Monday Morning Update 1/15/18

Top News

Systems at Hancock Health (IN) remain down following a ransomware attack Thursday. I saw no patient advisory on the health system’s website or social media accounts, but its patient portal gives a “this site can’t be reached” error.

The health system’s CEO said the attack wasn’t triggered by an employee opening a malware-infected email, adding, “This was not a 15-year-old kid sitting in his mother’s basement.” He declined to disclose the amount of the ransom being demanded.

Reader Comments

From Pulpy Juice: “Re: KLAS. They should separate reports from a provider who has invested in a vendor in a separate category.I know of two companies that fit this situation, where the glowing reports of customers who own a stake in a vendor are folded in with those of real customers that have no financial interest.” It’s the same as site references or visits, where the supposedly objective peer organization is either being paid by the vendor or owns a stake in it. That situation can be somewhat resolved by asking that the provider and/or vendor disclose any relationships that might compromise objectivity, although you have no way to make them do it or to verify their claims. In KLAS’s case, the only solution I see would be to require vendors to disclose any customer ownership, then skip surveying those organization since KLAS has no way to tell whether the interviewee is influence by (or even aware of) that connection.

From Nida Partee: “Re: HIMSS parties. Can you post details of vendor parties that we as providers can be invited to? I think Cerner is having theirs Tuesday night but I can’t find others.” I never get invitations so I don’t know when they are. If you’re a vendor and are OK with providers registering to attend your event, send me the signup link and I’ll run it here. I would be hesitant to mention a “no signup required” party since I have a few dozen thousand readers and you don’t want to be overwhelmed.

From Searcher: “Re: searching HIStalk for keywords and showing the results in chronological order. Can this be done?” Yes. Use the second of the two search widgets, with or without specifying a date range. It’s not as slick as the Google custom search above it since I had some guy create it for me, but it does allow specifying a keyword which then displays the results in date order. It is surprisingly difficult to even display a date on WordPress search results, much less to filter or sort the results by it.

From Born Free: “Re: GLG’s expert network. I’m curious about HIStalk readership from both sides – have you joined this or other network or does your company use one?” Readers are welcome to share their experience. It’s a brilliant business model for sure. I joined GLG many years ago in my pre-HIStalk days, specifying my area of expertise and desired hourly rate. They then emailed me occasionally with opportunities to complete a survey or get on a call with a vendor, although 90 percent of the time, that vendor wanted specific experience I didn’t have (such as working daily in the imaging field). Invoicing and payment was online, which was pretty cool back then. I remember getting on a call with an investment guy looking for health IT stock insight and I concluded that he should just recommend or buy Cerner shares. I should have taken my own advice now that I’ve looked up CERN’s historical share price – had I invested $10,000 on that day, my shares would now be worth $70,000.

From Allspice: “Re: employee leave policies. My employer, a large EHR vendor, says our maternity, paternity, and family leave policies are competitive. New dads get nothing, however, beyond the standard FMLA. I would be interested in what readers or even company spokespeople have to say about family leave policies.” Readers can email me their company’s policies anonymously and I’ll summarize them here. 

HIStalk Announcements and Requests

Poll respondents think a filed lawsuit is newsworthy if it involves a high-profile dependent or makes dramatic claims, although 44 percent agree with me that since anyone can file a lawsuit and make unproven claims, it’s not news until a decision is rendered or a settlement is reached (possibly years later given our constipated, expensive legal system). Furydelabongo says he/she doesn’t care about intellectual property disagreements but likes to hear about those in which there’s an opportunity for public comments. Clustered is interested in lawsuits that resonate with his/her experience or that test some principle, although I would say it’s hard to separate a watershed moment from a plaintiff simply hitching a ride on a popular belief that may or may not be relevant.

New poll to your right or here, as suggested by a reader: do you trust KLAS’s product rankings? Click on the poll’s “comments” link after voting to elaborate further.

Listening: new from Norway’s The Dogs, one of my favorite hard-rocking bands ever.

What I Wish I’d Known Before …

A reader survey respondent brilliantly recommended a new feature called “What I Wish I’d Known Before …” in which I provide the topic, you provide the answers, and we all learn from them. The first installment will be, “What I Wish I’d Known Before Replacing My Hospital’s Time and Attendance System,” a question you will hopefully answer here. This is a great idea, but it will die quickly if I don’t get enough responses to be interesting.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

February 13 (Tuesday) 1:00 ET. “Beyond Sliding Scale: Closing the Gap Between Current and Optimal Glycemic Management Practices.” Sponsor: Monarch Medical Technologies. Presenter: Laurel Fuqua, BSN, MSN, EVP/chief clinical officer, Monarch Medical Technologies. The glycemic management practices of many hospitals and physician staff differ from what is overwhelmingly recommended by experts and relevant specialty societies. As a result, they are missing an opportunity to improve the quality, safety, and cost of care for their patients with diabetes and hyperglycemia, which commonly represent more than 25 percent of their inpatient population. Hospitals that transition from sliding-scale insulin regimens to consistent use of basal / bolus / correction protocols are seeing reductions in hyperglycemia, hypoglycemia, and costs. Making this shift more effective and efficient is the use of computerized insulin-dosing algorithms that can support dedicated staff using a systematic approach.

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

Acquisitions, Funding, Business, and Stock

McKesson CEO John Hammergren says Change Healthcare, of which McKesson owns 70 percent, may run its IPO in 2018.

Athenahealth will move forward with previously announced plans to expand its Atlanta office by 40,000 square feet at a cost of $2.7 million. The company cut 60 Atlanta jobs in October as part of restructuring and elimination of 9 percent of its 5,500 jobs nationwide.

Decisions

• Ochsner Hancock Medical Center (MS) will replace Evident with Epic.
• Gunderson Moundview Hospital and Clinics (WI) will switch from Cerner to Epic in 2018.
• Animas Surgical Hospital (CO) will switch from Harris Healthcare to Cerner in 2018.

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

CVS lists a position for senior product manager of its Boston-based digital innovation lab.

Government and Politics

The VA’s Aurora, CO hospital – construction of which the VA has acknowledged to be running more than $1 billion over budget and years behind schedule – won’t have enough positions filled to be fully operational at its planned summer opening and won’t actually be fully completed. The new campus lacks  space for a rehab center, so the Denver hospital that the new one replaces will remain in use for at least three years. Total price for the new 182-bed hospital, originally pitched as $328 million, will exceed $2 billion, or $11 million per bed. The project is being run by the Army Corps of Engineers.

Privacy and Security

Oklahoma State University for Health Sciences (OK) notifies 280,000 Medicaid patients that their billing information has been exposed to an “unauthorized third party” who gained access to network folders.

Other

A frozen parking lot drain causes a sink to overflow in the lower level of an office building that houses the data center of MaineHealth’s Memorial Hospital (NH), causing service interruptions that won’t be resolved until Monday at the earliest when new servers and other equipment are delivered.

A doctor who has studied 757 physician suicides finds that:

• It’s a seven-to-one ration of male doctors to female.
• Anesthesiologists are the highest-risk specialty, most of whom kill themselves by overdose and often in call rooms.
• Outwardly happy doctors often commit suicide to the shock of their co-workers.
• The death of a patient seemed to be a factor in several cases.
• Medical students who failed their boards or don’t get their desired residency have killed themselves.
• Inhumane working conditions and administrative pressure are sometimes mentioned in suicide notes.
• Sleep deprivation is a factor.
• Doctors don’t seek help because they don’t trust that their mental health records will remain confidential.

AAFP offers forms that allow family doctors to screen patients for social needs (aka social determinants of health). I’m not sure how this information could be incorporated easily into an EHR other than by manual scanning, however.

In Canada, a consultant’s report concludes that Nanaimo Regional General Hospital’s over-budget, behind-schedule Cerner rollout has been mismanaged by Island Health and recommends that further rollouts across Vancouver Island be halted until problems are fixed. The report disputes the  perception of the hospital’s loudly-complaining doctors that software is causing patient safety issues. The consultants say the hospital wasn’t ready for go-live, employees weren’t adequately engaged and trained, and the hospital’s toxic climate of distrust made it worse.

Weird News Andy says, “Dr. Ook will see you now.” Researchers from the Borneo Nature Foundation filming orangutans catch them creating a muscle-soothing ointment from plants by chewing them into a paste and then rubbing the paste onto the affected joints, piquing the interest of researchers who wonder if the plant’s anti-inflammatory properties could be used in humans. WNA says it’s weird because they could even use their feet to unscrew medication bottle lids.

Sponsor Updates

• Summit Healthcare will exhibit at the IHE Connectathon January 15-19 in Cleveland.
• Voalte publishes a white paper, “3 keys to patient-centric care team communication.”
• Access will showcase its paperless, web-based eForms, and electronic patient signatures solutions at the 2018 MUSE Executive Institute.

Blog Posts

• University of Iowa Health Care Increases Industry-Sponsored Clinical Trial Opportunities with TriNetX (TriNetX)
• Rx.Health and Redox Partner to Bring Integration-Ready, Evidence-Based Technologies to Healthcare Organizations (Redox)
• Connect with Your Patients Through Two-Way Texting (Solutionreach)
• Defining the Perfect Prescription and Achieving it in Four Steps (Surescripts)
• The Emergence of Choice: Why Consumers Own the Future of Healthcare (Huron)

Contacts

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

News 1/12/18

Top News

Release of information/HIM vendor Ciox Health sues HHS, saying HIPAA’s limitation on how much patients can be charged for copies of their medical records has saddled providers with hundreds of millions of dollars in new costs and “threaten to bankrupt the dedicated medical records providers who service the healthcare industry.” 

Ciox Health was recently named, along with several dozen Indiana hospitals, in a lawsuit claiming that the hospitals fraudulently claimed to give patients requested copies of their medical records within three business days 50 percent of the time as HHS requires. The lawsuit also says Ciox Health illegally profited from overcharging patients for their records in violation of anti-kickback laws.

Reader Comments

From Evergreen: “Re: Brent Shafer. I know him and he’s a nice guy, but he doesn’t have much relevant background either as a subject matter expert or as CEO of a publicly traded company.” My reaction to Cerner’s choice to replace the late Neal Patterson:

• Netherlands-based Philips doesn’t have the healthcare cachet of Cerner and Shafer has worked there for 12 years. I was expecting a stronger pedigree, either within health IT or as a publicly traded health-related company’s CEO.
• I’m surprised that running an international company’s US business unit was enough of a track record to justify becoming Cerner’s CEO and chairman.
• Despite Cerner’s insistence upon the death of Neal Patterson that the company’s succession plan would allow it to replace him quickly, it took six months, perhaps raising the question of who else was considered, which of those declined, why internal candidates were ruled out, and what factors landed Shafer the job?
• It’s tough to replace a visionary, passionate founder with a strong will who has held the CEO role since the beginning, rather like Apple searching for a replacement for Steve Jobs.
• Still, Cerner’s board chose Shafer with appropriate due diligence and he has the complete authority to lead the company his way.

From PHG: “Re: Philips. Announced internally that they will shutter their North American headquarters in Andover, MA by 2020, move 2,000 employees to a new facility in Cambridge, and lay off or transition many roles to different facilities.” The story hit the papers late Thursday as you described it, with Philips following other companies that have left suburbia for downtown Boston (Kendall Square in its case). 

From Polite Discourse Please: “Re: CIO/CNIO guest authors. You might get more people interested if you applied a more strict comment policy to avoid some of the reader nastiness that Ed Marx got at times. I suggest either not allowing anonymous comments or approving only professional, respectful responses.” I agree and would be happy to do that. I don’t like censoring people, but on the other hand I’m embarrassed when a guest author gets skewered, even though I can tell when they’ve written something that is likely to raise emotion. Ed told me recently that he wasn’t bothered much by the criticism and in fact got a lot more positive responses offline, such as invitations to events and mentorship requests from some folks all the way to the CEO level.

From Allscripts Watcher: “Re: Practice Fusion. Hearing that part of the Allscripts plan is to eliminate the free model and start charging providers $200 per month.” Unverified, but reasonable, although customer defection is likely to be substantial. I still question how many active users Practice Fusion has (they’ve always been coy about usage numbers) and whether selling patient data and drug company ads brought in much revenue. Allscripts knows, though, and says $100 million is a good deal, presumably in acquiring a marketable product since the customer base is iffy. Allscripts has turned into a health IT mutual fund in buying low with hopes of selling high (in the form of higher share price).

From Duke Hazard: “Re: my 20-bed hometown hospital. Overpaid staff by millions of dollars,  making its providers some of the country’s highest paid. Whether it’s by incompetence or corruption, it’s inexcusable.” Auditors find that the appropriately named Cavalier County Memorial Hospital (ND) has been overpaying two doctors and a nurse practitioner for almost 10 years, totaling $2.5 million and making them among the country’s highest paid. They’re no longer at the hospital, but a new CFO is. I’d put my money on corruption – how can executives miss plowing such a large chunk of their revenue into the hands of just three providers without anyone noticing for 10 years?

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Wolters Kluwer Health will sell its ProVation Medical gastroenterology software business to Clearlake Capital Group for $180 million in cash. Wolters Kluwer Health says it will focus instead on broad, multi-specialty products.

The Sacramento Bee notes that few people have heard of California’s second-richest company behind Apple – McKesson.

People

Philips promotes Vitor Rocha, head of the company’s ultrasound business, to CEO of North America. He replaces Brent Shafer, who will become Cerner chairman and CEO on February 1.

HHS promotes Kathryn Marchesini to ONC’s chief privacy officer.

Qlik names Mike Capone (Medidata Solutions) as CEO.

Announcements and Implementations

Ochsner Health System (LA) will integrate its Epic system with the state’s prescription monitoring program via Appriss Health’s PMP Gateway service.

A Reaction Data survey of 889 doctors almost evenly split between ambulatory and hospital practice finds that Epic leads all vendors by far in being chosen in system replacements. Dissatisfaction among all EHR users seems to be significant, but in the absence of specific “hate it” numbers, I’m reading between the lines that EClinicalWorks is the least-disliked (maybe or not the same as “most-liked”) vendor, Allscripts finishes worst of all, but ironically 70 percent of the users of new Allscripts acquisition Practice Fusion are advocates of that product.

Sales

Portneuf Quality Alliance (ID) selects population health management technology from Lightbeam Health Solutions.

Springhill Medical Center (LA) will implement Medhost’s EDIS.

DaVita Physician Solutions, affiliated with DaVita Kidney Care, chooses Epic as the foundation for its chronic kidney disease / end-stage renal disease EHR called CKD EHR. The press releases is tough to follow, but Epic will apparently replace its internally developed Falcon Platinum EHR and offer users a migration path.

Technology

The Boston Globe highlights the progress EHR vendors are making with embedded virtual assistant technology that resembles Alexa and Siri. EClinicalWorks rolled out its assistant Eva to customers in December, Epic will reportedly launch a virtual assistant next month. and Athenahealth has one in the works.

Government and Politics

Brooke Army Medical Center (TX) personnel launch Army Medicine’s first virtual medical center, which will also serve as a test site for additional centers.

Privacy and Security

Sensato Cybersecurity Solutions and ComplyAssistant develop a scalable medical device cybersecurity operations program for hospitals that includes device monitoring, breach detection, and automated assessment and risk scoring.

Other

A US News & World Report survey finds that software developer is the best job of 2018, The report considered hiring demand, work-life balance, income, and future prospects. Healthcare jobs usually top the list and still hold positions 2-5 with dentist, physician assistant, nurse practitioner, and orthodontist. All the highest-paying jobs are in healthcare, as the jobs tying for first with a $208K median salary are anesthesiologist, OB/GYN, oral and maxillofacial surgeon, orthodontist, and surgeon.

Weird News Andy knew that some hospitals dump patients, but he says it’s still shocking to see it happening on video. A bystander records University of Maryland Medical Center Midtown Campus (MD) security guards wheeling out a patient dressed only in her hospital gown and dropping her off at a bus stop on a 30-degree night. The bystander called police and medics took her back to the same hospital.

Sponsor Updates

• MedData will exhibit at the HFMA WI Mega Healthcare Conference January 15-17 in Wisconsin Dells.
• Nordic releases a new video, “Achieving a return on your EHR investment in 2018 and beyond.”
• Arcadia Healthcare solutions publishes a new white paper, “Building the Successful Accountable Care Organization.”
• NTT Data will offer AI-based solutions from Pieces Technologies to healthcare customers.
• Parallon Technology Solutions will exhibit at the MUSE Executive Institute January 14-16 in Newport Coast, CA.
• Experian Health will exhibit at the HFMA Western Symposium January 14-18 in Las Vegas.
• ZeOmega achieves significant growth and product innovation in 2017.
• Forward Health Group earns the highest score in clinician engagement among population health vendors in the KLAS Research 2017 Population Health Management report.

Blog Posts

• Tech could lower healthcare delivery toil by 50% (LiveProcess)
• Guiding Principles to Consider When Using Cerner’s Model Order Sets (Optimum Healthcare IT)
• Raising the Stakes in 2018, CMS Continues Focus on Appeals and Grievances (Medecision)
• Why you should share notes with patients (Meditech)
• It’s time to embrace a universal identity management system (Experian Health)
• Redox in the New Year: Squeezing into 2018 (Redox)
• Healthcare IT Recovery: 4 Business Continuity Myths Debunked (Spok)
• How Harbor Health Plan Utilizes PatientPing to Improve Member Outcomes (PatientPing)
• GDPR Compliance – What US Healthcare Organizations Need to Do (Impact Advisors)
• Artificial Intelligence in Health IT – Catalyst for Change? (FDB)

Contacts

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

Cerner Names Brent Shafer as Chairman and CEO

Cerner announces that it has hired Brent Shafer as its board chair and CEO, effective February 1. The 60-year-old Shafer had been CEO/EVP of Philips North America from since 2014 and a Philips employee since 2005. Prior to that, he held roles at Hill-Rom, GE Medical Systems, HP, Johnson & Johnson, and Intermountain Healthcare.

Cerner co-founder Cliff Illig, who has held interim roles as CEO and board chair since the death of Neal Patterson in July 2017, will resume his previous role as vice-chairman of the board.

Illig said in a statement, “Brent is a proven chief executive who has helped lead the growth and strategies of a complex, multinational organization over a number of years. He is committed to innovation, with extensive knowledge of healthcare, technology, and consumer markets and an exceptional skill set that complements Cerner’s strong leadership team. Since our founding, Cerner has used the power of information technology to disrupt and improve healthcare. The addition of Brent to our leadership team positions Cerner well for our next era of growth.”

Shafer said in the announcement, “For decades, Cerner has built its reputation on meaningful innovation and driving client value. This company’s history of remarkable, sustained growth is testament to a strong leadership culture and I’m excited to celebrate many new milestones with Cerner associates around the world. My commitment to Cerner’s clients, shareholders, and associates worldwide is that we will continue to be the catalyst for real and effective improvement across healthcare.”

According to SEC filings, Shafer will earn a base salary of $800,000, will be eligible for a $1.2 million annual bonus, will be awarded $4 million worth of Cerner shares plus a $3.7 million award to replace his forfeited Philips equity, and will be allowed use of Cerner’s corporate aircraft up to $100,000 annually. He will be paid two years’ salary if the company is sold.

News 1/10/18

Top News

Change Healthcare announces GA of healthcare’s first enterprise-scale blockchain product, incorporating the technology into its Intelligent Healthcare Network for claims management.

The company says its use of blockchain will create a single source of truth that will enable greater auditability, traceability, and trust that will encourage creation of innovative services.

President and CEO Neil de Crescenzo said in a statement, “While others are experimenting with use cases, the pervasiveness of our Intelligent Healthcare Network has enabled us to quickly deploy blockchain at scale in addressing a highly administrative process, providing a launching pad for broad adoption. We will continue to leverage blockchain and other technologies to develop additional applications that can make healthcare more patient-centric while addressing cost and quality.”

Change Healthcare’s Intelligent Healthcare Network processes 50 million claims-related events each day using blockchain, which the company says is a successful demonstration of its capability in high-volume transaction processing.

