who can help overcome the resistance of clinicians and employees; develop a patient education and marketing strategy; and evaluate outcomes to support improvement.
  • Major health system adoption barriers are cost, payment, and technical issues, with a key factor being how well state Medicaid pays for the service.
  • A literature review finds that while telehealth interventions appear equivalent to in-person care, its effect on the the usage of other services is not clear.
  • Use of remote experts to support neonatal resuscitation at small hospitals reduces transfers and thus cost, but it is rarely used because nobody pays for it.
  • Kaiser Permanente doctors who take chest pain triage telephone calls spent less time per call compared to nurses and sent fewer patients to the ED, but patients accepted the recommendations of doctors at a higher rate. Mortality rates for calls taken by doctors and nurses were similarly low, but direct-to-physician protocols worked best to reduce ED visits and costs.
  • Appropriate antibiotic use for acute respiratory infections was about the same in telemedicine and in-person visits, but strep tests were used in only 1 percent of direct-to-consumer visits vs. 78 percent in urgent care centers, leading to more repeat visits following telemedicine sessions.
  • CMS’s 2013 decision that a telemedicine doctor can serve as the physician backup for advance practice providers in critical access hospital EDs has led some hospitals to replace local doctor coverage to reduce costs.

I took a quick look at the websites of a few big health systems to see if they had posted their price lists on January 1 as CMS requires, with these results from checking news releases and then searching for “price list” (of course, ignoring the fact that the lists themselves are unhelpful gibberish to consumers):

  • New York Presbyterian – has information for one campus only that I could find
  • Florida Hospital (now AdventHealth Orlando as of January 1) – yes, but as an XML document that gives an immediate browser error
  • Jackson Memorial Miami – yes, but buried deep in the site’s structure
  • UPMC Presbyterian – yes, in Excel (the best job of all those I checked)
  • Methodist Indianapolis – no
  • Montefiore – yes
  • Methodist San Antonio – yes
  • Orlando Regional Medical Center – no
  • Methodist Memphis – yes
  • UCSF – yes
  • Ohio State – yes

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Pro tip from downloading hospital price lists: if admitted to UPMC Shadyside and you take Ativan, the 1 mg dose costs 99 percent less than the 0.25 mg dose (I guess it’s expensive to have someone cut the 0.5 mg tablet in half). Their CDM is full of oddities like this that I assume are the result of shortened descriptions that don’t tell the full story. I started to compare prices across health systems for a few common items, then realized how pointless that would be for consumers or anyone else.

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Former New York City Health + Hospitals SVP/CIO Bert Robles is fined $9,000 by the city’s Conflicts of Interest Board for convincing an Epic EVP to let his girlfriend take an Epic certification course with him and for asking his employees to get the girlfriend an H+H ID card so she could use office space and computers to study.

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California plastic surgeons derail the attempt of cosmetic surgeons to advertise themselves as “board certified,” with the former questioning the American Board of Cosmetic Surgery’s training program as a “bogus marketing tool” and claiming that 24 percent of its members have been the subject of disciplinary actions after they left other specialties to perform elective and cash-paid breast augmentation, hair transplants, and tummy tucks without extensive training.


Sponsor Updates

  • The Journal of Clinical Pathways interviews Richard Loomis, MD chief informatics officer for clinical solutions at Elsevier.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 1/4/19

January 3, 2019 News 6 Comments

Top News

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Alphabet’s life sciences company Verily —  the former Google Life Sciences — raises $1 billion in a new capital funding round.

CEO Andrew Conrad says that the money will prepare the company to “execute as healthcare continues the shift toward evidence generation and value-based reimbursement models.”

Some of Verily’s projects include smart contact lens, continuous glucose monitors, development of bioelectric medicines, hand tremor reduction software, retinal imaging, surgical robotics, healthcare performance measurement, risk prediction models for chronic disease management, and precision medicine.


