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Monday Morning Update 4/8/19

April 7, 2019 News 13 Comments

Top News

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Urgent care EHR/PM vendor DocuTAP will merge with urgent care solutions vendor Practice Velocity, the companies said in a teaser announcement that promises further details later. 


Reader Comments

From Not From Monterey: “Re: Cerner Rev Cycle. Can any site that has converted, including billing, say that claims are going out the door speedily, bills are being sent out, A/R is doing well, etc.? We have Cerner clinicals and a third-party reg/sched system. We need to either go all-Cerner or all-Epic and we’re not making any progress because of fear of Cerner Rev Cycle.” I’ll open the floor to readers.

From Weekend Warrior: “Re: Politico’s Morning EHealth. Cutting back to three days per week. Cue sound of bubble bursting?” Politico launched its free weekday newsletter in mid-2014 under the umbrella of “EHealth.” Healthcare technology has lost some of its luster due to the end of federal incentives, market saturation, the domination of a few broad-line vendors, and technology’s lack of success in improving outcomes, cost, or public health in general. As a result, HIMSS, other conferences, and low-value websites have had to trade their long-term credibility for short-term vendor cash where never is heard a discouraging word. Unlike those organizations, while I don’t find a lot I need to know from Politico and maybe 10% of any given issue at most seems relevant, they are good at bird-dogging government stories and that’s important. I think the toilet bowl water is already swirling around some poorly run sites and “curators” that can’t deliver decision-making eyeballs – the Reaction Data survey from a couple of years ago exposed the difference between having a enthusiasm-powered but expertise-light website, newsletter, or social media account that no C-level reader would ever follow.


HIStalk Announcements and Requests

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Poll respondents are skeptical about any near-term benefits of artificial intelligence in healthcare. As they should be.

New poll to your right or here: Hospital software vendor employees: how are business conditions now compared to two years ago?

Thanks to the following companies that recently supported HIStalk (without gaining any editorial control for doing so, I should add). 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.


Acquisitions, Funding, Business, and Stock

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Crain’s Chicago Business says the attempt by Allscripts to diversify itself away from smothering competitors Epic and Cerner in a slowing EHR market hasn’t paid off for investors, as disappointing financial reports have sent shares down. It expresses some hope that selling patient data – through its Veradigm (the former Allscripts Payer & Life Sciences) and Practice Fusion businesses – will eventually boost financials, although analysts say competitors could easily enter growth markets such as population health with products better than those Allscripts sells. Above is the five-year share performance of MDRX (down 39%) vs. the Nasdaq (up 99%). Shareholders hate watching companies promising but failing to deliver, even with a good excuse such as being deep in a market that is receding and a consolidating customer base that is standardizing solutions from competing vendors.

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I expected Inc.’s pretend letter to Apple CEO Tim Cook from Steve Jobs to be lame, but it was actually pretty brilliant in defining what Apple should be doing beyond sitting on a pile of cash, announcing late market entries in video streaming and credit cards, and allowing the Mac to age ungracefully. This is a great idea:

Google is our new nemesis, remember? They attacked our core business model with that Android PoC. But, Tim, c’mon… Google is weak. They can’t innovate worth beans and most of their revenue still comes from online ads, which are only valuable because they constantly violate user privacy. You could cut their revenues in half if you added a default 100% secure Internet search app to iOS and Mac OS. Spend a few billion and make it faster and better than Google’s ad-laden wide-open nightmare. This isn’t brain surgery.


People

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Google Cloud healthcare vertical leader Greg Moore, MD, MS, PhD joins Microsoft as corporate VP, health technology and alliances. He was at Geisinger from 2010-2016.


Announcements and Implementations

Medsphere announces GA of its cloud-based Wellsoft Urgent Care, which includes the top-rated Wellsoft EDIS – which it acquired in late February 2019 — along with practice management and patient engagement applications.


Privacy and Security

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Hardin Memorial Hospital (KY) is working to restore systems taken offline by a reported cyberattack of an unstated nature.

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Dropbox pays a bounty of $319,000 for being made aware of 254 product security flaws that were documented by hackers who participated in a one-day security vulnerability bug hunt. The CEO of the hacker challenge company HackerOne suggests that companies not necessarily use the bounty programs to find their biggest vulnerabilities, but rather those with the most value at stake, such as systems that hold medical or customer data.


Other

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The Madison paper belatedly notes the 40th birthday of Human Services Computing, launched March 22, 1979 in an apartment building basement by its only full-time employee, a computer science instructor named Judy Faulkner. She later renamed the company to Epic Systems, which now has nearly 10,000 employees, $3 billion in annual revenue, and a billion-dollar campus. The company still insists on the personal touch – incoming calls are answered by a human rather than a machine and outbound mail always bears old-fashioned postage stamps rather than electronic postage.

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A breathless Google-Harvard Medical School NEJM article sees a time in which AI reviews every medical decision for appropriateness, catches provider mistakes, and refers tough cases to experts for diagnosis. Sounds good, but I’m puzzled at what the future of medical practice will be when on one hand you have frightful deviation in diagnosis and treatment (use of outdated data, refusal to follow evidence-based medicine, hurried decision that are often wrong, and a tendency to over-treat rather than to wait patiently) versus having AI simply calling the shots by looking deeply and broadly at what has worked on similar patients. Or, embedded the practices of the best doctors for the benefit of the majority. Do you allow those poorly-performing doctors to keep their involvement, just as we did in anointing hospitals as the overseer of population health even though they showed zero interest and aptitude in it when nobody was paying? We should just admit science doesn’t always drive medical decisions and the practice of medicine can be inconsistent, illogical, expensive, dangerous to patients, and not necessarily a positive influence on patient outcomes. My conclusion – do everything you can to avoid becoming enmeshed in the rabbit hole of diagnostic and treatment Whac-A-Mole – a well-intentioned medical system can cause more harm than good in unsuccessfully chasing one problem after another in an uncoordinated manner, especially when they’re getting paid either way. 

The New York Times notes the frightening but seldom-reported spread of drug-resistant fungal infections, likely caused by rampant antimicrobial overprescribing and use in feed crops. Government agencies and hospitals don’t usually publicly acknowledge outbreaks because of fears of negative publicity and the fact that patients can’t do much about it anyway. You have to admire those bugs – while humanity is divided into whether it’s us or the cockroaches that run out the clock, the ever-transforming bacteria, viruses, and fungi just keep adapting to whatever we throw at them and may eventually kill us all off (if we don’t do it to ourselves first). 

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A 39-year-old Villanova adjunct professor should probably have questioned why the health insurance she bought over the Internet cost her just $250 per month. The answer: it wasn’t real insurance, but instead was a short-term junk insurance plans like the White House is pitching that does not cover pre-existing conditions and pays only a fixed price for a short list of services. She says the agent for the publicly traded insurance broker lied to her about the Chubb-provided coverage even though the acceptance letter she signed made it clear that the non-ACA compliant plan doesn’t cover emergency services, either. The plan offered to pay a grand total of exactly $0 for her $22,500 worth of emergency sepsis treatment, with the hospital demanding to be paid upfront for the resulting foot amputation.


Sponsor Updates

  • MDLive and Redox will exhibit at ATA 2019 April 14-16 in New Orleans.
  • Meditech, Mobile Heartbeat, PatientSafe Solutions, and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at AONE April 10-13 in San Diego.
  • NextGate and ROI Healthcare Solutions will exhibit at Cerner SERUG April 9-12 in St. Pete Beach, FL.
  • The local paper covers PatientPing’s partnership with the Lewis and Clark Information Exchange.
  • PerfectServe, Voalte, and Vocera will exhibit at ANIA April 10-13 in Las Vegas.
  • PreparedHealth will exhibit at ACMA April 13-17 in Seattle.
  • Optimum Healthcare IT announces a refreshed brand identity.
  • Sansoro Health releases a new podcast, “Pigs, Pain Management & Palliative Care.”
  • Surescripts will exhibit at the EClinicalWorks Health Center Summit April 9-11 in Boston.
  • TriNetX acquires Custodix NV’s InSite network, establishing the world’s largest clinical research network.
  • Wellsoft will exhibit at the Texas Organization of Rural and Community Hospitals event April 10-12 in Dallas.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates. Send news or rumors.
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News 4/5/19

April 4, 2019 News 5 Comments

Top News

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PatientsLikeMe looks for a buyer after the Committee on Foreign Investment in the United States demands that its majority owner, a Chinese investment firm, divest its holdings in the company. The personalized health network has raised $127 million in several venture rounds.

The Trump administration expanded the committee’s oversight last year as concerns heightened around national security and trade secrets, a move that caused Chinese investments in US companies to plunge from $46 billion to just under $5 billion over the last two years.


Reader Comments

From Sagebrush Sister: “Re: CIO vendor entertainment violations. Looking for examples, as my organization is hosting a Pebble Beach outing for key clients. They didn’t consider the healthcare folks and I’m trying to get them to add CEs, even if just for damage control.”

From John R. Public: “Re: America’s Health Insurance Plans whining. It’s funny that they are crying wolf after they’ve harassed providers forever for information while providing them with dated stacks of papers or confusing web pages that are not actionable.” AHIP says 2020 implementation of mandatory data sharing under CMS’s proposed interoperability rules is unrealistic given the effort required to comply with standards that aren’t yet defined.

From HIT OG: “Re: CareCloud. Laid off 40 employees yesterday via a conference call.” Unverified.


HIStalk Announcements and Requests

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Readers have sent some great alternatives to buying a big swath of HIMSS conference exhibit hall space, which I’ll run shortly, Meanwhile, your suggestions are welcome.


Webinars

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


People

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Spok names Timothy Tindle (Harris Health System) as CIO.

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Quil, the joint digital health venture of Comcast and Independence Health Group, names former Imprivata executive Carina Edwards as CEO.

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Ascend Innovations hires Marty Larson (Greater Dayton Area Hospital Association) as president and CEO.

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Michelle Blackmer (CareEvolution) joins Verato as VP of marketing.

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Jim Costanzo (Ernst & Young) will succeed Bruce Cerullo as Nordic’s CEO on July 1. Cerullo will become chairman of the board.

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Sonifi Health hires Cheryl Cruver (Aetna) as chief revenue officer.


Sales

  • The Heights Hospital will implement RCM and health IT software and services from MTBC when it opens in Houston later this year.

Announcements and Implementations

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UMass Memorial Health System will roll out video-based substance use disorder evaluation software at three of its EDs over the next three months. The technology, developed by four physicians from within its Memorial Medical Group, was the winning submission in the annual UMass Prize for Academic Collaboration and Excellence.

Innovaccer launches social determinants of health surveys that feed into its community resources referral program.

The Consumer Technology Association, organizer of CES, forms a working group with nearly 30 healthcare and tech companies to develop standards and best practices for AI in healthcare.

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Healthgrades develops a customer data platform to help providers better aggregate and manage health data and power CRM systems.

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ProMedica’s Coldwater Regional Hospital (MI) will go live on Epic next month. The Toledo, OH-based provider began a system-wide implementation in 2015.

InstaMed launches a blockchain-powered platform for payments.


Government and Politics

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The FTC wins a $50 million court judgment against Omics International, an India-based scientific research publishing company that has for years been accused of deceptive business practices. A judge in Nevada, where the company has a mailing address, has also ordered the company to stop misleading authors about the legitimacy of its publications, marketing conferences with unconfirmed speakers, and failing to disclose fees.

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Departing FDA Commissioner Scott Gottlieb, MD will return to the American Enterprise Institute to work on drug pricing. He joined the think tank as a resident fellow in 2002.


Privacy and Security

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Amazon announces the availability of six new HIPAA-compliant Alexa healthcare skills. Organizations participating in the invite-only, HIPAA-eligible program include Express Scripts, Cigna, Livongo, Boston Children’s Hospital, multi-state Providence St. Joseph Health, and Atrium Health (NC).


Other

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The New York Times highlights the popular trend of “restaurant-style” medicine offered by prescription-on-demand companies like Roman, Kick Health, and Nurx. Medical experts point out these startups give consumers the power to choose their drugs and then have their choices validated by a remote physician, a service that typically omits any type of counseling about potential side effects. Detractors warn that despite their buzzy marketing, convenience, and multimillion-dollar fundraising rounds, consumers should approach these services with caution. The big question I always have – why would a doctor agree to practice in this type of arrangement that violates just about everything in the Hippocratic Oath? (answer: easy work for $$$). It’s too bad that our culture sees prescribing as just a minor speedbump to getting what we think we should have, regardless whether it’s likely to be beneficial or safe.

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Bloomberg looks at the lengths hospital chain Narayana Health will need to go to in order to care for India’s poorest patients under the country’s new national health insurance plan. The company, which already offers assembly-style procedures at rock-bottom prices, was launched by cardiac surgeon Devi Shetty in 2000 with a $20 million loan from his father-in-law. Shetty has tapped his son to lead a software startup dedicated to analyzing and trimming costs from Narayana’s operations, which are already operating on razor-thin margins that, when all is said and done, result in outcomes equal to or better than those of US hospitals. Shetty says, “I would like in my lifetime for every citizen of this planet to get health care at a price they can afford to pay without having to beg or sell something.”

Meanwhile in the US, a West Health-Gallup survey finds that one in eight Americans borrowed a total of $88 billion last year to pay for healthcare services. Sixty-five million people deferred care altogether because of cost.

An outside review of Memorial Sloan Kettering Cancer Center finds that the organization violated conflict-of-interest policies and fostered a culture that valued profits over research and patient care. MSKCC’s relationship with AI startup Paige.AI was one of the issues that triggered the review, as reports noted that it shared pathology slides with the startup as some of MSKCC’s top executives were given lucrative participation arrangements.

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This is bizarre: People claiming to work for Passport Health Plan are showing up in an unmarked van around poor neighborhoods in Louisville, KY offering members $20 for DNA samples. Those who underwent a cheek swab were told they were being tested for cancer.

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This is how obituaries should be written, as the family of 63-year-old Iowan Tim “Lynyrd” Schrandt describes him in a way that makes you wonder how he interacted with his doctors and nurses. The big finish is this:

Tim led a good life and had a peaceful death, but the transition was a bitch. And for the record, he did not lose his battle with cancer. When he died, the cancer died, so technically it was a tie! He was ready to meet his Maker, we’re just not sure the Maker is ready to meet Tim. Good luck, God! We are considering establishing a GoFundMe account for G. Heileman Brewing Co., the brewers of Old Style beer, as we anticipate they are about to experience significant hardship as a result of the loss of Tim’s business. Keep them in your thoughts.


Sponsor Updates

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Contacts

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

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News 4/3/19

April 2, 2019 News 1 Comment

Top News

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Walgreens announces executive changes, store layout redesign, and cost-cutting measures following its announcement of disappointing quarterly results Tuesday.

WBA shares closed down 13 percent Tuesday after the company released results that fell short of expectations for both earnings and revenue. They’re down 12 percent on the year and up just 14 percent over the past five years vs. the Nasdaq’s 96 percent gain.

In yet another example of the “healthcare is big business that takes money from the ill” paradigm, the company’s US pharmacy operations delivered disappointing results because of a mild flu season and a de-emphasis of tobacco.

The company says it has created a new digital leadership team and embedded Microsoft within it.


Reader Comments

From Clarence Oveur: “Re: exhibiting at HIMSS. We’re questioning the value. Wondering if you are hearing that from other companies?” I’ve heard from a couple of folks who asked me what I thought about moving their multi-hundred thousands of dollars of exhibit hall expense into something that might generate actual leads (which for them, HIMSS19 did not, and I’ve heard that quite a bit). Most of those who have toyed with that idea in past years got scared into paying up over fears (likely justified) that competitors would create innuendo around their absence. Consider these points:

  • Make sure customers and prospects don’t see an exhibit hall pullout as a sign of financial challenges. Tell them well beforehand why you’ve changed strategies and where you’ll spend the money instead.
  • You’ll still probably want a convenient way to connect with people during the conference, which might be an exhibit hall meeting room, a staffed HIMSS Bistro table (if they offer that service again), or either a single event or a series of dinners with an executive. HIMSS locks down basically everything in sight of the convention center and then some, so solve the real estate issue early (a la the JP Morgan Healthcare Conference, which to many attendees is held in unofficial hotels, coffee shops, and park benches because the main venue is sold out).
  • Don’t fail to work the hall even if not exhibiting in it. You might find a prospect, partner, employee, acquirer, or acquiree just from wandering around in the right places as a plain old registrant.
  • Figure out the kinds of activities that offer better ROI than a glitzy booth. Maybe it’s a series of webinars, regional events, testimonial videos, or sponsorships (OK, that was self-serving) that work all year instead of for just three days.
  • Take that tiny part of exhibiting that represents education and make that the focus instead of just watching unengaged passersby offloading swag from your podium.

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I’m interested in what readers think about companies who decide to stop exhibiting at the HIMSS conference, so tell me here. Do you care? What other ways can they connect with prospects? I’m especially interest in hearing from companies that have moved their exhibit hall expense into other forms of marketing that turned out to be more effective.


Webinars

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


Acquisitions, Funding, Business, and Stock

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NTT Data Services acquires Cognosante Consulting, which provides services to state Medicaid programs. It will operate as NTT Data State Health Consulting.

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The Knoxville paper covers PerfectServe’s three 2018 acquisitions, its 220 local employees, and the use of its secure provider communications solution by UT Medical Center.


