Monday Morning Update 1/14/19

Top News

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

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

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

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

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

Other

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

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

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

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

Sponsor Updates

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

Blog Posts

• Evolution of the Data and Data Engineer (Liaison Technologies)
• Call it a Crusade: Why I Started Loyale Healthcare (Loyale Healthcare)
• Why nine hospitals worked together to achieve success for their patients (Meditech)
• How Health Care CFOs Can Survive – And Thrive – In The M&A Boom (Waystar)
• Checklist for a Consumer-Friendly Patient Financial Experience (Patientco)
• Meeting the communication needs of today’s care teams: An interview with CEO Terry Edwards (PerfectServe)
• Clare Medical: Making House Calls Even More Effective with enTouch (PreparedHealth)
• Health IT Predictions for 2019 (Sansoro Health)
• The Next Generation of Care: The Connected Healing Ecosystem (Vocera)
• Pagers’ Popularity: 5 Reasons It’s Still a Top Communication Tool in Healthcare (Spok)
• Why nine hospitals worked together to achieve success for their patients (Meditech)
• Customer innovation: Avera Health. (Voalte)
• 8 Pitfalls for Startup PT Practices (WebPT)
• Three Keys to Get a Venture-Backed Startup Off the Ground (ZappRx)

Contacts

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

Weekender 1/11/19

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

In Case You Missed It

• News 1/11/19
• EPtalk by Dr. Jayne 1/10/19
• Readers Write: Expanding the Horizon of Clinical Surveillance
• Machine Learning Primer for Clinicians–Part 11
• News 1/9/19
• Curbside Consult with Dr. Jayne 1/7/19
• Monday Morning Update 1/7/19

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

News 1/11/19

Top News

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

Sales

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

Announcements and Implementations

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

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

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

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

Government and Politics

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

• You Want to Play with FHIR? 5 Tips to Get Started (Healthwise)
• Congratulations to Ed Kopetsky, the 2018 CIO of the Year (Huntzinger Management Group)
• Boost your claims processing solution in 2019 (Hyland)
• CRM for Population Health: Engaging Healthy Consumers (Influence Health)
• Telehealth – Rural Health Center (EClinicalWorks)

Contacts

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

Morning Headlines 1/9/19

The NHS Long Term Plan

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

Healthgrades Acquires Influence Health

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

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

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

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

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

News 1/9/19

Top News

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

Sales

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

People

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

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

Announcements and Implementations

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

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

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

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

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

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

Other

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

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

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

• Are You Ready For Your Next Epic Upgrade? (Optimum Healthcare IT)
• 5 Tips for Adopting Telemedicine into Your Practice (AdvancedMD)
• Bluetree’s take on the new release cycles (Bluetree)
• Hybrid Cloud, not Multi-Cloud, is the Future (Datica)
• 6 Top Cybersecurity Trends to Embrace in 2019 (Burwood Group)

Contacts

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

Monday Morning Update 1/7/19

Top News

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

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

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

People

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

Government and Politics

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

Other

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

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

• Why External Audits are the Best Way to Ensure Revenue Integrity (Hayes Management Consulting)
• Creative Solutions to EHR Training Challenges (Part One) (HCI Group)
• Optimum’s Top 5 Blog Posts of 2018 (Optimum Healthcare IT)
• Seeking Solutions: The Opioid Crisis (Huntzinger Management Group)
• IMAT Solutions Helps Health Payers to Become Data-Driven Organizations (Imat Solutions)
• Similarities between HIPAA and GDPR (Impact Advisors)
• The top five takeaways from the 2018 Gartner Identity and Access Management Summit (Imprivata)
• How Allina Health used EHR data to increase provider efficiency and satisfaction (Nordic)
• A Balanced Digital Marketing Strategy for Your Medical Practice (Influence Health)
• A Simple Wish: Free Up Time for Patient Care (InterSystems)
• Do You Have a “Doctor Famous” Problem? (Kyruus)
• The New Year’s Resolutions You Need to Make if Your Industry Relies on Data (Liaison Technologies)
• “This call is being recorded for Quality Assurance …” (Vyne Medical)
• Rethinking Your Routine in 2019 (Netsmart)
• Checklist for a Consumer-Friendly Patient Financial Experience (Patientco)
• Home health agency thinks like a hospital (PreparedHealth)
• What Do the Top 10 Most Wired Hospitals Have in Common? (Spok)
• ONC Technical Expert Panel: An Insider View (Sansoro Health)
• The Ins and Outs of Test Automation (Santa Rosa Consulting)
• Consumerism Will Spark Change Across the Industry: My Top Seven Health IT Predictions for 2019 (Surescripts)
• The Secret to Documenting for Medical Necessity (WebPT)

Contacts

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

News 1/4/19

Top News

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

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

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

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

People

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

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

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

Announcements and Implementations

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

Health Level Seven International publishes the FHIR Release 4 standard.

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

Privacy and Security

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

Other

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

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

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

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

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

Sponsor Updates

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

Blog Posts

• Primary care’s next high-return opportunity: Substance use disorder treatment (Advisory Board)
• Happy and Health 2019! (Agfa Healthcare)
• Five Ways You’re Already Using Machine Learning: A Day with AI (Apixio)
• Best Practices for Switching EHRs (Aprima)
• Why Is It Important to Test Backups? (Atlantic.Net)
• Get the most out of your decision support tools (Bluetree)
• ‘Twas the Night Before Clinical Surveillance (Bernoulli Health)
• 6 Top Cybersecurity Trends to Embrace in 2019 (Burwood Group)
• Informed Decisions at the Point-of-Prescribing – A Possible Solution for Medication Adherence (CoverMyMeds)
• Update from the 2nd NCQA Digital Quality Summit (Diameter Health)

Contacts

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

Monday Morning Update 12/31/18

Top News

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

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

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

Reader Comments

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

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

People

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

Other

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

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

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

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

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

Contacts

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

News 12/28/18

Top News

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

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

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

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

Sales

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

Other

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

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

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

Sponsor Updates

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

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

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

Contacts

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

Monday Morning Update 12/24/18

Top News

Rep. Jim Banks (R-IN), chairman of the House’s VA technology subcommittee, questions the VA’s plan to implement Cerner patient scheduling, noting:

• The VA’s Epic Cadence pilot under the MASS contract worth up to $624 million has been successful even though VA leaders keep stopping and restarting the project, decided at one point that the VA didn’t need resource-based scheduling, and then said that a VistA scheduling enhancement (VSE) would suffice.
• The Epic implementation would be nearly finished if the VA hadn’t slowed the project down, which made VSE look favorable.
• The VA hasn’t said what it will cost to move to Cerner scheduling, the timelines required, and the benefit to veterans.
• The VA should consider using FHIR to connect Cerner to Epic scheduling.

Reader Comments

From Archie Tech: “Re: NYT’s Epic piece. Didn’t really get into the gist of the company’s success.” Epic’s campus is cool, but writers tend to fawn over the architecture and bucolic location to the exclusion of finding out more relevant facts about the company, possibly because Judy doesn’t really want to be interviewed at all, much less about the secrets of Epic’s success. I worry that her PR recalcitrance is depriving the industry of the chance to understand how, against all odds, a nerdy, introverted computer science professor created a mammoth tech company in an unlikely location by breaking every rule in the book. Writers who have earned a rare, brief audience with her invariably ask dopey, fawning questions whose answers don’t provide much insight.

From Amish Avenger: “Re: Centra Health’s first loss in a decade, blamed on unexpected Cerner costs and hiring hundreds of trainers. So they planned to install a new EHR + rev cycle system across an entire health system and didn’t anticipate a need to train people? There must be more of a story here. Did Centra believe that Cerner would train everyone or that a new EHR would be as intuitive as a cell phone?” Centra spent double the $33 million it expected for implementing Cerner this year, then was hit after its September 1 go-live with lower productivity that reduced net revenue by 10 percent. It “unexpectedly” hired 400 consultants for two months to help with the go-live. The health system had other revenue-impacting problems (a nursing shortage, executive turnover, and reduced payments) that might have been conveniently blamed on Cerner, but surprise costs for training suggests that the health system either missed something or got bad advice. I think they were replacing a hodgepodge of systems that included McKesson and Allscripts.

From Silicon Valley Geek: “Re: Health 2.0 API survey. It’s got a lot of great data despite all the Epic bashing. I’m a big fan of your astute and objective survey credibility analysis. I’ve love to know if you see methodology flaws or red flags in this one.” My observations on the survey, which was apparently targeted to unnamed and undefined “small health tech vendors”:

• Only 64 respondents completed the survey, but it was not stated how those respondents were chosen, whether multiple respondents work for the same vendor employer or what jobs they hold, or what defines a “small health tech vendor.”
• I’m not sure that all small health tech vendors are created equal in terms of expertise, market success, information they need or provide, or their product’s competitive position with EHR vendors.
• The responses aren’t too surprising and pass the common sense test, but the premise of asking small vendors if the big ones are holding them back incorporates inherent bias.
• The poll’s bottom line is that EHR vendors are improving in allowing API and other access to their systems, but pricing (especially app store) remains an issue, Athenahealth and Allscripts are easiest to work with while Epic trails the pack, and small vendors are worried that big ones are trying to steal their intellectual property.
• The poll also raises the question of whether health system EHR customers contribute to the problem by their lack of interest in working with small vendors.
• Perhaps more insight could have been gleaned by asking health systems which systems they want to use from small vendors and whether their EHR vendor has said yes or no to integrating with them. It’s easy for a startup to blame EHR vendors for their own lack of market success, but I don’t hear health systems complaining that their EHR vendors won’t support the integration those health systems need. The “one throat to choke” health system business imperative, along with ridiculously long and imitative procurement processes, are perhaps most responsible for small-vendor market challenges rather than their involuntary reliance on other vendors.