Reader Comments

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From Dr. Demento: “Re: Annals of Internal Medicine article on machine learning and inequitable treatment. I’m wondering how you’ll respond to these, especially the editorial.” The article says that because machine learning analyzes historic data, it will perpetuate longstanding health disparities that are based on racism and classism, an issue that has arisen in other areas such as trying to predict which citizens are likely to commit crimes. The article provides a healthcare example of using ML to predict patient deterioration, which might underrepresent African American patients who were treated differently, or discharge care planning that might place too much emphasis on patients from high-income ZIP codes since they have more control over discharge conditions such as transportation, home meds, etc. I see the potential problem, but all aspects of life contain certain assumptions and biases and it’s asking a lot of a machine to somehow iron them out even though we ourselves are usually unaware of them. There’s also the issue of whether a machine is being “unfair” when it makes observations that may or may not need to consider social determinants of health instead of simply making a recommendation that works for most people. I’m all for being aware of these issues and fine-tuning the algorithms accordingly, but ML has to reflect an inherently unfair reality (see: Flint’s water crisis). I worry more about it drawing incorrect inferences because, like the humans that oversee it, the technology can’t always distinguish between correlation and causation. The bottom line is that humans should always be managing the machine, second-guessing it, and demanding transparency into how it arrives at its conclusions because we’re the adults in the room. Expecting a machine to be less biased than the human history it learns from is a nice idea and worth keeping in mind, but we’re probably a long way from making that the most important issue in machine learning.


HIStalk Announcements and Requests

HISsies ballots went out via email Thursday morning to readers who subscribe to HIStalk updates and have recently clicked the link to read new posts.

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I’ve lamented lately that healthcare providers rarely use electronic signature platforms such as DocuSign to process emailed forms, clinging instead to mailed paper copies and faxes. I received an emailed contract for a family event this week sent via ESign Genie – it’s just $8 per sender per month. It’s probably naive to think that just because providers could improve their own efficiency, delight their customers, and improve their records retention for just $8 per month that they will actually do so, but at least we customers know that if they don’t, they simply don’t care what makes life easier or better for us.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

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Medsphere acquires supply chain vendor HealthLine System a few weeks after raising $32 million that it said would be used for acquisitions.

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Epic expands sales to include dentists and life insurance and diagnostics companies as VP of Population Health Alan Hutchison says the company is “moving beyond the walls” as it seeks to create – and dominate – the single repository space for patient health data. Hutchinson adds that the company is also in talks with assisted-living and nursing home facilities.

Apple drags the stock market down after lowering revenue guidance, which the company blames on poor sales in China due to that country’s economic problems and its trade war with the US. Analysts noted that despite Apple’s blaming the Chinese economy alone, the market for expensive phones is falling apart everywhere and consumers are pushing back against the “Apple tax” in which they faithfully line up every year to pay a premium for a commodity product. AAPL shares dropped 10 percent Thursday and the company is now a long way from its recent trillion-dollar valuation, as share price has dropped nearly 40 percent since early October.

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Jvion raises a growth equity investment of an unspecified amount, led by JMI Equity. The Atlanta-based company, which last raised $9 million in 2016, seems to have evolved from a coding optimization and analytics vendor to “the market leader in healthcare AI.”

Good news for patients already scrambling to pay for outrageously priced meds: Pending regulatory approval, Bristol-Myers Squibb will acquire Celgene in a $74 billion deal that will combine two of the nation’s biggest pharma companies.

HIMSS forms a media partnership with FindBiometrics, a publisher of biometric ID solution news.

A fascinating ProPublica article looks at the forced “retirement”of older employees, noting that more than half of American workers over age 50 leave jobs because of their employer’s decision, not their own, imperiling their financial planning for retirement. Notes:

  • Only 10 percent of those older employees who are pushed out find a job paying the same or more
  • Both employers and employees use the term “retirement” to save face
  • Companies pitch long-term benefits such as 401Ks and promotions even though they know full well most employees will never benefit from them
  • Employers can force older workers out the door by changing their job responsibilities, pay, hours, work locations, or annual review expectations
  • Employers use “stealth layoffs” of early retirement and eliminated positions to replace older workers with younger, cheaper employees or to offshore their jobs
  • Federal protections have been cut way back as companies – many of them publicly traded and desperately trying to prop up earnings – have made pleas to “remake their workforces”
  • Employees who refuse to relocate for job opportunities are often cast aside for more eager co-workers
  • IBM is an example of layoffs, forced retirements, and mandatory relocations that push older workers to leave – not just of those who make more money, but to skew the mix younger by ditching older workers
  • Companies intentionally skirt age discrimination laws by forcing job applicants to list their education dates (as a proxy for birthdate), hoping to avoid the high insurance premiums and perceived lower productivity of older workers
  • The article concludes that older workers need to keep up their learning (especially technology); network instead of wasting time chasing online ads; save money under the assumption that their entire earning career could be limited to the 30 or so years after college and before being forced out of the job market; and to avoid waiting too long to work for themselves instead of for someone else

People

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Zac Jiwa (MI7) joins The Karis Group as president/CEO.