Reader Comments

From Bama Boyz: “Re: Practice Fusion. Revenue of only around $60 million, tried to sell at 4-5 times revenue with no takers, and Allscripts has been trying to build a low-end cloud product that is going nowhere two years in. Allscripts needs a cloud product, Practice Fusion’s investors are tired, and thus the deal makes sense even with no winners.” Unverified, although it’s interesting if a company that offers a free, no-maintenance EHR is making $60 million selling patient data and drug company EHR ads. I observed on November 1 that the previously high-flying Practice Fusion had fallen off everyone’s radar with modest at best EP attestation numbers, especially for a product that’s free and has been around for more than 10 years. The $100 million cash acquisition price doesn’t even cover the $157 million that VCs unwisely fed it. Allscripts adds yet another ambulatory EHR to its fleet, increases market share by buying a questionably quantified customer base that isn’t paying anything, and drops another discounted day-old pastry into its mixed bag of unrelated acquisitions. On the plus side, it gets a market-tested cloud offering for small practices that can be quickly retooled into a licensed product instead of an ad-supported freebie. I don’t know what happened to the somewhat secretive Care Otter/Allscripts development team that was supposed to demo its new EHR at MGMA but didn’t. The challenges for Allscripts will be to figure out how to sell the Practice Fusion product to those small practices (Practice Fusion required only filling out a short registration page) and keeping cross-selling expectations realistic. I’ll also note that MDRX shares are up 44 percent in the past year vs. the Nasdaq’s 30 percent, so the market likes what Allscripts is doing.

From Grapevine: “Re: Philips PHM (Wellcentive). Laid off half their sales force a week before Christmas.” I reached out to the company, which provided this response:

Philips is engaged in increasing efficiencies in its Population Health Management business to meet evolving customer strategic goals, challenges, and needs with agility and focus. The Population Health Management market is a very promising, yet highly dynamic growth market. After careful consideration, Philips undertook a very limited restructuring of specific positions in a number of functions in December 2017, with those positions being eliminated in January 2018. Employees affected by this limited restructuring will be provided with a comprehensive separation package and transition support.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor QuadraMed, Healthcare Identity Experts. The Plano, TX-based company provides award-winning end-to-end healthcare identity management solutions that include enterprise master patient index software, MPI clean-up services, EMPI analytics, and staffing. It can diagnose, treat, cure, and prevent identity issues with 99 percent accuracy. The typical hospital’s 8-12 percent duplication rate – which gets a lot worse after a merger or acquisition — places patients at risk for medical errors, impedes interoperability efforts, hampers ACO operations, and jeopardizes EHR conversions. Simple EHR vendor matching algorithms use a handful of identifiers that require an exact or phonetic match, yielding only 50 percent accuracy and a lot of false matches. QuadraMed’s probabilistic algorithm analyzes many patient demographic data points and tunes out data entry errors to deliver 99 percent accuracy. Customer Newark Beth Israel Medical Center (NJ) reports that it dropped its duplicate record rate from 11.1 percent to 0.2 percent, improving its registrar workflow as well as patient safety. Thanks to QuadraMed, Healthcare Identity Experts for supporting HIStalk.

Mrs. H shared an update from her Missouri elementary school classroom, which is now equipped with STEM books and activities courtesy of readers who funded her DonorsChoose grant request: “When they opened the packages, I had a roomful of students who have never been more excited about creating and taking books with activities home to share with their families. I have a list of students waiting to take home a project to share! Thank you for bringing learning opportunities to my amazing kids and encouraging them to be excited about STEM!”

I’m looking for a health system CIO or IT director who can become a regular HIStalk contributor Dr. Jayne style. I can also use a nurse in a CNIO or other informatics role as a second contributor. Reader survey respondents suggested I add these additional voices and I agree, although I’ve tried before with minimal success — I need expertise, good writing skills, and a commitment to sticking to a schedule. If you’re the CIO/CNIO equivalent of Dr. Jayne, contact me, but don’t be surprised when I ask you to write a sample post – several people have been gung ho until faced with the pressure of that first empty page, causing their sudden disappearance. 

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Siemens will take its Healthineers business public in an April IPO that will value the company at $48 billion, Reuters reports.

Eric Topol notes that healthcare has for the first time become the #1 source of American jobs, passing the retail sector. The federal government predicts that five of the seven fastest-growing industries over the next 10 years will be in healthcare. Topol concludes, “Human resources are the #1 driver of the $3.4 trillion healthcare expenditures/year; the job growth is unchecked. We watched an industry with nearly six decades of unbridled growth, with poor outcomes relative to the rest of the world, and did so little to alter the course.” I suspect the vast majority of those newly created jobs will not involve actually delivering care.

Sales

Kootenai Health (ID) selects the legacy data archiving solution of Parallon Technology Solutions to allow it to view extracted, self-hosted Meditech Magic data via a viewer.

UCSF Medical Center (CA) will implement IV safety analytics from Bainbridge Health, a spinoff of Children’s Hospital of Philadelphia.

In Canada, Peterborough Regional Health Centre expands its integration relationship with Summit Healthcare to include additional care coordination connectivity and integration with Connecting Ontario.

People

Video visit vendor MDLive hires Rich Berner (Allscripts) as CEO.

Announcements and Implementations

USPTO awards Glytec another patent, this time for personalized, computer-guided selection and dosing of any oral or injectable diabetes regimen.

Government and Politics

ONC Principal Deputy National Coordinator Genevieve Morris says regulations that will define and regulate information blocking will be published this spring. She says providers aren’t always comfortable sharing information with other providers whose security practices are unknown, but adds,

I think some of those trust concerns are used as a red herring to try to limit the sharing of data for competitive purposes. We’ve seen this with HIPAA, where we’ve been told ‘we can’t give that to you because of HIPAA.’ That’s totally misinterpreting HIPAA and these trust issues become a scapegoat for not wanting to share data for competitive reasons. Trying to figure out where that is happening versus real issues with sharing health information is part of the job that we take on.

HHS OIG says Georgia Medicaid made a lot of unallowable payments because the several systems it uses to assign ID numbers can’t detect duplicates.

Other

A Tufts analysis finds that the growing volume of data collected in clinical drug trials is increasing drug development time and adding integration challenges since most drug companies and research organizations still don’t collect EHR data electronically.

Sponsor Updates

• Casenet releases version 6.4 of its TruCare care management platform.
• Kyruus will offer its ProviderMatch patient access solutions on Epic’s App Orchard for seamless patient scheduling.
• Boston-based startup news site VentureFizz interviews ZappRx founder and CEO Zoë Barry.
• OpGen and Merck subsidiary ILUM Health Solutions will collaborate in a CDC-funded project to develop cloud- and mobile-base antimicrobial stewardship software for hospitals in Colombia that will support WHO’s WHONET global drug resistance monitoring software.
• Iatric Systems will integrate HealthGrid and Meditech solutions to help Ephraim McDowell Health (KY) with value-based care initiatives. 
• PerfectServe will integrate its clinical communication and care team collaboration platform with Microsoft Skype for Business to allow clinicians to conduct video conversations from within the PerfectServe application.
• Meditech will integrate aggregated data from Arcadia Healthcare Solutions into its Web EHR and analytics product for population health management.
• Besler renews its HFMA Peer Review designation.
• Netsmart will embed the virtual doctor service of American Well in long-term care and behavioral health EHR,  giving patients improved access to professionals and allowing them to obtain services from home.
• Culbert Healthcare Solutions will exhibit at the HFMA Revenue Cycle Conference January 18-19 in Foxborough, MA.
• Dimensional Insight will exhibit at the MUSE Executive Institute January 14-16 in Newport, CA.
• KLAS recognizes Aprima as a top-tier vendor of ambulatory RCM services for the large and small clinic categories.
• Iatric Systems will exhibit at the MUSE Executive Institute January 14-16 in Newport Coast, CA.
• InstaMed will exhibit at the HFMA Western Region Symposium January 14-17 in Las Vegas.

Blog Posts

• You Have Secure Texting…So Why Do You Need Mobile Device Management? (Spok)
• Raising the Stakes in 2018, CMS Continues Focus on Appeals and Grievances (Medecision)
• 2017 Innovator of the Year Awards (AdvancedMD)
• New Year’s Resolutions for the ACO (Arcadia Healthcare Solutions)
• The Case for Continuous Clinical Surveillance (Bernoulli)
• Meeting CMS Guidelines: New Reporting System for the Quality Payment Program (CareSync)
• Utilizing Location Technology to Help Protect Healthcare Staff (CenTrak)
• Hardware Improvements Greatly Improve Practice Functionality (Chart Logic)
• 3 Tricks for a Healthy Approach to Legacy Systems (Leidos Health)
• Why is it Important to Remain Compliant with State Mandates Around Prior Authorization? (CoverMyMeds)
• Set the Stage for Project Success by Investing in Business Analysts (CTG)
• Best Practices for Supporting Old and New Systems (Divurgent)
• Promoting System Efficiency in High Turnover Staff (Hayes Management Consulting)
• CIO Chat – John Kravitz, Geisinger Health System (Huntzinger Management Group)
• GDPR Compliance – What US Healthcare Organizations Need to Do (Impact Advisors)
• What are the conditions for use of secure messaging within healthcare settings? (Imprivata)
• Using Video to Change the Healthcare Consumer Experience (Influence Health)
• What to Expect When Deductibles Reset (and How to Ensure Patient Payments) (InstaMed)

Contacts

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

Monday Morning Update 1/8/18

Top News

ONC publishes a draft of its Trusted Exchange Framework as directed by Congress in the 21st Century Cures Act.

ONC hopes to create “a single on-ramp to interoperability for all.” Click the graphic to enlarge.

The public comment period is open through February 18. ONC expects to publish the final version late this year.

Reader Comments

From Chip McFlaude: “Re: Meltdown and Spectre CPU bug. The software patch will likely degrade performance on all IT systems. We’re waiting for benchmarks from Epic.” The near-certain performance hit that the patch will cause – and the possible need to add computing horsepower to offset it – is something providers and vendors should be paying attention to. Application of the patch isn’t optional even if hardware upgrades can’t be done first. Needless to say (hopefully, anyway), health systems need to apply the patch to every computing device – smartphones, desktops, servers, etc. — now that the flaw’s existence has been globally publicized and malware authors are rushing their new releases to market. 

From Just Another Healthtech Insider: “Re: KLAS. I founded a very successful health IT consulting firm that was always highly ranked in KLAS, but we never made the official list because we refused to pay KLAS for consulting services to be moved up from ‘not statistically relevant.’ Healthcare organizations rely on this information not realizing that moving up on the list may involve paying KLAS for their advice on how to rank higher. It may well be that KLAS helps vendors improve in general to also improve their scores specifically and that’s OK, although mixing vendor consulting with vendor ranking will always create suspicion, justified or otherwise. But has been observed many times, KLAS isn’t exactly either Consumer Reports or Black Book in transparently selling statistically validated customer reports that were collected on a large scale via transparent methods. Whether KLAS has a high impact on purchasing decisions or not, the possibility that it might has created an ever-expanding , KLAS-enriching vendor demand and relationships that are far from arm’s length. I don’t expect KLAS to ever publicly list how much it is paid annually by each vendor it ranks, but they fact that they’re paid at all serves as a reminder that it’s a consulting firm, not an influence-free industry watchdog. Unfortunately, the steps KLAS would need to take to achieve the latter would destroy its lucrative business model, so you either accept them as-is or not.

From Press Hangry: “Re: public relations firms. Our company needs PR services and would be interested in your recommendations, from boutique firms to larger ones.” I don’t have a good company-facing view of who does what, but PR folks are welcome to complete this form about their firms and I’ll forward the information to those companies that occasionally ask for help.

HIStalk Announcements and Requests

Most poll respondents say their 2017 was better than 2016, although commenters reported that they experienced personal illness, loss of family members, and concerns about the country’s direction.

New poll to your right or here: what makes a newly filed lawsuit newsworthy? My opinion is that accusations mean zero until a jury weighs the evidence and renders a verdict, but that’s just me not wanting to waste time on the vast majority of lawsuits that don’t result in a decisive victory either way.

HISsies nominations are still open.

HIMSS18 is just eight weeks away. Like every year, I’m getting a lot of post-New Year’s Day sponsorship information requests and new sponsors who are anxious to get started. I greatly appreciate the interest and the support. Lorre will be thrilled to get on a call to make it happen before March when we’re all hearing slot machines 24×7.

We provided three video cameras for Mrs. S’s third grade class in Pennsylvania in fully funding her DonorsChoose grant request to enrich her scientific methods unit. She reports, “My students are already planning out the science experiments that they want to conduct at home and record. There are so many possibilities of things to record and fun lessons to do with these video cameras!”

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

Last Week’s Most Interesting News

• A study finds minimal use and outcomes improvement of patients using a hospital’s patient portal while admitted as an inpatient.
• A report finds that one of many problems at VC-backed, four-state Medicare Advantage insurer Clover Health is that an analytics bug caused its outreach employees to call its healthiest members instead of its sickest to offer health advice.
• Doctors at the VA hospital in Roseburg, OR say administrators anxious to fudge their quality data ordered them to discharge sick ED patients and steer chronically ill patients to hospice care to avoid having them die in-house.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

The price of the world’s best-selling drug, Humira, has doubled in the past five years to $38,000 per year and accounts for two-thirds of its manufacturer’s $26 billion in annual revenue. It costs multiples more in the US than in the rest of the world and so far the company has done a good job squelching competing biosimilars.

Sales

Adventist Health outsources management of its revenue cycle and clinical applications employees to Cerner.

Decisions

• Cherokee Medical Center (AL) will switch from Medhost to CPSI Evident in February 2018.
• Merit Health-Batesville (MS) will go live with Medhost inpatient EHR in March 2018.
• Siloam Springs Regional Hospital (AR) replaced Medhost with McKesson’s inpatient EHR in September 2017.

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

Glytec’s software-as-a-medical-device for outpatient insulin titration earns a US patent.

Government and Politics

VA Secretary David Shulkin says in an interview that the VA has held off signing a contract with Cerner because the company’s definition of interoperability includes only the exchange of CCDAs, adding that, “To say it wasn’t a good meeting would be an understatement.” I doubt it was a intended as a shrewd VA contracting strategy to announce Cerner as its no-bid EHR vendor and then drag the publicly traded company along until it agrees to the VA’s terms under the threat of killing the golden goose, but at least the VA didn’t sign first and ask questions later as they seemed desperate to do just a few weeks ago. Having VA and DoD both using Cerner is not a guarantee of interoperability, but the bigger challenge might be connecting the VA to its many community-based providers, who use every EHR on the market. Going live without that capability when spending $10 billion or more is ludicrous. This is the first evidence I’ve seen that the VA might be listening to skeptical members of Congress instead of its White House selection committee who displayed questionable expertise in declaring Cerner the only viable choice. You have to wonder if Cerner could wangle out of the scrutiny more easily if they were working with a big government contractor used to making problems go away.

Other

An 18-year-old who pretended to be a doctor – running his own clinical and urgent care and strolling hospital halls in a white coat – is sentenced to 3 1/2 years in prison after pleading guilty to charges that also include stealing $35,000 from an 86-year-old “patient.” The fantastically named Malachi Love seems indignant that he was caught: “I’m just a young black guy who opened up a practice who is trying to do some good in the community. If that is a negative thing, we have a lot more work to do in the community than to single out me … Just because someone has the title doctor in front of their name does not necessarily imply MD.”

Sponsor Updates

• Optimum Healthcare IT creates an infographic titled “Formulary Management: Effects of Standardized Vs. Non-Standardized.”
• The American Heart Association names Sphere3 CEO Kourtney Govro a co-chair of the Kansas City Go Red for Women Luncheon on April 18.
• Surescripts will exhibit at the ASAP Annual Conference January 10-12 in Naples, FL.
• Visage Imaging will exhibit at the ACR-RBMA Practice Leaders Forum January 12-14 in Chandler, AZ.
• ZeOmega’s Jiva tackles major challenges surrounding population identification and stratification.

Blog Posts

• Crucial Lessons for Successful IT Transitions (Santa Rosa Consulting)
• Smart Hospitals and Future Technology Today (The SSI Group)
• Two Ways PRM Software can Increase Patient Satisfaction (Solutionreach)
• New Year Resolutions: Improving Transitions of Care (Summit Healthcare)
• See Voalte Platform at HIMSS18! (Voalte)
• How to Build a Single Customer View (West Corp.)
• Technology Brings Laser-Like Focus to Claim Status Monitoring (ZirMed)

Contacts

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

News 1/5/18

Top News

A Mayo Clinic Jacksonville study finds that only around 20 percent of inpatients who had previously registered for its patient portal actually used it during their stay, concluding that inpatient portal use probably doesn’t improve outcomes.

Mayo’s portal provides a real-time view of lab results, admission notes, consultation reports, and operative notes. It does not, however, give patients access to progress notes or provide electronic messaging with care teams, which might help explain why they didn’t bother to log on (or the fact that they were busy being sick). There’s also the question of whether Mayo’s inpatients are representative of the populations of other health systems.

It may also be that staff communication there was good enough that patients didn’t have to chase down news about themselves on the portal.

What I would want in an inpatient portal, or more specifically, a custom app running on a tablet:

• An integrated call system that allows me to indicate what I want or need and have my request prioritized and routed appropriately (just more ice at some point or a pain med now?)
• A schedule of my meds due, a photo of each dose to double-check employees who might screw up, and a link to a standard medical reference so I remember what it’s for.
• Two-way video would be nice for employees who otherwise have to make their way to my room for something that isn’t critical (maybe I want to ask a pharmacist a question, for example).
• The ability to create tasks for staff (like fix my TV) and for staff to create tasks for me (like get out of bed and walk down the hall twice a day), with completion times noted and stored for accountability.
• A Bluetooth-powered hospital badge that would flash the name and title of the person on the screen along with their photo and then record it so I could review it afterward.
• A list of ordered but not yet performed tests or procedures, ideally with the dates and times they are scheduled.
• Some idea of my care plan, success metrics, and expected outcomes.
• A display of every line item being charged for my stay in as near real time as possible.
• The usual hotel-like options for requests involving food, entertainment, and housekeeping.
• The ability to record what a caregiver is telling me so I can review it afterward to avoid missing something important.
• The Bluetooth badge-powered ability to display a giant, flashing red dollar sign when a hospital-sent caregiver enters my room who – despite my explicit instructions — isn’t in-network with my insurance.

Reader Comments

From Glory Basking: “Re: solutions, platforms, systems, applications. What’s the difference?” You would need to ask the marketing folks who love these terms and use them interchangeably. I remember an insistent email from a company’s marketing VP who was appalled that I had described its programmer utility (not the VP) as a “tool” instead of its preferred, overarching “platform.” That made me think of old-school techies would reference “a piece of software” — which was odd indeed since software is neither physical or divisible – or when an IBMer urged me in my short time as a vendor employee to always refer to our software as “solutions”or the even more grandiose “solution set” because it lulls the prospect into overlooking its many faults in picturing it as a reliable problem-solving appliance activated by writing a large check.

From Spinnaker: “Re: health IT podcasts. Which ones do you recommend?” I’ve never listened to any podcast – health IT or otherwise – but readers are welcome to make a recommendation. I would much rather skim the news visually for a minute or two (like on HIStalk) than sit through a real-time audio recording whose pacing I can’t control, but then again my attention span is so short that when I listen to the car radio (which isn’t often), I usually leave it on scan.

From Festivus: “Re: more EHR vendor lawsuits. See link.” Newly filed lawsuits are fun to write about, but I’ve mostly stopped because you’re just hearing one side of the story. Anybody can sue anyone for any reason in the good old United States of Litigious Peoples, so it’s journalistically lazy to write about a newly filed lawsuit as though it contains verified facts. Wait for the outcome – that’s the actual news.

From Thank You: “Re: HIStalk. It’s critical to my job and so valuable. I just wanted to drop a note and say thank you for all the hard work and effort you put into maintaining it and keeping the content fresh!” Thanks. I don’t have any time-suck hobbies other than starting with an empty screen and filling it up the best I can, so this is my golf or Facebooking.

