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Monday Morning Update 5/13/19

May 12, 2019 News 3 Comments

Top News

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David Brailer, MD, PhD – the country’s first National Coordinator going back to 2004 – urges support for HHS’s proposed interoperability rules. He says that $35 billion worth of incentive payments have made EHRs almost universal, but those systems “have failed miserably in bringing information to patients and consumers.”

Brailer notes that the federal government failed to make sure those EHRs could share information. He thinks it should have defined patient information as belonging to “the people whose bodies it comes from.”

Brailer concludes, “These rules, if implemented as proposed, will transform the experience of consumers. We will finally be able to gather all of our health information in one place and make sense of it. If we want to switch physicians, hospitals, or health plans, our data will move with us and we won’t have to fear retaliation. When we arrive at an emergency room, our information will be there. We will be able to use our personal information to pick the physician or health system that matches our needs. We can discover what new genetic therapies or advanced clinical trials might hold unique promise for us. These proposed rules are fundamentally necessary if we want to improve our health.”

It’s no surprise, Brailer says, that technology vendors, hospitals, and physician associations that “make a fortune off of the current system” are opposed to the proposed changes, which would “make it easy for hospitals to switch technology vendors.”

Brailer is chairman of Health Evolution, which is apparently the conference-running remnant of Brailer’s investment-focused private equity firm Health Evolution Partners, which  lost its sole limited partner (California’s CalPERS) in 2014 after poor returns.


Reader Comments

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From Creaky Joints: “Re: Greenway Health SuccessEHS. I’m hearing that it will be end-of-life in September 2019. Can you confirm?” Greenway Health predecessor Vitera acquired Birmingham-based SuccessEHS in 2013. Its EHR/PM is targeted to community health centers and FQHCs. The company provided this response to my inquiry:

All of us at Greenway Health are committed to the success of our customers and we understand the leading role our support, software, and services play in that success. This week, after extensive analysis of our SuccessEHS platform, we informed customers that we will move up the platform’s end-of-life date and partner with them to transition to our flagship platform, Intergy. (Intergy, which recently was named 2019 Best in KLAS “Most Improved Physician Practice Product,” will evolve into our next-generation platform.) This was not an easy decision to make, but we did so with our customers’ best interest in mind.

The dates customers need to migrate will depend on their reporting needs. All SuccessEHS customers who plan to participate in incentive programs for the 2019 reporting period must migrate to Intergy no later than September 30, 2019. This will allow them to be on Intergy for a 90-day period to meet the reporting requirements. SuccessEHS customers who do not plan to participate in a government incentive program will have until December 31, 2019, to migrate to Intergy.

From AHitDuke: “Re: non-poach agreements. How many have them? Allscripts, Cerner, Epic, and NextGen seem to.” I assume you mean between customer and vendor since vendors agreeing not to hire each other’s employees is illegal unless the organizations have a documented business collaboration. I’ve seen at least a couple of contracts in which customers agree not to hire their vendor’s employees and vice versa. The vendor may also prevent customers from hiring their employees without permission via their employment agreements.


HIStalk Announcements and Requests

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Two-thirds of poll respondents would not be thrilled if their vendor announced a new focus on boosting profits, while one-third wouldn’t care unless any changes affected them negatively. Smartfood99 wonders how anyone could see it as positive (and indeed, few respondents did), while Les V. Fewer says publicly traded and VC-backed vendors will always get to that point and providers might as well assume that to be the eventual case and execute their selecting and contracting accordingly.

New poll to your right or here: What is the #1 driver of HHS’s new interoperability push? This question was precipitated by “The Big Fib” Readers Write article that was polarizing (although it has 43 likes and just five dislikes). Feel free to click the poll’s “comments” link after voting to explain your choice, to complain that I didn’t include an obvious option, or to argue about the very nature of polling that by definition precludes the intellectually lazy “all of the above” option.

Listening: new from Andrew Bird, an indie singer-songwriter and trained, degreed violinist (which he sometimes plays like a guitar on stage) who used to be in the Squirrel Nut Zippers. I was streaming a Spotify indie station on Sonos and a track that caught my ear turned out to be his. The same thing happened again an hour later. His music is smart, introspective, and occasionally soaring and he always surrounds himself with fine backing band members. Play “Manifest” around other people and I’ll wager they’ll ask you what they’re hearing. I’m also streaming the Mermen Pandora station (which includes bands like the Blue Stingrays and the witty, mask-wearing Los Straitjackets) because I just realized I haven’t listened to surf rock in a long time and I really like it, especially the trippy, minor-chords, tremolo arm-bending variety. 

I’m in a constant, low-level state of frustration with Gmail’s Select All, Delete All function for trashing everything in the Promotions tab, which never works. Some Google engineer kludged a macro-like function that you can watch executing as the screens flip by, only to find that when it has finished its ugly work, most of the messages remain. I can repeat this process several times and still not empty that tab. I use Gmail on the IPhone as well and it’s often squirrely in showing messages that I deleted long ago on the web version – at this moment I’ve pruned my inbox to just nine messages, but the IPhone version still shows hundreds of long-deleted ones. I still argue that Yahoo Mail is the best email client I’ve used, especially since I’m not a fan of Outlook or Apple Mail.


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

May 30 (Thursday) 2:00 ET. “ONC Data Blocking Proposed Rule: What Health Systems Need to Know.” Sponsor: Philips PHM. Presenter: Greg Fulton, industry and public policy lead, Philips. Proposed data-blocking regulations could specify fines, disincentives, and de-certification of providers who don’t provide an API for patients to extract all of their data. This webinar will describe who is deploying APIs, the scope of data and third-party apps that can be used, the seven costs that do not count as a data-blocking exception, and the health system protections that don’t involve using a vendor. It will also provide examples of data blocking and further exceptions.

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


Acquisitions, Funding, Business, and Stock

A fascinating Axios article looks at how entrenched conglomerates squelch competition from startups:

  • Walmart, Amazon, and Apple buy competitors who threaten their market share. It notes that Apple has acquired 20-25 companies in the past six months alone.
  • Razor companies Schick and Gillette, which control 90% of the US market, use their patent portfolios to file lawsuits that take years to expensively resolve.
  • The razor companies also buy startups, which Schick buying upstart Harry’s this week for $1.37 billion and Unilever acquiring Dollar Shave for $1 billion.
  • Direct-to-consumer companies give their acquirer growth and a wealth of customer data.
  • The disruptors aren’t always absorbed into oblivion – the razor startups have retained their management, gained the resources need to scale, and at least in Dollar Shave’s case, haven’t raised prices.

People

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SailPoint Technologies promotes Cam McMartin to COO.


Other

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Norway’s new public health minister Sylvi Listhaug says in an interview that “people should be allowed to smoke, drink, and eat as much red meat as they like. The government may provide information, but I think people in general know what is healthy and what is not.” She is a smoker who doesn’t want the country’s anti-smoking laws made more stringent, explaining, “Are they going to have to to into the woods or up on a mountaintop or down to the docks just to take a drag?” She was previously Minister of Agriculture, Minister of Immigration, Minister of Justice, and now Minister for the Elderly and Public Health. These comments came in an interview where she is pictured with a cigarette in one hand and a Pepsi in the other. She’s actually more rational in the full interview than the snippets suggest, explaining that smoking is harmful but that’s no reason to make smokers feel stupid, instead advocating programs that discourage young people from smoking. She also argues that it’s not the government’s job to tell people how to lead their lives.

Escambia County, Florida launches an investigation into its emergency medical services to figure out who authorized the purchase of billing software whose glitches forced the county to write off $6 million before it was turned off for good. The contract was was split into three parts to keep it below the threshold that requires county commission approval. One commissioner said, “This $49,999 deal is going to stop, period. We already sit here all day long, so we might as well approve every purchase order.” The software is from Des Moines-based ESO Solutions.

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The Minneapolis paper observes that most of the 1.4 million people who have received breach notice letters from Puerto Rico-based claims clearinghouse Inmediata have never heard of the company and are questioning how it obtained their medical information in the first place, raising the interest of the Minnesota’s attorney general. The letters don’t explain the company’s business and don’t include the names of the recipient’s provider.


Sponsor Updates

  • Meditech will exhibit at the 2019 IHI Patient Safety Congress May 15-17 in Houston.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS New England Spring Conference May 16 in Foxborough, MA.
  • Relatient will exhibit at the Cleveland Clinic Patient Experience May 13-15 in Cleveland.
  • The SSI Group will exhibit at the Cerner CommunityWorks Summit May 14-16 in Kansas City, MO.
  • TriNetX will present at ISPOR 2019 May 18-22 in New Orleans.
  • Nordic launches a video series titled “Consultants in Conference Rooms Getting Coffee.”
  • Voalte will exhibit at the Mississippi HIMSS Spring Conference May 16 in Ridgeland.
  • Vocera CFO Justin Spencer will present at the Bank of America Merrill Lynch Healthcare Conference May 15 in Las Vegas.
  • Huron elects Ekta Singh-Bushell to its boards.

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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 5/10/19

May 9, 2019 News No Comments

Top News

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Harris Healthcare acquires clinical communication and collaboration software company Uniphy Health for an undisclosed sum.

Uniphy Health merged with PracticeUnite in 2016.


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.

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


Acquisitions, Funding, Business, and Stock

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The private equity arm of Audax Group acquires The Chartis Group, a Chicago-based health IT advisory firm, from RLH Equity Partners.

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TransformativeMed will use a Series A funding round of $6 million to expand sales and marketing efforts for its Cores clinical workflow apps for Cerner Mpages.

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Home health testing company LetsGetChecked raises $30 million in a Series B round led by LTP. The New York City-based company has raised $42 million since launching five years ago. It also offers a companion app to help consumers track and analyze their health, lab, and wearables data.

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Novant Health (NC) launches a digital health and engagement division to enhance its ability to virtually connect with patients from anywhere at any time. SVP and Chief Digital Health and Engagement Officer Hank Capps, MD and Senior Director of Digital Health and Engagement Stephanie Landry will head up the new division.


People

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Capsule Technologies names Hemant Goel (Spok) CEO.

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Howard Wilson, MD (Castlight Health) joins Zynx Health as SVP of customer success.

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Medhost promotes CFO Ken Misch to the additional role of president.


Sales

  • The Connecticut Dept. of Social Services selects analytics software from HBI Solutions.
  • Quorom Health will implement RCM technology and services from R1 RCM across 26 hospitals.
  • St. Joseph’s/Candler (GA) selects wayfinding technology from Connexient.

Announcements and Implementations

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Hardin Memorial Health (KY) becomes the first hospital to go live on IBM Watson Imaging Patient Synopsis, which provides radiologists with a summary of relevant patient data from a variety of contextual sources.

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Appalachian Regional Healthcare implements tele-ICU capabilities from Advanced ICU Care at its 12 hospitals in Kentucky and West Virginia.

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A new KLAS report on global EHR market share finds that:

  • Epic added more beds in 2018 (11,666) than any other vendor, most of them coming from its regional wins in Singapore, but otherwise Epic signed fewer than its average number of new contracts at just four.
  • Cerner signed two counties in Sweden as its first Millennium deployment in the Nordics, but otherwise sold no Millennium deals outside of Europe.
  • Agfa Healthcare, Dedalus, and InterSystems won eight or more decisions each.
  • Latin America saw a large number of EHR purchases, with MV leading all vendors.
  • Few deals were signed in the Middle East and Africa, with Health Insights winning two deals and InterSystems one.
  • InterSystems signed three hospitals in China.
  • No new contracts were signed by hospitals in Canada, although four legacy Meditech customers contracted for an upgrade to Expanse.

Other

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The American Medical Association’s annual physician practice survey finds that for the first time, employed physicians outnumber those who have ownership in their practices. Physicians are shifting to larger practices (mostly in abandoning solo ones) and more are working for hospitals.

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Cedars-Sinai (CA) equips its post-op patients with Fitbits to encourage them to walk 1,000 steps around the hospital per day after a study led by Timothy Daskivich, MD found an increased step count led to a reduction in length of stay. The hospital has also created an app that ties step counts in to tours of artwork found throughout the hospital.


Sponsor Updates

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  • Hyland team members spend time helping out at St. Mary’s Food Bank as part of the company’s Volunteer Time Off program.
  • Access announces that its EForms user interface now integrates with Meditech Expanse.
  • Elsevier Clinical Solutions will exhibit at the American Association of Immunologists conference May 9-13 in San Diego.
  • EClinicalWorks will exhibit at ASCA 2019 May 15-17 in Nashville.
  • HGP publishes its “Health IT April Insights.”
  • Ambient Clinical Analytics and Iatric Systems partner to deliver point-of-care FDA Class II-cleared solutions to health systems utilizing Meditech EHRs.
  • Imprivata and InterSystems will exhibit at the Healthcare Providers Transformation Assembly Millenium Event May 14-15 in Nashville.
  • OnPartners profiles Information Builders CEO Frank Vella.
  • Intelligent Medical Objects will exhibit at the Netsmart Connections 2019 User Group Meeting May 12-15 in Washington, DC.
  • Halifax Health (FL) expands its use of Access e-forms management to include Meditech-integrated and tablet-enabled informed consent solutions in its Cardiac Catheterization Lab and Anesthesiology Department.
  • DrFirst will work with enterprise pharmacy system vendor PDX to offer pharmacies technology that will help them increase the fill rate of new prescriptions.
  • OptimizeRx will present at the Oppenheimer Emerging Growth Conference May 14 in New York City.
  • FDB unveils new global branding.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 5/8/19

May 7, 2019 News 4 Comments

Top News

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CMS Administrator Seema Verma invites people to tell their stories of their struggles in obtaining copies of their health records or with providers failing to share their information.

My personal experience (and that of others) is that alerting HHS, including filing an OCR complaint, is a waste of time that changes nothing, but it’s a nice thought.

Maybe CMS should require Medicare providers to post a notice on their wall that lists the information rights of patients, including a telephone number and email address to report information blocking offenders. Then fine them for non-compliance rather than just having OCR provide “technical assistance” and closing the incident.


Reader Comments

From Erudite: “Re: Cedars and Medlio. The founder is complaining about the manner in which the ‘no’ was conveyed. Why did Techstars part ways with Cedars? What credentials does the Cedars CIO have to compete with notable early-stage investors? Why is Cedars using their tax-exempt earnings to help folks play VC? They should shut down the accelerator and ask the CIO to focus on his job or go out and raise money from limited partners to run a fund.” The co-founder’s side of the story is that her struggling startup was abused in interviewing with the Cedars CIO and that she as since accumulated “multiple examples of the CIO’s unethical behavior” sent to her after her article. She’s pondering whether to go public with those examples, which I would warn might elevate her diatribe from “unfortunate” to “libelous.” I know little about the Cedars accelerator, but I recall that accepted companies get significant funding, access to internal experts, a good shot at earning a paid pilot, and the involvement of people like the CIO who actually work in frontline healthcare. I think a better view of the Cedars program would come from a company that has completed it. I’m with you on non-profit health systems using their patient-provided profits to do unrelated work, but that horse has long since left the barn and is playing excitedly in fields green with cash.

From Corrective Action: “Re: listing experience as ‘more than 20 years.’ People do that because if they put in the actual number, especially once it is 30 or more, they may not even get an interview despite being highly capable, physically and mentally sound, and ready for another 10-plus years of work ahead of them. It isn’t about math, it’s about age discrimination.” I hadn’t thought of that, although I’ll say that many of the folks who say they have ‘more than 13 years of experience’ when they have 13 years, two months are not old enough to worry about age discrimination. I have noted obvious efforts on LinkedIn to sidestep the ageism issue – lack of a photo, omission of dates for education, and listing only the most recent jobs. I’m interested in the result. Would it be like a dating app, where you can Photoshop your picture but then have your lack of transparency become embarrassingly obvious in the resulting a face-to-face encounter? Or are potential romantic and employment targets willing to waive their biases if the personal encounter goes well and thus it’s worth a shot to underplay age to earn the face-to-face?

From Medical Minion: “Re: making patient care more human. You’ve complained that front desk people are often cold and robotic to patients. Why didn’t you complain to their employer instead?” For the same reason I don’t complain when a Walmart cashier doesn’t try to be my new best friend or an Uber driver fails to provide scintillating chitchat. Healthcare has become a huge, impersonal business and those on the front lines are buried several layers deep in dysfunctional organizations that don’t treat them especially well or reward them for good customer service behaviors. I don’t hold them accountable to sprint to the front lines full of enthusiasm and empathy. Full waiting rooms ensure corporate-wide indifference.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Omni-HealthData, powered by Information Builders. Omni-HealthData helps health systems make operational decisions and improve the insights needed to improve outcomes and patient care. It’s a complete information management solution that gives providers and payers a 360-degree view of members, patients, workforce, facilities, community care organizations, and other critical domains. The platform, developed with St. Luke’s University Health Network, combines data integration (hospitals, physician practices, nursing home, telemedicine, financial information, etc.), data quality, and master data management that power InfoApps out-of-the-box information applications (hospital patient experience, quality and safety, balanced scorecard, physician practice dashboard, and population care analytics). It is built on the WebFocus BI and analytics platform, which also provides advanced analytics (visualization, location analytics, enterprise search); predictive analytics; and social media analytics. Customers have used its data management platform to develop integrity and integration solutions, analytics dashboards for clinics, a customer-facing portal with analytics, an self-serve reporting with visualization. Instead of learning complex tools and worrying about data preparation, users can serve themselves and quickly get answers and insights from relevant data, right when they need it. It’s easy for non-technical, mainstream users to get and analyze information on both web browsers and mobile devices.Thanks to Omni-HealthData for supporting HIStalk.

