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.

News 12/5/18

Top News

A ProPublica report finds that the so-called “Mar-a-Lago gang” of three wealthy supporters of President Trump reviewed the VA’s proposed $10 billion Cerner contract before it was signed even though none of them had healthcare IT or military experience, naming themselves as an “executive committee.”

The physician member of the group, Bruce Moskowitz, also pressed the VA to use his self-developed ED locating app instead of collaborating with Apple. He named his son as the VA’s point person for the proposed project that was eventually abandoned.

The group reportedly got VA Secretary David Shulkin fired for being inadequately deferential to them.

Member Ike Perlmutter (chairman of comic book publisher Marvel Entertainment) has reportedly turned his guns on current VA Secretary Robert Wilkie, angered that Wilkie stopped taking his calls and that he released emails that contained Perlmutter’s name in relation to the VA’s no-bid Cerner contract.

Reader Comments

From Avenel Can’t Save This Trainwreck: “Re: Allscripts. Confirming that at least 250 were laid off, 40 of them from sales. Paragon and HHS support to be offshored. Closing offices and laying employees off is necessary because the company has a debt problem.” Unverified. I didn’t see a WARN notices, so perhaps the company is closing offices and offering transfer opportunities to those displaced, meaning that the resulting intentional attrition isn’t technically considered to be a layoff. With regard to your debt observation, I looked up the debt-to-equity ratio of these publicly traded health IT vendors (lower numbers are better):

• Cerner: 9
• NextGen Healthcare: 12
• Athenahealth: 24
• CPSI: 91
• Allscripts: 116

From Smattering: “Re: consulting. Can all these health IT people really make a living as independent consultants?” It should be obvious from the LinkedIn profiles you sent that “consulting” is a euphemism for “desperately seeking a full-time job.” Offering to consult isn’t the same as actually earning a living as a permanent consultant. I suspect that quite a few formerly high-flying health IT executives have been shocked to find that their consulting services were in low demand once they lost their purchasing influence, especially since it’s obvious that a sudden urge to become a consultant coincided with being unceremoniously shown their employer’s door. Reading LinkedIn profiles can be depressing. 

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor PatientBond. The Elmhurst, IL-based company’s solutions address consumerism and evolving reimbursement models, amplifying patient engagement initiatives by using consumer psychographics (attitudes, values, lifestyles, and personalities) and digital engagement. Health systems use it for marketing, targeted patient acquisition, reducing no-shows, performing digital follow-up, sending health reminders, performing surveys, closing care gaps, and reducing readmissions. Clients include Partners HealthCare, Shawnee Mission Health, Aurora Health Care, and Trinity Health. The company’s psychographics and digital engagement were paired with the American Heart Association’s care plans to create AHA’s Health Motivation Platform to drive patient behavior change. You can determine your own patient segment by taking the company’s 12-question survey. Thanks to PatientBond for supporting HIStalk.

Webinars

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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

Acquisitions, Funding, Business, and Stock

Medical device manufacturer ResMed continues its recent string of health IT acquisitions by announcing plans to buy inhaler use monitoring technology vendor Propeller Health for $225 million. Madison-based Propeller Health has raised $70 million.  

Medication safety technology vendor Tabula Rasa HealthCare will acquire Australia-based parenteral medication dosing calculation vendor DoseMe.

Meditech acquires its London-based partner Centennial Computer Corporation as part of its creation of Meditech UK.

I was barely interested in McKesson even before it bailed on health IT, but for those who still care, the company will relocate its global headquarters from San Francisco to Las Colinas, TX. Not shockingly, that’s where the company’s incoming CEO Brian Tyler lives (and where costs are much less). Pretty much every place I’ve ever worked that changed office locations ended up near the CEO’s opulent house since the commute time of that one person outweighs that of hundreds of employees despite HR’s claim that its ZIP code analysis makes that location best for everyone.

Athenahealth files the SEC notice of its shareholder vote on the company’s proposed acquisition by subsidiaries of Veritas Capital and Elliott Management. Interesting points:

• The acquirers will take on several billion dollars of debt to finance the acquisition.
• Termination fees of several hundred million dollars are specified for both sides of the transaction.
• 65 companies expressed interest in acquiring Athenahealth — 32 companies and 33 financial sponsors.
• Athenahealth’s board worried that the company could not meet financial expectations due to declining market opportunities because of low customer switching rates from competing products, a declining win rate, and the need to spend more money on product development to remain competitive.
• Athenahealth’s change-in-control plan for its top executives provides each with a one-year severance; a year’s bonus; 9-12 months of medical and dental coverage depending on title; full vesting of unvested shares; and up to $10,000 in outplacement costs. That provides Golden Parachute Compensation ranging from $800,000 (for the former interim CFO) to $5.5 million (for the CFO).
• Former CEO Jonathan Bush would get $4.8 million under a previously negotiated separation agreement. He also owns 900,000 ATHN shares valued at around $122 million.
• Jeff Immelt, who served as board chair for nine months, leaves with $420,000 and shares worth $1.8 million.

Sales

• Arizona HIE Health Current chooses Diameter Health for data interchange and clinical data quality.

People

Harry Greenspun, MD (Korn Ferry) joins consulting firm Guidehouse as chief medical officer.