From Spam in a Can: “Re: EHRs. Epic’s ‘we make you more money’ claims are erroneous, if not disingenuous, according to this journal article.” I’m not sure it says that. A JAMA Ophthalmology article recaps a survey of ophthalmologists about EHR use. My takeaways:

• The very long survey drew 348 respondents from a random sample of 2,000 AAO members invited, which isn’t a fantastic sample size or response rate (the US has about 18,000 practicing ophthalmologists). Only one respondent was selected within a given ZIP code and the survey was delivered via email. Of those respondents, only 265 reported using an EHR, so hopefully the authors discarded the 83 responses of those who don’t (but thus leaving the sample size even tinier).
• Epic was the most-used EHR, although only a vendor ranking was provided rather than actual numbers.
• 77 percent of EHR-using ophthalmologists say their practice is owned by physicians and only 6 percent by hospitals, which raises an interesting question – why the heck are so many of them using Epic instead of a specialty-specific EHR/PM? That seems suspicious.
• The 72 percent of respondents who use EHRs say their net revenues and productivity have declined while their practice costs have increased.
• Only 9 percent said net practice revenue increased with EHR use, while 35 percent said it stayed the same and 41 percent said it decreased. That seems odd since most of them also said coding levels and charge capture were unchanged or higher, leaving only reduced productivity as a possibility. Or that changes were associated with EHR implementation but not caused by it since time passed and situations changed either way.
• 36 percent of ophthalmologists said they would go back to paper if given the chance.
• A great majority of respondents said practice costs went up after implementing an EHR, but the study demographics also noted that most practices were running their first EHR. Obviously EHRs are more expensive than paper and the study didn’t ask respondents how much they thought costs rose, only whether they did, which again could have been due to unrelated factors over time.
• Many respondents were pushed into using EHRs because of Meaningful Use incentives, which brought their own burdensome EHR documentation requirements.
• It’s a perception study, which means that while practicing doctors rendered an opinion about cost, revenue, and profits, their participation was not vetted by role (so they aren’t necessarily involved in practice management) and their actual numbers weren’t reviewed.

HIStalk Announcements and Requests

The frantic Post-New Year’s, pre-HIMSS housekeeping is underway. Sponsors who want to be featured in my HIMSS guide will be receiving a link to the data collection form (anxious ones can contact Lorre). It’s also time to open the HISsies nominations, recalling that it’s like a political primary – the candidates with the most votes will appear for voting on the final ballot, so don’t complain later if you don’t nominate now.

Ms. M’s pre-K class in New York City received the science kits that HIStalk readers provided in funding her DonorsChoose teacher grant request. She reports, “We have been talking about volcanoes for the past few weeks. Many of the children didn’t even know what a volcano was. We are excited to start using these items within the next few weeks. You have made a tremendous impact on our class. Happy New Year.”

Listening: Garner, NC-based Sarah Shook & the Disarmers, a rare glimpse at what country music could be if devotees would stop throwing money at (a) throaty, big-city pretty boys inexplicably wearing cowboy hats indoors, and (b) privileged, bespangled warblers hiding their shiny pop ambitions behind a faux front of populism. This band is classic country meets sneering punk, unpolished and and full of hard-life experience, which is what country music used to be before big corporations took it over with harmless mannequins who would flee the studio in confusion if confronted with an actual pedal steel guitar or upright bass. I like that Sarah is an angry activist who chose as her band mates experienced (meaning: kind of old) musicians who really round out the sound.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

VC-backed, four-state Medicare Advantage insurer Clover Health is not only losing money, failing to negotiate lower-cost provider contracts, and leaving patients on the hook for bills it won’t pay, it is also struggling with its highly-touted analytics technology. A bug in its algorithm that was supposed to rank members from sickest to healthiest for outreach calls had reversed the order with nobody noticing for several months, wasting the time of reps who called its healthiest customers first in chasing the high-hanging fruit.

Enterprise telehealth platform vendor InTouch Health will acquire direct-to-home telehealth platform vendor TruClinic.

AMA-backed Akiri, which offers a secure subscriber data transport network for healthcare, raises $10 million in a Series A funding round.

Sales

The US Army expands its use of Vocera communications technology, adding a new hospital and expanding the rollout of two others.

Capital Region Medical Center (MO) chooses CloudWave’s managed, cloud-based disaster recovery services for Meditech.

LA County Department of Health Services renews its revenue cycle management software and services contract with Harris Healthcare’s QuadraMed Affinity Corporation.

Hospital Sisters Health System (IL) chooses Health Catalyst’s Data Operating System analytics system for its ACO and PCIN.

People

Mike Ruotolo (Inovalon) joins PatientSafe Solutions as regional sales VP.

Announcements and Implementations

A new KLAS report on population health management identifies six functionality areas (data aggregation, data analysis, care management, administrative and financial reporting, patient engagement, and clinician engagement) and finds that HealthEC and Forward Health Group lead the pack, with feedback coming mostly from ACOs. Health Catalyst, Arcadia, and Philips Wellcentive topped satisfaction for IDNs/CINs. Narrowly-focused PHM solutions offered by EHR vendors scored surprisingly poorly in clinician engagement compared to leaders Forward Health Group and Enli. 

Government and Politics

HIMSS adds VA Secretary David Shulkin to a Friday morning session at HIMSS18 called “It Takes a Community – Delivering 21st Century Coordinated Care for Those In and Out of Uniform” that also features Defense Health Agency Director Vice-Admiral Raquel Bono. I assume the VA will have signed its Cerner contract by then, but you never know. I noticed that HIMSS will also need to change the title of fellow keynoter Eric Schmidt, whose credential as executive chairman of Google parent Alphabet will end at company’s board meeting this month when he assumes the less-keynoterly title of “technical advisor.”

Other

A fascinating article by oncologist and author Siddhartha Mukherjee, DPhil, MD describes “the dying algorithm,” a 2016 Stanford project that mined EHR data retrospectively to create a deep neural network that could accurately predict whether a given patient would die within the next year. Interestingly, the algorithm works well but remains a black box because it’s not easy to figure out what it learned or how it applies its information to individual cases. It’s also interesting that despite sounding coldly high tech, the algorithm was developed with a nobler, more humane purpose – to identify terminally ill patients within the 3-12 month survival “sweet spot” in which palliative care is most effective in not wasting resources too early, but allowing patients enough time to settle their affairs.

New versions of the cell-enabled Apple Watch are randomly rebooting in hospitals, apparently affected – as its documentation acknowledges is possible – by pacemakers, defibrillators, and other medical equipment. Users report that switching the watch to airplane mode while in the ICU prevents rebooting.

I enjoyed this video from Brad Nieder, MD, a practicing doctor and comedian whose “The Health Humorist” website invites folks to, “Put on a paper dress. Grab a magazine from 1987. This won’t hurt a bit!”

Sponsor Updates

• Healthfinch is mentioned in KLAS’s emerging companies report.
• AssessURhealth joins Greenway Health’s online marketplace.
• Formativ Health renovates new space with sustainability in mind.
• Ingenious Med staff volunteer with Open Hand Atlanta to deliver meals to the homebound.
• KLAS highlights Health Catalyst as a high performer in a new population health management report.
• Kyruus will exhibit at the JP Morgan Healthcare Conference January 8-11 in San Francisco.
• ZeOmega adds identification and stratification tools to its Jiva population health management solution.

Blog Posts

• CIO Chat – John Kravitz, Geisinger Health System (Huntzinger Management Group)
• Singletrack: Small is Beautiful, and it Just Might Last (EClinicalWorks)
• 2018 Predictions from Healthcare Leaders Across the Country (Hayes Management Consulting)
• Identifying Cybersecurity Threats in Healthcare IT (The HCI Group)
• DrFirst Response to The President’s Commission on Combating Drug Addiction and the Opioid Crisis Report (DrFirst)
• Hunt Regional Medical Center Improves Patient Experience with Vocera (Vocera)
• Cost Savings from Standardizing the Formulary (Optimum Healthcare IT)
• Virtual Desktop Infrastructure – Drivers, Security, Costs and Benefits (Huntzinger Management Group)
• One Hospital, 62 Lives Saved: Our Work Gets Real (Iatric Systems)
• 2017: A Year in Review of Our Most Popular Content (Kyruus)
• When compliance dashboards and annual audits are not enough (Impact Advisors)
• 3 New Year’s Resolutions to Push Payers Into the Digital Age (InstaMed)
• InterSystems Healthcare Leadership Conference: Sun, sand and the future of health IT (InterSystems)
• Digital Transformation in Healthcare and Life Sciences Wrap Up: Have you defined your path? (Liaison Technologies)
• In Mammography, History Matters (LifeImage)
• How Advisory Services Helps Value-based Care Organizations Reach Their Goals (Lightbeam Health Solutions)
• How EHRs give time back to nurses (Meditech)
• If it’s 2018, it must be time for interoperability, data dumping, and changing chart ownership (Medicomp Systems)
• One Organization’s Journey to Whole-Person Care: Landis Communities (Netsmart)
• Happy New Year from Nordic (Nordic)
• With SayIt from NVoq, your Cloud-Based Speech Recognition is not just accurate, but always HIPAA compliant (NVoq)
• Reduce hospital readmission rates through tech-driven care coordination (Experian Health)
• ONC Speaks Up for Physicians (PatientKeeper)

Contacts

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

News 1/3/18

Top News

Some systems of Jones Memorial Hospital (NY) – including Meditech — remain down following an unspecified December 27 cyberattack.

The hospital is asking patients to bring in their insurance card, meds list, and whatever medical history they have.

Reader Comments

From Debtor: “Re: news article calling American Well a start-up. What’s the shelf life? That company was founded in 2012. Or is it just a more-hip way to say ‘small business’ with no implicit time constraint?” I agree. I posit that a “start-up” will possess these characteristics, the absence of any meaning it’s just a less-sexy “business”:

• Founded within the past five years.
• Has not been acquired. 
• Founders are still running the show.
• Annual revenue is under $50 million and headcount under 100.
• Implicit valuation is less than $500 million and funding is via bootstrapping, angel investors, and early funding rounds.
• The business model is uncertain and stability is absent.
• Growing quickly while remaining unprofitable.

From Sparsely Populated: “Re: hospital construction. All those publish or perish authors should consider trying to correlate big health system construction expense with patient satisfaction and improved outcomes.” That would be interesting, as is the fact that some are questioning why health systems are building Taj Mahospitals while proclaiming themselves fit for purpose as benevolent overseers of declining public health. It’s a Pandora’s box of trying to tie non-clinical hospital overhead to their effect on the only metric that matters – patient outcomes. Locals, however, don’t understand or don’t care that health system costs sap the national economy even if they boost the local one, so they’re proud to show off fancy buildings to visitors.

From Deal Watcher: “Re: wondering about EHR decisions. Singapore docs want Epic and the CIOs want Allscripts in a decision that was supposed to be made by December 31. Nova Scotia has been out on RFP and it’s between Allscripts and Cerner, perhaps on hold since the entire Canadian Maritime was considering collaborating on a single integrated EHR. The VA is still delayed despite strong rhetoric from Secretary David Shulkin – if interoperability is their goal, why invest $10+ billion in a new EHR that won’t get them very far instead of waiting a few years for MU3 and mandated APIs that will allow interoperability initiatives like the Carin Alliance go mainstream?” Singapore will announce its decision in the next 2-4 weeks, I hear. I haven’t heard about anything new from Nova Scotia. I’ve also never heard of the CARIN Alliance, an apparently for-profit member organization convened by former government officials as a Leavitt Partners project to facilitate consumer-directed exchange.   

From MD Professor: “Re: prescription drug monitoring programs. In my state, the focus on reducing opiate prescribing has seen skyrocketing rates of IV heroin use and overdoses even as available treatment programs have been reduced in number and insurance covers less of the high cost. Prescribing of even non-opiate controlled substances requires five minutes to deal with the state’s website. It only works with some browsers and enforces rigid password and reset rules that encourage poor security practices. The hospital says EHR interfacing is too expensive. I personally think the state makes the process cumbersome on purpose to dissuade clinicians from prescribing, so I don’t expect improvements to PDMP integration or usability any time soon.” You’ve identified four significant problems: (a) reducing the supply of legally manufactured opiates has raised their street cost and pushed users to less-reliable products that may kill them or steer them to crime to pay for their habit; (b) we are mired in the never-ending “war on drugs” that cannot be won by Darwinism, incarcerating users or dealers, fining drug distributors, or trying to limit access to drugs; (c) addicts trying to quit have few affordable treatment options; and (d) the use of PDMPs is creating unintended consequences even as it sucks up provider time. I don’t know the answer, but I’m pretty sure PDMPs specifically and technology in general aren’t it. A public health expert would tell you that few chronic conditions can be resolved by shaming or punishing those who have them, even if their own choices contributed.

From Jennifer Coons, RN: “Re: Seiling Municipal Hospital (OK). I know there have been lots of comments and rumors on HIStalk about my hospital and our decision to change vendors and I wanted to take time to address them and put them to a close. I appreciate your consideration in posting this letter to your readers.” Jennifer is administrator of the hospital. Click the graphic above to enlarge her letter explaining why the hospital recently reversed its decision to replace CPSI/Evident Thrive with Athenahealth and is now back on the former.

From Sick Doc: “Re: urgent care centers. I became ill with a high fever on New Year’s Day. All the urgent care centers were closed for the holiday.” I’ve often said that it’s no wonder that people show up in the ED for non-emergent issues. Private practices are nearly always closed outside of what used to be called bankers’ hours, urgent care centers set their own hours, and health system clinics stick to a university-like schedule, with only the ED offering the certainty that the lights will be on and the desk staffed. You would think a provider business case exists for being available for the other 14 or so hours each weekday plus weekends and holidays. I wonder if telemedicine providers similarly limit their availability?

From Banner Downgrade: “Re: Banner – University Medical Center, Tucson, AZ. A patient writes to the paper to complain about the EHR.” The letter writer says that following Banner’s “downgrade’ from Epic to Cerner:

• His 30-minute appointment took more than 3.5 hours.
• Banner’s Cerner system doesn’t receive his information his local doctors are sending.
• Automated paging is no longer offered, so waiting patient names are called out by nurses.
• He received a 13-page printout (sounds like a visit summary and/or patient education handout) that previously he could have accessed online.
• He no longer receives telephone appointment reminders.

HIStalk Announcements and Requests

Most poll respondents celebrate a winter holiday and most of those observe Christmas. Either way, the days are getting longer; we’re back in the post-holiday, pre-HIMSS frenzy; and it’s just 76 days until spring in the Northern Hemisphere.

New poll to your right or here: was 2017 an overall better year for you than 2016? You can elaborate further in the poll’s comments (click its “comments” link after voting).

Some reader survey respondents suggesting eliminating some sections of HIStalk. I decided to let democracy rule – vote on which of the listed sections I should keep or drop in a survey I call “HIStalk Hot or Not.” I’ll be making a few more changes in response to feedback from survey respondents, one of whom received a late Christmas present in the form of an Amazon gift card (check your junk mail, folks, since all I had was an email address and the emailed gift card hasn’t been claimed yet).

Anonymous Epic Developer’s DonorsChoose donation funded math games for Ms. M’s first-grade class in Goldsboro, NC and solar energy study materials for Mrs. Z’s elementary school class in Brooklyn, NY. Anonymous made a donation that paid for a STEAM center (resources and furniture) for Ms. M’s elementary school class in Albuquerque, NM and a laptop and case for Mrs. H’s high school class in Fayetteville, NC. The teachers took the time to email me on New Year’s Day to say thanks.

This may be the last DonorsChoose update based on responses to the “keep or drop” survey above. One reader survey respondent dismissed the DonorsChoose updates as undesirable “virtue signaling,” a term (made up by a magazine in 2015) that I had to look up and found to be incorrectly applied since it indicates saying but not actually doing something virtuous (like helping teachers in need). Not to mention that I’m celebrating reader financial support of students, not bragging on my own. I admit that while most of the 570 reader survey responses were constructive and/or supportive, others ranged from dismissive to downright hostile and that always stings for awhile.

Last Week’s Most Interesting News

• A consultant says Vermont’s HIE is not meeting the needs of its stakeholders and advises it to improve its services and financial sustainability.
• A physician says missed meds are due to complex psychological issues rather than just patient forgetfulness, raising the question of whether a Big Brother-like pill tracker can improve outcomes.
• The Indian Health Service issues and RFI for help in planning an IT future that will likely not involve the VA’s VistA, on which its RPMS systems are based.

Webinars

January 24 (Wednesday) 1:00 ET: “Location, Location, Location: How to Deploy RTLS Asset Management for Capital Savings.” Sponsor: Versus Technology. Presenter: Doug Duvall, solution architect, Versus Technology. Misplaced or sub-optimally deployed medical equipment delays patient care and hampers safety-mandated preventive maintenance. It also forces hospitals to buy more equipment despite an average utilization that may be as low as 30 percent, misdirecting precious capital dollars that could be better spent on more strategic projects. A real-time locating system (RTLS) cannot only track asset location, but also help ensure that equipment is properly distributed to the right place at the right time. This webinar will provide insight into the evaluation, selection, and benefits of an RTLS-powered asset management solution.

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

Acquisitions, Funding, Business, and Stock

Cancer informatics vendor Inspirata acquires Toronto-based Artificial Intelligence in Medicine, whose product uses AI/NLP to extract oncology information from clinical documents.

Sales

Union General Hospital (GA) chooses Cerner to replace McKesson Paragon and Athenahealth, planning a CommunityWorks deployment of Millennium, RCM, and HealtheIntent.

Decisions

• Slidell Memorial Hospital (LA) will switch from McKesson to Epic in 2018.
• Lavaca Medical Center (TX) will replace Healthland with Cerner in 2018.
• Merrick Medical Center (NE) will replace Healthland with Epic.
• Wayne Medical Center (TN) will switch from Meditech to Cerner in June 2018.

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

Sweden-based telemedicine and care center operator Doktor.se opens a clinic in a Swedish county where primary care is free, meaning that under Swedish law, everyone in Sweden can now access free virtual visits.

Black Book launches a mobile survey app.

Government and Politics

Doctors at the VA hospital in Roseburg, OR say metrics-obsessed administrators ordered them to discharge sick ED patients to make sure the hospital’s VA quality ratings (and administrator bonuses) didn’t suffer even though more than half its beds are always vacant. The hospital is also alleged to have told doctors to avoid listing congestive heart failure as an admitting diagnosis (since the hospital would be penalized for poor preventive care) and to steer chronically veterans to hospices to avoid having them counted as an in-hospital death.

Other

How cold it is? It’s so cold that exhibitionists are flashing drawings of themselves. It’s so cold that lawyers are putting their hands in their own pockets. It’s so cold that systems at IU Health Ball Memorial Hospital (IN) have gone down due to a shattered fiberoptic line.

Here’s Vince’s 30-year look back at the health IT landscape of January 1988, when long-timers might have been distracted by the latest episode of “The Cosby Show,” the end of the war in Iraq, or the scramble to get Michael Jackson “Bad” concert tickets.

Sponsor Updates

• Leidos Health publishes a white paper titled “Ready or Not, It’s MACRA Time.”
• Meditech announces its support for several STEM-related school initiatives.
• Audacious Inquiry’s Julie Boughn is recognized as a 2018 FedHealthIT100 awardee for contributions in modernizing enterprise health IT.
• AssessURhealth announces several 2017 company milestones, including a 170-percent increase in customer growth.
• Besler Consulting releases a new podcast, “American Healthcare: Worst value in the developed world?”
• CoverMyMeds celebrates its 2017 North American Visionary Innovation Leadership Award from Frost & Sullivan.
• KLAS recognizes CTG as Best in KLAS for Partial IT Outsourcing.