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Best Buy promotes Asheesh Saksena to president of its new health division, which will focus on technology and services to help seniors age in place. The company acquired senior-focused mobile device and emergency call service company GreatCall last October for $800 million.

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NLP software vendor Talix names Bob Hetchler SVP of sales and Eileen Rivera VP of marketing. Both come from Ciox Health.


Announcements and Implementations

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Mercy Health Network selects PatientPing’s real-time patient notification service for its ACO members in Iowa.

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Health Level Seven International publishes the FHIR Release 4 standard.

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KLAS publishes Part 1 of its overview of population health management technology, noting the “good product, good relationship” vendors above and listing the weak partners as Allscripts, Athenahealth, and Philips Wellcentive. HealthEC is the only vendor KLAS calls out as excelling at providing strategic guidance. HealthEC and Health Catalyst finished tops for helping healthcare organizations negotiate value-based reimbursement contracts, while Forward Health Group finished best in ongoing optimization and training. Philips Wellcentive and NextGen Healthcare slipped year over year after acquiring their respective products, while Allscripts and Athenahealth haven’t met customer functionality expectations.


Privacy and Security

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HHS publishes cybersecurity guidelines for managing threats and protecting patients, plus technical resources and templates for healthcare organizations of varying sizes.


Other

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An NHS provider’s tweet lamenting a string of no-show patients goes viral in England, prompting many to suggest that patients be fined for missing appointments. NHS data show that missed appointments cost the national service $273 million each year and result in over 1 million wasted clinical hours.

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Nurses at Intermountain Medical Center in Utah comfort grieving families with printouts of their loved one’s last EKG enclosed in a tube with a note that reads, “May my heart be a gentle reminder of the love I have for you.”

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Eric Topol, MD pokes fun at the hype surrounding wearables, a timely observation given the many people who will likely spend the next few weeks addicted to their devices as they struggle to maintain what will soon become short-lived New Year’s resolutions.

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This question never seems to go away – is it OK that Epic (reading between the lines here) has a reputation of bringing its legal muscle to bear on anyone who uses a screenshot of its software in an research article, especially if the screen in question was built or customized by a customer? Epic, despite being full of nice people most of the time, is somewhere between rigorous and paranoid in sending the lawyers after anyone (even a customer) who says or writes basically anything about Epic’s contracts, products, project management methods, training materials, or documentation outside of an Epic-controlled environment. If you have experience with this as a provider either way, let’s hear your story.

A couple sues OB/GYN John Boyd Coates, MD after discovering that he, rather than an anonymous sperm donor, is the father of their 41 year-old daughter. The discovery came to light after their daughter received results from a consumer genetics test. Coates delivered the baby girl himself in 1977.


Sponsor Updates

  • ROI Healthcare Solutions publishes its 2018 highlights.
  • Cerner adds prescription pricing and benefit information from CoverMyMeds to e-prescribing workflows within its EHR.
  • Healthcare Growth Partners publishes its December Health IT Insights.
  • Nordic posts a podcast titled “Preparing for changes to value-based care reimbursement in 2019.”
  • AdvancedMD publishes a case study featuring Surgical Specialists of Jackson (MS).
  • Atlantic.Net announces GA of its Windows Server 2019 Datacenter Cloud Serve OS for use in its Public Cloud.
  • Datica releases its new book, “Complete Cloud Compliance: How regulated companies de-risk the cloud and kickstart transformation.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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Monday Morning Update 12/31/18

December 30, 2018 News 9 Comments

Top News

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A CenturyLink outage left several hospitals without Internet service Friday, also taking down phones, 911 access, and ATMs all over the country.

North Colorado Medical Center was forced to go back to paper documentation, while its parent organization Banner Health had phone problems since the outage also affected Verizon Wireless.

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FCC has launched an investigation since 911 calls couldn’t get through.


