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News 12/18/19

December 17, 2019 News 4 Comments

Top News

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Amazon Web Services adds ICD-10 and RXNorm linking to its Amazon Comprehend Medical natural language processing service.

Developers can use the API-driven, pay-per-use services to extract codes from unstructured text with higher accuracy than rules-based systems, according to AWS.

I’m impressed at how deeply AWS is pushing into terminology and semantics issues so early in its health IT work. Comprehend Medical was announced a year ago.


Reader Comments

From Jan Madrid: “Re: evidence-based medicine. You asked in your interview with Mr. Alkire from Premier why employers have to use the financial level to get health systems to follow accepted good practices. I found the answer enlightening – they are just now considering it.” Healthcare has always been slow (at best) or resistant (at worst) to insist that physicians practice according to widely accepted evidence in the inevitable tension of science versus art. Every doctor and hospital either thinks they’ve figured out the secret sauce for best outcomes (highly unlikely) or they are just too tied to business as usual to think through doing a better job. The percentage of medical decisions that can be based on available evidence is pretty small, but even then the practice variation is wide. One of our hospital’s lesser-skilled doctors told me rather defiantly a few years ago that he liked prescribing opiates to people with colds, adding that he was the doctor and nobody could second guess him. Many doctors, especially the older ones and surgeons, were trained to think they are infallible, God-like super-scientists who float in a higher plane than their peers and the rest of us. I don’t think medical education, especially residencies, is training doctors to become science-based, patient-centered team players, but then again, we don’t make their paycheck dependent on it (and in fact, it’s exactly the opposite since drug companies happily reward irrational prescribing). That’s the raison d’être for Premier’s Contigo Health as mentioned in the interview, i.e. the businesspeople who pay employee medical bills are asking doctors to behave rationally.

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From AnonMD: “Re: Verge Health. Mark Crockett, MD has exited as CEO. Connie Moser has been appointing acting CEO.” Unverified. The company’s executive page and the respective LinkedIn profiles remain unchanged. I’ve emailed the company but haven’t heard back. UPDATE: verified by the company, with a press release to follow in 1-2 days.

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From Boring Pants: “Re: VCU Health. Going to Epic, which will replace a Cerner implementation that has been in place for more than 15 years. IDX for rev cycle will be wiped away as well.” Unverified, but the source is internal.

From Value-Added Reseller: “Re: patient portals and Meaningful Use. Your note was on target. I hated it when practices answered the ‘why do you want an EMR?’ question with ‘we want the government to pay for it.’ I knew they wouldn’t expend the effort to make the EMR useful and productive and would then blame the vendor. Clients that view the EMR as a strategic asset tend to be most successful.” Many or most doctors, to be blunt, are terrible businesspeople, grabbing impulsively at anything that looks like it will put cash in their pockets. But in this case, it did exactly that, as long as they were willing to claim they were using the EHR meaningfully even when they weren’t. It’s also true when you think about it that the vast majority of doctors are using an EHR they didn’t choose or maybe didn’t even want, whether it’s in a medical practice, a hospital, or elsewhere. 


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Central Logic. The Sandy, UT-based company’s pioneering, purpose-built Transfer Center platform helps health system transfer centers connect with their referring facilities to improve transfer efficiency, decrease costs, and realize revenue opportunities. Transfer Center is seamlessly integrated with On Call Scheduling (customizable calendars and schedules that can be shared, combined, and redeployed) and Advanced Reporting (real-time reporting of actionable information). Patients get routed quickly to the appropriate health system resources and the health system benefits from higher acceptance rates and the better load-balancing. Case studies include Mercy Medical Center – Des Moines, which replaced its outsourced transfer center with an internally managed solution, increasing transfers by an average of 9% per year and allowing analysis of external referral sources and the ability to perform case reviews. Thanks to Central Logic for supporting HIStalk.

Here’s a Central Logic explainer video I found on YouTube.

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I’m embarrassed that I didn’t mention Donors Choose donations before Monday given that I have received quite a few new donations since, all of which will enjoy a two-for-one match from my Anonymous Vendor Executive (AVE). Unless otherwise instructed, I always mention only the first names of individual donors without their specific donation amounts, but I list the company and donation for those who mention their employer. Thanks to Christina, Bill, Mike, and Carla. Thanks also to Diameter Health, which provided an amazing $2,000 for classroom projects (which by the magic of AVE matching, will fund at least $6,000 worth of teacher projects). I’ll choose the projects – nearly $9,000 worth with the matching, plus I always find additional matching funds — and report back where the money went this week. I am confident that the butterfly effect of these donations will help turn some of these kids of today into tomorrow’s scientists, leaders, parents, musicians, teachers, or passionate pursuers of whatever interests them.

Listening: Trans-Siberian Orchestra. I took Mrs. HIStalk to see them recently and it was the most sensory-overloading, musically satisfying concert I have ever seen. Forget that their theme is Christmas – instead of Mariah Carey yodeling her way through a description of what she wants for Christmas (spoiler: it’s me), it’s like Pink Floyd and Van Halen rocking out while surrounded by lasers and pyro like you can’t even imagine. We will no doubt see them again every chance we get.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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HealthStream-owned credentialing vendor VerityStream acquires seven-employee competitor CredentialMyDoc for $9 million.

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1-800 Contacts acquires Israel-based 6over6 Vision, whose smartphone app allows consumers in certain non-US countries (including Canada) to perform their own eye exams, skipping a trip to the eye doctor for new prescriptions for glasses and contact lenses. 1-800-Contacts already offers Express Exam, a $20 smartphone exam that is reviewed by a remote doctor. The American Optometric Association is, not surprisingly, is very much against having its members bypassed and has asked the FDA to shut Express Exam down. Purely out of concern for patient safety, you understand.  

Fujifilm will reportedly buy Hitachi’s diagnostic imaging business for $1.5 billion to improve its competitive position against Siemens, GE, and Philips.


Sales

  • BJC HealthCare chooses Sectra’s enterprise imaging solution for 14 of its hospitals.

People

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Ryan Allen, MHA (State of Alabama) will join UAB Health System (AL) as CISO.


Announcements and Implementations

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HIMSS and Forrester Research announce a research project (meaning an online survey) that will look at “the evolving digital doctor-patient relationship.” The survey is available via an open web link and doesn’t seem to limit who participates, so I’m not too sure I would trust the results. It’s also hard to believe that two big organizations did such a shoddy job designing the survey instrument – available responses for the very first question (above) are not only illogical, no combination of answers I chose allowed me to proceed to the second question. Clearly HIMSS needs some usability help.

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A KLAS report on the care management component of population health management notes that Athenahealth, Allscripts, Epic, and Cerner aren’t delivering adequate customized workflows, leading to the success of Arcadia in supplementing their functionality.


Government and Politics

ONC posts the agenda for its annual meeting on January 27-28 in Washington, DC.

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HHS publishes a report describing its plans to improve internal data sharing.


Privacy and Security

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Computer systems of three-hospital Tidelands Health (SC) are apparently still down following a malware attack of an unspecified nature last Thursday.

The City of New Orleans lays out the effects of having the city’s 4,000 computers taken offline to remove ransomware from an attack last Friday: the police can’t run background checks, EMS phone lines are down, municipal and traffic courts are closed, Healthcare for the Homeless can’t see patients because its EHR is offline, WIC vouchers won’t be issued, online job search is down, businesses must file monthly sales tax forms manually, and all payments must be made via check or money order. Maybe HIMSS will move the annual conference there in sympathy again like it did in 2007, when the city was clearly not ready for prime time given the obvious shortage of hotel and restaurant workers and “don’t drink the water” signs all over the convention center due to another in a long string of infrastructure failures.


Other

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Tim Kelsey, CEO of the Australian Digital Health Agency, resigns after a couple of years to take a job as SVP of analytics with HIMSS. He oversaw the country’s MyHealthRecord project (which cost $1.5 billion plus $300 million in annual maintenance) that has had a lot of issues with security problems and poor public acceptance. He also co-founded Dr. Foster Intelligence, a UK analytics firm that reviewed NHS performance data.

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Thailand’s largest healthcare group will provide video second opinions for residents of China in a partnership with China’s Ping An Good Doctor. The service, “Overseas Top-Tier Doctors,” will be available for purchase on Ping An Good Doctor’s mobile app. The hospital group manages 48 hospitals and employs 12,000 doctors. Ping An Good Doctor has more than 60 million active users.

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The CEO of continuous glucose monitoring manufacturer Dexcom apologizes for the Thanksgiving weekend failure of its Follow data sharing function, which allows people (often parents of young children) to monitor a user’s glucose results. He says the company moved the function to a new cloud service without configuring it for optimal performance, causing it to fail. The company will also roll out an in-app messaging feature and dedicated update page for its website following complaints that it did not notify users for hours and even then only via a Facebook update.

Another “only in America” healthcare story – a man who performed thorough research into his hip replacement insurance coverage still gets a surprise bill for $3,000 – the certified registered nurse practitioner who entered the room to help out while the man was under anesthesia was out of network. The CRNP’s hospital-contracted employer said it rarely contracts with insurers. The hospital, showing either its incompetence or embarrassment at being called out, says the bill was a mistake and cancelled it, but only after a reporter started asking questions.


Sponsor Updates

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  • CoverMyMeds employees help Gladden House deliver food for holiday meals to 110 seniors in Franklinton, OH.
  • InstaMed announces that Billie Jean King will keynote the Healthcare Payments Summit May 5-6 in Philadelphia.
  • AdvancedMD publishes an e-guide, “The ABCs of Patient Engagement.”
  • Frost & Sullivan honor Avaya with its 2019 Customer Value Leadership Award for Customer Journey Intelligence.
  • Wolters Kluwer adds Clinical Insights content from UpToDate to its Lexicomp drug information system.
  • Thomas Health (WV) goes live with Meditech Expanse.

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 12/16/19

December 15, 2019 News 9 Comments

Top News

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Hackensack Meridian Health, New Jersey’s largest health system, admits that it has paid a ransomware hacker to regain access to its computer systems.

Some of those systems remain down two weeks after the attack began.

The health system did not reveal the amount paid, but says it carries insurance for that purpose.

Meanwhile, the city of New Orleans declares a state of emergency after shutting down all of its servers and websites following ransomware threats.


Reader Comments

From Student Union: “Re: new jobs listed in the ‘people’ section. Why do some of them not include a link to the announcement?” I learn of some of them via LinkedIn notifications from my 3,000 connections and I don’t link in those cases. My criteria for mentioning someone’s new job are: (a) I only list VP and above since I would be overwhelmed with job changes otherwise; and (b) the person has to be recognizable to many readers based on their healthcare history.

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From Pleiades: “Re: Monarch Medical Technologies. FDA has recalled both of their EndoTool glycemic management / insulin dosing software products. They only offer these two products and can’t implement them at any hospital because of the open recall.” FDA recalled EndoTool IV in June 2019 because of calculation errors and and recalled EndTool Subq in November 2019 because it was distributed without FDA’s approval or clearance.

From Meaningless Use?: “Re: patient portals. A recent HIStalk interviewee said they were important because they were part of the Meaningful Use requirement. How is that important? Also, where would we be today without the HITECH Act and Meaningful Use? Many of those in the industry who started pre-MU know no other reality.” My thoughts:

  • The stimulus-focused MU program artificially goosed EHR demand similarly to the “cash for clunkers” program. Although to be fair, MU payments were tied to use rather than purchase – if you already had an EHR, you could get free money by simply using it per federal government requirements.
  • Sales jumped for products nobody wanted when they were spending their own money, encouraging vendors to lie and providers who were anxious to lap at the taxpayer trough to buy products without due diligence or commitment to process change.
  • Innovation was stifled because the industry’s collected wad was shot on the same old systems that weren’t selling before.
  • Health IT was chosen as a shovel-ready project that could pump a lot of stimulus money into the economy quickly, and those involved made an earnest but fumbled attempt to give taxpayers $35 billion worth of benefit by conditioning the payouts on accomplishments (or lies about accomplishments via unverified attestation) on metrics that did little to improve patient outcomes, access, or cost. Providers were thinking only of their taxpayer welfare payments rather than the welfare of their patients when they bought these systems and attested that they were using them magnificently.
  • Patient portals seemed sexy to an industry with a poor technology track record, but nobody bothered to ask patients if they wanted them or demanded that providers do more than to simply offer them to earn their taxpayer payday.
  • Portals also gave providers an excuse for doing nothing else to improve communication with their patients, They could simply pat themselves on the back and cash their checks for turning on a portal that few patients signed up for and far fewer actually used. People do what they are paid to do – no more, no less.
  • But as with most technology, it’s the people rather than the tools that are the problem. Providers like Kaiser embraced both EHRs and portals and have delivered pretty amazing benefits to patients, to the point that its portal is extensively used for patient-provider messaging, routine refill and appointment requests, and inquiries. They made their portal a competitive differentiator because it was profitable for them to do so.
  • Patient portals are the technological manifestation of healthcare paternalism – patients are expected to use them (a separate one for each provider) even though the doctors may or may not, those multiple providers don’t exchange information, they are just as provider-protective since providers don’t promise quick or detailed responses to portal-posted patient concerns, and users still get a clipboard full of blank forms shoved in their face when they show up for a visit. You would likely change banks if the best technology they could come up with looked anything like a patient portal.
  • Without MU, EHR sales would have picked up more gradually and smaller medical practices would probably have opted out. But that would have forced vendors to improve their products and encouraged new entrants to offer something better. The market was speaking before MU artificially manipulated it.
  • I would be uneasy claiming in the absence of evidence that EHR adoption has improved outcomes, access, or cost to any extent, much less $35 billion worth. I would also cite endless surveys showing minimal patient use of portals and minimal improvement in any type of outcome as a result.

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From Darth Vader: “Re: UnitedHealth Group. With all this talk about reducing healthcare costs, why isn’t anyone in Congress talking about UHG, and in particular, Optum? How ingrained is this organization in every nook and cranny of the US healthcare ecosystem?” We’ve societally accepted that US healthcare is a business in which patients are the widgets of production, so it was inevitable that the whole mess (or at least the most profitable parts of it) would be controlled for maximum profit by publicly traded companies, private equity firms, and profit-admiring health system executives. Those groups are also big political donors and advertisers. The track record of a constituent-focused member of Congress dismantling a hated and excessively profitable monopoly, at least in the past few dozen years, isn’t very good. One person’s excess costs is someone else’s income and the latter don’t readily give it up.


HIStalk Announcements and Requests

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Most poll respondents believe that patients own the data that providers record about them. Actually I should probably say that they wish it were true, but are aware that legally (and with ownership, that’s all that counts) patients have no such claim. Reader Conflated added a poll comment that provides a thorough overview of the issue:

It seems like three concepts are being conflated in this conversation. One is ownership of the records of the services performed by a provider (“the data”). The second is rights to access the data. The third is rights to “do stuff” with that data.

It would seem the original copy of the records stored on a provider’s EHR (or the paper records in their record closet) belong to the provider. The patient doesn’t own that copy of the records. It documents the work the provider did, the observations and results the provider captured, the medical recommendations the provider made, and is the basis of mounting a legal defense if the provider is sued for malpractice. Not to mention, there are record retention requirements the provider is required to follow, another hallmark that they own those records.

However, the patient also has a right to access and copy ALL of the provider’s records about them. That copy belongs to the patient.

Taking these two points together, then, it seems like the provider and the patient both have a right to own a copy of the same data. On a right to “do stuff” with the data, this is the more complicated thing, and the area in which HIPAA most needs a refresh. Just because a provider “owns” their copy of the records doesn’t inherently give them rights to “do stuff” with it. We have also seen some legislation that the provider has an obligation to do some stuff at the direction of the patient with said data (e.g., securely transmit it to another provider), but the provider still gets to retain a right of ownership of their copy of the data.

New poll to your right or here: What data sharing issues, if any, did you experience in your 2019 provider visits?

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The “like” button you see on each article tells me that the most-liked HIStalk items in the couple of years I’ve been using it (like votes minus dislikes) are, in order:

  1. Pretzel Logic 9/30/19
  2. Readers Write: To Douse the Flames of Physician Burnout, Target the Four Biggest Time-Wasters in the EHR
  3. A Machine Learning Primer for Clinicians — Part 1
  4. Book Review: Bad Blood
  5. Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
  6. Neal Patterson’s Final CHC Speech — November 16, 2016
  7. HIStalk Interviews Vince Ciotti, Retired HIS-torian
  8. The Smokin’ Doc Celebrates a Successful HIMSS
  9. Readers Write: The Big Fib
  10. CIO Unplugged 3/21/18

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My Anonymous Vendor Executive (AVE) offered to provide more Donors Choose matching money, but I’m stymied since I still have nearly $10,000 of AVE’s previous donation in my account. Reason: most of the larger donations I’ve received came from HIMSS-related activities, such as lunch with a CIO or other promotional event, and I haven’t done those lately. I propose that we put that money to work as follows:

  • I will (since the AVE suggested it) match donations $2 for every $1, and other matching will surely increase the bang for your donation buck.
  • For company donations of $1,000 or more, I’ll include a text message of your choice in an HIStalk update email in addition to the usual thank-you message on the site.

I’m open to other ideas as well. Let’s spend AVE’s money on a great cause. If you want to donate, here’s how:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my DonorsChoose account).
  3. I’ll be notified of your donation and you can print your own receipt for tax purposes.
  4. I’ll pool the money, apply the matching funds, and publicly report here (as I always do) which projects I funded.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Blue Cross Blue Shield of Massachusetts integrates its member app with Amazon’s PillPack pharmacy, allowing members who take multiple medications to order their prescriptions, pay for them, and schedule their delivery. The app will encourage those patients to switch their pharmacy to PillPack, in which case all of their information will be automatically transferred.


Sales

  • DHR Health Institute for Research and Development (TX) joins the TriNetX global health network to improve clinical trials access to Hispanic residents of the Rio Grande Valley.