Blog Posts

• MACRA Quality: A step-by-step beginner’s guide (AdvancedMD)
• New Hypertension Guidelines (Arcadia Healthcare Solutions)
• Actionable Content: A Framework for Better Decision Making (Change Healthcare)
• Free Up Your Staff Time to Help Improve Patient Reviews (ChartLogic)
• How to Grab the Attention of Hiring Managers and Recruiters (Direct Consulting Associates)
• The Future of Data and Analytics in Healthcare (Dimensional Insight)

Contacts

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

The 20 Most Important Health IT Takeaways of 2017

1. Hospital Consolidation Ran Amok, Benefiting Cerner and Epic

The big are getting bigger and more profitable among both health systems and their technology vendors. The resulting rip-and-replace projects are offsetting the first wave of post-Meaningful Use demand slack-off. That trend will continue as health systems use their favorable billing rules to acquire not only medical practices, but nursing homes. The industry marches toward a few multi-state, legally non-profit but hugely profitable operators controlling their freshly expanded markets.

The EHR vendor market has consolidated into:

1. Epic and Cerner for US inpatient, as Epic announced plans to move down-market with a less-expensive basic system and Cerner held its advantage among large health systems that are contemplating merging into mega-systems.
2. Epic for health system-connected private practices.
3. Meditech for small health systems and those in Canada.
4. CPSI for cash-strapped rural and safety net hospitals.
5. Allscripts for hospitals in Australia and Europe, with newly acquired Paragon remaining an unknown.

2. Ambulatory Vendors Faced Reduced Post-MU Demand

Most practices that want an EHR already have one, and even some of those are being forced to displace their preferred system after being acquired by big health systems using Epic and Cerner. Ambulatory EHR vendors face several negative market pressures: complaints about poor usability and interoperability, technologically outdated products that still have to be maintained and enhanced, and lack of demand. The Department of Justice’s $155 million False Claims Act settlement with EClinicalWorks could portend similar charges against its competitors.

The bright spot for ambulatory EHR vendors is revenue cycle services (which they are well equipped to provide) and population health management technology (which they are not).

3. Value-Based Care Sounded Good, But Had Minimal Impact

Everybody likes the idea of paying for value instead of services performed — until they look at the work required and the potential profit lost. Heads in the beds and butts in the waiting room seats will continue to be the main driver as long as Medicare keeps paying for them.

4. The Press Exposed Questionable Business Practices

Theranos, Outcome Health, and NantHealth had their bubbles burst by dogged investigative reporting. Those exposés will likely continue as the shrinking journalism industry finds that those stories sell.

5. ONC Was Mostly Irrelevant

Much of the work around hot topics such as interoperability, EHR safety, and cybersecurity happened outside of ONC’s sphere of influence as it faced personnel changes and threatened budget cutbacks in a vastly different political environment.

6. The VA Rushed to Judgment

The VA — pushed by the White House to choose Cerner with the general thesis that running the same system as the VA will be good for veterans — announced to Congress that it will quickly sign a VistA-replacing Cerner no-bid contract despite unanswered questions around cost, DoD interoperability, and information exchange with the community-based providers that serve veterans.

The VA’s contract signing deadline of November was missed as Congress failed to move the VA’s money around to fund the deal, with the resulting extended timeline allowing Congress to pressure the VA into developing an actual plan on interoperability outside the federal government’s walls.

7. New Inpatient EHR Entrants Quickly Hit a Wall

The inpatient aspirations of EClinicalWorks and Athenahealth were dampened not only by complexity, the market’s preference for broad and mature product suites, and entrenched competition, but also by a DOJ settlement and activist investor pressure, respectively. ECW remained characteristically quiet, but the cost-cutting and executive-shedding Athenahealth was reduced to publicly sparring with CPSI over the decisions of tiny hospitals instead of with Epic over the large ones.

8. Allscripts and Greenway Announced Plans to Streamline Their Ambulatory EHR Portfolios

Both companies said they will develop a single system to replace their multiple aging ones.

9. Drug Companies Suddenly Became Interested in EHR Data That Technology Allowed Them To Obtain

Pharma needs to justify high drug prices and analyzing individual patient outcomes is one way to do that. They also found value in performing virtual clinical studies, recruiting clinical trials participants, and detecting adverse effects.

10. AI Hype Became Rampant as IBM Watson Health Turned Into a Marketing Term

Already-inflated expectations for artificial intelligence and machine learning expanded further, but the lack of results from IBM Watson Health, the paucity of transparency on exactly what Watson is doing and how, and Watson’s high-profile failure at MD Anderson encouraged moderating expectations even as Google and other technology firms look for healthcare nails to pound with their profitable hammers.

11. FHIR, APIs, and the CommonWell-Carequality Linkage Decreased Interoperability Barriers In Meeting The Minimal Market Demand For It

It predictably turned out that technology wasn’t the biggest barrier in exchanging patient information with competitors – it was that providers are fiercely protective of their business. Interoperability always works when demand exists, such as among multiple hospitals and practices within the same health system.

Providers will make interoperability happen quickly only if their profits depend on it. Perhaps the “data blocking” standard should be applied to health systems that manage to exchange information with disparate systems only within their own organization.

12. Population Health Management Presented Promise Without Many Definitive Results

Population health management and its associated technologies are an inherently good thing to patients, but the business model is marginal and slipping as the federal government steers the reimbursement ship back to fee-for-service. Implementation models vary widely, it’s early to publish definitive results, and providers whose profit comes from traditional services show reluctance to kill their golden goose. The track record of innovation whose only benefit is to patients is unfortunately poor.

13. The Federal Government’s Anti-ACA Efforts Threatened Provider Incomes

The federal government’s efforts to kill the ACA without an alternative in place will increase the number of uninsured patients who will still show up in the ED knowing they won’t be turned away, putting pressure on health system bottom lines that look great now only because their non-operational investments are killing it in a booming stock market.

The disrupted risk pool will continue to hamper insurers and the lack of political will to address exorbitant US healthcare charges guarantees that healthcare will be a mess for a long time except for deep-pockets consumers who can afford boutique care.

14. Big Companies Once Again Showed Their Health IT Short Attention Spans

McKesson sold out and GE mulled its healthcare IT exit as both companies chased the next shiny object in the face of sliding profits. Historical precedents are ample that buying health IT products from a company whose toes are dipped in other industries – especially if, as is nearly always the case, they turn out to be crappy health IT vendors — will nearly always leave customers stuck with a far-worse product turfed off hastily to a new owner at a devalued fire sale price.

15. Potential New Entrants Like CVS and Amazon Worried Health Systems As Hopeful Consumers Cheered

Health systems realized that despite the political clout that allowed them to become the default but questionably well-suited profiteer for everything from oncology practices to population health management, the market is becoming attractive to potential competitions such as CVS and Amazon that are not burdened by inefficiency and consumer indifference. The question of “who owns the patient” is valid, even if insulting to the patient who shouldn’t be “owned” by anyone.

16.  Cyberattacks Mostly Spared Hospitals, But Hit For-Profit Company Bottom Lines Hard

WannaCry and NotPetya malware caused temporary disruption of the operations of a handful of US hospitals, but publicly traded Merck and Nuance took big but temporary financial hits due to crippled operations.

17. The Federal Government Chased the Tip of the Healthcare Fraud Iceberg

Medicare’s pay-and-chase practices have created a ton of fraud and a few ounces of penalties that haven’t deterred the large number of scammers who make fortunes working the system’s many holes. A few high-profile settlements and prosecutions showed the risk to criminals, but the reward remains infinitely larger and the risk of actually serving prison time is minimal.

18. HIMSS Kept Getting Bigger

Cash-flush HIMSS has to spend its vendor-provided money somewhere, with competing publications and conferences topping its acquisition list and increasingly making it the all-controlling industry voice.

19. Technology Did Little to Improve the Opioid Crisis

Doctor-shopper databases have done little to improve the opioid situation, which remains a people rather than a technology problem due to user demand, doctor willingness to supply it due to questionable prescribing practices and sometimes outright fraud, and the ever-growing and ever-cheapening illegal drug supply that is happy to take up the slack if legal prescribing declines. Continuing demand with reduced supply does little except to raise prices and encourage customers to seek out more dangerous alternatives.

20. Digital Health Had a Few Bright Spots Among Unproven Apps

Consumer health apps and platforms continue to seem like good ideas even in the absence of evidence that they positively impact outcomes, they have minimal mainstream uptake outside of the quantified selves, and providers show no interest in looking at piles of self-captured information (especially when they aren’t being paid to do so) that provides little basis for intervention.

Patient engagement technologies offer promise in improving outcomes for a narrow subset of consumers, although definitive proof is mostly lacking. Technology vendors see the market opportunity in under-diagnosis, the extent and societal health value of which is questionable.

As an uplifting New Year’s bonus for “year in review” honors, I look back at the best health IT-related video ever created. The “Hamilton”-inspired production of Mary Washington Healthcare (VA) was appropriate to its location, magnificently written and performed by its employees, and reflective of the aspirations of a hospital implementing a new EHR.

News 12/29/17

Top News

A consulting firm’s review of Vermont’s HIE finds that 91 percent of its stakeholders think the state needs such a service, but VHIE is meeting the needs of only 19 percent of them.

VHIE gets 95 percent of its funding from public sources, which raises a sustainability red flag. It has spent $44 million, most of that provided from federal Meaningful Use funds.

The report says data quality is a problem; VHIE’s “cumbersome” opt-in policy has limited enrollment to 20 percent of the state’s population; and most users have view-only access.

The consulting firm recommends that VHIE:

• Provide search capability for extracted portions of the full record of patients
• Allow providers to submit public health reports and registry data
• Implement a master patient index and provider directory that can link patients to providers or ACOs
• Provide quality reports to support data-driven care
• Allow providers to submit Meaningful Use reports directly from their EHRs
• Coordinate with the state’s all-payer claims database to allow analyzing cost at patient and population levels

The HIE is run by Burlington-based Vermont Information Technology Leaders, which agreed with the consultant’s findings. John Evans, VITL president and CEO, will retire on January 1, 2018.

Reader Comments

From Mordecai: “Re: Renaissance Weekend. I received an invitation – have you heard of it?” I haven’t heard of it. According to its website, Renaissance Weekend  — not to be confused with those goofy Renaissance Faires where historically accurate / BDSM attired attendees frequently exclaim “huzzah” and “good morrow” while they waveth a smoked turkey leg in one hand and cell phone in the other — is an invitation-only retreat of diversely accomplished folks who get together to talk about public policy, innovation, science, and other heady topics. I’m interested in hearing from anyone who has attended or was invited. The idea of going someplace fun for brainy discussions is pretty cool, although interested folks would probably need a connection to be invited and a good supply of extroversion to make it worth going. Maybe there’s something similar with bar lowered for the rest of us. I knew a guy once who convened his own retreat sort of thing, where he invited interesting and diverse people to join him for a day (or maybe it was a weekend) of freewheeling, friendly discussion, although I can see that devolving into a beer bust.

HIStalk Announcements and Requests

An anonymous reader’s contribution to DonorsChoose, with matching funds applied from my anonymous vendor executive, fully paid for these teacher projects:

• Science books for Ms. C’s elementary school class in Provo, UT.
• Programmable robots for Ms. M’s elementary school class in Clermont, FL.
• A programmable robot for the Robot Coding Club of Mrs. J’s elementary school class in Cleveland, OH.
• STEAM kits for Mrs. K’s elementary school class in Winnetka, CA.
• A document camera for Mrs. W’s elementary school class in Elm City, NC.
• Six tablets and a printer for Mrs. J’s elementary school class in Forest Park, GA (it tugged at me when she mentioned that three of her students are homeless)
• Math activity centers for Mrs. S’s pre-kindergarten class in Hillsville, VA.

I was working early and funded the projects at around 4 a.m., but the apparently also early-rising Mrs. W got in touch almost immediately to say, “WOW! What a wonderful surprise! I can not thank you enough for your generosity! I am so excited to be able to give all of my students the ability to watch and interact with my daily lessons. This document camera will allow my students to be in the moment as I model lessons. This will also help students to be more engaged. Thank you!”

Webinars

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

Acquisitions, Funding, Business, and Stock

I realized this morning that it has been nearly six months since Neal Patterson died on July 9, at which time Cerner said its longstanding succession plan meant that “the process to select a new CEO is nearing a conclusion.” CFO Marc Naughton said in the October 26 earnings call that the board would “take their time and go through the process in a very careful manner.” Co-founder Cliff Illig remains as chairman and interim CEO. I don’t know how long the average publicly traded company takes to name a permanent CEO, but six months with an interim seems like a long time.

Sales

Shepherd Center (GA) will implement Epic in a Community Connect agreement with Piedmont Healthcare (GA).

People

Kyruus hires Chris Gervais (Threat Stack) as SVP of engineering.

Government and Politics

A health law firm says CMS is warning hospitals that they cannot send patient information by text messaging in any form since secure texting systems are unreliable. That seems unlikely other than for using messaging to transmit orders, which Joint Commission has raised as a potential problem because of the inconsistent workflow involved in entering them into EHR. I’ve reached out to CMS for a response. UPDATE: per the response I received from CMS, my suspicions were correct. Texting patient information among healthcare team members remains OK as long as the platform is secure, while texting patient orders is prohibited in all cases.

A ProPublica report finds that CMS has done little to investigate private practice doctors who nearly always bill at the most complex visit rate. One Alabama doctor coded 95 percent of his visits at the highest intensity vs. 5 percent of his peers, for which Medicare paid $450,000. An expert blames EHRs that assign billing codes based on which boxes are checked, saying, “Those programs tend to upcode.”

Privacy and Security

Systems at Jones Memorial Hospital (NY) go down due to an unspecified cyberattack. Amusing to me is that the hospital is located in Wellsville.

21st Century Oncology will pay a $2.3 million HHS OCR settlement for potential HIPAA violations involving a hacker using remote desktop protocol to penetrate the company’s network SQL database.

Other

The Peoria, IL newspaper describes the planned February 1 complete IT switchover of two hospitals that OSF HealthCare has acquired, which the IT team hopes to complete in just the seven hours between the 12:01 a.m. agreement effective time and the day shift’s start at 7:00 a.m. The OSF team has staged equipment on rolling carts, practiced assembly and testing, labeled 2,000 cables with their destination, and created training videos for non-technical employees and volunteers who will help with the conversion. CTO James Mormann says OSF is considering using its expertise to spin off a new IT system switching business.

Apple apologizes for intentionally slowing down older IPhones that have diminished battery capacity in an attempt to avoid unexpected shutdowns, offering as a mea culpa a price reduction on batteries for the IPhone 6 or newer from the usual $79 price to $29. The company will also provide a battery health meter in an IOS update in early 2018.

The latest Gallup poll of most ethical professions ranks nurses at the top, with doctors and pharmacists coming in at #4 and #5 even as the honesty ranking of pharmacists fell to its lowest score since 1994. Finishing dead last were members of Congress, car salespeople, and lobbyists.

Only a small fraction of Washington doctors are using the state’s prescription drug monitoring program database, leading one legislator to advocate making their participation mandatory. The state medical association blames standalone PDMP software that doesn’t connect to EHRs. Epic integrates with the state’s system, but only one hospital has turned it on. An expert recommends that the state double the PDMP’s technology budget, integrate the system with EHRs, and pay doctors to use it to avoid resistance to yet another unfunded mandate that takes up their time.

A New York Times article notes the new healthcare possibilities of the latest-generation Apple Watch, which connects directly to cellular networks instead of requiring tethering to an IPhone. It mentions the AliveCor KardiaBand for capturing EKGs, but observes that such devices can flood doctors with questionably useful information that they don’t know where to store. The company has responded by developing a software platform for doctors.

A NEJM op-ed piece questions the psychology behind patients who don’t take their prescribed medications and the role of the Proteus “digital pill” that monitors their medication adherence. The physician author says the problem is rarely caused by patients forgetting to take their meds – despite what they tell their doctor – but rather the psychology in acknowledging their mortality. Some snips:

Understanding takes time, and it’s often easier to tell people what to do than explore why they don’t do it. Even having studied the psychological factors driving non-adherence among patients with coronary disease, I often lapse into check-the-box mode with my patients … For those of us who struggle, the most effective adherence booster may be giving doctors and patients the time to explore the beliefs and attributions informing medication behaviors. These conversations can’t happen in a 15-minute visit. Given how little our health care system seems to value such interactions, it’s no wonder that skepticism often greets these new, unproven, and costly technologies. But though this skepticism may be warranted, it may also reflect a fear that the technology is intended to replace our efforts, rather than facilitate them.

A Froedtert Hospital (WI) anesthesiology resident with a history of depression kills himself on Christmas day by barricading himself in the OR, withdrawing fentanyl from the computerized dispensing system under a patient’s name, and administering it to himself.

Contacts

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

News 12/27/17

Top News

The Indian Health Service — which is about to have the VistA rug pulled out from under it as the VA frantically couples with Cerner — issues an RFI looking for help in figuring out how it can “modernize, augment, or replace RPMS legacy health IT systems, including, but not limited to, its clinical, administrative, financial and HIT infrastructure.”

IHS’s RPMS is based on VistA.

Reader Comments

From Steve E: “Re: Stanford Children’s Hospital. The $1.2 billion facility is open and it’s impressive, with lots of technology. You should write a piece on it.” The expanded 361-bed building opened December 9. It’s a beautiful facility, as it should be for $3.3 million per bed. We take a different approach in the US in building elaborate campuses for which we all pay with no promises that outcomes will improve. Patient satisfaction scores will rise because of amenities, although those aren’t any better of a predictor of long-term quality of life than impressive lobbies filled with crystal awards. I freely admit my cynicism about our profit-motivated healthcare non-system. 

HIStalk Announcements and Requests

The 82 percent of meeting attendees who sneak looks at their phones are most likely checking email or their calendar, although a few admit to being drawn to non work-related distractions such as news sites, Twitter, Facebook, Instagram, or Snapchat. THB says shiny object fascination is an addiction that can be cured only by confiscating everybody’s phone at the start of a meeting. Bored Amy observes that everybody at her company is so swamped that multi-tasking to keep up with email is mandatory, while MasterBlaster probes deeper into the “just in case you’re needed” meeting invitations where people are just sitting in the room on standby as the core meeting progresses just fine without their involvement.

Too many meetings are held just because they are on a recurring schedule, often bloated with an ever-expanding roster of marginally involved attendees who can’t escape after being added to a single agenda and never removed from the list. There’s also the age-old meeting problems that make participation frustrating: nobody takes charge, there’s no agenda or action items, nobody puts a stop to pontificating and factless chatter, and specific to-do assignments are not made even though it’s assumed that the next meeting will be held on the appointed calendar day. In that regard, self-gratification by phone may be a reasonable defense mechanism. It may be that just getting together without a specific purpose adds value in keeping everyone updated, but the odds aren’t good.

New poll to your right or here: which winter holiday do you consider to be your primary celebration? I’m happy to observe any holiday and I admit that I’m pleased rather than annoyed when someone wishes me Happy Holidays, Happy Kwanzaa, or Happy Anything Else instead of the traditional Merry Christmas — I’ll take all-too-rare best wishes from strangers any way I can get them. “Merry Christmas” is kind of weird anyway, grammatically speaking – when do we use the word “merry” otherwise? As a contrarian, I enjoy wishing people a John Lennon-style “Happy Christmas” just to stir them from their holiday coma with socialistic suspicion.

An anonymous reader sent a donation to DonorsChoose, which with matching funds will provide math materials for the kindergarten class of Mrs. A in Black Creek, NC.

I was binge-watching the engrossing “Halt and Catch Fire” on Netflix when I was struck by this strange but mostly unrelated fact, which I will present as a trivia question that you won’t get right without cheating. In what city was Microsoft founded, the same city in which Amazon’s Jeff Bezos was born?

Last Week’s Most Interesting News

• A newly submitted House bill would allow clearinghouses to sell patient data.
• Drug overdose deaths cause US life expectancy to drop for the second year in a row.
• Greenway Health files plans to lay off 120 of its Georgia-based employees in moving some functions to Tampa.

Webinars

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

Government and Politics

I was curious about former Rep. John Fleming, MD — appointed early this year to the newly-created ONC position of deputy assistant secretary for health technology reform — since I have heard next to nothing about him. I emailed my ONC contact on Christmas Day and got a quick reply,  which is either admirable or sad that both of us were keeping an eye on work email on the holiday. Fleming is leading workgroups on burden reduction, usability, and quality measures and I see he’s written some “Health IT Buzz” blog posts.

