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Monday Morning Update 6/3/19

June 2, 2019 News 11 Comments

Top News

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The vendor members of the HIMSS Electronic Health Record Association raise “significant concerns” about proposed federal rules covering interoperability. Their draft comments note that:

  • The rule limits EHR vendor profits and thus discourages innovation because it requires them to share their intellectual property. The proposed rule would require vendors to offer interoperability elements with “reasonable and non-discriminatory terms.”
  • The compulsory licensing rule would require developing documentation, APIs, and patents, creating a regulatory burden that might “outweigh the opportunity that remains.”
  • ONC’s definition of “interoperability elements” and “electronic health information” are overly broad and unreasonable, while some of the defined exceptions would be nearly impossible to enforce.
  • EHR vendors can’t deliver the programming necessary in the proposed 24-month timeline, especially when they are dealing with other CMS and ONC regulatory requirements.
  • The proposed rule includes ambiguous definitions such as “reasonable,” “as soon as possible,” and “near real-time,” which is risky when penalties can be issued of up to $1 million per infraction.
  • EHRA recommends publishing an Interim Final Rule this year to allow continuing clarification and feedback and to create a way that vendors can get quick answers to their questions.

The Health Innovation Alliance this week said the rule is too vague and contains too many loopholes, recommending that ONC and CMS “go back to the drawing board.”


HIStalk Announcements and Requests

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More than half of poll respondents say vendor and hospital burnout in health IT is caused by excessive workload and time pressure rather than organizational, management, and compensation issues. Furydelabongo says that work overload could be a symptom of having incompetent or overly ambitious managers, while Drex cites the nearly universal absence of good IT governance in hospitals that encourages employees work at whatever tasks they believe are important or that executives complain the loudest about.

New poll to your right or here: What method did you use the last time you communicated directly with a doctor who was providing care to you? I’m looking for your most recent exchange, the final one in your most recent encounter.

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Happy 16th birthday this week to HIStalk, which I started writing in June 2003. I think it was June 6, but I’m not certain since I sometimes think it was June 3. Back then:

  • Some big healthcare names were George W. Bush, Tommy Thompson, Tom Scully, Dennis O’Leary, Erich Reinhardt, Linda Kloss, Anthony Principi, and Neal Patterson.
  • Hospitals were struggling with early CPOE implementations.
  • Kaiser Permanente had just chosen Epic.
  • Cerner had just made its first UK sales and opened its new headquarters.
  • HIMSS offered HIMSS03 in San Diego (with keynotes from Jeff Immelt, Rudy Giuliani, and Patch Adams) following Summer HIMSS in Chicago and also launched Solutions Toolkit, the predecessor to HIMSS Analytics.
  • Computers ran Windows XP while users licked their wounds caused by Windows ME and awaited / dreaded the promised magic of Windows Vista as the effects of the “every other Windows release sucks” rule were about to be felt.
  • People sent messages on BlackBerry devices and talked on the Nokia cell phones that dominated the market.
  • Companies such as MercuryMD, Misys, First Consulting Group, Per-Se, IDX, Healthlink, Quovadx, Alaris, and Sentillion were making a few sales.
  • Health IT news came slowly and with little critical review other than from expensive, influential newsletters such as “Inside Healthcare Computing” and “HIS Insider.”

Listening: new from NF (Nate Feuerstein), a 28-year-old, Michigan-based, Eminem-influenced rapper whose lyrics are emotional but commendably free of profanity (a change he made in 2010, saying that he’s Christian even though his music is not) and misogyny. His vocal rhythms immediately embed themselves in your head even if the lyrics don’t. The link is for “Let You Down,” which is not only a dramatic video, but also a powerful song about the strained relationship between a disappointed father and his son who has bitterly decided that their superficial relationship is over.

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

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Webinars

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


Decisions

  • Bayhealth (DE) switched from Avaya To Cisco Systems for call center technology in April 2019.
  • Highpoint Health (IN) will replace Meditech with Allscripts in July 2019.
  • ProMedica Coldwater Regional Hospital (MI) replaced Meditech with Epic on May 1, 2019.
  • Chestnut Hill Hospital (PA) will go live on Epic in August 2019.
  • Baptist Health Floyd (IN) will replace Allscripts with Epic In June 2019.

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


Announcements and Implementations

SailPoint earns a US patent for its application of AI/ML to identify peers among system users to detect those whose access profile is unusual enough to warrant review for potential security concerns.


Other

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Eric Topol notes the nearly identical, relentless price increases for competing best-selling injectable arthritis drugs Humira and Enbrel, which generated a combined $28 billion in 2018 sales. Today’s price is more than double that of 2012, with cash-paying patients paying more than $5,000 per month even with the best coupon offered by GoodRx. The cost is much less in the UK, which doesn’t allow endless drug company patent filings and lawsuits that block competition for biologic drugs.

CDC reports that the number of US measles cases has broken the 25-year-old record even though we’re only halfway through the year. Measles is classified as “eliminated” in the US, but that achievement is at risk for the first time in a generation.

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I’m fascinated that Cincinnati-based Bon Secours Mercy Health will sell its majority stake of an RCM company it bought for $60 million in 2016 for $1.2 billion. The Catholic health system, former in September 2018 with the merger of Mercy Health and Bon Secours Health System, had just announced its merger with Ireland’s largest healthcare provider, a five-hospital system in Dublin, with intentions I don’t quite understand (unless they’re using Ireland’s favorable tax status to benefit their for-profit ventures).


Sponsor Updates

  • Sansoro Health announces an integration partnership with OpiSafe, which provides clinical decision support for opioid prescribers.
  • TriNetX will exhibit at Academy Health June 2-4 in Washington, DC.
  • A study finds that hospitals using Meditech Expanse outperformed Cerner and Epic clients in CMS quality and value measures.
  • Wolters Kluwer Health promotes Greg Samio to president and CEO of health learning, research, and practice.
  • The SSI Group will exhibit at the Alabama HFMA Annual Institute June 2-4 in Destin, FL

Blog Posts


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News 5/31/19

May 30, 2019 News 3 Comments

Top News

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Precision medicine platform vendor Tempus raises $200 million in a Series F funding round that values the Chicago-based company at $3.1 billion.

CEO Eric Lefkosky, JD founded the company in 2015 after launching two marketing companies, a logistics technology company, and a venture capital firm. He is also chairman and co-founder of Groupon and formerly served as that company’s CEO. 


Reader Comments

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From Food for Chewing: “Re: KLAS’s new report on Cerner revenue cycle management. I’m curious to know if Cerner paid for or commissioned the report.” KLAS responded to me by saying that it was initially creating the report without Cerner’s involvement, but Cerner asked KLAS to convene a big-client summit that was hosted by Intermountain. The Cerner clients then asked KLAS to provide quarterly updates about Cerner’s progress. Cerner will engage around those results, and while KLAS tell me specifically that Cerner is paying, it’s not unreasonable since Cerner commissioned the follow-up. Cerner won’t get much immediate mileage from this initial report – the client feedback (at least as reported in the “Key Findings” summary, which is all I can see) is nearly universally negative, not surprising given the meeting’s genesis (no pun intended for you Cerner DoD MHS types).

From Crowdfunding Not for the Weak at Heart: “Re: HEAL Diabetes Clinic. Received an email indicating that after its StartEngine funding campaign, CEO Richard Koffler ‘surprised us by announcing his resignation from the company.’ The company decided that it couldn’t move forward without home, so it is shutting down and returning any leftover money to investors.” The company’s webpage says it has closed and Koffler’s LinkedIn indicates that he has resigned. It offered a ketogenic diet program.

From Non-Corporate Man: “Re: your experience with an HIT vendor owned by a large company. My experience was the opposite. I did just about every job you could think of in corporate HIT, did an MBA and law degree while working full time, and got the CEO job because I knew all the pieces.” My only for-profit experience was with this vendor, but it was eye-opening to see what happens when a Fortune 500 company acquires a failing software vendor that quickly disappears into the murk of the corporate balance sheet once it fails to meet overly optimistic expectations. They only bought us with the questionable hope that our sexy-sounding business would jumpstart their anemic growth rate, apparently actually believing our financials that must have been quite the work of fiction ( (I speculate our executives offered them the “Promises & Lies” version of our P&L).

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From Union Rep: “Re: HIT headlines. This one is surely among the worst.” I agree. As health IT wit goes, this is half. The story itself is basically a rewritten press release, so someone was anxious to show some poorly executed creativity in the headline in desperately punning “Sunrise.” I can only imagine the damage they would do in trying to work “Millennial” into a Cerner sales announcement.


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-state Bon Secours Mercy Health will sell a majority stake in its Ensemble Health Partners RCM and Epic optimization business to Golden Gate Capital for $1.2 billion.

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Cerner initiates a $0.18 quarterly dividend, its first-ever such payment and $0.03 greater than it originally mentioned in February. Opinions vary on whether companies that initiate dividend payments are showing signs of strength (making so much money that they might as well share it with investors) or weakness (management can’t entice people to buy the stock otherwise). I generally side with the latter. Companies that are doing well and expect strong future performance would be better off investing the money in their own business and let the success-driven share price increase reward its shareholders. But that’s just me, and if CERN shareholders love the stock, they can just reinvest the dividends themselves. CERN shares are down 3% vs. the Nasdaq’s 3% rise since Brent Shafer took over on January 10, 2018.

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Government health IT contractor Apprio creates a new commercial healthcare division to market its RCM services to hospitals and health systems.