People

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Rx Savings Solutions promotes Daron Sinkler to VP of sales.


Announcements and Implementations

Partners HealthCare announces a five-year digital health initiative that includes online appointment scheduling, video visits, implementation of OpenNotes, procedure and imaging cost estimates, improved interoperability, posting of ED wait times, and customized patient communications. The program also includes an incubator component. The Boston paper says the program will cost at least $100 million


Other

An article in Wired predicts the end of drug trials that use a placebo group, i.e. patients who receive no actual treatment for their conditions to determine the benefit to those who do. EHR data can identify similar patients, then compare the new product’s results with those of the existing standard of treatment as a “synthetic control arm.” The author wisely notes that this is probably why drug company Roche paid nearly $2 billion to acquire oncology EHR vendor Flatiron Health in early 2018, having foreseen the use of real-world data for drug approvals now that EHRs are ubiquitous.

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I like this proposed rework of HIPAA that appeared in the Health Affairs blog last week. It calls out HIPAA’s most glaring deficiencies in falling short of broad patient privacy protection – it regulates only covered entities and those covered entities get a free pass under “treatment, payment, and operations.” Not to mention that the US lags behind in failing to protect the information of its citizens via Europe’s GDPR.

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Florida pain management practice chain Korunda Medical will pay $85,000 to settle HIPAA charges that it ignored a patient’s request to send an electronic copy of their medical records to a third party, then charged the patient an excessive amount for the paper copies it sent. The patient filed a complaint in March 2019, OCR provided penalty-free “technical assistance” to the practice and closed the complaint, but the patient filed a second complaint four days later when Korunda ignored the records request again.

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Cigna will implement an AI-powered medication adherence monitoring program in January. The company says knowing whether patients are taking their meds as prescribed will allow it to improve care, while privacy experts worry that the objective of insurers is always to pay less and that the “digital dystopia masquerading as healthcare” will allow Cigna to cancel policies or avoid paying claims. Cigna paid $54 billion to acquire pharmacy services vendor Express Scripts earlier this year.

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A PGY-1 osteopathic resident at AdventHealth Orlando and self-proclaimed “influencer” apologizes for pitching several healthcare products on his social media accounts, one of them a sketchy nutritional supplement for rave music festival attendees that he sells as a company rep. He explains, “It makes a lot of sense that I shouldn’t be using my medical degree as a platform to sell products. But no one teaches you this stuff.” He’s also planning to use his experience to start a business that will monitor medically related social media posts for appropriateness.

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An interesting New York Times article describes how Amazon Web Services “strip mines” startups by copying their software, especially open source, and then selling it themselves. AWS generated $25 billion in revenue last year and is Amazon’s most profitable business.

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In Pakistan, several cardiac inpatients die when hundreds of lawyers in their customary black suits storm a hospital, angered that one of their peers told them he had been mistreated when he brought a relative in for treatment. At least 200 lawyers vandalized hospital property, damaged vehicles, set fire to a police van, and beat several doctors. Physicians and employees then fled the hospital, leaving patients unattended, and the hospital then closed when the doctors mounted a protest strike.


Sponsor Updates

  • Redox releases a new podcast, “An interview with Dr. Fatima Paruk, Microsoft’s Chief Medical Innovation Officer.”
  • OmniSys launches the Pharmacy Talk newsletter.
  • PatientPing releases a new customer success video featuring UI Health Senior Director, Care Continuum, Rani Morrison.
  • Academic Radiology features an editorial from Visage Imaging’s MingDe Lin, “Accelerating the Translation of Artificial Intelligence from Ideas to Routine Clinical Workflow.”

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 12/13/19

December 12, 2019 News 5 Comments

Top News

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In Boston, Partners HealthCare plans to spend $100 million on a five-year digital health initiative focused on developing patient self-service technologies including online appointment scheduling, ED and urgent care wait times, and cost estimates; virtual care via text and video; and access to aggregated medical records including OpenNotes.


Reader Comments

From Darth Vader: “Re: Optum/UHG layoffs. See UHG latest results? Talk about systemic risk. With all this talk about reducing healthcare costs, why isn’t anyone in Congress talking about UHG and in particular Optum? Just how ingrained is this organization in every nook and cranny of the US healthcare ecosystem?” Vader’s observation comes just a few days after OptumRx’s purchase of Diplomat Pharmacy for $300 million.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Tampa Bay Lightning owner and former hedge fund manager Jeff Vinik invests $5 million in health IT integration vendor Bridge Connector, bringing its total funding to $25 million. Vinik is also a minority owner of the Boston Red Sox.

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Surgical automation and software vendor Caresyntax acquires OR analytics company Syus alongside a $45 million funding round.

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Proteus Digital Health’s previously announced restructuring plans will include eliminating 292 jobs and closing several facilities by January 18. According to the local paper, the company will turn its focus from digital therapeutics for blood pressure, hypertension, and cholesterol to infectious disease and oncology, “expensive therapies that tie payments to the actual use of the drug.”

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BJC HealthCare in Missouri lays off 200 employees as it outsources some IT services to an unnamed managed service provider. The health system cut about 10% of its IT workforce in July 2018 after wrapping up an Epic roll out.

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NextGen acquires telemedicine vendor Otto Health.

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LeanTaas raises $40 million in a Series C funding round led by Goldman Sachs. The Silicon Valley company has developed predictive analytics for optimal utilization of ORs, infusion centers, and labs.

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Pharmacy benefits manager Express Scripts develops a list of recommended digital health tools for payers and providers organized into treatment categories that include depression, anxiety, asthma, and diabetes. Products and services from Livongo, Omada Health, Propeller Health, and WellDoc are among the initial group of recommended solutions.

The Chartis Group acquires The Greeley Company, a consulting and staffing firm based in Boston.


Sales

  • Lakeland Regional Health (FL) will implement care team coordination technology from Andor Health.
  • The NC HealthConnex HIE will use CarePort Health’s real-time care notifications and reporting capabilities to improve care coordination at UNC Health Care’s 12 hospitals.

People

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CynergisTek names Tony Douglas (Symantec) SVP of sales.

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Gregory Adams becomes chairman and CEO of Kaiser Permanente after serving in the interim role since the unexpected death of CEO Bernard Tyson last month.

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NIH names Joshua Denny, MD (Vanderbilt University Medical Center) CEO of the All of Us research program.

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Charlie Greenberg (Merck) joins PatientPoint as SVP of campaign quality and compliance.


Announcements and Implementations

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Faith Regional Health Services (NE) goes live on Epic.


Government and Politics

The Justice Department will look into Google’s $2.1 billion Fitbit acquisition for possible antitrust violations related to amassing data on American consumers.


Privacy and Security

Korunda Medical (FL) will pay OCR $85,000 to settle potential HIPAA violations related to multiple complaints from the same patient that it wanted an unreasonable fee for medical records, and failed to provide the records in the requested format in a timely manner.


Other

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Baxter Regional Medical Center (AR) will use a donation from community members to fund in-house development of an interface between its Cerner EHR and 400 smart IV pumps.

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Avante Skilled Nursing and Rehabilitation Centers (FL) pilot the Furry Palz Program from Thrive Behavioral Sciences. Designed to rest in the laps of dementia patients, simulated breathing sounds from the robotic pets help to relieve symptoms of agitation, isolation, and depression.


Sponsor Updates

  • AdventHealth Waterman and Sentara Virginia Beach General Hospital showcase reductions in hypoglycemia and glycemic practice variation utilizing Glytec’s glucose management technology and services.
  • Healthwise receives a Gold Digital Health Award for a patient education video in the Health Information Resource Center’s 2019 fall competition.
  • InterSystems releases a new PulseCast podcast, “Dave Menninger: Discovering the Hidden Dollars Within Your Data.”
  • Vanguard profiles Intelligent Medical Objects General Counsel Charlotte Tart.
  • Nordic releases a new podcast, “Avoiding common pitfalls of an affiliate extension program.”
  • Arcadia congratulates its ACO customers in achieving over $423 million in Medicare Shared Savings Program savings in 2018.
  • Wolters Kluwer Health adds Clinical Insights with enhanced content from UpToDate to its Lexicomp drug information resource.

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 12/11/19

December 10, 2019 News No Comments

Top News

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“Smart pill” medication management company Proteus Digital Health struggles to stay afloat after a $100 million funding round fails to materialize. Once valued at $1.5 billion, the Silicon Valley-based company furloughed employees for several weeks in November until it could acquire $5 million in emergency funding. Company officials say they are looking at restructuring options, while unnamed insiders point to a lack of traction with patients as a big reason for the company’s stymied growth.

Meanwhile, competitor EtectRx receives FDA clearance for its smart ingestible, which is being tested by researchers at Brigham and Women’s Hospital and Fenway Health in Boston for use with HIV medication.


Reader Comments

From Dr. Doyle: “Re: The Great NHS Heist. Interesting movie on the NHS.” Backers of the documentary make it available on Youtube ahead of the UK general election on December 12. The documentary, which aims to highlight increasing efforts to take the NHS private, has been in the works for a number of years. It made its theatrical debut in London last month.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Emergency medical services technology company ESO acquires trauma registry software vendors Clinical Data Management, Lancet Technology, and Digital Innovation.

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Former Outcome Health EVP Ashik Desai pleads guilty to charges of fraud, admitting that, “When I was at Outcome Health, there were practices going on there that were wrong. I participated in those practices that ended up defrauding Outcome’s customers.” Three other former employees, including former CFO Brad Purdy, have pled not guilty. Former CEO Rishi Shah and former president Shradha Agarwal will make their court appearances next week.


Sales

  • Hospital Sisters Health System Medical Group (IL) will implement Relatient’s patient engagement software.
  • Saint Peter’s University Hospital (NJ) selects Vox Telehealth’s FemmeCare for C-Section and Hysterectomy programs to help patients better prepare for and recover from surgeries.
  • Precision medicine company Astarte Medical selects commercialization services from Get-to-Market Health.

People

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Paul Wilder (Philips) joins CommonWell Health Alliance as executive director.

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Innara Health promotes Chris Mathia to CEO.

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AI-based diagnostics vendor IDx Technologies promotes John Bertrand to CEO, replacing founder Michael Abramoff, MD who has become executive chairman. The company has also hired Seth Rainford as president and COO, and promoted Danika Simonson to the new position of chief of staff.


Announcements and Implementations

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Advocate Lutheran General Hospital (IL) implements AI-enabled stroke-detection software from Viz.ai. The technology will be rolled out to the entire Advocate Aurora Health network by early next year.

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Floyd Medical Center (GA) launches a telemedicine program for stroke and neurology patients leveraging providers from Erlanger Health System (TN).

IntelliGuard integrates its RFID-enabled medication tracking technology for anesthesiologists with Epic.

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Wyckoff Heights Medical Center (NY) goes live on Allscripts Sunrise and FollowMyHealth software.

LogicStream Health will make its Drug Diversion App available early next year.

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With help from the Medical University of South Carolina’s Center for Telehealth, Roper St. Francis Healthcare adopts tele-ICU services from Advanced ICU Care at three of its hospitals.


Privacy and Security

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Hopes of returning to normal operations within a week are dashed as the Government of Nunavut in northern Canada continues to recover from an early November ransomware attack that took its computer systems offline. Health department officials still have no idea when they’ll be able to get their Meditech system and telehealth capabilities back up and running. Chief of Staff François deWet, MD says several things have made the “IT apocalypse” eye-opening:

  • Having a disaster plan already in place was key to communicating needs and updates with affiliate organizations, which in turn ensured healthcare services weren’t interrupted.
  • The fact that the department was in the midst of a Meditech upgrade before the ransomware attack happened resulted in more reliable backups, which are in the process of being restored.

Other

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A Bright.md survey of 521 consumers finds that they trust their current providers and healthcare organizations with their health data far more than they do their health insurance companies, technology companies like Amazon or Google, or telemedicine vendors.


Sponsor Updates

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  • Bluetree employees impact 23 organizations by volunteering 264 hours across 13 states and India during the company’s annual Give Back Week.
  • HHS expands its contract with Audacious Inquiry for the development of a national Patient Unified Lookup System for Emergencies system.
  • Avaya announces that Earvin “Magic” Johnson will keynote Avaya Engage 2020 February 4 in Phoenix.
  • Data Center Knowledge features Atlantic.Net in its “Trends in Data Center Network and IT Security” report.
  • Wolters Kluwer Health adds machine learning and AI capabilities to its Sentri7 healthcare-acquired infections surveillance software.
  • Huron will provide consulting and implementation services for Omnicell customers.
  • SymphonyRM releases a new podcast, “Edward Marx and Four Pillars of Innovative Leadership.”

Blog Posts


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Monday Morning Update 12/9/19

December 7, 2019 News No Comments

Top News

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Hackensack Meridian Health (NJ) brings its clinical systems back online after a downtime of several days, rumored to be the result of a ransomware attack.

The 17-hospital system, New Jersey’s largest, rescheduled 100 elective surgeries.

The health system did not post updates on its social media accounts and declined to comment other than describe the problem as “externally-driven technical issues that are affecting the performance of our IT network.”


Reader Comments

From OptumOrange: “Re: Optum / UHG layoffs. Looks like it was 1,400 people who received two weeks’ notice. March 2020 is the next round.” Unverified, but several folks said they were affected. Company executives just told investors that Optum generates more than half of UnitedHealth Group’s profit in bringing in an expected $112 billion of the parent company’s $260 billion in revenue for next year. Optum offers pharmacy benefits management, direct care via urgent care centers and physician offices, post-acute care, analytics, and population health management.

Smartfood99 left a comment about EHR vendors offering low-margin RCM services that I thought was wise enough to deserve its own spot here. It explains the hazards in adding services that are profitable, but less so than the company’s core business:

Software may be high margin, but the cost to maintain customer relationships through service and updates is low margin. While there there is a built-in revenue stream, it weakens the balance sheet for new vendor-searching hospital executives concerned about the fiscal health of the EHR company. In short, hospital executives look very closely at the bottom lines of companies they are about to make a 10-year investment with. Profitability = survival, especially when rumors of EHR vendor demise are the norm over the past few years and planted by competitor sales people like a software bug.

If you are already paying for lots of support people and development people that cut in to the bottom line, you have to be careful how you add to that mix and what it does to the balance sheet. Losing even just two or three net-new business deals a year because hospital executives base their final decision on perceived vendor long-term viability can snowball for any EHR vendor not named Epic. Such decisions that seem to make short-term sense often put the EHR vendor on the path to the dustbin of history after a slow, drawn-out death that leaves the hospital partner in a lurch.

Sure, even marginal profits and larger revenues matter, but in this business, perception of sustainability means much, much more. This doesn’t even cover the fact that having the capital to enable your business to pivot as needs change and your systems age is served in no way by being a glorified consulting company, but with all the risks that come with employing and managing larger staffs as business ebbs and flows.


HIStalk Announcements and Requests

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I’m super impressed with my $480 (Black Friday special) HP laptop. It’s sleek and made of metal rather than plastic, it’s fast because of its solid state disk drive and 16 GB of memory, it makes no sound at all, the touchscreen display is surprisingly large and vibrant, and setup took just a few minutes with no bloatware to de-install. It’s been years since I set up a new laptop, so I was surprised at how easy Windows makes it – you just log on with your Windows ID and a few minutes later it’s all done. Bitdefender reminded me that I don’t have a VPN installed and I pledged to be better about using one when on public Wi-Fi, so I chose Surfshark since it was Cyber Monday priced at $48 for 27 months and it works just fine.

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

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Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

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


Acquisitions, Funding, Business, and Stock

The best and most concise health IT investment and market report I’ve seen comes from Healthcare Growth Partners, which just posted its November highlights of M&A, buyouts, investments, news headlines, and public company performance. It notes that valuations are driven significantly by sentiment versus metrics, and both sentiment and the markets are at all-time highs. 


People

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Zach Mortensen, MBA (ZM Advisors) joins pharma services provider Parexel as chief strategy officer.

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Population health management technology vendor Geniq hires Jay Colfer (SSI Group) as co-CEO.


Government and Politics

The Bureau of Labor Statistics says healthcare added 45,000 jobs in November and 414,000 jobs in the past 12 months. We don’t know what those people are doing, but we know who is paying them (all of us).


Other

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This is insightful. AI companies will focus on the US market because, unlike in the rest of the world, providers here can make money finding and treating undiagnosed patient conditions. That gives AI a business case.

Welcome to our American healthcare non-system. A tiny online survey finds that diabetics — most of them covered by health insurance — are buying, selling, and trading insulin and glucose strips on the black market because of lack of affordability or timely availability.

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A study finds that unintentional ED ordering of duplicate laboratory and radiology orders was reduced more than 40% by swapping out interruptive alerts for a simple on-screen highlighting of the existing order in red, although no improvement was seen with medication order duplicates. The alert displays when the duplicate item is being selected instead of as a final step or after-the-fact order queue alert. The study raises an interesting point – how many duplicate orders are created because of poor visual layout or navigation of the active medication list? We assume that just because information is displayed somewhere, somehow in the EHR that duplicates are inexcusable, especially with the added layer of warnings. I speculate that clinicians are just too busy attempting to multi-task with poor keyboarding technique in disruptive environments since even smart and careful ones make mistakes.

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In England former Oxford University Hospitals CIO and Chief Digital Officer Peter Knight pleads guilty to fraud for falsifying his educational credentials to get the job, which he held for two years before resigning.

Partners HealthCare, soon to be renamed to Mass General Brigham, reports earning $484 million of operating income on $14 billion in revenue in its most recent fiscal year. The CFO says the increased profit came from having sicker patients and raising its prices, along with Epic’s more accurate coding.

HIMSS announces Global Health Equity Network, which allows interested parties to support its work by (a) paying to attend HIMSS20; and (b) sponsoring HIMSS. You can also “dialogue” with leaders, probably via A and B.