Reader Comments

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From Soccer Mom: “Re: hospital price lists. Will they really be posted online by January 1 per that new requirement you mentioned?” Not in a way that will make the slightest difference to healthcare costs. The “requirement” carries no punishment that I’ve seen for non-compliance, so I will predict that approximately one hospital out of 100 will comply by January 1 (it will be easy to check this week). My reaction to the administration’s toothless, well-intended, but fake healthcare price transparency PR move:

  • Hospitals will at best bury an Excel version of their charge master in some obscure website location where patients can’t readily find it.
  • Charge master prices are meaningless and provide zero consumer competitive shopping value.
  • You as a paying health insurance holder can’t see the negotiated prices under which you will actually be billed since those companies and health systems delight in keeping that information secret, even from (maybe especially from) patients.
  • Patients who suddenly start seeing stories about posted prices (even though the original requirement was announced in April) will question what the fuss was all about when they see that the information is useless, other than to raise their hackles that their big-building, high-employment hospital is charging $5 for an easily recognizable aspirin.
  • Having worked in hospitals forever, I can say with certainty that hospitals intentionally make their charge masters hard to understand. I won a certain amount of admiration from an early hospital employer for being able to obfuscate the entire charge master’s descriptions so that only employees could figure the items out – we got a lot fewer patient complaints about our $10 boxes of Kleenex after the description was changed to “absorbent wipes.”

From Mike: “Re: DonorsChoose. Thanks for doing what you do (and to Mrs. HIStalk for putting-up with it). Here’s a donation. My nieces and nephews are getting used to this idea of me donating instead of buying them more stuff.” Thanks. I’m holding Mike’s DonorsChoose donation since I’m expecting fresh matching funds from my generous anonymous vendor executive (UPDATE: the extremely generous matching funds just arrived, so see below). Mrs. H was happy to see your comment, if for no other reason than because I had to leave my solitary spare bedroom – aka my HIStalk writing place – to show her your message.

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From Wandering Eyeballs: “Re: the medical resident who hung himself after struggling to use the hospital’s computer system. I’d love to know what system it was.” The website of NHS University Hospitals Birmingham says they use OceanoPAS, which was recently developed specifically for the trust by Servelec. I doubt they’ll be adding this particular user experience to their marketing material, although a competitor could certainly milk it.

From Big Orange Marble: “Re: our executive hire press release. Why didn’t you list that he came from [high-profile company name omitted]?)” Because he didn’t – he took a crappy, short-lived job after leaving the impressive company but before joining yours. I report where someone worked last, not where they worked best. Your career isn’t going so well if its high point came three jobs back.

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From Spittle Slinger: “Re: designing software with doctors. This article says engineers should work with them directly.” No doubt, but while acknowledging these factors:

  1. Doctors and their workflows are not universal. Location, practice setting, specialty, and education all influence why every doctor thinks their way is the best way. Pleasing them all with a single product design is not possible.
  2. Design isn’t the same as design validation. Ask a single doctor to design a new system and it will probably miss the mark in many ways. I’ve seen some truly awful, shortsighted, and dangerously presumption-driven software that was proudly proclaimed to have been “developed by a practicing doctor for his own use.”
  3. Software sales are often scotched by deep functionality and workflows that violate an individual clinician’s reality rather than failing to embrace it. It’s safer to keep it general if you want to sell broadly.
  4. What doctors say they want isn’t the same as what they would actually use. Doctors who think they are smarter than most of their peers (and that’s a lot of them) often think software needs to protect patient from their less-gifted colleagues (see: clinical decision support).
  5. EHRs that doctors proclaim as unfriendly or unhelpful were often designed by doctors whose vision was limited to what was in front of them, i.e. the paper chart. You won’t get a lot of innovation asking a user what they want. Apple was at one time the boldest, most innovative company in the world because they gave people capabilities they didn’t even know they needed. Build to user spec would have given us slick-looking cassette players.
  6. The best way to incorporate doctors in software design is to observe them, note their challenges and their lack of having the right information at the right time, and then go offline to come up with creative solutions. Have doctors validate the design. Doctors are good at poking holes in clearly visible, faulty assumptions and that’s the best use of their time.
  7. Don’t forget that not all clinicians are doctors. A lot of clinical system use is by nurses, therapists, and other professionals and doctors are clueless about their requirements and workflows.
  8. It’s easy to be lured into the idea that clinical software can be as easy and fun to use as Facebook, Twitter, or Amazon. The fact that such software is not available is not because the rest of us are missing how cool that would be, but because it won’t work.
  9. Selling to health systems means meeting the needs of hospital executives who are mostly in charge. Making doctors happy is incidental.
  10. A given doctor’s idea of a great work environment might be the freedom to be a sometimes-illogical cowboy who disregards everybody else’s data needs and quality oversight. Their perfect system has been around for years – a clipboard and underlings who obey tersely barked orders. Doctors weren’t the ones crying for that to change.