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Talkspace raises $50 million in a Series D round led by Revolution Growth, bringing its total funding to $107 million. Optum’s behavioral health business has signed on for the company’s online therapy service.

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Pillo Health raises $11 million to complete its Series A round. Lead investor Stanley Black & Decker will work with Pillo to launch a direct-to-consumer version of its digital home health companion later this year.

Patient relationship management vendor Welkin Health raises $17.5 million in a Series B round, bringing its total funding to $30 million.


Sales

  • UCLA Health (CA) selects Microsoft’s Azure cloud computing services to speed up data analysis for researchers and precision medicine efforts.
  • The Louisiana Dept. of Health will implement provider credentialing software from Verisys.
  • Allegheny Health Network (PA) selects Vynca’s end-of-life care planning technology.

People

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Mount Sinai Health System (NY) names Andrew Kasarskis, PhD (Icahn School of Medicine) as EVP and chief data officer.

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Roni Zeiger, MD (Smart Patients) joins Facebook as head of health strategy.


Announcements and Implementations

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

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OHSU Doernbecher Children’s Hospital (OR) offers parents Locus Health’s app-based remote monitoring software for use post-discharge.

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PerfectServe announces GA of embedded messaging within Cerner.


Privacy and Security

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In Australia, auditors warn Victoria’s public health system officials that weak cybersecurity practices have left facilities vulnerable to attacks. A review of security measures at several hospitals within the state found similar weaknesses, including weak passwords, poor system and network monitoring, inadequate user access controls, and lack of appropriate governance and policy frameworks. Barriers to implementing all 72 of the recommended cybersecurity measures include lack of budget and staff, plus a lack of awareness around third-party vendor security protocols.

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Allegheny Health Network brings its Epic system back online after an unspecified network issue caused it to go down Wednesday morning. The outage affected all seven of its Western Pennsylvania hospitals.

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Indiana-based Medical Informatics Engineering and its subsidiary NoMoreClipboard will pay $900,000 to settle a multistate lawsuit brought against it last year by 16 state attorneys general over a 2015 breach that compromised the data of 4 million patients. Meanwhile, nobody is planning a PHI heist of 4 million clipboards.


Other

Canada’s Sunnybrook Health Sciences Centre will integrate its self-developed SunnyCare clinical workflow solution with CPSI Evident’s Thrive EHR. The organizations will also establish an outcomes innovation center in Toronto.

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A New York Times investigation finds that pediatric cardiologists at UNC Children’s Hospital (NC) were so alarmed at high death rates that they questioned — in secretly recorded department meetings obtained by the newspaper — whether they would send their own children there for surgery. From the Times article:

  • The hospital’s death rate was among the worst among the 82 institutions that publicly report it.
  • Cardiologists and hospital executives were all worried about the hospital’s high death rate, but didn’t know what to do about it.
  • Since 2015, the hospital had lost two of its pediatric cardiac intensivists and some experienced nurses, closed its CIC unit, and didn’t have a dedicated cardiac intensive care unit.
  • A transplant surgeon failed to show up to perform a heart transplant when a donor heart became available on a weekend, leading one cardiologist to say, “This is what you signed up for. Who is he to play God with some kid’s life?”
  • UNC said it has since replaced leadership that hospital administrators called “a dysfunctional group.”
  • So many hospitals offer complex pediatric heart surgeries that some hospitals, including UNC, perform few cases and thus have limited resources and experience. Several hospitals have shut down similar programs or merged with others in hopes that higher volumes would drive better outcomes.
  • UNC says mortality data alone isn’t a good measure and termed it “critically important” to instead look at risk-adjusted data, but then refused to release that data because it says the data doesn’t adequately reflect that its patients are sicker.
  • The since-retired head of the children’s hospital told cardiologists to follow their conscience if that included referring patients to other hospitals, but warned them that reduced surgery volume would hurt hospital revenue and possibly cost them their jobs.

Sponsor Updates

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  • HCTec employees volunteer with the Gentlemen’s Quest of Tampa and the United Way.
  • Elsevier Clinical Solutions will exhibit at ASCO June 1 in Chicago.
  • EClinicalWorks will exhibit at the SCPHA Association Annual Clinical Network Retreat June 7-9 in Myrtle Beach, SC.
  • Glytec publishes a new case study, “Paul Chidester, MD: How Sentara Healthcare Achieved the Standard of Care in Glycemic Management, and Your Organization Can, Too.”
  • Google Cloud releases a new video, “American Cancer Society: Powering cancer research using Google Cloud machine learning.”
  • Hayes Management Consulting will host a reception during the AAMC Compliance Officers’ Symposium June 6 in Washington, DC.
  • Audacious Inquiry celebrates 15 years in business by reflecting on 15 significant company milestones.
  • Nordic releases a new podcast, “How to build an effective hub-and-spoke relationship.”
  • NextGate publishes a new case study, “Enterprise Patient Matching Helps KeyHIE Establish Integrated Network of Accurate, Accessible Health Records and Drive Down Duplicate Record Rate to Less than 1%.”

Blog Posts


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News 5/29/19

May 28, 2019 News 3 Comments

Top News

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Cardinal Health makes a $10 million investment in home medical monitoring technology and monitoring services vendor Medically Home Group.

The company says that its remotely monitored “virtual hospital room” that it sets up in the patient’s home saves the 60% of the expense of hospitalization that is related to fixed costs, such as buildings.


Reader Comments

From Hospital Digital Marketer: “Re: Google. Did they ban healthcare systems from posting star ratings for doctors in search results? We pay a lot to our survey vendor to post these on our website, but the stars disappeared after Google updated its search engine results pages.” I’ll invite marketing folks to weigh in since this isn’t something I follow.

From Pendulous Appendages: “Re: management. What eventually happened to your software vendor employer manager who refused to alert customers to a problem that put patients in harm’s way?” I Googled him and turned up nothing, leaving me free to speculate hopefully that karma found him despite his apparent corporate fast track back then. I did locate his boss, the corporate suit who was parachuted into our office as a 20-something newly minted executive assigned to lend his vast knowledge to our failing operation – he later became CEO of several large healthcare companies (one of which he took public, another of which was sold to an especially scummy drug company) and is now an investment company partner. My takeaways from this:

  • The people who end up in charge have the drive, ambition, and personality quirks that set their direction early. They never spent time as programmers, clinicians, or cube-dwellers, having been chosen early on for internships and consulting assignments that skipped the hands-on layer. It doesn’t hurt to be a family friend or relative of a company bigwig.
  • Some of the anointed ones are screaming, petulant psychopaths (the CEO I mentioned above was the poster child for that), while others are generally amiable since they aren’t really emotionally invested in the assignment that they know is just a brief stop on their ascent to the summit. I didn’t mind working for the later-career ones who took the top job as a favor for our investors and therefore were more often bemused than tyrannical in realistically assessing their ability to do anything more than delay the inevitable.
  • They took every job with the next one in mind. Those of us rowing the boat saw a lot of captains come and go. We were happy to see most of them leave, apprehensive about which company man would be sent to our corporate hinterlands to replace them, and full of conflicting thoughts about their jobs and lives versus ours as we passed around the newspaper reports of their opulent home purchases and saw them wheeling their testosterone-boosting sports cars (all but one were male) into their reserved parking spots each day.
  • The rise to the top can be achieved even while running failing, doomed companies as long as you can make their corporate budget contribution look temporarily better than when you arrived (i.e., laying people off, cutting R&D, sunsetting products, increasing maintenance and services fees). This is not a good thing for customers, but then again, having a perpetually money-losing software vendor isn’t sustainable anyway.  
  • The victory lap for circuit-riding CEOs is in venture capital and other investment activity, which lines their pockets even more than running companies.

HIStalk Announcements and Requests

I occupied some of my time over the long weekend with binge-watching: all but the final couple of episodes of ”What/If” and continued progress on “Justified,” both of which I recommend for unchallenging yet engrossing entertainment. Next up is “High Seas.” It’s fun that so many series are available on the streaming services we use (Netflix, Hulu, and Amazon Prime) that when someone asks you what you’re watching or vice versa there’s an 80% chance the other person hasn’t heard of it, unlike the old “three networks” days when everybody talked about the same shows. I didn’t realize until getting engrossed in “Justified” that it’s an old series, having run on FX from 2010 to 2015, magically reborn to feed the streaming beast. 

I was browsing on my Chromebook as I often do (because it’s light and small, just right for a break in the easy chair) when I recalled that Microsoft Office 365 contains fully functional Web versions of the suite (Word, Excel, OneDrive, etc. – everything except Access) that run just fine on it. I could do nearly everything I do on a full Windows desktop on the Chromebook, although “nearly” still prevents a full switch. I suppose I could just get a small, lightweight laptop for these situations, such as a Surface, but I don’t really need one.

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Welcome to new HIStalk Platinum Sponsor Google Cloud. Solutions include unified, HIPAA-compliant and HITRUST CSF-certified data storage with Cloud Healthcare API access; the BigQuery managed, server-less data warehouse; the Cloud Machine Learning Engine and TensorFlow for building and training custom models; collaboration tools such as the G Suite productivity suite and Chromebooks; and Cloud Healthcare API and Apigee Healthcare APIx to bridge systems and applications with FHIR and DICOM support. Customers include Cleveland Clinic (extending its EHR and performing analytics via APIs); Lahey Health (collaboration); Hunterdon Healthcare (collaboration); and Colorado Center for Personalized Medicine (data warehouse for patient and genetic data for personalized diagnoses and treatment as well as research). Rush University Medical Center powers its MyRush app with Google Cloud, improving customer experience and patient outcomes with API-enabled services, use of 250 analytics variables, and management of the access gateway with OAuth, validation policies, and traffic management. Google Cloud offers a free tier that provides everything from storage to development tools, APIs, and analytics. CIOs can connect with the company at CHIME’s Fall CIO Forum in November. Thanks to Google Cloud for supporting HIStalk.