Informatics troubadour Ross Martin, MD, MHA lays down “Put the Patient First*,” a healthcare protest song that Ross says he’s been contemplating writing for 15 years. The asterisk-referenced refrain is brilliant – “Put the patient first, right behind me.” I also note that Ross’s utterly amazing and complex “HITECH: An Interoperetta in Three Acts” celebrated its 10th anniversary this year.


Sponsor Updates

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  • StayWell contributes to the Las Americas Immigrant Advocacy Center.
  • Black Book Research recognizes Netsmart as the number one post-acute technology platform for the fifth year in a row.
  • CereCore collects and delivers supplies to the Tennessee Baptist Children’s Home.
  • Pivot Point Consulting employees in Chicago work with Project C.U.R.E. to assemble medical supplies for delivery to hospitals in developing countries.
  • Redox releases its first podcast, “An Interview with Jonathan Bush.”
  • SymphonyRM releases a new podcast, “Edward Marx and Four Pillars of Innovative Leadership.”
  • TriNetX expands into South Korea in partnership with EvidNet.
  • Visage introduces semantic annotations for the Visage 7 Enterprise Imaging Platform.
  • UASE Ministry of Health collaborates with Vocera to improve care team communication and optimize patient safety.

Blog Posts


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News 12/6/19

December 5, 2019 News 3 Comments

Top News

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RCM vendor Waystar acquires Recondo Technology, which specializes in automated revenue cycle software and services.


Reader Comments

From Foundational Confused: “Re: non-profit hospital donations. You’ve said that sending money to them is a terrible use of it. How do you personally differentiate between a foundation doing good versus one just burning money?” I like supporting organizations that truly need the money and will put it to good use for a directly connected social mission. Health systems stretch the definition of non-profit (and certainly that of a charity) with million-dollar executives, vast real estate holdings, and a can’t-miss business model that allows them to charge high prices and stifle competition on the backs of people in need, not to mention that they are so adept at raking in cash that they, themselves donate to other non-profits. My paltry donation would pale to the amount of money they can print via cranking out via high patient charges and collections. I would rather help a smaller, struggling non-profit that doesn’t have the luxury of sticking it to Medicare and insurers, whose mission is in danger of disappearing without outside help and that doesn’t employ mahogany wings full of power-broking suits who spend their day plotting deeper dives into the healthcare cookie jar (I say that while acknowledging the irony that I’ve been part of that particular problem for a long time). My personal donation choices are animal rescue and sanctuary organizations, food banks, Donors Choose, and Salvation Army, where a few hundred dollars can really make a direct difference instead of covering maybe one hour of the HR VP’s time.

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From Party On: “Re: HIStalk reception at HIMSS20. Wondering how to obtain an invite and which evening it will occur.” The tenth and final HIStalkapalooza was at HIMSS17, I’m sorry to say. Maybe we can all schedule a time during HIMSS20 week to simultaneously reminisce by watching the video of that final evening with Party on the Moon and several hundred industry kindred spirits. 


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

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


Acquisitions, Funding, Business, and Stock

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Premier is reportedly arranging talks with several potential acquirers in seeking a sale of the company, with reports of its interest sending share price and trading volume up this week.

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Clinical surveillance and data visualization company Decisio Health closes a $13 million Series B funding round.


Sales

  • Seminole Hospital District in Texas will implement CPSI subsidiary American HealthTech’s post-acute EHR at Memorial Health Care Center.
  • In England, Birmingham and Solihull Mental Health NHS Foundation Trust chooses Hyland Healthcare’s OnBase content services software.
  • Integris Health (OK) and Woman’s Hospital (LA) select Health Catalyst’s Corus Suite of patient, departmental, and equipment utilization and cost analytics.
  • Cleveland Clinic London will use Vocera’s care team communication and workflow technology when it opens in 2021.
  • In California, Natividad and the Monterey County Health Department will implement NextGate’s Enterprise Master Patient Index across its 19 clinics and other agencies.
  • American Oncology Network selects PatientPoint’s patient and provider engagement solutions for its community oncology practice network.

People

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Stephanie Reel, CIO/vice provost for IT at Johns Hopkins University and SVP/CIO of Johns Hopkins Medicine, will retire on July 1, 2020 after a 30-year Hopkins career. She says that she’s channeling Elton John in announcing her “Love Mondays World Tour” and sent me her Thanksgiving letter that outlines her future plans to enjoy family, travel, life in general, and a move from Baltimore after 25 years to Falls Church, VA. Few CIOs have had her tenure and breadth of IT responsibility over one of the country’s highest-ranked health systems as well as its correspondingly highly-ranked university through the impressive growth of both as an unfailingly steady hand on the IT tiller. I’m not saying I “know” her personally, but a couple of interviews and some private conversations about personal issues in which she was generous with her time and offers to assist make her #1 in my book.

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Change Healthcare EVP/CIO Alex Choy will retire early next year.

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Cletis Earle (Kaleida Health) joins Penn State Health and Penn State College of Medicine as SVP/CIO.

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John Halamka, MD will join Mayo Clinic (MN) as president of its Mayo Clinic Platform, an initiative he describes as a “portfolio of new digital platform businesses focused on transforming health by leveraging artificial intelligence, the internet of things, and an ecosystem of partners for Mayo Clinic.” Halamka has spent the past 25 years in various positions, including CIO at Beth Israel Deaconess Medical Center in Boston, now part of Beth Israel Lahey Health.

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Patient transfer solution vendor Central Logic promotes Barry Dennis, RN, MBA to the newly created position of SVP of clinical operations.

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Google co-founders Larry Page and Sergey Brin will step down from their respective roles within parent company Alphabet as part of management streamlining that will see Google CEO Sundar Pichai take on the additional role of Alphabet CEO.


Announcements and Implementations

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PatientPing enhances its collaboration network with Callouts (sharing member information with point-of-care providers using multiple EHRs) and Spotlights (a performance dashboard for readmissions, hospital utilization, and post-acute network management).

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PMD makes patient-to-provider messaging and multi-provider group messaging with patients available through its app’s secure messaging capabilities.

Kindred Healthcare (KY) implements Netsmart’s Referral Manager software across its 70 LTAC hospitals.

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A Surescripts report finds that the use of EHR-integrated prescription price tools more than doubled in 2019, also noting that prescriptions represent 17% of spending on goods and services that are provided directly to patients and are projected to increase 6.3% per year.

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A KLAS report on ERP implementation consulting finds that among software vendors, every Infor consulting services client that was contacted is dissatisfied because the company’s consultants don’t understand the software or how to apply change management. PwC earns high marks from clients; KPMG performs well and Deloitte poorly on Workday and Oracle implementations; and for Infor implementation work, ROI Healthcare Solutions delivers high value while Avaap delivers strong outcomes.


Government and Politics

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The American Hospital Association and other hospital groups file a lawsuit challenging HHS’s proposed requirement for hospitals to publicly post confidential pricing information. The plaintiffs say that disclosure of negotiated insurer charges would confuse patients about their out-of-pocket costs, adding that the rule is unlawful anyway because it exceeds CMS’s authority. 


Other

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Physician services firm TeamHealth, which was acquired by investment firm Blackstone for $6.1 billion in early 2017, tells the Senate that it didn’t send surprise, out-of-network ED bills to thousands of patients in 2017 to generate revenue – their real purpose was to pressure insurers into signing more lucrative contracts. It also says that most of the public griping about balance billing comes from patients who don’t understand their coverage and mistake their co-pay, co-insurance, or deductible as a balance billing. The company suggests that Congress require insurers to immediately pay out-of-network providers at 125% the average allowed amount; require them to send the provider a check for the full amount that includes patient responsibility and then let the insurer rather than the provider collect the patient’s portion; cap ED patient cost-sharing at $1,000; and offer arbitration for dispute resolution.

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UC Davis will offer an online course titled “The Health and Wellbeing of Medical Providers,” which will be taught by UC Davis Health Chief Wellness Officer Peter Yellowlees, MD, MBBS (yes, he did earn both degrees years apart even though they are basically equivalent). The 20-CME, $800 course begins on February 24. The course text, “Physician Suicide Cases and Commentaries,” was written by the instructor.

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Cerner loses a $600,000 lawsuit that was brought by an air ambulance company after Cerner’s health plan refused to pay for a toddler’s air ambulance transportation after initially authorizing it.

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In Australia, a women is sentenced to 25 months in prison for falsifying her application for a high-paying government CIO role. She lied about her education and work experience, gave herself a glowing recommendation in posing by telephone as a former employer, and used a supermodel’s photo as her LinkedIn headshot. Her attorney blames her actions on being “off with the pixies” due to stopping her weight loss drug.


Sponsor Updates

  • Ensocare will exhibit at the National Veterans Small Business Engagement December 9-11 in Nashville.
  • First Databank’s Meducation medication adherence solution wins Cerner’s first Open Developer Experience Program Member Adoption Award.
  • Glytec will exhibit at the IHI National Forum December 8-11 in Orlando.
  • EClinicalWorks publishes a new customer success story, “Compass Medical: Growing a Practice, Saving Lives.”
  • Gartner has recognized InterSystems as a leader in its “2019 Gartner Magic Quadrant for Operational Database Management Systems.”
  • Kyruus Executive Assistant and Office Manager Lisa Marie Rosson Guidi wins the Spirit Award from The Admin Awards.
  • PCare leverages cybersecurity services from By Light Professional IT Services as it pursues HITRUST certification.
  • PatientPing adds enhanced member information sharing capabilities and real-time network utilization dashboards to its enterprise care collaboration technology.

Blog Posts


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Contacts

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News 12/4/19

December 3, 2019 News 10 Comments

Top News

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Amazon Web Services announces the rollout of Amazon Transcribe Medical, a real-time transcription tool that software developers can use to transcribe speech and then send the resulting text to EHRs and other AWS tools such as the Amazon Comprehend Medical language service.

The company is positioning service as a replacement for transcriptionists, scribes, and transcription software.

It’s a “service” only in the technical sense – despite some sites misinterpreting it as a standalone product, it isn’t. Developers will need to build it into their own products and AWS will charge for usage. 


Reader Comments

From Curious: “Re: Meditech. I’ll l be interested to see if MaaS + Expanse can make Meditech competitive with CPSI, which owns the community and price-sensitive hospital market because they do the billing for their clients. Meditech should get into outsourced billing. The margin isn’t great, but they need it to gain new customers. However, no one who works for Meditech in Boston is going to say it since the people who would be hired to do billing aren’t going to work in Boston.”


HIStalk Announcements and Requests

I’m finding that reading Samuel Shem’s “Man’s 4th-Best Hospital” is more of a chore than I anticipated, which is surprising given how much I liked “House of God” (this one is long and heavy-handed with simplistic cynicism), but I’ll probably finish it despite its tiring anti-EHR diatribes. Meanwhile, I’ve purchased Elizabeth Rosenthal’s “An American Sickness,” which I’ve somehow managed not to read since it came out in 2017.


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

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


Acquisitions, Funding, Business, and Stock

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Agfa is negotiating the sale of its Europe-focused healthcare and imaging IT business to Italy-based clinical software vendor Dedalus for more than $1 billion, excluding expected frontrunner CompuGroup Medical. The business includes enterprise imaging, hospital information systems, an enterprise content management solution, and patient engagement tools. It looks like a done deal since the companies have already said they expect it to close in Q2 2020. The business generates around $200 million in annual revenue, so that’s a pretty rich multiple for a company to pay to acquire a slightly larger competitor.

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Cerner names Amazon Web Services as its preferred cloud, AI, and machine learning provider. You aren’t having déjà vu – Cerner named AWS as its preferred cloud provider in July 2019, so this announcement adds the obvious AI and ML components that will be incorporated into the Cerner Machine Learning Ecosystem for creating and deploying machine learning models. AWS called Cerner a “healthcare and life sciences organization” in the announcement rather than a software vendor, which I guess is slightly accurate since a microscopic part of its business involves running a few workplace clinics. As far as I know, its life sciences work is limited to selling patient EHR data to drug companies. 

Allscripts launches a $200 million private offering of convertible senior notes in a transaction that is far too complex for me to understand. 

An investigative report finds that Amazon’s on-site medical unit contractor Amcare is failing to send injured warehouse employees to outside care providers when needed and is also, per OHSA inspections, using unsupervised EMTs and athletic trainers outside of their allowed scope of their practice. Amcare is authorized to render first aid using EMTs, but OSHA’s investigation of employee complaints found evidence that employees are being refused treatment and their injuries are not always reported per federal law.

Heritage Valley Health System (PA) files suit against Nuance for failing to prevent the 2017 malware attack that the lawsuit claims spread from Nuance to the health system, taking down its computer and biomedical systems.


Sales

  • Two health systems in Puerto Rico select Health Gorilla’s interoperability solution.

Announcements and Implementations

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Change Healthcare offers providers free access to National Decision Support Company’s CareSelect clinical decision support system that meets Medicare’s PAMA advanced imaging requirements, which take effect on January 1, 2020.

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KLAS looks at PACS outside the US, noting that in Europe, Sectra and lesser-known regional vendors are tops at meeting customer expectations; Philips and Agfa are seen as best positioned to address future needs; and Change Healthcare, Fujifilm, GE Healthcare, Philips, and Cerner are frustrating customers with their lack of development. Philips has taken the lead in Canada with the decline of Intelerad and Change Healthcare, while Intelerad and Philips lead performance in Asia and Oceania although satisfaction scores in that region are lower and customers complain about poor vendor support. KLAS concludes that some market leaders are lagging as the market is demanding cloud technology and lighter infrastructure over client-server PACS. 


Government and Politics

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FDA will hold a public workshop on the use of AI in radiological imaging February 25-26 on the NIH campus in Bethesda, MD that will also cover potential FDA regulation. A post-event webcast will be available.


Other

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Dexcom confirms that its G6 continuous glucose monitor hasn’t sent results and alerts – most of them intended for the parents of children with diabetes who are managing their conditions – since Friday due to a server overload problem. The company, which didn’t notify users until a Saturday morning Facebook post, experienced a similar one-day outage a year ago. Dexcom’s most recent Facebook update, from Monday, says they are back to “near normal performance.” Users complained that the company didn’t issue alerts by other channels such as text message or even its webpage for customers who don’t use social media and didn’t update its support line with a notice that they were experiencing issues, forcing callers to remain on hold for long periods. Shares of the publicly traded company, which has $1 billion in annual revenue, dropped a few percentage points at Monday’s market open but have since rebounded.

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Researchers find that the few mental health smartphone apps that have actually undergone clinical trials – 19 trials versus the hundreds of available apps whose efficacy hasn’t been measured — are not effective when used alone. Apps for depression, anxiety, substance use, self-injurious thoughts, sleep problems, depression, alcohol, and smoking aren’t as effective as web-based interventions, possibly because the apps aren’t used as often, interventions might be less effective due to the casual and impromptu nature of smartphone use, and the form factor does not allow simply translating proven, on-site psychotherapy processes to the screen as has been done with web-based apps. The authors warn that ineffective apps may discourage users from seeking interventions that actually work. They recommend that phone apps be designed to take advantage of that platform’s unique capabilities for context sensing, always-on access, prompting, and the ability to perform physiological assessments.

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A researcher’s review of anonymized electronic patient records of cardiac arrest patients who were transported by ambulance to Lifespan Health System (RI) finds that at least 11 patients over 2 1/2 years had misplaced breathing tubes, all of whom died. Rhode Island is one of few states that does not limit ET tube placement to paramedics, but a firefighter’s union killed a proposal to bring the state in line with others, declaring to audience applause in a public meeting, “We’re the experts, not doctors who are doing it when they’re in nice ORs or nice ERs with bright lights and a lot of people helping them.” A misplaced ET tube is considered to be a “never event” in emergency medicine since placement can and should be confirmed. Ambulance services, like hospitals, are required to report such mistakes to the state’s health department, but they would be aware of issues only of the hospital notifies them after the fact.

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Kaiser Health News looks at rarely useful interruptive medical monitoring alarms, whose most frequent outcome is disturbing patient rest and burning out clinicians who are forced to listen to their insistent clanging all day long. Joint Commission says 85% to 99% of the alarms don’t require clinical intervention. Bed alarm sales jumped in 2008 when CMS decided to stop paying for hospital fall injuries even as CMS later discouraged their use in nursing homes in considering them a “restraint” as residents remained bedridden to keep the alarms quiet. The article observes that alarm proliferation has created a market for clinical alarm management consultants and software vendors who review alarm-capable device settings and install software that reviews the alerts before notifying employees.

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HIMSS will “curate” (there’s a trendy millennial word for you) 12-15 digital health startups to pitch investors at the J. P. Morgan Healthcare Conference via its Health 2.0 acquisition, which seemed more appropriate when Health 2.0 was a for-profit company instead of having the non-profit HIMSS choose which companies get in front of potential investors. FYI to HIMSS – it will be 2020 soon, so please fix that date. Also note that the socialism-despising sharks at J.P. Morgan Chase who oversee this investor orgy happily received $25 billion of your tax dollars stay afloat back in 2008, although they had to pay $13 billion for ignoring their own due diligence process in screwing around with mortgage-backed securities. Both numbers are chicken feed to a company whose annual profits are tracking at around $50 billion. Greed is good, at least for the company’s bottom line and for CEO Jamie Dimon, whose net worth is around $2 billion.