A friend who has a terminal illness whose treatment is likely to bankrupt her family (even if her insurance covers part of the cost, which isn’t guaranteed) let me know she’s getting a divorce even though her marriage is fine. Her family’s financial advisor told her to transfer their joint assets to him, divorce him, then sign up for Medicaid to give her a reasonable chance at getting the treatment that could save her life. Divorce laws are unique to each state, so I didn’t ask whether her husband is required to move out or whether his caregiver role will be affected. Our healthcare system is certainly interesting.


Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.


Acquisitions, Funding, Business, and Stock

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The Practice Fusion unit of Allscripts has been served a criminal grand jury subpoena regarding EHR certification and anti-kickback statue compliance, according to company SEC filings. The original US Attorney’s information request came in March 2017, so presumably Allscripts was aware of at least some level of federal interest before its $100 million acquisition of Practice Fusion in January 2018.

UBiome, the high-valuation startup that was recently raided by the FBI after overbilling complaints from insurers, suspends the sale of its prescription-only microbiome tests, leaving it with just one consumer test that doesn’t require a doctor’s order (and that insurers won’t pay for). I think we’re getting enough case studies to prove that the investor-funded Silicon Valley mantras of “move fast and break things” and “ask forgiveness rather than permission” don’t work well when they try to elbow their way to the massive healthcare trough. On the other hand, we’re learning that cash-hungry doctors will prescribe just about any crap those companies sell as long as it doesn’t directly harm patients.


People

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Ciox Health hires Pete McCabe (GE Onshore Wind) as CEO, replacing Paul Roma.


Announcements and Implementations

Post-acute care technology vendor Brightree will connect with CommonWell.


Government and Politics

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FDA will hold a five-hour webinar, demo, and technical discussion of its open source, user-configurable MyStudies clinical trials data-gathering framework on Thursday, May 9. 

NIH and the Navajo Nation sign the first tribal data-sharing agreement, which will allow NIH grant recipients to continue a birth cohort study. 


Other

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The board chair and two board members of University of Maryland Medical System – whose purchase of hundreds of thousands of dollars worth of children’s health books got its CEO and the author who was also Baltimore’s mayor fired – resign over a no-bid software contract. Real Time Medical Systems, whose founder and CEO is former UMMS board member and donor Scott Rifkin, MD, provided UMMS with predictive analytics software for clinical and financial improvements. Rifkin says the one-year contract involved zero cost and he intended to extend it afterward at no charge.

Astria Health (WA) files Chapter 11 bankruptcy, blaming its financial situation on its EHR conversion and hiring of a revenue cycle management company that failed to meet agreed-on accounts receivables collection targets. The announcement didn’t name either vendor, but it signed with Cerner in January 2018

A small study finds that obese patients who were sent text reminders and provided with remote feedback weighed themselves more often and were more physically active, but 12-month weight loss was exactly the same as in the control group at four pounds.

A nurse whose son died in a car accident obtains video taken by the driver of the other car that shows first responders walking around without doing anything, rolling her son around without protecting his neck, digging through his pockets before starting treatment, and lifting him onto a stretcher by his belt loops without using a backboard. One EMS crew member was fired, another quit to go to fire school, and the EMS chief eventually resigned. 

A man who is transported to an in-network hospital with a facial injury is billed $167,000 by its on-call plastic surgeon, who is among the large percentage of doctors in that specialty who don’t contract with insurers because they don’t have to.

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Four University of Arizona journalism students work with the local newspaper on a grant-funded project in which they developed an app to review businesses and tourist destinations for their access to those with physical disabilities. They also created a health site allows users to read health news, search for a clinic, and find health events.

Studies find that the elevated carbon dioxide levels found in conference rooms and classrooms impair cognitive ability, perhaps refuting my theory that meetings are mostly attended by people who aren’t all that bright. 


Sponsor Updates

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  • Avaya employees assemble 50,000 meals for those less fortunate in collaboration with Rise Against Hunger.
  • San Diego Woman Magazine features Burwood Group SVP of Technology Joanna Robinson in its Power Women issue.
  • Divurgent is named a Microsoft Gold Partner.
  • Collective Medical adds the capability for users of its platform to identify high-risk infants, including those with neonatal abstinence syndrome.
  • The Tampa Bay Times features Collective Medical’s work with the Florida Hospital Association and the Florida chapter of the American College of Emergency Physicians to combat the opioid epidemic.

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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 5/6/19

May 5, 2019 News 12 Comments

Top News

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From the Allscripts earnings call:

  • The company reported record first-quarter bookings despite revenue growth that was less than it had predicted.
  • One Paragon client was committed to switch EHRs until “they experienced the sales implementation by one of our competitors” and extended their Paragon agreement for five years. The hospital was Waverly Health Center, which would suggest that the abandoned replacement vendor was EClinicalWorks, who announced them as a new inpatient customer in April 2018.
  • The company says that recent development of a Paragon ambulatory platform has caused five clients to come back in the past 90 days.
  • CEO Paul Black notes that the company has “the longest-tenured leadership among the top three publicly traded companies in the marketplace,” which he says allows the company to focus on long-term priorities.
  • Black says Veradigm positions the company as a top provider to payer and life sciences markets, to the point that EHR competitor NextGen partnered with Allscripts instead of developing a competing product.
  • Acquisitions over the past five years have added $300 million in annual recurring revenue “at a net cost approaching zero.”
  • Black says Allscripts is the only one of three companies (I assume he’s referring to Epic and Cerner) that is making significant investment in core acute care solutions.
  • In responding to an analyst’s observation that company debt increased due to share buy-back, the company says it is comfortable with its leverage position.

Reader Comments

From Big System CIO: “Re: HIStalk interview. My experience is that going on record encourages the vendor community to overwhelm us in claiming they can assist, regardless of whether we need help or not.” BSC politely declined my interview request for a reason I hadn’t considered – mentioning an initiative in our conversation guarantees that vendors who read it will bug them endlessly to pitch their services. I guess cold-calling it must work at least occasionally or they would stop doing it. I’m interested in both the provider and vendor side of this issue – how do you feel about reps randomly dialing someone up at the hospital hoping for a hit?

From Just Asking: “Re: IT in faith-based health systems. You’ve said you had experience there. What should I look out for if I take the IT executive job offer in front of me?” I can only relate my personal experience, which certainly varies by organization. The top problems that my IT peers had in working for an organization whose faith wasn’t ours (and that was one of the more extreme ones, I suspect) were:

  • The culture was inbred, where everybody went to the same churches, graduated from the same unimpressive church-affiliated universities, and had been chosen since their diaper-wearing years for fast-tracking through various internship and training programs in traveling from one hospital to the next to the way to the top. It’s tough participating constructively in meetings where everybody except you as the IT person has longstanding, trust-based relationships that drive everything instead of knowledge or experience.
  • IT was the dumping ground for underperforming but well-connected junior employees who were untouchable and knew it, so their pathetic job performance demotivated everybody else.
  • IT felt like being an American contractor sent to work in a Middle Eastern hospitals – we were tolerated at best, never respected, and were forced to follow the corporation’s cultural-religious rules while having our own ignored. Be careful taking a job with any health system that declares itself to be a ministry unless you actually want to work for a ministry.
  • Just about every major strategic IT decision was made in meetings to which IT was not leading or even invited because, as one top-ranking executive said in being unaware that he was on a conference line, “Can’t we get one of our own in there?”
  • On the flip side, they paid me well, the benefits were unbelievable, the glass ceiling was obvious but tolerable unless you fancied yourself qualified to be on the executive fast track, and I think they were doing the best they could to integrate us interlopers into the organization in at least a clumsy, superficial way.

From Bewilderment: “Re: succession plan. People joke about that of Judy Faulkner. What’s yours?” I don’t have one. I’ll probably just keep going until I drop dead and then the HIStalk page will be forever frozen on whatever I wrote last (hopefully something decent, unlike good Hollywood actors who died after making an awful last movie as their unplanned swan song). I won’t care at that point. If I quit by choice, I’ll say goodbye.


HIStalk Announcements and Requests

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Last week’s reader-requested poll was a good one. Universal interoperability won’t happen until at least 5-10 years (so say 42%) or more than 10 years if ever (46%). Some comments:

  • Until you get into the details of turning a clinical note into something transmittable between two systems, you cannot understand the complexity. I remember spending an hour in a meeting discussing what values should be in the “stool appearance” drop-down. Unless every provider uses the same list, or every interface engine has a translation table, how can one system send to the other? Things like that need to be done with thousands of ideas on what exactly a stool appearance drop-down should look like. Of course you can always transmit entire documents and notes, but if you want to make data interoperable, it needs years and clinical revamping.
  • Everyone everywhere? From legacy systems run by stressed organizations operating at the margin of survival? Patient-generated data, from outside of hospital/ clinic? Genomic data? Third-party analysis of same? Clinically relevant is the touchstone. Truly clinically relevant may be much smaller subset, but, still, you have to get to it. Patient-sovereign software, leveraging API-architecture through consent / authorization / access services and the patient’s right to their data, may be a route, which works because it flips the paradigm.
  • I still vividly remember attending an interoperability conference in 2003, at that time experts were sure that in 5-10 years, all systems would be talking to each other. What year is it now?
  • Data exchange will only move forward once EMR vendors and health systems understand they do not own the data, it belongs to the patient. And to get to that point may take payment penalties for those that do not share.
  • Ask five physicians what “all clinically relevant data” is and you’ll get seven different answers. The reality is that all all of the data you mention in your example can be shared today. Why isn’t it? Because doctors aren’t demanding it and because there remain competitive business reasons to not share data with providers (aka as competitors) outside an IDN. Interoperability remains mostly a business challenge, not a technology challenge.
  • There are aspects that will take longer (e.g., pathology), as today it is not widely digitized. More needs to be done to emphasize the need for the FULL relevant record – too much emphasis still today for making only PAMI (procedures, allergies, medications, and immunizations) data interoperable, as the least common denominator. Finally starting to see more recognition of interoperability needed for clinical reports, which is addressed in the next version of FHIR, but will still take a long time.
  • “All” clinically relevant information is casting a wide net, including all scanned documents, waveforms, diagnostic resolution MRIs and mammos and cine loops, and it also assumes that every internal niche clinical system in a large organization can participate in HIE or at least communicate with the primary system responsible for HIE. If that’s what you mean, it won’t happen in 10 years in this country with our broken fragmented healthcare system, and maybe never.

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New poll to your right or here: How would you react to your software vendor announcing a focus on boosting profits, including reorganizing and cutting products and headcount? I thought of the question because of Cerner, but we’ve seen plenty of examples over the years and I’m interested in what you think. Comments are welcome, so just click the poll’s “Comments” link after voting.

Dear everyone on LinkedIn and elsewhere: please stop describing yourself as having “over XX years experience.” It’s not like a toddler’s mom or a former addict who feels the need to proudly account for fractional years, so just round up if you are that insecure. Thank you.

Live Nation is offering $20 lawn seats to some mediocre outdoor concerts (mostly 1980s has-beens and country), but I still bought tickets to three of them. It’s worth $20 to create a summer memory of sprawling on the grass while listening to the B52s supplement their Social Security checks by cautiously frugging yet again through “Rock Lobster.”

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

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Webinars

May 21 (Tuesday) 2:00 ET. “Cloud-Based Data Management: Solving Healthcare’s Provider Data Challenge.” Sponsor: Information Builders. Presenters: Jeremy Kahle, manager of planning and business development, St. Luke’s University Health Network; Shawn Sutherland, patient and member outcomes, Information Builders; Bill Kotraba, VP of healthcare solutions and strategies, Information Builders. Inaccurate provider data negatively impacts revenue cycle, care coordination, customer experience, and keeping information synchronized across systems and functions. SLUHN will describe how it created a single version of provider data from 17 sources, followed by a demonstration of how that data can be used in reports and geospatial analysis. Learn how Omni-HealthData Provider Master Edition provides rapid ROI in overcoming healthcare organization provider data issues.


Acquisitions, Funding, Business, and Stock

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The former “citizen-scientist in residence” of UBiome – the microbiome testing vendor that was just raided by the FBI after complaints of insurance overbilling – lists Theranos-like warning signs:

  • The company didn’t hire a CFO until 2017, then fired him shortly afterward.
  • A long list of scientists endorsed the company’s tests, but it’s not clear if any of them ever actually tried them. He says that “too many advisors are really just outsiders with an ego.”
  • The company hasn’t released any clinical data despite listing thousands of partnerships with famous research institutes.
  • VCs lose money when they back what turns out to be a fraud, but the scientific advisors just walk away from the train wreck unnoticed.

Government and Politics

FDA shuts down its “alternative summary reporting” program for breast implants and says it will eventually extend the shutdown to include all medical device problem reporting. The program allowed manufacturers to submit summary reports instead describing safety incidents individually, thus hiding them from the public eye.


Other

Doctors are using EHRs to identify patients in measles outbreak areas who have not received the measles vaccine. It mentions NYU Langone Health, which has created alerts in Epic that notified doctors and nurses that a patient lives in a ZIP code that is experiencing a measles outbreak. Epic collected customer best practices for dealing with measles and published them into a how-to guide.

A woman who counts on getting emotional support from fellow breast cancer patients from a closed Facebook group complains that people like her are “trapped” after not realizing years ago how cavalierly Facebook manages and sells the private data of its users. She says, ‘’Our group cannot simply pick up and leave … how do we keep the same cycle from repeating on a new platform?” I will, as I often do, take the counterpoint. The group absolutely can leave Facebook and move to a platform that they control. Facebook’s most insidious tactic is hooking users on its wide-ranging services to the point that like Pavlov’s dogs, they will obediently waste hours each day in return for a reward treat that was paid for by those companies willing to buy ads and user data. Use an independent technology platform that isn’t funded by invisible, unethical data practices. Consider whatever cost is involved for the platform and its support to be the price of not having your medical information sold like at a Turkish rug bazaar.

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Interoperability expert Grahame Grieve is named the winner of the 2019 John P. Glaser Health Informatics Innovator Award. My most recent interview with him (from March 2019) is here. This is a nice summary by Robert Murphy, MD of UTHealth’s School of Biomedical Informatics:

As a physician and an informatician, I am singularly impressed by Grieve’s focus on pragmatic outcomes derived from a comprehensive array of tactics that are steadily moving us toward interoperability—notably, standards development, implementation, and adoption; open source and tool development and devising interoperability toolkits; enterprise architecture and governance; and clinical document and clinical interoperability solutions. He and his colleagues are extraordinary change agents within healthcare

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This seems largely pointless: a new hospital in South Korea will be crammed with tech gadgets that would appear to have zero impact on outcomes or cost – hologram images of isolated patients for “visits,” augmented reality-based wayfinding systems, facial recognition biometric access, and voice assistant-powered patient room amenities. A telecom vendor is co-building the hospital, so naturally it is bragging on 5G connectivity that always seems like hype more than anything. I’m picturing patients wandering around in gowns emblazoned with Nascar-like phone company ads. I am amused that one of Yonsei University Health System’s hospitals is named Gangnam Severance Hospital, which makes me picture Psy being marched off the premises with final check in hand following a musical restructuring.

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In England, former hospital CIO Richard Corbridge warns in an op-ed piece that NHS’s digital leaders are leaving for jobs in the private sector, frustrated by health secretary Matt Hancock’s unfunded push for a technology revolution such as “axe the fax.” Corbridge, who just left NHS after 23 years to join Boots as director of innovation, says hospitals can afford only 1% of their budget for IT after the cost of dealing with an aging population, historic underfunding, and staff shortages.

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In England, Guinness World Records tells a nurse who ran the London Marathon in scrubs to raise money for Barts Charity that her time won’t qualify as a record for “running a marathon while dressed in a nurse costume” because it requires the uniform to include a dress, a pinafore apron, and a white nurse’s cap. They also advised her that wearing scrubs could confuse people into thinking she’s a doctor. She notes, “I’ve certainly never seen a male nurse wearing a dress to work.” I might take the side of GWR, however, since it isn’t looking for occupational accuracy in certifying records of runners dressed as lobsters or telephone booths (why those records even exist is another issue), with its guidelines cautioning costumed record seekers, “No one wants to run 26 miles dressed as a rabbit only to find out their ears weren’t long enough.”


Sponsor Updates

  • Gartner cites Lightbeam Health Solutions in several industry reports.
  • Mobile Heartbeat will exhibit at the Kentucky Hospital Association event May 8-10 in Lexington.
  • Waystar will exhibit at the Office Practicum 2019 User Conference May 9-11 in Orlando.
  • Netsmart will exhibit at LTC 100 May 5-8 in Naples, FL.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS CSO Spring Conference May 10 in Dublin, OH.
  • OmniSys will exhibit at the HCP Spring Hospital Pharmacy Conference May 6-8 in Miami.
  • Experian Health will exhibit at the NCPDP 2019 Annual Technology & Business Conference May 6-8 in Scottsdale, AZ.
  • Redox will exhibit at the Prime Health Innovation Summit May 7 in Glendale, CO.
  • Relatient will exhibit at PNW MGMA May 8-10 in Tacoma, WA.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, Louisiana.
  • Surescripts will exhibit at the NCPDP Annual Conference 2019 May 6-8 in Scottsdale, AZ.
  • Hungary’s University of Debrecen joins the TriNetX network to increase collaboration and growth in commercial clinical studies.
  • Voalte will exhibit at the Kentucky Hospital Association Annual Convention May 8-9 in Lexington.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 5/3/19

May 2, 2019 News 5 Comments

Top News

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Allscripts announces Q1 results: revenue flat, adjusted EPS $0.16 vs. $0.15, beating on earnings but falling short of revenue expectations. 