Here’s a panel discussion on “The Future of Health” from Google’s just-concluded Cloud Next 19 developer conference.


Webinars

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

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Change Healthcare files an amended prospectus for a $200 million IPO, double the value of its mid-March filing.

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Apple reportedly acquires Tueo Health, which is developing an app to monitor the nighttime breathing of asthmatic children. The deal was supposedly done in late 2018, but nobody noticed until now.

UCSF ends its plan to affiliate with Dignity Health’s four Bay Area hospitals, citing unresolved issues related to women’s reproductive services, LGBTQ care, and end-of-life options.


Sales

  • Loma Linda University Medical Center chooses QuadraMed for patient identity management.
  • Western Maryland Health System chooses PeraHealth’s Rothman Index for real-time monitoring of patient condition.

People

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Surgical automation and software vendor Caresyntax hires Tim Lantz (Sentry Data Systems) as president.

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Divurgent hires Bill Bottomley (HighPoint Solutions) and Mary Beth Seaman (HighPoint Solutions) as client services VPs.


Announcements and Implementations

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Muhlenberg Community Hospital (KY) replaces Meditech with the Epic system of its corporate parent, Owensboro Health, with the project coming in under budget at $2.3 million. 

Imprivata enables its Confirm ID EPCS solution to run under the Google Chrome browser, making it more accessible to Meditech users.


Government and Politics

A Kaiser Health News analysis reviews whether the reduced cost involved with healthcare overhaul could wipe out “the industry” (meaning providers, insurers, and others) that provides 20% of the country’s employment. The article quotes economists who previously worried that the bloated and growing healthcare sector was being used as a “wildly inefficient jobs program” to drag the country out of the Great Recession. A healthcare economist observes that hospitals make up the top six employers in Boston and two of the top three in Nashville, with the main source of healthcare cost savings being layoffs that he estimates would impact 2 million people, equally split between providers and insurers. Another economist agrees, but says high healthcare costs sap non-healthcare industries in ways that can’t be easily measured.


Other

I missed this earlier: HHS OIG report finds that ACOs (of the six it studied) that run a single EHR are able to to share electronic data in real time, whereas those using multiple EHRs are limited to phone calls and faxes. The report also notes that care coordination outside the network is hard even with HIEs (since they provide limited data) and that most ACOs aren’t using analytics to personalize care. 

A federal lawsuit questions whether hospitals are sidestepping anti-kickback laws by overpaying the salaries and perks of doctors they hire whose test and procedure volume generates hospital profits that exceed their specialty-specific losses. It highlights the aggressive practices of Wheeling Hospital (WV) to increase its market share, which include directly tying physician compensation to the hospital revenue they generate and hiding doctor payments within office lease terms that give some doctors incomes that are multiples of what their private practice counterparts are making. Meanwhile, CMS dropped the hospital’s quality star rating to one, the lowest possible score.

A study estimates the annual cost of physician burnout at $4.6 billion, or $7,600 per doctor per year. Now that WHO has added “burnout” as a rather vaguely defined ICD-11 diagnosis (symptoms: exhaustion, negativity, and reduced productivity), let’s hope we don’t medicalize it by paying for questionable treatment that then creates consumer demand as we’ve done for other newly defined conditions – we don’t want doctors to burn out from treating doctor burnout.


Sponsor Updates

  • Nuance customers in Colorado, Mississippi, and Ohio adopt the company’s CDI solutions.
  • Surescripts expands its White Coat Award to include categories for health systems, pharmacies, and pharmacy technology leaders, as well as EHR vendors.
  • FDB releases MedKnowledge Canada to support bi-lingual medication management app development.
  • The Chartis Group publishes a paper titled “Launching a Revenue Cycle Automation Strategy.”
  • Aprima will exhibit at the NJMGMA Practice Management Conference June 5-7 in Atlantic City.
  • In Argentina, Emergencias deploys Avaya’s IX Contact Center software to help save lives.
  • Bluetree will exhibit at the IPMI Healthcare IT Institute June 2-4 in San Antonio.
  • Burwood Group will exhibit and present at the Southern California CIO Executive Summit June 5 in Universal City.
  • PeriGen publishes a white paper titled “How to Reduce Exposure to Obstetric Megaverdicts with AI-Driven Technology.”
  • CompuGroup Medical will exhibit at the Arizona Medical Association Annual Meeting June 1 in Chandler.
  • CoverMyMeds will exhibit at the NG Healthcare Provider Symposium June 5-7 in Savannah, GA.

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Monday Morning Update 5/27/19

May 26, 2019 News 4 Comments

Top News

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The VA skips a House committee meeting that addressed oversight of its Cerner implementation, but attends a Senate meeting long enough to oppose a bill that proposes creating an independent advisory committee to oversee the $10 billion project.


Reader Comments

From Anon E. Mouse: “Re: EHR timers. Cerner was the vendor that wasn’t directly mentioned in the article, although it’s obvious since Eva Karp works for Cerner. Cerner’s Lights On Network has been freely available with such timers for years and is used by many of their clients daily. Cerner invests a ton of effort in building additional timers as they introduce new software and functionality and then works to attack the problem areas to improve performance and clinical workflow.” Cerner’s write-up of Lights On Network describes its benefits: finding users whose system actions suggest that they could use help, identifying system bottlenecks, flagging unusual system settings, and benchmarking against other Cerner clients.


HIStalk Announcements and Requests

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A convincing 97% of poll respondents who have coordinated post-acute care for someone said it was hard, with the biggest issue being trying to coordinate the activities of the care team and family. Some comments:

  • Vicki says organizations served only their own interests in caring for her family members, such as a SNF that wasn’t interested in helping find a home health provider other than the one it owns.
  • Clark’s experience with transitions from ICU to LTAC, SNF, home care, and therapy providers is that nobody every had current patient information, creating both frustration and danger.
  • Brittany’s experience with hospice care is that medical equipment wasn’t delivered, transportation was delayed, and nurses misunderstood the family’s wishes and kept the family member over-sedated in denying them the chance to have meaningful final moments together.
  • Another reader reports that they experienced excellent coordination at Johns Hopkins, but had a “consistently horrendous” experience at their own hospital, where they are a physician faculty member. HIM dragged their feet on providing an electronic copy of the medical records, obtaining images required two trips and upfront payment of fees, a chaotic discharge process created delays that necessitated rescheduling home health appointments, refrigeration-required antibiotics were delivered early when nobody was home, prescriptions were sent to the wrong pharmacy, hospital nurses argued with the family over the medication list in insisting that their computer must be correct, and the hospital ran out of common medical supplies.
  • Caregiver Informaticist says their family member’s care was never coordinated in several trips between LTAC and the acute care hospital, with no information sharing after being falsely told that the LTAC’s doctors round at the hospital and attend joint care planning meetings.

New poll to your right or here: What is the main cause of burnout among employees of health IT vendors and hospital IT departments? My experience working for a crappy vendor makes “all of the above” attractive, but let’s focus on the most important item on the list. For me, that was incompetent, uncaring managers who interfered with our productivity in trying to add value to processes they would never understand, poring over their MBA textbooks in their spiffy offices with the doors shut before emerging into the cube farm to make a lofty pronouncement that after applying their exemplary insight to our operation, they had figured out the solution to our problems (we had tried it before and failed, but saying so elicited scorn that what we had been missing then was their keen leadership). Worst of all, they had no healthcare background and thus nothing but contempt for our users and the patients who depended on our systems – we were just a widget factory that happened to sell healthcare software. I made an impassioned, stick-figure level plea to one of the suits about a patient-endangering software defect that I had laboriously documented urging him to simply allow us to notify all customers of the problem since we hadn’t yet figured out how to fix it. His answer: “We don’t owe those clients a damned thing.”


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Monday is Memorial Day, created not to serve as a nonchalant kickoff to summer, but rather to set aside time to remember those who died while serving in the armed forces. It’s perfectly fine to pass on attending a ceremony or an increasingly rare Memorial day parade, but perhaps you know someone who lost a family member (especially if it happened within the past handful of years) who was serving and could drop them a quick email or social media acknowledgement of their loss. Here’s another idea – take flowers to a cemetery that has a section set aside for soldiers and leave one on each grave that doesn’t already have some.

In Flanders Fields
By John McCrae

In Flanders Fields the poppies blow
Between the crosses row on row
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.


Webinars

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.


People

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HHS promotes Jose Arrieta to CIO.


Announcements and Implementations

Lawrence General Hospital completes its implementation of Meditech Expanse under a fixed-fee implementation agreement with Santa Rosa Consulting.

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A new KLAS report covering opioid prescription intelligence finds that all vendors reviewed performed well. PastRx tops the list in pulling PDMP data into the chart for physician review, while AffirmHealth and Collective Medical were praised in their respective regional pain management clinic and ED environments. Appriss Health and DrFirst were seen as less helpful in developing an opioid stewardship strategy since they work with users only indirectly.

In England, Guy’s and St Thomas’ NHS Foundation Trust issues a 10-year, $225 million tender for a enterprise EHR that will be used by up to 35,000 employees of three London-based trusts.