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The systems of urgent care software vendor T-System are apparently offline, as reported by malware hunters who found evidence of a ransomware attack on its servers. The company’s PR contact didn’t respond to my inquiry and any problems have not been publicly acknowledged, but the company’s website has been down since at least Friday when we last checked. UPDATE: a T-System spokesperson provided this response:

Through proactive monitoring of our systems, last week T-System identified a cybersecurity incident that has temporarily affected the availability of our Advanced Coding System (ACS) services. After learning of the incident, we promptly took relevant systems offline and commenced an investigation with the assistance of external experts who have expertise in the specific type of malware involved in the incident. Over the past few days, we have been working with our internal team and the external experts to restore backups and move back into production the systems that we initially took offline. We are working closely to restore these systems as quickly and safely as possible. Because of our early detection of the incident and our architecture, we do not – at this time – expect the incident to impact unsecured PHI or other personal information. We have been in direct contact with our clients with updates about the incident. The investigation is ongoing.

In Australia, a cancer center’s six-month, small-scale trial of IBM Watson for matching patients to available clinical trials worked well, but the cancer center won’t move ahead pending product improvements and its own EHR implementation.

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Weird News Andy channels “Young Frankenstein” in titling this story Abby Normal. A Duke Health surgeon successfully completes the first transplant of a dead donor’s heart into a live patient, a procedure that has been performed for 10 years in the UK and in 619 procedures in last year alone in expanding the potential donor pool. WNA notes that equivalent US numbers would be nearly all of the 3,400 US heart transplants that were performed last year.


Sponsor Updates

  • Avaya names Jon Brinton (Mitel Networks)  as VP, North America channel sales.
  • Bluetree Network names Florid Sau (City of Hope Medical Center) an executive partner.
  • Clinical Architecture will exhibit at the IHI National Forum December 8-11 in Orlando.
  • AGS Health is recognized in the top 75 of “India’s Best Workplaces in IT and IT-BPM 2019” based on a rigorous assessment of the company’s fairness, credibility, respect, pride, and camaraderie.
  • EPSI announces a new advanced analytics product.
  • Hyland Healthcare announces new products and updates at RSNA.
  • CoverMyMeds will exhibit at the NG Healthcare Summit December 9-11 in Amelia Island, FL.
  • Cumberland Consulting Group will exhibit at the AHIP Consumer Experience & Digital Health Forum December 10-11 in Chicago.

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Contacts

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Monday Morning Update 12/2/19

December 1, 2019 News 7 Comments

Top News

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CNBC’s Chrissy Farr looks at doctors who join digital health companies but then clash with the development side of the house.

Those involved say that doctors are accustomed to making decisions solo rather than being the “token hire” who is expected to rubber stamp developer decisions. They are sometimes seen as the unwelcome voice of reality in calling out product or company flaws that impact health, as “first, do no harm” clashes with “move fast and break things.” 

A diagnostics company CEO “flipped out” when a newly hired doctor questioned the clinical and business wisdom of using staffing company doctors to write testing prescriptions without reviewing patients thoroughly.

A former digital health doctor says she has yet to meet a happy healthcare person in the digital health field.

Developers complain about the black-and-white opinions of doctors who are not used to being challenged, while doctors bristle at the Silicon Valley emphasis on “obsessively delighting” users that doesn’t make sense in medical situations.


Reader Comments

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From Jagged Little Pill: “Re: Walgreens. Wasted no time after the story you reported on October 30 about closing many of their owned clinics. It’s curious they didn’t wait until after the holiday rush, when it’s nearly impossible to get into your primary care office. I imagine that the nurse practitioners are running to new jobs as fast as they can.” Retail clinics were the hottest thing going not long ago, and it seemed like a great fit for Walgreens to boost its “health hub” concept by offering medical services. The lesson to learn is that publicly traded companies veer in reactionary fashion from one strategy to the next in a desperate search for quarterly earnings, which are hard for huge companies to find, and Walgreens is considering going private and thus needs to preen its financials to chum the private equity sharks. In the mean time, Walgreens seems happy to lease its back-of-store real estate pop-up style to third-party clinic operators and UnitedHealth Group insurance sales centers while also opening Jenny Craig weight loss centers. Remember, too, that this was the company that jumped with zero due diligence into an ultimately embarrassing Theranos partnership that also vacated its drugstore premises. WBA shares are down 30% in the past year and 13% in the past five. 

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From Holiday Journal Time: “Re: hospital EHR alerts. It’s hard for clinicians to argue that alerts are a huge burden when they spend less than one minute per month on them.” Researchers look at how much time Duke University Health System providers spend dealing with the 75 most common interruptive alerts generated by Epic that represent 95% of the alert total, calculating the on-screen time between alert presentation and dismissal (“dwell time.”) Most alerts were closed within three seconds and providers spent just one minute per month dealing with them, leading the authors to postulate that it’s the interruption that alerts create — rather than the time required to manage them — that contributes to burnout. However, the authors excluded drug-drug and drug-duplicate alerts, which are the most common, because they weren’t able to calculate times. It should also be noted that quickly dismissed alerts aren’t necessarily a good thing – it’s likely that users are just reflexively clicking to get rid of the majority of them that are not helpful while missing the critical ones. I also note the financial success of co-author UCSF Department of Medicine chair Bob Wachter, MD,  whose conflict of interest statement in the article includes book royalties, compensation and stock options for serving on the boards or advisory boards of several companies, a royalty stake in one company, and a consulting arrangement with a startup that pays cash and stock.


HIStalk Announcements and Requests

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Two-thirds of poll respondents have had their employment forcibly cancelled, but 61% of them said that their long-term career benefited as a result. HappyCIO lost their executive position in a purge, but used the opportunity to relocate for a move up that had been stymied by excessive contentment. An unexpected layoff three years ago forced nurse informaticist Quilmes Boy to rebuild his resume and rush into ill-suited jobs that weren’t good fits, but he’s happy in a new job now even though it pays less. Michael’s pharma employer was set to lay him off after taking paternity leave but instead transferred a co-worker, but he’s sorry he stuck around given the obvious writing on the wall. Marshall was RIF’ed by new vendors at 55 years of age because he was above an arbitrary Excel-sorted salary row, but he used his contacts and knowledge to recover in a different role. Charles took a common path – his vendor employer laid him off, but he took job in a hospital’s IT department.

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New poll to your right or here: Does a patient own the data that a provider has recorded about them? TH made a good devil’s advocate argument last week – it’s true across all industries that you don’t own data that’s about you, and without the interpretation and validation of the provider who captured and recorded it, it’s not worth much (try selling a drug company a worksheet containing a list of your prescriptions and your blood pressure reading history). An extension of that argument might be that if the patient owns it, why can’t they insist that the provider change or delete it? Is having a right to obtain your data necessarily synonymous with owning that data? Is it different than credit scoring companies that know nearly everything about every American and make fortunes selling their most private information freely, giving the subject of that information little control or recourse?

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Welcome to new HIStalk Platinum Sponsor AGS Health. The revenue cycle management and business process outsourcing company provides billing, coding, analytics, and data integration solutions to healthcare providers all over the US, with $35 billion in annual managed receivables and 24 million charts coded by 6,000 degreed, certified specialists each year. A large academic medical center decreased its denials inventory by 72% by implementing 70 AGS-recommended front-end coding fixes while saving 40% of its outsourcing coding denial management costs, while another major organization decreased its A/R days by 10% and resolved 85% of aged receivables within six months of working with the company. The company recently named industry long-timer Patrice Wolfe (Medicity) as CEO. Thanks to AGS Health for supporting HIStalk. 

I’m struggling to comprehend while still working down the Thanksgiving leftovers that it’s just over three weeks until Christmas and just 98 days until HIMSS20 kick offs.

Speaking of holidays and HIMSS, it’s that slow time of year in which Lorre can work more closely with prospective HIStalk sponsors than in the crazy January and February that follows, when every company is trying to make themselves heard above the vendor din. I suggested she offer inducements of the wacky variety – (a) giving new sponsors an hour or two of Smokin’ Doc standee time in their HIMSS booth for the surprising number of people who want selfies; and (b) providing extra hand-holding for those 10×10 booth-dwellers who, like us in previous years, are questioning the value of their significant investment for the other 362 days of the year.


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

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


Acquisitions, Funding, Business, and Stock

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Consumer Reports observes that the list price for arthritis drug Humira has jumped 78% in five years, but most of the increase went to the pharmacy benefit manager middlemen (CVS Caremark, Express Scripts, and OptumRx) that took a bigger cut of its $5,174 per month list price. AbbVie generates $20 billion per year in Humira sales, but PBMs are pocketing 40% of its 2019 cost.


People

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Analytics technology vendor SymphonyCare hires Brad Case (Estrella Health) as chief strategy officer. He was previously chief development officer for predecessor company Symphony Corporation, which was sold to Influence Health in 2013 and then re-acquired by SymphonyCare’s founder and former CEO Ravi Kalla in 2017.

Todd Helmink (ConnectiveRx) joins secure messaging app vendor QliqSoft as chief revenue officer.


Privacy and Security

Great Plains Health (NE) is taken offline in a ransomware attack, leading it to cancel non-emergency appointments and procedures.


Other

In Australia, an auditor’s report warns that Queensland Health’s decision to push back replacement of its 30-year-old corporate information system – following allegations of conflict of interest within the replacement team — places it at risk since the system hasn’t been vendor supported since 2015. The system was provided by Australia-based ISoft, which sold itself in IBA in 2007 following a newspaper’s disclosure of financial irregularities. A replacement will cost Queensland Health at least $150 million.

Politico reports that the Department of Homeland Security’s inadequate software and sloppy paper record-keeping has caused treatment delays and lapses of care for migrants in its custody. Immigrations and Customs Enforcement announced plans to implement EClinicalWorks in 2014, but advocates complain that ICE’s information isn’t shared with other government agencies and medical providers.

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A travel website author visits Arizona-based MedAire, which provides ground-to-sky advice for airline crews who are attending to distressed passengers. It notes that unlike what you see in movies, airlines don’t usually ask whether there’s a doctor on board, preferring to deal with a known factor rather than checking passenger medical credentials or distressing travelers with a public announcement.


Sponsor Updates

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  • StayWell team members in Daly, CA serve meals at the North Peninsula Food Pantry & Dining Center.
  • Zynx Health will exhibit at the Institute for Healthcare Improvement National Forum December 8-11 in Orlando.
  • LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
  • Health Catalyst will host a patient safety reception at the Institute for Healthcare Improvement December 9 in Orlando.
  • NextGate will exhibit at the HIMSS Southern California Chapter 2019 CXO Symposium December 2 in Yorba Linda.
  • Netsmart consolidates its Ozark and Springfield offices in Missouri.
  • Redox previews its new podcast.
  • SymphonyRM publishes a new case study, “Health System Drives 15% Increase in Patient Visits, 380% Annual Wellness Visit Growth.”
  • Visage Imaging will exhibit at RSNA December 1-5 in Chicago, where it will demonstrate semantic annotations for Visage 7 as a work in progress.
  • The Marketing Trends Podcast features Vocera Chief Marketing Officer Kathy English.

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 11/27/19

November 26, 2019 News 7 Comments

Top News

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Federal prosecutors charge the two founders and two other executives of waiting room advertising technology vendor Outcome Health with fraud, claiming that the company inflated its revenue over a six-year period to help it raise $1 billion in funding, of which at least $225 million went directly into the pockets of the founders.

Indicted are the company’s former CEO Rishi Shah (33), former President Shradha Agarwal (34), former CFO Brad Purdy (30), and former EVP Ashik Desai (26).

Fascinating claims from the SEC litigation document:

  • A company salesperson warned Shah that company fraud was widespread, to the point that client performance reports were being edited directly in PowerPoint.
  • Desai joined the company as a 19-year-old intern, then became EVP over analytics.
  • Agarwal wasn’t really a co-founder even though the company positioned her as such. Shah’s original co-founder, an unnamed university classmate, left in November 2009. It was apparently Derek Moeller, who resigned as president to buy a Seattle-area company that recycles plastic into garden growing containers.
  • Shah had described the company’s “chicken and egg” problem, where it needed ad revenue to install more waiting room devices, but needed the devices to raise revenue. He decided to start forecasting the number of offices and device and sell that ad space even though it wouldn’t be available for months, which he later admitted in a meeting of entrepreneurs that, “It’s fraud, right, I mean you’re selling something you don’t have.” The company billed and recognized the full amount immediately.
  • The “selling of futures” became such an ingrained part of the company’s culture that its analysts were tasked with producing scheduled “delta report” that tracked the difference between claimed offices and devices with the real, lower number.
  • The company’s controller warned the executives that GAAP revenue recognition is based on actual delivery of ads rather than upfront invoicing, after which they kept the controller in the dark about the “delta reports.”
  • Desai falsified an ROI study in showing that Outcome’s ads boosted prescription counts by 27% in six months with a confidence level of 80%, when the actual figure was a 4% increase with 71% confidence. That allowed the company to claim that the ads generated $2 million in drug company revenue vs. the actual $116,000. For another drug ad, the company claimed that prescriptions increased 35% from Outcome ads when they actually decreased 3%.
  • In a Theranos-like move, a newly hired Outcome COO found himself out of a job within three weeks of warning Shah of the falsified ROI reports. He wasn’t named in the filings, but it was Vivek Kundra, a former White House CIO and Salesforce EVP who is now COO of CRM software vendor Sprinklr. His LinkedIn omits his nine-month stint with Outcome Health.
  • Also Theranos-like was that the company was exposed by a Wall Street Journal investigative report.

Reader Comments

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From Dr. Herzenstube: “Re: Exponential Medicine conference earlier this month. I’m wondering if any HIStalk readers went and can comment on whether it’s worth the astronomical price tag?” The Exponential Medicine conference was held early in November at the Hotel del Coronado in San Diego, with a registration fee of $4,750 and “favorable rates” offered to non-profit and government employees. It’s run by TED-aspiring Singularity University, which despite its name and .org web address, is a for-profit company rather than a real university, offering programs to rich executives instead of poor students. The web page is a thicket of buzzwords (“curate,” “reimagining,” “blockchain,” and “recharging” at yoga sessions and dinners under the stars) and speakers ranged from the mildly interesting to the clearly self-promoting, entertaining the junketeers who lived it up far from the prying eyes of their patients who are being bankrupted by their expense-bloated bills. I’m sure everybody had a good time, though.

From Eriksson: “Re: Cerner in Sweden. See this article.” The ComputerSweden article says that Region Skåne has postponed its Cerner implementation because the company has failed to understand the extend of Millennium changes that are needed to support the Swedish Patient Data Act. The region chose to store its data in Cerner’s cloud – unlike another region that is hosting its own system locally – and US cloud data protection is too weak to comply with Swedish law. Cerner has proposed sending patient data to 12 of its business units across nine countries, but the region wants processing of its most sensitive patient information to be performed within Sweden. The impact of the EU’s more stringent approach to privacy is creating interesting challenges for vendors based in the US, where privacy requirements are often contained in negotiated contractual terms rather than in enforced laws. Some of Sweden’s requirements:

  • Systems must have adequate access control to ensure that only people who need to see a patient’s information for their jobs can do so.
  • The patient has a right to block data from the view of their own provider and from other EHR-using providers.
  • The patient has a right to see their information.
  • The provider must provide a patient with a list of healthcare entities that have accessed their data so they can determine whether it was justified.
  • A provider can see the information of a patient of another provider only if they also have a current patient relationship, if the patient has consented, and if the person accessing the information checks a box to indicate that they understand before proceeding.

From Insider: “Re: KLAS. Changing vendor scores right as we approach final submissions for Best in KLAS. Scores from the question added earlier this year, ‘Does this vendor consistently exceed your expectations?’ will be eliminated from the scoring algorithm, effective today. It will be restored to the algorithm on July 1, 2020 to give all clients who were interviewed within an 18-month window the chance to answer this question before it affects a vendor’s KLAS scores.” Seems reasonable, although you wonder why KLAS walked its decision back and why it didn’t anticipate problems. Timing might suggest that some lesser-performing vendors complained once they saw how their scores would be affected.


HIStalk Announcements and Requests

In the spirit of Thanksgiving, here’s an anonymized, excerpted version of an email that a reader  — a former big-time CIO and industry long-timer whose name you would recognize unless you’ve been living under a rock — sent to Lorre this week, which touched her (and then me) deeply in putting life into perspective:

I want to say thank you to Mr. H and associates for this really valuable blog. I became disabled a while ago from a head injury that forced me to retire from healthcare, with a long road to recovery. Your blog helps, as it challenges me to remember stuff (my memory is episodic) and to get up to speed in the never-ending drama we call healthcare here in the US.

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I’m distracted today by the sharply divisive debate that has been raised by the AP Stylebook’s Twitter – do you “pre-heat” the oven or do you just “heat” it? I would argue that you do neither and rather “set” the oven and wait until it reaches temperature (since you’re heating the food, not the oven), but given the choices, I’m going with B since I also don’t like the terms pre-authorize, pre-arrange, pre-board, pre-medicate, pre-order, pre-pay, pre-wash, and pre-record for the same reason — “pre” doesn’t modify the word, but rather is a lazy shortcut to what should be a procedural instruction (heat oven to 350 degrees, then put in the turkey). I dislike “pre-existing conditions,” but I don’t have a better replacement unless it would be “pre-coverage conditions,” and but even then you might have had coverage, just with a different insurer.


Webinars

December 10 (Tuesday) 1:00 ET. “Move on from the age of the inefficient EHR.” Sponsor: Intelligent Medical Objects. Presenters: Jim Thompson, MD, physician informaticist, IMO; Obaid Baig, product manager, IMO. The EHR seems more like transactional workflow system rather than an intuitive clinical documentation tool, creating the possibility of loss of data consistency and the need for manual workarounds. The presenters will describe how to turn an EHR into a powerful tool that can help improve workflows and documentation so that clinicians can focus on care, not coding and reimbursement.