Announcements and Implementations

An excellent new KLAS report finds that most EHR vendors are progressing well toward supporting a national patient record network now that CommonWell is connected to Carequality, which the authors call “the connection heard round the US” as users of Cerner and Epic can now exchange information. Another factor is the connection of Meditech to CommonWell and NextGen Healthcare to Carequality. Click the above graphic to see fascinating adoption numbers by vendor. Interesting facts:

• Allscripts and Medhost have not enabled connectivity at all.
• Allscripts says it will connect TouchWorks and Sunrise in 2019, but the company hasn’t committed to enabling Paragon, Professional, or other products.
• Longstanding CommonWell member Medhost has yet to connect anything.
• EClinicalWorks customer connections have tripled since March 2018 and CPSI has done a good job in integrating connectivity.
• Virence Health (the former GE Healthcare IT) and Greenway Health have made little progress.
• Cerner customers face the most significant technical hurdles in connecting, requiring 3-6 months to install Resonance and to perform mapping, making Cerner is the vendor furthest away from plug-and-play interoperability.
• Epic and Athenahealth enable connectivity by default and thus nearly all users of Epic and Athenahealth have connected, which has given them the chance to move on to other pressing projects.
• The CommonWell-Carequality connection has removed the final obstacle to widespread sharing of records as nearly all EHR users can connect quickly and inexpensively.
• The biggest interoperability barrier is that providers don’t really care about sharing data and thus don’t bother to actually share records even though EHR vendors have stepped up to make it possible for them to do so.

Another new KLAS report reviews clinical surveillance technology, finding that despite the claims of several vendors, Epic and Cerner are the only vendors whose surveillance tools have significant usage. It notes that Epic’s surveillance tools are the hardest to set up due to lack of vendor guidance and best practices, but users who have gone live have created the largest variety of use cases. Cerner, Epic, Stanson Health, and Bernoulli users say the alerts improve patient care and reduce readmissions

UCSF will study and manage weight loss in newborns by using SMART on FHIR to integrate Epic with NEWT, a free, web-based, hospital-developed newborn weight loss tracking tool. UCFS’s study is called Healthy Start.

UK-based EMIS Group announces a new cloud-based version of EMIS Web, the UK’s most widely-used clinical system. New features include federated appointments, a voice assistant, video consultations, and analytics.

Government and Politics

A Tennessee nurse practitioner pleads guilty to scamming the military’s Tricare medical insurance out of $65 million via the usual route – conducting telemedicine sessions that resulted in prescriptions for expensive compounded medications that were provided by pharmacy co-conspirators who were also charged.

Privacy and Security

A Florida hospitalist staffing group will pay $500,000 to settle HHS OCR charges that it violated HIPAA in 2011-12 by sharing patient information with someone posing as a billing company employee who then exposed the information to the Internet, all without having a business associate agreement with the billing company or having performed a risk assessment.

Other

In Australia, Queensland Health’s hospital EHR project will run $188 million over budget if implemented in the 12 remaining hospitals, with an auditor-general’s report noting that Cerner can name its price for contract extensions knowing that its customer has not considered alternative systems. The report also concludes that the project can’t continue without further funding and says the system does not provide value for money.

Bill Gates names “Bad Blood” as one of five of this year’s books he recommends. Gates says it is “insane” that Theranos hard-coded demo blood testing machines to display a stuck status bar so they could blame connectivity for the machine’s not working. He says Theranos stumbled because it didn’t have healthcare experts on its board; it sported a Steve Jobs-inspired take-no-prisoners outlook that isn’t appropriate for healthcare; and it allowed Elizabeth Holmes to make her personal legacy the company’s most important goal.

In Canada, the health minister of Newfoundland and Labrador blames Telus Health’s Med Access lab results distribution software for delays in delivering results to several hundred patients in the past year.

Darn, this was almost a clean sweep – an offshore company’s expensive CPOE market report lists six “global top players,” five which are trivia questions having not sold CPOE systems for a long time.

A Wired article says that unlike Amazon and Google, Facebook has no interest in furthering mankind beyond simply growing its own business and assuming that the world will benefit, leaving it with a platform whose chief attributes are tracking and targeting users. A member of Canada’s parliament said in a hearing involving the governments of nine countries – at which Facebook CEO Mark Zuckerberg was a no-show – that “While we were playing on our phones and apps, our democratic institutions seem to have been upended by frat-boy billionaires from California.”

I was thrilled to discover Fakespot, an AI-powered analyzer of reviews on Yelp, Tripadvisor, and Amazon that spots reviews that are likely phony and then recalculates the star rating accordingly. Those sites could do this themselves, of course, but then they wouldn’t have nearly as many reviews to brag about and their advertising revenue might be threatened. Amazon should allow reviews only from people who have actually purchased the item via Amazon, Yelp should ignore reviewers who have posted few reviews or who are posting about businesses all over the world (likely for cash unless they travel extensively), and Tripadvisor really can’t do much about the flood of fake reviews since neither of these methods would work for a global travel site.

In Japan, National Center for Child Health and Development will work with Sony to see if that company’s AI-powered robotic dog Aibo can measurably reduce stress and provide emotional support to children facing long hospital stays. Sony is selling Aibo’s “First Litter Edition” for the US market for $2,900, although there’s a wait list and they won’t ship to Illinois for some reason. Reviews have been OK, although some testers didn’t expect that having a robotic pet that learns that, like a real puppy, you have to train them (although presumably not in the peeing or chewing kind of way).  

Speaking of robots, Weird News Andy volunteers to spearhead an ICD-10 revamp to include the trendy electric scooters that are sending 1,000 people a month to EDs. WNA notes the billing challenge when available codes consider only scooters of the mobility and non-motorized varieties. I swear we’re regressing to children in fawning over scooters, wasting most of our free time playing with toys (of the Internet-enabled variety), and reducing discourse about global events and politics to a spirited game of Rock ‘Em Sock ‘Em Robots.