Government and Politics

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The VA’s self-developed, open source workflow tool Light Electronic Action Framework (LEAF) wins a government health IT magazine’s innovation award. The team used the tool to develop a telehealth provider volunteer site for hurricane relief efforts (pictured above) within 24 hours.


Other

A data study finds that Canadian buyers of marijuana (where it is legal) avoid paying by credit card since they know their data is likely to be stored on servers in the US (where it isn’t legal). Also in play is that some employers enforce zero-tolerance policies for non-medical use. Canada’s own Office of the Privacy Commissioner recommends that buyers pay cash since the US government can access their credit card records without a warrant and could prevent them from entering the US.

I’m fascinated by this: Elon Musk’s SpaceX uses its Falcon 9 rocket to launch the first 60 low-Earth, 500-pound satellites of its $10 billion Starlink broadband service, which will offer inexpensive broadband connectivity to the northern US after six launches, the whole country after 12, and the entire populated world after 30. The company will use the revenue from the broadband service to fund its planned colonization of Mars.

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An interesting op-ed piece by the co-founder of a clinician collaboration platform says that architects ruined healthcare by emphasizing grand, soothing aesthetics for visitors while eliminating the conference rooms and lounges where clinicians can interact with each other. He also opines that the Disney-created concept of hiding the “messy parts” of running a hospital means that the healthcare professionals themselves are the messy parts. He concludes that hospital design is now obsessed with distracting people from thinking about their health rather than making them healthy.

More evidence that Americans are too science-challenged to form rational healthcare opinions: people are OK with the widespread rollout of untested medical treatments, but object to randomized trials in which two equally acceptable treatments are applied to separate groups to determine which is better. Experts can’t explain the results, but think people might worry that consent is required from those who don’t get a particular treatment or that such tests should be unnecessary because experts should already know what works.

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A third-year UTHealth medical school student who has undergone six brain surgeries, survived on artificial nutrition due to gastroparesis, and had a stroke that left her temporarily paralyzed from the waist down says the experience (along with deficits in her hand function from the stroke) has motivated her to consider a career in physical medicine and rehabilitation and neurology.


Sponsor Updates

  • Meditech; NextGate; Clinical Computer Systems, developer of the Obix perinatal data system; CereCore; CloudWave; Experian Health; PatientKeeper will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Waystar will exhibit at the EClinicalWorks Education Expo May 27-31 in Boston.
  • The Chartis Group publishes a white paper titled “Bridging the Digital Divide in the Healthcare C-Suite: Positioning IT for Success in the New Health Economy.”
  • OmniSys and Surescripts will exhibit at the PioneerRx Connect 2019 May 31-June 2 in Orlando.
  • Relatient welcomes its 100th employee.
  • Sansoro Health releases a new 4×4 Health Podcast, “Intellectual Property for Entrepreneurs and Investors.”
  • The SSI Group will exhibit at the South Carolina HFMA Annual Institute May 28-31 in Myrtle Beach, SC.
  • PatientKeeper will demonstrate its EHR optimization solutions this week at E-Health in Toronto and MUSE Inspire in Nashville.
  • Community First Health Plans goes live with ZeOmega’s Jiva LTSS for long-term care.

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News 5/24/19

May 23, 2019 News 18 Comments

Top News

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California-based drone-delivery company Zipline announces $190 million in funding and plans to expand its healthcare-focused service to the US, starting in North Carolina.

Founded in 2011, the company initially focused on delivering vaccines, blood products, and medications to remote clinics in Rwanda and Ghana. CEO Keller Rinaudo says Zipline is now ready to provide similar services to remote areas in the US: “People think what we do is solving a developing economies problem. But critical-access hospitals are closing at an alarming rate in the US, too, especially if you live in the rural US.”


Webinars

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

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Helix lays off employees and closes two of its four offices after announcing earlier this month that it will pivot from direct-to-consumer DNA testing to a provider-focused population health management business. The company has raised $300 million over the last four years. Its most high-profile contract seems to have been with organizers of the Healthy Nevada Project, which had promised last spring to hand out Helix testing kits to 40,000 of its public health data project participants.

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Global imaging and IT company Agfa considers selling off the health IT and integrated care parts of its European healthcare business, the most high-profile part of which is its Orbis EHR. Analysts believe potential acquirers could include Cerner, Philips, or CompuGroup Medical, which made a purchase offer in 2016.


People

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Diabetes management software vendor Glooko names Mark Clements, MD (Children’s Mercy Kansas City) CMO.

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Russell Siebert (ZirMed) joins analytics company VisiQuate as EVP of growth.

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MDLive appoints Kristen Lalowski (N-of-One) chief product officer.

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MD Anderson Cancer Center (TX) hires David Jaffray (University Health Network/Princess Margaret Cancer Centre) as its first chief technology and digital officer.

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Former FDA Commissioner Scott Gottlieb, MD returns to venture capital firm New Enterprise Associates as a special partner on its healthcare investment team.

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Mona Hanna-Attisha, MD receives the inaugural Vilcek-Gold Award for Humanism in Healthcare from the Vilcek Foundation and The Arnold P. Gold Foundation. The pediatrician discovered Flint, Michigan’s lead poisoning crisis by analyzing patient data in Hurley Medical Center’s Epic system. She has donated the $10,000 prize to the Flint Kids Fund.

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Provation names Rick Jennings (Teammate) CTO and Erin Surprise (Hoonuit) SVP of professional services. Wolters Kluwer Health sold Provation to Clearlake Capital last year for $180 million.


Sales

  • Consulate Health Care (FL) will leverage Collective Medical’s network for better insight into senior care transitions.

Announcements and Implementations

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Innovaccer announces GA of patient outreach management software.

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Reports surface that Amazon is developing a voice-activated wearable capable of detecting emotion that may also offer users advice on how to interact with others.


Government and Politics

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Travis Air Force Base’s David Grant USAF Medical Center (CA) will go live on MHS Genesis, the DoD’s new Cerner-based system, in September. Other facilities in the initial wave of implementations will include Naval Air Station Lemoore and US Army Health Clinic Presidio of Monterey in California, and Mountain Home Air Force Base in Idaho.


Privacy and Security

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Indiana-based Medical Informatics Engineering will pay OCR $100,000 to settle HIPAA violations stemming from a 2015 data breach that impacted nearly 4 million patients. OCR’s investigation determined that the EHR vendor hadn’t performed a thorough risk analysis before hackers broke into the system using a compromised user ID and password. Other sources have said the company ignored the recommendations of a cybersecurity firm hired at the beginning of 2015, which included strengthening weak login credentials created so that end users didn’t need individual user names and passwords. The company was named in a multi-state December 2018 lawsuit brought by 12 attorney generals over its lack of health data protection.


Other

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Burnout exists in the IT trenches, too, according to a local Madison, WI news outlet. It dedicates a good chunk of copy to the complaints of former Epic employees who have moved on to greener, less grueling pastures. Rachel Neill, CEO of health IT staffing company Carex Consulting, says Epic experiences a 20-30% churn in employees each year, with the majority of replacements coming straight out of college. “They’re looking for someone who can keep on going, going, going until they can’t any more,” she adds. Epic disputes that claim, saying that its actual voluntary turnover is about 10% per year, which is below average for companies in health IT specifically and in the Midwest in general, and that employees work about the same hours per week as salaried US employees overall. Epic Director of Human Resources Allison Stroud believes that most employees feel “happy and challenged, which ends up being one of the best ways to prevent burnout.”


Sponsor Updates

  • Elsevier Clinical Solutions, FormFast, Imprivata, and Intelligent Medical Objects will exhibit at the 2019 MUSE Inspire Conference May 28-29 in Nashville.
  • EPSi shares the updated features of its EPSi 19.1 financial decision support and budgeting software.
  • Hayes Management Consulting hires Yara Hentz (Monster) as client success manager.
  • Goliath Technologies releases an updated version of its Performance Monitor software.
  • Kyruus will host the Sixth Annual Thought Leadership on Access Symposium (ATLAS) September 23-24 in Boston featuring a keynote by Toby Cosgrove, MD.
  • Matter will feature Intelligent Medical Objects co-founder Frank Naeymi-Rad at a networking event on May 29 in Chicago.
  • HBI Solutions joins the Iatric Systems AI Solutions Center.
  • NextGate responds to requests for information by CMS and ONC on strategies to improve patient matching, underscoring the importance of standards, proven technology, and data governance.
  • Glytec receives patent allowances from regulatory bodies in Australia, Japan, and Israel related to systems and methods for insulin titration and glycemic management.

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News 5/22/19

May 21, 2019 News 8 Comments

Top News

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ONC finds that interoperability among office-based physicians didn’t improve a bit from 2015 to 2017 even though more doctors used information from outside sources. The percentage who sent, received, and integrated the information didn’t change and only 10% of doctors participated in all four domains.

Only 30% of doctors received an electronic summary of care record, 20% were sent ED notifications, and hospitals provided electronic patient discharge summaries to just 25% of PCPs.

Here’s a tip for ONC. Just about every hospital uses Cerner, Epic, or Meditech. The fact that some hospitals are able to do the right thing using those systems means the challenge is not a vendor or technology problem – it’s that some providers just don’t want to do it, no matter how much their patients might benefit. Think about this when you anoint these foot-dragging health systems as the official steward of everybody’s overall health. The jammed interoperability floodgates would magically open by Labor Day if their payments depended on it.