Sales

  • In England, Great North Care Record chooses Cerner for information exchange.
  • San Francisco medical group Brown & Toland will implement Epic for ambulatory for its 2,500 independent physicians. The network manages insurance functions for its members and says Epic is the only system that can support both patient care and insurance administration.

Announcements and Implementations

UnitedHealthcare and the American Medical Association will work together to create 20+ ICD-10 codes related to social determinants of health that can be used to trigger referral to social and government services.

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KLAS looks a patient privacy monitoring solutions, with Protenus, FairWarning MPS, and Maize Analytics topping the list. Purchasing decisions are often driven by reducing false positive warnings, at which FairWarning MPS was found to excel.

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MIT Technology Review notes that DeepMind demonstrated a prototype of its AI-powered retina scanning device in London last week. The 30-second scan can detect retinopathy, glaucoma, and macular degeneration. It’s still years away from availability, however, since the company hasn’t yet submitted it for UK regulatory review.

Meditech expands its Meditech as a Service offering, which was initially offered only to critical access hospitals, to all community health systems.


Government and Politics

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The VA joins DirectTrust’s anchor bundle, which will allow its employees to use Direct messaging and information exchange to communicate with 1.8 million providers.


Privacy and Security

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“60 Minutes” visits Hancock Regional Hospital (IN) to talk about its January 2018 ransomware attack in which it paid a hacker $55,000 to regain access to its files. The hospital notes that not only was it back in business on the Monday following the Thursday attack, it has since learned that antivirus software that can only recognize a particular technical signature would not have helped (since the strain was new) and it has since added a system that instead looks for patterns of malicious behavior. The hospital also contracted with cybersecurity vendor Pondurance because “if we’re attacked by humans and the only thing we have to defend ourselves is software, then the humans will win.”

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An Indian state’s health agency exposes the information of 12.5 million women who had undergone pregnancy-related testing by leaving the Internet-connected database unsecured. The agency didn’t respond to warnings that its information was exposed and the problem was fixed only when India’s Computer Emergency Response Team removed the health information three weeks later. The MongoDB server is still online and exposed, with other agency information still accessible by anyone. The medical data was especially sensitive since it involves data collected to support India’s ban on prenatal sex determination tests, which it implemented to prevent widespread selective abortion of unborn females.


Other

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Epic’s April Fools’ Day home page makeover contained some Onion-worthy gems:

  • Epic hires CNBC host Jim Cramer as a financial advisor after he urged Apple to buy Epic on “Mad Money.” The funniest part about that bit is Judy Faulkner’s actual response at the time, when she asked a reporter with puzzlement, “Who’s Jim Cramer?” which apparently annoyed him based on his tweets about it afterward.
  • The rollout of MyMom, which encourages a health lifestyle with “a dose of love, a firm hand, and perhaps a little guilt.” It will include “genetic test processing filters that predict the likelihood that one day, you’ll have one just like you, and see how you like that.”
  • Epic adds a 200-member support team for Fortnite by Epic Games after its reception employees take 400 calls per hour that were intended for the gaming company (that’s apparently a real statistic).

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Dear PR people: “discreet” means watching what you say or being modest, which isn’t really an adjective you want to use when referring to data points (that would be “discrete.”)

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Kaiser Health News calls out respected hospitals such as Swedish Medical Center, Mayo Clinic, Cleveland Clinic, and University of Miami for offering profitable but medically unproven stem cell-related therapies even as FDA tries to shut down clinics that do the same thing. Some hospitals are even employing informercial-like sales pitches and enthusiastic but anecdotal patient stories to lure cash-paying patients in. One area in which evidence is ample – hospitals and medical practices will do whatever people pay them to, regardless of scientific merit. Just because hospitals are non-profit, unlike medical practices, doesn’t mean they don’t relish bringing in the cash through any legal (and sometimes illegal) means.

Researchers find that Ontario’s experimental payment of bonuses of up to $36,000 for PCPs to keep their patients out of the ED created unintended consequences, with most of the money going to small-town doctors whose patients had fewer PCP visits, less after-hours care, more ED visits, and higher ambulatory costs. The bonus-earning doctors also had lower-acuity patients. The authors identify a problem in creating rewards for those who are already exhibiting the desired behaviors instead of changing those who aren’t, also noting that the payment rules encouraged doctors to send patients to the ED or to specialists instead of to a walk-in clinic.  

Pharma bro Martin Shkreli is sent to solitary confinement for using a contraband cell phone to continue running his renamed, price-jacking Turing Pharmaceuticals from his federal prison cell. I’m pretty sure we haven’t heard the last of him since people who are willing to do most anything for money somehow keep finding new ways to take it away from someone else.


Sponsor Updates

  • Imprivata will offer its PatientSecure biometric patient ID solution with Verato’s cloud-based MPI as a comprehensive solution to address patient identification and record matching.
  • PatientBond will exhibit at the 2019 UCA Urgent Care Convention & Expo April 7-10 in West Palm Beach, FL.
  • Meditech publishes a case study on the use of its CAUTI prevention and surveillance tool by RCCH Healthcare Partners.
  • AdvancedMD will exhibit at the American Society of Addiction Medicine meeting April 4-7 in Orlando.
  • Aprima will exhibit at the CORHIO Forum April 4-5 in Denver.
  • PatientPing and Lightbeam Health Solutions will exhibit at the National Association of ACOs spring conference April 24-26 in Baltimore.
  • Avaya works with Nuance to develop new self-service automation capabilities with easy-to-navigate conversational interfaces integrated in its Avaya IX Contact Center solutions.
  • CompuGroup Medical will exhibit at the AZ HIMSS Annual IT Summit April 11 in Phoenix.
  • DocuTap will present and exhibit at the Urgent Care Association Convention & Expo April 7-10 in West Palm Beach, FL.

Blog Posts


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Contacts

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

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Monday Morning Update 4/1/19

March 31, 2019 News 6 Comments

Top News

A two-doctor ENT practice in Michigan closes for good and its partners retire after they refuse to pay a hacker $6,500 to restore their ransomware-encrypted systems.

Some of their patients worry about starting over at new practices that can’t get their previous records.

The partners decided not to pay because they had no guarantee that the hackers would restore their data or that they wouldn’t extort them further afterward. They also didn’t want to rebuild their practice from scratch.

The doctors apparently practiced within Swedish American’s Brookside Specialty Center. They declined a TV interview, saying the FBI is now involved.


Reader Comments

From Cyrus of Persia: “Re: [vendor name omitted]. Rumor is they’re for sale after raising $80 million but failing to keep up with their valuation. The co-founder left in December for VC-land, a high-profile client ripped and replaced because the product didn’t work, and none of the company’s sales have gone live.” Unverified, so I’ve omitted their name for now, but I welcome readers to comment.

From Mawkish: “Re: [vendor name omitted]. I heard they have abandoned their development efforts to create an enterprise behavioral health EHR/PM system for the community mental health center and larger mental health / substance abuse agency marketplace after three years of signing up customers who paid deposits with promises that they would be involved in product design, with the remainder not due until go-live. This removed those customers from the marketplace for legitimate solutions. At least the company is refunding the deposits after laying off 40 developers and returning  to their roots of selling EHR/PM to the small practice marketplace.” Unverified, so again I’ve left the name out until I can ask for a company response. I’m not a big fan of pre-announcing software since the only possible reason is to convince prospects to hold off buying an immediately available competing product, but then again, customers who fall for that rather obvious ploy probably would have found a way to screw up their selection and implementation anyway. Still, it’s good news that the company is providing refunds, which isn’t a given in the rough-and-tumble world of health IT.

From Irritable Cereal Bowl: “Re: opioid lawsuits. Good for the states that are suing McKesson and other drug distributors who shipped enormous quantities of opiates that they had to know were being misused.” I disagree – every dose that was sent to those states was dispensed by a state-licensed pharmacy, on the order of a state-licensed prescriber, and under the jurisdiction of the DEA, which tracks every dose of opiates that is shipped to a pharmacy. Clearly those states were asleep at the wheel in expecting the deep-pockets drug wholesalers to provide oversight of legal but inappropriate drug use. If I were McKesson, I would sue the boards of pharmacy and medicine in those states, and perhaps their attorneys general and law enforcement agencies, for failing to do their jobs in protecting the public. Maybe individual prescribers and pharmacies as well since every single transaction is readily available. Drug distributors are required to report unusual usage patterns to the DEA and they failed to do that (not that the DEA isn’t already inspecting pharmacies and prescribers), but blaming them for the immoral and probably illegal behavior of prescribers and dispensers is clearly deflecting blame long after the fact. You can’t tell me that a tiny town from which flowed millions of doses of opiates that were being dispensed to patients who lined up around the pharmacy’s block every single day was too subtle of a problem for their police departments to detect.


HIStalk Announcements and Requests

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Most poll respondents say EHR design is not a major cause of physician burnout.

New poll to your right or here: How much impact will AI have on patient satisfaction, outcomes, and cost in the next five years? Click  the poll’s “comments” link after voting to explain, especially if you punt with the safe “some” option.

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About 20 percent of poll respondents call their PCP by their first names instead of “Doctor  XXX.” Some agree with me that the PCP is working for them and therefore there’s no need for academic formality, at least once the relationship has been established, while others prefer that both patient and doctor use formal titles (Mr. Ms., etc.) One respondent says they call anyone who has earned a doctorate as “Doc,” but that’s a slippery slope when you separate a medical practice degree (MD/DO) from other medically related doctorates (PhD, DNP for nurses, PharmD for pharmacists, etc.). That doesn’t even consider saying “No fries, thanks, Dr. Jones” in answering the drive-through query of your philosophy PhD. Or, what to do when both patient and doctor have earned doctorates in any academic discipline — do they call each other “Doctor” in the exam room? Or if the poetry PhD patient is called “Mr.” or “Ms.” by their PCP, do they correct them with academic haughtiness? We’ve polluted the etymologic waters quite a bit by assuming holders of doctorates of medicine, dentistry, chiropractic, podiatry, and veterinary medicine should get an extra dose of respect beyond those who hold every other doctorate. My experience is those who are most insecure about their doctorates (usually DO’s and DC’s) are the most likely to insist on being called “doctor.”


Webinars

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


People

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Medical imaging software vendor Novarad names Paul Jensen (Microsoft) as president.

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Julie Flaschenreim (Fairview Health Services) joins Hennepin Healthcare as CIO.


Other

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I really dislike the headline of this article from HIMSS, and not just because they misspelled “ZIP” as “Zip,” used unrelated stock photography, and pitched their recent acquisition Healthbox. ZIP codes do not “define” health outcomes, although situations that are common in the economic demographics of those who reside in a given location certainly do. As the headline fails to indicate, people who live in South St. Louis would not get instantly healthier by moving to Palo Alto since there’s no guarantee their social determinants of health would change along with the relocation to an area with a closer Whole Foods, or that their healthcare journey isn’t already set in stone to some degree. There’s also the meme-bursting phenomenon of a single ZIP code covering wildly disparate income ranges, such as parts of San Francisco and Atlanta in which multi-million dollar apartments are flanked by the homeless and working poor (if you like digging deeper, check out census department’s Gini Index measure of income concentration.)  I agree with the remainder of the article, just not the simplistic concept that knowing someone’s address is all you need to understand their health.

Former Microsoft CEO Steve Ballmer gauges return on investment in healthcare by looking at the average age of death, which he says has increased only 0.6 years in the past 20 even as healthcare spending rose dramatically. He says employers should look at their prices and costs, such as whether end-of-life spending really increases overall value, but adds that a non-transparent system of healthcare management and delivery makes such analysis nearly impossible.


Sponsor Updates

  • Meditech produces a new podcast, “Clinical efficiency and the journey to Expanse.”
  • Mobile Heartbeat and Clinical Computer Systems, developer of the Obix perinatal data system, will exhibit at the BGHIMSS & INHIMSS Annual Spring Conference April 4-5 in Florence, IN.
  • NextGate will exhibit at the CCI Symposium April 4-6 in Greenville, SC.
  • Netsmart will exhibit at the LeadingAge IL Annual Meeting April 2-4 in Schaumburg, IL.
  • Nordic will present at the Quality of Care Outcomes Research Scientific Sessions April 5-6 in Arlington, VA.
  • Medhost congratulates its 19 hospital customers that earned CMS’s five-star quality rating.
  • Practice Velocity, T-System, Wellsoft will exhibit at the 2019 UCA Urgent Care Convention & Expo April 7-10 in West Palm Beach, FL.
  • Cooper University Health Care (NJ) expands its use of Access Passport’s electronic forms solution to oncology and surgical services.
  • The Oliver Wyman Health Podcast features Qventus CEO Mudit Garg.
  • SymphonyRM will sponsor the Women in Data Science Pittsburgh @CMU event April 4.
  • Visage Imaging will exhibit at the 2019 SBI/ACR Breast Imaging Symposium April 4-6 in Hollywood, FL.
  • Vocera will exhibit at the Beryl Institute Patient Experience Conference April 3 in Dallas.

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News 3/29/19

March 28, 2019 News No Comments

Top News

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Medicare Advantage payer Clover Health lays off 140 employees as part of a restructuring that will eventually add more staffers with health insurance and clinical backgrounds. The company, which has touted its predictive analytics capabilities since launching in 2012, has raised nearly $1 billion. It operates in seven states including Tennessee, where it plans to open an office in Nashville.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Healthcare CRM vendor SymphonyRM expands to Pennsylvania with the opening of its Health AI Center of Excellence in Pittsburgh.

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Teladoc Health shares rise on the news it will launch its services in Canada.

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Digital prescription startup Xealth raises $11 million in a funding round led by McKesson Ventures, Novartis, Philips, and ResMed. The company has developed software that enables providers to prescribe apps, devices, and services from their EHRs. It has raised nearly $20 million since launching out of Providence St. Joseph Health (WA) in 2017.


People

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Max Hanner (HCTec) joins Pivot Point Consulting as VP of business development.

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Clarify Health names Imran Qureshi (Health Catalyst) chief data science officer.

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Medication tracking company Kit Check promotes Doug Zurawski to SVP of clinical strategy and MaryAnn Jensen to VP of strategic marketing; and names Amy Langan (Fresenius Kabi) CMO and Eric Bolling (Cardinal Health) EVP. I interviewed Kit Check co-founder and CEO Kevin MacDonald last December.


Sales

  • OSF HealthCare (IL) will use Redox’s interface capabilities to connect its clinical systems with third-party applications.

Announcements and Implementations

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Sutter Health (CA) will pilot an AI-enabled digital voice assistant developed by Suki in primary care, dermatology, and orthopedics.

The multi-state Lewis and Clark Information Exchange adds PatientPing’s real-time care alerts and patient utilization details to its HIE services.

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Inspira Health (NJ) implements Intraprise Health’s wayfinding technology at its three hospitals.

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United Regional Health Care (TX) will go live on Epic next week.

Thirty-five bed Lackey Memorial Hospital (MS) rolls out Evident’s Thrive EHR.


Government and Politics

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Departing FDA Commissioner Scott Gottlieb, MD tweets that the agency will make good on its promise to release thousands of patient safety reports after Kaiser Health News found manufacturers have for years been taking advantage of a secretive, alternate summary reporting program that kept patient safety impacts hidden from public view.

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The Australian Digital Health Agency will offer qualifying vendors $30,000 to integrate interoperability standards into their clinical software so that providers using different systems can share health information. The incentive is part of the country’s larger effort to do away with paper-based communication and faxes by 2022.


Privacy and Security

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Officials at Northampton General Hospital in England say they are fending off at least 240 data-breach attempts a day, and worry that the problem will only escalate as NHS facilities become paperless. They list phishing email campaigns, unpatched software, and a lack of cybersecurity expertise as their biggest concerns.

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CynergisTek adds around-the-clock monitoring to its line of cybersecurity, privacy, and compliance services for healthcare.


Other

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Prosecutors say the former Vanderbilt University Medical Center nurse on trial in Tennessee for a medical injection error made at least 10 mistakes that led to the death of a patient, many in line with findings from a CMS investigation. The nurse has pled not guilty despite admitting she made a mistake. Errors included:

  • Being distracted by an unrelated conversation with another staff member when she grabbed the wrong drug from the dispensing cabinet.
  • Overriding a cabinet safeguard even though it wasn’t an emergency situation and she hadn’t checked with the hospital pharmacy.
  • Ignoring four warnings or pop-ups about the medication being withdrawn.
  • Not noticing the drug in hand was a powder instead of a liquid.
  • Overlooking a boldfaced warning immediately before injecting the drug.