From Spikes High: “Re: doctor EHR complaints. We need to catalog them for the public good.” It wouldn’t be all that useful given the variables involved:

• The doctor’s background and experience with competing products is always going to drive their perceptions. Complaints about a particular EHR may in fact be complaints about all EHRs.
• Much of what a physician sees and is required to do is defined by their employer, the patient’s insurer, government regulations, or malpractice requirements, not the EHR vendor.
• Complaints about usability can be caused by poor training or lack of experience rather than the product itself.
• Doctors sometimes unrealistically expect off-the-shelf EHRs to mimic their own highly individualized workflows or specialty-specific preferences.
• The all-over-the-place complaints about a particular product mean any problems aren’t black and white, and every vendor has clients who happily use its systems.
• The benefits of an EHR don’t necessarily accrue to those who are forced to use it and thus dissatisfaction is inevitable. Complaints about EHR productivity loss, mandatory data entry, or unwelcome administrative oversight could easily be made about unwelcome paper processes as well. Doctors struggle with the idea that they’ve willingly given up their autonomy to self-enriching businesspeople armed with EHRs and an indifference to their factory workers, including those who wear white coats.
• Here’s how to tell what parts of the EHR doctors find useful. Survey solo concierge practitioners who pay for systems out of their own pockets and who use only the functionality they need to achieve good outcomes and productivity. Mine is implementing Elation EHR, he told me last week, and he practically spat on the ground when describing his previous job working for a hospital that mandated Epic (but mostly because he didn’t like working for a hospital whose executives were making millions while reducing his income).

HIStalk Announcements and Requests

A reader who wishes to remain anonymous made a generous donation to my DonorsChoose project, asking that I choose elementary and middle school STEM projects. Those are my favorite as well because we’re losing ground globally in STEM and I think it’s important to generate interest in younger students. This donation, along with matching funds, fully funded these teacher grant requests:

• Science and weather learning activity sets for Ms. C’s elementary school class in Shepherd, TX
• Math manipulatives for Ms. A’s pre-kindergarten class in Washington, DC
• Hands-on science kits for Ms. D’s elementary school class in Kansas City, MO
• A Chromebook for STEAM studies for Ms. G’s elementary school class in Bronx, NY
• STEM creative materials for Ms. K’s middle school class in Bridgeport, CT
• An interactive quiz gaming system for Ms. K’s elementary school class in Milwaukee, WI
• STEM creative building toys for Ms. B’s pre-kindergarten class in Washington, DC

Ms. B responded quickly in emailing, “My students are truly going to feel like January is gift-opening time all over again!”

Poll respondents communicate with their PCP by sending patient portal messages (which was surprising to me as by far the #1 answer), filling out online forms, and visiting the office to obtain or deliver paper forms. Almost unheard of are texting, using electronic signature such as DocuSign to complete forms electronically, and (thankfully) faxing. Selection Bias correctly notes that my readers may not be representative. Two readers love communicating by portal and one just calls the office.

New poll to your right or here, for provider IT folks – has your EHR vendor refused your request to integrate with a small vendor’s system? Vote and then explain what you asked for and how your EHR vendor responded.

Webinars

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

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

Sales

• Community Regional Medical Center (CA) chooses Phynd for provider enrollment, management, and reporting, to be integrated with Epic.

People

Tenet Healthcare hires Christopher Walden, RN, MHA (Health First) as VP/east region client services leader.

Announcements and Implementations

BayCare (FL) goes live on indoor patient way-finding powered by Connexient’s MediNav. The hospital’s visitor app includes detailed floor maps, department and clinic locations, real-time location, points of interest, and driving and parking directions.

Other

A New York Times health article says that more than half of older Americans – the population in whom medical care is most complex — can’t understand medical information such as the purpose and interpretation of a particular test, weight graphs, and insurance coverage. It recommends that providers stop using abbreviations with patients, make forms and instructions more easily understood, and communicate more clearly while encouraging patient questions. Commenters also blamed provider reluctance to write things down instead of just reciting them orally, assigning non-clinical employees to respond to emailed patient questions, and the economic reality of short appointments and lack of follow-up that cause patient misunderstandings or questions to be missed. One reader’s insightful comment urged that patients be given the NNT (number needed to treat, which is the number of patients who would have to be treated with a given drug to prevent one bad outcome) and NNH (number needed to harm, the number of patients who take a drug before one of them is harmed). Informaticists, what say you on the NNT/NNH issue?

In England, a medical resident hangs himself in his first week on the job after struggling to use the hospital’s computer system. If that’s not bad enough of a computer testimonial, (a) his body wasn’t found for two days because of a scheduling mix-up; and (b)hospital employees told his frantic parents to call the police instead of them because they couldn’t find him in their computer — it turns out that his name had been entered incorrectly.

Inc. lists 10 words and phrases used in business that really need to go away (I wasn’t convinced until I saw “curate,” which ranks near the top of my list of perfectly good words that have been ruined by idiots trying to make “making a list” seem impressive):

• Digital transformation
• Disruption
• Synergy
• Crushing it
• Superstar
• Curate
• Girl boss
• Open the kimono
• Move the needle
• Reach out

A reader forwarded a link to Episode 1 of “Chiefs in Carts Getting Coffee,” in which Arkansas Children’s Hospital SVP/CIO Jon Goldberg interviews EVP/COO Chanda Chacon while riding in a golf cart (“I think she’ll appreciate the subtleness of this blue, boxy beast.”) Goldberg also sends a “Fone Free Friday” message to the entire organization every week that has developed a cult following.

Sponsor Updates

• Pivot Point Consulting’s Seattle team wraps presents for the Forgotten Children’s Fund.
• OpenText completes its acquisition of Liaison Technologies.
• Lightbeam Health Solutions publishes a new case study, “The South Bend Clinic: Using Analytics to Thrive Under Value-Based Contracts.”
• The local paper covers LogicStream’s app to prep hospitals for drug shortages.
• More providers sign on for Meditech Expanse in 2018.
• NextGate announces a milestone year with significant market growth and achievements.
• NVoq publishes a new Meditech use case featuring Alliance Community Hospital.
• PatientPing publishes a coordinated care success story featuring Houston Methodist.
• The “Winning in Health” podcast features Sansoro Health CEO Jeremy Pierotti.
• ZappRx will work with global biopharma company Genentech on idiopathic pulmonary fibrosis, allergic asthma, and chronic idiopathic urticaria.
• Zen Healthcare IT welcomes Guardian Health Service to its interoperability community.
• ZeOmega achieves NCQA PHM Prevalidation for its Jiva PHM platform.

Blog Posts

• Gift Guide for the Data-Focused Enterprise (Liaison Technologies)
• 3 Key Principles to Prevent Nurse Burnout (LiveProcess)
• Meditech celebrates 50 years of bold innovation (Meditech)
• A Personal Journey to Recovery (Netsmart)
• Nordic gives back 2018: A roundup of causes to consider supporting (Nordic)
• 5 Predictions for Healthcare and Health Outcomes in 2019 (PatientBond)
• Two Machine Learning Models Your Revenue Cycle Should Experiment With (Patientco)
• How to make health IT the ally (vs. the enemy) of physicians (PatientKeeper)
• “Advocate First” Case Manager Expands Services at Home Health Agency (PreparedHealth)
• 2019: The Year of AI Operationalization in Healthcare (Qventus)
• What makes healthcare integration so complex? (Redox)
• Top Four Mistakes Hospitals Make When Capturing Data for Medicare Reimbursement (TransUnion)
• Clinical communication is the foundation of quality care. (Voalte)
• 5 Easy Steps to Create High-Quality Videos for Your Practice (WebPT)

Contacts

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

News 12/21/18

Top News

3M will acquire MModal’s technology business – most notably AI-powered physician documentation technology — for $1 billion.

MModal’s transcription, scribing, and coding services are not part of the deal. 3M will remain an MModal partner in that business, which generates $200 million in annual revenue.

3M’s health IT offerings under 3M Health Information Systems include clinical documentation risk assessment systems.

The sale is just under the entire price paid for MModal by private equity firm One Equity Partners – JP Morgan Chase’s private equity arm — in 2012. The vendor filed for Chapter 11 bankruptcy in 2014, reporting assets of $626 million and liabilities of $852 million along with declining sales, but emerged from Chapter 11 later the same year.

The acquisition price represents 10 times annual adjusted EBITDA.

3M will bring over 750 Pittsburgh-based employees of MModal.

Reader Comments

From CMIO: “Re: Greenway Health. Our salesperson told me that development of Prime Suite is ending other than for compliance issues. He is telling customers to move to a different EHR. It apparently has something to do with the MIPS issues you reported they are having.” Not true, according to Greenway, which provided this response:

We are actively communicating with our customers regarding MIPS reporting capabilities. It is important to note that Greenway Health is not ending development for Prime Suite and is not forcing customers to move to another EHR. Customers can remain on Prime Suite and take advantage of future upgrades, as well as consider other Greenway solutions and services that drive practice success. We are continuously partnering with our customers to determine the path forward that best meets their needs.

Webinars

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

Acquisitions, Funding, Business, and Stock

Tablet-based EHR vendor DrChrono raises $10 million in funding.

GE shares rise on the news that the struggling company will continue with plans to spin off its healthcare business through an IPO that will likely take place next year.

A paywalled piece in STAT looks at the shaky ground IBM Watson is experiencing in several hospitals in China. The company announced in 2016 that 21 facilities would adopt the cognitive computing technology for oncology as part of a multi-year arrangement with Hangzhou CognitiveCare.

People

Collective Medical hires Steven Goldschmidt (MatrixCare) as VP of business development, post-acute care.

Mark Dunnagan (NC HealthConnex) joins Smartlink Health Solutions as VP of health informatics.

Tabula Rasa HealthCare names Kevin Boesen, PharmD (formerly CEO of $131 million Tabula Rasa acquisition SinfoníaRx) as chief sales officer. Boesen, who studied improv at Second City in Chicago, launched a popular skit-based video series with his brother about the pharmacy profession while both were professors at the University of Arizona.

Cancer informatics company Inspirata hires Greg Tennant (DrFirst) as chief strategy and marketing officer. Inspirata acquired Caradigm from GE Healthcare in June.

ClearData appoints Michael Donohue (Axial Exchange) chief marketing officer and Dean Fredenburgh (AWS) chief revenue officer.

Greenway Health hires Susan Kohler (Centene) as chief compliance officer and Patrice Nedelec (SCC Soft Computer) as VP of quality assurance and regulatory affairs.

Sales

• Orlando Health will implement Epic, joining several of the largest Allscripts Sunrise customers that have done the same.
• Ten-state Adventist Health System selects Vyne Medical’s Trace communications management software.
• In Michigan, the Genesys Physicians Hospital Organization will implement Allscripts subsidiary 2bPrecise’s Genomic EHR Monitor.
• Ohio’s Hospice will deploy Netsmart’s EHR at its eight facilities.

Announcements and Implementations

Kids Rock Cancer-Maryville University goes live on FormFast as part of its music therapy programs for pediatric cancer centers.

Geisinger (PA) adds ProviderMatch for Consumers from Kyruus to its website, giving patients the ability to find best-fit physicians and schedule appointments.