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In an accompanying report, ONC also finds that only about half of people were offered access to their online medical record in 2018, unchanged from 2017. About 60% of those looked at their information at least once. Most people said they have no need to view their online record.


Reader Comments

From AC: “Re: EHR internal timers and event log monitoring. Epic measures this. Customers should make sure they are getting an Executive Packet (Physician Well-Being section) and request access to Epic Signal. You should see if you can get Epic to interview with you on this topic or to share an overview. It might benefit their customers since not all of them take advantage of the tools available or even know about them.” I would like to hear more if someone from Epic or a client site is willing to share details. The study I cited suggests that tools like this can highlight EHR areas that could be streamlined and to quantitatively measure the impact of making system changes. It would also be interesting for an EHR vendor or its clients to compare the time and clicks required for specific functions across multiple health systems to identify best practices.

From Jack Ripa: “Re: HIMSS. Says investors are attending its conferences to follow trends.” MobiHealthNews (which is owned by HIMSS) runs a commercial from HIMSS TV (which is owned by HIMSS) that was recorded at HIMSS19 (which is owned by HIMSS) that says investors are finding value in attending conferences (that are owned by HIMSS). You, too have been (owned by HIMSS). Investors are there, of course, but I would assume everybody already knows that. Pro tip: despite appearances, the people wearing snappy suits are lightweights – the folks with real money (to whom the nattily attired genuflect) show up wearing clothes that are more commonly seen on golf courses and Applebee’s happy hour because they don’t need to impress anyone.

From Interview Analyzer: “Re: interviews. CEOs on occasion seem to get fresh ideas from your questions that I wonder, do they follow up with you afterward to pick your brain?” I’m pretty sure that my questions, while sometimes refreshingly off the wall or embarrassingly uninformed, have minimal business utility to someone who lives and breathes their particular niche. I attribute what you’ve read to: (a) interviewees who are being nice because they are HIStalk fans or who aren’t but hope to score flattery points; or (b) the interviewee being surprised at hearing thoughts from someone who lacks a verbal filter and who understands the race but has no horse in it. Neither party would have reason to continue the conversation offline and indeed that has never happened.


HIStalk Announcements and Requests

Readers recommended several folks for me to interview and that’s been fun. Let me know if you have suggestions of others who are interesting, doing good work, and confident enough to speak boldly about their area of interest.


Webinars

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

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Private equity firm TPG sells its chain of cancer hospitals in India to oncology device and software vendor Varian Medical Systems for $283 million, proving that healthcare as a profit-driven industry isn’t just an American concept.

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Inova Personalized Health Accelerator invests an unspecified amount in Ireland-based Deciphex, which develops AI-powered digital pathology triaging applications such as Patholytix Preclinical.

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A Signify Research report finds that the EHR market in EMEA (Europe, Middle East, and Africa) is highly fragmented, with Cerner being the only vendor that holds a double-digit percentage of the region’s estimated $3.7 billion in annual spending.

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Google parent Alphabet’s Verily signs deals with several drug companies to display study recruitment ads to people who search for certain symptoms. Verily’s Project Baseline, launched in 2017, invites people to sign up (it’s a 12-minute online process) to contribute their research data, participate in surveys and focus groups, and test new technologies in working with partners Stanford Medicine, Duke University School of Medicine, and the American Heart Association.

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PatientsLikeMe founder Jamie Heywood expresses frustration that the federal government’s Committee on Foreign Investment is forcing the company to sell itself because its key investor is China-based genomics company ICarbonX. PatientsLikeMe is expanding beyond offering people a platform for discussing their conditions and symptoms with others with the same condition, now collecting their blood samples for AI analysis to understood more about human disease. Heywood says the government was concerned about exposing de-identified patient data to Chinese investors and insisted that the company prove that its work presented no national security risks.


Sales

  • Camden Coalition of Healthcare Partners chooses ACT.md’s social determinants of health collaboration system, which will support its care model identifying high-utilization patients and visiting their homes to help with medications, transportation, and connecting with social services.
  • In England, Gloucestershire Hospitals NHS Foundation Trust will implement Allscripts Sunrise.
  • Baystate Health (MA) selects Artifact Health’s mobile physician query platform to give physicians a faster way to review records in its clinical documentation improvement program.
  • Central Ohio Primary Care will use Updox for document management and communications services.

People

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Greg Miller (Health Catalyst) joins TransformativeMed as chief growth officer.

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Hackensack Meridian Health hires Pam Landis (Atrium Health) as VP of strategic digital programs.


Announcements and Implementations

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Google releases an updated enterprise edition of its much-maligned Glass, promoting the product from its Google X skunkworks division to mainstream Google. The $999 Glass won’t be sold directly to consumers – its audience is companies that want to sell their productivity-enhancing industrial software. The new version has a beefed-up processor and runs on Android with easier API integration. Google’s blog post says that Sutter Health is a development partner, which probably relates to its use of (and investment in) the Augmedix remote scribe service.

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A new KLAS report on practice management systems for practices of 11 or more doctors finds considerable variation in performance even those systems have been around forever. Epic continues to lead in satisfaction by far as customers report lower A/R days and better cash flow, while NextGen Healthcare is steadily improving. Practices of 76+ doctors report growing dissatisfaction with Cerner, mostly due to the product itself, and only 40% of them expect to see improvement in the next year. Satisfaction with Athenahealth has also declined significantly as customers say the company’s changing culture has impacted product support. They also express uncertainty about the company’s merger with Virence Health. Greenway Health performed well in mid-sized practices and is improving.


Government and Politics

The TL;DR version of why Missouri is the only state that can’t figure out how to launch a prescription drug monitoring database: (a) politics; (b) a family doctor-state senator who keeps squashing legislative efforts over privacy concerns that he somehow links to federal meddling in gun ownership; and (c) proposed bills that would have made physician use of the system mandatory.


Other

A Harvard Business Review article describes how New York City Health + Hospitals uses data science to identify homeless patients and match them to community services. They look for patient records that contain:

  • A home address of a homeless shelter or hospital
  • The words “homeless” or “shelter” in the home address
  • 10 or more ZIP code changes in one year
  • Registration-collected “homeless” flags from those few facilities that record it
  • ICD-10 codes for homelessness in the problem list, diagnostic assessment, or billing record

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I’m a big fan of giving patients a way to communicate their self-assessed health status to clinicians via an electronic form. Patient-reported outcomes for early chemotherapy side effect detection is one example, where patients report how they’re feeling or problems they are having that can then trigger EHR alerts for quick follow-up. An oncology researcher found that cancer patients who were provided that method of feedback lived an average of five months longer than those who weren’t, which doesn’t sound all that impressive until you remember that chemo drugs that cost hundreds of thousands of dollars often can’t deliver even that modest life extension. This concept should be applied to routine encounters – why must doctors swoop into the exam room and immediately start reading an electronic or paper form for the first time to see why you are there and then ask you all over again, wasting a couple of the few minutes patients get? I can’t figure out why the SF-36 form with additional specific data collection isn’t used widely, other than (a) clinicians aren’t paid to review it; (b) providers aren’t really interested in a patient deep dive as much as cranking out billable work; and (c) providers are afraid of being sued for missing something that turned out to be important. I have never personally seen this form, or anything like it, used out there in the Wild West of healthcare’s front lines, suggesting that my providers don’t really want to open up a can of medical worms by asking how I’m doing overall except as the rhetorical question part of exam room small talk.

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Analysis by US News & World Report finds that Washington, New Hampshire, and Minnesota are the best states overall when taking into account everything from healthcare to the economy. Dead last at #50 is Louisiana, which beat out fellow cellar-dwellers Alabama, Mississippi, West Virginia, and New Mexico. The public health implications are significant given the key role of states in driving public health, setting spending levels on social services, and creating and enforcing healthcare-related laws. You might also assume that telemedicine could be important if skilled clinicians agree with the conclusions and elect to live elsewhere.

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I missed this story that illustrates how healthcare price competition should work if you buy the idea that care is a commodity. SSM Health will charge just a flat $25 for a questionnaire-based, call-back virtual physician visit. It appears to be a white-labeled service from Zipnosis. I wondered where the country would get enough pharmacists when chain drug stores were popping up on every corner, so with that fear proven to be unfounded, I can now wonder whether we have enough doctors to staff telemedicine services. Probably so given puzzlingly modest adoption, although being a telemedicine doctor must be like working as an Uber driver except the money is good, you can work from home in your pajamas, and your car stays clean (note to self: patent the idea of telemedicine surge pricing). It sounds potentially dehumanizing as a doctor, however, since the only important outcomes involve volume, patient satisfaction, and not getting sued since the patients have low-acuity needs that are being addressed episodically. Maybe it will devolve into those 1980s 1-900 telephone services for sex and psychics, although the objective there was to keep callers on the line with the meter running (there’s another note to self in maximizing profit from chatty patients). 

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An interesting study finds that the overconfidence of wealthy people makes everybody think they are more competent than they really are, proving that “fake it until you make it” and some level of snobbishness works, especially in one-off situations such as job interviews. I’ll add an unresearched postulate – executives often think they are smarter and more insightful than everyone else just because someone put them in charge, causing them to overvalue lone-wolf instinct instead of underling-assembled facts and analysis (I wrote about this way back in 2006 in describing what I called “Man of Action Syndrome.”)