Other

Industry long-timer Orlando Portale says too many self-appointed AI pundits are expounding on a topic they know nothing about, which is unfortunately not uncommon in the “big hat, no cattle” world of health IT:

There remains a great deal of confusion from self-professed digital health evangelists and conference bloviators who don’t grok how AI/machine learning actually works … I suggest learning how to code or teaming with someone who does. Build something, otherwise your prognostications are without merit. To my physician friends on the digital health speaking circuit: AI/machine learning is a science, no different than the courses you had in med school. Treat the field with the same deference … Consider redirecting time wasted on Twitter cutting and pasting articles about other people’s work toward building something useful.

A study finds that excessive CT scanning turns up a lot of unrelated kidney tumors (“incidentalomas”) that are over-treated by removing the kidney, exposing the patient to more harm than benefit. This is yet another example of where our excessively fine-tuned diagnostic capabilities (which are getting more sophisticated by the minute as technology such as AI advances) lead clinicians down an expensive and sometimes patient-endangering rabbit hole. We need proven, affordable prevention and treatment strategies for already-detectable and clinically meaningful conditions, not companies that are anxious to profit from the consumer misconception that new diagnostic capabilities will improve societal health. Only outcomes matter. We could also use one where just being exposed to it carries its own significant danger via medical errors, overtreatment, and a frequent disconnect between science and practice.

Tanmay Bakshi, a 14-year-old IBM Watson programmer, is convinced of the value of AI in healthcare. He’s working on a project to help a disabled woman communicate through a neural network that models her brain. He developed his first IOS app at age nine, has published 150 YouTube videos to teach young people about technology, consults with major corporations, and has delivered keynote and TEDx presentations.

Sponsor Updates

Blog Posts

• Tech Blog: Virtual Desktop Infrastructure – Drivers, Security, Costs and Benefits (Huntzinger Management Group)

Contacts

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

News 12/22/17

Top News

Despite appearances, Medhost wasn’t hacked this week, the company says. The cyber intruder penetrated Medhost’s domain registrar (not its actual server or site) and then redirected visitors to a new webpage claiming he or she had stolen patient data. The company did a nice job explaining what happened and getting the site restored as quickly as the propagation of the restored DNS allowed.

Lesson learned for anyone running a website: use a complex domain registrar account password and turn on two-factor authentication if they offer it. I changed mine this morning.

Webinars

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

Acquisitions, Funding, Business, and Stock

Silicon Valley, meet Bubble 2.0 (and possibly the need for SEC Oversight Part Zillion): the juice manufacturer behind Long Island Iced Tea changes its name to Long Blockchain Corp. even though it admits that it is only beginning to look at blockchain with the vague idea that it might be something cool. The news sent micro-cap shares soaring 200 percent.

A previously dismissed shareholder rights law firm’s securities class action lawsuit against Quality Systems, Inc. is reversed on appeal, with the law firm claiming that Quality Systems/NextGen touted increasing revenue through February 2012, at which time the CEO sold his shares at a high price just before the company lowered guidance and reported lower net income. Above is the QSII share price chart from January 2012 through today, with QSII (dark blue, down 65 percent) vs. the Nasdaq (light blue, up 147 percent).

Sales

USF Health (FL) chooses Kyruus to help its access center match patients to providers.

People

Nordic promotes Michelle Lichte to EVP of client partnerships.

Gary Gartner, MD, MS (Allscripts) joins NextGen Healthcare as VP of clinical solutions.

Announcements and Implementations

A new KLAS report looks at healthcare management consulting (click the graphic to enlarge).The most-trusted partners of respondents in each consulting firm category (cross-industry, healthcare-specific, focused healthcare-specific) were Deloitte, Premier, and Optum. KLAS hasn’t sent me any report announcements since early 2014, so in checking their site to see how the company has grown, I note that it lists 12 executives and a 24-employee research team.

Government and Politics

A newly submitted House bill would allow clearinghouses to sell patient data in a reincarnation of previous bills that were suggested by lobbyists for Experian, The SSI Group, and Availity. Clearinghouses would not be considered HIPAA business associates or covered entities, and like providers that can use patient data without individual consent under the nebulous umbrella of treatment, payment, and operations, would not be required to seek authorization from patients and would be allowed to charge patients for providing copies of their own data. Unlike providers, they would also be allowed to sell data. Hat tip to Politico for turning this up.

The just-passed tax law will affect non-profits that include health systems, hitting them with a 21 percent excise tax on each salary of $1 million or more among their five highest-compensated employees who don’t provide medical services. Also affected will be universities (because of their highly paid presidents and sports coaches) and religious organizations. Given historical health system indifference to high salaries and the enforceability of existing employment contracts, the most likely outcome is that they will just figure out how to bill insurers and patients more to cover their new cost of doing business.

Privacy and Security

Fortified Health Security’s 2018 cybersecurity report finds that nearly all of its web and network penetration tests allowed access to patient information, while 33 percent of systems could be compromised due to incorrectly configured Citrix, VMware Horizon, and SSL VPNs. A rather shocking 72 percent of networks tested were at risk because of weak passwords. It recommends that organizations:

• Maintain and enforce security policies and procedures.
• Keep an updated inventory of devices that store, process, or transmit electronic PHI.
• Use strong security engineering when rolling out remote access solutions and web applications that store patient information in a SQL database.
• Enforce creation of strong passwords.
• Consider implementing systems data loss prevention, security incident event monitoring, and intrusion detection.
• Encrypt data at rest.
• Don’t get indifferent about patch management even though it’s a never-ending slog.

Technology

Wired magazine covers CareCoach, a $200 per month human-powered, tablet-presented simulated pet avatar that monitors high-need and elderly patients by checking in, offering medication reminders, and providing a bonding experience. It’s a good idea, although the avatar’s synthesized voice and inherent processing delays are hard to overlook.

Apple finally admits what many IPhone users have suspected – iOS intentionally slows down older iPhones. Not to sell users a newer model, but to prevent the old phones from shutting down because of deteriorating battery capacity. The takeaway: consider replacing your battery to speed your phone back up  instead of spending $1,000 on a replacement.

Bloomberg reports that Apple is developing electrocardiogram capability for its Watch in which wearers will touch two fingers from the opposite hand on the watch’s frame, possibly helping detect arrhythmias. Apple is behind since AliveCor’s Kardiaband add-on band for the Apple Watch is already FDA approved to capture EKGs.

Twitter continues to kill off its only virtue — mandatory brevity — by allowing its users to stitch together a string of tweets. I haven’t seen proportionately more user brilliance in the expansion of the 140-character limit to 280, no different when people who just couldn’t bear to edit their magnificent thoughts started attaching pictures of words that would not have fit otherwise.

Other

Sixty-three thousand drug overdose deaths in 2016 caused US life expectancy to drop for the second year in a row, the first time that has happened since the early 1960s.

A cafeteria worker at Advocate Trinity Hospital (IL) who says “you don’t have to wait until you get rich to help others” spends $5,000 to buy toys for pediatric patients at Advocate Children’s Hospital. In this tenth year of her project, she will donate half the toys to children in Puerto Rico. 

Dilbert, like “The Simpsons,” somehow remains relevant and edgy after many years.

Sponsor Updates

• Protenus publishes its November Breach Barometer.
• Liaison Technologies rolls out a single user interface for access to its Alloy integration and data management platform.
• HealthLoop will integrate its automated care plans and check-ins with patient activity and behavior analytics from Sherbit.
• A new release of Harris Healthcare’s Novus Meds medication reconciliation application offers mobile physician access and embedded drug knowledge, developed with Hunterdon Medical Center (NJ)
• CloudWave employees collect toys for United Way.
• Conduent will open a global technology and innovation hub in Raleigh, NC.
• LogicStream Health publishes a new case study featuring Tampa General Hospital, “Decreasing C.diff Rates Through Appropriate Testing with a Clinical Process Improvement software platform.”
• Mazars USA will donate $100,000 in 2018 to nine charities that will work to fight hunger.

Blog Posts

• InterSystems Healthcare Leadership Conference: Sun, sand and the future of health IT (InterSystems)
• Gunnison Valley Health Significantly Improves Revenue Cycle Time with ABILITY | EASE All-Payer (Ability Network)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• A Data-Inspired Future? You’re Looking at It (Liaison Technologies)
• In Mammography, History Matters (LifeImage)
• How providers can bridge care gaps caused by social determinants of health (Meditech)
• The Relationship between Artificial Intelligence and Healthcare: Why It’s Complicated and Why Robot Doctors Aren’t Our Future (Medicomp Systems)
• Is Your Revenue Cycle Ready for the New Year? (Navicure)
• 3 solutions to easily comply with shifting healthcare laws and regulations (Experian Health)
• Healthcare IT Trends to Watch in 2018 (PokitDok)
• How Will the CVS-Aetna Merger Transform the Patient Care Landscape? (Redox)
• Spread Holiday Cheer with These 6 Salesforce Carols (Salesforce)
• Two Bundled Payment Models Recalled by CMS, Others Still in Effect (The SSI Group)
• Save 15 Hours of Phone Time Each Week (Solutionreach)
• Quality improvement: more than just HEDIS (Verscend Technologies)
• Here’s to a happy, health New Year! (Voalte)
• The power of effective clinical communication (Vocera)
• 13 Benefits of a Pilot Project Before Buying (West Corp.)

Contacts

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

News 12/20/17

Top News

Medhost’s public website medhost.com was hacked Tuesday morning, according to a cyber intruder’s message that replaced the company’s usual home page content.

The hacker demanded 2 bitcoin ($37,000), threatening to otherwise “sell the patient data and do a media release regarding the lack of security in a HIPPA [sic] environment.” Medhost offers hosted financial and clinical systems, an emergency department system, a patient portal, and a health and wellness site.

The site had returned to normal by Tuesday afternoon with no acknowledgement of the previous problem on the site or on social media. A Medhost spokesperson did not return my call in which I asked for verification of the hacker’s claim that patient data was exposed.

UPDATE: shortly after the normal home page was restored late Tuesday afternoon, the site was apparently hit again with the “this website has been hacked” message restored.

UPDATE 2: Medhost CISO William Crank reports that the problem has been resolved and no information was compromised:

MEDHOST has full control of the domain, and the restoration of the domain and associated applications has been completed. Depending upon geographic location, sites may already have full access, but it is possible that the DNS restore process could take up to 24 hours to propagate the changes due to TTL. Intermittent application impact may be experienced by end users during that time. MEDHOST wants to reiterate that there is no indication that sensitive information was comprised and the incident didn’t extend beyond the redirection of the MEDHOST DNS to a static site with the message your article referenced. We strive to provide a robust and secure platform for our clients and continue to investigate this incident and its root cause.

Reader Comments

From Athenahealth: “Re: APIs. We have integrations with over 200 innovators and a developer community of 7,000, processing 700 million calls per month. Our single-instance, multi-tenant cloud platform allows a global integration model that allows immediate access to all partners for our clients – where innovators connect once and then are activated at clients with the flip of switch. We agree that talking numbers is interesting, but more so, let’s start to talk about API usability and the downstream impact of API calls.” It’s encouraging that Allscripts, Epic, and now Athenahealth have checked in with big API usage numbers. None of these are surprising – Allscripts (in the form of the acquired Eclipsys) pretty much defined the idea of inpatient systems with “hooks” as we called them in the old days, while Epic and Athenahealth stay current in deploying modern technologies and Athenahealth’s system is based on connectivity. I’m guessing Cerner has impressive numbers although I haven’t seen them.

From Event Attendee: “Re: John Halamka’s installation as Harvard Medical School’s inaugural International Healthcare Innovation Professor of Emergency Medicine. I had the distinct honor of attending and snapped a picture of a few notable CEOs in the room – Jonathan Bush (Athenahealth), Girish Navani (EClinicalWorks), and Hoda Sayed-Friel (Meditech). It’s remarkable that they spent the morning together honoring his lifetime of achievement.”

From Earth Shatterer: “Re: Epic. What exactly is Sonnet?” Sonnet is a streamlined, cheaper, faster-install subset of Epic’s full software suite being developed that will target small hospitals and physician groups, post-acute care facilities, and some international organizations. It will be released in March 2018. Sonnet was announced at HIMSS17 along with Utility, a fast installation program that gets customers live faster with fewer modifications. Epic says Utility implementations started in Q4 2017 (it’s now Epic’s most popular implementation method) and the first Utility-implemented customers will go live in 2018. Judy Faulkner chooses all Epic product names herself and they always contain a subtle reference, in this case with the word “sonnet” as translated from Italian as “little song.” Epic has tried similar rollouts in the past, twice in a partnership with Philips in the early 2000s and another attempt a few years later using the Sonnet name that may have failed because of newly mandated Meaningful Use requirements, but this one seems like a done deal.

From Who Else Remembers?: “Re: selection consultants having a conflict of interest. This is reminiscent of the late 1980s and early 1990s when Arthur Andersen was accused of a similar bias. Back then, the cozy relationship resulted in a string of predictable yet questionable wins for Gerber Alley and Statlan. Anderson would do the selection and inevitably be granted a large advisory and implementation role post award. Notably, Jay Toole and Andersen were crisscrossing the country espousing the virtues of a best-of-breed approach that needed lots of consulting help, for which Andersen was all to eager to offer the brave buyers of these footnotes in HIT history.” It’s a longstanding question of whether consulting firms that sell system services should be asked to help customers choose those same systems, at least without first recusing themselves from earning future business related to the selection. On the other hand, health systems can hire whoever they want and are presumably acting in their best interest. You mentioned Jay Toole, and in tracking him down, I learned that Dearborn Advisors filed Chapter 7 bankruptcy and apparently closed earlier this year. For more about Gerber Alley, see Vince’s HIS-tory.

From Fanny Pacque: “Re: vendor underbidding. Epic underbids (probably to their advantage) relative to their competitors. Implementation services, additional software, etc. always come later and require direct third-party engagement. This is the tick-tock on how you get to projects that go 2-3x over budget. Example: San Francisco Department of Public Health, which is a few months out from choosing Epic and they’re already bidding out voice recognition software, revenue cycle implementation, HIM, and patient outreach. You can see why Allscripts, Cerner, and others might suggest increased transparency on this topic since they provide fully loaded proposals.” San Francisco DPH’s several Epic-related RFPs are here (on the right side of the page as part of RFP 47-2017). I would think a prospect would know to compare apples to apples in choosing a vendor, but sometimes they get so mentally locked in to their favored vendor that they don’t dig deep enough and/or their lack of EHR selection experience makes them unsuited to detect contract land mines.

HIStalk Announcements and Requests

The efficiency of DonorsChoose is always impressive to see – we funded the teacher grant request of Mrs. A in Michigan on December 10 and her students are already using the STEM kits and experiment books we provided just nine days later, as evidenced by the photos above. She reports, “My students and I are so elated that this project was funded. The excitement they showed when we unwrapped the science kits was unprecedented! I wanted to thank you again for your very generous donation. The students are now able to take science out of the science classroom and bring it in to their homes. Not only have you allowed the students to experience science phenomena, you have also allowed their families to as well! Many of my students and their families do not have access to the items that will enable them to perform these experiments and now they do! You have truly helped to create lifelong memories.”

Welcome to new HIStalk Platinum Sponsor Ellkay, which brilliantly taglines itself as “Healthcare Data Plumbers.” The Elmwood Park, NJ-based company enables interoperability, providing a data pipeline for 45,000 practices and 500 PM/EHRs and connecting hospitals, practices, labs, payers, HIEs, and ACOs using almost any system. Products include connectivity for diagnostic labs; PM/EHR integration and data migration, lab orders and results interfaces; and ACO/HIE connectivity solutions. Its CareEvolve portal and interfaces provide clinical workflow support between laboratories and the point of care, while hundreds of hospitals have used Ellkay’s data extraction, conversion, and archiving services to decommission legacy systems. Black Book included Ellkay on its list of 2017’s most disruptive health IT companies that have top customer satisfaction scores. The company’s “Our Story” page is the most entertaining and fascinating backgrounder I’ve seen and the story about why they installed beehives on the company roof roped me in completely. Thanks to Ellkay for supporting HIStalk and for entertaining and informing me with an unusually cool website.

Webinars

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

Acquisitions, Funding, Business, and Stock

High-profile Silicon Valley investor Bill Gurley – an early Uber backer whose startup Brighter was just acquired by Cigna – launches Stitch Health, a Slack-like care team coordination and patient engagement platform. The Connect team communication system costs from $6 to $18 per user per month depending on features. Stitch CEO and co-founder Bharat Kilaru is a 2015 Harvard MBA graduate and ran a Nashville clinic for the underserved until 2013.

Pittsburgh-based specialized outpatient clinical documentation vendor Net Health will be acquired by two private equity firms and the company’s management team.

Humana and two private equity firms will acquire home health and long-term care operator Kindred Healthcare for $4 billion, continuing the trend of insurers moving into direct patient care.

A New York Times review of proposed health system mega-mergers contains some interesting quotes:

• “Hospital executives are realizing that someone else, including an insurance company employing the nurse at a walk-in clinic or the doctor at a surgery center, wants to take over their relationship with patients — and the potential revenue that those patients represent.”
• “But many point to the promises of past mergers as reason to doubt whether the hospital mergers allow much more than an ability to demand higher prices from insurers. After the last wave of mergers that took place a few years ago, the hospitals didn’t use that opportunity to bring their costs down.”
• “The challenge cannot be underestimated in asking these massive institutions to come together and change into something radically different. You’re taking a zebra and a zebra … what they want to become is a unicorn.”

Silicon Valley, meet Bubble 2.0: SoftBank will invest up to $300 million in a dog-walking app vendor that has already raised $40 million.

Sales

Mercy Health chooses PatientPing for real-time patient care coordination.

People

Recondo Technology hires Craig Niemiec (AxisPoint Health) as CFO.

Patrick Neil Mescall, PhD (Businessolver) joins VirtualHealth as SVP of channel development.

Former National Coordinator Karen De Salvo, MD, MPH, MSC joins Dell Medical School at the University of Texas at Austin as a professor, with appointments in internal medicine and population health.

Announcements and Implementations

A survey of a few dozen hospital CIOs finds that the biggest jump in deployed mobile strategy components over the next three years will be in critical test result alerts, clinical decision support alerts, and care team assignments. Respondents also indicated that their investment in communications technologies will be slightly more driven by system integration capabilities than by end user needs.

I’ve never heard of CHIME’s 2014 spinoffs AEHIS, AEHIT, and AEHIA – which seem to have been created primarily to help CHIME to lasso new dues-paying members who don’t meet the job qualifications to join CHIME since they aren’t CIOs (security executives, CTOs, and application leaders, respectively) – but for those CHIME members who are interested, they’re waiving dues for 2018. I don’t quite understand why a prominently posted press release on the site of AEHIS (that’s the security group) is “Fujifilm Captures New Customers for its Synapse Enterprise Imaging Solutions,” but then again I don’t usually like providers and vendors sharing an association-provided membership bed even when a logical connection exists. As readers have observed, CHIME is mimicking HIMSS in seemingly trying to get bigger, more vendor-friendly, and more executive-compensating, but its members are apparently OK with that and that’s all that counts.

Government and Politics

Americans say healthcare is the country’s second-biggest problem behind the government, Gallup finds. Healthcare hasn’t been one of the top two problems since 2007, when it finished a distance second to Iraq.

Privacy and Security

White House Homeland Security Advisor Tom Bossert says in a Wall Street Journal op-ed piece that North Korea launched the WannaCry malware attack earlier this year that hit hospitals hard, adding, “Pyongyang will be held accountable.”

A Black Book survey finds that 84 percent of healthcare provider organizations don’t have a chief information security officer, 54 percent don’t conduct cybersecurity risk assessments, and 39 percent don’t perform regular firewall penetration testing. The survey also finds that few boards of directors actively discuss cybersecurity.