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor SailPoint Technologies. The Austin, TX-based company’s platform manages digital identities, allowing organizations to see and control access to apps (on-premise, cloud, web), devices, infrastructure, and structured and unstructured data. Deployment options include SaaS, AWS or Azure cloud, data center, or via a managed service provider. Specific functionality includes provisioning, self-service access requests, access certifications, separation of duties, user-managed password resets, file access management including Microsoft Office, and AI-driven reporting. Specific platforms supported include Epic, Cerner, SAP, Workday, Box, Dropbox, and SharePoint. PeaceHealth dropped its 28-day turnaround time for providing access to two days, is able to run yearly employee access certification campaigns, and has reduced provisioning contractor headcount by 25. Thanks to SailPoint Technologies for supporting HIStalk.

Listening: the new, final album from The Cranberries, completed by the band from demo tracks found on the hard drive of singer Dolores O’Riordan, who died in January 2018 at 46 of accidental drowning. The Cranberries have made recordings in that manner before — she poured so much emotion into the demos that her studio versions couldn’t match them, so they sometimes went with the first draft. She had been through a lot, so the new album is more wistful, reflective, and less angry than “Zombie,” of which I would say her 1995 performance on SNL is still one of the rawest and best in that show’s history from long ago when singers wrote their own songs, performed them with emotion, and used minimal stage equipment with no computers, Auto-Tune corrected vocals, or sequiny dancers. My expectation of just listening to the new album without emotion turned out to be unrealistic as I spent the afternoon looping the achingly perfect title track “In The End.”

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It’s a big holiday weekend, so happy Cinco de Cuatro to all.


Webinars

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


Acquisitions, Funding, Business, and Stocks

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CirrusMD raises $15 million in a Series B funding round. Its chat-based telemedicine software will be implemented at three VA medical centers.

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Medical device integration and patient monitoring company Capsule Technologies acquires clinical surveillance software vendor Bernoulli Health. Capsule Technologies was acquired by Francisco Partners from Qualcomm just before HIMSS, where it re-emerged from its Qualcomm Life brand as Capsule Technologies (before Qualcomm, it was Capsule Technologie).

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CBNC reports why the FBI raided venture-funded microbiome startup UBiome: the company was billing insurers multiple times without patient consent and pressuring its doctors to approve its tests (which it should be noted have zero proven clinical value). The company has placed its two co-founders – who are also its co-CEOs – on administrative leave.  

Medhost adds hospital business office outsourcing services.

ResMed announces Q3 results: revenue up 12%, adjusted EPS $0.89 vs. $0.92. 

Inovalon reports Q1 results: revenue up 57%, adjusted EPS $0.10 vs. –$0.04.


Sales

  • Oklahoma Spine Hospital selects Evident’s Thrive EHR.

People

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Netsmart promotes Kevin Kaufman to CFO.

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Mindy Heintskill (Walgreens) joins MDLive as chief marketing officer.

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Medhost promotes Jason Myers to CIO and Rick Brown to chief development officer.

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Cerner Chief People Officer Julie Wilson will retire on June 30 after 16 years in that position and 24 with the company.


Announcements and Implementations

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Cantata Health adds a resident referral portal to its NetSolutions EHR for skilled nursing facilities.

In Massachusetts, Lahey Health System and Tufts Medical Center implement secure communications and notification capabilities from Secure Exchange Solutions as part of the ELINC HIE.

Woman’s Hospital (LA) goes live on Meditech Expanse Point of Care.

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North York General Hospital in Toronto goes live on Spok’s Care Connect contact center technology.


Other

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AMIA announces its first group of Fellows (FAMIA) in applied informatics. 

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DirectTrust seeks members to serve on its Direct Standards Consensus Body.

Medlio co-founder Lori Mehen recounts her negative experience in applying for the Cedars-Sinai Accelerator, saying that the CIO (presumably Darren Dworkin) told her seven minutes into her 15-minute scheduled meeting with him that not only would he vote no, but that he would also “veto anyone who says yes,” describing his tone as “belligerent and hateful” in telling her, “We don’t need your help getting our patients to find our doctors.” (It should be noted that this is one side of the story and other companies, especially those who were actually accepted into the program, have spoken positively about their experience and Darren’s involvement). She concludes:

We’re certain that we’re not going to be accepted. Nevertheless, it was imperative that I write this before they make their final decision. I’ve discussed this with my partners and they both agree, in the off chance we would have been accepted, we want to go on record as saying Cedars can go f%&k themselves. I’m not supposed to say this because doing so will almost certainly cost me, but that’s exactly why I must. Not just for me, or for my co-founders, but for all the other startups he has abused and will continue to abuse.

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The University of Maryland works with local officials to deliver a kidney via drone to the University of Maryland School of Medicine three miles away, where it was successfully transplanted into a 44 year-old woman who had been on dialysis for eight years. Baltimore traffic must be awful to risk having a kidney-bearing drone come crashing to earth for such a short trip.

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I’m not sure if this is an example of social engineering hacking, incredibly bad security practice, or incredibly good cybersecurity humor.


Sponsor Updates

  • Securance Consulting gives Engage a five-star for the fourth year in a row for being a Best Practice Meditech Hosting Provider.
  • Elsevier will work with PhactMI to develop a new semantic search portal that will offer providers scientifically accurate, current, and unbiased information.
  • EClinicalWorks will exhibit at the 2019 AAOE Annual Conference May 4-7 in Nashville.
  • EPSi extends early-bird pricing for the Visis EPSi Summit, taking place October 22-24 in Austin, TX, through May 31.
  • HCTec publishes a new case study featuring St. Luke’s University Health Network.
  • Iatric Systems will exhibit at the NCHiMA Quad-State event May 5-8 in Myrtle Beach, SC.
  • InterSystems will exhibit at the DoD/VA & Gov Health IT Summit May 8-9 in Alexandria, VA.
  • Kyruus announces the availability of ProviderMatch DirectBook in the Cerner App Gallery for direct scheduling into Cerner Millenium.
  • OptimizeRx will integrate Eversana’s patient support and specialty distribution models into its real-time EHR network.
  • Artifact Health partners with HCPro to provide compliant, time-saving CDI templates for provider queries.
  • The Customer Relationship Management Institute awards Wolters Kluwer customer support teams the NorthFace ScoreBoard Award for exceeding customer service expectations.
  • Henry Ford Health System (MI) expands its use of CarePort software with the implementation of Guide, Connect, and Insight solutions.
  • ROI Healthcare Solutions launches a new “day-in-the-life” content series focusing on its project managers.
  • Dimensional Insight publishes a new white paper, “How Successful Are Healthcare Organizations with Clinical Analytics?”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 5/1/19

April 30, 2019 News 15 Comments

Top News

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Meditech posts Q1 results: revenue down 5.7%, EPS $0.97 vs. $0.08. The big bump in earnings was due to a $46 million year-over-year swing in unrealized marketable securities gains.

Product revenue dropped 21%, operating income was down 33%, and net cash earned from operations was down 44%.


Reader Comments

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From Dramatic Entrance: “Re: provider online reviews. This survey says patients find them critical when choosing.” This gives me an opportunity to illustrate how the headline of a survey’s results is often misleading or its methodology so shaky that the results mean little. For this particular one:

  • The survey’s 839 respondents were self-selected, recruited by using a survey tool’s survey bank and thus likely not validated in any way.
  • The survey question asked whether a positive online reputation is important, where a better question would have been, “How important was online reputation when you chose your most recent provider?” Never ask people what they think or believe when you could just as easily ask them what they actually do.
  • Half of respondents said they have submitted negative provider feedback but were never contacted, but the question didn’t ask how they submitted their criticism (Yelp? The practice website’s contact form? Complained to the front desk person on the way out?)
  • The survey lumped all providers together, everything from hospitals to dentists to doctors. That means the somewhat skimpy respondent count was then segmented further.
  • The company that performed the survey sells reputation management services. They did not engage an independent survey organization that would have followed defensible methodology.
  • Perhaps worst of all, lazy sites that are desperate for “news items” reworded the results into a pointless story with unrestrained headlines and no disclaimer about the obvious validity concerns.

From Ornery Cuss: “Re: health IT startups. Why do you let other sites offer more coverage?” My audience is mostly at the health system C-level, and as the lack of market success of most startups validates, those self-proclaimed disruptors don’t typically fare well trying to pass off half-baked outsider ideas to conservative health systems that are looking for solutions to real problems that offer quick return on investment. Sites that love writing about startups are usually run by people with minimal actual health IT experience who find their naiveté less of a hindrance when they write speculatively about companies nobody’s heard of. I’ll give those companies airtime once they’ve done something impressive enough to take up reader time, which right there excludes 90% of them. Otherwise, it’s like a major league baseball fan studiously following tee-ball games.


HIStalk Announcements and Requests

Listening: new from Interpol, Manhattan-based indie pop-rockers who have been at it since 1997 and who still sound great (think Joy Division). I was excited about hearing them for the first time, at least until I used the HIStalk search function to realize that I first recommended them in January 2009. At least I still do.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Philips announces poor Q1 revenue and earnings that strong growth in China could not offset. Its connected care group posted a 1% revenue drop, while its Personal Health businesses grew sales 5%. The company’s strongest segment was electric toothbrushes. The company said in the earnings call that “we are developing a much more end-to-end care orchestration environment that hospital and care providers are excited about,” but it is taking time to roll that out.

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Computer Sciences Corp accuses India-based Tata Consultancy Services of stealing its source code to develop a competing life insurance administration application. Epic won a $420 million trade secrets award from Tata in 2016, claiming that company employees exploited their role as Kaiser consultants to download proprietary Epic materials to help them develop competing software.

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The Kansas City business paper digs up some interesting Cerner SEC filings related to the involvement of activist investor and tiny shareholder Starboard Value, with which Cerner signed a legally binding cooperation agreement for reasons I can’t fathom other than Starboard’s swagger scared rookie Cerner CEO and board chair Brent Shafer into avoiding the kind of public battle that took out Athenahealth’s Jonathan Bush:

  • Starboard Value made its run at Cerner two days after Shafer announced his new “operating model.”
  • Two of Cerner’s four new board members were nominated by Starboard – former AliphCom President Melinda Mount (AliphCom was the original name of now-liquidated Jawbone) and former Cloudmark CEO George Reidel.
  • Cerner agreed in writing to implement profit-boosting cost cuts and operating changes and to announce those plans via a press release.
  • Cerner agreed to reimburse Starboard up to $275,000 for the legal fees the investor spent to force its way onto Cerner’s board.

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The Wall Street Journal reports that Health Catalyst expects to raise up to $200 million in its IPO.


Sales

  • Metro Health – University of Michigan Health chooses Glytec’s FDA-cleared EGlycemic Management System to standardize best practices in glycemic management.
  • HealtHIE Nevada and the Nevada Hospital Association will implement Collective Medical to provide point-of-care insights to reduce avoidable admissions by supporting care collaboration and event notification across EDs, hospitals, post-acute care, behavioral health, and ambulatory settings.
  • Catholic Charities of Baltimore will implement the SmartCare EHR from Streamline Healthcare Solutions.

People

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OptimizeRx hires Stephen Silvestro (Wolters Kluwer) to the newly created position of chief commercial officer.

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OurHealth names Brian Norris, RN, MBA as interim VP of IT.

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Impact Advisors promotes Erin Svarvari to VP of operations.


Announcements and Implementations

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A new KLAS report looks at hospital EHR market share and makes these points:

  • Epic gained a net 121 hospitals in 2018, losing just one existing customer.
  • Cerner’s net hospital gain was 100, mostly because of its VA deal that represented 167 hospitals, but it lost 65 Millennium accounts, nearly all of which moved to Epic.
  • Nearly all large hospitals and multi-hospital systems that are choosing EHRs (which is not all that many these days) are choosing Epic, while Cerner is selling mostly to smaller hospitals.
  • Meditech had a net loss of 18 hospitals, while Allscripts lost 28 while gaining only three.
  • Market share in hospitals of 500+ beds is mostly Epic, with 58% vs. Cerner’s 27%.
  • Meditech Expanse is selling well and customers are upgrading, but its users are mostly small hospitals, quite a few of which are being acquired by large systems that then convert Meditech to their corporate standard of Epic or Cerner.
  • Allscripts is losing Sunrise and Paragon customers to other vendors as few choose to replace their Allscripts-acquired legacy products with Sunrise.
  • Athenahealth has stopped hospital sales at least temporarily, while EClinicalWorks sold no new hospital contracts in 2018 and the hospital product has not yet reached beta testing.

Imprivata launches IAM Cloud Platform, a cloud-based identity and access management platform that is powered by Microsoft Azure Active Directory. The initial release includes Healthcare Seamless SSO single sign-on.

Meditech launches a professional services division, expanding its implementation offerings to include spearheading quality initiatives, physician consulting, performing  interoperability assessments, and lending expertise to analytics and population health projects.

Verisk will analyze EHR data collected by Human API for life insurer risk scoring and benchmarking.


Other

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Paychecks at 34,000-employee Hackensack Meridian Health are incorrect for the second consecutive pay period due to what it says are problems related to its Oracle PeopleSoft payroll implementation. One employee’s paycheck was for 19 cents, while others have reported that errors caused them problems in qualifying for a mortgage and avoiding bank overdraft charges.

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Bob Wachter makes an interesting observation – a doctor told him that he enjoys the companionship and collegiality of working with a scribe just as much as he enjoys their help with documenting patient care. I had never really considered that a typical practice or clinic doctor interacts only superficially with employees and even that might be awkward because of the perceived rank and authority issue. This reflects on what Dr. Jayne just wrote about in hospitals ending the old-school “medical staff dinners” where everybody got together with their peers for decent food, socializing, and hospital updates, building trust all around (as we say in IT, a lot of people like our employees but hate our department). I’ll also add my own observation – frontline doctors are an easy target for drug company reps who are trained to push emotional buttons (fake friendship, fake mutual interests, fake romantic interest) to generate more prescriptions. In fact, I’ll add observation #2 – doctors (especially procedure specialists like surgeons) often behave bizarrely and childishly when attending hospital-convened meetings because they live their work lives in a fluorescent caves where they are expected to issue curt orders while never really learning professional niceties, while hospitalists and other non-procedure docs who have to get along with patients and families are not much different from the rest of us in skillfully riding the conference room chairs. I bet I could sit here and cobble together a burnout remediation strategy around these factors.

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Business Insider tries DNTL, a New York City “walk-in dental bar” that offers online appointments, IPad form completion, a massage exam chair, and a TV in the treatment room. Its services are covered by dental insurance. Maybe the important takeaway here is that consumers value convenience and atmosphere topmost when they consider a service – such as teeth cleanings or even dental procedures — to be a commodity where outcomes are assumed to be similar everywhere (whether that’s actually the case is irrelevant). Contrast that with the average clinic or doctor’s office, where patients wait in uncomfortable waiting rooms to be seen later than scheduled, nobody really cares if they are comfortable or anxious, treatment is mostly episodic and impersonal, and it’s like cattle being prodded through an abattoir on the frustrating round-trip journey from and back to the sidewalk (hopefully in no worse shape).

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In China, police haul a thoracic surgeon away in handcuffs after he refuses to see a patient whose husband had jumped the line, then tells officers he can’t leave to make a statement because he has patients waiting. In a slight medical irony, the surgeon — perhaps aided by knowing where to punch when a scuffle ensued – broke the husband’s rib.

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Weird News Andy codes this story as W61.92 and expresses relief that the birds that were involved weren’t sick because that would have been “ill eagle.” A woman who is taking photos of a sky full of eagles is hit by a pair of them who were engaged in the mating ritual called “cartwheeling,” whereupon they drop from the sky, and in this particular case, into her lap. The happy couple flew away unharmed, but the accidental falconer required bandages and a tetanus shot.


Sponsor Updates

  • AdvancedMD will exhibit at ACOG May 3-6 in Nashville.
  • Mumms Software will integrate DrFirst’s e-prescribing and medication management software with its hospice EHR.
  • CoverMyMeds will exhibit at the NCPDP Annual Conference May 6-8 in Scottsdale, AZ.
  • CTG will exhibit at the KACHE event May 2-3 in Garden City, KS.
  • Diameter Health will present at the Annual DoD/VA & Government HIT Summit May 8-9 in Alexandria, VA.
  • DrFirst structures a new $17 million commercial financing facility with SunTrust.
  • Wolters Kluwer accelerates healthcare data mapping with artificial intelligence to bridge data silos.

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 4/29/19

April 28, 2019 News 4 Comments

Top News

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HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

Above are the old vs. new penalty tiers.


HIStalk Announcements and Requests

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Nearly 40% of a large number of poll respondents don’t see Epic, Cerner, and Meditech getting new EHR competition in the next 10 years, although 25% of respondents think Silicon Valley firms could potentially enter that market. Holly says EHRs are a dying breed with the only hope being third-party add-ons to make it all work, while Bitbot foresees data science-driven workflows that will overshadow outdated databases and processes. DrLyle takes the long view that the future entails a lot more home care, virtualization, and at-risk entities setting up clinics whose needs could be met by a slimmed-down EHR for care tasks. Matthew Holt agrees that hospitals have tied themselves to Epic and Cerner and sees the threat being that chronic care will move to the home and hospitals see their business cut back to performing procedures and attending to dying patients.

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New poll to your right or here, as suggested by a reader who is COO of a health system that is making an EHR decision and looking at vendor interoperability capabilities and federal initiatives: When will every provider in every care setting be able to reliably exchange all clinically relevant patient information? (continuity of care document, consultation notes, discharge summary, imaging integration, DICOM diagnostic imaging reports, history and physical, operative note, progress note, procedure note, and unstructured document).

I’m interested in interviewing insightful, non-vendor people who are doing work that would inspire my readers. Let me know who you recommend. Many of those I reach out to don’t have the interest, time, or organizational approval to speak frankly (and some don’t have the courage to undergo an unscripted conversation), so I’m casting the net.