Sponsor Updates

  • Dimensional Insight will exhibit at the 2019 MUSE Inspire Conference May 28-31 in Nashville.
  • Bluetree will exhibit at the HIMSS Southern California 2019 Annual Healthcare IT Conference May 23 in Los Angeles.
  • CarePort Health will exhibit at ACMA Northern California May 28-29 in Napa.
  • The Chartis Group publishes a paper titled “EHR Benefits: Unlocking the Secrets of Successful Organizations.”
  • Authority Magazine profiles Collective Medical CEO Chris Klomp.
  • CoverMyMeds will exhibit at the 2019 CMSC Annual Meeting May 28-June 1 in Seattle.
  • Hunt Scanlon highlights Direct Recruiters’ integration with sister company Direct Consulting Associates.

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Curbside Consult with Dr. Jayne 5/20/19

May 20, 2019 News 2 Comments

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In a recent issue of Applied Clinical Informatics, researchers from the Arch Collaborative detailed their examination of the relationship of EHR user satisfaction to the investment in training made by the users’ organizations.

This comes as no surprise to those of us who have spent time in the EHR implementation trenches. Those who have more effective training tend to be better users of a given system. Being a better user often leads to less frustration compared to those who are struggling with the system. In general, people who experience less frustration might tend to be happier with their workday, or at least with the tasks that have to be completed in the EHR.

The data was compiled from a survey of 72,000 clinicians across 156 provider organizations to identify which elements determine whether a user reports higher levels of user satisfaction. The authors noted, “If healthcare organizations offered higher-quality educational opportunities for their care providers – and if providers were expected to develop greater mastery of EHR functionality – many of the current EHR challenges would be ameliorated.”

I’ve seen health systems that would allow physicians to go live on a system with only a couple of hours of classroom training with no hands-on experience and no ability to personalize or configure the system even though the system had those capabilities. In my experience, users trained in this manner have a greater tendency to turn into raging EHR haters than those who receive training that includes laboratory scenarios and the ability to create favorites and defaults.

I’ve also seen plenty of go-lives at organizations that didn’t hold physicians accountable for mastering the EHR. “Difficult” individuals might be allowed to opt out of training altogether after putting up barriers to participation in scheduled sessions.

I watched one hospital bend over backwards to schedule training at the time and place demanded by each subspecialty department, only to have a large number of physicians no-show their scheduled sessions. Conversely, I’ve worked with hospitals that demanded their providers attend training sessions and complete practice scenarios before being allowed access to the production system. Of course the latter group of providers seemed happier with the changes in workflow brought by the EHR than those who fought the process. In the study, physicians who reported poor training were “over 3.5 times more likely to report that their EHR does not enable them to deliver quality care.”

The researchers looked at multiple organizations across a subset of EHR systems and noted that a smaller portion (20%) of variation in user experience can be attributed to the actual software, but a larger portion (50%) of variation resulted from differences in how users acted on the system. They were able to identify both successful and unsuccessful provider organizations using the same systems. They also noted nearly 500 examples where two physicians of the same subspecialty at the same organization used the EHR and cited markedly different user experiences. In almost 90% of those situations, the more satisfied physicians said they had better training or more effort spent on personalizing the EHR.

Ultimately, the authors recommend that organizations require at least four hours of EHR training if they want to avoid frustrating their users. I would suggest that four hours doesn’t scratch the surface of what it takes to be an EHR power user. Physicians often argue that systems aren’t intuitive and it shouldn’t take them that long to learn how to do it since paper is “a no brainer,” but I point them back at the countless hours that they spent as medical students, interns, and residents learning to write a good note. Only through time and practice are the 10-page history and physical documents generated by third-year medical students whittled down into a two-page admission note done by a resident and a one-pager dictated by an attending physician.

The authors use the example of the scalpel, which “is a tool that has a very simple interface and use, but using it with confidence and safety requires knowledge of anatomy and surgical techniques coupled with practice to use it skillfully. In other industries, it is well recognized that education and training are of paramount importance to the successful use of professional-grade software. We need to recognize that this also holds true for EHRs and the practice of medicine.”

The authors recommend standardizing EHR training paradigms, although they were not able to identify a single methodology that performed better than the rest. They did note that more training needs to be focused on user-level configuration or personalization. However, they also noted that improved user training “needs to be balanced with a parallel focus on better designed and smarter software that can better meet nuanced needs of healthcare.” They also note that “these findings do not negate the need for EHR developers to continue to improve their user interfaces to be more intuitive, nor do they negate the critical need to reexamine the current regulatory and billing requirements that drive so much of the clinical documentation burden faced by providers today …”

They look to the future in considering the growing role of decision support within EHRs and how it might impact patient care. “For this vision to become a reality, physicians will need to know the limits of their technology’s advice in the same way that pilots know the limits of a plane’s autopilot. Without clearly understanding the EHR’s limits or how to use the technology, care providers will not trust the technology they work with.”

I like the airplane analogy. One of the EHRs I’ve worked with is an extremely robust system and some users complain it’s too complicated. I used to say that it is like a fighter plane – you want a system that is completely capable in case you wind up in a dogfight, even though most of the time you are just going to be on patrol. Users need to understand how to efficiently and effectively use the features that make up 80% of their day, but they also need to know how to access the next level of features for when the one-off situations arrive in the office.

The authors made some forceful comments that made my attention, one being that “caregivers who do not understand EHR technology are a threat to quality care and will likely not realize an efficiency gains in using the EHR nor be able to use the technology fully to advance care quality.” They go on to “advocate for caregivers to adopt EHR technology expertise as a core competency of their profession.”

I’m sure some physicians reading the study might be up in arms over its conclusions. I’ve been known to say that if some physicians would spend the same amount of time actually learning the EHR that they do complaining about it, they’d find themselves in a different place. This piece seems to reinforce that sentiment.

What do you think about the impact of training on EHR user satisfaction? Leave a comment or email me.

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Monday Morning Update 5/20/19

May 19, 2019 News 7 Comments

Top News

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JP Morgan Chase will acquire medical payments platform vendor InstaMed for more than $500 million. It’s the bank’s largest acquisition since the 2008 financial collapse, when it took over the failing Bear Stearns and Washington Mutual.

The bank’s head of wholesale payments says that 90% of providers still bill on paper. He says an acquisition makes more sense than starting from scratch since InstaMed has already created both the platform and its extensive network.

InstaMed, founded in 2004, had raised $134 million in funding. Co-founders Bill Marvin and Chris Seib were previously with Accenture. The 300-employee, Philadelphia-based company processed $94 billion in transactions last year.


Reader Comments

From Malted Milk Ball: “Re: ‘most powerful’ and ‘most influential’ lists. What is their methodology?” You’ve seen those click-baity “Best Hamburger in All 50 States” and “The Best Dog Breeds for Families” lists, compiled by some social media-savvy kid who has zero first-hand experience but who knows how Google and steal data from online sites. As far as I can tell given minimal transparency on the process, this is the same. Either someone is nominated (most likely by themselves) or aforesaid Googler simply heads over to LinkedIn. At least HIMSS is honest in accepting nominees for its “Most Influential Women in Health IT Awards,” although a committee of unstated membership makes the final decisions, gives preference to HIMSS members, and obligates nominees to contribute two HIMSS fluff pieces. It’s also good to remember that HIT fame is fleeting – Modern Healthcare’s 2008 “Most Influential in Healthcare” list was topped by Steve Case (Revolution Health Group) and Eric Schmidt (Google), then rounded out by some folks who have since passed away as well as those who are mostly forgotten, are now viewed less favorably, or who held a powerful role for a short time (former Hackensack CEO John Ferguson, short-term National Coordinator Rob Kolodner, and former FDA Commissioner Andrew von Eschenbach caught my eye among faded politicians and lots of people I’ve never heard of).


HIStalk Announcements and Requests

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A combined 53% of poll respondents take the federal government at its word in pushing interoperability to give patients more control and to save money, although a significant number believe its motivation is to benefit data brokers or to discredit previous administrations.

New poll to your right or here: If you’ve coordinated post-acute care for someone in the past five years, how hard was it? The bonus question, which you can answer by clicking the poll’s Comments link after voting, is how technology might have made the process easier or better.

Dear people who are writing for public consumption: please don’t start sentences with “there,” “so,” and “and.” It would also be nice if you didn’t mismatch a collective subject with a plural verb, as in, “The group of hospital CEOs are attending a conference.” Don’t misspell the possessive “its” as “it’s,” a mistake so prevalent that it seems more the rule than the exception. You can certainly write however you like when your readers are acquaintances — the folks with whom you would be comfortable wearing a ketchup-stained tee shirt or after having one-too-many glasses of wine —  but everybody else is forced to judge you on your thoughts and how well you express them. Most knowledge workers whose writing style is below average will see significant ROI from applying the slight bit of effort that is required to move to above-average (especially since the average is moving down). I’m preachy about this, but only because I want all readers to do everything they can to be successful.

Happy Victoria Day to readers in Canada.

Listening: Brooklyn-based Afrobeat band Ikebe Shakedown, a 1970s-style groove of big horns and wah-wah guitar funk. The Afrobeat genre was created long ago by the legendary Fela Kuti and is carried on by groups like Newen Afrobeat. I’ve seen an Afrobeat band live at an outdoor event and it gets people moving more than just about any other kind of music. I’m also still playing a lot of surf rock ran across the all-female, Canada-based Surfrajettes, which YouTubers compare to a Tarantino movie, what Austin Powers extras do on break, and “one of the best living room bands I’ve seen.”