Sponsor Updates

• Burwood Group helps patients connect with Santa at Advocate Children’s Hospital.
• AdvancedMD publishes a new guide, “In or Out-source Your Value-Based Care Revenue Cycle Management.”
• Aprima announces EHR integration with SE Healthcare’s Physician Empowerment Suite software.
• Bernoulli Health will exhibit at the AARC Congress through December 7 in Las Vegas.
• KLAS recognizes Bernoulli Health in its 2018 clinical surveillance report.
• Clinical Architecture will exhibit at the AHIMA Data Institute December 6-7 in Las Vegas.
• Dimensional Insight will exhibit at the MDM-Forum through December 6 in Denver.
• DocuTap’s Eric McDonald will present at 1 Million Cups in Sioux Falls, SD December 5.
• Meditech adds diabetes management capability to Expanse Ambulatory.
• Access releases EFR Mobile, which supports electronic forms and signatures capability on mobile devices.
• EClinicalWorks publishes a podcast titled “Strengthening Patient Engagement in Illinois.”

Blog Posts

• AI takeaways from RSNA 2018 (Hyland)
• PACS limitations demand a new imaging paradigm (Hyland)
• A New Twist on ‘An Apple a Day’: Reflections from Becker’s Revenue Cycle Conference (Meditech)
• The latest technology in health care (Meditech)
• How a health information search engine can help overcome physician burnout (EClinicalWorks)
• Survey says: Cerner clients share where they are in the paperless journey (Access)
• The faces of Agfa HealthCare at RSNA 2018 (Agfa HealthCare)
• Technology, Workflow and Outcomes: Finding Balance for Nurses (Bernoulli Health)
• AWS re:Invent re:Actions – Controlling risk is important, but confusing (Datica)
• Signature Ready (Culbert Healthcare Solutions)
• Are Poor Patient Relationships Killing Your Hospital’s Bottom Line? (Docent Health)

Contacts

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

Morning Headlines 12/4/18

ResMed to Acquire Propeller Health, a Leader in COPD and Asthma Connected Health Solutions, for $225 Million

Connected health technology vendor ResMed will acquire Madison, WI-based Propeller Health for $225 million.

Tabula Rasa HealthCare to Acquire DoseMe, a Precision Dosing Software Company

Tabula Rasa HealthCare will acquire DoseMe, which will become part of its CareVention HealthCare technology and service division.

VA Shadow Rulers Had Sway Over Contracting and Budgeting

Newly released documents show that President Trump’s Mar-a-Lago Trio reviewed confidential VA documents including the $10 billion Cerner contract, despite having zero military or health IT experience.

Minnesota among states suing over health data hack

Minnesota is among several states suing several Indiana companies, including Medical Informatics Engineering, for a 2015 data breach that exposed the PHI of 4 million patients.

Monday Morning Update 12/3/18

Top News

Reuters reports that a federal judge involved with the final legal step in the CVS/Aetna acquisition feels as if he has been just a cog in the wheel of a shady business deal – one that vocal opponents have said will drive up costs and steer patients away from traditional providers. Judge Richard Leon, who ended up pushing final court proceedings to December 3, told DoJ, CVS, and Aetna lawyers that after reviewing the approved motion, “I kind of got this uneasy feeling that I was being kept in the dark, kind of like a mushroom. I’m very concerned, very concerned that you all are proceeding on a rubber-stamp approach to this.”

Reader Comments

From underTheRadar: “Re: Allscripts. Allscripts is having significant layoffs this week. Rumor has it that 250 people in services and development will be let go. Merry Christmas.” Unverified. Comments left at TheLayoff.com from within the last week may provide some context:

• Most US based Paragon Support staff will be terminated on either 12/16/2018 or 2/1/2019. Offshore resources are not impacted and hiring.
• Just got the call, position no longer needed, last day 12/14.
• Was told seven US Allscripts offices closing before January, a consolidation effort. Separate from ongoing space reorgs, such as Alpharetta. Anyone know which offices?

HIStalk Announcements and Requests

A tiny pool of respondents finds more value in HIMSS than RSNA. Steve Gould says of RSNA, “Any show that doesn’t ruin Thanksgiving weekend with family provides more value. It is unconscionable that the dates have not moved to run Tuesday-Friday instead of requiring people to arrive either Friday or Saturday for a Sunday morning start.” John Wayne is a fan of neither: “I think both conferences are a waste of time and money and have become cash cows for the organizers with mediocre content, massive and poorly organized exhibit areas, and inconvenient dates with difficult travel requirements. Can’t the Internet make these obsolete?”

New poll to your right or here: As a consumer, are you worried about Amazon potentially using your medical data to influence your purchasing decisions?

HISsies nominations are still open. Coveted honors like “Industry figure in whose face you’d most like to throw a pie” and “Industry figure with whom you’d most like to have a few beers” will be based on your recommendations. Given that Jonathan Bush didn’t leave Athenahealth until June, I suppose he’s still eligible.

Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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

Acquisitions, Funding, Business, and Stock

Remote patient monitoring startup Myia raises $6.75 million in a seed funding round led by BootstrapLabs and Zetta Venture Partners. The San Francisco-based company has developed software that analyzes data from wearables and sensors to predict relapses in chronically ill patients. Co-founder and CTO Bryan Smith came to the company from PokitDok.