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


Government and Politics

Politico calls out the well-funded effort by healthcare’s profiteers to shut down anything that looks like socialized medicine (such as Medicare for All), including the American Hospital Association, America’s Health Insurance Plans, individual insurance companies, biotech companies, Chambers of Commerce, health systems, and trade associations. Their talking points, which omit the real motivation of preserving the patient-funded golden goose, are that Americans would lose choice (like they have a lot of choice anyway), everybody would be forced into a “one size fits all” system, and Americans would pay more and wait longer for worse care. The AMA has pulled out of the group, with the remaining members publicly accusing it of caving in to the liberal left. Healthcare companies spent $568 million lobbying the 535 members of Congress in 2018 alone, more than any other industry, and their bucks seem to be working since nobody is doing much to upend the healthcare cash register.


Other

Google Health posts a video describing the EHR search project it is doing with Ascension. It contains a mock-up of the combined information dashboard, which to my eyes looks little different from the standard tools provided by Epic, Cerner, and other EHR vendors, with the biggest differentiator that it combines information from multiple EHRs for those ever-expanding big health systems that are in perpetual replacement mode. The search function could be useful depending on how much intelligence powers it beyond simple text string scanning. The doctor who’s narrating is Alvin Rajkomar, MD, who is coming up on three years with Google, but also continuing his practice as a UCSF hospital medicine attending.

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CNBC reports that medical students and residents are teaching themselves to perform surgical procedures by watching unvetted YouTube videos. The article cites a study of 68,000 videos that show how to perform a fracture procedure, of which only 16 met even the most barebones criteria, such as identifying the on-camera person who was doing the teaching. UCSF’s Atul Butte made a good point on Twitter about potential oversight, however – textbooks aren’t regulated and at some point you have to trust your doctor for choosing appropriate learning material. After all, the surgeon who would have taught them in person could have been incompetent.

A study finds that US life expectancy, unlike that of most wealthy countries, has declined for three straight years after 60 years of increasing longevity, with key contributors being midlife drug overdoses, suicides, and organ system diseases. I suppose the glass half full side of the argument is that this is an indictment of our society, not our hospitals, and even the authors dismiss our dysfunctional health system as a cause and instead point to lack of social and support systems, poor education, and lack of living wages, all of which lead to “deaths of despair.” The largest number of excess deaths occurred in Pennsylvania, Ohio, Kentucky, Indiana, and Florida.

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Medical University of South Carolina says drug purchasing software that was developed by one of its IT network engineers is saving it millions by looking for the best price in the supply chain at any given moment. It has spun the company off as AscendRx, with the former IT employee Jonathan Yantis serving as CEO. I would tell you more, but the company’s Squarespace website returns a “Website Expired” error.

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Geisinger says its researchers can predict arrhythmia and death using AI analysis of ECG data, but our HIStalk AI expert Alexander Scarlat, MD provides a critique, which should always be employed before believing any attention-seeking AI headline since it’s never as straightforward as it sounds:

  • Mortality is by definition an imbalanced dataset (since more people lived than died) so area under the curve is not an appropriate metric. F1 score would be better suited.
  • It isn’t surprising that AI performed better in analyzing raw ECG data than humans. It’s like showing a cardiologist the actual ECG rather than a summary of its features.
  • Someone could die with a normal ECG for two reasons – either their cause of death wasn’t cardiac related or the model could be predicting on perhaps a 0.51 chance of being abnormal, barely over the default 0.5 cutting point.
  • The neural network should have been queried on the reasons and features it made it decide on the abnormal ECG.

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This is the best “excessive hospital charges” story ever. A three-year-old girl sticks a shoe from her Polly Pocket doll in each nostril. Her mother was able to remove one of them with tweezers, but the urgent care was unable to extract the second one and advised taking her to a Dignity Health hospital’s ED. Mom says the doctor there removed it within one second, having had ample practice with slippery Tic Tacs. She was billed $2,659 ($1,732 for the hospital, $927 for the doctor) and her family is stuck paying the full amount because of her high-deductible insurance plan. The hospital declined to provide the methodology behind its price, but scolded Mom in an emailed response to a media inquiry that she should have understood her plan better and gone to urgent care. Medicare would have paid the hospital $101, which you could argue is either a defense or indictment of why they charged her more. By the way, Dignity’s CEO made $10.3 million last year, the CIO made $2.3 million, and 27 executives exceeded $1 million in compensation.


Sponsor Updates

  • HIMSS names Audacious Inquiry Director Lindsey Ferriss a 2019 Extraordinary Women in Health IT awardee.
  • Datica and InterSystems will exhibit at AWS re:Invent December 2-5 in Las Vegas.
  • Spok earns top secure messaging and clinical communications honors in Black Book’s annual cybersecurity study.
  • ISalus Healthcare integrates prescription price transparency and electronic prior authorization solutions from CoverMyMeds with its EHR and practice management software.
  • Elsevier Clinical Solutions, Hyland, and InterSystems will exhibit at RSNA December 1-5 in Chicago.

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 11/25/19

November 24, 2019 News 6 Comments

Top News

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Wisconsin-based nursing home IT vendor Virtual Care Provider, Inc. is hit by ransomware, taking down electronic patient records, Internet service, email, billing, and phone systems across 80,000 PCs and servers running hundreds of nursing homes in 45 states.

The hacker is demanding $14 million to provide the encryption key, which the company says it can’t afford.

VCPI says some of its client facilities may be forced to shut down due to their inability to order drugs, generate bills, and pay employees.

Ironically, VCPI sells IT security and HIPAA risk analysis services.


HIStalk Announcements and Requests

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Over 80% of poll respondents think that Ascension’s data analysis agreement with Google is legal, but two-thirds also think the relationship is unethical.

New poll to your right or here: Have you ever been laid off or otherwise lost a job other than for performance issues? Click the poll’s Comments link after voting to share your experience.

I regularly worry that my 2.5-year-old, inexpensive Acer laptop will fail and leave me without a backup other than my Chromebook, which works great but doesn’t run some niche Windows apps that I need. I’ve been watching for a deal on something similar and saw a pre-Black Friday offer on an HP Pavilion 15z with AMD Ryzen 5, 16 GB of memory, 256 GB SSD storage, and a 15.6” touch display. I wanted 16 GB (which isn’t as common or cheap as it was a couple of years ago for some reason) and SSD since I’ve become spoiled by both, so my $480 order is in. I’ll report back after it arrives early next month.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Google’s venture fund provides $4 million in seed funding to Rad AI, a radiology workflow optimization software company that was started in 2018 by a radiologist who entered medical school at 16 and now practices in North Carolina.


Sales

  • SCL Health will offer virtual services using Bright.md’s SmartExam asynchronous virtual care platform.
  • Steward Health Care chooses Health Catalyst’s Data Operating System and Rapid Response Analytics. 
  • Humber River Hospital chooses CloudWave to support Meditech and its infrastructure.

People

Cooper University Health Care promotes interim CIO Dustin Hufford, MBA to SVP/CIO


Government and Politics

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The VA says that it hasn’t worked out jurisdictional issues with the Department of Defense over patient information that will be stored in their respective Cerner systems, admitting that nobody really thought about data sharing issues when the projects were conceived. Existing laws may require veterans to make separate requests to the VA and DoD to obtain their health records despite the goal of a single record for each patient. The VA also acknowledges that its March go-live at Mann-Grandstaff VA Medical Center (WA) will involve a limited implementation that will require employees to toggle between Cerner and VistA. 


Privacy and Security

Medical researchers observe that European Union’s General Data Protection Regulation has caused problems for their studies that cross national borders outside the EU. NIH Director Francis Collins says his study of diabetics in Finland ground to a halt when NIH could not meet the privacy requirements of its national equivalent in Finland. Neither the US nor Canada are recognized by the European Union as providing adequate data protection, so researchers must sign contracts to accept Europe-based audits or to cede legal jurisdiction to the originating country’s courts. GDPR isn’t an issue when patient information is anonymized, but countries haven’t agreed on how that anonymization can be performed and some studies include sample data that cannot be stripped of identifying characteristics.


Other

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Bloomberg notes that Inovalon Chairman and CEO Keith Dunleavy, MD is a billionaire once again following a 60% run-up in the analytics platform vendor’s stock price in the past year. Timing is everything, though — the company went public in early 2015 at $27 per share and is down 36% since, while the Nasdaq rose 74% in the same period.

Allscripts defends its work on an $18 million software implementation in the Bahamas that has resulted in no applications live after three years and $8 million in payments. The company responded to a newspaper’s request for comment that it is in full compliance with the contract and is waiting on approval from the government, which says it is looking for a replacement system. Allscripts misidentified its client in the response as the “Public Housing Authority” rather than the “Public Hospitals Authority.”

Medical residents in South Korea complain that while their weekly work hours are newly capped at 80, they are seeing more patients without much help from specialists in learning new procedures. They also claim that hospitals shut off after-hours EHR access to make it look like they are complying with the hours cap, but give them other work to perform instead.

In Australia, a government review of misused private data looks at Queensland Health’s Cerner IEMR, which allows employees and staff at any of its 14 hospitals to view the records of all patients. The government worries that the hospitals don’t fully understand how to configure the system’s privacy controls, such as flagging high-profile records to warn users that any inappropriate access will be investigated. However, one hospital’s HR director says its P2Sentinel access monitoring system issues reports that aren’t that useful, leading to a huge backlog of potential inappropriate viewing incidents that the hospital doesn’t have time to investigate. 

Two Colorado state agencies announce that a bug in their tracking system allowed several batches of contaminated medical and recreational marijuana to be sold, triggering a recall of such products as Ghost Cake Killah and Grape Ape.


Sponsor Updates

  • Chilmark Research highlights Bright.md in its new report, “Primary Care for the 21st Century: Technology-enabled and On Demand.”
  • Greenway Health’s Intergy EHR receives five industry accolades in 2019.
  • Nextech Systems gives its customers access to Relatient’s patient self-scheduling, automated waitlist, and patient intake capabilities.
  • The Chartis Group announces the winners of The Chartis Center for Rural Health 2019 Performance Leadership Awards.
  • Hyland Healthcare’s Advisory Councils share insight into top health IT trends including AI, cloud, and optimization.
  • LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference December 2-4 in Houston.
  • Gartner recognizes NextGate as a ‘Notable Next-Generation EMPI Vendor.’
  • Nordic staff volunteer at The River Food Pantry and donate gifts for 65 local children.
  • KLAS Research recognizes PatientPing as a high-performing, emerging healthcare IT company.
  • SailPoint will exhibit at AWS re:Invent December 2-6 in Las Vegas.
  • Visage Imaging will exhibit at RSNA December 1-5 in Chicago.
  • Wolters Kluwer Health publishes a new report, “Mending Healthcare in America 2020: Consumers & Cost.”

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 11/22/19

November 21, 2019 News 7 Comments

Top News

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The American Medical Association adopts a policy that calls for increased state and local funding to modernize public health IT systems. AMA also wants provider EHRs to be capable of automatically sending reportable conditions to public health agencies.

AMA is also encouraging state governments to engage state and national medical specialty societies and public health agencies when considering new mandatory disease reporting requirements.


Reader Comments

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From Fatted Calf: “Re: layoffs. Your list of the steps people go through after being laid off should have included advice.” That wasn’t the reader’s question that I was answering via my reality check, but here you go:

  1. Don’t be ashamed at being laid off and don’t try to hide the fact that you are involuntarily seeking employment. Layoffs are a failure of executives and only they should feel shame. Develop a one-sentence description of why you no longer work there (general cutbacks, product sunsetted or sold, etc.) and practice succinctly answering the question, “Why did you leave?” because it will be asked often.
  2. Set your alarm to get up early every day, dress in real clothes, keep a calendar, make calls, exercise, and treat every day like a workday whose goal is to find a new job. Lack of time is no longer an excuse.
  3. Spend a day debriefing yourself in writing. What did you like and dislike about your job and employer? What did you and they do wrong? What good and bad job decisions did you make?The only point of this is to get that crap out of your head so you can move on to more productive pursuits than moping around and second-guessing. It’s amazing sometimes how committing something to writing frees up brain storage and mental CPU cycles.
  4. Don’t badmouth your previous employer. You stayed in your rut until the choice wasn’t yours, so there’s no virtue in complaining only afterward how bad it was.
  5. Take several days to plan your ideal career and who might hire you to practice it. You have the opportunity, no matter how unwelcome, to change your preconceived notions about yourself and the niche into which your former employer placed you.
  6. Polish your LinkedIn, adding your job’s end date, changing your title for “seeking a new opportunity,” and make sure your “About” section is punchy and reflects your abilities. Please don’t use stuffy third-party wording, aka the Godcam view of yourself, such as “Seasoned health system manager” – make it personal, direct, and memorable (and include a decent headshot that isn’t cropped from a phone photo from your last beach trip). Then create one-page, one-sided resume that gets to the point with the most important information listed first. Hiring managers don’t care too much about your personal statements and they already know that you’ll provide references on request. Unless you’re applying for a low-level job, you won’t get hired via an application or resume anyway, with incompetent corporate HR departments being one big reason, so make calls and get out of the house instead of staring at your laptop trying to use IT skills alone to get hired.
  7. Attend a local conference such as a HIMSS chapter if you aren’t willing to relocate or a national conference if you are. Those can be target-rich environments for job searches, or at worst, for learning about how the world revolves outside your former company. I also got a couple of good jobs working with a recruiter who I vetted pretty carefully, so while not everyone’s experience is positive, it worked for me.
  8. Decide if you are willing to move under any circumstances. If not, then your job search and networking activities will look different than if you’re willing to relocate.
  9. Increase your visibility with LinkedIn articles, tweets, or anything else that could catch a potential employer’s eye, assuming that your insight and writing ability match your job expectations.
  10. Reach out to everybody you know via email or LinkedIn messaging and keep a worksheet of who you contacted and when. Use the six degrees of separation power of LinkedIn to figure out who might hire you and the email searching ability of Google to get that person’s work email address so you can introduce yourself. You only need to hit one home run to forget the swings and misses.

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From RansomwareHitsHome: “Re: Casamba LLC. A ransomware attacked has forced some agencies that use its software back to paper records and forms.” The California-based post-acute care EHR vendor hasn’t publicly acknowledged the attack, but this update was provided by one of its customers.

From FlyOnTheWall: “Re: Allscripts layoffs. The highest number I heard was greater than 350, but I’ll stand on my 125-150 let go until I find out more. They are in publicity damage control.” Unverified. I checked WARN notices for Illinois and Pennsylvania for the last several months and didn’t see any Allscripts entries, but WARN applies only to office closures and mass layoffs since they’re intended for giving the state rather than the employees a heads-up.


HIStalk Announcements and Requests

A reader approves of my activation of two-factor authentication to secure my Gmail accounts, but warns that the SMS-based verification option is not secure. He has first-hand experience – he lost $4,000 within minutes of someone using a SIM port hack to steal his cell phone number, which then allowed the hacker to reset the passwords for Gmail, banking, Twitter, etc. I took his advice and switched the authentication method to Google Authenticator, a free app that – like those flashing hardware dongles in the old days – generates authentication codes every few seconds. It’s like SMS messaging, except you open the phone or tablet app to get the current code and the mobile device doesn’t even need to be online at the time (unlike the SMS option). I had a few false starts in trying to figure out how to link the app to multiple email accounts from multiple mobile devices, but I finally figured it out by Googling. Another option is Google Prompt, which allows you to simply touch a phone pop-up acknowledging that it’s really you logging in on the other device, but it only works when the Gmail app is open and I don’t use it.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


People

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Jon McAnnis (Providence Health Plans) joins Zoom+Care as CIO.

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Regenstrief Institute promotes Indiana University School of Medicine professor Shaun Grannis, MD to VP of data and analytics.

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Nick White (Deloitte) joins Orbita as EVP of patient care solutions.

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OurHealth promotes Brian Norris, RN, MBA to EVP of population health.


Announcements and Implementations

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Orbita announces GA of OrbitaAssist, a bedside virtual health assistant designed to complement nurse call systems. Back-end software routes patient requests to the appropriate member of the care team, while front-end AI assures the patient their request is being fulfilled.

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Datica will debut its new cloud compliance technology, including end-to-end cloud managed services, in early December.

Imprivata announces OneSign 7.0, which adds single sign-on for web based applications.


Government and Politics

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Kaiser Health News publishes a retrospective look at stalled federal efforts to ensure the safety of EHRs. Ideas have included developing a database to track reports of deaths and injuries related to health IT and establishing an EHR safety center, neither of which have come to fruition due to funding and oversight issues. The issue gets even thornier thanks to a 21st Century Cures Act clause that prohibits the FDA from getting involved. Medical informaticist Dean Sittig, PhD says, “There wasn’t a lot of interest [at ONC] in talking about things that could go wrong. They gave out $36 billion. It’s hard for them to say EHRs aren’t safe.”

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The Mann-Grandstaff VA Medical Center in Spokane, WA is hiring 108 more employees to cover anticipated productivity losses during its Cerner go-live on March 28. VA officials insist they are on track to meet that deadline, but will have no qualms about pushing it back should patient safety become an issue.


Privacy and Security

Google Health lead David Feinberg, MD attempts to clarify the company’s HIPAA-compliant work with Ascension, pointing out that the health system is piloting an interface concept he first mentioned at the HLTH Conference last month.

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In the wake of Google’s Fitbit acquisition and health data trust debacle with Ascension, Wired offers step-by-step instructions on how to manage the privacy settings of popular health apps like Fitbit, Apple Health, and Google Fit. Some consumers have become so wary of Google and its plans for their health data that they have abandoned their Fitbits. One concerned user explained, “I’m not only afraid of what they can do with the data currently, but what they can do with it once their AI advances in 10 or 20 years.”


Other

A hospital in Bangalore, India will use its patient data to map areas where pothole-related injuries send up to four cyclists each day to its ED.

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Kaiser Permanente will name its new medical school after former CEO Bernard Tyson, who passed away earlier this month. The school will open next summer in Pasadena, CA and will offer free tuition to its first five graduating classes.