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

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The Alabama Supreme Court rules that purchasers of all software, regardless of whether it is off-the-shelf or customized, must pay state sales tax. Russell County Community Hospital paid the state $18,000 in sales tax for its Medhost software and equipment (as correctly billed separately by the company to comply with state law), but the hospital then petitioned the Department of Revenue for a refund in arguing that what it had actually purchased was non-taxable “custom software programming.” The Supreme Court disagreed, ruling that “all software, including custom software created for a particular user, is ‘tangible personal property’ for purposes of Alabama sales tax.”


Sales

  • University of Rochester Medical Center joins the TriNetX research network to expand access to clinical trials and for cohort discovery.
  • KPMG will offer Waystar’s social determinants of health data to users of its clinical intelligence platform for care continuum optimization. 

Announcements and Implementations

Pivot Point Consulting launches HIM services that it will back with quality guarantees.


Government and Politics

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FDA warns users of do-it-yourself artificial pancreas systems that the individual components, including software, don’t necessarily work together to accurately control blood glucose levels. This follows a report of a patient who received repeated insulin overdoses due to incorrect blood sugar readings issued by their homebrew setup.


Other

A single-hospital review finds that adding internal timer functions to the EHR and monitoring its event log allows the hospital to reliably measure the before-and-after result of software changes. It this determined that streamlining the nurse’s EHR patient history function reduced user clicks and the time required by more than 70%. I like this work for two reasons: (a) it highlights the importance of focusing relentlessly on optimizing clinician EHR time; and (b) it provides an automated way to capture the result that goes beyond (or perhaps hand-in-hand with) user surveys and anecdotal reports from the more IT-friendly clinicians.

Unrelated but interesting: Uber and Lyft drivers who are waiting to pick up fares at Reagan National Airport are logging out of the company driver apps right before big planes land, with the AI of the apps then triggering surge pricing because of the driver shortage. The drivers then log back in a couple of minutes later and are paid at the higher rate. Maybe this is more relevant than I think in illustrating that software-enabled gaming of the system is likely happening all over healthcare.

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This might be the news item needed to convince movie studios to make a Theranos-like movie about microbiome testing company UBiome, which was recently raided by the FBI after complaints of billing fraud. Co-founder and co-CEO Jessica Richman, PhD lied about her age to qualify her for various low-rent “Under 30” awards even though she was 40 at the time. I pulled the photo above with Maria Shriver from her Twitter – the now-45-year-old Richman is on the left. In a Theranos-like poorly kept romantic secret, insiders also say she was in a relationship with her co-founder, Zachary Apte. It’s pretty obvious – online records I checked in the free parts of some people-searching sites show both of them living at the same address in Washington (the article says they have houses in two states) and voter records confirm that Richman is 45 and Apte is 34. Lack of age-checking leads me to ponder how organizations that have separate awards for women verify the nominations – do they go strictly by appearance or name and are slippery slopes inevitable?

Newly filed tax records indicate that UPMC CEO Jeffrey Romoff got a 40% raise in 2018, with $8.5 million in total compensation. Another two dozen of the health system’s executives exceeded $1 million. UPMC reported FY2017 profit of $189 million on revenue of $13.5 billion.

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I’m pretty sure this little guy who had just emerged from tonsil surgery at UPMC Susquehanna was happier to be comforted by Annie Hager, RN than one of UPMC’s million-dollar executives. He even brought her flowers for his follow-up visit, making it her turn to cry.


Sponsor Updates

  • Patient engagement and Next Best Action technology vendor SymphonyRM doubles its client base year over year.
  • Ken Congdon, content marketing manager at Hyland, publishes “EMR Optimization is the Hottest Thing Since … EMRs.” 
  • Lightbeam Health Solutions publishes a new white paper, “Data-Driven Solutions Providers and Payers Need for Value-Based Care Alignment.”
  • Mobile Heartbeat and Voalte will exhibit at NWone May 20 in Stevenson, WA.
  • Waystar will exhibit at the ECW Education Expo May 27-31 in Boston.
  • NextGate will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Netsmart will exhibit at the Leading Age TX Annual Conference May 19-22 in Austin, TX.
  • Flywire Health and The SSI Group will exhibit at HFMA Region 1 May 21-22 in Uncasville, CT.
  • QuadraMed publishes a new case study, “Atlantic Health System Entrusts Patient Identity Leader for MPI Cleanup Before Massive Epic Rollout.”
  • Vocera will exhibit at the Northern Ohio HIMSS Spring Conference May 23 in Cleveland.

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News 5/17/19

May 16, 2019 News No Comments

Top News

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A large clinician survey finds that training is the #1 predictor of positive user EHR experience. Little correlation was found with the actual EHR product they use.

The report by KLAS’s Arch Collaborative warns that organizations can’t rely on software usability to create physician user success and that poor EHR users are a threat to quality.


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

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Glytec receives a patent allowance for interactions between its insulin titration software and connected diabetes technologies like smart insulin pens and pumps and continuous glucose monitoring systems.

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Axios number-crunchers determine that healthcare’s top CEOs made a combined $2.6 billion last year, with nearly half of those leading pharmaceutical companies. Allscripts CEO Paul Black took home $7 million, while Cerner’s Brent Shafer earned nearly $10 million. McKesson’s John Hammergren was paid $18 million, including a $4 million bonus for hitting financial targets even though the company faced several lawsuits. Community Health Systems CEO Wayne Smith, who continues to sell off unprofitable hospitals, received a similar perk for reasons that were unrelated to patient outcomes.


Sales

  • Great Lakes Medical Imaging (NY) will implement NextGate’s enterprise master patient index.

People

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National urgent care provider American Family Care hires Claudius Moore (The South Bend Clinic) as VP of IT.


Announcements and Implementations

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Hospital operator HCA Healthcare will roll out its SPOT algorithm and alert system for the early detection of sepsis to emergency rooms in the coming months. It also plans to expand the technology’s capabilities to include the detection of post-operative complications, early signs of deterioration, and shock in trauma patients.

Baptist Health implements PatientPing’s real-time care alert software for its ACO members in Louisiana, Kentucky, and Indiana.

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The HCI Group will lead Texas-based Val Verge Regional Medical Center’s Meditech Expanse implementation.

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InterSystems releases a new version of its TrakCare EHR – used in 25 countries, but not in the US — that is built on its IRIS for Health data platform that supports FHIR standards.


Privacy and Security

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Hospitals scramble to install a security update from Microsoft after the company discovers a zero-day vulnerability in older systems with Remote Desktop Protocol that make them prime targets for ransomware attacks. “The thing that makes this one so dangerous,” says Allina Health’s threat and vulnerability management expert Jeremy Sneeden, “is that you don’t need any access. A lot of vulnerabilities, you need a username and password, or some sort of access to the machine, to make the vulnerability work. But these — I guess they’re calling them ‘wormable’ now — they don’t need credentials, and that’s why they spread so quickly.”


Other

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A ProPublica investigation of bitcoin transactions finds that at least two US companies that offer ransomware recovery services sometimes simply pay the hacker’s demanded ransom, then bill the client multiples of that amount for technical work and try to sell them ongoing security services. The recovery firms say their clients don’t want to deal directly with the extortion aspects of paying a ransom, don’t want figure out how to buy bitcoin, or want to avoid interacting with the hackers directly. Proven Data’s website says that paying ransom is a last resort since it supports criminal activity and carries no guarantee of recovering data, but its CEO admits that most ransomware is too hard to break so it’s easier just to pay. He says hospitals are among his clients. Legal experts say that serving as a ransomware payment intermediary could be construed as criminal conspiracy.

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The drug company behind a new Botox-like product pays for luxury trips to Cancun for a dozen dermatologists who were coached to talk the product up on social media and post photos of themselves on the supplied model runway and confetti-throwing station, possibly violating FTC’s requirements on disclosures. Evolus, which targets selfie-obsessed millennials who are increasingly undergoing cosmetic surgery, says it isn’t required to report doctor payments to the Open Payments database because it doesn’t sell anything that Medicare or Medicaid pays for, which allows the company’s salespeople to “be very closely involved in high touch and customer-centric and engage with these practices outside of their traditional business hours.” 

Joint Commission will give accredited hospitals real-time access to their quality measures that are submitted via its ECQM reporting process. The system’s cloud-based technology is provided by Apervita.

An article published in NEJM suggests that healthcare adopt analytics techniques that are common in the intelligence community, such as:

  • Using less-structured data storage, such as data lakes, to reduce data modeling
  • Incorporating automated metadata tagging to enhance searching and association of disparate items
  • Using natural language processing
  • Implementing cell-level security to manage data object access
  • Replacing hypothesis-based research with mining for unsuspected correlations

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The Journal of Reproductive Health finally redacts a company-funded study claiming the $330 Daysy thermometer from Swiss company Valley Electronics identifies fertility with 99.4% accuracy. Concerns about the study’s validity had been raised by researchers over a year ago. Reproductive researcher Chelsea Polis spearheaded the redaction efforts, first emailing the company and then the journal to point out the study’s questionable methodology, which included a low participation rate, poorly designed questionnaires, and cherry-picking results for marketing purposes.

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Theranos whistleblower Erika Cheung reflects on her decision to share her misgivings about the company’s business practices with CMS. “I was so paranoid about Theranos and them spying on me, I had a burner phone just to call the Centers for Medicare and Medicaid Services because I was so scared that I was going to get sued or they were going to come after me. Being followed is a very terrifying thing. That was probably the hardest thing: just conquering your own fear and just saying, ‘OK, whatever happens, you’re just going to get through it.” Cheung has since founded the nonprofit Ethics in Entrepreneurship to help startups avoid a Theranos-like fate.