Webinars

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


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call following release of quarterly results that met Wall Street expectations:

  • Chairman and CEO Brent Shafer says the involvement of activist investor Starboard Value was consistent with the company’s existing efforts to improve company financial performance.
  • Cerner has engaged turnaround consulting firm AlixPartners to look for efficiency and cost-saving opportunities that won’t negatively impact Cerner clients.
  • Key projects include looking at management structure and costs, reviewing the company’s product portfolio, rationalizing its facilities, and reviewing non-personnel costs.
  • The company will be more selective in evaluating low-margin deals.
  • Cerner will go at-risk with providers to generate higher-margin business.
  • The company notes that while the EHR market is mature, it can cross-sell revenue cycle and ambulatory products to that client base.
  • Cerner admits that companies will likely issue “competitive messaging” to Cerner’s clients about its focus on increasing margins, but says those clients needs the company to be more efficient and to bring products to market faster.
  • Asked by an analyst about the apparent de-emphasizing of the RevWorks revenue cycle management business, the company says it contributes about $200 million in annual revenue but isn’t growing, suggesting that other opportunities are more promising. It also notes that Cerner uses its Works offerings “to more tightly align the client to Cerner” for additional software and services sales and it reviews the profitability of individual clients.
  • CFO Marc Naughton notes that Cerner’s $4.5 billion Innovation Campus was completely paid for by Missouri and Kansas City tax incentives.

Meanwhile, Cerner implements a hiring freeze, telling employees that “we can do better if we target our attention on areas that represent the largest and most profitable growth opportunities and drive client satisfaction and retention.”

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The New York Times notes the sometimes clinically sloppy practices of online birth control seller Nurx, which has used unlicensed personnel to dispense medications that had sometimes been returned by other customers, told its doctors to prescribe birth control to at-risk women as long as the patient agreed, and followed the Silicon Valley mantra of asking forgiveness rather than permission. The company responded to the article by saying that those practices ended a year ago with executive replacements.

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The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors. Reports suggest that insurers complained about being overbilled by the company, while individual customers had previously filed Better Business Bureau complaints saying that their insurance was billed thousands of dollars for tests they thought they were buying in full for less than $100. The FBI is also apparently interested in how the company pays its doctors for referrals. In an interesting twist noted by CNBC’s Chrissy Farr, UBiome’s former product VP is now CEO at Nurx (see the item above).

Tampa-based, Hearst-owned MHK (formerly known as MedHOK) moves to a new 30,000-square-foot office at Harborview Plaza this week. The company has 250 employees.

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Vocera announces Q1 results: revenue down 12%, adjusted EPS -$0.17 vs. $0.04, beating Wall Street expectations for both. From the earnings call:

  • The company had its strongest non-healthcare bookings ever in Q1, including a multi-million dollar deal with retailer Nordstrom that was triggered by a former IT person at a hospital customer site who joined Nordstrom’s IT group and suggested Vocera as a solution.
  • Provider consolidation is leading to larger deal sizes, which adds complexity to the sales and approval process, but benefits Vocera as a unified platform vendor.
  • The company is winning 70-80% of the deals it is involved with, with little competitive impact from Cerner CareAware and no effect so far from Hill-Rom’s pending acquisition of Voalte.
  • The company was awarded authority to operate with the Navy and Air Force.
  • Market acceptance of the company’s new Smartbadge has exceeded expectations.

Sales

  • SacValley MedShare HIE chooses Zen Healthcare IT as its data integration platform in the “integration as a service” model.

Announcements and Implementations

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InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research. The couple, whose net worth has been estimated at $2.5 billion, has signed the Giving Pledge, in which they will give most of their assets to philanthropic causes. Terry Ragon founded InterSystems in 1978 as a vendor of the MUMPS (Massachusetts General Hospital Utility Multi-Programming System) that was invented by two eventual Meditech pioneers (Neil Pappalardo and Curt Marble) and MD/PhD student Robert Greenes (now a biomedical informatics professor at Arizona State University). MUMPS powers systems sold by Epic, Meditech, and many other health IT vendors as well as the VA’s VistA. Privately held InterSystems has since added sophisticated database, integration, HIE, and clinical systems to its portfolio for both healthcare and non-healthcare sectors.


Other

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Arizona State University and Mayo Clinic break ground in Phoenix on the 150,000-square-foot Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs. The facility, which will open in 2020, will be connected to Mayo Clinic


Sponsor Updates

  • Lightbeam Health Solutions will exhibit at the BCBS 2019 National Summit April 29- in Grapevine, TX.
  • Qventus will present at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Mobile Heartbeat will exhibit at the Trauma Center Association of America’s Annual Conference April 28-May 3 in Las Vegas.
  • Netsmart Director of Post-Acute Community Strategist Teresa Craig will speak at the 2019 Association for Home and Hospice Care of NC Expo April 29 in Raleigh.
  • Nordic will host receptions during Epic XGM on April 30 and May 7 in Madison, WI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Michigan Section Conference May 3 in Frankenmuth.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Redox will exhibit at Epic XGM April 29-May 10 in Verona, WI.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, LA.
  • Surescripts will exhibit at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.
  • The Healthcare Rap podcast features SymphonyRM Director of Client AI Chris Hemphill.
  • Wolters Kluwer Health will present at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 4/26/19

April 25, 2019 News 2 Comments

Top News

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Cerner reports Q1 results: revenue up 8%, adjusted EPS $0.61 vs. $0.58, meeting expectations for both.


Reader Comments

From Vishnu: “Re: EClinicalWorks. This is the second example of the company ignoring sexual harassment. It simply relocates offenders when a problem is identified.” A Change.org petition filed by a Bangalore women’s rights organization – which should be noted to contain accusations that have not been proven as far as I know — demands that the company resolve the “indifference of the management and implicit and explicit sanction of sexual harassment” at the company’s Bangalore office. It names a company director as violating an employee who was then told that she had to “accept it in good spirit” if she planned to be promoted, had her email access turned off while on medical leave, had the person she had accused assigned to interrogate her on behalf of the company, and was threatened by the HR and legal departments before eventually being fired. 

From ATHBEL: “Re: Athenahealth layoffs. Most of the sales and some of the onboarding staff associated with the hospital product were let go. The majority of the operation staff was not eliminated. It was actually a pleasant surprise how much of the functional expertise in both product dev and support was retained and rolled into stable operating divisions within Athena. It was established with customers awhile ago that there would be no new sales or onboarding while the new ownership figured out what to do with the product. I have no idea what direction they’re taking the hospital segment and I don’t think Veritas does at this point either, honestly. The only speculation on sunsetting the product in any sort of near term is solely from competitors.” Unverified. Thanks for the info.


Webinars

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


Acquisitions, Funding, Business, and Stock

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CPSI will acquire patient engagement vendor Get Real Health for $11 million. Get Real Health saw a surge in exposure earlier this year when Microsoft suggested that HealthVault users migrate their health data to the company’s Lydia PHR.

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Seattle-based genetic testing and health coaching startup Arivale shuts down and lays off its 120 employees without warning. The company, which had raised $50 million, concluded that its annual consumer price of $1,200 to $3,500 didn’t cover the cost of performing the necessary tests. CEO Clayton Lewis also noted that Arivale wasn’t successful in convincing people that data and lifestyle changes would necessarily improve their health. Startup executives who love the idea of quantifying themselves or being paid for healthy lifestyles keeping learning an expensive lesson — they represent a tiny, navel-gazing minority whose time would be wisely spent studying their target audience as they prowl the junk food, cigarette, and alcohol aisles of Walmart while steering a wide berth around the pharmacy’s bathroom scales and blood pressure cuffs. 

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Bain Capital hires financial advisors to help it assess the potential sale of Waystar. The RCM vendor was created in 2017 from the merger of ZirMed and Navicure, which joined Bain Capital’s portfolio in 2016.

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ED software startup Vital launches with $5 million in seed funding. Developed by Mint.com founder Aaron Patzer, Vital’s technology uses predictive analytics to help ED staff identify high-risk patients, reduce wait times, and improve efficiencies.

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The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility. It accuses the company of:

  • Requiring long-term exclusivity from customers
  • Punishing customers with higher prices if they obtain prescriptions from another company
  • Illegally pressuring Allscripts to prevent it from taking its business elsewhere
  • Sidelining RelayHealth’s ability to compete against Surescripts for six years through strict contract provisions

Sales

  • Arkansas Children’s will automate workflows and documentation into its Epic EHR and Haiku application using Excel Medical’s medical device integration software.
  • Duke Health (NC) signs a seven-year contract with Visage Imaging for its enterprise imaging software.
  • Medical transportation company LogistiCare selects call center software and services from Avaya.
  • Senior living provider Plum Healthcare (CA) will implement Netsmart’s MyUnity EHR as part of a 10-year partnership with the vendor that will involve the co-development of new senior-focused technologies and services.

People

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Jeff Macko (Revature) joins Continuum Health IT as president and managing partner.

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T2 Tech Group hires Geri Pavia (Orion Health) as VP of business development.


Announcements and Implementations

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Philips develops patient management software and companion practice management consulting services for radiation oncology departments.

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Atchison Hospital (KS) goes live on Meditech Expanse with consulting assistance from Engage.


Privacy and Security

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A JAMA-published finds that 29 out of 36 depression and smoking cessation apps transmit data to Facebook or Google, while only 12 disclose that fact in their privacy notices. The study’s authors advise that, “Users should be aware that their use of ostensibly standalone mental health apps, and the health status that this implies, may be linked to other data for other purposes, such as marketing targeting mental illness. Critically, this may take place even if an app provides no visible cues (such as a Facebook login), and even for users who do not have a Facebook account.” Facebook, meanwhile, expects to pay up to $5 billion in fines to the FTC for privacy violations.


Other

Twenty-eight health systems join the Medicaid Transformation Project to improve the delivery of behavioral healthcare services through the use of digital tools. The project’s next initiatives will focus on maternal and infant care and substance and opioid use. The project was launched last year by former CMS acting administrator Andy Slavitt and the Avia healthcare innovation network.

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A joint study between Kaiser Permanente and FDB finds that the deployment of clinical decision support for drug-disease interactions generated acceptable interruptive alerts with which clinicians agreed 92-99% of the time. Kaiser Permanente plans to implement the decision support software beyond the four regions in which it was piloted.

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Genital herpes diagnosis and treatment website HerpAlert handled 20 times its usual number cases after the Coachella music festival started, eclipsing the previous record that was set during 2018’s Oscars weekend. Patients submit photos and get a $99 doctor’s confirmation and a prescription sent to the pharmacy of their choice in an average of two hours. It’s pretty amazing that big businesses that are being built around the fact that FDA doesn’t allow over-the-counter sales of low-risk drugs for fairly obvious conditions. That business model wouldn’t work in many countries, where you can buy whatever you want from the pharmacy as a responsible adult without paying a fee to have an online doctor rubber stamp your request with a tech company taking its vig for medical matchmaking.


Sponsor Updates

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  • HCTec team members head to ThriftSmart for the company’s quarterly volunteer day.
  • EClinicalWorks will exhibit at the 2019 IPHCA Annual Conference April 29-30 in Indianapolis.
  • Ellkay will exhibit at the Executive War College Conference on Laboratory & Pathology Management April 30-May 1 in New Orleans.
  • The California Health Care Foundation features Healthfinch and its work with safety-net clinics in California.
  • InterSystems will exhibit at Epic XGM May 1-2 in Verona, WI.
  • Ivenix will exhibit at the New England Nursing Informatics Consortium Annual Symposium April 26 in Waltham, MA.
  • The “HIT Like a Girl” podcast features Kyruus CMO Erin Jospe, MD.
  • ConnectiveRx will exhibit at the Asembia Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
  • Nordic unveils a new logo.
  • PerfectServe achieves certified integration with the Spectralink Versity smartphone.
  • Humber River Hospital in Toronto upgrades to Meditech Expanse.
  • Optimum Healthcare IT publishes a new infographic, “Q1 2019 Health Data Breach Report.”
  • Meditech publishes a new case study, “Kalispell Regional Advances Diabetes Management Through Patient Registries.”
  • The Arizona Hospital and Healthcare Association offers PatientPing’s real-time care alerts and context stories to member hospitals through its Affiliated Partners Program.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 4/24/19

April 23, 2019 News 1 Comment

Top News

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HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers.

The models are:

  • Primary Care First, in which small primary care practices will be paid a fixed fee per patient per month, with bonuses for keeping them healthy and penalties if their patients are sicker than expected.
  • Direct Contracting, for larger practices willing to go at risk for their overall Medicare patient spending.

Reader Comments

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From Ex-Athena: “Re: Athenahealth. Laid off about 200 people today, including most of the hospital division. I think that’s a good indication of the future of the hospital product.” The company confirms that it is laying off “less than 4%” of its workforce (which would be about 200 employees) in a reorganization to integrate the former Athenahealth with Virence Health, two months after its take-private acquisition by Veritas Capital. The company did not list specific jobs or locations. Thanks to the several readers who gave me a heads up.


HIStalk Announcements and Requests

Listening: the new, final studio album from the O’Jays, which includes everything I love about exuberant 1970s-era Philadelphia soul like “Love Train” and “Back Stabbers” (smooth vocals, touches of my beloved doo-wop background harmonies, tinkly guitar riffs over horns and disco keyboards, and mellifluous talking over the music to set the scene). They still have two members of the original five after 61 years. These old guys don’t mess around in giving their fans their best – Rolling Stone notes that they rehearsed for nine weeks –seven days per week, 10 hours per day – to prepare for their Las Vegas shows. The album is great and the group deserves historical appreciation that goes far beyond simple nostalgia. This is the perfect summer music for family-friendly picnics and beach trips that will get everyone subconsciously swaying and bobbing along, the most fun music I’ve heard in a long time. It thus earns my highest recommendation.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Censinet launches its health system vendor management platform and raises $7.8 million in a Series A funding round. Founder and CEO Ed Gaudet was previously with Imprivata.

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Another reminder that US healthcare is a business – publicly traded American Addiction Centers operates call centers, a sales and marketing organization, and SEO-savvy websites that generate $22,000 annual revenue per client thanks to insurers who cover their services. They’ve been sued for leaving patients unattended who then died under their care, for which they blame short sellers of their shares. 

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Amazon begins promoting its mail order pharmacy, as powered by its $1 billion acquisition of PillPack in June 2018.

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Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse, with consulting assistance from Engage. 


Sales

  • Cape Cod Healthcare chooses unified communications and contact center solutions from Avaya.
  • Boston Children’s Hospital will offer medical second opinions to patients in China using More Health’s collaboration platform and network.

People

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HIMSS hires its former board chair Sebastian Krolop, MD, PhD, MSc (Deloitte) as chief operating and strategy officer.

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Washington University School of Medicine names Maria Russo (Kaiser Permanente) to the newly created position of CIO.


Announcements and Implementations

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Relatient announces its Messenger two-way chat solution that allows provider staff to text patients in real time for patient engagement, making it part of its appointment reminder and broadcast messaging solution. The company notes that not only is chat the most patient-preferred communication mode, 90% of text messages from known senders are read within three minutes.

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Definitive Healthcare releases its 2019 healthcare trends survey results:

  • The most important of 2018 trend was mergers, acquisitions, and partnerships
  • The rise of healthcare consumerism was second-most important, followed by telehealth
  • Few respondents observed anything important happening with AI/machine learning, staffing shortages, cybersecurity, and EHR optimization
  • The least-important trend was wearables and remote monitoring

NYU School of Medicine researchers and the research institute that developed Siri create an algorithm that can analyze audio interviews to detect markers of post-traumatic stress disorder that elude subjective human detection. It could confirm accuracy of the diagnosis that makes up one-fifth of all VA benefits claims, but also detect veterans with PTSD who won’t admit that they have problems. Other PTSD detection research is looking at measuring stress hormones in saliva. 

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Deep users of real-time location systems urge other organizations to look beyond tracking functionality to data visibility, improved patient care, and increased efficiency, according to a new KLAS RTLS report. TeleTracking, CenTrak, and Midmark lead the pack, while Cerner and Airista Flow trail all other vendors dismally in satisfaction and actual use cases.


Other

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Financial Times profiles startups that pay patients for their digitized data, such as wearables, and then offer it to drug and device manufacturers, researchers, and FDA. The interesting aspects of these business models: (a) the information doesn’t require de-identification because the patient and data recipient sign a contract covering the terms under which it can be used; and (b) the recipient pays the patient directly.

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AliveCor’s KardiaMobile personal ECG device earns FDA indications for bradycardia and tachycardia, trumping Apple by going beyond atrial fibrillation detection.


Sponsor Updates

  • AdvancedMD publishes a new e-guide, “Pediatrics: Specialized Practice Tools to Boost Your Business Results.”
  • Former CMS leader Andy Slavitt will keynote Arcadia’s Aggregate conference April 24-26 in Boston.
  • Gartner recognizes Avaya as an April 2019 Peer Insights Customers’ Choice for unified communications.
  • Collective Medical CEO Chris Klomp will speak at the 2019 Utah State of Reform Conference April 24 in Salt Lake City.
  • Cumberland is named to Forbes’s “America’s Best Management Consulting Firms for 2019.”
  • Surescripts will exhibit at the Asembia Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
  • Datica CMO Kris Gösser will speak at the Seattle Health Innovators meetup at Cambia Grove April 24.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 4/22/19

April 21, 2019 News 2 Comments

Top News

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HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment.

ONC will present a webinar on Draft 2 on April 23.

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In related news, ONC announces that it will open a four-year, $900,000 per year (first year) funding opportunity for a non-profit to serve as the Recognized Coordinating Entity to oversee TEFCA’s Common Agreement for qualified Health Information Networks.