Carefluence announces GA of its FHIR-enabled server and tools on AWS.

Walgreens pharmacies and Verily will work together to develop solutions for patients with chronic conditions, initially focusing on medication management and a virtual solution for type 2 diabetes patients.

Government and Politics

The VA is considering terminating its $624 million Epic-Leidos patient scheduling system pilot project and buying a similar system from Cerner.

CMS issues an RFI asking for feedback on whether or not the consulting practices of hospital accreditation agencies like The Joint Commission pose a conflict of interest.

Other

The New York Times visits Epic with these observations (and some great campus photos):

• It calls CEO Judy Faulkner “a septuagenarian coding savant” and a “billionaire recluse.”
• Employees are required to attend 2.5 hour monthly staff meetings that it compares to “a megachurch experience.”
• Employees are encouraged to keep the company’s wealth local by living within 45 minutes of campus and buying from area merchants instead of Amazon.
• All employees have private offices, every conference room is required to have windows, and stairs are mandatory for socialization even though the climbing requirement limits building height to three stories.
• The 75-year-old Faulkner, who the reporter describes as shy and distracted, told her that she will never retire.
• The majority shareholders – mostly Faulkner’s future heirs and Epic employees – have been instructed to always vote to keep Epic private, and when they have to choose a new CEO, to pick an Epic software developer.
• Faulkner says she focuses on software and customer relations, adding that, “I look at our financial information maybe for a minute a month.”
• Each employee gets a company-paid, month-long sabbatical every five years, with Epic footing the bill for two people.

A Forbes expose on London-based videoconferencing app vendor Babylon Health finds that despite having raised $85 million and convinced NHS to eventually use its chatbot-powered consumer diagnostic app, the latter software wasn’t tested anywhere else and didn’t work. The article notes:

• Doctors who audited the system found that the chatbot gave the wrong diagnosis 10-15 percent of time.
• The company ran afoul of advertising regulators who found that the “independent study” that validated its triage feature was actually internal testing involving professional actors posting as patients by following company-provided scripts.
• Babylona claimed that its chatbot scored higher on medical exams than human doctors, but didn’t mention that the software was required to answer only 15 of 50 questions and was allowed to submit three answers to each question.
• The company claims to be unaware of analyses suggesting that its users seek ED care at a higher rate than those who call England’s 111 advice line.
• Babylon’s focus on “building fast” and “reaching escape velocity” caused it to downplay the concerns of its employee doctors while treating its data scientists like rock stars.
• The company will need to apply its technology to more patient records and to measure its outcomes to be successful.

Chipotle started requiring employees to sign arbitration agreements as a condition of employment in 2014, a practice affirmed as legal by a Supreme Court case involving Epic. Now Chipotle is being overwhelmed by the number of pay-related arbitration cases that have been brought against it by former employees – each involving a cost of $30,000 to $50,000 – and has tried to convince a judge to stop accepting the filings. He said no. Chipotle hasn’t been paying its share of the arbitration filing fee and is fretting that each case must be heard in the individual county in which the employee worked (and Chipotle has 2,400 locations all over the country).

Sponsor Updates

• EPSi releases v18.3 with several functional and performance improvements.
• PatientKeeper reports that it has deployed its EHR optimization software at 24 sites over the last year, representing 1,900 end users.
• Loyale Healthcare extends wishes for peace on Earth, goodwill to patients, and prosperity for providers in 2019.
• Imprivata develops EPCS Ready, an online resource for providers preparing to meet federal Electronic Prescribing for Controlled Substances requirements.
• The Chartis Group publishes a new report, “Managing Medicare to Break Even: Better Patient Outcomes at Lower Costs.”
• PMD expands access to its free, HIPAA-compliant, text messaging service for care teams.
• Intelligent Medical Objects congratulates winners of the AMIA PitchIT! competition.
• PM360 magazine selects ConnectiveRx’s BrandHub portal as one of the most innovative services of 2018.
• A study in the World Journal of Diabetes validates the TriNetX platform’s ability to use real-world data to generate real-world evidence to replicate results from randomized clinical trials.

Blog Posts

• An Integrated EHR to Advance Chiropractic Education and Practice (EClinicalWorks)
• 5 Ways to Think Beyond the Switchboard (Spok)
• Overcoming Provider Objections to Delegating Refill Requests (Healthfinch)
• 2018 Healthcare IT Year in Review (Optimum Healthcare IT)
• Seeking Solutions: The Opioid Crisis (Huntzinger Management Group)
• Why Hackers Accessing Your Network is the Top Risk for 2019 (Iatric Systems)
• Imat Solutions Helps Health Payers to Become Data-Driven Organizations (Imat Solutions)
• From Digital Flyer to Virtual Lobby: The Evolution of the Hospital Website (Influence Health)

Contacts

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

News 12/19/18

Top News

HHS OCR issues an RFI for help in identifying aspects of HIPAA’s privacy and security regulations that may be impeding value-based care and care coordination.

OCR is also interested in public comments about Privacy Rule changes it is considering, including:

• Rewarding or requiring providers to share PHI with other providers and families
• Requiring EHRs to include information about treatment, payment, and operations disclosures in the accounting of disclosures in separating “use” and “disclosure”
• Eliminating the requirement that providers get written acknowledgment that patients have received a Notice of Privacy Practices.

OCR is also looking at how long it takes for patients to get copies of their medical information, whether the currently allowed 60 days is too long, and whether covered entities should be required to give patients copies of their electronically stored information faster.

Also in the RFI is an important clue about OCR thought process – they want to know if providers are refusing to share PHI for treatment purposes or are requiring requesting providers to fill out request forms that go beyond HIPAA.

The long document is mandatory reading for those who follow HIPAA requirements and information sharing.

Reader Comments

From Med4295831: “Re: Greenway Health. Sent an email this week to all customers recommending that they file a MIPS hardship exemption for 2018 because Prime Suite’s Promoting Interoperability measures were calculated incorrectly.” Unverified, but the reader sent the email he or she says they received.

From Grand Delusion: “Re: PokitDok. One of several HIStalk sponsors being acquired. Thoughts?” We’re seeing the usual industry consolidation, but it does seem that my sponsors are often involved, for which I can offer these potential reasons:

• The companies were looking for exposure in hoping for that particular outcome.
• Companies moving up the food chain may sponsor at a higher rate and thus would attract attention otherwise simply because they are growing and honing their message.
• The exposure drew attention to them that they wouldn’t have had otherwise, perhaps of the Fear of Missing Out variety.
• Coincidence, especially since I have quite a few sponsors.

Webinars

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

Acquisitions, Funding, Business, and Stock

Change Healthcare acquires “intellectual property and other key assets” of health IT API and blockchain vendor PokitDok,  which Change will use to launch its API and Services Marketplace.

Canada-based health IT vendor Premier Health will acquire Cloud Practice, which offers an EHR based on an open source product developed by McMaster University, for up to $5 million, most of it in tiny-capitalization shares whose price has swung wildly between $0.04 and $0.85 in the past year.

ResMed’s string of health IT acquisitions continues as its Brightree post-acute care technology subsidiary acquires Apacheta, which offers mobile software for medical equipment vendors.

K Health, which offers a free AI-powered, questionnaire-driven app for consumers that uses a “People Like Me” history database, raises $25 million in a Series B funding round, increasing its total to $38 million. The company’s business plan apparently involves eventually selling its service to employers and placing referrals to paying doctors. The Israel-based company, formerly known as Kang Health, obtained its treatment history database from an HMO in Israel, which is likely a limitation for the US market.

Sales

• Johns Hopkins Medicine will implement Nuance Dragon Medical One and Dragon Medical Advisor for its “Joy at Johns Hopkins Medicine” physician burnout reduction program.
• Mid-Valley Hospital (WA) chooses Cerner Millennium and HealtheIntent.

People

FDA names Amy Abernethy, MD, PhD (Flatiron Health) as principal deputy commissioner for food and drugs.

Providence St. Joseph Health hires B. J. Moore (Microsoft) as CIO. Moore — whose background includes cloud, AI, and enterprise commerce – will report to the health system’s CFO, who also came from Microsoft. It’s an interesting choice for the country’s third-largest health system given that Moore has no advanced degree, no healthcare experience, and a deeply technical work history. It’s also odd that he’s reporting to the CFO, who also had no previous healthcare experience. I don’t know how EVP/CIO Janice Newell fits in – she’s still on the leadership page, but wasn’t mentioned in the announcement. 

Todd Rothenhaus, MD (Athenahealth) joins medical equipment tracking system vendor Cohealo as CEO. He replaces co-founder Brett Reed, who will move to president.

Chronic disease management technology vendor Livongo Health hires Zane Burke (Cerner) as CEO, replacing Glen Tullman, who moves to executive chairman. The company also promoted Chief Medical Officer Jennifer Schneider, MD, MS to president. Livongo’s valuation is $800 million and Tullman has indicated that the company may go public in early 2019.

Paula LeClair (Onduo) joins Glytec as executive director and GM of outpatient.

Atrium Health hires Rasu Shrestha, MD, MBA as EVP/chief strategy officer.

Announcements and Implementations

NextGen Healthcare launches Health Data Hub, a cloud-based HIE platform for sharing and aggregation of patient data. 

Netsmart will work with Kindred Healthcare to develop a clinical platform for long-term, acute care hospitals, rehab, and care management.

Government and Politics

Senator Lamar Alexander (R-TN), who is active in federal health IT initiatives in his roles of chairman of the Senate’s HELP committee and author of the 21st Century Cures Act, will not seek reelection in 2020 after serving three terms. 

Other

Teladoc Health EVP/COO/CFO Mark Hirschhorn resigns following publicity and lawsuits over his romantic affair with a since-resigned Teladoc employee to whom he gave stock tips. The company had previously stood by its decision to discipline Hirschhorn with a one-year suspension of share vesting. TDOC shares dropped 6 percent after Monday’s announcement but regained ground Tuesday, having increased 35 percent in the past year vs. the Nasdaq’s 2.4 percent loss.

This tweet by a palliative care doctor drew interesting Twitter responses as she decried negation of “hundreds of years of our communication as healers” for not being allowed by compliance to write “history of” in the HPI (history of present illness). Some reactions:

• “History of” is not a good choice of words since it suggests that the condition has resolved.
• Doctors who argue that “I’ve always done it this way” also don’t see the benefits of turning their patients over to hospice doctors like the author.
• “Billing” is not the same as “compliance” and being counseled for the former posing as the latter is not ethical.
• The VA doesn’t have those problems – they use the language that’s best for communication among healthcare professionals.
• Just wait until hospitals try to make you document every inpatient as having malnutrition to make the numbers look better.
• Being paid by CMS requires jumping through hoops and the compliance officer is just trying to do their job in an insurance-driven world.
• Open a direct patient care practice and stop taking insurance.