Sponsor Updates

  • Elsevier Clinical Solutions will exhibit at the Beryl Institute Patient Experience Conference April 3-5 in Dallas.
  • EClinicalWorks and Imprivata will exhibit at the AMGA 2019 Annual Conference March 28-30 in National Harbor, MD.
  • Ensocare will exhibit at the American Case Management Association Conference April 13-17 in Seattle.
  • FormFast and Iatric Systems will exhibit at the Health Connect Partners Spring 2019 conference April 1-3 in Anaheim, CA.
  • Hayes Management Consulting welcomes Nancy-Linn Swain as director of training and engagement, and Bo Zhang as senior financial analyst.
  • HGP advises Clearwave in its significant growth investment from Frontier Capital.
  • Healthwise will exhibit at the EClinicalWorks Enterprise and Urgent Care Summit April 1-3 in Fort Lauderdale, FL.
  • InterSystems releases the latest update of its IRIS data platform featuring enhanced performance and scalability, cloud support, integration capabilities; and enhanced support for Java, Python, and C# development.
  • Intelligent Medical Objects will exhibit at the AORN Global Surgical Conference & Expo April 6-10 in Nashville.
  • Spok publishes “The Non-CIO’s Guide to Interoperability.”
  • The local paper covers Nordic’s move to new, expanded office space.
  • With help from Pivot Point Consulting, Acumen Physician Solutions adds legacy data archiving technology powered by SMART on FHIR from Trinisys to its Acumen 2.0 powered by Epic software for nephrology practices.
  • Glytec announces that its Glucommander Outpatient insulin dosing management software is now capable of receiving data from DarioHealth’s smart glucose meter.
  • Lightbeam Health Solutions and AMGA have developed a collaborative to help providers maximize the effectiveness of Medicare Advantage and other value-based contracts.
  • Health Catalyst receives top marks for healthcare analytics in Chilmark Research’s latest report.
  • Cooper University Health Care (NJ) expands its use of Access Passport e-forms to oncology and surgical services.
  • Vail Health (CO) improves care team communication with Spok’s Care Connect solution, and continues to expand its use of the software.
  • The Chartis Group hires Beth Price (North Highland) as director of its oncology solutions practice.

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News 3/27/19

March 26, 2019 News No Comments

Top News

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The Justice Department won’t dispute a federal court’s decision that the Affordable Care Act is unconstitutional and should therefore be eliminated in its entirety.

This two-sentence announcement represents a position shift from earlier arguments in which the Trump administration advocated striking down only certain of ACA’s consumer protections, such as the requirement that insurers cover pre-existing conditions. 

A group of Republican governors sued the federal government after Congress eliminated the penalty for not buying health insurance, arguing that the decision renders the entire ACA unconstitutional, a position with which the federal government now agrees.


HIStalk Announcements and Requests

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Lorre found and fixed a bunch of new HIStalk email signups (over 1,000, actually) that went automatically and silently into an “unconfirmed” status in the bulk email service I use, requiring manual approval. Welcome if you got your first email today. Sign up here if you aren’t sure since you won’t get duplicate emails even if you’re already on the list.

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Welcome to new HIStalk Platinum Sponsor Ensocare. The Omaha-based company’s care coordination solution includes software; a national network of post-acute care providers, services, and community-based organizations backed by 24-hour support; and solutions that help hospitals and payers succeed under value-based care. Transition of care solutions include Transition (hospital discharge software); NEMT (links hospitals to non-emergency medical transport providers); and SDoH (connects patients with community services that can help with social determinants of health). Patient engagement solutions include Wellplan (digital care plans) and Aftercare (RN-led scheduled phone calls). The company’s care coordination platform is integrated with Cerner, Meditech, Epic, and VistA to automate discharges and post-acute referrals. Its Patient Choice app allows patients and families to explore post-acute care options at the bedside. Thanks to Ensocare for supporting HIStalk.  


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Sales

  • Atlantic General Hospital chooses Welltok-owned Tea Leaves Health for analyzing referral patterns and expanding its physician network.


    People

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    Collective Medical names Jim Lacy (Waystar) as president / COO.


    Announcements and Implementations

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    Philips acquires Idaho-based teleradiology practice Direct Radiology, whose 70 radiologists provide services to 300 hospitals, imaging centers, and medical practices.

    UC Davis offers a three-month online educational program titled “Health Information Literacy for Data Analytics Specialization,” which targets technologists with no healthcare experience. Courses include Healthcare Data Literacy, Healthcare Data Models, Healthcare Data Quality and Governance, and Analytical Solutions to Common Healthcare Problems. UC Davis also offers a five-course analytics certificate program for which healthcare experience is recommended, with completion in 15 months or less at at cost of $6,125.

    Netsmart will implement the 360X interoperability standards for managing referrals and sharing information between PCPs and community-based healthcare providers.

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    A KLAS review of 2018 health IT purchasing decisions finds that the most active areas were PACS, population health management, ERP, and secure communications. Markets are mature for EHR/PM, automated dispensing cabinets, cardiology systems, ERP, home health, PACS, patient accounting, and smart pumps. Newer and more disruptive areas are behavioral health, patient privacy monitoring, population health management, secure communications, virtual care platforms, and vendor-neutral archive. Vendors ranked at the top of KLAS’s assessment of customer satisfaction and retention are American Well (leads by far), FairWarning, Varian, BD, Protenus, Omnicell, Grifols, Workday, Nuance, and Baxter. Top reasons for replacing systems are integration, consolidation, and functionality, with price falling outside the top five.


    Government and Politics

     

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    Outgoing FDA Commissioner Scott Gottlieb clarifies interview comments that some sites interpreted as his call for more EHR regulation.

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    Duke University will pay $112.5 million to settle federal False Claims Act charges that one of its researchers falsified pulmonary research data to win $200 million in federal research grants. Duke fired heavily grant-funded biologist Erin Potts-Kant in 2013 for embezzlement, after which she pleaded guilty to forgery and Duke retracted several of her papers. The former Duke lab analyst turned whistleblower, 34-year-old Joseph Thomas (above), will be paid $33.75 million of the settlement, while the remainder is set aside to repay the grant money involved.

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    HELP committee chairman Lamar Alexander (R-TN) says HHS’s proposed interoperability rules will provide a definition of information blocking, require insurers to give patients copies of their data, mandate that EHRs support API access, and require hospitals to send ADT notifications to a patient’s doctors. He quotes a Tennessee family doctor who sends printed copies of an admitted patient’s record from his EHR to the hospital for re-keying because it would cost his practice $317,000 per year to send information electronically (he didn’t say who would get that money).


    Other

    Fast Company looks at healthcare’s “giant patient-matching mess,” which it mostly blames on (a) EHR vendors not using a standard format for entering patient information; (b) provider consolidation that dumps the patient records of other facilities into a single database; and (c) lack of an easy way to de-duplicate records of common names that sometimes also share a birthdate. It notes CHIME’s 2015 $1 million National Patient ID Challenge that it eventually abandoned because the problem is too complex, a conclusion reached by Pew, which could only recommend that EHR vendors force standardization of addresses using US Postal Service records. It notes that other countries think the US is fighting an impossible battle to figure out which is the right Maria Garcia or John Smith given Congress’s ban on a national health ID.

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    In Australia, investigative reports show that Queensland Health was so desperate to prove the financial viability of its Cerner-powered IEMR that it planned to go live at Princess Alexandra Hospital in mid-2015 even though the project was in “cannot meet objectives” status. The plan was halted only when a Cerner VP and the project’s delivery director said a six-month, big-bang implementation was not possible, especially in radiology and pathology.

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    Bloomberg notes the increasing number of doctors who choose a telemedicine practice now that reimbursement has been sorted out and startups such as Hims and Roman need doctors to generate their lifestyle prescriptions. A startup that was founded strictly to place doctors in telehealth jobs says about 25 percent practice full time, with most of the remainder being those fresh out of school or easing into retirement. Doctors still need to be licensed individually by each state — the doctor who is the subject of the Bloomberg article spent $10,000 to gain licenses in 26 states.

    Stat reports that digital health startups are struggling with how to respond to users who express suicidal thoughts using their mostly unattended platforms. Patients are threatening self-harm during video visits and people are posting suicidal comments to the Facebook pages of hospitals and practices or even to their patient portals.

    Researchers retest the DNA of 49 people whose consumer genetics tests told them they are at risk, with commercial labs failing to reach the same conclusion in 40 percent of them. Some of the “increased risk” classifications were also incorrect, as the observed variants are common and benign. The authors conclude that consumer DNA testing results should be confirmed by clinical labs that understand the variants better.


    Sponsor Updates

    • First Databank’s Meducation patient instructions creation system is added to Epic’s App Orchard.
    • Aprima, an EMDs company, announces integration with RavePoint.
    • Avaya introduces a cloud transformation program, making it easier for companies to adopt the cloud communications infrastructure that best meets their needs.
    • The Digital Healthcare Podcast features Collective Medical CMO Benjamin Zaniello, MD.
    • CoverMyMeds will exhibit at the Technology Health Experience Conference March 28-30 in St. Louis.
    • Culbert Healthcare Solutions will exhibit at AMGA March 27-30 in National Harbor, MD.
    • DocuTap will exhibit at the Pediatric Urgent Care Conference April 3-5 in Dallas.

    Blog Posts


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    Monday Morning Update 3/25/19

    March 24, 2019 News 1 Comment

    Top News

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    Departing FDA Commissioner Scott Gottlieb — reacting to the “Death By 1,000 Clicks” article — says FDA oversight of EHRs would be appropriate “when they’re doing things that could create risk for patients” in turning into a medical device.

    Gottlieb added, however, that Congress would need to define those conditions. He doesn’t expect any changes in the next several years.  


    Reader Comments

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    From Captive Cursor: “Re: Beth Israel Lahey Health. Named former Dartmouth-Hitchcock CIO Peter Johnson as interim CEO of the new entity. He would be an interesting interview.” Johnson’s LinkedIn says he’s been an independent consultant since leaving Dartmouth-Hitchcock in 2011 after 26 years and I know he has covered CIO roles since. I agree that it might be fun to interview him.

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    From From Athena With Love: “Re: Athenahealth. Post-acquisition layoffs are about to happen (April) according to rumors.” I’m pretty sure you can count on layoffs, especially when combining two companies that must have quite a bit of corporate overlap. The real question is how they handle the product portfolio, especially the GE Healthcare part. That’s compounded by the fact that healthcare experience, especially that obtained from somewhere other than Athenahealth, is hard to find among the executive team members.The corporate raider script, especially with hedge funds like Elliott Management, seldom wavers from: (a) create distress by criticizing the targeted company publicly and maybe applying some dirty tricks; (b) use the resulting share price drop to bully the board into selling the company at a discount; (c) cut costs mercilessly to shore up the financials while the company is sequestered away from investor oversight as a private entity; and (d) either find another willing buyer, or as is more likely with Athenahealth, expand into sexy-sounding areas with big potential, take it public again, and transport wheelbarrows of cash to the bank before the company’s long-term prospects turn out to be less impressive than the juiced numbers and creative story suggested. Vertitas Capital’s big healthcare IT score was selling the healthcare database business of Thomson Reuters, renaming it Truven Health Analytics, and then selling it to IBM for more than double the $1.25 billion it had paid just four years earlier. Athenahealth’s prospects are probably less rosy in the absence of a likely buyer (especially one as desperate as IBM), the overall sagging of the EHR market, having product that were run into the ground by GE Healthcare in its mix, and the significantly inflated company value that was purely due to Jonathan Bush’s involvement.

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    From Randall N’Jobu: “Re: doctors. I saw an article wondering how many people call their doctor by first name. Survey your readers?” Take a few seconds to answer and I’ll share the results. I’ve noticed than I’ve changed my practice of always calling my PCP “Dr. XXX” changed when I moved to a concierge doctor, where it’s more personal, less formal, and in my mind more appropriate to use first names since he’s working directly for me. Oddly enough, however, both concierge docs I’ve seen call me “Mr. XXX” even as I called them by their first names, so maybe I’m either faux-pas’ing or something about the situation has turned the tables (they are also younger than I, so that may play a part, as I included in the poll). Physician readers, are you put off when patients call you by your first name, do you invite it, or what do you really prefer? I remember cringing in my early hospital days with a 20-something nurse would address an 80-year-old patient as “Mildred,” but that perhaps was a signal that informality was moving from society in general to medicine in particular.

    From Dollar Cost Averaging: “Re: healthcare IPOs. Are they suddenly a thing again?” I’m no expert, but it seems to me that companies see the recessionary writing on the wall and figure they need to either move now or wait years for the cycle to turn back around.


    HIStalk Announcements and Requests

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    A third of not very many poll respondents say they saw something at HIMSS19 worth following up on. They left us to guess what that was.

    New poll to your right or here: How much doctor burnout is caused by EHR design (workflows, screens, clicks, etc.)?


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Sales

    • Iowa Health Information Network will provide real-time patient notifications to its provider members using PatientPing, replacing Iowa’s Statewide Alert Notification system. 
    • University of Vermont Medical Center will use solutions from Loopback Analytics to identify at-risk patients and improve outcomes related to specialty medications.

    People

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    Two ROI Healthcare Solutions executives – Founding Partner / CFO Kathy London and Managing Partner / President Jim Jancik – announce their retirement.


    Other

    The VA struggles with documenting care for veterans who have undergone gender reassignment surgery, as one advocate wants all EHR mentions of surgery and previous gender removed to protect them from violence, while others say providers need to know the patient’s full history.

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    A “Madison Magazine” columnist says the local airport should be renamed from Dane County Airport to Judith Faulkner Airport as Epic has remade the area’s economy from its Oscar Mayer heritage of making “wieners and pimento luncheon meats” (the company bailed to Chicago in 2015) and Epic saved the area from “one of the most forlorn demographics in all the world.” He notes that Epic makes it possible to take direct flights to Phoenix, San Francisco, and Los Angeles and has fueled the growth of hip venues that cater to its campus full of young adults with significant incomes.

    Wolters Kluwer is providing International Space Station astronauts with access to its UpToDate medical information resource. I admit that I don’t follow low-orbit type projects, especially now that they sell seats to space tourists, but this announcement made me wonder what will happen if an occupant has a stroke, heart attack, or even appendicitis. I assume it would be like in the remote parts of the world, where doctors on the ground instruct crew members who have undergone the most basic of medical training to perform diagnostic tests or minor treatments in sort of a celestial MinuteClinic, but without the option to call an ambulance to take them to a better equipped hospital.

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    Warner Music Group signs a startup’s AI-powered algorithm to release 20 albums in the next year. Endel creates custom soundscapes such as “Sunny Afternoon” and “Rainy Night” that embed custom frequencies that are tailored to a particular listener’s mood, location, and heart rate. Endel’s engineers said their songs are intended to serve as tailored background music rather than album tracks, but agreed since all 20 albums can be “made just by pressing one button.” They had to hire an entertainment lawyer to figure out who to list as artists for collecting royalties, finally settling to just listing all the engineers as songwriters.

    A woman sues Olive Garden for up to $1 million for failing to warn her that her “defective” stuffed mushrooms were “extremely hot,” claiming that after the first bite she staggered through the restaurant with it stuck in her throat, vomited in the restaurant’s kitchen, headed off to the ED, then called 911 on the way because she thought “death was imminent.” She was taken to the hospital, then airlifted to Parkland Hospital’s burn unit. Personally, I would be more tempted to snoop in her medical records than those of Jussie Smollet.


    Sponsor Updates

    • Lightbeam Health Solutions, Experian Health, and PerfectServe will exhibit at the AMGA 2019 Annual Conference March 27-30 in National Harbor, MD.
    • MDLive and Redox will exhibit at ATA19 April 14-16 in New Orleans.
    • Meditech will host the 2019 Home Care Optimization Symposium March 26-27 in Atlanta.
    • NextGate achieves advanced technology partner status in the AWS Partner Network.
    • OmniSys will exhibit at the Computer-Rx T.H.E Conference March 28-30 in St. Louis.
    • QuadraMed’s EMPI partners with LexisNexis Risk Solutions Partners to prevent patient identification errors.
    • Surescripts will exhibit and present at the 2019 AMCP Managed Care & Specialty Pharmacy Annual Meeting March 25-28 in San Diego.

    Blog Posts


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    Reader Survey Results: How I Would Change EHRs

    March 24, 2019 News 3 Comments

    I asked readers how they would change EHRs to improve outcomes and reduce costs while still meeting the requirements imposed by the US healthcare system. That’s the basic question EHR vendors face every day. Some of the excerpted answers I received are as follows. Non-clinician responses are indicated with an asterisk.


    * Keep them headed in the direction they’re on: platforms supporting standardized open APIs. The Fortune article was hysteria-feeding bias by writers who don’t understand economics, technology, or healthcare. Chopra had the best take in the article: MU was a messy process but it was a necessary down payment that will yield benefits to patients for years to come.


    Create true app store-type environment being opened up by the recent mandate for FHIR APIs,  a way to totally separate the data entry issue from the clutches of current vendors. The most practical complementary situation in the interoperability realm would be a timeline approach to presenting links to patient specific information for the caregiving team. There are many candidates whose product offerings could be customized to fulfill this.


    * Allow doctors to create/buy their own EHRs with no regulatory restrictions on interoperability other than summary reports, lab interfaces, and pharmacy interfaces. This puts agency back into the hands of the frontline clinicians themselves and allows us to cut the complexity out of entrenched vendor products and brings e-health back to the basics, where it belongs.


    * I would move EHR interoperability to something more similar to the SWIFT financial network. A cooperative would operate a set of datacenters and network. Transactions on this network would be defined by a set of standards (HL7+X12 but with a strong opinion on what that actually means.) Messages would be routed from the providers to the cooperative then onward to other providers or insurers or wherever. Failure to reply to requests with the appropriate clinical information would result in an increase in the transaction fee that the networks charge for submitted claims.