Decisions

• Eastland Memorial Hospital (TX) will switch from Azalea Health to a new EHR vendor. Two companies are under consideration.
• Adams Memorial Hospital (IN) replaced its Evident financial management software with technology from Harris Healthcare.
• Titus Regional Medical Center (TX) switched from Allscripts to Epic’s EHR and revenue cycle management software.

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

Memorial Hospital (NH) moves from three EHRs to Epic as part of its unification with MaineHealth.

In the UK, NHS vendor Emis Group will shift 40 million patient records from its servers onto AWS as part of a continued national push for more flexible health data exchange and easier set up of digital health services like video consults and chatbot triage.

Beatrice Community Hospital and Health Center (NE) goes live on Epic.

Other

In Finland, researchers determine that Instagram can be an accurate predictor of flu outbreaks after combing through 22,000 posts spanning six years and then comparing them with public health data from the same time period.

USA Today points out that the National Practitioner Data Bank is sorely underused by licensing boards when it comes to keeping up with malpractice payments and disciplinary actions taken against doctors. Nearly half of state medical boards checked the database less than 100 times last year, while 13 boards didn’t check it at all, amounting to 137,000 total searches by the boards. The analysis is part of a year-long investigation into medical licensing system deficiencies that have kept dangerous doctors in practice.

In JAMA, physicians argue against EHR vendor gag clauses, pointing out that an inability to share screenshots, video, and other types of visual media prevent end users from sharing and learning from usability issues that may endanger patients. They advocate for policies that require EHR vendors to:

• Permit the release of information in a timely manner when it informs the usability and safety of the EHR product and enables comparison of specific challenges across products.
• Promote a culture of safety that encourages identification and dissemination of usability and safety issues by EHR vendors and provider organizations.

Sponsor Updates

• TriNetX team members make 300 sandwiches for the Life Science Cares Food for Free program.
• LiveProcess will exhibit at the Oklahoma Hospital Association 2018 Convention & Tradeshow December 5-7 in Oklahoma City.
• LogicStream Health, OmniSys, and Sansoro Health will exhibit at the 2018 ASHP Midyear Clinical Meeting December 2-6 in Anaheim, CA.
• Inc.com features Waystar CEO Matt Hawkins in “31 Tech Predictions for 2019.”
• Netsmart will exhibit at the I2I Center for Integrated Health’s Visionary Voices conference and exhibition December 5-7 in Pinehurst, NC.
• The Visiting Nurse Association Health Group joins PreparedHealth’s EnTouch Network.
• Redox will host a networking event at the IHI National Forum December 7 in Orlando.
• Vocera will exhibit at the Healthcare Patient Experience Transformation Assembly December 3 in Denver.
• The Phoenix Business Journal awards WebPT President Heidi Jannenga with the Ed Denison Business Leader of the Year Award.

Blog Posts

• Tackling Complex Integrations to Enable Business Process Automation (Liaison Technologies)
• Managing Adaptive Change in Healthcare (Loyale Healthcare)
• Is Your Hospital Strategically Interoperable? (NextGate)
• Enhancing Autism Services with Technology (Netsmart)
• How to do more with patient portals (Experian Health)
• Medical Bills & Healthcare Payments: Lessons from a Mobile P2P App (Patientco)
• 5 ways your answering service is hurting your practice (PerfectServe)
• These Good Payroll Practices Will Get You Through Year-end Easier (ROI Healthcare Solutions)
• CMS Price Transparency rule enforced January 1, 2019. Are you ready? (TransUnion)
• 10 years on, Voalte still delivers the ‘wow’ factor. (Voalte)
• Q&A With the 2018 Ascend Practice of the Year Winner (WebPT)

Contacts

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

News 11/30/18

Top News

Unsealed court documents reveal that two Iranian hackers were responsible for SamSam ransomware attacks on 200 organizations earlier this year in the US and Canada, including Allscripts. The victims, which also included hospitals and municipalities, wound up paying over $6 million in ransom and incurring over $30 million in lack-of-access losses. Allscripts hasn’t revealed how much money it handed over to the still-at-large hackers, and could wind up losing more money if a class-action lawsuit filed against it by an orthopedics practice in Florida winds up in court.

Reader Comments

From Client Advocate: “Re: SpinSci. Does Anyone know if SpinSci is still in business? And, which hospitals have deployed their solutions successfully? Looking at their website, the company was started in 2005 but the latest documentation is from 2017. Crunchbase lists them as having 49 employees and $1.7M in revenue; either their staff is predominantly outside the US or, after almost 13 years, they may not have ever really taken off? Can anyone shed some light on this organization?” The oddly worded language throughout their website would suggest they’ve at least offshored their copyrighting talent. They say they’re a Dallas-based company with several global locations, including India and China.

Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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

Acquisitions, Funding, Business, and Stock

CVS Health finalizes its $70 billion acquisition of Aetna, promising to include claims data, analytics, connected devices, digital health apps, and remote patient monitoring in a “new innovative healthcare model” that will focus heavily on preventative care. CVS Health CEO Larry Menlo has also said the company will devote more retail space to medical services as it seeks to become a healthcare destination.

Seattle-based startup Xealth announces GA of software that enables providers to send patients digital recommendations for over-the-counter healthcare products, apps, and services from within their EHR and patient portal. Pennsylvania providers Providence St. Joseph Health and UPMC have gone live with the technology (which seems to be retailer-agnostic despite headlines to the contrary) in several departments. Privacy advocates warn that patients may wind up sharing sensitive PHI with retailers like Amazon, though the company will likely get its hands on that information anyway if its just-announced EHR data-mining capabilities come to fruition.