A judge rules that the former CEO of St. Mary’s Hospital (FL) can sue CNN for libel over a report by Anderson Cooper in which the hospital’s pediatric surgery mortality rate was claimed to be running triple the national average. David Carbone, MHA says CNN compared the hospital’s 12.5 percent mortality rate for open heart surgery to a national average for all surgeries and didn’t risk-adjust the data. The hospital closed its pediatric cardiothoracic surgery program two months later amid public backlash, triggering CEO Cardone’s resignation. CNN argued that its report didn’t mention Carbone by name and that disagreeing with the method of comparing mortality rates doesn’t support a claim of intentional defamation.

A cardiologist’s New York Times opinion piece called “Dr. Google is a Liar” says that fake medical news spread by social media and search engines (as in the above example, which features a video by the hilariously phony Dr. Leonard Coldwell) threatens our lives, making these observations:

• A woman had a heart attack after not taking her prescribed statin because she had read wacky Internet information from sites run by zealots, peddlers of alternative therapies, and people just looking for attention.
• False claims that HPV vaccine causes seizures has reduced vaccination coverage in Japan from 70 percent to less than 1 percent.
• Sites pushing alternative therapies for cancer argue that tumors are a healthy reaction, that surgery spreads harmful cells, and that medications cause cell mutations by increasing acidity.
• News sites regularly overstate alternative therapy benefits because less-rigorous observational studies that contradict medical wisdom  make better stories than the not-shocking results of randomized controlled trials.
• Doctors should weave science with stories to become as effective as the “merchants of medical misinformation.”

Weird News Andy titles this story “Socks Appeal.” A man who sniffs his socks every evening after work when changing clothes develops a severe respiratory fungal infection from breathing in spores.

Sponsor Updates

• Casenet staff volunteer at the Christmas in the City event in Boston.
• Audacious Inquiry appoints Penny Thompson (CMS) to its board.
• EClinicalWorks publishes a podcast titled “How EClinicalWorks is Reducing the Risk of Physician Burnout.”

Blog Posts

• More Providers Sign On for MEDITECH Expanse in 2018 (Meditech)
• Go from ESignature LCD to MVP (Access)
• Your employee resigns unexpectedly. Here’s what to do next. (Advisory Board)
• Tools to Help Your Practice Optimize the End-of-Year Rush and Help Your Patients Optimize Their High-Deductible Medical Plans (Aprima)
• There’s a movement happening in healthcare IT (Bluetree)
• Takeaways from the 2018 AARC Conference (Bernoulli Health)
• The 2018 Hot List – What Healthcare Developers Were Reading (Datica)
• 6 Keys to Connected Care from Yale New Haven Health (Burwood Group)
• Physicians’ Compensation Remains Flat, Many Look to Revenue Cycle Management for a Revenue Boost (ChartLogic)
• 2018 Year in Review (CoverMyMeds)
• Innovation Amidst the Crisis: Part 4 – Resource Allocation and Access (Divurgent)

Contacts

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

Monday Morning Update 12/17/18

Top News

A federal judge in Texas rules that the Affordable Care Act is unconstitutional because Congress eliminated the penalty for people who don’t sign up for health insurance. He sided with the White House-supported lawsuit brought by 20 Republican state attorneys general, which argued that if the penalty is unconstitutional, then so is the entire ACA.

The Trump administration filed a brief asking the court to overturn the ACA’s ban on preexisting conditions, opening the door for insurers to once again price coverage based on medical history. The White House also opted not to defend the ACA in court, an unusual move for the executive branch that traditionally defends existing laws.

The ruling did not include an injunction, however, so nothing will change until higher courts review the ruling. The ACA has survived several more credible legal threats.

Texas’s Republican attorney general often files strategic lawsuits in the district of the conservative federal judge, Reed O’Connor, who nearly always sides with Republican challenges to Democratic policies.

Reader Comments

From Smitten: “Re: fax machines. It’s about time hospitals were dragged kicking and screaming into the 21st century.” I shall allow Calvin and Hobbes to respond.

From Sure Winner: “Re: Jonathan Bush’s comments. It makes you contemplate whether today’s ‘what have you done for me lately’ investment environment is capable of driving long-term economic growth versus short-term profits and churn. Investors don’t care about mission and long-term vision. We see the same problem in the VC startup funding space. I question whether there is even a place for publicly traded companies in a field like healthcare that should be steered by a higher moral compass.” The problem with taking investment money (including going public) is that your #1 customer is now fickle shareholders, and whatever business you thought you were in becomes secondary to making good-looking numbers each and every quarter. You can maintain some degree of control if you resist taking too much money early and thus can set a long-term trajectory that is clearly good for everyone, but as in Athenahealth’s case, you can ignore individual investors only to the point they own enough shares to bully the board (and Athena’s board showed zero backbone in jettisoning Bush on non-news and character assassination planted by the activist investor turned eventual participant in the acquisition). As for healthcare, the moral compass is now permanently subservient to the quest for the dollar even in non-profits, although the private equity purchase of nursing homes, medical practices, and hospitals is a particularly troublesome development that could happen only in a screwed-up healthcare country like ours. It’s a slippery slope once you declare healthcare to be a business as happened in the 1960s with the rollout of Medicare, when hospital patients become a MBA-managed production widget and healthcare became known for massive costs, poor outcomes, impressive buildings, and economy-leading employment. The venture capitalist will see you now.

From Indigo Bunting: “Re: patient wayfinding solutions. Can anyone share insight about how vendors such as Jibestream, Logic Junction, and Gozio Health have fared? I’m interested in deployments, usage, and sustainability. Did Mayo Clinic ever commercialize their in-house solution?”

From Tuner Fish: “Re: holiday music. Your nomination for worst?” It’s a toss-up between the wretched Paul McCartney froth of “Simply Having a Wonderful Christmas Time” (his post-Beatles work is mostly awful without Lennon around to temper his sappy pop tendencies) and the oddly titled “Christmas Time is Here,” which is my own “Gloomy Sunday” in throwing me into melancholy. No pop artist in their right mind wants to put any effort into making a Christmas album (especially of classic covers) knowing that the songs will be ignored for 11 months of each year (if not permanently) and will then be strung together into a bizarre playlist of novelty tunes and ancient chestnuts whose only commonality is December 25. In fact, some popular songs have no Christmas references at all – “Jingle Bells”, “Let It Snow,” “My Favorite Things” (playing now as I write this), and the suddenly unacceptable (after 75 years) “Baby It’s Cold Outside.” Our holiday music is like that neighbor whose unrestrained Christmas joy compels him to litter his already-littered yard with unrelated inflatables ranging from Baby Jesus to Santa Claus to Mickey Mouse and even Homer Simpson, a grotesque tableau I heard described on the radio this week as “like Walmart puking on your lawn.”

HIStalk Announcements and Requests

Just over half of poll respondents think that the US should follow England’s lead in banning fax machines in hospitals. GZ says a ban isn’t necessary and faxing is a good backup to more modern options. Brian Ahier thinks CMS should lead the movement and stop requiring clinicians to fax information to it, while Edward Hobbs agrees that Medicare and Medicaid are among the worst offenders in requiring either mailed  paper copies or fax. Frank Poggio notes that it’s not just healthcare – other industries require the barely-better option of printing, signing, scanning, and emailing PDFs instead of using electronic signature. Dr. Rick blames fax usage on poor EHR design. RobLS says OCR should crack down on insecure PHI transmission. Crying Fowl believes doctors should be required to use secure electronic communication as a condition of licensure and notes that referral information often comes from non-providers such as schools that don’t have fax alternatives, although he or she advocates outlawing faxes from pharmacies in states that have mandatory e-prescribing.

New poll to your right or here: Which ways have you used in the past year to communicate with your PCP? I came up with quite a few choices, but I’m sure I still missed some (though I omitted telephone calls intentionally).

I saw a hospital’s entry into my RFI Blaster for requesting consulting engagement information from several HIStalk sponsors, which reminds me to remind you that it exists. Fill out the simple form and send your RFI to one or several companies in a couple of minutes.

Webinars

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

Acquisitions, Funding, Business, and Stock

GE is frantically trying to undo the Jeff Immelt-caused damage that just about tanked the whole enterprise (and may still do so), with this as the latest redo – the company will try to create a separate business from the dregs of GE Digital, the company’s failed attempt to remake itself into a software vendor focusing on Internet of Things automation of manufacturing. GE Digital CEO William Ruh will leave the company and GE CEO Larry Culp predicts that the spun-off business will perform better in not being managed by GE, which says all you need to know about GE (despite GE’s self-admiration for cranking out great managers, Culp’s an outsider, having made hundreds of millions running a medical device company). GE shares have bled 60 percent of their value in the past year, now priced about the same as they were in 1992.

It’s exhausting trying to keep up with what Amazon may or may not do in healthcare. CNBC reports that the company considered moving into home health testing via a potential acquisition of Boston-based Confer Health that never occurred. Confer, whose technology hasn’t yet been approved by the FDA, was founded by a Harvard PhD neuroscientist and the obligatory computer guy (and online ad technology developer) who has recently moved on to become a product manager for my favorite online furniture store Wayfair.

Sales

• Valley Health System (NJ) chooses NextGate’s EMPI.

Announcements and Implementations

A Waystar survey finds that two-thirds of Americans are challenged in at least one category of social determinants of health and most of them don’t talk to their doctors or insurers about it.

Government and Politics

Politico’s Dan Diamond contrasts the suddenly apolitical ACA-related tweets of CMS Administrator Seema Verma (last year vs. this year above) as Open Enrollment wound down this weekend and an HHS transparency investigation by House Democrats looms.

Other

Bloomberg Businessweek looks at Japan’s healthcare-caused debt problems, noting that:

• The country’s long life expectancy and low-cost doctor visits have caused healthcare costs to increase at 40 times the rate of economic growth since 2000 even as Japan’s taxpayer base shrinks.
• The country’s universal coverage allows patients to see doctors whenever they want without seeing a gatekeeper first and for doctors to bill for as many patients as they can see.
• Most doctors work in hospitals, which have a globally disproportionate number of beds and an above-average amount of expensive diagnostic equipment.
• Those over 65 are responsible for two-thirds of the healthcare costs and will vote against politicians who suggest reining in expenses.
• Doctors do not coordinate care and the government worries that they won’t participate in a data-sharing network that is planned for 2020.