    Say you don’t return a request for patient data promptly or fail to submit an HL7 ADT message when a trigger happens — some percentage of your claims for the next year will be put into a general fund that supports the network. Awards are given from the general funds to whistleblowers who point out failure and non-compliance. Additional failures or non-compliance will result in a steadily increasing withholding from each payment your org receives. Failure to join the network or repeated non compliance with the requirements will lead to loss of Medicare and other government payments. US digital service and some CMS lawyers form the initial public committee that organizations go before to submit complaints against each other, appeal decisions, etc.


    * All big systems were designed around billing, and the visit is the hub. That should be tossed out and redesigned so patient is the hub.


    * Phase out Meaningful Use. Halt any usability mandate initiatives (let free market decide). Pass legislation that makes it much more difficult to sue for patent infringement. For EHR software that is released and used in production at publicly funded health systems, screenshots, videos, and specific descriptions of functionality / workflow should be shareable with open public (excluding PHI stuff) i.e. greatly limit an EHR vendor’s ability to nix content from web with IP protection claims


    * I would allow malpractice carriers to drive the market need for effective electronic clinical documentation through how they price premiums rather than CMS reporting requirements. That should shift the market dynamic away from a great billing product to one built around patient safety.


    *Interoperability: generate rich patient records with specific variability and define a set of assertions that are associated with those cases. Send them via CCDA and FHIR and ensure that each EHR can receive, reconcile, and directly incorporate all data into their EHR.

    Usability: generate a standard set of the top 10 nursing and physician workflows — give the workflow 100 points. Then for every time the user has to switch contexts from the patient to the computer, deduct seven points. Every time the user has to switch from the keyboard to the mouse, deduct five points. Every keystroke the user has to enter to do a search – deduct one point. Grade it based on standard: 90 percent A, 80 percent B, 70 percent C, 65 percent D.

    Error reporting: Put the EHRs under FDA CFR and require they publish all harms with their customer notice to a Federal EHR Adverse Event Reporting System (FEHRAER?). All potential patient safety or safe use issues reported to the same system, but perhaps we would mine those for trends and allow them to remain non-public.

    When someone cheats on their MU reporting or MU certification, a change in suit color is in order. Not just fines. but hard time.


    * Centrally managed (decentralized storage) common health record structure that all EHR technology vendors and providers of all types are forced to contribute to. This would break up monolithic EHR vendors, stimulate creativity, and allow each provider to select the tools used to contribute to a commonly defined health record. This would solve the interoperability issues and allow the market evolve quickly. Basically we follow the ubiquitous app store approach. We could use a distributed ledger approach to record management.


    * We need to focus on the paradigm that exists around our transition from paper-based, trust-based, fee-for-service charting to an electronic health archive and medical billing support infrastructure. There is no direct correlation between the two worlds. And I am not talking about the change felt by payers and providers. We have not changed the patients’ encounter as dramatically as we need to in order to support new world order in healthcare.

    Patients are typically scheduled in much the same way as before. The Doctor’s office visit is mostly the same. And what is scary is the huge push and hyper focus for MORE office visits. A vastly different office visit is required. And since everyone is a consumer, we all share the same responsibility to adapt.

    One very tangible change would be patients acknowledging that their visit with the physician is being recorded. Recorded sessions will be saved for 24 hours until the medical record has been appropriately updated and accurate labs and meds are ordered and prescribed. This one process change has many downstream benefits to both accuracy and integrity. There are ways to incorporate many levers to assist, however, it starts with changing the patient’s point of view of a doctor’s visit.


    * Systems that you can easily dictate into via headset, for example, as you are performing assessments, “breath sounds diminished in left lower lobe, slight wheeze in left upper lobe, strong, loose, productive cough. Resp Rate 14, pulse 84”, etc.
    having discussions with patients, “Mr. Gonzales indicates shortness of breath walking up one flight of stairs”. System would be smart enough to catalog information discretely in the right places in the right way to make it interoperable.
    Alexa-like recall of important information or tasks “Alexa, please reconcile Mr. Jones medication list and show me any discrepancies” “Alexa, what is Mrs. Smith risk of 30 day readmission and what should we do to mitigate it?” “Alexa, what routine care items / screenings is Ms. D’Meanor due for?”


    * At the health system level at a minimum, standardization of content based on evidence should be required. Utilizing 4,000 different order sets, customized care plans with zero evidence, lack of consistent clinical decision support should be disallowed. EHRs only get better when the information available at the point of care is better.


    Implement National Patient Identifier, and mandate that it cannot be SSN. Get rid of the old school “funny Money” mentality of charges that all the stakeholders can get an accurate view of value in health care, and not monopoly money gross revenue nonsense that is currently what is floated out there.


    * I think we need some UPS-style time and motion studies to understand how to make the EHR more natural and complementary to physician and clinician practice. Some future improvements should be possible based on this understanding, for example:

    • Narrowing what is on a screen based on context in the patient encounter
    • Narrowing what is on a pick list based on context
    • Improving adoption and usability of no-touch UI’s

    There is a lot to be learned for the major EHR vendors from the computer gaming industry on having commands and data elements be contextual. I think we need to shatter the “project mentality” in EHR rollouts and just assume optimization never is finished. If any investment deserves the the continuous improvement process, it’s this one.


    * Get rid of the need to document every single minutiae. Let the doctors decide and be responsible for what they enter in (if they start making mistakes or not entering important information, it’s on them and their insurance). Have a simpler interface for physicians, and another a complex one for “scribers” (could be the same as what’s currently offered). What’s required for simpler interface should be arrived at by a mix of EHR vendors and physicians (AMA), make this required for certified software. This you could be standardized across the US. If the doctors don’t like it, they can switch to the scribers interface and go nuts but no complaining anymore about the interface. Only the simple interface should be required for the software to be certified.

    If the bean counters want something tracked and entered in, let them pay for it in the term of scribes, etc. This will easily track the true cost of of all this data entry which is currently being paid through physician time. Since they love tracking costs, they should love this, right?

    Have a tool to download record from patient portal, in an open and readable format. Even better two formats, one human readable, and one machine readable. Make this required and always available if you want to be certified.

    Have tool in patient portal and in EHR to submit feedback on the software. A copy goes to the vendor, one to the health system, and a copy goes to regulators, available through FOIA to anyone (once personal details are scrubbed).

    Not really something that can be done on EHR side but:

    Make health systems pay for failing to share patient’s records (if the above functionality fails). Make this an increasing cost based on delay and also based on the amount of money the health system generates (not profit, as they’re all not-for-profit).

    Make the health system generate a single, detailed bill. If the health system is not-for-profit,” it should have both the cost of the material and how much they charge for it in the bill. If the bill goes out past a certain date, the patient doesn’t have to pay it. Let them deal with paying outside the network, etc.


    * I worked in financial services technology in 90s and early 00s. If you free the data, innovation will come. We’re in generation 1. There are whole entities just forming that normalize, curate data. Better user centered design will come when SME for particular problems are able to enter at a price point commensurate with value. Add-on and systems next to the EHR will become primary home for tasks for specialized workflows. EHRs that can build and partner for these models will succeed. The ones that stay data locked will be the last system stand alone docs have before getting eaten by local mother ship. That could take decades. Ones that unlock data and become integration partners have a chance at survival.

    The larger orgs that command a premium $ in their practice and have a handle on ROI and total cost of practicing will bring support for doctors into exam room. MGH in Boston has been doing this for almost a decade.

    There is no perfect technology. Our ability to acknowledge data integration is key is tantamount.

    Although politically undesirable, move to a unique patient identifier/set of unique keys per patient would help immensely.


    Since early 2013, the Texas Medical Association has recommended to ONC that they should require all EMR data elements to be XML tagged using a single national standard, much like the accounting profession successfully uses XBRL. With a universally-understood tagged data structure, physicians and hospitals would ideally be able to pick up their databases and move them quickly and cheaply between vendors. Vendors then would be forced to compete on their user interface, including usability.

    XML is just one approach for tagging. FHIR is analogous to this approach, but it’s not being used in a “pick up your database and change” way, as far as I know.

    If, in 2013, the ONC had started us on the XML tag journey (or its equivalent), we would be far, far closer to true interoperability and data sharing.


    * Leverage the massive amount of data that has already been collected over the past 10 years. Utilize machine learning to automate the largely repetitive tasks done by clinicians. A run-of-the mill CAP admission already gets the same order set anyway, with the same billing codes. There is no need for things like this to be done manually every single time. Machine learning should be able to take care of 80 percent of the tasks currently done by clinician end users. The other 20 percent are the unique clinical situations where we need clinicians to use their experience and critical thinking skills to solve complex medical problems beyond the capabilities of machine learning.


    Mandate interoperability and provide real teeth to enforcing this with real consequences for facilities, systems, and technology that does not share all the data. This includes providing all to the patient. Don’t let perfection stand in the way of progress when it comes to interoperability – start with something and expand on it.

    Relegate the EHR to a database and allow for customized solutions as an overlay for specialties and individual workflow.

    Stop punishing doctors with data entry and find an alternative to capture of information and allow them to return to the art and joy of medicine.

    Require justification form variation from standards of practice established and proven holding clinicians accountable for that variation when they find alternative paths and treatment protocols.

    Make the technology a part of medical education and allow those individuals to contribute to rethinking the solutions, workflow, and layout. They are unencumbered by the baggage of paper notes and as digital natives would have new and innovative ideas that we could use. They are also deeply invested in fixing this unholy mess since they are forced to use this archaic solution and are often the data entry clerks of choice as the most junior clinical employee, wasting all their training time on updating the system  — residents spend 70+ percent of their time in their basement room updating the EMR not seeing patients.


    My notes would be minimal, perhaps even written primarily by the patient. Diagnoses would be common language and not all the absurd detail ICD-10 brings. Real-time costs would be part of ordering and someone other than me could figure out the charging in the end. Make the screens as simple as an iPad, intuitive so that they just work as expected.


    News 3/22/19

    March 21, 2019 News 5 Comments

    Top News

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    Providence St. Joseph Health EVP / Chief Digital Officer and venture fund manager Aaron Martin participates in a Reddit AMA (Ask Me Anything) that quickly turns ugly as participants – including claimed former employees of his Digital Innovation Group — press him about layoffs and a reported sexist, bullying, and stressful culture. I’ll paraphrase a few comments, although I’m obviously unable to verify their accuracy:

    • Is spending hundreds of millions of dollars on what is essentially a tech start-up consistent with the Sisters of Providence mission?
    • Bragging that two-thirds of the leadership team is women doesn’t reflect a culture that favors “young brogrammers.”
    • More than 80 employees left last year.
    • “People joined DIG because they were inspired by the mission and often took a step back in pay to make a difference. Then, it takes about three weeks at DIG to realize you’ve been tricked. It’s not mission-driven, it’s driven by bullies who care for no one but themselves. I think the leadership team would even turn on each other if needed.”
    • Participants questioned whether Martin profits personally from deals on top of his reported $1.6 million in compensation, also claiming that the sale of Circle Women’s Health Platform to Wildflower Health “involved Providence paying Wildflower $4M to take it, kind of like a dowry.”
    • A participant said that PSJH’s acquisition of blockchain vendor Lumedic (although not part of Martin’s group) “appears to be the hiring of a group of five executive-level ($$$) friends who used to work together at previous companies with a pointless blockchain vaporware company and no actual intellectual property (patents) or software engineers or working product. Why is PSJH throwing money at scammy, buzzword-slinging suits?”

    Reader Comments

    From BurbianEHR: “Re: Lahey / Beth Israel post-merger administration layoffs. Starting today.” Unverified, but not surprising.


    HIStalk Announcements and Requests

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    I’ve received some good responses to my “how would you change EHRs” question, although respondents face the same challenges as vendors – you don’t get the pie-in-the-sky satisfaction of submitting a “world peace” type answer because the US health system defines EHR requirements, not vice versa. Your assignment, then, is to describe how you would make EHRs better while still allowing them to function in the unreal realities of our healthcare system.

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    The Forbes “Death by 1,000 Clicks” article stirred some nostalgia about those heady Meaningful Use days, when EHR vendors turned into shameless used car salespeople in hawking their previously unwanted wares. HIMSS, too – my favorite insanity moment was when HIMSS launched a road show series called “Takin’ HIT To the Streets” (subtitled “The ARRA Era”) in late 2009 as a self-appointed convener of sellers and potential buyers.

    My comment from November 2009:

    The HIMSS Takin’ HIT to the Streets campaign (gag, even for Doobie Brothers fans) leaps that last boundary of member organization common sense —  they’re paying people to attend the sales presentations of their vendor members. I’ve been watching the remake of the old miniseries “V” and I think maybe vendor visitors have taken over Steve Lieber’s body since the previously furtive and tentative vendor-HIMSS gropefest has advanced to a full-on public consummation.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Unite Us, whose platform connects providers with community resources to address social determinants of health, raises $35 million in a Series B funding round, increasing its total to $45 million. Two of the three co-founders are military veterans – CEO Dan Brillman served in Iraq and Afghanistan and still flies as an Air Force Reserves major, while Taylor Justice graduated from West Point and spent time as an Army infantry officer. The company was founded in 2013 to connect veterans to resources that could help them adjust to civilian life.

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    France-based medical appointment app vendor Doctolib raises $171 million in a funding round, valuing the company at more than $1 billion. It recently added video visits and digital prescriptions.


    Sales

    • LifeBridge Health will implement Artifact Health’s physician query solution to expedite accurate coding of patient records.
    • Hospital de la Concepcion (PR) chooses FormFast’s electronic signature system, integrated with Meditech.
    • Humana selects Inovalon’s analytics solution.
    • First Health of the Carolinas chooses HealthMyne’s imaging decision support for screening and following lung cancer patients.

    People

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    Outgoing CVS Health EVP Meg McCarthy, who has a long background in health IT, is appointed to the board of Marriott International. She served early in her career as a Navy Medical Services Corps lieutenant at Bethesda Naval Hospital and earned an MPH focusing on hospital administration.


    Announcements and Implementations

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    Medhost responds to a whistleblower lawsuit in which two former IT employees of Community Health Systems claim that CHS fraudulently attested for Meaningful Use and that Medhost made false statements to earn Meaningful Use Stage 2 certification for its EHR. Medhost denies the allegations, notes that the federal government has declined to get involved in the lawsuit, and says that its software is successfully used by hundreds of facilities and continues to be chosen by sophisticated clients who have analyzed and compared it extensively.

    The American Academy of Family Physicians offers a Primary Care Innovation Fellowship to study EHR usability and support for primary care.


    Privacy and Security

    A study finds that 79 percent of medication-related Android apps share user data, most commonly their device information, browsing history, and email address. Four apps were found to share medical conditions and six sent the user’s drug list. Recipients include social media companies and two private equity firms. The study notes that HealthEngine, Australia’s most popular medical appointment scheduling app, shares user information with personal injury law firms without providing an opt-out option.


    Other

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    NHS’s new technology group surveys clinicians on what one technology change they would make, with the #1 answer by far being integration of patient records.

    A GAO report finds that two-thirds of air ambulance transports, which cost an average of around $40,000, are out-of-network for insured patients. That means they are billed for huge balances even though they didn’t make the decision to call in an aircraft instead of using ground ambulance. Air ambulance providers are prohibiting from balance-billing Medicare and Medicaid patients, but privately insured passengers are fair game.

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    The Kansas City lakefront estate of former Cerner CEO Neal Patterson is put up for online auction. The 13,000-square-foot house on four acres was built in 1993 by the development company owned by Patterson and Cerner co-founder Cliff Illig, which created the gated Loch Lloyd community in which the house is located. It is appraised at $3.26 million. Patterson died in July 2017.

    Several board members of University of Maryland Medical System resign or take leaves of absence following investigative reports indicating that one-third of the board members have business dealings with the health system, one of them being Baltimore Mayor Catherine Pugh, who says she’s a victim of a “witch hunt” in failing to disclose her deal. She sold the health system $500,000 worth of her self-published children’s books, of which not a single copy has ever been bought by anyone else.

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    I missed this earlier: Rochester Institute of Technology researchers begin commercialization of a cardiovascular monitoring system embedded in a toilet seat, which they expect to sell (via their Heart Health Intelligence startup) to hospitals hoping to reduce readmissions of congestive heart failure patients. I assume it works better for women.


    Sponsor Updates

    • EClinicalWorks will exhibit at Endo Expo 2019 March 23-25 in New Orleans.
    • Hayes Management Consulting will host a networking event at the 2019 HCCA Compliance Institute April 8 in Boston.
    • Imprivata will exhibit at Texas HIMSS March 25-26 in Austin.
    • InterSystems will exhibit at the AMIA Informatics Summit March 25-28 in San Francisco.