HGP puts together a list of digital health investors by round size, observing that size-agnostic investors like Khosla Ventures (Color Genomics, Iora Health, Oscar Health, Vicarious Surgical) tend to be more driven by the potential for disruption than incremental change, especially when it comes to patient empowerment technologies. 

In local news coverage of Minnesota-based St. Luke’s $300 million expansion plans, President and CEO John Strange vocalizes the tension many hospital execs must be feeling when it comes to managing consumer expectations in the midst of budgeting for new square footage while attempting to adopt the latest and greatest health IT:

“With the technology changes, you are still going to need certain facilities such as operating rooms and ICUs, but more and more care is moving to outpatient. We’re just trying to make sure we have the right facility for the technology and that is an interesting scenario. The real wild card is Amazon and Google getting into healthcare, and there is rumor they are applying for a manufacturing license,” Strange said. “You could see a physician and have your prescription droned out to you. How does the local pharmacy compete against that? The hospital pharmacy is a significant part of our budget. I tell people our competition here is not Essentia. It is Amazon, Google, and Apple.”

Sales

• Southcoast Health (MA and RI) selects collaborative care and telemedicine technology from Orb Health to help it launch chronic care management services.

People

Former UPMC CMIO Dan Martich, MD joins The Chartis Group as principal of its informatics and consulting practice.

Announcements and Implementations

During its annual investor day, UnitedHealth CEO David Wichmann touts the company’s PHR, calling it an “effective closed loop health information exchange centered on the consumer.” The software, which will be offered to all beneficiaries, is being beta tested by three ACOs, and will soon become available to 1 million providers. Wichmann added that it’s capable of connecting to multiple EHRs (one of those likely being Athenahealth, given the company’s attempts to purchase it). UnitedHealth plans to eventually offer the technology to other payers, though it would seem the PHR market has been losing relevance since Apple came on the scene. 

Government and Politics

Ahead of ONC’s annual meeting, HHS releases 74 pages of weekend reading in the form of proposed recommendations for reducing regulatory and administrative burdens caused by health IT. Comments on the draft strategy are due January 28.

Executive Director John Windom says the VA’s Office of Electronic Health Record Modernization will hire 135 people over the next six months as it ramps up Cerner implementation efforts. Five hundred VA and other EHR end users will attend trainings at Cerner’s campus during that same timeframe in preparation for deployment beginning in 2020.

CMS launches the Procedure Price Lookup tool to help consumers compare prices at outpatient facilities and ambulatory surgery centers.

Privacy and Security

An alliance of healthcare stakeholders develops a code of conduct to help developers of third-party apps outside the scope of HIPAA appropriately handle consumer health data. The code of conduct is part of a three-phase framework that the CARIN (Creating Access to Real-time Information Now) Alliance hopes will ultimately compel developers to certify their apps according to its standards. The alliance was formed by former federal health IT heavyweights David Blumenthal, MD David Brailer, MD Aneesh Chopra, and Mike Leavitt.

Atrium Health (NC) reports that over 2 million patient medical records may have been compromised by hackers who targeted its billing services vendor, AccuDoc Solutions, in September.

Other

Healthcare management experts Lawton Burns and Mark Pauly pen a tongue-in-cheek report on the healthcare industry’s tendency to make, believe, and buy in to “deceptive, misleading, unsubstantiated, and foolish statements.” Touching on everything from the failure of Theranos to the misguided marketing blitz behind IBM Watson to CVS Health’s promise to achieve – finally – the Triple Aim with Aetna’s assets, the authors break down the origins of healthcare’s acute tendency to “say something positive when there is nothing positive to say.”

Cleveland Clinic MD Mikkael Sekeres recounts how health information exchange allowed him to follow a patient’s final days from afar.

New healthcare access research from Kyruus finds that convenience is king when it comes to luring consumers through the four walls of a medical facility. Appointment availability, location, insurance acceptance, and clinical expertise were the deciding factors of those looking for new providers. Over half of the largest age groups in the study said they would switch providers if they didn’t offer online appointment scheduling.

Sponsor Updates

• Hyland Healthcare delivers enterprise-first imaging with new innovations and solution upgrades at RSNA through November 30 in Chicago.
• Constellation will offer Imprivata’s OneSign single sign-on technology to its medical liability insurance customers.
• The local paper interviews LogicStream Health CEO Patrick Yoder.
• Diameter Health receives the Distinguished Paper Award at the AMIA 2018 Annual Symposium for its research paper, “Interoperability Progress and Remaining Data Quality Barriers of Certified Health Information Technologies.”

Blog Posts

• Consumerism of Care: Where to Begin? (Part Two) (The HCI Group)
• Top 10 Best Practices For Choosing a Managed Services Partner (HCTec)
• Technology helps radiologists see more, be more (Hyland)
• Strong Financials: The Key to Your CRM Playbook (Influence Health)
• 5 blogs from home care and hospice thought leaders (Meditech)
• Picking an EHR vendor: Is your vision 20-20? (Leidos Health)
• 5 Ws for a successful health IT contract transition (Nordic)

Contacts

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

News 11/28/18

Top News

Amazon will announce this week launch of a software product for insurance companies that mines electronic patient records, including both structured and unstructured data. It will look for incorrect coding or diagnoses to improve quality and lower cost.