Reader Comments

From Looming Clouds: “Re: health IT fire hose. Give me five things I need to know about healthcare as an outsider.”

  • Fix a problem using the most appropriate tools and methods, which may have nothing to do with technology. Companies desperately seeking a nail for their software hammer to pound always end up quietly slinking off in shame.
  • Remember that you, your friends, and your family are all patients at one time or another. You probably wouldn’t want someone like yourself affecting their care with your technology tinkering.
  • It’s tough to automate an industry whose key players (clinicians) don’t really buy into the idea of conveniently computer-amenable concepts such as evidence-based medicine, standardized practices, and reducing practice variation, especially when they are right. Medicine is half business, half science. Even those of us in the industry don’t really care which technology tools our doctors (or our accountants, or our carpenters, etc.) use – we judge them on the factors that, at best, are invisibly influenced by the technology they choose. Clinicians of all types rarely love hospital-mandated software because 80% of its functionality enforces rules set by their many overlords that add nothing to patient care and force them to enter data for someone else’s benefit.
  • People and organizations, even those in healthcare (maybe especially those in healthcare) do whatever rewards them most personally as long as they don’t have to intentionally harm patients. It’s not as ethical and purely motivated as you see on medical TV shows. Don’t be fooled into thinking that medical practices (which are always for-profit) are less nobly motivated than theoretically not-for-profit health systems and insurers. All of them will find the money no matter where Medicare and insurers hide it.
  • The only thing that matters that long-term outcomes are improved, patient access is made easier, or costs are reduced. Everything else is a nice-to-have at best. Do patients and your business a favor and find some other profit opportunity if you can’t address these issues.

HIStalk Announcements and Requests

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Two-thirds of poll respondents spend 1-3 hours each week reading healthcare and healthcare IT news, which is plenty of time to catch up on the latest news, rumors, and opinions on HIStalk (maybe 30-45 minutes of skimming per week, tops) plus whatever else is out there.

New poll to your right or here: Will Cerner, Epic, and Meditech face any new health system EHR competition in the next 10 years? If so, from whom? A lot of people (admittedly, most of them clueless) seem to think that EHRs are dinosaurs that are in imminent danger of being felled in their tracks by a Silicon Valley-launched asteroid and are planning an after-party in which a replacement product suddenly sheds all the unpleasant functionality (coding, billing, documentation) in giving clinicians a fun, rewarding system written just for their needs that will free them from the electronic shackles created by the people who provide their incomes. Those whose deep psychological insight allows them read between the lines I write might detect my skepticism.

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Thanks to Prepared Health for upgrading its HIStalk sponsorship. The company’s EnTouch Network makes it easier for patients to stay healthy at home by connecting them with providers, caregivers, and payers. Health systems use the platform to stay connected to referral sources, involve the patient’s caregivers in their care, receive real-time alerts of changes in risk or care setting, and monitor for fraud and abuse via GPS-powered visit verification. The co-founders have a long industry history going back to the early days of Medicity, which I should mention was HIStalk’s first-ever sponsor back in 2005 or so. The big company news this week is that Jefferson Health chose Prepared Health its digital technology partner for post-acute and transitional care for its 14 hospitals.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Haven opens a New York City office to attract technology talent, according to a LinkedIn post by its CTO. Open positions — which are described with just a generic job title — include clinical, data and analytics, product, and technology.

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The Kansas City business paper provides an update on Phase 3-4 construction at Cerner’s $4.5 billion Innovations Campus, with the latest efforts adding 777,000 square feet. Campus construction will be completed in 2025 with space for 16,000 employees. You have to wonder if this was a bad idea (at least in the absence of a reliable crystal ball when it was announced in 2016) given the company’s subtle retrenchment for what seems likely to be a tougher haul, which might also be true of Epic.

Several Blue Cross Blue Shield plans are sponsoring ACOs and opening their own primary care practices and urgent care centers to reduce the use of expensive hospital care.

I hadn’t checked NantHealth’s share price lately – it is $0.79, valuing the company at just $86 million and no doubt annoying those IPO-day buyers who in mid-2016 paid $21 per share (now sporting a 96% haircut). Shares of the other health IT train wreck Castlight Health are down 91% from their IPO day close in March 2014. It’s always good to remember an inviolate Wall Street rule – buying company shares early means that insiders who know way more than you are happy to dump shares on you at the price they have set.


People

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David Bean (Complete Merchant Solutions) joins Prepared Health as SVP of sales and marketing.


Announcements and Implementations

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NYC Health + Hospitals brings Epic live at 19 more locations, increasing its total to 50 and taking the $1 billion project it calls H2O past the halfway point of 45,000 users.

MDLive launches CareLink, a telehealth program that helps health plans and systems improve quality metrics via increased member engagement and lower cost. Optima Health (VA) is a pilot site.


Other

Weird News Andy will love this. An ambulance headed for a hospital ED with a patient whose heart is racing at 200 beats per minute restores normal rhythm when the ambulance hits a pothole.


Sponsor Updates

  • Formativ Health will demonstrate its Patient Engagement Platform at the NAHAM annual conference April 23-26 in Orlando.
  • Lightbeam Health Solutions will exhibit at NAACOS Spring 2019 April 24-26 in Baltimore.
  • Vyne Medical, Experian Health, and Relatient will present and exhibit at NAHAM April 24-26 in Orlando.
  • Mobile Heartbeat will exhibit at the 2019 LONE Spring Conference April 25-26 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Colorado State Conference April 25-26 in Colorado Springs.
  • CloudWave partners with Nutanix to bring the first certified health information solution to healthcare organizations running Meditech.
  • Redox will exhibit at the AWS Healthcare & Life Sciences Symposium April 24-25 in Boston.
  • Surescripts will exhibit at Matrixcare Directions 2019 April 24-26 in Nashville.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • TriNetX CMO Manfred Stapff, MD publishes “First-line treatment of essential hypertension: A real-world analysis across four antihypertensive treatment classes” in the Journal of Clinical Hypertension.
  • Voalte will exhibit at the NC HIMSS Chapter Annual Conference April 23-25 in Raleigh.
  • Vocera will exhibit at the Minnesota Organization of Leaders in Nursing 2019 Spring Conference April 25 in Brooklyn Park, MN.

Blog Posts


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Contacts

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

April 18, 2019 News 3 Comments

Top News

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IBM halts sales of Watson for Drug Discovery due to low demand.

The company says it will intensify its focus on clinical development. 

The Watson for Drug Discovery web page is still active, including testimonials from Barrow Neurological Institute.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Healthcare data integration vendor Redox raises $33 million in a Series C funding round. It has raised $50 million since launching five years ago.

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EMV Capital acquires San Francisco-based Wanda, a clinical decision support company focused on preventing adverse events.

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After merging last year, healthcare consulting firms HealthInsight and Qualis Health rebrand to Comagine Health. HealthInsight CEO Marc Bennett has assumed leadership of the new company.

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The Theranos saga just won’t go away. CB Insights reports the company was awarded five new patents in March and April, all filed between 2015 and 2016. Theranos founder Elizabeth Holmes, meanwhile, is preparing for her day in court. Charged with several counts of wire fraud and conspiracy to commit wire fraud, she has filed a motion in federal court to to force prosecutors to hand over thousands of communication records between the FDA, CMS, and Wall Street Journal reporter John Carreyrou, whose reporting helped bring the company’s fraudulent activities to light. A trial date has not been set, given the 17 million documents federal prosecutors must sift through to build their case.


People

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Tom Niehaus (TJN Advisory) rejoins CTG as EVP of North American operations.

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White River Health System (AR) promotes Jeff Reifsteck to AVP/CIO.

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EarlySense names Matt Johnson (Sowell & Co.) as CEO.

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Robert Fosmire (Kareo) joins Greenway Health as SVP of customer success.


Sales

  • Sentara Healthcare (VA) selects PACS software from Mach7 Technologies.
  • Prisma Health (SC) will implement patient access and provider directory technology from Kyruus.

Announcements and Implementations

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After more than a year of training led by a core team of 20, Carris Health (MN) will go live on Epic at six facilities next month.

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Best Buy begins offering TytoCare’s at-home telemedicine kit online and at select stores in Minnesota. The TytoHome kit retails for $300 plus the cost of a virtual visit with partners that include American Well, LiveHealth Online, and Sanford Health.

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In New York, Northwell Health opens an Emergency Telepsychiatry Hub to serve EDs in New York City, Long Island, and Westchester County. The hub’s 35-member team expects to conduct 5,000 consultations this year.

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A new KLAS report on enterprise resource planning systems  (HR, finance, and supply chain) finds that cloud-based systems are attractive and organizations are willing to consider them even if it means replacing their incumbent vendor. Workday leads the field despite gaps in supply chain functionality. Infor and Oracle offer newer, lower-rated products; earn client criticism for not taking an active lead during implementation; and have a significant percentage of customers who say they wouldn’t buy those products again. 


Government and Politics

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In England, the NHS develops the National Events Management Service, a digital personal health record for children that parents may use in place of the traditional paper version they are expected to bring with them to all pediatric appointments. The new service also features real-time messaging capabilities for birth notifications, address changes, and change-of-practice notifications.

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An ONC data dive into the ways in which hospitals used their EHR data between 2015 and 2017 finds:

  • A hospital’s use of EHR data varied significantly by vendor; Epic, Meditech, and Cerner users had the highest rates of data utilization to inform clinical practice
  • Small, rural, critical access, state and local government, and non-teaching hospitals had the lowest rates of EHR data utilization
  • Hospitals most frequently use EHR data to support quality improvement efforts, monitor patient safety, and analyze organizational performance
  • Utilization of EHR data slowed significantly (in some cases stalling completely) between 2016 and 2017

Privacy and Security

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The communications director at Northern Light’s Acadia Hospital in Maine mistakenly emails a spreadsheet containing the names of 300 patients with Suboxone prescriptions and those of their providers to a reporter at the Bangor Daily News. The spreadsheet was an attachment buried in a chain of emails between the hospital employee and the reporter, who was developing a story on the the availability of Suboxone – a drug given to patients battling opioid addiction – in the Bangor region. The hospital’s privacy lapse has, ironically, made the paper’s pages.


Other

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Columbia University (NY) reminds medical staff of the importance of its upcoming transition to Epic, which will encompass converting aging systems to the new or upgraded Epic software across Columbia, Weill Cornell Medicine, and NewYork-Presbyterian facilities. “We knew staying the course was not an option,” said Jack Cioffi, MD, president of ColumbiaDoctors and an executive sponsor of the EpicTogether project. “The pain points we feel now with CROWN and SCM will fade with Epic. That’s not to say we won’t experience new ones these next nine months, but we will be able to better address and fix them. We will have a more efficient, comprehensive system to support us in delivering the best care possible.” Rolling go-lives will take place between 2020 and 2022.


Sponsor Updates

  • Elsevier’s new Transition to Practice platform helps retain newly licensed nurses and build their confidence and satisfaction.
  • EClinicalWorks and Imat Solutions will exhibit at the NAACOS Spring 2019 Conference April 24-26 in Baltimore.
  • Imprivata and Kyruus will exhibit at NAHAM April 23-26 in Orlando.
  • Solutions Review interviews InterSystems Director of Product Management Jeff Fried.
  • Ivenix publishes a new white paper, “Exploring Real-World Performance of IV Pumps.”
  • Vocera receives an Authority to Operate from the DoD, extending the potential purchase and deployment of its Vocera Badge to facilities in the Air Force and Navy.
  • Phynd Technologies migrates its Provider 360° platform to AWS, has partnered with the American Board of Medical Specialties, and joined the Drupal Association.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Health System IT Professionals vs. Would-Be Disruptors: Unfairly Dismissive or Appropriately Skeptical of Outsiders?

April 17, 2019 News 2 Comments

I asked provider IT professionals to weigh in on this question, whose genesis was an outsider’s assessment via an HIStalk comment: do we health system IT people automatically dismiss potentially disruptive technologies (such as AI) because we are too entrenched or too well rewarded by the status quo?

The edited responses are below. Thanks to those who offered their excellent insights.


Outsiders have trouble with understanding the speed at which physicians want to move. They are one of few occupations still paid by the piece, not by the hour or a salary. Every second they are waiting for information to populate on a screen, the screen to flip, or the log-in sequence is a lot of money to them. Until you have a database faster than MUMPS, don’t waste my time. For that reason alone, blockchain is a non-starter.


I’ve been involved in minimally transformative ideas and projects that are shot down due to the (over) regulatory environment. A lot of industries are heavily regulated (airlines and nuclear power come to mind), but their regulations are generally around safety. In healthcare, the regulations are around both safety and the prevention of entities over-profiting (Stark). Sometimes these regulations contradict each other and the outsider only understands some of them.


I believe any technology that puts information and decision-making into the hands of the patient has the potential to be disruptive. This will not be a get-rich-quick application, Most people requiring our services are older and even less receptive to change than outsiders would perceive us to be.


They are correct. We actually look to see if incentives are aligned, like everyone else. We rapidly adopted pagers, cell phones, MRIs, and stem cell treatment when we were paid for it or it makes our lives easier. We didn’t rapidly adopt EMRs or other IT solutions when they made our lives harder and cost us money. The issue is not doing something new, it’s doing something reasonable. Make sure incentives are aligned with realistic business models before introducing anything new. One of my favorite quotes: “Incentives matter, whether you think they do or not.”


I think we probably are resistant to AI, but not solely because of incentives. There’s too much vaporware out there and it takes a lot of time to weed through the good and bad, with the good often being no better than the best systems already provide at the added cost of an AI system and/or of nominal value. If they want to blame someone, blame IBM, who taught us that you need to spend a year training your commercial software only to have it continue to provide inaccurate info. To be fair, it is providers that control the data that makes AI training work and our reluctance to share is probably an issue. On the other hand, Google did manage to wrestle millions of records away from the NHS and they still have nothing to show for it.


It’s the pot calling the kettle black. Everyone wants into the healthcare cash cow, but no one wants skin in the game when it comes to actual outcomes, and that includes providers.


Take a look at the technology adoption lifecycle. We’re still in the innovator phase and they’re not yet screaming from the rooftops to get on board. Technology adoption takes 10-20 years, even for consumer products (many of which in recent years had the benefit of being “free”). Why should they be expecting instant results?


We’re dragging our feet on AI when it comes to digital imaging so we don’t tick off providers. We provide a lot of exceptions where it may not work, yet we don’t fire the entire medical community when we have a misdiagnosis rate of 10%.


What disruptors don’t understand is that their solutions are typically unaffordable in the long term for health systems that like to spend more money building buildings than they do to support their existing IT infrastructure. The new shiny object may get some attention and might even get an executive to bite, but at the end of the day, it falls on IT to implement, support, and maintain that disruptive solution over time, all while our budgets shrink due to “cost controls.” The disruptors must demonstrate real-world (not hypothetical) ROI and in reality be at minimum a budget-neutral solution in order for us to take them seriously.


Treating people, while doing no harm, is an art in addition to science. Humans are not machines made to exacting specs that benefit solely from repeatable process. The chance of patient harm or malpractice is real with bleeding edge technology.


Everyone I know on the health IT side is very aware of our limitations and looking for any way we can help out the providers. AI/ML, although promising, so far has limited proven use cases. That, coupled with a very high barrier to entry due to the skills required, means that AI/ML often gets lumped into the “maybe, if we have money left over” part of the budget. Not a lot of healthcare organizations ever get to make it to funding that portion of the budget. Trust me, if you proved your ML model could improve clinical care and/or save lots of money, organizations would adopt it in a heartbeat. If you haven’t proven its value, then why would you expect us to adopt it?

Honestly, it sounds like a comment from someone who runs an ML-centric company and can’t find a partner to provide the training for their model. That’s a risk and investment for the healthcare organization, and typically the vendor gets most of the benefit if it works even though they tapped the provider’s knowledge and training to make the product. If you really want us to do that, show up with a fully-funded project, including our expenses, and we’ll consider it if you give us partial ownership of the successful project. At this stage of the game, that’s the only deal that makes sense.


You can kill people with the wrong tech, bad tech, or badly-implemented tech. As a clinician who supported clinical decision support, it is easy to talk it, but harder to prevent the medical misadventures that may happen to said Heath IT Outsider’s child.


Speaking as a provider who works in the vendor space, we prefer to wait and see what works in other industries before taking a risk and sinking big development dollars into expensive new solutions. Exhibit A: cloud computing, which went mainstream with Amazon Web Services in 2006, but only in the last few years have we seen this model take off in our industry with web-hosted EHRs. That’s why we’re always 15 years behind. None of the established players wants to spend $500m to develop a buzzword concept (remember “big data”?) that will fold or go out of fashion next year.


Next time you are sick, open your AI program get a diagnosis, prescription, and any blood tests. There is a place in healthcare for AI, but it is not replacing trained medical professionals


I’m guessing that comment came from a former Elizabeth Holmes devotee. Health IT outsiders have a long history of declaring the US health system stupid, launching a startup, then quietly giving up a year later. If our outsider had any real ideas, they’d have products in the marketplace making money. Optum, Health Catalyst, Arcadia, and many more aren’t waiting around for provider permission. They are innovating, pushing the quality-cost envelope, and growing. I don’t know if AI will truly move the needle positively in healthcare any time soon, but I’d have to hear a great conspiracy theory to believe provider IT people are protecting their EHR vendor from AI, open APIs, or any other technologies that would make the customers happier and their jobs more fulfilling.


As a health system CIO, Individuals who are flabbergasted by the risk-averse nature of the healthcare industry as a whole do not fully understand nor appreciate the current healthcare system business model. It has a customer (patient) market that is shrinking. It is becoming more segmented, with alternative specialized scope limited services. The net revenue opportunity per patient is shrinking as operating costs (especially labor and regulatory related) continue to increase.