    Blog Posts


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    Contacts

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    Get HIStalk updates. Send news or rumors.
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    News 3/20/19

    March 19, 2019 News 6 Comments

    Top News

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    A Kaiser Health News – Fortune article titled “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong” says the federal government’s Meaningful Use program cost $36 billion, yet 10 years later, the system is an “unholy mess.” It makes these points:

    • Malpractice and whistleblower lawsuits have exposed an underreported number of cases in which patients were potentially harmed by EHR problems.
    • EHRs remain a “sprawling, disconnected patchwork” of systems that now-unhappy users bought quickly to collect incentive payments.
    • Doctors aren’t allowed to publicly talk about observed safety issues because of “gag clause” requirements of either their employer or their EHR vendor.
    • A survey found that 20 percent of consumers found mistakes in their EHR records, most often involving medical history.
    • User customization makes it hard to compare safety records across health systems and sometimes the site’s own configuration creates the problem.
    • Experts note that while the EHR solved several problems, it created a big one lacking visual cues to assure clinicians that they are working in the intended patient’s record.
    • A MedStar usability study found that an ED doctor ordering Tylenol is faced with a drop-down that lists 86 options, many of them inappropriate for a given patient.
    • The article includes a brilliant comment from WellSpan SVP/CIO Hal Baker, MD: “Physicians have to cognitively switch between focusing on the record and focusing on the patient … I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to [entering a computer] record, and it’s a pretty complicated interface.” 
    • The urgency to dump money into the Meaningful Use program in 2009 – it was part of an economic stimulus program that targeted  “shovel-ready” projects – left too little time to consider interoperability or broader improvements an instead rewarded only widespread adoption.
    • EHR vendors rushed out aggressive sales tactics to get their place in the EHR Meaningful Use land grab, figuring they could fine-tune implementations afterward, leading to customer complaints and lawsuits over shoddy software and patient harm.
    • An unknown number of doctors and hospitals falsely attested to EHR use to earn incentive payments.
    • Patients still can’t get copies of their own medical records easily and inexpensively from hospitals.
    • Some patients who are suing for malpractice claim that hospital employees changed EHR entries after the incident and refused to turn over audit logs that would prove it.

    Thoughts on the “Death By 1,000 Clicks” Article (And Your Chance to Weigh In)

    This article was a good rehash of how we went from the first glimmers of Meaningful Use to today’s “unholy mess.” It doesn’t contain much of anything new for industry followers, but it will reach a mass audience as the Fortune cover story.

    The Past, Which By The Way, Can’t Be Changed

    • Healthcare was slower than most industries to adopt technology.
    • Meaningful Use was an ill-conceived, rushed stimulus project that paid EHR-resistant doctors to use (not necessarily buy) EHRs in government-mandated ways with the vague hope that patient care and cost would improve once they were in place.
    • The short payment timelines discouraged innovation as providers were forced to buy the same outdated systems they didn’t want before the government offered bribes.
    • EHR vendors fought for their share of the resulting taxpayer-funded windfall with aggressive sales tactics and over-the-top marketing that were a lot more sophisticated than the old EHRs that were gathering dust on their shelves.

    Provider Greed Made Today’s Undesirable EHR Situation Possible

    • Hospitals and practices bought whatever inexpensive, quickly implemented system would get their faces into the government trough as quickly as possible.
    • They did the bare minimum required to earn incentives.
    • The government used the honor system of unverified attestation to trigger checks, leading some providers to lie.
    • In the case of larger practices and most hospitals, they didn’t ask (and didn’t really care) what physician users thought of the systems they considered before buying.
    • They customized new EHRs to work like paper charts and their old systems.
    • They under-invested in training, physician support, and optimization, opting instead to push the decisions of committees – often with minimal user involvement – to the front lines.
    • Freshly armed with the technical means to allow easy sharing of patient data, they have refused to do so.
    • They didn’t allow doctors to publicly share EHR-related patient safety information because of malpractice concerns, competitive worries, and the lack of incentive to help someone else’s patients.

    The Challenges to Making It Better

    • Doctors and hospitals don’t believe in standardizing processes, either within their own organizations or across competing ones. They all believe they have a self-developed secret sauce that is better than everyone else’s. The same patient will receive different care depending on where they go in the absence of “one best way.” You don’t want to be the developer that has to code around that.
    • Doctors and other clinicians are the only professionals who are expected to perform their own clerical work and to perform data entry during professional encounters. Hospitals are willing to force their doctors to perform tasks that other professional employers (law firms, accounting practices, and even dental practices and veterinary practices) would find not only insulting, but a waste of highly-paid resources when lower-skilled employees could do the work.
    • The executives who require doctors to use computers generally don’t use them themselves.
    • Only a tiny part of what is entered into an EHR directly contributes to patient care and the user of that information is often not the person who enters it.
    • Doctors don’t like to have bosses or to have their decisions questioned, yet ancillary departments and EHRs catch and prevent their mistakes regularly, creating tension between doctors and almost everyone else, especially when the doctor is not a hospital employee. Everybody thinks they understand patient care – or at least their particular pet aspect of it — better than everyone else.

    The Big Question: What Would An EHR Look Like If Clinicians Designed It For Themselves?

    We will never know because clinicians don’t drive our healthcare system. It’s mostly overseen by hospital and practice executives, insurers, regulators, and the government. I would also wager that getting consensus would be impossible since nearly every doctor mistakes their opinion for irrefutable fact.

    There’s also the question of whether clinicians have enough of a broad view to design software that will be used by thousands of users. EHR design is the de facto consensus of a broad swath of users in the most heavily represented specialties and user configuration options are the safety valve for practice deviations (which is why EHRs are so deeply configurable).

    It’s also a pie-in-the-sky fantasy that a clinical system should be as easy to use as Facebook, Amazon, or an IPhone. It’s true that those systems empower their users with smart design, but their functionality is comparatively simple and users are motivated because their purpose is largely recreational.

    The Bottom Line

    EHR vendors are incented to create the systems that customers will buy. Companies selling well in a contracting EHR market Cerner, Epic, EClinicalWorks, etc. – are delivering what customers want (“customers” not necessarily being synonymous with “users.”) They have no incentive to build products that everybody hates, and given the competitive environment, they would do whatever they can to gain market share.

    The underlying business model drives EHR design, and that’s what a lot of clinicians don’t like (and especially their place in it). That resentment gets pushed both down and up.

    There’s still an immediate need for not only allowing, but encouraging system users to publicly and anonymously report patient-endangering software bugs. Vendors have not done a good job in pushing these notices out, and even in cases where they do, word doesn’t always filter down from the hospital’s IT department to end users.

    Now Comes Your Part

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    Enough griping about EHRs or leaving laypeople to draw their own conclusions about them. What would you change? Tell me here,  be specific, and assume (as EHR vendors are expected to do) that our screwy US healthcare system is off the table.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Health Catalyst hires bankers to initiate its IPO.


    Announcements and Implementations

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    Apple quietly rolls out new models of the IPad Air and IPad Mini. The former has a larger display, a processor that’s three times faster, and support for the Apple Pencil, while the latter hasn’t changed much except to add Pencil support (and thus supports high-margin Pencil sales). Apple seems more focused on the impending announcement of its video streaming service and other high-margin, non-commoditized services.

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    Sopris Health claims that its chat-powered digital assistant app allows clinicians to create a visit note in 45 seconds, or the time required to walk from one exam room to the next. Co-founder and CEO Patrick Leonard previously worked for Aetna’s consumer technology group and was CTO of the symptom-checking app ITriage that Aetna acquired in 2011 along with its developer, Healthagen.  

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    A new KLAS report on the medical oncology technology needs of community cancer canters finds that Flatiron Health leads the pack, as Cerner, Epic, and McKesson Specialty Health lag in supporting workflows. Cerner and Epic also score poorly in connecting with EHRs of other vendors.


    Government and Politics

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    A whistleblower lawsuit brought by two former IT employees of Community Health Systems accuses the for-profit hospital chain of submitting fraudulent attestations for Meaningful Use, reaping $544 million in incentive payments in 2012-2015. It adds that CHS acquired 60 hospitals of Health Management Associates that attested to Meaningful Use payments even though their Pulse EHR was poorly integrated and require printing paper at multiple stages during a patient’s stay. The lawsuit also claims that Medhost made false statements to get its EHR certified under Meaningful Use Stage 2. The former employees also say that CHS used Medhost partially because of illegal kickbacks in the form of providing free Medhost Financials with the purchase of its clinical applications.

    The White House’s US Digital Service says the VA’s newly developed online eligibility tool for veterans who seek private care under 2018’s MISSION Act is so flawed that it should be scrapped. warning that it will be slow, will cause errors, and will require an extra 5-10 minutes for each appointment booked. The report says VA contractor AbleVets isn’t the problem – it’s the VA’s poor oversight and a rush to bring the system live in June without adequate testing or integration with six existing VA systems. VA doctors are already pushing back, with one saying, “These people are out of their minds. We aren’t housekeepers, doorkeepers, or garbage men.” The VA says it needs $5.6 million to finish work on the system, which it says will cost $96 million in this fiscal year. An inefficient approval and scheduling process caused major delays in the VA’s 2014 rollout of a similar program, creating the need for this new project.


    Other

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    Samuel Shem, MD – who in 1978 wrote what might be medicine’s most enduring novel in “The House of God,” which is a lot like MASH except more clinical and more cynical– calls EHRs “the new bullying to all of us in medicine.” He calls EHRs “an epic intrusion and frustration in our doctors’ lives” that require more time than actually delivering care, He also notes that EHRs are billing machines that have not been proven to improve safety or quality of care. I’ve read “House of God” many times and hereby give you some teasers to encourage you to do the same:

    • “The delivery of good medical care is to do as much nothing as possible.”
    • “It’s an incredible paradox that being a doctor is so degrading and yet is so valued by society.”
    • “Gomers (Get Out Of My Emergency Room) are human beings who have lost what goes into being human beings. They want to die, and we will not let them. We’re cruel to the gomers, by saving them, and they’re cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them.”
    • “To do nothing for the gomers was to do something, and the more conscientiously I did nothing, the better they got.”
    • “It ain’t easy to do nothing, now that society is telling everyone that their body is fundamentally flawed and about to self-destruct. People are afraid they’re on the verge of death all the time.”

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    For more insightful medical wit, check out retired ED doc and author Rada Jones, MD, who describes herself as, “I speak like a vampire since I lived most of my life in Transylvania” and who just relocated to Thailand with her husband. She offers “47 Tips to Keep You Away From My ER” (which actually contains 49), one of which is, “NEVER EVER stand around minding your own business. It’s the most dangerous thing known to man. 90 percent of my assault victims were doing just that.”

    Glen Falls Hospital (NY) reaches a confidential settlement with Cerner over the $38 million of revenue it lost due to billing problems after go-live.

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    A study finds that implementing EHR-generated severe sepsis alerts didn’t improve treatment performance measures or patient outcomes. Two-thirds of the alerts were true positive, but only eight percent of those doctors used the EHR sepsis order set, with two-thirds saying they would rather enter their own orders and 58 percent expressing skepticism about whether the alert captured a meaningful change in clinical status.

    Stat notes that despite the hype associated with Stanford’s widely reported study of the Apple Watch’s ability to detect atrial fibrillation, it’s hard to look at the overall effects since the study was not a randomized controlled trial and instead just observed what users experienced. It did not look at false positives, how many doctor visits resulted, the conclusions from those visits, and whether wearing the Watch can actually improve the health of a large population.

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    Doctors in England express concern about fast-growing online visit provider Babylon, which NHS has embraced under its GP at Hand program. Local NHS cost have skyrocketed as 40,000 Londoners have joined Babylon’s program, which as a medical group requires people to leave their local practice (which patients often don’t understand), creating economic upheaval under NHS’s per-patient payment model that looks at where the practice – not the patient – is located. Doctors also complain that Babylon attracts the most easily managed patients, sticking them with the more complex ones under the fixed payment. Insiders also raise questions about the company’s AI-powered chatbot, which sometimes delivers flawed results and has not  been peer-reviewed.

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    At least 48 adult strangers find that they are half-siblings after taking home genetic tests and sharing their results, their newly discovered father being an Indiana fertility doctor who admits that he used his own sperm instead of that of donors in the 1970s and 1980s. Meanwhile, some former writers for “The Onion” launch a home DNA testing parody site called “DNA Friend.”


    Sponsor Updates

    • AdvancedMD will exhibit at NATCON March 25-27 in Nashville.
    • Aprima will exhibit at the AIMSVAR Annual Conference March 21-22 in San Antonio.
    • EClinicalWorks publishes a case study of the implementation of ECW’s population health management tools at Adult Medicine of Lake County (FL).
    • Avaya announces further integration with Google Cloud Contact Center AI.
    • Bernoulli Health becomes an Affiliate member of the Intel IoT Alliance; its Bernoulli One solution has been named an Intel IoT Market Ready Solution.
    • Culbert Healthcare Solutions will exhibit at AMGA March 27-30 in National Harbor, MD.
    • Divurgent launches a data and analytics approach to address physician burnout.

    Blog Posts


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    Contacts

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

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    Monday Morning Update 3/18/19

    March 17, 2019 News 2 Comments

    Top News

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    Change Healthcare files IPO documents for a $100 million IPO. Analysts estimate the company’s value at up to $12 billion.

    The company, of which McKesson owns 70 percent with two private equity groups holding the remainder, reports adjusted net income of $281 million on $3.3 billion in revenue in 2018.

    Change took on $6.1 billion in debt to create the business last year in merging the former Emdeon with McKesson’s IT business, after which McKesson was paid $1.25 billion and PE firms Blackstone and Hellman & Friedman received $1.75 billion.

    Shares will trade on the Nasdaq under the symbol CHNG.

    CEO Neil de Crescenzo’s 2018 compensation was $8.3 million; former CFO Al Hamood (now president of ATI Physical Therapy) was paid $13.3 million; EVP Rod O’Reilly earned $5.6 million; former sales EVP Mark Vachon was paid $6.4 million; and EVP/CIO Alex Choy’s compensation was $3 million.

    The six non-employee board members were each paid cash and options worth $400,000 to $573,000.

    Seventeen of the 19 company directors and executive officers are male.


    HIStalk Announcements and Requests

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    Last week’s poll is a toss-out since responses were evenly spread and few in number, so let’s move on.

    New poll to your right or here, for HIMSS19 provider attendees: did you discover an interesting product or service that you will follow up on? Click the poll’s “comments” link if you vote yes to tell us what piqued your interest.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Mobile health evaluation company Signify Health acquires TAV Health, which offers a platform to connect community and health partners to address social determinants of health. Signify’s CEO is former Athenahealth SVP/Chief Product Officer Kyle Armbrester.

    For-profit hospital operator HCA acquires a majority ownership in for-profit Galen College of Nursing, which offers instruction on five campuses and online.


    People

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    Chris Belmont (Intelligent Retinal Imaging Systems) joins The HCI Group as EVP of strategy and operations.

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    ROI Healthcare Solutions hires Brent Prosser (Infor) as SVP of sales.


    Announcements and Implementations

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    Peterson Regional Medical Center (TX) goes live on Meditech Expanse with patient accounting and supply chain help from CereCore.


    Privacy and Security

    Singapore’s Health Sciences Authority reports yet another healthcare-related breach in that country after discovering that one of its contractors failed to secure an online database of blood donors containing the information of 800,000 people. The website of the contractor, Secur Solutions Group, has gone offline.


    Other

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    A large RN survey finds that a hospital’s work environment plays a big part in whether nurses are satisfied with the hospital’s EHR and how they perceive its contribution to patient care and safety.

    The Canberra, Australia newspaper reviews the 40 patient safety bulletins issued to EHR users in 2018 by the Cerner project team at Queensland Health, many of related to software updates. They include problems with children’s weights, unexpected drug name changes, switching to the wrong record when multiple patient windows are open, and creation of duplicate encounters.

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    A Virginia woman complains that her dying husband had to endure a low-quality, 35-minute telemedicine encounter with an Inova psychiatrist who needed to evaluate his “do not resuscitate” request. She complained, “I hope there’s a real reflection in the medical community about the ethics of these teledoctors.”

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    Doctors at University of Virginia Children’s Hospital develop an IPad-based system that allows NICU babies to go home earlier, replacing a pen-and-paper and call-in system for parents to report their baby’s feedings and weight. The system sends data immediately to Epic. It was developed by Charlottesville-based Locus Health and its use has been expanded to 15 children’s hospitals. The designers are a pediatric cardiologist and his NICU pediatrician wife.

    Ontario, Canada scraps a $500,000 public health vaccination reporting system and goes back to paper forms after finding problems caused by incompatibilities with physician EHRs, one of which was that the vaccine names don’t match.

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    The Atlantic covers the “uniquely American phenomenon” of medical debt, as 60 percent of people who file bankruptcy say medical bills played a major part. It says medical debt will probably increase as fewer people buy insurance, deductibles are raised, sales of poor-coverage junk plans increase, and out-of-network bills increase as insurers narrow their networks. The article focuses on how to negotiate a bill with a hospital:

    • Ask about financial assistance, including charity care if uninsured
    • Ask to be billed at the same rate Medicare pays
    • Ask for a payment plan or full payment discount

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    A study finds that applying deep learning to just a few hundred patient EHR records can accurately predict the outcome of chronic diseases (rheumatoid arthritis in this case). The same model then works fairly well across other hospitals. The authors believe that decision support should involve training models on aggregated patient data from multiple healthcare systems, then extending the model to other providers.


    Sponsor Updates

    • NextGate and Nordic will exhibit at Texas HIMSS March 25-26 in Austin.
    • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Virginia Section Conference March 17-18 in Charlottesville.
    • Flywire and Experian Health will exhibit at the HFMA Revenue Cycle Conference March 20-22 in Austin.
    • Recondo Technology and MedeAnalytics partner to create a single, powerful revenue cycle management platform.
    • PatientPing publishes a new case study, “Houston Methodist Coordinated Care Achieves Savings of Over $680,000 Within First Year of PatientPing Partnership.”
    • PatientKeeper will exhibit at Hospital Medicine 2019 March 24-27 in National Harbor, MD.
    • SymphonyRM releases a new e-book, “Competing in an Amazon World: Four-Step Action Plan for Health Systems.”