Sponsor Updates

  • EClinicalWorks will exhibit at DDW 2019 May 18-21 in San Diego.
  • KPMG adds Waystar’s social determinants of health data to its Clinical Intelligence platform.
  • Ellkay, Healthfinch, and Healthwise will exhibit at Cerner NARUG May 20-22 in Richmond, VA.
  • Ensocare will exhibit at the ACMA Northern California Chapter meeting May 28-29 in Napa, CA.
  • EPSi will exhibit at HFMA Region One May 21-22 in Uncasville, CT.
  • Healthgrades names the 2019 Patient Safety Excellence Award and Outstanding Patient Experience Award recipients.
  • Imprivata will exhibit at NTI May 21-23 in Orlando.
  • AMIA inducts Intelligent Medical Objects CMO Andrew Kanter, MD and Physician Informaticist Jonathan Gold, MD into the Fellow of the American Medical Informatics Association class of 2019.
  • Kyruus will exhibit at the Healthcare Marketing & Physician Strategies Summit May 21-23 in Chicago.
  • NextGate publishes a new case study, “4 Innovations in Patient Identification.”
  • OptimizeRx will present at the B. Riley FBR Investor Conference May 22-23 in Beverly Hills.
  • Waystar enhances its Agency Manager solution with invoice verification capabilities.
  • The Silicon Valley Business Journal features Vocera CNO Rhona Collins, DNP, RN.
  • Meditech publishes a new case study booklet, “The Innovators: Meditech Customers in Action.”
  • The latest version of TrakCare from InterSystems extends its mobile capabilities to all clinical workflows.

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News 5/15/19

May 14, 2019 News 8 Comments

Top News

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AliveCor extends its ECG lead (no pun intended) over Apple with KardiaMobile 6L, which offers a six-lead ECG and expanded detection of arrhythmias including atrial fibrillation, bradycardia, and tachycardia.

The $150 consumer device has earned FDA clearance, works on both Apple and Android devices, and will reach the market in June.


Reader Comments

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From Unconjoined Twin: “Re: Medi-Span. Hit by malware. We can’t do our monthly medical loads to Epic.” Verified, although I missed this when it first came up a week ago. Netherlands-based Wolters Kluwer released a statement Monday saying that it has restored most systems – which include CCH cloud-based tax systems and other applications in addition to healthcare — after it took them offline after discovering “the installation of malware.” Discussion on Reddit says the company’s website was down, along with its Internet access, email, and phones, with one person indicating that two of their employees received emails from a Wolters Kluwer email address that contained malicious links. A Krebs on Security report says file directories that are used to store new versions of its software were found to be writable by anonymous users, at least one of whom apparently uploaded suspicious files.


HIStalk Announcements and Requests

I’m increasingly annoyed by big health systems that suddenly claim they’re passionate about empathy, post-discharge care coordination, patient engagement, innovation, social determinants of health, and patient experience. Why now? They could have done those things at any time and didn’t. They were fat and happy until threatened by disruption and possible payment changes that threaten their massive bottom lines, so now they are suddenly the self-proclaimed experts and advocates. At least they are providing a good reminder that health systems do only what someone pays them to do, which isn’t necessarily the right thing. Maybe we need a tech innovation that dispenses dollar bills every time a doctor washes their hands or doesn’t prescribe an unnecessary antibiotic.


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

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Business Insider looks at startup Sempre Health, which texts patients to offer them cash savings if they fill their new prescription quickly. The discounts are funded by drug companies as an alternative to drug coupon programs. Co-founder and CEO Anurati Mathur was a data scientist at Propeller Health and before that at Practice Fusion.


People

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Greenway Health hires Geeta Nayyar, MD, MBA (Femwell Group Health) as chief medical officer, where she will help guide development of the company’s next-generation, cloud-based EHR/PM known as Project Polaris, which the company says will incorporate the best features of  Intergy, Prime Suite, and SuccessEHS.


Announcements and Implementations

Collective Medical enhances its platform to enhance collaboration among physical and behavioral providers by adding a consent feature that complies with CFR 42 Part 2. The combined efforts of a physician group and community providers in using the system reduced 911 calls by 44%, EMS transport by 47%, ED visits by 36%, and hospital admissions by 42%.

Cerner will connect its systems to state prescription drug monitoring program databases using DrFirst.

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Definitive Healthcare adds prescription drug claims to its all-payer commercial claims platform, allowing users to analyze prescribing patterns, diagnoses, procedures, and referrals.

Storage array vendor Infinidat, whose systems use disk-based storage with memory caching, creates a software-defined flash array called Epic Compatibility Mode that it hopes will allow it to earn Epic certification since Epic does not allow disk-based storage for performance reasons.

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Relatient announces GA of an electronic registration and check-in solution that expands its Digital Front Door strategy and patient engagement platform.

Appriss Health announces a dynamic patient matching solution for its prescription drug monitoring program connectivity system.

CHIME and Sheba Medical Center at Tel Hashomer – Israel’s largest hospital – will create a health innovation lab within the hospital’s innovation center.


Government and Politics

A medical laboratory sales rep receives a 50-month prison sentence for Medicare fraud after he used a sham non-profit group to convince seniors living in low-income housing to submit to genetic testing. He recruited two healthcare providers via Craigslist to provide phony documentation, netting the three co-conspirators $100,000 in commissions from two clinical labs.


Other

A doctor who followed the suggestion of a conference speaker on social media to Google herself is shocked to find 100 negative reviews and comments that had been left on Vitals, Healthgrades, and Google, with none of the reviewers being actual patients but rather anti-vaccine activists who targeted her because of a social media comment she made in support of a colleague who was undergoing vaccine-related cyberbullying. None of the three sites removed the ratings until she got her lawyer involved. I notice that Healthgrades has removed the fake reviews, but the nut jobs have now just thumbs-downed them, while WebMD still has nearly all one-star reviews. A pediatric practice that posted a video recommending the HPV vaccine had its webpage as well as outside ratings websites flooded with 10,000 negative reviews and comments, while the Facebook of an internist who simply mentioned that his office had received its flu vaccine shipment was bombarded with hundreds of comments accusing him of poisoning children. We live in a shaky society when people can muster up so much ignorance and anger over a flu shot.

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Well said. It’s not the job of a business to tell customers how to reconfigure their lives for the convenience of the business. The “problem” isn’t that of patients.

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The Department of Defense profiles eight senior Army nurses who worked together early in their careers at William Beaumont Army Medical Center. Among them is WBAMC CIO/CMIO Lt. Col. Rich Clark (fourth from left in the photo above), who says, “Even though I work in IT, being a nurse helps bridge the gap between the physicians and IT. We look at IT from a clinical perspective now, to support the clinicians. I love coming to work every day, no day is ever the same. For us it feels like yesterday that we were in the operating room and medical ward. It’s not just the camaraderie, but it’s the mission, too. We’re taking care of America’s sons and daughters. It’s not about the money, it’s about the role and the impact that you can make.”


Sponsor Updates

  • AdvancedMD will exhibit at the America Psychiatric Association event May 18-22 in San Francisco.
  • Arcadia CMO Rich Parker, MD will speak at the New England HIMSS Conference May 16 in Foxborough, MA.
  • Artifact Health will exhibit at ACDIS 2019 May 20-23 in Orlando.
  • Avaya will exhibit at the E-Health Conference & Tradeshow May 26-29 in Toronto.
  • Dan Mendelson joins the board of Audacious Inquiry.
  • Datica CEO Travis Good, MD will speak at HITRUST 2019 May 21-23 in Grapevine, TX.
  • CompuGroup Medical will exhibit at the McKesson Sales Meeting May 15-16 in Las Vegas.
  • Impact Advisors VP John Stanley is named as one of Consulting magazine’s top 25 consultants.
  • Collective Medical updates software functionality to include a new consent feature to support better care collaboration between mental and physical health providers.
  • A UCONN computer science and engineering team sponsored by Diameter Health prototypes a new clinical user interface at UCONN’s Senior Design Presentation Day.
  • Cumberland Consulting Group will exhibit at the Medicaid and Government Pricing Congress May 20-22 in Orlando.

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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.

Blog Posts


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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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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.

Blog Posts


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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

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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.
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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.

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Reader Comments

  • CommentsTwoWeeksLate: I'd be really disappointed if the "de-identified" data set contained full birth dates or zip codes. That doesn't seem t...
  • Code Jockey: Mr. H - this is a response to 'Really' but I'm not sure how to respond to his post. Also, this is a note for both you an...
  • Clarence: From my experience 7 years as an Epic employee and then 4+ years integrating 3rd party clinical content/software into EH...
  • meltoots: I take issue with one thing in this. The ACR AUC system is ridiculous for specialist physicians. I am a board certified ...
  • Really: Come on Code Junkie... Would any software company on the planet let you take their code, do a minor modification and ...
  • Code Jockey: Sigh.... Code Corrections - the origin of this conversation was a statement by someone that Epic clients were creating t...
  • WhatstheretoWonder: Fairly clear that the ambitions were crushed by unchecked capitalism and Republican waffling on doing the necessary chec...
  • Woodstock Generation: Re: Mr. HIStalk's response to Post-Acute Pat - Mr. HIStalk, you couldn't have said it better about today's healthcare i...
  • It'sNotYouIt'sMe: I also at some point "consented" to give my bank and credit data to Equifax. If you asked the average person when they s...
  • Michael: Re: WSJ article - "without the patient's knowledge or approval." All of the patients consent to give their DNA for resea...

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