Entrepreneurs by their very nature take financial risks if they see an opportunity for a high financial return when no one else does. There is a ton of cash flow within the healthcare industry, but no new opportunities for significant cash infusion The customers (patients) do not have any opportunity to shift their spending from one source to another. The industry players are protecting their revenue stream as best they can. Most healthcare providers and hospitals do not have an entrepreneurial spirit, nor do they have the financial reserves to take on the financial risks.

It is also important to note that the financial industry and venture capitalists do not invest in healthcare providers nor hospitals. The risk is just too high for no foreseeable reward. Thus, it is not surprising at all to me that “health IT outsiders” looking to be disruptors are disappointed when they are not embraced with open arms. I predict that someday there will be disruptors who will change the business model itself with a better SYSTEM of mousetraps rather than just one highly effective mousetrap.


I don’t see provider IT people as being entrenched or particularly well rewarded. Rather, we insiders are pragmatic. Too often we’ve been sucked in by the breathless exuberance of the purveyor of the next big thing that will revolutionize healthcare, only to realize that it’s not nearly what it’s cracked up to be. Or worse, we take the blame for it not turning out to be what it was purported to be.

Technology is evolutionary, not revolutionary. Incremental advances by potentially disruptive technologies – once field tested – make their way into the mainstream. Let’s not forget that a mere 15 years ago, EHRs seemed revolutionary.

Look at FHIR. The bright shiny object du jour which will solve all problems in the delivery of healthcare. Will this technology magically address every issue? Absolutely not. Or will it even address any of the issues better than some long-existing technology? I’m on the fence. Is FHIR really even disruptive? Nope. Interfaces have been around since there was more than one computer. But by being a pragmatist and viewing FHIR as an incremental improvement, I get painted as a curmudgeon.


I think there is an extreme sense of being jaded from a long list of previous failures. People often don’t understand the complexities of healthcare, the countless variations, the messy data, the fickle users mixed with the extreme regulations of privacy and billing. Add all of that to hospital bureaucracy, understaffed IT departments, and low-salaried (and therefore often mediocre) IT staff and you have more sub-optimal systems than you can count.


Healthcare doesn’t operate financially as other industries. I’ve spent the majority of my career in community hospitals and it is difficult for them to sink money into disruptive technologies when you’re payer mix is 40-60% government. We would love to invest in disruptive technologies, but when replacing an EMR originally installed in the mid-90’s causes a financial burden, what’s a girl to do?


What’s the evidence of benefit to (a) patients and their caregivers first; (b) physicians, nurses, and other bedside technical caregivers second; and (c) then everyone else? As a 40+ year emergency physician and 20+ year medical informaticist, let’s see the evidence that AI and other disruptive technologies deal with the chaos of patient variability and sensitivity to initial conditions better than the competent, compassionate physician.


This is healthcare. Ultimately, people’s live are literally on the line. There is no room for alpha or even beta level products in a production environment. If AI can do my job and help save lives, so be it. But that is not now and it is not anytime soon.


The workplace dynamics of provider-based healthcare are different than any other industry. Who is the customer? Is it the patient, doctor, nurse, CFO, payer, government, or someone else? Or all of the above?  Outsiders have not not been able to solve that riddle yet, although things may be changing with consumerism on the rise.

Also, in my long experience as a CIO (25+ years), it is rarely the CIO who calls the shots. Hospital CEOs are notoriously risk averse with a huge herd mentality when it comes to IT. The history of the industry is littered with multiple failures of so-called IT solutions. In addition, CFOs control the purse strings, and if they do not control IT, are out to hamstring it.

I have seen several outside CIOs try to “fix healthcare” and they have all failed to recognize the unique cultural characteristics.


I’m not worried about protecting my paycheck. There are always positions available in my particular medical specialty and my current income isn’t that great anyway. What I am worried about are the costs and potential negative consequences of inadequately designed and tested “disruptive technology.”

Healthcare technology is not like trying a bunch of free or cheap apps on your personal IPhone to see if any generate major or disruptive improvements. Instead, with healthcare technology, there are significant upfront costs (often with no guarantees of benefit or acceptance), significant personnel costs for installation and training, significant changes to workflow, and potential for unintended consequences, including inefficiencies, lost revenue, and actual harm to patients if it doesn’t work correctly. Indeed, I’d be concerned that anyone who jumps on the bandwagon too quickly is impulsive and reckless.

Add to that all of the half-baked snow jobs that we’ve been sold over the years and it’s no wonder that HIT providers (and users) are cautious and skeptical.


I welcome the challenge, but I am more often than not faced with those who do not want to accept that they don’t know the extent of what they DO NOT KNOW about the unique specifications of the industry. If only the industry was established in the status quo. Most who make such proclamations dismiss the history to the why and how we are where we are. Case in point — the Jim Cramer declaration and folks like Chrissy Farr who just pass along without doing the basic journalistic research on Epic. If they came about it with some sort of due diligence, it might be a different story.


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News 4/17/19

April 16, 2019 News 6 Comments

Top News

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The New York Times reviews the use of an IPhone-powered whole-body ultrasound scanner in Uganda and other developing nations. The $2,000, US-made device addresses the issue that two-thirds of the world’s population gets no imaging at all due to cost, geography, and machine availability.

The sign that the device is real – it has earned FDA’s marketing clearance. The sign that it works disruptively for public health – one of the company’s backers is the Bill and Melinda Gates Foundation, which unerringly funds projects that deliver the biggest bang for the global buck.

It’s a beautifully written and photographed article.

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The tap-and-swipe Butterfly IQ device offers 18 presets for images such as cardiac and deep abdomen. It stores data in Butterfly Cloud to offer HIPAA-compliant image sharing with patients and peers.

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The inventor is DNA sequencing pioneer and Yale School of Medicine genetics professor Jonathan Rothberg, PhD, who I hereby elevate to the top of my “most interesting people in health IT” list (and that’s a short list).


Reader Comments

From OOB?: “Re: Epic and Cerner. This article says they’ll be out of business within 10 years because their EHR technology is outdated.” That’s just attention-seeking silliness since surely nobody who has any connection to health IT could be that uninformed. I’ll offer just three of the many dozens of counterpoints that come immediately to mind:

  • Seeing Epic and Cerner as offering just “EHRs” – which is an awful and misleading term in the first place – is marking yourself as a clueless technology fanboy who has never worked a day in hospital IT. Their systems run every hospital department and service, including non-clinical ones, and then roll the vast amount of information up into a single database for operational management, reporting, patient access, etc. With what, exactly, would they replace all those systems, which are integrated with every kind of clinical device made?
  • It would take even a tech giant probably five years and $1 billion to develop a competing system assuming they could recruit the right subject matter experts, and given the maze of governmental, regulatory, financial, and clinical minefields to be navigated, no publicly traded company would devote the resources to get Version 0.1 into testing, much less find buyers among conservative health systems who have little interest in bearing the beta testing pain. Even Microsoft and Google couldn’t give away their crappy consumer-targeted personal health records and ended up shutting them down, so don’t expect them run off and responsibly build a laboratory information system or IV barcode scanning.
  • No tech company is working on anything at this scale. They might try to cherry-pick a few seemingly easy targets, but they aren’t hiring armies of people who know how healthcare works to help them design a system that would actually function beyond offering sexy screens. You cannot build healthcare software with 23-year-olds sitting in a Silicon Valley and slinging rad code in between company-provided foosball and beer pong.

From Dignity Defined: “Re: Cerner. Do you you see them cutting back?” All vendors whose sales were goosed by Meaningful Use (note to self – that would be a fun song title) are already cutting back in various ways and will continue to do so. I asked the question publicly when Meaningful Use first came into play of how vendors who geared up for a competitive battle of a fixed duration would gracefully downsize once the feed trough had been licked dry. Nobody could look past the boom years. Hospitals and practices will continue to buy products that provide ROI (why wouldn’t they?) but now that government’s contribution to the equation has been eliminated, software and services will have to pay their own way, which will likely involve lower prices, more tangible short-term benefits, and recurring costs that align with the benefits delivered. Cerner, Epic, and Meditech have won the hospital core IT system wars and the independent ambulatory market seems to be consolidating pretty quickly, so the ripple effects will be seen every aspect of health IT, especially consulting. Cerner is particularly vulnerable because it is publicly traded and has underperformed despite winning billions in federal government business, so in the absence of a fiery, singularly-focused co-founder at the helm, it must now redirect its attention to Wall Street type (although it’s been doing that for years, just to a lesser degree). Note that Cerner Millennium and maybe Cerner itself would not exist today if Neal Patterson hadn’t told 1990s investors that it would take a lot of years and money to create a new hospital IT architecture and they would just have to suck it up until it was done.

From Pistolero: Re: clinical decision support to detect questionably beneficial orders. Why isn’t it more widely used?” I would say:

  • Some and maybe most doctors don’t necessarily think minimum-necessary when ordering – they think more along the lines of, it can’t hurt to get more information while we’re drawing blood anyway
  • But it can hurt – the descent into the medical misadventure maelstrom often starts with a pointless test whose value must be conformed to normal range by aggressive therapy that is unlikely to improve and may in fact worsen a patient’s outcomes as armies of uncoordinated niche experts ply their trade aggressively
  • Doctors are trained around the paradigm of every patient being unique, and given that they see only their own small number of patients, they don’t always see the big health picture in which their patient is one data point in a see of historical information that, along with the N-of-one experience, will determine likely outcomes
  • Even questionably beneficial orders are profitable as long as insurers continue paying for them

HIStalk Announcements and Requests

I use AP Stylebook standards about 99% of the time when writing HIStalk (big exceptions – I always use an Oxford comma and I use post office state abbreviations, in both cases feeling as though AP is way off base in mandating a less-readable form). You probably didn’t notice that I started writing “99%” this week instead of “99 percent” because they just changed their standard. Today I learned from them that “farther” refers to physical distance, while “further” is an extension of time, so now I can obsess about that. Thank goodness they don’t use “everyday” incorrectly (as “I brush my teeth everyday,” which drives me crazy) or incorrectly capitalize a noun that isn’t used as a title (“I sent my Mom a present,” which is wrong). I admit that I’m sadly out of touch in believing that you show respect to those who listen or read what you have to say by following the grammatical rules of the road as best you can, although I’m offended only by obvious indifference usually encouraged by text messaging and posting Facebook nonsense.


Webinars

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


Acquisitions, Funding, Business, and Stock

Interoperability platform vendor Bridge Connector raises $10 million, increasing its total to $20 million.

HM Health Solutions, a 3,200-employee insurance-focused IT vendor owned by Pennsylvania-based insurer Highmark, lays off 239 employees. 

London-based Medbelle raises $7 million to create what it calls a “digital hospital” that sounds more like an online marketplace for cosmetic and weight loss surgery practices that also includes a care coordination platform.


Sales

  • Jefferson Health chooses Prepared Health as its digital technology partner for connecting its 14 hospitals to post-acute, home care, and social determinants of health providers for coordination of hospital-to-home care transitions.
  • Fullerton Health, which owns 500 medical facilities in the Asia Pacific region, hires Health Catalyst to assess its data analytics potential. 

People

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Denis Zerr (Catholic Health Initiatives) joins Radiology Partners as CIO.

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Change Healthcare promotes Dan Mowery to VP of channel partner and customer marketing.


Announcements and Implementations

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PMD adds video chat capability to PMD Secure Messaging application, extending support for telehealth charge codes for interprofessional teleconsults and virtual check-ins.

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InterSystems adds HealthShare Provider Directory to the 2019.1 release of HealthShare, providing a single source of truth for provider demographics and relationships. The release also includes a renaming of HealthShare Information Exchange to HealthShare Unified Care Record.

NPR observes that rural areas whose local hospital closes take an economic hit — retirees move out or look elsewhere, heavy industry bails because there’s no ED, and medical practices close because doctors don’t want to drive 30 minutes to see their hospitalized patients.

Meditech announces Expanse Labor and Delivery, which includes status boards, mother-baby recall, flowsheets, and fetal monitoring integration.

A Solutionreach survey of healthcare providers finds that patient relationship software that includes text messaging improves outcomes through reminders, reduces no-shows, and decreases phone time while increasing revenue.


Government and Politics

Vermont politicians struggle with the privacy and legal issues over changing patient participation in the HIE operated by Vermont Information Technology Leaders from opt-in to opt-out, which VITL says is needed because low participation has caused low HIE usage. Only in maple syrup-producing areas (Vermont contributes half the US total) would a politician describe the maturation of a policy “as it sugars off.”

The VA issues a $1.5 million, no-bid contract to Minburn Technology Group for HPE Synergy server modules and frames that will be used to convert 131 instances of VistA data to Cerner.


Privacy and Security

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India-based IT outsourcing giant Wipro admits that its systems have been breached in a phishing campaign, with hackers using the company’s own systems to attack its customers. Wipro, which sells cybersecurity services, has hired another firm to investigate. Wipro has 170,000 employees and annual revenue of $8 billion.

Facebook actively planned to provide user data to companies willing to buy it or to advertise with Facebook while denying the data to companies that it saw as competitive, all while putting on a public face of protecting user data, an NBC News investigative report finds. Reporters found few examples where Facebook executives expressed any interest in user privacy except as a PR strategy or in profitably selling data access to app vendors.


Other

The DC business paper confirms Dudevorce’s reader rumor that I ran Monday – Inova Health System will stop offering its MediMap genetic testing for medication response after FDA warns it that the test is being marketing illegally. Inova says it was told it by someone unstated that didn’t need FDA’s approval, but FDA made it clear that patients were potentially being put at risk because the unproven tests could lead to bad medical decisions. 

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Clinicians at Bagram Airfield, Afghanistan are trialing a trauma digital documentation system from T6 Health Systems, which the company says can integrate with Epic, Cerner, Meditech, and Allscripts. USAF trauma surgeon Lt. Col.Valerie Sams, MD  of the 455th Expeditionary Medical Group (on the right above) is leading the trial.

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Zuckerberg San Francisco General Hospital changes its billing policy to eliminate balance billing and to set an income-adjusted maximum on patient payments, courtesy of some fine investigative reporting by Sarah Kliff at Vox. Let’s give her the credit instead of the hospital – until the expose ran, they were perfectly happy picking the pockets of patients by intentionally remaining out of network with EVERY private insurer so they could tap ED patients – many of whom didn’t have a choice because it’s San Francisco’s only a trauma center – with high bills that were quickly sent to collectors. One might reasonably expect that hospital heads should roll for creating and enforcing this policy in the first place, but that won’t happen. The hospital recently toyed with the idea of ditching the Zuckerberg part of its name (bought with a $75 million donation) over Facebook privacy shame, but at this point they’ve soiled their own name worse than Facebook.

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Internist and health polity researcher Dhruv Khullar, MD, MPP writes a brilliant Stat editorial titled “Healthcare needs less #innovation,” making these points:

  • The US healthcare system can’t even provide basic care safely and consistently, performing worse than almost all peer nations.
  • As others have suggested, we need more “chief imitation officers” who bring home best practices from elsewhere rather than chief innovation officers.
  • We have “a dissemination and implementation problem” in failing to consistently use medical developments for an average of 17 years after they have been proven.
  • It’s nice to be in a swanky single hospital room hooked up to monitoring and Alexa-powered nurse call systems, but even nicer to know you won’t die of a catheter infection because someone failed to follow a checklist or use antiseptics improperly.
  • Today’s culture favors using the latest shiny technical object as a solution instead of addressing problems the best way.
  • Today’s tech startups follow the Theranos model of making grand claims while studiously avoiding publishing peer-reviewed studies.

A randomized clinical trial finds no evidence that workplace wellness programs work, as a large US company’s employees who participated said they they exercised more and watched their weight, but data analysis found no measurable improvement in their health, their healthcare expenditures, or their employment outcomes in the following 18 months.

In England, NHS Director of Digital Development Sam Shah says that hot technologies from other industries such as AI, virtual reality, and quantum computing should be placed on healthcare’s back burner in favor of building the less-exciting but vital underpinnings that can give consumers easier access, incorporate technology into care delivery, and to integrate data across IT systems and hospitals.

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An India-based paper says that the number of India-based doctors serving as scribes for US hospitals is growing quickly, noting that US-based, $6 billion IKS Health employs 450 doctors in Mumbai and Hyderabad to support customers such as Massachusetts General Hospital and plans to increase doctor headcount to more than 1,000 this year. One doctor says it’s a good deal for young doctors who not only earn money, but prepare to advance their careers by learning medical best practices and documenting care in sophisticated EHRs.

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InstaMed publishes its ninth annual report on healthcare payment trends, noting:

  • 90% of providers still bill and collect using manual, paper-based processes
  • 77% of providers say they rarely get payments within the first month of billing
  • 91% of providers get paid by paper check by at least one payer even though almost all of them would rather have money sent by EFT

Sponsor Updates

  • Mumms Software adds DrFirst’s e-prescribing and medication management capabilities to its hospice EHR.
  • CarePort will exhibit at the NAACOS Spring Conference April 24-26 in Baltimore.
  • The Texas Hospital Association features Collective Medical in its latest podcast.
  • CoverMyMeds will host a block party instead of a groundbreaking as construction starts on its $240 million headquarters.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Monday Morning Update 4/15/19

April 14, 2019 News 2 Comments

Top News

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A private company in China is deploying medical vans to rural areas to perform exams and to test urine and blood, but it’s not a benevolent government project. Private healthcare company WeDoctor (part of technology giant Tencent) offers the service so it can collect enormous amounts of patient data that it uses to train its AI-powered diagnostic engine.

Participation isn’t optional since the government requires villagers to submit to examination. They don’t necessarily know that a private company is involved.