Yet another exercise proves that de-identifying patient data doesn’t really work, as a university in Australia (as several have done) matches up a publicly released Australia Medicare database and re-identifies patients by linking their information to other publicly available databases. The Australian government is considering laws that would make re-identifying government data illegal, which is an interesting (and not in a good way) approach.

Other

A reader whose company has nothing to do with healthcare consulting was surprised to have it shortlisted among the “Top 10 Healthcare Consulting Firms 2018,” which comes with a (free) certificate and (not free) interview reprint rights from a magazine called Enterprise Services Outlook. The magazine shares a telephone number and street address with shady magazines (CIO Review and Healthcare Tech Outlook) published by Bangalore-based marketing firm SiliconIndia. I’ve previously noted the hilarious misspelling of HIPAA on the cover of Healthcare Tech Outlook and the fact that its covers always feature males. It has published an article by UC Health CIO Steve Hess (which also appeared word for word in Becker’s Hospital Review under a different UC Health author’s name) and by other health system CIOs like Marc Probst and Dan Waltz who probably don’t even realize who they’re writing for. The magazine invites readers who “skimp” [sic] its questionable vanity content to join its august roster of contributors.

Jenn ran this fun item on HIStalk Practice: an Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own epinephrine and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

Moxe Health founder and CEO Dan Wilson reads “’Twas the Night Before Go-Live,” an HIT-focused song parody written by Jay Rath. Jay fascinates me because in addition to having spent time with Epic, he’s a former staffer at “The Onion,” a contributor to “Mad” magazine, and has a broad background in theater and radio comedy.

Wendy from Bellin Health (WI) sent a photo of the Epic Willow team’s holiday-decorated cubicle area in the IT department that creatively adds a fireplace inside and a welcome mat out front. The coats inside prompted me to check Green Bay’s weather forecast – Tuesday was to be sunny with a relatively balmy high of 40 degrees and a low of 11, but Christmas will be biting as temps struggle to rise to zero (Fahrenheit, just to be clear).

Sponsor Updates

• The InstaMed team delivers over 900 presents to the Children’s Hospital of Philadelphia.
• Definitive Healthcare adds visual dashboards to its hospital and provider databases.
• Elsevier Clinical Solutions publishes a new white paper, “Build or Buy: Considerations when adding a new Clinical Decision Support System.”
• FormFast publishes a new case study, “East Alabama Medical Center Saves Time and Cuts Costs with FormFast’s Leading Form Design Technology & Services.”
• Healthfinch publishes a new case study featuring Valley Medical Group.
• Data analytics from Arcadia Healthcare Solutions supports a New York Times skin cancer investigation.
• T-System President and CEO is recognized at D CEO’s “Excellence in Healthcare” awards program.
• Besler Consulting releases a new podcast, “Perspectives on the Alex Azar nomination for HHS Secretary.”
• Mphasis Eldorado and Change Healthcare expand their partnership to include integration between Javelina and Change Healthcare’s payment integrity services.

Blog Posts

• 5 Tips for a Consumer Friendly Front Desk (Hayes Management Consulting)
• 6 Resolutions for a Healthier and Happier New Year (Healthgrades)
• The Evolution of Healthcare and Railways (Optimum Healthcare IT)
• eGartner to healthcare provider CIOs: Evaluate biometrics for their most important patient identification use cases (Imprivata)
• The New Healthcare CRM: Moving Beyond Marketing (Influence Health)
• A Look Back: The Top Tips of 2017 (Leidos Health)
• Red Flags You Have a Patient Access Problem (Kyruus)
• MIPS Cost Component – Three Things You Need to Know! (Impact Advisors)
• The Healthcare Platform Advantage: How to Do More With Less (Spok)
• Address All Four Parts of HIPAA Compliance (AdvancedMD)
• Agfa HealthCare proudly supports the UNICEF Emergency Fund (Agfa HealthCare)
• Q4 Industry Report: Shadow IT’s positives and negatives within healthcare (Datica)
• Amazon, CVS and Aetna: Online Medicine and the Future of Healthcare (CareSync)
• Navigate the Penalties & Bonuses of the 2018 MIPS Reporting Year (Chart Logic)
• Celebrating the Holidays with Karson and Make-A-Wish Foundation (CoverMyMeds)
• Embracing the Spirit of Giving (Dynamic Computing Services)
• How Will Artificial Intelligence and Machine Learning Impact Healthcare? (Dimensional Insight)

Contacts

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

Monday Morning Update 12/18/17

Top News

The Atlanta business paper has corrected its story that stated Greenway is closing its Atlanta and Carrollton, GA offices, now indicating that only the Atlanta office will close.

The company is moving some functions from Carrollton to Tampa, but a spokesperson says 500 employees of Greenway Revenue Services and other customer-facing functions will continue their work in Carrollton.

Greenway will also hire another 100 revenue cycle management employees for that location in the next few weeks and is actively hiring for its Tampa office.

The Georgia WARN act site indicates that the Atlanta office will be closed and 24 employees laid off, while the Carrollton layoff involves 96 Greenway employees.

Reader Comments

From Portland Liquid Sunshine: “Re: Cambia Grove. The director, program director, and others have left in the past few months. The new director has no background in innovation.” I don’t know anything about the Seattle healthcare innovation and investment workspace, but comparable offerings elsewhere have struggled.

From Associate CIO: “Re: UIC, Epic, and Cerner. The main issue that Cerner has (and I am surprised that Allscripts isn’t protesting as well as they finished third) is that the state of Illinois has a very strict procurement process. Final bids have to be all-inclusive, which Cerner’s was, but Epic’s was not since it included only licensing. The cost of Epic could end up being twice that offered by Cerner.” I extracted and summarized Associate CIO’s comment left on last week’s post since it interests me a lot.

From Slick Willie: “Re: UIC, Epic, and Cerner. The project was baked as soon as UIC hired Impact Advisors because (a) they always choose Epic, and (b) they always help with the implementation of Epic. Cerner has valid points.” Unverified. Statistics would  prove how often an Impact Advisors-led EHR selection results in an Epic decision and a follow-up implementation contract, but I assume that only the company could provide those numbers and I don’t expect that to happen unless the state of Illinois requests them as part of its review of Cerner’s protest.

From Aaron Iota: “Re: API transaction counts. Does that really matter?” Not to me. Prospects and observers should focus on: (a) whether open APIs are offered and to what outside systems; (b) which third-party vendors are using them; and (c) whether the APIs are meeting customer needs in giving them functionality they would not have otherwise had. A high transaction count simply validates that the APIs are functional and capable of scaling. It’s also true that customers of EHR vendors that offer a broader solution will find less value in APIs to outside systems that they may not require. High API usage means that the market wants interoperability and is getting it, which is the biggest takeaway. It might be interesting also to know whether the EHR vendors are charging for those services since “available” doesn’t necessarily mean “free.” 

From In the Know: “Re: Athenahealth. This is a little old news (October), but I don’t remember you mentioning it. Another Athena exec is gone as now-former CMO Todd Rothenhaus has been replaced by Kevin Ban. Seems like the only one left from one year ago is JB, and I wonder for how much longer?” It’s mostly a new management crew with the exception of Paul Armbrester (chief product officer since 2015) and Paul Merrild (SVP of sales since 2011).

HIStalk Announcements and Requests

The most common forms of on-the-job sexual harassment reported by poll respondents are inappropriate public comments, unwelcome touching, and seductive behavior. The comments are enlightening — if not entirely encouraging — with regard to male behavior. Perhaps the “glass half full” takeaway is that few respondents reported outright sexual assault or the insinuation that their hiring or advancement was predicated on their sexual submission. Note: please don’t misinterpret those percentages – the poll targeted only those who have been sexually harassed and multiple choices were allowed, so that 36 percent “degrading comments” figure means that one-third of the votes (not of participants) involved it. In other words, it is not correct to infer that 36 percent of all female readers have experienced degrading comments at work.

New poll to your right or here: which do you surreptitiously check most often on your phone during meetings? I’m always curious what drives people to tune out of meeting participation and instead steal sly glances at their phone held just below table level (as though the other attendees can’t tell that they are either screwing around with their phone or contemplating their crotch). Is it being invited to a meeting that you didn’t really need to attend, tuning out when you have nothing to contribute, or just being helplessly lured to the distraction machine that is so readily available?

Consider giving some closure to 2017 by completing my one-yearly reader survey. The results help me plan for 2018, and even though I can’t implement every suggestion or idea and I don’t make decisions by committee, there’s never been a year that I didn’t use quite a few suggestions to reapportion my HIStalk time. I’ll also randomly draw some responses from folks who will get a $50 Amazon gift card.

RIP Pat DiNizio, the 62-year-old Smithereens singer / songwriter who died last week at 62. I shall play the fabulous “Behind the Wall of Sleep” and “Blood and Roses” in his memory.

Reader Vicki made a generous donation to my DonorsChoose classroom project fund, which with matching money from my anonymous vendor executive and other sources fully paid for these teacher grant requests:

• A robotics construction kit for Ms. C’s second grade class in Asheville, NC.
• Math and science games for Mrs. T’s elementary school class in Merrill, MI.
• Science kits for Mrs. C’s elementary school class in Hamilton Twp, NJ.
• A microscope, safety goggles, and an elementary mixtures science kit for Ms. T’s elementary school class in Washington, DC.
• A Rube Goldberg Machine engineering kit for Ms. Ms. H’s sixth grade class in Blaine, MN.

Last Week’s Most Interesting News

• Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health.
• Greenway Health announces the layoff of 120 employees and the closing of its Atlanta offices as it moves some operations to Tampa.
• For-profit oncology operator 21st Century Oncology will pay $26 million to settle DOJ charges that it submitted fraudulent Meaningful Use documentation and paid its doctors to refer patients to its lab and radiation businesses.
• CliniComp sues Cerner for infringing on a 2003 patient right after it loses its challenge to the VA for choosing Cerner in a no-bid contract.
• The White House leads a half-day introductory meeting on EHR interoperability.

Webinars

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

Acquisitions, Funding, Business, and Stock

Ability Network raises $545 million in debt financing.

Cigna acquires health plan digital engagement platform vendor Brighter. The price was not disclosed, but the company had raised $49 million in funding and had apparently pivoted from its original business of offering an online marketplace for discounted dental care.

Sales

The Department of Defense chooses McKesson to provide a $400 million digital imaging network.

Decisions

• Memorial Hospital (IL) will switch from Meditech to Cerner in January 2018.
• Mountain View OB-GYN (PA) will replace EClinicalWorks with Epic’s ambulatory EHR in 2018.
• Medical Specialists of St Luke’s (MO) will replace EClinicalWorks with Cerner’s ambulatory EHR in June 2018.
• Fillmore County Hospital (NE) will move from NextGen to Cerner’s EHR in 2018.
• Cass County Memorial Hospital (IA) went live with Epic in November 2017.

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

People

John Halamka, MD, MS is installed as Harvard Medical School’s first International Healthcare Innovation Professor, where he will focus on emergency medicine.

Announcements and Implementations

Microsoft announces a private preview of an AI-powered healthcare chatbot project, with partners including Aurora Health Care and UPMC.

Geneia will integrate its cost and quality analyics solution with Salesforce Health Cloud.

Other

In South Australia, a clinical hematologist from Royal Adelaide Hospital – testifying at a coroner’s inquest into the deaths of several patients who were underdosed on chemotherapy – warns that a problematic Allscripts rollout has caused the planned 2009 implementation of electronic chemotherapy ordering to remain on hold, exposing patients to the risk of error-containing handwritten orders.

Weird News Andy says there’s a very dark comedy somewhere in this story. Organizations that offer doctors hands-on training sessions involving cadavers sometimes hold them in hotel ballrooms – including those of Disney, Hilton, and other big names — with a few sheets of plastic laid over the carpet to catch the inevitable spills and flying bone fragments. Reuters reporters saw cadavers being delivered via the hotel’s main passenger elevators, gore-covered doctors wandering hallways trying to find someplace to wash their hands, conference organizers setting up snack stations near the cadavers, and vacated ballroom trash cans overflowing with bloody materials and used syringes. Doctors are cutting downstairs and amateur porn auteurs are filming in the rooms, so don’t crawl on the carpet or use the comforter as a blanket.

Sponsor Updates

• Liaison Technologies leads the market in data regulatory compliance with its award-winning Alloy platform.
• Huffington Post profiles TriNetX.
• ZirMed’s Crystal Ewing joins the WEDI 2018 Board of Directors.
• PM/EHR vendor Chart Talk will offer its users patient engagement and communication capabilities from Solutionreach.

Blog Posts

• Henry Ford Adds More Choosing Wisely Alerts (Stanson Health)
• Red Flags You Have a Patient Access Problem (Kyruus)
• You’ve got a good radiology solution. Here’s how to make it great.(NVoq)
• Revenue Integrity: Improving Financial Stability (Impact Advisors)
• Patient Needs and Retail Healthcare (The SSI Group)
• 4 Practice Marketing Lessons Gleaned from Star Wars (Solutionreach)
• RSNA 2017: Visage’s Top Five (Visage Imaging)
• A chief resident’s tips for smartphone communication in an academic hospital. (Voalte)
• How mobile devices are impacting patient satisfaction (WiserTogether)
• Prior Authorization: Healthcare’s Biggest Bottleneck? – Part 1 (ZappRx)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne, Lt. Dan.
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News 12/15/17

Top News

Cerner files a protest with the state of Illinois, claiming that it unfairly chose Epic for a $100 million project at UI Health, which uses both systems.

Cerner says its bid was lower and that it was not allowed to demonstrate its product during the selection. It also says that UI Health hired as its IT selection consultant Impact Advisors, which it says could benefit from an Epic selection, a charge Impact Advisors denies in saying it works with clients of all three UI Health bidders (Epic, Cerner, and Allscripts).

UI Health chose Epic in September 2017 with plans to replace systems from Cerner, Allscripts, and McKesson in a late 2019 go-live.

The health system responded to the protest by saying that it has experienced Cerner problems in the past; that Epic beat Cerner on RFP scoring; and Cerner wasn’t invited to do a demo because it failed a technical review.

UI Health says it twice tried to roll out Cerner ambulatory and failed both times due to system performance problems that it claims Cerner has admitted. It also notes that Cerner is ranked well below Epic by KLAS. Cerner pointed out that its academic medical center market share is significant and raises the question of how it failed the technical review, noting also that UI Health hasn’t upgraded its systems per Cerner’s recommendations.

Reader Comments

From Considerable Girth: “Re: White House EHR meeting. It’s interesting that as it was happening, the VA seemed to be digging deeper into Cerner’s interoperability capability as their planned contract signing data passed. Could it be that Cerner downplayed the idea of interoperability to make the case that the VA’s only hope of connecting to the DoD was to also buy Cerner? Rumor is that politicians and even some White House folks are puzzled at how Epic has connected to dozens of VA and DoD sites and 100 percent of Epic sites that are interested in sharing information.” Unverified. The VA, which planned to have its fast-tracked, no-bid Cerner contract signed by now, seems to be suddenly realizing that theoretical interoperability with the DoD and community-based providers isn’t necessarily a reality. That’s the kind of information that should have been fleshed out in performing due diligence, dictating strong contract terms, and convening stakeholders to define mutually agreeable goals, all of which seemed to have been skipped in the VA’s White House-pressured rush to sign a Cerner contract. Both the VA and DoD have awful track records in choosing, planning, and executing IT contracts and allowing cash-flush vendors and consulting firms to pull wool over their eyes, so somehow I don’t think everybody (especially veterans) lives happily ever after just because Cerner is running in both places. I have heard speculation from a couple of folks that Cerner might have de-emphasized interoperability to the VA to make its product seem like the only logical choice for connecting to the DoD, and while that’s just talk, the VA seems to be parroting that concept.

From Gert: “Re: MedKeeper. Was recently acquired, but the mystery is who bought them.” Unverified. The IV workflow technology company lists no press contacts or other ways to reach it beyond product sales or support, so I couldn’t ask.

From FormerCIO: “Re: Dirty Dirge’s data on CHI is incorrect – they have only 103 hospitals and the allocation of systems is also incorrect.” I don’t have access to the Definitive Healthcare database to which that reader referenced, so I can’t say, although he or she seemed pretty solid on the details.

From Bet on Black?: “Re: Allscripts. Paul Black claims 1 billion third-party API calls to Allscripts in 2017. Vendors such as Athenahealth, Epic, Cerner, and Meditech – what is your apples-to-apples comparison?” That’s an interesting question, although the admirable “openness” could be a measure of the business necessity of supporting a narrower product line. It also depends whether common integration – such as simply displaying another company’s external clinical reference information via an Infobutton – should be counted vs. sharing data with actual transaction systems. Or for that matter, if transaction count in general is more a function of client volume than technical capability. Putting out a press release invites competitive comparisons. UPDATE: Epic says they’re handling 900 million transactions per month via public APIs, 415 million per month to power customer-developed services, and 21 billion connections to/from Epic-provided services (such as mobile apps and MyChart). So we have Allscripts at 83 million transactions per month to external systems and Epic at 1.3 billion – Cerner, Meditech, and Athenahealth, you’re up, at least if you believe that interoperability is about competing vendors rather than simply being happy that the market has demanded and received API access to EHRs.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Formativ Health. The company’s technology-agnostic patient access, revenue cycle, and practice operations services help patients feel like people and helps providers streamline operations, reduce leakage, improve insurance verification, and empower physicians to focus on keeping patients healthy. The 10-state, 450-employee company, based in New York City and a spinoff of Northwell Health, serves 3.5 million patients. It was selected a couple of months ago to provide management services to independent physicians via the Pennsylvania Medical Society’s Care-Centered Collaborative. Thanks to Formativ Health for supporting HIStalk.

This week on HIStalk Practice: 21st Century Oncology again finds itself in hot legal waters. HHS announces opioid code-a-thon winners. Clinicient acquires Keet. Infinity Behavioral Health Services acquires Health Assets Management. Greenway announces Georgia closures, layoffs. Alivio Medical Center joinsVillageMD. The FTC warns privacy-conscious consumers about at-home DNA testing kits. PRM Pro Jim Higgins shares five technological advances improving primary care communication.

I sometimes cringe upon reading negative comments left on my annual Reader Survey, no different than a mother being told by a stranger that her child is ugly. Still, I take some comfort in the many positive observations and the fact that even critics are apparently still reading HIStalk despite the flaws they perceive. I spend many hours each day writing it and ask only that you spend maybe three minutes completing the once-yearly, one-page survey to provide hopefully constructive input. You get the pride of participating in the democratic process, the satisfaction that you didn’t have to wait in a freezing voting line, the freedom from being harassed at the polls, and the hope of winning a $50 Amazon gift certificate. I’m secretly hoping that the Russians try to rig the vote.

Webinars

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

Acquisitions, Funding, Business, and Stock

The struggling Lifespan (RI) and the struggling GE (in the form of GE Healthcare) will collaborate in trying to save the health system $182 million over six years by identifying inefficiency using “cutting-edge analytics and tools.” Recently tanking GE shares are trading at their 1997 prices after a couple of bursts of misplaced investor enthusiasm, the Dow’s biggest loser since 2001 when Jeff Immelt took charge.

One-time high-flyer Greenway Health will close its Atlanta and Carrollton, GA offices in January and lay off 120 employees there as it moves operations to its Tampa, FL location. Greenway announced in October that it would merge functionality from all of its EHR/PM products into a next-generation product, but also said at that time that it would leave customer support intact in Carrollton while moving some functions to Tampa. The company was ironically recently named as Atlanta’s “Top Workplaces 2017” by the Atlanta newspaper. Greenway Health was created in 2013 as a repackaging of three holdings of its new private equity owner – publicly traded Greenway Medical Technologies, Vitera Healthcare Solutions, and SuccessEHS. Vitera was formerly Sage Software, which had purchased the former Medical Manager PM/EHR from Emdeon. Carrollton, population 25,000, is now stuck with an albatross of a street name since the soon-to-be vacated Greenway headquarters building sits on a street also named Greenway. UPDATE: the local business paper’s report that I cited was incorrect and has been updated. Greenway is moving some jobs from Carrollton to Tampa, but that office will remain open. More information is in the 12/18 Monday Morning Update.