A woman who announced her pregnancy on social media, clicked on Facebook maternity-wear ads, created a baby registry on Amazon, and tagged Instagram photos with #babybump complains that she was served up targeted baby-related ads after her child was stillborn. Instead of questioning why she needed to share her personal information on ad-targeting sites that make it clear that they use it for deliberate intrusion, she says those sites should have used the same technology to infer her loss from her postings and then suppressed the ads. She also blamed Facebook for not providing an option to turn off parenting ads, although it offers exactly that deep in some menu.

Weird News Andy says Southwest Airlines must have a heart beyond the one in its logo. A SWA flight bound for Dallas returns to Seattle when the airline realizes that a “life-critical cargo shipment” (a human heart) was inadvertently left on the plane instead of being delivered to a local tissue bank. The re-routing allowed the heart to reach its destination before it would have been unusable. I was curious about the tissue bank, LifeNet Health — it reported 2016 revenue of $353 million and paid its CEO $1.4 million. It’s fascinating to see the healthcare niches that are exploited by multi-million dollar businesses.

Sponsor Updates

• PatientPing employees participate in the Massachusetts Department of Children & Families’ annual holiday drive.
• The local news features Mobile Heartbeat’s partnership with Corpus Christi Medical Center (TX).
• Sansoro Health releases a new podcast, “From Implementer to Innovator.”
• Wolters Kluwer Health and the Association of Community Health Nursing Educators will award a grant to a nurse educator to support community and public health educational research.
• Nordic CEO Bruce Cerullo is recognized as one of the top 50 large-company CEOs in the US, as rated by employees.

Blog Posts

• How to Address the Top Three IT Challenges in Physician Practices (LightSpeed Technology Group)
• Intelligent Medical Objects Congratulates Winners of the AMIA PitchIT! Competition (Intelligent Medical Objects)
• When it Comes to Data, What Can Healthcare Learn from Retail? (Liaison Technologies)
• 5 Key Factors to Adoption of Healthcare Communication Technology (LiveProcess)
• Conference Recap: LogicStream Health at ASHP Midyear 2018 (LogicStream Health)
• Thriving in a Cost-Conscious Healthcare Marketplace (Loyale Healthcare)
• Quality Assurance is a Priority in Revenue Cycle (Vyne Medical)
• How to implement a successful care transition (Meditech)
• Patient-Driven Payment Model (PDPM): A Primer for Skilled Nursing Success (Netsmart)
• 4 Steps to Protect Revenue During Annual Deductible Resets (OnPlan Health)
• Ensure Your Patient Financial Communication Rises Above the Spam (Patientco)
• Case manager delivers care despite limited resources (PreparedHealth)
• What’s on your health IT executives’ wish list? (Voalte)
• Unwrapping MIPS and the Final Rule: How to Prepare for 2019 (WebPT)
• Got ECTAS? Wellsoft Supports Canadian Hospital Clients with ECTAS Certification (Wellsoft)

Contacts

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

News 12/14/18

Top News

Jonathan Bush appears on CNBC six months after stepping down from Athenahealth as president and CEO, and one month after the company’s sale to activist investor Elliott Management and Veritas Capital for $6 billion. The interview touched on a number of topics, from Bush’s advice to CEOs facing similar pressures, to the role his personality may have played in Elliott’s due diligence, to the future of Athenahealth. A few snippets:

• On the dearth of publicly-traded companies: “You’ve got to acknowledge that the kind of cynicism and beat-downs that we witnessed probably hurt the number of stocks. There are half as many stocks on the Nasdaq today as there were when I took Athena public not that long ago, 10 years ago. You look at what happened to me … Athena was, since IPO, an average 23 percent annual return. Not for nothing Elliott was 13 over the same period. No offense guys, don’t sue me. If a 23 percent annualized return is not enough because they’re going to have a two-year period where things are going to be bumpy when you retool, when the administration changes, when your regulatory environment changes … It just makes it appealing to stay away.”
• On his attempts to cater to Elliott’s early demands: “My experience is running a company with a gun to your head is no way to run a company. Better to just say pull the trigger. The damage to the company culture during that one-year period, the damage to the optimism, to employee retention, to our ability to hire technology executives, and the damage to my family, my friendships … not that anybody was mean, just that everybody was afraid all the time. People would say, ‘We’d better talk in person’ as if the phone was bugged. I’m sure nobody was bugging phones, but that was the tone and tenor of a company that was wildly … we were a very candid, honest, open company. That attracted people. It attracted customers and executives from places that were more defensive in their posture. The death of optimism at Athena made it a hard place to run, made it a hard place to sell, and that was exclusively due to that experience. It was not a cynical, negative, fearful place before. It turned on a dime.”
• On attempts to make him look bad in the media: “If you’re cynical and you can use the media well, you can take humanity and twist it into a dark thing. They did a great job and I didn’t do a good job responding. I do not claim to be a great activist investor battler … What I was surprised at was that nobody sort of said that, isn’t this interesting … that one page of divorce filings from 14 years ago brought forward by the Daily Mail of London – after somebody sat at the Cambridge Community Courthouse to get that one page, throw out the other 1,800 pages – somehow gets playback by you guys and the rest of the press as if that’s just a perfectly normal thing … they’ll go through your trash, they’ll follow you, and until someone was actually following me taking pictures … I was walking with a former colleague asking about a new HR hire and we were walking down the side of the Charles River … my wife got texts of the two of us walking, and you know, who’s your husband with?”
• On his cult of personality and its impact on his ouster: “At the time [we founded Athena], no one believed, no one entered. There was no VC in healthcare IT and we needed a little bit of reindeer games to get attention, to get on your show, to get doctors to come to our 10×10 booth at … HIMSS, to attract entrepreneurs. We went from $800 million of VC going into healthcare IT in the year we started the More Disruption Please program to $4.8 billion and almost all of them touching Athena in one way or another because we made it sexy and fun to enter this otherwise sclerotic and overregulated space.”
•  On his future plans, including running for office: “I like going where they ain’t, and where honorable people aren’t operating. Certainly healthcare IT was one of those places. It could be that politics is becoming one of those places. I don’t know. I know I just want to be of service. I would like to make sure that whatever I do with the rest of my life is optimistic and has the notion of a unifying opportunity for everyone in it. Don’t we all?”
• On Athenahealth’s future: “My fondest wish is that it becomes that secure, reliable, connected tectonic plate that allows liquidity in the healthcare system. I think it has everything it needs to be that as long as it can get the tone back, get the cultural energy back – somewhere that people want to come and get excited. I think they can do it.”

Reader Comments

From InTheKnow: “Re: Cerner. Hosted customers experienced a five-hour downtime Wednesday due to a network looping area in one of its data centers. Customers had to break out the prescription pads and order requisitions.” I reached out to Cerner after several receiving several reader reports – the company confirms it experienced a since-resolved “internal configuration matter.” One reader’s facility went down the second week of their ambulatory go-live, leading to his or her dry conclusion of, “To say leadership is ‘not happy’ is an understatement.”

From Mad Fax Beyond Interoperability’s Thunderdome: “Re: eliminating faxes. Not only is faxing universally available, it is built on an open standard, deployed on an open architecture, and immune from adding tolls or being hijacked for monetization. The ‘usefulness’ to anything other than human eyeballs brings security. Other technical solutions could solve this, but the trend toward walled garden tools and away from net neutrality worry me. The vector doesn’t quite reach Mad Max post-apocalypse concepts, but a return to sneaker net is not out of the question. Patient-centered-distributed, edge-of-network that allow individuals to get their own information are out there, such as HIEofOne.” Faxing is like aspirin – it would be a headline-splashing miraculous development making people gazillionaires if it were released today. Faxing is a symptom of our healthcare system’s failing rather than one of its problems. Be careful of wishing ill will upon fax unless your memory is short enough not to remember what healthcare was like without it or your naivete is so strong that you see only good things resulting from taking away something that just works.

From We Bring Good Things to Life (By Selling Them to Better Companies): “Re: GE. Rumored to be selling its RCM business to Athenahealth.” Unverified.

From HIStalker: “Re: Advocate Aurora Health. Had a drama-free multi-specialty, big bang go live on Epic on December 1, replacing Allscripts. The first of 10 hospitals will go live in October, replacing Cerner. When complete, AAH will be one of Epic’s largest single-instance customers. Cerner Healtheintent will remain in place.” The Chicago-area mega-system has 70,000 employees and annual revenue in the $11 billion range.

From LA Lady: “Re: HIMSS. CEO Hal Wolfe unceremoniously dumped long-time, highly visible COO Carla Smith without a public announcement. She deserves at least a thank you for her tireless work.” Carla’s LinkedIn says she left HIMSS in November after 17 years and is now consulting. I don’t know the circumstances of her departure. New leaders have the right to pick their team, but we as dues-paying members might question those choices and how they affect (or signal) the organization’s direction that we don’t get to explicitly vote on. I suspect that those of us who were already wary of the unbridled growth ambitions and vendor-like behavior of HIMSS – funded by our dues and our other HIMSS spending — aren’t going to like what’s coming. They’re still ignoring my request for copies of their 990 tax forms, which they’re required by law to provide, and that never happened under Steve Lieber.

HIStalk Announcements and Requests

It’s last call for the HISsies nominations for 2018. Surely you have thoughts about the year’s stupidest vendor action, the most overrated technology or buzzword, and the industry figure with whom you’d like to have a few beers.

Webinars

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

Acquisitions, Funding, Business, and Stock

ChartLogic parent company MedSphere will use $32 million in new financing for expansion efforts, including acquisitions and hiring.

Sources say Apple has at least 50 doctors on staff across various projects, with some keeping their roles a secret in accord with company culture. Others have been given a bit more media leeway as the company looks to convince providers it is taking their data-overload and “worried well” concerns to heart. Apple’s consistent hiring of medical experts has pundits predicting that the company is getting serious about developing devices and apps that cater to the chronically ill. The company hasn’t mentioned what part, if any, of its second campus in Austin, TX will be used for healthcare projects. The $1 billion facility will house up to 15,000 employees on 133 acres.

People

Evergreen Healthcare Partners names Beth Zuehlke (Healthfinch) SVP of consultant engagement.