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From Organized Chaos: “Re: HBO’s ‘Bleed Out’ documentary. It’s fascinating and frustrating on many levels, although some of the content feels unnecessary. It is being promoted as being about medical errors, which seems like an incorrect and unsatisfactory label. Still, it should remind us about the fragile, fragmented nature of healthcare system delivery.” I don’t have HBO and haven’t seen it, but “Bleed Out” — which is getting good early reviews — is a “citizen’s investigation” by a filmmaker whose mother was left with permanent brain damage after an operation that he claims went wrong. The patient lost all her life savings due to medical bills and the filmmaker sued for malpractice, so he’s not exactly an unbiased researcher. The movie PR piece cites a Hopkins estimate that medical errors kill at least 250,000 people in the US each year as the third-leading cause of death, although I worry that, like every time Joe Public sees a video and immediately renders a verdict, an N-of-one family story about a complicated care episode isn’t the best way to address the problem (but it’s good at creating a rallying cry). I’ll also note that the “third leading cause of death” conclusion of the research paper wasn’t backed by good methodology since it was mostly intended to convince CDC to use more than just ICD-10 codes on death certificates. Much of the movie’s focus is on E-ICU at Aurora West Allis Medical Center, which a now-retired surgeon labeled on-camera as “plain goddamn sloppy medicine” and which the filmmaker claims wasn’t effective because his mother’s deteriorating vital signs either weren’t noticed or weren’t reported by the remote staff. Advocate Aurora Health told employees a couple of weeks ago when the movie came out that it regrets the patient’s outcome, but noted that juries found no negligence by the hospital or doctors in the malpractice case. The movie’s tagline of “The American healthcare system just messed with the wrong filmmaker” reeks of sensationalistic propaganda instead of unbiased investigation.


HIStalk Announcements and Requests

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Just over half of poll respondents who claim to work for provider organizations say their EHR vendor has refused to integrate with a system they wanted to implement from a small vendor. Frank Poggio says the big vendors know better than to refuse outright – they just give a far-off implementation date or an unrealistic price tag. Dave says Epic has never refused integration requests from his IT department, while Adam says his small vendor employer was shut down by the clinic’s large health system parent rather than Epic. People who’ve never worked in health IT often miss the nuances in play here – integration is a risky pain point for the IT department, departments that want a particular system often don’t have the clout to get it budgeted or implemented, and vendors often ignore user requests that haven’t been pushed up the health system’s C-level food chain. In other words, lack of cooperation among competing entities isn’t limited to vendors.

New poll to your right or here, reflecting further on what I would ask Epic CEO Judy Faulkner in the unlikely event that she agreed to be interviewed: what do you like reading most in an executive interview? I’ve interviewed a ton of CEOs and always strongly urge them to avoid spouting the marketing-pushed boilerplate and show some personality and humor in a genuine conversation, which works about one time in 10. I only interview CEOs since VPs play it too safe in worrying about getting themselves fired with a flip comment, but I’ve also learned from experience that consulting firm CEOs are inexplicably the hardest to bring to life, riding banality relentlessly even when I ask them provocative, off-the-wall questions.

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My anonymous vendor executive replenished the very substantial fund he or she created for me to use for DonorsChoose project matching. This and other matching allowed me to fully fund these projects with Mike’s donation last week:

  • Three Chromebooks and wireless mice for Ms. G’s high school science class in Panama City, FL, which was out of school for five weeks after Hurricane Michael
  • Physics study materials for Ms. B’s high school engineering class in Cleveland, OH
  • 12 sets of headphones for Ms. B’s elementary school class in Cass Lake, MN
  • A white board for Ms. G’s high school chemistry class in Darlington, SC
  • Composition notebooks for science journals for Ms. O’s middle school class in San Antonio, TX
  • A wireless microphone system for Mr. H’s elementary school class in Salinas, CA
  • Linear equation graphing tools for Ms. K’s elementary school class in West Peoria, IL
  • Math manipulatives for Ms. M’s elementary school class in Griffin, GA
  • Wobble chairs, whiteboards, lapboards, and book bins for Ms. S’s elementary school class in League City, TX

I know we all can’t wait for the serious education, demonstrated non-profit budget responsibility, and extreme patient focus of HIMSS19, so you’ll be thrilled to know that it starts in just 42 days.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Acquisitions, Funding, Business, and Stock

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Stanley Black & Decker launches Pria, a voice-controlled, smartphone-integrated medication management and caregiver communication tool that supports independent living.