Reader Comments

From TaTa Toothy: “Re: Key Dental Group. The practice’s EHR vendor locks it out of its patient database after the practice drops its system.” Key Dental Group (FL) says dental software vendor MOGO is refusing to return its 4,000 patient records following termination of its license. The practice put out a press release titled “HIPAA Security Incident” that warns patients that it has no control over how their data will be protected by the vendor. MOGO’s LinkedIn says the product is “HIPPA-compliant.”

From DiJourno: “Re: fake health IT news. Running all positive stories is a clue.” You can easily recognize advertiser-friendly “news” sites by simply checking their 10 most recent stories to see if they wrote anything negative, especially about an advertiser. I explain when people ask why I’m so cynical that: (a) the frontlines health IT view is a far cry from profit-motivated irrational exuberance supported by vendor-friendly news sites; and (b) fluff written by armchair quarterbacks is in ample supply and thus the obvious need is to inject reality. I grade sites this way: (a) can I immediately use what I just read; (b) did I learn something I wouldn’t have found elsewhere; (c) can I at least paraphrase a given story in casual conversation to sound smart? Otherwise, I have  more entertaining ways to waste my time.

HIStalk Announcements and Requests

The earlier-than-usual start of HIMSS19 means it’s time to open up the HISsies nominations, my version of the political primaries. I’ve unsuccessfully hoped every year since the first HISsies in 2008 to avoid dozens of email exchanges like these:

• (Reader) “I can’t believe the stupid choices for the HISsies voting. It’s the same every year and it should have had X as a choice.”
• (Me) “Readers do the nominating. Nobody nominated X. So you are complaining now that you don’t like the choices even though you couldn’t be bothered to take 10 seconds to nominate X yourself?”
• (Reader) No response.

Welcome to new HIStalk Gold Sponsor NextGate. The Monrovia, CA-based company offers a cloud-based identity management solution (patient matching, duplicate record cleanup, provider attribution, and biometric ID), provider registry, and  relation registry. Customer success stories include Geisinger, Rochester RHIO, and two UK providers. The company works with more than 100 provider organizations. Thanks to NextGate for supporting HIStalk.

Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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

Sales

• Australia’s Queensland Health chooses NextGate’s cloud-based Provider Registry to create a statewide referral service directory.
• Sweden-based Västra Götalandsregionen will implement Cerner Millennium in its 17 hospitals and 200 primary care centers, Cerner’s second regional contract in Sweden.

People

Former University of Utah health system CEO Vivian Lee, MD, PhD, MBA, who resigned after clashing with the university’s cancer hospital leadership, joins Verily as president of health platforms. She will oversee products related to health system improvement and population health. She finished her contract with the university as a radiology professor at a salary of $1 million per year.

Announcements and Implementations

MModal launches Scout Follow-Up, an AI-powered radiology follow-up workflow solution.

HIMSS announces its 2019 “Most Influential Women in Health IT” winners:

• Aashima Gupta (Google)
• Kisha Hortman Hawthorne, PhD, MHA, MBA (Children’s Hospital of Philadelphia)
• Christine A. Hudak, PhD, RN (Kent State University)
• Lygeia Ricciardi, EdM (Carium)
• Heather Sulkers (CAMH)

Government and Politics

The GAO will investigate rumored VA meddling by three political supporters of President Trump who said they “were anointed by the President” as private citizens. The three, including concierge doctor Bruce Moskowitz, say they voluntarily offered their help to the VA but were given no authority over the VA’s decisions. The initial ProPublica investigation found that Moskowitz’s negative experience with Cerner led the group to urge then-VA Secretary David Shulkin to perform more due diligence before giving Cerner a $10 billion, no-bid contract. Former officials say Shulkin was fired because of friction with the group over the Cerner contract.

Privacy and Security

BCBS of North Carolina emails a medical claims report for 158 employees of Wilmington, NC to the wrong city.

Systems of two OH and WV hospitals remain down following a ransomware attack Friday, with their EDs remaining on partial diversion.

Other

A Black Book survey finds that the CIO’s strategic role has diminished as non-IT department leaders are making more purchasing decisions. It questions whether the “chief” part of the CIO title is at risk as only 21 percent of CIOs say they are involved in innovation projects and departmental purchasing decisions, with 29 percent viewing their role as tactical. Nearly all C-suite colleagues view CIOs as technology providers and order-takers who don’t need to be involved in transformation and innovation efforts. The report finds that average CIO tenure is down to 3.2 years.

The Washington Post finds that a private equity firm’s acquisition of a national nursing home chain led to dramatically decreased quality of care as the chain was loaded up with debt; cash was extracted to pay investors and PE firm management fees; buildings were sold and leased back at unreasonable rents to free up cash that the private equity company extracted; and employees were laid off as the nursing homes were unable to pay the new debt and rent costs. A company consultant said the bankers and investment people who run the PE firm “did not know a thing about this business at all.” The PE firm says things were going fine until Medicare reduced payments. The PE firm has sold the chain to a non-profit, but the question remains – are the slash-and-burn, flip-focused private equity methods appropriate in healthcare?

I found this “Black Friday for Healthcare”article by Loyale Healthcare CEO Kevin Fleming both interesting and timely. He says:

• The Black Friday phenomenon involves value + enticement + urgency.
• Disruption is caused by a commitment to a delivering a superior customer experience, not by simply rolling out digital tools (he was quoting an article by former Sutter Health SVP/CIO Jon Manis).
• “Delight disruption” in healthcare must include both clinical and financial positive experiences.
• Medical tourism may represent the first wave of healthcare consumerism.
• Amazon knows us better than we know ourselves via its rich database, allowing it offer easy shopping, comparing, and buying, and healthcare is beginning to amass such data.
• Healthcare’s version of retail growth involves offering rewarding personal experiences; enticing consumers with an attractive, affordable product that drives word-of-mouth exposure; and addressing people who delay or avoid care because they think they can’t afford it.