Henry Chao (Sparksoft) joins federal health IT vendor FEI Systems as CTO. Chao led the roll out of Healthcare.gov during his time as CMS CIO and deputy director. He published “Success or Failure? The Untold Story of HealthCare.gov” in September.

Sales

• New York-Presbyterian Hospital signs a 10-year agreement with Philips for its IntelliSpace Enterprise Edition informatics software.
• Beaumont Accountable Care Organization (MI) selects HealthEC’s population health management technology and services.
• WakeMed (NC) will deploy Goizio Health’s wayfinding and patient engagement app, which will include access to Epic’s MyChart.
• Chesapeake Regional Medical Center (VA) will equip its EMTs with Pulsara’s hospital notification app next month.

Announcements and Implementations

Amazon works with Omron Healthcare to develop a skill for Alexa that connects the virtual assistant to the vendor’s blood pressure monitor.

Wake Forest Baptist Health’s Davie Medical Center (NC) implements Vocera’s clinical communication and workflow software as part of its surveillance monitoring efforts.

A TransUnion Healthcare study finds that 80 percent of a hospital’s self-pay revenue comes from  just 30 percent of self-pay accounts, an important figure as more people are losing health insurance and patient-responsible balances are increasing sharply. A previous study found that a typical hospital could boost their bottom line a lot more by optimizing their revenue cycle instead of cutting costs.

A new KLAS report on EHRs for orthopedic practices finds that SRS Health and Modernizing Medicine deliver the best workflows, Epic does well as an enterprise solution while Cerner is overwhelming to smaller facilities, and Allscripts Professional finishes last in lacking prebuilt orthopedics content.

Skilled nursing provider Marquis Companies reports reducing hospital admissions by 60 percent in a pilot project with Collective Medical, which gives individual skilled nursing facilities instant notification when a resident seeks care at a local hospital so they can, under appropriate circumstances, be treated by the SNF instead.

Privacy and Security

OCR fines Pagosa Springs Medical Center (CO) $111,000 for failing to cut off a former staffer’s access to a Web-based scheduling calendar that included PHI.

OCR seeks input on modifying HIPAA rules to improve coordinated care, with comments due February 11.

Other

HCA (TN) develops and promises to share its Sepsis Prediction and Optimization of Therapy (SPOT) software, which uses AI-powered algorithms to analyze patient data in real time to look for signs of an impending infection. According to HCA, SPOT is capable of diagnosing a patient 20 hours before a physician, increasing survival rates between 4 and 7 percent.

Cancer survivor and patient advocate Grace Cordovano points out that providers aren’t the only ones with questions about the Apple Watch’s new ECG feature. She proposes Apple create a FAQ page for consumers that answer the following questions about alerts:

• Who do I call – my primary care physician, cardiologist, or 911?
• When do I confidently ignore, act upon, or wait to make actionable decisions about alerts I’ve received?
• What do I do if I don’t have a PCP or cardiologist and have to wait three to four weeks or months for a new patient appointment?
• What if my care team doesn’t use this wearable technology in their practice or recognize the value of the data that is generated?
• Does Apple have a national registry of physicians by zip code that I may call for a virtual consult?

Sponsor Updates

• Cuero Community Hospital (TX) adds several FormFast solutions to its current implementation.
• HCTec releases a new video, “Why Partner with an External firm for EMR Support?”
• The Allscripts Developer Program includes Healthfinch in its list of top nine apps for 2018.
• Imat Solutions releases a new podcast, “Phil Beckett, Interim CEO at HASA, Discusses Why Data Confidence Matters.”
• Halifax Health (FL) reports improved physician satisfaction and productivity, and patient care after implementing AI-powered documentation software from Nuance.
• Douglas Thompson (Advisory Board) joins The Chartis Group as principal.
• Collective Medical partners with the South Carolina Hospital Association, giving its members access to the company’s real-time, risk-adjusted, event notification and care collaboration tools.

Blog Posts

• Thinking about jumping into artificial intelligence? The AI is the easy part. (Advisory Board)
• Nordic gives back 2018: A roundup of causes to consider supporting (Nordic)
• What did CIOs achieve in 2018—and what’s on the docket for 2019? (Spok)
• Blockchain and Cryptocurrency in Healthcare (The HCI Group)
• Health IT November Insights (HGP)
• Why MSPs Need Application Availability Monitoring (Goliath Technologies)
• Embrace Technology to Educate and Engage Patients (Healthwise)
• Huntzinger Applauds Beebe Healthcare’s Recognition of its Teams for Quality and Safety (Huntzinger Management Group)
• SQL Tip: Using a Date Dimension Table to Calculate Patient Days by Location (Iatric Systems)
• Google Ads Certifications to Up Your Healthcare Marketing Game (Influence Health)
• Keeping Pace with an Evolving Patient Access Journey (Kyruus)
• How to implement a successful care transition (Meditech)
• How Cloud Technology Rescued Big Sur Island (EClinicalWorks)

Contacts

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

News 12/12/18

Top News

Allscripts will sell its majority share of Netsmart for $525 million, earmarking the proceeds for paying down debt, investing in specific growth areas, and repurchasing shares.

Allscripts acquired its 51 percent stake in Netsmart in March 2016 by contributing $70 million in cash and its Homecare business, partnering with private equity firm GI Partners to invest a total of $950 million in Netsmart.

The Allscripts ownership share will be purchased by its former co-investor GI Partners and private equity firm TA Associates, with the deal expected to close by the end of the year.

MDRX shares rose 4 percent Monday on the news, tempered by a Leerink analyst’s question of why Allscripts would sell out after touting Netsmart’s growth as its original reason for investing in it. The analyst also noted that Allscripts recently blamed its weak bookings on management’s distraction with the Netsmart business.

Netsmart will operate as an investor-backed independent entity. Netsmart CEO Mike Valentine says the company’s growth will accelerate as an independent company, hinting that Netsmart may pursue acquisitions as  it focuses on homecare growth.

Reader Comments

From Tennessee Tuxedo: “Re: HIStalk. A recent Washington, DC meeting included a technical expert panel discussing whether market forces could influence EHR vendors to change their pricing structure for access to their APIs. One vendor rep said, ‘It does when it shows up on HIStalk.’ I call it being HIStalked. Keep up the great work.” Thanks. I’m happy to be turned into a verb that suggests shining a light on arguably questionable practices. 

From Amatriciana: “Re: DonorsChoose. I’d like to make a donation again this year when the matching funs are the highest, I really appreciate the extra matching you got last year.” I’ve exhausted the matching money from my anonymous vendor executive, but other DonorsChoose matching opportunities abound – the last round of donations were matched 5x and even 10x by foundations. Instructions:

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.

From Dirk Squarejaw: “Re: Dr. Jayne. She cited a story from CNN. Fake news!” I’m not sure if this is a tongue-in-cheek comment, but I’m not entirely opposed to calling CNN “fake news” (although I prefer “dumbed-down entertainment posing as news that intentionally keeps people agitated and thus coming back.”) CNN and other news outlets have found that factual and nuanced reporting of complex world events doesn’t draw the profitable eyeballs of the intellectually lazy who want sensationalistic stories (including the medical ones), news “celebrities” who blast out opinions that pander to a targeted demographic, and shallow entertainment posing as current events (The Onion satirized it brilliantly back in 2013). However, you can’t blame CNN – they provide the supply of crap that our fellow citizens demand, at least in those rare occasions in which they tire of watching funny YouTube videos, posting nearly indecipherable Facebook rants, and entertaining themselves by using filters on their selfies or selecting lame GIFs as reactions to avoid the intellectual marathon of stringing actual words together. Compare CNN’s choice of top stories to that of the far more responsible American edition of BBC News. Pathetic news reporting reflects rather than causes our increasingly unsustainable culture, which resembles an overweight, angry, and socially outcast teenager who locks themselves in their room surrounded by videogames, drugs, and junk food until something sets them off from self-indulgence to violence.

From Significant Mother: “Re: smartphones. What’s your take on Apple’s high-end models not selling well?” Beyond fanboy status, phones have become a commodity in performing equally well for making calls (a minor use case for most people), texting, running apps, or browsing the web. It’s a mature market in which vendors add questionably useful features and tweak form factors as a differentiator and incumbents are threatened by lower-cost competitors. The only battleground remaining is over the all-important camera, and while Apple has improved in that area at least in terms of pixel wars that matter little for online photo posting, Google Pixel’s Night Sight (AI-powered low-light performance) is the only newsworthy development.

From Fax Me a Simile: “Re: NHS’s fax machine ban. We should do the same here!” You are assuming (incorrectly, I suspect) that providers would be thereby forced to adopt more modern interoperability technologies even though our hospitals aren’t government-run as in the fax-axing England. Most likely they would simply go back the pre-fax standard of mailing photocopies or asking patients to hand-deliver documents. You would also be removing the only form of interoperability that is universal, that costs next to nothing, that never goes down, and that has rarely spilled PHI. Mandate other forms of interoperability (instead of just banning a particular one) if you feel the need to intervene against market forces, but note that providers aren’t paid to share patient data and are rarely punished for refusing to do so, so you’ll just screw patients in trying to force cooler but harder, more expensive technology on providers who aren’t the major beneficiary.

HIStalk Announcements and Requests

Listening: Deadland Ritual, a new bluesy, hard rock band assembled by the underrated Black Sabbath bass player Geezer Butler, also featuring Billy Idol’s highly competent guitarist Steve Stevens, the drummer from Guns N’ Roses, and Scars on Broadway singer Franky Perez. It sounds quite a bit like Black Sabbath, but with a more driving, clean sound and minus Ozzy’s sometimes grating vocal stylings.

Webinars

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

Here’s the recording of last week’s CitiusTech webinar, “Make the Most of Azure DevOps in Healthcare.”

Sales

• Berkshire Health Systems (MA) will implement Meditech Expanse.
• Molina Healthcare selects Inovalon for improving member care and documentation.
• National post-acute care provider Signature HealthCare chooses MatrixCare’s EHR for all of its 115 Signature locations.
• Normal Regional Health System (OK) will implement Meditech-integrated Access Passport to make electronic forms available on IPads.

People

Denise Hines, DHA, MS (EHealth Services Group) joins HIMSS as Chief Americas Officer.

Announcements and Implementations

Zen Healthcare IT announces its expanded HIE capability based on its work with Arizona’s Health Current HIE.