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A former marketing SVP of Novant Health sues the health system for reverse discrimination, claiming that as a white male, he was fired as part of a corporate diversity push and was replaced with two minority hires. David Duvall, MBA, MPH says that at least five other white male executives, including the CIO, were terminated and replaced almost immediately with “either a racial minority and/or female.” He was let go right before his five-year anniversary, when his termination would have entitled him to 18 months of base pay, 1.5 times his previous bonus, $200,000 in retirement benefits, and company-paid health insurance.

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Digital health investor, consultant, and author Terri Mead critiques her second annual visit as a participant in Verily’s Project Baseline Health, a four-year study announced in 2017 that aims to create a database of the sequenced genomes of 10,000 volunteers. Study participants like Mead also agree to wear activity trackers that share their sleep patterns, activity, heart rate, and other health metrics with Verily researchers. Her criticisms:

  • The “archaic” use of Google Forms to capture patient intake data.
  • The risk of inconsistent and unreliable data thanks to manual data entry that does not use drop-downs that are tied to medical terminology.
  • The study expressed no interest in her “female parts,” which left her assuming that they consider females “a standard deviation away from males.”
  • Lack of follow up on patient adherence to use of wearables, some of which she stopped using months before.
  • Abandonment of lung/breathing tests due to budget issues.

Sponsor Updates

  • AMIA inducts Intelligent Medical Objects VP of Customer Experience Steven Rube, MD and VP of Clinical Informatics Eric Rose, MD into its 2020 class of fellows.
  • Optimum Healthcare IT publishes a new case study, “Cerner Millenium Implementation at Ellis Medicine.”
  • The Chartis Group publishes a new paper, “Being a Digital Health System: It’s No Longer a Question of If or When.”
  • Pivot Point Consulting releases the first episode of its new Get to the Point podcast, “Flexibility vs. Interoperability. Can Clinical Documentation Do Both?”
  • Imprivata updates its OneSign authentication and access software to offer users seamless cloud-based access from any device.

Blog Posts


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Contacts

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News 11/20/19

November 19, 2019 News 9 Comments

Top News

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The American Medical Association adopts a policy that calls for EHRs to be able to collect the preferred name and clinically relevant, sex-specific anatomy of transgender patients.

AMA’s policy aligns with recommendations that medical documentation contain the patient’s preferred name, gender identity, pronoun preference, and history of medical transition history as well as current anatomy.


Reader Comments

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From Creative Juice: “Re: being laid off. I’m thinking about suing. Advice?” Don’t bother. Allow me to list the steps you’ll go through after being laid off, ending with the distant speck of light at the end of the unemployment tunnel:

  1. You will experience the ultimate humiliation in coming home early to notify your family that you are no longer employed, threatening your identity in ways you could not have imagined. 
  2. For a couple of days after being marched out, you’ll embrace false hope that your former employer will call to explain it was all a big mistake or that they want you to come back in a different role.
  3. You will expect an uprising from customers that will never happen, or expect those customers with whom you worked closely to call you cold with job offers, which will also never happen.
  4. You will commiserate with former co-workers who also got the axe, convening depressing lunches and not-so-happy hours where the conversation gets louder and faster as you try to convince each other that the company or your former boss will fail without you, which they won’t. 
  5. Most of your “work friends” will disappear from your life permanently because (a) they weren’t really your friends, they just shared employer space with you, and (b) nobody wants to hang around former colleagues who were marched out and who are now seeking comforting scuttlebutt about how bad things are at work.
  6. You will consider legal action, which is pointless. Even if you are legally right (and you aren’t), it would take years to arrive at a resolution that will not include hiring you back. Not to mention that employment lawyers want their money upfront (they know you won’t win) and it doesn’t really matter anyway because you signed away your right to sue as a condition of receiving severance.
  7. You will belatedly update your resume and think about overdue networking as the reality sets in that your income stream is ending. The grim reality of signing up for unemployment will cause endless anguish because you don’t see yourself as one of those pathetic people.
  8. Initially you will apply for no positions because of the indignity of the hiring process, then later you will apply for every job in sight because of the indignity of being unemployed.
  9. You will struggle with the idea that many of the seemingly good jobs are located in far-away areas where you don’t want to live, requiring uprooting the family with new schools for the kids and a new job for your working spouse (if you have either). You will also rage at the Catch-22 fact that you might get more money later if you move, but you need money now to move.
  10. You will eventually find some kind of job, either (a) a short-term one or even a contracting gig that will help pay some bills while you keep looking, or (b) one that is better than your previous one. Then you will rejoice that your incompetent former employer kicked you out of their sorry nest. I’m not one to offer unjustified cheerleading – if you are competent and willing to work, your lot will improve, and if not, then I don’t blame your previous employer for booting you.

From Oingo Bongo: “Re: Allscripts. Heard from a contact that there’s been another round of Paragon staff. Got any info on that?” The company laid people off last week, and while I haven’t heard anything specifically regarding Paragon, I can’t imagine that’s a growth area. Also relevantly not growing is MDRX share price, down 12% in the past year vs. the Nasdaq’s 22% gain.


HIStalk Announcements and Requests

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Reader AC made a great suggestion to turn on two-factor authentication for Gmail and other important services that don’t enable it by default, following my story about a hospital employee stealing co-worker logins using a keylogger program. I did it and it was painless. Gmail prompted me to enter a one-time verification code that it sent via SMS message, which it does each time I log in from a new device. Once I did that, it’s business as usual with no further verification unless I (or someone else) logs in from a different device. That means a hacker who has obtained my login credentials still can’t hijack my email account. An extra feature – you can ask Gmail to generate a bank of one-time codes to use when you won’t have your phone. Thanks for that advice. I can’t even imagine the headache and security exposure that would be involved with someone gaining full access to my email account, including all the personal and confidential information it contains.

Listening: the first, eponymous album by The Doors from 1967’s Summer of Love. “The Crystal Ship” alone is worth the ride. Mr. Mojo Risin’ had just turned 23 when the album came out, the beginning of his four-year term as the country’s most dangerous and reckless poet, musician, and performance artist until the unfortunate intersection of drugs and bathwater sent him to “The End” (as it did Whitney Houston and Dolores O’Riordan of the Cranberries). I’m also enjoying new from singer-songwriter JP Saxe, who I think is probably going to be pretty big.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Sales

  • Mary Free Bed Rehabilitation Hospital (MI) will implement Epic in an $8 million, 10-year Community Connect agreement with Covenant HealthCare.
  • Cooper University Health Care chooses Phynd for provider management.
  • Novant Health will implement KenSci’s AI platform to match workforce demand to capacity and to identify patients who are at risk for longer stays or readmission.
  • Visiting Nurse Service of New York selects Netsmart CareManager for care coordination, data reporting, and analytics support for its population health management programs.

People

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Ryan Miller (Anthem) joins Change Healthcare as SVP of corporate development.

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Medical practice software and services vendor IKS Health hires Kelly Reed, DO (The Iowa Clinic) as SVP of clinical services and outcomes.


Announcements and Implementations

Collective Medical will add HIE CCD data to its care team platform, connected by Kno2.

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Virtusa will add EHR data to its VLife life sciences platform from the InterSystems IRIS for Health interoperability solution .


Privacy and Security

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National Veterinary Associates, which owns 700 veterinary hospitals and boarding facilities, is struggling to recover from an October 27 ransomware attack that affected 400 of its locations. The company declined to answer questions about the malware or whether it paid a ransom.


Other

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American healthcare in a nutshell: the manufacturers of heart stents assure their investors that a widely praised study that proved the less-than-expected value of such procedures won’t hurt their business much. Translation: hospitals, doctors, and device manufacturers aren’t about to let medical evidence get in the way of their profits, meaning your odds of being stented won’t change just because we now know that it doesn’t work any better than a prescription. Meanwhile, a cardiologist whose research helped develop a new drug for a rare type of heart failure criticizes the manufacturer for setting the price of the capsule at $225,000 per year versus the estimated cost-effective price of $17,000.

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A Bahamas senator says he “makes no apologies” for his involvement with the 2016 signing of an $18 million contract with Allscripts and Infor that was supposed to transform healthcare there, even through the Public Hospital Authority warned Allscripts in late 2018 that it wasn’t happy that the company hadn’t installed any software anywhere despite having been paid $7 million. The local newspaper speculates that the government will give Allscripts a 60-day cure notice, then terminate the contract with expectation of a full refund. The government blames Allscripts in “a glaring lack of oversight” for “a staggering increase in implementation costs” beyond agreed-on amounts, with consulting firm Avaap billing the government $1.5 million. The paper also notes that the Allscripts proposal was stamped as received 11 days after the tender’s closing, which had already been extended by 14 days. The country’s minister of health declares the project “a bust.”

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A free clinic in Syracuse, NY closes after 12 years when the part-time founding doctor found that she was spending more time maintaining its EHR than seeing patients.

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Johns Hopkins Bloomberg School of Public Health profiles Assistant Professor Smisha Agarwal, MPH, MBA, PhD in its magazine, which describes her as “the school’s first faculty for digital health” in a sharp contrast between investor-crazed US digital health and public-focused health projects overseas. Snips:

  • She says we don’t know how to integrate digital tools with health system, we don’t know if they are cost effective, and we need to be careful not to amplify existing healthcare inequities, such as improving health only in urban areas or for those people who own a mobile phone.
  • She hopes mobile clinical decision support tools can help shift caregivers away from triaging low-severity illnesses and providing preventive services, data from which could then be used to apply machine learning algorithms to predict poor outcomes for intervention.
  • She says that a downside of digital health is opportunity cost, where resources are moved from established programs to experimental digital programs.
  • She worries about gender inequity in countries where the men are the primary phone owners and the effect on needed pregnancy and newborn care.
  • She sees the biggest transformational opportunities for digital health being putting real-time data in front of caregivers, using analytics to target high-risk patients, assisting providers who have limited training with education or remote assistance, and counting births and newborn deaths.

Sponsor Updates

  • Avaya announces the availability of Google Cloud contact center AI integration with its IX Contact Center solutions.
  • Netsmart takes the top spot for the fifth year in a row for customer satisfaction in Black Book Market Research’s annual look at the post-acute health technology market.
  • Dimensional Insight will exhibit at the New England HIMSS Maine Conference November 21 in Portland.
  • EClinicalWorks posts a podcast titled “Telluride Medical Center: On the Primary Care Frontier.”
  • Collective Medical partners with Kno2 to add enhanced clinical data capabilities including continuity of care documents to its clinical insights and analytics software for HIEs.
  • Virtusa enhances the health data integration capabilities of its VLife life sciences platform with the integration of the InterSystems IRIS for Health Data technology.
  • Woman’s Hospital (LA) will expand its use of Spok solutions.
  • Vocera will resell Spectralink Versity smartphones, which has been certified for use with its clinical communication and workflow system.
  • Optimum Healthcare IT completes Epic go-lives at several hospitals under Deaconess Health System’s CareConnect program.
  • A five-year study finds that a health literacy incentive program using health education content from Healthwise lowered healthcare costs.

Blog Posts


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Contacts

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Monday Morning Update 11/18/19

November 17, 2019 News 4 Comments

Top News

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HHS, as promised, expands its previous plan to require hospitals to publicly post all of their payer-negotiated charges by also requiring insurers to do the same.

Hospitals would also be required to post the cash payment they are willing to accept for 300 common, shoppable services.

The rule will take effect on January 1, 2021 in the imaginary world where no lawyers live (the American Hospital Association, Association of American Medical Colleges. Children’s Hospital Association, and Federation of American Hospitals immediately said they’re suing for HHS overstepping its bounds).

President Trump said in announcing his executive order:

First, we are finalizing a rule that will compel hospitals to publish prices publicly online for everyone to see and to compare. So you’re able to go online and compare all of the hospitals and the doctors and the prices, and, I assume, get résumés on doctors and see who you like. And the good doctors — like, I assume these two guys are fantastic doctors, otherwise you wouldn’t be here. (Laughter.) And the bad doctors, I guess they have to go and hide someplace. I don’t know. Maybe they don’t do so well, I don’t know. But if they’re not good, we — we are more interested in the good ones. It’s called rewarding talent.

Second, we’re putting forward a proposed rule to require health insurance providers to disclose their pricing information to consumers. We’re giving American families control of their healthcare decisions. And the freedom to choose that care is right before them on the Internet and elsewhere, but on the Internet. Very, very open. Very transparent. That’s why it’s called transparency.


Reader Comments

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From Who Diss?: “Re: Who’s Who. This CIO was recognized as a ‘Top Medical Professional’ by a seedy-looking organization’s press release.” A variety of “who’s who” scammers contact people cold, preying on their vanity by advising them that they have been “chosen” by their admiring peers or the company’s editor to be included as a member in a paid online listing. After that, they are hit with the upsell to buy lifetime memberships or vanity crap like wall plaques and hardcopy books. You CIOs, pharmacists, doctors, and nurses who I see listed on this particular one’s site got taken, I’m sorry to tell you. Please don’t list this laughable accomplishment on your resume, which in some LinkedIn examples shares space with bogus educational credentials. Above is the company’s luxurious office suite in Valley Stream, NY, conveniently located above the dumpster in which visitors can pitch their “award” and possibly their careers right out the window.

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From Gobsmacked Compliance Professional: “Re: SCL Health and Providence. I was having dinner adjacent to a restaurant’s ‘private’ dining room and was gobsmacked to overhear a detailed discussion about their plan to merge, including proposed timeline, financials, etc. Annual reports are due in December and will be interesting reading.” Unverified. SCL owns eight hospitals in Colorado, Kansas, and Montana that generate $2.5 billion in annual revenue. Providence operates 51 hospitals with annual revenue in the $23 billion range. Maybe this alleged privacy slip is yet another example of hospital people loudly saying things they shouldn’t within earshot of others.

From Register Ringing: “Re: HIMSS20. Look at this page of well over 1,000 things they’re trying to sell to exhibitors.” Vendors can whip out their checkbook to buy nearly every square inch of the convention center or to have HIMSS push their sales message to attendees, including:

  • Sponsor pre- or post-conference supplements to “own the conversation” ($20,000).
  • Pay HIMSSTV to record a panel discussion in their booth ($20,000).
  • Get the impartial, hard-hitting journalists at Healthcare IT News to tweet out links to “one of your thought leadership content pieces” ($20,000, or $22,500 if you want them to just write the piece themselves).

HIStalk Announcements and Requests

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Few poll respondents think the Allscripts-Northwell collaboration will result in a commercially successful EHR any time soon.

New poll to your right or here: How would you characterize Ascension’s data analysis agreement with Google? Click the poll’s Comments link after voting to explain.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Brighton Park Capital acquires a majority stake in patient engagement platform vendor Relatient and appoints former Siemens USA President Eric Spiegel as the company’s board chair.


Sales

  • Amedisys will deploy NVoq’s cloud-based speech recognition solutions for dictation and automation.
  • Thomas Health (WV) will add Meditech’s web-based Ambulatory solution to its Expanse system, implemented by CereCore.
  • San Gorgonio Memorial Hospital chooses the Azure-hosted Sunrise Community Care from Allscripts. Googling suggests that they are replacing Allscripts Paragon.
  • Beebe Healthcare (DE) will improve workflow efficiency and clinician communication using TransformativeMed’s EHR-embedded work management and notification modules to eliminate printed patient lists.

People

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CereCore hires Joe Wurzer (Leidos Health) as RVP of sales and business development.


Privacy and Security

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The FBI arrests a former IT employee of an unnamed New York City hospital, charging him with installing a keylogger program on dozens of employee PCs to capture their email login credentials so he could steal their photos and tax records. I was thinking that this sort of information shouldn’t have been stored on a work PC in the first place, but then realized that he probably grabbed their logins to Gmail or other web-based personal email services.


Other

The Washington Post covers “rural America’s busiest emergency room,” Avera Health’s telemedicine center in South Dakota that provides remote ED service for 15,000 emergencies each year covering 179 hospitals in 30 states “where the choice is increasingly to have a doctor on screen or no doctor at all.” Rural ED visits have increased 60% in the past 10 years, but hospitals are closing, doctors aren’t willing to move to small towns, and standalone EDs are going broke. One small hospital signed up at a cost of $70,000 per year after it received four critical automobile accident victims with just an single RN working, with no doctors available within an hour’s drive. Fun fact – the virtual service’s doctors wear scrubs and lab coats to their suburban office park location so they will look like real doctors to their TV patients. The virtual ED clinicians must work patiently with local nurses who may have no experience with intubating patients or who need help running a code blue. Avera ECare’s telemedicine network also offers services for ICU, school health, pharmacy, clinics, behavioral health, correctional health, and hospitalist coverage.

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The Pittsfield, MA paper covers the $35 million implementation of Meditech Expanse by Berkshire Health Systems. The article focuses on the hospital’s problems with the Allscripts FollowMyHealth patient portal – the inability to share data, uncertainty over how the company might use its data for marketing, low usage in the 30-40% range, and patients who either can’t sign on to FollowMyHealth or who sign up directly with the service instead of through the hospital-provided link. The health system is a longstanding Meditech customer for inpatient and is apparently replacing Allscripts ambulatory with Meditech.

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The Wall Street Journal profiles the technology underpinnings of the new $2.1 billion, 368-bed Stanford Hospital that opened this weekend. It was originally scheduled to be open in early 2018, but was delayed because Apple’s spaceship headquarters project sucked up all the Silicon Valley steelworkers. I was curious about Stanford’s financials, which show $4 billion in annual revenue, a profit of nearly $450 million, several executives in the $1-2 million range, and not-unreasonable IT compensation (the CMIO was paid $770K, while the CIO made $500K). Hospital features include:

  • Bedside keypads that allow patients to choose entertainment and control temperature, lighting, and window blinds.
  • Swisslog robotic dispensing for pharmacy and medication delivery by robots.
  • A fleet of automated guided vehicles for delivering laundry and collecting trash.
  • Tracking of staff an inventory in real time.
  • Remote patient monitoring.