People

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Revenue cycle management firm Access Healthcare Services hires David Tassoni (Brimstone Consulting Group) as president of US operations.


Other

A JAMIA-published study of comments that clinicians enter when overriding clinical decision support warnings finds that the text can be mined to identify system shortcomings about 26 percent of the time. Interesting examples: (a) a low-potassium warning that was issued for a patient taking digoxin, caused by techs entering “hemolyzed” instead of a number in the K result; (b) a rule that didn’t identify carvedilol as a beta blocker and thus warned that one had not been ordered; and (c) a cyclosporine level warning that was triggered by an order for the ophthalmic form. I’ve written a lot of clinical decision support rules and analyzed both the override rates as well as the comments and it was always informative, even when doctors used the freeform space to lash out against the world. Here is the most important lesson I’ve learned – you have to look at how often the rule changed behavior, i.e., the problematic order was abandoned or the suggested entry or discontinuation of another order was performed as expected. That’s the only true measure of whether the doctor found the information useful. Although I had some doctors told me that they intentionally avoided immediately doing what the computer recommended just to prevent giving it the satisfaction of finding their mistake (they changed it afterward hoping our analysis wouldn’t notice their near-miss). I’ll add another item from experience – sometimes doctors think a human is reading their free-text comments in real time, as they might have with paper orders, and thus enter enter critical information such as a conditional or corollary order, expended instructions, or an order for an item they couldn’t find using the search box.

Kaiser Health News finds that hospices don’t always have staff available to meet the needs of patients, are rarely being punished for failing to respond to family calls, sometimes don’t have someone to answer questions about new drug and equipment orders, or skip skilled visits because of to understaffing. I’m really frustrated with a health system in which everybody and his brother makes fortunes off sick patients, yet the only place open after weekday business hours is the ED.

In India, Apollo Hospitals complains that the depositions of doctors that were presented to a panel investigating the hospital death of Tamil Nadu’s former chief minister (who was also an award-winning actress) contain significant court transcription errors, such as “incubation” instead of “intubation.”

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The Bangor, ME newspaper profiles 68-year-old Frank Bennett, who is working through his bucket list in the five years since he was diagnosed with Lou Gehrig’s disease, apparently caused by Agent Orange exposure in Vietnam – choosing a dog, buying a Model A Ford, skydiving, taking family vacations to the Caribbean, and proposing all over again to his wife of 46 years. He’s receiving care from a ALS coordinated care program. He says,

We’re all dying, some at a different rate. I’m not afraid of dying. I fear the process. And my caregivers and family — what they have to see and go through. That bothers me the most. I want people to remember me the way I used to be.


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 12/28/18

December 27, 2018 News 5 Comments

Top News

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Cinematic butt-kicker Chuck Norris, who is a shocking 78 years old, talks about physician burnout in his monthly health column.

He says PCPs have only an ever-shortening 7-22 minutes to spend with each patient, meaning that health and lifestyle counseling get pushed aside.

Chuck also notes that insurance company and government requirements force doctors to spend half their time documenting in the EHR as “medical clerks.”

In an unrelated item suitable for a slow news day, Chuck’s real name is Carlos.


Reader Comments

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From Carbon Dating App: “Re: BS in healthcare. Check out Wharton School’s list.” The Ivy League school’s tongue-in-cheek report bluntly labels as BS many recent healthcare examples of “deceptive, misleading, unsubstantiated, and foolish statements,” even including medical literature in which a self-appointed expert considers only a single theory in performing studies that cannot be replicated. The authors cite a major BS problem in trying to improve healthcare quality while reducing costs, in which programs are launched based entirely on political appeal and the optimistic idea that their skimpy details can be refined on the fly. The article includes a BS Checklist Manifesto to identify these major forms:

  1. Top-down solutions in which C-level executives come up with visionary ideas and then move on to the next shiny object as their underlings are forced to try to implement complex change without their involvement.
  2. Consulting firms that pitch one-size-fits-all solutions for healthcare that have saturated the market in other industries and thus require fresh sales.
  3. Silver bullet solutions with little evidence to back them up, such as EHRs and care coordination, that make incrementalism seem meek in comparison.
  4. Following self-appointed gurus such as Don Berwick, Michael Porter, or Michael Hammer, with programs such as the Triple Aim receiving widespread endorsement even though nobody can define the numerator, denominator, or desirable ratio and people continue to confuse ”health” with “healthcare.”
  5. The faddish idea of disruption, which has never really taken off in healthcare, partly because consumers don’t like the idea of healthcare change and neither do the companies and people making fortunes from it.
  6. Stage-based models (of which Meaningful Use is an example) that support models that are often simplistic or wrong.
  7. Excel-driven assumptions that prove wildly incorrect over the long term, such as the prediction that Medicare would cost $12 billion by 1990 instead of the actual $110 billion or that ACOs would save big money.
  8. Fashionable bandwagons, such as hospital mergers and vertical integration that don’t improve performance, as health systems “get the bug that has infected your competitor.”
  9. The idea that best practices such as those of Cleveland Clinic and Mayo Clinic will work for everyone else as consultants claim.
  10. Buzzwords such as “scale,” “synergy,” “population health,” and the worst offenders of three-letter acronyms such as ACO and EHR.

From Academic Health System CIO: “Re: HIStalk. I am a long-time reader and appreciate your very reasonable list of questions to Judy Faulkner and balanced comments about the New York Times article. Thanks for the site, the balance of topics, and approach to the field.“ Thanks. The most fascinating aspect of the Epic story involves the company’s culture and its ability to identify and train bright new college graduates to function effectively in healthcare technology. I can’t imagine any other industry in which a 24-year-old employee with no relevant non-Epic work experience can command the attention of highly experienced health system clinicians and executives and actually get them to complete a painful project as defined by agreed-on metrics. I can assure you that is almost unheard of, as most significant health system endeavors devolve into endless debates and deflected responsibility (everybody is empowered to say no, but nobody can say yes). I would also love to know more about architecture and technology deployment – when’s the last time you heard of an Epic site going down due to Epic’s software (rather than hardware, network, or remote access middleware)? Most of us in the industry have never attended UGM and the company’s close-to-the-vest culture means we don’t really know how Epic works or how its success might be replicated, which I suppose is a good thing from Epic’s perspective but bad for those of who want to understand the legacy of what Judy built. 

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From Split Pea: “Re: big data. What do you think of this article?” Van Halen’s concert rider required promoters to provide dressing room M&Ms with the brown ones removed, not because they were self-entitled prisses (which they were, but still …), but so they could assess the likelihood that the promoter had read the agreement carefully and followed through on their commitments. Likewise, when I see that a paid author can’t spell the possessive “its” correctly, I assume their abilities are limited and I stop reading. I also avoid Facebook because it’s depressing to see so many comments that sound like they were written by an angry, bitter six-year-old. We might have been better off as a pre-social media society when you had to earn the ability to influence by first passing the scrutiny of a responsible editor or event organizer.

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From Mister Bittermuch: “Re: HIPAA. I planned to use the light week to catch up on risk assessment work, but with the lapse in government funding, the NIST regulatory resources supporting HIPAA are unavailable. Maybe HHS will, as it has for recent disasters, issue a temporary emergency guidance suspending HIPAA because we can’t get to the necessary resource material (just kidding). Google and file reposting will keep us secure.” The positive aspect of having a dysfunctional government is that things can’t get much worse in its absence.


HIStalk Announcements and Requests

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I rarely use the term “it will change your life” in describing a technology purchase, but I’m happy to say that Mrs. HIStalk’s brilliant Christmas gift to me of a Sonos Play:1 speaker will do exactly that for just $149. The 5x5x6 inch, four-pound speaker connects over WiFi to your mobile device using the Sonos app, which you then use to tune the Play:1 in a couple of minutes by walking around the room with your phone or tablet. The sound is incredibly powerful and rich and the app integrates your streaming music choices (Spotify premium, Pandora, and TuneIn Radio in my case) into a single user interface from which you can choose individual Spotify tracks or playlists, a Pandora station (like jazz for dinnertime or hair band screaming for household chores), or live radio from all over the country. The app works over WiFi rather than via Bluetooth or infrared, so you can control everything from anywhere as long as you’re on the same WiFi. She gave one to a relative as well and has already ordered a second one so they can use them as wireless surround sound rear speakers, while we’re getting a second one for ourselves so we can cover the whole house with music (either the same or different sources). It sounds and works a lot better than old-school speakers-in-the-ceiling home audio and is actually fun to set up in just a couple of minutes, not to mention that you can just unplug the power cord, move it to another room, and plug it back in to get back to the music. I’m pretty sure it has plenty of kick for a patio or back yard gathering, too. Meanwhile, I got Mrs. H an Apple Watch (the Series 3, which was a steal on Black Friday and offers nearly every benefit of the Series 4) and she’s trying to figure out how to incorporate it into her lifestyle beyond the obvious fitness tracking 