    Blog Posts


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    News 3/15/19

    March 14, 2019 News 9 Comments

    Top News

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    Rutland Regional Medical Center (VT) notifies 72,000 patients of a breach after discovering that the email accounts of nine employees had been hacked late last year.

    Hospital officials believe the hack originated outside of the US.

    RRMC did similar damage control in 2017 after an employee exposed patient information by sending a bulk email to patients using CC: instead of BCC:.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Health research network TriNetX raises $40 million in financing, earmarking the funds for enhancing its analytics software and further expanding in Asia, Europe, and South America.

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    Medical record retrieval and image-sharing company EHealth Technologies secures $41 million in financing.


    People

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    Haven hires Sandhya Rao (Partners Healthcare) as VP of clinical strategy.

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    PatientPoint names Wes Staggs (Blue Ridge) as its first EVP of customer success.

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    Australia-based Telstra Health names former New Zealand National Health IT Board Director Graeme Osborne, who also spent seven years leading New Zealand’s EHealth Program, to run its hospital software business unit, which includes the EHR it acquired along with Emerging Systems in 2014.

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    Wendy Hill (Cerner) joins Netsmart as its first chief people officer.


    Sales

    • In Australia, SDS Pathology will replace its Triple G Ultra lab system with SCC Soft Computer.
    • Val Verde Regional Medical Center (TX); Bayamon Medical Center (PR); Puerto Rico Women’s and Children’s Hospital; and Massachusetts Health Collaborative members Harrington Healthcare, Holyoke Medical Center, and Heywood Healthcare will implement Meditech Expanse.

    Announcements and Implementations

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    Johns Hopkins Health System (MD) goes live with Bluetree’s Service Center for Epic users.

    Partners HealthCare leverages Appriss Health’s PMP Gateway interface to become the first health system in Massachusetts to integrate its EHR with the state’s PDMP.

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    OhioHealth goes live on Epic.


    Privacy and Security

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    Emerson Hospital (MA) notifies patients of a data breach that occurred last May when an employee of its billing vendor, MiraMed Global Services, sent electronic patient files to an unauthorized third party. The hospital’s forensics team found the files to be of such poor quality that the data was likely not used in further malicious activity.


    Other

     
    Documentarian Alex Gibney shares his experience developing “The Inventor: Out for Blood in Silicon Valley,” a Theranos documentary that will debut on HBO Monday night. A few highlights:
    • The overriding theme, beyond company paranoia, is the willingness of Holmes to “fake it until you make it.”
    • Gibney likens Elizabeth Holmes to Thomas Edison in that both invented larger-than-life celebrity personas to sell themselves and their inventions. His footage of her in-house interviews shows that she worked hard to present that contrived version of herself. “[T]hat was precious to us,” he says, “because, if you’re talking about the psychology of deception, now we had an opportunity to show from the inside out how that deception was manufactured.”
    • After a team member interviewed Holmes in 2017, Gibney concluded that, “Elizabeth perceived herself to be a victim. Not somebody who was contrite, but somebody who was brought low by forces who were out to get her because she was a woman.”
    • After acquiring footage of Holmes and her boyfriend and company executive Sunny Balwani jumping in a bouncy house to MC Hammer’s “U Can’t Touch This” in celebration of FDA’s marketing clearance for one of its tests, Gibney admits, “It was jaw-dropping to see the delusional behavior inside the company.”

    Sponsor Updates

    • Nordic names Michael Malecha (Huron) senior director of ERP solutions.
    • Elsevier adds new assessment capabilities to its ClinicalKey Student medical education platform.
    • EClinicalWorks and InterSystems will exhibit at the Rise Nashville Summit March 17-19.
    • HBI Solutions will present and exhibit at the Population Health Colloquium March 19 in Philadelphia.
    • The University of Florida recognizes The HCI Group CEO Ricky Caplin as one of its outstanding young alumni.
    • HGP publishes the results of its 2018 health IT private equity survey.
    • Imprivata will exhibit at Texas HIMSS March 25-26 in Austin.
    • Medhost recaps its 2018 business growth.
    • Spok releases a new case study featuring Vail Health (CO).
    • EHealth Exchange expands its use of InterSystems solutions by selecting its HealthShare unified care record to power its HIE.
    • Meditech releases a video showing how its solutions deliver real results to executives, providers, and patients.

    Blog Posts


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    News 3/13/19

    March 12, 2019 News 3 Comments

    Top News

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    Hill-Rom will acquire mobile clinical communications vendor Voalte for up to $195 million. Hill-Rom hopes to enhance its point-of-care delivery of actionable insights and to drive its growth and margin.

    Voalte’s annual revenue is $40 million. It has 200 healthcare customers.


    Reader Comments

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    From Boston Beanboy: “Re: Salesforce. You might enjoy this article – replace ‘Salesforce’ with any EHR vendor’s name and ‘sales rep’ with ‘clinician.’ It’s the same story.” A biased but interesting article written by  the CEO of a sales platform that runs on Salesforce says sales reps hate Salesforce because the system wasn’t designed for them, it doesn’t help them meet their goals, and it turns them into highly-paid data entry clerks where which they enter the bare minimum of information required for them to collect their commissions. As a result, 75 percent of sales managers don’t trust the information in Salesforce users want a system that is personalized, flexible, integrated, and that helps them close deals instead of requiring more work. Comments posted that have EHR counterparts include:

    • Salesforce wasn’t designed for the sales rep – it was designed to get information into a database so that work can be inspected and shared
    • Sales reps are like everyone else in avoiding the use of a system that provides them no personal value
    • Companies sell bots that can do some of the data entry work for users
    • Sales teams that use a defined process love Salesforce because it tells them what to do to close more deals, but reps who pride themselves on using their own methods hate it
    • Lack of Salesforce integration is often a problem with the implementation, not the platform
    • Companies use CRM as a tax on salespeople, a way to capture their information to make replacing them easier

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    From Grand Padano: “Re: Athenahealth. Any plans to interview its new CEO? The chatter about what’s happening there post take-private is enormous.” I usually turn down interview requests from companies whose CEO is a new hire (thus giving us little to talk about except his or her optimistic plans) and has no healthcare experience (which Bob Segert does not). But I’ll consider it.

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    From Junto: “Re: Epic on EHR-caused physician burnout. Judy is officially out of her depth if she thinks hiding behind loose research from KLAS is an appropriate response to physician burnout. It would be nice to hear from her how Epic can be part of the solution instead of deflected the EHR as a non-issue. It’s also beyond comical that KLAS, which makes an exponential percentage of revenue from EHR vendors, conveniently has research at hand for Judy saying EHRs are all that bad.” Epic CEO Judy Faulkner cites an upcoming KLAS report’s study as evidence that minimal correlation exists between EHR and physician burnout. The surveys came from KLAS’s Arch Collaborative, which benchmarks user experience survey results across its 150 paying members, which includes Epic (price ranges from a one-time $1,250 cost to $60,000 annual membership depending on organization size). As with most of KLAS’s research, the real question is their methodology – who they surveyed, how the questions were worded, who actually responded, and how well the results extend to other organizations. All that aside, my thoughts are:

    • I agree with Judy’s point that while doctors often don’t find their EHRs to be empowering and don’t enjoy the time required to feed the beast with their laboriously typed (or dictated) information, surveys don’t always tease out details about the software vs. the rules it enforces that someone else has saddled users with (the “someone else” being insurers, the federal government, and the frequent worst enemy of doctors – their employers).
    • Site-specific implementation issues are often involved, primarily setup, training, support, and ongoing communication about why the system works as it does.
    • EHRs may well have usability issues, but saying that EHRs specifically cause burnout (rather than being associated with it) is like saying that Word and Outlook burn us out when what we really hate is being overworked and underappreciated, being used short of our potential, being required to provide documentation that does not benefit us, and losing our idealistic view of our profession that turned out to be just another crappy job working for faceless overlords.
    • If Epic or another specific EHR were actually causing burnout, it would be reported by nearly every clinician user of those systems, and I haven’t seen that to be the case.
    • The VA’s VistA, one of the most antiquated and ugly systems ever built, has high user acceptance and minimal reported contribution to burnout because it has the luxury of focusing on what a doctor needs to deliver care rather than for billing, a situation that exists nearly nowhere else. It will be interesting to see how its replacement with Cerner, which was built around billing and administrative requirements, is perceived by those same doctors.
    • The argument that all EHRs cause burnout is also an argument that the software isn’t the problem. Those systems look and work wildly differently, with the only common ground being that they were chosen by organizations who wanted them to work in a certain way. I haven’t seen much evidence that doctors universally love any EHR despite the vendors of those system exploiting every competitive advantage they can find. It’s easy to hate the lawnmower when what you really hate is mowing the lawn.
    • EHR design and implementation decisions reflect what the decision-makers want and those aren’t the same people who actually use the EHR.
    • Burnout is not consistent across specialties even though many of them use the same EHR to varying degrees.
    • Working conditions often require doctors to complete their work after hours at home using the EHR, making it likely they won’t love it.
    • Asking Judy her opinion makes for great click-bait for dopey journalists looking for Twitter fodder, but doesn’t otherwise mean a whole lot. She doesn’t have to defend selling the market-leading product or to speak for the entire industry in explaining why the health systems that buy EHRs are somehow wrong.
    • The bottom line is that EHRs or not, physicians would be burned out because of the demands made by  those who pay them. All bets are off if you treat them like a monkey that gets fed only after dancing to organ music. Epic can’t fix that.

    From Pointed Rejoinder: “Re: doctor empathy via robot. Not possible.” It may be unreasonable to expect skilled doctors, especially those such as surgeons and ED doctors whose services are one-and-done, to also be empathetic in a non-phony way to someone they don’t know. Still, nurses do it well all the time and I’ve seen some of our nastiest surgeons – feared and reviled for their tantrums and intentional hurtfulness toward hospital employees – behaving remarkably tenderly with a deceased patient’s family, which as a hospital employee always made me wonder if we really are incompetent, if the doctor was just using us as a punching bag proxy for our employer, or if they were simply putting on an act for their paying customers. Maybe hospitals should hire “empathists,” otherwise unemployable amateur actors who can pretend to be empathetic, letting them take the doctor’s handoff after delivering bad news in helping patients and families get through those first painful moments of understanding.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Australia-based imaging software vendor Mach7 announces that it will implement a restructuring and cost-cutting program that it hopes will propel its US growth, firing its CEO and eliminating the CTO role in favor of strategic product management. The company has several high-profile US customers including Penn Medicine, UW Medicine, Brigham and Women’s, University of Virginia Health System, Adventist Health, Sentara, and Broward Health.

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    Business Insider notes that companies such as Hims and Roman that send lifestyle prescriptions directly to the customer’s door often use TruePill, which aspires to the Amazon Web Services of mail-order pharmacy by offering itself as a B2B API and fulfillment service. The technology-focused company can send 100,000 orders per day and allows companies to control the patient experience in the form of custom packaging and shipping options. Co-founder Sid Viswanathan was also a co-founder of a business card scanning company acquired by LinkedIn, while CEO Imar Afridi was working as a CVS pharmacist two years ago.

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    The Philadelphia paper questions whether Medicaid-heavy Temple Health — the closest thing to a public hospital in the country’s poorest large city — can survive competition from well-funded and growing competitors such as Penn and Jefferson. Temple is considering selling the cancer system it bought seven years ago, which is its most profitable business, to keep afloat. Temple has survived only because the state chips in a non-guaranteed $150 million per year, not only because the health system offers healthcare services, but because it employs many people.

    Insurers Cambia Health Solutions and BCBS North Carolina sign a long-term management services agreement in which they will share corporate services and operate in five states under the Cambia Health Solutions name.


    Sales

    • In Qatar, Alfardan Group and Chicago-based Northwestern Medicine select Allscripts Sunrise Ambulatory, Surgery, Radiology, Clinical Performance Management, Lab, and IPro Anesthesia for their joint project.
    • Chapters Health System (FL) will implement hospice and home health EHRs from WellSky.
    • DrFirst implements an interoperability gateway to provide medication histories to the Missouri Health Connection HIE.

    People

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    Carol Steltenkemp, MD, MBA, former board chair of HIMSS and the Kentucky EHealth Board, is promoted from CMIO to external chief medical officer of University of Kentucky HealthCare.

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    Virta Health, which offers type 2 diabetes treatment via virtual health coaches and a ketogenic diet, hires Derek Newell, MPH, MBA as head of commercial. He was previously CEO of digital health benefits technology vendor Jiff and then president of its acquirer Castlight Health for 17 months.


    Announcements and Implementations

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    A new KLAS report on quality improvement software finds a near-revolt of users of the worst-performing Conduent and IBM Watson Health (the former Truven). The top-rated vendors for hospitals are Nuance and Quantros, while the ambulatory-focused vendor list is topped by Mingle Health, SPH Analytics, and Healthmonix.


    Government and Politics

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    HHS’s Office of Inspector General opens a position for Health Information Technology Attorney, looking for someone with expertise in EHR incentive payments, EHR interoperability, and breach notification to represent OIG in civil fraud enforcement and compliance with corporate integrity agreements. Do something wrong in health IT land and maybe you’ll get to meet the successful candidate.


    Other

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    ECRI Institute lists its top patient safety recommendations for 2019:

    1. Don’t rely solely on EHR information for diagnostic stewardship and test result management
    2. Manage patient expectations around antibiotics
    3. Review burnout and listen to provider concerns
    4. Deploy mobile health technology wisely by identifying patients who are good candidates, give them training, and monitor the systems for user error and inactivity
    5. Provide training and communication to ensure that all providers treat people who have behavioral health needs with dignity and respect
    6. Detect changes in a patient’s condition, including using alarms and other technology appropriately
    7. Use simulation training to maintain device and procedure skills
    8. Recognize the early signs of sepsis in all setting and develop protocols supported by tools for rapid response
    9. Increase awareness, surveillance, and reporting around peripheral intravenous catheter infections
    10. Standardize patient safety efforts across large systems and leverage the privilege and confidentiality benefits from forming a patient safety organization

    An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month, claiming that practices that provide services under risk-bearing contracts would be happy to give Apple a cut. I seriously doubt all of this, but mostly the idea that the Watch is collecting information that will allow doctors to deliver better, more cost-effective care to entire populations. 

    America’s homeless population is fueling a resurgence of “medieval” diseases such as typhus, shigellosis, hepatitis A, and trench fever caused by living in unsanitary conditions.

    A Health Affairs blog post questions whether CMS’s push to give people easier access to their medical provider-managed information will improve outcomes or improve smart shopping, when instead what is known to work is (a) making easily understood information available when they are making a decision; and (b) allowing them to share in any cost savings. The authors are encouraged by apps such as Apple HealthKit that help consumers understand their data and take action on it, but nobody really knows how they will be used.

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    A man who threatened to sue MIT Technology Review for using his picture to accompany an article explaining why hipsters all look alike – he called it “click-bait” and “a tired cultural trope” — inadvertently proves the article’s conclusion when the editor-in-chief sends him a screen shot of the stock photo (which wasn’t of him) and concludes on Twitter, “All of which just proves the story we ran: Hipsters look so much alike that they can’t even tell themselves apart from each other.”


    Sponsor Updates

    • Optimum Healthcare IT adds ERP to its service lines.
    • AdvancedMD and Aprima will exhibit at the AAOS conference March 12-16 in Las Vegas.
    • Arcadia will host Aggregate 2019 April 24-26 in Boston.
    • Artifact Health will exhibit at OHIMA 2019 Annual Meeting & Trade Show March 18-20 in Columbus, OH.
    • Avaya expands its line of video collaboration solutions with new offerings designed for smaller meeting spaces.
    • CompuGroup Medical will exhibit at the Arizona Medical Association Spring Conference March 16 in Phoenix.
    • Collective Medical releases a video featuring New Mexico Hospital Association Director of Policy Beth Landon.
    • Cumberland Consulting Group will exhibit at the Health Plan Alliance Spring Leadership Meeting March 19-22.
    • Diameter Health will exhibit at the Rise Nashville Summit March 17-19.

    Blog Posts


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    Monday Morning Update 3/11/19

    March 10, 2019 News No Comments

    Top News

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    FDA has given the manufacturers of surgical staplers an exemption from publicly reporting problems to its MAUDE database of medical device failures, allowing them to hide widespread problems by submitting just 100 incidents in 2016 vs. the 10,000 that were actually reported.

    FDA’s alternate summary reporting program – created to save FDA employee processing time — allows manufacturers to send a quarterly or annual spreadsheet list of problems instead of detailed reports.

    Several experts, including former FDA Commissioner Rob Califf, said they’ve never heard of the program. Companies that use the option tend to keep quiet about it to prevent competitors or prescribers from finding out the true patient impact.

    Among the non-reporters are manufacturers of pelvic mesh, the da Vinci surgical robot, and several critical heart devices.

    FDA responded to the Kaiser Health News report by saying it will analyze the summary reports, also adding it will make public the 41,000 safety reports it has received that involved surgical staplers. Those reports included 366 deaths, 9,000 serious injuries, and 32,000 malfunctions.

    It’s puzzling that FDA received so many patient safety incident reports that it decided its best action was to stop requiring them.