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CIOs are expanding their use of “low-code” drag-and-drop automation tools such as Microsoft PowerApps to quickly create applications that automate business processes, which Gartner says will make up 65% of application development in the next five years. St. Luke’s University Health Network (PA) VP/CIO Chad Brisendine says his team has built 20 applications – none of which took more than 20 hours to create – to extract information from hospital systems. A non-programmer needed just eight hours to develop an app that extracts information from its Workday HR system to issue CME reminders to doctors. A Microsoft case study describes how Northwell Health used Dynamics 365 (and its Healthcare Accelerator) and PowerApps to develop a daily rounding app. I admit that the geek in me is aroused.

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Several readers forwarded the full text of a just-published article that tried to correlate physician-perceived EHR usability with burnout, with the big conclusion being that EHRs “received a grade of F by physician users.” My critique:

  • The sample size was just 870 doctors surveyed out of 31,456 invited, of which the authors used “a deliberate oversampling of non-primary care specialties.”
  • Perceived EHR usability was compared to “everyday items” such as Microsoft Excel (which also earned an F), an ATM, and a microwave oven.
  • I’m not clear on how the authors expected respondents to answer usability questions about “my EHR,” which would depend on their practice (one or more clinics, one or more hospitals, both, etc.)
  • The authors mentioned an “incentivized secondary survey,” which suggests that they paid people to complete it.
  • They note that respondents may have been conflating EHR usability with the burden of documentation it supports, with their pushback being against documentation requirements rather than the tool that captures it. 
  • A reader says that while one of the authors is an executive of the notoriously EHR-hating AMA, its own JAMA wouldn’t publishing the findings and it ended up in Mayo Clinic Proceedings, probably because of the low response rate.

Sponsor Updates

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  • OmniSys employees in Greenville, TX collect hundreds of canned goods for those in need.
  • The Wharton School’s “Work of Tomorrow” podcast features MDLive CEO Rich Berner.
  • The Salt Lake Tribune features Health Catalyst CEO Dan Burton.
  • OpenText and Redox will exhibit at Salesforce’s Dreamforce November 19-22 in San Francisco.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Perinatal-Neonatal Symposium November 18 in Williamsburg, VA.
  • KLAS Research recognizes PatientPing as a high-performing, emerging healthcare IT company.
  • Surescripts and TriNetX will exhibit at AMIA’s annual symposium November 17-19 in Washington, DC.
  • SymphonyRM publishes a new white paper, “AI Next Best Actions vs. Traditional CRM.”
  • T-System adds EvidenceCare’s clinical decision support tool to its emergency department documentation software.

Blog Posts


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Mr. H, Lorre, Jenn, Dr. Jayne.
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News 11/15/19

November 14, 2019 News 7 Comments

Top News

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The HHS Office for Civil Rights will look into the HIPAA compliance of Google’s data-sharing arrangement with Ascension.

Google has pledged to cooperate with OCR investigators, stressing that its work with Ascension adheres to HIPAA and “comes with strict guidance on data privacy, security, and usage.”

The company added in an amended damage-control blog post that, “Patient data … is not used for any other purpose than servicing the product on behalf of Ascension. Specifically, any Ascension data under this agreement will not be used to sell ads.”

Google Cloud now knows that its parent company has a consumer image problem that, while not on the magnitude of Facebook’s, could still serve as a roadblock for its technical work that has nothing to do with search engine ads.

Perhaps most puzzling is why Google hasn’t enlisted its new high-profile healthcare hires to explain the project or to describe why it’s likely that patient data is more secure within Google’s systems than in those of any hospital or medical practice.

The odds that this deal violates HIPAA are zero. It only violates the data rights that consumers wish they had. 


Reader Comments

From RumorMonger: “Re: Allscripts. Reducing workforce today to cut costs, with a rumored 25-50 people let go.” Unverified, but reported to me by several readers, some of whom said weeks ago that the cutback was scheduled for November 18. Rumored areas impacted are Sunrise, support, and development.

From PizzaSlinger: “Re: Cerner layoffs. A manager apparently sent the layoff script to the associates he was laying off.” I hate that layoffs have become corporate business as usual, with companies unskillfully using them to (a) dump deadwood and high earners while dodging employment law issues; or (b) to quickly juice their financial numbers to arouse some bean counter. I get really worked up when the company cluelessly acknowledges the announcement with a cheery statement that while the valued (to a point) former associates will be missed, the company is hiring wildly otherwise. Maybe the “overall headcount increase” promise encourages investors and customers, but it throws salt in the layoff wound by clearly indicating that the affected “associates” aren’t worth retraining or reassigning. Still, I commend Cerner for sending its executioners a script – which was forwarded to me — to make the employee’s final contact with the company smooth. My summary of it:

  • Schedule the appointment ahead of time using an attached link (I assume using the link automatically alerts campus security to be close by at the designated time since that wasn’t emphasized nearly enough in the script otherwise).
  • “Anticipate their reaction so you can prepare.” Having laid people off myself, I don’t think you can do this with any degree of accuracy. Most employees are initially stunned, so the idea is to get them off campus without a working access badge before their Kubler-Ross’s “denial” turns to “anger.” I’m surprised that the instructions advised making the appointment ahead of time since that’s a sure sign of impending trouble, although it’s also awkward to have a layoff when some of those affected are on PTO and thus likely to hear from co-workers or a telephoning manager that they are now unemployed. It’s also a good idea to tell the survivors not to let their former co-workers into the building.
  • Coordinate with the co-worker who gets the fun job of marching the employee to the “offboarding support area” and then packing up their pitiful personal effects while they are getting the axe.
  • Don’t tell people their job has been eliminated while they are at a client site or driving.
  • Keep the conversation short, no more than 20 minutes, but book the room for 30-60 minutes so they can compose themselves without being kicked out of the room to make way for the next execution. 
  • Have Kleenex on hand.
  • Tell them not to return to the office, but advise them that they will remain an active employee through January 14, 2020.

HIStalk Announcements and Requests

The best lesson we can learn from the Ascension-Google controversy is that Americans are naive in thinking that HIPAA gives them broad privacy protection, so perhaps the shock – justified or not – that a company that most Americans know only for searching and serving ads is holding their medical data will open much-needed consumer privacy law discussion. Many people, even media types, seem shocked that HIPAA addresses only providers, or that they get a free pass under “treatment, payment, and operations.” I don’t question the data-sharing deal since it’s really not all that unusual other than consumers react more quickly when it’s Facebook or Google than if they found out that many, many other companies are sifting through their medical information, sometimes paying some other organization for the privilege. Bottom line – Ascension did nothing intentionally wrong, patient data is almost certainly safe, and both Ascension and Google now know they have a public trust issue that isn’t limited to just this tiny aspect of their businesses. I’m waiting to see if Ascension’s interest really is related to clinical outcomes rather than their own financial ones and whether anyone raises the issue of whether Ascension really has 50 million signed Notice of Privacy Practices forms on file (and whether those are valid if they were signed before Ascension acquired the original hospital). All this aside, the issue goes well beyond these two organizations.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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NextGen will acquire patient intake, scheduling, and payment software company Medfusion for $43 million. Medfusion will spin off its data services business into a separate entity named Greenlight Health. Steven Malik sold Medfusion in 2010 to Intuit for $91 million, then reacquired it in 2013. He owns the North Carolina FC of United Soccer League and North Carolina Courage of National Women’s Soccer League and is working to build a $2 billion entertainment complex in Raleigh.

The planned merger of Sanford Health (SD) and UnityPoint Health (IA) to form one of the country’s largest health systems is called off, with Sanford’s CEO saying that UnityPoint Health’s executives “failed to embrace the vision.”


Sales

  • St. Joseph’s/Candler will implement Tabula Rasa Healthcare’s DoseMeRx precision dosing software across its facilities in Savannah, GA.
  • Willis-Knighton Health System (LA) selects Meditech Expanse.
  • Humana, GuideWell, and Trusted Health Plan will use Healow Insights integrated services from EClinicalWorks for interoperability among their networks.

People

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Surgical software vendor Provation Medical hires Daniel Hamburger, MBA, MS (Renaissance Learning) as CEO. He replaces Dave Del Toro, who will join the company’s executive board.

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Jamie Trigg (Seattle Children’s) joins Virginia Mason Health System (WA) as CTO.


Announcements and Implementations

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The St. Louis Children’s Hospital and Washington University Heart Center (MO) sends high-risk infant cardiac patients home with Locus Health’s remote monitoring app.

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Best Buy ups its digital health offerings with the addition of TytoCare’s at-home medical exam device and companion app. The $300 device comes equipped with attachments that can be used during a telemedicine visit with partners from several health systems and telemedicine companies.

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CHI Memorial Hospital (TN) implements Epic.

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WellSky develops the WellSky IO interoperability framework to help post-acute and community providers connect to patient data exchanges.

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The Michiana Health Information Network, Indiana Health Information Exchange, and HealthLinc will merge operations under the IHIE brand in January. IHIE executives believe the consolidation will create new value propositions and help scale services. IHIE has played around with several business models since launching in 2004, including its ThriveHDS clinical data repository services offshoot, which shut down after just nine months. The HIE’s CEO and COO presented “Said the HIE: ‘Reports of Our Death Are Greatly Exaggerated” at HIMSS earlier this year.

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Amazon Web Services launches AWS Data Exchange, giving users the ability to find, subscribe to, and use third-party data in the cloud. Healthcare use cases include subscribing to aggregated data from historical clinical trials to accelerate research activities, and subscribing to aggregated and de-identified healthcare claims and transaction data to improve care delivery.

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In Canada, Ontario health officials announce a Digital First for Health strategy that will aim to give patients the ability to book appointments online, access their medical records, and take advantage of more telemedicine services within the next three to four years. Providers will be given access to interoperable records, and enhanced data integration and predictive analytics.

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A KLAS report on remote patient monitoring finds that nearly all users get measurable outcomes, but the market is changing to demand products that are patient-centric, that engage patients, and that offer patient-provider interaction, all using consumer-based rather than proprietary medical devices. Health Recovery Solutions and Vivify Health are leading the evolution, but the report’s conclusions are incomplete because several vendors refused to participate (Resideo, Care Innovations, Medtronic, and Philips).

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Patient safety groups ECRI Institute and the Institute for Safe Medication Practices will merge, with ISMP becoming an ECRI Institute subsidiary.


Privacy and Security

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I can’t tell if this is satire or serious: Google’s alleged whistleblower takes to The Guardian to outline why he or she felt compelled to share concerns about “the Nightingale Project” with, presumably, the Wall Street Journal: “After a while I reached a point that I suspect is familiar to most whistleblowers, where what I was witnessing was too important for me to remain silent. Two simple questions kept hounding me: did patients know about the transfer of their data to the tech giant? Should they be informed and given a chance to opt in or out? In short, patients and the public have a right to know what’s happening to their personal health information at every step along the way. To quote one of my role models, Luke Skywalker: ‘May the force be with you.’”

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Health Care Cost Institute CEO and former CMS Chief Data Officer Niall Brennan tries to calm the masses.


Other

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The American Medical Association co-sponsors a study that finds that perceived EHR usability is poor and contributes to physician burnout. The article is paywalled so I can see only the highlights (except for the graphic above, tweeted out by one of the authors), although I notice that response rates weren’t good. The authors conclude that EHRs scored an F with self-reported doctor scores in the bottom 9% across all industries and then correlated those scores to burnout. The correlation versus causation issue would lead me to question, do EHRs burn doctors out, or do burned-out doctors hate EHRs as a tangible manifestation of their unhappiness? Also, I’m not sure that it’s fair to compare an EHR to Amazon, a Google search, or a microwave oven, especially since those tools are voluntarily chosen for personal benefit. Doctors are frustrated with their EHR, but they’re also frustrated with nearly everything else about their jobs (and many of them must be frustrated with the AMA itself as well, given that only a fraction of US doctors are members, so maybe the EHR vendors should study that phenomenon).

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STAT looks at the integral role remote healthcare coaches play in the success of headline-grabbing digital health companies like Omada Health, Livongo, and Fitbit. Omada Health CEO Sean Duffy admits that though he’s a big fan of tech, “It’s hard to recreate human accountability.”

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Results of the Apple Heart Study are in, leaving researchers with several solid takeaways regarding the Apple Watch’s ability to alert users to abnormalities. The eight month study of 400,000 users – one of the largest of its kind – found that the device notified two thousand of an irregular pulse; 84% of which were found to have atrial fibrillation. Researchers concluded that passive monitoring can be beneficial, but more work needs to be done for the Watch to be truly useful in helping at-risk, rather than young and healthy, populations. Apple just launched a separate Research app to study heart, movement and hearing issues, and women’s health.


Sponsor Updates

  • Apixio celebrates several milestones including its 10th anniversary, adding 17 new provider and payer customers in 2019, and making Deloitte’s 2019 Technology Fast 500 list of fastest-growing companies in North America.
  • Ellkay will exhibit at Momentum 2019 November 22-24 in Orlando.
  • Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
  • CarePort Health’s post-acute provider database and patient choice application, CarePort Guide, is now available in the Epic App Orchard marketplace.
  • HealthCrowd will present at the Florida Association of Health Plans 2019 Connect Conference November 19 in Orlando.
  • In Australia, Hyland integrates Medrefer’s referral technology with its OnBase enterprise information technology.
  • InterSystems will exhibit at Healthcare Providers Transformation November 18-20 in Denver.
  • Intelligent Medical Objects will exhibit at the AMIA 2019 Annual Symposium November 16-20 in Washington, DC.
  • Kyruus CTO Chris Gervais will present at Salesforce’s DreamForce November 20 in San Francisco.
  • AMIA inducts Clinical Architecture CIO Shaun Shakib into the 2020 Class of AMIA Fellows.
  • Recondo Technology announces that bookings for its automation solution for prior authorization transactions has accelerated in 2019 to 60 health systems, most of them Epic users.
  • ZDNet profiles Nuance.
  • Health Catalyst appoints Julie Larson-Green (Qualtrics) and S. Dawn Smith (Cologix) to its Board of Directors.
  • The Chartis Group publishes a new white paper, “Creating a Successful Physician Enterprise in Academic Health Systems.”

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 11/13/19

November 12, 2019 News 26 Comments

Top News

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Google announces Project Nightingale, a partnership with 150-hospital Ascension in which the company will gain access to the identifiable data of potentially all of Ascension’s patients to apply predictive analytics for patient care.

Business Insider reports that the information of 20 million patients has been uploaded to the cloud, with that of another 30 million patients scheduled for transfer in February.

The Wall Street Journal says the data being shared is not de-identified and is essentially the patient’s entire record. It also notes that at least 150 Google employees have access to the data.

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The organizations are testing EHR search software and tools that present EHR data graphically to clinicians.

Ascension’s patients and doctors were not notified of the project, except for the 2,000 doctors and nurses who are testing the EHR search function.

Ascension says the deal meets HIPAA requirements because Google has signed a Business Associate Agreement.

Quoted in the announcement was Ascension EVP / Chief Strategy and Innovation Officer Eduardo Conrado, who spent 26 years as a Motorola IT and marketing executive and four years as an Ascension board member before joining the health system’s executive team in September 2018.


Reader Comments

From Laid Off and Up: ”Re: recent layoffs. Why do companies fail to understand how bad they look laying off employees in November and December?” I assume that unrestrained desperation to make Excel cells jump forcibly through hoops to earn a bean counter hurrah outweighs the justified black eye that results from showing previously valued “associates” the door during the two-month holiday window. It’s never a great time to lose your job, but prospects are dim until after New Year’s, long nights invite depressing self-analysis, and it’s an unenviable acting job trying to appear upbeat along with holiday-spirited family and friends. Layoffs are a management failure, but November and December cutbacks suggest a higher level of knee-jerk incompetence. I’ll offer my advice from having served on both sides of the forced march out the door — you don’t want to work for a company that conducts regular layoffs anyway, so they’re doing you a favor by forcing you to choose a better employer.


HIStalk Announcements and Requests

I’m excited that my pre-ordered copy of “Man’s 4th Best Hospital” by Samuel Shem was deposited into my Kindle library upon its release today. I expect that will be the subject of my next book review. Meanwhile, if you think I should read a particular book and report on it, let me know.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Cerner lays off 131 employees in its latest round of cost-cutting. 

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Value-based care clinical quality platform vendor Apervita raises $22 million from an incremental investment.

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Premier launches Contigo Health, a network of member health systems that will use EHR-integrated, evidence-based clinical decision support to optimize care for employees of its employer members. It will also identify available employer health and wellness programs. Premier acquired evidence-based clinical decision support vendor Stanson Health a year ago for $51.5 million, which I would guess forms a key part of this offering. This announcement is a pretty big deal – as big tech companies start trying to figure out this maddeningly complex market, publicly traded Premier knows it inside and out (supply chain, quality improvement, analytics, technology, clinical delivery, etc.) and has now, via Contigo Health, formed relationships with 35 health systems representing 440 hospitals as well as several national employers to address cost and quality issues (also note that health systems are longstanding Premier member-owners). I wrote here several years ago that Premier was the company to watch in terms of disruption and execution and this announcement doesn’t throw water on that prediction. If I were Google or Amazon and was anxious to get a healthcare foothold… well, let’s leave it at that.


Sales

  • Mercy will implement Bright.md’s asynchronous virtual care platform to provide online triage, diagnosis, and treatment for patients at any location at any time.
  • In Northern Mariana Islands, Commonwealth Healthcare Corporation will upgrade its Medsphere legacy system to CareVue EHR and revenue cycle.

People

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Jon Zimmerman (Athenahealth) joins Holon Solutions as CEO.