Sales

New York EHealth Collaborative chooses Verato’s Auto-Steward for automating the correction of MPI patient mismatches on the SHIN-NY HIE.

In Canada, six-hospital CHAMP will implement Meditech’s Web EHR.

People

Peter Pronovost, MD, PhD — Hopkins Medicine SVP for safety and quality and perhaps healthcare’s most influential quality expert — will join insurer UnitedHealthcare as SVP of clinical strategy.

Announcements and Implementations

The HIMSS-owned Personal Connected Health Alliance releases new Continua Design Guidelines that support patients sharing data with providers.

Meditech will offer the patient electronic signatures solutions of Access in its cloud-based Web EHR subscription offering.

Government and Politics

Florida-based cancer treatment center operator 21st Century Oncology will pay $26 million to settle federal charges that submitted false Meaningful Use attestations that included falsified EHR usage data and phony utilization reports onto which it Photoshopped EHR vendor logos. The settlement also covers whistleblower-reported alleged Stark Law violations involved with paying doctors based on how many patients they referred to company-owned labs and radiation centers. 21st Century Oncology filed Chapter 11 bankruptcy earlier this year to protect itself from creditors and several fraud lawsuits.

A Chicago Tribune report finds that medical regulation is so lax in Illinois that “even the most desperate of doctors can find financial reward,” pointing out the fraud-filled home health industry that finds it easy to swindle Medicare and Medicaid. It notes that anyone can start a home health business by just paying a $25 license fee with no criminal background check required, leaving them free to troll public areas to recruit patients which, under Medicare rules, don’t have to be certified for care first.

HHS OIG approves a small pilot project in which medication management pharmacists employed by a Medicare Advantage plan will receive real-time discharge information from the hospital’s EHR to help reduce readmissions, which OIG says won’t run afoul of anti-kickback rules.

A former Johns Hopkins Health System patient appointments supervisor files a False Claims lawsuit claiming that he was ordered to “fill the plane” with patients from outside Maryland to skirt state limits on revenue paid by residents. The plaintiff says the health system’s medical concierge service prioritizes appointments for out-of-state patients as directed by top brass.

The FCC, as expected, reclassifies broadband providers as information services rather than telecommunications, reversing its 2015 ruling and freeing those companies from FCC oversight and thus allowing them to selectively prioritize or price traffic to any given website as long as they disclose their practices. Several states have already announced lawsuits challenging the decision. The broadband providers have declined to promise that they won’t do exactly what everyone fears, and unlike money-grabbing cable providers that can be easily fired, there’s no much of a cord-cutting option for the Internet unless you count cellular data. The only tiny consolation is that they didn’t abuse their customers too much before 2015, but that was a long time ago in Internet years.

Other

Eighty percent of the 500 C-level health IT executives surveyed by Healthcare Growth Partners report no impact on their business from the Trump administration’s activities and potential ACA changes, although the report notes that provider IT capital budgets were already in place for 2017 by Election Day. The number of executives who believe health IT is in an investment bubble increased from to 36 percent from 29 percent on 2015.

In Scotland, outpatients at Glasgow hospitals miss 12 percent of scheduled appointments, with 20-something men being the least reliable. NHS Greater Glasgow plans to enhance its automated text and call reminder system to require patients to respond to prevent their appointment from being given to another patient.

Texas medical resident Rachel Pearson, MD/PhD pens an Onion-worthy letter to the editor of a magazine, complaining that none of her patients have worked a day in their lives, they are ungrateful, they vomit and pee on her, and they have to be bribed to be examined. It’s a tongue-in-cheek reference to the still-unfunded federal CHIP program that insures most of her pediatric patients.

A hospital in China suspends a radiologist after she is caught on video playing a phone game while performing a CT scan.

Sponsor Updates

• AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.
• Spok publishes an explainer video for its Care Connect product.
• Medhost customer Mt. San Rafael Hospital (CO) becomes one of the country’s first to meet MU Stage 3 objectives.
• Liaison Technologies awards its second Data-Inspired Future Scholarship to AI-focused high school senior.
• Leidos Health publishes a white paper titled “From Good to Great: Strategic EHR Optimization Can Get You There.”
• Clinical research network TriNetX adds Natural Language Processing to extract information from physician notes and clinical reports, link it to other EHR data, and then present the combined information to researchers who can then design studies and identify potential patient participants.
• Logicworks launches targeted professional services portfolio for AWS.
• PokitDok becomes the first healthcare technology company to achieve CAQH CORE Phase IV Certification.

Blog Posts

• Fighting Cancer with CAR T and Big Data (Medicomp Systems)
• Claim Denials…Why do we still struggle after all these years? (Optimum Healthcare IT)
• Insights Around Data Access at the Patient Registries Summit 2017 (Liaison Technologies)
• Three Reasons Your Transfer Center Needs Image Exchange (LifeImage)
• 6 Exciting New Services from AWS Re:Invent 2017 (Logicworks)
• Meditech’s 5 best blogs of 2017 (Meditech)
• Focused on Recovery with a Whole-Person Approach (Netsmart)
• How Haitian high schoolers made me a better healthcare consultant (Nordic)
• Pause Before You Press (CloudWave)
• 4 ways to make your revenue cycle more predictable (Experian Health)

Contacts

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

News 12/13/17

Top News

CliniComp, fresh off its failed legal challenge of the VA’s choice of Cerner in a no-bid contract, sues Cerner for patent violation.

CliniComp says Cerner violated its 2003 patent for a remote hosted hospital system.

Reader Comments

From Dirty Dirge: “Re: big health system mergers. Who wins, Epic or Cerner?” I would instead ask whether the potential benefits of standardizing systems justify ripping and replacing existing EHRs when their sites cover a big swath of geography without much service area overlap. Maybe it’s OK to limit patient information exchange to the basics, like CCDs, since patients rarely seek care outside their local area. The most compelling argument would be populating a single database that can support analytics, operational analysis, research, and best practices, but that could theoretically be done on the back end with a lot of semantic data translation. The only comparably sized  model is the Kaiser’s use of Epic, but their implementation happened a long time ago; they have more focused corporate control than I would expect of newly merged health systems that can’t even name a single CEO; and Kaiser controls more of the patient experience as an insurer as well as a provider. Perhaps most at risk are Allscripts ambulatory or Meditech in sites included in the merger plans. My guess would be that the highest-priority system projects would involve administrative systems to allow executives to get a handle on their sprawling enterprises. We are really entering uncharted territory since most “huge” health systems have revenue of $2-5 billion vs. the dozens of billions that the proposed mega-mergers would create. Lower-tier vendors should take note – as hard as it already is to sell systems, it’s about to get a lot harder when you have to earn face time with a CIO who controls the IT strategy and budget of more than 100 hospitals (in comparison, Kaiser has only 39 hospitals).

Associate CIO provides these merger-related figures from Definitive Healthcare:

• Dignity Health’s 48 hospitals run Cerner Millennium.
• Catholic Health Initiative’s 153 hospitals use Cerner (61), Epic (65), and Meditech (27), also on the ambulatory side running McKesson (4) and Allscripts (21).
• Ascension Health’s 132 hospitals use Cerner except for Providence and Wheaton Franciscan, which use Epic.
• Providence St. Joseph’s 58 hospitals use Epic (37), Meditech (19), and Allscripts (3).

In terms of dominant vendor in the two proposed mega-mergers, it’s obviously Cerner over Epic (109 vs. 65 and 130 vs. 39, respectively). Here’s a fun opportunity for Definitive or HIMSS Analytics to list the major systems (beyond just the EHR) used by these health systems that are contemplating merging.

From Comprn: “Re: Lifepoint Health. RIF including multiple VPs, about 25 FTEs, due to lower-than-expected earnings.” Unverified. The 72-hospital company cut its revenue and profit forecasts in late October due to fewer-than-expected admissions for the fiscal year. LPNT shares are down 15 percent over the past year vs. the Nasdaq’s gain of 27 percent, valuing the company at $2 billion. It’s probably tough competing with systems bigger than yours that don’t pay taxes and that are equally profit-motivated.

From Trust but Verify: “Re: White House EHR meeting. A news site says [publication name omitted] broke the story but I saw it two days before on HIStalk.” Correct. An anonymous reader sent me the agenda via my Rumor Report online form and I posted the information in Sunday night’s post. Nobody else ran anything that I saw until at least Monday morning, so I’m pretty sure all mentions were triggered by reading it on HIStalk. One site that emailed me late Sunday ran their item (with the agenda that I sent them) Monday morning, but didn’t give credit. I’m also surprised at news organizations that cite one particular health IT website as a source when it’s pretty much like Wikipedia, with no original content.

HIStalk Announcements and Requests

Cumberland Consulting Group’s employee volunteer and community action group donated $1,000 to my DonorsChoose project, which with matching funds from my anonymous vendor executive and other sources funded the entire cost of these projects for high-need classrooms:

• Take-home family math activities for Ms. D’s elementary school class in Houston, TX.
• Hands-on math games for Ms. K’s first-grade class in Indianapolis, IN.
• Games for science game night for Mrs. S’s elementary school in Gautier, MS.
• Microscopes, telescopes, and science kits for Mrs. B’s elementary school class in Gulfport, MS.
• Take-home science activity kits for Mrs. M’s elementary school class in Chattanooga, TN.
• STEM kits for Mrs. M’s elementary school class in Paterson, NJ.
• STEM books and activity kits for Mrs. H’s elementary school class in Sugar Creek, MO.
• Programmable robots for Mrs. G’s elementary school class in Brownsville, TX.
• After-school science kits and supplies for Mrs. P’s elementary school class in Pocatello, ID.
• 200 sets of headphones for Ms. C’s elementary school class in Provo, UT.
• STEM project kits for family game nights for Ms. M’s elementary school class in Fayetteville, NC.
• Programmable robots and a Chromebook for Mrs. G’s elementary school class in Miami Gardens, FL.
• STEM kits for Ms. T’s elementary school class in Bronx, NY.
• STEM project kits for family game nights for Mrs. H’s elementary school class in Canyon, TX.
• Programmable robots for Mrs. F’s high school class in Glen Dale, WV.
• STEM activity kits for a student-led STEM gender and ethnic diversity project of Mrs. I’s high school class in Orangeburg, SC.
• Math and science resources for Ms. S’s first-grade class in Dayton, OH.
• Headphones for the technology lab of Ms. W’s elementary school class in Memphis, TN.

Can you please take 3-5 minutes to complete my once-yearly, one-page HIStalk reader survey? I’ll use the results to plan for 2018, but if you need even more motivation, I’ll be randomly drawing respondents to win a $50 Amazon gift card. Thank you.

Webinars

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

Acquisitions, Funding, Business, and Stock

Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.

Physician scheduling system vendor QGenda acquires ED physician scheduling software vendor Tangier.

Aetna CEO Mark Bertolini tells investors that he envisions that a merger with CVS would allow placing health hubs in pharmacies that would serve as health system navigators, especially for the 60 percent of people who don’t have a regular doctor. He says it could work like the Genius Bar in Apple Stores.

Nashville-based health IT staffing firm ALKU acquires Holland Square Group, a health IT consulting firm also based in the Nashville area. Holland Square Group is a DoD MHS Genesis subcontractor under Leidos.

Sales

OhioHealth (OH) chooses Casechek’s implant supply chain automation.

People

Hans Morefield (Experian) joins substance use disorder technology vendor Chess Health as CEO. The company’s executive chair is industry long-timer John Holton.

CTG hires Jeff Gerkin (Manpower Group) as EVP of sales.

Brett Jarvis (LinkedIn) will join Solutionreach as SVP of customer success.

Announcements and Implementations

Mental and behavioral screening software vendor AssessURhealth offers its app on the Athenahealth Marketplace.

New Jersey’s state medical society brings its OneHealth New Jersey HIE live.

Legacy Data Access will offer its 800 hospital customers a hosted, AI-powered clinical data service in partnership with Life2.

Firelands Regional Medical Center (OH) goes live on Meditech’s Web EHR.

New York – Presbyterian installs telemedicine kiosks in some of its New York-based Duane Read drugstores, making its ED doctors available to review problems that are not life-threatening.

Ground was broken this week on what would have been Cerner CEO Neal Patterson’s 68th birthday on the Patterson Health Center, a $41 million critical access hospital on the Kansas-Oklahoma border that is mostly funded by the Patterson Foundation. The facility, which combines two existing hospitals that merged on November 1, will offer a 15-bed hospital, health clinic, rehab services, a wellness center, and public green space. The family was represented by Neal’s nephew Alan Patterson:

Uncle Neal never really left the farm. He came back to Harper County just about any chance he had. Even after he was a big shot on the cover of Forbes Magazine, he came home at harvest to drive a combine, bring meals to the field, and hang out with the guys when the work was done. If you drove by the farm, you would often see him running the company from a laptop while sitting on the front porch of the farmhouse where he grew up. To me, he was a big kid who was 30 years older than me but enjoyed doing the same things I did. He was like another high school buddy would come back to visit his parents and hang out …  Neal traveled the world and he saw something troubling that most of us don’t see. He saw that small towns were in a healthcare crisis and they were being left behind. He saw that people in rural areas had poorer overall health compared to people in bigger communities. Little hospitals were not the most profitable areas of the business, nor the ones that would help ensure his company made quarterly earnings… but he did not care. He knew that good healthcare facilities and technology were important to rural communities

Government and Politics

A Wisconsin judge dismisses the revenue cycle system lawsuit that Agnesian Healthcare filed against Cerner, noting that Agnesian’s contract requires it to submit to arbitration in Cerner’s home state of Missouri instead of suing. Anesian claimed in the now-dismissed September 2017 lawsuit that a botched RCM conversion from McKesson to Cerner in 2015 cost it $16 million in revenue and $200,000 per month due to coding and billing errors, while Cerner insists that it fixed the problems in 2016.

CDC Director Brenda Fitzgerald is recusing herself from issues related to health IT and oncology because she is legally required to keep her illiquid investments in LLCs involving Greenway Health (EHRs) and Isommune (cancer detection). Fitzgerald – a former OB-GYN, Air Force major, and commissioner of Georgia’s Department of Public Health – and her ED physician husband reported assets valued at up to $16 million.

The New Yorker profiles “Estonia, the Digital Republic,” describing how the post-Soviet republic of 1.3 million people transformed itself into a digital society that embraces robots, a personalized chip ID, making nearly all business and personal information available online, giving every person ownership of data recorded about them, and a “once only” policy that pulls in existing information for everything from buying a house to seeing a doctor.  The country is reconsidering the definition of “population” by connecting virtual talent in an “e-residency” program that allows citizens of other countries to become residents of Estonia with access to digital services without ever setting foot in the country. Some snips from the fascinating article:

“I’ll show you a digital health record,” she said, to explain. “A doctor from here”—a file from one clinic—“can see the research that this doctor”—she pointed to another—“does.” She’d locked a third record, from a female-medicine practice, so that no other doctor would be able to see it …  E-ambulance is keyed onto X-Road, and allows paramedics to access patients’ medical records, meaning that the team that arrives for your chest pains will have access to your latest cardiology report and ECG. Since 2011, the hospital has also run a telemedicine system … Rita Beljuskina, a nurse anesthetist, led me through a wide hallway lined with steel doors leading to the eighteen operating theatres. Screens above us showed eighteen columns, each marked out with 24 hours. Surgeons book their patients into the queue, Beljuskina explained, along with urgency levels and any machinery or personnel they might need. An on-call anesthesiologist schedules them in order to optimize the theatres and the equipment … She logged on with her own ID. If she were to glance at any patient’s data, she explained, the access would be tagged to her name, and she would get a call inquiring why it was necessary. The system also scans for drug interactions, so if your otolaryngologist prescribes something that clashes with the pills your cardiologist told you to take, the computer will put up a red flag.

Privacy and Security

An Accenture-conducted, AMA-sponsored survey of 1,300 physicians survey finds that 83 percent have experienced cyberattacks and want cyber hygiene tips, a guide on conducting a risk assessment, and easy-to-understand HIPAA instructions. The survey’s methodology isn’t the best, however:

• Respondents were apparently self-selected and only completed an online survey.
• If only AMA members were polled (the report doesn’t say), that would be only a tiny, non-representative subset of all US doctors.
• Respondent demographics were not provided, such as the size of their practice site or whether they work for a health system.
• Half of respondents say they have an in-house security official, although the question wasn’t asked about that person’s time allocation and credentials.
• More than one-fourth of responding physicians say they have outsourced security management, but the survey didn’t ask what that means.
• More than half of respondents say someone clicked on a phishing link, which doesn’t really seem like a cyberattack unless it resulted in downtime.
• Only 37 percent reported that an employee inappropriately accessed PHI, which is surely low.

Technology

Apple will launch the IMac Pro this week at an entry price of $5,000 for 32 GB of memory and 1 TB of storage and up to $17K for a fully loaded machine, testing the limits of just how much of an Apple tax even professional users are willing to pay. It’s not an Apples-to-apples comparison, but my Acer laptop has 16 GB, 1 TB (along with a 128 GB SSDD for running Windows 10) and cheap available upgrades and I only paid a bit more than $500. Even that capacity is excessive since nearly everything I use is on the Web.

Other

Two-thirds of the few dozen interviewed patients who got their lab results via a clinic’s patient portal weren’t given further explanation, sending most of them to Google to try to figure out what the results mean. The article concludes that just displaying lab numbers on a portal isn’t enough, especially for patients with abnormal results.

In Canada, all-digital Humber River Hospital opens a Meditech-powered, 4,500-square-foot Command Centre in which staff monitor real-time incidents such as delayed care and provider workload issues. It also contains a 26-panel GE Wall of Analytics with live video feeds from patient care areas.

A just-published review of a 2016 Netherlands bake-off of 32 algorithms that analyze tissue slides to detect breast cancer metastasis finds that seven performed better than a panel of 11 pathologists when limited by typical workflow time constraints. The best algorithms performed equal to the pathologist panel when time constraints were removed. 

A review of 1,300 clinic visits finds that patients asked their doctors for specific lab tests, referrals, pain meds, other medication an average of once per visit; the doctor agreed to write the order for what they wanted 85 percent of the time; and those patients who were turned down gave the doctor lower satisfaction scores.

Javon Bea, CEO of five-hospital Mercyhealth (WI), was paid $8.38 million in 2016, far more than basically any charity or health system. The newest tax form I found was from 2014 and even then the CIO made over $750,000. Maybe nobody wants to live in Janesville, WI or work for Mercyhealth if they have to pay that much. Axios notes that even under his previously slightly lower pay, Bea earned $72 per patient day, although he told the local paper that his then-$3 million paycheck had no impact on healthcare costs even as he increased the system’s revenue from $33 million to $1 billion. 

Sponsor Updates

• Spok launches a library of stories illustrating the ROI of clinical communication technology.
• Optimum Healthcare IT completes its work as primary partner for UCI Health in its Epic Connect strategic partnership with UC San Diego Health.
• Change Healthcare SVP of Product Development and Technology Michael Wood joins the 2018 Class of the Nashville Health Care Council Fellows.
• AssesURHealth raises $2,700 for the American Foundation for Suicide Prevention as part of the Out of the Darkness Tampa Bay Walk.
• Change Healthcare will integrate Tibco’s Connected Intelligence product line with its products.
• Besler Consulting releases a new podcast, “S10 changes you should know about.”
• Glassdoor includes CoverMyMeds in its list of Best Places to Work in 2018.
• Diameter Health achieves NCQA Certification for all 2017 e-measures.
• Vyne’s Trace and FastAttach solutions earn HITRUST CSF certification.
• EClinicalWorks will exhibit at the New York Society for Gastrointestinal Endoscopy 41st Annual New York Course December 14-15 in New York City.
• The “I Love Madison Podcast” features Healthfinch VP of Finance and Operations Leah Roe.
• Technology Headlines Magazine names Intelligent Medical Objects CEO Frank Naeymi-Rad one of the 50 Most Admired CEOs of 2017.
• ConnectiveRx publishes a new white paper, “Boost prescriber knowledge and confidence using in-EHR formulary-status messaging.”