Employees at Mercy South (MO) were scheduled to protest Tuesday after the hospital required employees to receive a flu shot unless they offer medical or religious reasons.

Former Chicago Bears coach Mike Ditka is released from the hospital after being treated for a mild heart attack. Above is the mental picture I immediately conjured given that it’s Thanksgiving and RSNA.

Sponsor Updates

• Medicomp Systems publishes an e-book titled “Interoperability and the Quest to Solve Healthcare’s Seemingly Unsolvable Problem.”
• Bernoulli Health will exhibit at the American Association for Respiratory Care Congress December 4-7 in Las Vegas.
• CoverMyMeds will exhibit at ASHP Midyear December 3-7 in Anaheim, CA.
• Divurgent publishes a new success story on its Physician Efficiency Program.
• PointClickCare recognizes Liaison Technologies as its Partner of the Year.
• LiveProcess will exhibit at the National Healthcare Coalition Preparedness Conference November 27-29 in New Orleans.
• MDLive provides free online health consultations to California residents impacted by wildfires.
• National Decision Support Co. will exhibit at RSNA November 25-30 in Chicago.
• Wolters Kluwer Health will present at the ASHP Midyear Clinical Meeting December 2-6 in Anaheim, CA.
• The Pharmacy Podcast Network features ZappRx.

Blog Posts

• Opening day at RSNA 2018 in Chicago (Agfa Healthcare)
• Top 10 Considerations for HIPAA Compliant File Storage (Atlantic.Net)
• Cutting Through the Noise – Streamlining Alerts to Help Improve Patient Safety (CoverMyMeds)
• Medical Schools in the Digital Age: The teachingEHR (Dimensional Insight)
• Understanding what matters most to hospice patients (Meditech)
• Interoperability and the Quest to Solve Healthcare’s Seemingly Unsolvable Problem (Medicomp Systems)
• Driving Recovery in the Opioid Crisis – The Technology to Get Us There (Netsmart)
• The IT Service Management Series – Part 1: Knowledge Management – Recognizing your most valuable free asset (CloudWave)
• Simplifying the billing process to alleviate patient financial pain points (Experian Health)
• Recap: PatientPing Hosts Texas Community Summit (PatientPing)
• FAQ: Platforms vs. Point Solutions (Spok)
• Avoid a One-Size-Fits-All Patient UX. Here’s How. (Patientco)
• EHR Optimization: Are We There Yet? (PatientKeeper)
• New Jersey Case Manager Fights “Tooth and Nail” for Patients (PreparedHealth)
• Did EHRs Solve Everything? (Optimum Healthcare IT)
• Communication data at a glance. (Voalte)
• How Medicare Advantage is boosting value-based insurance design (Wellcentive)
• What is Defensible Documentation? (WebPT)

Contacts

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

Morning Headlines 11/27/18

Mental health therapy at Walmart? It’s now a thing

Managed care company Beacon Health Options creates a new business to oversee the launch of mental health clinics in retailers like Walmart, promising virtual access to providers during peak hours.

Black Book Survey of More Than 1,500 Executives Confirms the Changing Role of the Healthcare CIO

The purchasing-decision power of hospital CIOs falls over the last three years from 71 percent to 8 percent, according to a Black Book report.

Patients discharged sooner in hospitals with highest use of electronic health records

A Case Western Reserve University study finds that patients are discharged almost four hours earlier at hospitals that use EHRs at the highest federal standard of implementation.

Monday Morning Update 11/26/18

Top News

RSNA 2018 kicks off in Chicago’s McCormick Place, running through Friday.

A big focus of the conference is artificial intelligence and machine learning.

RSNA 2017 drew nearly 53,000 registrants, half of them imaging professionals.

Chicago was under a blizzard warning Sunday evening, with up to 13 inches of snow expected, driven by wind gusts of up to 45 mph. Highs Tuesday and Wednesday will be in the mid-20s.

Reader Comments

From Participle Dangler: “Re: your mention of Papa Roach. Lead singer Jacoby Shaddix remains active in hometown causes and supports NorthBay HealthCare’s hospice program.” The Vacaville, CA-born singer – who turned his life around from substance abuse and depression – also supports causes related to hunger and homelessness, having been raised with both.

HIStalk Announcements and Requests

I tossed out last week’s poll due to obvious technological attempts to stuff the ballot box (nearly nobody believes that Allscripts legitimately earned Black Book’s “best integrated EHR/PM” survey finding). I added CAPTCHA protection this week, although I have little doubt that a script kiddie without much else going on in life can crack that as well.

New poll to your right or here: for those who attend both the HIMSS and RSNA conferences, which provides more value? Vote and click the poll’s “comments” link to explain or to suggest another conference that is better than those two.

Webinars

December 5 (Wednesday) 1 ET. “Tapping Into the Potential of Natural Language Processing in Healthcare.” Sponsor: Health Catalyst. Presenters: Wendy Chapman, PhD, chair of the department of biomedical informatics, University of Utah School of Medicine; Mike Dow, senior director of product development, Health Catalyst. This webinar will provide an NLP primer, sharing principle-driven stories so you can get going with NLP whether you are just beginning or considering processes, tools, or how to build support with key leadership. Dr. Chapman’s teams have demonstrated phenotyping for precision medicine, quality improvement, and decision support, while Mr. Dow’s group helps organizations realize statistical insight by incorporating text notes along with discrete data analysis. Join us to better understand the potential of NLP through existing applications, the challenges of making NLP a real and scalable solution, and the concrete actions you can take to use NLP for the good of your organization.