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Datica CTO Travis Good, MD will leave the company’s management team. He will remain a Datica board member and is starting a new venture that is focused on personal data and privacy


Announcements and Implementations

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Cricket Health Chief Product Officer Geoffrey Clapp builds VA Care Finder, a free Amazon Alexa skill that allows veterans to provide an address and to be given the closest three VA locations by driving distance (including traffic conditions), powered by the VA’s Facility API. The screenshot above is from an Echo Show device. He’s working on enhancements to use Alexa’s default home location, answer questions about specific facility hours or address, and answer questions about service lines, such as mental health, rather than all locations. Alexa’s limitations don’t allow him to link to external services or to use mapping tools. He’s hoping to explore the VA’s many other APIs to see if appointment scheduling is a possibility. He concludes in his Veterans Day post,

With these APIs — and there is much, much more than just the facilities subset API that I’ve exposed here — the developer community can now get access to data we only dreamed about back in the highly-mentally-scarring VistA integration days of yore. The fact that nearly all the data that is available to internal development teams at the VA or USDS is also available to every hacker, startup, and BigCo means we can do what APIs are meant to — OPEN THE DATA — and build stuff no one ever thought of (or, thought of but didn’t have the budget for…I see you, VA) and there are few populations as deserving of innovation as our Veterans.

A Black Book survey of health information management professionals finds that 93% are optimistic that AI can streamline document creation and capture a holistic patient history to improve outcomes and revenue integrity.

Prepared Health develops an API that users FHIR 4.0 to connect home care agencies and other providers to health plans and hospitals for referrals, care management, and billing.


Government and Politics

Politico reports that CMS Administrator Seema Verma signed a $2.25 million government contract to hire at least 40 consultants to polish her personal brand, several of them former Trump campaign workers who billed taxpayers up to $380 per hour to perform tasks that have always been managed by CMS’s civil servants. HHS cancelled the contract in April 2019 after Politico reported on it, but at least $744,000 had already been spent.


Other

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In Israel, Sheba Medical Center says it will create “the first fully VR-based hospital.” That’s certainly a press release stretch, unless the hospital plans to sell off all those buildings in the photo above and instead pass out VR headsets to patients. They calmed down a little further down the page, specifically listing that the hospital will use virtual reality for therapy services and education.

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The non-profit Health Care Cost Institute gains access to de-identified Blue Cross Blue Shield claims in a multi-year partnership agreement. UnitedHealthcare stopped sharing its claims data with the group earlier this year, citing privacy concerns about HCCI, which is a non-profit competitor to its claims data-selling Optum subsidiary.

The Environmental Protection agency is proposing to ignore the conclusions of academic studies in its rulemaking unless the authors submit all raw data, including any patient medical records that were reviewed, for public inspection. EPA says outsiders should be able to independently review all study data to verify the conclusions of the researchers. The measure would make it more difficult to pass new environmental laws because the personal health information that was involved is often collected under confidentiality agreements. EPA’s proposed standard would exceed those for published medical studies, which do not require investigators to submit raw data.

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A newspaper in India interviews Viren Prasad Shetty, the COO of India-based Narayana Health, which plans to expand from its 30 hospitals and 6,000 beds to 30,000 beds. Interesting points:

  • The company plans to create a virtual health network that involves apps rather than buildings in an Uber-like model that will allow it to grow more quickly at a lower cost.
  • He says India’s plan to add a new medical school in every three districts of India isn’t adequate because many of the graduates leave the country, noting that the US has more India-graduated nephrologists than India itself.
  • He predicts that “the biggest export-earning industry of this country will be our manpower,” specifically medical caregivers as declining populations leave Western countries with no one to care for their senior citizens.
  • Narayana’s 20% annual growth in cancer services eclipses that of its primary focus of cardiac services, so “we will want to convert all our hospitals into cancer hospitals.”
  • He says the company’s strength is that is led by a core group of doctors – including cardiac surgeon and CEO Devi Shetty, MBBS – instead of business executives, which makes it attractive to doctors.

A man who expected his hernia repair to cost around $10,000 is shocked at the for-profit hospital’s $116,000 bill for the 91-minute outpatient procedure, including $1,700 for a pair of scissors. He had passed on buying real health insurance and instead enrolled in a health-sharing ministry that pools medical bills among self-pay patients outside the purview of insurance regulations. He was approved for up to $50,000, but inadvertently chose the most-expensive area hospital and didn’t realize that patients who are covered by health-sharing ministries are billed at the same rate as uninsured or cash-paying patient without the benefit of heavy insurer-negotiated hospital discounts. The hospital refuses to budge on the $67,000 balance he owes. He’s demanding that Virginia’s consumer protection office force the hospital to write off his balance, but an attorney with Virginia Poverty Law Center says the hospital will probably just sell off his debt to a collection agency for 10 cents on the dollar. 

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An American Osteopathic Association survey finds that 75% of Americans feel lonely. My free advice – forget your pretend friends on Facebook and make an effort to interact with actual human beings instead of accidentally trampling them on the sidewalk while staring down in wonderment at your phone’s compelling but imaginary world. The most provocative art I’ve seen recently is by photographer Eric Pickersgill (above), who showed what real life would look like once the “small, cold, illuminated devices” of social media addiction are removed. He describes it as: “This phantom limb is used as a way of signaling busyness and unapproachability to strangers while existing as an addictive force that promotes the splitting of attention between those who are physically with you and those who are not.”


Sponsor Updates

  • Apixio will exhibit at the Rise Annual Risk Adjustment Forum November 12-14 in Scottsdale, AZ.
  • Clinical Architecture will exhibit at AMIA November 16-20 in Washington, DC.
  • Diameter Health will exhibit at the Advent HEDIS 2020 Client Conference November 19 in Scottsdale, AZ.

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 11/11/19

November 10, 2019 News 4 Comments

Top News

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Kaiser Permanente Chairman and CEO Bernard Tyson died unexpectedly Sunday of unspecified causes. He was 60 years old.

EVP/Group President Gregory Adams will serve as interim chairman and CEO.


Reader Comments

From Jake the Snake: “Re: health IT blog sites. Some of them seem to be violating FTC’s endorsement rules in running puff pieces that don’t disclose payments or business relationships.” The reader provided examples in which (a) a company rep’s thinly disguised sales pitch that wasn’t listed as a paid spot even though I’m guessing it was; and (b) an article that talked about an industry issue, but then made the leap to quoting someone from the company or pitching their product as a solution. The Federal Trade Commission’s endorsement guidelines prohibit making a statement that a consumer might reasonably assume is an honest opinion and not an advertiser message. That includes being shown using a product, being paid to mention a product (even if indirectly), or being given a product to try and then either making misleading claims or failing to disclose being paid to mention the product. I doubt the examples provided run astray of FTC’s guidelines. For me, I quit reading one local food site that was pitching particular restaurants, chefs, or menu items in a blatant pay-for-play “featured restaurant” manner without disclosing it, which was pretty obvious since the same handful of places kept popping up despite unenthusiastic online reviews.   

From Ghost in the Machine: “Re: Cerner’s acquired Siemens businesses. Norway is very small in the overall story. Some of the platforms from that deal will be put out onto the market. Apparently the German workforce has been told that its multiple offices will consolidate to Berlin. The changes are unrelated to the Sweden delays — they are part of the business focus on earnings and product portfolio.” Unverified.


HIStalk Announcements and Requests

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Eighty percent of poll respondents believe that their employer gets at least 50% of the benefit of their conference networking.

New poll to your right or here: Will the collaboration between Allscripts and Northwell result in delivery of a commercially successful EHR within three years? Click the poll’s Comments link after voting to make your case in ways that a binary response cannot.

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I’m becoming more uncomfortable with the idea that when I thank a service member, my motivation might be influenced by my urge to feel virtuous by throwing out that increasingly automatic and empty saying. It’s better to hire a veteran or their family member, donate to support groups, and vote for politicians who support veterans (and ideally, who are veterans themselves who understand the responsibility involved in sending people off in harm’s way). I’m also not to sure that someone who has served in the military necessarily gets good vibes from a “Happy Veterans Day” greeting or anything else that requires them to acknowledge my recognition. For today, I will just say to veterans out there that I know you made a sacrifice that I didn’t and thus will never fully understand, and for that, I honor you. 

I haven’t thought of Robert Lorsch of MMR Global very much since I interviewed him in 2013 after his company filed lawsuits against EHR vendors, Walgreens, non-profit hospitals, and the government of Australia for developing personal health record technology that he claimed – not very convincingly — infringed on his intellectual property. Turns out he died in May 2017 and the company seems to have met its maker before Bob. 


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Canada-based Intelerad Medical Systems is reportedly seeking a buyer. 


People

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Toni Laracuente, RN (Change Healthcare) joins Medicomp Systems as chief nursing officer.

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Accreditation Council for Graduate Medical Education hires Bruce Metz, PhD (University of Connecticut Health Center) as its first CIO.


Announcements and Implementations

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Michigan HIEs Michigan Health Information Network and Great Lakes Health Network will merge to form an organization with $28 million in annual revenue and 169 employees. The governor recently vetoed $1 million in funding for MiHIN.


Privacy and Security

University of Chicago wants its medical center dismissed from a class action lawsuit that accuses it of sharing patient information with Google in an agreement that the plaintiff says violates his HIPAA rights. The university’s motion says that while the plaintiff claimed that the de-identified information could be re-identified through timestamps and free-text notes, he never claimed that Google actually did so and that its contract with Google prohibits it from even trying to re-identify patient data. The university added that its Notice of Privacy Practices informs patients that their data might be used for research and they won’t be paid even if a commercially viable product results.


Other

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Sony expects to earn FDA clearance next month for Nucleus, an OR integration tool it acquired in 2016 that is sold outside the US. The hardware device displays multiple simultaneous images – including 3D and 4K — from video-based medical equipment that can also be recorded, broadcast, or routed to a different display.

In India, government-run Rajendra Institute of Medical Sciences will track its 300 doctors via GPS to make sure they are physically present in the building during their paid hours of  9:00 a.m. to 5:00 p.m. The hospital administrator says he expects doctors to eat in the building because leaving means they won’t make it back in their allotted one hour.

Weird News Andy awards an A for effort to this life sentence prisoner who argued that doctors who were treating his septicemia had to revive him with epinephrine, so that meant he was “dead” and thus had fulfilled his sentence. The appeals court disagreed, finding that life sentences aren’t satisfied just because doctors revive someone.


Sponsor Updates

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  • CereCore staff prepped and served lunch to over 400 people at the Nashville Rescue mission.
  • CMS selects Lightbeam Health Solutions as a stage 1 participant in its Artificial Intelligence Health Outcomes Challenge to demonstrate how AI tools can predict risk.
  • LiveProcess will present at the IAEM Conference November 15-20 in Savannah, GA.
  • Meditech congratulates customers recognized by CHIME as Healthcare’s Most Wired organizations, including Avera Health (SD), Frederick Regional Health System (MD), Lima Memorial Health System (OH), Woman’s Hospital (LA), and Doylestown Hospital, PA.
  • Mobile Heartbeat will exhibit at the Pediatric Trauma Society’s Annual Meeting November 11-16 in San Diego.
  • Nordic and Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the HIMSS Gulf Coast Chapters GC3 Conference November 13-15 in Biloxi, MS.
  • Gartner names OpenText a leader in its 2019 Magic Quadrant for Content Services Platforms.
  • PatientPing congratulates its national network of ACOs for generating more than $430 million in shared savings in 2018 under the MSSP.
  • Wisconsin Health News profiles Redox.
  • SymphonyRM publishes a new white paper, “AI Next Best Actions vs. Traditional CRM.”
  • Voalte will host VUE19 November 13-15 in Sarasota, FL.

Blog Posts


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Contacts

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News 11/8/19

November 7, 2019 News No Comments

Top News

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Just one in 10 discharged patients go online to access their medical information, according to a study that looked at data from 2,410 hospitals over a two-year period.

The analysis also found that patients at non-profit hospitals are more likely to take advantage of access than their counterparts at for-profit organizations, as are patients at teaching hospitals.

The authors conclude that “policy efforts have failed to engage a large proportion of patients in the electronic use of their data or to bridge the ‘digital divide’ that accompanies health care disparities.”


Reader Comments

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From Being There: “Re: HLTH conference. As a participant and attendee, I found this to be a first-rate event. Other than a couple of HHS speakers who seemed more intent on politics versus real healthcare, the rest were engaging, interesting, and first rate. I especially like the panel discussion format used in the tracks I attended. As an exhibitor, I was disappointed in the value provided for the cost incurred. Activity was low most of the time, including the happy hour which helped a bit, but not enough. My theory is that there is just too many good speakers and sessions which are running concurrently such that, if I didn’t have to be in the exhibit area, I would have been attending tracks and sessions instead. PS: the free Mimosas on Sunday morning were especially nice.”

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From Mandibular Process: “Re: HIMS. Why in the world would a company name themselves this?” I took “in the world” part of this question literally, assuming that a company that was started in 2014 would choose this name only if (a) it is clueless, or (b) it is brazenly hiding behind some other country’s less-litigious legal system. Not so. Even though the HIMS website does not list people or places (not uncommon with foreign companies trying to look domestic), I tracked them down to Arizona, where a postal race is probably unfolding to see whether our industry’s HIMSS or from the Viagra-selling website HIMS will land the first cease-and-desist letter.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Reuters reports that CompuGroup Medical is one of two top bidders for the health IT and integrated care parts of Agfa’s European healthcare business.

American Well acquires behavioral telehealth and telepsychiatry service provider Aligned Telehealth.

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Lawyers for Elizabeth Holmes contend in a hearing that the FDA destroyed emails that are vital to her defense. The former Theranos CEO and co-defendant Ramesh “Sunny” Balwani –a former Theranos executive and romantic partner of Holmes — face up to nine counts of wire fraud and two counts of conspiracy to commit wire fraud. The FDA has admitted to having only partial emails from the former director of its diagnostics regulatory division, which it blames on a faulty email storage system.


Sales

  • The Ohio State University Wexner Medical Center will implement Visage Imaging’s Visage 7 Enterprise Imaging Platform in all of its radiology departments, replacing its legacy PACS.
  • Boston Health Care for the Homeless will use an addiction treatment-focused EHR from Netsmart to help care for patients with opioid use disorder.
  • Prisma Health (SC) selects telehealth technology and services from MDLive.
  • Health and human service agency network Innovative Management Solutions (NY) will implement population health analytics and risk management tools from Arcadia.

People

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Federal health IT vendor DSS names Christopher Kunney (Coker Group) chief of strategy and business development and Roy Hammar (Cerner) chief of client engagement.


Announcements and Implementations

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The National Council for Behavioral Health and disaster relief non-profit Americares pilot a text-based messaging program at eight Texas health clinics that uses patient engagement software from Epharmix to help patients with medication adherence.

California-based HIE Manifest MedEx and HBI Solutions develop MX Analyze, a predictive analytics tool designed to help providers manage high-risk patients and care transitions.

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A new KLAS report says that the patient engagement ecosystem is a complex and overwhelming area of health IT that spans 80 capabilities and “a slew of vendors claiming to offer them.” KLAS analysts didn’t interview clients in this case – they compared vendor claims to provider priorities. Among vendor-agnostic products, Allscripts, CiperHealth, and GetWellNetwork offer multiple solutions that align with market priorities. EHR vendor patient portals from Epic, Athenahealth, and NextGen, even though their use is limited, meet the key provider demands for bill payment and self-scheduling. Sonofi Health and PCare lead in the interactive patient systems category, Orca and Luma are notable outreach vendors, and Salesforce and Docent Health perform well in the broad category of CRM, rounding, and wayfinding. KLAS notes that providers reap most of the benefit of these systems, with only 20% of vendors claiming improved clinical outcomes.


Government and Politics

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The VA gives all veterans access to their medical records via Apple’s Health Records app following an earlier limited rollout.


Privacy and Security

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The Government of Nunavut in northern Canada prioritizes getting its health department’s Meditech system back online after a DoppelPaymer ransomware attack over the weekend crippled digital services across its networks. Officials anticipate returning to normal operations within a week.


Other

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Researchers at Emory University in Atlanta find a direct correlation between opioid abuse-related tweets and overdose deaths in several Pennsylvania counties. The researchers hope to further refine their machine-learning algorithm to help public health officials monitor opioid abuse within certain populations.

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Kyruus surveys 1,000 consumers for the third year in a row to better understand their healthcare access preferences. A few findings:

  • Consumers are relying more heavily on hospital websites than in years past when it comes to searching for healthcare information.
  • Scheduling appointments by phone, while still the dominant method, is losing losing ground to online booking.
  • Consumers care more about insurance acceptance and clinical expertise than a health system’s reputation or appointment availability.
  • Thirty-three percent of respondents say they would switch providers for access to virtual visits.

Sponsor Updates

  • EClinicalWorks and HealthCrowd will exhibit at the TAHP Texas Covered Health Care Conference + Expo November 11-12 in Austin.
  • Ensocare will exhibit at the 2019 Leadership and Physician Advisor Conference November 15-17 in Miami.
  • EPSi will exhibit at the HFMA Region 9 Annual Conference November 10-12 in New Orleans.
  • Formativ Health will sponsor the Wounded Warrior Project Carry Forward 5K November 9 in Jacksonville, FL.
  • Patientco celebrates new office space in Atlanta.
  • Healthwise, Imprivata, and Intelligent Medical Objects will exhibit at NextGen UGM 2019 November 10-13 in Orlando.
  • Hyland names the State of Minnesota Department of Health as the winner of its 2019 Government Innovation Award.
  • InterSystems debuts its PulseCast podcast, “John Halamka: Making the Most of Decentralized Data.”
  • Definitive Healthcare SVP of Strategy Kate Shamsuddin wins the Worcester Business Journal’s Outstanding Women in Business Award.
  • Glytec publishes a new study focused on the “Current State of Inpatient Diabetes Care and Glycemic Management.”

Blog Posts


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Reader Comments

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