Blog Posts

• How Hawaii’s Busiest Emergency Room Went Paperless with Electronic Patient Signatures (and Your Hospital Can, Too). (Access)
• MIPS Tips (Aprima)
• What Real-Time Data Could Have Done for These Patients (Bernoulli Health)
• Why Let’s Encrypt is Our Favorite Open Source Project This Year (Datica)
• Recapping Redox’s Bold Predictions for 2017 (Redox)
• MHealth Trends Report: Patient Expectations for Healthcare Communication (CareSync)
• CIO Chat – Laura Smith, UnityPoint Health (Huntzinger Management Group)
• Measuring Value: The Real ROI of Communication Technology (Spok)
• Technology Supporting Navigation (Carevive)
• Utilizing Location Technology to Help Protect Healthcare Staff (CenTrak)
• Blockchain: What Is It and How to Build a Business Case (Change Healthcare)
• The Top Three Executable Strategies of Successful Affiliation (Leidos Health)
• Questions to Ask Yourself About Your Practice’s Billing Department (ChartLogic)
• Turning Medicine Upside Down (EClinicalWorks)
• SQL + SSRS Tip: Time Blocking (Iatric Systems)
• 6 Steps to an Effective Revenue Integrity Program (Hayes Management Consulting)
• Healthcare 2025: Digital Healthcare Platforms First (The HCI Group)
• Avoiding Hand-to-Hand Combat: M&A Survival Tactics (Huntzinger Management Group)
• Clinical Data Management Quality Solutions: Hiding in Plain Sight (Diameter Health)

Contacts

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

Monday Morning Update 12/11/17

Top News

The White House’s Office of American Innovation will host a half-day meeting Tuesday on EHR interoperability, led by Jared Kushner and CMS Administrator Seema Verma. Thanks to the reader who forwarded the agenda, which did not include a list of invitees. Working groups will address four topics:

• How CMS, ONC, and HHS can encourage interoperability and accelerate its timeframe.
• The methods of authentication that could be used and how can the industry can be aligned to support them.
• How patients and physicians can be engaged in interoperability and how and any HIPAA issues can be addressed.
• How can the private sector can become engaged and their participation jump-started by the government’s release of claims or other data.

HIStalk Announcements and Requests

Fairly few male readers are worried that incidents in their past could result in new claims of sexual harassment. HarassedMan was pursued by a male superior and urges employers to provide clear training, policies, and enforcement procedures. HISJunkie wonders whatever happened to innocent until proven guilty and also suggests that a man who is terminating a female employee for cause think carefully about the situation.

New poll to your right or here, continuing last week’s poll: women, what kind of sexual harassment have you experienced? I found my inquiry limited by the format of a poll, so perhaps I’ll follow up with a survey to answer questions such as:

• Did you rebuff the advances, and if so, did it hurt your career?
• Did you report it to HR, and if so, was the issue resolved to your satisfaction?
• If you didn’t rebuff or report, why not?
• Have you ever provided sexual favors or accepted sexual situations — or worked with someone who did — to get hired or to improve job prospects? This is hard to ask, but it happens and encourages bad situations for others. I feel sorry for a man or woman who successfully stops an uncomfortable situation but sees their job suffer because co-workers accept it as quid pro quo.
• Are you considering taking any legal action or going public with incidents from your past?

Three dozen clinician respondents are mixed on whether hospital VIP patients have better clinical outcomes. Nearly half say yes, while around one-fourth each say the outcomes are the same or worse as in the cheap seats. I was appalled at my first hospital job in learning that my for-profit employer – whose outcomes were universally terrible, as you would expect when bean counters oversee all the clinical decisions of a badly educated medical staff recruited for obedience and volume rather than quality –cleared an entire hallway to house the hypochondriac mother of our very profitable eye surgeon. Our profit-obsessed executives convened emergency department head meetings to make sure everybody figuratively genuflected to meet her every need (I got stuck running out to get the kind of wine she preferred since our nutritional services people could barely open cans and heat up food service frozen entrees) and made rare appearances in patient care areas only because she was propped up back there like a queen. At least working for a for-profit hospital shortened the path to my disillusionment with hospitals and maybe humanity in general.

Listening: new from Bully, Nashville-based grunge rockers who sound like Hole mixed with the Breeders. The tiny female singer, who has a rather chirpy conversational voice but can really belt it out cathartically when singing, looks quite a bit like Lucy in the original “Twin Peaks.” 

Friend at Impact generously donated $1,000 to my DonorsChoose project, asking that I focus on elementary school STEM materials (which I’m quite happy to do since I usually seek those out). I applied a dollar-for-dollar match from my anonymous vendor executive plus other matching (the $1,000 donation ended up fully funding a stunning $8,200 worth of grants) for these projects in schools whose students are almost all from low-income households:

• Lab coats, goggles, science journals, and activity kits for Ms. G’s fourth-grade class in Los Angeles, CA.
• An IPad for running programmable robot kits for Ms. S’s elementary school technology club in Los Angeles, CA.
• Three video cameras for home science experiments for Mrs. S’s third-grade class in Philadelphia, PA.
• STEAM activity kits for the after-school elementary school program of Mrs. M in Springdale, AR.
• Math activity kits and games for Mrs. H’s elementary school class for the deaf and blind in Mobile, AL.
• Programmable robots for Mrs. W’s elementary school class in Cartersville, GA.
• Programmable robots for Mrs. O’s elementary school class in Garland, TX.
• STEM kits and experiment books for Mrs. A’s elementary school class in Detroit, MI.
• Six electronic note pads for Mrs. N’s elementary school class in Farmville, MI.
• Take-home math and STEM games for Mrs. F’s elementary school class in Mescalero, NM.
• A STEM bundle for Mrs. T’s kindergarten class in Dallas, TX.
• Take-home math game bags for Ms. M’s elementary school class in Bronx, NY.
• STEM games for Mr. M’s elementary school class in Milwaukee, WI.
• Weekly take-home science projects for Ms. I’s elementary school class in Oxnard, CA.

This Week in Health IT History

One year ago:

• President Obama signs the 21st Century Cures Act into law.
• The Wireless-Life Sciences Alliance trade group and the HIMSS-owned Personal Connected Health Alliance merge.
• CommonWell Health Alliance and Sequoia Project’s Carequality announce plans to connect their respective systems.
• The American Heart Association, AMA, DHX Group, and HIMSS launch the non-profit Xcertia to establish best practices for mobile health apps.
• SocialWellth brings back the Happtique app certification program.
• MD Anderson considers layoffs and research cutbacks after losing $102 million in the first two months of its fiscal year, with the cost of its Epic implementation being one of four factors hurting its bottom line.

Five years ago:

• Mediware acquires inpatient rehabilitation and respiratory services documentation systems vendor MediServe.
• Allscripts sues NYC Health + Hospitals for choosing Epic at what the company says is a $535 million premium to its own bid, to which the health system responds that Allscripts lacks an integrated EHR and that the company is suing to try to prop up its sagging share price.
• McKesson Paragon beats out Cerner as the #2 product suite behind Epic in Best in KLAS, while Agfa, McKesson, and Allscripts were ranked as the worst vendors overall.

Ten years ago:

• MedAssets conducts its IPO.
• Dairyland Healthcare brings in a new executive team following its acquisition by Francisco Partners.
• NextGen creates a revenue cycle management division for physician practices.
• Philips acquires ICU monitoring technology vendor Visicu for $430 million, paying 12 times Visicu’s annual revenue.

Last Week’s Most Interesting News

• FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).
• Dignity Health and Catholic Health Initiatives announce plans to merge in creating the country’s largest health system in terms of revenue.
• Advocate Health Care announces plans to merge with Aurora Health Care.
• The Sequoia Project announces that its Carequality initiative connects more than half of all US healthcare providers, with 1,000 hospitals, 25,000 clinics, and 580,000 providers exchanging 1.7 million clinical documents monthly.
• CVS announces an agreement to buy Aetna for $69 billion.
• Former GE CEO Jeff Immelt says the company tried to buy Epic but was immediately rebuffed and also considered acquiring Cerner but thought the $2 billion price was too high.

Webinars

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

Acquisitions, Funding, Business, and Stock

Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.

Patient payments technology vendor Cedar raises $13 million in a Series A funding round. Co-founder Florian Otto, DDS, MD, PhD was sales VP for ZocDoc before starting Cedar in April 2016.

The urge to merge reaches manic levels as Ascension and Providence St. Joseph Health are reportedly talking about combining to create a 191-hospital system with $45 billion in annual revenue, eclipsing last week’s signed agreement between Dignity Health and Catholic Health Initiatives that set the short-lived annual revenue record of $28 billion. Ascension is a Cerner shop, while Providence St. Joseph Health – formed in a July 2016 merger — uses Epic, Meditech, and Allscripts.

Decisions

• Albion Family Practice (PA) will switch from Allscripts to Epic ambulatory EHR in 2018.
• Saratoga Hospital Medical Group (NY) went live with Athenahealth ambulatory EHR in Q4 of 2017.
• Munroe Regional Medical Center (FL) switched from Medhost to Cerner in 2017.

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

People

Atlantic Health System promotes Ben Bordonaro to chief administrative information officer.

Government and Politics

A GAO report finds that the VA spent $1.1 billion on four failed efforts to modernize VistA – HealtheVet, iEHR, VistA Evolution, and EHRM. GAO also notes that the VA has requested $4.1 billion for IT in 2018. Among the 15 key VA contractors on the failed projects was Cerner, who will sell the VA its VistA replacement system. An interesting tidbit from the report is that two of the VA’s systems are over 50 years old, both of them COBOL-based mainframe systems.

Privacy and Security

UNC Health Care (NC) notifies 24,000 patients that their PHI was contained on an unencrypted laptop stolen from a dermatology practice it had acquired in 2015. The health system pledges in the announcement to do a better job of reviewing the security of practices it acquires.

Other

In England, Royal Surrey County Hospital goes back to paper scheduling after an upgrade to its Allscripts system fails. I think they are using the Oasis Medical Solutions PAS, acquired by Allscripts in mid-2014.

I ran across Medsender, a company I hadn’t heard of that promises to end 100 percent of medical record faxing or else there’s no cost to the customer. The company claims the product can be installed in 60 seconds and works with any EHR. Founder/CEO Zain Qayyum developed the product in 2014 while attending Marist College full time. 

The operating income of UMass Memorial Health Care (MA) declined 74 percent in the fiscal year that ended September 30, with executives noting a modest increase in insurer payments, its $200 million in capital projects, and a $700 million Epic implementation that has taken doctors away from their revenue-generating clinic work as they build the system.

Sponsor Updates

• Sunquest Information Systems hosts its 19th annual holiday toy drive for Aviva Children’s Services.
• Surescripts will exhibit at the Health Care Law Institute 2017 December 14 in New York City.
• A national IDN upgrades to ZeOmega’s Jiva 6.1 population health management platform.
• LogicStream Health will exhibit at the IHI National Forum December 10-13 in Orlando, and will host a poolside party December 11 from 6:30-8:30pm ET.

Blog Posts

• Redox Microservices Journey Part Two, Principles (Redox)
• 10 Last-Minute Marketing Tactics to End 2017 with Great Results (Salesforce)
• Ambulatory Surgery Center Payment and Process in 2018 and Beyond (The SSI Group)
• Year End Newsletters – Keeping Your Patients in the Know (Solutionreach)
• Bridging complex healthcare systems. (Voalte)
• 4 Ways to Reduce Call Volume with SMS (West Corp.)
• Where disease management and employee wellness overlap (WiserTogether)

Contacts

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

News 12/8/17

Top News

FDA releases three sets of digital health guidance: clinical decision support (draft), reassertion that lifestyle apps will not be treated as medical devices (draft), and how software will be assessed as a medical device (final).

FDA will focus its attention and medical device status on software that analyzes medical images, physiological monitoring data, sound waves, sleep apnea monitor data, spectroscopy data, and slide pathology, as well as software that uses undisclosed algorithms.

FDA says software isn’t a medical device just because it:

• Uses patient information to present treatment guidelines and drug interaction / allergy alerts.
• Offers prioritized alternatives to orders and drugs using generally accepted practices.
• Suggests an intervention or a test consistent with clinical guidelines or drug labeling.
• Makes suggestions for chemotherapy.
• Uses rule-based tools to compare patient data to practice guidelines.
• Provides tools, calculators, or protocols for TPN or enteral nutrition. 
• Provides patients with prescription reminders and instructions that are consistent with FDA labeling.
• Helps patients choose a non-prescription drug based on their symptoms.
• Is intended only for healthcare facility use.
• Allows patients to document or illustrate their conditions with their providers.

FDA also says it will not enforce its own requirement that electronic patient software be classified as a medical device if it isn’t certified by ONC.

Software that stores, converts, or displays medical images will also be moved to non-device status, but software that analyzes the images will be treated as a medical device.

Software that flags patient results based on specific parameters (such as out-of-range results or opportunities for complementary tests) will not be regulated as a medical device as long as it only performs the same interpretation that the practitioner could do themselves.

HIStalk Announcements and Requests

CompuGroup Medical and its US CEO Benedikt Brueckle donated $500 to my DonorsChoose project, which when matched with funds from my anonymous vendor executive and other sources (I found some GREAT matching, as you’ll see, $5 for each $1 in some cases) fully paid for these classroom projects:

• STEM games for Mrs. S’s fourth-grade class in Columbus, OH.
• A mobile science lab for Mrs. N’s middle school class in Bay Shore, NY.
• Ten sets of headphones for Ms. M’s elementary school class in Philadelphia, PA.
• A library of 30 fiction and non-fiction books for Ms. E’s elementary school class in Bronx, NY.
• A carbon dioxide meter and air quality mapping supplies for Mrs. E’s elementary school class in Detroit, MI.
• A STEM activity table for Mrs. S’s elementary school class in Malden, MA.
• STEM activity centers for Ms. Z’s pre-kindergarten class in Fort Worth, TX.
• Air quality meters for Mrs. A’s fifth-grade class in Greenville, PA.
• A three-day environmental science mountain camping trip for Mrs. V’s fifth-grade class in Los Angeles, CA.

Several teachers, including Ms. E, responded almost immediately: “We want to thank you for your warm heart and generosity. I can’t begin to tell you what it means to these kids to have information at their fingertips! They are kind-hearted, sweet, intelligent kids who sometimes just need a little boost and you are a part of them. Again, thank you, and we will send pictures after we get the books. Our classroom is a better place because of your awesome contribution.”

This week on HIStalk Practice: Burke Pediatrics (VA) partners with Food for Others as part of a new food prescription program aimed at ensuring patients can put healthy food on their tables. The Y builds out health IT infrastructure with HIPAA compliance, cybersecurity services. Teladoc drops lawsuit against Texas Medical Board. AJC investigation highlights physician contributions to opioid epidemic. CyberKnife Center of Miami selects Identillect. Aprima integrates DocBuddy voice recognition. HealthiPass raises $7.2 million. UnitedHealth buys DaVita Medical Group in multi-billion dollar deal.

Webinars

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

Acquisitions, Funding, Business, and Stock

Dignity Health and Catholic Health Initiatives sign a merger agreement that will create the country’s largest health system as measured by operating revenue. The new Catholic health system will have $28 billion in revenue, 139 hospitals, and 159,000 employees, operating in 28 states. The CEOs of each organization will become co-CEOs of the new system. Dignity uses Cerner, while I believe CHI runs a mix of Meditech, Allscripts, Cerner, and Epic.

I’m interested that the asset management company co-owned by Nobel-winning economist Richard Thaler – which focuses on shares that are mispriced due to irrational investor psychology – holds 2.8 percent of the outstanding shares of Allscripts, worth around $72 million. MDRX shares are up around 12 percent over the past 12 months (vs. the Nasdaq’s 48 percent) and 30 percent over the past five years (vs. the Nasdaq’s 129 percent). It’s Thaler’s theories rather than his investing acumen that earned him a Nobel — the Fuller & Thaler Behavioral Small-Cap Equity fund has performed consistently worse over several years than the Dow, Nasdaq, and S&P 500.

A Huffington Post article profiles ReHAP, an algorithm-driven system for hospitals to help hospital rehab therapists identify and prioritize patients who need their services. The co-founder is Krishnaj Gourab, MBBS, who is chair and medical director of rehab informatics and analytics at Johns Hopkins Bayview Medical Center (MD).

An Axios financial analysis of 84 large health systems finds that while their patient care margins are slim, they’re making a fortune with their Wall Street investments and M&A activity in raising their overall average profit margin to 6.7 percent on their huge revenue volumes, with the article concluding, “Large not-for-profit hospital systems now resemble and act like Fortune 500 companies instead of the charities they were often built as. They consequently hold immense financial and political power.” The analysis unfortunately and rather obviously mixes up “millions” with “billions” in the pop-up graph legends, but commendably provides the raw data as Google Docs spreadsheet. The most profitable health system is Kaiser Permanente at $3.1 billion in FY2016-27 profit, of which 38 percent was generated by its investments. To take the counterpoint, one contributing factor in the success of any charity is to accumulate enough assets to iron out the operational cash flow challenges, although people often get suspicious when those war chests swell and executives take home multi-million dollar salaries. Not to mention that the stock market won’t always perform as well as it has lately.

Anil Sethi, MS – who became director of Apple Health in 2016 after the company acquired his personal health record company Gliimpse — will leave Apple to focus on his new startup Ciitizen. Former ONC Chief Privacy Officer Deven McGraw, JD, MPH also works for Ciitizen, which helps people obtain and share information and health-related legal documents.  

Sales

Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.

Announcements and Implementations

Solutionreach announces SR Schedule, which allows physician practices to offer the patients easy self-scheduling. 

Aprima integrates its EHR with DocBuddy voice-powered physician workflow for mobile devices. A hand surgeon early adopter says it saves him 45 minutes per day.

EBroselow will integrate ASHP’s AHFS DI Essentials database into its SafeDose bedside dosing application.

Government and Politics

The rate of growth of US healthcare spending slowed in 2016, but still increased by $354 per capita to $10,348 in consuming 17.9 percent of the gross domestic product.

Other

A report from public health grant-making organization De Beaumont Foundation and Johns Hopkins University presents use cases describing how public health agencies could use provider EHR data without running afoul of HIPAA.

A TransUnion report on Millennials finds that 60 percent don’t understand their health insurance benefits. They also also pay their medical bills more slowly than other generations, mostly because they entered the workforce as lower-income employees just as employers shifted more healthcare payments onto consumers and thus they don’t have the money. The report suggests that providers educate Millennial patients at the point of service, give them an upfront cost estimate when possible, and encourage them to pay at the time of service.

The Indianapolis paper profiles Chuck Dietzen, MD, medical director for pediatric rehabilitation at Riley Children’s Health (IN); founder of the non-profit Timmy Global Health; and co-founder and chief medical officer of EHR/PM vendor ISalus Healthcare.

St. Joseph Healthcare (ME) will eliminate 24 jobs as parent organization Covenant Health centralizes billing after completing its Cerner implementation.

Fun from The Onion.

Sponsor Updates

• LogicStream Health launches clinical process modules for sepsis, CAUTI, and VTE.
• Nordic releases a new podcast, “Consolidating your EHR after a merger or acquisition.”

Blog Posts

• The Digital Transformation in Healthcare and Life Sciences: Improve Productivity and Simplify Operations to Enable Strategic Focus (Liaison Technologies)
• Health-care bankruptcy filings have more than tripled this year (MedData)
• 5 tools designed to prevent nurse burnout (Meditech)
• 7 Insights and predictions of the future of care delivery: Dumping data, disillusioned doctors, and other dilemmas (Medicomp Systems)
• ONC Meeting Recap (Netsmart)
• What is a Health Check? (CloudWave)
• 3 tools you need to manage the modern revenue cycle (Experian Health)
• PatientPing Hosts Inaugural New England Community Event (PatientPing)
• ePatientco Visits the NYSE with the Metro Atlanta Chamber (Patientco)

Contacts

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