    HIStalk Announcements and Requests

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    Around half of poll respondents say the federal government’s role in interoperability should be to set technical standards, while the distant #2 choice is for the federal government to stay out of it entirely and let the market figure it out.

    New poll to your right or here: for provider employees, how much time and energy does your employer devote to planning or delivering value-based care?


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Sales

    • Medway NHS Foundation Trust joins TriNetX’s global health research network to attract more clinical trials and to support research collaboration.

    Decisions

    • Firelands Regional Medical Center (OH) replaced Aris Radiology with REAL Radiology For teleradiology in fall 2018.
    • Braxton County Memorial Hospital (WV) will Implement 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.


    Privacy and Security

    Columbia Surgical Specialists (WA) pays $15,000 to regain access to its data following a ransomware attack, explaining, “We received notice from the people that encrypted the files just a few hours before several patients were scheduled for surgeries, and they made it clear we would not have access to patient information until we paid a fee.”


    Other

    Kaiser Permanente apologizes for one of its doctors telling a 79-year-old inpatient that he is dying via a telemedicine robot. The family says it was hard to hear what the doctor was saying due to the robot’s small speaker, but it was clear when he said, “I don’t know if he’s going to get home” due to the patient’s failing lungs. The man’s daughter recorded the incident on video thinking the family would be receiving care instructions. The patient died two days later. It sounds harsh, but I’m not so sure – not all telemedicine visits will result in good news, the provider isn’t necessarily geographically accessible to the patient, and the idea that empathy requires physical presence may need to be challenged. Or perhaps it’s unreasonable to expect skilled clinicians to be good at comforting patients or consoling their families as much as we as patients would like it. There’s probably no good way to be told – accurately, as it turns out – that you are dying.

    23andMe will add type 2 diabetes risk factors to its consumer genetic screening once FDA approves the test, although the science behind it is shaky (it looks at a package of existing genetic traits rather than a specific genetic abnormality and it is known to be super inaccurate for black Americans, for example) and it has not been reviewed in the medical literature. My questions:

    • How many people already have known diabetic risk factors, what are they doing about it, and how does this new test benefit anyone other than 23andMe?
    • A big percentage of people have known diabetic risk and it’s not clear how many of them take action that are proven effective to avoid moving to active diabetes. What would patients do differently from the results of this test? How does this test change outcomes?
    • What is the immediate course of action for someone who tests positive? Call their PCP for an immediate appointment and then be identified for life as “prediabetic” and run up bills for drugs and monitoring? Who’s going to pay? How many of those patients have already been told by their PCP that they are at risk but haven’t done anything?
    • Is 23andMe motivated more by its partner agreements that allow those who are identified as being at risk to sign up for paid coaching programs?
    • As one expert says, “You might as well just look in a mirror. That’s as good a predictor for diabetes as all your genes put together.”
    • Every medical student is taught that you don’t measure something just because you can — the course of action is uncertain; chasing a lab result isn’t necessarily beneficial to the patient; medicalizing a symptom-free patient often doesn’t make sense;  and plenty of people already have diabetes but don’t receive treatment.
    • The odds that this test will move the US public health needle is just about zero despite our widespread (and profitable) misperception that we just need to diagnose more stuff.

    Sponsor Updates

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    • US Air Force Reservist Senior Master Sergeant Andrew Branning, director of CloudWave’s project management office and quality and recently returned from overseas deployment, nominates his supervisor Mark Middleton, VP of cloud services and chief quality officer, for the Patriot Award. The award, overseen by the DoD’s Employer Support of the Guard and Reserve, allows citizen soldiers to recognize the supervisors who support their work by offering flexible schedules, time off before and after deployment, and family care.
    • Seven hospitals in Mississippi and Alabama form the Mississippi Meditech CIO Collaborative to share common goals, challenges, and a dedication to improving healthcare with EHR technologies.
    • Medhost enables integration of National Decision Support Co.’s CareSelect Imaging with its EHR.
    • NextGate will exhibit at State Health IT Connect Summit March 18-20 in Baltimore.
    • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Virginia Section Conference March 17-18 in Charlottesville.
    • FlyWire’s global payment and receivables business accelerates into 2019 after integrating OnPlan Health.
    • Experian Health will exhibit at the Semi-Annual ACO Leadership Forum March 11-12 in Chicago.
    • Sansoro Health releases a new podcast, “The Power of Patient & Family Engagement.”
    • Vocera will exhibit at the NYONEL Annual Meeting & Leadership Conference March 17 in Tarrytown.

    Blog Posts


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    News 3/8/19

    March 7, 2019 News 2 Comments

    Top News

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    Amazon, Berkshire Hathaway, and JPMorgan Chase decide to call their healthcare venture Haven.

    The bare-bones website launched along with the brand is light on concrete details about the company’s plans, though visitors can glean a few details about its goals and structure if they dig deeply enough:

    • Haven will focus on offering employees of the founding companies easier access to primary care, easier-to-understand health insurance, and affordable medications.
    • It will use data and technology in unspecified ways to meet those goals.
    • Haven seeks to become an ally of rather than a competitor to healthcare stakeholders.
    • Profits will be reinvested.
    • It may one day share its solutions with other interested parties.

    Of its nine-member team, only CEO Atul Gawande, MD and Head of Communications Brooke Thurston have health system experience. CTO Serkan Kutan comes from Zocdoc, Head of Measurement Dana Safran from BCBS, and COO Jack Stoddard and Chief of Staff Megan McLean from Comcast.


    Reader Comments

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    From La Vida Loca: “Re: [company CEO name omitted]. Have you seen his arrest record?If I were on the board, which he controls, I would be investigating moral turpitude as a cause. What does that do to the business?” I hadn’t heard that, but Googling turns up a September 2018 arrest and his co-founder wife has since left the company. I’m not naming him because I don’t see that he ever went to trial.

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    From Cranapple: “Re: CareTrac HIE. Reading between the lines, it is folding because the big Epic hospitals in Minnesota won’t share data.” The forwarded announcement from Southern Prairie Community Care says the HIE doesn’t have a business case because large health systems won’t share their data, adding that HIE’s technology vendor Change Healthcare won’t devote the resources to connecting the HIE to the EHealth Exchange (which the state requires of HIOs) that would have given the smaller players at least some big-hospital data.

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    From Amy Gleason: “Re: healthcare costs. Check out what my daughter wrote about her monthly infusions. Her newest insurance pays $202K per year more than the last insurance. She is horrified and doesn’t understand why there isn’t an app that would help her.” First off, Amy has moved on from the shuttered CareSync and is now working for the White House’s US Digital Service on HHS/CMS interoperability projects. Her daughter Morgan’s write-up describes the situation – she gets the same infusion every month from the same doctor, same hospital, and same nurses, but the three insurers that have covered her have paid wildly different prices. Like normal humans, she’s wondering exactly how forcing hospitals to publish their chargemasters accomplishes anything when the healthcare world revolves around confidential discounting with each insurance company. I wish I had something encouraging to say, but Morgan has already wisely concluded that “I am thinking that we might really need to just burn the healthcare system to the ground and completely start over,” although I won’t burst her bubble by mentioning that fire trucks – in the form of politicians who are well paid by the profitable status quo – always manage to squelch those flames.

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    From Odd Bedfellows: “Re: Molina Healthcare. Offering its Washington State Medicaid members a free 90-day subscription to Amazon Prime.” There’s so much wrong here that I don’t know where to start, so I’ll save my snarkiness for this – even after the free subscription ends, the Medicaid members pay just $5.99 per month and that’s a lot less than I pay. You folks in Washington are generous to provide your less-fortunate neighbors with two-day delivery and Prime Video streaming while you’re off working. Still, I’ll table my cynicism temporarily in noting that for those who have transportation issues and who live in food desert neighborhoods, Prime could indirectly improve health and lower costs and I assume that Amazon is footing some or most of the cost in its attempt to get every American on Prime (and 100 million of us have already signed up).


    HIStalk Announcements and Requests

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    Welcome to new HIStalk Platinum Sponsor Artifact Health. The Boulder, CO-based company made headlines this week for its just-announced work with AHIMA to deliver compliant physician query templates (documentation clarification) via its cloud-based platform. Health systems using Artifact reduced their AR days by increasing response rates to nearly 100 percent and reducing average response time by 80 percent. Doctors can respond from their computers or smartphones (often in just three taps) and appreciate receiving the same format for all queries (CDI, inpatient, outpatient, and pro fee). Their responses are recorded directly in Cerner, Epic, or Meditech to become part of the legal medical record with no manual recordkeeping by CDI specialists and coders. Thanks to Artifact Health for supporting HIStalk.

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    I decided to leave my HIMSS19 burner phone active for a bit longer, just in case you want to text me something interesting.

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    I’ve received a few reader inquiries lately about not getting my email updates because of spam-blocking or other email filtering on their end. Sign up again if you are among them – you only need to enter your email address and there’s no risk otherwise.


    Webinars

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Long-term and post-acute care software vendor PointClickCare acquires LTPAC-focused medication management company QuickMar.

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    Chronic disease management-focused digital health company Livongo hires underwriters to prepare a Q3 IPO that’s expected to bring in $1 billion. The company has raised $240 million since former Allscripts CEO Glen Tullman started it in 2014.

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    Philips acquires Carestream Health’s imaging IT solutions business – which includes VNA, diagnostic and enterprise viewers, and clinical, operational, and analytics tools — for an unspecified amount.


    People

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    Impact Advisors hires Jay Backstrom (Schumacher Clinical Partners) to lead its newly expanded telehealth consulting service.

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    Apixio hires Jennifer Pereur (Hill Physicians Medical Group) as VP of solutions and Terry Ward (Change Healthcare) as SVP of solutions.


    Sales

    • Allina Health (MN) selects patient engagement software from PatientWisdom.
    • In Texas, Arise Austin Medical Center and The Hospital at Westlake Medical Center will adopt Allscripts Sunrise.
    • The Escambia County Healthcare Authority in Alabama will implement Cerner Millenium at D.W. McMillan Memorial Hospital, Atmore Community Hospital, and four clinics. Atmore appears to be running Epic under Infirmary Health. The hospitals will also run Cerner RCM, ancillary, and ambulatory as well as outsource its business office to Cerner.
    • The University of Kansas Health System chooses Connexient’s MediNav digital wayfinding software.
    • WakeMed Health & Hospitals (NC) selects PeraHealth’s Rothman Index predictive analytics.

    Government and Politics

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    VA officials tell members of a House appropriations committee that it will roll out its new Cerner EHR at three facilities in the Pacific Northwest early next year. John Windom, head of the VA’s EHR modernization effort, told lawmakers the pilot had been slowed down to give end users more training time. Also on the VA’s to-do list: finish converting VistA data into a Cerner-friendly format for migration, getting a permanent deputy secretary installed to oversee the roll out, and ensuring VA providers have security clearance to access DoD health records.

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    This op-ed lays part of the blame for the spectacular rise and self-destructive fall of Theranos at the feet of the US Patent and Trademark Office, which it says has done “a terrible job” of ensuring that whether inventions actually work. The office has admitted to operating on an honor code, a system that worked well for founder Elizabeth Holmes:

    Yet more than a decade after Holmes’ first patent application, Theranos had still not managed to build a reliable blood-testing device. By then the USPTO had granted it hundreds of patents. Holmes had been constructing a fantasy world from the minute she started writing her first application, and the agency was perfectly happy to play along.


    Privacy and Security

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    Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett, who was treated in its ED following his claim of being attacked in a racially motivated incident. One terminated nurse says that she and co-workers were fired for simply scrolling past the actor’s name on an EHR list while looking for other patients. The real crime in this story is that a grown man named Justin thinks Jussie sounds better.

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    Medical billing vendor Wolverine Solutions Group notifies hundreds of thousands of patients from an undisclosed number of providers and health plans of a ransomware attack that occurred last September. The company has been sending out notifications on a rolling basis since December, and expects to wrap up messaging by the end of this month, at which point it will have a better idea of how many people were affected.


    Other

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    Auditors blame a 2017 implementation of Cerner’s billing system for the $38 million revenue loss of Glen Falls Hospital (NY), which was forced to lay off employees after losing 12 percent of its annual patient services revenue due to bills that went out late or were never sent.  

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    A brilliant article in Science looks at how the public relations chief of the American Diabetes Association came up with the term “prediabetes” in trying to scare doctors and their patients to take action to address slightly elevated blood glucose levels, a mostly benign, symptom-free condition that had previously been labeled “impaired glucose tolerance.” ADA rolled out the term on a wide scale and keeps broadening the definition to include more people, now counting one in three Americans as being prediabetic even though studies show that only single-digit percentages of them will ever have diabetes. Since then, billions of dollars have been spent to address the observed blood glucose levels – mostly weight loss and exercise programs that have shown few results – and the now-medicalized “condition” has created a cottage industry of fitness coaches, dietary products, glucose monitors, and prescription drugs that now consume at least $44 billion of US healthcare spending each year and line the coffers of the ADA with up to $27 million annually in drug company contributions. A researcher who advocates wider use of prescription drugs to treat prediabetes has earned $5 million from the companies that sell those drugs and many doctors who wrote the ADA’s standards of care have also made millions. A Mayo diabetes clinician concludes, “The people who lose are the people who go from being a healthy person to being a patient. Now, they have the sick role. They have to go for checkups and tests and treatments … I just don’t think we [prevent diabetes] by making every healthy person a patient.” @EricTopol lauded the article, calling prediabetes “mass, dumbed, down medicine and scaremongering one of three (84 million) adults and 1 billion people worldwide, supported by pharma, propelled by guidelines from trusted organizations … with 80 percent of such individuals at no risk.”

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    Dear HIMSS Media, I’m confused – is this event in Santa Clara or LA?

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    In an attempt to prevent hospital readmissions, researchers at the Rochester Institute of Technology in New York develop a sensor-embedded toilet seat they say can detect deteriorating conditions in congestive heart failure patients.


    Sponsor Updates

    • PMC Regional Hospital (IN) completes its Meditech Expand implementation with help from Engage Consulting.
    • EClinicalWorks will exhibit at the AAPM Annual Meeting March 7-9 in Denver.
    • Ellkay will exhibit at the ACMG Annual Clinical Genetics Meeting April 2-6 in Seattle.
    • EPSi will exhibit at the Metro New York HFMA Chapter’s Joseph A. Levi 60th Annual Institute March 7-8 in Uniondale.
    • Healthfinch publishes the third e-book in its refill optimization series, “Achieving Refill Protocol Consensus.”
    • Huntzinger achieves a score of 96.4 in the HIT Advisory Services Category of the “Best in KLAS Software & Services 2019” report.
    • Hyland releases a new enterprise search solution as part of OnBase content management platform.
    • Imprivata will exhibit at SoCal HIMSS March 12 in Duarte.
    • Mobile Heartbeat invites vendors with complementary solutions to integrate with its CURE Connect API Suite via its new CURE Connect Interoperability Program.
    • NPR profiles Kentucky Hospital Association, Kentucky Office of Rural Health, and Collective Medical efforts to develop a statewide care coordination network.
    • Apixio announces that it has grown its customer base to 36 health plans and provider groups, and has analyzed 11 million documents for Medicare Advantage and private plan beneficiaries.
    • Netsmart earns multiple top Black Book awards across behavioral health and post-acute healthcare settings.
    • Sansoro Health makes available a cloud-hosted test environment for digital health companies and health IT developers to test application workflows in a real EHR environment.
    • PatientPing announces that its national network of ACOs generated over $100 million in shared savings for 2017 under the CMMI Next Generation ACO Program.

    Blog Posts


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    Contacts

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

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    News 3/6/19

    March 5, 2019 News 4 Comments

    Top News

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    FDA Commissioner Scott Gottlieb, MD resigns, effective next month. He resignation letter did not indicate the reason for his departure from the job he has held since May 2017.

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    Gottlieb was a supporter of digital health technologies and modernization of FDA’s approach to regulating them. That included development of FDA’s Digital Health Software Precertification Program that allowed certified software vendors to fast-track their products to market. He also advocated using EHR data for post-market electronic safety surveillance of drugs and medical devices.

    The 46-year-old Gottlieb previously worked for FDA in 2002-2003 and 2005-2007 and was a venture partner specializing in healthcare from 2007 until he was appointed FDA commissioner.

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    Gottlieb tweeted on January 3 that he was not leaving FDA, a denial that was apparently greatly exaggerated.


    Reader Comments

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    From Minor Trauma: “Re: HIMSS Analytics. Now that it’s owned by Definitive Healthcare, should they still be using the HIMSS ‘not-for-profit’ position in soliciting survey responses, especially when working with PwC, another commercial org?” Definitive Healthcare didn’t buy HIMSS Analytics – they bought the HIMSS Analytics provider data business. HIMSS kept the consulting business, mostly involving its various Adoption Models, and that work (including this survey) will continue under the HIMSS Analytics name. Definitive CEO Jason Krantz responded to my inquiry on your behalf as follows:

    Definitive Healthcare bought the data services part of HIMSS Analytics, which collects and provides data and analytics on the healthcare provider community. The data assets and clients of this part of the business will be entirely integrated into the Definitive ecosystem, which should be massively beneficial to those clients as we combine the best of both products. HIMSS Analytics will, however, remain an ongoing concern with a renewed focus on their mission of helping healthcare providers utilize technology more effectively to drive improved patient outcomes. In essence they are providing consulting services to providers with a focus on goals that are consistent with their non-profit objectives.  