It’s a slow holiday time until after New Year’s Day, but even so, two companies have signed up as new HIStalk Platinum sponsors in the past week, obviously using their quieter time to reflect on their need to bolster their expensive HIMSS presence with a timely announcement, not to mention exposure that lasts a full year instead of three days and that reaches decision-makers rather than just booth booty seekers. Thanks for the support.


Webinars

January 17 (Thursday) 1:00 ET. “Panel Discussion: Improving Clinician Satisfaction & Driving Outcomes.” Sponsor: Netsmart. Presenters: Denny Morrison, PhD, chief clinical advisor, Netsmart; Mary Gannon, RN, chief nursing officer, Netsmart; Sharon Boesl, deputy director, Sauk County Human Services; and Allen Pendell, SVP of IS and analytics, Lexington Health Network. This panel discussion will cover the state of clinician satisfaction across post-acute and human services communities, turnover trends, strategies that drive clinical engagement and satisfaction, and the use of technology that supports those strategies. Real-world examples will be provided.

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


Sales

  • FirstCare Health Plans will offer a virtual care program powered by MDLive.

Other

Odd: a study of 400,000 ICU patients in the UK finds that short men die at a higher rate than tall ones. The author has no idea what this means or what ICUs should do differently (if anything), but speculate that maybe it’s related to incorrectly sized equipment or erroneous drug dosing, providing this unhelpful advice: “The message from this research is for doctors to be more aware of people’s height.” I’ll also say that I’ve seen a few cases in which critical drugs were incorrectly dosed by doctors who failed to take into account a patient’s missing extremity due to amputation or birth defect.

A study finds that the vision of students in Japan is the worst it has ever been, which the government says is due to excessive time spent staring at smartphones and mobile games.

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In India, a patient’s three sons trash the ICU and beat up security guards after she dies of lung disease. One of them says her treatments were performed incorrectly, the hospital pressed them to pay her bill every day, and employees as well as doctors demanded cash bribes to check on her.


Sponsor Updates

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More than 1,000 Meditech employees in its Georgia, Massachusetts, and Minnesota offices participated in the company’s Holiday Giving program to help 60 underprivileged families.

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First Databank employees volunteered at the South San Francisco Holiday Toy and Food Drive.

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Definitive Healthcare and its employees donated $100,000 in cash and and hundreds of volunteer hours to 30 charities in its home state of Massachusetts in 2018.


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Reader Comments

  • Lazlo Hollyfeld: It is just a form of self-promotion and attention grabbing that is legion at HIMSS. If you can name one objective an...
  • Lazlo Hollyfeld: This is the cool, angsty ‘insider’ take but it ignores that large gatherings like this present several opportunities...
  • Mr. HIStalk: It's tough when the hospital won't reopen for a year or more (if ever -- Adventist Health didn't seem to want to commit ...
  • Brian Too: I am a little disappointed Ellkay didn't bring the bees to HIMSS 2019. Can you imagine the pictures, the headlines, t...
  • NoGoodDeedGoes...: RE: Adventist Health & Paradise - your coverage is warranted, but your commentary would have been better off omitted...
  • Vaporware?: I almost feel a little bad and embarrassed for Cerner. It's notable that MEDITECH's "re-branded" and "old" EMR has score...
  • Dave N: I also am continually amazed at how many men don't wash their hands after using the restroom. Society still struggles to...
  • RE: Pink Socks: Please check the facts. Not everything revolves around Epic. Here's the original website https://pinksocks.life/...
  • Brian Too: "We’ll need a new ICD-10 code for [...] Gwyneth Paltrow’s Goop..." Might I suggest 2 ICD-10 codes? F6101 - Lif...
  • Brian Too: "...the VA’s EHR project could balloon beyond its estimated $16 billion budget..." Sorry to be cynical, but wasn't ...

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