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WeDoctor, whose valuation is several billion dollars, operates online hospitals, sells data to drug companies, and offers appointment scheduling and video visits. It is connected to 2,700 hospitals, 220,000 doctors, 15,000 pharmacies, and 27 million active users. The founder saw an opportunity to disrupt a clogged medical system in which patients wait in line for hours just to schedule an appointment or resort to buying timeslots from scalpers.

WeDoctor says it has the healthcare information of 180 million people, and while China has no laws that protect personal information, the company says it uses only de-identified patient data for its AI work.

China is gaining an edge in healthcare AI because government control allows collecting and using patient data in ways that would not be legal in most countries.


Reader Comments

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From Unilateral Disarmament: “Re: Cerner. The financial community is expressing amazement that Cerner paid so much attention to Starboard Value given the hedge fund’s low percentage ownership.” Quite a few experts are shocked that Cerner gave the Starboard Value hedge fund two seats on its board when it holds barely more than 1% of CERN shares. As one analyst said, 1% doesn’t give you much power to force change – just sell your shares if you don’t like the company’s operation, adding that two board seats usually comes only with a 5-10% position. Cerner rationalizes by saying it approved the new board members and they are well qualified (which they are), but the company did indeed capitulate quickly. They may regret that later now that they’ve invited a hedge fund into their house. Cerner also made it clear that they intentionally replaced visionary co-founder Neal Patterson (who, when healthy, would have told Starboard where to stick their ideas) with an “operator” in Brent Shafer, which sounds like a message that resonates better with a hedge fund than customers. He is an untested CEO and the whole “operational model” thing he keeps talking about sounds like something dreamed up by accountants rather than leaders, which if you are pandering to Wall Street, is probably the right thing to do. Maybe I’m just bitter in missing the competitive healthcare passion among pre-operator founders Neal, Judy, and Jonathan Bush.

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From Dudevorce: “Re: Inova Genomics. FDA warned them about illegally marketing their tests and predicting response to medications. Their MediMap web pages went down shortly afterward. Oncologist Donald “Skip” Trump, MD was hired by Inova to develop a cancer genomics program as the Inova Schar Cancer Institute. He recently disappeared from the Inova websites.” FDA issued a warning letter to Inova Genomics Laboratory on April 4, saying that its MediMap genetic tests for predicting medication response has not earned FDA’s marketing approval, also noting that the tests were being ordered by lab doctors with the results sent directly to patients without involving their own doctor. Links to the MediMap web pages now forward to Inova’s main site (I took the screen grab above from a cached copy). That other Donald Trump no longer appears under Inova’s “find a doctor” page.


HIStalk Announcements and Requests

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Most vendor poll respondents have seen business conditions slip in the past couple of years, whether than means reduced sales activity, provider consolidation that leads to bigger but rarer deals, or longer sales cycles.

New poll to your right or here: How much time do you spend each week reading healthcare and health IT news, online or in print, excluding social media but including peer-reviewed journals?

Listening: new from Darlingside, extremely likeable, Boston-based indie folkies who huddle around a single microphone and create amazing harmonies around thoughtful lyrics that sometimes involve a dystopian future of uncertain outcome. Perhaps I was just in the mood for it after spending extra time in bed Sunday morning reading old Rolling Stone interviews with John Lennon. You might picture him as having been bitter, cynical, and slightly wacky with regard to Yoko Ono, but only the last one is true – he was a troubled troubador who lacked confidence about his musicianship and just wanted to play 1950s American rock and roll as a guitarist who was “not technically good;” saw the Beatles through the lens of always being pressured to write songs even as he and Paul McCartney fought for album space and collaborated less and less over time; and worried about where the world was heading. It’s hard to believe how thoughtful, worldly, and searingly honest he came across even in early interviews in his 20s. You can feel his pain in this 1970 interview when he declared that the Beatles were the best rockers in Britain until Brian Epstein put them into matching suits and booked them for 20-minute shows instead of their usual 6-7 hours: “The Beatles music died then, as musicians. That’s why we never improved as musicians. We killed ourselves then to make it and that was the end of it. George and I are more inclined to say that. We always missed the club dates because that’s when we were playing music, and then later on, we became technically efficient recording artists – which was another thing – because we were competent people, and whatever media you put us in, we can produce something worthwhile.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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The Detroit business paper profiles Detroit Medical Informatics, an EHR consulting firm started in 2015 by Hass Saad, MD. He says the company is generating $4-6 million in annual revenue, has four full-time employees, and works with 300 physician consultants in serving 20 clients.

A Stat editorial compares the proposed information-sharing rules of ONC/HHS to the Protestant Reformation, where information previously accessible only to priests was made available to everyone via the newly invented printing press, but notes that the final rule could be diluted through the influence of the AHA and lobbyists who are not fans of losing Medicare money when caught hoarding patient information out of competitive spite.

It’s interesting when member organizations change their names or membership criteria to spur growth outside their original mission, such as CHIME when it weakened its membership criteria to include non-CIOs. The latest is AONE (American Organization of Nursing Executives), which in realizing that the “executives” part of its name limits its membership count, has thus decided to rename itself American Organization for Nursing Leadership. The doors have been flung open to dues-payers who are “not just defined by your title, but above all by your actions.” Someone should do a study on how much hospitals spend on dues and conference attendance whose value is primarily driven by vanity.


Decisions

  • Humboldt General Hospital (NV) will replace Medhost with Cerner in November 2019.
  • Kingman Regional Medical Center (AZ) will implement Meditech this spring, replacing Cerner.
  • Van Wert Health (OH) switched from Cerner to Epic in June 2018.

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


Other

Imprivata explains further the Windows API flaw it commendably discovered in testing its product against new Windows updates (and which Microsoft not-so-commendably broke with a failing API with no acknowledgment to developers who rely on it). I agree that the QE team deserves acknowledgement – I’ve been loaned out to testing teams over the years and it is thankless, unbelievably complex work where 99% of the tests turn up no problems, but some weird example fails only in a particular series of steps that must be replicated and documented for fixing. Those testing teams I worked on also got no love from developers, who were more exasperated than appreciative that their bugs were caught before code was shipped, so it’s nice that Imprivata gives those folks a shout-out:

Imprivata’s core Epic user switch functionality continues to work as intended with or without the Windows API. Instead, the feature that was affected by the API deprecation was a failsafe mechanism and not core functionality. For this to be seen at a customer site, a series of unfortunate events would need to occur, and we would define it as more of an edge case. However, due to the potential it has on our customer’s clinical workflows, we felt it important enough to notify our base as soon as we discovered it. Kudos to our QE team for finding this during our qualifications!

Researchers find that cancer surgery outcomes are poorer in affiliates of top-ranked cancer hospitals that share their name. The authors conclude that hanging the big-brand cancer center’s name on the affiliate makes patients think they will receive care as good as that delivered by the mother ship, but that doesn’t actually happen. To me, the fact that a cancer hospital is a desirable brand is a troubling in itself – having worked for a hospital that affiliated with one of the big names, we talked a lot about sharing protocols and tapping the Big Cancer Center’s expertise, but I’m not sure it really made a positive difference. The health system eventually dumped the affiliation for that of another Big Cancer Hospital, which should have raised all kinds of questions about the before-and-after advantages, the cost to rent the big name, and whether patient outcomes changed as a result.


Sponsor Updates

  • Netsmart will exhibit at the NHPCO Leadership and Advocacy Conference April 15-17 in Washington, DC.
  • Sansoro Health releases a new podcast, “Tacking Information Blocking with an ONC Expert.”
  • Surescripts will exhibit at the 2019 OCHIN Learning Forum April 16-18 in Portland.
  • Vocera will exhibit at the 2019 Argentum Senior Living Executive Conference & Expo April 15 in San Antonio.
  • Wolters Kluwer Health CEO Diana Nole discusses areas where AI will impact future patient care.

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 4/12/19

April 11, 2019 News 3 Comments

Top News

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Cityblock Health raises $65 million just three months after announcing a Series A round of $21 million.

The New York City-based company was spun out of Alphabet’s Sidewalk Labs in 2017.

The company offers care coordination services and technology that cater to Medicaid patients in underserved areas.


Reader Comments

From Ralestorm: “Re: Windows APIs. Check out this problem, in which a sign-off Epic user’s session is restored when a different user logs in afterward. I’ve seen this with other systems and vendors as a CMIO over the years.” This is a timely reminder that APIs create dependencies that can screw things up. Imprivata found out from internal testing that a Microsoft Windows 10 API is no longer working, so that when users switch within a XenApp session, the new user will be dropped back into the previous user’s session. The interesting aspects are these:

  • Microsoft has never told software developers who use the API that it is no longer working or why it’s broken. It has not been officially deprecated, but reports are widespread that it fails.
  • Imprivata caught the problem in its Windows 10 testing, which a lot of vendors might not have done.
  • The problem is technical, but the result could be clinical – users could sign on and inadvertently start entering orders on the wrong patient.
  • Imprivata has modified its OneSign agent to use a new Windows API and will post a hotfix before qualifying Windows 10 1809, a nifty bit of release coordination.
  • Microsoft is touting its new commitment to healthcare, and while this is not a healthcare-specific issue, it might make you wonder whether it really understands the critical nature of its internal APIs and has the communications channel in place to work with vendors who rely on them.
  • As quaint as it seems today as everybody pins interoperability hopes on APIs, this is the problem that healthcare software vendors avoided years ago by refusing to use third-party software components published by companies whose conduct and business outcomes were outside of their control. 

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From Jiggy Jardust: “Re: Cerner. Will it follow the path of Athenahealth now that an activist investor is embedded?” Maybe. My thoughts:

  • Cerner’s share price has been going in the wrong direction for quite some time, even now down considerably since before it signed huge contracts with the DoD and VA. Clearly the company wasn’t impressing investors.
  • The hedge fund activist investor Starboard Value wasn’t as venomous as the one involved with Athenahealth’s – which used some truly deplorable smear tactics to get Jonathan Bush fired so that the reputation-faded Jeff Immelt could broker a questionable deal to sell out – and Cerner was unusually pliable about agreeing to making changes even before the hedge fund had a chance to go low. Starboard wasn’t even a significant holder of CERN shares.
  • Brent Shafer had already laid out Cerner changes, but whether he will survive in his first CEO job reporting to an activist-heavy company board of nearly all new members is anyone’s guess.
  • Whether you like Cerner’s changes may well depend on whether you are an investor or a customer. The recent announcements seem to shift focus to the former, who like the idea of the latter covering the cost of higher company revenue and profit, and Starboard’s track record of making money from activist investing is outstanding. Customers, however, aren’t necessarily going to be big fans of plans to boost profits by cutting costs and increasing revenue.
  • Today’s Cerner is vastly different from the one that Neal Patterson was running until he died in mid-2017. The contrast between the publicly traded Cerner and its chief rival in privately held Epic was already sharp, but even more so now that Cerner is seeking fresh horizons and has involved hardcore Wall Street types for whom it’s just another investment to milk hard.

From Clinical Trials Curious: “Re: software to manage clinical trials. A researcher from a large academic medical center is surprised that we don’t have a platform for managing our clinical trials. We’re a medium-sized health system using an EHR, but manage trials outside it. Are people using specific software?” I’ll invite readers from similar organizations to respond. If you work for a clinical trials management software vendor that has community health system customers, I’ll waive my rule and allow you to give your company‘s information in your comment.

From CIO a NO GO: “Re: MD Anderson. Reportedly offered a candidate the CIO role after a long search with many fits and starts. The ‘recruit’ insisted on tenure status and that stopped the process. They are in desperate need of direction after the Epic Rollout Blowup but it doesn’t appear that they will budge or that anyone will jump into the deep end without a life jacket.” Unverified. I haven’t followed that position since Chris Belmont left in August 2017. The organization struggled with post-Epic financial problems (since resolved, apparently), a high-profile failure to make IBM Watson Health do anything useful, and the resignation of its president following investigation of institutional upheaval and a heavy-handed management style. The new president comes from Canada, so I don’t know how much relevant IT background he brings, especially regarding Epic.


HIStalk Announcements and Requests

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Provider IT people — here’s a final chance to explain to outsiders who think we drag our feet on implementing disruptive technologies. I’ll recap soon.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Multi-vertical records retrieval company Ontellus acquires medical records request vendor ChartSwap. Healthcare Growth Partners advised ChartSwap on the transaction. Ontellus President Newton Ross will lead the new ChartSwap division, while Dawn Toups (Verisma Systems) will join the company as VP of provider sales.

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Glytec receives another patent allowance for systems and methods related to its Therapy Advisor. When released, the new product will broaden the company’s capabilities beyond insulin optimization to include inhaled, oral, and non-insulin injectable diabetes medications.


People

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Patient transfer software company Central Logic names Matt Dinger (Epic) VP of professional services.

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Government health IT vendor Ventech Solutions promotes Tonia Bleecher to chief growth officer and hires Timothy Moore (Auburn University) as SVP of commercial health IT and Nathan Anthony (IBM Watson Health) as VP of healthcare enterprise solutions.


Sales

  • In Canada, Mackenzie Health will deploy patient engagement software and services co-developed by GetWellNetwork and FlexITy at a new hospital set to open late next year.
  • Summit Health Management will deploy population health management technology from Arcadia across its physician practices and New Jersey-based Summit Medical Group.

Announcements and Implementations

Partners HealthCare (MA) will equip its clinicians and researchers with the tools necessary to develop their own AI algorithms through its MGH & BWH Center for Clinical Data Science. The center collaborated with the American College of Radiology and computing company Nvidia to develop a similar set of software and services that will be offered for free to radiologists around the country.

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Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse with consulting help from Engage.

Teladoc Health will work with Cincinnati Children’s Hospital Medical Center to develop telemedicine software for pediatric hospitals. The hospital opened a telehealth command center several years ago.


Government and Politics

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AHRQ awards Northwell Health (NY) SVP Thomas G. McGinn, MD a $1 million grant to further his work on developing a clinical decision support system that integrates seamlessly with EHRs and presents minimal disruption to provider workflows.


Sponsor Updates

  • EClinicalWorks will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Ensocare will exhibit at the ACMA 2019 National Conference April 14-17 in Seattle.
  • EPSI extends early-bird pricing for its 2019 summit through April 30.
  • Modern Healthcare ranks Optimum Healthcare IT as #2 among the largest healthcare IT consulting firms.
  • Healthwise will exhibit at ANIA April 11-13 in Las Vegas.
  • Mobile Heartbeat releases a new video featuring its clinical communication and collaboration work with Freeman Health System.
  • PatientPing transforms care for high-risk, high-utilizing patients across North Carolina through its care coordination platform.
  • Vocera will add Julie Iskow (Medidata Solutions) and Bharat Sundaram (Vizient) to its board.
  • SyTrue names former HMS Holdings EVP/Chief Strategy Officer Cynthia Nustad to its advisory board.

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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Vendor Alternatives to Exhibiting at the HIMSS Conference

April 10, 2019 News 1 Comment

The HIMSS conference exhibitor roster turns over every year as a significant portion of companies either sign up for the first time or previous exhibitors decide not to return. I’ve heard from more of that latter group after HIMSS19 who are questioning the return on investment, which for most of them means generating sales leads.

Most vendors have no plans to stop exhibiting. Some are happy with the value they receive in having a lot of people they need to see who are in a single place at a single time. Others worry that their absence will be exploited by competitors as a sign of weakness or that customers will question their commitment. The exhibit hall is likely safe from mass defection, especially for long-established and large vendor players.

However, small and medium-sized vendors who rack up significant booth, travel, and staffing costs for just three frantic days may wonder if they should be spending the money elsewhere. That’s especially true as the industry has settled down into less of a land-grab mentality now that Meaningful Use money has been spent, major software decisions have been locked in at health system corporate levels, and health systems worry about margins as their core business faces unknown changes.

I asked vendor readers for ideas of how they might reallocate some or all of their HIMSS exhibition costs into efforts that would yield more tangible business results. Thanks to those who took the time to share their thoughts.


We don’t exhibit, but we send more than 10 people to HIMSS and get a meeting room instead. We set up meeting room appointments prior to the conference so we can use our time efficiently. We’ve gotten a lot out of this and plan to keep it up.


We use our budget to attend the shows where we already have a big client presence. We go as attendees, offering a dinner with our strategic client advisory board. We don’t get leads, but the partnerships lend to better product strategies and focus areas for the business. HIMSS isn’t a big lead generator for us, so the rest of the budget I would diversify into PR activities and a solid PR agency. We also do sponsored blog content and attend smaller conferences.


We go every year because we want our name on there and it’s an opportunity to meet with customers and partners. But we absolutely do not recover the cost of attendance in ROI. HIMSS is where vendors show off to each other, not where customers come away having made purchasing decisions.


We exhibited at one HIMSS conference 15 years ago as a startup selling a small departmental system and decided never again. Every year a few of us attend the show (we can always rustle up some guests-of-vendors badges), and we set ~20 meetings with current and potential partners. Every year we’re grateful we don’t exhibit. We’re still spending money attending the shows, so we’re not saving as much as we could be, but our expenses are less and we get good value out of the face-to-face meetings. We’ve never specifically allocated the funds we would have spent at HIMSS to other efforts, but the remainder has gone toward our general marketing budget.


We stopped exhibiting at HIMSS following the 2018 show. Even though we booked a booth for 2019 during the 2018 show, we forfeited our deposit because it was cheaper than following through and burning the hundreds of thousands we’d have to shell out to be present as we originally planned. Instead, we found smaller, more regional shows that offered more engagement with our specific target audience. We carried out some branding campaigns, spent more on content development and distribution, and sponsored some webinars that again allowed us to better target our outreach and drive the right people to our event.