Johns Hopkins All Children’s Hospital (FL) parts ways with its president, cardiovascular chief, chief of staff, and surgery department chair following  a newspaper’s report that its Heart Institute mortality tripled between 2015 and 2017 even as employees warned management about the work of specific surgeons. At least 11 children died in the 18 months after the internal warnings. This is yet another reminder that (a) we would be hosed without investigative journalism; and (b) a hospital’s fancy buildings, brand name, and self-stroking advertising aren’t necessarily indicative that they aren’t screwed up internally in a way that may harm patients. US News & World Report must be embarrassed to have named All Children’s to its “Best Children’s Hospitals” for cardiology and heart surgery for 2018-2019 and Hopkins should be equally embarrassed for taking over All Children’s six years ago with a promise to elevate its heart surgery program as one of the country’s best and instead made it the highest-mortality hospital in Florida. 

Black Book finds that non-profit health systems of greater than 1,000 beds are happy with their EHR choice even after suffering through blown budgets and lost revenue, but 88 percent of mid-sized regional systems regret their implementation due to hidden costs, unexpected consulting fees, lost revenue, patient frustration, and clinician burnout. Black Book speculates that those hospitals focused too much on choosing the right functionality and getting the implementation done efficiently while failing to address workflows, usability, and interoperability. Other findings:

• Three-fourths of C-suite respondents question whether their EHR switch was worth it.
• Nearly all financially challenged hospitals regret the decision of their executives to replace their EHR.
• Three-fourths of respondents say interoperability declined after implementing a new system even though the technical capability exists, probably because nobody is paying them to exchange patient information.
• Hospitals report that their new EHR hasn’t helped them attract doctors.
• Two-thirds of executive respondents say they worried about their jobs during the replacement.

Other

A small study finds that providing hospital inpatients with tablets that are set up to access a patient portal didn’t improve patient activation, although patients did sometimes use the portal to look up information.

I missed this from a few months back. An expert says that while consumer DNA tests aren’t very useful, any company that can figure out how to make whole-genome sequencing free or cheap can become the Google of that field in providing the “sweet Texas crude” that is needed for clinical treatment and research. He notes that tests such as those offered by Ancestry.com and 23andMe lure customers into donating “an intensely personal, incredibly valuable asset” instead of being paid when their data is sold or used to create new drugs or other products. He adds,

The bigger a genomic network becomes, the more likely it is that correlations previously impossible to detect will be uncovered, and the more people and groups will sign on to mine the information for gold … Genomic marketplaces are already attracting partners interested in paying for access to your DNA sequences and related information, with your consent … But the marketplace will really thrive when 2G DNA companies eventually tap into the wellspring of dollars that today supports the Web: advertising. Genomic networks could become the richest source of detailed, opted-in data ever collected for targeted advertising. As more gene-linked products and services appear, these marketplaces should diversify beyond health and medicine, and the revenues flowing through them should explode. And you’ll get your cut.

Brilliant: Texas prisons will begin 3D printing of dentures for inmates, restoring functionality at a cost of just $50 per set and addressing complaints that many US prisons are so financially strapped to provided medical care that dentures are rarely provided and only in cases of medical necessity (the inability to chew doesn’t count). The photo above is of an inmate’s 3D-printed dentures, which are remarkably lifelike. Good job, Texas.

Dr. Gottlieb channels Dr. Suess in a tweet that is as amusing as it is timely.

Shriners Hospitals for Children offers its young patients video visits with Santa Claus this week. Shriners used the Santa visits to test its Dimension Data telemedicine system rollout in 2015.

A woman dies of hypernatremia after attempting a “soy sauce colon cleanse,” an Internet fad that involves drinking a quart of soy sauce over two hours.

Sponsor Updates

• AssessURHealth raises $6,750 for the American Foundation for Suicide Prevention Tampa Bay Out of the Darkness Tampa Walk.
• Netsmart profiles Army Reserve / National Guard VP David Aug in its “Meet Our Veterans” series.
• The Baltimore Sun includes Audacious Inquiry in its list of top workplaces.
• Atlantic.Net partners with Veeam Software to offer customers data protection and availability solutions.
• Bluetree launches an Epic-focused service center.
• Healthcare Growth Partners publishes its November Health IT Monthly Insights report.
• Datica releases a new book, “Complete Cloud Compliance.”
• ChiefExecutive profiles Collective Medical CEO Chris Klomp.
• KLAS rates partial IT outsourcing services from Cumberland Consulting Group with above market average scores in all key performance areas.
• Gartner includes Dimensional Insight in two hype cycle reports on healthcare.
• Bernoulli is integrating NIST’s Cybersecurity Framework v. 1.1 into its Bernoulli One medical device integration and continuous surveillance platform.

Blog Posts

• Foster Safe ED Discharges with MEDITECH’s HEART Pathway Toolkit (Meditech)
• Healthcare and the Holidays (Optimum Healthcare IT)
• What an 18th-century clockmaker can teach us about cost control. (Really.) (Advisory Board)
• Predictive Analytics in Care Management (Arcadia)
• ‘Twas the Night Before Clinical Surveillance (Bernoulli Health)
• CoverMyMeds Creating Opportunity in Franklinton (CoverMyMeds)
• #GivingTuesday (Direct Consulting Associates)
• CMS Changes to Physician Fee Schedule 2019: What you need to know. (DocuTap)

Contacts

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

Monday Morning Update 12/10/18

Top News

In England, Health Secretary Matt Hancock bans NHS from buying new fax machines and insists that they be phased out by March 31, 2020.

The Royal College of Surgeons agrees, estimating that NHS still has 8,000 fax machines in service.

Here we hospital people thought we were being cutting edge by moving to multifunction devices that at least bundled faxing with printing and scanning. On the other hand, if a business case exists for using something other than fax, they would already be gone.

Reader Comments

From Digital Debonair: “Re: paging systems. A Texas hospital found that Epic-issued consult pages were not being delivered if the message size exceeded character limits – 280 characters for pagers, 160 for mobile phones. The hospital limited Epic’s ‘reason for consult’ field to 100 characters and added an alert to the intended recipient’s mobile device when the limit is exceeded. Once again, technology’s unintended consequences bring us to the least common denominator instead of fixing the problem by breaking the message into segments or getting the communications vendors to increase their character limits. It’s fascinating that each hospital has to discover and solve this problem on their own. Sigh … we have so many miles to go.” Unverified, but the hospital’s email warning to the medical staff was attached. I verified that Sprint and Verizon have 160-character limits, while ATT breaks messages into multiple 160-character segments automatically. SMS stands for “short message service,” so perhaps the real problem is that hospitals try to use that service for something for which it was not intended (not short, in other words) regardless of the convenience of doing so. There’s also the question of whether PHI should be sent over SMS instead of via an encrypted messaging app that could also provide a larger character limit.

From Wan Complexion: “Re: Most Wired. You didn’t list the winners.” I don’t see the point, even as someone who has run IT in organizations that won. We should judge health systems on outcomes, cost, and consumer focus, not on using tools that should drive those results (but usually don’t). I ate at a McDonald’s and it was still awful despite (or perhaps because of) an enviable arsenal of enterprise-wide technology. By “Most Wired” standards, I should have loved it.

HIStalk Announcements and Requests

Poll respondents fear that Amazon will use the medical data they can get to influence their buying habits, although to be honest I’d trust Amazon a ton more than Google or Facebook since Amazon’s business model involves moving merchandise, not serving up ads that clearly were chosen using information those companies really shouldn’t have.

New poll to your right or here: should hospitals be prohibited from using fax machines? Vote and then click the poll’s “comments” link to explain.

I’m questioning those frantically gesticulating TV weather people who this weekend are milking camera time with what they call a “winter storm,” “winter weather,” and of course the inevitable “wintry mix.” It’s not winter until December 21, although I recognize that the less-hysterical “fall storm” won’t keep hunkered-down eyeballs glued to the TV commercials and the result isn’t any different regardless of what the calendar says.

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

Webinars

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

Acquisitions, Funding, Business, and Stock

Allscripts shares hit a 52-week low last week, having shed 34 percent in the past three months. Anonymous posters on TheLayoff.com claim that around 80 percent of the 1,700 McKesson EIS people who joined Allscripts with the acquisition 14 months ago are no longer there.

IBM sells off several software lines to an India-based company, among them Lotus Notes/Domino, which should elicit hope from IBM’ers who have been stuck on that unpopular platform while the rest of the world moved on. Maybe they’ll replace it with GroupWise.

Medication reminder technology vendor MyMeds issues a press release whose headline appears to be intentionally misleading, dutifully picked up by some crappy health IT sites as a “partnership” between the company and Mayo Clinic. Plowing through the fluff reveals the actual development – the app will offer users Mayo Clinic’s drug information (for which I assume the company is paying). Any resemblance to “teaming up” appears to be coincidental.

InterSystems releases a cloud-hosted version of its TrackCare EHR for hospitals in the UAE and Middle East, licensed in a pay-per-usage model.

Hill-Rom’s newest hospital bed will include FDA-approved sensors for monitoring heart and respiratory rates, checking vital signs 100 times per minute and alerting nurses of abnormalities. The price was not announced, but the company’s traditional bed is among the most expensive with a list price of $20,000.

Decisions

• Northside Hospital System (GA) replaced Allscripts with Cerner in October 2018.
• Gifford Medical Center (VT) went live on EClinicalWorks in April 2018, replacing Evident.

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

Announcements and Implementations

Citizens Memorial Hospital (MO) upgrades to Meditech Expanse.

Hospital Sisters Health System integrates Epic with SeamlessMD’s patient engagement solution using SMART on FHIR. 

Government and Politics

Six pain management doctors in Michigan are charged with insurance fraud and unjustified opiate prescribing in submitting $464 million in phony insurance claims.

Other

Here’s an interesting tweet from Apple CEO Tim Cook. I’m not sure the silver bullet for people managing their health lives inside of an IPhone, but I’m sure a citation-desperate academic will compare life expectancy of IOS and Android users vs. a control group of non-cell users.

An article by Penn’s Wharton School weighs in on Amazon’s announcement that it will mine unstructured patient data using AI and machine learning in its Comprehend Medical program, saying the service could:

• Empower consumers.
• Deliver new insights, particularly with regard to radiology, and connect people with clinical trials.
• Allow insurers to deny enrollment of patients with potentially expensive conditions.
• Lighten the workload of doctors.
• Erode physician loyalty as patients could manage their own medical information or choose to share information with competitors such as retail clinics.
• Replace consultants who perform custom predictive analytics for individual clinical conditions.
• Raise questions about data accuracy, especially if consumers are allowed to add or change their information.
• Cause major problems if Amazon were to be breached.
• Raise questions of who’s paying the bill for the Amazon service.
• Lure clinicians into becoming overly reliant on technologies instead of learning, improving, and questioning how the models work.