    From Digital Native Uprising: “Re: HIMSS. How much did it receive for its sale of the data business of HIMSS Analytics?” The number wasn’t announced and Jason Krantz from Definitive Healthcare (as I asked him the question above) was obviously not willing to provide details. Long-timers will remember that HIMSS originally bought that business from someone else whose name I’ve forgotten in 2003 and renamed it the HIMSS Solutions Toolkit. I always wonder how much HIMSS paid for acquisitions such as Healthbox and Health 2.0’s conferences, not to mention the mostly forgotten acquisitions of the rights to Disruptive Women in Healthcare, the MHealth Summit conference, the Medical Banking Project (apparently still around with HIMSS under John Casillas), Health Story Project, Microsoft Healthcare Users Group, and several other organizations that were rolled up into something bigger that no longer use their original names.

    From Bohn E. Maroney: “Re: Orlando Health’s venture capital arm. Is it ethical for health systems to create or invest in for-profit businesses?” I admit that it makes me nervous when someone who is making healthcare decisions on behalf of a patient – whether it’s a hospital with private company investments, a doctor earning royalties, or the average for-profit medical practice — stands to benefit financially from ordering a particular course of therapy. I don’t think financial influence would encourage them to knowingly harm a patient, but it might sway them toward overuse, especially if the patient risk is low and their insurance company is footing the bill. That’s why we have a zillion times more diagnostic imaging machines than pure science says we need and armies of drug company reps living in mansions. We set ourselves up for disappointment in hoping that doctors and hospitals will act more nobly than the rest of society in declining to take the perfectly legal action that benefits them most. In all aspects, conscience has proven to be an ineffective deterrent to questionably ethical behavior.


    HIStalk Announcements and Requests

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    I just read this book that Datica was offering at HIMSS19 and found it to be very good, especially given my modest knowledge of the technical underpinnings, business imperatives, and legal considerations of cloud computing. The authors are Datica CEO/Chief Privacy Officer Travis Good, MD and Chief Marketing Officer Kris Gösser. It finally convinced me that cloud isn’t “someone else’s hard drive.” Coincidentally, I just read that Lyft’s IPO documents reveal that it pays $100 million per year to Amazon Web Services for cloud computing services. 


    Webinars

    March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

    March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


    Acquisitions, Funding, Business, and Stock

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    Medical device maker Zoll Medical acquires Golden Hour Data Systems, which offers charting, revenue cycle management, and hospital integration software for emergency medical service companies.


    People

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    ROI Healthcare Solutions hires Jeff Tennant (Leidos) as executive director of revenue cycle IT services.

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    Practice Velocity hires Deven Shah (FTD) as VP of software development.


    Announcements and Implementations

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    AHIMA and Artifact Health will offer templates and a mobile app for delivering compliant physician query templates, which means coders asking doctors to clarify their documentation for accuracy and maximum payment.

    The Sequoia Project will hold a public forum webinar on the federal government’s proposed information blocking policies on March 19 as part of its Interoperability Matters initiative.

    A smallish survey of senior healthcare leaders finds that two-third of health systems have rolled out executive dashboards to aid in decision-making, but rarely use them daily. The survey also found that healthcare systems use an average of four analytics tools, while one in six of them use 10 or more.


    Privacy and Security

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    This is true of healthcare, too, where collecting and selling patient data is everywhere. In related news, Facebook gets caught for its practice of harassing users to provide their telephone number to support two-factor authentication, then immediately using that number to target ads, with the newfound twist being that Facebook allows looking up users by their telephone number with no opt-out provision. Also like healthcare, Facebook does little to correct wrongdoing until it makes headlines.


    Other

    A Health Affairs article warns that “consumer-driven healthcare” is an appealing-sounding but potentially harmful health reform concept because healthcare isn’t a classic market that can be shaped by consumer actions. Patients don’t understand healthcare, they don’t choose providers based on quality and price, and their insurers don’t have enough bargaining power to drive down prices, so health reform that is based on consumerism is likely to fail. It also notes that, unlike in other markets, giving patients what they want in a “customer is always right” model can compromise provider integrity and result in patient harm.

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    A startup in Japan develops AI-powered software for existing closed-circuit security cameras that can detect shoplifters by their suspicious body language such as fidgeting, potentially allowing employees to deter their crime by asking them if they need help. The company’s website lists possible healthcare uses, such as detecting poor physical condition, and I can see hospitals using it to identify hospital visitors who are struggling to navigate the usual consumer-unfriendly hallways, although if hospitals cared that much, they would probably address the problem rather than the symptom.

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    Another interesting Health Affairs article looks at how patient portals have been integrated into the care processes of four health systems:

    • Ochsner Health System has created a hypertension program in which patients complete surveys about their diet, exercise, medications, and social determinants of health via Epic’s MyChart; are issued a blood pressure device that sends their readings directly to MyChart; are offered help with using digital tools via a Genius Bar-type desk; and are monitored by a care team that includes pharmacists and health coaches. Blood pressure control and patient satisfaction have improved and PCP visits have been reduced by 29 percent.
    • Sutter Health has convinced 79 percent of ambulatory care patients to use its Epic patient portal and has motivated clinicians to respond to patient  messages by using a triaging system and offering them incentives for answering messages within one business day. Patients are also using the portal for online scheduling, appointment wait-listing, and booking video visits.
    • Stanford Health Care invites patients to sign up for MyChart via a text message and automatically verifies their sign-up identity by asking questions about publicly available data, which has increased primary care patient enrollment to 87 percent. The portal also allows patient check-in, facility way-finding, and Open Notes chart information access. It is also being used to survey patients about unaddressed symptoms and needs. Stanford also shares all physician notes, other than those related to mental health, across all disciplines.
    • UC San Diego Health offers inpatients the use of tablets from which they can manage room settings (lights, shades, thermostats) and access Epic’s MyChart Bedside inpatient portal to review meds, procedures, test results, care team members, and educational materials.

    Sponsor Updates

    • Cantata Health’s NetSolutions and Optimum platforms win Black Book’s highest satisfaction awards for ERP, long-term care, and hospital revenue cycle management.
    • OptimizeRx will present at the annual Roth Conference March 17-19 in Orange County, CA.
    • Healthcare Growth Partners posts its February health IT insights.
    • Bernoulli Health receives ISO 13485:2016 and Medical Device Single Audit Program certifications from Intertek.
    • Nancy Landman (IBM) joins The Chartis Group’s Information & Technology Practice leadership team.
    • DrChrono expands its partnership with CoverMyMeds, offering end users electronic prior authorization and support services, and prescription pricing transparency.
    • STAT profiles Nuance’s new ambient listening system for patient encounters.
    • Aprima will exhibit at the LHC Group Revenue Cycle Leadership Conference March 11-12 in New Orleans.
    • Atlantic.Net CEO Marty Puranik weighs in on a Facebook feature that lets people look up users by their phone number or email address.
    • Bluetree donates 624 trees to the National Forest Foundation at HIMSS19.
    • Healthfinch publishes an ebook titled “Achieving Refill Protocol Consensus – Best Practices for Creating and Maintaining Protocol Content.”
    • DrFirst’s RCopia is certified as compliant with the NCPDP Script 2017 e-prescribing standard.
    • NJ Biz profiles CarePort Health.
    • CareVive names Ethan Basch, MD (UNC School of Medicine) director of its Scientific Advisory Board.
    • ChartLogic will exhibit at the AAOS annual meeting March 12-16 in Las Vegas.
    • The Silicon Slopes podcast features Collective Medical CEO Chris Klomp.
    • CoverMyMeds will exhibit at the MHA Business Summit March 6-8 in Las Vegas.

    Blog Posts


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    Contacts

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    Monday Morning Update 3/4/19

    March 3, 2019 News 1 Comment

    Top News

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    Beth Israel Deaconess Medical Center, Lahey Health, and three community hospitals complete their merger to form 35,000-employee Beth Israel Lahey Health to better compete with Partners HealthCare.

    CEO Kevin Tabb, MD says in a Boston Business Journal interview that the organization will keep multiple EHRs and focus on their interoperability in the short term (Epic, Meditech, and homegrown) because post-merger is the worst time to rip and replace, but “it was always my belief, and is still my belief, that in the intermediate to long term, we will need to standardize on a system. But when and which one, I can’t tell you yet.”

    Tabb came from BIDMC. Former BIDMC CIO John Halamka, MD, MS is executive director of BILH’s Health Technology Exploration Center. He commendably declined to wear a tie for the new website’s photo like his fellow male executives, instead wearing his traditional black outfit while sporting a down-filled black outdoor jacket atop. 


    Reader Comments

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    From No-Frills Rills: “Re: experience. I would like to hear examples of where your readers received fantastic patient care in which technology was involved.” I created a survey for readers to describe their technology-assisted positive patient care experience.

    From Topicality: “Re: listing new sales. Why didn’t you list this vendor’s contract extension?” It’s not really a new sale when a health system decides not to fire a vendor by instead extending its contract. I consider it a sale when a customer upgrades from a vendor’s older product to their newer one since that requires a new contract and implementation (Soarian to Millennium, Magic to Expanse, Paragon to Sunrise, etc.) Otherwise, nobody other than the customer and the vendor cares.

    From HIMSSanity Check: “Re: HIMSS19 exhibit hall. I agree with your poll respondents that it should be limited to pure health IT vendors.” I don’t agree, starting with the idea that the exhibit hall is “too big.” It is bigger than I would like, but HIMSS offers the supply of exhibit space that the market demands – vendors wouldn’t keep coming back and buying bigger booths if they weren’t seeing a return on investment (OK, the clueless ones would, but not forever). While I would enjoy not having to walk endless miles to see it all or even to find a particular vendor, it wouldn’t make sense for HIMSS to turn down the revenue that exhibitors are happy to pay. The exhibit hall is like a mall – the big anchor stores are intentionally placed far apart, smaller ones theoretically enjoy the resulting shopper traffic, and any company that doesn’t see value is free to let its lease lapse and spend its money elsewhere. Malls are struggling, though, as consumers have decided that they no longer value the orgy of chain-shopping or plopping their kids on Santa’s lap while mobilizing the hunt for a discounted Instant Pot, and it could be that conferences are also due some attendee recalibration. I’ve always been struck by people and companies who extol virtual visits and monitoring patients remotely, yet still spend their employer’s money to show up simultaneously at a distant location to discuss those very subjects without apparent irony. Here’s an idea – take three work-from-home days, eat and drink way too much while listening to the audio recordings of the educational sessions afterward and looking at vendor ads, and arrange a conference call with old industry friends as do-it-yourself networking. I’ll add one more point to my overly long dissertation – most of us say with honesty that we value the conference mostly for its networking opportunities, but we also expect vendors to foot the bill, which makes the exhibit hall the profit center whose equivalent (in more ways than one) is the casino of a Las Vegas hotel that you can’t avoid while enjoying everything it makes possible.

    From Dojo: “Re: anti-vaxxers. Social media shouldn’t give them a platform. Pinterest has started blocking all searches for ‘vaccination.’” Our global problem isn’t that ill-informed and ill-mannered people have learned to use social media — it’s that our society has created so many ill-informed and ill-mannered people in the first place. Soul-sucking Facebook in particular is giving us a scary look into who’s out there (no wonder younger people are abandoning it in droves). The same person spouting vitriol on Facebook probably doesn’t do so in public, however, so the anonymity offered by social media fans those angry flames, mostly again because we aren’t collectively bright enough to avoid giving trolls the limelight they were justifiably denied when responsible people ran media outlets and thus controlled the podium. Those news outlets even make Facebook and Twitter the sources of their stories and then turn the comments of anonymous posters into follow-up stories, which is cheaper than hiring actual reporters to track down facts, especially when readers would rather be entertained than informed.


    HIStalk Announcements and Requests

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    Only around one-third of poll respondents sent or received information by fax in the past year, with just one-third of those who did so saying that it was only for healthcare purposes. I’ll summarize as this – while most of us don’t use fax any more, it’s not just healthcare still using it. Respondent Foxy Faxxer is a clinician who gets faxes – often because nobody can figure out how to use Direct messaging – and has few alternatives since his or her university employer won’t pay for scanners.

    That leads me to conclude that faxing is a reliable, free, no-training-required interoperability standard that everyone has agreed on, making it hard to create a business case for replacing it (especially for the sender, who doesn’t really care what happens on the other end). You would be impressed if you took away the “faxing is so 1990s” stigma away and envision a technology in which anyone, anywhere can send you documents of any size, at no cost to anyone, with next to zero work on either end, that can be triggered to automatically create documents from inside even proprietary systems such as EHRs, that arrive immediately and print themselves out into a common workplace in-basket, and that support asynchronous communication. Still, I can’t think of any cases in which I’ve used fax other than in healthcare, where the whole “print, sign, scan, and attach to an email” suggestion raises a contempt-filled “we don’t do that” from the person on the other end who clearly doesn’t care what customers think.

    New poll to your right or here: What primary interoperability role should the federal government play?

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

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    Webinars

    March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

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


    Sales

    • Houston Methodist Hospital joins TriNetX’s global health research network for evaluating study feasibility, facilitating academic discussion, and increasing participation in clinical trials.

    Announcements and Implementations

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    Microsoft will shut down Microsoft Band and Microsoft Health Dashboard apps and services on May 31, following discontinuation of its Band fitness tracker two years ago. The company is offering active users of the service a partial refund of the cost of their Band 1 and Band 2 devices.


    Other

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    A Charlotte, NC man complains to the local TV station after a Novant Health nurse asks him puzzling questions about his huge weight loss, heroin addiction, and suicidal tendencies, after which started receiving large bills for services he hadn’t received. He finally discovered that his identity is tied to four patient profiles in Novant’s EHR, some of them bearing names such as “zzz test z chart correction,” suggesting that someone did their IT testing in the production environment.

    BCBS Michigan paid its CEO $19.2 million last year, with the insurer adding that “we are keeping health care affordable to the best of our ability here in Michigan.”

    In Australia, a hospital’s internal review concludes that “disjointed information flow” in its Cerner EHR, along with other factors, contributed to a newborn baby’s brain damage. A midwife entered a test result in the EHR that suggested pre-eclampsia, but the obstetrician didn’t see it because OBs use a different EHR view and the catch-all “results view” function wasn’t working correctly. The review also found that clinicians monitored the mother’s symptoms using the wrong assessment tools and that the regional clinic where she was first seen should have given her a paper copy of her record to hand-carry to the hospital. EHealth Queensland had previously issued a patient safety alert that warned obstetricians that the EHR’s labor progression monitoring module wasn’t working correctly and Cerner could not fix the problem, requiring the entire module to be turned off.

    Everything that’s screwy about US healthcare, part 59. For-profit mental health and addictions provider Sovereign Health (which shut down last year over fraud accusations) sues insurer Anthem for sending checks for services received by patients to the patients themselves instead of to Sovereign, with many of those patients predictably pocketing the cash like it was lottery winnings instead of forwarding it on to Sovereign. Critics, which include the AMA, say insurers do that to punish out-of-network providers, while insurers say they have no contract with the out-of-network providers and therefore the checks represent true reimbursement to the patient and it’s the patient’s job to make good. A medical ethics professor concludes, “Only in our crazy, market-driven, bureaucratic mess of a system would we think about this kind of a solution … You’re going to be giving out these sums of money that a lot of people never see in a year and tell them their duty is to shift it over to the out-of-network service provider? You can’t be serious.” An attorney representing Sovereign said that sending piles of cash to people who are addicted, some of them who receive the check while still in rehab, is an invitation to disaster, not to mention that insurers don’t tell the providers that they’ve paid the patient. One patient received a check for $240,000 following a surgery.


    Sponsor Updates

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    • Lightbeam Health Solutions team members attend the Dallas Area Habitat for Humanity dedication ceremony for the home they worked on last October.
    • Meditech releases the latest episode in its Thought Leader Podcast series, “Addressing the Opioid Crisis.”
    • NextGate raised $3,000 for St. Jude’s Children Research hospital during HIMSS19.
    • Black Book recognizes Nordic for top EHR implementation consulting, and Epic consulting and advisory services.
    • OmniSys will exhibit at the APCI Annual Convention and Stockholders’ Meeting March 7-10 in Nashville.
    • Securance Consulting awards CloudWave’s OpSus Live cloud hosting solution a “Best Practice” rating after completing the Meditech Infrastructure and Supporting IT Process Audit.
    • Experian Health will exhibit at the MGMA Financial Conference March 3-5 in Las Vegas.
    • Visitors to Bluetree’s HIMSS19 booth allowed the Epic consulting firm to donate 624 trees that will be planted by the National Forest Foundation.
    • PerfectServe discusses product and bolsters client relationships at its fifth annual customer advisory board meeting.
    • PreparedHealth will exhibit at the 2019 AMDA Annual Conference March 7-10 in Atlanta.
    • Sansoro Health releases a new 4×4 Health Podcast, “Air-Traffic Control for Patient Care.”
    • Surescripts will exhibit at the 2019 PBMI National Conference March 4-6 in Palm Springs, CA.
    • SymphonyRM publishes a new e-book, “Competing in an Amazon World: Four-Step Action Plan For Health Systems.”
    • The MedTalk Podcast features Wolters Kluwer Health Senior Manager of Clinical Effectiveness Lisa Kean.

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