December 6 (Thursday) 11 ET. “Make the Most of Azure DevOps in Healthcare.” Sponsor: CitiusTech. Presenter: Harshal Sawant, practice lead for DevOps and mobile, CitiusTech. Enterprise IT teams are moving from large-scale, project-based system implementations to a continuously evolving and collaborative process that includes both development and business teams. This webinar will review healthcare DevOps trends and customer stories, describe key factors in implementing a DevOps practice, describe how to assess Azure DevOps, and lay out the steps needed to create an Azure DevOps execution plan.

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

Acquisitions, Funding, Business, and Stock

Intelerad acquires radiologist worklist technology vendor Clario Medical.

Announcements and Implementations

Nuance launch PowerScribe One, a radiology reporting platform that includes AI-powered diagnostic and decision support tools. 

Other

Two Ohio hospitals go on ED diversion after their systems are attacked by ransomware.

An Indiana doctor says his lawsuit against EHR/RCM vendor SSIMED (now Meridian Medical Management) for losing 70 percent of his practice’s claims for more than nine years triggered a 2014 DEA raid of his offices for overprescribing narcotics, as accused by former employees of his practice.

Spectrum Health’s transplant clinic tells a patient that they won’t perform a heart transplant because she can’t afford the post-surgical immunosuppressant drugs, suggesting that she undertake “a fundraising effort of $10,000,” after which a newspaper columnist concludes that it’s not a healthcare system if “you can’t have a heart unless you do GoFundMe for $10K.”

In Australia, a conspiracy theorist with no medical background charges $4,000 to serve as an expert witness for estranged parents who disagree on vaccinating their children. She has threatened to sue the newspaper for reporting about her services, defending her “support for the public’s right to vaccination choice.” The doctor – she earned a PhD in humanities — claims that a secret WHO committee orchestrates pandemic hysteria under the direction of the World Bank.

In England, a woman sues a hospital for not telling her about her father’s Huntington’s disease, saying she would have aborted her child (now eight years old) if she had known that the girl has a 50 percent chance of being afflicted by the neurological disease. The woman’s father – who had killed his wife – refused to give doctors permission to tell his daughter about his condition, fearing that she would abort the baby. The legal precedent could be significant – do doctors and hospitals have the legal duty to perform genetic due diligence and to override privacy requirements in telling those who may be affected by an identified genetic disorder? A genetic ethics expert observes:

How much effort should a clinician make in chasing up relatives? And those relatives might be unhappy to be tracked down and given unwelcome information – for example, that they possess a gene that predisposes them to breast cancer. You cannot take back that information once you have given it.

ProPublica finds that CPAP machines used for sleep apnea often are programmed to report usage data back to the patient’s insurance company, the device’s manufacturer, the medical equipment distributor, and the ordering doctor. Insurers say too many patients who are prescribed the costly machines don’t use them regularly. The article notes that an industry has been created around the potentially serious but often undiagnosed condition, with sleep studies, the CPAP machine, and the required ongoing use of supplies raising the financial concerns of insurers. Medicare requires physicians to document that their patients use CPAP for at least four hours per night in at least 21 of each 30 days, a policy quickly adopted by private insurers, and the manufacturers say their surveillance meets those documentation requirements. 

I saw this commercial watching Thanksgiving parade lip-syncing – UPMC is running $3 million worth of national ads for its living-donor liver donor program as it fights with the dominant local health plan. The KHN article notes that hospitals are trying to lure well-insured patients into their hospitals – and to diminish the impact of insurers trying to control costs despite the health system’s market clout — by creating a national and international brand based on high-priced procedures that few people need. Hospital for Special Surgery and Yale New Haven Hospital are also running national TV ad campaigns that, unlike direct-to-consumer drug company ads, are not regulated by FDA for accuracy. Some Internet wags claim that UPMC’s ad is voiced over by Benedict Cumberbatch of “Sherlock” and it does indeed sound like his highly compensated voice.

Weird News Andy’s turkey day must have caused him to miss this story. A Paris hospital that is recruiting participants for a fecal implant study is overwhelmed with calls, emails, and visits after someone takes a photo of the offer and posts it to social media, claiming that anyone who shows up with a fecal sample will be given $57.

Sponsor Updates

• Healthwise will exhibit at the NextGen Patient Experience November 27-29 in San Diego.
• Imat Solutions will sponsor the SHIEC reception at ONC’s 2018 Annual Meeting November 29 in Washington, DC.
• Influence Health customers UCLA Health, Advocate Health Care, Virginia Mason, and Texas Health Resources win seven EHealthcare Leadership Awards.
• InterSystems will exhibit at RSNA November 25-30 in Chicago.

Blog Posts

• Huntzinger Congratulates the Most Wired Recipients (Huntzinger Management Group)
• PACS limitations demand a new imaging paradigm (Hyland)
• Make Sure Remote Access to Your Network is as Safe as a Deadbolt (Iatric Systems)
• 5 Crafty Ways Your Competitors are Poaching Your Patients (Influence Health)
• Engagement without Commitment: The Healthcare Dilemma (InterSystems)
• Community Health Network’s Multi-Channel Approach to Enhancing Patient Access (Kyruus)

Contacts

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