A ProPublica report finds that journal articles written by physician researchers often don’t disclose the money they’re paid by drug and medical device companies as required, with the medical journals doing little checking of their own. Among them is the dean of Yale’s medical school, the president-elect of the American Society of Clinical Oncology, and the president of clinical operations at Sarah Cannon Research Institute. The reports didn’t have to dig all that deeply – they simply looked up compensation as reported to CMS’s Open Payments Database and compared that to the disclosures section of published articles.

Weird News Andy says this patient hacked up a lung, kinda. A patient coughs up what looks like a bright red, leafless tree, which turned out to be a six-inch-wide blood clot formed in his right bronchial tree (and now you can see how apt that name is). I’ll spare you the photo just in case you’re eating  breakfast since it’s both fascinating and disturbing.

Sponsor Updates

• Liaison Technologies awards its Data-Inspired Future Scholarship to BYU dual-major student Andrew Pulsipher.
• Loyale Healthcare introduces the Patient Financial Bill of Rights.
• Mobile Heartbeat will exhibit at the ONL Winter Meeting December 14 in Burlington, MA.
• National Decision Support Co. and Redox will exhibit at the IHI National Forum December 9-12 in Orlando.
• NextGate launches a fundraising campaign to help customer HealtheConnect Alaska recover from the earthquake.
• Netsmart will exhibit at the TAMHO Annual Conference December 11 in Franklin, TN.
• The Business Gist features Sansoro Health CEO Jeremy Pierotti in a new video, “The challenge of sharing medical records.”
• New data from Surescripts shows that its benefit optimization tools have saved patients as much as $8,032 in out-of-pocket costs on a single prescription.
• Vocera launches three leadership councils to accelerate healthcare transformation.
• ZappRx will exhibit at Advances in IBD December 13-15 in Orlando.
• Healthwise discusses why its partnership with ZeOmega benefits clients.

Blog Posts

• Fix EMRs to Spark More Computer Love (Medicomp Systems)
• New Pharma Targets Increasing Costs & Shortages of Generic Drugs (Liaison Technologies)
• The latest technology in healthcare (Meditech)
• 5 Key Takeaways From MHUG 2018 (Mobile Heartbeat)
• Upping the Game for Home Healthcare Workers: Improving Satisfaction and Patient Outcomes (NVoq)
• Location, Location, Location? Yes! (CloudWave)
• Efficient patient registration is important during flu season (Experian Health)
• ‘Tis the Season for a Tailored Patient Payment Plan (Patientco)
• What IT’s All About in Healthcare (PatientKeeper)
• How to Survive a Practice Management System in Transition (ROI Healthcare Solutions)
• Stanford Children’s Health CMO’s Tips for Succeeding with Consumer-Driven Healthcare Strategies (SymphonyRM)
• How many technologies does it take to coordinate care? (Voalte)
• 7 Steps to Successfully Practice PT in a New State (WebPT)

Contacts

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

News 12/7/18

Top News

It’s been a busy week for Apple when it comes to healthcare:

• The FCC clears an Apple-branded sleep monitor built using technology the company gained from its Beddit acquisition last year. 
• Apple Watch 4 users who update to watchOS 5.1.2 can now use the ECG app and notification feature for irregular heart rhythm.
• The US PTO awards the company a patent for interchangeable AirPod earbuds that can incorporate biometric sensors for heart rate and temperature monitoring.

Reader Comments

From Bjorn Again: “Re: out-of-work executives temporarily consulting. Many just need a title while playing out their parachute and await their next position. I’m a career consultant and these folks distract our prospects from the skills and work we propose, sometimes even making us look bad as we don’t expect to be paid $300/hr. Sometimes they bid or leverage their previous relationships to win over a better, but slightly lesser known option. The big one for me is the old-time vendor execs who have been culled out and are now consulting, suddenly claiming to understand BI, blockchain, machine learning, cloud, etc. after working 27 years for a mainframe-based company, passing off a hobby or reading LinkedIn articles as a professional skill.”

From Former Startup CEO: “Re: startups. Graduating from an incubator or developing a minimally viable product is just the beginning. Companies don’t know how to grow to profitability and the time and expensive of onboarding one new client doesn’t match growth expectations of 10 per week for several months. They don’t know how to gain business or traction. Investor portfolios are filled with dogs (bad investments) and puppies (soon to be dogs) because it’s too hard to deploy their solution.”

Webinars

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

People

Pam Matthews, RN, MBA (Collie Group Consulting) joins Georgia Health Information Exchange Network as executive operations officer.

Sales

• Nicklaus Children’s Health System (FL) selects Health Catalyst’s Data Operating System to optimize its RCM.
• CaroMont Health (NC) will deploy physician time-tracking and payment software from Ludi.

Announcements and Implementations

A new KLAS report on telehealth platforms finds that few vendors have customers using their product for all three forms of telehealth (on-demand care, virtual visits, and specialty consultations). Epic — whose product works only within its own system — and InTouch lead in value and impact, while only Epic, American Well, and MD-Live have more than half their customers moving along an EHR integration path.

Privacy and Security

Politico reports that Partners HealthCare (MA) briefly took its Epic EHR offline Wednesday to handle unspecified technical issues. A hospital spokesperson was quick to rule out the possibility of a data breach. This Twitter thread, prompted by the Partners event, provides some amusing insight into provider attitudes towards downtimes.

Government and Politics

The VA announces at its telehealth event in Washington, DC that it will offer telemedicine services to vets at select Walmart stores.

Other

In Canada, physicians argue for more input into the already-contentious bidding process for Nova Scotia’s One Person One Record System. Cerner and Allscripts are vying for the contract. The Doctors Nova Scotia association says the process needs more providers involved to avoid the EHR problems faced by Cerner customer Island Health in Vancouver. According to DNS President Tim Holland, MD, “If you look at how the electronic health record was set up on Vancouver Island, it crippled their healthcare system, it completely paralyzed their ability to deliver care in hospital, and it had a huge negative impact on patient health and patient safety … if done poorly, this could cripple our healthcare system. It’s very important that frontline healthcare workers — doctors, nurses, and the organizations that represent them — are involved in the development and implementation of this system.”

I missed this in Health Affairs last month: Pascal Metrics develops software that uses machine learning and EHR data to detect and alert providers to medical errors in real time. Developers found that the program could detect errors as they happened at higher rates than current methods, but experts have pointed out that the false positives triggered by the software would a pain for hospitals to deal with.

Medical City Dallas mistakenly bills a patient for $13,000 after a “patient portal mix-up,” according to MCD. The situation was remedied only after the patient took her predicament to the local news. Coincidentally, University of Michigan researchers find that out of 2,300 patients, only one-third used a patient portal in 2017. Respondents cited lack of need, a desire to speak with their provider face to face, and not knowing about portal availability as top reasons for their lack of use.

Teladoc is quick to refute claims of inappropriate employee relations and insider trading that were made in an article from the Southern Investigative Reporting Foundation. The report says the CFO was having an affair with the lower-level employee and shared company stock advice with her. The employee bragged to co-workers who complained to their boss, who pushed through an investigation. The CFO got off with a warning and a one-year loss of share vesting, his girlfriend was not disciplined and later left the company with an unstated severance, but the boss who pushed the investigation was fired. Nobody was investigated by the SEC for insider trading. The company said it acted swiftly and fairly in taking appropriate disciplinary action.

I find it ironic that Googlers argue for fairness in machine learning when their co-workers are preparing to strike over the company’s plan to launch a censored search engine in China.

A Weird News Andy wannabe reader is happy he beat WNA to the punch with this story. In England, a pharmacist faces life in prison for strangling his wife in a staged burglary that he hoped would allow him to collect $2.6 million in life insurance. He planned to use the money to join his same-sex lover in Australia, where they would use the wife’s frozen embryos to start a family. Police examined the IPhones of the man and his wife, discovering that Apple Health showed her resting while he was frantically staging the phony crime. It also showed that her phone was moved 14 steps as he took it outside and dropped it for police to find, with the time stamp disproving his claim that she was alive when he left.

Sponsor Updates

• The CoverMyMeds team stuffs backpacks for chronically ill campers and their families at Flying Horse Farms.
• Imprivata partners with DigiCert to enable remote identity proofing for electronic prescribing of controlled substances.
• EClinicalWorks will exhibit at the 2018 National Ryan White Conference on HIV Care & Treatment December 11-14 in National Harbor, MD.
• The EHealthcare Leadership Awards honors Formativ Health as the Platinum winner in the Best Patient Access & Convenience category.
• FormFast and Healthgrades will exhibit at the IHI National Forum December 9-12 in Orlando.
• HCTec features former University of Virginia Health System CIO Rick Skinner in a new Executive Insights video on “Characteristics of a Trusted Partner.”
• The Health Information Resource Center honors Healthwise with three Digital Health Awards for its patient education videos.
• Imat Solutions releases a new podcast, “Phil Beckett of HASA Discusses Why Data Quality Matters.”
• Wolters Kluwer joins the Healthcare Services Platform Consortium to help advance interoperability efforts and improve patient care.
• Forrester ranks Arcadia.io’s Analytics as top in the current offering category in its Healthcare Analytics evaluation.
• Spok partners with Standard Communications to implement Spok Care Connect across VA hospitals.
• Healthfinch releases a new e-book, “Implementing Standardized Refill Protocols.”
• T-Systems offers its T-Sheets flu templates to all EDs and urgent care staff free of charge during National Influence Vaccination Week.
• Solutionreach partners with Jive by LogMeIn to offer customers easier, faster communication options.
• Nuance will integrate clinical data exchange capabilities from Halfpenny Technologies with its AI-powered clinical documentation solutions.

Blog Posts

• Ready for E&M Documentation Simplification? Not So Fast (Hayes Management Consulting)
• Three Steps for Success with Clinical Order Sets (Optimum Healthcare IT)
• Consumerism of Care: Where to Begin? (Part Three) (HCI Group)
• Risks of Not Delegating Refill Requests (Healthfinch)
• 90-Day Episodes of Care and the New Patient Communication Framework (Healthwise)
• Why Hackers Accessing Your Network is the Top Risk for 2019 (Iatric Systems)
• What GDPR Means for Healthcare Digital Marketers (Influence Health)
• Reflections on Global Summit: A Japanese Perspective (InterSystems)
• A Series on Chatbots: Guiding Principles for Chatbot Integration (Kyruus)

Contacts

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