We also invested in some technologies to help us connect with our target audience, including ZoomInfo and Definitive Healthcare. That way we could identify the accounts (health systems and hospitals) we wanted to contact and find out exactly who the people were who should be our target buyers. A quarter of a million to half a million dollars can go a long way when you spread it out to different activities and you identify those that will support your marketing and sales efforts. And we’re just a former 20×20 vendor. Think about the major players and all the floor space and investment they burn.


We will continue to exhibit, but an alternative would be to do a roadshow. We would evaluate which cities would be the best locations for existing and targeted prospects. Select an event marketing team to pick venues. Then use the money for team, rent venues, catering, AV, travel, swag, etc. A key component would be to pay to have featured customers and internal team members travel to and speak at event.


An alternative to paying for a large booth is to simply downsize and pay for a 10×20 or even a 10×10 booth. Your company will save a ton on expenses and will benefit from reduced staffing and reduced equipment, etc. But you still maintain a listing in the HIMSS guide so that customers and partners can find you. This will also force you to choose the most impactful people that need to attend and forces a decision on what products you really need to showcase. Sort of like downsizing when you move — it forces some tough decisions.


We stopped three years ago. We spent about $300,000 on a booth, had 90 leads (most were students) and only 12 actual decision makers. Twelve leads for $300,000 is a bad investment. Now we hold an industry breakfast and it has been a great event – CIOs, CTOs, and CMIOs only. We had 30-40 people for about $20,000, a much better investment. The attendees are the ones driving this and frankly we’ll spend our dollars elsewhere. This convention has become nothing but a money grab for HIMSS and the value is long gone.


I would invest those resources in organic PR, meaning I would take the time and effort to document client success stories, translate them to meaningful, educational information to prospects, and pitch that content to trade press, national media, etc. (not sponsored content). I would also consider investing in good, well-produced, reusable video content.


As a small company, we stopped having a physical booth at HIMSS a few years ago for many of the reasons you described — cost, being lost in caverns and hinterlands of the exhibit hall, very few real leads, etc. We still have what we believe is a strong presence for our size by doing other things — working with partner companies in their booths, leveraging healthcare ecosystem areas like the Intelligent Health Pavilion, and partnering with our customers to have educational sessions on the agenda. We also promote our attendance at HIMSS before the conference with customers and on our website / social media so we can make sure to connect with those who we need to see during the show. A few weeks prior, we do a press release about the various ways we will be participating at HIMSS, and during the show we are posting / tweeting “Live from HIMSS”. I guess you could say we have virtualized our booth for HIMSS!


Register as a participant, attend be at all the social events and relevant educational sessions, keep the elevator speech short (2-3 sentences), arrange for a Wednesday or Thursday evening offsite event that can be promoted over the week. Don’t try to cram so much in up front. Create some mystery and intrigue. Useful or unique bling (or chocolate) may help.


This actually occurred at my last company. We opted to host an event at HIMSS, a one-night, blowout event that was half the cost of the booth for the week. We spent months prospecting and getting folks to the event, while setting up meetings outside of the exhibit area (restaurants, hospitality suite, etc.) for 1:1 meetings. This works much better in Las Vegas than it does Orlando.


Is HIMSS a huge financial commitment? It sure is. And if all you’re going to measure is lead generation, then it won’t be worth it. The cost per qualified lead at HIMSS in my experience is north of $10K or even $15K. And clearly there are cheaper ways to get to leads if that is your only measure of success.

But HIMSS is also a place to get stuff done. Strategic partnerships, briefings with current and potential partners, window shopping for possible M&A, early look at emerging trends and competitor positioning, and … gasp … customer engagement (which shouldn’t be confused with lead generation.) A well-planned and executed HIMSS with proper organizational support yields far more benefits than simple leads.

Having said all that, if HIMSS were to disappear as an expo, I would not be all that disappointed. It’s become more of a place to be seen. The nuclear arms race of HIT marketing, if you will. Unfortunately denuclearization only works if everyone disarms. And we know that won’t happen. So we make the most of it with planning and outreach months in advance.

Finally let’s not forget the HIMSS points system. If you have years spent supporting HIMSS, pulling out for even one year knocks you back to zero. And suddenly you’re at the back of the bus in terms of booth selection, making it an even harder ROI to justify.


Have a party right across the street with free alcohol and food. Has that been done before?


Invest in breakfast briefings and lunch and learns as a way to drive targeted executives interested in your solutions and offerings.


As a provider, I don’t care if vendors exhibit, especially if I’m told in advance the reason for not having an actual booth. Having some company representation at the conference to meet with, even if not at a booth, is generally sufficient for my needs.


Exhibit at AHIMA and select state HIMA conferences.


No customers come to HIMSS,  just other vendors. I would rather invite customers and prospects to a smaller, more intimate event and invest in interesting thought leadership or education for that base. For example, physician roundtables with an industry thought leader.


Work with Becker’s and CHIME more closely.


Drive a subject matter interest thought leadership 1.5 day summit for 50 persons


News 4/10/19

April 9, 2019 News 5 Comments

Top News

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Cerner bows to pressure applied by an activist investor — and perhaps as a result of its own self-examination led by Chairman and CEO Brent Shafer, who was hired in January 2018 — by appointing four new board members. Hedge fund operator Starboard Value owns 1.2% of outstanding CERN shares.

Starboard was less adversarial in this case than with previous targets, steering clear of public criticism of the company and not delving into operating minutiae with a public call for changes.

In a previous example, Starboard took control of Darden Restaurants despite owning just 10% of the company by observing that its Olive Garden restaurants are too generous with breadsticks, use non-standard sized drink straws, and over-salt the pasta. Starboard managed to get every member of Darden’s well-qualified board replaced in October 2014, since which DRI shares have since risen 169% vs. the Dow’s 60%.

The new, well-credentialed Cerner directors — former top executives of Hill-Rom Holdings, MedAssets, Jawbone, and Cloudmark, two of them nominated by Cerner and two by Starboard – now represent 40 percent of the board. Another board member will be retiring.

Chairman and CEO Brent Shafer stated previously and reiterated today that the company has identified opportunities to “unlock the company’s significant potential” in creating a new operating model and will focus on improving profits and efficiency along with ramping up innovation. He says Cerner has:

  • Replaced the president position with chief client officer
  • Eliminated the strategic business unit structure
  • Reviewed its product portfolio to maximize development resources
  • Centralized operational functions that were previously spread across multiple executives who reported to the COO
  • Announced plans to pay share dividends, repurchase more shares, and add free cash flow generation as an executive bonus metric
  • Expanded margins

Starboard Value was a significant shareholder and an activist investor in MedAssets a few years back. It also triggered the sale of physician services vendor Envision Healthcare to a private equity firm last year.

CERN shares were up 10% at Tuesday’s market close. They’re up 17% over the past five years vs. the Nasdaq’s 93% rise.

Perhaps I missed it, but I wasn’t aware that Cerner was being pressured by Starboard, although in this case the relationship seems more collaborative than Starboard’s history would suggest and Shafer had already implemented changes to reposition the company in ways that Starboard would likely have found aligned with its own areas of focus.


Reader Comments

From Mark: “Re: HealthVault. Why can’t a company that’s worth $700 billion leave something running for probably $10,000 per year? They probably spend that on fancy coffee for management alone.” This is probably good news for Apple and other Microsoft technical competitors since MSFT tends to turn tail and run at spectacularly mistimed points after burning through a ton of cash and partner / customer goodwill with little to show for it as competitors find a way to sell their own versions of the same technology. This is the company that couldn’t figure out how to find success in offering a smartphone (Lumia and Windows Phone), a music player (Zune), a streaming service (Groove), a fitness tracker (Band), a browser (IE/Edge), a search engine (Bing), a smart speaker (Cortana), a tablet (Surface RT), a sophisticated movement tracker (Kinect), and now a personal health record even as Apple gets accolades for its own product and the government begins a hard push on giving patients their data. I’m being nice in not mentioning Microsoft’s healthcare-specific fumbling with Sentilion single sign-on and Azyxxi / Amalga / Caradigm. Keep that history in mind as the company starts playing the soothe-the-cobra music in trying to convince healthcare that this time, in the face of entrenched cloud competition from Google and Amazon, it’s serious about healthcare interoperability and AI.

From Spinal Screw: “Re: HIStalk. I find it hard to believe that anyone has time to read it all.” Not everyone does, but somehow quite a few folks – many of them running big provider and vendor organizations and some of them likely outcompeting you – invest the time in their success. I’m editorially selective and good at summarizing, but even I can’t tell you everything you need to know in a 30-second phone read in the coffee line or on the toilet and you may or may not be good at skipping stuff that you don’t think applies to you. I have no incentive to pad it out with fluff or verbosity. You might be in the wrong business or need a productivity makeover if you don’t have 5-10 minutes per day to follow your field.


HIStalk Announcements and Requests

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A reader commented that opinions expressed on HIStalk – both mine and those of readers – “reek heavily of cynicism of status-quo-ism” in always being skeptical of potentially disruptive developments (such as AI, EHRs, digital health, etc.) without offering alternative solutions, all because we’re protecting our hospital paychecks. This tension between would-be disruptors and those who keep the IT lights on today is important – we’re always going to be defending ourselves to impatient, often naive disruptors whose technology hammer is desperately seeking a healthcare nail to pound as we try to maintain a responsible, enterprise-driven approach. Here’s your chance to respond, perhaps considering these issues in your comments on the survey form I created. I’ll recap our collective thoughts in a few days.

  • Are provider health IT people really averse to investigating and using disruptive technologies or are we just jaded by a long list of previous failures?
  • What are the outsiders missing about what makes healthcare different?
  • What is the potential of technology-powered disruption in a mostly non-profit healthcare system that is heavily regulated and full of entrenched stakeholders ranging from hospitals to insurers to drug and device companies?

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Welcome to new HIStalk Platinum Sponsor Relatient. The Franklin, TN-based company offers a patient-centered approach to patient engagement that recognizes that “it’s not just a phone, it’s healthcare’s digital front door.” Solutions include appointment reminders and rescheduling, on-demand outreach for events such as weather delays, patient self-scheduling and waitlisting, satisfaction surveys, AR balance messaging, MDpay balance collection, and health campaign management (recalls, education, portal promotion). The service requires no app, no portal, and no password (since the service validates directly to the phone) and communicates with patients via their preferred channel (phone, email, or text messaging, the latter preferred by a startling 98% of patients vs. the basically zero who like patient portals). Patients are engaged as comfortably as they would be with friends and families, using behavioral science to meet their wants and needs without having a clumsy app inserting itself. An Epic-using pediatric hospital dropped its clinic no-show rate by 27 percent within six weeks, while a FQHC uses it to help meet the needs of diabetic patients with transportation problems. It’s integrated with a long list of systems that include those of Epic, Cerner, Allscripts, Meditech, EClinicalWorks, and Athenahealth. Thanks to Relatient for supporting HIStalk.

Listening: King Crimson, purely because the reclusive and formerly retired Robert Fripp — the only consistent band member as its 72-year-old guitar player — just did an amazing press conference for the band’s 50th birthday as reported by Rolling Stone. It’s a delightful, wry look at the challenges and rewards of playing in a band whose membership is constantly evolving (Fripp loves blowing it up and starting over to stir his creative juices) and whose epic progressive music plays great live even though each musician must count different time signatures in their heads in front of thousands of audience members in playing songs recorded decades ago by someone else. Their tour goes out in June and has some US dates. Certainly many (including me) enjoy the take-no-prisoners “21st Century Schizoid Man” (original vocals by ELP’s Greg Lake) or the mostly improvised “Asbury Park,” but my favorite will always be “Starless.” How cool it must be to bemusedly explain to your grandchildren that time in 1969 when, as an impossibly young man of 23, Grandpa was rocking half a million people at England’s Hyde Park weeks before Woodstock and the moon landing, and now he’s about to hit the road again.


Webinars

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


Acquisitions, Funding, Business, and Stock

Morgan Stanley predicts that Apple’s healthcare opportunity is $15 to $313 billion in annual revenue within the next eight years, with analysts speculating (with little evidence to back it up) that the company could roll out medical-grade wearables within AirPods, integrate sensor-powered apps into the Watch, get insurers to pay for the Watch, or buy healthcare companies. The prediction seems laughable given its assumption that the company’s 2027 healthcare revenue could exceed today’s total revenue even as Apple scrambles to defend its mature market position. People keep trying to make excuses for Apple’s unpleasant slide into middle-aged corporate mediocrity and often predict healthcare as its savior based on one-off ideas like Apple Health Records and the Watch EKG that are interesting to consumers but don’t have any kind of monetization path (Rule #1 in healthcare – patients do not pay. Rule #2 – neither do doctors.)

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Clinical data integration vendor Diameter Health raises a $9.6 million Series A-1 funding round led by new investor Optum Ventures.

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DocuTAP and Practice Velocity announce that their merged companies will be branded as Experity.


Sales

  • Acuity Healthcare, which owns three long-term acute-care hospitals, chooses HCS Interactant as its enterprise health IT platform. 
  • AdventHealth will implement Par80’s referral management system.
  • McKesson chooses Google Cloud as its preferred cloud provider for infrastructure, platforms, applications, and analytics.
  • Australia’s NSW Health signs a 13-year contract with Sectra for enterprise radiology imaging for its 11 Local Health Districts.
  • Signature Healthcare will implement Meditech Expanse.

People

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OptimizeRx hires Denys Ashby (CaptureRx) as VP of hospital and health systems.

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Jeff Fallon (Oneview Healthcare) joins patient experience technology vendor EVideon as CEO.


Announcements and Implementations

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Google Cloud opens its healthcare API for beta testing, offering an interoperability engine that supports FHIR,  HL7v2, DICOM, patient de-identification, and machine learning.

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Microsoft will shut down its HealthVault service on November 20, 2019. The notice – sent via email to registered users — expands the company’s January 2018 warning that it would retire HealthVault Insights and its December 27, 2018 announcement that Direct messaging would no longer be supported. Now the whole thing has been scrapped.

Fortified Health Security publishes its 2019 Horizon Report on the cybersecurity risks of connected medical devices.

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Montefiore St. Luke’s Cornwall Hospital goes live on Artifact Health’s physician query solution to expedite accurate coding just four weeks after the project began.

Saratoga Hospital goes live on integration of B. Braun Medical’s smart IV pumps with Meditech Magic as delivered by Iatric Systems.

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DirectTrust earns ANSI accreditation to develop interoperability and identity standards and invites industry stakeholders to participate.

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Recondo Technology announces record bookings and growth in Q1.


Government and Politics

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A jury finds a South Florida nursing home operator guilty of defrauding Medicare and Medicaid of nearly $1 billion via fraudulent billing. The best part of the story is this – he used part of the $37 million he pocketed to bribe a Penn basketball coach to get his son admitted into the Ivy League university. Former Penn basketball coach Jerome Allen, who has pleaded guilty to money laundering in connection with the incident, admits that he accepted $300,000 in bribes to get the son — Morris Esformes — admitted to the Wharton School, after which he never played a single second of Penn hoops. The son’s LinkedIn says he last worked as a summer analyst for merchant bank The Raine Group. Somehow I expected that – state-school guys like me who spent our summers sweating doing dirty, low-paid work outdoors (in my case, coal mines) always knew people with better-connected parents who got them clean, connection-creating jobs working as caddies or perhaps merchant banking. One guy I knew donated his daughter’s way into dental hygiene school (“I’ll buy the damned place if I have to,” he told everyone who would listen, which apparently included the admissions folks) and got his underachieving son into medical school despite the kid’s having been caught breaking into his undergrad college’s administration office to manually improve his grades.


Other

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In Australia, newly opened, 488-bed Northern Beaches Hospital delays its HIE project after it finds “unacceptable errors and omissions.” A sign that the grand opening wasn’t going well – the CEO quit the day after the ribbon-cutting ceremony.

Massachusetts Governor Charlie Baker, speaking at a Partners HealthCare innovation event, says he is skeptical of the promises of AI. He adds that healthcare is rightfully held to a higher standard than other industries and that patient privacy must not be compromised. Baker was the final decision-maker for AI projects in his previous roles in government and provider organizations and says AI was often less useful than its developers thought, it takes longer than expected to make it work, and the choice and formatting of input data complicates the issue.

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Ireland’s state data agency rules that people don’t have an absolute right to have their names spelled correctly, reviewing a TV producer’s complain that the fada (an accent or diacritic mark) in his name was omitted by University Hospital Galway because its software doesn’t support the special character.

Cigna’s PR people shrink from the glare of public spotlight as the insurer suddenly agrees to pay the out-of-network hospital ED bills of a woman’s two daughters who had attempted suicide – one by slashing, one by pills – by reversing its initial decision that neither event was life-threatening. The mother was relieved about the bill, but the story doesn’t provide any insight on what it’s like to have two daughters of unstated age who tried to kill themselves simultaneously.

Weird News Andy codes it as W61.42XA. A Detroit motorcyclist dies when one of several turkeys that were crossing the road take flight and hit him in the chest, causing him to lose control. WNA cautions, however, that we must escalate our coding work to keep up with the stupidity of people, providing as evidence this story in which a 10-year-old boy is critically injured after falling off the car driven by one of his parents as he “surfs” on the roof.


Sponsor Updates

  • Audacious Inquiry joins HL7 and IHE.
  • Spok announces its upcoming conference participation at AONE, the Healthcare IT Institute, and AMDIS PCC Symposium.
  • Impact Advisors is named as one of Modern Healthcare’s largest healthcare IT consulting firms.
  • Digital prescription savings company OptimizeRx announces integration with Cerner and Epic.
  • Aprima will exhibit at the ACP Internal Medicine Meeting April 11-13 in Philadelphia.
  • Audacious Inquiry joins Health Level Seven International and Integrating the Healthcare Enterprise as an organizational member.
  • CompuGroup Medical will exhibit at the Henry Schein National Sales Meeting April 11-13 in Denver.

Blog Posts


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